Project CHOICE: Choosing Healthy Options in Coping with Emotions, a Personalized-Feedback EMA/EMI Study for Emerging Adults Leaving Psychiatric Partial Hospitalization

摘要 成年初期是有问题的心理健康问题的常见时期，尤其是情感问题 焦虑和抑郁等障碍，以及有问题的饮酒模式。大量饮酒可能会导致 导致消极的心理健康、学习、身体健康和认知功能结果。特别是， 饮酒的人更有可能患有精神共病，临床结果更差。 与精神症状学或单独饮酒相比，共病与更多的风险有关，然而 在精神健康环境中很少成为目标。用物质作为应对负面情绪的动机 增加风险，因为那些用来应对的人经历的问题最多。因此，将目标定为 酒精的使用，特别是在EA中使用情感障碍的人用来应对。 对酒精的典型治疗是简短的、以激励为基础的，并提供规范的反馈。我们建议 为了加强我们在精神护理中对使用酒精的情感障碍患者的现有干预措施 Copy，它利用了技术。技术允许实时评估高风险情况 通过生态瞬时评估(EMA)和生态提供干预内容 瞬时干预(EMI)。提供量身定制、及时降低风险的消息，与 个性化的规范反馈可能会通过以下方式影响有问题的使用和抑郁/焦虑结果 使用的可能性和使用的负面结果。我们建议通过以下方式加强我们现有的试点干预 整合参与者反馈和协议完善。在第一阶段，我们将(1)对试点进行更改 基于参与者和研究人员的经验，对改进的干预措施进行评估 一系列焦点小组。在第二阶段，我们将测试我们的改进干预(PFIcope EMI)，并在随机、 对照治疗试验，与仅在基线(PnF)提供的个性化规范反馈相比。 PFIcope EMI包括：1)面对面的个性化反馈会议，介绍规范 信息，讨论个人的使用，并生成要在EMI中使用的风险降低消息；2)EMA以 监测情绪、使用意图、实际饮酒、应对动机和替代应对技能的使用情况； 基于EMA的定制消息(EMI)(即，标准化反馈加上个性化风险降低消息 当个体报告负面情绪和使用意图时)。PNF条件将收到1)面对面的通知 个性化反馈会议，介绍规范信息，讨论个人使用情况，发表于 基线。我们预计，该项目将导致开发一种明确、新颖的技术-- 支持对酒精和抑郁/焦虑共病的EA进行实时干预，稍后可以进行测试 在一台多点全动力RCT中。

ABSTRACT Emerging adulthood represents a common time for problematic mental health issues, particularly affective disorders such as anxiety and depression, and problematic patterns of alcohol use. Heavy alcohol use can lead to negative mental health, academic, physical health, and cognitive functioning outcomes. In particular, individuals who use alcohol are more likely to have psychiatric comorbidity and have poorer clinical outcomes. Comorbidity is associated with more risk than psychiatric symptomatology or alcohol use alone, yet is rarely targeted in mental health settings. Using substances for the motive of coping with negative affect compounds risks, as those who use to cope experience the most problems. As such, it is important to target alcohol use, particularly in EA with affective disorders who use to cope. Typical treatment for alcohol is brief, motivationally-based, and provides normative feedback. We propose to enhance our existing interventions with EA in psychiatric care with affective disorders who use alcohol to cope, which capitalized on technology. Technology allows for assessment of high-risk situations in real time through Ecological Momentary Assessment (EMA) and delivery of interventional content by Ecological Momentary Intervention (EMI). The delivery of tailored, just-in-time risk reduction message paired with personalized normative feedback may impact problematic use and depression/anxiety outcomes by reducing the likelihood of use and negative outcomes of use. We propose to enhance our existing pilot intervention by integrating participant feedback and protocol refinement. In Phase 1, we will (1) make changes to the pilot PFIcope+EMI, based on participant and researcher experience; (2) evaluate the refined intervention through a series of focus groups. In Phase 2, we will test our refined intervention (PFIcope+EMI) and in a randomized, controlled treatment trial as compared to personalized normative feedback only, delivered at baseline (PNF). The PFIcope+EMI consists of: 1) an in-person personalized feedback session to present normative information, discuss the individual's use, and generate risk reduction messages to be used in EMI; 2) EMA to monitor affect, use intention, actual alcohol use, coping motives, and alternate coping skills utilization; and 3) tailored messages (EMI) based on EMA (i.e., normative feedback plus individualized risk reduction messages when individuals report negative affect and use intention). The PNF condition will receive 1) an in-person personalized feedback session to present normative information, discuss the individual's use, delivered at baseline. We anticipate that this project will lead to the development of a well-specified, novel, technology- supported, real-time intervention for EA with comorbid alcohol and depression/anxiety that can be later tested in a multi-site fully-powered RCT.