Validating an Autonomous Interactive Internet-Based Delivery of an Empirically Supported Cognitive Behavioral Therapy for Comorbidity

项目摘要 拟议工作的广泛目标是对一种专门的计算机进行随机对照试验- 提供认知行为治疗（CBT），以补充标准酒精使用障碍（AUD）治疗， 患有共病焦虑障碍（“共病”）的患者。合并症在AUD治疗中既常见， 患者（高达50%），并赋予一个月内恢复饮酒的风险大幅增加 治疗后。因为研究表明，简单地增加一个标准的精神病治疗， 实质上改善共病个体的AUD结果，我们开发了一种基于CBT的干预措施 旨在破坏相互加剧负面影响的正反馈循环（“恶性循环”; VC）， 饮酒行为/冲动（“VC-CBT”）。在一项RCT中，接受治疗师治疗的AUD患者- 提供VC-CBT表现出显着改善酒精使用的结果相比，那些谁 接受了标准的焦虑治疗不幸的是，大多数以社区为基础的AUD治疗计划并不 拥有经过专业培训和具备提供VC-CBT所需技术专长的临床工作人员。帮助 为了弥合这一“研究到实践”的差距，我们继续开发一种完全自主和交互式的计算机- 已交付版本的VC-CBT，并已在AUD患者中证明其功能。现在，我们建议 测试计算机提供的VC-CBT的临床疗效，以及机制和过程， 这是假设工作。目的I是一项随机对照试验，比较计算机提供的VC- CBT是一种强度匹配的计算机主动控制干预，专注于健康的生活方式。 256名患有共病焦虑症的住院AUD治疗患者将接受VC- CBT或主动控制干预，以获得200例完成1个月，4个月和8个月的随访。我们 预测VC-CBT组在随访时将显示出上级酒精相关结局， 对照组目的二评估在何种程度上计算机交付的VC-CBT选择性地赋予 技能和知识的目标，以及他们是否传达（调解）干预措施的治疗效果。这 需要一系列正式的“因果步骤”的关联分析：治疗技能/知识; 技能/知识影响结果;以及，治疗影响结果，有与无统计学控制的影响， 技能/知识。目标三将测试理论推导的预测，计算机交付的VC-CBT 温和派（即，削弱）实时负面影响水平与饮酒行为之间的关联/ 催促。这将通过分析一系列每天两次的生态瞬时评估来完成 （EMA）参与者在三次随访前7天在其自然环境中记录 评估。这项工作的影响将是提供一个可扩展的和廉价的手段， 合并AUD治疗患者的其他不良AUD治疗结局。这项工作还将提供 关于合并症治疗机制和变化过程的新科学知识。

Project Summary The broad goal of the proposed work is to conduct a randomized controlled trial of a specialized computer- delivered cognitive-behavioral therapy (CBT) to supplement standard alcohol use disorder (AUD) treatment in patients with a co-occurring anxiety disorder (“comorbidity”). Comorbidity is both common in AUD treatment patients (up to 50%) and confers a substantial increase in the risk of a return to drinking in the months following treatment. Because research shows that simply adding a standard psychiatric treatment does not substantially improve the AUD outcomes of comorbid individuals, we developed a CBT-based intervention aimed at disrupting the positive-feedback loop (“vicious cycle”; VC) of mutually aggravating negative affect and drinking behavior/urges (the “VC-CBT”). In an RCT, AUD treatment patients who received the therapist- delivered VC-CBT demonstrated significantly improved alcohol use outcomes as compared to those who received a standard anxiety treatment. Unfortunately, most community-based AUD treatment programs do not have clinical staff with the specialized training and technical expertise needed to deliver the VC-CBT. To help bridge this “research-to-practice” gap, we went on to develop a fully autonomous and interactive computer- delivered version of the VC-CBT and have demonstrated its functionality in AUD patients. Now, we propose to test the clinical efficacy of the computer-delivered VC-CBT, as well as the mechanisms and processes by which it is hypothesized to work. Aim I is a randomized controlled trial comparing the computer-delivered VC- CBT to an intensity-matched computer-delivered active control intervention that focuses on healthy lifestyles. 256 individuals in residential AUD treatment who have a comorbid anxiety disorder will receive either the VC- CBT or the active control intervention to obtain 200 cases that complete a 1-, 4- and 8-month follow-up. We predict the VC-CBT group will demonstrate superior alcohol-related outcomes at follow-up relative to the control group. Aim II evaluates the extent to which the computer-delivered VC-CBT selectively imparts the skills and knowledge targeted and whether they convey (mediate) the interventions therapeutic effect. This entails a formal series of “causal steps” analyses of the associations of: treatmentskills/knowledge; skills/knowledge outcomes; and, treatmentoutcomes with vs. without statistically controlling the effect of skills/knowledge. Aim III will test the theoretically-derived prediction that the computer-delivered VC-CBT moderates (i.e., weakens) the association between levels of real-time negative affect and drinking behavior/ urge. This will be accomplished by analyzing a series of twice-daily ecological momentary assessments (EMAs) that participants record in their natural environment for the 7 days prior to each of the three follow-up assessments. The impact of this work would be to provide a scalable and inexpensive means of improving the otherwise poor AUD treatment outcomes of comorbid AUD treatment patients. The work will also provide new scientific knowledge about the mechanisms and processes of change in comorbidity treatment.