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 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.