Efficacy and Mechanisms of CBT4CBT for Alcohol Use Disorders

 描述（由申请人提供）：认知行为疗法（CBT）是一种治疗酒精使用障碍的既定方法，但在临床实践中，它受到传播和有效实施的许多障碍的阻碍，其中包括对其如何发挥作用的有限理解（即，行动机制）。该提案旨在评估一种新的基于计算机的酒精使用障碍认知行为治疗计划（CBT 4CBT），旨在解决这些障碍。拟议的R 01项目（在完成R21 AA 021405之后;卡罗尔，PI）将在180名门诊治疗寻求者中评价CBT 4CBT或临床医生提供的CBT与标准常规治疗（TAU）相比在减少酒精使用方面的疗效。治疗将在8周内进行，并将包括6个月的随访期，以评估治疗效果的持久性。多个行为，经验和认知措施将被用来制定一个更完整的理解CBT工程，以减少酒精使用的机械过程。该项目的具体目标如下：1.通过一项为期8周的随机试验，评估CBT 4CBT或临床医生提供的CBT相对于TAU在减少酒精使用方面的疗效，随访6个月。我们预计任何一种形式的CBT在增加治疗和随访期间禁欲天数（PDA）的百分比方面都比TAU更有效。2.评估CBT的假定机制在多大程度上作为两种形式的CBT相对于TAU减少酒精使用的治疗效果的中介。我们预计，反映技能获得和实施的指数将介导CBT对酒精使用的影响（即，PDA）。探索性目标将包括评估认知功能水平作为CBT直接和间接效应的调节因素，以及探索CBT形式（临床医生提供与计算机提供）在作用机制方面的差异。这将是第一个充分的随机对照试验，以评估计算机交付的CBT版本作为酒精使用障碍的虚拟“独立”干预的有效性，这可能对更广泛地使用这种具有成本效益的CBT形式具有明确的意义。此外，在同一试验中纳入传统的临床医生提供的CBT将允许对CBT的机制进行新的检查，因为可以在有和没有“关系”因素的情况下评估活性成分（例如，治疗师同情，温暖，治疗联盟），通常有助于结果。

 DESCRIPTION (provided by applicant): Cognitive Behavioral Therapy (CBT) is an established approach for alcohol use disorders, yet it is hindered by a number of obstacles to dissemination and effective implementation in clinical practice, which include a limited understanding regarding how it exerts its effects (i.e., mechanisms of action). This proposal aims to evaluate a novel computer-based cognitive behavioral therapy program for alcohol use disorders (CBT4CBT) designed to address these obstacles. The proposed R01 project (which follows the completion of R21 AA 021405; Carroll, PI) will evaluate the efficacy of CBT4CBT or clinician-delivered CBT in comparison to standard treatment as usual (TAU) at reducing alcohol use among 180 outpatient treatment seekers. Treatments will be delivered over the course of 8-weeks and will include a 6-month follow-up period to assess durability of treatment effects. Multiple behavioral, experiential, and cognitive measures will be used to develop a more complete understanding of the mechanistic processes by which CBT works to reduce alcohol use. The specific aims of the project are as follows: 1. Evaluate the efficacy of CBT4CBT or clinician-delivered CBT relative to TAU at reducing alcohol use through an 8-week randomized trial, with 6-month follow-up. We expect either form of CBT will be more effective than TAU at increasing the percentage of days abstinent (PDA) during treatment and follow-up. 2. Evaluate the extent to which CBT's putative mechanisms act as a mediator of treatment effect on reducing alcohol use in both forms of CBT relative to TAU. We expect indices reflecting the acquisition and implementation of skills will mediate the effect of CBT on alcohol use (i.e., PDA). Exploratory aims will include the evaluation of levels of cognitive function as moderators of CBT's direct and indirect effects, as well as exploration of differences across CBT formats (clinician-delivered vs. computer- delivered) with respect to the mechanisms of action. This will be the first adequately powered randomized controlled trial to evaluate the effectiveness of a computer-delivered version of CBT as a virtual `stand-alone' intervention for alcohol use disorders, which could have clear implications for making this cost effective form of CBT more broadly accessible. Furthermore, the inclusion of traditional clinician-delivered CBT within the same trial will allow for novel examination of CBT's mechanisms, as the active ingredients can be evaluated with and without `relational' factors (e.g., therapist empathy, warmth, therapeutic alliance) that typically contribte to outcomes.