Mechanisms underlying patient-treatment matches and mismatches in alcohol therapy

说明(申请人提供)：本提案是对RFA-AA-07-005的回应。在Project Match的结果令人失望之前，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。在Project Match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一范式。然而，进一步的研究使用了来自Project Match的治疗师干预措施的观察者评级，成功地确定了3个患者-治疗交互作用，并展示了患者属性和治疗师干预措施之间的特定匹配和不匹配如何预测治疗效果。具体地说，研究结果表明，治疗后饮酒与治疗结构水平与患者抵抗力水平(即反对他人的影响)之间发生匹配或不匹配，与治疗师对抗水平与患者抵抗力水平与患者特质愤怒之间的不匹配有关。目前尚不清楚的是这些匹配和错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行为疗法中所谓的作用机制的现有文献，本研究将使用基于观察者的酒精治疗过程评级来检查(1)对酒精使用的信念的认知变化，(2)改变谈话，和(3)会话中抵抗作为潜在机制的作用。该项目将从Project Match的后续护理(n=138)和门诊(n=138)分支中抽取患者样本。线性回归和结构方程模型将被用来检验所谓的机制是否在治疗后酒精使用频率的匹配和不匹配效应中起中介作用。拟议的研究设计将考虑衡量变量的时间顺序，以增加观察到的调解效果将满足行动机制的基本标准的可能性。如果结果是肯定的，这项研究的结果将验证这些患者-治疗匹配和错配效应的重要性，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，作为检验这些匹配效应在酒精中毒治疗中的前瞻性随机临床试验的基础。如果结果是肯定的，这项研究的结果将验证患者-治疗匹配和错配效应的重要性，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，作为检验这些匹配效应在酒精中毒治疗中的前瞻性随机临床试验的基础。

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.