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台专门的计算机进行随机对照试验- 认知行为疗法(CBT)补充标准酒精使用障碍(AUD)治疗 患有共病焦虑症(“共病”)的患者。共病在AUD治疗中很常见 患者(高达50%)，并使在接下来的几个月里重新饮酒的风险大幅增加 在治疗之后。因为研究表明，简单地增加一种标准的精神治疗并不能 显著改善共病个体的AUD结果，我们开发了一种基于CBT的干预 旨在打破相互加剧负面影响和风险的正反馈循环 饮酒行为/冲动(VC-CBT)。在随机对照试验中，接受治疗师治疗的AUD患者- 与那些使用VC-CBT的人相比，交付VC-CBT的人显示出显著改善的酒精使用结果 接受标准的焦虑症治疗。不幸的是，大多数以社区为基础的AUD治疗项目并没有 拥有提供VC-CBT所需的专业培训和技术专长的临床工作人员。帮助 为了弥合这种从研究到实践的鸿沟，我们继续开发了一种完全自主和交互的计算机-- 提供了VC-CBT的版本，并已在AUD患者中展示了其功能。现在，我们建议 测试计算机提供的VC-CBT的临床疗效以及通过以下方式进行的机制和过程 它被认为是可行的。AIM I是一项随机对照试验，比较了计算机传递的VC- CBT是一种强度匹配的计算机提供的积极控制干预措施，重点是健康的生活方式。 在住宅区接受AUD治疗的256名患有焦虑症的患者将接受VC- CBT或主动对照干预获得200例，分别完成1、4、8个月的随访。我们 预测VC-CBT组在随访中表现出比 对照组。AIM II评估了计算机提供的VC-CBT选择性地给予 有针对性的技能和知识，以及它们是否传达(调解)干预的治疗效果。这 需要对以下各项之间的关联进行一系列正式的“因果步骤”分析：治疗技能/知识； 技能/知识结果；以及，在没有统计控制效果的情况下治疗结果 技能/知识。AIM III将检验计算机提供的VC-CBT的理论推导预测 缓和(即削弱)实时负面情绪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实现 (EMAS)参与者在三次跟进前7天在其自然环境中进行记录 评估。这项工作的影响将是提供一种可扩展和廉价的改进手段 合并AUD患者的AUD治疗结果较差。这项工作还将提供 关于共病治疗中改变机制和过程的新的科学知识。

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.