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.
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