Recovery from addiction: Behavioral economics and value-based decision making.

Behavioral economics provides a general framework to explain the shift in behavioral allocation from substance use to substance-free activities that characterizes recovery from addiction, but it does not attempt to explain the internal processes that prompt those behavioral changes. In this article we outline a novel analysis of addiction recovery based on computational work on value-based decision making (VBDM), which can explain how people with addiction are able to overcome the reinforcement pathologies and decision-making vulnerabilities that characterize the disorder. The central tenet of this account is that shifts in molar reinforcer preferences over time from substance use to substance-free activities can be attributed to changes in evidence accumulation rates and response thresholds in the context of choices involving substance use and substance-free alternatives. We discuss how this account can be reconciled with the established mechanisms of action of psychosocial interventions for addiction and demonstrate how it has the potential to empirically address longstanding debates regarding the nature of impairments to self-control in addiction. We also highlight conceptual and methodological issues that require careful consideration in translating VBDM to addiction and recovery

The role of mindfulness in identity development and goal-setting in emerging adults

The purpose of this mixed-methods dissertation study was to investigate the role of mindfulness in the process of identity development and goal-setting among emerging adults, from two different identity approaches – the identity status model and narrative identity. Of the total sample (N = 130), 119 undergraduate students completed the questionnaires and provided turning point narratives in the online survey. The results showed that the diffusion identity status was negatively associated with mindfulness, goal-setting and narrative identity, whereas more advanced identity maturity was positively associated with mindfulness, goal-setting and narrative identity. In addition, both mindfulness and identity maturity index significantly predicted goal-setting. The relationship between mindfulness and goal-setting was also fully mediated by identity maturity index. Nevertheless, no associations among narrative identity, mindfulness, and goal-setting were found. Using extreme group analysis, the qualitative findings supported the quantitative findings by showing that the narratives in the extremely high identity maturity group were likely to demonstrate participants’ engagement in exploration, acceptance of challenges, perspective changes in life and the worldview, and positive emotion states. The findings provided implications for theory and practice in terms of the importance of incorporating mindfulness-based interventions in facilitating these specific aspects of identity development and goal-setting in emerging adults. Particularly, the findings highlighted that mindfulness promotes emerging adults’ openness to new experiences and willingness to face challenges in rapidly changing occupational structures and social environments. Limitations and directions for future research were also discussed

Relationship Between Stress and Young Adults\u27 Complementary and Alternative Medicine Use

Complementary and alternative medicine (CAM) refers to a group of diverse medical and healthcare systems, practices, and products not treated as conventional medicine. The body of literature on stress and stress management among young adults has not addressed the use of CAM modalities for stress management among this population. The theoretical foundation of the study was based upon the transactional model of stress and coping, which describes stress as an interaction between an external stressor and the resources available to eliminate the stressor. The purpose of this quantitative study was to examine whether variables such as exposure to CAM, stress level, dispositional coping style, sociodemographic variables, and social support influence young adults\u27 use of CAM modalities for stress management. This study sought to determine to what extent dispositional coping, exposure to and knowledge of CAM, and sociodemographic variables affect young adults\u27 use of CAM modalities for stress management. This study also sought to answer whether there is a difference in the perceived stress of participants who use CAM modalities and those who do not. A quantitative cross-sectional correlational study was employed, using a survey methodology, to identify whether the factors identified in the study influence young adults\u27 use of CAM modalities. Results showed that knowledge of CAM and dispositional coping style significantly influence the use of CAM modalities; sociodemographic variables do not influence the use of these modalities. Furthermore, the use of CAM modalities was found to have a significant relationship to stress level. The findings of the current study suggest the CAM techniques can be adapted and introduced into college settings so that students can better manage their stress level

Exploring the Roles of Impulsivity and Self- Compassion as Risk Factors for Analgesic Addiction.

Addiction to analgesics remains a global problem among those with chronic pain while prevention strategies remain limited. This thesis aimed to investigate and reduce the effects of psychological risk factors towards painkiller dependence. These included impulsivity and meta-cognitive factors [Self-hate (HS), Self-inadequacy (IS) and Self-reassurance (RS)]. The meta-cognitive factors are sub-scales within the “Forms of Self-criticising/Self-attacking” self-report measure often used in researching Self-compassion. Compassion is regarded as being warm and understanding towards ourselves during suffering or feeling inadequate, rather than responding harshly with self-criticism. Impulsivity, the tendency to choose smaller-but-sooner rewards in lieu of larger-but later rewards, is a well-known risk factor for developing drug dependence but has not been fully investigated for its role towards painkiller dependence. Additionally, the meta-cognitive risk factors have not been investigated for their role towards painkiller dependence or their relationship with impulsivity. A novel facet of all three studies was that they were all delivered via a bespoke webplatform. Study 1, a cross-sectional study of one group of participants (N=259) aimed to (1) explore the prevalence of painkiller dependence within participants who had chronic pain; (2) elucidate the role of cognitive and behavioural aspects of impulsivity towards painkiller dependence and (3) to investigate the role of IS, HS and RS towards painkiller dependence. Notable significant positive correlations were found between painkiller dependence and daily prescription painkiller consumption; Pain Intensity; Pain Frequency (PF); IS; HS and facets of impulsivity. Regression analysis highlighted low scores for Delay Discounting (DD) and high scores on Lack of Perseverance, NU and IS predicted higher levels of painkiller dependence. Three significant interaction terms (PF x IS; HS; RS) allowed for a moderation analysis to address Aim 3. This showed that IS, RS and HS acted as moderators for PF on Painkiller dependence. Results indicate impulsivity, IS, and HS to be risk factors for painkiller dependence. Study 2 was a pilot randomised controlled trial (RCT) aimed to assess acceptability and feasibility of a web-platform that delivered a Compassionate Mind Training (CMT) intervention to those with chronic pain. Participants were randomised into one of two groups (CMT vs. Relaxation). CMT group participants engaged with a 4 psycho-education video library and a CMT intervention. RM group participants listened to theory-neutral relaxation music and did not engage with CMT related activities. All participants completed the study with no attrition. All feedback questions pertaining to acceptability and feasibility were above the threshold value of 5. Analysis of participant feedback led to two major additions to the web-platform: A dynamic colour-coded timetable and a personal Pain Diary. These new features were applied to Study 3 which was a large-scale version of Study 2. Study 3, an RCT aimed to (1) reduce severity of identified risk factors for painkiller dependence (as found in Study 1) by increasing Self-reassurance and (2) seek associations between variables which reduced/increased in CMT group participants. Participants were randomised into one of two groups (CMT [n=39] vs. Relaxation [n=40]) Both groups completed self-report measures and the DD task at three timepoints. An Intent-To-Treat analysis was applied to reduce attrition bias. Major outcomes of the study were significant reductions within CMT group participants for: painkiller dependence (p < .001), prescription painkiller consumption (p < .001). NU (p < .001) and Self-hate (p < .001). Additionally, Self-reassurance in the CMT group significantly increased (p = .02). To conclude, this piece of research identified and reduced previously unknown risk factors for painkiller dependence. These results may provide benefit for those prescribed painkillers by screening those who may be deemed vulnerable as well as widening our understanding of risk factors for substance dependence

Relative expected value of drugs versus competing rewards underpins vulnerability to and recovery from addiction

This is the final version. Available on open access from Elsevier via the DOI in this recordBehavioural economic theories of addiction contend that greater expected value of drug relative to alternative non-drug rewards is the core mechanism underpinning vulnerability to and recovery from addiction. To evaluate this claim, we exhaustively review studies with human drug users that have measured concurrent choice between drugs vs. alternative rewards, and explored individual differences. These studies show that drug choice can be modulated by drug cues, drug devaluation, imposition of costs/punishment and negative mood induction. Regarding individual differences, dependence severity was reliably associated with overall drug preference, and self-reported drug use to cope with negative affect was reliably associated with greater sensitivity to mood induced increases in drug choice. By contrast, there were no reliable individual differences in sensitivity to the effect of drug cues, drug devaluation or punishment on drug choice. These findings provide insight into the mechanisms that underpin vulnerability to dependence: vulnerability is conferred by greater relative value ascribed to drugs, and relative drug value is further augmented by negative affective states in those who report drug use coping motives. However, dependence does not appear to be characterised by abnormal cue-reactivity, habit learning or compulsion. We then briefly review emerging literature which demonstrates that therapeutic interventions and recovery from addiction might be attributed to changes in the expected relative value of drug versus alternative rewards. Finally, we outline a speculative computational account of the distortions in decision-making that precede action selection in addiction, and we explain how this account provides a blueprint for future research on the determinants of drug choice, and mechanisms of treatment and recovery from addiction. We conclude that a unified economic decision-making account of addiction has great promise in reconciling diverse addiction theories, and neuropsychological evaluation of the underlying decision mechanisms is a fruitful area for future research and treatment.Alcohol Change UKMedical Research Council (MRC

The Significance of Touch in Psychiatry

Touch is one of the fundamental media for interpersonal communication. Over recent decades, scientific efforts have been devoted to establishing the significance of touch, particularly affective touch, in the treatment and prevention of mental disorders and clarifying the underlying mechanisms of touch and massage therapy. This book contributes to this rapidly expanding area of research and gives new insights on recent clinical and experimental findings. A strong plea is made by the editors for well-designed clinical studies which require very special methodologies. A broad spectrum of various touch therapies are already available at present. Modern treatment and prevention of mental disorders should go beyond the pharmacological and psychotherapeutic approaches and should make use of the beneficial effects of touch therapies with the additional benefit of a very small risk of adverse outcomes

Self-balancing sanctuarying : a grounded theory of relaxation and autogenic training

The purpose of this study was to discover how relaxation in general works, and how components of Autogenic Training (AT) (Luthe and Schultz, 2001), a relaxation therapy, may be working together and separately in an anxiolytic process. A corollary purpose was to develop recommendations for clinical practice. Data consisted of personally and historically collected interviews (n=46) and diaries (n=34). Participants with less than moderate anxiety volunteered from the community at large; and, participants with moderate to severe anxiety were drawn from the Royal London Hospital for Integrated Medicine’s AT Department and British Autogenic Society therapist’s client lists. A classical Glaserian grounded theory analysis methodology was used to determine participants’ main concern (self-balancing) and the way they continually resolved this concern (sanctuarying). The theory of relaxation as a self-balancing sanctuarying process emerged from analysis of what 21 people from the community at large say they do to relax in everyday life. The activities they choose for sanctuarying are self-emergent, and their continuing use is contingent upon managing hindrances and integrating feedback to the process so that the benefits of doing the activity are maximized. Three switching strategies, distracting and blocking, managing and controlling, and letting go and allowing, are central. Benefits which are not consciously or analytically generated are: restoring, refreshing and re-energizing me; maintaining and building me; and growing and developing me. Maintaining and building me are characterized by integrating and strengthening the core self and connecting to the community; growing and developing me is characterized by expanding self-discovery. The theory of self-balancing sanctuarying was used on an emergent fit basis to analyse 25 interviews and 34 diaries gathered from people with symptoms of moderate to severe anxiety whilst learning to practice Autogenic Training. This analysis broadened and deepened the grounded theory. This thesis contributes to knowledge in many areas. It is the first classical grounded theory of relaxation and of Autogenic Training, theoretically situating and/or challenging extant descriptive and conceptual models of both relaxation and AT. It supports the clinically functional equivalence of certain forms of relaxation and supports Teasdale and Barnard’s (1995) Interacting Cognitive Subsystems Model. It supports and challenges certain aspects of core affect theory, of the cognitive appraisal theory of emotions, and of Fredrickson’s (2001, 2003) broaden and build theory of positive emotions. It adds a grounded perspective to the spiritual well-being debate, bringing new knowledge to it. It adds new data to the field of the phenomenology of hypnagogic images. It discusses the implication of Self-balancing Sanctuarying for training of AT therapists and for their clinical practice with anxious clients