Multimodales Monitoring psychotherapeutischer Prozesse in der Behandlung alkoholkranker Patienten

Abstract

Background: Research on addiction treatment lacks prospectivelongitudinal studies that analyze with observational instrumentsbehavior of alcohol dependent patients during therapy sessions.With the "Video-Assisted Monitoring of Psychotherapeutic pro-cesses in chronic psychiatric disease (VAMP)" this study investi-gates 64 chronic alcohol dependent patients at three time-points,t1 (week 3), t2 (month 6), and t3 (month 12) during the first year ofthe Outpatient Longterm Intensive Therapy for Alcoholics (OLITA).Aims: Change of therapeutic processes between t1, t2, and t3,prediction of cumulative abstinence probability during a follow-up of up to 4 years, construction of the TOPPS ( Therapy Orientationby Process Prediction Score).Methods: 175 video recordings of therapy sessions were analyzedwith the VAMP. After each video recording, patients and therapistsrated their experience of the therapeutic alliance. Change oftherapeutic processes over time were tested with repeatedmeasures ANOVA, and prediction of cumulative abstinence pro-bability by therapy processes was determined with Cox Regressi-on Analysis.Results: Most of the processes changed only marginally betweent1, t2 and t3. The TOPPS predicts cumulative abstinence probabilityat all of the three time-points (p < 0,001) by integrating eightprocess variables with the highest predictive validity: Experienceof ressources, abstinence self-efficacy, implicit craving, relapsealertness, relapse risk, disease concept, dysfunctional therapeuticengagement, dysfunctional problem solving of current problems.Patients who relapsed after 12 months showed continuously lowTOPPS from t1 to t3. However, patients who maintained long-termabstinence had high TOPPS at t1 which increased slightly betweent2 and t3 (p < 0,015).Conclusions: The eight TOPPS processes are determined from thecurrent behavior of a patient during a specific therapy session andindicate to which extent his common behavior predicts probabi-lity of longterm abstinence or relapse risk. The results suggest toemploy the TOPPS in addiction therapy as a guideline of indivi-dual relapse prevention strategies.