Efficacy and Mechanisms of CBT4CBT for Alcohol Use Disorders

 说明(申请人提供)：认知行为疗法(CBT)是一种针对酒精使用障碍的既定方法，但在临床实践中推广和有效实施存在一些障碍，包括对其如何发挥作用(即作用机制)的有限理解。这项提案旨在评估一种新的基于计算机的酒精使用障碍认知行为治疗计划(CBT4CBT)，旨在解决这些障碍。拟议的R01项目(在R21 AA 021405完成后；卡罗尔，PI)将评估CBT4CBT或临床医生提供的CBT与标准照常治疗(TAU)在减少180名门诊求诊者酒精使用方面的效果。治疗将在8周内进行，并将包括6个月的随访期，以评估治疗效果的持久性。将使用多种行为、经验和认知测量方法来更完整地理解CBT减少酒精使用的机制过程。该项目的具体目标如下：1.通过为期8周的随机试验，评价CBT4CBT或临床医生提供的CBT相对于TAU在减少酒精使用方面的疗效，并进行6个月的随访。我们预计，无论哪种形式的CBT在增加治疗和随访期间戒断天数(PDA)方面都将比TAU更有效。2.评估与TAU相比，CBT的假定机制在多大程度上对减少两种形式CBT的酒精使用起到了治疗效果的中介作用。我们预计反映技能获得和实施的指数将中介CBT对酒精使用(即PDA)的影响。探索性目标将包括评估认知功能水平作为CBT直接和间接影响的调节因素，以及探索不同CBT形式(临床医生提供与计算机提供)在作用机制方面的差异。这将是第一个评估计算机提供的CBT版本作为酒精使用障碍的虚拟“独立”干预措施的有效性的充分有效的随机对照试验，这可能对使这种具有成本效益的CBT形式更广泛地获得具有明显影响。此外，将传统的临床医生提供的CBT纳入同一试验将允许对CBT的机制进行新的检查，因为有效成分可以在有或没有“相关”因素(例如，治疗师的共鸣、温暖、治疗联盟)的情况下进行评估，这些因素通常会影响结果。

 DESCRIPTION (provided by applicant): Cognitive Behavioral Therapy (CBT) is an established approach for alcohol use disorders, yet it is hindered by a number of obstacles to dissemination and effective implementation in clinical practice, which include a limited understanding regarding how it exerts its effects (i.e., mechanisms of action). This proposal aims to evaluate a novel computer-based cognitive behavioral therapy program for alcohol use disorders (CBT4CBT) designed to address these obstacles. The proposed R01 project (which follows the completion of R21 AA 021405; Carroll, PI) will evaluate the efficacy of CBT4CBT or clinician-delivered CBT in comparison to standard treatment as usual (TAU) at reducing alcohol use among 180 outpatient treatment seekers. Treatments will be delivered over the course of 8-weeks and will include a 6-month follow-up period to assess durability of treatment effects. Multiple behavioral, experiential, and cognitive measures will be used to develop a more complete understanding of the mechanistic processes by which CBT works to reduce alcohol use. The specific aims of the project are as follows: 1. Evaluate the efficacy of CBT4CBT or clinician-delivered CBT relative to TAU at reducing alcohol use through an 8-week randomized trial, with 6-month follow-up. We expect either form of CBT will be more effective than TAU at increasing the percentage of days abstinent (PDA) during treatment and follow-up. 2. Evaluate the extent to which CBT's putative mechanisms act as a mediator of treatment effect on reducing alcohol use in both forms of CBT relative to TAU. We expect indices reflecting the acquisition and implementation of skills will mediate the effect of CBT on alcohol use (i.e., PDA). Exploratory aims will include the evaluation of levels of cognitive function as moderators of CBT's direct and indirect effects, as well as exploration of differences across CBT formats (clinician-delivered vs. computer- delivered) with respect to the mechanisms of action. This will be the first adequately powered randomized controlled trial to evaluate the effectiveness of a computer-delivered version of CBT as a virtual `stand-alone' intervention for alcohol use disorders, which could have clear implications for making this cost effective form of CBT more broadly accessible. Furthermore, the inclusion of traditional clinician-delivered CBT within the same trial will allow for novel examination of CBT's mechanisms, as the active ingredients can be evaluated with and without `relational' factors (e.g., therapist empathy, warmth, therapeutic alliance) that typically contribte to outcomes.