Psychological flexibility-based interventions versus first-line psychosocial interventions for substance use disorders: Systematic review and meta-analyses of randomized controlled trials

Toshitaka,; Sato, Hirofumi; Watanabe, Norio; Kondo, Masaki; Masuda, Akihiko; Hayes, Steven C.; Akechi, Tatsuo

doi:10.1016/j.jcbs.2019.07.003

Cited by 34 publications

(23 citation statements)

References 31 publications

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“…Research shows that PF can achieve this goals at higher education [32,75,76] and in drug-related behaviours and disorders [77]. This can be achieved by capitalizing on the clinical application of the PF model, coined Acceptance and Commitment Therapy (ACT; [35]) that indicates six therapeutic facets, three of them align to the MyUSE goals: to increase mindfulness, promote the identification of values, and cultivate committed actions [32,78,79].…”

Section: Discussionmentioning

confidence: 99%

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

et al. 2021

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Background Digital harm-reduction interventions typically focus on people with severe drug-use problems, yet these interventions have moderate effectiveness on drug-users with lower levels of risk of harm. The difference in effectiveness may be explained by differences in behavioural patterns between the two groupings. Harnessing behavioural theories to understand what is at the core of drug-use behaviours and mapping the content of new interventions, may improve upon the effectiveness of interventions for lower-risk drug-users. To the best of our knowledge, this is the first study to systematically apply the Behaviour Change Wheel (BCW) approach to understand the components, influencing capabilities, opportunities, and motivations (COM-B) of higher education students to change their drug-use behaviors. It is also the first study which identifies specific patterns of behaviours that are more responsive to harm reduction practices through the use of the Theoretical Domain Framework (TDF). Methods We employed an explanatory sequential mix-method design. We first conducted an on-line survey and a Delphi exercise to understand the factors influencing COM-B components of higher education students to change their drug-use. Subsequently, we mapped all evidence onto the COM-B components and the TDF domains to identify clusters of behaviours to target for change, using a pattern-based discourse analysis. Finally, a series of multidisciplinary group meetings identified the intervention functions—the means by which the intervention change targeted behaviours and the Behavioural Change Techniques (BCTs) involved using the behaviour change technique taxonomy (v.1). Results Twenty-nine BCTs relevant to harm-reduction practices were identified and mapped across five intervention functions (education, modelling, persuasion, incentivization, and training) and five policy categories (communication/marketing, guidelines, regulation, service provision, and environmental/social planning). These BCTs were distributed across eight identified saturated clusters of behaviours MyUSE intervention attempts to change. Conclusions The BCTs, identified, will inform the development of a digitally delivered behaviour change intervention that focuses on increasing mindful decision-making with respect to drug-use and promotes alternatives to drug-use activities. The findings can also inform implementation scientists in applying context-specific harm-reduction practices in higher education. We present examples of how the eight identified clusters of target behaviours are mapped across the COM-B components and the TDF, along with suggestions of implementation practices for harm reduction at student population level.

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Section: Discussionmentioning

confidence: 99%

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

et al. 2021

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“…The therapy explicitly targets helping people build flexible and broad repertoires for living their lives well rather than for eliminating symptoms of any specific diagnosis (Hayes et al 2012). Nevertheless, ACT has demonstrated effectiveness in reducing the symptoms of various psychological disorders and behavior challenges like anxiety, depression, somatic health problems, suicide, and substance misuse (A-Tjak et al 2014;Ducasse et al 2018;Ii et al 2019). Moreover, studies have indicated potential for ACT in preventing behavioral health concerns in high risk populations and promoting well-being (Dindo et al 2018;Grègoire et al 2018;Ostergaard et al 2020).…”

Section: Psychological Flexibility Processes As the Therapeutic Change Mechanisms Of Acceptance And Commitment Therapymentioning

confidence: 99%

Exploratory Study of Common Changes in Client Behaviors Following Routine Psychotherapy: Does Psychological Flexibility Typically Change and Predict Outcomes?

Brandon

Pallotti

Jog

2020

J Contemp Psychother

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Psychological flexibility refers to a modifiable pattern of interacting with one’s experiences with openness and awareness (acceptance-and-mindfulness) and active engagement guided by personal values (commitment-and-behavioral activation). Psychological flexibility has a base of research literature that supports its utility as a model of human behavioral health and pathology. Although the model is central in organizing the therapeutic processes of Acceptance and Commitment Therapy, researchers have argued that psychological flexibility processes might be activated in other effective therapy models included in routine psychotherapy, even if those models do not purport to target those processes. This study explored the degree to which aspects of clients’ psychological flexibility, specifically acceptance-and-mindfulness and commitment-and-behavioral activation, changed after episodes of routine psychotherapy and were predictors of outcome changes for a clinically heterogeneous sample (n = 197) in a naturalistic treatment setting. Results showed statistically significant and small improvements in acceptance-and-mindfulness (d = 0.22) and commitment-and-behavioral activation (d = 0.24) and that changes in psychological flexibility were significant predictors of changes in both flourishing and distress, explaining 42% and 23% of those respective therapy outcomes. Whereas a mix of therapy approaches may slightly improve psychological flexibility, more explicit attention to strengthening it might benefit the work of diverse psychotherapists given its potential relevance to achieving common overarching therapy outcomes.

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“…These factors are both internal (i.e., personality and affective experience) and external (i.e., familial and peer interaction) in nature and impact the course of SUD (Witkiewitz et al, 2014). Nearly 8 million Americans are also identified as having one or more co-occurring mental health disorders, further contributing to relapse (Center for Behavioral Health Statistics and Quality, 2015;Ii et al, 2019). This suggests that one-third of individuals with SUD also present with comorbidities, such as depression, anxiety, stress, and posttraumatic stress disorder (PTSD; Hermann et al, 2016;Svanberg et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, SUD is treated with evidence-based practices, such as cognitive behavioral therapy (CBT), motivational interviewing (MI), and contingency management (CM; Lee et al, 2015). While established protocols have shown to be efficacious for SUD treatment, 30 to 50% of individuals remain abstinent for only short periods of time (Lee et al, 2015;Ii et al, 2019). Due to limitations treating chronic and comorbid presentations, established protocols may not be best suited for long-term SUD treatment (Clarke et al, 2014;Lee et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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The Choice Point Model of Acceptance and Commitment Therapy With Inpatient Substance Use and Co-occurring Populations: A Pilot Study

Berman¹,

Kurlancheek²

2021

Front. Psychol.

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Objectives: Acceptance and Commitment Therapy (ACT) is an empirically supported treatment which aims to enhance self-acceptance and a commitment to core values. The present study examined the effectiveness of the Choice Point model of ACT in a residential substance use disorder (SUD) setting. Choice Point is a contemporary approach to ACT and targets transdiagnostic processes.Methods: This uncontrolled quasi-experimental design assessed 47 participants taking part in Choice Point for Substances (CHOPS) in order to investigate its influence on psychological inflexibility, values-based action, and self-compassion over time. The study additionally assessed for sleeper effects and associations between transdiagnostic processes and warning signs of relapse.Results: Findings demonstrated a decrease in psychological inflexibility and increases in values-based action and self-compassion over time. Gains were maintained at follow-up, and sleeper effects were observed for psychological inflexibility and mindfulness. Correlational analysis suggested that all transdiagnostic processes were related to warning signs of relapse at follow-up.Conclusion: These results provide preliminary evidence for the feasibility, acceptability, and effectiveness of CHOPS for SUD. Observed sleeper effects in psychological inflexibility and mindfulness indicate that CHOPS may provide longer-term benefits critical to a population where relapse is common. While encouraging, these findings should be interpreted with caution. Future research should utilize comparison groups when investigating CHOPS.

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Psychological flexibility-based interventions versus first-line psychosocial interventions for substance use disorders: Systematic review and meta-analyses of randomized controlled trials

Cited by 34 publications

References 31 publications

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

Reducing drug-use harms among higher education students: MyUSE contextual-behaviour change digital intervention development using the Behaviour Change Wheel

Exploratory Study of Common Changes in Client Behaviors Following Routine Psychotherapy: Does Psychological Flexibility Typically Change and Predict Outcomes?

The Choice Point Model of Acceptance and Commitment Therapy With Inpatient Substance Use and Co-occurring Populations: A Pilot Study

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