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

验证基于互联网的自主交互式交付经验支持的共病认知行为疗法

• 批准号: 10404961
• 负责人: MATT G KUSHNER
• 金额: $ 43.65万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10404961
• 关键词: Address; Adoption; Aftercare; Alcohol consumption; Alcohols; Anxiety; Anxiety Disorders; Attenuated; Behavioral; Belief; Clinical; Cognitive; Cognitive Therapy; Communities; Computers; Control Groups; Coping Skills; Data; Ecological momentary assessment; Education; Educational process of instructing; Environment; Expectancy; Exposure to; Feedback; Funding; Goals; Health Services Accessibility; Heavy Drinking; Hour; Individual; Internet; Intervention; Knowledge; Knowledge acquisition; Learning; Mediating; Meta-Analysis; Modeling; Neurosciences; Outcome; Participant; Patients; Pattern; Physiological Processes; Process; Psychiatric therapeutic procedure; Psychotherapy; Randomized; Randomized Controlled Trials; Relapse; Research; Resources; Risk; Series; Subgroup; System; Technical Expertise; Testing; Therapeutic; Therapeutic Effect; Therapeutic Intervention; Time; Training; Treatment outcome; Work; active control; alcohol comorbidity; alcohol use disorder; anxiety symptoms; anxiety treatment; base; clinical efficacy; comorbidity; computer program; coping; design; drinking; drinking behavior; experience; follow up assessment; follow-up; healthy lifestyle; improved; improved outcome; interactive feedback; negative affect; pandemic disease; programs; reduce symptoms; remote intervention; research to practice; skill acquisition; skills; transmission process; treatment as usual; treatment center; treatment program; trial comparing; virtual

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.

项目总结