CBM: A Novel Intervention for Alcohol Dependence and Social Anxiety

描述（由申请人提供）：酒精依赖和社交焦虑是常见的，并且相当重叠。传统的心理治疗和药理学方法治疗这一人群对酒精的影响有限。目前的建议是对同时出现酒精依赖和社交焦虑症状的个人进行创新干预的第一步，同时调查了一种增加这两个问题脆弱性的关键机制：注意力偏差。具体而言，该提案将实施认知偏差修正（CBM）干预措施，旨在直接将注意力偏差从酒精相关和/或社会威胁线索中转移出来。酒精依赖和社交焦虑升高的合格参与者将被随机分配到这2（酒精CBM与酒精控制）2（焦虑CBM与焦虑控制）试点随机对照试验（N = 68）的四种条件之一。该建议的主要目的是评估CBM干预措施对减少注意力偏差，酒精使用和社交焦虑症状的单独和互动贡献。我们还将测试实验干预的可接受性。该提案的次要目的是确定受试者内对酒精相关和社交威胁线索的注意力变化是否与酒精使用和社交焦虑症状的减少有关。合格的参与者将参加8次会议的CBM（和/或控制）干预。在基线，培训后和一个月的随访中，参与者将完成评估措施：1）对酒精相关和社会威胁线索的注意力偏差的变化; 2）自我报告的酒精使用和社交焦虑症状的变化。参与者还将完成关于他们对干预的可信度，有用性和整体满意度的看法的测量。或者主要假设是酒精CBM将改善酒精结果，焦虑CBM将改善社交焦虑结果。我们还预测，将有一个显着的相互作用，其中有一个联合酒精CBM/焦虑CBM干预的协同效应。最后，我们将探讨焦虑CBM是否改善酒精的结果，如回避-应对认知模型所预测的那样。这项拟议的干预措施协调了酒精依赖和社交焦虑的治疗，基于最前沿的研究，对治疗提供者的培训要求最低，反映了很高的临床意义。开发策略来抵消酒精相关和社会威胁线索的相对自动处理，包括转移注意力偏见的技术，是一种创新的方法，可以作为一种有用的治疗工具。该试点项目的信息和效应大小将 有助于为将来的R 01提交提供信息，在R 01提交中，我们将更全面地测试CBM的有效性，包括治疗结果的潜在介导者和调节者，以及将CBM纳入标准临床护理的最佳实践。

DESCRIPTION (provided by applicant): Alcohol dependence and social anxiety are common, and considerably overlapping. Traditional psychotherapeutic and pharmacological methods for treating this population have had limited impact on alcohol outcomes. The current proposal represents a first step in utilizing an innovative intervention for individuals with co-occurring alcohol dependence and social anxiety symptoms, while investigating a key mechanism shown to increase vulnerability for both problems: attentional biases. Specifically, this proposal will implement Cognitive Bias Modification (CBM) interventions designed to directly shift attentional biases away from alcohol-relevant and/or socially threatening cues. Eligible participants who have alcohol dependence and elevated social anxiety will be randomly assigned to one of four conditions in this 2 (Alcohol CBM vs. Alcohol Control) by 2 (Anxiety CBM vs. Anxiety Control) pilot Randomized Control Trial (N = 68). The primary aim of this proposal is to evaluate the separate and interactive contributions of the CBM interventions on reductions in attentional biases, alcohol use, and social anxiety symptoms. We will also test the acceptability of the experimental intervention. The secondary aim of this proposal is to determine whether within-subject changes in attention toward alcohol-relevant and socially-threatening cues are associated with reductions in alcohol use and social anxiety symptoms. Eligible participants will engage in an 8-session CBM (and/or Control) intervention. At baseline, post-training, and one-month follow-up, participants will complete measures assessing 1) changes in attentional biases toward alcohol-relevant and socially-threatening cues; and 2) changes in self-reported symptoms of alcohol use and social anxiety. Participants will also complete measures about their perceptions of the intervention's credibility, helpfulness, and their overall satisfaction. Or primary hypotheses are that the Alcohol CBM will improve alcohol outcomes, and the Anxiety CBM will improve social anxiety outcomes. We also predict that there will be a significant interaction, whereby there is a synergistic effect of the combined Alcohol CBM/Anxiety CBM intervention. Finally, we will explore whether the Anxiety CBM improves alcohol outcomes, as predicted by the Avoidance-Coping Cognitive model. This proposed intervention coordinates the treatment for alcohol dependence and social anxiety, is based on cutting edge research, and requires minimal training for treatment providers, reflecting high clinical significance. Developin strategies to counteract relatively automatic processing of alcohol-relevant and socially threatening cues, including techniques to shift attentional biases, is an innovative approach that could serve as a useful therapeutic tool. Information and effect sizes from this pilot project will help inform a future R01 submission in which we will more fully test the effectiveness of CBM, including potential mediators and moderators of treatment outcome, and the best practices for incorporating CBM into standard clinical care.