A Randomized, Controlled Trial of the Efficacy of an Interoceptive Exposure-Based CBT for Treatment-Refractory Outpatients with Opioid Dependence

Otto, Michael W.; Hearon, Bridget A.; McHugh, R. Kathryn; Calkins, Amanda W.; Pratt, Elizabeth M.; Murray, Heather W.; Safren, Steven A.; Pollack, Mark H.

doi:10.1080/02791072.2014.960110

Cited by 15 publications

(15 citation statements)

References 66 publications

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“…This study found no difference in any measure between the three treatment arms. This mirrors recent findings in prescription opioid dependence where the addition of counselling to OST made no difference to drug related outcomes [ 55 ], and in treatment-refractory opioid dependent individuals where there was no evidence for the superiority of a cognitive behavioural intervention over an active comparison condition [ 56 ]. Another study cited loss of hope as a reason for non-attendance at counselling sessions [ 57 ].…”

Section: Discussionsupporting

confidence: 78%

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

et al. 2018

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BackgroundApproximately 3% of people receiving opioid substitution therapy (OST) in the UK manage to achieve abstinence from prescribed and illicit drugs within three years of commencing treatment. Involvement of families and wider social networks in supporting psychological treatment may be an effective strategy in facilitating recovery, and this pilot study aimed to evaluate the impact of a social network-focused intervention for patients receiving OST.MethodsA two-site, open feasibility trial randomised patients receiving OST for at least 12 months but still reporting illicit opiate use in the past 28 days to one of three treatments: 1) treatment as usual (TAU), 2) Brief Social Behaviour and Network Therapy (B-SBNT) + TAU, or 3) Personal Goal Setting (PGS) + TAU. The two active interventions consisted of 4 sessions. There were 3 aims: 1) test the feasibility of recruiting OST patients to a trial of B-SBNT, and following them up over 12 months; 2) test the feasibility of training clinicians to deliver B-SBNT; 3) test whether B-SBNT reduces heroin use 3 and 12 months after treatment, and to explore potential mediating factors. The primary outcome for aim 3 was number of days of heroin use in the past month, and a range of secondary outcome measures were specified in advance (level of drug dependence, mental health, social satisfaction, therapist rapport, treatment satisfaction, social network size and support).ResultsA total of 83 participants were randomised, and 70 (84%) were followed-up at 12 months. Fidelity analysis of showed that B-SBNT sessions were clearly distinguishable from PGS and TAU sessions, suggesting it was possible to train clinical staff to an adequate level of competence.No significant differences were found between the 3 intervention arms in the primary or secondary outcome measures. Attendance at psychosocial treatment intervention sessions was low across all three arms (44% overall).ConclusionsPatients receiving OST can be recruited into a trial of a social network-based intervention, but poor attendance at treatment sessions makes it uncertain whether an adequate dose of treatment was delivered. In order to achieve the benefits of psychosocial interventions, further work is needed to overcome poor engagement.Trial registrationISRCTN Trial Registration Number: ISRCTN22608399.Date of registration: 27/04/2012. Date of first randomisation: 14/08/2012.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1600-7) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 78%

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

et al. 2018

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“…In addition, our review found two studies using interoception in substance use disorders with differing results; the mindfulness based intervention showed some statistically significant results, while CBT for interoceptive cues did not. 37,73 Paulus and colleagues review treatment for interoceptive dysfunction in addiction and highlight potential approaches to modulate interoceptive function and insular activation patterns, including mindfulness-based approaches and physical exercise. 81 Paulus and colleagues also discuss the role of increasing the frontal control network and reducing urges through cognitive training.…”

Section: Discussionmentioning

confidence: 99%

Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions

Khoury¹,

Lutz

Schuman‐Olivier

2018

Harv Rev Psychiatry

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Interoception, or the process of sensing, interpreting, and integrating internal bodily signals, has increasingly been the subject of scientific research over the past decade but is still not well known in clinical practice. The aim of this article is to review clinical treatment interventions that use interoception, to synthesize the current research knowledge, and to identify the gaps where future research is needed. We conducted a comprehensive literature search on randomized, controlled trials that both include interoception in treatment interventions for individuals with psychiatric disorders and measure aspects of interoception using self-report measures. Out of 14 randomized, controlled trials identified, 7 found that interventions with interoception were effective in ameliorating symptoms. These studies included individuals with anxiety disorders, eating disorders, psychosomatic disorders, and addictive disorders. All of the intervention studies with positive clinical outcomes also demonstrated changes on interoceptive measures; however, these measures were often related to specific illness symptoms. Interoception may be a mechanism of action in improving clinical symptomatology, though studies incorporating general, symptom-independent interoceptive measures remain scarce. To further our understanding of the role interoception has in psychiatric disorders and their treatment, more studies integrating interoceptive measures are needed, along with a clearer definition of interoceptive terms used.

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“…A subset of studies focused on sub-populations of individuals receiving OAT that (a) had an additional substance use condition [n = 6, 8.3%; these included cocaine use (n = 4, 5.6%) [67,71,76,80], moderate to heavy alcohol use (n = 1, 1.4%) [39], or sedative/hypnotic dependence (n = 1, 1.4%) [85], (b) had a psychiatric disorder or prominent symptoms associated with a psychiatric disorder [n = 5, 6.9%, including a personality disorder (n = 2, 2.8%) [68,79], personality or psychiatric disorder (n = 1, 1.4%) [95], depression (n = 1, 1.4%) [45], or mid-to high level psychiatric symptoms (n = 1, 1.4%) [93], (c) were pregnant women (n = 3, 4.2%) [55,91,98], (d) were veterans (n = 2, 2.8%) [92,94], (e) were positive for HIV (n = 2, 2.8%) [54,70], (f) had chronic low back pain (n = 1, 1.4%) [103] or (g) were described as being in poor mental or physical health based on a predetermined cutoff on the Opiate Treatment Index Health Symptoms Scale of the Global Severity Index of the Symptom Check-list (n = 1, 1.4%) [62]. One study only recruited individuals that had "failed to respond to the standard course of treatment" [46]. [40,42,43,45,68,71,73,76,77,88,92,95,97], alcohol use [42, 43, 58, 80-83, 88, 92, 95, 104], adherence to OAT [42,43,49,…”

Section: Study Populationsmentioning

confidence: 99%

“…One study only recruited individuals that had "failed to respond to the standard course of treatment" [46]. [40,42,43,45,68,71,73,76,77,88,92,95,97], alcohol use [42, 43, 58, 80-83, 88, 92, 95, 104], adherence to OAT [42,43,49,53,54,61,72,86,102,110], HIV/HCV risk behavior [54,57,60,61,67,88,89,91,105], withdrawal symptoms [40,49,65,73,86,87,96], adverse events [49,58,75,102], measure of craving [49,83], relapse prevention [41,106], drop-outs from...…”

Section: Study Populationsmentioning

confidence: 99%

“…Findings, drug use. Thirty-four studies (47.2%) [39, 42, 46, 49, 53, 58, 63, 64, 68, 71, 72, 75, 77, 79-82, 84, 85, 87-89, 91-95, 97-99, 101, 104, 108, 109] assessed the use of illicit drugs (as described by the study authors) either through urinalysis (n = 18/34, 52.9%) [53, 58, 63, 71, 72, 79, 80, 85, 87, 89, 93-95, 97, 98, 101, 104, 109] or through self-report measures (n = 16/34, 47.0%) [39,42,46,49,64,68,75,77,81,82,84,88,91,92,99,108]. Most studies (n = 21/34, 61.8%) [42, 46, 49, 53, 58, 63, 64, 72, 75, 80, 81, 84, 85, 87-89, 91-95, 97, 98, 101, 104, 109] were designed with a counselling [53, 63, 72, 80, 85, 87, 89, 93-95, 97, 98, 101, 104] or OAT-only [58,94,109] control group.…”

Section: Syntheses For Secondary Outcomesmentioning

confidence: 99%

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Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

et al. 2020

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Background Guidelines recommend that individuals with opioid use disorder (OUD) receive pharmacological and psychosocial interventions; however, the most appropriate psychosocial intervention is not known. In collaboration with people with lived experience, clinicians, and policy makers, we sought to assess the relative benefits of psychosocial interventions as an adjunct to opioid agonist therapy (OAT) among persons with OUD. Methods A review protocol was registered a priori (CRD42018090761), and a comprehensive search for randomized controlled trials (RCT) was conducted from database inception to June 2020 in MEDLINE, Embase, PsycINFO and the Cochrane Central Register of Controlled Trials. Established methods for study selection and data extraction were used. Primary outcomes were treatment retention and opioid use (measured by urinalysis for opioid use and opioid abstinence outcomes). Odds ratios were estimated using network meta-analyses (NMA) as appropriate based on available evidence, and in remaining cases alternative approaches to synthesis were used. Results Seventy-two RCTs met the inclusion criteria. Risk of bias evaluations commonly identified study limitations and poor reporting with regard to methods used for allocation concealment and selective outcome reporting. Due to inconsistency in reporting of outcome measures, only 48 RCTs (20 unique interventions, 5,404 participants) were included for NMA of treatment retention, where statistically significant differences were found when psychosocial interventions were used as an adjunct to OAT as compared to OAT-only. The addition of rewards-based interventions such as contingency management (alone or with community reinforcement approach) to OAT was superior to OAT-only. Few statistically significant differences between psychosocial interventions were identified among any other pairwise comparisons. Heterogeneity in reporting formats precluded an NMA for opioid use. A structured synthesis was undertaken for the remaining outcomes which included opioid use (n = 18 studies) and opioid abstinence (n = 35 studies), where the majority of studies found no significant difference between OAT plus psychosocial interventions as compared to OAT-only. Conclusions This systematic review offers a comprehensive synthesis of the available evidence and the limitations of current trials of psychosocial interventions applied as an adjunct to OAT for OUD. Clinicians and health services may wish to consider integrating contingency management in addition to OAT for OUD in their settings to improve treatment retention. Aside from treatment retention, few differences were consistently found between psychosocial interventions adjunctive to OAT and OAT-only. There is a need for high-quality RCTs to establish more definitive conclusions. Trial registration PROSPERO registration CRD42018090761.

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A Randomized, Controlled Trial of the Efficacy of an Interoceptive Exposure-Based CBT for Treatment-Refractory Outpatients with Opioid Dependence

Cited by 15 publications

References 66 publications

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions

Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: A systematic review with network meta-analyses

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