Web-Based Treatment of Heavy Drinking Among Women with a History of Sexual Trauma

描述（由申请人提供）：辛西娅·斯塔彭贝克博士在酒精研究方面有着坚实的基础，重点是研究酒精使用、创伤暴露、人际攻击和情绪调节之间的关联。她的长期职业目标是建立在她以前的经验进行实验室和实验研究，成为一个独立的临床科学家，能够通过开发，评估和广泛传播的个人在风险与酗酒相关的问题的治疗干预酒精研究领域作出实质性贡献。通过她的5年培训计划和补充研究计划，指导临床科学家研究职业发展奖为她实现这一目标提供了机会。培训计划的目的包括获得进行随机对照试验的经验，继续发展先进的多元统计技能，获得如何利用技术管理和传播治疗干预措施的知识，以及介绍和传播数据。将通过一项互动式培训计划来实现这些更直接的目标，该计划包括直接指导、正式课程、研讨会、讲习班、出席国家会议以及撰写手稿和赠款。Stappenbeck博士通过培训计划中概述的活动获得的知识将通过拟议的研究得到增强。该研究计划的目标是开发和实证评估一种基于网络的干预措施，以减少有性侵犯史的大学女性的大量饮酒，这些女性表现出较高的心理困扰水平。有性侵犯史的女大学生往往比没有性侵犯史的女大学生报告更多的酗酒和心理困扰。此外，有攻击史的妇女往往难以调节自己的情绪和忍受痛苦，这可能导致一种饮酒来科普痛苦的模式。创伤暴露、消极情绪和不良应对策略与酒精治疗后的不良治疗结果和复发相关。通过酒精干预提高痛苦耐受力和情绪调节技能，可以通过降低饮酒以科普抑郁或焦虑的动机以及建立适应性应对策略来增强有性侵犯史的女性的治疗效果。因此，基于网络的干预将包括减少饮酒的认知行为技能，并结合辩证行为疗法的情绪调节和痛苦耐受技能。这项研究的第一阶段包括初步开发和不断完善的基于网络的干预模块使用迭代过程中，参与者和专家对干预材料的反馈意见，然后进行公开试验，以进一步完善干预和网站。第二阶段包括一项随机对照试验，其中将招募有性侵犯史和心理困扰水平升高的酗酒大学女性，并随机接受干预或仅进行对照评估。将在基线和治疗后以及治疗后1个月和6个月进行基于网络的调查，以更全面地检查与干预相关的变化机制。黛布拉·凯森博士、丹尼斯·多诺万博士、梅勒妮·哈内德博士和大卫阿特金斯博士将担任该奖项的导师，威廉·乔治博士将担任顾问。总的来说，导师团队将提供内容领域的专业知识，随机临床试验的进行，先进的统计分析，以及使用技术来提供干预措施。华盛顿大学的资源提供了一个有利于发展酒精研究事业的环境，并获得了作为独立科学家开展职业生涯所需的技能。拟议的奖项将为Stappenbeck博士向NIAAA提交的第一份R01申请提供试点数据，以更严格地测试这种干预措施对更大样本的主动控制，并与NIH增加和保持强大的研究人员队列的目标相一致，以满足国家的行为和临床研究需求。

DESCRIPTION (provided by applicant): Dr. Cynthia Stappenbeck has a strong foundation in alcohol research with an emphasis on examining the associations among alcohol use, trauma exposure, interpersonal aggression, and emotion regulation. Her long-term career goal is to build upon her previous experience conducting laboratory and experimental research to become an independent clinical scientist able to make a substantive contribution to the field of alcohol research by developing, evaluating, and widely disseminating therapeutic interventions among individuals at risk for problems associated with heavy drinking. Through her 5-year training plan and complementary research plan, the Mentored Clinical Scientist Research Career Development Award provides an opportunity for her to achieve this goal. Aims of the training plan include gaining experience conducting randomized controlled trials, continuing to develop advanced multivariate statistical skills, gaining knowledge on how to leverage technology for the administration and dissemination of therapeutic interventions, and presenting and disseminating data. These more immediate goals will be achieved through an interactive training plan comprised of direct mentorship, formal coursework, seminars, workshops, attendance at national conferences, and manuscript and grant writing. Dr. Stappenbeck's knowledge gained through the activities outlined in the training plan will be augmented by the proposed research. The goal of the research plan is to develop and empirically evaluate a web-based intervention to reduce heavy drinking among college women with a history of sexual assault who display elevated levels of psychological distress. College women with a history of sexual assault often report more heavy drinking and psychological distress than women without a history of assault. Moreover, women with assault histories often have difficulty regulating their emotions and tolerating distress which can lead to a pattern of drinking to cope distress. Trauma exposure, negative mood, and poor coping strategies have been associated with poor treatment outcomes and relapse following alcohol treatment. Incorporating distress tolerance and emotion regulation skills with an alcohol intervention may enhance treatment effects among women with a history of sexual assault by decreasing their motivation to drink to cope with depression or anxiety and by building adaptive coping strategies. Therefore, the web-based intervention will include cognitive behavioral skills for reducing alcohol consumption and incorporate emotion regulation and distress tolerance skills from Dialectical Behavior Therapy. The first phase of this research includes the initial development and continued refinement of the web-based intervention modules using an iterative process in which participant and expert feedback on intervention material is received and then an open trial is conducted to further refine the intervention and website. The second phase consists of a randomized controlled trial in which heavy drinking college women with a history of sexual assault and elevated levels of psychological distress will be recruited and randomized to receive the intervention or an assessment only control. Web-based surveys will be administered at baseline and post-treatment as well as 1- month and 6-months post-treatment in order to provide a more thorough examination of the mechanisms of change associated with the intervention. Drs. Debra Kaysen, Dennis Donovan, Melanie Harned, and David Atkins will serve as mentors on this award and Dr. William George will serve as an advisor. Collectively the mentorship team will provide expertise in the content areas, the conduct of randomized clinical trials, advanced statistical analyses, and use of technology to deliver interventions. Resources at the University of Washington provide an environment conducive to developing a career in alcohol research and gaining the skills necessary to launch a career as an independent scientist. The proposed award will provide pilot data for Dr. Stappenbeck's first R01 submission to NIAAA to more rigorously test this intervention against active controls with a larger sample and is consistent with NIH's goal of increasing and maintaining a strong cohort of investigators to address the Nation's behavioral and clinical research needs.