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

项目总结/摘要 重度/高危酒精使用被认为是一个相关的公共卫生问题，因为它与以下因素有关： 性风险行为、事故、健康状况不佳和负面生活后果（5，6）。双过程模型 酒精使用描述了两个认知系统参与维持大量饮酒-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 酒精的使用往往侧重于提高个人的自我控制（自上而下）技能。最近，研究人员 强调了针对酗酒者表现出的自动食欲认知偏见的重要性。认知 偏差修正（CBM）是一种在扭转认知偏差方面显示出有希望效果的干预措施 对酒精使用障碍的个人（19-23）。CBM目前被认为会改变认知 偏见，可能会干扰实施基于技能或动机的干预措施，并可能作为最好的 对现有干预措施的补充（18）。最近的工作已经开始关注神经认知机制， CBM的作用，并已发现大脑系统的显着变化，潜在的奖励（即，NAcc和 杏仁核）和执行控制（即，dlPFC，mPFC）（26，27）。根据这些调查结果，本拟议项目 将研究CBM对与酒精使用相关的神经认知过程的影响， 重度/高危饮酒者。该项目的主要目的是检查CBM对神经认知的影响 在有兴趣改变酒精使用的重度/高危饮酒者中进行。作为次要目标， 该项目将调查神经和认知变化与酒精使用变化之间的关联， 更好地了解CBM如何导致饮酒行为的成功改变。重度/高危饮酒者 （n=40;年龄18-34）将从社区招募参加本项目，并通过电话进行资格筛选。 参与者将接受基线评估，线索反应（CR）和接近避免任务（AAT）， fMRI，基于网络的酒精使用干预，随机分为CBM或假训练。第一训练 会议（CBM与假手术）将在这个时候发生，然后是4个在线会议超过一周。基线 将在1周随访时重复评估和fMRI程序，并再次测量饮酒量 通过1个月和6个月的随访在线进行。据推测，煤层气集团将表现出更大的变化， 在CR和AAT任务期间，与假手术组相比，BOLD活性在上述确定的区域中， 更大程度地减少饮酒。根据NIAAA的优先事项，“制定有效的方法.治疗酒精 滥用和依赖[和]酒精相关的后果”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，试图更好地了解 建立信任措施的机制。这项拟议的项目旨在扩大最近的发现，这种机制的病人 使用主要基于网络的干预措施，向重度/高危饮酒者提供酒精使用障碍。这项研究将 也是第一个研究CBM后BOLD变化和饮酒行为之间关系的人。

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.