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; 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决定性特征。认知功能 最常见的是在药物使用者中受到损害（注意，工作记忆和抑制作用 控制）恰恰是参与行为和受益可能是必要的功能 疗法。这可能与认知行为方法（CBT）特别相关，因为这些功能是 为了（1）进行治疗所需的需要，（2）获得新的认知和行为技能，以及 策略和（3）有效地实施它们。该项目将评估培训设计的程度 在试验之前，提高这些目标功能（注意，工作记忆，抑制控制）之前 计算机化的CBT（CBT4CBT）改善了治疗的参与度和结果：治疗将在 2阶段。在第一阶段，有150名可卡因使用障碍的人，所有人都参加了一个密集的 门诊计划将被随机分配到以下4周的“预备”条件之一：（1）没有培训 （像往常一样治疗，tau）； （2）快速节制起始程序（RAI）的4周，或（3）4周 RAI PLUS认知控制培训（CCT）具有货币激励措施，以提高绩效。在第二个 阶段，所有参与者将接受为期8周的CBT4CBT试验（总计12周）。目标变化 认知功能和可卡因的使用将在基线，在4周预备阶段之后进行评估， 为期8周的CBT4CBT试验，以及1-、3和6个月的随访访谈。使用选择的任务神经影像 评估工作记忆，认知控制和渴望调节的认知相关性（n-back，stroop， 渴望的调节）将在3个时间点（基线，准备阶段，CBT4CBT阶段）进行。 这些将用于评估（1）两个阶段治疗反应的神经认知预测指标，（2）效应 关于神经认知靶标的准备程序，以及（3）与之相关的神经功能的变化 准备条件和CBT4CBT。我们假设提高了注意力，工作记忆和 抑制性控制将与更好的学习和实施CBT技能有关，从而减少 可卡因使用。包括六个月的随访，以评估干预效果的持久性。小说 提供激励措施取决于改善认知训练任务的绩效的策略可能会 在此样本中，大大提高了CCT的有效性。认知增强的策略 通过评估认知的影响，治疗的开始超出了该领域的先前研究 可修改治疗反应的介体，而不是测试改善认知功能的直接影响 关于毒品使用结果。如果证明是有效的，则在开始之前增强认知功能的策略 治疗可能会推广到其他物质使用障碍，因为它以认知功能障碍为定义 成瘾的特征。