Eric D. Claus, Ph.D. - US grants

DESCRIPTION (provided by applicant): We believe that alcohol use is related to the increase in frequency and severity of IPV through a process of over-arousal resulting from the cortically and psycho physiological arousing effects of alcohol during the ascending limb of intoxication and at peak BAC compounded by the unique behavioral and affective patterns of violent couples. We hypothesize that distressed violent (DV) partners will have greater difficulty regulating emotion in response to evocative partner stimuli under the influence of alcohol compared to distressed nonviolent (DNV) partners. As such, this study will utilize electroencephalography (EEG), psychophysiology and pupillary response measures to investigate the effects of alcohol on the ability to regulate emotional arousal when viewing evocative partner stimuli in distressed violent (DV) partners compared to distressed nonviolent (DNV) partners. One partner from each DV couple will be pseudo-randomly selected and yoked to a DNV partner of the same sex and comparable relationship distress for participation in the experiment. To test the overall hypothesis that over-arousal is a mechanism through which alcohol is associated with increases in the frequency and severity of IPV, the selected partners will participate in a counter-balanced placebo session and alcohol administration session during which EEG, psychophysiology and pupillary response measurements of arousal will be collected during an emotion regulation task. The study is comprised of one Stimuli Acquisition Session and two Emotion-Regulation Sessions. During the Stimuli Acquisition Session, partner stimuli for use in the emotion-regulation task will be acquired through a video-taped discussion of a disagreement via the researcher facilitated Couple's Problem Inventory (CPI). Segments of the videos will be selected where the DV and DNV partners display Contempt, Belligerence, Criticism, and Defensiveness, Stonewalling and neutral behaviors for presentation to the partner during the emotion regulation task. The selected partners (DV, DNV) will return to the laboratory on two separate occasions for the completion of the Emotion-Regulation Sessions of the study. Participants will consume either an alcohol beverage or placebo beverage (counter-balanced alcohol and placebo conditions) and complete the emotion-regulation task during which evocative and neutral stimulus clips will be shown. The data will be analyzed using repeated measures ANOVA with a between-subjects factor. We expect that DV partners will experience significantly greater arousal than DNV partners during evocative stimuli. We also expect that DV partners will experience greater difficulty regulating emotion during evocative stimuli than DNV partners and that this effect will be compounded during alcohol administration. Findings from this study will provide firm evidence that alcohol is associated with IPV a mechanism of over-arousal. Furthermore, these are processes that are amenable to novel therapeutic intervention via methods such as biofeedback and neurofeedback to increase behavioral flexibility and reduce drinking and IPV in DV couples.

Description: Although modestly effective treatments exist for alcohol use disorders (AUD), many individuals relapse to heavy alcohol use after completing treatment, suggesting the need for a better understanding of factors that contribute to successful outcomes. Whereas much of the focus in past studies has been on identifying what treatments work for AUDs, only recently has there been a focus on why particular treatments work, and the mechanisms by which treatment leads to changes in drinking. This focus on mechanisms of behavior change (MOBCs) has the potential to not only allow for an accumulation of knowledge about the process by which treatment leads to better outcomes, but also may lead to the development of new treatments or modifications of existing treatment approaches that target empirically supported mechanisms known to lead to change. Existing research has focused on potential mechanisms including alcohol cue reactivity, affect regulation, and behavioral control, but these constructs have largely been tested using self-report measures, and there is a noticeable paucity of studies that examine these mechanisms from a neurocognitive perspective. To address this gap in knowledge, the proposed study will examine MOBC at multiple levels including self- report, behavioral performance, and neural network engagement, with a focus on the function of the lateral and medial frontal control networks, striatal based reward networks, and amygdala networks underlying emotional reactivity. One hundred eighty treatment-seeking individuals with an AUD will be randomized to receive either 8 weeks of Cognitive Behavioral Treatment (CBT) or Mindfulness Based Treatment (MBT) after receiving 4 weeks of a platform treatment that focuses on enhancing motivation to change. To establish the temporal relationship between changes in drinking and changes in these MOBCs, patients will be assessed at: (a) baseline; (b) four weeks into treatment; (c) immediately post-treatment; and (d) 9- and 15-months post- baseline. Self-report measures and behavioral tasks will be administered at monthly intervals during treatment; and fMRI will be collected at baseline, and at 3, and 9-months post baseline. Relationships between changes in drinking and changes in the proposed MOBCs will be examined using advanced mixed modeling techniques that have been pioneered by the research team. Further, the project will leverage data collected in a separate project examining MOBC in a non-treatment seeking sample using the same measures collected at similar timepoints. By identifying MOBCs of CBT or MBT that differentially contribute to changes in drinking, the proposed project will not only derive a deeper understanding of successful behavior change, but also may inform the development of novel treatments for AUD. In addition, by identifying neurocognitive factors predictive of successful change, it may be possible to utilize this knowledge to match specific treatments with particular patient neurocognitive profiles.

Project Summary: Approximately ?fteen percent of individuals in the US smoke cigarettes. Despite multiple attempts to quit, most smoking cessation attempt fails within one year. Predicting who will be unable to remain abstinent from smoking would improve cessation outcomes by providing objective feedback regarding relapse risk and allowing for more ef?cient allocation of relapse prevention resources. Our own pilot data and recent reviews of the literature suggest considerable promise in identifying biomarkers for relapse using neuroimaging approaches. While some studies have begun to investigate relapse prediction, few, if any studies have exam- ined the process of relapse or prolonged abstinence longitudinally after initial abstinence has been achieved. The focus of this proposal is to derive neuroimaging markers that prospectively predict subsequent relapse as well as to understand how the brain changes to support continued abstinence. To accomplish the aims of this project, 50 former smokers who have quit within the last three to six months will complete functional MRI scans of cognitive control, cue reactivity, and intrinsic connectivity at baseline and at 3-, 6-, and 9-month follow-up ses- sions to identify those biomarkers that are stable over time prior to relapse. Deriving neural predictors of future relapse among those individuals who have recently made a quit attempt could be extremely important for patient- treatment matching and/or differential allocation of resources based on risk for relapse. In addition, by identifying the changes that occur in brain function after recovery, it may be possible to target relevant networks with brain stimulation techniques.