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，进一步的研究已经使用观察员评级的治疗师干预从一个匹配的善后处理网站，成功地支持两个三个治疗师的行为，患者属性匹配的假设来自Beutler和Clarkin的系统治疗选择模型。具体而言，（1）治疗前对患者痛苦的治疗情绪焦点和（2）治疗师对患者特质反应的指导性显著预测了治疗后一年内的饮酒频率。 本计划延续的第一个目标是在从其他MATCH康复中心随机选择的患者样本（N=127）中复制这些结果。此外，该项目将通过在MATCH门诊中心随机选择的患者样本（N=127）中进行测试，确定这些匹配效应对门诊人群的普遍性。第二个目标是测试这些匹配效应的理论基础。本研究假设治疗过程中患者的情绪唤醒对治疗情绪焦点和饮酒之间的关系起中介作用。也有人假设，在会话中的病人合作调解治疗师的指导性和饮酒之间的关系。 将使用Baron和Kenny的方法进行因果链分析，以确定中介变量。该项目的第三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。将使用线性回归分析来检验接受匹配、部分匹配或不匹配治疗特征的患者之间治疗后饮酒结果的差异。对于所有三个目标，结果变量将是治疗后一年内饮酒频率和重度饮酒频率。如果是积极的，本研究的结果将：（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）有助于研究酒精治疗效果的理论和方法，（3）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。

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 support two of three therapist behavior by patient attribute matching hypotheses derived from Beutler and Clarkin's Systematic Treatment Selection model. Specifically, (1) the emotion focus of therapy in response to patient distress before treatment and (2) therapist directiveness in response to patient trait reactance 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 randomly selected from an additional MATCH aftercare site (N=127). Additionally, the project will determine the generalizability of these matching effects to an outpatient population by testing for them among a sample of randomly selected patients from MATCH outpatient sites (N=127). The second objective is to test the theoretical underpinnings of these matching effects. It is hypothesized that patient emotional arousal in treatment mediates the relationship between therapy emotion focus and drinking. It is also hypothesized that in-session patient collaboration mediates the relationship between therapist directiveness and drinking. Causal chain analysis will be conducted using Baron and Kenny's method to identify mediator variables. The third objective of the project is to test the predictive validity of an a priori multi-dimensional typology for matching therapist interventions to patient attributes. Linear regression analysis will be used to test for differences in post-treatment drinking outcomes among patients who received a matched, partially matched, or mismatched therapy profile. For all three objectives the outcome variables will be frequency of drinking and frequency of heavy drinking during the year after treatment. If positive, the results of this study will: (1) re-establish patient-treatment matching as a valuable paradigm for enhancing patient drinking outcomes, (2) contribute to theory and methodology for studying alcohol treatment effectiveness, and (3) provide clinicians with practical techniques to significantly improve their patients' outcomes.