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）：这是最近完成的“父母”R01 的竞争性续展申请（AA015069：“共病酗酒者焦虑症的 CBT 治疗”）。多达一半的酒精使用障碍 (AUD) 治疗患者同时患有焦虑症，这些患者复发饮酒的比率是其他患者的两倍。为了解决这个问题，家长 R01 评估了一项基于 CBT 的计划，该计划将三个疗程的跨诊断焦虑减少疗法与三个疗程相结合，旨在消除焦虑与饮酒之间的认知和行为联系（例如，期望、应对饮酒动机） ，条件关联）。在一项包含 300 多个病例的随机试验中，家长 R01 表明，与添加减压对照治疗（53%复发）并与单独接受 AUD 治疗的匹配的非随机队列（61% 复发）进行比较。虽然这证实了母体 R01 中的主要研究假设，但必须承认，效果并不大，而且 CBT 仅减轻了与同时发生的焦虑症相关的复发风险增加的大约一半。幸运的是，母体 R01 的结果也指出了可能显着提高 CBT 治疗效果的修改方法。具体来说，母体 R01 的研究结果表明，是解耦疗法而不是减少焦虑疗法导致了酒精结果的改善。这表明进一步强调解耦治疗要素将提高 CBT 的整体有效性；然而，减少焦虑对于改善这些患者的酒精结果的重要性仍然不明确。例如，专门用于减少焦虑的三个课程可能不足以影响父母 R01 的酒精结果。或者，可能需要减少焦虑疗法与解耦疗法协同作用，以改善酒精结果。更新工作将使用拆解方法来隔离这些治疗成分在两个剂量水平下的单独和相互作用的效果，以达到提高已验证但仍处于次优性能的效果的目标 CBT 的父 R01 版本。 350 名患有焦虑症的 AUD 患者将被随机分入接受以下任一组的组： 1) 六次 CBT 治疗以减轻焦虑 (CBT-AR)； 2）六次用于焦虑-酒精解耦的CBT（CBT-DC）；或者，3) 原始的 CBT，包括三个减轻焦虑的课程和三个解耦课程 (CBT-O)。根据父 R01 研究结果表明解耦成分是 CBT 疗法的活性成分，我们预测 CBT-DC 组（六次 DC 疗程）将获得最佳的酒精结果，其次是 CBT-O（三个 DC 会话），然后是 CBT-AR（零 DC 会话）。如果 CBT-O 的性能优于其他两组，则该设计还表明 AR 和 DC CBT 组件之间的协同效应。