Addressing Problem Drinking from the Bottom-Up: An Investigation of the Neural and Behavioral Effects of Cognitive Bias Modification (CBM)

项目摘要/摘要 大量/高风险饮酒被认为是一个相关的公共卫生问题，因为它与 性危险行为、事故、健康状况差和负面生活后果(5，6)。的双进程模型 酒精使用描述了维持重度酒精使用的两个认知系统--自上而下 控制系统和自下而上的自动食欲系统(8-11)。现有的循证干预措施 饮酒倾向于提高个人的自控力(自上而下)技能。最近，研究人员发现 强调了瞄准酗酒者表现出的自动食欲认知偏差的重要性。认知 偏差修正(CBM)是一种在逆转认知偏差方面显示出良好效果的干预措施 酒精使用障碍患者对酒精的态度(19-23岁)。目前，煤层气被认为可以改变认知 可能会干扰以技能为基础的或激励性干预措施的实施的偏见，并可能起到最好的作用 现有干预措施的附属品(18)。最近的工作已经开始研究大脑的神经认知机制。 并发现奖赏背后的大脑系统发生了显著变化(即NAcc和 杏仁核)和执行控制(即dlPFC、mPFC)(26，27)。根据这些发现，这个拟议的项目 将在一个新的样本中调查CBM对与酒精使用相关的神经认知过程的影响 酗酒者/危险饮酒者。这个项目的主要目的是检验CBM对神经认知的影响。 有兴趣改变饮酒习惯的重度/高风险饮酒者的饮酒过程。作为次要目标，这 该项目将调查神经和认知变化与酒精使用变化之间的关系 更好地理解CBM是如何成功改变饮酒行为的。酗酒者/危险饮酒者 (n=40；年龄18-34岁)将从社区招募参加这一项目，并对电话进行资格筛选。 参与者将接受基线评估、线索反应性(CR)和接近回避任务(AAT) 功能磁共振成像，基于网络的酒精使用干预，以及随机进入CBM或假训练。第一次培训 会议(CBM VS SHAM)将在此时进行，随后将在一周内进行4次在线会议。基线 在1周的随访中，将重复评估和功能磁共振程序，并将再次测量饮酒量 通过1个月和6个月的跟踪在线。据推测，煤层气小组将在 在CR和AAT任务和显示期间，上述确定的区域中的大胆活动与假手术组比较 更大程度地减少饮酒。与NIAAA优先考虑的“为…设计有效方法”保持一致治疗酒精 滥用和依赖[以及]与酒精有关的后果“使用”广泛的科学领域“ 拟议的项目结合了神经科学和临床方法，试图更好地理解 煤层气的形成机制。这项拟议的项目旨在将最近发现的这种机制推广到患者身上。 使用主要基于网络的干预措施向重度/高风险饮酒者提供酒精使用障碍。这项研究将 也是第一个调查CBM后大胆变化与饮酒行为之间的关联的人。

PROJECT SUMMARY/ABSTRACT Heavy/at-risk alcohol use is considered a relevant public health problem given its association with sexual risk behavior, accidents, poor health, and negative life consequences (5,6). Dual process models of alcohol use describe two cognitive systems involved in the maintenance of heavy alcohol use—a top-down control system and bottom-up automatic appetitive system (8-11). Existing evidence-based interventions for alcohol use tend to focus on enhancing individuals' self-control (top-down) skills. Lately researchers have highlighted importance of targeting automatic appetitive cognitive biases that heavy drinkers exhibit. Cognitive Bias Modification (CBM) is one intervention that has shown promising effects on reversing cognitive biases toward alcohol among individuals with alcohol use disorders (19-23). CBM is currently thought to alter cognitive biases that may interfere with implementation of skills-based or motivational interventions and may act best as an adjunct to existing interventions (18). Recent work has begun to look at the neurocognitive mechanisms of action of CBM and has found significant changes in brain systems underlying reward (i.e., NAcc and amygdala) and executive control (i.e., dlPFC, mPFC) (26,27). In line with these findings, this proposed project would investigate the effects of CBM on neurocognitive processes related to alcohol use in a novel sample of heavy/at-risk drinkers. The primary aim of this project is to examine the effects of CBM on neurocognitive processes among heavy/at-risk drinkers interested in changing their alcohol use. As a secondary aim, this project will investigate associations between neural and cognitive changes and changes in alcohol use to better understand how CBM might lead to successful changes in drinking behavior. Heavy/at-risk drinkers (n=40; ages 18-34) will be recruited from the community for this project and phone screened for eligibility. Participants will undergo baseline assessments, a cue-reactivity (CR) and approach avoid task (AAT) during fMRI, web-based intervention for alcohol use, and randomization to CBM or sham training. The first training session (CBM vs. sham) will occur at this time, followed by 4 online sessions over one week. Baseline assessments and fMRI procedures will be repeated at 1-week follow-up and drinking will again be measured online via 1- and 6-month follow-ups. It is hypothesized that the CBM group will exhibit greater changes in BOLD activity compared to the sham group in the above identified regions during CR and AAT tasks and show greater reductions in drinking. In line with NIAAA's priority to “devise effective methods for…treating alcohol abuse and dependence [and] alcohol-related consequences” using a “wide range of scientific areas” this proposed project incorporates both neuroscientific and clinical approaches in attempting to better understand the mechanisms of CBM. This proposed project aims to extend recent findings of such mechanisms in patients with alcohol use disorder to heavy/at-risk drinkers using a primarily web-based intervention. This study would also be the first to investigate associations between BOLD changes and drinking behavior following CBM.