Affect regulation training (ART) for alcohol use disorders: Development of a novel intervention for negative affect drinkers (original) (raw)
Related papers
Changes in Affect and Drinking Outcomes in a Pharmacobehavioral Trial for Alcohol Dependence
Addictive Disorders & Their Treatment, 2012
Objective-Despite extensive research exploring affect in alcohol dependent individuals in recovery, empirical research on affective changes over the course of psychosocial treatment and their role on drinking outcomes has been minimal. The present study examined the relationship between changes in positive affect (PA), negative affect (NA), and drinking outcomes during a pharmacobehavioral trial. Method-Data for these post-hoc exploratory analyses were derived from a clinical trial of 321 alcohol dependent male and female individuals. The study design had four treatment arms for medication: three levels of dose of ondansetron as well as a control condition (placebo). All participants received weekly cognitive behavioral therapy for twelve weeks. We conducted an exploratory evaluation of changes in negative and positive affect and drinking behavior over time during the treatment phase of the trial using multilevel modeling. Results-Participants experienced substantial reductions in drinking, decreases in NA, and increases in PA over the course of treatment. Individuals who experienced increases in PA over the course of treatment significantly reduced their drinking in subsequent weeks, while those who had reductions in NA only experienced reductions in drinking later in treatment if they also reported increases in PA. These results support the role of affect regulation in treatment. Conclusions-These results suggest that affective change during the course of treatment may serve as one potential mechanism of action for changes in drinking behavior. The interaction between reductions in NA and increases in PA may be particularly important in promoting new coping skills and reducing drinking.
Journal of Child & Adolescent Substance Abuse, 2017
This pilot randomized clinical trial tested an emotion regulation enhancement to Cognitive Behavior Therapy (CBT) with 29 college student problem drinkers with histories of complex trauma and current clinically significant traumatic stress symptoms. Participants received eight face-to-face sessions of manualized internet-supported CBT for problem drinking with or without trauma-focused emotion regulation skills (Trauma Affect Regulation: Guide for Education and Therapy, TARGET). Both interventions were associated with sustained (at one-month follow-up) reductions in self-reported drinking frequency, drinking related impairment, and heavy drinking in the past week, as well as post-traumatic stress disorder (PTSD) and complex PTSD symptoms, and improvement in self-reported emotion regulation. The enhanced intervention was associated with significantly greater sustained reductions in complex PTSD symptoms and resulted in medium/ large effect size reductions in days of alcohol use (versus small effects by CBT). Emotion regulation enhancement of CBT for college student problem drinkers with interpersonal trauma histories warrants further investigation.
Emotion Regulation in Alcohol Dependence
Background: The main aim of this study was to investigate, in alcohol-dependent (AD) patients, the use of the 5 emotion regulation strategies specified in Gross’s (1998, Rev Gen Psychol, 2, 271) process model of emotion regulation with the use of a semi-structured interview allowing a detailed and high- quality assessment of emotion regulation strategies. A secondary aim was to examine the possible influ- ence of protracted abstinence and detoxification on emotion dysregulation. Finally, the association between the level of craving and the types of regulation strategies was investigated. Methods: Forty-four treatment-seeking AD patients with varying time spent in rehabilitation, and 26 healthy controls were interviewed using a version of the Emotion Regulation Interview (Werner et al., 2011, J Psychopathol Behav Assess, 33, 346) adapted to alcohol dependence. Results: Compared to controls, AD patients reported significantly greater use of response modula- tion and attentional deployment, but lesser use of cognitive change. Among patients, (1) rehabilitation duration was positively correlated with the use of cognitive change and (2) the use of response modula- tion was positively associated with the level of craving. Conclusions: These findings clarify the specific pattern of emotion dysregulation associated with alcohol dependence. They also suggest that (1) abstinence is associated with a shift toward more adap- tive emotion regulation patterns and that (2) inefficient regulation strategies may lead to craving and the maintenance of alcohol use. If these findings are confirmed through longitudinal and mediation designs, they will have important clinical implications.
Journal of consulting and clinical psychology, 2011
As emotion regulation is widely considered to be a primary motive in the misuse of alcohol, our aim in the study was to investigate whether deficits in adaptive emotion-regulation skills maintain alcohol dependence (AD). Method: A prospective study investigated whether emotion-regulation skills were associated with AD and whether these skills predicted alcohol use during and after treatment for AD. Participants were 116 individuals treated for AD with cognitive-behavioral therapy. Emotion regulation and severity of AD symptoms were assessed by self-report. Alcohol use during treatment was assessed by Breathalyzer and urine analysis for ethyl glucuronide; alcohol use during the 3-month follow-up interval was assessed by self-report. Results: Pretreatment emotion-regulation skills predicted alcohol use during treatment, and posttreatment emotion-regulation skills predicted alcohol use at follow-up, even when controlling for other predictors potentially related to emotion regulation. Among a broad range of specific emotion-regulation skills, the ability to tolerate negative emotions was the only skill that negatively predicted subsequent alcohol consumption when controlling for the other skills. Individuals in the AD sample reported significantly larger deficits in emotion-regulation skills than did those in a nonclinical control sample but significantly less than did those in a sample of individuals exclusively meeting criteria for major depressive disorder. Conclusions: Enhancement of general emotion-regulation skills, especially the ability to tolerate negative emotions, appears to be an important target in the treatment of AD.
Frontiers in Psychiatry
Background: Tailored psychological interventions based on individual risk factors are likely to improve treatment for Alcohol Use Disorders (AUDs). Key risk factors for poor treatment outcome include alcohol craving, positive expectations of alcohol consumption, and impulsivity. Design: Pragmatic randomized Cognitive-Behavioral Treatment (CBT) trial. Setting: Public hospital alcohol and drug clinic. Participants: Three-hundred seventy-nine patients (65% male; Age years M = 44.32, SD = 10.75) seeking treatment for AUD. Procedure: Patients were randomly allocated into treatment as usual (TAU) or targeted treatment. Patients in targeted treatment were allocated one of three treatment modules focusing on craving, positive expectancy, or impulsivity based on assessment results. Treatment included eight, 1 h sessions of CBT over 12 weeks delivered by clinical psychologists. Hypotheses: Targeted treatment was expected to have fewer drinking days and consume less alcohol during the treatment period than TAU. Improvement in targeted mechanisms was predicted to be greatest for patients within matched conditions. Results: Patients attended an average of 4.4 sessions with 93 (25%) completing the whole 12-week treatment episode. The mean proportion of drinking days between sessions was 5% with an average consumption of 64 grams of ethanol. No significant effect of targeted treatment was identified on drinking days or consumption. The craving (b = −18.97, 95% CI = −31.44, −6.51) and impulsivity (b = −26.65, 95% CI = −42.09, −11.22) modules demonstrated significant reductions in their targeted constructs over treatment, above TAU. Only reduction in craving was associated with reduced drinking days [exp(b) = 0.958, p = 0.003] and alcohol consumption [exp(b) = 0.962, p = 0.02]. Significant indirect effects for the targeted craving module through craving reduction were Coates et al. Personalized CBT for AUD identified for reduction in drinking days (β = −0.72, 95% CI = −1.50, −0.158) and alcohol consumption (β = −0.78, 95% CI = −1.72, −0.11). Conclusions: In the context of a public health service, the effectiveness of individualized treatment targeting risk mechanisms identified during pre-treatment assessment was not confirmed. Some evidence was found for improved treatment response to the implementation of a manualized craving module when pre-treatment craving was high.
Clinical Psychology & Psychotherapy, 2001
Negative mood states are credited to exacerbate excessive drinking among problem drinkers. We developed an emotional cue exposure treatment procedure and applied it to three problem drinkers who have a history of drinking excessively under stressful emotional states. All three preferred a controlled drinking goal and received an average of seven sessions of treatment. Treatment comprised of providing alcohol (priming doses), followed by negative mood induction and response prevention of further drinking. Reductions were observed in the quantity and frequency of drinking, the Beck Depression Inventory, the Severity of Alcohol Dependence Questionnaire (Form C) and the Impaired Control Questionnaire scores. Increments were observed in self-efficacy to face different difficult situations. These gains were maintained at the 6-month follow-up. Providing alcohol to problem drinkers in treatment, followed by negative mood induction and response prevention, is clinically feasible and may benefit clients who drink under a variety of stressful mood states.
Journal of Consulting and Clinical Psychology, 2011
Objective: Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. Method: The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n ϭ 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. Results: Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f 2 ϭ 0.78). Participants (n ϭ 432) who received the craving module had significantly fewer heavy drinking days during treatment (d ϭ 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f 2 ϭ 0.92) and 1 year posttreatment (f 2 ϭ 0.03). Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre-to postmodule reductions in negative mood. Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. Conclusions: The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment.