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，行为变化和预防以及特定的挑战主题，01-GM-104：行为变化研究机制。认知行为疗法（CBT）是一种有效的治疗酒精依赖的方法。然而，许多用于研究CBT的治疗前-治疗后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如何工作的信息要少得多。近年来，人们对研究治疗前和治疗后评估之间发生的变化-变化过程-以及对该研究在治疗开发中的重要作用的重新理解重新产生了兴趣（Hayes，Hope和Hayes，2007）。CBT的核心机制是获得和使用应对技能。然而，在对10项测试应对作为CBT的假设作用机制的研究进行的综述中，Morganstern和Longabuagh（2000）得出结论认为，CBT通过其对应对的影响发挥作用的假设没有得到支持。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，在给定的研究中评估多种介质（即机制）具有巨大的益处。如果研究了两种或两种以上的机制，人们可以确定其中一种机制是否更合理或对结果的贡献更大。此外，考虑到任何一项治疗结局研究所需的时间和资源，对多种潜在机制的评估具有成本效益。在许多研究中，一些机制可能反复出现，而另一些机制则被搁置一旁。除了应对技能，CBT有效性的两个关键机制是提高自我效能和自信，减少对酒精使用的积极结果预期（Moos，2007）。另外两种机制，被认为是在许多不同的干预措施，包括CBT，正在增加治疗联盟和减少/调节负面情绪状态。在本研究中，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周的酒精依赖CBT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测量上述4种理论上相关的行为机制来绘制成功的CBT的变化过程（即，每周一次）。正如Hayes等人（2007年）所述，这种“地图”将具有几个重要的意义，包括：（1）进一步完善现有的治疗程序;（2）更清楚地了解恢复、治疗退出、反应不良和复发的过程;（3）进一步发展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多次发生的4种理论上相关的行为变化机制（即，每周治疗一次）。为了研究过程随时间的演变，需要进行这种细粒度的分析。这样的“地图”将有几个重要的意义，包括：（1）进一步完善现有的治疗程序;（2）更清楚地了解恢复，治疗脱落，反应差和复发的过程;（3）进一步发展经验支持的治疗过程。

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.