Developing and Evaluating a Positive Valence Treatment for Alcohol Use Disorder with Anxiety or Depression

开发和评估治疗伴有焦虑或抑郁的酒精使用障碍的正价疗法

• 批准号: 10596013
• 负责人: ROBIN L AUPPERLE
• 金额: $ 24.49万
• 依托单位: LAUREATE INSTITUTE FOR BRAIN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596013
• 关键词: Address; Adverse effects; Affect; Alcohol consumption; Alcohols; Anxiety; Awareness; Behavior Therapy; Binding; Clinical; Clinical Trials; Cognitive Therapy; Corpus striatum structure; Data; Diagnosis; Diagnostic; Evidence based treatment; Exhibits; Feasibility Studies; Feedback; Functional disorder; Future; Goals; Health; Individual; Intervention; Learning; Life; Maintenance; Measures; Mental Depression; Naltrexone; National Institute on Alcohol Abuse and Alcoholism; Negative Valence; Neurosciences; Outcome; Participant; Patient Self-Report; Patients; Personal Satisfaction; Pilot Projects; Positive Reinforcements; Positive Reinforcer; Positive Valence; Process; Prognosis; Protocols documentation; Public Health; Randomized; Reporting; Rewards; Source; Stress; Symptoms; System; Target Populations; Testing; Treatment Efficacy; Waiting Lists; Well in self; Work; acamprosate; alcohol abuse therapy; alcohol intervention; alcohol use disorder; anxiety symptoms; associated symptom; clinically significant; contingency management; depressive symptoms; design; efficacy evaluation; experience; feasibility testing; follow-up; improved; improved outcome; negative affect; neural circuit; non-drug; novel; pharmacologic; positive emotional state; primary outcome; psychosocial resources; recruit; reinforcer; remediation; response; reward processing; satisfaction; secondary outcome; social; success; symptom treatment; therapy development; Address; Adverse effects; Affect; Alcohol consumption; Alcohols; Anxiety; Awareness; Behavior Therapy; Binding; Clinical; Clinical Trials; Cognitive Therapy; Corpus striatum structure; Data; Diagnosis; Diagnostic; Evidence based treatment; Exhibits; Feasibility Studies; Feedback; Functional disorder; Future; Goals; Health; Individual; Intervention; Learning; Life; Maintenance; Measures; Mental Depression; Naltrexone; National Institute on Alcohol Abuse and Alcoholism; Negative Valence; Neurosciences; Outcome; Participant; Patient Self-Report; Patients; Personal Satisfaction; Pilot Projects; Positive Reinforcements; Positive Reinforcer; Positive Valence; Process; Prognosis; Protocols documentation; Public Health; Randomized; Reporting; Rewards; Source; Stress; Symptoms; System; Target Populations; Testing; Treatment Efficacy; Waiting Lists; Well in self; Work; acamprosate; alcohol abuse therapy; alcohol intervention; alcohol use disorder; anxiety symptoms; associated symptom; clinically significant; contingency management; depressive symptoms; design; efficacy evaluation; experience; feasibility testing; follow-up; improved; improved outcome; negative affect; neural circuit; non-drug; novel; pharmacologic; positive emotional state; primary outcome; psychosocial resources; recruit; reinforcer; remediation; response; reward processing; satisfaction; secondary outcome; social; success; symptom treatment; therapy development

PROJECT SUMMARY Only 20-30% of individuals with alcohol use disorder (AUD) exhibit long-term benefits with leading pharmacologic (e.g., acamprosate, naltrexone) and behavioral therapies (e.g., cognitive behavioral therapy, contingency management). Nearly half of individuals seeking treatment for AUD experience clinically significant anxiety and depression symptoms (ANX/DEP), which relate to worse long-term outcomes. Positive valence system (PVS) dysfunction is a common and pernicious feature of both AUD and ANX/DEP that is predictive of poor functioning and prognosis. Although PVS dysfunction represents a shared pathophysiologic mechanism across AUD and ANX/DEP, it is not sufficiently targeted by existing treatments. Our team developed a behavioral intervention, Amplification of Positivity (AMP), to enhance PVS function through increasing exposure and responsivity to non-drug rewards. In our previous work, AMP was found to increase positive valence outcomes (e.g., positive affect, social connectedness, life satisfaction), enhance reactivity of PVS neural circuits (i.e., striatal response to social reward), and decrease negative valence outcomes and symptoms for individuals with ANX/DEP. We have begun to modify this intervention for the treatment of co-occurring AUD and ANX/DEP (AMP-A), completing an initial pilot feasibility study. For the proposed study, we will further develop and refine AMP-A based upon qualitative and quantitative feedback from clinicians and participants and complete a pilot study of the protocol with eight individuals diagnosed with AUD and reporting clinically elevated ANX/DEP symptoms - further refining the protocol based on feedback from this pilot. We will then recruit 60 individuals with AUD+ANX/DEP and randomize them to complete AMP-A or cognitive behavioral therapy (CBT) – a first-line treatment for AUD that has small effects on the PVS. All participants will complete clinical and self-report measures before, during and after therapy and at 3-month follow-up. This project will accomplish the following aims: (1) Further develop and refine AMP-A to optimize its acceptability and potential clinical utility; (2) Determine the effects of AMP-A compared to CBT on the PVS, as measured by self-report of positive affect, social connectedness, well-being, and reward processing; (3) Determine whether increases in PVS function are associated with greater clinical improvement of alcohol use, anxiety, and depression. Results will have important implications for the treatment of AUD and co-occurring anxiety or depression by determining the utility of directly targeting the PVS, which will pave the way for future research seeking to remediate the harmful effects of these conditions.

项目摘要 只有20-30％的酒精饮用障碍患者（AUD）具有长期利益。 药理学（例如，辅助剂，纳曲酮）和行为疗法（例如，认知行为疗法， 应急管理）。在临床上寻求AUD经验治疗的人中，近一半 重要的动画和抑郁症状（ANX/DEP），这与较差的长期结局有关。积极的 价系统（PVS）功能障碍是AUD和ANX/DEP的常见和有害特征 尽管PVS功能障碍代表共享的病理生理学 跨AUD和AND/DEP的机制，现有治疗方法无法充分针对。 我们的团队开发了一种行为干预措施，扩大了积极性（AMP），以增强PVS 通过增加对非药物奖励的曝光和反应性来功能。在我们以前的工作中，AMP是 发现增加积极的价结果（例如积极影响，社会联系，生活满意度）， 提高PVS神经回路的反应性（即对社会奖励的纹状体反应），并降低负面 患有Anx/DEP的个体的价结果和症状。我们已经开始修改这种干预措施 同时发生的AUD和ANX/DEP（AMP-A）的处理，完成了初步的试验可行性研究。 对于拟议的研究，我们将根据定性和 临床医生和参与者的定量反馈，并完成了对协议的试点研究 被诊断为AUD和报告临床升高的Anx/Dep符号的人 - 进一步完善 基于此飞行员的反馈的协议。然后，我们将招募60名具有AUD+ANX/DEP的人 随机将它们随机完成AMP-A或认知行为疗法（CBT） - AUD的一线治疗 对PV的影响很小。所有参与者将在，期间，之中和 治疗后和3个月的随访。 该项目将实现以下目的：（1）进一步开发并完善AMP-A以优化其 可接受性和潜在的临床效用； （2）确定与CBT对PVS相比的AMP-A的影响 通过积极影响，社会联系，福祉和奖励处理的自我报告； （3） 确定PVS功能的增加是否与饮酒的临床改善有关 焦虑和沮丧。结果将对AUD和同时发生的治疗具有重要意义 通过确定直接针对PV的效用，焦虑或沮丧，这将为未来铺平道路 旨在补救这些条件的有害影响的研究。