Project#1: Cognitive Control Training to Enhance CBT4CBT

项目

• 批准号: 8742766
• 负责人: KATHLEEN M. CARROLL
• 金额: $ 50.33万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8742766
• 关键词: Abstinence; Affective; Area; Attention; Back; Behavior Therapy; Behavioral; Chronic; Cocaine; Cognition; Cognitive; Cognitive Therapy; Disease; Drug usage; Effectiveness; Evaluation; Frequencies; HIV risk; Image; Impaired cognition; Incentives; Individual; Interview; Lead; Learning; Measures; Mediating; Mediator of activation protein; Neurocognitive; Neurophysiology - biologic function; Outcome; Outpatients; Participant; Performance; Phase; Population; Prefrontal Cortex; Procedures; Psychotherapy; Randomized; Readiness; Regulation; Relative (related person); Research; Risk Behaviors; Sampling; Short-Term Memory; Specimen; Substance Use Disorder; Testing; Time; Training; Treatment outcome; Urine; addiction; cocaine use; cognitive control; cognitive enhancement; cognitive function; cognitive training; computerized; craving; design; effective therapy; endophenotype; executive function; follow-up; improved; improved functioning; innovation; intervention effect; neuroimaging; novel; novel strategies; primary outcome; programs; relating to nervous system; research and development; response; secondary outcome; skill acquisition; skills; treatment as usual; treatment response; treatment strategy; week trial

ABSTRACT: Project #1 Cognitive dysfunction is increasingly considered to be a defining feature of addiction. The cognitive functions most commonly found to be impaired among substance users (attention, working memory, and inhibitory control) are precisely those functions that may be necessary for engaging and benefiting in behavioral therapies. This may be particularly relevant for cognitive behavioral approaches (CBT), as these functions are needed in order to (1) engage in and attend to treatment, (2) acquire new cognitive and behavioral skills and strategies, and (3) implement them effectively. This project will evaluate the extent to which training designed to enhance those target functions (attention, working memory, inhibitory control) delivered prior to a trial of computerized CBT (CBT4CBT) improves treatment engagement and outcome: Treatment will be delivered in 2 phases. In the first phase, 150 individuals with cocaine use disorder, all of whom are attending an intensive outpatient program, will be randomized to one of the following 4-week 'preparatory' conditions: (1) no training (treatment as usual only, TAU); (2) 4 weeks of a rapid abstinence initiation procedure (RAI), or (3) 4 weeks of RAI plus cognitive control training (CCT) with monetary incentives for improved performance. In the second phase, all participants will receive an 8-week trial of CBT4CBT (12 weeks total). Changes in the targeted cognitive functions and cocaine use will be assessed at baseline, after the 4 week preparatory phase, after the 8-week CBT4CBT trial, and at 1-, 3, and 6-month follow-up interviews. Neuroimaging using tasks selected to assess cognitive correlates of working memory, cognitive control, and regulation of craving (N-Back, Stroop, Regulation of Craving) will be done at 3 time points (baseline, post preparatory' phase, post CBT4CBT phase). These will be used to evaluate (1) neurocognitive predictors of treatment response in both phases, (2) effects of preparatory procedures on neurocognitive targets, and (3) changes in neural function associated with the preparatory conditions and CBT4CBT. We hypothesize improved function in attention, working memory, and inhibitory control will be associated with better learning and implementation of CBT skills and hence to reduced cocaine use. A six-month follow-up is included to evaluate the durability of intervention effects. The novel strategy of providing incentives contingent on improved performance on cognitive training tasks is likely to substantially improve CCT's effectiveness within this sample. The strategy of cognitive enhancement prior to initiation of treatment goes beyond previous research in this area by evaluating the effect of cognition as a modifiable mediator of a response to treatment, rather than testing direct effects of improving cognitive function on drug use outcomes. If shown to be effective, the strategy of enhancing cognitive function prior to initiation of treatment may generalize to other substance use disorders as it targets cognitive dysfunction as a defining feature of addiction.

摘要：项目#1 认知功能障碍越来越被认为是成瘾的一个决定性特征。认知功能 最常见的是物质使用者受损（注意力、工作记忆和抑制能力） 控制）正是那些参与行为并从中受益所必需的功能 疗法。这可能与认知行为方法（CBT）特别相关，因为这些功能是 需要 (1) 参与和参加治疗，(2) 获得新的认知和行为技能，以及 (3) 有效实施战略。该项目将评估培训设计的程度 增强试验前交付的目标功能（注意力、工作记忆、抑制控制） 计算机化 CBT (CBT4CBT) 提高治疗参与度和结果：治疗将在 2 个阶段。在第一阶段，150 名患有可卡因使用障碍的人都在接受强化治疗 门诊计划，将被随机分配到以下 4 周“准备”条件之一：(1) 没有培训 （仅照常治疗，TAU）； (2) 4 周快速戒断启动程序 (RAI)，或 (3) 4 周 RAI 加上认知控制训练 (CCT)，并通过金钱激励来提高绩效。在第二个 阶段，所有参与者将接受为期 8 周的 CBT4CBT 试用（总共 12 周）。目标的变化 认知功能和可卡因使用情况将在基线时、4 周准备阶段后、 为期 8 周的 CBT4CBT 试验以及 1、3 和 6 个月的随访访谈。使用选择的任务进行神经影像学 评估工作记忆、认知控制和渴望调节的认知相关性（N-Back、Stroop、 渴望调节）将在 3 个时间点进行（基线、准备阶段后、CBT4CBT 阶段后）。 这些将用于评估（1）两个阶段治疗反应的神经认知预测因子，（2）效果 神经认知目标的准备程序，以及（3）与神经认知目标相关的神经功能的变化 准备条件和CBT4CBT。我们假设注意力、工作记忆和 抑制控制将与更好地学习和实施 CBT 技能相关，从而减少 使用可卡因。其中包括为期六个月的随访，以评估干预效果的持久性。小说 根据认知训练任务绩效的提高提供激励的策略可能会 显着提高该样本中 CCT 的有效性。术前认知增强策略 通过评估认知作为治疗的效果，开始治疗超越了该领域的先前研究 对治疗反应的可修改调节因素，而不是测试改善认知功能的直接效果 关于药物使用结果。如果证明有效，则在开始之前增强认知功能的策略 治疗的方法可能会推广到其他物质使用障碍，因为它针对认知功能障碍作为定义 成瘾的特征。