Behavioral Research in Technology and Engineering (BRiTE Center), University of Washington.
University of Massachusetts Medical School.
Behav Ther. 2019 Nov;50(6):1030-1041. doi: 10.1016/j.beth.2019.01.009. Epub 2019 Feb 8.
Abstinence self-efficacy, coping skills, and therapeutic alliance are hypothesized mechanisms of behavioral change (MOBCs) in cognitive-behavioral therapy (CBT) for alcohol use disorder (AUD). However, little is known about when these hypothesized MOBCs change during treatment or in relation to the initiation of abstinence from alcohol, which the current study investigated. Patient-reported abstinence self-efficacy, drinking-related coping skills, and therapeutic alliance were measured at every session throughout a 12-session clinical trial that previously showed equivalent drinking reductions in female-specific individual- and group-based CBT for AUD. Participants (N = 121 women) were classified into subgroups based on whether and when they first initiated 14 days of continuous abstinence from alcohol during treatment. Interrupted time-series analyses evaluated the magnitude and timing of change in MOBC variables in relation to the initiation of abstinence. All three MOBC measures showed gradual improvements throughout treatment (within-subjects d = 0.03 to 0.09 change per week). Participants who initiated abstinence during treatment experienced additional sudden improvements in abstinence self-efficacy (d = 0.47) and coping skills (d = 0.27), but not therapeutic alliance (d = -0.02), the same week they initiated abstinence. Participants who were already abstinent when treatment started maintained higher abstinence self-efficacy and coping skills, but not therapeutic alliance, throughout treatment compared to participants who never initiated abstinence. Initiating abstinence may help facilitate improvements in abstinence self-efficacy and drinking-related coping skills. Clinicians may help patients anticipate when and how much these variables are expected to improve during treatment and encourage initiation of abstinence to potentially help facilitate improvements in abstinence self-efficacy and coping skills.
禁欲自我效能、应对技能和治疗联盟被假设为认知行为疗法（CBT）治疗酒精使用障碍（AUD）的行为改变机制（MOBC）。然而，对于这些假设的 MOBC 在治疗过程中何时发生变化，或者与开始戒酒之间的关系，目前知之甚少，本研究对此进行了探讨。在一项 12 期临床试验中，在每次治疗过程中都测量了患者报告的禁欲自我效能、与饮酒相关的应对技能和治疗联盟，该试验先前表明，针对 AUD 的女性个体化和基于小组的 CBT 在减少饮酒方面效果相当。参与者（N = 121 名女性）根据他们在治疗过程中是否以及何时首次开始连续 14 天戒酒，被分为亚组。中断时间序列分析评估了 MOBC 变量与戒酒开始相关的变化幅度和时间。所有三种 MOBC 测量指标在整个治疗过程中均显示出逐渐改善（个体内 d = 0.03 至 0.09，每周变化）。在治疗过程中开始戒酒的参与者，在开始戒酒的同一周内，在禁欲自我效能（d = 0.47）和应对技能（d = 0.27）方面出现了额外的突然改善，但在治疗联盟方面（d = -0.02）并没有出现改善。与从未开始戒酒的参与者相比，治疗开始时已经戒酒的参与者在整个治疗过程中保持了更高的禁欲自我效能和应对技能，但治疗联盟没有变化。开始戒酒可能有助于促进禁欲自我效能和与饮酒相关的应对技能的改善。临床医生可以帮助患者预测这些变量在治疗过程中何时以及预计会有多大程度的改善，并鼓励开始戒酒，以帮助促进禁欲自我效能和应对技能的改善。
