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。在大麻依赖者中同时出现焦虑症是一个紧迫的公共卫生问题，因为焦虑升高与大麻治疗效果较差有关。综合模型表明，焦虑症患者中与大麻有关的问题可能通过依赖大麻来控制焦虑和大麻戒断而得以维持。虽然已作出努力，单独评估大麻依赖和焦虑症的治疗方法，但对这些病症同时出现时的治疗方法进行的调查几乎没有。动机增强疗法（MET）联合认知行为疗法（CBT）是一种有效的干预大麻依赖的方法，但对焦虑患者的效果非常有限。治疗焦虑障碍的一种新颖而有前途的方法是使用跨诊断焦虑治疗，这种治疗促进了焦虑精神病理患者的治疗，而不考虑特定类型的焦虑障碍。其中一种治疗方法，虚假安全行为消除治疗（FSET），可能对大麻依赖焦虑患者特别有用，因为它侧重于消除可能在短期内有效减少焦虑，但在长期内可能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。该项目的目的是测试一种新颖的综合方法的可行性和实用性

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.