Effectiveness of interpretation training to reduce anxiety: Evaluating technology-based delivery models and methods to reduce attrition

项目摘要/摘要 大约25%-30%的美国人口将经历严重到有资格参加 焦虑症在他们一生中的诊断。关键的是，大多数人将得不到治疗，创造了一个 迫切需要考虑提供能够满足以下方面需求的精神卫生服务的替代方法 规模更大。认知偏差修正(CBM)对焦虑的干预具有相当大的前景，可以作为一种 满足这些需求。这些程序改变了有偏见的思维方式，例如选择性地分配威胁 解释，这是已知的导致和维持焦虑。用于解释偏差的煤层气(CBM-I) 在实验室通过计算机给药时已确定疗效，并有明确的目标证据 接触(即改变解释，已确定的机制)。现在，有效性需要测试。 在社区中，使用足够大的样本来评估其影响的关键调节器，包括交付 方法(计算机与移动电话)和增加最少的人类接触(对于那些有磨损风险的人)。 鉴于基于网络的干预措施的高辍学率，解决人员流失问题至关重要。私家侦探的实验室是理想的 定位于测试CBM-I的主持人。具体地说，通过PI的MindTrails网站(与实验室的 之前的NIMH R34MH106770奖)，该实验室已经拥有向公众提供煤层气的基础设施，并且 招募大量焦虑的样本。此外，PI和Co-I已经建立了基础设施来进行移动传感 Mod和CBM-I通过手机交付。因此，该项目可以响应NIMH的请求 “有助于推进心理健康护理个性化的有效性试验。”海流 提案旨在比较通过计算机和移动设备交付的CBM-I的有效性和目标参与度 电话，并测试为有辍学风险的参与者添加最少的人际接触是否提高了保留率和 结果。研究1将在移动设备上提供CBM-I方案的试行可行性和用户体验测试 电话。研究2将检查实验室当前基于计算机的在线CBM-I数据，以帮助确定 消耗的经验性指标。研究3将对有效性的主持人进行初步测试。也就是说，在 研究3，N=840名高度焦虑的参与者将被随机分成3种情况之一：1)提供CBM-I培训 通过计算机(在现有的MindTrails站点)；2)通过手机提供CBM-I培训；3)对照组- 仅限心理教育。CBM-I条件包括每周5次培训课程。基于理论上-和 经验性地得出的自然减员预测因素，参与者被确定为条件1和条件2中辍学的高风险 然后将被随机分配以添加最少的人类接触(使用TeleCoach协议)或不更改。 使用这种自适应干预，称为序贯、多重分配、随机试验(SMART)， 项目可以测试CBM-I交付方式的效果和人类接触的附加值，以提高 留住辍学风险较高的参与者。

Project Summary/Abstract Approximately 25-30% of the U.S. population will experience anxiety pathology severe enough to qualify for an anxiety disorder diagnosis during their lifetime. Critically, the majority will not receive treatment, creating a serious need to consider alternative approaches to delivering mental health services that can meet needs on a larger scale. Cognitive Bias Modification (CBM) interventions for anxiety hold considerable promise as a way to meet these needs. These programs alter biased ways of thinking, such as selective assignment of threat interpretations, which are known to cause and maintain anxiety. CBM for interpretation bias (CBM-I) has established efficacy when administered via computer in the laboratory, and there is clear evidence for target engagement (i.e., change in interpretations, the identified mechanism). Now, effectiveness needs to be tested in the community, using sufficiently large samples to evaluate key moderators of its effects, including delivery method (computer vs. mobile phone) and the addition of minimal human contact (for those at risk of attrition). Addressing attrition is critical given high rates of drop out for web-based interventions. The PI's lab is ideally positioned to test moderators of CBM-I. Specifically, via the PI's MindTrails web site (established with the lab's prior NIMH R34MH106770 award), the lab already has the infrastructure to deliver CBM to the public and recruit large anxious samples. Moreover, the PI and Co-I have established infrastructure to do mobile sensing of mood and CBM-I delivery via mobile phones. Thus, the project can respond to NIMH's request for “Effectiveness trials that can contribute to advancing the personalization of mental health care.” The current proposal aims to compare effectiveness and target engagement of CBM-I delivered via computer vs. mobile phone, and test if adding minimal human contact for participants at risk of dropout improves retention and outcomes. Study 1 will provide a pilot feasibility and user experience test of the CBM-I program on mobile phones. Study 2 will examine the lab's current online, computer-based CBM-I data to help determine empirical indicators of attrition. Study 3 will provide the primary test of moderators of effectiveness. Namely, in Study 3, N=840 high anxious participants will be randomized to one of 3 conditions: 1) CBM-I training delivered by computer (at existing MindTrails site); 2) CBM-I training delivered by mobile phone; 3) Control group- Psychoeducation only. CBM-I conditions include 5 weekly training sessions. Based on theoretically- and empirically-derived predictors of attrition, participants identified as high-risk for dropout in conditions 1 and 2 will then be randomly assigned to add minimal human contact (using the TeleCoach protocol) or no change. Using this adaptive intervention, known as Sequential, Multiple Assignment, Randomized Trial (SMART), the project can test both the effects of CBM-I delivery method and the added value of human contact to improve retention for participants at high-risk for dropping out.!