Integrated CBT for Cannabis Dependence with Co-occurring Anxiety Disorders

综合 CBT 治疗大麻依赖与同时发生的焦虑症

• 批准号: 8545755
• 负责人: JULIA D BUCKNER
• 金额: $ 19.88万
• 依托单位: LOUISIANA STATE UNIV A&M COL BATON ROUGE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8545755
• 关键词: Adult; Affect; Aftercare; Anxiety; Anxiety Disorders; Arousal; Behavior; Behavioral; Cannabis; Clinical Trials; Cognitive Therapy; Consultations; Data; Development; Diagnosis; Disease remission; Educational process of instructing; Esthesia; Feedback; Fright; Goals; Guidelines; Intervention; Investigation; Lead; Left; Maintenance; Manuals; Marijuana Dependence; Mental Depression; Modeling; Motivation; National Institute of Drug Abuse; Outcome; Participant; Patients; Persons; Phase; Physiological; Protocols documentation; Psychopathology; Public Health; Quality of life; Randomized Controlled Trials; Relapse; Relative (related person); Reliance; Research; Safety; Severities; Staging; Substance Addiction; Substance Use Disorder; Symptoms; Testing; Therapeutic; Time; Treatment Protocols; Treatment outcome; Withdrawal; Withdrawal Symptom; arm; base; clinically relevant; coping; depressive symptoms; disability; experience; high risk; improved; negative emotional state; neglect; novel; public health relevance; randomized trial; skills; therapy development; trait

DESCRIPTION (provided by applicant): Cannabis dependence is the most common illicit substance dependence in the U.S. and people with cannabis dependence are highly vulnerable to anxiety disorders. The co-occurrence of anxiety disorders among those with cannabis dependence is a pressing public health matter given elevated anxiety is related to poorer cannabis treatment outcomes. Integrative models suggest that cannabis-related problems among those with anxiety disorders may be maintained by a reliance on cannabis to manage anxiety and cannabis withdrawal. Although effort has been undertaken to evaluate treatments for cannabis dependence and anxiety disorders in isolation, investigations of the treatment of these conditions when they co-occur have been virtually absent. Motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for cannabis dependence, yet outcomes are highly limited for anxious patients. One novel and promising approach to treating anxiety disorders is the use of transdiagnostic anxiety treatments that facilitate the treatment of patients with anxiety psychopathology regardless of the specific type of anxiety disorder. One such treatment, False Safety Behavior Elimination Treatment (FSET), may be particularly useful with cannabis dependent anxious patients as it focuses on the elimination of behaviors that may be effective in decreasing anxiety in the short-term, but can maintain and even exacerbate anxiety in the long-term (i.e., false safety behaviors). The use of cannabis to manage anxiety can, therefore, be targeted in such a treatment. The objective of this project is to test the feasibility and utility of a novel, integrated approach to treatment of patients with cannabis dependence and anxiety disorders who use cannabis as a maladaptive coping strategy. Phase I of the proposed project will feature the development and refinement of a specialized group protocol (i.e., Integrated Cannabis and Anxiety Reduction Treatment or ICART) for integrating MET-CBT for cannabis dependence with FSET. MET will be used to increase motivation to quit cannabis, CBT for cannabis dependence to teach patients skills to manage high-risk cannabis use situations, and FSET will be used to teach patients skills to manage their anxiety. The initial protocol will be modified based on the experience gained in the treatment of two groups (6 patients each) with the integrated treatment. Phase II will be a randomized controlled trial examining the relative efficacy of the refined ICART treatment (n = 30) versus MET-CBT alone (n = 30). After post-treatment assessments, the ICART group will be followed for 3 months to examine maintenance of gains; the participants originally assigned to the control condition will be offered ICART. It is hypothesized that ICART will produce better outcomes than the control. Based on the outcome of this preliminary trial, the ICART protocol will be further refined and readied for larger-scale clinical trials.

描述（由申请人提供）：大麻依赖是美国最常见的非法物质依赖，大麻依赖者极易患焦虑症。大麻依赖者同时出现焦虑症是一个紧迫的公共卫生问题，因为焦虑加剧与大麻治疗效果较差有关。综合模型表明，焦虑症患者中与大麻相关的问题可能通过依赖大麻来控制焦虑和大麻戒断而得以维持。尽管已经努力单独评估大麻依赖和焦虑症的治疗方法，但几乎没有对这些疾病同时发生时的治疗方法进行研究。动机增强疗法（MET）与认知行为疗法（CBT）相结合是治疗大麻依赖的有效干预措施，但对于焦虑患者来说，效果非常有限。治疗焦虑症的一种新颖且有前途的方法是使用跨诊断焦虑治疗，无论焦虑症的具体类型如何，该方法都有助于治疗焦虑精神病理学患者。其中一种治疗方法是虚假安全行为消除治疗（FSET），可能对大麻依赖焦虑症患者特别有用，因为它的重点是消除可能在短期内有效减少焦虑但可能维持甚至加剧焦虑的行为从长远来看（即错误的安全行为）。因此，使用大麻来控制焦虑可以成为这种治疗的目标。该项目的目的是测试一种新颖的综合方法的可行性和实用性 治疗使用大麻作为适应不良应对策略的大麻依赖和焦虑症患者。拟议项目的第一阶段将重点开发和完善专门的团体协议（即综合大麻和焦虑减少治疗或 ICART），以将大麻依赖的 MET-CBT 与 FSET 结合起来。 MET 将用于增加戒除大麻的动力，CBT 用于治疗大麻依赖，以教授患者管理高风险大麻使用情况的技能，FSET 将用于教授患者管理焦虑的技能。最初的方案将根据两组（每组 6 名患者）综合治疗的治疗经验进行修改。 II 期将是一项随机对照试验，检验改良 ICART 治疗 (n = 30) 与单独 MET-CBT (n = 30) 的相对疗效。治疗后评估后，ICART组将进行3个月的随访，以检查增益的维持情况；最初分配给控制条件的参与者将获得 ICART。假设 ICART 将产生比对照更好的结果。根据初步试验的结果，ICART方案将进一步完善，为更大规模的临床试验做好准备。