A randomized trial of female-specific cognitive behavior therapy for alcohol dependent women.

Abstract

This study compared Female-Specific Cognitive Behavioral Therapy (FS-CBT) to evidence-based, gender-neutral CBT (GN-CBT; Epstein & McCrady, 2009) for women with alcohol use disorder (AUD). Women (N = 99) with AUD, mean age 48, were randomly assigned to 12 outpatient manual-guided sessions of FS-CBT (n = 44) or GN-CBT (n = 55). Women were assessed at baseline and 3, 9 and 15 months after baseline for drinking and for specific issues common among women with AUD. A FS-CBT protocol was developed that was discriminable on treatment integrity ratings from GN-CBT. No treatment condition differences were found in treatment engagement, changes in drinking, alcohol-related coping, abstinence self-efficacy, motivation to change, or constructs directly targeted in FS-CBT (sociotropy, autonomy, depression, anxiety). Women in both conditions were highly engaged and satisfied with treatment, and reported significant reductions in drinking and changes in desired directions for all other variables except social support for abstinence. In the year following treatment, women in the FS-CBT but not in the CBT condition reported an increase in percentage of abstainers in their social networks (0.69% per month, SE = 0.21, p = .002). The value and appeal of female-specific programming in AUD treatment has been established in the wider literature (Epstein & Menges, 2013), and the current study provides support for the use of the Female-Specific Cognitive Behavioral Therapy (FS-CBT) manual as an option that may yield outcomes similar to standard gender-neutral CBT for women with AUD. Future research should examine whether FS-CBT enhances treatment utilization for women. (PsycINFO Database Record

Treatment Interventions for Women With Alcohol Use Disorder

“… 58 The FS-CBT manual (a) highlighted two clinical themes meaningful to women, self-care and autonomy; (b) included female-specific interventions focused on coping with negative emotions and developing/enhancing women’s social network supportive of abstinence; and (c) provided women-specific examples throughout to personalize the material to each woman’s issues, such as dealing with heavy drinkers in the social network, parenting, life-stage transitions, trauma, self-esteem, and relationships. 59 In an RCT comparing FS-CBT to an evidence-based, gender-neutral CBT for AUD, Epstein and McCrady found that women in both treatment conditions were highly engaged, reported a high level of satisfaction with the treatment, significantly reduced their drinking, and improved in other areas of life functioning such as depression, anxiety, autonomy, and sociotropy. 58 There were no treatment condition effects, and the FS-CBT treatment was equally effective as the gender-neutral one.…”

“…Using Network Analysis, a novel statistical approach that uses multilevel vector autoregression estimation for multiple time series data to simultaneously examine change among several hypothesized mechanisms of change, Holzhauer and colleagues compared pathways to drinking reduction among women in gender-neutral versus FS-CBT. 59 , 92 Across treatments, women changed their drinking via increased coping skills, abstinence self-efficacy, and increased autonomy. For women in FS-CBT, change in drinking also occurred through decreases in sociotropy and increases in social support for abstinence.…”

Moderators of sudden gains after sessions addressing emotion regulation among women in treatment for alcohol use

“…At this baseline assessment, the participants met with a trained research assistant, completing additional self-report questionnaires and interviews to establish baseline measures of the outcome variables. They then were randomized to treatment condition (see parent RCT references for additional details, Epstein et al, under review; McCrady et al, 2016). …”

“…For instance, issues related to interpersonal functioning, emotion and mood regulation, and self-care have been shown to be particularly prevalent and relevant among women with AUD compared to men with AUD (Walitzer & Dearing, 2006; Timko, Finney, & Moos, 2005). The data used for the current study were from two clinical trials in which the second and fifth authors developed and tested a female-specific, cognitive behavioral treatment (FS-CBT) for AUD (Epstein et al, under review). In Study 1, FS-CBT was derived from and compared to an evidence-based, gender-neutral CBT (Epstein & McCrady, 2009); the data used in the current analyses were collected from women randomized to the female-specific CBT condition.…”

“…Two randomized clinical trials (RCTs) (McCrady, Epstein, Hallgren, Cook, & Jensen, 2016; Epstein et al, under review) from which data were drawn for the current study provided a unique opportunity to examine moderators of change after particular treatment sessions. In the clinical trials, specific manual-guided interventions were administered consistently in each session, across participants, so that the effect of specific interventions (i.e., identifying and reducing depression/anxiety symptoms in sessions five and six) on drinking in the following days and weeks could be examined (Epstein & McCrady, 2009).…”