TY - JOUR TI - Tipping toward change DO - https://doi.org/doi:10.7282/T38915NN PY - 2010 AB - Objective: Psychosocial treatment research is shifting from a focus on randomized clinical trials to evaluating mechanisms of change. Researchers are interested in change mechanisms specific to certain treatments, across treatments and even those that occur outside of treatment. One phenomenon, sometimes called “assessment reactivity,” is change that occurs during the pre-treatment assessment period of clinical studies. For instance, Epstein et al. (2005) found that 45% of the women in an outpatient treatment for alcohol dependence became abstinent before treatment began. This dissertation further investigated possible mechanisms predicting the pre-treatment drinking cessation occurring in that study. Method: Alcohol dependent women (n=102) participated in a study of 6 months of individual or couple CBT for alcohol use disorders. The current study examined demographic, drinking severity, psychopathology, motivation, and partner/relationship variables to determine which significantly predicted pre-treatment abstinence. Results: Four variables differentiated pre-treatment abstinent from non-abstinent women: percent of days abstinent prior to the Telephone Screen, having a goal of abstinence, women’s ratings of benefits of drinking cessation and their ratings of costs. A multivariate logistic regression with all four predictors was conducted to determine their relative importance in predicting pre-treatment abstinence when controlling for the effects of the other predictors. Results from the logistic regression analysis indicated that more pre-Telephone Screen days abstinent and higher ratings of the benefits of drinking cessation and lower ratings of perceived costs were significantly associated with an increased likelihood for pre-treatment abstinence between Baseline and session 1 of treatment. Having a goal of abstinence did not predict women’s pretreatment abstinence when controlling for the effects of the other factors. Conclusions: Change was occurring before women made contact with the study and is not exclusively linked to assessment reactivity. The fact that a high rating of the benefits of change in particular, but also a low rating of costs were strong predictors of actual change, provides further evidence that making positive cognitive shifts toward change may be one of the most important mechanisms of behavior change. KW - Clinical Psychology KW - Alcoholism--Treatment KW - Women alcoholics KW - Women--Substance abuse--Treatment LA - eng ER -