Emotional reactivity and difficulties in emotional regulation in drug users: a study in adolescents undergoing treatment in a therapeutic community

Purpose The purpose of this study is to investigate which emotions and difficulties in the emotional regulation of adolescents with illicit substance consumption. Design/methodology/approach In total, 41 adolescents undergoing treatment for the use of alcohol and drugs were recruited. The instruments used were the emotional rating scale and the difficulties in the regulation of emotions scale. Findings Emotional reactivity showed significant differences in the sadness dimension in relation to the number of cannabis cigarettes smoked daily and length of stay, and in the surprise dimension in relation to the number of cannabis cigarettes smoked daily. There was a significant correlation between happiness and age, surprise and number of siblings, sadness and school absenteeism and fear, school absenteeism and number of substances consumed. In regard to difficulties in emotional regulation, there were significant differences between the groups, in strategies regarding the gender of the participants and the number of substances consumed, in non-acceptance and impulses and in the number of substances consumed and in the awareness of the type and number of substances consumed. There was a significant correlation between strategies, non-acceptance, awareness and impulses and the number of substances consumed. Originality/value This study demonstrated that the emotional problems of adolescents admitted to a therapeutic community are predictors of illicit substance use.

Attachment and Therapeutic Alliance in Substance Use Disorders: Initial Findings for Treatment in the Therapeutic Community

Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology.Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER).Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology.Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.

The Peniston & Kulkosky Treatment for Chemical Dependence: a Replication, and Assessment of the Importance of the Electroencephalograph (EEG) Biofeedback Component of the Protocol

<p>This thesis is primarily a replication of Peniston and Kulkoskys' (1989; 1990) treatment (PKT) study which reported successful outcomes for alcoholics using an alpha/theta electroencephalograph (EEG) biofeedback protocol. The PKT protocol consists of 6 temperature biofeedback sessions of training increased hand temperature, followed by 30 sessions of training, via EEG biofeedback, increases in alpha/theta band amplitude. The latter sessions included visualizations of personality and physiology changes, and visualisations of scenes where alcohol is refused. Another aim of this study was to determine whether the EEG biofeedback element of the protocol was superior in outcomes to the subject simply listening to monotonous sounds. In addition to three months of therapeutic community treatment, one experimental group of 15 subjects received the PKT protocol, the other received a modified version excluding EEG biofeedback, and a control group of 14 subjects had no additional treatment. Post-treatment follow up revealed significant improvements for all three groups in key psychometric instruments. These were the Multiaxial Personality Inventory (MCMI-II), Situational Confidence Questionnaire (SCQ), Life Purpose Questionnaire (LPQ), and, at follow up, Addiction Severity Index (ASI). The control group changed in fewer MCMI-II scales, and had a higher treatment drop out rate. At follow up the groups' abstinence rates, using Peniston and Kulkoskys' measure, were also similar. However, when more sensitive relapse measures were applied, the PKT groups' relapse results were about twice those of the control group. This was significant for male subjects' mean number of days using substances, whereas female subjects' abstinence rates were high in all three groups. This therapeutic modality enhances therapeutic community treatment outcomes in a small sample of subjects, a result not common in the literature. It merits further investigation and implementation in a New Zealand setting.</p>

The Peniston & Kulkosky Treatment for Chemical Dependence: a Replication, and Assessment of the Importance of the Electroencephalograph (EEG) Biofeedback Component of the Protocol

<p>This thesis is primarily a replication of Peniston and Kulkoskys' (1989; 1990) treatment (PKT) study which reported successful outcomes for alcoholics using an alpha/theta electroencephalograph (EEG) biofeedback protocol. The PKT protocol consists of 6 temperature biofeedback sessions of training increased hand temperature, followed by 30 sessions of training, via EEG biofeedback, increases in alpha/theta band amplitude. The latter sessions included visualizations of personality and physiology changes, and visualisations of scenes where alcohol is refused. Another aim of this study was to determine whether the EEG biofeedback element of the protocol was superior in outcomes to the subject simply listening to monotonous sounds. In addition to three months of therapeutic community treatment, one experimental group of 15 subjects received the PKT protocol, the other received a modified version excluding EEG biofeedback, and a control group of 14 subjects had no additional treatment. Post-treatment follow up revealed significant improvements for all three groups in key psychometric instruments. These were the Multiaxial Personality Inventory (MCMI-II), Situational Confidence Questionnaire (SCQ), Life Purpose Questionnaire (LPQ), and, at follow up, Addiction Severity Index (ASI). The control group changed in fewer MCMI-II scales, and had a higher treatment drop out rate. At follow up the groups' abstinence rates, using Peniston and Kulkoskys' measure, were also similar. However, when more sensitive relapse measures were applied, the PKT groups' relapse results were about twice those of the control group. This was significant for male subjects' mean number of days using substances, whereas female subjects' abstinence rates were high in all three groups. This therapeutic modality enhances therapeutic community treatment outcomes in a small sample of subjects, a result not common in the literature. It merits further investigation and implementation in a New Zealand setting.</p>

‘The English language enables me to visit my pain’. Exploring experiences of using a later-learned language in the healing journey of survivors of sexuality persecution

Aims and objectives: This qualitative study explores the experience of using a later-learned language, English (ELX), in the therapeutic journey of refugee survivors of sexuality persecution to enhance understanding of the role of language in their rehabilitation. Design/methodology/approach: This is a multiple case study of three refugees, persecuted in their home country because of their sexual orientation, who are regular attendees of a therapeutic community, Room to Heal, based in London. A qualitatively driven mixed-method research design using Interpretative Phenomenological Analysis (IPA) and ethnography was employed. Data and analysis: Data were gathered through semi-structured interviews with the first author. They consisted of questions about the relationship between the participants’ languages, emotions and sense of self. Findings/conclusions: Participants shared common positive experiences characterised by feelings of the ELX being a liberating tool that empowered them and enabled them to bear witness to their trauma, express their same-sex love more easily and be more self-accepting, and contributed to the (re)invention and performance of a ‘new’ self. Originality: The originality resides first in the unique profile of the participants – victims of persecution because of their sexual orientation; second in the unique context – a therapeutic community supporting refugees; and third in the methodology – a qualitatively driven mixed-method design combining IPA and ethnography. Significance/implications: The findings support an embodied perspective of languages and highlight the need for therapists to be aware of multilingualism and its effects. The reduced emotional resonance of a later-learned language may offer its users a way to access trauma and build a new self within the therapeutic process.

An acute change? Does treatment within a therapeutic community for personality disorders affect local acute service use

Purpose The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project. Design/methodology/approach The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data. Findings The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance. Originality/value PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

Providing Treatment in a Prison-Based Therapeutic Community for Those Who Have Committed Sexual Offences

This article explores some of the difficulties inherent in managing risk in those who have committed sexual or other violent offences and how this may impact on their ability to re-integrate into the community. It discusses the work undertaken at HMP Grendon, a prison-based therapeutic community (TC), to address these difficulties and help residents develop a pro-social lifestyle starting in custody and continuing on release. The article aims to describe how the TC model offers a containing and adaptive environment, and how this can provide opportunities to address offence-related behaviour, which is not always possible in other prison settings. Furthermore, it describes some of the difficulties inherent in undertaking work of this nature, in the need for an accurate understanding of the relevant areas of risk, and the tensions developing a therapeutic relationship with individuals with complex needs. Methods of assessment of risk and need are discussed, and how they are used in a collaborative manner to have the most accurate picture of what will help residents to maintain their pro-social lifestyle on release.