2/2 Gambling Addiction: Treatment Mediators and Moderators

2/2 赌博成瘾：治疗中介者和调节者

基本信息

批准号：
8071510
负责人：
CARLOS BLANCO
金额：
$ 40.74万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-20 至 2013-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8071510
关键词：
Adherence Aftercare Awareness Bankruptcy Behavior Behavior Therapy Behavioral Belief Clinic Clinical Research Cognitive Cognitive Therapy Commit Comorbidity Control Groups Coping Skills Disease Dropout Educational process of instructing Effect Modifiers (Epidemiology)Effectiveness Emotional FDA approved Family Family history of Freedom Funding Future Gambling Goals Health Healthy People 2010 Imprisonment Impulsivity Individual Intervention Investigation Life Style Mediating Mediator of activation protein Mental Health Mental disorders Modification Motivation National Institute of Mental Health Occupations Outcome Pathological Gambling Patients Pharmaceutical Preparations Population Prevalence Primary Health Care Psychotherapy Public Health Randomized Randomized Controlled Trials Readiness Relapse Research Resistance Severities Site Societies Subgroup Support Groups Testing Therapeutic Treatment Efficacy Treatment outcome Waiting Lists Work addiction cognitive change coping cost efficacy trial follow-up improved innovation meetings motivational enhancement therapy novel physical conditioning psychosocial randomized trial skills social standard of care suicide rate treatment response trial comparing

项目摘要

DESCRIPTION (provided by applicant): Pathological gambling is a highly underrated, yet extremely serious public health problem with enormously detrimental effects on individuals and families, and with an estimated yearly cost to society of over 5 billion dollars due to lost jobs, debt, bankruptcy, and incarcerations. Despite growing public awareness of the prevalence and damaging consequences of PG, there is presently no established psychosocial treatment for PG and no FDA approved medications. Through extensive pilot work and an NIMH-funded randomized trial (R21 MH064568) we have developed a treatment termed Cognitive-Motivational Behavior Therapy (CMBT) that has shown excellent retention and treatment efficacy. CMBT helps pathological gamblers resolve their motivational ambivalence and increases their readiness to change. Once patients are committed to change, the CMBT therapist then systematically corrects their specific cognitive biases, teaches them coping and resistance skills, and encourages lifestyle changes to innoculate them against relapse. Using the 'Collaborative R01s for Clinical Studies of Mental Disorders' mechanism, we now propose to conduct a study to identify mediators and moderators of this innovative treatment and to test its efficacy in a large randomized controlled trial with 200 pathological gamblers. We will randomize gamblers to CMBT or Cognitive-Behavioral Therapy (CBT) as a comparison condition and assess them before, during, and after treatment as well as at 3, 6, and 12-month follow-up. We hypothesize that the effect of CMBT will be mediated by readiness to change, cognitive distortions, coping skills, and therapeutic alliance, whereas CBT will be mediated only by the last three, since it does not specifically target motivation. Hypothesized moderators include psychiatric comorbidity, baseline levels of gambling severity and of motivation to change, impulsivity and family history of PG. Specifically, we hypothesize that although CMBT will be superior on average to CBT in improving treatment retention and decreasing gambling behavior, those differences will be even larger in the presence of psychiatric comorbidity or family history of PG, higher baseline levels of impulsivity or gambling severity, or in individuals with lower motivation to change. We are confident that the findings from this study will significantly improve our understanding of PG and inform future research on the treatment of this very recalcitrant and difficult psychological disorder. PUBLIC HEALTH RELEVANCE: Pathological gambling (PG) is a serious public health problem with enormously detrimental effects on individuals and families, yet there is a paucity on treatments of proven efficacy for this disorder. After developing Cognitive-Motivational Behavior Therapy (CMBT) and testing it in a small NIMH-funded randomized trial (R21 MH064568), we propose to conduct a rigorous large-scale efficacy trial comparing CMBT versus Cognitive-Behavioral Therapy to identify treatment mediators and moderators of both treatment approaches. The findings from this study will significantly improve our understanding of PG and inform future research on this disorder.

描述（由申请人提供）：病态赌博是一种被高度低估但极其严重的公共卫生问题，对个人和家庭造成巨大的不利影响，预计每年因失业、债务、破产而给社会造成的损失超过 50 亿美元和监禁。尽管公众越来越意识到 PG 的患病率和破坏性后果，但目前还没有针对 PG 的既定心理社会治疗方法，也没有 FDA 批准的药物。通过广泛的试点工作和 NIMH 资助的随机试验 (R21 MH064568)，我们开发了一种称为认知动机行为疗法 (CMBT) 的治疗方法，该疗法显示出出色的保留率和治疗效果。 CMBT 帮助病态赌徒解决他们的动机矛盾心理并提高他们改变的意愿。一旦患者决心改变，CMBT 治疗师就会系统地纠正他们特定的认知偏见，教他们应对和抵抗技能，并鼓励他们改变生活方式，以预防旧病复发。利用“精神障碍临床研究协作 R01”机制，我们现在建议开展一项研究，以确定这种创新疗法的调节因素和调节因素，并在一项有 200 名病态赌徒参与的大型随机对照试验中测试其疗效。我们将赌徒随机分组接受 CMBT 或认知行为疗法 (CBT) 作为比较条件，并在治疗前、治疗期间、治疗后以及 3、6 和 12 个月的随访时对其进行评估。我们假设 CMBT 的效果将通过改变准备、认知扭曲、应对技巧和治疗联盟来调节，而 CBT 将仅由后三者调节，因为它不专门针对动机。假设的调节因素包括精神共病、赌博严重程度和改变动机的基线水平、冲动性和 PG 家族史。具体来说，我们假设，虽然 CMBT 在提高治疗保留率和减少赌博行为方面平均优于 CBT，但在存在精神合并症或 PG 家族史、冲动性基线水平较高或赌博严重程度的情况下，这些差异会更大，或改变动力较低的个人。我们相信，这项研究的结果将显着提高我们对 PG 的理解，并为未来治疗这种非常顽固且困难的心理障碍的研究提供信息。公共健康相关性：病理性赌博 (PG) 是一个严重的公共健康问题，对个人和家庭造成极大的不利影响，但目前已证实对这种疾病有效的治疗方法却很少。在开发认知动机行为疗法 (CMBT) 并在 NIMH 资助的小型随机试验 (R21 MH064568) 中对其进行测试后，我们建议进行一项严格的大规模疗效试验，比较 CMBT 与认知行为疗法，以确定治疗中介和调节因素两种治疗方法。这项研究的结果将显着提高我们对 PG 的理解，并为未来对该疾病的研究提供信息。