Kavanagh David J, Sitharthan Gomathi, Young Ross M, Sitharthan Thiagarajan, Saunders John B, Shockley Natalie, Giannopoulos Vicki
School of Medicine, University of Queensland, Queensland, Australia.
Addiction. 2006 Aug;101(8):1106-16. doi: 10.1111/j.1360-0443.2006.01488.x.
To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction (emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric.
Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE.
Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia.
People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded.
Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance.
Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression.
Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions.
These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.
测试对于烦躁不安时饮酒的人群，增加以节制为导向的线索暴露（CE）或在烦躁情绪诱导后进行线索暴露（情绪性线索暴露，ECE）是否比单纯认知行为疗法（CBT）能带来更好的治疗效果。
多中心随机对照试验，比较CBT与CBT + CE以及CBT + ECE。
澳大利亚布里斯班和悉尼学术治疗单位的门诊室。
有酒精滥用问题且在烦躁不安时难以控制饮酒量的人群（n = 163）。排除当前患有重度抑郁发作的人群。
所有参与者均接受为期八周、每周一次、每次75分钟的酒精问题个体治疗，各条件下的CBT元素保持不变。从第二阶段开始，CBT + CE组参与者在接触酒精线索时抵制饮酒，部分疗程中会给予两剂他们偏好的饮料作为启动剂量。在初始的CE疗程后，CBT + ECE组参与者在进行CE之前回忆负面经历，以接触与个人相关的情绪线索。
酒精摄入量、相关问题、酒精预期、自我效能感和抑郁情况。
各条件下平均改善情况均非常显著，且在12个月内效果维持良好。与单纯CBT相比，CBT + CE和CBT + ECE组的治疗保留率和对酒精消费的影响逐渐减弱。各条件下酒精依赖和抑郁的变化无差异。
这些数据并未表明在标准CBT基础上增加基于诊所的CE能改善治疗效果。可能需要采用不同的方法来处理渴望。
