Refinement and Pilot Testing of a Computerized Distress Tolerance Intervention with Just-In-Time Text Message Reminders for Cannabis Use Disorder

针对大麻使用障碍的实时短信提醒的计算机化应激耐受干预的完善和试点测试

• 批准号: 10681967
• 负责人: Richard Macatee
• 金额: $ 28.77万
• 依托单位: AUBURN UNIVERSITY AT AUBURN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10681967
• 关键词: Anxiety; Behavior; Cannabis; Chronic; Classification; Control Groups; Cues; Data; Devices; Distal; Distress; Ecological momentary assessment; Emotional; Feedback; Frequencies; Harm Reduction; Health education; Heterogeneity; Imagery; Individual; Intervention; Interviewer; Learning; Link; Machine Learning; Measurement; Measures; Methods; Modification; Motivation; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Physiological; Physiology; Population; Prevalence; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Reporting; Risk Factors; Sampling; Severities; Shapes; Signal Transduction; Stress; Testing; Text Messaging; Time; Training; Treatment Efficacy; United States; Visual; Work; cannabis cue; comparative efficacy; computerized; cost; craving; cue reactivity; depressive symptoms; disability; distress tolerance; efficacy evaluation; efficacy testing; emotion regulation; emotional distress; follow-up; group intervention; habituation; high risk; improved; intervention cost; intervention effect; intervention refinement; long term abstinence; marijuana legalization; marijuana use; marijuana use disorder; marijuana user; negative affect; neurophysiology; novel; personalized intervention; pilot test; portability; psychoeducation; psychoeducational; psychosocial; response; secondary outcome; texting support; urinary; wearable device

Project Summary. The prevalence of daily cannabis use and Cannabis Use Disorder (CUD) has increased in the United States over the past two decades. Brief, computerized harm reduction interventions that target specific high-risk CUD populations could be an efficient approach to reducing CUD. Distress intolerance (DI), which refers to the tendency to negatively appraise and escape aversive emotional states, is a risk factor associated with stress-related cannabis use motivation and CUD severity/chronicity. Thus, a brief, accessible, low-cost intervention that reduces DI in those with CUD and elevated DI could have a significant public health impact. This proposed Stage I project aims to modify an existing two-session computerized distress tolerance intervention to optimize emotion regulation learning/generalization and test its impact on DI and cannabis use outcomes in a randomized controlled trial. Specifically, the intervention will be condensed to one-session and its imaginal exposure module will be modified to shape emotional engagement with the aim of maximizing within-session habituation, which will be signaled with a novel audio/visual cue (habituation cue). Habituation cues will then be delivered in just-in-time text message reminders triggered by naturalistic distress reported via ecological momentary assessment. After obtaining feedback on the modified Emotional Engagement Distress Tolerance Intervention in a small sample (Specific Aim 1), the intervention’s efficacy compared to a stringent, credible, time-matched health education control intervention will be tested in a randomized controlled trial in 80 cannabis users with CUD and high DI. To measure the intervention’s mechanistic target engagement (Specific Aim 2), multi-method DI assessments will be administered through four-month follow-up. To measure the intervention’s impact on cannabis use (Specific Aim 3a), stress-related cannabis use motivation (lab stress- elicited craving and neurophysiological drug cue reactivity, ecological momentary assessment of stress-elicited cannabis use) will be assessed through the intervention period. Interviewer-assessed cannabis use frequency, CUD severity, and urinary THC metabolite concentration will be measured through 4-month follow-up. Quality of life and anxiety/depression symptoms will also be measured as secondary outcomes through 4-month follow-up (Specific Aim 3b). As an exploratory aim, a wristworn device will be used to measure ambulatory physiology during a portion of the intervention period to evaluate the feasibility of detecting heightened real- world distress based on objective indicators (Specific Aim 4).Our central hypothesis is that, compared to a control intervention, the Emotional Engagement Distress Tolerance Intervention will produce superior reductions in multi-method assessments of DI, stress-related cannabis use motivation, disordered cannabis use, and psychosocial functioning. Successful completion of the proposed aims will (1) justify a subsequent Stage II trial, and (2) inform efforts to integrate the just-in-time habituation reminders with wearable technology in order to increase emotion regulation generalization opportunities and decrease participant report burden.

项目摘要。每日使用大麻和大麻使用障碍（CUD）的流行率在2010年有所上升。 美国在过去的二十年里。简短的、计算机化的减少伤害干预措施， 特定的高风险CUD人群可能是减少CUD的有效方法。痛苦不耐受（DI）， 指的是倾向于消极评价和逃避厌恶的情绪状态，是一个危险因素 与压力相关的大麻使用动机和CUD严重性/慢性相关。因此，一个简短的，可访问的， 一种低成本的干预措施，减少那些患有CUD和DI升高的人的DI，可能会对公共健康产生重大影响。 冲击这项建议的第一阶段计划，目的是修改现有的两个时段的计算机化遇险容忍 干预以优化情绪调节学习/概括，并测试其对DI和大麻使用的影响 随机对照试验的结果。具体而言，发言将压缩为一次会议， 它的形象曝光模块将被修改，以塑造情感参与， 会话内习惯化，其将用新的音频/视觉提示（习惯化提示）来发信号。习惯化 然后，线索将通过即时短信提醒传递，提醒由自然主义的痛苦报告通过 生态瞬时评估在获得对修改后的情绪投入困扰的反馈后， 耐受性干预在小样本（具体目标1）中，干预的疗效比较严格， 可信的，时间匹配的健康教育控制干预措施将在一项随机对照试验中进行测试，在80 有CUD和高DI的大麻使用者。测量干预措施的机械目标参与（具体 目标2），将在4个月随访期间进行多方法DI评估。测量 干预对大麻使用的影响（具体目标3a），与压力相关的大麻使用动机（实验室压力- 引起的渴望和神经生理药物线索反应，生态瞬时评估的压力引起的 大麻使用）将在干预期间进行评估。访谈者评估的大麻使用频率， 将通过4个月随访测量CUD严重程度和尿THC代谢物浓度。质量 生活和焦虑/抑郁症状也将作为次要结局进行测量，直至4个月 后续行动（具体目标3b）。作为探索性目的，将使用腕戴式设备测量步行 在干预期的一部分期间的生理学，以评估检测升高的真实的- 我们的中心假设是，与一个基于客观指标的世界困境相比， 在控制干预中，情绪投入痛苦容忍干预会产生上级 减少DI的多方法评估，与压力相关的大麻使用动机，大麻紊乱 使用和心理社会功能。成功完成拟议目标将（1）证明随后 第二阶段的试验，以及（2）通知努力整合即时习惯提醒与可穿戴技术 以增加情绪调节的泛化机会，减少被试的报告负担。