Understanding Treatment Dropout Among Women with Posttraumatic Stress Disorder and Heavy Drinking

对于患有创伤后应激障碍的人来说，放弃治疗是一个主要的挑战 创伤暴露后的创伤后精神障碍(PTSD)和酒精使用障碍(AUD)。PTSD+AUD的治疗在以下方面有效 减少症状，但治疗自然减员是一个关键问题。PTSD+AUD患者的辍学率 比那些单独患有创伤后应激障碍的人更高，辍学与临床改善较少相关。一个更清晰的 了解导致辍学的因素，包括那些开始提供服务但没有开始的人 治疗(无效者)和那些开始治疗但没有完成治疗的人(不完全者)将使我们 制定战略，改善这一人群的保留率和治疗结果。检查可修改的 和理论上知情的结构，如难以容忍情绪痛苦和应对动机 酒精的使用，可能会提高我们对治疗辍学的认识。此外，观察员对会期的评分 行为，或“薄片”评级，是一种衡量预测因素的方法，更接近于何时发生辍学和 有可能成为辍学的有力预测指标。薄片指的是短的(例如30秒)视频剪辑 由受过训练的观察者对特定的结构或感兴趣的结果进行评级的表达行为。建议数 F32将使用混合方法，使用从现有的 性侵犯后患有创伤后应激障碍和酗酒的女性的临床试验。具体目标是：1)识别 通过进行定性访谈，与不成功者和未完成者退学原因相关的主题 与性侵犯服务提供者(N=10)合作，这将被用来制定“薄片”评级 用于目标2)预测辍学和相关治疗的观察参与者行为的结构 使用薄片评级和高级统计方法进行加工(N=100)。退学治疗将是 在每种治疗条件下(想象暴露和酒精技能训练)和之间进行检查 治疗条件，以测试某些薄片结构是否更好地预测某些特定的辍学 治疗的类型。我们还将检查与辍学有关的治疗过程的轨迹：困难 忍受情绪和对酒精的渴望。3)通过以下方式丰富目标2的量化调查结果并将其纳入背景 同时进行定性访谈，探讨参与治疗的妇女的治疗开始和辍学情况 性侵犯后创伤后应激障碍和酗酒的临床试验(N=25)。申请者将接受培训 在1)创伤后应激障碍和酒精治疗过程研究中，2)在临床试验中进行预测辍学的研究， 3)收集和分析定性和定量数据的技能发展；4)手稿和助学金 写作。拟议的研究将对我们理解辍学做出重大贡献，这是必要的 制定增加保留率和改善治疗结果的战略的第一步 弱势群体。

Treatment dropout is a primary challenge for individuals suffering with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) following trauma exposure. Treatments for PTSD+AUD are effective at reducing symptoms, yet treatment attrition is a critical issue. Dropout rates among individuals with PTSD+AUD are higher than for those with PTSD alone, and dropout is associated with less clinical improvement. A clearer understanding of the factors that contribute to dropout, including those who initiate services but do not start treatment (nonstarters) and those who start but do not complete treatment (noncompleters), will enable us to develop strategies that improve retention and treatment outcomes for this population. Examining modifiable and theoretically informed constructs, such as difficulty tolerating emotional distress and coping motives for alcohol use, may improve our understanding of treatment dropout. Additionally, observer ratings of in-session behavior, or “thin slice” ratings, is a method of measuring predictors more proximal to when dropout occurs and has the potential to be a robust predictor of dropout. Thin slice refers to short (e.g. 30 second) video clips of expressive behavior rated by trained observers on specified constructs or outcomes of interest. The proposed F32 will use mixed methods to explore reasons for treatment dropout using data collected from an existing clinical trial for women with PTSD and heavy drinking following sexual assault. Specific aims are: 1) To identify themes related to reasons for dropout for nonstarters and noncompleters by conducting qualitative interviews with providers of sexual assault services (N = 10), which will be used to develop the “thin slice” rating constructs of observed participant behavior for use in Aim 2. 2) To predict dropout and related treatment processes (N = 100) using thin slice ratings and advanced statistical methods. Treatment dropout will be examined within each treatment condition (imaginal exposure and alcohol skills training) and between treatment conditions to test whether certain thin slice constructs are better at predicting dropout for certain types of treatment. We will also examine trajectories of treatment processes related to dropout: difficulty tolerating emotions and alcohol craving. 3) To enrich and contextualize Aim 2 quantitative findings by concurrently conducting qualitative interviews exploring treatment initiation and dropout with women enrolled in a clinical trial for PTSD and heavy drinking following sexual assault (N = 25). The applicant will receive training in 1) PTSD and alcohol treatment process research, 2) conducting studies predicting dropout in clinical trials, 3) skill development for collecting and analyzing qualitative and quantitative data, and 4) manuscript and grant writing. The proposed study will make substantial contributions to our understanding of dropout, a necessary first step to the development of strategies to increase retention and improve treatment outcomes for this vulnerable population.