Both active interventions last six weeks and consist of eight modules designed to reduce cannabis use and common mental health symptoms. With a targeted sample size of n = 210 per treatment arm, data will be collected at baseline immediately before program use is initiated; at six weeks, immediately after program completion; and at three and six months post baseline assessment to assess the retention of any gains achieved during treatment.
Secondary outcomes will include further measures of cannabis use and use of other substances, changes in mental health symptoms and mindfulness, client satisfaction, intervention retention and adherence, and adverse effects.
However, even people with CUD who perceive a need for treatment might be reluctant to seek traditional professional help.
Furthermore, weekly semiautomatic motivational and adherence-focused guidance-based feedback was sent out in her name, as were answers to any questions raised by users , there remains room for improvement.
One potential way to further improve the program would be to incorporate previously-neglected but promising approaches within IMI, including mindfulness.
, MBI were found to have a small effect reducing substance misuse, a medium effect reducing cravings, and a large effect reducing levels of stress relative to alternative treatments .
Despite these promising findings, that most studies on the effectiveness of MBI hitherto focused on substances like tobacco, alcohol, or poly-substance use , the efficacy of a brief, two-sessions intervention that combined MI and mindfulness meditation was examined as a means to reduce cannabis use in young adult females.
All of the steps in this RCT, including subject recruitment, the consent procedure, eligibility screening, the baseline and further assessments, and the randomization of participants to one of the three study arms are depicted in Fig.
Frequent cannabis users from the general population will be recruited directly through the website canreduce.ch, which is well-known since earlier versions of the program have been advertised broadly .
Hence, even though the program is primarily advertised in the German-speaking part of Switzerland, it is possible that people from other parts of Switzerland, and from Germany and Austria will participate as well.
Once informed about the study, potential participants must give informed consent by confirming that by agreeing to participate, they are permitting their data — anonymized and aggregated with data from others collected over the course of the study — can be both analyzed and made available to others within an open repository.
The current section describes the contents of the active study arms. First, features that pertain to both study arms will be described.
Both study arms consist of eight modules that must be completed within a time frame of six weeks.
In the first section, participants can fill out their personally-targeted consumption for the upcoming week by entering how many ‘standard joints’ they are planning to smoke each day can be visualized, as well.
Adding these introductory audios in study arm 1 is important, as they allow participants to select the voice that sounds more sympathetic to them and is, therefore, preferred to guide them through the mindfulness practices of subsequent modules.
To automate this process, we predefined emails with specific trigger conditions like a) an empty diary in week 2, b) being in week 3 and having completed only one module, and c) reaching the end of the six weeks but having completed fewer than four modules.
Over the course of the program, the companions’ thoughts and experiences are displayed in written text at critical points within the modules, with the chosen companion displayed by default.
Besides the clinician’s guide to MBRP, other mindfulness-based resources were considered, as well, when the contents of the modules were developed .
However, even if the pros seem to outnumber the cons, participants may still be motivated to reduce their consumption; e.g., by affording some cons greater weight than others and by replacing ostensible pros with alternative behaviors.
Mindfulness is introduced in the second part of the module , as is how it might help participants to reduce their cannabis use .
Subsequently, its intention is to increase participants’ awareness of their personal triggers to use cannabis at the end of this module to strengthen their own foundation and gain new stability, which might be particularly important after they have focused on personal triggers.
In this module, participants are encouraged to take the time they need to work on their needs so they can improve their general well-being and, thereby, construct a solid foundation upon which they may reduce their cannabis consumption.
The sixth module begins with a description of how low moods, problems, and the use of cannabis are connected and how this might ultimately create a vicious cycle .
This module details how participants can nurture their lifestyle-balance and self-care to better achieve and maintain their consumption goal.
At the end of the module, the eCoach also will point out how mindfulness was a core element of all the modules and will encourage them to continue practicing it regularly.
Furthermore, and analogous to study arm 2, the eCoach now introduces each module in written form and summarizes the main lessons learned at the end of each module.
CANreduce is a website accessed by an internet browser from a computer, tablet, or smartphone.
After clicking an e-mail verification link to ensure that the e-mail address they have entered is correct, they can create their password and start the baseline assessment procedure.
It is expected, for example, that participants will experience some mild withdrawal symptoms — such as craving, mild depressive states, and sleep problems. These symptoms are mitigated by being explicitly addressed within the modules.
Total scores range from 0 to 20, with a score of 4 or more indicating cannabis dependence .
Scores are interpreted as follows: 0 for no problem, 1–2 for a low level, 3–5 for a moderate level, 6–8 for a substantial level, and 9–10 for a severe level of abuse.
Use of any services besides CANreduce, like online counseling, drug counseling, general practitioner, psychologist, or psychiatrist.
Adherence and Retention: Adherence is operationalized as average completion rate spanning the eight modules, with module completion rate defined as the highest page number visited divided by the highest page number available in a given module.
mice involves specifying a multivariate distribution for the missing data and drawing imputations from their conditional distributions by Markov chain Monte Carlo .
To investigate the exploratory research question of whether study arm 1 , a confidence interval approach will be used for the ES of the difference between these two study arms, using a two-sided 0.05 level of significance .
Based on pre-specified LMM model parameters, new values for the primary outcome were simulated and tested by z-tests for the comparison between study arms 1 and 3 for the interaction.
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The study is supported by the Swiss National Science Foundation .
MPS was responsible for generating the hypotheses and for the description of statistical analyses as well as for the references for CBT-based content.
MPS, PhD, is associate professor at the University of Zurich, psychotherapist and scientific director of the Swiss Research Institute of Public Health and Addiction ISGF, a WHO Collaborating Centre, associated with the University of Zurich.
Comparing a mindfulness- and CBT-based guided self-help Internet- and mobile-based intervention against a waiting list control condition as treatment for adults with frequent cannabis use: a randomized controlled trial of CANreduce 3.0.
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