Remote Guided Caffeine Reduction

The purpose of this online research study is to determine whether or not a gradual caffeine reduction program developed at Johns Hopkins can help people reduce their caffeine use. The investigators will provide materials to help guide caffeine reduction and ask questions to track caffeine use over several weeks. The investigators will also assess how reducing caffeine may benefit common caffeine-related problems such as anxiety, sleep disturbances, and gastrointestinal distress. The study will also determine whether or not people like participating in this caffeine reduction program in an online format.

There is emerging evidence that some individuals have difficulty cutting down or eliminating caffeine consumption in spite of clinically significant problems exacerbated by caffeine use. This study will evaluate whether a caffeine reduction program developed at Johns Hopkins can help people reduce their caffeine use in an online format. Volunteers will participate in an intervention study conducted entirely online, including video visits for screening, instructions for caffeine reduction, and follow up. The study also involves filling out online surveys sent via email and text message. During screening, participants will be asked questions about their personal characteristics including demographic information, weekly caffeine consumption, and general medical history. Participants who are determined to be eligible after screening will be randomized to either the immediate or delayed treatment group. Those in the immediate treatment group will have their next session immediately after screening while those in the delayed treatment group will have their next session 7 weeks after screening. At this session, participants receive a digital copy of a caffeine reduction manual and instructions on how to gradually cut down caffeine. After this, participants will complete weekly online surveys over six weeks. Participants will complete two follow-up video visits at 7 and 14 weeks after participants received the caffeine reduction instructions. The investigators will measure caffeine consumption over time using the online surveys and interview questions during video visits, and the investigators will also measure how various caffeine related problems may improve during caffeine reduction, such as sleep problems, gastrointestinal issues, and anxiety. During the end of study sessions, participants will answer questions related to acceptability of the online format and report on participants' current caffeine use.

Caffeine Dependence, Anxiety, Sleep Disturbance, Gastrointestinal Dysfunction, Sleep Initiation and Maintenance Disorders, Caffeine; Sleep Disorder, Caffeine, Caffeine-Induced Anxiety Disorder, Caffeine Withdrawal, Caffeine-Induced Sleep Disorder, Without Use Disorder, Caffeine Abuse, Insomnia, Anxiety Disorders, Sleep Disorder, Heartburn, Diarrhea

caffeine, caffeine reduction, online study, manualized treatment, caffeine fading, remote intervention, remote trial

Caffeine consumption and secondary measures will be examined before, during, and after the caffeine reduction intervention and compared between immediate and delayed treatment groups.

Weekly caffeine consumption is to be measured before and after using the caffeine reduction program, which has been summarized in a "Guide to Caffeine Reduction and Cessation" manual to help people reduce their caffeine use. Those in the immediate treatment group will receive the guide immediately after screening.

Weekly caffeine consumption is to be measured before and after using the caffeine reduction program, which has been summarized in a "Guide to Caffeine Reduction and Cessation" manual to help people reduce their caffeine use. Those in the delayed treatment group will receive the guide seven weeks after screening.

We will provide participants with a Guide to Caffeine Reduction and Cessation in order to help the reduce their caffeine use and determine their ratings of treatment acceptability.

To determine to what extent participants will engage with a remote caffeine reduction intervention for caffeine-related problems and find it acceptable, we will calculate the percentage of completed assessments for each video visit among eligible participants.

At the 7 Weeks Follow-Up video visit, we will use an internally-developed standardized treatment acceptability questionnaire to determine as well as self-reported agreement with the items on the treatment acceptability survey (e.g., "Overall, was the Guide to Caffeine Reduction and Cessation easy to use?"; "Overall, was the guide to Caffeine reduction and Cessation helpful?"). Acceptability questions are scored from 0-3 where lower scores indicate less acceptability (e.g., 0=not at all easy, not at all helpful; 3 = very easy, very helpful).

To determine to what extent participants are successfully able to reduce their caffeine consumption following the remote intervention, we will assess caffeine consumption as determined by the standardized caffeine assessments at 7-and 14-week post-treatment follow-ups and compare this with consumption at the screening and treatment televisits. Based on participant responses to the number, type, and amount of caffeinated beverages, caffeine consumption is calculated at each assessment in milligrams (mg).

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine to what extent participants report improvement in common caffeine-related problems following the remote intervention, we have developed a standardized measure of the extent to which common problems related to excessive caffeine consumption bothered participants within the past 7 days, e.g., "During the past 7 days, I have consumed caffeine in larger amounts or over a longer period than I intended." Participants rate the extent to which these problems bothered them on a scale from 0-3 where 0 = not at all a problem and 3 = major problem. Higher sum scores on the measure indicate greater caffeine-related problems.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in day-to-day anxiety, we will utilize the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety 8a assessment. The questionnaire asks the extent to which anxiety-related items affected the participants over the past 7 days on a scale of 1 (never) to 5 (always). Higher scores reflect greater anxiety.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in day-to-day anxiety, we will utilize the Generalized Anxiety Disorder-7 (GAD-7). The GAD-7 consists of items asking the participant to rate on a scale of 0 (not at all) to 3 (nearly every day) the extent they have experienced anxiety related symptoms where higher scores indicate greater anxiety related symptoms.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in sleep problems, we will utilize the PROMIS Sleep Disturbance 8a assessment. The questionnaire asks the extent to which sleep-related items affected the participants over the past 7 days on a scale of 1 (not at all) to 5 (very much). Higher scores reflect greater sleep disturbance.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in sleep problems, we will utilize the Pittsburgh Sleep Quality Index (PSQI), which contains 19 self-rated items for different components where a score of 0 indicates no difficulty and a score of 3 indicates severe difficulty. Higher global scores indicate greater sleep difficulties.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in sleep problems, we will utilize the Insomnia Severity Index (PSQI), which contains 5 self-rated items concerning sleep difficulties.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in gastrointestinal problems, we will utilize the PROMIS Reflux-13a/Diarrhea-6a. These items ask the extent to which gastrointestinal-related items affected the participants over the past 7 days on a scale of 1 (never) to 5 (always). Higher scores reflect greater gastrointestinal problems.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether caffeine reduction is accompanied by a reduction in gastrointestinal problems, we will utilize the Gastrointestinal Symptoms Rating Scale (GSRS) which consists of 15 items describing gastrointestinal distress where responses range from 0 (no discomfort at all) to 6 (very severe discomfort) and where higher scores indicate more severe gastrointestinal symptoms.

Baseline, at the time of intervention visit (within 1-2 weeks of screening), at 7 weeks post-intervention visit, at 14 weeks post-intervention visit

To determine whether participants randomized to the immediate intervention group (at 7-weeks post enrollment and post-treatment) show greater caffeine change in caffeine-related problems relative to the delayed treatment group at 7-weeks post-enrollment (prior to delayed treatment). This randomization will allow us to compare the initial efficacy of our intervention with caffeine reductions that may occur spontaneously over the same duration.

Inclusion Criteria: 18-75 years old Reside in the United States Read, write, and speak English fluently Able to access a video camera on a smart phone, tablet, or other computer Able to receive text messages or emails (or both) Suitable caffeine consumption Indicate suitable reason for caffeine reduction Interested in getting help to gradually reduce or eliminate caffeine consumption as part of a research study Exclusion Criteria: Any current medical or psychiatric disorder or symptoms that, in the opinion of the investigators, may interfere with or preclude completion of the study [many psychiatric or medical concerns such as insomnia or anxiety are not anticipated to interfere with study participation and will not generally be exclusionary]