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Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense.

ABSTRACT: Driving under the influence (DUI) of alcohol is a major public health concern, and many individuals continue to drink and drive even after being convicted of a DUI offense. Latinos, in particular, are disproportionately likely to be arrested for a DUI, have higher rates of recidivism, and are more likely to die in alcohol-related accidents than non-Latino Whites. Latinos also experience significant disparities in accessing alcohol-related treatment.This study protocol paper describes a randomized trial of cognitive behavioral therapy (CBT) compared to usual care in DUI programs for individuals with a first-time offense and at-risk drinking. We will utilize a two-group randomized design where individuals enrolled in a DUI program with a first-time conviction will be randomized to CBT (n = 150) or usual care (n = 150). Participants will be assessed at baseline, immediately post-treatment, and 6-months post-treatment. Recidivism data will be collected using administrative data within 2 years post-treatment.This project has the potential to benefit a large population of vulnerable individuals who are at risk of DUI recidivism. It also develops a new model of care by providing treatment in DUI programs to reduce disparities associated with poor treatment access. Trial registration NCT02588703.

SUBMITTER: Chan Osilla K

PROVIDER: S-EPMC4815153 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense.

Chan Osilla Karen K Watkins Katherine E KE Kulesza Magdalena M Flórez Karen K Lara-Greenberg Marielena M Miles Jeremy N V JN

Addiction science & clinical practice 20160331 1

<h4>Background</h4>Driving under the influence (DUI) of alcohol is a major public health concern, and many individuals continue to drink and drive even after being convicted of a DUI offense. Latinos, in particular, are disproportionately likely to be arrested for a DUI, have higher rates of recidivism, and are more likely to die in alcohol-related accidents than non-Latino Whites. Latinos also experience significant disparities in accessing alcohol-related treatment.<h4>Methods/design</h4>This ...[more]

PMID: 27036221

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Project description:BackgroundAdherence to computerized cognitive behavioral therapy (cCBT) programs in real-world settings can be poor, and in the absence of therapist support, effects are modest and short term. Moreover, because cCBT systems tend toward limited support and thus low-intensity treatment, they are typically most appropriate for people experiencing mild to moderate mental health difficulties. Blended therapy, that is, combining direct therapist contact with cCBT or psychoeducational materials, has been identified as one possible approach to address these limitations and widen access to individual CBT for depression. Building on the initial success of blended therapy, we explore an integrated approach that seeks to seamlessly combine face-to-face contact, electronic contact, and between-session activities. Integration also considers how the technology can support therapists' workflow and integrate with broader health care systems. The ultimate aim is to provide a structure within which therapists can deliver high-intensity treatments, while also greatly reducing face-to-face contact.ObjectiveThe research aimed to explore patients' and therapists' views on using a system for the delivery of individual treatment for depression that integrates face-to-face therapist contact with access to online resources and with synchronous online therapy sessions that allow collaborative exercises, and to establish design requirements and thus key design considerations for integrated systems that more seamlessly combine different modes of communication.MethodsWe conducted a series of four user-centered design studies. This included four design workshops and seven prototype testing sessions with 18 people who had received CBT for depression in the past, and 11 qualitative interviews and three role-play sessions with 12 CBT therapists experienced in the treatment of depression. Studies took place between July and December 2017 in Bristol, United Kingdom.ResultsWorkshops and prototyping sessions with people who had received CBT identified three important requirements for integrated platforms delivering CBT therapy for depression as follows: (1) features that help to overcome depression-related barriers, (2) features that support engagement, and (3) features that reinforce learning and support the development of new skills. Research with therapists highlighted the importance of the therapist and client working together, the impact of technology on therapists' workflow and workload, challenges and opportunities related to the use of online resources, and the potential of technology to support patient engagement. We use these findings to inform 12 design considerations for developing integrated therapy systems.ConclusionsTo meet clients' and therapists' needs, integrated systems need to help retain the personal connection, support both therapist- and patient-led activities, and provide access to materials and the ability to monitor progress. However, developers of such systems should be mindful of their capacity to disrupt current work practices and increase therapists' workload. Future research should evaluate the impact of integrated systems on patients and therapists in a real-world context.

Project description:Attending school is a multifaceted experience. Students are not only exposed to new knowledge but are also immersed in a structured environment in which they need to respond flexibly in accordance with changing task goals, keep relevant information in mind, and constantly tackle novel problems. To quantify the cumulative effect of this experience, we examined retrospectively and prospectively, the relationships between educational attainment and both cognitive performance and learning. We analyzed data from 196,388 subscribers to an online cognitive training program. These subscribers, ages 15-60, had completed eight behavioral assessments of executive functioning and reasoning at least once. Controlling for multiple demographic and engagement variables, we found that higher levels of education predicted better performance across the full age range, and modulated performance in some cognitive domains more than others (e.g., reasoning vs. processing speed). Differences were moderate for Bachelor's degree vs. High School (d = 0.51), and large between Ph.D. vs. Some High School (d = 0.80). Further, the ages of peak cognitive performance for each educational category closely followed the typical range of ages at graduation. This result is consistent with a cumulative effect of recent educational experiences, as well as a decrement in performance as completion of schooling becomes more distant. To begin to characterize the directionality of the relationship between educational attainment and cognitive performance, we conducted a prospective longitudinal analysis. For a subset of 69,202 subscribers who had completed 100 days of cognitive training, we tested whether the degree of novel learning was associated with their level of education. Higher educational attainment predicted bigger gains, but the differences were small (d = 0.04-0.37). Altogether, these results point to the long-lasting trace of an effect of prior cognitive challenges but suggest that new learning opportunities can reduce performance gaps related to one's educational history.

Dataset Information

Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense.

Publications

Study design to evaluate cognitive behavioral therapy among a diverse sample of adults with a first-time DUI offense.

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