Integrating Cognitive Neuroscience Toward Understanding of Mechanisms of CBT for Alcohol Use Disorders

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PROJECT SUMMARY/ABSTRACT Cognitive Behavioral Therapy (CBT) is an established approach for alcohol use disorders (AUD), yet it is hindered by a number of obstacles to dissemination and effective implementation in clinical practice, which include a limited understanding regarding how it exerts its effects (i.e., mechanisms of behavior change). Improved understanding of mechanisms of behavior change could spur the development of novel interventions that amplify the effect of evidence-based interventions for AUD, potentially transforming addictions treatment and the way we conduct behavior change interventions more broadly. Recent developments in cognitive science and neuroscience hold great promise for accelerating the understanding of mechanisms of behavior change associated with CBT. The proposed Independent Scientist Award will foster Dr. Kiluk's career development in these areas to advance understanding of how CBT changes cognition, behavior, and the brain. The independent clinical trial to be conducted under this proposal (R01AA024122; PI – Kiluk) will evaluate the efficacy of a computer-delivered CBT (CBT4CBT) or clinician-delivered CBT in comparison to standard treatment as usual (TAU) at reducing alcohol use among 180 outpatient treatment seekers. Treatments will be delivered over the course of 8-weeks and will include a 6-month follow-up period to assess durability of treatment effects. Multiple behavioral, experiential, and cognitive measures will be used to develop a more complete understanding of the mechanistic processes by which CBT works to reduce alcohol use. The specific aims of the project are as follows: 1. Evaluate the efficacy of CBT4CBT or clinician-delivered CBT relative to TAU at reducing alcohol use through an 8-week randomized trial, with 6-month follow-up. We expect either form of CBT will be more effective than TAU at increasing the percentage of days abstinent (PDA) during treatment and follow-up. 2. Evaluate the extent to which CBT's putative mechanisms act as a mediator of treatment effect on reducing alcohol use in both forms of CBT relative to TAU. We expect indices reflecting the acquisition and implementation of skills will mediate the effect of CBT on alcohol use (i.e., PDA). This project directly links with Dr. Kiluk's career goals of incorporating cognitive neuroscience approaches to identify mechanisms of evidence-based interventions, with a focus on how CBT interventions affect change in functional domains of addiction such as executive function, negative affect, and incentive salience, consistent with NIAAA's Addictions Neurocognitive Assessment battery. Training in cognitive neuroscience and neuroimaging through collaboration with experts in these areas at Yale School of Medicine will facilitate achievement of these goals.