CBT Treatment of Anxiety Disorder in Comorbid Alcoholics

描述(由申请者提供)：在我们由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)治疗计划，该计划适用于酒精使用障碍和焦虑症共病(“共病”)患者。在R21的第一阶段，我们通过修改焦虑症CBT治疗的标准要素和传递系统来创建混合CBT计划，以适应正在接受酒精中毒治疗的患者共病的具体问题。在R21的第二阶段，我们进行了一项临床试验，结果显示，与那些没有接受混合CBT治疗的患者相比，通过4个月的随访，混合CBT治疗显著降低了焦虑症症状和再次饮酒的风险。我们现在建议进行一项混合CBT治疗方案(阶段3)的对照临床试验，在该试验中，我们将研究60名酒精中毒治疗患者(社交恐惧症、恐慌症和广泛性焦虑症各20名)在两种治疗条件(CBT与主动安慰剂对照)(N=120)中的每一种治疗条件下的临床试验。在CBT条件下，三个治疗单元将分别作为两个治疗疗程和两个“自习室”疗程(共12个疗程)的重点。在学习大厅里，受试者在监督下复习学习材料并练习教授的应对技能。 在治疗过程中。对照组受试者在“治疗”日接受放松训练，并在“自习室”日阅读和练习放松训练。(RT是有结构和可信的，但对焦虑症或饮酒结果几乎没有影响。)研究干预和照常进行的酒精中毒治疗将并行进行；随后，受试者将在治疗后、4个月和12个月接受评估。中心预测是，与安慰剂对照组相比，$CBT治疗组在随访中表现出的复发较少，我们还将探索这一效应是否由焦虑症状的减少所介导，以及CBT治疗效果是否因焦虑障碍亚型而不同(即，受到缓解)。这项研究的中心假设的证实将支持这样的结论，即混合CBT治疗方案可以显着降低许多酒精紊乱患者合并焦虑障碍的再次饮酒风险。

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.