Testing the Efficacy of a Technology-Supported Lifestyle Physical Activity Intervention Among Women with Depression in Alcohol Treatment

测试技术支持的生活方式体育活动干预对抑郁症女性酒精治疗的效果

• 批准号: 10443834
• 负责人: Ana M Abrantes
• 金额: $ 65.17万
• 依托单位: BUTLER HOSPITAL (PROVIDENCE, RI)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10443834
• 关键词: Abstinence; Addictive Behavior; Affect; Aftercare; Alcohol consumption; Alcohols; Behavioral; Child Care; Coping Skills; Counseling; Coupled; Data; Depressed mood; Dropout; Ecological momentary assessment; Educational Intervention; Emotions; Goals; Health; Health education; Individual; Intervention; Knowledge; Life Style; Measures; Mediating; Mental Depression; Mental disorders; Monitor; Outcome; Participant; Physical activity; Physical assessment; Play; Population; Precipitating Factors; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Relapse; Reporting; Role; Self Efficacy; Shame; Stressful Event; Technology; Telephone; Testing; Time; Woman; Work; acceptability and feasibility; addiction; alcohol abstinence; alcohol abuse therapy; alcohol craving; alcohol use disorder; base; cardiorespiratory fitness; coping; cost; craving; depressive symptoms; drinking; early alcohol use; efficacy testing; exercise intervention; fitbit; fitness; flexibility; follow-up; improved; interpersonal conflict; medical specialties; men; mobile application; negative affect; negative emotional state; negative mood; novel; positive emotional state; pressure; primary outcome; reduced alcohol use; relapse patients; relapse risk; response; secondary outcome; social; social stigma; treatment effect

ABSTRACT Alcohol use disorder (AUD) is a significant and costly public health problem. Women develop AUD more quickly and suffer a broader range of adverse alcohol-related health consequences than men. Yet, due to stigma, shame, and child care issues, women are less likely to receive specialty addiction treatment. Moreover, mounting evidence indicates factors that precipitate relapse differ between men and women. Men are more likely to relapse in response to positive emotional states and social pressure while negative emotional states are important precipitators of relapse in women. Indeed, women often report drinking to cope with negative emotions and express a lack of alternate coping strategies. Given the robust evidence for physical activity (PA) in decreasing depression, negative affect, and alcohol craving, PA interventions may play an important role as an alternate coping strategy for women with AUD and a means to decrease relapse. Our team was the first group to develop and test a lifestyle physical activity (LPA) approach with women with AUD (R34 AA024038). LPA is a new PA paradigm that emerged as an alternative to the gym-based fitness training interventions that struggle with high dropout and lack transportability to varied settings. LPA interventions represent simple, low- cost, and flexible approaches that are supported by brief counseling and activity monitors (e.g., Fitbit) to facilitate goal-setting and self-monitoring. In our Stage 1a and 1b studies, we developed and demonstrated initial support for an LPA+Fitbit intervention for women with AUD and depression. The intervention consisted of 6 brief, phone-based PA counseling sessions focused on increasing PA and strategically using bouts of PA to cope with affect and alcohol cravings and use of the Fitbit fitness tracker and mobile app. Our preliminary work established the acceptability and feasibility of this intervention. In addition, results of an initial randomized controlled trial (RCT; N = 50) showed that, relative to a health education contact (HEC) control, women in the LPA+Fitbit intervention had higher rates of alcohol abstinence, greater reductions in depression and negative affect, and increased PA at the 3-month follow-up. We propose to build on our promising preparatory work and take the next step by conducting a fully powered (N=214), Stage 2 RCT to test the efficacy of the LPA+Fitbit intervention, compared to a Fitbit Only condition, for women with AUD and depression in alcohol treatment. In addition, to elucidate mechanisms of treatment effects, we will employ two, 10-day bouts of ecological momentary assessment (EMA) to obtain multiple daily measures of affect, cravings, drinking, and PA engagement during early recovery (i.e., first 90 days) coupled with objective assessment of PA (i.e., Fitbit data). This project will contribute much-needed knowledge on the role of PA in reducing alcohol use, depressive symptoms and negative mood in women with AUD. If the efficacy of the LPA+Fitbit intervention can be established, depressed women with AUD will have a valuable adjunct to traditional alcohol treatment that can server as an alternate coping strategy during early recovery, when relapse risk is highest.

抽象的 酒精使用障碍（AUD）是一个重大且代价高昂的公共卫生问题。女性发展澳元更多 比男性更快地遭受与酒精相关的健康不良后果。然而，由于 由于耻辱、耻辱和儿童保育问题，女性接受专业成瘾治疗的可能性较小。而且， 越来越多的证据表明，导致男性和女性复发的因素有所不同。男人比较多 可能因积极情绪状态和社会压力而复发，而消极情绪状态则可能复发 是女性旧病复发的重要诱因。事实上，女性经常报告说喝酒是为了应对负面情绪 情绪并表达缺乏替代应对策略。鉴于体力活动 (PA) 的有力证据 在减少抑郁、负面情绪和酒精渴望方面，PA 干预可能发挥重要作用： 患有 AUD 的女性的替代应对策略和减少复发的方法。我们队是第一名 小组针对患有 AUD 的女性制定并测试生活方式体育活动 (LPA) 方法 (R34 AA024038)。 LPA 是一种新的 PA 范式，作为基于健身房的健身训练干预措施的替代方案而出现。 与高辍学率作斗争，并且缺乏适应不同环境的能力。 LPA 干预措施简单、低 成本以及由简短咨询和活动监测器（例如 Fitbit）支持的灵活方法 促进目标设定和自我监控。在我们的 1a 和 1b 阶段研究中，我们开发并证明了 初步支持对患有 AUD 和抑郁症的女性进行 LPA+Fitbit 干预。干预措施包括 6 场简短的电话 PA 咨询课程，重点是增加 PA 并战略性地使用多次 PA 应对情感和酒精渴望以及使用 Fitbit 健身追踪器和移动应用程序。我们的初步 工作确定了这种干预措施的可接受性和可行性。此外，初步随机化的结果 对照试验（RCT；N = 50）表明，相对于健康教育接触（HEC）对照， LPA+Fitbit 干预的戒酒率更高，抑郁症和消极情绪的减少幅度更大 影响，并在 3 个月随访时增加 PA。我们建议在我们有希望的筹备工作的基础上再接再厉 下一步，进行全功率 (N=214) 第 2 阶段 RCT，以测试 LPA+Fitbit 的功效 与仅使用 Fitbit 的情况相比，针对酒精治疗中患有 AUD 和抑郁症的女性进行干预。在 此外，为了阐明治疗效果的机制，我们将采用两次为期 10 天的生态治疗 瞬时评估 (EMA)，以获得情感、渴望、饮酒和 PA 的多项每日测量结果 早期恢复期间（即前 90 天）的参与度以及 PA 的客观评估（即 Fitbit 数据）。该项目将提供有关 PA 在减少酒精使用方面的作用的急需知识， 患有 AUD 的女性的抑郁症状和消极情绪。如果 LPA+Fitbit 干预的功效可以 如果确定的话，患有 AUD 的抑郁女性将获得传统酒精治疗的宝贵辅助， 可以作为早期恢复期间复发风险最高时的替代应对策略。