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

项目总结/摘要 认知行为疗法（CBT）是一种治疗酒精使用障碍（AUD）的既定方法，但它是 由于在临床实践中传播和有效实施方面存在一些障碍， 包括对它如何发挥作用的有限理解（即，行为改变机制）。 对行为改变机制的更好理解可以刺激新干预措施的发展 这扩大了AUD循证干预的效果，可能改变成瘾治疗 以及我们更广泛地进行行为改变干预的方式。认知科学的最新发展 和神经科学对于加速理解行为改变的机制有很大的希望 与CBT有关。拟议的独立科学家奖将促进基鲁克博士的职业发展， 这些领域，以促进理解CBT如何改变认知，行为和大脑。独立 根据本提案进行的临床试验（R 01 AA 024122; PI - Kiluk）将评价 与常规标准治疗相比，计算机提供的CBT（CBT 4CBT）或临床医生提供的CBT (TAU)在180名门诊寻求治疗者中减少酒精使用。治疗将在 为期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 行为，经验和认知的措施将被用来发展一个更完整的理解， CBT减少酒精使用的机械过程。 该项目的具体目标如下： 1.评价CBT 4CBT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， 为期8周的随机试验，随访6个月。我们希望任何一种形式的CBT都比 治疗和随访期间戒断天数（PDA）百分比增加时的TAU。 2.评估CBT的假定机制在多大程度上充当了治疗效果的中介， 与TAU相比，两种形式的CBT都使用酒精。我们预计指数反映收购， 技能的实施将介导CBT对酒精使用的影响（即，PDA）。 该项目直接与Kiluk博士的职业目标相联系，即将认知神经科学方法纳入 确定循证干预的机制，重点是CBT干预如何影响 成瘾的功能域，如执行功能，负面影响和激励显着性，一致 用NIAAA的成瘾神经认知评估电池。认知神经科学培训， 通过与耶鲁医学院这些领域的专家合作， 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.