Integrated CBT for Cannabis Dependence with Co-occurring Anxiety Disorders

描述(申请人提供)：大麻依赖是美国最常见的非法药物依赖，大麻依赖者极易患焦虑症。大麻依赖者中焦虑障碍的共同发生是一个紧迫的公共卫生问题，因为焦虑加剧与较差的大麻治疗结果有关。综合模型表明，焦虑症患者中与大麻有关的问题可能是通过依赖大麻来管理焦虑和大麻戒断而维持的。虽然已经努力单独评估大麻依赖和焦虑症的治疗方法，但几乎没有对这两种情况同时发生时的治疗进行调查。动机增强疗法(MET)结合认知行为疗法(CBT)是治疗大麻依赖的有效干预措施，但对焦虑患者的疗效非常有限。治疗焦虑症的一个新的和有希望的方法是使用跨诊断焦虑症治疗，这种治疗方法便于治疗患有焦虑精神病的患者，而不考虑特定类型的焦虑症。一种这样的治疗方法，虚假安全行为消除治疗(FSET)，可能对大麻依赖焦虑患者特别有用，因为它侧重于消除在短期内可能有效降低焦虑，但从长期来看可能维持甚至加剧焦虑的行为(即虚假安全行为)。因此，使用大麻来管理焦虑可以成为这种治疗的目标。该项目的目标是测试一种新的、综合的方法的可行性和实用性 将大麻作为一种适应不良应对策略的大麻依赖和焦虑症患者的治疗。拟议项目的第一阶段将制定和完善一项专门的团体议定书(即综合大麻和减少焦虑治疗或ICART)，以便将针对大麻依赖的MET-CBT与FSET结合起来。MET将用于增加戒除大麻的动机，CBT用于治疗大麻依赖，教患者管理高风险大麻使用情况的技能，FSET将用于教患者控制焦虑的技能。最初的治疗方案将根据两组(每组6名患者)综合治疗的经验进行修改。第二阶段将是一项随机对照试验，检验改良的ICART治疗(n=30)与MET-CBT单独治疗(n=30)的相对疗效。在治疗后评估后，ICART组将被跟踪3个月以检查收益的维持情况；最初被分配到对照条件的参与者将被提供ICART。据推测，ICART将产生比对照组更好的结果。根据这项初步试验的结果，ICART方案将进一步完善，并为更大规模的临床试验做好准备。 公共卫生相关性：尽管大麻依赖者极易患焦虑症，焦虑程度升高与大麻依赖治疗结果较差有关，但以前的研究没有研究如何有效地治疗大麻依赖和焦虑症共存的患者。目前研究的目标是开发和评估治疗这些人的专门疗法的可行性。总体目标是减少大麻使用、与大麻相关的问题和戒断症状、焦虑和残疾，同时提高生活质量并检查潜在的治疗结果的可能机制。

DESCRIPTION (provided by applicant): Cannabis dependence is the most common illicit substance dependence in the U.S. and people with cannabis dependence are highly vulnerable to anxiety disorders. The co-occurrence of anxiety disorders among those with cannabis dependence is a pressing public health matter given elevated anxiety is related to poorer cannabis treatment outcomes. Integrative models suggest that cannabis-related problems among those with anxiety disorders may be maintained by a reliance on cannabis to manage anxiety and cannabis withdrawal. Although effort has been undertaken to evaluate treatments for cannabis dependence and anxiety disorders in isolation, investigations of the treatment of these conditions when they co-occur have been virtually absent. Motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for cannabis dependence, yet outcomes are highly limited for anxious patients. One novel and promising approach to treating anxiety disorders is the use of transdiagnostic anxiety treatments that facilitate the treatment of patients with anxiety psychopathology regardless of the specific type of anxiety disorder. One such treatment, False Safety Behavior Elimination Treatment (FSET), may be particularly useful with cannabis dependent anxious patients as it focuses on the elimination of behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term (i.e., false safety behaviors). The use of cannabis to manage anxiety can, therefore, be targeted in such a treatment. The objective of this project is to test the feasibility and utility of a novel, integrated approach to treatment of patients with cannabis dependence and anxiety disorders who use cannabis as a maladaptive coping strategy. Phase I of the proposed project will feature the development and refinement of a specialized group protocol (i.e., Integrated Cannabis and Anxiety Reduction Treatment or ICART) for integrating MET-CBT for cannabis dependence with FSET. MET will be used to increase motivation to quit cannabis, CBT for cannabis dependence to teach patients skills to manage high-risk cannabis use situations, and FSET will be used to teach patients skills to manage their anxiety. The initial protocol will be modified based on the experience gained in the treatment of two groups (6 patients each) with the integrated treatment. Phase II will be a randomized controlled trial examining the relative efficacy of the refined ICART treatment (n = 30) versus MET-CBT alone (n = 30). After post-treatment assessments, the ICART group will be followed for 3 months to examine maintenance of gains; the participants originally assigned to the control condition will be offered ICART. It is hypothesized that ICART will produce better outcomes than the control. Based on the outcome of this preliminary trial, the ICART protocol will be further refined and readied for larger-scale clinical trials. PUBLIC HEALTH RELEVANCE: Although people with cannabis dependence are highly vulnerable to anxiety disorders, and elevated anxiety is related to poorer cannabis dependence treatment outcomes, previous research has not examined how to effectively treat patients with co-occurring cannabis dependence and anxiety disorders. The goal of the current research is to develop and evaluate the feasibility of a specialized therapy for treating these persons. The overarching aim is to decrease cannabis use, cannabis-related problems and withdrawal symptoms, anxiety, and disability while simultaneously improving quality of life and examining possible mechanisms underlying treatment outcomes.