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（AUDs）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。在这个关键时刻，一个变革性的下一步等待着该领域的发展，具体来说，是开发和评估一个同步的、逐节的反馈和指导系统，以加强治疗联盟，改善治疗过程，并最终改善结果。在拟议的研究中，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，每周进行个别治疗。每次疗程结束后，患者将完成简短的工作联盟量表（WAI），用以衡量患者对治疗联盟的看法。将评估两种治疗条件。在实验条件下，在每次治疗后，治疗师将获得关于患者治疗联盟报告的反馈和指导（反馈条件）。具体来说，反馈将包括患者对联盟的看法的描述性信息，以及治疗师可以用来加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，不向治疗师提供治疗联盟的反馈（无反馈条件）。将对基线、治疗结束以及治疗后3、6、9和12个月的患者进行全面的研究评估。该项目的具体目标有三个方面。第一个目的是测试向治疗师提供反馈和指导的效果，这些反馈和指导是关于患者对治疗联盟的总体看法，患者提供的治疗联盟得分（在12周治疗方案中参加的治疗会议的平均值）。第二个目的是测试在治疗期间(a)和12个月随访期间(b)向治疗师提供反馈和指导的效果，这些反馈和指导是关于患者对酒精介入治疗联盟的看法（以戒酒天数和每个饮酒日的饮酒百分比进行操作）。第三个目的是在12个月的随访期间，测试患者提供的总体治疗联盟评分（在12周的治疗方案中参加的治疗疗程的平均值）作为反馈条件和酒精参与之间拟议关系的中介。与向治疗师提供患者对治疗联盟的看法反馈相关的积极结果将代表该领域的重要进步。此外，在本研究中评估的反馈技术在社区环境中的直接可移植性。

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.