Psychotherapy Process in Alcohol Treatment Matching

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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.