Digital Phenotyping of Anxiety and Anxiety-Related Alcohol Co-occurrence: Pilot Study

Anxiety and anxiety-related disorders frequently co-occur with alcohol use problems resulting in an enormous humanitarian and economic cost to society. The proposed research will use digital technology to examine person-specific risk factors predicting problematic alcohol use in individuals vulnerable to anxiety and anxiety-related disorders and will use this information to design a personalized intervention for individuals seeking psychological treatment. Results from this research will integrate output from novel and innovative digital technology methods into psychotherapy, advancing research on personalized treatment and prevention efforts.

This control condition will provide an experimental comparison to test the process of personalization.

This second control condition will provide an experimental comparison to test the effects of health-related tracking and therapeutic contact.

A Cognitive Behavioral Therapy (CBT) skills based intervention will be delivered to participants randomized to the personalized intervention. Influential constructs driving alcohol use will be identified using the person specific digital phenotyping model, will be targeted using CBT skills, and will be tracked across sessions. Results from the person-specific model will be reviewed each week. This iterative, data-driven, decision-making process will continue for 12 sessions.

Participants randomized to this condition will receive a 12-session CBT skills based treatment targeting a non-personalized construct selected from the person-specific digital phenotyping model.

Participants randomized to this condition will receive 12 supportive counseling sessions that are non-directive in nature (providing support and validation for non-acute weekly stressors). Participants will continue digital phenotyping but will not discuss their person-specific model during session, controlling for the effect of therapist contact and digital phenotyping.

This diagnostic interview will be used to assess change in psychiatric diagnoses at the beginning and end of research participation.

A series of self-report measures specific to each individual's symptom profile will be used to assess changes in anxiety (e.g., generalized anxiety, panic, agoraphobia, social anxiety) or anxiety-related (e.g., post-traumatic stress) symptom severity over the course of the study. In general, higher scores indicate greater symptom severity; whereas lower scores indicate lower symptom severity.

Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8, Week 9, Week 10, Week 11, Week 12

The Alcohol Use Disorder Identification Test (AUDIT) self-report measure will be used to assess changes in alcohol use and AUD symptoms over the course of the study. Scores on the AUDIT range from 0 to 40, with higher scores indicating greater alcohol use risk.

Baseline, Week 1, Week 2, Week 3, Week 4, Week 5, Week 6, Week 7, Week 8, Week 9, Week 10, Week 11, Week 12

The number of sessions completed during the 12- week pilot randomized clinical trial will be used to assess treatment retention. Scores on this measure range from 0 to 12, with 12 representing the maximal number of sessions attended.

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 1. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 2. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 3. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 4. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 5. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 6. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 7. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 8. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 9. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 10. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 11. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

The Utility of Treatment Inventory self-report measure will be used to assess perceived helpfulness of therapy skills presented during Week 12. Scores will range from 0 (Not at all helpful) to 7 (Very helpful).

This self-report measure will be used to assess the working therapeutic alliance at each session to measure changes in therapeutic alliance. Scores on this measure range from 36 to 252 with higher scores representing stronger therapeutic alliance.

Inclusion Criteria: Access to a smartphone Between 18 and 65 years Clinically significant anxiety and anxiety-related disorder (AARD) symptoms Problematic alcohol use Interest in telehealth psychotherapy Residence within the state in which the PI is licensed Exclusion Criteria: Demonstrated indicators of more intensive or acute care