CBM: A Novel Intervention for Alcohol Dependence and Social Anxiety

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DESCRIPTION (provided by applicant): Alcohol dependence and social anxiety are common, and considerably overlapping. Traditional psychotherapeutic and pharmacological methods for treating this population have had limited impact on alcohol outcomes. The current proposal represents a first step in utilizing an innovative intervention for individuals with co-occurring alcohol dependence and social anxiety symptoms, while investigating a key mechanism shown to increase vulnerability for both problems: attentional biases. Specifically, this proposal will implement Cognitive Bias Modification (CBM) interventions designed to directly shift attentional biases away from alcohol-relevant and/or socially threatening cues. Eligible participants who have alcohol dependence and elevated social anxiety will be randomly assigned to one of four conditions in this 2 (Alcohol CBM vs. Alcohol Control) by 2 (Anxiety CBM vs. Anxiety Control) pilot Randomized Control Trial (N = 68). The primary aim of this proposal is to evaluate the separate and interactive contributions of the CBM interventions on reductions in attentional biases, alcohol use, and social anxiety symptoms. We will also test the acceptability of the experimental intervention. The secondary aim of this proposal is to determine whether within-subject changes in attention toward alcohol-relevant and socially-threatening cues are associated with reductions in alcohol use and social anxiety symptoms. Eligible participants will engage in an 8-session CBM (and/or Control) intervention. At baseline, post-training, and one-month follow-up, participants will complete measures assessing 1) changes in attentional biases toward alcohol-relevant and socially-threatening cues; and 2) changes in self-reported symptoms of alcohol use and social anxiety. Participants will also complete measures about their perceptions of the intervention's credibility, helpfulness, and their overall satisfaction. Or primary hypotheses are that the Alcohol CBM will improve alcohol outcomes, and the Anxiety CBM will improve social anxiety outcomes. We also predict that there will be a significant interaction, whereby there is a synergistic effect of the combined Alcohol CBM/Anxiety CBM intervention. Finally, we will explore whether the Anxiety CBM improves alcohol outcomes, as predicted by the Avoidance-Coping Cognitive model. This proposed intervention coordinates the treatment for alcohol dependence and social anxiety, is based on cutting edge research, and requires minimal training for treatment providers, reflecting high clinical significance. Developin strategies to counteract relatively automatic processing of alcohol-relevant and socially threatening cues, including techniques to shift attentional biases, is an innovative approach that could serve as a useful therapeutic tool. Information and effect sizes from this pilot project will help inform a future R01 submission in which we will more fully test the effectiveness of CBM, including potential mediators and moderators of treatment outcome, and the best practices for incorporating CBM into standard clinical care.