[Show abstract][Hide abstract] ABSTRACT: Objectives
Disorders of behavioral dysregulation often involve more than one dsyregulated behavior (e.g., drug abuse and aggression, alcohol abuse and gambling). The high co-occurrence suggests the need of a transdiagnostic treatment that can be customized to target multiple specific behaviors.Method
The current pilot study compared a 20-week, individual transdiagnostic therapy (mindfulness and modification therapy [MMT]) versus treatment as usual (TAU) in targeting alcohol problems, drug use, physical aggression, and verbal aggression in self-referred women. Assessments were administered at baseline, post-intervention, and 2-month follow-up.ResultsWilcoxon signed-ranked tests and multilevel modeling showed that MMT (n = 13) displayed (a) significant and large decreases in alcohol/drug use, physical aggression, and verbal aggression; (b) significantly greater decreases in alcohol/drug use and physical aggression than did TAU (n = 8); and (c) minimal-to-no deterioration of effects at follow-up. Both conditions showed significant decreases in verbal aggression, with no statistically significant difference between conditions. MMT also displayed greater improvements in mindfulness.Conclusions
Preliminary findings support the feasibility and efficacy of MMT in decreasing multiple dysregulated behaviors.
[Show abstract][Hide abstract] ABSTRACT: Although the current diagnostic manual conceptualizes personality disorders (PDs) as categorical entities, an alternative perspective is that PDs represent maladaptive extreme versions of the same traits that describe normal personality. Existing evidence indicates that normal personality traits, such as those assessed by the five-factor model (FFM), share a common structure and obtain reasonably predictable correlations with the PDs. However, very little research has investigated whether PDs are more extreme than normal personality traits. Utilizing item-response theory analyses, the authors of the current study extend previous research to demonstrate that the diagnostic criterion for borderline personality disorder and FFM neuroticism could be fit along a single latent dimension. Furthermore, the authors' findings indicate that the borderline criteria assessed the shared latent trait at a level that was more extreme (d = 1.11) than FFM neuroticism. This finding provides further evidence for dimensional understanding of personality pathology and suggests that a trait model in DSM-5 should span normal and abnormal personality functioning, but focus on the extremes of these common traits.
Full-text · Article · Oct 2013 · Journal of personality disorders
[Show abstract][Hide abstract] ABSTRACT: A variety of obstacles (e.g., lack of transportation, less availability of treatment in rural districts) contribute to underutilization of treatment among patients with substance use disorders, warranting the need to develop innovative strategies for enhancing access to treatment for these patients. The telehealth in-home-messaging-device is a small message-delivering and monitoring device connected via landline phone to a secure server that provides assessment and disease self-management education to patients in their homes. We describe the development of a Substance Use Disorder telehealth management program (SUD program) for use on this device and a feasibility pilot of the program with six outpatient veterans with substance use disorders referred by their primary medical care providers. These patients indicated that the SUD program was acceptable, easy to use, and helpful toward addressing their substance use problems. Home telehealth technology may be an innovative and feasible approach for providing substance abuse evidence-based treatment either as an adjunct to specialty treatment for substance use disorders or as a stand-alone intervention within primary care for a larger number of patients who may otherwise not access traditional treatment services. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
No preview · Article · Aug 2013 · Psychological Services
[Show abstract][Hide abstract] ABSTRACT: Background:
There are few effective smoking cessation interventions for adolescent smokers. We developed a novel intervention to motivate tobacco use behavior change by (1) enhancing desire to quit through the use of abstinence-contingent incentives (CM), (2) increasing cessation skills through the use of cognitive behavioral therapy (CBT), and (3) removing cessation barriers through delivery within high schools.
An exploratory four-week, randomized controlled trial was conducted in Connecticut high schools to dismantle the independent and combined effects of CM and CBT; smokers received CM alone, CBT alone, or CM+CBT. Participants included 82 adolescent smokers seeking smoking cessation treatment. The primary outcome was seven-day end-of-treatment (EOT) point prevalence (PP) abstinence, determined using self-reports confirmed using urine cotinine levels. Secondary outcomes included one-day EOT PP abstinence and cigarette use during treatment and follow up.
Among participants who initiated treatment (n=72), group differences in seven-day EOT-PP abstinence were observed (χ(2)=10.48, p<0.01) with higher abstinence in the CM+CBT (36.7%) and CM (36.3%) conditions when compared with CBT (0%). One-day EOT-PP abstinence evidenced similar effects (χ(2)=10.39, p<0.01; CM+CBT: 43%, CM: 43%, CBT: 4.3%). Survival analyses indicated differences in time to first cigarette during treatment (χ(2)=8.73, p=0.003; CBT: Day 3, CM: Day 9, CM+CBT: Day 20). At one- and three-month follow ups, while no differences were observed, the CM alone group had the slowest increase in cigarette use.
High-school, incentive-based smoking cessation interventions produce high rates of short-term abstinence among adolescent smokers; adding cognitive behavioral therapy does not appear to further enhance outcomes.
No preview · Article · Mar 2013 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: The objective was to compare the efficacy of motivational enhancement therapy coupled with cognitive behavioral therapy (MET-CBT) to brief advice for treatment of substance use in pregnancy.
This was a randomized, parallel, controlled trial that was yoked to prenatal care and delivered at hospital outpatient clinics. We enrolled 168 substance-using women who had not yet completed an estimated 28 weeks of pregnancy. Obstetrical clinicians provided brief advice, and study nurses administered manualized MET-CBT. The primary outcome was percentage of days in the prior 28 days in which alcohol and/or drugs were used immediately before and 3 months postdelivery.
There were no significant differences across groups in terms of self-reported percentage of days in which drugs or alcohol were used prior to and 3 months postdelivery. Biological measures showed similar results. There was a trend (P=.08) for lower risk of preterm birth among those who received MET-CBT.
The tested interventions had similar therapeutic effects. Hence, both treatments may be suitable for pregnant substance users, depending on the population, setting and provider availability. Interventions that are intensified after delivery may decrease postpartum "rebound" effects in substance misuse.
Full-text · Article · Jul 2012 · General hospital psychiatry
[Show abstract][Hide abstract] ABSTRACT: Individuals with cocaine dependence often evidence poor cognitive control. The purpose of this exploratory study was to investigate networks of functional connectivity underlying cognitive control in cocaine dependence and examine the relationship of the networks to the disorder and its treatment. Independent component analysis (ICA) was applied to fMRI data to investigate if regional activations underlying cognitive control processes operate in functional networks, and whether these networks relate to performance and treatment outcome measures in cocaine dependence. Twenty patients completed a Stroop task during fMRI prior to entering outpatient treatment and were compared to 20 control participants. ICA identified five distinct functional networks related to cognitive control interference events. Cocaine-dependent patients displayed differences in performance-related recruitment of three networks. Reduced involvement of a "top-down" fronto-cingular network contributing to conflict monitoring correlated with better treatment retention. Greater engagement of two "bottom-up" subcortical and ventral prefrontal networks related to cue-elicited motivational processing correlated with abstinence during treatment. The identification of subcortical networks linked to cocaine abstinence and cortical networks to treatment retention suggests that specific circuits may represent important, complementary targets in treatment development for cocaine dependence. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
No preview · Article · Jul 2012 · Psychology of Addictive Behaviors
[Show abstract][Hide abstract] ABSTRACT: Assess the relative effects of a variety of illicit and licit drugs on risk for adverse birth outcomes.
We used data from two large prospective investigations, and a novel analytic method, recursive partitioning class analysis to identify risk factors associated with preterm birth and delivering a small for gestational age infant.
Compared to cocaine and opiate non-users, cocaine users were 3.53 times as likely (95% CI: 1.65-7.56; p = 0.001) and opiate users 2.86 times as likely (95% CI: 1.11-7.36; p = 0.03) to deliver preterm. The odds of delivering a small for gestational age infant for women who smoked more than two cigarettes daily was 3.74, (95% CI: 2.47-5.65; p<0.0001) compared to women who smoked two or less cigarettes daily and had one previous child. Similarly, less educated, nulliparous women who smoked two or fewer cigarettes daily were 4.12 times as likely (95% CI: 2.04-8.34; p < 0.0001) to have a small for gestational age infant.
Among our covariates, prenatal cocaine and opiate use are the predominant risk factors for preterm birth; while tobacco use was the primary risk factor predicting small for gestational age at delivery. Multi-substance use did not substantially increase risk of adverse birth outcomes over these risk factors.
Full-text · Article · Apr 2012 · The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
[Show abstract][Hide abstract] ABSTRACT: Individual differences in behavioral inhibition and behavioral activation may place certain people at greater risk for neuropsychiatric disorders and engagement in risky behaviors. Therefore, studying the neural correlates of behavioral inhibition and activation may help us understand neural mechanisms underlying risk behaviors in both clinical and non-clinical populations. To investigate, we assessed the relationships between white matter integrity and measures of behavioral inhibition and behavioral activation in 51 healthy participants using diffusion tensor imaging (DTI) and the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scale. Scores on the Fun-Seeking subscale of the BAS positively correlated with DTI fractional anisotropy in the left corona radiata and adjacent superior longitudinal fasciculus, and with mean diffusivity in the left inferior longitudinal fasciculus and inferior fronto-occipital fasciculus after controlling for age, gender, and education. These findings suggest that the integrity of white matter connecting extensive brain regions implicated in self-control and the processing of rewards and emotions are associated with individual differences in the motivation for seeking and participating in fun and novel experiences.
Full-text · Article · Apr 2012 · Human Brain Mapping
[Show abstract][Hide abstract] ABSTRACT: Contingency management (CM) reduces drug use, but questions remain regarding optimal targets and magnitudes of reinforcement. We evaluated the efficacy of CM reinforcing attendance in patients who initiated treatment with cocaine-negative samples, and of higher magnitude abstinence-based CM in patients who began treatment positive.
Initially cocaine-negative patients (n = 333) were randomized to standard care (SC), SC + CM reinforcing submission of negative samples with $250 in prizes ($250Abs), or SC + CM reinforcing attendance ($250Att). Initially cocaine-positive patients (n = 109) were randomized to SC, $250Abs, or higher magnitude CM ($560Abs).
For initially cocaine-negative patients, $250Abs and $250Att were equally efficacious to SC in enhancing longest duration of abstinence (LDA); $250Att patients submitted lower proportions of negative samples when missing samples were considered missing, but these patients also attended more study sessions, provided more samples, and submitted a higher proportion of negative samples than SC patients when expected samples were analyzed, ps < .05. In initially cocaine-positive patients, both CM conditions increased proportions of negative samples relative to SC when missing samples were excluded from analyses, but only $560Abs was efficacious in increasing LDA and proportion of negative samples when expected samples were analyzed, ps < .05. Follow-ups revealed no differences among groups, but LDA was consistently associated with abstinence during follow-up, p < .05.
High magnitude abstinence-based reinforcement improved all abstinence outcomes in patients who began treatment while using cocaine. For patients initiating treatment abstinent, both attendance- and abstinence-based CM resulted in improvements on some measures.
Full-text · Article · Jan 2012 · Journal of Consulting and Clinical Psychology
[Show abstract][Hide abstract] ABSTRACT: Although previous surveys have indicated high rates of illicit and prescription drug misuse among college students, few have assessed negative consequences, personal concerns, or interest in interventions for drug use. In a survey of 262 college students who self-reported lifetime use of an illicit drug, 69% reported at least one negative consequence over the course of their lifetime and 63% in the past year. Many also reported being moderately concerned (28%) about their drug or medication misuse and moderately interested in some form of intervention (76%). The frequency of marijuana use and medication misuse in the past month was related to increased negative consequences and personal concerns even when controlling for the frequency of past month alcohol use. There were relatively few differences as a function of gender or year in college.
Preview · Article · Jan 2012 · Journal of College Student Development
[Show abstract][Hide abstract] ABSTRACT: The wars in Iraq and Afghanistan are associated with high rates of post-traumatic stress disorder (PTSD) and comorbid alcohol use disorders. The pharmacotherapy of these comorbid conditions has received relatively little study. The current study compared the serotonin uptake inhibitor, paroxetine, to the norepinephrine uptake inhibitor, desipramine. It also evaluated the adjunctive efficacy of the Food and Drug Administration (FDA)-approved alcoholism pharmacotherapy, naltrexone, relative to placebo. Four groups of predominately male veterans (n=88) meeting current diagnostic criteria for both alcohol dependence (AD) and PTSD were randomly assigned under double-blind conditions to one of four groups: paroxetine+naltrexone; paroxetine+placebo; desipramine+naltrexone; desipramine+placebo. Main outcome measures included standardized scales that assessed symptoms of PTSD and alcohol consumption. Paroxetine did not show statistical superiority to desipramine for the treatment of PTSD symptoms. However, desipramine was superior to paroxetine with respect to study retention and alcohol use outcomes. Naltrexone reduced alcohol craving relative to placebo, but it conferred no advantage on drinking use outcomes. Although the serotonin uptake inhibitors are the only FDA-approved medications for the treatment of PTSD, the current study suggests that norepinephrine uptake inhibitors may present clinical advantages when treating male veterans with PTSD and AD. However, naltrexone did not show evidence of efficacy in this population. This study was registered with ClinicalTrials.gov, registration number NCT00338962 and URL: http://clinicaltrials.gov/ct2/show/NCT00338962?term=desipramine+AND+alcohol+dependence+AND+depression&recr=Closed&rank=1.Keywords: alcohol and alcoholism; psychopharmacology; PTSD; naltrexone; veterans; comorbidity
Preview · Article · Nov 2011 · Neuropsychopharmacology
[Show abstract][Hide abstract] ABSTRACT: This is a Stage I open pilot to develop a new intervention, Mentorship for Alcohol Problems (MAP), for individuals with alcohol-use disorders in community treatment programs.
Ten mentors participated for 6 months until 30 mentees received MAP for 12 weeks. Behavioral and biological measures were conducted in addition to fidelity measures. Four focus groups were held with participants and clinician feedback surveys were completed.
Feasibility and acceptance data in the domains of patient interest, safety and satisfaction were promising. Mentees reduced their alcohol and substance use and the majority of mentors sustained abstinence. Fidelity measures indicated that mentors adhered to the delivery of treatment.
MAP shows promise to be incorporated into professionally run outpatient alcohol treatment programs to assist in the reduction of alcohol and substance use.
Full-text · Article · Nov 2011 · Alcohol and Alcoholism
[Show abstract][Hide abstract] ABSTRACT: The mechanisms by which behavioral therapies for substance use disorders (SUDs) exert their effects and the components of treatment that contribute most to substance use outcome remain unclear. Disruptions to aspects of impulse control and attention have been hypothesized to contribute to the development and maintenance of addiction; moreover, alterations in these processes may underlie responses to treatment.
Individuals participating in a randomized clinical trial evaluating computer-assisted cognitive behavioral therapy (CBT) for substance abuse participated in fMRI Stroop before and after treatment. A non-substance-using comparison group performed the same task under test-retest conditions.
The patient group demonstrated decreased Stroop-related BOLD signal in regions including the anterior cingulate, inferior frontal gyrus and midbrain at post-treatment relative to pre-treatment, and displayed a greater decrease in the subthalamic nucleus and surrounding regions compared to healthy controls following test-retest.
Behavioral therapies may be associated with reduction in substance use and effects on neural systems involved in cognitive control, impulsivity, motivation and attention.
Full-text · Article · Oct 2011 · Drug and alcohol dependence
[Show abstract][Hide abstract] ABSTRACT: Using cross-sectional data and structural equation modeling, we evaluated whether coping self-efficacy to abstain from drinking in various situations accounted for the relationship between internalizing (depression, anxiety) and externalizing (aggression, low socialization) dimensions with problematic alcohol use in 292 first-time DWI offenders. Results indicated that an internalizing dimension indirectly predicted problematic alcohol use through coping self-efficacy in negative situations only, whereas an externalizing dimension indirectly predicted problematic alcohol use through coping self-efficacy in positive situations only. These findings support two potential pathways to problematic drinking behavior among DWI offenders and suggest that internalizing and externalizing dimensions may differentially predict high risk drinking situations due to one's inability to abstain in specific situations.
Full-text · Article · Oct 2011 · Psychology of Addictive Behaviors
[Show abstract][Hide abstract] ABSTRACT: Many factors comprise a patient's decision to disclose use of drugs. Pregnant women may report drug use because they would like help with their addiction but the stigma associated with drug use may dampen their willingness to disclose. Knowledge about the accuracy of self-reported drug use as compared to urine toxicology screens can assist clinicians in the management of substance use in pregnancy.
We compared the urine toxicology screens and self-reported use of marijuana or cocaine for 168 women enrolled in an integrated obstetrical/substance abuse treatment program. We stratified by various periods of self-reported use and race and utilized Cohen's kappa to measure overall agreement between self-report and toxicology tests.
Most women with a positive toxicology screen reported use in the past 28 days (78% for marijuana, 86% for cocaine). However, many women reported their most recent use to be outside of the assays' detection window (14% for marijuana, 57% for cocaine). We did not find differences in self-report for women with positive urine between Whites and non-Whites (p = 1.00). Agreement over the previous month was good (Kappa = 0.74 and 0.70 for marijuana and cocaine, respectively.).
A question about use of marijuana or cocaine during the preceding month rather than the prior few days may be a better indicator of use.
No preview · Article · Oct 2011 · Journal of Substance Use
[Show abstract][Hide abstract] ABSTRACT: The Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study sought to answer questions about the benefits of combining behavioral and pharmacological interventions (naltrexone and acamprosate) in alcohol-dependent patients. Our goals were to identify trajectories of heavy drinking before randomization in COMBINE, to characterize patients in these trajectories, and to assess whether prerandomization trajectories predict drinking outcomes. We analyzed daily indicators of heavy drinking 90 days before randomization using a trajectory-based approach. Each patient was assigned to the most likely prerandomization heavy-drinking trajectory, and the baseline characteristics of participants in the baseline trajectories were compared. The main and interactive effects of these trajectories and treatment factors (acamprosate, naltrexone, or combined behavioral intervention) on summary drinking measures during active treatment (16 weeks) were assessed. We identified five trajectories of heavy drinking prerandomization: "T1: frequent heavy drinkers"; "T2: very frequent heavy drinkers"; "T3: nearly daily heavy drinkers"; "T4: daily heavy drinkers"; and "T5: daily heavy drinkers stopping early" before randomization. Trajectory membership was significantly associated with all drinking outcomes. Patients in "T5: daily heavy drinkers stopping early" had comparable drinking outcomes to those in "T1: frequent heavy drinkers," whereas the remaining trajectories were associated with significantly worse outcomes. The baseline trajectory did not interact significantly with the treatment condition. These exploratory analyses confirmed the hypothesis that baseline trajectories predict postrandomization drinking outcomes. Interestingly, "T5: daily heavy drinkers stopping early" had outcomes that were comparable to the least severe baseline trajectory "T1: frequent heavy drinkers," and baseline trajectories of heavy drinking did not moderate the treatment effects.
[Show abstract][Hide abstract] ABSTRACT: To assess methadone maintenance treatment (MMT) patients' willingness to use, and perceived efficacy of, conventional and unconventional group stress reduction treatments.
A survey, developed by the authors, was administered to 150 MMT patients.
Levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were relatively high; however, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. The highest rated conventional and unconventional treatments in terms of willingness and perceived efficacy were nutrition and spiritual counseling, respectively, whereas the lowest rated conventional and unconventional group treatments were anger management and visualization training, respectively. White race was a significant predictor of lower willingness to try conventional and unconventional group therapies and lower perceived efficacy of unconventional group treatment, whereas female sex and older age were significant predictors of higher levels of willingness to try unconventional group treatment. Higher levels of substance use problems were associated with increased willingness to try conventional group treatment. Higher levels of anxiety emerged as a significant independent predictor of treatment willingness and perceived efficacy for both conventional and unconventional group treatments.
The relatively high levels of treatment willingness and perceived efficacy of conventional and unconventional group stress reduction treatments point to the feasibility of offering these interventions in MMT and suggest that, in particular, high levels of anxiety are associated with greater treatment willingness and perceived treatment efficacy.
Full-text · Article · Sep 2011 · Journal of Addiction Medicine
[Show abstract][Hide abstract] ABSTRACT: Often high recidivism substance-using patients have difficulty connecting to outpatient treatment contributing to greater functioning disturbances. Approaches to address this problem frequently are staff extensive.
This study evaluates the impact of peer mentorship and/or enhanced dual recovery treatment (DRT) on individuals who are inpatients, substance abusing, and have a history of high recidivism. The primary outcome is post-discharge treatment attendance.
In an inpatient Veterans Administration hospital setting, 96 patients with a history of high recidivism and current and/or past diagnosis of substance use disorders were randomized to either (i) Treatment As Usual (TAU), (ii) TAU + DRT + Mentorship for Addictions Problems to Enhance Engagement to Treatment (MAP-Engage), or (iii) TAU + MAP-Engage.
Overall MAP-Engage was found to be comparable to the DRT + MAP-Engage and both of these conditions were significantly better than TAU alone at increasing adherence to post-discharge substance abuse, medical, and mental health outpatient appointments. CONCLUSION/SCIENTIFIC SIGNIFICANCE: MAP-Engage offers an alternative approach to address lack of attendance to outpatient treatment appointments post discharge that is relatively low in staff reliance.
No preview · Article · Aug 2011 · The American Journal of Drug and Alcohol Abuse
[Show abstract][Hide abstract] ABSTRACT: Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e.g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.
Anteriormente reportamos los resultados posteriores al tratamiento de un estudio piloto al azar que examinaba una nueva intervención de crianza basada en la afectividad para madres matriculadas en un tratamiento por uso de sustancias y cuidado para niños de hasta tres años de edad (Suchman, DeCoste, Castiglioni, McMahon, Rounsaville y Mayes, de próxima publicación). El Programa Madres e Infantes (MTP) es una terapia de crianza individual con 12 sesiones semanales que busca mejorar la capacidad maternal para el funcionamiento de reflexión y suavizar las difíciles y distorsionadas representaciones mentales sobre la crianza. En un estudio piloto al azar, 47 madres que estaban matriculadas en un tratamiento ambulatorio de abuso de sustancia y cuidado del niño de edad hasta los 3 años, fueron asignadas al azar al MTP versus el Programa de Educación de los Padres (EP) - una intervención de comparación que proveía orientación en cuanto al manejo y desarrollo de casos individuales. Al final del tratamiento, la condición de las madres en el MTP demostró un mejor funcionamiento de reflexión, calidad de la representación y conducta de prestación de cuidado que la condición de las madres en el PE. En esta investigación, examinamos si los beneficios del MTP al momento del post-tratamiento se habían mantenido al momento del seguimiento a las 6 semanas.
Recientemente, también identificamos dos componentes del funcionamiento de reflexión de los padres - un componente que se enfoca en sí mismo, el cual representa la capacidad de la madre de mentalizar acerca de emociones personales fuertes (ira, culpa, dolor) y el impacto de las mismas en el niño, y un componente que se enfoca en el niño, el cual representa la capacidad de la madre de mentalizar acerca de las emociones del niño y su impacto en la madre (Suchman, DeCoste, Borelli y Leigh, de próxima publicación). En este estudio, reexaminamos los resultados del post-tratamiento usando estos dos relacionados aunque distintos componentes.
Dans le passé nous avons fait état de résultats après traitement à partir d'une étude pilote randomisée testant une nouvelle intervention de parentage basée sur l'attachement pour des mères suivant un traitement pour toxicomanie et s'occupant d'enfants de la naissance à trois mois (Suchman, DeCoste, Castiglioni, McMahon, Rounsaville, & Mayes, sous presse). Le Programme Mère et Petits Enfants, abrégé en anglais MTP est une session de 12 semaines de thérapie de parentage individuel qui a pout but d'augmenter la capacité maternelle au fonctionnement de réflexion et pour atténuer les représentations mentales souvent dures et déformées de parentage. Dans une étude pilote randomisée, 47 mères qui étaient inscrites pour un traitement non résidentiel pour toxicomanie et s'occupant d'enfants de la naissance à trois ans d'âge ont été randomisées entre le MTP et le Programme d'Education Parentale (abrégé PE en anglais) - une intervention de comparaison qui offrait un suivi individuel de chaque cas et des conseils de développement. A la fin du traitement les mères dans la condition MTP ont fait preuve d'un meilleur fonctionnement de réflexion, d'une meilleure qualité de représentation et d'un meilleur comportement de mode de soin que les mères dans la condition PE. Dans cette enquête, nous avons examiné si les bénéfices du MTP après traitement ont été maintenus au suivi de 6 semaines. Récemment, nous avons aussi identifié deux composantes du fonctionnement parental de réflexion - une composante auto-concentrée représentant la capacité du parent à “mentaliser” à propos d'émotions personnelles fortes (par exemple la colère, la culpabilité ou la douleur) et leur impact sur l'enfant et une composante centrée sur l'enfant représentant la capacité du parent à “mentaliser” à propos des émotions de l'enfant et leur impact sur la mère (Suchman, DeCoste, Borelli, & Leigh, sous presse). Danscetteétude nous avonsré-examiné les résultats après traitement en utilisantcesdeux concepts liésmaisdistincts.
Bereits zuvor wurden Postinterventionsbefunde einer randomisierten Pilotstudie vorgestellt, die eine neue bindungsbasierte Elternintervention für Mütter überprüfte, die an einer Behandlung für Substanzmissbrauch und Fürsorge für Kinder von Geburt an bis zum vollendeten vierten Lebensjahr teilnahmen (Suchman, DeCoste, Castiglioni, McMahon, Rounsaville, & Mayes, in press). Bei besagtem Mutter und Kleinkind Programm (MTP) handelt es sich um eine 12 Sitzungen umfassende, individuelle Elterntherapie, dessen Ziel es ist, die mütterliche Reflexive Funktion zu fördern und harsche und verzerrte mentale Repräsentationen des Elterndaseins abzumildern. In einer randomisierten Pilotstudie, wurden 47 Mütter im Rahmen einer ambulanten Behandlung für Substanzmissbrauch und Fürsorge für Kinder zwischen Geburt und drei Jahren versorgt und wurden entweder der MTP oder einem Eltern Edukationsprogram (PE) randomisiert zugewiesen - Letzteres diente als eine Vergleichsintervention, die individuelles Fallmanagement und Entwicklungsberatung zum Inhalt hatte. Am Ende der Behandlung zeigten die Mütter der MTP Bedingung eine verbesserte Reflexive Funktion, Repräsentationsqualität und Fürsorgeverhalten im Vergleich zu Müttern in der PE Bedingung. In dieser Studie wurde untersucht, ob die Vorteile der MTP im 6-wöchigen Follow-Up aufrechterhalten wurden.
Vor kurzem, haben wir zwei Komponenten der elterlichen reflexiven Funktion herausgearbeitet - eine selbstfokussierte Komponente, die die elterliche Fähigkeit verkörpert über starke persönliche Emotionen (z.B. Wut, Schuldgefühle, Schmerz) und ihren Einfluss auf das Kind zu mentalisieren, sowie eine kindfokussierte Komponente, die die elterliche Fähigkeit darstellt über die Emotionen des Kindes und deren Einfluss auf die Mutter zu mentalisieren (Suchman, DeCoste, Borelli, & Leigh, in press). In dieser Studie haben wir die Ergebnisse nach der Behandlung einer erneuten Prüfung Hinblick auf diese zwei verwandten jedoch individuellen Konstrukte unterzogen.
[Show abstract][Hide abstract] ABSTRACT: Cigarette smoking is the leading cause of preventable death in the world, and long-term abstinence rates remain modest. Mindfulness training (MT) has begun to show benefits in a number of psychiatric disorders, including depression, anxiety and more recently, in addictions. However, MT has not been evaluated for smoking cessation through randomized clinical trials.
88 treatment-seeking, nicotine-dependent adults who were smoking an average of 20cigarettes/day were randomly assigned to receive MT or the American Lung Association's freedom from smoking (FFS) treatment. Both treatments were delivered twice weekly over 4 weeks (eight sessions total) in a group format. The primary outcomes were expired-air carbon monoxide-confirmed 7-day point prevalence abstinence and number of cigarettes/day at the end of the 4-week treatment and at a follow-up interview at week 17.
88% of individuals received MT and 84% of individuals received FFS completed treatment. Compared to those randomized to the FFS intervention, individuals who received MT showed a greater rate of reduction in cigarette use during treatment and maintained these gains during follow-up (F=11.11, p=.001). They also exhibited a trend toward greater point prevalence abstinence rate at the end of treatment (36% vs. 15%, p=.063), which was significant at the 17-week follow-up (31% vs. 6%, p=.012).
This initial trial of mindfulness training may confer benefits greater than those associated with current standard treatments for smoking cessation.
Full-text · Article · Jun 2011 · Drug and alcohol dependence