Assignment 1.3 SWK-662

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1 1.3 Assignment: Context of Practice Evaluation Kathrine Sullivan Indiana Wesleyan University SWK-662-01HL: Research Proposal 2: Research Method/ Writeup 10/22/23

2 Develop a Question What is the appropriate evidence-based intervention for treating depression and anxiety with a history of alcohol use? Find the Evidence “Mechanisms of change in female- specific and gender neutral cognitive behavioral therapy for women with alcohol use disorder.” Abstract Objective: In a randomized trial for women with alcohol use disorders (AUD), the efficacy of Female-Specific Cognitive Behavioral Therapy (FS-CBT) was compared with Gender-Neutral CBT (GN-CBT; Epstein et al., 2018). The current study examined whether putative mechanisms of change differed between treatment conditions, using a novel statistical approach. Both treatments were hypothesized to work by increasing use of alcohol-related coping skills (coping) and confidence to abstain from drinking (confidence), but FS-CBT additionally targeted female-salient mechanisms: anxiety, depression, sociography (i.e., overinvestment in others’ opinion of oneself), autonomy, and social networks supportive of abstinence. Method: Ninety-nine women with AUD (55 in GN-CBT, 44 in FS-CBT) completed self- report assessments at baseline and 0-, 6-, and 12-months posttreatment. Multilevel vector autoregression estimation was used to analyze associations between putative mechanisms of change, and network models of those associations were generated using network analysis. Results: Across conditions, higher confidence and coping were directly associated with less drinking; autonomy was directly and indirectly associated with drinking. Additionally, network analysis indicated that although variation in depression was associated with change in other

3 variables specifically for GN-CBT, sociotropy was associated with change specifically in FS- CBT. Conclusions: Women receiving CBT-AUD changed their drinking through increased confidence to abstain and greater use of coping skills. Autonomy played a central role in behavior change across treatment conditions. Participants receiving treatment tailored to women also changed through decreases in sociotropy and increases in social support for abstinence. For women who received standard CBT, changes in depression were important to clinical improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved) ( APA PsycNet , n.d.). “Course and treatment of patients with both substance use and posttraumatic stress disorders.” Abstract Posttraumatic stress disorder (PTSD) is a common co-occurring diagnosis in patients with substance use disorders (SUDs). Despite the documented prevalence of this particular “dual diagnosis,” relatively little is known about effective treatment for SUD-PTSD patients. This article reviews empirical research on the course and treatment of SUD-PTSD comorbidity and highlights clinically relevant findings. Based on this review, the following is noted: PTSD is highly prevalent in SUD patients, consistently associated with poorer SUD treatment outcomes, and related to distinct barriers to treatment. Specific treatment practices are recommended for substance abuse treatment providers: (a) All patients should be carefully screened and evaluated for trauma and PTSD; (b) referrals should be provided for concurrent treatment of SUD-PTSD, if available, or for psychological counseling with the recommendation that trauma/PTSD be addressed; and (c) increased intensity of SUD treatment should be offered in conjunction with referrals for family treatment and self- help group participation (Ouimette et al., 1998).

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4 Analyze the Evidence The first study provides a stronger research design because it is a meta-analysis of ninety- nine controlled trials. This study provides a substantial number of controlled trials completed on women. This provides the reader with a more comprehensive view of the efficacy of CBT for depression and anxiety in women with a history of alcohol use. This study provides the reader with required information when making decisions about the efficacy of CBT. The second study provides information on the efficacy of psychological counseling partnered with referrals for family treatment and self-help group participation. This a wider range of trials and information. The information listed in the study is important and provides adequate information. However, I believe that both studies provide treatment options that would help Casey with her problem. The first study provides a look at individualized therapy and the use of CBT. CBT is a type of therapy that helps the patient learn to alter or change unhealthy or unhelpful way of behaving, emotions and thinking. When treating depression and anxiety and addiction this is important. For the patient to make positive lifestyle changes they must be able to identify those behaviors or emotions that are keeping them in their current situation. The second study discusses more group and family counseling alongside the individualized CBT. Casey would benefit from additional support and encouragement when making lifestyle changes. I also believe that group therapy regardless of if it is family or support group is important for patients like Casey. It allows her to know that she is not alone and that she has others who are understanding and empathetic to her current situation. Combine the evidence with your understanding of the client. The evidence provided in the first study article fits better with Casey’s case. This study was a meta- analysis of CBT on women with anxiety and depression and AUD. I would use CBT

5 in my treatment plan for Casey. Starting with CBT would allow Casey to acknowledge her emotions, behaviors, and thought process. She would then be able to address and change those things when working on treatment. I also believe this would be less overwhelming for Casey and help her feel more relaxed when working with a therapist. The second article does not ft as well due to randomized treatment plans and not specific. It discusses additional psychotherapy that individuals being treated for depression, anxiety with AUD may benefit from. I do agree that at some point in Casey’s treatment this may need to be discussed. Application to practice. I would implement the CBT intervention from the first article with Casey. I would start by completing an assessment with Casey. I would also discuss with Casey what to expect during at sessions for the next six weeks. I would also develop CBT treatment plan around depression, anxiety, and AUD.

6 Reference APA PsycNet . (n.d.-b). https://psycnet.apa.org/record/2020-11019-001 Ouimette, P., Brown, P. J., & Najavits, L. M. (1998). Course and treatment of patients with both substance use and posttraumatic stress disorders. Addictive Behaviors , 23 (6), 785–795. https://doi.org/10.1016/s0306-4603(98)00064-1

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