Kelly Lourah M, Crane Cory A, Zajac Kristyn, Easton Caroline J
Rochester Institute of Technology, College of Health Sciences and Technology, 153 Lomb Memorial Drive, Rochester, NY, 14623.
University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030.
Adv Dual Diagn. 2021 Aug 10;14(3):85-98. doi: 10.1108/add-09-2020-0020. Epub 2021 May 21.
Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. We hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response.
DESIGN/METHODOLOGY/APPROACH: A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (=29) to those in DC (=34).
Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (e.g., family, strangers) during treatment. For men depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up.
Although integrated CBT's efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.
Integrated CBT buffered depressive symptoms' impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms.
RESEARCH LIMITATIONS/IMPLICATIONS: This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples.
过去的研究证明了综合认知行为疗法（CBT）对物质使用障碍（SUD）和亲密伴侣暴力（IPV）的疗效，以及该人群中抑郁症状的高发生率。然而，关于抑郁症状如何影响治疗结果却知之甚少。我们假设综合CBT而非标准药物咨询（DC）能够缓冲抑郁症状对治疗反应的负面影响。
设计/方法/途径：对一项随机试验进行二次分析，将被分配接受为期12周的针对SUD和IPV的综合CBT的男性（=29）与接受DC的男性（=34）进行比较。
大多数（60%）样本报告有任何抑郁症状。在控制基线IPV的情况下，报告有任何抑郁症状与治疗期间可卡因筛查呈更阳性相关。在有抑郁症状的男性中，综合CBT而非DC与较少的可卡因筛查阳性相关。在控制基线酒精变量的情况下，综合CBT和抑郁症状在治疗期间均与亲密关系之外（如家庭、陌生人）的攻击性降低相关。对于有抑郁症状的男性，与DC相比，综合CBT与较少的非IPV攻击性相关。对其他物质、IPV或随访时的影响不显著。
尽管综合CBT改善SUD和IPV的疗效已得到证实，但尚未对治疗反应的调节因素进行研究。
综合CBT缓冲了抑郁症状对可卡因使用的影响，但仅改善了无抑郁症状男性的非IPV攻击性。
研究局限性/启示：本研究发现了一些证据表明在治疗结束时抑郁症状对CBT在可卡因和攻击性方面存在不同反应，但三个月后这种差异并未持续。未来的研究应探索综合CBT治疗SUD和IPV的机制，包括情绪调节，以及在现实世界样本中对抑郁症状的影响。
