Identifying Multiple Mechanisms of Change in Alcoholism Treatment

描述(由申请人提供)：本申请涉及广泛的挑战领域(01)行为，行为改变，以及预防和特定挑战主题，01-GM-104：行为改变研究的机制。认知行为疗法(CBT)被公认为是治疗酒精依赖的一种有效方法。然而，许多用于研究CBT的前后处理设计，虽然在回答有关治疗是否有效的问题方面很重要，但提供的关于CBT如何起作用的信息要少得多。近年来，人们对研究治疗前和治疗后评估之间发生了什么--变化的过程--重新燃起了兴趣，并重新认识到这项研究在治疗发展中的重要作用(Hayes，Hope，&Hayes，2007)。CBT的一个核心机制是获得和使用应对技能。然而，在对10项将应对作为CBT的假想作用机制的研究的综述中，摩根斯坦和Longabuagh(2000)得出结论，没有支持CBT通过其对应对的影响而起作用的假设。虽然已经提出了几种可能的机制来解释CBT的影响，但很少有一种以上的机制被研究。根据Kazdin(2007)的说法，多个调解人的评估(即。机制)在特定的研究中有巨大的好处。如果研究了两种或两种以上的机制，就可以确定哪一种更可信，哪一种对结果的贡献更大。此外，考虑到任何一项治疗结果研究所需的时间和资源，对多种潜在机制的评估是具有成本效益的。纵观许多研究，一些机制可能会反复成为可能的竞争者，而另一些机制则会半途而废。除了应对技能，CBT有效性的两个关键机制被认为是增加自我效能和自信，以及减少对饮酒的积极结果预期(Moos，2007)。另外两种机制被认为在许多不同的干预措施中发挥作用，包括CBT，它们正在增加治疗联盟和减少/调节负面情绪状态。在目前的研究中，参与者将是72名酒精依赖的男性和女性，他们同意参加为期12周的CBT酒精依赖试验。此外，将在基线、治疗结束和治疗后3个月对患者进行全面的研究评估。本研究的首要目标是通过在治疗过程中多次(即每周)测量上述4种理论上相关的改变的行为机制来描绘成功的CBT的改变过程。正如Hayes等人所说。如(2007)号文件所述，这种“地图”将产生几个重要影响，包括：(1)进一步完善现有的治疗程序；(2)更清楚地了解康复、退出治疗、反应不良和复发的过程；(3)进一步发展有经验支持的治疗过程。虽然已经提出了几种可能的机制来解释CBT的影响，但很少有一种以上的机制被研究。本研究的目的是通过测量治疗期间(即每周治疗一次)中4个理论上相关的改变的行为机制，来描绘成功的CBT的改变过程。为了研究过程随时间的展开，需要这样的细粒度分析。这样的“地图”将有几个重要的影响，包括：(1)进一步完善现有的治疗程序；(2)更清楚地描述康复、治疗中断、反应不良和复发的过程；以及(3)进一步发展经验性支持的治疗过程。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (01) Behavior, Behavioral Change, and Prevention and specific Challenge Topic, 01-GM-104: Mechanisms of Behavior Change Research. Cognitive-behavioral therapy (CBT) is well-established as an effective treatment for alcohol dependence. However, many of the pretreatment-posttreatment designs used to study CBT, while important in answering questions about if a treatment works, provide much less information about how CBT works. In recent years, there has been a resurgence of interest in studying what happens between the pretreatment and posttreatment assessment- the process of change-and a renewed understanding of the important role of this research in treatment development (Hayes, Hope, & Hayes, 2007). A central mechanism of CBT is the acquisition and use of coping skills. However, in a review of 10 studies that tested coping as a hypothesized mechanism of action of CBT, Morganstern and Longabuagh (2000) concluded that there is no support for the hypothesis that CBT works through its effects on coping. Although several possible mechanisms have been proposed to explain the effects of CBT, it is rare that more than one mechanism is studied. According to Kazdin (2007), the assessment of multiple mediators (viz. mechanisms) in a given study has enormous benefits. If two or more mechanisms are studied, one can identify if one is more plausible or makes a greater contribution to the outcome. In addition, the assessment of multiple potential mechanisms is cost efficient, given the amount of time and resources needed for any one treatment outcome study. Across many studies, some mechanisms may repeatedly emerge as possible contenders while others fall by the wayside. In addition to coping skills, two key mechanisms posited to underlie the effectiveness of CBT are increasing self-efficacy and self- confidence and reducing positive outcome expectancies for alcohol use (Moos, 2007). Two other mechanisms, thought to be operating across many different interventions, including CBT, are increasing the therapeutic alliance and reducing/regulating negative emotional states. For the present study, participants will be 72 alcohol dependent men and women who agree to participate in a 12-week trial of CBT for alcohol dependence. In addition, comprehensive research assessments will be conducted with patients at baseline, end of treatment, and 3-months posttreatment. The overarching goal of the present study is to map the process of change in successful CBT by measuring the aforementioned 4 theoretically relevant behavioral mechanisms of change on multiple (i.e., weekly) occasions during treatment. As Hayes et al. (2007) state, such a "map" would have several important implications, including, (1) further refinement of existing treatment procedures; (2) a clearer picture of the processes of recovery, treatment dropout, poor response, and relapse; and (3) further development of empirically supported treatment processes. Although several possible mechanisms have been proposed to explain the effects of CBT, it is rare that more than one mechanism is studied. The goal of the present study is to map the process of change in successful CBT by measuring 4 theoretically relevant behavioral mechanisms of change on multiple occasions during treatment (i.e., following weekly treatment sessions). Such a fine-grained analysis is needed in order to study the unfolding of processes over time. Such a "map" would have several important implications, including, (1) further refinement of existing treatment procedures; (2) a clearer picture of the processes of recovery, treatment dropout, poor response, and relapse; and (3) further development of empirically supported treatment processes.