2/2 Gambling Addiction: Treatment Mediators and Moderators

2/2 赌博成瘾：治疗中介者和调节者

• 批准号: 8271428
• 负责人: CARLOS BLANCO
• 金额: $ 26.46万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-20 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8271428
• 关键词: Adherence; Aftercare; Awareness; Bankruptcy; Behavior; Behavior Therapy; Behavioral; Belief; Clinic; Clinical Research; Cognitive; Cognitive Therapy; Commit; Comorbidity; Control Groups; Coping Skills; Disease; Dropout; Educational process of instructing; Effect Modifiers (Epidemiology); Effectiveness; Emotional; FDA approved; Family; Family history of; Freedom; Funding; Future; Gambling; Goals; Health; Healthy People 2010; Imprisonment; Impulsivity; Individual; Intervention; Investigation; Life Style; Mediating; Mediator of activation protein; Mental Health; Mental disorders; Modification; Motivation; National Institute of Mental Health; Occupations; Outcome; Pathological Gambling; Patients; Pharmaceutical Preparations; Population; Prevalence; Primary Health Care; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Readiness; Relapse; Research; Resistance; Severities; Site; Societies; Subgroup; Support Groups; Testing; Therapeutic; Treatment Efficacy; Treatment outcome; Waiting Lists; Work; addiction; cognitive change; coping; cost; efficacy trial; follow-up; improved; innovation; meetings; motivational enhancement therapy; novel; physical conditioning; psychosocial; randomized trial; skills; social; standard of care; suicide rate; treatment response; trial comparing

DESCRIPTION (provided by applicant): Pathological gambling is a highly underrated, yet extremely serious public health problem with enormously detrimental effects on individuals and families, and with an estimated yearly cost to society of over 5 billion dollars due to lost jobs, debt, bankruptcy, and incarcerations. Despite growing public awareness of the prevalence and damaging consequences of PG, there is presently no established psychosocial treatment for PG and no FDA approved medications. Through extensive pilot work and an NIMH-funded randomized trial (R21 MH064568) we have developed a treatment termed Cognitive-Motivational Behavior Therapy (CMBT) that has shown excellent retention and treatment efficacy. CMBT helps pathological gamblers resolve their motivational ambivalence and increases their readiness to change. Once patients are committed to change, the CMBT therapist then systematically corrects their specific cognitive biases, teaches them coping and resistance skills, and encourages lifestyle changes to innoculate them against relapse. Using the 'Collaborative R01s for Clinical Studies of Mental Disorders' mechanism, we now propose to conduct a study to identify mediators and moderators of this innovative treatment and to test its efficacy in a large randomized controlled trial with 200 pathological gamblers. We will randomize gamblers to CMBT or Cognitive-Behavioral Therapy (CBT) as a comparison condition and assess them before, during, and after treatment as well as at 3, 6, and 12-month follow-up. We hypothesize that the effect of CMBT will be mediated by readiness to change, cognitive distortions, coping skills, and therapeutic alliance, whereas CBT will be mediated only by the last three, since it does not specifically target motivation. Hypothesized moderators include psychiatric comorbidity, baseline levels of gambling severity and of motivation to change, impulsivity and family history of PG. Specifically, we hypothesize that although CMBT will be superior on average to CBT in improving treatment retention and decreasing gambling behavior, those differences will be even larger in the presence of psychiatric comorbidity or family history of PG, higher baseline levels of impulsivity or gambling severity, or in individuals with lower motivation to change. We are confident that the findings from this study will significantly improve our understanding of PG and inform future research on the treatment of this very recalcitrant and difficult psychological disorder. PUBLIC HEALTH RELEVANCE: Pathological gambling (PG) is a serious public health problem with enormously detrimental effects on individuals and families, yet there is a paucity on treatments of proven efficacy for this disorder. After developing Cognitive-Motivational Behavior Therapy (CMBT) and testing it in a small NIMH-funded randomized trial (R21 MH064568), we propose to conduct a rigorous large-scale efficacy trial comparing CMBT versus Cognitive-Behavioral Therapy to identify treatment mediators and moderators of both treatment approaches. The findings from this study will significantly improve our understanding of PG and inform future research on this disorder.

描述(申请人提供)：病态赌博是一种被高度低估的但极其严重的公共卫生问题，对个人和家庭具有极大的有害影响，估计每年因失业、债务、破产和监禁而给社会造成的损失超过50亿美元。尽管公众越来越多地意识到PG的流行和破坏性后果，但目前还没有针对PG的心理社会治疗，也没有FDA批准的药物。通过广泛的试点工作和NIMH资助的随机试验(R21 MH064568)，我们开发了一种名为认知动机行为疗法(CMBT)的治疗方法，已显示出良好的保留和治疗效果。CMBT帮助病态赌徒解决他们的动机矛盾心理，并增加他们改变的准备。一旦患者致力于改变，CMBT治疗师就会系统地纠正他们特定的认知偏见，教他们应对和抵抗技能，并鼓励改变生活方式，以防止复发。利用“精神障碍临床研究协作R01”机制，我们现在建议进行一项研究，以确定这一创新治疗的中介和调节因素，并在一项有200名病态赌徒参加的大型随机对照试验中测试其有效性。我们将随机将赌徒接受CMBT或认知行为疗法(CBT)作为比较条件，并在治疗前、治疗中、治疗后以及3个月、6个月和12个月的随访中对他们进行评估。我们假设，CMBT的影响将通过改变的意愿、认知扭曲、应对技能和治疗联盟来中介，而CBT只会通过最后三个因素来中介，因为它不专门针对动机。假设的调节因素包括精神合并症、赌博严重程度的基线水平和改变的动机、冲动和PG的家族史。具体地说，我们假设，尽管CMBT在改善治疗保留率和减少赌博行为方面平均而言将优于CBT，但当存在精神合并症或PG家族史、较高的冲动或赌博严重程度基线水平，或改变动机较低的个人时，这些差异将更大。我们相信，这项研究的结果将极大地提高我们对PG的理解，并为未来治疗这种非常顽固和困难的心理障碍的研究提供参考。公共卫生相关性：病理性赌博(PG)是一个严重的公共卫生问题，对个人和家庭具有极大的有害影响，但目前还缺乏被证明有效的治疗这种疾病的方法。在开发认知动机行为疗法(CMBT)并在NIMH资助的小型随机试验(R21 MH064568)中进行测试后，我们建议进行一项严格的大规模疗效试验，比较CMBT和认知行为疗法，以确定这两种治疗方法的治疗介体和调节器。这项研究的发现将极大地提高我们对PG的理解，并为未来对这种疾病的研究提供参考。