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

描述(申请人提供)：问题描述：酒精依赖(AD)困扰着近14%的人口。数据一直表明，难以处理情绪状态是酒精使用障碍(AUD)发展和维持的关键因素。这些关系在患有创伤后应激障碍(PTSD)等共病精神障碍的个人中尤其牢固。因此，许多治疗方案都包含了技能培训，而技能获得被认为是改变导致改善AUD治疗结果的重要机制。然而，检验这些应对中介假说的研究结果未能找到对假想关系的支持。经验接受的潜在作用：认知-行为应对技能干预使用两种一般方法针对消极和积极的情感状态；增加经验接受或认知控制策略。体验式接受包括愿意体验一个人的思想、感觉、记忆、渴望和身体感觉，而不去评判它们或试图改变它们。初步数据表明，经验性接受在治疗方案联盟和长期AUD结果之间起中介作用，值得进一步研究。建议的研究设计：这项初步研究的主要目标是初步确定经验接受是否是遵循Kazdin和Nock的建议而改变AD和PTSD患者减少酒精使用的一种机制。60名患有阿尔茨海默病和创伤后应激障碍的患者将完成为期一周的每日基线交互式语音反应(IVR)电话监测，然后随机进入两个简短的应对指令集之一：经验接受或认知控制，他们将被要求在两种渴望情绪诱导期间使用这些指令，一种是消极的，一种是积极的。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，为期五周，在此期间，他们将提供每天的IVR监测数据，并将接受每周简短的电话指导联系。参与者将在为期六周的研究结束后返回完成后续评估方案和汇报情况。数据分析将检验经验性接受是否在应对指导和减少饮酒之间的关系中起到中介作用。对公共健康的影响：尽管在过去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AUD相关的个人和社会成本仍然巨大，特别是当它们与创伤后应激障碍共存时。需要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性接受将增加与AUD治疗中先前的应对技能调查相关的特异性，并使我们能够检查这种特殊的应对方法是否为AUD治疗领域未来调查的潜在有效途径。

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.