Division of Addiction Psychiatry, Department of Psychiatry, University of Massachusetts Medical School.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai.
J Consult Clin Psychol. 2020 Jun;88(6):541-553. doi: 10.1037/ccp0000492. Epub 2020 Feb 17.
In a randomized trial for women with alcohol use disorders (AUD), the efficacy of Female-Specific Cognitive Behavioral Therapy (FS-CBT) was compared with Gender-Neutral CBT (GN-CBT; Epstein et al., 2018). The current study examined whether putative mechanisms of change differed between treatment conditions, using a novel statistical approach. Both treatments were hypothesized to work by increasing use of alcohol-related coping skills (coping) and confidence to abstain from drinking (confidence), but FS-CBT additionally targeted female-salient mechanisms: anxiety, depression, sociotropy (i.e., overinvestment in others' opinion of oneself), autonomy, and social networks supportive of abstinence.
Ninety-nine women with AUD (55 in GN-CBT, 44 in FS-CBT) completed self-report assessments at baseline and 0, 6, and 12 months posttreatment. Multilevel vector autoregression estimation was used to analyze associations between putative mechanisms of change, and network models of those associations were generated using network analysis.
Across conditions, higher confidence and coping were directly associated with less drinking; autonomy was directly and indirectly associated with drinking. Additionally, network analysis indicated that although variation in depression was associated with change in other variables specifically for GN-CBT, sociotropy was associated with change specifically in FS-CBT.
Women receiving CBT-AUD changed their drinking through increased confidence to abstain and greater use of coping skills. Autonomy played a central role in behavior change across treatment conditions. Participants receiving treatment tailored to women also changed through decreases in sociotropy and increases in social support for abstinence. For women who received standard CBT, changes in depression were important to clinical improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
在一项针对酒精使用障碍（AUD）女性的随机试验中，比较了女性特定认知行为疗法（FS-CBT）与性别中立认知行为疗法（GN-CBT；Epstein 等人，2018）的疗效。本研究使用一种新的统计方法，研究了治疗条件下变化的潜在机制是否存在差异。两种治疗方法都被假设通过增加使用与酒精相关的应对技能（应对）和戒酒的信心（信心）起作用，但 FS-CBT 还针对女性突出的机制：焦虑、抑郁、社交依赖（即过度关注他人对自己的看法）、自主性和支持戒酒的社交网络。
99 名 AUD 女性（GN-CBT 组 55 名，FS-CBT 组 44 名）在基线和治疗后 0、6 和 12 个月完成了自我报告评估。采用多层向量自回归估计分析了变化的潜在机制之间的关联，并使用网络分析生成了这些关联的网络模型。
在两种条件下，更高的信心和应对与饮酒量减少直接相关；自主性与饮酒量直接和间接相关。此外，网络分析表明，尽管 GN-CBT 中抑郁的变化与其他变量的变化有关，但社交依赖与 FS-CBT 中特定变量的变化有关。
接受 CBT-AUD 的女性通过增加戒酒的信心和更多地使用应对技能来改变她们的饮酒行为。自主性在治疗条件下的行为改变中起着核心作用。接受针对女性的治疗的参与者也通过减少社交依赖和增加戒酒的社会支持来改变。对于接受标准 CBT 的女性，抑郁的变化对临床改善很重要。（PsycInfo 数据库记录（c）2020 APA，保留所有权利）。
