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很常见，而且有相当大的重叠。治疗这一人群的传统心理治疗和药物治疗方法对酒精结果的影响有限。目前的提案是利用一种创新的干预措施对同时存在酒精依赖和社交焦虑症状的个人进行干预的第一步，同时调查了一种关键机制，该机制被证明会增加这两个问题的易感性：注意力偏差。具体地说，这项提议将实施认知偏差修正(CBM)干预，旨在直接将注意力偏差从与酒精相关的和/或对社会构成威胁的线索中转移出来。有酒精依赖和社交焦虑升高的合格参与者将被随机分配到本2(酒精CBM与酒精控制)中的四种情况之一，由2(焦虑CBM与焦虑控制)试点随机对照试验(N=68)。这项建议的主要目的是评估CBM干预在减少注意力偏差、酒精使用和社交焦虑症状方面的单独和交互作用。我们还将测试试验性干预的可接受性。这项建议的次要目的是确定受试者内部对酒精相关和社会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。符合条件的参与者将参与为期8节的CBM(和/或控制)干预。在基线、训练后和一个月的随访中，参与者将完成评估1)对酒精相关和社会威胁线索的注意力偏差的变化；以及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、帮助和总体满意度的看法的测量。或者，基本假设是酒精CBM将改善酒精结果，而焦虑CBM将改善社交焦虑结果。我们还预测，将会有显著的相互作用，由此会有酒精煤层气/焦虑性煤层气干预的协同效应。最后，我们将探索焦虑的CBM是否如回避-应对认知模型所预测的那样改善酒精结果。这项拟议的干预措施协调了酒精依赖和社交焦虑的治疗，以尖端研究为基础，只需要对治疗提供者进行最低限度的培训，反映了很高的临床意义。制定策略来抵消相对自动处理与酒精相关的和社会威胁的线索，包括转移注意偏差的技术，是一种创新的方法，可以作为一种有用的治疗工具。此试点项目的信息和效果大小将 在未来的R01报告中，我们将更全面地测试CBM的有效性，包括潜在的治疗结果调解人和主持人，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.