Integrating Cognitive Neuroscience Toward Understanding of Mechanisms of CBT for Alcohol Use Disorders

项目摘要/摘要 认知行为疗法(CBT)是治疗酒精使用障碍(AUD)的既定方法，但它是 在临床实践中传播和有效实施受到一些障碍的阻碍，其中 包括对它如何发挥其影响(即，行为改变的机制)的有限理解。 对行为改变机制的更好理解可以刺激新干预措施的发展 这放大了循证干预对AUD的影响，潜在地改变了成瘾治疗 以及我们进行更广泛的行为改变干预的方式。认知科学的最新进展 神经科学为加速理解行为改变的机制带来了巨大的希望 与CBT相关联。拟议的独立科学家奖将促进Kiluk博士在 这些区域有助于加深对CBT如何改变认知、行为和大脑的理解。无党派人士 根据这一建议(R01AA024122；Pi-Kiluk)进行的临床试验将评估 计算机提供的CBT(CBT4CBT)或临床医生提供的CBT与常规标准治疗的比较 (Tau)在180名门诊求诊者中减少酒精使用。治疗将通过 疗程为8周，并将包括6个月的随访期，以评估治疗效果的持久性。多重 将使用行为、经验和认知测量方法来更全面地了解 CBT减少酒精使用的机械过程。 该项目的具体目标如下： 1.评估CBT4CBT或临床医生提供的CBT相对于TAU在通过以下方式减少酒精使用方面的有效性 一项为期8周的随机试验，随访6个月。我们预计，无论哪种形式的CBT都将比 在治疗和随访期间增加戒断天数(PDA)的百分比。 2.评估CBT的假定机制在多大程度上调节治疗效果 酒精在两种形式的CBT中的使用相对于TAU。我们预计反映此次收购的指数和 技能的实施将调解CBT对酒精使用(即PDA)的影响。 这个项目直接与Kiluk博士的职业目标联系在一起，他的职业目标是将认知神经科学方法纳入 确定循证干预机制，重点关注CBT干预如何影响 成瘾的功能领域，如执行功能、负面情绪和激励突显，一致 使用NIAAA的成瘾神经认知评估电池。认知神经科学培训和 通过与耶鲁医学院这些领域的专家合作进行神经成像将促进 实现这些目标。

PROJECT SUMMARY/ABSTRACT Cognitive Behavioral Therapy (CBT) is an established approach for alcohol use disorders (AUD), 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 behavior change). Improved understanding of mechanisms of behavior change could spur the development of novel interventions that amplify the effect of evidence-based interventions for AUD, potentially transforming addictions treatment and the way we conduct behavior change interventions more broadly. Recent developments in cognitive science and neuroscience hold great promise for accelerating the understanding of mechanisms of behavior change associated with CBT. The proposed Independent Scientist Award will foster Dr. Kiluk's career development in these areas to advance understanding of how CBT changes cognition, behavior, and the brain. The independent clinical trial to be conducted under this proposal (R01AA024122; PI – Kiluk) will evaluate the efficacy of a computer-delivered CBT (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). This project directly links with Dr. Kiluk's career goals of incorporating cognitive neuroscience approaches to identify mechanisms of evidence-based interventions, with a focus on how CBT interventions affect change in functional domains of addiction such as executive function, negative affect, and incentive salience, consistent with NIAAA's Addictions Neurocognitive Assessment battery. Training in cognitive neuroscience and neuroimaging through collaboration with experts in these areas at Yale School of Medicine will facilitate achievement of these goals.