Changing impulsivity with mindful breathing therapy to reduce problem drinking

描述(由申请者提供)：解决大学生饮酒者使用问题物质的有效策略是瞄准核心危险因素。可以说，大学生饮酒问题最清楚的风险因素之一是冲动，这种关系存在于冲动的各个维度。现有证据支持冲动干预的重要性，以限制大学生中的问题饮酒，但几乎没有被证实的治疗冲动的任何方面的方法。这种明显的缺乏可能是因为传统观点认为冲动是一种不可改变的人格特征。然而，最近的研究表明，个性可以改变，并且对行为操纵很敏感。因此，显然需要针对个人及其行为模式的核心变化采取新的方法。正念冥想(MM)是这方面的唯一选择，因为MM在减少冲动行为(包括问题饮酒)方面特别有用，但它的确切作用 在影响冲动的不同维度以及影响问题的改变方面，饮酒还有待探索。基于最近研究的证据，以及我们自己的试点工作，我们假设MM减少大学生问题饮酒的机制之一是通过减少冲动-此外，对改变大学生问题饮酒的关注并没有明确地关注饮酒行为本身。这项第一阶段治疗研究的具体目标是：1)修改和进一步开发基于呼吸的正念疗法(BBMT)，以减少大学生的冲动和问题饮酒；2)通过试点随机对照试验(RCT)调查应用BBMT减少问题饮酒的可行性和初步疗效；3)检查通过行为和自我报告评估衡量的冲动变化，作为BBMT对问题饮酒观察效果的可能中介之一。这些目标将分两个阶段实现。在第一阶段，我们将扩展和全面开发现有的BBMT计划和手册，以确定开放标签试验(n=10)中针对问题饮酒和冲动的有效治疗剂量。使用第一阶段的改良治疗材料，在第二阶段，我们将进行一项随机对照试验，比较改良的BBMT和支持性咨询+渐进性肌肉放松(SC+PMR)对照条件(n=36)对问题饮酒的影响，在基线、4周和8周以及3个月的随访中进行评估。其他潜在的中介因素，如感知到的压力和焦虑，也将在最终模型中进行检验。这项研究对不太愿意承认自己饮酒问题的学生饮酒者具有重大影响，因为它解决了高危学生的核心脆弱性(冲动)，以限制耻辱并可能减少对变革的抵制。一个在正念、冲动和行为治疗开发方面经验丰富的不同团队已经聚集在一起，以实施拟议的R34项目，并为未来的全面治疗开发研究做准备。

DESCRIPTION (provided by applicant): An efficacious strategy for addressing problem substance use among college student drinkers is to target core risk factors. Arguably one of the most clearly documented risk factors for problem drinking among college students is impulsivity, with the relationship holding across various dimensions of impulsivity. Available evidence supports the importance of intervening with impulsivity to limit problem drinking among college students, but there are few proven treatments for any dimension of impulsivity. This notable lack may be due to the traditional view of impulsivity as an unchangeable personality trait. However, recent research suggests personality can change and is sensitive to behavior manipulation. As a result there is clear need for novel approaches targeted at core changes in the individual and their behavior patterns. Mindfulness meditation (MM) is a unique option in this direction as MM is especially useful in reducing impulsive behaviors including problem drinking, but its exact role in affecting different dimensions of impulsivity and in effecting change in problem drinking has yet to be explored. Based on evidence from recent studies, as well as our own pilot work, we hypothesize that one of the mechanisms by which MM reduces problem drinking among college students is by lessening impulsivity - moreover, the focus on changing college student problem drinking is done without any explicit focus on drinking behavior itself. The specific aims of this Stage 1 therapy development study are to: 1) modify and further develop a breathing-based mindfulness therapy (BBMT) for reducing impulsivity and problem drinking among college youth; 2) investigate the feasibility and preliminary efficacy of applying BBMT for reducing problem drinking with a pilot randomized controlled trial (RCT); 3) examine changes in impulsivity, as measured by both behavioral and self-report assessments, as one of possible mediators in the observed effect of BBMT on problem drinking. These aims will be achieved in two phases. In Phase 1 we will expand and fully develop the existing BBMT program with manuals to determine the effective treatment dosage for both problem drinking and impulsivity in an open label trial (n = 10). Using the modified treatment materials from Phase 1, in Phase 2 we will conduct a RCT comparing the effects of modified BBMT to a Supportive Counseling + Progressive Muscle Relaxation (SC + PMR) control condition (n = 36 each) on problem drinking, assessed at baseline, weeks 4 and 8, and a 3-month follow-up. Other potential mediators such as perceived stress and anxiety also will be examined in the final model. This study has great implications for reaching student drinkers who are less willing to acknowledge their drinking problems since it addresses core vulnerability (impulsivity) among at-risk students in a manner that limits stigma and may reduce resistance to change. A diverse team experienced in mindfulness, impulsivity and behavior therapy development has been assembled to conduct the proposed R34 project and prepare for a full therapy development study in the future.