Kate B. Wolitzky-Taylor, Ph.D. - US grants

DESCRIPTION (provided by applicant): My goal in obtaining this Kirschstein-NRSA Individual Fellowship is to support my research in pathological worry interventions. More specifically, despite the ostensible prevalence of academic worry at the college and university level, there is a paucity of research in this area. In addition, there is an even greater dearth of research investigating treatments for excessive and uncontrollable academic worry. Further, the research on non-pharmacological treatment strategies for reducing pathological worry (as seen in its most severe form in generalized anxiety disorder GAD) is limited. My research goal is to investigate the potential benefits of several interventions in reducing academic worry and the distress associated with that worry. I propose to conduct a 4-arm randomized clinical trial investigating the relative efficacy of three self-administered interventions and a wait-list control condition for students experiencing pathological academic worry: a) worry exposure, b) expressive writing, c) pulsed audio-photic stimulation, and d) wait-list control. If any or all of the active interventions prove to be efficacious, future investigations regarding the efficacy of these interventions on more general worries in a clinical GAD population may be warranted.

DESCRIPTION (provided by applicant): The candidate, Dr. Kate Wolitzky-Taylor, is proposing to receive training in (a) effectiveness research methodology; and (b) clinical and research issues in treating comorbid anxiety disorders in substance using populations. The purpose of acquiring training in these areas is for the candidate to develop a program of work aimed at (a) increasing access to cognitive-behavioral treatment (CBT) for anxiety disorders among those with substance use disorders; (b) adapting CBT protocols for anxiety disorders to be suitable and appropriate for delivery to persons with substance use disorders; (c) ensuring that these adapted CBT protocols are consistent with and fit into the culture of typical addictions treatment settings; and (d) examining the effectiveness of these interventions in real-world clinical settings such as Intensive Outpatient Programs in community addictions treatment centers. Previous Experience: The candidate has received extensive training and experience in the research and treatment of anxiety disorders. She has excelled in both conducting research in the treatment of anxiety disorders and in delivering CBT for anxiety disorders to a wide variety of patients. Her experiences include an undergraduate research assistantship at the Trauma and Anxiety Recovery Program at the Emory University School of Medicine, doctoral training in clinical psychology at the Laboratory for the Study of Anxiety Disorders at the University of Texas at Austin s Department of Psychology, completing a research-oriented clinical internship in the Department of Psychiatry at the Medical University of South Carolina in the Traumatic Stress Track, and her current postdoctoral research fellowship at the Anxiety Disorders Research Center at the University of California-Los Angeles Department of Psychology. Career Goals: The candidate aspires to obtain a tenure-track faculty position in a psychology department in which she can build a research program that incorporates her current expertise in anxiety disorders with her burgeoning interest in the treatment of comorbid anxiety and substance use disorders (SUDs) and the evaluation of CBT protocols in real-world clinical addictions settings. Research Career Development Plan: The primary goals of the career development plan are to (a) learn about both evidence-based and typically delivered treatments for SUDs, both broadly and in the context of anxiety-SUD comorbidity and (b) develop skills needed to adapt CBT for anxiety disorders to a community clinical setting providing addictions treatment and secondary goals include (a) learning methodology of effectiveness research and (b) advanced statistical training in approaches for analyzing data from effectiveness trials. These goals will be accomplished through directed readings, clinical experiences, consultation, coursework, and participation in seminars and conferences. Research Project: The candidate is proposing to (a) adapt the CALM Tools for Living CBT program for anxiety disorders that demonstrated effectiveness in a large-scale effectiveness study in primary care (NIMH-funded U01; PIs Craske and Roy-Byrne are mentors on this proposal); and (b) examine the effectiveness of the adaptation in an outpatient addictions treatment clinic. The adaptation will be designed to be appropriate for a substance use disorder population and feasible for integration and adoption into a typical outpatient addictions treatment program. The effectiveness trial will be a pilot study to assess preliminary effectiveness and feasibility. Institutional Environment: The UCLA community provides a wealth of relevant training opportunities. The UCLA Department of Psychology receives considerable federal funding for research, and the clinical psychology program is consistently ranked as the top program in the country. In addition, UCLA s School of Public Health, Health Sciences Research Center, Integrated Substance Abuse Programs, and Institute for Social Research are highly regarded and will all be utilized as resources for completing training objectives.

Project Summary Alcohol use disorders and social anxiety disorder are highly comorbid and associated with significant impairment. Social anxiety comorbidity is associated with poorer addiction treatment engagement and outcomes. Thus, addressing underlying social anxiety symptoms that may lead to and maintain alcohol problems, as well as undermine successful treatment for alcohol use disorders, is warranted. This proposal aims to develop and evaluate a fully integrated outpatient program for comorbid social anxiety and alcohol use disorders that weaves evidence-based treatment for social anxiety disorder (i.e., exposure-based cognitive behavioral therapy) into a traditional, evidence-based treatment for alcohol use disorders. First, we will develop the protocol for the fully integrated treatment (FIT). The overarching goal of FIT will be to simultaneously deliver alcohol use disorder treatment and social anxiety disorder treatment. Development will be an iterative process guided by previous research (including our own), and by input from clinicians, administrators, and patients in an outpatient substance use disorder treatment clinic. After the protocol is developed, we will use our established clinician training procedures to train clinicians at our community partnered clinic to competently deliver the intervention. After protocol development and clinician training, we will conduct a pilot randomized clinical trial (RCT) comparing the efficacy of our fully integrated treatment (FIT) for comorbid alcohol use and social anxiety disorders to usual care (UC) in the community substance use disorder specialty clinic. The goals of the RCT will be to gather data regarding acceptability, feasibility, and preliminary efficacy of the FIT protocol. We will randomize treatment-seeking participants (N = 60) who have comorbid social anxiety and alcohol use disorders. We will assess treatment engagement, social anxiety outcomes, and alcohol use outcomes at baseline, 3-months, and 6-months from baseline. We will also gather qualitative and quantitative acceptability data from patients after completing FIT, which may guide final refinements of FIT prior to testing in a larger-scale grant. The knowledge gained from this investigation has the potential to significantly improve the treatment of alcohol use disorders and make a significant public health impact. The focus on direct translation to community practice paradigms and the emphasis on full mental health and addiction treatment integration significantly advance the field.

Project Summary This project aims to develop and evaluate a behavioral intervention for adolescent cannabis use disorder that emphasizes adaptive responding to negative affective symptoms (e.g., depression, anxiety). Maladaptive cognitive, behavioral, and emotional reactions to negative affect are associated with substance use and substance use problems (including cannabis). Adolescence and young adulthood represents a developmental period in which the regulation of negative emotions is still being developed, as well as a time when cannabis use is prevalent and cannabis use disorders onset. Thus, developing and evaluating cannabis use disorder interventions that emphasize the improvement of responding to negative affect may be particularly important for this developmental period. First, we will develop an intervention that weaves skills and strategies for responding adaptively to negative affect, particularly as it relates to high-risk times for cannabis craving and use, into an evidence-based substance use disorder intervention for individuals in late adolescence and early adulthood. After developing the initial protocol and delivering it to a small sample of participants, we will gather feedback to guide refinements to the intervention. After refining the intervention, which we plan to be a 12-session individual treatment, we will conduct the pilot randomized clinical trial. Participants (N = 80) aged 18-25 with cannabis use disorder and elevations in constructs representing maladaptive reactivity to negative affect (i.e., high anxiety sensitivity, low distress tolerance, or facets of emotion dysregulation including high emotional suppression and low cognitive reappraisal ability) will be randomized to receive either: (a) standard cognitive behavioral therapy for adolescent substance use disorders (SUD-CBT) or (b) the novel intervention we develop, affective management training for cannabis use disorders (CUD-AMT). Participants will be assessed at baseline, post-treatment, and a 6-month follow-up assessment on self-report and behavioral indices of the targeted mechanisms, as well as on substance use outcomes (both cannabis-specific and substances more broadly defined). A sub-set of participants (n = 50) will also undergo pre- and post-treatment fMRI assessment to evaluate whether neural indices of emotion regulation are improved to a greater extent in CUD-AMT compared to SUD-CBT. Cannabis use disorder is the most prevalent substance use disorder among adolescents and young adults, and often leads to the use of other substances. Negative affect and disorders associated with high negative affect (i.e., anxiety and unipolar mood disorders) are highly prevalent and associated with significant substance use disorder comorbidity. Targeting a process that is still malleable in late adolescence and young adulthood and that is associated with the maintenance of substance use disorders has the potential to reduce the burden of substance use disorders in this population, thus making a significant public health impact.