Addressing Problem Drinking from the Bottom-Up: An Investigation of the Neural and Behavioral Effects of Cognitive Bias Modification (CBM)

自下而上解决饮酒问题：认知偏差修正 (CBM) 对神经和行为影响的调查

• 批准号: 9567437
• 负责人: Kelli Danielle Tahaney
• 金额: $ 3.28万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-16 至 2020-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9567437
• 关键词: Accidents; Address; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcoholic beverage heavy drinker; Alcohols; Amygdaloid structure; Area; Attention; Behavior; Behavioral; Brain; Clinical; Cognition; Cognitive; Communities; Conscious; Cues; Dependence; Desire for food; Development; Eligibility Determination; Evidence based intervention; Exhibits; Frequencies; Functional Magnetic Resonance Imaging; Future; Goals; Health; Heavy Drinking; Home environment; Impaired cognition; Impairment; Individual; Injury; Inpatients; Internet; Intervention; Investigation; Lead; Life; Maintenance; Measures; Medial; Medical emergency; Methods; Modeling; Modification; National Institute on Alcohol Abuse and Alcoholism; Neurocognitive; Neurologic; Neurologic Effect; Nucleus Accumbens; Online Systems; Outcome; Participant; Patients; Physical Dependence; Population; Prefrontal Cortex; Procedures; Process; Public Health; Randomized; Relapse; Reporting; Research; Research Personnel; Rewards; Risk; Sampling; Self-control as a personality trait; Stimulus; Substance Use Disorder; System; Telephone; Thinking; Time; Training; Treatment outcome; Work; alcohol abuse therapy; alcohol cue; alcohol effect; alcohol exposure; alcohol intervention; alcohol related consequences; alcohol risk; alcohol use disorder; base; behavior change; blood oxygen level dependent; cognitive change; cognitive function; cognitive process; cognitive system; craving; cue reactivity; drinking; drinking behavior; emotional abuse; executive function; follow-up; high risk drinking; high risk sexual behavior; improved; increased appetite; insight; interest; medical specialties; motivational intervention; neuroimaging; neuromechanism; novel; novel strategies; physical conditioning; placebo group; recruit; relating to nervous system; sex risk; skills; theories; therapy development; young adult

PROJECT SUMMARY/ABSTRACT Heavy/at-risk alcohol use is considered a relevant public health problem given its association with sexual risk behavior, accidents, poor health, and negative life consequences (5,6). Dual process models of alcohol use describe two cognitive systems involved in the maintenance of heavy alcohol use—a top-down control system and bottom-up automatic appetitive system (8-11). Existing evidence-based interventions for alcohol use tend to focus on enhancing individuals' self-control (top-down) skills. Lately researchers have highlighted importance of targeting automatic appetitive cognitive biases that heavy drinkers exhibit. Cognitive Bias Modification (CBM) is one intervention that has shown promising effects on reversing cognitive biases toward alcohol among individuals with alcohol use disorders (19-23). CBM is currently thought to alter cognitive biases that may interfere with implementation of skills-based or motivational interventions and may act best as an adjunct to existing interventions (18). Recent work has begun to look at the neurocognitive mechanisms of action of CBM and has found significant changes in brain systems underlying reward (i.e., NAcc and amygdala) and executive control (i.e., dlPFC, mPFC) (26,27). In line with these findings, this proposed project would investigate the effects of CBM on neurocognitive processes related to alcohol use in a novel sample of heavy/at-risk drinkers. The primary aim of this project is to examine the effects of CBM on neurocognitive processes among heavy/at-risk drinkers interested in changing their alcohol use. As a secondary aim, this project will investigate associations between neural and cognitive changes and changes in alcohol use to better understand how CBM might lead to successful changes in drinking behavior. Heavy/at-risk drinkers (n=40; ages 18-34) will be recruited from the community for this project and phone screened for eligibility. Participants will undergo baseline assessments, a cue-reactivity (CR) and approach avoid task (AAT) during fMRI, web-based intervention for alcohol use, and randomization to CBM or sham training. The first training session (CBM vs. sham) will occur at this time, followed by 4 online sessions over one week. Baseline assessments and fMRI procedures will be repeated at 1-week follow-up and drinking will again be measured online via 1- and 6-month follow-ups. It is hypothesized that the CBM group will exhibit greater changes in BOLD activity compared to the sham group in the above identified regions during CR and AAT tasks and show greater reductions in drinking. In line with NIAAA's priority to “devise effective methods for…treating alcohol abuse and dependence [and] alcohol-related consequences” using a “wide range of scientific areas” this proposed project incorporates both neuroscientific and clinical approaches in attempting to better understand the mechanisms of CBM. This proposed project aims to extend recent findings of such mechanisms in patients with alcohol use disorder to heavy/at-risk drinkers using a primarily web-based intervention. This study would also be the first to investigate associations between BOLD changes and drinking behavior following CBM.

项目概要/摘要 大量/高风险饮酒被认为是一个相关的公共卫生问题，因为它与 危险性行为、事故、健康状况不佳以及负面的生活后果 (5,6)。双进程模型 饮酒描述了与维持大量饮酒有关的两种认知系统——自上而下 控制系统和自下而上的自动食欲系统（8-11）。现有的循证干预措施 饮酒往往侧重于增强个人的自我控制（自上而下）技能。最近研究人员已 强调了针对酗酒者表现出的自动食欲认知偏差的重要性。认知的 偏见修正（CBM）是一种干预措施，在扭转认知偏见方面显示出良好的效果 患有酒精使用障碍的人对酒精的态度（19-23）。 CBM 目前被认为可以改变认知 偏见可能会干扰基于技能或动机干预措施的实施，并且可能会发挥最佳作用 现有干预措施的补充 (18)。最近的工作已经开始研究神经认知机制 CBM 的作用，并发现奖励背后的大脑系统（即 NAcc 和 杏仁核）和执行控制（即 dlPFC、mPFC）（26,27）。根据这些发现，本拟议项目 将在一个新样本中研究 CBM 对与饮酒相关的神经认知过程的影响 重度/高危饮酒者。该项目的主要目的是检查 CBM 对神经认知的影响 对改变酒精使用感兴趣的重度/高危饮酒者的过程。作为次要目标，这 该项目将调查神经和认知变化与饮酒变化之间的关联 更好地了解 CBM 如何成功改变饮酒行为。重度/高危饮酒者 （n=40；年龄 18-34 岁）将从社区中招募参与该项目，并通过电话筛选资格。 参与者将在训练期间接受基线评估、提示反应性（CR）和避免接近任务（AAT） fMRI、基于网络的饮酒干预以及 CBM 或假训练的随机化。第一次训练 此时将进行一次会议（CBM 与 sham），然后在一周内进行 4 次在线会议。基线 将在 1 周随访时重复评估和功能磁共振成像程序，并再次测量饮酒情况 通过 1 个月和 6 个月的后续行动进行在线跟踪。预计CBM组将在以下方面表现出更大的变化： 在 CR 和 AAT 任务期间，与假手术组在上述确定区域中的 BOLD 活动相比，并显示 饮酒量进一步减少。与 NIAAA 的优先事项“设计有效的方法......治疗酒精 滥用和依赖[以及]与酒精相关的后果”使用“广泛的科学领域” 拟议的项目结合了神经科学和临床方法，试图更好地理解 煤层气的机制。该拟议项目旨在将此类机制的最新发现扩展到患者身上 主要使用基于网络的干预措施，对重度/高危饮酒者进行酒精使用障碍治疗。这项研究将 也是第一个调查 CBM 后 BOLD 变化与饮酒行为之间关系的人。