Some effective therapeutic factors in group cognitive-behavioral therapy with problem drinkers

The mechanisms of cognitive-behavioral treatment with 18 problem drinkers (14 men) during 12 2-hr sessions with two therapists were investigated. The patients were studied pretreatment, and 3-7 days, 3 months and 6 months after treatment. The sample was divided into two groups of nine patients: For Group A, the therapists cued and reinforced all positive self-statements, statements of attitudes or feelings, and future-oriented "verb" statements; challenged negative self-statements; used self-disclosure; and helped the patients achieve a compromise between their real and ideal selves through role playing, modeling and rehearsal. For Group B, treatment was the same except that therapists used only anonymous case histories and not self-disclosure; kept personal opinions to a minimum; and did not reinforce positive self-statements or challenge negative ones. According to videotape ratings, Group A improved across the sessions significantly more than Group B in these areas: positive and negative self-statements, future-oriented "verb" statements, and statements of attitudes or feelings. There were nonsignificant differences in: reinforcements by therapists and alcohol-related sentences. Across the 6 months of follow-up, Group A improved significantly more than Group B in: a behavioral rating made by a psychologist after a structured interview; alcohol consumption (according to self-reports and corroboration); and measures of Social Avoidance and Distress, Fear of Negative Evaluation, Neuroticism and Extroversion. There was a nonsignificant difference in a measure of Psychoticism. Results show that manipulation of cognitive factors improved the maintenance of behavioral gains, and that selective reinforcement and relevant self-disclosures and opinions by therapists increased treatment success.