Alcohol Therapeutic Interactive Voice Response Study
This study tested a new way of using the telephone to help people retain the skills and motivation they learned during Cognitive Behavioral Therapy (CBT) for alcohol dependence. Study participants called in to an automated phone system to complete a daily survey and to practice specific skills acquired during their CBT sessions.
This Interactive Voice Response (IVR) system is a more elaborate "Therapeutic" IVR (TIVR) then the previously researched IVR systems. In addition to completing the daily survey, patients used this TIVR to review and/or practice the coping skills they learned in CBT and receive personalized feedback about their clinical progress.
The primary goal of this study was to test whether the TIVR enhances the therapeutic effect of CBT for alcohol dependence. Our long-term objective was to develop interventions specifically designed to capitalize on the unique advantages of IVR. The public health implications of effective, low-cost interventions for alcohol dependence that can be accessed remotely are considerable.
Cognitive Behavioral Coping Skills for Alcohol Dependence
The following Cognitive Behavioral Skills are taught to patients during therapy and encouraged using the telephone system:
Coping with Cravings: Cravings and urges to drink or use drugs are normal and should be expected from time to time in your sobriety.
Managing Thoughts about Using: Challenge your thoughts about using. Remember the negative outcome from using.
Problem Solving: Use your brain to solve problems and consider doing nothing, instead of reacting inpulsively.
Refusal Skills: The more rapidly and convincingly you can say “no” to offers to drink and pressures to use drugs, the less likely you are to relapse.
Coping with a Risk or Lapse: A slip or lapse is a major crisis in recovery. A plan in advance to cope with this crisis can help you get back on your horse and return to abstinence.
Managing Stress: The ability to manage stress boosts your well-being and fortifies your sobriety.
Managing Negative Thinking: Recognizing and changing negative thought patterns and breaking negative thought chains helps you handle difficult situations well.
Anger Awareness and Management: You can gain insight into how specific events might influence your thoughts, feelings and behaviors and use that insight to manage your anger.
Social Support: There are different kinds of support, different sources of support, and different ways to get the help and support you need.
Listening: Listening is an active skill, because it involves attending to and trying to understand what the other person is communicating, rather than just waiting for your own turn to talk.
Assertiveness: Assertive responses to difficult situations can reinforce your sobriety.
Increasing Pleasant Activities: When you have more fun things to do you won’t use drugs or alcohol just to create fun in your life and you will have more positive feelings about yourself and sobriety.
The TIVR maintenance enhancement has four components:
Daily Self Monitoring Questionnaire This is a 21-item questionnaire that the patient completes each day for measures of daily coping, daily perceived pain control, and daily mood. It also includes items asking about medication use and stress. This part of the call takes approximately three minutes to complete. The remaining therapeutic interactive voice response (TIVR) components are optional and patients use them at will, as frequently or infrequently as they like. This component is designed to improve self-monitoring of pain behavior, use of coping skills, and use of medication.
Review of Skills Participants are able access a verbal review of eight different pain management skills they learned during the 11 weeks of cognitive behavioral group therapy (relaxation response, diaphragmatic breathing, positive self-talk, cognitive restructuring, activity-rest pacing, distraction techniques, reappraisal of pain, and defusing catastrophizing). Each review is approximately 5 minutes in length. The review messages are recorded in the voice of an experienced therapist with a soothing telephone voice.
Guided Rehearsal of Pain Coping Skills (Practice Sessions) Patients can access guided rehearsals of eight of the coping skills taught during CBT (body scan relaxation, diaphragmatic breathing, visualization, autogenic training, brief relaxation techniques ("minis"), cognitive restructuring, and sleep induction). For example, a patient who is feeling very tense or cannot fall asleep can call the TIVR to access a 10-minute relaxation message.
Monthly Therapist Feedback Message Once a month, Dr. Naylor analyzes computer-collated patient-specific data and records a personalized message for each participant onto the TIVR. These messages contain a summary of that person's daily reports to the TIVR for the past month; insight into possible relationships between use of coping skills, mood, stress and pain levels based on these daily data; suggestions for other pain management tactics; and verbal encouragement. Patients find these personalized monthly messages to be both valuable feedback and a continuing positive connection with the therapist. They also recognize that the value of the messages increases with the frequency of their own use of the TIVR, especially the Daily Questionnaire. Therefore, an important effect of the Monthly Message is to increase self-monitoring and adherence to pain management skills, and to improve overall motivation to remain engaged in the TIVR.