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

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

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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）：病理赌博是一个高度被低估但极为严重的公共卫生问题，对个人和家庭产生了极大的有害影响，并且由于工作，债务，破产和监禁而导致的社会每年估计每年成本超过50亿美元。尽管公众对PG的患病率和破坏性后果的认识越来越大，但目前尚无针对PG的社会心理治疗，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，该治疗表现出了出色的保留率和治疗功效。 CMBT帮助病理赌徒解决他们的动机矛盾情绪，并增加了他们的愿望。一旦致力于改变患者，CMBT治疗师就会系统地纠正其特定的认知偏见，教会他们应对和抵抗技巧，并鼓励生活方式改变以使他们无辜地避免复发。使用“协作R01S进行精神障碍机制的临床研究），我们现在建议进行一项研究，以识别这种创新治疗的介体和主持人，并在一项与200个病理赌徒的大型随机对照试验中测试其功效。我们将将赌徒随机为CMBT或认知行为疗法（CBT）作为比较条件，并在治疗之前，期间和治疗后以及3、6和12个月的随访中进行评估。我们假设CMBT的效果将通过准备变化，认知扭曲，应对技巧和治疗联盟的效果来介导，而CBT仅在过去三个中介导，因为它不是专门针对动机。假设的主持人包括精神病合并症，赌博严重程度的基线水平以及PG的动力，冲动性和家族史。具体而言，我们假设CMBT平均比CBT更好地比CBT更好地改善治疗保留率和赌博行为，但在存在精神病合并症或家族病史的情况下，这些差异将更大，在PG的家族病史，抗冲动性或赌博严重程度的较高基线水平，或者在具有较低动力变化的患者中，这些差异将更大。我们有信心，这项研究的发现将显着提高我们对PG的理解，并为对这种非常顽固和困难的心理障碍的治疗提供未来的研究。公共卫生相关性：病理赌博（PG）是一个严重的公共卫生问题，对个人和家庭产生了巨大的影响，但是对这种疾病的可靠疗效的治疗却很少。在开发了认知动机行为疗法（CMBT）并在NIMH资助的小型随机试验（R21 MH064568）中对其进行了测试，我们建议进行严格的大规模效能试验，以比较CMBT与认知行为疗法相比，以识别两种治疗方法和调理方法。这项研究的发现将大大提高我们对PG的理解，并为未来对该疾病的研究提供信息。