Adapting an Effective CBT for Comorbidity to a Computer-Delivered Format
Condition: Generalized Anxiety Disorder; Panic Disorder; Social Anxiety; Alcohol Use Disorder
MeSH terms: Alcoholism; Anxiety Disorders; Panic Disorder
Study type: Interventional

Summary: 
      Up to one-half of those in treatment for alcohol use disorder (AUD) has a co-occurring
      anxiety disorder ("comorbidity"), a condition that marks a high degree of treatment
      resistance, severity and relapse risk in AUD treatment patients. The investigators
      conceptualize comorbidity as a feed-forward system ("vicious cycle", [VC]) of interacting
      negative affect/stress, drinking motives/behavior, coping skills deficits, environmental
      circumstances, and neurobiological adaptations. Based on this model, the investigators
      developed and validated the VC cognitive-behavioral therapy (VC-CBT) to disrupt this system
      at several key linkage points. In a recently completed randomized controlled trial (RCT), the
      investigators found that adding the VC-CBT to standard AUD inpatient treatment resulted in
      better alcohol outcomes 4 months following treatment than did adding an anxiety treatment or
      standard AUD treatment alone. With a number needed to treat (NNT) index of 8 (relative to
      standard AUD treatment alone), the VC-CBT could, if broadly disseminated, have a large
      positive impact on AUD treatment. Unfortunately, several significant barriers related to the
      resource- and expertise-intensive delivery of the VC-CBT limit its dissemination potential
      and, hence, the impact of this otherwise effective treatment. Therefore, to maximize the
      public health and scientific potential of the investigators work, the investigators propose
      to adapt the therapist-delivered VC-CBT to a computer-delivered format to facilitate reliable
      and economical dissemination of the VC-CBT while maintaining its established efficacy.
    

Detailed description: 
      The first phase of the work (Year 1) will be to adapt the 6-session therapist-delivered
      VC-CBT for delivery on an internet-based computer platform. This work will be done using a
      standard iterative process for developing e-content in partnership with local technology
      experts experienced in producing engaging and effective e-learning products. Approximately 5
      patients will be employed in this phase. The second phase (Years 2 and 3) will be devoted to
      a single arm pilot trial to test the efficacy of the refined computer-delivered VC-CBT. The
      investigators will recruit AUD treatment patients with co-occurring anxiety disorder to
      receive the computer-delivered VC-CBT (50 patients). Participants will complete follow-up
      assessments one and four months following treatment. Participants will rate user satisfaction
      and will be evaluated on skill and knowledge acquisition as well as use of the tools in the
      follow-up period. Success in the proposed work will serve as pilot data in support of a
      rigorous randomized clinical trial. The proposed work aims to provide an easy and inexpensive
      computer-delivered version of the VC-CBT that has comparable efficacy to the validated but
      resource-intensive therapist-delivered version. Achieving this will enable the VC-CBT therapy
      to benefit more AUD treatment patients and to be more easily studied by other investigators.
    

Intervention name(s): Computer-based VC-CBT
Intervention type(s): Behavioral
Intervention description(s): Computer-based VC-CBT: Three, one-hour computerized therapy sessions delivered on an interactive computerized platform with therapy blocks dedicated to each of three primary modules/goals: 1) psycho-education, 2) skills learning, and 3) individualized practice
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment