Integrated CBT for Cannabis Dependence with Co-occurring Anxiety Disorders

描述（由申请人提供）：大麻依赖是美国最常见的非法物质依赖，大麻依赖者极易患焦虑症。焦虑症在大麻依赖者中的共同发生是一个紧迫的公共卫生问题，因为焦虑症的升高与大麻治疗结果较差有关。综合模型表明，焦虑症患者中与大麻相关的问题可能会通过依赖大麻来控制焦虑和大麻戒断来维持。虽然已经作出努力，单独评价大麻依赖和焦虑症的治疗，但实际上没有对这些病症同时发生时的治疗进行调查。动机增强疗法（MET）与认知行为疗法（CBT）相结合是对大麻依赖的有效干预，但焦虑患者的结果非常有限。治疗焦虑症的一种新颖且有前途的方法是使用跨诊断焦虑治疗，其促进患有焦虑精神病理学的患者的治疗，而不管焦虑症的具体类型。一种这样的治疗，错误安全行为消除治疗（FSET），可能对大麻依赖性焦虑患者特别有用，因为它专注于消除可能在短期内有效减少焦虑但可以长期维持甚至加剧焦虑的行为（即，虚假安全行为）。因此，使用大麻来控制焦虑可以成为这种治疗的目标。本项目的目的是测试一种新的综合方法的可行性和实用性， 治疗使用大麻作为适应不良应对策略的大麻依赖和焦虑症患者。拟议项目的第一阶段将制定和完善一项专门的群体议定书（即，综合大麻和减少焦虑治疗或ICART），用于将MET-CBT与FSET结合治疗大麻依赖。MET将用于增加戒烟的动力，CBT用于大麻依赖，以教授患者管理高风险大麻使用情况的技能，FSET将用于教授患者管理焦虑的技能。将根据两组（每组6例患者）在综合治疗中获得的经验修改初始方案。II期将是一项随机对照试验，检查改进的ICART治疗（n = 30）与MET-CBT单独治疗（n = 30）的相对疗效。治疗后评估后，将对ICART组进行3个月的随访，以检查增益的维持情况;最初分配到对照组的受试者将接受ICART。据推测，ICART将产生比对照更好的结果。根据这项初步试验的结果，ICART方案将进一步完善，并为更大规模的临床试验做好准备。 公共卫生相关性：虽然大麻依赖者极易患焦虑症，而且焦虑的升高与大麻依赖治疗效果较差有关，但以前的研究尚未研究如何有效治疗大麻依赖和焦虑症并存的患者。目前研究的目标是开发和评估治疗这些人的专门疗法的可行性。总体目标是减少大麻使用，大麻相关问题和戒断症状，焦虑和残疾，同时改善生活质量并检查治疗结果的可能机制。

DESCRIPTION (provided by applicant): Cannabis dependence is the most common illicit substance dependence in the U.S. and people with cannabis dependence are highly vulnerable to anxiety disorders. The co-occurrence of anxiety disorders among those with cannabis dependence is a pressing public health matter given elevated anxiety is related to poorer cannabis treatment outcomes. Integrative models suggest that cannabis-related problems among those with anxiety disorders may be maintained by a reliance on cannabis to manage anxiety and cannabis withdrawal. Although effort has been undertaken to evaluate treatments for cannabis dependence and anxiety disorders in isolation, investigations of the treatment of these conditions when they co-occur have been virtually absent. Motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for cannabis dependence, yet outcomes are highly limited for anxious patients. One novel and promising approach to treating anxiety disorders is the use of transdiagnostic anxiety treatments that facilitate the treatment of patients with anxiety psychopathology regardless of the specific type of anxiety disorder. One such treatment, False Safety Behavior Elimination Treatment (FSET), may be particularly useful with cannabis dependent anxious patients as it focuses on the elimination of behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term (i.e., false safety behaviors). The use of cannabis to manage anxiety can, therefore, be targeted in such a treatment. The objective of this project is to test the feasibility and utility of a novel, integrated approach to treatment of patients with cannabis dependence and anxiety disorders who use cannabis as a maladaptive coping strategy. Phase I of the proposed project will feature the development and refinement of a specialized group protocol (i.e., Integrated Cannabis and Anxiety Reduction Treatment or ICART) for integrating MET-CBT for cannabis dependence with FSET. MET will be used to increase motivation to quit cannabis, CBT for cannabis dependence to teach patients skills to manage high-risk cannabis use situations, and FSET will be used to teach patients skills to manage their anxiety. The initial protocol will be modified based on the experience gained in the treatment of two groups (6 patients each) with the integrated treatment. Phase II will be a randomized controlled trial examining the relative efficacy of the refined ICART treatment (n = 30) versus MET-CBT alone (n = 30). After post-treatment assessments, the ICART group will be followed for 3 months to examine maintenance of gains; the participants originally assigned to the control condition will be offered ICART. It is hypothesized that ICART will produce better outcomes than the control. Based on the outcome of this preliminary trial, the ICART protocol will be further refined and readied for larger-scale clinical trials. PUBLIC HEALTH RELEVANCE: Although people with cannabis dependence are highly vulnerable to anxiety disorders, and elevated anxiety is related to poorer cannabis dependence treatment outcomes, previous research has not examined how to effectively treat patients with co-occurring cannabis dependence and anxiety disorders. The goal of the current research is to develop and evaluate the feasibility of a specialized therapy for treating these persons. The overarching aim is to decrease cannabis use, cannabis-related problems and withdrawal symptoms, anxiety, and disability while simultaneously improving quality of life and examining possible mechanisms underlying treatment outcomes.