PSYCHOTHERAPY PROCESS IN ALCOHOLISM TREATMENT MATCHING

申请者摘要：医患匹配效果的最新研究 酒精治疗的结果好坏参半，没有定论。此外， 心理治疗(例如，认知、行为和动机治疗 增强疗法)继续显示大致相同的疗效， 尽管患者的理论立场和声称的机制不同 变化。这个项目的具体目标是确定如何治疗 有效性受患者特征之间的相互作用的影响 以及心理治疗的过程。 这项研究将利用患者信息和档案数据集 随机化临床配对项目的心理治疗录像 最初设计用于评估患者-治疗匹配效果的试验 三种治疗酗酒的社会心理疗法。拟议的研究将 补充项目比赛对机械化治疗的检验分析 所有治疗中都存在潜在的过程。 来自Project Match的布朗大学研究部门的168名患者将 被选为本次研究的对象。患者和治疗流程维度具有 预测酒精中毒治疗的有效性将是有希望的 选自一种名为系统的患者-治疗匹配模型 治疗选择(STS)。项目匹配数据可以用来测试3个这样的 与STS模型中的假设相匹配。每一种假设都规定了理想 患者特征和治疗过程变量之间的关系。 焦点的3个患者特征将是：(1)情绪困扰，(2)和 外化应对方式；(3)心理反应。 对于这些患者属性中的每一个，STS模型指定治疗 将产生最佳结果的进程。相应的三种疗法 过程变量将是治疗师干预的程度 每个病人(1)试图增加或减少病人的情绪唤醒 级别，(2)洞察力或行为重点，以及(3)指令性或 非指令性。这些方面的治疗将通过STS疗法进行衡量 评价表，将由两名训练有素的观察员完成，共选定4名 为每个患者提供治疗疗程。它们之间的关系 患者-治疗互动(例如，患者电抗和指导性 治疗干预)和酒精使用结果将在 治疗后三个月和一年的随访。 这项研究将揭示裁剪重要性的新信息 治疗师对寻求酒精中毒治疗的患者的干预。是这样的 信息将显著提高酒精中毒的治疗效果。

APPLICANT'S ABSTRACT: Recent research on patient-treatment matching effects in alcohol treatment has produced mixed and inconclusive results. Further, psychotherapy treatments (e.g., cognitive behavioral and motivational enhancement therapies) continue to demonstrate roughly equivalent efficacy, despite different theoretical stances and purported mechanisms of patient change. The specific objective of this project is to identify how treatment effectiveness is impacted by the interaction between patient characteristics and the process of psychotherapy. This study will utilize an archival data set of patient information and videotaped psychotherapy treatment from Project MATCH, a randomized clinical trial originally designed to evaluate patient-treatment matching effects across 3 psychosocial treatments for alcoholism. The proposed research will compliment Project MATCH's analyses of manualized treatments by examining underlying processes present in all of the treatments. The 168 patients from Project MATCH's Brown University research unit will be selected for this study. Patient and therapy process dimensions that have shown promise for predicting the effectiveness of alcoholism treatment will be selected from a model of patient-treatment matching called Systematic Treatment Selection (STS). Project MATCH data can be used to test 3 such matching hypotheses from the STS model. Each hypothesis specifies ideal relationships between a patient characteristic and a therapy process variable. The 3 patient attributes of focus will be: (1) emotional distress, (2) an externalizing coping style, and (3) psychological reactance. For each of these patient attributes, the STS model specifies treatment processes that will result in optimal outcomes. The 3 corresponding therapy process variables will be the extent to which therapist interventions with each patient (1) attempt to increase or decrease a patient's emotional arousal level, (2) are insight or behavior focused, and (3) are directive or non-directive. These aspects of therapy will be measured by the STS Therapy Rating Scale, which will be completed by two trained observers on 4 selected therapy sessions for each patient. The relationship between each patient-therapy interaction (e.g., patient reactance and the directiveness of therapy interventions) and alcohol use outcomes will be assessed at the three-month and one year post-treatment follow-ups. This study will reveal new information about the importance of tailoring therapist interventions to patients seeking treatment for alcoholism. Such information will significantly enhance alcoholism treatment effectiveness.