3 - (SYM 94) Examination of Client Language Using a Novel Coding System in a Multi-session, Dual Target Intervention for Heavy Drinking Veterans with PTSD

Purpose: Heavy drinking and PTSD are common and debilitating conditions among military Veterans. As Veterans prefer interventions that focus on drinking and PTSD concurrently, a new 5-session, 30-minute treatment, Primary Care Treatment Integrating Motivation and Exposure (PC-TIME), provides personalized feedback on individual drinking behaviors, written trauma narratives, and in-vivo exposure to trauma stimuli. Data indicated PC-TIME patients reduced alcohol use and reported fewer PTSD symptoms post-treatment. To better understand the within-session processes by which PC-TIME exerts its therapeutic effects, we adapted the MISC 2.5 to reliably code PC-TIME sessions to capture a) change language about drinking behavior, and b) engagement in session-based PTSD treatment activities.

Methods: Participants’ (N= 32) recordings were coded by four trained raters. Original MISC 2.5 codes (Change Talk [CT], Sustain Talk [ST], Follow-Neutral for alcohol use) were coded reliably (all ICCs ≥ 0.7). Coding for PTSD was captured by assigning Approach (AP; e.g., “I want to reduce my PTSD”) or Avoid (AV; e.g., “I can’t confront these memories”) codes with additional subcodes specifying treatment components (Processing, Narrative, and In-Vivo).

Results: Session 1 (alcohol-focused) elicited M= 21.6 (SD= 14.4) CT and M= 15.9 (SD= 10.9) ST statements. Session 1 CT was negatively correlated with heavy drinking days and average drinks per week at 8-week follow-up (rs= - 0.41 to -0.44). When examining PTSD treatment language, AP and AV codes were recorded over Sessions 2 through 4 with M_AP and M_AV codes ranging from 10.89 to 32.53 and 2.11 to 6.17 per session, respectively. Proportion scores for AP and AV were positively correlated with all drinking outcomes (rs= 0.58 to 0.74), with the exception of AV being negatively correlated with average drinks per week (-0.75).

Conclusions: Findings provide continued support for the relationship between CT and drinking reductions. Clients in the trial also offered considerably more language reflecting engagement in PTSD treatment compared to avoidance language. Subsequent exploration of in-session CT and AP/AV language on alcohol use and PTSD symptoms may enhance our understanding of the impact of exposure-based PTSD treatments.