Objective: Clients who receive alcohol use disorder (AUD) treatment experience variable outcomes. Measuring clinical progress during treatment using standardized measures (i.e., measurement-based care) can help indicate whether clinical improvements are occurring. Measures of mechanisms of behavioral change (MOBCs) may be particularly well-suited for measurement-based care; however, measuring MOBCs would be more feasible and informative if measures were briefer and if their ability to detect reliable change with individual clients was better articulated.
Method: Three abbreviated measures of hypothesized MOBCs (abstinence self-efficacy, coping strategies, anxiety) and a fourth full-length measure (depression) were administered weekly during a 12-week randomized trial of cognitive-behavioral therapy (CBT) for women with AUD. Psychometric analyses estimated how reliably each measure distinguished within-person change from between-person differences and measurement error. Reliability coefficients were estimated for simulated briefer versions of each instrument (i.e., instruments with fewer items than the already-abbreviated instruments) and rates of reliable improvement and reliable worsening were estimated for each measure.
Results: All four measures had good reliability (.86-.90) for detecting within-person change. Many participants (41.4%-62.5%) reliably improved on MOBCs from first to last treatment session. Reliable improvement on MOBCs was associated with reductions in percentage of drinking days (PDD) at 3, 9, and 15-month follow-ups. Simulated briefer versions of each instrument retained good reliability for detecting change with only 3 (self-efficacy), 11 (coping strategies), 5 (anxiety), or 10 items (depression).
Conclusions: Brief MOBC measures can detect reliable change for individuals in AUD treatment. Routinely measuring MOBCs may help with monitoring clinical progress. (PsycInfo Database Record (c) 2021 APA, all rights reserved).