BUMI-CBT กับการช่วยเหลือผู้ป่วย ให้เปลี่ยนแปลง พฤติกรรมดื่ม แอลกอฮอล์ ดรุณี ภู่ขาว (Bsc. Nursing, MS (Mental heath), MN, PhD Candidate, Department of Psychiatry, UQ) วิทยาลัยพยาบาลบรมราช ชนนีสระบุรี

What is the BUMI-CBT?  A brief group intervention consisting of five 3-hour daily sessions for 5 consecutive days.  BUMI-CBT - Buddhism-Motivational Interviewing-Cognitive behavioural Therapy

Rationale  The growing problem of alcohol misuse  The limitation of current treatment used for alcohol used disorders in Thailand  The lack of clinical trials evaluating intervention programs designed to facilitate drinking behavioral change

Principles used to develop BUMICBT  1. Evidence based both (1) theories to understand problematic drinking behaviour and interventions to help people change  2. Holistically response to patients’ needs

STAGES OF DEVELOPMENT  1.To conduct a theoretical review of Western theories used to understand and treat problematic drinking b ehaviours  2.To conduct a critical review of the research literature evaluating the effectiveness of brief treatment for alcohol inpatients

STAGES OF DEVELOPMENT (Cont.)  3. To examine specific issues relating to Thai culture  4. To identify cultural sensitivity strategies 4.1To understand traditional Thai knowledge relating to problematic drinking behaviour and behavioural change

STAGES OF DEVELOPMENT (Cont.) 4.2To analyse a traditional Thai knowledge of behavioural change and Western theoretical and practical perspective relating to the determinants of alcohol use behaviour and treatment process and strategies 4.3 To formulate a new model which will provide a framework to understand how alcohol use behaviour is developed and maintained

STAGES OF DEVELOPMENT (Cont.) 4.4 To formulate a new treatment model 4.5 To incorporate a culturally-specific theoretical base and therapeutic strategies appropriate to Thai culture into the new treatment program

An Integrated Buddhist & Western conceptual framework of determinants Of problematic drinking behaviour

A Buddhist-MI-CBT framework intervention for helping people to change

45 Randomized 19 Received standard care 26 Received BUTMICBT+ standard care Study Schema 65 Patients Screened F/up 3 (3mth) F/up 2 (1mth) F/up 4 (6mth F/up 2 (1mth) F/up 3 (3mth) F/up 4 (6mth) F/up3 (6mth) F/up 1: End point

 Comparison of the number of abstinent days during the whole period of follow up Experimental Control Significance Constant covariate  group group (F)a baseline  (F)a   Mean SD Mean SD  -Number of total ***.53  abstinent days  a ANCOVA test  *** P<.001

Time to first drink

Findings & Discussion  A significant for the reduction in drinking over time for experimental group  Significantly higher number of people who are abstinent among experiment group over the 6 month period  A significantly for the higher quality of life over time for the experimental group  A significant change across time for motivation & self efficacy  A significant higher working alliance  No significant difference in coping skills over time between groups

Findings & Discussion  This is the first randomised control trial study to examine a psychological treatment for this group  Findings provide preliminarily support for an added benefit of psychological group treatment for inpatients  Clearly, need to enhance skills at follow up  Treatment duration could be extended with a greater focus on behavioural skill development to enhance follow up at outcome  Clearly, need to undertake further research into developing this approach

Effectiveness of BUMICBT (Cont.)  High global satisfaction  High level of satisfaction with the content and delivery method  Patients rated 20 sub-items loaded for cultural appropriateness highly demonstrating a positive cultural evaluation of BUMICBT.

Limitation of the study  Problems with follow up due to cost and resources resulting in missing data  One therapist: potential biasing of results

Future directions and suggestions  To identify the mechanism of change, the relationship between outcome and process variables, the relationship between the clients characteristics and the outcome  The need for multi-centre trials: larger sample  Trial 2 week treatment duration with more focus on behavioural skills  To explore the provision of post treatment follow up therapy to enhance treatment gains

Acknowledgements  Prof. John B Saunders  Prof. David Kavanagh  A/Prof. Frank Varghese  A/Prof. Savitri Assanangkornchai  พระครรชิต คุณวโร วัดญาณเวศก วัน จ. นครปฐม

Acknowledgements  Thanyarak Hospital Director & Nursing Staff for ongoing support and assistances in this project  Saraburi Nursing College for supporting of my study  Prabaromarajjajanok Institute, Thailand for the PhD scholarship