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

项目总结/摘要 大约25-30%的美国人口将经历焦虑病理严重到足以有资格获得治疗。 焦虑症的诊断在他们的一生中。关键是，大多数人不会接受治疗， 迫切需要考虑提供精神卫生服务的替代方法，以满足 更大的规模。认知偏差修正（CBM）干预焦虑有相当大的希望，作为一种方式， 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，这是众所周知的原因和保持焦虑。解释偏倚的CBM（CBM-I） 当在实验室中通过计算机给药时，已确立疗效，并且有明确的证据表明， 接合（即，解释的变化，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因素，包括交付 方法（计算机与移动的电话）和增加最小的人际接触（对于那些有磨损风险的人）。 鉴于基于网络的干预措施的退出率很高，解决自然减员问题至关重要。私家侦探的实验室 测试建立信任措施第一阶段的主持人具体来说，通过PI的MindTrails网站（与实验室的 之前获得NIMH R34 MH 106770奖项），该实验室已经拥有向公众提供煤层气的基础设施， 招募大量焦虑的样本。此外，PI和Co-I已经建立了进行移动的传感的基础设施 通过移动的电话传递情绪和CBM-I。因此，该项目可以响应NIMH的要求， “有效性试验有助于推进心理健康护理的个性化。”当前 一项提案旨在比较通过计算机与移动的提供的建立信任措施-I的有效性和目标参与度 电话，并测试是否为有辍学风险的参与者增加最少的人际接触可以提高保留率， 结果。研究1将提供移动的CBM-I项目的试点可行性和用户体验测试 手机.研究2将检查实验室目前的在线，基于计算机的CBM-I数据，以帮助确定 自然减员的经验指标。研究3将提供有效性调节剂的初步测试。即在 研究3，N=840名高度焦虑的参与者将被随机分配到3个条件之一：1）提供CBM-I培训 通过计算机（在现有的MindTrails站点）; 2）通过移动的电话提供建立信任措施-I培训; 3）对照组- 只有心理教育。CBM-I条件包括每周5次培训课程。基于理论上-和 在条件1和2中，受试者被确定为脱落的高风险， 然后将被随机分配到添加最小的人类接触（使用TeleCoach协议）或没有变化。 使用这种适应性干预，称为顺序，多重分配，随机试验（SMART）， 该项目可以测试CBM-I交付方法的效果和人类接触的附加值，以提高 保留高风险辍学的参与者。

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.!