Effects of CBT Microinterventions on Mechanisms of Change Among Adults with AUD: Using Eye Tracking to Measure Pre-Post Cognitive Control, Stimulus Salience and Craving

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Project Summary/Abstract This proposed R21, Effect of CBT Microinterventions on Mechanisms of Behavior Change among Adults with AUD: Using Eye Tracking to Measure Pre-Post Cognitive Control, Stimulus Salience and Craving in response to PAR-14-053 NIAAA Mechanisms of Behavior Change in the Treatment of Alcohol Use Disorder, uses a translational team science approach to isolate and examine the effect of three different Cognitive Behavioral Therapy (CBT) interventions (functional analysis (FA), cognitive restructuring for alcohol related thoughts (CR), and dealing with cravings (DC)) on specific hypothesized mechanisms (cognitive control, stimulus salience, or craving/arousal, respectively). This R21 uses an innovative paradigm pairing a “microintervention” design (Strauman et al., 2013) with eye tracking laboratory tasks used successfully to show deficits of cognitive control over cocaine and nicotine cues (DiGirolamo, Smelson, & Guevremont, 2015; DiGirolamo et al., 2016), and to objectively measure stimulus salience (Field & Cox, 2008) and craving/arousal (Chae et al., 2008; DiGirolamo et al., 2016 EBR) in response to alcohol cues. To achieve the study’s two specific aims, 80 (30% female) participants with AUD will be assessed with antisaccade (to measure cognitive control) and attentional bias (to measure stimulus salience and pupil diameter) eye tracking tasks at baseline (Week 1), then randomized to receive one of four experimental microinterventions with a study therapist in Week 2 and re-assessed immediately after. Each of three conditions is a different 60 minute manual-guided CBT microintervention (FA, CR, or DC) from our efficacious 12 session CBT treatment protocol (Epstein & McCrady, 2009). The 4th, control, condition is a microintervention on alcohol and drug psycho-education. At Week 3, after a week of implementing skills learned in Week 2, mechanisms and drinking will be assessed again. Specific Aim 1. To isolate and preliminarily assess the impact of specific CBT microinterventions on potentially malleable hypothesized mechanisms of change in drinking using a novel laboratory paradigm and conducted by a translational science team. Specific Aim 1 includes three hypotheses: Hypothesis 1. A microintervention comprising functional analysis will lead to improvement in cognitive control measured by an antisaccade eye tracking task, and to reduction in drinking. Hypothesis 2. A Cognitive Restructuring of Alcohol- Related Thoughts microintervention will lead to reduction in stimulus (alcohol cue) salience and to reduced drinking. Hypothesis 3. A “Dealing with Craving to Drink” microintervention will lead to reduced craving and arousal in response to alcohol cues, and reduced drinking. Specific Aim 2. To test specificity of CBT interventions’ effect on particular MOBCs, we will test each microintervention’s effects on all three purported mechanisms.