Computer-based Training in Cognitive Behavioral Therapy: Web-based delivery of CB

描述(由申请人提供)：我们对CBT4CBT计划作为门诊治疗辅助措施的初步评估表明，在非法药物阳性的尿毒学筛查中，有统计学上的显著影响，以及超过6个月的显著效果持续时间。然而，尽管基于计算机的治疗有着巨大的希望，而且我们和其他人的工作提供了非常令人鼓舞的初始数据，但计算机辅助治疗的良好控制的随机临床试验仍然很少见。拟议的项目将是首次对CBT4CBT进行评估，提供最低限度的临床医生支持，而不是作为治疗的辅助手段，并将允许对CBT4CBT作为潜在的“独立”干预进行初步评估。这也将是CBT4CBT的第一次试验，包括临床医生提供的CBT情况，因此将允许对这种方法可能最适合的个体类型进行一些探索，而不是那些对临床医生提供的CBT有反应的人。具体目标是：“对180名符合当前非法药物滥用或依赖标准的寻求治疗的个人进行为期12周的随机试验。参与者将被随机分配到三种情况之一：(1)社区治疗计划的标准门诊咨询，(2)个别临床医生提供的CBT，或(3)基于网络的CBT4CBT，只进行最少的咨询。”通过终止研究治疗后6个月的随访，评估治疗效果的长期持久性和/或延迟出现。对于这些分析，我们假设CBT的任何一种版本(临床医生和基于网络的)都将比标准治疗更有效。主要结果措施将是减少物质使用，按照尿毒学筛查确认的每周物质使用频率来实施。将使用治疗利用和干预措施的相对费用的衡量标准来评估议定书干预措施的成本效益。作为一个探索性目标，我们假设增量成本效果比(ICERs)将有利于计算机提供的CBT而不是临床医生提供的CBT。其他次要结果将被用来评估基于网络的CBT4CBT是否保留了传统临床医生管理的CBT的关键特征(例如，应对技能的获得、变化策略的使用)，并评估这些作为结果的潜在中介因素以及可能缓和对临床医生提供的CBT与计算机提供的CBT的反应的几个参与者变量。 与公共卫生相关：尽管基于计算机的治疗有着巨大的前景，但计算机辅助治疗的良好控制的随机临床试验仍然很少见。这项拟议的项目将是对CBT4CBT的首次评估，CBT4CBT是一种很有前途的基于计算机的治疗方法，提供最少的临床医生支持，而不是作为治疗的辅助手段，并将允许对CBT4CBT进行初步评估，作为一种潜在的“独立”干预措施。

DESCRIPTION (provided by applicant): Our initial evaluation of the CBT4CBT program as an adjunct to outpatient treatment indicated statistically significant effects on percent of urine toxicology screens that were positive for illicit drugs as well as significant durability of effects over 6 months. However, despite the enormous promise of computer- based treatments as well as very encouraging initial data from our work and others, well-controlled randomized clinical trials of computer-assisted therapies are still rare. The proposed project will be the first evaluation of CBT4CBT delivered with minimal clinician support, rather than as an adjunct to treatment, and will allow preliminary evaluation of CBT4CBT as a potential 'stand-alone' intervention. It will also be the first trial of CBT4CBT to include a clinician-delivered CBT condition, and thus will permit some exploration of the types of individuals for whom this approach might be most appropriate versus those who respond to clinician-delivered CBT. Specific aims are: "To conduct a 12 week randomized trial with 180 treatment-seeking individuals meeting current criteria for illicit drug abuse or dependence. Participants will be randomized to one of three conditions: (1) standard outpatient counseling at a community treatment program, (2) individual clinician delivered CBT, or (3) web-based CBT4CBT with minimal counseling. "To evaluate the long-term durability and/or delayed emergence of treatment effects through a six month follow-up after termination of the study treatments. For these analyses, we hypothesize that either version of CBT (clinician and web-based) will be more effective than standard treatment. The primary outcome measures will be reduction in substance use, operationalized as the frequency of substance use by week confirmed by urine toxicology screens. Measures of treatment utilization and relative costs of the interventions will be used to evaluate cost effectiveness of the protocol interventions. As an exploratory aim, we hypothesize that incremental cost-effectiveness ratios (ICERS) will favor computer- delivered over clinician delivered CBT. Other secondary outcomes will be used to evaluate whether web- based CBT4CBT retains key characteristics of traditional clinician-administered CBT (e.g., acquisition of coping skills, use of change strategies) and to evaluate these as potential mediators of outcome as well as several participant variables that may moderate response to clinician-delivered versus computer-delivered CBT. PUBLIC HEALTH RELEVANCE: Despite the enormous promise of computer-based treatments well-controlled randomized clinical trials of computer-assisted therapies are still rare. The proposed project will be the first evaluation of CBT4CBT, a promising computer-based treatment, delivered with minimal clinician support, rather than as an adjunct to treatment, and will allow preliminary evaluation of CBT4CBT as a potential 'stand-alone' intervention.