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。年，每日大麻使用和大麻使用障碍(CUD)的流行率上升。 在过去的二十年里，美国。简要、计算机化的减少伤害干预措施，目标是 特定的高危CUD人群可能是减少CUD的有效方法。窘迫不耐受(DI) 它指的是消极评价和逃避厌恶情绪状态的倾向，是一个风险因素 与应激相关的大麻使用动机和戒毒严重程度/慢性病有关。因此，一个简短的、可访问的 降低CUD患者DI和升高DI的低成本干预措施可能会对公共卫生产生重大影响 冲击力。这一拟议的第一阶段项目旨在修改现有的两期计算机化的遇险容差 优化情绪调节学习/概括的干预措施及其对吸毒者和大麻使用的影响 一项随机对照试验的结果。具体地说，干预将浓缩为一次会议和 其想象中的曝光模块将被修改以塑造情感投入，目的是最大化 会话中的习惯化，这将通过一个新的音频/视觉线索(习惯化线索)来发出信号。习惯化 然后，提示将以即时短信提醒的形式发送，由通过以下方式报告的自然主义危难触发 生态瞬时评估。在获得关于修改后的情绪投入苦恼的反馈之后 在小样本耐受性干预(特定目标1)下，干预效果较严格， 可信的、时间匹配的健康教育控制干预措施将在80%的随机对照试验中进行测试 吸食大麻和吸毒率高的吸毒者。衡量干预的机械性目标参与度(具体 目标2)，将通过四个月的跟踪实施多方法依赖注入评估。要测量 干预对大麻使用的影响(具体目标3a)，与压力有关的大麻使用动机(实验室压力- 诱发渴求和神经生理学药物提示反应性，应激诱导的生态瞬时评估 (大麻使用)将在干预期内进行评估。面试者评估的大麻使用频率， 通过4个月的随访，测量CUD严重程度和尿THC代谢物浓度。质量 生活质量和焦虑/抑郁症状也将在4个月内作为次要结果进行衡量 后续行动(具体目标3b)。作为一项探索性的目标，将使用腕式设备来测量行走能力 在干预期的一段时间内进行生理学检查，以评估检测实时血压升高的可行性。 基于客观指标的世界危机(具体目标4)。我们的中心假设是，与 控制性干预、情绪投入苦恼耐受性干预会产生优势 减少对DI的多方法评估、与应激有关的大麻使用动机、混乱的大麻 使用和心理社会功能。成功完成提议的目标将(1)证明随后的 第二阶段试验，以及(2)告知将即时习惯提醒与可穿戴技术相结合的努力 以增加情绪调节泛化机会，减轻参与者报告负担。