An arousal-control and cross-over design was used to evaluate the reliability, specificity, and validity of the Normative Appetitive Picture System (NAPS), a cue exposure protocol with sets of visual alcohol, cigarette, and control cues. The authors also examined the utility of conceptualizing cue reactivity as a multidimensional phenomenon involving independent approach and avoidance dimensions. University student participants (n=369) rated multiple cue images in terms of arousing properties and capacity to elicit separate approach and avoidance inclinations. They also completed a battery of substance-related individual-difference measures. Results indicated that NAPS protocol reactivity profiles had good reliability and high specificity across cue types and individuals with different substance use histories. Avoidance reactivity independently predicted self-reports of substance-related behaviors, after controlling for approach reactivity.
Despite the growing recognition for multidimensional assessments of cue-elicited craving, few studies have attempted to measure multiple response domains associated with craving. The present study evaluated the Ambivalence Model of Craving (Breiner et al., 1999; Stritzke et al., 2007) using a unique cue reactivity methodology designed to capture both the desire to use (approach inclination) and desire to not consume (avoidance inclination) in a clinical sample of incarcerated female substance abusers. Participants were 155 incarcerated women who were participating in or waiting to begin participation in a nine-month drug treatment program. Results indicated that all four substance cue-types (alcohol, cigarette, marijuana, and crack cocaine) had good reliability and showed high specificity. Also, the validity of measuring approach and avoidance as separate dimensions was supported, as demonstrated by meaningful clinical distinctions between groups evincing different reactivity patterns and incremental prediction of avoidance inclinations on measures of stages of change readiness. Taken together, results continue to highlight the importance of measuring both approach and avoidance inclinations in the study of cue-elicited craving.
A training partnership was established with the Florida Department of Corrections in 2003, and over the ensuing years, art therapy graduate student interns from Florida State University's Graduate Art Therapy Program have been placed in local prisons at different times. Recently, the art therapy interns worked closely with the supervising psychologist in one prison to alleviate and redirect aggression by integrating cognitive-behavioral techniques with art therapy directives. The art therapy interns and the psychologist developed a curriculum using a combination of workbook exercises and art tasks to develop and increase the participants' anger management skills, the Art Therapy Anger Management Protocol. This article provides an overview of art therapy in prison, the cognitive-behavioral approach to anger management with prison inmates, and how art therapy was used to support this approach. Examples of completed art tasks designed to correspond with the workbook curriculum are presented. Overall, this article presents the successful collaboration between the psychologist and art therapists and demonstrates how they facilitated improvement in the participants' anger management skills through this program.
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