Behavioral Research in Technology and Engineering (BRiTE) Center.
Department of Psychiatry.
J Consult Clin Psychol. 2021 Apr;89(4):277-287. doi: 10.1037/ccp0000643.
Clients who receive alcohol use disorder (AUD) treatment experience variable outcomes. Measuring clinical progress during treatment using standardized measures (i.e., measurement-based care) can help indicate whether clinical improvements are occurring. Measures of mechanisms of behavioral change (MOBCs) may be particularly well-suited for measurement-based care; however, measuring MOBCs would be more feasible and informative if measures were briefer and if their ability to detect reliable change with individual clients was better articulated.
Three abbreviated measures of hypothesized MOBCs (abstinence self-efficacy, coping strategies, anxiety) and a fourth full-length measure (depression) were administered weekly during a 12-week randomized trial of cognitive-behavioral therapy (CBT) for women with AUD. Psychometric analyses estimated how reliably each measure distinguished within-person change from between-person differences and measurement error. Reliability coefficients were estimated for simulated briefer versions of each instrument (i.e., instruments with fewer items than the already-abbreviated instruments) and rates of reliable improvement and reliable worsening were estimated for each measure.
All four measures had good reliability (.86-.90) for detecting within-person change. Many participants (41.4%-62.5%) reliably improved on MOBCs from first to last treatment session. Reliable improvement on MOBCs was associated with reductions in percentage of drinking days (PDD) at 3, 9, and 15-month follow-ups. Simulated briefer versions of each instrument retained good reliability for detecting change with only 3 (self-efficacy), 11 (coping strategies), 5 (anxiety), or 10 items (depression).
Brief MOBC measures can detect reliable change for individuals in AUD treatment. Routinely measuring MOBCs may help with monitoring clinical progress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
接受酒精使用障碍（AUD）治疗的患者会出现不同的治疗结果。使用标准化的测量方法（即基于测量的护理）来衡量治疗期间的临床进展，可以帮助确定是否正在出现临床改善。行为改变机制的测量方法（MOBCs）可能特别适合基于测量的护理；然而，如果测量方法更简短，并且能够更好地说明其检测个体患者可靠变化的能力，那么测量 MOBCs 将更加可行和有意义。
在一项为期 12 周的针对 AUD 女性的认知行为疗法（CBT）随机试验中，每周对三个假设的 MOBC 简化测量方法（戒酒自我效能、应对策略、焦虑）和第四个全长测量方法（抑郁）进行管理。心理测量分析估计了每个测量方法在区分个体内变化与个体间差异和测量误差方面的可靠性。为每个仪器模拟更简短的版本（即比已经简化的仪器项目更少的仪器）估计了可靠性系数，并为每个仪器估计了可靠改善和可靠恶化的比率。
所有四个测量方法在检测个体内变化方面都具有良好的可靠性（0.86-0.90）。许多参与者（41.4%-62.5%）在 MOBC 上从第一个到最后一个治疗阶段都可靠地改善了。MOBC 的可靠改善与 3、9 和 15 个月随访时的饮酒天数百分比（PDD）减少有关。每个仪器的模拟简短版本都保留了良好的可靠性，仅使用 3（自我效能）、11（应对策略）、5（焦虑）或 10 个项目（抑郁）即可检测到变化。
简短的 MOBC 测量方法可以检测 AUD 治疗个体的可靠变化。定期测量 MOBC 可能有助于监测临床进展。
