Dismantling the Components and Dosing of CBT for Co-Occurring Disorders

拆解 CBT 治疗并发疾病的成分和剂量

• 批准号: 9102860
• 负责人: MATT G KUSHNER
• 金额: $ 49.8万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9102860
• 关键词: Address; Affect; Aftercare; Alcohol consumption; Alcohols; Anxiety; Anxiety Disorders; Behavioral; Beryllium; Cognitive; Cognitive Therapy; Communities; Control Groups; Couples Therapy; Coupling; Diagnostic; Dose; Effectiveness; Elements; Equilibrium; Expectancy; Goals; Grant; Health; Intervention; Link; Modification; Outcome; Parents; Patients; Pattern; Play; Process Measure; Randomized; Relapse; Risk; Role; Stress; Sum; Testing; Therapeutic; Therapeutic Effect; Time; Treatment outcome; Work; alcohol use disorder; anxiety management; anxiety reduction; base; cohort; coping; design; drinking; dual diagnosis; effective therapy; experience; follow-up; improved; premature; problem drinker; programs; randomized trial; relapse patients; relapse risk; response; treatment as usual; treatment of anxiety disorders

DESCRIPTION (provided by applicant): This is a competitive renewal application for the recently completed "parent" R01 (AA015069: "CBT Treatment for Anxiety Disorder in Comorbid Alcoholics"). Up to half of patients in treatment for an alcohol use disorder (AUD) have a co-occurring anxiety disorder and these patients relapse to drinking at twice the rate of other patients. To address this, the parent R01 evaluated a CBT-based program that combined three sessions of trans-diagnostic anxiety reduction therapy with three sessions designed to de-couple the cognitive and behavioral bonds linking anxiety to alcohol use (e.g., expectancies, coping drinking motives, conditioned associations). In a randomized trial with over 300 cases, the parent R01 showed that adding this CBT to a residential community-based AUD treatment significantly improved four-month alcohol outcomes (e.g., 41% relapsed) compared to adding a stress reduction control treatment (53% relapsed) and compared to a matched, non-randomized cohort undergoing the AUD treatment alone (61% relapsed). While this confirmed the primary study hypotheses in the parent R01, it must be acknowledged that the effects were not large and that the CBT alleviated only about half of the increased relapse risk associated with co- occurring anxiety disorders. Fortunately, the results of the parent R01 also point the way to modifications that are likely to significantly increase the therapeutic effect of the CBT. Specifically, the pattern of findings in the parent R01 indicates that the de-coupling therapy, rather than the anxiety reduction therapy, caused the improved alcohol outcomes. This suggests that further emphasizing the de-coupling therapy elements would increase the CBT's overall effectiveness; however, the importance of anxiety reduction for improving alcohol outcomes in these patients remains ambiguous. For example, the three sessions devoted to anxiety reduction may have been insufficient to affect alcohol outcomes in the parent R01. Alternatively, anxiety reduction therapy may be needed to work synergistically with de-coupling therapy to improve alcohol outcomes. The renewal work would use a dismantling approach to isolate the separate and interactive effects of these therapy components at two dose levels toward the goal of increasing the effectiveness of the validated but still sub-optimally performing parent R01 version of the CBT. 350 AUD patients with an anxiety disorder would be randomized to groups receiving either: 1) six sessions of CBT for anxiety reduction (CBT- AR); 2) six sessions of CBT for anxiety-alcohol de-coupling (CBT-DC); or, 3) the original CBT with its three anxiety reduction sessions and three de-coupling sessions (CBT-O). Based on the parent R01 findings indicating that the de-coupling components are the active ingredients of the CBT therapy, we predict that the best alcohol outcomes will be obtained in the CBT-DC group (six DC sessions) followed by the CBT-O (three DC sessions) further followed by the CBT-AR (zero DC sessions). This design would also indicate synergy effects between the AR and DC CBT components if the CBT-O out-performs the other two groups.

描述（由申请人提供）：这是对最近完成的“父” R01（AA015069：“ CBT焦虑症治疗合并症中的焦虑症）的竞争更新应用程序”。在酒精使用障碍（AUD）治疗中，多达一半的患者患有同时发生的焦虑症，并且这些患者以其他患者的速度饮酒复发。为了解决这个问题，父级R01评估了一个基于CBT的程序，该计划将三个跨诊断焦虑症疗法的三个会议与三个旨在解除与酒精使用联系起来的认知和行为键（例如，预期，应对饮酒动机，有条件联想）的三个课程。在一项超过300例病例的随机试验中，父母R01表明，将此CBT添加到基于居民的基于社区的AUD治疗中可显着改善四个月的酒精结果（例如41％复发）与增加压力减少对照治疗（53％复发）相比，与匹配的，非偶性的同胞进行了AUD治疗（61％相关）（61％）（61％）。尽管这证实了父r01中的主要研究假设，但必须承认，这种影响并不大，并且CBT仅减轻了与发生焦虑症有关的增加的复发风险的一半。幸运的是，母体R01的结果还指向了修改可能会显着增加CBT治疗效应的方法。具体而言，父母R01中发现的模式表明，去偶联疗法而不是减少焦虑疗法会导致饮酒结果的改善。这表明进一步强调去偶联疗法的元素将提高CBT的总体效率。但是，减少焦虑症对改善这些患者酒精预后的重要性仍然模棱两可。例如，致力于减轻焦虑的三个课程可能不足以影响父r01的酒精预后。另外，可能需要减少焦虑疗法才能与去偶联疗法协同作用以改善酒精预后。更新工作将采用拆卸方法来隔离这些疗法成分在两个剂量水平上的单独互动效果，以提高经过验证的有效性，但仍表现不佳 父级R01版本的CBT版本。 350例焦虑症患者将被随机分为接受的组：1）六次CBT减少焦虑症（CBT- AR）； 2）CBT的六个会议用于焦虑 - 酒精偶联（CBT-DC）；或3）原始CBT及其三个焦虑减少会议和三个去耦合会议（CBT-O）。基于父r01的发现，表明DE偶联成分是CBT疗法的活性成分，我们预计将在CBT-DC组（六个DC会话）中获得最佳的酒精结果，然后再进行CBT-O（三个DC疗程）（三个DC疗程），然后再进行CBT-AR（CBT-AR-AR（Zero dc sessions））。如果CBT-O超过其他两组，则该设计还将指示AR和DC CBT组件之间的协同作用。