Jason B. Luoma

DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies?

Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Functional Analytic Psychotherapy have recently come under fire for “getting ahead of their data” ( Corrigan, 2001 ). The current article presents a descriptive review of some of the actual evidence available. Dialectical Behavior Therapy and Acceptance and Commitment Therapy have a small but growing body of outcome research supporting these procedures and the theoretical mechanisms thought to be responsible for them. Functional Analytic Psychotherapy has a limited research base, but its central claim is well substantiated. The claims made in the published literature about these technologies, at least by their originators, seem proportionate to the strength of the current evidence. There is no indication that those interested in the new wave of behavior therapy innovations are less committed to empirical evaluation than has always been the case in behavior therapy.

Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders.

OBJECTIVE Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of acceptance and commitment therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program. METHOD Consecutive cohort pairs were assigned in a pairwise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of 6 hr of treatment that would have occurred at that same time. The ACT intervention consisted of three 2-hr group sessions scheduled during a single week. RESULTS Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at 4-month follow-up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow-up. Effects of the ACT intervention on treatment utilization at follow-up were statistically mediated by posttreatment levels of shame, in that those evidencing higher levels of shame at posttreatment were more likely to be attending treatment at follow-up. Intervention effects on substance use at follow-up were mediated by treatment utilization at follow-up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance. CONCLUSIONS These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use.

Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes

Little is known about the assessment and treatment of self-stigma in substance abusing populations. This article describes the development of an acceptance based treatment (Acceptance and Commitment Therapy–ACT) for self-stigma in individuals in treatment for substance use disorder. We report initial outcomes from a study with 88 participants in a residential treatment program. The treatment involves 6 h of a group workshop focused on mindfulness, acceptance, and values work in relation to self-stigma. Preliminary outcomes showed medium to large effects across a number of variables at post-treatment. Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.

Measuring weight self-stigma: the weight self-stigma questionnaire.

Stigma associated with being overweight or obese is widespread. Given that weight loss is difficult to achieve and maintain, researchers have been calling for interventions that reduce the impact of weight stigma on life functioning. Sound measures that are sensitive to change are needed to help guide and inform intervention studies. This study presents the weight self‐stigma questionnaire (WSSQ). The WSSQ has 12 items and is designed for use only with populations of overweight or obese persons. Two samples of participants—one treatment seeking, one nontreatment seeking—were used for validation (N = 169). Results indicate that the WSSQ has good reliability and validity, and contains two distinct subscales—self‐devaluation and fear of enacted stigma. The WSSQ could be useful for identifying individuals who may benefit from a stigma reduction intervention and may also help evaluate programs designed to reduce stigma.

Randomized Trial Comparing Mindfulness-Based Relapse Prevention with Relapse Prevention for Women Offenders at a Residential Addiction Treatment Center

Reincarceration rates are high among substance-involved criminal offenders. This study (conducted during 2010–2011 in an urban area and funded by a Washington State University-Vancouver mini-grant) used a randomized design to examine the effectiveness of mindfulness-based relapse prevention (MBRP) as compared to relapse prevention (RP), as part of a residential addictions treatment program for women referred by the criminal-justice system (N = 105). At 15-week follow up, regression analyses found women in MBRP, compared to RP, reported significantly fewer drug use days and fewer legal and medical problems. Study limitations and future research directions for studying the efficacy of MBRP are discussed.

Burnout among the addiction counseling workforce: The differential roles of mindfulness and values-based processes and work-site factors

Although work-site factors have been shown to be a consistent predictor of burnout, the importance of mindfulness and values-based processes among addiction counselors has been little examined. In this study, we explored how strongly experiential avoidance, cognitive fusion, and values commitment related to burnout after controlling for well-established work-site factors (job control, coworker support, supervisor support, salary, workload, and tenure). We conducted a cross-sectional survey among 699 addiction counselors working for urban substance abuse treatment providers in six states of the United States. Results corroborated the importance of work-site factors for burnout reduction in this specific population, but we found that mindfulness and values-based processes had a stronger and more consistent relationship with burnout as compared with work-site factors. We conclude that interventions that target experiential avoidance, cognitive fusion, and values commitment may provide a possible new direction for the reduction of burnout among addiction counselors.

Substance abuse and psychological flexibility: The development of a new measure

Psychological flexibility is a relatively new clinical construct targeted by Acceptance and Commitment Therapy, a behavior analytic treatment incorporating mindfulness and values interventions, among other processes. Poor psychological flexibility has been shown to relate to clinical problems as well as normative life challenges, and efforts to increase psychological flexibility have correlated with improvements for a variety of psychological difficulties, including substance abuse. The Acceptance and Action Questionnaire (AAQ) is currently the standard measure of psychological flexibility, but in substance misusing samples, has not shown adequate psychometric properties. Content-specific variants of the AAQ have been effective in other treatment domains, suggesting that a substance abuse focused version of the AAQ may be useful. This article details the construction and initial validation of such a measure, the AAQ-SA, which demonstrated good internal consistency, factor structure, and construct validity. In addition, the AAQ-SA appeared to be empirically distinguishable from the AAQ. Future researchers are advised to address limitations of this study and encouraged to expand the empirical database on substance abuse treatment with this new measure.

The Development and Psychometric Properties of a New Measure of Perceived Stigma Toward Substance Users

A self-report measure of perceived stigma toward substance users was developed and studied. An initial measure was created based on a previously developed scale that was rated by experts for content validity and quality of items. The scale, along with other measures, was administered to 252 people in treatment for substance problems in the United States during 2006–2007. Refinement efforts resulted in an eight-item scale with good face validity, construct validity, and adequate levels of internal consistency. Most relationships with other constructs were as expected. Findings suggest that perceived stigma is distinct from other forms of stigma.

Examining the Implicit Relational Assessment Procedure: Four Preliminary Studies

The Implicit Relational Assessment Procedure (IRAP) is a relatively new measure of implicit cognition that tests cognition as relational behavior instead of an associative activity and thus may provide a more specific measure of cognitive repertoires, including those for social biases, than better known implicit measures such as the Implicit Association Test (IAT). A small body of IRAP research provides tentative evidence for this measure’s potential. The current study adds to this research by using the IRAP to assess for social biases for race, religion, gender, and obesity. Overall results show medium to large effect sizes for all conditions except obesity, as well as interesting trends at the trial-type level. These outcomes and possible future directions of IRAP research are discussed.

Stigma predicts residential treatment length for substance use disorder

Abstract Background: Stigma has been suggested as a possible contributor to the high rates of treatment attrition in substance-dependent individuals, but no published empirical studies have examined this association. Objectives: The present paper assessed the relationship between baseline stigma variables and length of treatment stay in a sample of patients in a residential addictions treatment unit. Methods: The relationship between baseline stigma variables (self-stigma, enacted stigma, and shame) and length of stay for participants (n = 103) in a residential addictions treatment unit was examined. Results: Higher self-stigma predicted longer stay in residential addictions treatment, even after controlling for age, marital status, race, overall mental health, social support, enacted stigma, and internalized shame. However, other stigma variables (i.e. internalized shame, stigma-related rejection) did not reliably predict length of treatment stay. Conclusion: These results are consistent with other findings suggesting that people with higher self-stigma may have a lowered sense of self-efficacy and heightened fear of being stigmatized and therefore retreat into more protected settings such as residential treatment, potentially resulting in higher treatment costs. Specialized clinical interventions may be necessary to help participants cope with reduced self-efficacy and fear of being stigmatized.