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Russell PD, Blessing A, Morissette SB. The Indirect Influence of Cannabis Use Disorder Symptoms on PTSD Symptom Severity Through Psychological Inflexibility. Subst Use Misuse 2024; 59:1895-1900. [PMID: 39104206 DOI: 10.1080/10826084.2024.2383979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Background: One in five college students (21%) report using cannabis in the past month, and approximately 10% develop cannabis use disorder (CUD). Further, college students have high rates of trauma exposure, and CUD is prospectively linked to posttraumatic stress disorder (PTSD). Given the high rate of co-occurrence, research is needed to understand transdiagnostic, modifiable factors that could account for the relationship between CUD and PTSD. Psychological inflexibility (PI) is one such factor and refers to difficulty adapting thoughts or behaviors to various situations that reflect of one's personal values. Objectives: PI predicts worse PTSD symptom severity and has been established as a maintaining factor between alcohol use and PTSD, albeit no studies have examined this relationship with CUD. Results: College students (N = 336) completed self-report measures of CUD, PI, and PTSD. A cross-sectional mediation model explained 54% of the variance in PTSD symptom severity, F(5, 330) = 78.86, p < .001. After controlling for age, gender, and probable alcohol use disorder, CUD was not directly associated with PTSD symptom severity, yet was indirectly associated with PTSD through higher PI. Specifically, CUD was associated with higher PI (b = 0.31, p < .05, 95% CI [0.07, 0.54]), and higher PI was associated with greater PTSD symptom severity (b = 1.07, p < .001, 95% CI [0.95, 1.19]). Conclusion: Although CUD has been previously linked with worse PTSD symptoms, results suggest that this occurs through PI. Importantly, PI is malleable, and may be an important treatment target for co-occurring CUD and PTSD in college students.
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Affiliation(s)
- Patricia D Russell
- Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alexis Blessing
- Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Sandra B Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas, USA
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Dwyer CL, Padula CB. Context matters: Exploring the adaptive nature of self-regulation skills in predicting abstinence among veterans with alcohol use disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:692-702. [PMID: 38551499 DOI: 10.1111/acer.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/23/2024] [Accepted: 02/02/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is highly prevalent among veterans in the United States. Self-regulation skills (e.g., coping and emotion regulation) are important biopsychosocial factors for preventing relapse. However, how variation in self-regulation skills supports abstinence based on contextual demands is understudied in veterans with AUD. METHODS In a prospective longitudinal design, treatment-seeking veterans (n = 120; 29 females) aged 23-91 with AUD completed the Alcohol Abstinence Self-Efficacy Scale to assess temptation to drink across several high-risk situations (i.e., negative affect, social/positive emotions, physical concerns, and craving/urges) as well as the Brief-COPE and Emotion Regulation Questionnaire to assess self-regulation skills. Abstinence status was assessed at 6 months. T-tests were used to identify self-regulation skills that differed between abstinent and non-abstinent individuals. Multivariate regression with model selection was performed using all possible interactions between each high-risk situation and the self-regulation skills that significantly differed between groups. RESULTS Overall, 33.3% of participants (n = 40; nine females) were abstinent at 6 months. Abstinent individuals reported significantly higher use of suppression (p = 0.015), acceptance (p = 0.005), and planning (p = 0.045). Multivariate regression identified significant interactions between (1) planning and physical concerns (p = 0.010) and (2) acceptance, suppression, and craving/urges (p = 0.007). Greater planning predicted abstinence in participants with higher temptation to drink due to physical concerns (e.g., pain). For individuals with lower temptation to drink due to cravings/urges, simultaneous higher suppression and acceptance increased the likelihood of abstinence. Conversely, for participants with higher cravings, greater acceptance with lower suppression was linked to a higher probability of abstinence. CONCLUSIONS Results suggest that the adaptiveness of self-regulation skills in predicting AUD recovery is dependent on contextual demands and highlight the need for culturally sensitive treatments. Collectively, these findings indicate that further research on coping and regulatory flexibility may be an important avenue for tailoring AUD treatment for veterans.
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Affiliation(s)
- Candice L Dwyer
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Claudia B Padula
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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Schmitz JM, Stotts AL, Vujanovic AA, Yoon JH, Webber HE, Lane SD, Weaver MF, Vincent J, Suchting R, Green CE. Contingency management plus acceptance and commitment therapy for initial cocaine abstinence: Results of a sequential multiple assignment randomized trial (SMART). Drug Alcohol Depend 2024; 256:111078. [PMID: 38309089 DOI: 10.1016/j.drugalcdep.2023.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND This study tested an adaptive intervention for optimizing abstinence outcomes over phases of treatment for cocaine use disorder using a SMART design. Phase 1 assessed whether 4 weeks of contingency management (CM) improved response with the addition of Acceptance and Commitment Therapy (ACT). Phase 2 assessed pharmacological augmentation with modafinil (MOD) vs. placebo (PLA) for individuals not achieving abstinence during Phase 1. METHOD For Phase 1 of treatment, participants (N=118) were randomly allocated to ACT+CM or Drug Counseling (DC+CM), the comparison condition. At week 4, treatment response was defined as the submission of six consecutive cocaine-negative urine drug screens (UDS). Phase 1 non-responders were re-randomized to MOD or PLA as adjunct to their initial treatment. Phase 1 responders continued receiving their initial treatment. Primary outcomes included response rate and proportion of cocaine-negative UDS for Phase 1 and 2. Analyses used Bayesian inference with 80% pre-specified as the posterior probability (PP) threshold constituting moderate evidence that an effect exists. RESULTS Phase 1 response was higher in the ACT+CM group (24.5%) compared to the DC+CM group (17.5%; PP = 84.5%). In Phase 2, the proportion of cocaine-negative UDS among Phase 1 responders did not differ by initial treatment (PP = 61.8%) but remained higher overall compared to Phase 1 non-responders (PPs > 99%). No evidence of an effect favoring augmentation with MOD was observed. DISCUSSION Adding ACT to CM increased abstinence initiation. Initial responders were more likely to remain abstinent compared to initial non-responders, for whom modafinil was not an effective pharmacotherapy augmentation strategy.
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Affiliation(s)
- Joy M Schmitz
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States.
| | - Angela L Stotts
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States; Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Anka A Vujanovic
- Department of Psychological and Brain Sciences, Texas A&M University, United States
| | - Jin H Yoon
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Heather E Webber
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Scott D Lane
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Michael F Weaver
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Jessica Vincent
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Robert Suchting
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States
| | - Charles E Green
- Faillace Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, United States; UTHealth Center for Clinical Research & Evidence-Based Medicine, United States
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Vanderijst L, Hever F, Buot A, Dauré C, Benoit J, Hanak C, Veeser J, Morgiève M, Campanella S, Kornreich C, Mallet L, Leys C, Noël X. Psilocybin-assisted therapy for severe alcohol use disorder: protocol for a double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial. BMC Psychiatry 2024; 24:77. [PMID: 38279085 PMCID: PMC10821548 DOI: 10.1186/s12888-024-05502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND A significant number of individuals with alcohol use disorder remain unresponsive to currently available treatments, which calls for the development of new alternatives. In parallel, psilocybin-assisted therapy for alcohol use disorder has recently yielded promising preliminary results. Building on extant findings, the proposed study is set to evaluate the feasibility and preliminary clinical efficacy of psilocybin-assisted therapy when incorporated as an auxiliary intervention during inpatient rehabilitation for severe alcohol use disorder. Moreover, it intends to pinpoint the modifications in the two core neurocognitive systems underscored by dual-process models of addiction. METHODS In this double-blind, randomized, placebo-controlled, 7-month parallel-group phase II superiority trial, 62 participants aged 21-64 years will be enrolled to undergo psilocybin-assisted therapy as part of a 4-week inpatient rehabilitation for severe alcohol use disorder. The experimental group will receive a high dose of psilocybin (30 mg), whereas the control group will receive an active placebo dose of psilocybin (5 mg), both within the context of a brief standardized psychotherapeutic intervention drawing from key elements of acceptance and commitment therapy. The primary clinical outcome is the between-group difference regarding the change in percentage of heavy drinking days from baseline to four weeks posthospital discharge, while safety and feasibility metrics will also be reported as primary outcomes. Key secondary assessments include between-group differences in terms of changes in (1) drinking behavior parameters up to six months posthospital discharge, (2) symptoms of depression, anxiety, trauma, and global functioning, (3) neuroplasticity and key neurocognitive mechanisms associated with addiction, and (4) psychological processes and alcohol-related parameters. DISCUSSION The discussion outlines issues that might arise from our design. TRIAL REGISTRATION EudraCT 2022-002369-14 and NCT06160232.
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Affiliation(s)
- Laetitia Vanderijst
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium.
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium.
| | - Felix Hever
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Anne Buot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
| | - Charles Dauré
- Université de Paris, INSERM UMRS1144, 4 avenue de l'Observatoire, 75006, Paris, France
| | - Janaïna Benoit
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Catherine Hanak
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Johannes Veeser
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Margot Morgiève
- Université Paris Cité, CNRS, Inserm, Cermes3, F-75006, Paris, France
| | - Salvatore Campanella
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
| | - Charles Kornreich
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
- Psychiatric Institute, University Hospital Brugmann, Brussels, Belgium
| | - Luc Mallet
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, CNRS, Inserm, Paris, France
- Département Médical-Universitaire de Psychiatrie et d'Addictologie, Univ Paris-Est Créteil, DMU IMPACT, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Christophe Leys
- Research Center for the Promotion of Health, Prosocial Behavior and Wellbeing, Faculty of Psychology, Université libre de Bruxelles, Brussels, Belgium
| | - Xavier Noël
- Laboratory of Medical Psychology and Addictology, Faculty of Medicine, Université libre de Bruxelles, Brussels, Belgium
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Zhang B, Zhang R, Deng H, Cui P, Li C, Yang F, Leong Bin Abdullah MFI. Research protocol of the efficacy of probiotics for the treatment of alcohol use disorder among adult males: A comparison with placebo and acceptance and commitment therapy in a randomized controlled trial. PLoS One 2023; 18:e0294768. [PMID: 38051740 PMCID: PMC10697511 DOI: 10.1371/journal.pone.0294768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND AND AIM Primarily, this study compares the efficacy of probiotic and acceptance and commitment therapy (ACT) in alleviating the severity of alcohol craving and alcohol use disorder (AUD) among patients who had undergo two weeks of in-patient detoxification. Secondarily, this study compares the efficacy of probiotic and ACT in mitigating the severity of comorbid depression and anxiety symptoms; decreasing serum level of pro-inflammatory cytokines, such as interleukin 1β (IL-1β), interleukin 6 (IL-6), and tumor necrosis factor α (TNF-α); changing the event-related potential in electroencephalogram (EEG) and restoring microbiota flora in the gut of AUD patients. METHODS AND ANALYSIS Initially, during Phase I of the study, the serum level of IL-1β, IL-6 and TNF-α; ERP changes in the EEG and fecal microbiota content will be compared between 120 AUD patients and 120 healthy controls. Subsequently in Phase II of the study, 120 AUD patients will be randomized by stratified permuted block randomization into the probiotic, ACT and placebo groups in a 1:1:1 ratio. Participants in the probiotic and placebo groups will be administered one sachet per day of Lactobacillus spp. probiotic and placebo, respectively for 12 weeks. While those in the ACT group will receive one session per week of ACT for 8 weeks. Outcome measures will be administered at four timepoints, such as t0 = baseline assessment prior to intervention, t1 = 8 weeks after intervention began, t2 = 12 weeks after intervention and t3 = 24 weeks after intervention. Primary outcomes are the degrees of alcohol craving, alcohol withdrawal during abstinence and AUD. Secondary outcomes to be assessed are the severity of co-morbid depression and anxiety symptoms; the serum levels of IL-1β, IL-6 and TNF-α; changes in ERP and fecal microbiota content. TRIAL REGISTRATION NUMBER NCT05830708 (ClinicalTrials.gov). Registered on April 25, 2023.
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Affiliation(s)
- Bingyu Zhang
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | - Ruiling Zhang
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | - Hongdu Deng
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | - Ping Cui
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | - Chunyan Li
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
| | - Fan Yang
- Department of Psychiatry, 2 Affiliated Hospital, Xinxiang Medical University, Xinxiang, Henan, China
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Faber SC, Metzger IW, La Torre J, Fisher C, Williams MT. The illusion of inclusion: contextual behavioral science and the Black community. Front Psychol 2023; 14:1217833. [PMID: 38022926 PMCID: PMC10643524 DOI: 10.3389/fpsyg.2023.1217833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.
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Affiliation(s)
- Sonya C. Faber
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Isha W. Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Joseph La Torre
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Carsten Fisher
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
| | - Monnica T. Williams
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Behavioral Wellness Clinic, LLC, Tolland, CT, United States
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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7
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Oosten W, Vos E, Los L, Nelwan M, Pieters T. Towards a New Dynamic Interaction Model of Adolescent CUD Manifestation, Prevention, and Treatment: A Narrative Review. PSYCHOACTIVES 2023; 2:294-316. [PMID: 39280928 PMCID: PMC7616443 DOI: 10.3390/psychoactives2040019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Background Cannabis is one of the most popular drugs of the 21st century, especially among adolescents and young adults. Evidence of a variety of lasting neuropsychological deficits as a result of chronic cannabis use has increased. Furthermore, regular cannabis use is found to be a predictor of mental health problems, less motivation in school, and school dropout. Aim Our goal is to propose a theoretical model of adolescent cannabis use disorder (CUD) based on Zinberg's drug, set, and setting model and explicated by a review of the literature on adolescent cannabis use to improve the prevention and treatment of CUD for adolescents. Methods PubMed and Web of Science were searched for relevant publications as part of a hypothesis-based and model-generating review. Results Individual (set) and environmental (setting) risk factors play important roles in the development of CUD in adolescents. School performance, motivation, and attendance can be negatively influenced by persistent cannabis use patterns and adolescent brain development can consequently be impaired. Thus, cannabis use can be understood as both being the cause of poor school performance but also the consequence of poor school performance. To prevent and reduce adolescent CUD the drug, set, and setting must all be considered. It is important to notice that the multiple feedback loops (indicated in our dynamic interaction model) are not mutually exclusive, but offer important intervention focus points for social workers, addiction professionals, parents, and other care takers. Conclusion We argue that the three dimensions of drug, set, and setting contribute significantly to the eventual manifestation of CUD. Based on our dynamic interaction model, recommendations are made for possible preventive and therapeutic interventions for the treatment of adolescents and young adults with CUD.
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Affiliation(s)
- Wesley Oosten
- Freudenthal Institute, Utrecht University, P.O. Box 85 170, 3508 AD Utrecht, The Netherlands
| | - Elena Vos
- Trimbos Institute, P.O. Box 80 125, 3500 AS Utrecht, The Netherlands
| | - Leontien Los
- Department of Adolescent Psychiatry and Addiction Prevention, Brijder-Jeugd, 2553 NZ The Hague, The Netherlands
| | - Michel Nelwan
- Department of Children and Adolescent Psychiatry, Erasmus Medical Center Sophia, P.O. Box 2060, 3015 CN Rotterdam, The Netherlands
| | - Toine Pieters
- Freudenthal Institute, Utrecht University, P.O. Box 85 170, 3508 AD Utrecht, The Netherlands
- Department of Pharmaceutical Sciences, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80 082, 3508 TB Utrecht, The Netherlands
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Curyło M, Rynkiewicz-Andryśkiewicz M, Andryśkiewicz P, Mikos M, Lusina D, Raczkowski JW, Partyka O, Pajewska M, Sygit K, Sygit M, Cipora E, Kaczmarski M, Gawiński Ł, Banaś T, Strzępek Ł, Juszczyk G, Krzych-Fałta E, Bandurska E, Ciećko W, Zabojszcz M, Zdziarski K, Knyszyńska A, Kosior DA, Marczak M, Czerw A, Kozłowski R. Acceptance of Illness and Coping with Stress among Patients Undergoing Alcohol Addiction Therapy. J Clin Med 2023; 12:4767. [PMID: 37510882 PMCID: PMC10381120 DOI: 10.3390/jcm12144767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Acceptance of illness is a process in which a person with an illness accepts its presence and treats it as an integral part of their life. With regard to alcoholism, acceptance of illness is one of the important elements of the healing process. (2) Methods: The study group consisted of 104 residents in an addiction treatment ward. Questionnaires SOC-29, AIS and PSS-10 were used to check levels of coherence, stress and acceptance of illness. The analysis was based on regression analysis. Patient age was analysed as a moderator of correlations between perceived indicators. Moderation analysis was based on the simple moderation model. (3) Results: The level of perceived stress correlated negatively with all areas of the sense of coherence and with acceptance of illness. All areas of the sense of coherence correlated with acceptance of illness positively. (4) Conclusions: The acceptance of illness by the patient is a factor that can be motivating for further treatment, through a positive approach to illness and strengthening the sense of control in experiencing it. The combination of strengthening behavioural, cognitive and motivational resources can be used in the treatment of people experiencing the challenges of addiction to alcohol.
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Affiliation(s)
- Mateusz Curyło
- Department of Internal Medicine, Rehabilitation and Physical Medicine, Medical University of Lodz, 90-647 Lodz, Poland
- Medical Rehabilitation Department, The Ministry of the Interior and Administration Hospital, 30-053 Krakow, Poland
| | - Marlena Rynkiewicz-Andryśkiewicz
- Department of Treatment of Alcohol Abstinence Syndromes, Independent Public Healthcare Facility in Lezajsk, 37-300 Lezajsk, Poland
| | - Przemysław Andryśkiewicz
- Department of Treatment of Alcohol Abstinence Syndromes, Independent Public Healthcare Facility in Lezajsk, 37-300 Lezajsk, Poland
| | - Marcin Mikos
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland
| | - Dariusz Lusina
- Department of Orthopedics and Traumatology, University Hospital in Krakow, 30-688 Krakow, Poland
| | - Jan W Raczkowski
- Department of Internal Medicine, Rehabilitation and Physical Medicine, Medical University of Lodz, 90-647 Lodz, Poland
| | - Olga Partyka
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Monika Pajewska
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland
| | - Marian Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland
| | - Elżbieta Cipora
- Medical Institute, Jan Grodek State University in Sanok, 38-500 Sanok, Poland
| | - Mateusz Kaczmarski
- Medical Institute, Jan Grodek State University in Sanok, 38-500 Sanok, Poland
| | - Łukasz Gawiński
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
| | - Tomasz Banaś
- Department of Radiotherapy, Maria Sklodowska-Curie Institute-Oncology Centre, 31-115 Cracow, Poland
| | - Łukasz Strzępek
- Clinical Department of General and Oncological Surgery, St. Raphael Hospital Krakow, 30-693 Krakow, Poland
| | - Grzegorz Juszczyk
- Department of Public Health, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Edyta Krzych-Fałta
- Department of Basic of Nursing, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland
| | - Ewa Bandurska
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland
| | - Weronika Ciećko
- Center for Competence Development, Integrated Care and e-Health, Medical University of Gdansk, 80-204 Gdansk, Poland
| | - Michał Zabojszcz
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| | - Krzysztof Zdziarski
- Subdepartment of Social Medicine and Public Health, Department of Social Medicine, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Anna Knyszyńska
- Department of Humanities and Occupational Therapy, Pomeranian Medical University in Szczecin, 71-103 Szczecin, Poland
| | - Dariusz A Kosior
- Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Michał Marczak
- Collegium of Management, WSB University in Warsaw, 03-204 Warsaw, Poland
| | - Aleksandra Czerw
- Department of Economic and System Analyses, National Institute of Public Health NIH-National Research Institute, 00-791 Warsaw, Poland
- Department of Health Economics and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Remigiusz Kozłowski
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-131 Lodz, Poland
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Lipsett M, Wyant-Stein K, Mendes S, Berger E, Berkman ET, Terplan M, Cioffi CC. Addressing stigma within the dissemination of research products to improve quality of care for pregnant and parenting people affected by substance use disorder. Front Psychiatry 2023; 14:1199661. [PMID: 37351006 PMCID: PMC10282149 DOI: 10.3389/fpsyt.2023.1199661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
Substance use disorders are a common and treatable condition among pregnant and parenting people. Social, self, and structural stigma experienced by this group represent a barrier to harm reduction, treatment utilization, and quality of care. We examine features of research dissemination that may generate or uphold stigmatization at every level for pregnant and parenting individuals affected by substance use disorder and their children. We explore stigma reduction practices within the research community that can increase uptake of evidence-based treatment programs and prevent potential harm related to substance use in pregnant and parenting people. The strategies we propose include: (1) address researcher stereotypes, prejudice, and misconceptions about pregnant and parenting people with substance use disorder; (2) engage in interdisciplinary and transdisciplinary collaborations that engage with researchers who have lived experience in substance use; (3) use community-based approaches and engage community partners, (4) address stigmatizing language in science communication; (5) provide contextualizing information about the social and environmental factors that influence substance use among pregnant and parenting people; and (6) advocate for stigma-reducing policies in research articles and other scholarly products.
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Affiliation(s)
- Megan Lipsett
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Katie Wyant-Stein
- Diamond Lab, Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Simone Mendes
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Estelle Berger
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Elliot T. Berkman
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
| | - Mishka Terplan
- Friends Research Institute, Baltimore, MD, United States
| | - Camille C. Cioffi
- Department of Psychology, Center for Translational Neuroscience, University of Oregon, Eugene, OR, United States
- Prevention Science Institute, University of Oregon, Eugene, OR, United States
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10
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Grau PP, Sripada RK, Ganoczy D, Weinstein JH, Pfeiffer PN. Outcomes of Acceptance and Commitment Therapy for depression and predictors of treatment response in Veterans Health Administration patients. J Affect Disord 2023; 323:826-833. [PMID: 36529407 DOI: 10.1016/j.jad.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Acceptance and Commitment Therapy for depression (ACT-D) is a promising depression treatment which has not been evaluated on a large scale within VA. This study aimed to evaluate ACT-D's effectiveness in a national, treatment-seeking sample of Veterans. METHODS The sample comprised 831 Veterans who received a primary depression diagnosis and received at least two sessions of ACT-D during fiscal years 2015-2020. We used GLM to measure predictors of symptom change, treatment response (50 % reduction in PHQ-9 and AAQ-II scores), subthreshold depression symptoms (PHQ-9 < 10; AAQ-II < 27), and treatment completion. RESULTS Veterans experienced an average reduction of 3.39 points on the PHQ-9 (Cohen's d = 0.56) and 3.76 points on the AAQ-II (Cohen's d = 0.43). On the PHQ-9, 40 % achieved subthreshold depression symptoms. On the AAQ-II, 36 % of Veterans achieved subthreshold psychological inflexibility scores. Service-connected disability rating for depression and higher levels of medical comorbidity were both related to lower levels of overall depression symptom change and treatment response. Substance use disorder and bipolar/psychosis diagnoses were associated with greater reductions in psychological inflexibility. LIMITATIONS This is an observational study without a control group, so we were unable to compare the effectiveness of ACT-D to other usual care for depression. We were also unable to assess variables that can influence treatment success, such as therapist fidelity and patient engagement. CONCLUSIONS ACT-D achieved similar improvements in depression as reported in controlled trials. Adaptations to ACT-D may be needed to improve outcomes for Veterans with depression and comorbid PTSD.
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Affiliation(s)
- Peter P Grau
- VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), 2800 Plymouth Road, Bldg 16, Ann Arbor, MI 48109, United States; VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States.
| | - Rebecca K Sripada
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Dara Ganoczy
- Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
| | - Jonathan H Weinstein
- VA Northport Medical Center, 79 Middleville Road, Northport, NY 11768, United States
| | - Paul N Pfeiffer
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan Medical School, United States; Veterans Affairs Center for Clinical Management Research, Health Services Research and Development, Ann Arbor, MI, United States
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11
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Hook K, Sereda Y, Rossi S, Koberna S, Vetrova MV, Lodi S, Lunze K. HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia. AIDS Behav 2023; 27:431-442. [PMID: 35913589 PMCID: PMC9889571 DOI: 10.1007/s10461-022-03778-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 02/03/2023]
Abstract
HIV stigma is associated with negative physical and mental health outcomes. Intersectional stigma among persons living with HIV (PLHIV) results from interrelated, synergistic impacts of experiencing multiple stigma forms. Its relation with mental health outcomes is still an emerging area of study in this key population. This study aimed to evaluate associations of intersectional stigma, defined as endorsing high levels of HIV and substance use stigmas, with depressive and anxiety symptoms in a cohort of 111 PLHIV who inject drugs in St. Petersburg, Russia. Over a third of participants (37%) reported experiencing intersectional stigma (i.e., both stigma scores above the median). In adjusted analysis, lower Patient Health Questionnaire depression scale (PHQ-9) scores (beta (β=-4.31, 95% CI: -7.11 - -1.51, p = 0.003) and Generalized Anxiety Disorders Scale (GAD-7) scores (β=-3.64, 95% CI: -5.57 - -1.71, p < 0.001) were associated with having low scores for both HIV and substance use stigmas. Lower PHQ-9 scores (β=-3.46, 95% CI: -5.72 - -1.19, p = 0.003) and GAD-7 scores (β=-3.06, 95% CI: -4.62 - -1.50, p < 0.001) were also associated with high stigma on either HIV or substance use stigma scales. Controlling for demographics, depressive symptoms approximately linearly increased from both forms of stigma low to experiencing either form of stigma high to experiencing intersectional stigma, while levels of anxiety symptoms were comparable among participants with both types of stigma low and one stigma high. Participants who experienced intersectional stigma reported the greatest severity of both depressive and anxiety symptoms, as compared to individuals who endorsed low stigma scores (i.e., low stigma on both HIV and substance use stigma scales) or high scores of only one form of stigma. This suggests that intersectional stigma in this population of PLHIV who inject drugs in Russia is linked with worsened mental health outcomes, exceeding the effects of experiencing one form of stigma alone. Interventions to help people cope with intersectional stigma need to consider affective symptoms and tailor coping strategies to address impacts of multiple forms of mental health distress.
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Affiliation(s)
- Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Sarah Rossi
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Sarah Koberna
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Marina V Vetrova
- First Pavlov State Medical, University of Saint Petersburg, St. Petersburg, Russia
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Karsten Lunze
- Department of Medicine, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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12
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Silverstein SM, Rivera J, Gainer D, Daniulaityte R. ‘Things that you can't really suppress': Adverse childhood experiences in the narratives of people with opioid use disorder. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2022.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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13
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Strika-Bruneau L, Fauvel B, Dupuis D, Benyamina A. Articulation de la thérapie d’acceptation et d’engagement à la psychothérapie assistée par psychédéliques en addictologie. L'ÉVOLUTION PSYCHIATRIQUE 2023. [DOI: 10.1016/j.evopsy.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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14
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Pitil PP, Ghazali SR. Acceptance and Commitment Therapy and Weight-Related Difficulties in Overweight and Obese Adults: A Systematic Review. Psychol Rep 2022:332941221149172. [PMID: 36571322 DOI: 10.1177/00332941221149172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Multiple studies have investigated the efficacy of acceptance and commitment therapy (ACT) in improving psychological flexibility among overweight and obese individuals. However, to date, no specific reviews have focused on ACT and weight-related difficulties in this population. This systematic review of the literature aims to identify and assemble all ACT interventions in randomized controlled trials (RCT) that address weight-related difficulties in the treatment of overweight and obese adults. The PRISMA 2020 framework was used for the systematic review, includes manual and computerized database searches. Five databases (Medline, PubMed, Scopus, PsycInfo, and Google) were utilized to gather all articles that: (a) published in English; (b) adopted the RCT design; (c) used ACT as an intervention; (d) included adult participants aged over 18 years with BMI of over 25 kg/m2, and (e) included weight-related difficulties and weight as outcome measures. The review identified seven studies comprising 698 overweight or obese participants of both genders. Improvements were reported in weight-related difficulties and percentage of weight loss in the ACT group and the non-ACT group. The present review supports ACT as an effective intervention that can help adults with weight-related difficulties and excess body weight. Further studies should be conducted in various overweight or obese populations with a more systematic RCT research design to establish the effectiveness of ACT in this area.
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Affiliation(s)
- Patricia Pawa Pitil
- Faculty of Medicine & Health Sciences, 54706Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
- Faculty of Sports Science & Recreation, Universiti Teknologi MARA Sarawak Branch, Kota Samarahan, Malaysia
| | - Siti Raudzah Ghazali
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia
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15
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Obarska K, Binkowska AA, Marcowski P, Szymczak K, Lewczuk K, Sollich K, Banaszak M, Woronowicz B, Nowicka M, Skorko M, Gola M. Reducing craving and lapse risk in alcohol and stimulants dependence using mobile app involving ecological momentary assessment and self-guided psychological interventions: Protocol for a randomized controlled trial. Front Psychiatry 2022; 13:1011585. [PMID: 36590610 PMCID: PMC9795071 DOI: 10.3389/fpsyt.2022.1011585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence of alcohol consumption in Poland is estimated to be as high as 80% of the adult population. The use of stimulants is the second most common reason for seeking addiction treatment. However, treatment outcomes remain unsatisfactory, as 40-85% of individuals who complete various treatment programs relapse and fall back into addiction within 2 years following program completion. Methods The 13-armed randomized controlled trial aimed to assess the effectiveness of a mobile app-based self-guided psychological intervention delivered via a smartphone app (Nałogometr) in reducing craving and lapse risk in problematic alcohol or stimulants use. Participant recruitment and data collection will be performed from June 2022 to September 2022. The 4-week mobile intervention program will include short-term and long-term intervention modules based mainly on mindfulness and cognitive-behavioral therapy. Intervention effectiveness assessment will include Ecological Momentary Assessment. That is, we will collect longitudinal data on a set of characteristics of day-to-day functioning. The primary outcomes will include a self-reported number of lapses and addiction craving level. In contrast, the secondary outcomes will be the severity of problematic substance use, anxiety and depression scores, and life satisfaction scores. Conclusion This study will establish how mobile app-based self-guided psychological interventions can help reduce craving and lapse risk in alcohol and stimulant dependence. If successful, this randomized controlled trial (RCT) may provide an innovative, easily available, and cost-effective mHealth approach for craving and lapse risk in substance addictions. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT054 34429].
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Affiliation(s)
- Katarzyna Obarska
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Alicja A. Binkowska
- PredictWatch, Białystok, Poland
- DrugsTeam, NeuroCognitive Research Center, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Karol Szymczak
- PredictWatch, Białystok, Poland
- Institute of Psychology, The Maria Grzegorzewska University, Warsaw, Poland
| | - Karol Lewczuk
- PredictWatch, Białystok, Poland
- Institute of Psychology, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | | | - Maria Banaszak
- PredictWatch, Białystok, Poland
- Monar Association, Warsaw, Poland
| | - Bohdan Woronowicz
- PredictWatch, Białystok, Poland
- Consulting Center Akmed, Warsaw, Poland
| | | | - Maciej Skorko
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Mateusz Gola
- PredictWatch, Białystok, Poland
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Li Z, Shang W, Wang C, Yang K, Guo J. Characteristics and trends in acceptance and commitment therapy research: A bibliometric analysis. Front Psychol 2022; 13:980848. [PMID: 36452380 PMCID: PMC9702511 DOI: 10.3389/fpsyg.2022.980848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/24/2022] [Indexed: 02/05/2024] Open
Abstract
Purpose As acceptance and commitment therapy (ACT) becomes mainstream and a growing body of literature emerges, it is critical to map the global collaborative network and a quantitative and systematic assessment of ACT, as research on this topic is still lacking. This review aims to provide a comprehensive understanding of the trajectory, key themes, and future prospects in ACT research. Methods Publications were extracted from the Web of Science Core Collection before 2022. Excel 2019, VOSviewer, and CiteSpace software were used to analyze the characteristics and trends of ACT research. Examples include publications trend analysis, authors' cooperation network analysis, keywords co-occurrence analysis, and citation burst analysis. Results A total of 799 articles in 314 journals contributed by 2,862 authors from 958 institutions in 52 countries were identified. The number of publications has increased significantly since 2015. The United States/Utah State University is the most productive country/institution; Karolinska Institute, Utah State University, and King's College of London are the most significant nodes. Twohig M.P., Hayes S.C., and Levin M.E. are the most influential authors. Keyword co-occurrence analysis found the curative mechanisms, using network technology or mobile technology as adjuvant therapy, reducing psychological diseases of cancer patients were potential trends. Conclusion This review is the first attempt of its kind to systematically examine the knowledge structure and draw an evidence map of ACT research. It deepens the understanding of existing research, gives many operable research directions and suggests to future ACT research.
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Affiliation(s)
- Zhihong Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wenru Shang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, Gansu, China
| | - Caiyun Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Juanmei Guo
- Hospital Management Research Center, School of Management, Lanzhou University, Lanzhou, China
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Jensen ME, Stenbæk DS, Juul TS, Fisher PM, Ekstrøm CT, Knudsen GM, Fink-Jensen A. Psilocybin-assisted therapy for reducing alcohol intake in patients with alcohol use disorder: protocol for a randomised, double-blinded, placebo-controlled 12-week clinical trial (The QUANTUM Trip Trial). BMJ Open 2022; 12:e066019. [PMID: 36241352 PMCID: PMC9577917 DOI: 10.1136/bmjopen-2022-066019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/30/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Alcohol use disorder is a difficult-to-treat psychiatric disorder and a major burden on public health. Existing treatment efficacy is moderate, and relapse rates are high. Preliminary findings suggest that psilocybin, a psychedelic compound, can safely and reliably occasion highly meaningful experiences that may spur a positive change in drinking behaviour when administered in a therapeutic context. However, the efficacy of a single psilocybin administration and its potential neurobiological underpinnings still remain unknown. METHODS AND ANALYSIS To establish efficacy, we will investigate the effects of psilocybin-assisted therapy versus placebo in a randomised, double-blinded, placebo-controlled 12-week clinical trial. Ninety treatment-seeking patients, aged 20-70 years, diagnosed with alcohol use disorder will be recruited from the community via advertisement and referrals from general practitioners or specialised treatment units. The psilocybin or placebo will be administered in accordance with a protocol for psychological support before, during and after the dosing. Outcome assessments will be carried out 1, 4, 8 and 12 weeks postdosing. The primary outcome is reduction in the percentage of heavy drinking days from baseline to follow-up at 12 weeks. Key secondary outcomes are as follows: (1) total alcohol consumption, (2) phosphatidyl-ethanol, an objective biomarker for alcohol, (3) plasma psilocin, the active metabolite, to establish a possible therapeutic range, (4) the acute subjective drug experience as a possible predictor of treatment outcome and (5) neuronal response to alcohol cues and cognitive flexibility within corticostriatal pathways by use of functional MR brain imaging 1-week postdosing. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Committee on Health Research Ethics of the Capital Region of Denmark (H-20043832). All patients will be provided oral and written information about the trial before screening. The study results will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER EudraCT 2020-000829-55 and NCT05416229.
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Affiliation(s)
| | - Dea Siggaard Stenbæk
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tobias Søgaard Juul
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Patrick MacDonald Fisher
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Fink-Jensen
- Psychiatry Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Akbari M, Seydavi M, Davis CH, Levin ME, Twohig MP, Zamani E. The current status of acceptance and commitment therapy (ACT) in Iran: A systematic narrative review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hoel S, Victory A, Sagorac Gruichich T, Stowe ZN, McInnis MG, Cochran A, Thomas EBK. A Mixed-Methods Analysis of Mobile ACT Responses From Two Cohorts. Front Digit Health 2022; 4:869143. [PMID: 35633737 PMCID: PMC9133380 DOI: 10.3389/fdgth.2022.869143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Mobile transdiagnostic therapies offer a solution to the challenges of limited access to psychological care. However, it is unclear if individuals can actively synthesize and adopt concepts and skills via an app without clinician support. Aims The present study measured comprehension of and engagement with a mobile acceptance and commitment therapy (ACT) intervention in two independent cohorts. Authors hypothesized that participants would recognize that behaviors can be flexible in form and function and respond in an ACT process-aligned manner. Methods Mixed-methods analyses were performed on open-ended responses collected from initial participants (n = 49) in two parallel micro-randomized trials with: 1) first-generation college students (FGCSs) (n = 25) from a four-year public research university and 2) individuals diagnosed with bipolar disorder (BP) (n = 24). Twice each day over six weeks, participants responded to questions about mood and behavior, after which they had a 50-50 chance of receiving an ACT-based intervention. Participants identified current behavior and categorized behavior as values-based or avoidant. Interventions were selected randomly from 84 possible prompts, each targeting one ACT process: engagement with values, openness to internal experiences, or self-awareness. Participants were randomly assigned to either exploratory (10 FGCS, 9 BP) or confirmatory (15 FGCS, 15 BP) groups for analyses. Responses from the exploratory group were used to inductively derive a qualitative coding system. This system was used to code responses in the confirmatory group. Coded confirmatory data were used for final analyses. Results Over 50% of participants in both cohorts submitted a non-blank response 100% of the time. For over 50% of participants, intervention responses aligned with the target ACT process for at least 96% of the time (FGCS) and 91% of the time (BP), and current behavior was labeled as values-based 70% (FGCS) and 85% (BP) of the time. Participants labeled similar behaviors flexibly as either values-based or avoidant in different contexts. Dominant themes were needs-based behaviors, interpersonal and family relationships, education, and time as a cost. Conclusions Both cohorts were engaged with the app, as demonstrated by responses that aligned with ACT processes. This suggests that participants had some level of understanding that behavior can be flexible in form and function.
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Affiliation(s)
- Sydney Hoel
- Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Amanda Victory
- Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | | | - Zachary N. Stowe
- Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Amy Cochran
- Population Health Sciences and Mathematics, University of Wisconsin-Madison, Madison, WI, United States
- *Correspondence: Amy Cochran
| | - Emily B. K. Thomas
- Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
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Swogger MT, Smith KE, Garcia-Romeu A, Grundmann O, Veltri CA, Henningfield JE, Busch LY. Understanding Kratom Use: A Guide for Healthcare Providers. Front Pharmacol 2022; 13:801855. [PMID: 35308216 PMCID: PMC8924421 DOI: 10.3389/fphar.2022.801855] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
Kratom (Mitragyna speciosa Korth., Rubiaceae) is a plant native to Southeast Asia, where it has been used for centuries as a mild stimulant and as medicine for various ailments. More recently, as kratom has gained popularity in the West, United States federal agencies have raised concerns over its safety leading to criminalization in some states and cities. Some of these safety concerns have echoed across media and broad-based health websites and, in the absence of clinical trials to test kratom’s efficacy and safety, considerable confusion has arisen among healthcare providers. There is, however, a growing literature of peer-reviewed science that can inform healthcare providers so that they are better equipped to discuss kratom use with consumers and people considering kratom use within the context of their overall health and safety, while recognizing that neither kratom nor any of its constituent substances or metabolites have been approved as safe and effective for any disease. An especially important gap in safety-related science is the use of kratom in combination with physiologically active substances and medicines. With these caveats in mind we provide a comprehensive overview of the available science on kratom that has the potential to i clarity for healthcare providers and patients. We conclude by making recommendations for best practices in working with people who use kratom.
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Affiliation(s)
- Marc T Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - Kirsten E Smith
- Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program, Baltimore, MD, United States
| | - Albert Garcia-Romeu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Oliver Grundmann
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States.,College of Pharmacy, Department of Medicinal Chemistry, University of Florida, Gainesville, FL, United States
| | - Charles A Veltri
- Department of Pharmaceutical Sciences, Midwestern University College of Pharmacy, Glendale, AZ, United States
| | - Jack E Henningfield
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.,Pinney Associates, Bethesda, MD, United States
| | - Lorna Y Busch
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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Palmisano AN, Norman SB, Panza KE, Petrakis IL, Pietrzak RH. PTSD symptom heterogeneity and alcohol-related outcomes in U.S. military veterans: Indirect associations with coping strategies. J Anxiety Disord 2022; 85:102496. [PMID: 34775167 DOI: 10.1016/j.janxdis.2021.102496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 10/22/2021] [Accepted: 11/01/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study investigated the role of coping strategies in mediating the relationship between the 7-factor model of posttraumatic stress disorder (PTSD) symptoms and alcohol misuse in veterans. METHODS Data were analyzed from 615 veterans from a nationally representative study of U.S. veterans who met criteria for probable full or subthreshold PTSD. Path analyses examined the role of self-sufficient, socially-supported, and avoidant coping strategies in mediating associations between PTSD symptom clusters and alcohol use disorder (AUD), alcohol consumption, and alcohol-related consequences. RESULTS Negative affect PTSD symptoms were associated with AUD through increased use of avoidant coping. Additionally, dysphoric arousal PTSD symptoms were associated with AUD; avoidant coping was associated with AUD and increased alcohol consumption; self-sufficient coping was associated with reduced AUD likelihood anhedonia symptoms with decreased use of self-sufficient coping; and negative affect with decreased use of socially-supported coping and increased use of avoidant coping. CONCLUSIONS Results underscore the importance of avoidant coping strategies as potential mediators of the relation between PTSD symptoms and AUD. Interventions designed to mitigate engagement in avoidant coping strategies, and to bolster engagement in self-sufficient and socially-supported strategies may help reduce alcohol misuse in veterans with full or subthreshold PTSD.
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Affiliation(s)
- Alexandra N Palmisano
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA.
| | - Sonya B Norman
- Department of Psychiatry, University of California, San Diego, CA, USA; VA Center of Excellence for Stress and Mental Health, San Diego, CA, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, White River Junction, VT, USA; VA San Diego Healthcare System, San Diego, CA
| | - Kaitlyn E Panza
- Department of Psychiatry, University of California, San Diego, CA, USA; VA San Diego Healthcare System, San Diego, CA
| | - Ismene L Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; US Department of Veteran Affairs National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910222. [PMID: 34639523 PMCID: PMC8508349 DOI: 10.3390/ijerph181910222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk–benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70–80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.
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Mindfulness in Treatment Approaches for Addiction — Underlying Mechanisms and Future Directions. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00372-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
Purpose of Review
While the treatment of addictive disorders proves to be challenging, new treatment approaches that evolved around the concepts of mindfulness and acceptance have been utilized and investigated in recent years. Our goal is to summarize the efficacy and possible underlying mechanisms of mindfulness-based interventions (MBI) in addictive disorders.
Recent Findings
Various meta-analyses have suggested that MBIs show clinical efficacy in the treatment of addictive disorders. Considering the factors that impact addictive disorders, MBIs have been indicated to augment responsiveness to natural rewards in contrast to addiction-related cues as well as to increase top-down cognitive control, decrease subjective and physiological stress perception, and enhance positive affect.
Summary
In summary, MBIs hold promise in treating addictive disorders while larger randomized controlled trials with longitudinal study designs are needed to confirm their utility. Newest clinical endeavors strive to enhance the clinical utility of MBIs by augmentation or personalization.
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Feingold D, Zerach G. Emotion regulation and experiential avoidance moderate the association between posttraumatic symptoms and alcohol use disorder among Israeli combat veterans. Addict Behav 2021; 115:106776. [PMID: 33348279 DOI: 10.1016/j.addbeh.2020.106776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION the association between Posttraumatic Stress symptoms (PTSS) and Alcohol Use Disorder (AUD) among combat veterans is well established. However, little is known concerning the intertwining effect of distress oriented coping mechanisms on this association. In this study, we sought to explore the moderating role of experiential avoidance (EA), cognitive reappraisal (CR) and expressive suppression (ES) on the association between PTSS and AUD among Israeli combat veterans. METHOD Participants were 189 Israel Defense Forces (IDF) male combat veterans (mean age = 30.03) who completed a set of validated self-report questionnaires assessing PTSS, AUD, EA, CR and ES. Moderation analyses were conducted using a four-step hierarchical regression analysis and an ordinary least squares regression analysis. RESULTS Analyses indicated that individuals with average or high levels of EA or ES exhibited significant positive association between PTSS and AUD, yet those with low levels of EA or ES exhibited no significant association between PTSS and AUD (b = 0.14,Confidence Interval (CI)[0.06, 0.22, SE = 0.04, t = 3.65, p = .000, 95%] for EA and b = 0.17, CI[0.07, 0.25, SE = 0.04, t = 3.69, p = .000, 95%] for ES). In addition, CR moderated the association between PTSS and AUD (b = 0.18, CI[0.07, 0.29, SE = 0.06, t = 3.24, p = .001, 95%]), so that the association between PTSS and AUD is positive and stronger for higher levels of CR. CONCLUSIONS Our findings imply that EA, ES and CR and emotion regulation may be major facilitators of the association between PTSS and AUD among combat veterans. These findings are discussed in the Israeli context as well as in light of a general psychological perspective.
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Affiliation(s)
| | - Gadi Zerach
- Department of Psychology, Ariel University, Ariel, Israel
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