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

Abstract

Sudden gains (SGs) are defined as abrupt and significant improvements in mental health symptoms that occur between two psychotherapy sessions. Preliminary evidence suggests that SGs may be an important pattern of symptom reduction in the treatment of alcohol use disorder (AUD) (i.e., a steep between-session reduction in drinking or alcohol craving frequency or intensity) (Drapkin et al., 2015). The current study examined SGs within two randomized clinical trials (RCTs) testing female-specific cognitive behavior therapy (CBT) protocol for AUD (n = 146). We tested a priori hypotheses about whether women’s baseline depression, anxiety, and confidence to be abstinent while in a negative emotional state would predict attainment of SGs after attending sessions that addressed depression, anxiety, and emotion regulation (i.e., sessions five and six of the 12-session protocol). Data were collected at baseline, within treatment, and 15 months after baseline. Results showed that women with high levels of depression and/or anxiety and low confidence to be abstinent in a negative emotional state at baseline were more likely to experience a SG (steep decrease in drinking) after sessions five and six (p=.02). Further, among women with high levels of depression and/or anxiety at baseline, those who experienced both a SG in drinking after session five/six and had higher confidence to remain abstinent in a negative emotional state at the end of treatment reported lower drinking frequency at 9- but not 15-month follow-up [95% CI = (−2.65, −0.86)]. Findings support the value of providing interventions targeting mood and emotion regulation in AUD treatment for women.

Optimizing the length and reliability of measures of mechanisms of change to support measurement-based care in alcohol use disorder treatment.

“…Measuring MOBCs frequently throughout treatment also may help researchers more precisely identify sources of within-person change in MOBCs, including how changes in MOBCs may be linked with specific treatment experiences or behavioral antecedents of reliable improvement (Hallgren et al, 2018). For example, previous research has identified pretreatment characteristics of individuals and within-treatment session content that are associated with sudden changes in drinking, which are subsequently associated with long-term outcomes (e.g., Drapkin et al, 2015; Holzhauer et al, 2017); future research designs that include frequent administration of MOBC measures could further identify correlates of sudden, reliable changes in MOBCs using reliable change indices to further understand factors that potentially contribute to, and result from, sudden changes in MOBCs. Future research may also identify the optimal frequency of assessments (e.g., weekly, monthly) needed for detecting reliable improvement or for concluding that such improvements have become stable over time.…”

Treatment Interventions for Women With Alcohol Use Disorder

“…For instance, Holzhauer and colleagues combined a moderator analysis with testing the intensity and timing of reductions in drinking after specific outpatient treatment sessions that targeted depression and anxiety in female-specific AUD treatment. 89 Three moderators assessed at baseline—depression, anxiety, and self-efficacy to remain abstinent in negative affect situations—predicted sudden gains (i.e., a steep decrease in drinking) after Session 5 or 6, which included interventions to attenuate negative affect. The results suggest that women who enter treatment struggling with negative affect may respond well to very specific, targeted interventions for those problems.…”

Sudden gains and large intersession improvements in internet-based psychodynamic treatment (IPDT) for depressed adolescents

“…An increased capacity for affect regulation has also been described as a key focus in affect-focused psychodynamic psychotherapy (Frederickson et al, 2018) and furthermore seem to work as a time-varying predictor of subsequent changes in depression in the internet-based psychodynamic treatment used in this study (Mechler et al, 2020). A study of psychotherapy for women with alcohol use disorder showed that women with low confidence in their capacity to regulate emotions without using alcohol were more inclined to experience SGs after sessions targeting emotion regulation in relation to anxiety and depression (Holzhauer et al, 2017). However, to our knowledge no studies exist examining whether increases in the capacity for emotion regulation drives sudden gains in psychotherapy.…”