Department of Psychiatry - Addiction Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23, 1011 Lausanne, Switzerland.
Department of Psychology, Northumbria University, 8 Roseworth Terrace, Gosforth, Newcastle upon Tyne NE3 1LU, UK.
J Subst Abuse Treat. 2022 Sep;140:108799. doi: 10.1016/j.jsat.2022.108799. Epub 2022 May 7.
This study explored whether treatment-specific processes linking therapist behaviors, post-session client ratings, and 3-month proximal outcomes (i.e., end of treatment) can explain 12-month outcomes for two contrasting alcohol treatment conditions with equivalent overall outcomes.
This study is a secondary analysis of the UK Alcohol Treatment Trial (UKATT), a multi-center randomized controlled trial of treatment for alcohol problems comparing 3-session motivational enhancement therapy (MET) to 8-session social behaviour and network therapy (SBNT). Among 742 adult clients included in UKATT, 351 had one treatment session recorded and coded and were followed-up 3 and 12 months after baseline. The study team conducted serial mediation analyses to test whether the frequency and quality of MET and SBNT skills were related to 12-month alcohol outcomes (drinks per drinking day) through postsession client ratings of treatment progress (Processes of Change Questionnaire, PCQ), readiness to change (RTC) and social support for drinking after 3-months.
Higher quality of MET skills was related to higher PCQ scores, which were in turn related to greater post-treatment RTC, and subsequently to better alcohol outcomes. Total indirect effect was consistently significant. In contrast, only PCQ was predictive of treatment outcome in the SBNT portion of the model.
This study provides evidence from a large pragmatic trial that the quality of MET skills positively influences alcohol outcomes in part through improvements in motivation during treatment and actively trying to change when treatment ends. Research should explore the ways in which SBNT secured outcomes that were equivalent to MET.
本研究探讨了特定于治疗的过程是否可以将治疗师行为、治疗后客户评分以及 3 个月的近期结果（即治疗结束时）联系起来，从而解释两种截然不同的酒精治疗条件的 12 个月结果，这两种治疗条件的总体结果相当。
本研究是英国酒精治疗试验（UKATT）的二次分析，这是一项针对酒精问题的多中心随机对照试验，比较了 3 节动机增强治疗（MET）与 8 节社会行为和网络治疗（SBNT）。在 UKATT 纳入的 742 名成年患者中，有 351 名患者记录并编码了一次治疗，并且在基线后 3 个月和 12 个月进行了随访。研究小组进行了一系列中介分析，以测试 MET 和 SBNT 技能的频率和质量是否通过治疗后客户对治疗进展的评价（改变过程问卷，PCQ）、改变的准备程度（RTC）和治疗结束后 3 个月的饮酒社会支持与 12 个月的酒精结果（饮酒量）相关。
更高质量的 MET 技能与更高的 PCQ 分数相关，而 PCQ 分数又与治疗后更高的 RTC 相关，进而与更好的酒精结果相关。总间接效应始终具有显著性。相比之下，在 SBNT 部分的模型中，只有 PCQ 预测了治疗结果。
这项研究从一项大型实用试验中提供了证据，表明 MET 技能的质量通过改善治疗期间的动机以及在治疗结束时积极尝试改变，对酒精结果产生积极影响。研究应探讨 SBNT 如何确保与 MET 相当的结果。
