Document Detail

What do we know? Process analysis and the search for a better understanding of Project MATCH's anger-by-treatment matching effect.
MedLine Citation:
PMID:  15376825     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: A consistent matching result from Project MATCH was the impact of patient trait anger on the effectiveness of alcohol treatments. Despite that finding, subsequent work failed to identify mechanisms underlying the effect. The present study examined a potential mediator, therapist directiveness, to determine its relationship with patient anger, treatment modality and drinking outcomes.
METHOD: Observers rated therapist directiveness for 140 patients (70% men) at one MATCH aftercare site. ANOVA was used to test for the interaction between directiveness and patient anger, treatment differences in level of directiveness, the interaction between treatment modality and anger, and directiveness as a mediator of treatment modality effects.
RESULTS: A disordinal interaction was found between patient anger and therapist directiveness. Directiveness was associated with worse drinking outcomes among high anger patients and associated with less frequent drinking among low anger patients. Patient anger also interacted with treatment modality. Motivational enhancement therapy (MET) was more effective than cognitive behavioral therapy (CBT) for patients high in anger, whereas the reverse was true for patients low in anger. A lower level of therapist directiveness in MET mediated its superiority over CBT for high anger patients. Twelve-step facilitation therapy (TSF) was comparably effective to MET for high anger patients; it is interesting to note that TSF and MET did not differ in directiveness.
CONCLUSIONS: Therapist directiveness is important to consider when working with patients at varying levels of trait anger. Analysis of the therapy process and tests for mediation are critical to further understand active ingredients of psychosocial treatment.
Mitchell P Karno; Richard Longabaugh
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of studies on alcohol     Volume:  65     ISSN:  0096-882X     ISO Abbreviation:  J. Stud. Alcohol     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-09-20     Completed Date:  2004-12-21     Revised Date:  2014-07-28    
Medline Journal Info:
Nlm Unique ID:  7503813     Medline TA:  J Stud Alcohol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  501-12     Citation Subset:  IM    
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MeSH Terms
Alcoholism / psychology,  therapy*
Analysis of Variance
Anger* / physiology
Behavior Therapy / methods,  statistics & numerical data*
Cognitive Therapy / methods,  statistics & numerical data
Comprehension* / physiology
Middle Aged
Self-Help Groups / statistics & numerical data*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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