Psychotherapy Process in Alcohol Treatment Matching

描述(由申请人提供)：在项目匹配结果令人失望之前，患者与治疗匹配被视为提高酒精治疗有效性的一个有前途的范例。缺乏支持匹配治疗方式与患者属性匹配的研究结果，导致研究人员在很大程度上放弃了这一范式。然而，进一步的研究使用了来自一个比赛后护理地点的治疗师干预措施的观察者评级，成功地确定了3个患者属性匹配的假设。具体而言，(1)治疗师对患者特质反应的指导性，(2)治疗师对患者特质愤怒的指导性，以及(3)治疗前对患者抑郁症状反应的情绪焦点对治疗后一年的饮酒频率有显著预测作用。这项提议延续的第一个目标是在从另一个配对后护理地点(N=138)选择的患者样本中复制这些发现。此外，该项目将通过在匹配门诊地点(N=138)的患者样本中进行测试来确定这些匹配效果在门诊人群中的普及性。该项目的第二个目标是测试先验多维类型学的预测有效性，以将治疗师干预与患者属性相匹配。将使用方差分析来测试 治疗方案匹配或不匹配的患者在治疗后饮酒的差异。 第三个目标是检验匹配效果的假设中介。据推测，对于 处于中等或高度抵触或愤怒水平的患者，工作联盟将调解这一关系 在治疗师的指导性和饮酒之间。进一步的假设是，对于抑郁症状较高的患者，痛苦在治疗情绪焦点与饮酒之间的关系中起中介作用。对间接影响的审查将用于测试调解。对于所有这三个目标，主要结果变量将是治疗后一年内的饮酒频率。我们将分析每天饮酒的次数和大量饮酒的频率作为次要结果。如果结果是肯定的，这项研究的结果将(1)重新确立患者-治疗匹配作为提高患者饮酒结果的有价值的范例，(2)为临床医生提供显著改善患者结果的实用技术，以及(3)为研究酒精治疗有效性的理论和方法做出贡献。

DESCRIPTION (provided by applicant): Prior to the disappointing findings of PROJECT MATCH, patient-treatment matching was viewed as a promising paradigm for increasing alcohol treatment effectiveness. The paucity of findings to support matching treatment modality to patient attribute in MATCH has led researchers to largely abandon this paradigm. However, further study has used observer ratings of therapist interventions from one MATCH aftercare site to successfully identify 3 patient attribute matching hypotheses. Specifically, (1) therapist directiveness in response to patient trait reactance, (2) therapist directiveness in response to patient trait anger, and (3) the emotion focus of therapy in response to patient depressive symptoms before treatment significantly predicted drinking frequency during the year after treatment. The first objective of this proposed continuation is to replicate these findings in a sample of patients selected from an additional MATCH aftercare site (N=138). Additionally, the project will determine the generalizability of these matching effects to an outpatient population by testing for them among a sample of patients from MATCH outpatient sites (N=138). The second objective of the project is to test the predictive validity of an a priori multi-dimensional typology for matching therapist interventions to patient attributes. Analysis of variance will be used to test for differences in post-treatment drinking among patients who had a matched or mismatched therapy profile. The third objective is to test hypothesized mediators of the matching effects. It is hypothesized that for patients at medium or high levels of reactance or anger, the working alliance mediates the relationship between therapist directiveness and drinking. It is further hypothesized that for patients high in depressive symptoms, distress mediates the relationship between therapy emotion focus and drinking. Examination of indirect effects will be used to test for mediation. For all three objectives the primary outcome variable will be frequency of drinking during the year after treatment. We will analyze drinks per drinking day and the frequency of heavy drinking as secondary outcomes. If positive, the results of this study will (1) re-establish patient-treatment matching as a valuable paradigm for enhancing patient drinking outcomes, (2) provide clinicians with practical techniques to significantly improve their patients' outcomes, and (3) contribute to theory and methodology for studying alcohol treatment effectiveness.