Testing the Efficacy of a Technology-Supported Lifestyle Physical Activity Intervention Among Women with Depression in Alcohol Treatment

摘要 酒精使用障碍(AUD)是一个重大且代价高昂的公共卫生问题。女性发展更快 而且比男性更容易遭受与酒精有关的各种不良健康后果。然而，由于 在耻辱、羞耻和育儿问题上，女性接受专门的成瘾治疗的可能性较小。此外， 越来越多的证据表明，导致复发的因素在男性和女性之间有所不同。男人更多 对积极的情绪状态和社会压力的反应容易复发，而对消极的情绪状态的反应 是女性复发的重要诱因。事实上，女性经常报告饮酒是为了应对消极情绪 情绪，并表示缺乏替代的应对策略。考虑到体力活动的有力证据(PA) 在减少抑郁、消极情绪和饮酒欲望方面，PA干预可能发挥重要作用 为患有澳门氏症的妇女提供一种替代应对策略和减少复发的手段。我们队是第一个 小组开发和测试生活方式体力活动(LPA)方法与患有AUD的妇女(R34 AA024038)。 LPA是一种新的PA范式，作为以健身房为基础的健身训练干预的替代方案， 与高辍学率作斗争，缺乏对各种环境的可移植性。LPA干预代表了简单、低成本的 成本，以及由简短咨询和活动监控器(例如Fitbit)支持的灵活方法 促进目标设定和自我监控。在我们的1a和1b阶段研究中，我们开发并演示了 最初支持对患有AUD和抑郁症的女性进行LPA Fitbit干预。干预措施包括 在6个简短的电话PA咨询会议中，重点是增加PA和战略性地使用PA 为了应对情感和酒精渴望，以及Fitbit健身跟踪器和手机应用程序的使用。我们的预赛 工作确立了这一干预措施的可接受性和可行性。此外，初步随机化的结果 对照试验(RCT；N=50)显示，相对于健康教育接触者(HEC)对照组， LPA Fitbit干预有更高的戒酒率，抑郁和阴性的减少更多 在3个月的随访中，影响和增加了PA。我们建议在我们有希望的准备工作的基础上再接再厉，并 采取下一步，进行全功率(N=214)阶段2随机对照试验，以测试LPA Fitbit的效果 与仅使用Fitbit的情况相比，对酒精治疗中患有AUD和抑郁症的女性进行干预。在……里面 此外，为了阐明治疗效果的机制，我们将采用两轮，为期10天的生态学 瞬间评估(EMA)，以获得多项日常情感、渴望、饮酒和PA的测量 早期恢复期间(即前90天)的参与度以及对PA的客观评估(即Fitbit 数据)。该项目将提供关于PA在减少酒精使用方面的作用的急需的知识， AUD女性抑郁症状与负性情绪的关系如果LPA Fitbit干预的疗效可以 经证实，患有AUD的抑郁症女性将拥有传统酒精治疗的宝贵辅助手段 在复发风险最高的早期康复期间，可以作为一种替代应对策略。

ABSTRACT Alcohol use disorder (AUD) is a significant and costly public health problem. Women develop AUD more quickly and suffer a broader range of adverse alcohol-related health consequences than men. Yet, due to stigma, shame, and child care issues, women are less likely to receive specialty addiction treatment. Moreover, mounting evidence indicates factors that precipitate relapse differ between men and women. Men are more likely to relapse in response to positive emotional states and social pressure while negative emotional states are important precipitators of relapse in women. Indeed, women often report drinking to cope with negative emotions and express a lack of alternate coping strategies. Given the robust evidence for physical activity (PA) in decreasing depression, negative affect, and alcohol craving, PA interventions may play an important role as an alternate coping strategy for women with AUD and a means to decrease relapse. Our team was the first group to develop and test a lifestyle physical activity (LPA) approach with women with AUD (R34 AA024038). LPA is a new PA paradigm that emerged as an alternative to the gym-based fitness training interventions that struggle with high dropout and lack transportability to varied settings. LPA interventions represent simple, low- cost, and flexible approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to facilitate goal-setting and self-monitoring. In our Stage 1a and 1b studies, we developed and demonstrated initial support for an LPA+Fitbit intervention for women with AUD and depression. The intervention consisted of 6 brief, phone-based PA counseling sessions focused on increasing PA and strategically using bouts of PA to cope with affect and alcohol cravings and use of the Fitbit fitness tracker and mobile app. Our preliminary work established the acceptability and feasibility of this intervention. In addition, results of an initial randomized controlled trial (RCT; N = 50) showed that, relative to a health education contact (HEC) control, women in the LPA+Fitbit intervention had higher rates of alcohol abstinence, greater reductions in depression and negative affect, and increased PA at the 3-month follow-up. We propose to build on our promising preparatory work and take the next step by conducting a fully powered (N=214), Stage 2 RCT to test the efficacy of the LPA+Fitbit intervention, compared to a Fitbit Only condition, for women with AUD and depression in alcohol treatment. In addition, to elucidate mechanisms of treatment effects, we will employ two, 10-day bouts of ecological momentary assessment (EMA) to obtain multiple daily measures of affect, cravings, drinking, and PA engagement during early recovery (i.e., first 90 days) coupled with objective assessment of PA (i.e., Fitbit data). This project will contribute much-needed knowledge on the role of PA in reducing alcohol use, depressive symptoms and negative mood in women with AUD. If the efficacy of the LPA+Fitbit intervention can be established, depressed women with AUD will have a valuable adjunct to traditional alcohol treatment that can server as an alternate coping strategy during early recovery, when relapse risk is highest.