Psychotherapy Process in Alcohol Treatment Matching

描述（由申请人提供）：在项目匹配令人失望的结果之前，患者-治疗匹配被视为提高酒精治疗效果的有希望的范例。在MATCH中，缺乏支持将治疗方式与患者属性相匹配的研究结果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来自MATCH善后站点的治疗师干预的观察者评分，成功地确定了3个患者属性匹配假设。具体而言，(1)治疗师对患者特质抗拒的指导性，(2)治疗师对患者特质愤怒的指导性，以及(3)治疗前对患者抑郁症状的治疗情绪焦点显著预测治疗后一年的饮酒频率。本研究的第一个目标是在另一个MATCH术后护理中心（N=138）选择的患者样本中重复这些发现。此外，该项目将通过在MATCH门诊站点的患者样本（N=138）中进行测试，确定这些匹配效应在门诊人群中的普遍性。该项目的第二个目标是测试先验多维类型的预测有效性，以匹配治疗师干预与患者属性。方差分析将用于检验

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.