Neurophysiological Mechanisms of Accelerated Resolution Therapy (ART)

Overview

In brief, ART is an innovative "mind-body" (body-centric) psychotherapy that makes use of established core components of trauma-focused therapy including imaginal exposure and imagery rescripting to promote memory reconsolidation, all facilitated as the patient is directed by the therapist to perform sets of lateral left-right eye movements similar to rapid eye movements (REM). The investigators propose to investigate how ART may directly influence heart rate variability (HRV), EEG power spectral densities, and sleep architecture in three aims. At the broadest level, the investigators postulate that both within individual ART sessions, and across the full course of treatment (e.g. up to 4 sessions), ART results in a profound shift from sympathetic (arousal) to parasympathetic (rest) nervous system balance, and that this shift can be reliably measured by neurophysiological assessment using electrocardiogram (ECG) and electroencephalogram (EEG) measurement.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: N/A
    • Intervention Model: Single Group Assignment
    • Primary Purpose: Basic Science
    • Masking: None (Open Label)
  • Study Primary Completion Date: April 30, 2020

Detailed Description

Our long-term goal is to understand, from a mechanistic perspective, how ART appears to result in rapid, successful treatment of PTSD and related comorbidities. This knowledge will help to identify target populations for treatment, and objective approaches in which to evaluate patient outcome response beyond conventional reliance on self-report measures. Thus, specific aims of our proposal, which will make use of wireless equipment for Electrocardiographic (ECG) measurement of Heart Rate Variability (HRV), and Electroencephalographic (EEG) measurements of power spectral densities and sleep architecture, are as follows:

1. To quantify and characterize changes in HRV, EEG power spectral densities, sleep architecture, and ANS balance within individual sessions of ART, as well as before and at the end of treatment with ART (up to 4 sessions).

2. To examine whether the aforementioned ART-induced changes in HRV, EEG power spectral densities, sleep architecture, and ANS balance vary substantially in the setting of primary treatment for symptoms of post- traumatic stress disorder (PTSD), depression, acute stress disorder, complicated grief, and/or alcohol abuse.

3. To assess the degree of concordance between ART-induced objective measurement of changes in HRV, EEG power spectral densities, sleep architecture, and ANS balance and self-report changes in symptoms of PTSD, depression, acute stress disorder, complicated grief, and/or alcohol abuse.

The investigators will accomplish these objectives using a prospective, longitudinal, descriptive design to achieve robust results. Subjects (n=40) will be enrolled in the study based on symptomatology. All subjects will receive Accelerated Resolution Therapy (ART) on a weekly basis for up to 4 sessions. The dose of up to 4 sessions has been selected to insure what is believed to be an effective dose based on previous studies of ART for treatment of PTSD. The investigators will collect data pre, during, and post each ART session. The sample of 40 subjects will be drawn from referrals at private practices of designated licensed mental health clinicians certified in ART, referrals from stakeholders and academic and community partners (e.g. USF student veterans referred through the USF Office of Student Veterans), and referrals of immediate family members of an individual who received hospice care prior to death at Suncoast Hospice or Chapters Health System. All subjects will undergo an intake assessment by a licensed clinical psychologist to determine study eligibility at USF.

The investigators expect to obtain support for our central hypothesis that ART modulates neurophysiological mechanisms through neurophysiological biomarkers of the autonomic (parasympathetic) nervous system and improved sleep architecture. Knowledge from a mechanistic perspective, on how ART appears to result in rapid, successful treatment of symptoms of PTSD and related conditions will help to identify target populations for treatment, and objective approaches in which to evaluate patient outcome response beyond conventional reliance on self-report measures.

Interventions

  • Behavioral: Accelerated Resolution Therapy
    • The ART protocol first uses the technique of imaginal exposure to elicit physiological reactions associated with patient recall from beginning to end (verbally or non-verbally) of a traumatic/distressing experience. As physiological reactions emerge, the participant is directed to focus their attention on the specific body-centric reactions while laterally performing smooth pursuit eye movements which are achieved by tracking the clinician’s hand which oscillates from left-to-right at a short distance from the participant’s eyes. Then the participant is directed to imagine a positive way in which they prefer to recall their experience(s), including emphasis on “replacing” negative images in the brain with positive images. This technique is based on the process of memory reconsolidation, which allows for “adding” of positive material to the recall of negative, highly emotional past experiences.

Arms, Groups and Cohorts

  • Experimental: ART Treatment
    • A broad patient representation of male and female adults; aged > 18 years; English speaking; and significant clinical symptoms of any of the following conditions: PTSD, Depression, ASD, Complicated Grief, and Alcohol Abuse.

Clinical Trial Outcome Measures

Primary Measures

  • Change in Autonomic Nervous System (ANS) Imbalance
    • Time Frame: Baseline pre first ART session at study day 1 and post 4th ART session at 5 weeks
    • HRV, EEG power spectral densities, and sleep architecture

Secondary Measures

  • Changes in ANS During ART
    • Time Frame: During first ART session at 1 week and during 4th ART session at 5 weeks
    • HRV and EEG power spectral densities

Participating in This Clinical Trial

Inclusion Criteria

  • Posttraumatic Stress Disorder (PTSD): Score of > 33 on the 20-item DSM-V PTSD Checklist (PCL-V) or
  • Depression: Score of > 16 on the 20-item Center for Epidemiologic Depression Scale or
  • Acute stress disorder: Presence of criterions A-E on the 19-item Acute Stress Disorder Scale or
  • Complicated grief: Score of > 25 on the 19-item Inventory of Complicated Grief or
  • Alcohol abuse: Score of > 10 on 10-item Alcohol Use Disorders Identification Test (AUDIT) and
  • Corroboration of the above symptomatology through verification of the corresponding subscale of the 125-item Psychiatric Diagnostic Screening Questionnaire (PDSQ).

Exclusion Criteria

  • Currently engaged in another psychotherapy regimen including currently engaged in ART or another eye movement therapy, such as EMDR;
  • Have a major psychiatric disorder (e.g. bipolar disorder) deemed likely to interfere with treatment delivery;
  • Currently in a formal substance dependence treatment program (alcohol and/or drug) anticipated to interfere with treatment delivery (e.g. through detox and symptoms of physiological withdrawal). All persons recruited for potential study participation will undergo a clinical intake assessment, with completion of ART intake form, by a licensed clinical therapist, to determine study eligibility.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of South Florida
  • Provider of Information About this Clinical Study
    • Principal Investigator: Kevin Kip, Professor – University of South Florida
  • Overall Official(s)
    • Kevin E Kip, PhD, Principal Investigator, University of South Florida
    • Paula L Cairns, PhD, Principal Investigator, University of South Florida
  • Overall Contact(s)
    • Paula L Cairns, PhD, 8139749716, paulacairns@usf.edu

References

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Kip KE, Hernandez DF, Shuman A, Witt A, Diamond DM, Davis S, Kip R, Abhayakumar A, Wittenberg T, Girling SA, Witt S, Rosenzweig L. Comparison of Accelerated Resolution Therapy (ART) for Treatment of Symptoms of PTSD and Sexual Trauma Between Civilian and Military Adults. Mil Med. 2015 Sep;180(9):964-71. doi: 10.7205/MILMED-D-14-00307.

Kip KE, Diamond DM. Clinical, Empirical, and Theoretical Rationale for Selection of Accelerated Resolution Therapy for Treatment of Post-traumatic Stress Disorder in VA and DoD Facilities. Mil Med. 2018 Sep 1;183(9-10):e314-e321. doi: 10.1093/milmed/usy027.

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