Cocaine use disorder (CUD) is a debilitating psychopathology, with no recommended medication therapy or specific psychological intervention. Memory-focused cognitive therapy (MFCT) is a novel psychotherapy for CUD, theorized to modify and reconsolidate cocaine craving-related memories for cognitive and behavioral control. A pilot randomized controlled trial indicated that this therapy is associated with reduced craving and cocaine use. With an 80% confidence interval (CI) set for null hypothesis testing, we conducted an exploratory causal mediation analysis with confounder adjustment to determine whether increased cocaine abstinence following MFCT is mediated by reduced craving experience and increased emotion regulation. Participant data on the Difficulties in Emotion Regulation Scale did not meet screening evaluation as a potential mediator. Cocaine craving (assessed by the frequency version of the Craving Experiences Questionnaire) was associated with a total treatment effect of MFCT on cocaine abstinence at follow-up (1.499; 80% CI 1.114 to 1.970; p = .012). A significant natural indirect effect indicated that reductions in cocaine use were strongly mediated by reduced frequency of craving experience (1.753; 80% CI: 1.334 to 2.936; p < .0001). This study provides exploratory evidence in support of the theoretical action for MFCT and underscores the importance of craving as a therapeutic target.

中文翻译：

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对可卡因的渴望会介导可卡因的使用吗？以记忆为中心的认知治疗的随机对照试验研究分析

可卡因使用障碍（CUD）是一种使人衰弱的精神病理学，没有建议的药物治疗或特殊的心理干预措施。专注于记忆的认知疗法（MFCT）是一种用于CUD的新型心理疗法，其理论上旨在修改和巩固可卡因渴望相关的记忆，以进行认知和行为控制。一项先导性随机对照试验表明，该疗法与减少的渴望和可卡因的使用有关。为无效假设检验设置了80％的置信区间（CI），我们进行了探索性因果中介分析，并进行了混杂因素调整，以确定MFCT后可卡因戒酒的增加是否是由减少的渴望体验和情绪调节引起的。情绪调节困难量表中的参与者数据未达到筛查评估的潜在中介作用。可卡因的渴望（通过《渴望体验问卷》的频率版本进行评估）与MFCT对随访时可卡因戒断的总体治疗效果相关（1.499； 80％CI 1.114至1.970； p = 0.012）。明显的自然间接影响表明，可卡因的使用减少受到渴望体验频率的降低的强烈影响（1.753； 80％CI：1.334至2.936； p <.0001）。这项研究提供了探索性证据支持MFCT的理论作用，并强调了渴望将其作为治疗目标的重要性。明显的自然间接影响表明，可卡因的使用减少受到渴望体验频率的降低的强烈影响（1.753； 80％CI：1.334至2.936； p <.0001）。这项研究提供了探索性证据支持MFCT的理论作用，并强调了渴望将其作为治疗目标的重要性。明显的自然间接影响表明，可卡因的使用减少受到渴望体验频率的降低的强烈影响（1.753； 80％CI：1.334至2.936； p <.0001）。这项研究提供了探索性证据支持MFCT的理论作用，并强调了渴望将其作为治疗目标的重要性。