Mechanisms underlying patient-treatment matches and mismatches in alcohol therapy

描述（由申请人提供）：本提案是对RFA-AA-07-005的回应。在MATCH项目令人失望的结果之前，患者-治疗匹配被视为提高酒精治疗效果的有希望的范例。在MATCH项目中，缺乏支持将治疗方式与患者属性相匹配的研究结果，导致研究人员在很大程度上放弃了这种范式。然而，进一步的研究使用了来自MATCH项目的治疗师干预的观察者评分，成功地确定了3种患者-治疗相互作用，并证明了患者属性和治疗师干预之间的特定匹配和不匹配如何预测治疗效果。具体而言，研究结果表明，治疗后酒精使用与治疗结构水平与患者抗拒水平（即反对他人的影响）之间的匹配或不匹配以及治疗师对抗水平与患者抗拒水平和患者特质愤怒水平之间的不匹配有关。目前尚不清楚的是，这些匹配和不匹配效应对酒精使用产生影响的作用机制。拟议研究的目的是研究这些影响背后的潜在作用机制。根据这些效应背后的理论和现有的关于行为疗法作用机制的文献，本研究将使用基于观察者的酒精治疗过程评级来检验(1)关于酒精使用信念的认知改变，(2)改变谈话，(3)治疗过程中的抵抗作为潜在机制的作用。该项目将从MATCH项目的善后护理部门（n=138）和门诊部门（n=138）抽取患者样本。将使用线性回归和结构方程模型来检验所声称的机制是否介导了治疗后酒精使用频率的匹配和不匹配效应。拟议的研究设计将关注何时测量变量的时间序列，以增加观察到的中介效应满足作用机制基本标准的可能性。如果结果为阳性，本研究结果将验证这些患者-治疗匹配和不匹配效应的重要性，将为行为治疗的有效成分提供有价值的见解，并将提供令人信服的证据，以此为基础进行前瞻性随机临床试验，以检验酒精中毒治疗中的这些匹配效应。如果结果是肯定的，本研究的结果将验证患者-治疗匹配和不匹配效应的重要性，将为行为治疗的有效成分提供有价值的见解，并将提供令人信服的证据，以此为基础进行前瞻性随机临床试验，以检验酒精中毒治疗中的这些匹配效应。

DESCRIPTION (provided by applicant): This proposal is in response to RFA-AA-07-005. 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 attributes in Project MATCH led researchers largely to abandon this paradigm. However, further study has used observer ratings of therapist interventions from Project MATCH to successfully identify 3 patient-treatment interactions and to demonstrate how specific matches and mismatches between patient attributes and therapist interventions predict treatment effectiveness. Specifically, findings have shown that post treatment alcohol use is associated with the occurrence of a match or mismatch between the level of therapy structure in relation to the level of patient reactance (i.e., opposition to influence from others), and with mismatches between the level of therapist confrontation in relation to the level of patient reactance and patient trait anger. What remain unknown are the mechanisms of action through which these match and mismatch effects exert their influence on alcohol use. The objective of the proposed research is to study potential mechanisms of action that underlie these effects. Drawing on both the theories behind these effects and the extant literature on purported mechanisms of action in behavioral therapies, this research will use observer-based ratings of alcohol treatment sessions to examine the roles of (1) cognitive change in beliefs about alcohol use, (2) change talk, and (3) in-session resistance as potential mechanisms. The project will sample patients from both the aftercare (n=138) and outpatient (n=138) arms of Project MATCH. Linear regression and structural equation modeling will be used to test if the purported mechanisms mediate the match and mismatch effects on the frequency of post treatment alcohol use. The proposed research design will attend to the temporal sequence of when variables are measured to increase the likelihood that observed mediation effects will meet essential criteria for mechanisms of action. If positive, the results of this study will validate the importance of these patient-treatment match and mismatch effects, will provide valuable insights into the active ingredients of behavioral treatments, and will provide compelling evidence on which to base a prospective randomized clinical trial that examines these matching effects in treatments for alcoholism. If positive, the results of this study will validate the importance of patient-treatment match and mismatch effects, will provide valuable insights into the active ingredients of behavioral treatments, and will provide compelling evidence on which to base a prospective randomized clinical trial that examines these matching effects in treatments for alcoholism.