Reducing Alcohol Use & PTSD w/ Cognitive Restructuring & Experiential Acceptance

描述（由申请人提供）：问题陈述：酒精依赖（AD）折磨着近14%的人口。数据一致表明，应对情绪状态的困难是酒精使用障碍（AUD）发展和维持的关键因素。这些关系在患有共病性精神疾病，如创伤后应激障碍（PTSD）的个体中尤为明显。因此，许多治疗方案纳入了技能培训，技能习得被认为是导致AUD治疗结果改善的重要机制。然而，测试这些应对调解假设的研究结果未能为假设的关系找到支持。经验接受的潜在作用：认知-行为应对技能干预主要针对消极和积极情感状态；增加经验接受或认知控制策略。体验性接受包括愿意体验自己的想法、感受、记忆、渴望和身体感觉，而不去评判或试图改变它们。初步数据表明，体验接受在治疗方案联盟与长期AUD预后之间起中介作用，值得进一步研究。拟议的研究设计：本初步研究的主要目的是初步确定经验接受是否是遵循Kazdin和Nock建议的AD和PTSD患者减少酒精使用的机制。60名患有AD和PTSD的患者将完成为期一周的基线每日交互式语音应答（IVR）电话监测，然后随机分配到两个简短的应对指导集之一：经验接受或认知控制，他们将被要求在两次渴望情绪诱导中使用，一次是消极的，一次是积极的。在渴望诱导之后，参与者将被要求练习他们的随机应对策略五周，在此期间，他们将提供每日IVR监控数据，并将接受简短的每周电话指导联系。参与者将在六周的研究结束后返回完成随访评估协议和汇报。数据分析将检验经验性接受是否在应对指导和减少酒精使用之间起中介作用。公共卫生影响：尽管在过去的20年里，药物滥用治疗领域取得了令人印象深刻的进展，但与AUDs相关的个人和社会成本，特别是当它们与PTSD合并时，仍然是巨大的。完善我们对现有治疗方法中有效成分的理解是非常重要的。拟议的研究强调经验接受将增加特异性，与先前AUD治疗中的应对技能询问有关，并允许我们检查这种特殊的应对方法是否为AUD治疗领域的未来询问提供了潜在的富有成效的途径。

DESCRIPTION (provided by applicant): Statement of the problem: Alcohol dependence (AD) afflicts nearly 14% of the population. Data consistently show that difficulty coping with mood states is a critical factor in the development and maintenance of alcohol use disorders (AUD). These relationships are particularly robust among individuals with comorbid psychiatric disorders, such as posttraumatic stress disorder (PTSD). Many treatment packages have thus incorporated skills training, and skill acquisition has been posited to be an important mechanism of change leading to improved AUD treatment outcomes. However, the results of studies testing these coping mediation hypotheses have failed to find support for the hypothesized relationships. Potential role of experiential acceptance: Cognitive-behavioral coping skill interventions target negative and positive affective states using two general approaches; increasing either experiential acceptance or cognitive control strategies. Experiential acceptance consists of being willing to experience one's thoughts, feelings, memories, cravings, and bodily sensations without judging them or trying to change them. Preliminary data suggest that experiential acceptance mediates the relationship between treatment program alliance and long-term AUD outcomes and is worthy of further study. Proposed study design: The primary objective of this pilot study is to preliminarily determine whether experiential acceptance is a mechanism of change in decreasing alcohol use in individuals with AD and PTSD following the recommendations of Kazdin and Nock. Sixty individuals with comorbid AD and PTSD will complete a week of baseline daily Interactive Voice Response (IVR) telephone monitoring prior to randomization to one of two brief coping instruction sets: experiential acceptance or cognitive control, which they will be asked to use during two craving mood inductions, one negative and one positive. Following the craving inductions, participants will be asked to practice their randomized coping strategy for five weeks during which time they will provide daily IVR monitoring data and will receive brief weekly telephone coaching contacts. Participants will return to complete a follow-up assessment protocol and debriefing at the end of six weeks of study involvement. Data analyses will examine whether experiential acceptance mediates the relationship between coping instruction and decreased alcohol use. Public health implications: Despite impressive strides in the substance abuse treatment arena in the past 20 years, the personal and societal costs associated with AUDs, particularly when they are comorbid with PTSD, remain enormous. The need to refine our understanding of the active ingredients in existing treatments is of great importance. The proposed studies' emphasis on experiential acceptance will increase specificity, in relation to previous coping skill inquiries in AUD treatment, and allow us to examine whether this particular coping approach is a potentially fruitful avenue for future inquiry in the AUD treatment field.