Tailored Inhibitory Control Training to Reverse EA-linked Deficits in Mid-life
Condition: Smoking; Alcohol Drinking; Prescription Drug Abuse; Substance-Related Disorders; Oral Intake Reduced
MeSH terms: Substance-Related Disorders; Alcohol Drinking
Study type: Interventional

Summary: 
      Insufficient inhibitory control is one pathway through which early adversity is related to a
      range of problems including excessive alcohol use, tobacco use, and unhealthy eating. The
      proposed research leverages a neurally informed model of inhibitory control and how it can be
      improved to test the efficacy of a person-centered inhibitory control intervention in a
      sample of mid-life individuals with early adversity. The knowledge obtained by this study
      could be scaled into a flexible, low-cost, and wide-ranging intervention to remediate some of
      the effects of early adversity on inhibitory control and thus a number of prevalent health
      risking behaviors.
    

Detailed description: 
      Early adversity (EA) in humans is a major contributing factor to a range of deleterious
      physical and mental health outcomes extending through adulthood such as depression and
      anxiety, obesity and heart disease, and premature death. In addition to detracting
      significantly from individual well being and quality of life, these conditions also consume
      considerable resources from federal, state, and community organizations. The mechanisms
      through which EA exerts its effects on these outcomes are increasingly well understood, and
      include neurocognitive pathways related to executive function. An intervention that can
      successfully target, engage with, and alter the functioning of one or more of these
      mechanisms would be a promising way of mitigating the impact of EA on deleterious outcomes
      later in life. The proposed research focuses on one such pathway-deficits in inhibitory
      control (IC)-and tests the feasibility and efficacy of an intervention to increase
      functioning in that pathway in a sample of individuals who experienced EA. The intervention
      is grounded in a neurally informed model of change that specifies deficits in IC as an
      underlying causal factor common to several health-risking behaviors (HRBs). These IC deficits
      emerge during development as a result of a range of EA, and, critically, can be remediated in
      mid-life through targeted intervention. Research from our laboratory has validated an
      intervention that can increase IC performance and alter its underlying neural systems in
      young adults (Berkman, Kahn, & Merchant, 2014). The next step in this program of research,
      proposed here, is to test the efficacy of that intervention in a sample of mid-life
      individuals who have experienced EA and the extent to which our intervention generalizes to
      HRBs that are prevalent in that sample. The first Aim is to test whether the intervention
      alters the IC system in tasks both similar to and dissimilar from the training task in terms
      of both behavioral performance and neural functioning. The second Aim is to test whether
      alterations in the functioning of the underlying neural systems mediate the effect of the
      intervention on performance and disinhibition-related HRBs. The two Aims will be accomplished
      within the context of a single randomized controlled trial (RCT) with two arms (IC training
      vs. active control) and pre-post measurements of IC performance, IC neural systems, and HRBs.
      All participants (N = 110) come to the lab for an initial assessment of behavioral / neural
      measures of IC and HRBs, among other measures. Then, participants are randomly assigned to
      receive a Person-Centered Inhibitory Control (PeCIC) training or active control training,
      every other day for 3-4 weeks. The PeCIC systematically pairs IC engagement with alcohol,
      tobacco, and/or energy-dense food cues, depending on each participant's reports of
      disinhibited behavior in those domains. The active control task uses personalized cues and
      response time tasks but does not involve IC. Finally, participants return to the laboratory
      for an endpoint assessment where all baseline measures are repeated. The two Aims will be
      robustly tested in a series of analyses comparing the behavioral and neural change from pre-
      to postintervention between the groups.
    

Intervention name(s): Person-centered inhibitory control training; Active behavioral response training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): A brief, computer-based, multisession training aimed at increasing the connection between environmental risk cues (e.g., cigarettes) and engagement of the brain network for inhibitory control.; A brief computer-based, multisession training aimed at training behavioral responses to personalized environmental risk cues (e.g., cigarettes) that does not engage the inhibitory control network of the brain.
Other intervention name(s): PeCIC, ARM1; Active control, ARM2
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention