title: Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project.
abstract: OBJECTIVE
  Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relation between therapist empathy and alcohol treatment outcomes in data from a large, multisite, randomized controlled trial.
  
  
  METHODS
  Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the combined behavioral intervention condition of Project COMBINE. Sessions were evaluated by objective raters for both specific content (coping with craving, building social skills, and managing negative mood) and relational components (empathy level of the therapist). Multilevel modeling with clients nested within therapists evaluated drinks per week at the end of treatment.
  
  
  RESULTS
  Approximately 11% of the variance in drinking was accounted for by therapists. A within-therapist effect of empathy was detected (B = -0.381, SE = 0.103, p < .001); more empathy than usual was associated with subsequent decreased drinking. The Social and Recreational Counseling module (B = -0.412, SE = 0.124, p < .001), Coping with Cravings and Urges module (B = -0.362, SE = 0.134, p < .01), and the Mood Management module (B = -0.403, SE = 0.138, p < .01) were also associated with decreased drinking. No between-therapist effect was detected, and the Empathy × Module Content interactions were not significant.
  
  
  CONCLUSIONS
  The results of the study appear consistent with the hypothesis that skills building and therapist empathy are independent contributions to the overall benefit derived from the combined behavioral intervention.
authors.affiliation: Psychology Department, University of New Mexico.
authors.forename: Theresa B
authors.initials: TB
authors.lastname: Moyers
authors.affiliation: Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico.
authors.forename: Jon
authors.initials: J
authors.lastname: Houck
authors.affiliation: Psychology Department, University of New Mexico.
authors.forename: Samara L
authors.initials: SL
authors.lastname: Rice
authors.affiliation: Psychiatry and Human Behavior, Brown University Medical School.
authors.forename: Richard
authors.initials: R
authors.lastname: Longabaugh
authors.affiliation: Psychology Department, University of New Mexico.
authors.forename: William R
authors.initials: WR
authors.lastname: Miller
mesh_terms: D000077443:Acamprosate; D000223:Adaptation, Psychological; D000339:Affect; D000427:Alcohol Deterrents / Q000627:therapeutic use; D000437:Alcoholism / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003376:Counseling; D004645:Empathy; D006282:Health Personnel; D006801:Humans; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate