Enhancing Therapeutic Alliances in Alcoholism Treatment

描述(由申请人提供)：患者和治疗师之间的治疗联盟的建立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。在这一关头，一个变革性的下一步等待着该领域--具体地说，开发和评估同期的、逐届会议的反馈和指导系统，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。每个人都将参加为期12周的结构化治疗方案，每周单独治疗一次。每次治疗后，患者将完成工作联盟清单(WAI)的缩写，该量表衡量患者对治疗联盟的看法。将对两种治疗条件进行评估。在实验条件下，在每次参加治疗后(反馈条件)，将向治疗师提供关于患者关于治疗联盟的报告的反馈和指导。反馈特别需要患者对联盟的感知的描述性信息，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，不会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。该项目的具体目标有三个方面。第一个目标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患者提供的治疗联盟总体评分(在12周治疗方案期间参加的治疗会话中的平均值)的影响。第二个目的是测试向治疗师提供关于患者对酒精介入治疗联盟的看法的反馈和指导的效果(操作以戒酒天数和饮酒量的百分比表示)(A)在治疗期间和(B)在12个月的随访期内。第三个目标是测试患者提供的整体治疗联盟评分(在12周的治疗方案中参加的治疗期间的平均得分)，作为12个月随访期内反馈状况和酒精参与之间拟议关系的中介。向治疗师提供患者对治疗联盟的看法的反馈将是该领域的一项重要进步。此外，这项研究中评估的反馈技术将直接适用于社区环境。

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.