Background Multiple studies indicate that a lower plasma level of the acetylated form of the appetite-regulating hormone ghrelin and higher plasma levels of insulin lead to a reduction in subjective alcohol craving and a reduced mesolimbic cue reactivity in functional magnetic resonance imaging (fMRI) when being exposed to alcohol-associated stimuli. The ghrelin level can physiologically be reduced by the induction of stomach distension and the ingestion of glucose or lipids. Methods A total of 108 alcohol-dependent patients aged between 18 and 65 years are examined in the randomized, double-blind, placebo-controlled crossover study. After collecting demographic and psychometric data, participants take part in an alcohol exposure session. Afterwards, the participants go through the intervention condition (oral glucose intake) and the control condition (placebo intake) in a randomized order on two examination days. Blood samples are taken repeatedly (every 10 min) during the study course on both measuring days to determine changes in acetylated and total ghrelin and insulin plasma levels. In parallel, subjective alcohol craving after the glucose or placebo intake as the primary outcome is assessed using the Alcohol Urge Questionnaire (AUQ) and a visual analog scale (VAS). To examine the mesolimbic cue reactivity as the secondary outcome, a fMRI measurement is conducted while being exposed to alcohol-related stimuli. Appropriate statistical analysis will be used for the evaluation of the outcomes. Discussion If successful, the results of this study could offer alcohol-dependent patients a new potential option for acute short-term reduction of alcohol craving and thus prevent relapses and prolong periods of abstinence in the long term. Trial registration German Clinical Trials Register DRKS00022419 (UTN: U1111-1278-9428). Retrospectively registered on September 15, 2020.
Zusammenfassung Ziel der Studie Patient:innen mit komorbid auftretenden Substanzgebrauchsstörungen (SUD) und Borderline-Persönlichkeitsstörung (BPD) sind in ihrer Lebensqualität stark beeinträchtigt. Zusätzlich entstehen durch diese Komorbidität hohe direkte und indirekte Gesundheitskosten. Bisher sind die Behandlungsergebnisse bei dieser Komorbidität unbefriedigend und wirksame Add-on Strategien zu den etablierten Therapiekonzepten fehlen. Das Ziel dieser Studie war es, zu untersuchen, inwiefern Trauma Informed Hatha Yoga als ergänzendes Therapieelement zu einer stationären Dialektisch Behavioralen Therapie Sucht (DBT-S) die Veränderung der inneren Anspannung bei Patient:innen mit einer SUD und einer BPD modifizieren kann. Methodik In diese quasi experimentelle Studie konnten 39 Patient:innen, die an einer SUD und einer BPD leiden, eingeschlossen werden. Alle Patient:innen nahmen zum Studienzeitpunkt an einer zwölfwöchigen stationären psychotherapeutischen Behandlung im Rahmen der Dialektisch Behavioralen Therapie Sucht (DBT-S) teil. Die Teilnehmenden der Interventionsgruppe absolvierten begleitend hierzu für acht Wochen wöchentliche Trauma Informed Hatha Yoga Übungseinheiten. Die Veränderungen der inneren Anspannung der Patient:innen durch die Trauma Informed Hatha Yoga-Übungseinheiten wurden mithilfe einer visuellen Analogskala gemessen (VAS; 0–100). Ergebnisse Bei der Durchführung der Varianzanalyse mit Messwiederholungen bezüglich der Veränderungen der inneren Anspannung (Δ VAS) als abhängige Variable fanden wir einen signifikanten Interaktionseffekt Zeit x Gruppe, also einen unterschiedlichen zeitlichen Verlauf der Veränderungen der inneren Anspannung (Δ VAS) in den beiden Studiengruppen. Die Teilnehmenden der Kontrollgruppe zeigten hierbei im zeitlichen Verlauf signifikant unterschiedliche Veränderungen der inneren Anspannung (Anstiege und Abstiege), wohingegen sich in der Interventionsgruppe die innere Anspannung durch Yoga gleichmäßig reduzierte, Anspannungsspitzen also signifikant besser geglättet werden konnten. Schlussfolgerung Trauma Informed Hatha Yoga in Kombination mit der Teilnahme an einem stationären DBT-S Programm scheint basierend auf unseren Ergebnissen die Variabilität von innerer Anspannung bei Patient:innen mit SUD und BPD effektiver modifizieren zu können als eine alleinige stationäre DBT-S Therapie. Es erscheint daher sinnvoll, Trauma Informed Hatha Therapieeinheiten als ergänzende Elemente in DBT-S Therapiekonzepte zu integrieren.
<b><i>Background:</i></b> Borderline personality disorder (BPD) is one of the most common personality disorders among persons with substance use disorders (SUDs) and is characterized by severe clinical symptoms. The aim of this study was to investigate if the effect of dialectical behavior therapy for substance use disorders (DBT-S) inpatient treatment on psychopathological symptom load in patients suffering from both BPD and SUD can be augmented by weekly 60-min “Trauma Informed Hatha Yoga” sessions. <b><i>Materials and Methods:</i></b> Thirty-nine patients suffering from comorbid BPD and SUD were consecutively in time included in this quasi-experimental pilot study (first intervention then control group). In the intervention group, weekly Trauma Informed Hatha Yoga sessions were added to standard DBT-S for 8 weeks. The participants of the control group received standard DBT-S. All participants completed several self-report questionnaires to assess symptoms of depression, anxiety, symptoms of BPD, and their subjective stress perception at three points in time during the study course. <b><i>Results:</i></b> A repeated measures analysis of variance with patients’ psychopharmacological medication as covariate revealed a significant main effect of time for each of the psychometric scales (State and Trait Anxiety Inventory subscale for state anxiety [STAI-S] <i>p</i> = 0.001, Beck Depression Inventory [BDI] <i>p</i> < 0.001; Borderline Symptom List 23 [BSL] <i>p</i> = 0.036) indicating that the psychopathological symptom load of the patients was significantly lower at the end of the DBT-S therapy compared to the beginning in both study groups. Moreover, there was a significant interaction effect of group*time on the psychometric scales STAI-T (subscale for trait anxiety) sum score (<i>p</i> = 0.010) and the sum score of the Perceived Stress Scale (PSS) (<i>p</i> = 0.043). This was expressed by the fact that the participants of the intervention group showed a significant reduction of the STAI-T sum score as well as the sum score of the Perceived Stress Scale (PSS), while the control group did not. Due to the exploratory nature of this study, correction for multiple testing was omitted. <b><i>Conclusion:</i></b> Although they are very preliminary, our results suggest that practicing Trauma Informed Hatha Yoga on a regular basis in addition to DBT-S inpatient treatment seems to reduce the level of trait anxiety and perceived stress significantly more than DBT-S inpatient treatment alone. Nevertheless, the effectiveness of Trauma Informed Hatha Yoga in reducing trait anxiety and perceived stress in patients suffering from SUD und BPD must be tested in large randomized controlled trials.
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