Computerized Intervention for Distress Intolerance

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 DESCRIPTION (provided by applicant): Given the high relapse rates following treatment of substance use disorders (SUDs), preventative approaches targeting vulnerabilities implicated in SUD development are a promising avenue for reducing their public health burden. Well-supported models of the development of SUDs implicate negative reinforcement motives and dysfunctional appraisals of internal states as mechanisms in the transition from initiation to dependence. Emerging evidence indicates that distress intolerance (DI), which refers to the tendency to negatively appraise and escape aversive emotional states, is a risk factor uniquely associated with SUDs, coping-motivated substance use, and development of substance use problems. Although affect tolerance treatments have demonstrated efficacy in reducing relapse, these investigations did not target DI generally, instead focusing upon narrower domains of distress (e.g., anxiety), nor did they assess DI explicitly as a mechanism of change. Further, existing DI treatment research has focused on preventing relapse; the effect of reducing DI on preventing development of SUDs has not been studied. The extant DI literature is also limited by exclusive reliance upon self-report and behavioral measures of the construct. It is important to identify neurophysiological markers of DI to further clarify the construct and inform future ris identification and prevention efforts. The proposed study was designed to provide incremental training to the PI in psychophysiological assessment [specifically electroencephalogram/event-related potential (EEG/ERP)], technology-based interventions, and conducting clinical trials. In the proposed study, approximately 60 individuals with elevated DI and current cannabis use will be randomized to receive either a recently piloted two-session active DI intervention or a healthy behaviors control intervention. The first specific aim of the project is to determine if DI can be reduced relative to a placebo control via this brief DI intervention. The second specific aim is to determine if individuals in the DI intervention condition report less stress-induced cannabis craving at post-treatment relative to individuals in the healthy behaviors condition. The next specific aim is to determine if individuals in the DI intervention condition will have fewer Cannabis Use Disorder symptoms/diagnoses at four month follow-up, and report lower coping-motivated cannabis use and use- related problems at one and four month follow-ups, relative to individuals in the healthy behaviors condition. Relatedly, the next aim is to determine if reductions in DI mediate the DI intervention's effect on these cannabis use outcomes. The final aim is to examine if high and low DI individuals matched for cannabis use show differential event-related potentials (ERPs) to cues signaling negative reinforcement, and to determine if the DI intervention leads to changes in these ERPs. By examining a brief treatment for DI in a substance using sample, this study will provide critical knowledge regarding how to quickly and effectively reduce DI and potentially prevent SUDs.