Digital Phenotyping of Anxiety and Anxiety-Related Alcohol Comorbidity and Treatment

项目摘要 焦虑和焦虑相关障碍(AARD)是酒精使用问题(AUP)和 它们的共同出现(AARD-AUP)导致巨大的卫生成本和社会负担。自我用药 模型指出，患有AARD的人使用酒精来麻木或应对唤起和痛苦的负面情绪 情绪状态；然而，自我用药的纵向证据是混合的和心理治疗 将药物使用障碍的认知-行为治疗(CBT)技能与CBT干预相结合 Aard已经表现出了适度的成功。这些发现的异质性可能受到动态变化的影响。 以及特定于人的因素。我们假设，针对特定人的分析结果可以改善我们的 了解这种异质性，并可被利用来对AUP进行个性化干预。个性化 干预措施有可能增加症状的减少和改变率，以及治疗保留。 和联盟。由于历史原因，对特定人的精神病理学模式进行建模一直具有挑战性 数据收集和统计分析方面的限制。然而，越来越多的人获得数字表型-- 单学科集约型生态瞬时评价(EMA)的一种创新收集方法 与被动传感智能手机数据流(例如GPS数据、加速计、蓝牙/呼叫/短信)集成 数据)-为开发和评估真正个性化的心理学提供了令人信服的解决方案 干预措施。这样的数据可以用来生成单个人行为模式的统计模型 随着时间的推移。以前的数据驱动(即，基于反馈的)干预已经证明是成功的；然而，它是 不清楚使用特定于人的模型来适应积极的干预是减少症状还是改善 治疗效率(即变化率)、治疗滞留或治疗联盟。 该K99R00奖项将提供被动传感数据收集方法和临床指导方面的培训 试验，以及酒精研究方面的持续培训。在K99阶段，我将以以前的专业知识为基础 构建个人特定模型和识别个人特定因素检验自我用药模型 Aard-AUP，开发了一种个性化CBT技能干预的方法。在R00阶段， 这种干预的可行性将在试点三组平行随机临床试验(RCT)中进行测试，该试验 将测试个性化CBT技能干预的可行性，将其与两种控制条件进行比较 分别测试个性化和个性化方法的相对有效性。在个性化的 情况下，治疗师将回顾从特定人的模型中识别的影响因素，治疗这些 使用CBT技能的因素，并使用MindLAMP数字表型平台跟踪它们-测试数据- 用于个性化和调整每个会话的内容的驱动方法。调查结果将为未来提供信息 R01应用程序测试针对有问题的酒精使用的个性化干预。

Project Summary Anxiety and anxiety-related disorders (AARD) are notable risk factors for alcohol use problems (AUP) and their co-occurrence (AARD-AUP) results in tremendous health costs and societal burden. The self-medication model states that those with AARD use alcohol to numb or cope with arousing and distressing negative emotional states; however, longitudinal evidence for self-medication is mixed and psychological treatments integrate cognitive-behavioral therapy (CBT) skills for substance use disorders with CBT interventions for AARD have demonstrated modest success. The heterogeneity in these findings is likely influenced by dynamic and person-specific factors. We hypothesize that results from person-specific analyses can improve our understanding of this heterogeneity and can be harnessed to personalize interventions for AUP. Personalized interventions have the potential to increase symptom reduction and rate of change, as well as therapy retention and alliance. Modeling person-specific patterns of psychopathology has been challenging due to historical limitations with data collection and statistical analyses. However, increasing access to digital phenotyping – an innovative method for collecting single-subject intensive ecological momentary assessment (EMA) integrated with passive sensing smartphone data streams (e.g., GPS data, accelerometer, Bluetooth/call/SMS data) – offers a compelling solution for the development and evaluation of truly personalized psychological interventions. Such data can be used to generate statistical models of a single individual’s pattern of behavior over time. Previous data-driven (i.e., feedback-based) interventions have demonstrated success; however, it is unclear whether using person-specific models to adapt an active intervention reduces symptoms or improves therapeutic efficiency (i.e., rate of change), therapeutic retention, or therapeutic alliance. This K99R00 award will provide training in passive sensing data collection methods and conduct of clinical trials, as well as continued training in alcohol research. In the K99 phase, I will build on previous expertise constructing person-specific models and identifying person-specific factors testing self-medication models of AARD-AUP, developing a method for personalizing a CBT skills-based intervention. In the R00 phase, the feasibility of this intervention will be tested in a pilot three-group parallel randomized clinical trial (RCT), which will test the feasibility of a personalized CBT skills-based interventions compared to two control conditions testing the relative efficacy of personalization and personalization method, respectively. In the personalized condition, the therapist will review identified influential factors from the person-specific model, treat these factors using CBT skills, and track them using the mindLAMP digital phenotyping platforms – testing a data- driven method for personalizing and adapting the content of each session. Findings will inform future R01 applications testing personalized interventions for problematic alcohol use.