Psychotherapy Process in Alcohol Treatment Matching

描述（由申请人提供）：在PROJECT MATCH的令人失望的发现之前，患者治疗匹配被视为提高酒精治疗有效性的有希望的范例。在MATCH中，支持将治疗方式与患者属性相匹配的研究结果的缺乏导致研究人员在很大程度上放弃了这种范式。然而，进一步的研究使用了观察员评级的治疗师干预从一个匹配的善后处理网站，成功地确定3患者属性匹配的假设。具体而言，（1）治疗师的指导性，以应对患者的特质反应，（2）治疗师的指导性，以应对患者的特质愤怒，（3）治疗前的情绪焦点，以应对患者的抑郁症状显着预测饮酒频率在一年后的治疗。该拟定延续研究的第一个目的是在从其他MATCH善后护理中心（N=138）选择的患者样本中复制这些结果。此外，该项目将通过在来自MATCH门诊中心的患者样本（N=138）中进行测试，确定这些匹配效应对门诊人群的普遍性。该项目的第二个目标是测试一个先验的多维类型匹配治疗师干预患者属性的预测有效性。方差分析将用于检验 治疗后饮酒的差异在具有匹配或不匹配的治疗特征的患者中。 第三个目标是测试假设的中介匹配效果。假设对于 患者处于中度或高度的抗拒或愤怒状态时，工作联盟起到了中介作用 治疗师的指导和喝酒之间的关系进一步假设，对于抑郁症状严重的患者来说，痛苦介导了治疗情绪焦点和饮酒之间的关系。间接影响的检查将用于检验中介作用。对于所有三个目标，主要结局变量将是治疗后一年内饮酒的频率。我们将分析每个饮酒日的饮酒量和大量饮酒的频率作为次要结果。如果是肯定的，这项研究的结果将（1）重新建立患者治疗匹配作为一个有价值的范例，以提高患者饮酒的结果，（2）为临床医生提供实用的技术，以显着改善他们的患者的结果，和（3）有助于研究酒精治疗效果的理论和方法。

DESCRIPTION (provided by applicant): Prior to the disappointing findings of PROJECT MATCH, patient-treatment matching was viewed as a promising paradigm for increasing alcohol treatment effectiveness. The paucity of findings to support matching treatment modality to patient attribute in MATCH has led researchers to largely abandon this paradigm. However, further study has used observer ratings of therapist interventions from one MATCH aftercare site to successfully identify 3 patient attribute matching hypotheses. Specifically, (1) therapist directiveness in response to patient trait reactance, (2) therapist directiveness in response to patient trait anger, and (3) the emotion focus of therapy in response to patient depressive symptoms before treatment significantly predicted drinking frequency during the year after treatment. The first objective of this proposed continuation is to replicate these findings in a sample of patients selected from an additional MATCH aftercare site (N=138). Additionally, the project will determine the generalizability of these matching effects to an outpatient population by testing for them among a sample of patients from MATCH outpatient sites (N=138). The second objective of the project is to test the predictive validity of an a priori multi-dimensional typology for matching therapist interventions to patient attributes. Analysis of variance will be used to test for differences in post-treatment drinking among patients who had a matched or mismatched therapy profile. The third objective is to test hypothesized mediators of the matching effects. It is hypothesized that for patients at medium or high levels of reactance or anger, the working alliance mediates the relationship between therapist directiveness and drinking. It is further hypothesized that for patients high in depressive symptoms, distress mediates the relationship between therapy emotion focus and drinking. Examination of indirect effects will be used to test for mediation. For all three objectives the primary outcome variable will be frequency of drinking during the year after treatment. We will analyze drinks per drinking day and the frequency of heavy drinking as secondary outcomes. If positive, the results of this study will (1) re-establish patient-treatment matching as a valuable paradigm for enhancing patient drinking outcomes, (2) provide clinicians with practical techniques to significantly improve their patients' outcomes, and (3) contribute to theory and methodology for studying alcohol treatment effectiveness.