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

摘要 成年初显期是有问题的心理健康问题的常见时期，特别是情感问题。 焦虑和抑郁等疾病，以及酗酒的问题模式。大量饮酒会 导致负面的心理健康，学术，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病合并症，临床结果较差。 合并症与精神疾病或单独饮酒的风险更大， 很少在精神健康环境中成为目标。以应对负面情绪为动机的物质使用 复合风险，因为那些谁使用来科普经验的问题最多。因此，重要的是要瞄准 酒精的使用，特别是在EA与情感障碍谁用来科普。 典型的酒精治疗是简短的，基于动机的，并提供规范的反馈。我们提出 加强我们现有的干预与EA在精神病护理与情感障碍谁使用酒精， 科普，它利用了技术。技术允许对高风险情况进行真实的评估 通过生态瞬时评估（EMA）和生态干预内容的交付 即时干预（EMI）。提供量身定制的、及时的风险降低信息， 个性化的规范反馈可能会影响问题使用和抑郁/焦虑的结果，通过减少 使用的可能性和使用的负面结果。我们建议加强现有的试验计划， 整合参与者反馈和协议细化。在第一阶段，我们将（1）对试点进行修改 PFIcope+EMI，基于参与者和研究者的经验;（2）通过 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），并在一个随机， 对照治疗试验与仅在基线时提供的个性化规范性反馈（PNF）相比。 PFIcope+EMI包括：1）面对面的个性化反馈会议， 信息，讨论个人的使用，并生成用于EMI的风险降低信息; 2）EMA， 监测影响，使用意图，实际饮酒，应对动机和替代应对技能的使用;和3） 基于EMA的定制消息（EMI）（即，规范性反馈加上个性化风险降低信息 当个体报告负面影响和使用意图时）。PNF条件将收到1）一个人 个性化的反馈会议，介绍规范性信息，讨论个人的使用，提供 基线。我们预计，该项目将导致一个明确的，新颖的，技术的发展- 支持，实时干预EA与共病酒精和抑郁/焦虑，可以稍后测试 在一个多站点的全功率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.