Testing the Efficacy of a Technology-Supported Lifestyle Physical Activity Intervention Among Women with Depression in Alcohol Treatment

测试技术支持的生活方式体育活动干预对抑郁症女性酒精治疗的效果

• 批准号: 10443834
• 负责人: Ana M Abrantes
• 金额: $ 65.17万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10443834
• 关键词: Abstinence; Addictive Behavior; Affect; Aftercare; Alcohol consumption; Alcohols; Behavioral; Child Care; Coping Skills; Counseling; Coupled; Data; Depressed mood; Dropout; Ecological momentary assessment; Educational Intervention; Emotions; Goals; Health; Health education; Individual; Intervention; Knowledge; Life Style; Measures; Mediating; Mental Depression; Mental disorders; Monitor; Outcome; Participant; Physical activity; Physical assessment; Play; Population; Precipitating Factors; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Relapse; Reporting; Role; Self Efficacy; Shame; Stressful Event; Technology; Telephone; Testing; Time; Woman; Work; acceptability and feasibility; addiction; alcohol abstinence; alcohol abuse therapy; alcohol craving; alcohol use disorder; base; cardiorespiratory fitness; coping; cost; craving; depressive symptoms; drinking; early alcohol use; efficacy testing; exercise intervention; fitbit; fitness; flexibility; follow-up; improved; interpersonal conflict; medical specialties; men; mobile application; negative affect; negative emotional state; negative mood; novel; positive emotional state; pressure; primary outcome; reduced alcohol use; relapse patients; relapse risk; response; secondary outcome; social; social stigma; treatment effect

ABSTRACT Alcohol use disorder (AUD) is a significant and costly public health problem. Women develop AUD more quickly and suffer a broader range of adverse alcohol-related health consequences than men. Yet, due to stigma, shame, and child care issues, women are less likely to receive specialty addiction treatment. Moreover, mounting evidence indicates factors that precipitate relapse differ between men and women. Men are more likely to relapse in response to positive emotional states and social pressure while negative emotional states are important precipitators of relapse in women. Indeed, women often report drinking to cope with negative emotions and express a lack of alternate coping strategies. Given the robust evidence for physical activity (PA) in decreasing depression, negative affect, and alcohol craving, PA interventions may play an important role as an alternate coping strategy for women with AUD and a means to decrease relapse. Our team was the first group to develop and test a lifestyle physical activity (LPA) approach with women with AUD (R34 AA024038). LPA is a new PA paradigm that emerged as an alternative to the gym-based fitness training interventions that struggle with high dropout and lack transportability to varied settings. LPA interventions represent simple, low- cost, and flexible approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to facilitate goal-setting and self-monitoring. In our Stage 1a and 1b studies, we developed and demonstrated initial support for an LPA+Fitbit intervention for women with AUD and depression. The intervention consisted of 6 brief, phone-based PA counseling sessions focused on increasing PA and strategically using bouts of PA to cope with affect and alcohol cravings and use of the Fitbit fitness tracker and mobile app. Our preliminary work established the acceptability and feasibility of this intervention. In addition, results of an initial randomized controlled trial (RCT; N = 50) showed that, relative to a health education contact (HEC) control, women in the LPA+Fitbit intervention had higher rates of alcohol abstinence, greater reductions in depression and negative affect, and increased PA at the 3-month follow-up. We propose to build on our promising preparatory work and take the next step by conducting a fully powered (N=214), Stage 2 RCT to test the efficacy of the LPA+Fitbit intervention, compared to a Fitbit Only condition, for women with AUD and depression in alcohol treatment. In addition, to elucidate mechanisms of treatment effects, we will employ two, 10-day bouts of ecological momentary assessment (EMA) to obtain multiple daily measures of affect, cravings, drinking, and PA engagement during early recovery (i.e., first 90 days) coupled with objective assessment of PA (i.e., Fitbit data). This project will contribute much-needed knowledge on the role of PA in reducing alcohol use, depressive symptoms and negative mood in women with AUD. If the efficacy of the LPA+Fitbit intervention can be established, depressed women with AUD will have a valuable adjunct to traditional alcohol treatment that can server as an alternate coping strategy during early recovery, when relapse risk is highest.

摘要 酒精使用障碍（AUD）是一个重要的和昂贵的公共卫生问题。女性发展澳元更多 与男性相比，女性会更快地遭受更广泛的与酒精相关的不良健康后果。归因于 耻辱，羞耻和儿童保育问题，妇女不太可能接受专业成瘾治疗。此外，委员会认为， 越来越多的证据表明，促使复发的因素在男子和妇女之间存在差异。男性更 积极的情绪状态和社会压力可能会复发，而消极的情绪状态 是女性复发的重要诱因。事实上，女性经常报告饮酒是为了科普负面影响， 情绪和表达缺乏替代应对策略。鉴于体力活动（PA）的有力证据， 在减少抑郁、消极情绪和酒精渴望方面，PA干预可能发挥重要作用， 对于患有AUD的女性来说，这是一种替代的应对策略，也是减少复发的一种方法。我们队是第一个 在AUD女性中开发和测试生活方式体力活动（LPA）方法（R34 AA 024038）。 LPA是一种新的PA模式，作为健身房健身训练干预的替代方案出现， 与高辍学率作斗争，缺乏可转移到各种环境的能力。LPA干预措施简单，低- 成本，以及由简短的咨询和活动监测器支持的灵活方法（例如，Fitbit）至 促进目标设定和自我监控。在我们的1a和1b阶段研究中，我们开发并证明了 为患有AUD和抑郁症的女性提供LPA+Fitbit干预的初步支持。干预措施包括 6个简短的，基于电话的PA咨询会议，重点是增加PA和战略性地使用PA的回合 以科普影响和酒精的渴望和使用Fitbit健身追踪器和移动的应用程序。我们的初步 工作确定了这种干预的可接受性和可行性。此外，初步随机 对照试验（RCT; N = 50）显示，相对于健康教育接触（HEC）对照， LPA+Fitbit干预具有更高的戒酒率，更大程度地减少抑郁和负性。 影响，并在3个月随访时增加PA。我们建议在我们充满希望的筹备工作的基础上再接再厉， 下一步，进行全功率（N=214）第2阶段随机对照试验，以测试LPA+Fitbit的疗效 干预，与Fitbit Only条件相比，对于酒精治疗中患有AUD和抑郁症的女性。在 此外，为了阐明治疗效果的机制，我们将采用两次为期10天的生态学试验， 瞬时评估（EMA），以获得影响，渴望，饮酒和PA的多种日常措施 早期恢复期间的参与（即，前90天）结合PA的客观评估（即，Fitbit 数据）。该项目将有助于了解PA在减少酒精使用方面的作用， 抑郁症状和消极情绪的女性与AUD。如果LPA+Fitbit干预的效果可以 一旦确定，患有AUD的抑郁症女性将有一个有价值的辅助传统酒精治疗， 可以作为一种替代的应对策略，在早期恢复时复发的风险是最高的。