Principle-Based Integrative Therapy with Couples: Theory and a Case Example.

The Principle-Based Integrative Therapy (PBIT) framework harnesses the principles of change underlying each theoretical model within integrative couple therapy treatments. PBIT has commonalities with other integrative approaches, and additional advantages stemming from its four tenets that guide therapists in combining strengths across models and overcoming each of their deficiencies. Tenet 1 advises that each model adds a core principle or mechanism of action that other models do not automatically address. Tenet 2 focuses on how techniques of one model may actualize the principles of other models. Tenet 3 ensures complementarity and a lack of conflict across principles. A case study and common case considerations are presented to illustrate how Tenets 1-3 can work in integrating Cognitive-Behavioral, Multicultural, and Emotionally Focused Therapy models in working with a couple. Finally, Tenet 4 advocates for the use of models and empirically supported principles that also have received empirical support with diverse populations. Prerequisites and training implications for PBIT, and future clinical and research directions to further the utility of PBIT are discussed.

El marco de la Terapia Integrativa Basada en Principios (PBIT) aprovecha los principios de cambio que subyacen a cada modelo teórico dentro de los tratamientos de la terapia integrativa de pareja. La PBIT tiene similitudes con otros enfoques integrativos y otras ventajas que surgen de sus cuatro principios que guían a los terapeutas en la combinación de los puntos fuertes de los distintos modelos y en la superación de cada una de sus deficiencias. El primer principio recomienda que cada modelo agregue un principio o mecanismo fundamental de acción que otros modelos no aborden automáticamente. El segundo principio se centra en cómo las técnicas de un modelo pueden actualizar los principios de otros modelos. El tercer principio garantiza la complementariedad y la falta de conflictos entre los principios. Se presentan las consideraciones de un caso práctico y de casos comunes para ilustrar cómo estos tres principios pueden funcionar en la integración de los modelos de terapia congnitivo-conductual (CB), multicultural (MC) y centrada en las emociones (EFT) a la hora de trabajar con una pareja. Finalmente, el cuarto principio propone el uso de modelos y principios factuales que también hayan recibido apoyo empírico con diversas poblaciones. Se debaten los prerrequisitos y las consecuencias de la capacitación para la PBIT, así como las futuras direcciones clínicas y de investigación para impulsar la utilidad de la PBIT.

Comparison of three measurement models of discounting among individuals with methamphetamine use disorder.

BACKGROUND AND OBJECTIVES: Delay discounting is associated with numerous clinically significant aspects of substance use disorders (SUDs). Recent studies have demonstrated that different models for assessing discounting may result in disparate conclusions. The current study compared two discounting tasks: money now versus money later (M-M) and methamphetamine now versus money later (MA-M) among non-treatment seeking individuals (N = 59) with methamphetamine use disorder (MAUD). Results from each task were assessed using three different models for assessing delay discounting. METHODS: Discounting data were fit to three models of discounting, log k using Mazur's hyperbolic formula, area under the curve (AUC), and an alternative AUC model in which the delay values have been log transformed (AUClog). RESULTS: For both discounting tasks, the distribution of model-related outcomes were normally distributed when using log k and AUClog, but skewed for AUC. Discounting in the MA-M task was significantly greater compared to the M-M task when using log k and AUClog but not AUC. CONCLUSION: To our knowledge, the current study is the first to report significantly greater discounting in a MA-M relative to M-M discounting task among individuals with MAUD, an outcome consistent with other psychomotor stimulants and drugs of abuse. SCIENTIFIC SIGNIFICANCE: The differential results observed across the three discounting models reaffirm potential issues with AUC noted in recent studies and highlight that researchers must be cautious when deciding on their final model of discounting. (Am J Addict 2018;XX:1-8).

A COMPARISON OF MAZUR'S k AND AREA UNDER THE CURVE FOR DESCRIBING STEEP DISCOUNTERS.

Delay discounting describes how a reward loses value as a function of increasing delay to its receipt and has been reliably associated with a variety of vulnerable populations including those with substance use disorders (SUDs). Two commonly used models to assess delay discounting in the field of SUDs include log k derived from Mazur's hyperbolic equation and area under the curve (AUC). In the current study, we compared log k with AUC on delay discounting data obtained from non-treatment seeking, cocaine- and methamphetamine-dependent volunteers. We specifically chose this population in order to obtain a distribution of relatively steep discounters. The results show that the relationship between AUC and log k is better described by a quadratic rather than a linear function. In other words, changes in discounting, as measured by AUC and log k, are reflected differently across a range of obtained responses. Additionally, the distribution of AUC values was skewed, which appears to be more likely among populations exhibiting greater discounting. Finally, closer examination of indifference points revealed that AUC was almost perfectly predicted by the area from the two longest delays, with relatively less input from shorter delays. Given these results, researchers should exercise additional caution when deciding which method to assess discounting data and how final results are to be interpreted, particularly when dealing with relatively high rates of discounting. High rates of discounting are likely in populations with impulsive disorders such as those with SUDs.

COVID-19 Vaccines and Potential Implications for COVID-19-Specific Obsessive-Compulsive Disorder Presentations.

Public health crises, including the ongoing COVID-19 pandemic, have wide reaching implications on mental health, and have resulted in unique OCD presentations specific to respective crises. The distribution of highly efficacious and effective vaccines for COVID-19 present a crossroads for the COVID-19-specific OCD presentation, including the potential for COVID-19 presentation perpetuation or remission in the face of vaccinations. Individual differences may play a unique role in who does and does not see a reduction of OCD symptoms specific to this virus as a function of vaccination status. Here, we discuss prior health crises that have resulted in unique OCD presentations, review relevant assessment and intervention guidelines, discuss potential implications that vaccines may have on this COVID-19-specifc presentation, and provide case presentations and future recommendations for treatment providers and researchers.

Introduction to the Special Issue on Exploring the Versatility of Motivational Interviewing.

Evidence indicates that motivation early in treatment is critical to treatment outcome, and motivational interviewing (MI) has addressed this finding by helping individuals work through ambivalence about change. Not only has it demonstrated improvements in treatment outcome across treatment populations and settings, it has been adapted with success into brief motivational interventions. This special issue explores the use of MI with populations at great risk for ambivalence in therapy, including college students violating campus policy, individuals who have been trafficked, and individuals in exposure therapy. The papers further highlight the versatility of MI-based interventions, as well as their limitations, that may help inform future directions for adapting MI as we move toward digital and web-based interventions.

Assessment of demand for methamphetamine and cigarettes among individuals with methamphetamine use disorder.

Methamphetamine (MA) is a highly addictive stimulant with recent upward trends in prevalence and associated public health problems. Drug demand, as assessed by hypothetical purchasing tasks, has been useful in addictions research and may help our understanding of the factors influencing MA use. However, no studies have assessed MA demand using current models of demand. The purpose of the current study was to assess demand for MA using a hypothetical drug purchasing task. Given high rates of cigarette smoking among MA users, it was of interest also to assess and compare demand for MA relative to cigarettes. Participants consisted of non-treatment-seeking volunteers with MA use disorder (N = 18), of whom 17 reported daily smoking. Results showed the exponentiated demand model provided a good fit to consumption data. Results from Bayesian generalized linear modeling demonstrated multiple positive relationships (posterior probability ≥75%) between self-reported drug use (days MA used in the past 30 days, cigarettes smoked per day) and indices of demand for each drug (Qo, Omax, Pmax, and break point). Comparing MA to cigarettes, results from Bayesian generalized linear mixed modeling revealed greater abuse liability for MA compared to cigarettes (posterior probability ≥99%) based on α and essential value. Overall, the findings of the current study support the feasibility and validity of the exponentiated demand model for assessing demand for drugs among individuals with MA use disorder. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The relationship between lifetime stress and addiction severity in cocaine-dependent participants.

OBJECTIVE: The primary focus of the current report was to determine if there was an association between LSC-R and ASI-Lite scores in cocaine-dependent individuals. The secondary focus was to determine if any demographic/drug use variables or comorbid psychiatric diagnoses (e.g. alcohol-dependence, mood disorders) were associated with higher LSC-R or ASI-Lite scores. We hypothesized that scores on the LSC-R would be positively correlated with ASI-Lite scores. METHOD: The sample included 239 cocaine-dependent individuals. The primary assessments administered were the LSC-R, the ASI-Lite, and the demographic/drug use questionnaire. RESULTS: Simple linear regression revealed that total lifetime stress was positively and significantly correlated with total ASI-Lite scores; however, the r(2) value was very low indicating that this relationship is more likely explained by other factors. It was also determined that participants with a diagnosis of alcohol dependence versus those that did not had significantly higher ASI-Lite scores (even when the alcohol composite score was included as a covariate). Participants with a diagnosis of a mood disorder versus those who did not had significantly higher LSC-R scores and females had significantly higher LSC-R scores when compared to males. After performing a median split, those cocaine users with High LSC scores had significantly higher Beck Depression Inventory-II scores, total ASI-Lite scores, and Fagerström Test of Nicotine Dependence scores when compared to those individuals with Low LSC scores. Further analysis of the ASI-Lite demonstrated that composite scores in the domains of Medical, Drug, Legal, Family and Social Status, and Psychiatric were all significantly elevated in the High LSC group. CONCLUSIONS: Overall, those with higher lifetime stress demonstrated higher addiction severity and depressive symptoms versus those that endorsed lower lifetime stress. Thus, additional research should be conducted investigating the impact stressful life events has on drug use patterns and characteristics.

The impact of self-reported life stress on current impulsivity in cocaine dependent adults.

Current cocaine treatments may be enhanced with a better understanding of the underlying mechanisms that contribute to the onset and maintenance of the disease, such as life stress and impulsivity. Life stress and impulsivity have previously been studied independently as contributors to drug use, and the current study expands upon past research by examining how these factors interact with one another. The aim of the current study was to evaluate the role of life stress in predicting impulsivity in a non-treatment seeking cocaine-dependent sample (N=112). Analyses revealed that trait impulsivity (as measured by the Barratt Impulsiveness Scale) was associated with education (r=-3.09, p<0.01), as those who had higher educational attainment also reported lower rates of trait impulsivity. In addition, those over the age of 30 demonstrated lower impulsivity in decision-making (as measured by delay discounting) than those under 30 (t=2.21, p=0.03). Overall exposure to life stress was not significantly correlated to either aspect of impulsivity. However several specific life stressors were significantly related to greater impulsivity including having been put up for adoption or in foster care (t=-2.96, p<0.01), and having a child taken away against their will (t=-2.68, p=0.01). These findings suggest that age and education relate to impulsivity; and that while an overall compilation of life stress scores was not related to impulsivity, specific types of stress related to either being taken away from a parent or having a child taken away were. Future studies should assess these constructs longitudinally to restrict response bias.