The Effectiveness of Emotion Regulation Training and Cognitive Therapy on the Emotional and Addictional Problems of Substance Abusers

Article excerpt

Objectives: The purpose of this study was to investigate the effectiveness of emotional regulation training group therapy, based on Dialectical Behavioral Therapy(DBT) and Cognitive Therapy, on improving emotional regulation and distress tolerance skills and relapse prevention in addicts .

Method: In a quasiexperimental study, 39 patients with the diagnosis of opioid dependence based on DSM-IV criteria were randomly assigned in to two experimental and one control groups. The experimental groups took 10 ninety-minute sessions of group therapy. The subjects were evaluated using the Opiate Treatment Index (OPI), General Health Questionnaire-28 (GHQ- 28), and Distress Tolerance and Difficulties in Emotion Regulation Scales prior to the start of treatment, and at the sixteenth session. The control group did not take group therapy and was merely treated with naltrexone. Data were analyzed using repeated measures ANOVA and X^sup 2^ test .

Results: Scheffe test showed that both emotion regulation training and cognitive therapy were more effective than naltrexone increasing distress tolerance, emotion regulation enhancement, and decreasing the amount of drug abuse, health improvement, social functioning, somatic symptoms, anxiety, social dysfunction and depression enhancement(P<0.05). In addition, emotion regulation training was more effective than cognitive therapy, increasing distress tolerance and emotional regulation enhancement (p<0.05).

Conclusion: It seems that DBT skill training increase the effectiveness of pharmacotherapy and is more effective than cognitive therapy.

Keywords: Behavior therapy, Cognitive therapy, Group psychotherapy, Recurrence,Substance related disorders

Iran J Psychiatry 2010; 5:2:60-65

Substance use disorders (SUDs) represent a serious public health problem in the United States and all over the world (1). SUDs not only cause impairment and suffering on the part of the affected individual, but also create a significant burden for the family and society (2-5). The average Iranian addict is most likely male, married and employed (6). Data from various provinces and within different groups show that more than 90 % of the drug abusing population is male (6). In fact, the Rapid Situation Assessment (RSA) study claimed that, on average, 93 % of drug abusers in the nation are male (6).

Unfortunately, the results showed that, despite the persistence and effort by staff and family members, attrition and relapse rates were high. In one unpublished study by the welfare organization in Bandar-Abbas, a southern city in Iran, the-6-month relapse rates mounted to 95 %. Similar finding in Tehran and major cities showed such discouraging results (6).

According to one popular theory of addictive behavior, known as the "self-medication hypothesis" (SMH) individuals use drugs and alcohol to modulate their emotional states (7-10). It is clear that opioids are the primary drugs of abuse in Iran (6). According to SMH, substance addiction functions as a compensatory means to modulate distressful affects and self-soothe from unmanageable psychological states(7).

The view that substance abusers have difficulties regulating their emotions, and that negative emotional states precipitate substance use, is supported by a large body of empirical evidence (7- 10). The SMH considers the effects of drugs (e.g., opiates, cocaine, and alcohol) that interact with the inner states of psychological suffering and personality organization (11-13). Opiates (e.g., heroin, codeine, and oxycodone), in both natural and synthetic forms, have been widely used medically for their painreducing properties (14). According to Khantzian, opiate abuse functions as a temporarily adaptive response that mutes the rage and aggression (15,16). Khantzian asserted opiate abusers have not successfully established familiar defensive, neurotic, characterological, or other common adaptive mechanisms as a way of dealing with their distress. …