Enhancing Therapeutic Alliances in Alcoholism Treatment

描述（由申请人提供）：在患者和治疗师之间建立治疗联盟通常被视为酒精使用障碍（AUD）治疗中行为改变过程的核心组成部分。然而，作为这一结论基础的大多数研究都是描述性的。在这个节骨眼上，一个变革性的下一步等待着该领域-具体来说，开发和评估一个同期的，逐节反馈和指导系统，以加强治疗联盟，为改善治疗过程和最终结果服务。在拟定的研究中，参与者将是进入门诊AUD治疗的酒精依赖患者。每个人都将参加一个结构化的，为期12周的治疗方案，每周一次的个人治疗。每次治疗后，患者将完成工作联盟量表（阿威）的简短表格，该表格测量患者对治疗联盟的看法。将评价两种治疗条件。在实验条件下，关于患者关于治疗联盟的报告的反馈和指导将在参加的每个治疗会话之后提供给治疗师（反馈条件）。反馈具体将涉及患者对联盟的看法的描述性信息，以及治疗师可以用于增强联盟或维持已经强大的联盟的技术和策略。在“常规治疗”条件下，将不向治疗师提供关于治疗联盟的反馈（无反馈条件）。将在基线、治疗结束以及治疗后3、6、9和12个月对患者进行全面的研究评估。该项目有三个具体目标。第一个目的是测试向治疗师提供关于患者对治疗联盟的看法的反馈和指导对整体患者提供的治疗联盟评分（在12周治疗方案期间参加的治疗会话的平均值）的影响。第二个目的是测试向治疗师提供反馈和指导的效果，这些反馈和指导涉及患者对治疗联盟对酒精参与的看法（操作为戒酒天数百分比和每个饮酒日的饮酒量）（a）在治疗期间和（b）在12个月的随访期间。B）。第三个目的是测试整体，患者提供的治疗联盟评分（平均在12周的治疗方案期间参加的治疗会话），作为12个月随访期间反馈条件和酒精参与之间的拟议关系的中介。积极的结果与提供治疗师与患者的看法的治疗联盟的反馈将代表该领域的一个重要进展。此外，本研究中评估的反馈技术可以直接移植到社区环境中。

DESCRIPTION (provided by applicant): The establishment of a therapeutic alliance between the patient and therapist is generally viewed as a central component of the behavior change process in the treatment of alcohol use disorders (AUDs). However, the majority of research serving as the basis for this conclusion has been descriptive. At this juncture, a transformative, next-step awaits the field - specifically, the development and evaluation of a contemporaneous, session by session feedback and guidance system for enhancing the therapeutic alliance in the service of improving treatment process and, ultimately, outcomes. In the proposed study, the participants will be alcohol dependent patients entering outpatient AUD treatment. Each will participate in a structured, 12- week treatment regimen of weekly individual treatment sessions. After each session, patients will complete the short form of the Working Alliance Inventory (WAI), which measures patients' perceptions of the therapeutic alliance. Two treatment conditions will be evaluated. In the experimental condition, feedback and guidance regarding the patient's reports on the therapeutic alliance will be provided to the therapist following each treatment session attended (Feedback condition). The feedback specifically will entail descriptive information on the patient's perceptions of the alliance as well as techniques and strategies that could be used by the therapist in service of enhancing the alliance or maintaining already strong alliances. In the "usual treatment" condition, no feedback on the therapeutic alliance will be provided to the therapist (No Feedback condition). Comprehensive research assessments will be conducted with patients at baseline, end of treatment, and at 3-, 6-, 9-, and 12-months post-treatment. The project's specific aims are three-fold. The first aim is to test the effects of providing feedback and guidance to therapists regarding patient perceptions of the therapeutic alliance on overall, patient-provided therapeutic alliance scores (averaged across treatment sessions attended during the 12-week treatment regimen). The second aim is to test the effects of providing feedback and guidance to therapists regarding patient perceptions of the therapeutic alliance on alcohol involvement (operationalized as percent days abstinent and drinks per drinking day) (a) during the treatment period and (b) during the 12-month follow-up period. The third aim is to test overall, patient-provided therapeutic alliance scores (averaged across treatment sessions attended during the 12-week treatment regimen) as a mediator of the proposed relationship between Feedback condition and alcohol involvement during the 12-month follow-up period. Positive results associated with providing therapists with feedback on patient perceptions of the therapeutic alliance would represent an important advance for the field. Furthermore, there would be direct transportability of the feedback technology being evaluated in this study to community settings.