Understanding Treatment Dropout Among Women with Posttraumatic Stress Disorder and Heavy Drinking

治疗中断是创伤后应激障碍患者面临的主要挑战 创伤后应激障碍（PTSD）和酒精使用障碍（AUD）。PTSD+AUD的治疗有效， 减少症状，但治疗损耗是一个关键问题。PTSD+AUD患者的辍学率 比单独患有PTSD的患者高，并且辍学与临床改善较少相关。更清楚 了解导致辍学的因素，包括那些开始提供服务但没有开始的人; 治疗（非启动者）和那些开始但未完成治疗（非完成者），将使我们能够 制定策略，改善这一人群的保留和治疗结果。检查可修改 和理论上知情的结构，如难以忍受情绪困扰和应对动机， 酒精使用，可以提高我们对治疗脱落的理解。此外，观察员对会议期间 行为，或“薄片”评级，是一种测量预测因子的方法，更接近于何时发生辍学， 有可能成为辍学的可靠预测因素。薄切片是指以下内容的短（例如，30秒）视频剪辑： 由受过训练的观察者根据特定的结构或感兴趣的结果评定的表达行为。拟议 F32将使用从现有研究中收集的数据，采用混合方法探索治疗脱落的原因。 对患有创伤后应激障碍和性侵犯后大量饮酒的女性进行临床试验。具体目标是：（1）确定 通过进行定性访谈，探讨与未开始学习和未完成学业者辍学原因相关的主题 与性侵犯服务提供者（N = 10），这将用于制定“薄片”评级 目标2中使用的观察到的参与者行为的结构。2)预测脱落和相关治疗 过程（N = 100）使用薄片评级和先进的统计方法。治疗脱落将是 在每种治疗条件下（影像暴露和酒精技能培训）和 治疗条件，以测试某些薄片结构是否更好地预测某些 治疗的类型。我们还将研究与辍学相关的治疗过程的轨迹：困难 容忍情绪和酒精渴望。3)通过以下方式丰富目标2的定量结果并将其置于背景中： 同时进行定性访谈，探讨治疗的开始和退出， 性侵犯后PTSD和酗酒的临床试验（N = 25）。申请人将接受培训 在1）创伤后应激障碍和酒精治疗过程的研究，2）进行研究预测辍学的临床试验， 3)收集和分析定性和定量数据的技能发展，以及4）手稿和赠款 写作这项拟议中的研究将对我们理解辍学做出实质性贡献，这是一项必要的研究。 第一步，制定战略，以增加保留和改善治疗结果， 弱势群体。

Treatment dropout is a primary challenge for individuals suffering with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) following trauma exposure. Treatments for PTSD+AUD are effective at reducing symptoms, yet treatment attrition is a critical issue. Dropout rates among individuals with PTSD+AUD are higher than for those with PTSD alone, and dropout is associated with less clinical improvement. A clearer understanding of the factors that contribute to dropout, including those who initiate services but do not start treatment (nonstarters) and those who start but do not complete treatment (noncompleters), will enable us to develop strategies that improve retention and treatment outcomes for this population. Examining modifiable and theoretically informed constructs, such as difficulty tolerating emotional distress and coping motives for alcohol use, may improve our understanding of treatment dropout. Additionally, observer ratings of in-session behavior, or “thin slice” ratings, is a method of measuring predictors more proximal to when dropout occurs and has the potential to be a robust predictor of dropout. Thin slice refers to short (e.g. 30 second) video clips of expressive behavior rated by trained observers on specified constructs or outcomes of interest. The proposed F32 will use mixed methods to explore reasons for treatment dropout using data collected from an existing clinical trial for women with PTSD and heavy drinking following sexual assault. Specific aims are: 1) To identify themes related to reasons for dropout for nonstarters and noncompleters by conducting qualitative interviews with providers of sexual assault services (N = 10), which will be used to develop the “thin slice” rating constructs of observed participant behavior for use in Aim 2. 2) To predict dropout and related treatment processes (N = 100) using thin slice ratings and advanced statistical methods. Treatment dropout will be examined within each treatment condition (imaginal exposure and alcohol skills training) and between treatment conditions to test whether certain thin slice constructs are better at predicting dropout for certain types of treatment. We will also examine trajectories of treatment processes related to dropout: difficulty tolerating emotions and alcohol craving. 3) To enrich and contextualize Aim 2 quantitative findings by concurrently conducting qualitative interviews exploring treatment initiation and dropout with women enrolled in a clinical trial for PTSD and heavy drinking following sexual assault (N = 25). The applicant will receive training in 1) PTSD and alcohol treatment process research, 2) conducting studies predicting dropout in clinical trials, 3) skill development for collecting and analyzing qualitative and quantitative data, and 4) manuscript and grant writing. The proposed study will make substantial contributions to our understanding of dropout, a necessary first step to the development of strategies to increase retention and improve treatment outcomes for this vulnerable population.