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.

项目概要 拟议工作的总体目标是对专门的计算机进行随机对照试验 提供认知行为疗法 (CBT) 以补充标准酒精使用障碍 (AUD) 治疗 患有同时发生的焦虑症（“共病”）的患者。合并症在 AUD 治疗中很常见 患者（高达 50%），并导致几个月内重新饮酒的风险大幅增加 治疗后。因为研究表明，仅仅增加标准的精神治疗并不能 为了显着改善共病个体的 AUD 结果，我们开发了基于 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 AUD 治疗的患者接受了治疗师- 与那些接受 VC-CBT 的人相比，接受 VC-CBT 的饮酒结果显着改善 接受标准的焦虑治疗。不幸的是，大多数基于社区的 AUD 治疗计划并没有 拥有接受过提供 VC-CBT 所需的专门培训和技术专长的临床人员。帮助 为了弥合这种“研究与实践”的差距，我们继续开发了一种完全自主和交互式的计算机 交付了 VC-CBT 版本，并在 AUD 患者中展示了其功能。现在，我们建议 测试计算机传送的 VC-CBT 的临床疗效以及机制和过程 假设这是可行的。目标 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提供的主动控制干预措施，重点关注健康的生活方式。 256 名接受住院 AUD 治疗且患有焦虑症的患者将接受 VC- CBT 或主动控制干预获得 200 例完成 1、4 和 8 个月随访的病例。我们 预测 VC-CBT 组在随访中将表现出优于对照组的酒精相关结果 对照组。目标 II 评估计算机提供的 VC-CBT 有选择地传递信息的程度 有针对性的技能和知识以及它们是否传达（介导）干预措施的治疗效果。这 需要对以下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成果；并且，治疗结果与没有统计控制的效果相比 技能/知识。目标 III 将测试计算机提供的 VC-CBT 的理论预测 缓和（即削弱）实时负面情绪水平与饮酒行为之间的关联/ 敦促。这将通过分析一系列每日两次的生态瞬时评估来完成 (EMA) 参与者在三个后续跟踪中的每一个之前的 7 天在自然环境中记录的数据 评估。这项工作的影响将是提供一种可扩展且廉价的改进方法 合并 AUD 治疗患者的 AUD 治疗结果较差。该工作还将提供 关于共病治疗变化机制和过程的新科学知识。