Validating an Autonomous Interactive Internet-Based Delivery of an Empirically Supported Cognitive Behavioral Therapy for Comorbidity

验证基于互联网的自主交互式交付经验支持的共病认知行为疗法

• 批准号: 10597539
• 负责人: MATT G KUSHNER
• 金额: $ 45.82万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-15 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597539
• 关键词: Address; Adoption; Aftercare; Alcohol consumption; Alcohols; Anxiety; Anxiety Disorders; Attenuated; Behavioral; Belief; Clinical; Cognitive; Cognitive Therapy; Communities; Computers; Control Groups; Coping Skills; Data; Ecological momentary assessment; Education; Educational process of instructing; Environment; Expectancy; Exposure to; Feedback; Funding; Goals; Health Services Accessibility; Heavy Drinking; Hour; Individual; Internet; Intervention; Knowledge; Knowledge acquisition; Learning; Mediating; Meta-Analysis; Modeling; Neurosciences; Outcome; Participant; Patients; Pattern; Physiological Processes; Process; Psychiatric therapeutic procedure; Psychotherapy; Randomized; Randomized, Controlled Trials; Relapse; Research; Resources; Risk; Series; Subgroup; System; Technical Expertise; Testing; Therapeutic; Therapeutic Effect; Therapeutic Intervention; Time; Training; Treatment outcome; Work; active control; alcohol comorbidity; alcohol use disorder; anxiety reduction; anxiety symptoms; anxiety treatment; clinical efficacy; comorbidity; comparison control; computer program; coping; design; drinking; drinking behavior; experience; follow up assessment; follow-up; healthy lifestyle; improved; improved outcome; interactive feedback; negative affect; pandemic disease; programs; reduce symptoms; remote intervention; research to practice; skill acquisition; skills; transmission process; treatment as usual; treatment center; treatment program; trial comparing; virtual

Project Summary The broad goal of the proposed work is to conduct a randomized controlled trial of a specialized computer- delivered cognitive-behavioral therapy (CBT) to supplement standard alcohol use disorder (AUD) treatment in patients with a co-occurring anxiety disorder (“comorbidity”). Comorbidity is both common in AUD treatment patients (up to 50%) and confers a substantial increase in the risk of a return to drinking in the months following treatment. Because research shows that simply adding a standard psychiatric treatment does not substantially improve the AUD outcomes of comorbid individuals, we developed a CBT-based intervention aimed at disrupting the positive-feedback loop (“vicious cycle”; VC) of mutually aggravating negative affect and drinking behavior/urges (the “VC-CBT”). In an RCT, AUD treatment patients who received the therapist- delivered VC-CBT demonstrated significantly improved alcohol use outcomes as compared to those who received a standard anxiety treatment. Unfortunately, most community-based AUD treatment programs do not have clinical staff with the specialized training and technical expertise needed to deliver the VC-CBT. To help bridge this “research-to-practice” gap, we went on to develop a fully autonomous and interactive computer- delivered version of the VC-CBT and have demonstrated its functionality in AUD patients. Now, we propose to test the clinical efficacy of the computer-delivered VC-CBT, as well as the mechanisms and processes by which it is hypothesized to work. Aim I is a randomized controlled trial comparing the computer-delivered VC- CBT to an intensity-matched computer-delivered active control intervention that focuses on healthy lifestyles. 256 individuals in residential AUD treatment who have a comorbid anxiety disorder will receive either the VC- CBT or the active control intervention to obtain 200 cases that complete a 1-, 4- and 8-month follow-up. We predict the VC-CBT group will demonstrate superior alcohol-related outcomes at follow-up relative to the control group. Aim II evaluates the extent to which the computer-delivered VC-CBT selectively imparts the skills and knowledge targeted and whether they convey (mediate) the interventions therapeutic effect. This entails a formal series of “causal steps” analyses of the associations of: treatmentskills/knowledge; skills/knowledge outcomes; and, treatmentoutcomes with vs. without statistically controlling the effect of skills/knowledge. Aim III will test the theoretically-derived prediction that the computer-delivered VC-CBT moderates (i.e., weakens) the association between levels of real-time negative affect and drinking behavior/ urge. This will be accomplished by analyzing a series of twice-daily ecological momentary assessments (EMAs) that participants record in their natural environment for the 7 days prior to each of the three follow-up assessments. The impact of this work would be to provide a scalable and inexpensive means of improving the otherwise poor AUD treatment outcomes of comorbid AUD treatment patients. The work will also provide new scientific knowledge about the mechanisms and processes of change in comorbidity treatment.

项目摘要 拟议工作的广泛目标是进行专业计算机的随机对照试验 - 提供了认知行为疗法（CBT），以补充标准酒精使用障碍（AUD）治疗 患有焦虑症的患者（“合并症”）。合并症在AUD治疗中都是常见的 患者（高达50％），并承认几个月来饮酒的风险大幅增加 治疗后。因为研究表明，仅仅添加标准的精神病治疗不会 我们开发了基于CBT的干预措施，大大改善了合并个人的AUD结果 旨在破坏相互加剧的负面影响和 饮酒行为/冲动（“ VC-CBT”）。在RCT中，接受治疗师的AUD治疗患者 - 与那些人相比 接受了标准的焦虑疗法。不幸的是，大多数基于社区的AUD治疗计划没有 拥有提供VC-CBT所需的专门培训和技术专长的临床人员。提供帮助 弥合了这个“实践对实践”差距，我们继续开发了一个完全自动的互动计算机 - 提供了VC-CBT的版本，并证明了其在AUD患者中的功能。现在，我们建议 测试计算机传递的VC-CBT的临床效率，以及通过 它可以假设工作。 AIM I是一项比较计算机传递的VC-的随机对照试验 CBT符合强度匹配的计算机分配的主动控制干预措施，该干预措施着重于健康的生活方式。 有256名患有合并焦虑症的居民AUD治疗中的人将接受VC- CBT或主动控制干预措施以获得200例完成1个，4个月和8个月随访的情况。我们 预测VC-CBT组将在随访中证明与酒精相关的结果相对于酒精相关的结果 对照组。 AIM II评估计算机传递的VC-CBT的程度 技能和知识的目标以及它们是否传达（调解）干预措施的热效应。这 需要对以下协会进行一系列正式的“因果步骤”分析：治疗小技能/知识； 技能/知识Ioutcomes；并且，治疗未经统计控制的效果 技能/知识。 AIM III将测试理论上衍生的计算机传递VC-CBT的预测 温和派（即削弱）实时负面影响与饮酒行为的水平/ 敦促。这将通过分析一系列每日两次生态瞬时评估来实现 （EMAS）参与者在三个随访之前的每一天之前的7天都记录了自然环境 评估。这项工作的影响是提供改善的可扩展且廉价的方法 合并AUD治疗患者的原本不良AUD治疗结果。这项工作还将提供 关于合并症治疗变化的机制和过程的新科学知识。