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Brief CBT for high anxiety sensitivity decreases
drinking problems, relief alcohol outcome expectancies,
and conformity drinking motives: Evidence
from a randomized controlled trial
MARGO WATT
1
, SHERRY STEWART
1
, CHERYL BIRCH
2
,&
DENISE BERNIER
2
1
Department of Psychology, St Francis Xavier University, Nova Scotia, and
2
Dalhousie University,
Nova Scotia, Canada
Abstract
Background: High anxiety sensitivity (AS; fear of anxiety sensations) is associated with frequent and
problem drinking (Stewart, Samoluk, & MacDonald, 1999).
Aims: It was hypothesized that a program designed to reduce AS levels in young adult women would
also result in a decrease in their dysfunctional drinking behavior.
Method: The brief cognitive behavioral therapy (CBT) intervention was conducted in small group
format. Participants were selected to form high and low AS groups, according to their scores on the
Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992), and randomly assigned to participate in 3
one-hour sessions of either brief CBT (i.e., psycho-education, cognitive restructuring, and physical
exercise interoceptive exposure) or a control group seminar (discussion about psychology ethics).
Drinking measures were assessed at pre-treatment and 10 weeks post-intervention.
Results: Following the intervention, high AS participants in the CBT condition revealed significant
reduction in conformity motivated drinking and emotional relief expectancies, as well as a 50%
reduction in proportion meeting criteria for hazardous alcohol use as compared to other three groups.
Conclusion: Findings suggest that alcohol abuse might be effectively prevented among high risk
individuals with a brief CBT approach targeting high AS, and that AS may operate as one underlying
determinant of dysfunctional drinking behavior.
Declaration of interests: None.
Keywords: Anxiety sensitivity, cognitive-behavioural treatment, drinking behaviour, co-morbidity
Introduction
Anxiety sensitivity (AS) refers to the fear of arousal-related bodily sensations (e.g., increased
respiration and palpitations) arising from beliefs that these sensations have harmful
consequences (e.g., illness, loss of control, or embarrassment) (Reiss, 1991). AS has been
implicated in the development and maintenance of anxiety-related psychopathology,
particularly panic attacks (Schmidt, Lerew, & Jackson, 1997), although recently researchers
have begun to examine the role of AS in ot her disorders such as substance abuse (e.g.,
Stewart & Kushner, 2001; Stewart, Peterson, & Pihl, 1995). Indeed, some anxiety disorders
Correspondence: Margo Watt, Department of Psychology, St Francis Xavier University, PO Box 5000, Antigonish, Nova Scotia,
B2G 2W5, Canada. E-mail: mwatt@stfx.ca
Journal of Mental Health,
December 2006; 15(6): 683 – 695
ISSN 0963-8237 print/ISSN 1360-0567 online Ó Shadowfax Publishing and Informa UK Ltd.
DOI: 10.1080/09638230600998938
commonly co-occur with alcohol abuse and dependence (Stewart, 1996), and there is some
evidence to suggest that AS may be a common underlying factor contributing to this high
co-morbidity between these two disorders (Stewart et al., 1999).
High AS is associated with sensitivity to the anxiety-reducing effects of alcohol
(MacDonald, Baker, Stew art, & Skinner, 2000) and with the strength of tension-reduction
alcohol outcome expectancies (Karp, 1993). AS also is associated with negative rein-
forcement motives for drinking (i.e., coping and confo rmity motives) (Stewart, Zvolensky, &
Eifert, 2001). Both tension-reduction expectancies and coping and conformity motives for
drinking, in turn, are associated with relatively heavy and more problematic patterns of
drinking (Cooper, 1994). Thus, AS-focused interventions may improve drinking outcomes
and prevent alcohol disorders for high AS individuals by targeting their underlying
motivation for drinking.
Treating AS in clinical groups
Conrod, Pihl, Stewart, and Dongier (2000a) investigated the efficacy of targeting underlying
motivations for substance use with interventions classifying substance abusers according to
personality and individual difference factors (e.g., AS), thought to increase risk for substance
abuse. In this study, 243 community-recruited substance-abusing women were randomly
assigned to one of three 90-minute individual intervention sessions that differentially
targeted their personality profile and associated reasons for drug use: (i) a motivation-
matched interv ention targeting participants’ particular personality profile (e.g., AS versus
sensation seeking); (ii) a motivational control intervention which involved exposure to a film
designed to enhance their motivation for change; and (iii) a motivation-mismatched
intervention targeting a personality profile that did not match the client’s actual profile (e.g.,
sensation seeking intervention applied to a high AS woman). At six months post-treatment,
the motivation-matched intervention showed a significant reduction in frequency and
severity of problematic substance use as compared to other two groups.
Treating AS in non-clinical groups
Few studies have assessed the efficacy of this type of therapeutic approach among non-
clinical samples with high AS. One unpublished study (Harrington, Telch, Abplanalp, &
Hamilton, 1995) involved the random assignment of 120 undergraduates, with high or low
AS, to either a brief CBT intervention (i.e., psycho-education, interoceptive exposure, and
breathing retraining) or control group. Three 50-minute sessions were conducted in small
groups of 15 subjects. At post-treatment, high AS individuals in the CBT condition had
significantly lower ASI scores than subjects in the NST condition. No follow-up analyses
were conducted to determine durability of treatment gains or to test whether lowering AS
levels reduced later incidence of panic or improved substance use outcomes among these
students.
Conrod, Stewart, Comeau, and MacLean (in press) examined the extent to which the
personality-bas ed approach to substance abuse treatment could be adapted for high-risk
youth to intervene with early onset alcohol misuse. Interventions based on those used in the
Conrod et al. (2000b) study were adapted for use with a non-clinical sample of adolescents.
Interventions were administered in group format over two sessions, with a between-session
homework exercise, psycho-education, behavioral and cognitive coping skills training.
Efficacy was tested using a randomized control trial in nine Canadian high schools. Students
who showed personality risk (one SD above the mean on measures of AS, hopelessness, or
684 M. Watt et al.
sensation seeking) and who indicated drinking in the past four months were randomly
assigned to the appropriate personality intervention or to a no-treatment control group.
Participants were re-assessed four months later. Results indicated intervention effects on
drinking, binge drinking, and problem drinking symptoms which were specific to each
personality dimension; such as, reducing problem drinking symptoms and increasing
alcohol abstinence among high AS students (see Cooper, 1994), and reducing binge
drinking for sensation seeking students (Conrod et al., in press).
In an attempt to replicate findings that a brief 3-session CBT approach could reduce AS
levels (Harrington et al., 1995) and that an AS-focused intervention could reduce
problematic drinking behavior in high AS students (Conrod et al., in press), we designed
a brief, group-based CBT intervention to specifically target high AS in undergraduate
women. We selected women as participants to reduce variability due to gender, because
women have higher AS levels than men (Stewart, Taylor, & Baker, 1997), and because some
research suggests that AS may be particularly important in the drinking behaviour of women
(Stewart, Karp, Pihl, & Peterson, 1997). Whereas women are less likely to develop alcohol-
related problems than men, they tend to develop them faster than do men (Fillmore,
Golding, & Leino, 1997). Over 80% of undergraduates, both women and men, report
drinking alcohol and about 40% report a heavy drinking episode in the previous two weeks
(Ham & Hope, 2003). Lowering the proportion of students that engage in risk y drinking
behaviour is an objective of the US Surgeon General’s national health promotion and
disease prevention initiative (Department of Health and Human Services, 2000).
In contrast to the intervention studies conducted by Conrod et al. (2000b; in press),
participants in the present intervention were selected based on their personality
characteristics only, rather than on a combination of personality and substance misuse
behaviour, and the intervention was completely focused on reducing AS. In both selection of
participants and focus of intervention, our approach was more consistent with that of
Harrington et al . (1995).
High AS and low AS participants were randomly assigned to either CBT or a non-specific
treatment (NST) condition that was included to control for effects of group and therapist
exposure. Two clinical psychology doctoral students conducted each intervention with four
student therapists, in total, involved over the course of the three year study. These student
therapists were trained and supervised by the first author, a licensed clinical psychologist.
Student therapists were blinded to the AS status of the groups they were conducting for the
duration of the study, and assessors of outcome were blinded both to participants’ AS group
and intervention group status. The CBT program included three 50-minute sessions
conducted in small group format (6 – 10 participants) over three consecutive days. Sessions
involved education about anxiety, training in cognitive restructuring, and a novel
interoceptive exposure component of running. Outcome measures for AS levels were taken
at screening, immediately post-intervention, and at 10-week follow-up. High AS parti-
cipants showed greater ASI change from pre- to post-treatment than low AS participants,
but only in the CBT Treatment condition. The moderate-to-large effect (d ¼ .67)
was maintained at follow-up. Given that space here precludes a more detailed description
of the brief CBT program and of its efficacy in reducing high AS levels, please see
Watt, Stewart, Conrod, and Schmidt (in press) and Watt, Stewart, Lefaivre, and Uman
(in pres s).
The primary objectives of the present report were to identify whether there were important
baseline (pre-intervention) AS group differences in drinking patterns and problems, and to
test whether our brief AS-reduction CBT intervention could also result in a decrease in
dysfunctional drinking behavior among high AS individuals. Our first hypothesis was that
Brief CBT, AS, drinking 685
high AS participants would score higher on a variety of drink ing measures as compared to low
AS participants, prior to the intervention. Se condly, we predicted that high AS participants in
the CBT condition would show a greater reduction on these drinking measures from pre-
intervention to follow-up as compared to the other three groups.
Method
Participants
In total, 221 first-year undergraduate women from two universities in eastern Canada
participated in the brief CBT intervention (mean age ¼ 19.0; SD ¼ 1.8; range ¼ 17 – 33
years). Most participants (88%) were in their 1st year and the majority (92%) were
Caucasian from families-of-origin whose average yearly salary range was over $60,000.
Participants were selected based on their ASI scores obtained at in-class screening and
signified interest in participating in a research study. High AS and low AS groups were
randomly selected from students scoring at least one SD above and below, respectively , the
mean ASI screening score for females (i.e., 17.9 + 8.7). Mean (and SD) ASI screening
scores for the high AS and low AS gro ups were 34.16 (6.37) and 8.33 (3.58) and
respectively. The two groups did not differ significantly on any of the demographic variables.
Participants within each AS group were randomly assigned to either the CBT or NST
conditions to form four groups: High AS/CBT (n ¼ 51), Low AS/CBT (n ¼ 61), High AS/
NST (n ¼ 56), and Low AS/NST (n ¼ 53).
Measures
Demographics and drinking behavior questionnaire. An author-compiled questionnaire
assessed the following demographic characteristics: age, year of university, gender, ethnicity,
and family-of-origin annual income range. Typical alcohol use was assessed with quantity –
frequency methods which were embedded within the demographics questionnaire (see
Stewart et al., 1995). Participants reported the number of occasions per week on which they
normally consumed alcohol and then indicated the average number of standard alcoholic
beverages normally consumed per drinking occasion.
Anxiety Sensitivity Index (ASI; Peterson & Reiss, 1992). The ASI is a 16-item self-report
questionnaire where each item inquires about the amount of fear the participant experiences
in regard to bodily sensations commonly associated with anxiety. Participants rate each item
on a five-point Likert scale ranging from very little (0) to very much (4). The ratings on the
16 items are summed for a total ranging from 0 to 64. The ASI possesses good test-retest
reliability, criterion validity, and construct validity (Peterson & Reiss, 1992).
Drinking Motives Questionnaire – Revised (DMQ-R; Cooper, 1994). The DMQ-R is a 20-item
self-report instrument that yields scores on four drinking motive subscales (i.e., coping,
conformity, social, and enhancement). Respondents are asked to estimate how often they
were motivated to drink for the reason specified in each item on a five-point Likert scale.
Five items comprise each subscale, and the average of these items yields the subscale score.
The DMQ-R has excellent psychome tric properties (Cooper, 1994).
Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989). The RAPI is a well-
validated, 23-item self-report measure of drinking problems commonly experienced by both
686 M. Watt et al.
clinical and community samples of adolescents and young adults (Leccese & Waldron,
1994). Respondents were asked to indicate on a 5-point scale how many times ‘during the
last three months’ they had experienced specific negative consequences from drinking (e.g.,
went to school or work drunk). Anchors were changed from 0 (never) to 4 (more than 10
times) to 0 (never) and 4 (more than 6 times) to be more realistic for the shorter timeframe
(see Conrod et al., in press). Responses were summed to yield a problem frequency
composite score (Winters, 1999). Participants who scored more than 15 were classified as
‘‘high consequence’’ drinkers; those scoring 15 or less were classified as ‘‘light drinkers/non-
drinkers’’ (Thombs & Beck, 1994). This cut-off represents a relatively conservative
approach to identifying ‘‘high-consequence’’ drinkers so as to minimize false positives.
Alcohol Craving Questionnaire (ACQ; Singleton, Tiffany, & Henningfield, 1994). Alcohol
expectancies were assessed with a 27-item abridged version of the ACQ. Two 9-item
subscales were of relevance in this study measuring emotional relief expectancies and
emotional reward expectancies. Participants were asked to indicate the current strength of
each expectancy by rating their level of agreement with each item on a seven-point Likert
scale ranging from 1 (strongly disagree)to7(strongly agree). The ACQ pos sesses excellent
psychometric properti es (Singleton et al., 1994). The relief and reward expectancy
subscales, in particular, have been shown to possess high internal consis tency and good
structural validity (Birch et al., 2004).
Procedure
Questionnaires were administered to participants in all experimental conditions at pre- and
post-interventi on, and 10-week follow-up. For the purposes of the present study, only
drinking measures collected immediately pre-intervention and at the 10-w eek follow-up
were examined to provide an adequate window for capturing change in drinking behaviour.
ASI scores at post-intervention vs. screening have been presented previously (Watt et al.,
2006). The effect of the intervention on drinking behavior involved the analysis of only those
participants who completed the follow-up assessment (n ¼ 148). The average attrition rate
at follow-up was 33% with no significant differences in attrition across groups
(w
2
(3,219) ¼ 3.39, NS). The attrition rate was attributed to difficulties in scheduling partici-
pants for follow-up and the lack of incentive for participants to return (i.e., no additional
credit for participating in follow-up). Given that the attrition rate was not due to non-
compliance with treatment and that there were no significant differences on any of the
demographic or baseline variables between completers (i.e., participants who returned for
follow-up) and non-completers, the use of completer analyses (vs. intent-to-treat analyses)
was considered appropriate since intent- to-treat analysis is considered appropriate only if
non-compliance is assumed to be related to treatment outcome (see Sheiner, 2000).
1
Results
Analyses of pre-intervention group differences in drinking patterns and problems
One participant in the low AS-CBT group reported no alcohol consumption in the past year
on the quantity – frequency measure and did not complete any of other the drinking-related
measures. Her data was therefore excluded from all subsequent analysis. The first set of
hypotheses was tested with a set of one-way (AS group) ANOVAs and chi square analyses on
the pre-treatment drinking data. Cohen’s d was used as an estimate of the effect size with a
Brief CBT, AS, drinking 687
value greater than 0.80 representing a large effect, values between 0.50 – 0.80 representing a
moderate effect, and values between 0.20 – 0.50 representing a small effect (Cohen, 1988);
anything smaller than 0.20 i s regarded as inconsequential (Cohen, 1992). Consistent with
our hypothesis, scores on the quantity-frequency measure revealed that high AS participants
tended to drink marginally more frequently than low AS participants (F(1, 218) ¼ 3.34,
p ¼ .07) (see Table I).
Overall, 22% of participants (48/221) were identified as being ‘‘high-consequence’’
drinkers based on their RAPI scores (Thombs & Beck, 1994). As hypothesized, there was a
significant difference between the high AS and low AS groups (w
2
(1,218) ¼ 14.54, p 5 .001,
F ¼ 0.27) in terms of the proportion of each group identified as ‘‘high consequence’’
drinkers, with a disproportionately greater number of ‘‘high consequence’’ drinkers in the
high AS group (32%) as compared to the low AS group (12%) (see Table I). Phi (F) is used
as an estimate of effect sizes involving dichotomous outcomes, and is calculated by taking
the square-root of the chi-square statistic divided by the sample size. A F value greater than
0.50 represents a large effect, a value greater than 0.30 represents a moderate effect, a value
greater than 0.10 represents a small effect and a value lower than 0.10 represents a trivial
effect.
Given the four comparisons involved in the analyses of the DMQ-R subscales, a
Bonferroni correction (alpha ¼ .05/4 or .0125) was applied to reduce the probability of Type
I error. As predicted, high AS participants reported drinking significantly more often for
coping, F(1, 218) ¼ 26.73, p 5 .001, d ¼ .70 and conformity, F(1, 218) ¼ 34.19, p 5 .001,
d ¼ .78 motives than low AS participants. Following Bonferroni correction, there were no
significant AS group differences in reports of drinking for social, F(1, 218) ¼ 5.84, NS, or
enhancement, F(1, 218) ¼ 3.65, NS, motives (see Table I).
Given the two comparisons involved in the analyses of the ACQ expectancy subscales, a
Bonferroni correction (alpha ¼ .05/2 or.025) was applied. As predicted, high AS par-
ticipants reported significantly stronger relief expectancies than low AS participants,
F(1, 218) ¼ 33.89, p 5 .001, d ¼ .78 Also as hypothesized, there was no significant AS group
difference in reward expectancies, F(1, 218) ¼ 1.85, NS (see Table I).
Table I. Descriptive statistics for pre-intervention variables of interest as a function of AS Group (HAS vs. LAS).
High AS (n ¼ 106) Low AS (n ¼ 113)
M (SD) M (SD) F [w
2
] p
Drinking frequency 1.22 (0.91) 1.01 (0.76) 2.32 0.07
Drinking quantity 4.87 (2.36) 4.80 (2.45) 0.28 –
High consequence drinking 32% 12% [13.25] 0.001
Coping motives 11.00 (4.44) 8.31 (3.21) 26.15 0.001
Conformity motives 9.00 (4.29) 6.37 (2.04) 34.47 0.001
Social motives 18.30 (4.82) 16.69 (5.03) 5.27 –
Enhancement motives 15.72 (5.66) 14.37 (4.74) 2.69 –
Relief expectancies 20.58 (12.35) 13.07 (5.69) 0.001
Reward expectancies 22.36 (10.12) 20.35 (7.90) 1.85 –
Notes: Drinking frequency ¼ drinking occasions per week; Drinking quantity ¼ alcoholic beverages per drinking
occasion; High consequence drinking ¼ Proportion of participants scoring above clinical cut-point on Rutger’s
Alcohol Problem Index [RAPI; White & Labouvie, 1989]; Coping motives, Conformity motives, Social motives,
and Enhancement motives ¼ subscales of the Drinking Motives Questionnaire-Revised [DMQ-R; Cooper, 1994];
Relief Expectancies and Reward Expectancies ¼ expectancy subscales of the Alcohol Cognitions Questionnaire
[ACQ; Singleton et al., 1994].
688 M. Watt et al.
Analyses of follow-up group differences in drinking patterns and problems
We focused analyses on the effectiveness of the intervention on those aspects of drinking
behaviour to which high AS young women proved most susceptible in the initial between
groups analysis. First, a set of dependent sample chi-square analyses was cond ucted on
categorical RAPI scores (pre-intervention vs. follow-up ) to determine whether the brief
CBT intervention was differentially effective in reducing the proportion of ‘‘high-
consequence’’ drinker s in the high AS-CBT condition as compared to the other three
groups. A marginally significant reduction in the proportion of ‘‘high consequence’’ drinkers
from pre-intervention to follow-up was found for the high AS-CBT group only as measured
by a one-tailed McNem ar test for change (p ¼ .06). There was no significant reduction in
proportion of ‘‘high consequence’’ drinkers for the other three groups (see Figure 1).
Next, a set of 26262 (AS group6treatment condition6 time) mixed model ANOVAs
with time as the repeated measure was applied to the remaining continuous drinking
outcome measures of interest (i.e., drinking frequency, coping and conformity motives,
relief expectancies).
In contrast to hypothesis, no significant three-way interaction was observed for drinking
frequency, F(1, 139) ¼ 0.37, NS, or for coping motives (F(1, 144) ¼ .06, NS). There was a
marginally-significant three-way interaction for conformity motives (F(1, 144) ¼ 2.56,
p ¼ .11). Given that the pattern of means was consistent with our hypothesis (see Figure 1)
and statistical recommendations that alpha should be relaxed in such circumstances due to
the increased power necessary to detect significant interactions (Winer, 1971), we
proceeded to probe this three-way interaction further. The Treatment Condition6Time
simple interaction effect was specific to the high AS group, F(1, 66) ¼ 5.19, p 5 .05, as
opposed to the low AS group, F(1, 78) ¼ .03, NS. Furthermore, the significant reduction in
conformity motives from pre-treatment to follow-up was specific to high AS women in the
CBT condition, F(1, 27) ¼ 3.94, p 5 .05, as opposed to those in the NST/control condition,
F(1, 39) ¼ 1.33, NS. The magnitude of the effect of the CBT intervention in reducing
Figure 1. Proportion of ‘‘high consequence’’ drinkers in high AS and low AS groups in each Treatment Condition
at Pre-intervention and at Follow-up. (Asterisk indicates marginally significant difference at p ¼ .06, one-tailed
McNemar test).
Brief CBT, AS, drinking 689
conformity motives among high AS women from pre-treatment to follow-up (d ¼ 0.24)
indicated a small effect (see Figure 2).
There was a significant AS Gro up6Time interaction for relief expectancies,
F(1, 144) ¼ 4.16 p 5 .05, which was qualified by a marginally-significant three-way
interaction, F(1, 144) ¼ 2.77,p¼ .10 (Figure 3). We again probed this marginal interaction
further (Winer, 1971). The AS Group6Time simple interaction effect was specific to the
CBT, F(1, 70) ¼ 6.56, p 5 .05, as opposed to the NST, F(1, 73) ¼ .17, NS, condition.
Furthermore, the significant reduction in relief expectancies from pre-treatment to follow-
up was specific to high AS CBT, F(1, 27) ¼ 9.15, p 5 .01, as opposed to low AS CBT,
F(1, 43) ¼ 0.77, NS, parti cipants. The magnitude of the effect of the CBT intervention in
reducing relief expectan cies among high AS participants from pre-treatment to follow-up
(d ¼ 0.33) indicated a small effe ct (see Figure 3).
Discussion
The first objective of the present study was to identify potential diffe rences between high and
low AS participants in terms of drinking patterns and problems. High AS participants
revealed a tendenc y to consume alcohol more frequently per week than low AS participants.
This finding is consistent with the literature that has found a positive association between AS
levels and self-reported weekly drinking rates in panic disorder patients (Cox, Swinson,
Shulman, Kuch, & Reichman, 1993). Given that the difference was only marginally
significant, replication in future studies is required to establish its clinical importance. High
and low AS groups did not differ in the number of beverages consumed per occasion which
is consistent with the findings of Stewart et al. (2001) who found that elevated drinking
levels among high AS (vs. moderate and low AS) young adults were spe cific to frequency
(vs. quantity) of drinking.
High AS participants were disproportionately represented in the ‘‘high consequence’’
drinkers group who reported experiencing frequent alcohol problems based on their RAPI
Figure 2. Change in DMQ-R Conformity Motive Scores from Pre-intervention to Follow-up for HAS and LAS
groups in each Treatment Condition (Bars represent Standard Errors; Asterisk indicates significant difference at
p 5 .05).
690 M. Watt et al.
scores. Categorizing participants based on RAPI cut -off scores revealed that one-third of our
sample demonstrated clinically-significant alcohol problems at study outset. The implication
of this small-to-moderate effect cannot be overstated, particularly since participants were not
chosen for their drinking behavior but solely on the basis of ASI screening scores. This
finding extends, to women, the work of Conrod, Pihl, and Vassileva (1998) who found
elevated levels of alcoho l problems in a non-clinical sample of high AS young adult men.
High AS partici pants reported drinking more frequently for negative reinforcement
motives (i.e., coping and conformity) but not positive rei nforcement motives (i.e., social and
enhancement) than low AS participants; in other words, to control aversive states/
circumstances. Coping and conformity motives have been found to directly predict drinking
problems, even after controlling for usual levels of alcohol use (Cooper, 1994), and to
independently mediate relations between AS and increased drinking frequency (Stewart
et al. (2001).
High AS participants reported stronger beliefs that alcohol would provide emotional relief
(e.g., tension reduction) than low AS participants, but not emotional rewards (e.g., euphoric
effects). These findings extend, to a non-clinical sample of women, those of Karp (1993)
who showed a significant positive correlation between AS levels and expectations for
relaxation and tension reduction from alcohol among a male sample of alcoholics.
A second objective of the present study was to test whether a brief CBT intervention,
demonstrated to be effective in reducing AS levels (see Watt et al., in press), could also
result in a decrease in the dysfunctional drinking behavi our of high AS women. Whereas the
intervention did not yield the expected beneficial effect on frequency of alcohol
consumption in high AS individuals, it did yield a small effect on reported ‘‘high
consequence’’ drinking among high AS women assigned to the CBT condition. This
divergence in effects on drinking levels vs. problems is consistent with prior work indicating
that these two drinking indices are distinct constructs (e.g., Sada va, 1985). Although the
reduction in drinking problems for women in the high AS-CBT group was only marginally
significant from a statistical perspective, the effect did represent a 50% reduction in the
proportion with high consequence drinking in this group and was consistent with the
Figure 3. Change in ACQ-Now Relief Expectancy Scores from Pre-intervention to Follow-up for HAS and LAS
groups in each Treatment Condition. (Bars represent Standard Errors; Asterisk indicates significant difference at
p 5 .01).
Brief CBT, AS, drinking 691
findings of Conrod et al. (in press) who found that AS-reduction interventions can yield
improvements in problem drinking among non-clinical samples.
Evidence was found for the specificity of intervention effects as only high AS participants
in the CBT condition showed a significant reduction in conformity motives for drinking
from pre-intervention to follow-up. It was surprising not to find a similar reduction in
coping motives; however, conformity drinking to relieve negative emotions in social contexts
may be the negative reinforcement drinking motive that is most developmentally relevant for
young high AS drinkers (see Comeau, Stewart, & Loba, 2001).
High AS women assigned to the CBT intervention showed a significant reduction in
emotional relief alcohol expectancies. Finding this small but significant effect is exciting
given that reducing positive alcohol expectancies via expectancy challenge can lead to actual
changes in drinking behavior (see Darkes & Goldman, 1993). The present results suggest
that by reducing a personality risk factor (i.e., AS), one can actually reduce the strength of
associated relief alcohol expectancies. Further investigation is required, however, to fully
determine the extent to which changes in AS (or conformity motives and/or relief
expectancies) might media te the efficacy of the CBT interven tion in red ucing drinking
problems among high AS women.
Although we did not specifically select participants according to indices of alcohol misuse
or directly target problematic drinking behavior, findings from the present study resemble
those of Conrod and Castellanos (in press) and Castellanos and Conrod (in press) both of
whom found beneficial effects with similar brief interventions targeting dimensions of
personality risk for alcohol abuse, including AS, in a sample of adolescents. Further research
is needed to determine the most efficient method of preventing and treating early
onset alcohol misuse among high AS individuals. For example, is group (vs. individual)
therapy more or less beneficial; is it best to target the substance abuse directly, only its
underlying motivation for it (e.g., high AS), or some combin ation of both? Further research
is also needed to dismantle and identify the active component(s) of the present intervention,
such as further investigation of the exposure module.
This research is not without its limitations. Fir st, intervention effects are small.
Nonetheless, they are impressive given that the intervention was not focused on drinking
only the underlying m otivation for drinking. Perhaps, if our intervention had included a
more explicit focus on drinking (like the Conrod et al., 2000b, in press), larger effect sizes
would have been found. A second limitation was that no timeframe was specified on
questionnaire i tems inquiring about drinking frequency, quantity, or drinking motives. The
drinking patterns of young undergraduates may vary considerably over the course of an
academic year (see Greenbaum et al., 2005) and, participants may have had difficulty
answering questions about their ‘‘typical’’ drinking patterns. Speci fying a recent timeframe
(e.g., Timeline Followback methodology; Sobell, Maisto, Sobell, & Cooper, 1979) may
have yielded positive effects on drinking levels and maladaptive coping motives. A third
limitation is the lack of consideration of panic outcomes given that previous research has
shown this type of intervention to be effective for panic-related difficulties that are so
commonly co-morbid with alcohol problems (e.g., Harrington et al., 1995). A fourth
limitation concerns the lack of data pertaining to participants’ medical and psychiatric
diagnostic status. Finally, results are limited by their potential lack of generalizability to
males, non-Caucasians, and non-university students.
Future research could benefit from the use of a health information control group which
might provide a more robust test of similar hypotheses, as well as a multi-method approach
(e.g., biological challenges, implicit cognitive processing) to the assessment of treatment
outcome. Selecting participants bas ed on high and low AS cut-off scores may not accurately
692 M. Watt et al.
represent the latent structure of the AS construct, and use of taxometric methods to
determine those individuals in the high-risk latent class of AS might be a more fruitful
approach (Bernstein et al., 2006).
Alcohol use disorder is one of the most prevalent disorders in young people and carries
with it significant risk for serious, long-term adverse consequences (O’Neil, Parra, & Sher,
2001). Finding positive effects on drinking-related behavior among female college students
with an intervention designed to reduce a known risk factor for alcohol use disorder (i.e.,
high AS) offers the promise of being able to prevent the negative course of problem drinking
among young people. Whereas effect sizes for the present intervention are small, they are
impressive given that it is an early intervention. From a theoretical standpoint, the findings
of the present study suggest that AS is driving the problematic drinking behavior.
Consequently, targeting AS may be a more profitable approach to reducing drinking-related
problems than targeting drinking behavior itself, at least in young non-clinical samples
where problem drinking is not yet ingrained. Future research including a longer-term follow
up is needed to test the durability of these effects.
Note
1 Numbers for participants with complete data for both baseline and follow-up on the drinking measures varied
from 145 for frequency and quantity per week, to 147 for enhancement motives and reward expectancies, to 148
for all other drinking variables. The attrition rate was calculated based on a follow-up sample of 148.
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