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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
5R01AA012155-02
Application #
6371536
Study Section
Special Emphasis Panel (ZAA1-BB (05))
Program Officer
Mattson, Margaret
Project Start
2000-08-01
Project End
2003-07-31
Budget Start
2001-08-01
Budget End
2002-07-31
Support Year
2
Fiscal Year
2001
Total Cost
$196,250
Indirect Cost
Name
Brown University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001785542
City
Providence
State
RI
Country
United States
Zip Code
02912
Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane (2010) What explains the relationship between the therapist structure × patient reactance interaction and drinking outcome? An examination of potential mediators. Psychol Addict Behav 24:600-7
Karno, Mitchell P; Longabaugh, Richard; Herbeck, Diane (2009) Patient reactance as a moderator of the effect of therapist structure on posttreatment alcohol use. J Stud Alcohol Drugs 70:929-36
Longabaugh, Richard (2007) The search for mechanisms of change in behavioral treatments for alcohol use disorders: a commentary. Alcohol Clin Exp Res 31:21s-32s
Karno, Mitchell P (2007) A case study of mediators of treatment effectiveness. Alcohol Clin Exp Res 31:33s-39s
Karno, Mitchell P; Longabaugh, Richard (2007) Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment. Addiction 102:587-96
Karno, Mitchell P; Longabaugh, Richard (2005) An examination of how therapist directiveness interacts with patient anger and reactance to predict alcohol use. J Stud Alcohol 66:825-32
Karno, Mitchell P; Longabaugh, Richard (2005) Less directiveness by therapists improves drinking outcomes of reactant clients in alcoholism treatment. J Consult Clin Psychol 73:262-7
Longabaugh, Richard; Donovan, Dennis M; Karno, Mitchell P et al. (2005) Active ingredients: how and why evidence-based alcohol behavioral treatment interventions work. Alcohol Clin Exp Res 29:235-47
Karno, Mitchell P; Longabaugh, Richard (2004) What do we know? Process analysis and the search for a better understanding of Project MATCH's anger-by-treatment matching effect. J Stud Alcohol 65:501-12
Karno, Mitchell P; Longabaugh, Richard (2003) Patient depressive symptoms and therapist focus on emotional material: a new look at Project MATCH. J Stud Alcohol 64:607-15

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