Elizabeth A. R. Robinson

A PILOT STUDY OF GROUP MINDFULNESS-BASED COGNITIVE THERAPY (MBCT) FOR COMBAT VETERANS WITH POSTTRAUMATIC STRESS DISORDER (PTSD)

“Mindfulness‐based” interventions show promise for stress reduction in general medical conditions, and initial evidence suggests that they are accepted in trauma‐exposed individuals. Mindfulness‐based cognitive therapy (MBCT) shows substantial efficacy for prevention of depression relapse, but it has been less studied in anxiety disorders. This study investigated the feasibility, acceptability, and clinical outcomes of an MBCT group intervention adapted for combat posttraumatic stress disorder (PTSD).

Forgiveness and alcohol problems among people entering substance abuse treatment

Abstract Forgiveness is argued to be highly relevant to problematic substance use, yet supportive empirical evidence is lacking. Findings are presented from a longitudinal study exploring the relationship between religiousness and spirituality (RS) variables and alcohol use disorders. We examined forgiveness of self (ForSelf), of others (ForOthers), and by God (ByGod), hypothesizing positive relationships with RS and negative relationships with alcohol use and consequences, at both baseline (N = 157) and six-month follow-up (N = 126). ForSelf scores were significantly lower than ForOthers and ByGod scores, and ForOthers scores increased modestly over time. ByGod was most consistently associated with other RS variables. ForSelf and ForOthers were associated with alcohol-related variables at both time points, and baseline ForSelf and ForOthers were associated with fewer drinking consequences at follow-up, but not after controlling for other pertinent variables. ForSelf may be most difficult to achieve and thus most important to recovery, thereby preventing full recovery and fostering relapses.

Persistent insomnia, abstinence, and moderate drinking in alcohol-dependent individuals.

Insomnia is common, persistent, and increases the risk for relapse in alcohol-dependent (AD) patients. Abstinence has long been considered the best strategy for allowing sleep to normalize, although how many and which patients respond to abstinence is unknown. The aims of this study were to investigate the prevalence and correlates of both baseline and persistent insomnia in AD patients. The course of sleep problems in response to abstinence, moderate drinking, or relapse following treatment was also examined. A naturalistic longitudinal outcomes study interviewed 267 patients (69% male; mean age of 44 years) with DSM-IV alcohol dependence at baseline and 6 months later (84% follow-up rate) . The Sleep Problems Questionnaire, Time-Line Follow-Back Interview, and Brief Symptom Inventory measured insomnia, drinking, and psychiatric symptoms, respectively. Simple correlations, logistic regression, and repeated measures analysis of variance were used to analyze the data. At baseline, 47% of patients were classified with insomnia, which was independently predicted by female gender and psychiatric severity. Both abstinence and moderate drinking outcomes significantly predicted a reduction of insomnia symptoms after controlling for gender and psychiatric severity. Among patients with baseline insomnia, however, insomnia persisted in over 60% of cases, which was predicted by baseline insomnia severity. Moreover, insomnia persisted in one-quarter of patients despite abstinence. Treatment aimed at preventing relapse to heavy drinking provides good first-line therapy for insomnia in AD patients, but some may require insomnia-specific evaluation and treatment in addition to substance-focused treatment and psychiatric care. 

Mindfulness-Based Cognitive Therapy With Older Adults: An Exploratory Study

An 8-week mindfulness-based cognitive therapy (MBCT) group for older adults with depression and/or anxiety is described. This article is based on an exploratory study of this therapeutic approach and changes in participants’ symptoms associated with participation. Pre-post data from 5 MBCT groups showed significant improvements in reported anxiety, ruminative thoughts, and sleep problems and a reduction in depressive symptoms. Case examples are presented to illustrate these symptom changes. Findings showed that this nonpharmacological intervention is acceptable to older adults and is associated with positive changes. Suggestions are provided for both practitioners and researchers interested in using MBCT with older adults.

Multiple dimensions of spirituality in recovery: A lagged mediational analysis of alcoholics anonymous principal theoretical mechanism of behavior change

Alcoholics Anonymous (AA) states that recovery is possible through spiritual experiences and spiritual awakenings. Research examining spirituality as a mediator of AAs effect on drinking has been mixed. It is unknown whether such findings are due to variations in the operationalization of key constructs, such as AA and spirituality. To answer these questions, the authors used a longitudinal model to test 2 dimensions of AA as focal predictors and 6 dimensions of spirituality as possible mediators of AAs association with drinking. Data from the first 18 months of a 3-year longitudinal study of 364 alcohol-dependent individuals were analyzed. Structural equation modeling was used to replicate the analyses of Kelly et al. (Alcohol Clin Exp Res. 2011;35:454-463) and to compare AA attendance and AA involvement as focal predictors. Multiple regression analyses were used to determine which spirituality dimensions changed as the result of AA participation. A trimmed, data-driven model was employed to test multiple mediation paths simultaneously. The findings of the Kelly et al. study were replicated. AA involvement was a stronger predictor of drinking outcomes than AA attendance. AA involvement predicted increases in private religious practices, daily spiritual experiences, and forgiveness of others. However, only private religious practices mediated the relationship between AA and drinking.

Forgiveness and Mental Health Among People Entering Outpatient Treatment With Alcohol Problems

While forgiveness appears to be directly associated with treatment outcomes for alcohol problems, it may have indirect effects through mental health symptoms. We examined multiple dimensions of forgiveness: of self (ForSelf), of others (ForOthers), and by God (ByGod). Both ForSelf and ForOthers were strongly related to mental health at baseline (N = 157), whereas at 6 months, ForSelf was strongly related to mental health (N = 126). Longitudinally, baseline ForOthers predicted 6-month mental health symptoms. Forgiving oneself and others has implications for the mental health of alcoholics entering treatment.

Mental Health, not Social Support, Mediates the Forgiveness–Alcohol Outcome Relationship

Religiousness and spirituality are important to most Americans, and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which, in turn, would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others, fully mediating or operating through an indirect-only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect-only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were nonsignificant variables at baseline, follow-up, and longitudinally.

How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives

Evidence from multiple lines of research supports the effectiveness and practical importance of Alcoholics Anonymous and Narcotics Anonymous. Conference presenters discussed the relationship between 12-Step participation and abstinence among various populations, including adolescents, women, and urban drug users. Insight from the arts and humanities placed empirical findings in a holistic context.

A longitudinal study of drinking and depression as predictors of insomnia in alcohol-dependent individuals

Insomnia and depressive symptoms are common symptoms among alcohol-dependent (AD) patients. AD individuals (N = 364) were assessed during 2004–2009 in the Midwestern United States at baseline and 6-month intervals with the Sleep Problems Questionnaire, Time-Line Follow-Back interview, and the depression subscale of the Brief Symptom Inventory. Hierarchical Linear Modeling was used to analyze the data in this longitudinal study. When modeled separately, both quantity of drinking (p < .01) and depression (p < .001) predicted insomnia severity, controlling for time, age, and gender. Drinking also predicted depressive symptoms (p < .001), and its effect on insomnia was mediated by depression severity (p < .001).

Life-changing experiences, spirituality and religiousness of persons entering treatment for alcohol problems.

Abstract There is little empirical data published on the spirituality and religiousness of persons entering treatment for alcohol problems, particularly in comparison to a national sample. The frequency of life-changing spiritual and religious experiences in this treatment population is also unknown, although there is much speculation and a few qualitative studies on the role that such experiences may play in recovery. This study surveyed 90 patients entering treatment for alcohol problems and found that 54.4% at some time in their lives, had a life-changing spiritual or religious experience, compared to 39.1% in a large national survey. This studys sample also rated their spirituality higher than their religiousness, and higher than did the national sample. About a third, 32.2%, had no religious preference, compared to 13.8% in the national sample. Having had life-changing spiritual or religious experiences was associated with greater use of positive religious coping, some daily spiritual experiences, and higher self-ratings of ones self as spiritual and religious. Such experiences were not associated with patterns of alcohol use at treatment entry, demographic variables (sex, age, ethnicity, education, employment, or marital status), or AA involvement, including number of meetings attended in last year and in ones life-time. This study begins to elucidate the extent of spirituality and religiousness in those seeking treatment for alcohol problems and the role of life-changing spiritual and religious experiences in their recovery, which would appear to be more common than suggested by assumptions of spiritual alienation among alcoholics.