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的观察者评级，通过源自Beutler和Clarkin的系统治疗选择模型的患者属性匹配假设，成功地支持了三个治疗师行为中的两个。具体而言，(1)治疗前对患者痛苦反应的情绪焦点和(2)治疗师对患者特质反应的指导性显著预测了治疗后一年的饮酒频率。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=127)随机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=127)随机选择的患者样本中进行测试，来确定这些匹配影响对门诊人群的普适性。第二个目标是测试这些匹配效应的理论基础。假设患者在治疗中的情绪唤醒在治疗情绪焦点与饮酒之间起中介作用。它还假设，在会议期间的患者协作调节治疗师的指导性和饮酒之间的关系。 将使用Baron和Kenny的方法进行因果链分析，以确定中介变量。该项目的第三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。线性回归分析将用于测试接受匹配、部分匹配或不匹配治疗方案的患者在治疗后饮酒结果的差异。对于所有这三个目标，结果变量将是饮酒频率和治疗后一年内大量饮酒的频率。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)为研究酒精治疗有效性的理论和方法做出贡献，以及(3)为临床医生提供显著改善患者结果的实用技术。

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 support two of three therapist behavior by patient attribute matching hypotheses derived from Beutler and Clarkin's Systematic Treatment Selection model. Specifically, (1) the emotion focus of therapy in response to patient distress before treatment and (2) therapist directiveness in response to patient trait reactance 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 randomly selected from an additional MATCH aftercare site (N=127). Additionally, the project will determine the generalizability of these matching effects to an outpatient population by testing for them among a sample of randomly selected patients from MATCH outpatient sites (N=127). The second objective is to test the theoretical underpinnings of these matching effects. It is hypothesized that patient emotional arousal in treatment mediates the relationship between therapy emotion focus and drinking. It is also hypothesized that in-session patient collaboration mediates the relationship between therapist directiveness and drinking. Causal chain analysis will be conducted using Baron and Kenny's method to identify mediator variables. The third objective of the project is to test the predictive validity of an a priori multi-dimensional typology for matching therapist interventions to patient attributes. Linear regression analysis will be used to test for differences in post-treatment drinking outcomes among patients who received a matched, partially matched, or mismatched therapy profile. For all three objectives the outcome variables will be frequency of drinking and frequency of heavy drinking during the year after treatment. If positive, the results of this study will: (1) re-establish patient-treatment matching as a valuable paradigm for enhancing patient drinking outcomes, (2) contribute to theory and methodology for studying alcohol treatment effectiveness, and (3) provide clinicians with practical techniques to significantly improve their patients' outcomes.