CBT Treatment of Anxiety Disorder in Comorbid Alcoholics

描述（由申请人提供）：在我们的R21资助的试点工作中，我们开发并测试了一种新的认知行为疗法（CBT）治疗方案，用于同时发生酒精使用障碍和焦虑障碍（“共病”）的个体。 在R21的第一阶段，我们通过修改焦虑症CBT治疗的标准元素和递送系统来创建混合CBT计划，以适应正在接受酒精中毒治疗的患者中共病的特定问题。在R21的第2阶段，我们进行了一项临床试验，结果显示，与未接受混合CBT治疗的患者相比，混合CBT治疗在4个月随访时显著降低了焦虑症症状和复发饮酒的风险。我们现在建议进行一项混合CBT治疗包的对照临床试验（第3阶段），其中我们将研究60名酒精中毒治疗患者（20名患有社交恐惧症，恐慌症和广泛性焦虑症），两种治疗条件（CBT与活性安慰剂对照）（N=120）。在CBT条件下，三个治疗单元将分别是两个治疗会议和两个“学习大厅”会议（共12个会议）的重点。在自习霍尔斯里，受试者在复习学习材料和练习应对技巧时会受到监督 在治疗过程中。对照组受试者在“治疗”日接受放松训练（RT），并在“自习”日阅读和练习RT。(RT是结构化和可信的，但对焦虑症或饮酒结果几乎没有影响。研究干预和酒精中毒常规治疗将平行进行;之后，受试者将在治疗后、4个月和12个月时接受评估。 中心预测是，$ CBT治疗组在随访时的复发率将低于安慰剂对照组，我们还将探讨这种效果是否由焦虑症状减轻介导，以及CBT治疗效果是否与安慰剂对照组不同（即，是缓和的）焦虑症亚型。 该研究的中心假设的证实将支持以下结论，即混合CBT治疗方案可以显着降低许多患有共病焦虑症的酒精障碍患者复发饮酒的风险。

DESCRIPTION (provided by applicant): In our R21-funded pilot work, we developed and tested a novel Cognitive Behavioral Therapy (CBT) treatment program for individuals with co-occurring alcohol use disorder and anxiety disorder ("co-morbidity"). In stage 1 of the R21, we created the hybrid CBT program by modifying the standard elements and delivery systems of CBT treatment for anxiety disorder to fit the specific problem of co-morbidity among patents undergoing treatment for alcoholism. In stage 2 of the R21, we conducted a clinical trial showing that the hybrid CBT treatment substantially lowered anxiety disorder symptoms and risk for relapse to drinking by 4- month follow-up compared to those patients not receiving the hybrid CBT treatment. We now propose to conduct a controlled clinical trial of the hybrid CBT treatment package (stage 3) in which we will study 60 alcoholism treatment patients (20 each with social phobia, panic disorder and generalized anxiety disorder) in each of two treatment conditions (CBT vs. active placebo control) (N=120). In the CBT condition, three treatment units will each be the focus of two therapy sessions and two "study hall" sessions (12 sessions total). In study halls, subjects are proctored as they review study materials and practice coping skills taught in the therapy sessions. Control subjects undergo relaxation training (RT) on "therapy" days and will read about and practice RT on "study hall" days. (RT is structured and credible but has little effect on anxiety disorder or drinking outcomes.)The study interventions and alcoholism treatment-as-usual will run in parallel; following which, subjects will undergo assessments at post-treatment, four-months, and 12-months. The central prediction is that the$ CBT treatment group will demonstrate less relapse at follow-up than placebo controls and we will also explore whether this effect is mediated by anxiety symptom reduction and whether the CBT treatment effects differ for (i.e., are moderated by) the anxiety disorder subtype. Confirmation of the study's central hypothesis would support the conclusion that the hybrid CBT treatment package could significantly mitigate risk of relapse to drinking among the many alcohol-disordered patients with co-morbid anxiety disorder.