title: Addition of cue exposure to cognitive-behaviour therapy for alcohol misuse: a randomized trial with dysphoric drinkers.
abstract: OBJECTIVE
  To test whether addition of moderation-orientated cue exposure (CE) or CE after dysphoric mood induction (emotional CE, ECE) improved outcomes above those from cognitive-behaviour therapy alone (CBT) in people who drank when dysphoric.
  
  
  METHODS
  Multi-site randomized controlled trial comparing CBT with CBT + CE and CBT + ECE.
  
  
  METHODS
  Out-patient rooms in academic treatment units in Brisbane and Sydney, Australia.
  
  
  METHODS
  People with alcohol misuse and problems controlling consumption when dysphoric (n = 163). Those with current major depressive episode were excluded.
  
  
  METHODS
  Eight weekly 75-minute sessions of individual treatment for alcohol problems were given to all participants, with CBT elements held constant across conditions. From session 2, CBT + CE participants resisted drinking while exposed to alcohol cues, with two priming doses of their preferred beverage being given in some sessions. After an initial CE session, CBT + ECE participants recalled negative experiences before undertaking CE, to provide exposure to emotional cues of personal relevance.
  
  
  METHODS
  Alcohol consumption, related problems, alcohol expectancies, self-efficacy and depression.
  
  
  RESULTS
  Average improvements were highly significant across conditions, with acceptable maintenance of effects over 12 months. Both treatment retention and effects on alcohol consumption were progressively weaker in CBT + CE and CBT + ECE than in CBT alone. Changes in alcohol dependence and depression did not differ across conditions.
  
  
  CONCLUSIONS
  These data do not indicate that addition of clinic-based CE to standard CBT improves outcomes. A different approach to the management of craving may be required.
authors.affiliation: School of Medicine, University of Queensland, Queensland, Australia. d.kavanagh@uq.edu.au
authors.forename: David J
authors.initials: DJ
authors.lastname: Kavanagh
authors.forename: Gomathi
authors.initials: G
authors.lastname: Sitharthan
authors.forename: Ross M
authors.initials: RM
authors.lastname: Young
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Sitharthan
authors.forename: John B
authors.initials: JB
authors.lastname: Saunders
authors.forename: Natalie
authors.initials: N
authors.lastname: Shockley
authors.forename: Vicki
authors.initials: V
authors.lastname: Giannopoulos
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003463:Cues; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009517:New South Wales; D011793:Queensland / Q000453:epidemiology; D020377:Self Efficacy