PDF(Pubmed)
Abstract：
BACKGROUND: Cognitive behavioral therapy (CBT) is an effective treatment for alcohol use disorder (AUD). We hypothesized that the dorsolateral prefrontal cortex (DLPFC), a region implicated in cognitive control and goal-directed behavior, plays a role in behavior change during CBT by facilitating the regulation of craving (ROC).
METHODS: Treatment-seeking participants with AUD (N = 22) underwent functional magnetic resonance imaging (fMRI) scanning both before and after a 12-week, single-arm trial of CBT, using an ROC task that was previously shown to engage the DLPFC.
RESULTS: We found that both the percentage of heavy drinking days (PHDD) and the overall self-reported alcohol craving measured during the ROC task were significantly reduced from pre- to post-CBT. However, we did not find significant changes over time in either the ability to regulate craving or regulation-related activity in any brain region. We found a significant 3-way interaction between the effects of cue-induced craving, cue-induced brain activity and timepoint of assessment (pre- or post-CBT) on PHDD in the left DLPFC. Follow-up analysis showed that cue-induced craving was associated with cue-induced activity in the left DLPFC among participants who ceased heavy drinking during CBT, both at pre-CBT and post-CBT timepoints. No such associations were present at either timepoint among participants who continued to drink heavily.
CONCLUSIONS: These results suggest that patients in whom DLPFC functioning is more strongly related to cue-induced craving may preferentially respond to CBT.
METHODS: Treatment-seeking participants with AUD (N = 22) underwent functional magnetic resonance imaging (fMRI) scanning both before and after a 12-week, single-arm trial of CBT, using an ROC task that was previously shown to engage the DLPFC.
RESULTS: We found that both the percentage of heavy drinking days (PHDD) and the overall self-reported alcohol craving measured during the ROC task were significantly reduced from pre- to post-CBT. However, we did not find significant changes over time in either the ability to regulate craving or regulation-related activity in any brain region. We found a significant 3-way interaction between the effects of cue-induced craving, cue-induced brain activity and timepoint of assessment (pre- or post-CBT) on PHDD in the left DLPFC. Follow-up analysis showed that cue-induced craving was associated with cue-induced activity in the left DLPFC among participants who ceased heavy drinking during CBT, both at pre-CBT and post-CBT timepoints. No such associations were present at either timepoint among participants who continued to drink heavily.
CONCLUSIONS: These results suggest that patients in whom DLPFC functioning is more strongly related to cue-induced craving may preferentially respond to CBT.
摘要：
背景：认知行为疗法（CBT）是酒精使用障碍（AUD）的有效治疗方法。我们假设背外侧前额叶皮质(DLPFC)，涉及认知控制和目标导向行为的区域，通过促进渴求调节（ROC）在CBT过程中的行为改变中发挥作用。
方法：寻求治疗的受试者AUD（N=22）在12周之前和之后都接受了功能磁共振成像（fMRI）扫描，CBT的单臂试验，使用先前显示的ROC任务参与DLPFC。
结果：我们发现，在ROC任务期间测量的重度饮酒天数百分比（PHDD）和总体自我报告的酒精渴望从CBT之前到之后都显着降低。然而,我们没有发现任何大脑区域调节渴求或调节相关活动的能力随着时间的推移有显著变化.我们发现提示诱导的渴望之间存在显著的3向相互作用，左侧DLPFC中PHDD上提示诱导的脑活动和评估时间点(CBT前或后)。随访分析表明，在CBT期间停止大量饮酒的参与者中，提示引起的渴望与左侧DLPFC中提示引起的活动有关，在CBT前和CBT后的时间点。在继续大量饮酒的参与者中，在这两个时间点都没有出现这样的关联。
结论：这些结果表明，DLPFC功能与线索诱导的渴望更密切相关的患者可能优先对CBT作出反应。
方法：寻求治疗的受试者AUD（N=22）在12周之前和之后都接受了功能磁共振成像（fMRI）扫描，CBT的单臂试验，使用先前显示的ROC任务参与DLPFC。
结果：我们发现，在ROC任务期间测量的重度饮酒天数百分比（PHDD）和总体自我报告的酒精渴望从CBT之前到之后都显着降低。然而,我们没有发现任何大脑区域调节渴求或调节相关活动的能力随着时间的推移有显著变化.我们发现提示诱导的渴望之间存在显著的3向相互作用，左侧DLPFC中PHDD上提示诱导的脑活动和评估时间点(CBT前或后)。随访分析表明，在CBT期间停止大量饮酒的参与者中，提示引起的渴望与左侧DLPFC中提示引起的活动有关，在CBT前和CBT后的时间点。在继续大量饮酒的参与者中，在这两个时间点都没有出现这样的关联。
结论：这些结果表明，DLPFC功能与线索诱导的渴望更密切相关的患者可能优先对CBT作出反应。
