Lessons learned from psychotherapy research

In addictions treatment research, there has been a relative paucity of work on mechanisms of action that account for observed treatment effects. In studies that have been done, there is little evidence that the purported active ingredients of behavioral interventions such as cognitive-behavioral treatment or motivational interviewing actually mediate treatment effects. This suggests that new approaches are needed to study the process of change in behavioral treatments for addiction.

This article reviews several approaches that have been taken by psychotherapy researchers to identify mechanisms of change, including studies of critical sessions, change across sessions, and the relative importance of general vs. specific therapeutic factors.

These approaches all involve careful assessment of both therapist and patient behaviors during treatment sessions and study the relation of these factors to improvements or deteriorations in symptoms over the following weeks.

Suggestions are offered for how these methods could be used in addiction treatment research to generate hypotheses regarding mechanisms of change that could subsequently be tested in controlled studies.