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

描述（由申请人提供）：我们对CBT4CBT项目作为门诊治疗辅助的初步评估表明，在尿液毒理学筛查中，非法药物呈阳性的百分比有统计学意义上的显著效果，并且效果的持久性超过6个月。然而，尽管基于计算机的治疗有着巨大的希望，而且我们的工作和其他人的初步数据非常令人鼓舞，计算机辅助治疗的良好控制的随机临床试验仍然很少。拟议的项目将是CBT4CBT在最低限度的临床医生支持下的首次评估，而不是作为治疗的辅助手段，并将允许CBT4CBT作为潜在的“独立”干预措施进行初步评估。这也将是CBT4CBT的第一次试验，包括临床提供的CBT条件，因此将允许探索这种方法可能最适合的个体类型，而不是那些对临床提供的CBT有反应的个体。具体目标是：“对180名符合目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个条件之一：(1)社区治疗项目的标准门诊咨询，(2)临床医生提供CBT，或(3)基于网络的CBT4CBT，咨询最少。“通过研究治疗结束后6个月的随访来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的任何一个版本（临床和网络）将比标准治疗更有效。主要结果措施将是减少药物使用，通过尿液毒理学筛查确认每周使用药物的频率来实施。治疗利用的措施和干预措施的相对成本将用于评估协议干预措施的成本效益。作为一个探索性目的，我们假设增量成本-效果比（ICERS）将倾向于计算机提供的CBT而不是临床医生提供的CBT。其他次要结果将用于评估基于网络的CBT4CBT是否保留了传统临床管理的CBT的关键特征（例如，应对技能的获得，改变策略的使用），并评估这些作为结果的潜在中介以及可能调节临床提供与计算机提供CBT反应的几个参与者变量。

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.