Integrating Cognitive Neuroscience Toward Understanding of Mechanisms of CBT for Alcohol Use Disorders

整合认知神经科学以了解 CBT 治疗酒精使用障碍的机制

基本信息

批准号：
10019313
负责人：
BRIAN D. KILUK
金额：
$ 14.3万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-20 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10019313
关键词：
Achievement Addictive Behavior Affect Affective Alcohol consumption Ambulatory Care Area Behavior Behavioral Behavioral Mechanisms Brain Characteristics Client Clinical Clinical Trials Cognition Cognitive Cognitive Science Cognitive Therapy Collaborations Computers Data Development Evaluation Evidence based intervention Fostering Functional Magnetic Resonance Imaging Funding Goals Growth Independent Scientist Award Individual Intervention Knowledge Link Manuals Measures Mediating Mediation Mediator of activation protein Modeling Monitor Motivation National Institute on Alcohol Abuse and Alcoholism Neurocognitive Neuropsychological Tests Outcome Play Principal Investigator Process Randomized Role Supervision Testing Therapeutic Therapeutic Intervention TimeLine Training Validation Work active method addiction alcohol use disorder base behavior change career career development clinical practice cognitive function cognitive neuroscience coping effective therapy executive function follow-up improved incentive salience indexing medical schools meetings negative affect neuroimaging neuromechanism novel novel strategies programs randomized trial reduced alcohol use skill acquisition skills standard care treatment as usual treatment effect trial design

项目摘要

PROJECT SUMMARY/ABSTRACT Cognitive Behavioral Therapy (CBT) is an established approach for alcohol use disorders (AUD), yet it is hindered by a number of obstacles to dissemination and effective implementation in clinical practice, which include a limited understanding regarding how it exerts its effects (i.e., mechanisms of behavior change). Improved understanding of mechanisms of behavior change could spur the development of novel interventions that amplify the effect of evidence-based interventions for AUD, potentially transforming addictions treatment and the way we conduct behavior change interventions more broadly. Recent developments in cognitive science and neuroscience hold great promise for accelerating the understanding of mechanisms of behavior change associated with CBT. The proposed Independent Scientist Award will foster Dr. Kiluk's career development in these areas to advance understanding of how CBT changes cognition, behavior, and the brain. The independent clinical trial to be conducted under this proposal (R01AA024122; PI – Kiluk) will evaluate the efficacy of a computer-delivered CBT (CBT4CBT) or clinician-delivered CBT in comparison to standard treatment as usual (TAU) at reducing alcohol use among 180 outpatient treatment seekers. Treatments will be delivered over the course of 8-weeks and will include a 6-month follow-up period to assess durability of treatment effects. Multiple behavioral, experiential, and cognitive measures will be used to develop a more complete understanding of the mechanistic processes by which CBT works to reduce alcohol use. The specific aims of the project are as follows: 1. Evaluate the efficacy of CBT4CBT or clinician-delivered CBT relative to TAU at reducing alcohol use through an 8-week randomized trial, with 6-month follow-up. We expect either form of CBT will be more effective than TAU at increasing the percentage of days abstinent (PDA) during treatment and follow-up. 2. Evaluate the extent to which CBT's putative mechanisms act as a mediator of treatment effect on reducing alcohol use in both forms of CBT relative to TAU. We expect indices reflecting the acquisition and implementation of skills will mediate the effect of CBT on alcohol use (i.e., PDA). This project directly links with Dr. Kiluk's career goals of incorporating cognitive neuroscience approaches to identify mechanisms of evidence-based interventions, with a focus on how CBT interventions affect change in functional domains of addiction such as executive function, negative affect, and incentive salience, consistent with NIAAA's Addictions Neurocognitive Assessment battery. Training in cognitive neuroscience and neuroimaging through collaboration with experts in these areas at Yale School of Medicine will facilitate achievement of these goals.

项目概要/摘要认知行为疗法 (CBT) 是治疗酒精使用障碍 (AUD) 的一种既定方法，但它由于在临床实践中传播和有效实施存在许多障碍，对它如何发挥其影响（即行为改变的机制）的理解有限。提高对行为改变机制的理解可以刺激新型干预措施的发展放大 AUD 循证干预措施的效果，有可能改变成瘾治疗以及我们更广泛地进行行为改变干预的方式。认知科学的最新发展。和神经科学对于加速理解行为改变机制有着巨大的希望与 CBT 相关的独立科学家奖将促进 Kiluk 博士的职业发展。这些领域可以促进人们对 CBT 如何改变认知、行为和大脑的理解。根据该提案（R01AA024122；PI – Kiluk）进行的临床试验将评估计算机提供的 CBT (CBT4CBT) 或临床医生提供的 CBT 与通常的标准治疗相比 (TAU) 旨在减少 180 名门诊治疗寻求者的饮酒量。治疗将在疗程为期 8 周，并包括 6 个月的随访期，以评估治疗效果的持久性。将使用行为、经验和认知测量来更全面地理解 CBT 减少酒精使用的机械过程。该项目的具体目标如下： 1. 评估 CBT4CBT 或临床医生提供的 CBT 相对于 TAU 在减少饮酒方面的功效一项为期 8 周的随机试验，并进行 6 个月的随访，我们预计这两种形式的 CBT 都会比这更有效。 TAU 在治疗和随访期间增加禁欲天数 (PDA) 的百分比。 2. 评估 CBT 的假定机制在多大程度上充当减少治疗效果的中介相对于 TAU，两种形式的 CBT 中的酒精使用情况我们预计指数会反映收购和 TAU 的情况。技能的实施将调节 CBT 对酒精使用的影响（即 PDA）。该项目与 Kiluk 博士的职业目标直接相关，即将认知神经科学方法融入到确定基于证据的干预机制，重点关注 CBT 干预措施如何影响变化成瘾的功能领域，例如执行功能、负面影响和激励显着性，一致 NIAAA 的成瘾神经认知评估培训。通过与耶鲁大学医学院这些领域的专家合作，神经影像学将促进这些目标的实现。