title: Hybrid cognitive behavioral therapy versus relaxation training for co-occurring anxiety and alcohol disorder: a randomized clinical trial.
abstract: OBJECTIVE
  Treatment for alcohol use disorder (AUD) is far less effective for those with a co-occurring anxiety disorder. Surprisingly, adding an independent anxiety treatment to AUD treatment does not substantially improve the poor alcohol outcomes of these patients. This may reflect the lack of attention from independent treatments to the dynamic interaction of anxiety symptoms with alcohol use and drinking motivation. On the basis of this view, we assembled a cognitive behavioral therapy (CBT) program designed to both reduce anxiety symptoms and weaken the links between the experience of anxiety and the motivation to drink.
  
  
  METHODS
  344 patients undergoing residential AUD treatment with current social phobia, generalized anxiety disorder, or panic disorder were randomly assigned to receive either the CBT or an active comparison treatment, progressive muscle relaxation training (PMRT). Assessments took place immediately following treatment and 4 months later (n = 247).
  
  
  RESULTS
  As predicted, the CBT group demonstrated significantly better alcohol outcomes 4 months following treatment than did the PMRT group. Although both groups experienced a substantial degree of anxiety reduction following treatment, there were no significant group differences immediately after treatment and only a slight advantage for the CBT group 4 months after treatment.
  
  
  CONCLUSIONS
  These findings suggest that specific interventions aimed at weakening the association between the experience of anxiety and drinking motivation play an important role in improving the alcohol outcomes of these difficult-to-treat patients beyond that of anxiety reduction alone.
authors.affiliation: Department of Psychiary, University of Minnesota, MN 55454, USA. kushn001@umn.edu
authors.forename: Matt G
authors.initials: MG
authors.lastname: Kushner
authors.forename: Eric W
authors.initials: EW
authors.lastname: Maurer
authors.forename: Paul
authors.initials: P
authors.lastname: Thuras
authors.forename: Chris
authors.initials: C
authors.lastname: Donahue
authors.forename: Brenda
authors.initials: B
authors.lastname: Frye
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Menary
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hobbs
authors.forename: Angela M
authors.initials: AM
authors.lastname: Haeny
authors.forename: Joani
authors.initials: J
authors.lastname: Van Demark
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012064:Relaxation Therapy / Q000379:methods*; D016896:Treatment Outcome