Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY, United States.
Prevention Science Institute, University of Oregon, Eugene, OR, United States.
J Med Internet Res. 2024 Aug 29;26:e56119. doi: 10.2196/56119.
Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system's focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes.
The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects.
Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory-II) and anger (State-Trait Anger Expression Inventory 2-State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups.
Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12).
The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group.
ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241.
与患有酒精使用障碍（AUD）的伴侣生活在一起的个体可能会经历显著的心理困扰，并比没有 AUD 伴侣的个体更多地使用医疗保健服务。然而，现行治疗系统对伴侣的关注和个人障碍限制了这些个体获得自我帮助的机会。一项针对自我指导、基于网络的应对技能培训计划“停止旋转我的车轮（SSMW）”的初步工作表明，该计划有可能为这一人群拓宽现有的治疗方法。在这项研究中，我们对 SSMW 的主要结果进行了稳健的评估。
该研究旨在检验以下假设：与 AUD 伴侣生活在一起的女性（1）与常规网络护理（UWC）对照组相比，接受 SSMW 治疗的女性在减轻负面情绪（抑郁和愤怒）方面的效果是否更大；（2）与没有接受简短电话教练支持的 SSMW 治疗相比（SSMW 仅），接受 SSMW+教练支持的女性（SSMW+coach）的效果是否更大；（3）基线负面情绪是否调节治疗效果。
女性（平均年龄 45.7±10.8 岁；黑人：17/456，3.7%；白人：408/456，89.5%）被随机分配到 SSMW 仅、SSMW+coach 或 UWC 组。在基线、12 周后测和 6 个月和 12 个月随访时评估抑郁（贝克抑郁量表-II）和愤怒（状态-特质愤怒表达量表 2-状态愤怒）。
所有条件下的参与者在基线到后测和基线到随访期间的抑郁程度均有所下降；SSMW 仅和 SSMW+coach 组的愤怒程度有所下降，但 UWC 组没有。与 UWC 组相比，SSMW 仅组的愤怒减轻更显著（P=.03），而 SSMW+coach 组的抑郁减轻更显著（P<.001）。然而，从基线到随访，只有 SSMW+coach 组与 UWC 组相比，愤怒减轻的程度更大，但不具有统计学意义（P=.052）。尽管 SSMW 组之间的负面情绪结果没有差异（P=.06-57），但 SSMW+coach 组的项目参与度和满意度更高（均 P<.004）。基线负面情绪并没有调节作用，尽管 SSMW 仅和 SSMW+coach 组从基线到随访的临床相关抑郁症状缓解率（贝克抑郁量表≥14）更高（SSMW 仅组：33/67，49%；比值比 2.13，95%置信区间 1.05-4.30；P=.03；SSMW+coach 组：46/74，62%；比值比 3.60，95%置信区间 1.79-7.23；P<.001），而 UWC 组（21/67，31%）；但 SSMW 组之间的缓解率没有差异（P=.12）。
研究结果部分支持了假设。SSMW 条件比 UWC 更早出现效果，但 UWC 中的积极变化减轻了长期 SSMW-UWC 差异的假设。结果强调了在基于网络的临床试验中纳入积极对照的重要性。尽管 SSMW+coach 在参与度和满意度以及需要治疗的人数（SSMW 仅为 5.6；SSMW+coach 为 3.2）方面优于 SSMW 仅，但 SSMW 条件与 UWC 相比在抑郁症状缓解水平上具有可比性和优越性。总的来说，SSMW 无论是否有教练都可以减轻有意义的痛苦，并为这一庞大的、服务不足的群体增加可利用的治疗选择。
ClinicalTrials.gov NCT02984241；https://www.clinicaltrials.gov/study/NCT02984241。
