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: 10653941
• 负责人: Ana M Abrantes
• 金额: $ 65.33万
• 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/10653941
• 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; 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）是一个重大且昂贵的公共卫生问题。女性发展更多 与男性相比，迅速并遭受更广泛的不良酒精有关的健康后果。但是，由于 污名，羞耻和儿童保育问题，女性不太可能接受专业成瘾治疗。而且， 越来越多的证据表明，男女之间的沉淀复发有所不同。男人更多 可能会因积极的情绪状态和社会压力而复发，而情绪状态负面 是女性复发的重要抑制剂。确实，妇女经常举报喝酒以应对负面 情绪并表达缺乏其他应对策略。鉴于体育活动的强大证据（PA） 在减轻抑郁症，负面影响和渴望酒精时，PA干预可能起重要作用 AUD女性的另一种应对策略和一种减少复发的手段。我们的团队是第一个 与AUD女性（R34 AA024038）开发和测试生活方式体育锻炼（LPA）方法的小组。 LPA是一种新的PA范式，它是基于健身房的健身培训干预措施的替代方法 与高辍学的斗争和缺乏各种设置的运输能力。 LPA干预措施代表简单，低 - 成本和灵活的方法由简短的咨询和活动监视器（例如Fitbit）支持 促进目标设定和自我监控。在我们的1A和1B研究中，我们开发和证明了 对有声和抑郁症的女性进行LPA+FITBIT干预的初步支持。干预措施包括 6个基于电话的PA咨询会议的6个简短的PA咨询会议，旨在增加PA并使用PA的战略性 应对情感和酒精的渴望以及Fitbit健身跟踪器和移动应用程序的使用。我们的初步 工作确定了这种干预的可接受性和可行性。此外，初始随机的结果 对照试验（RCT; n = 50）表明，相对于健康教育接触（HEC）控制，女性 LPA+FITBIT干预的戒酒率更高，抑郁症的减少和负数更大 在3个月的随访中影响PA，并增加PA。我们建议以有希望的准备工作为基础 通过执行完全动力（n = 214），第2阶段RCT来测试LPA+FITBIT的功效，迈出下一步 与仅FITBIT条件相比，在酒精治疗中有AUD和抑郁症的女性相比，干预措施。在 另外，为了阐明治疗效果的机制，我们将采用两次，10天的生态回合 瞬时评估（EMA）获得多种每日情感，渴望，饮酒和PA的度量 在早期恢复期间的参与（即，前90天）以及对PA的客观评估（即Fitbit 数据）。该项目将为PA在减少饮酒中的作用方面提供急需的知识， AUD女性的抑郁症状和负面情绪。如果LPA+FITBIT干预的功效可以 建立，具有AUD的沮丧女性将具有传统酒精治疗的宝贵辅助手段 当复发风险最高时，可以在早期恢复期间作为替代应对策略。