Prediction of individual differences in adjustment to loss: Acceptance and valued-living as critical appraisal and coping strengths.

Our strengths-based model of coping with death and dying proposes acceptance and valued-living as key coping and appraisal strengths for the bereaved. These are core components of Acceptance and Commitment Therapy (ACT). The aim of this study was to provide an initial exploration of the theorized relationships via a survey of 97 bereaved university students. Using hierarchical regression analysis it was found that acceptance and valued-living were significant predictors of grief, while controlling for other model variables and loss characteristics. Results have implications for ACT-based approaches in supporting those bereaved who are struggling with their grief.

Acceptance and valued living as critical appraisal and coping strengths for caregivers dealing with terminal illness and bereavement.

OBJECTIVE: Informal caregivers of palliative care patients play an essential role in the coordination of care for patients during their final phases of life. However, undertaking a caregiving role can have enduring psychological consequences for caregivers and interfere with functioning. Studies have investigated a variety of factors associated with individual differences in caregiver psychosocial outcomes, but little is known about their relative impact, and there is a need for guiding models to support research in this area. METHOD: A review of the literature was conducted on factors influencing the psychological distress and grief of caregivers. Drawing from acceptance and commitment therapy (ACT) and Stroebe and colleagues' integrative risk factor framework, we developed a process model to describe individual differences in caregiver psychological distress and grief. RESULTS: The model presents caregiver psychological distress and grief as functions of death attitudes and communication about death and dying, mediated by acceptance and valued living from an ACT perspective. An outline of the empirical and theoretical underpinnings for each component in the model is provided. SIGNIFICANT OF RESULTS: The presented model is an inherently strengths-based model that is concordant with acceptance- and values- (ACT) based interventions to facilitate coping in caregivers.

The feasibility of telephone follow-up interviews for monitoring treatment outcomes of Australian residential drug and alcohol treatment programs.

BACKGROUND: Telephone follow-up interviewing is one method of monitoring treatment outcomes of individuals involved in drug and alcohol treatment programs. The present study is the first to examine the feasibility and generalizability of data obtained from telephone follow-up interviews after drug and alcohol treatment in Australia. METHODS: Participants attended 1 of 8 Salvation Army Recovery Service Centres where staff administered outcome measures at intake. Three-month postdischarge telephone follow-up interviews were conducted by researchers from the Illawarra Institute for Mental Health, University of Wollongong. RESULTS: A sample of 700 clients was obtained for follow-up (582 males; 118 females). A 51% follow-up rate was achieved at a cost of US$82 per completed interview. No significant differences in baseline characteristics between responding and nonresponding participants were found. CONCLUSIONS: Overall, the telephone methodology was shown to be feasible and relatively inexpensive. However, the introduction of outcome measures at the service level in parallel with follow-up data collection procedures complicated the collection of response data. The burden of introducing outcome measures in residential services may be reduced by utilizing a phased implementation strategy.

Relative importance of abstinence in clients' and clinicians' perspectives of recovery from drug and alcohol abuse.

This study collected data on drug and alcohol workers' (n = 55) and clients' (n = 139) perspectives on what constitutes a "recovery" from substance use disorder. Data were collected during 2010 from four residential faith-based treatment programs across the east coast of Australia. Self-report surveys specifically designed for this study were administered. Responses were compared using nonparametric test. Abstinence was seen as an important component of recovery but nonabstinent factors were also seen as having an important role. Staff placed more emphasis on clients taking responsibility for their problems and on the role of spiritual development. The importance of nonabstinence components was positively associated with a person's time in treatment and recovery. Implications, limitations, and future directions are noted.

Self-forgiveness, shame, and guilt in recovery from drug and alcohol problems.

BACKGROUND: People with drug and/or alcohol problems often experience feelings of shame and guilt, which have been associated with poorer recovery. Self-forgiveness has the potential to reduce these negative experiences. METHODS: The current study tested theorized mediators (acceptance, conciliatory behavior, empathy) of the relationships between shame and guilt with self-forgiveness. A cross-sectional sample of 133 individuals (74.4% male) receiving residential treatment for substance abuse completed self-report measures of shame, guilt, self-forgiveness, and the mediators. RESULTS: Consistent with previous research, guilt had a positive association with self-forgiveness, whereas shame was negatively associated with self-forgiveness. Acceptance mediated the guilt and self-forgiveness relationship and had an indirect effect on the shame and self-forgiveness relationship. CONCLUSIONS: These findings emphasize the importance of targeting acceptance when trying to reduce the effects of shame and guilt on self-forgiveness.

Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care?

CONTEXT: Patients in palliative care can experience substantial psychological suffering. Acceptance-based interventions from approaches such as Acceptance and Commitment Therapy have demonstrated effectiveness in helping people cope with a range of life challenges. However, there is a dearth of research examining mechanisms of therapeutic change for patients in palliative care. OBJECTIVES: To assess the relationships between acceptance, anticipatory grief, anxiety, and depression among patients in palliative care. METHODS: A cross-sectional survey was verbally administered to inpatients (N = 73) receiving palliative care. RESULTS: Correlations revealed that acceptance had a strong relationship with anticipatory grief, anxiety, and depression. A hierarchical regression analysis on anticipatory grief showed that acceptance was the largest predictor and accounted for an additional 13% of variance in anticipatory grief over and above anxiety and depression. CONCLUSION: The present study provides preliminary data suggesting that interventions that target acceptance may be indicated in patients in palliative care.

Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions.

INTRODUCTION AND AIMS: Despite clinical recommendations that further treatment is critical for successful recovery following drug and alcohol detoxification, a large proportion of clients fail to attend treatment after detoxification. In this study, individual factors and constructs based on motivational and volitional models of health behaviour were examined as predictors of post-detoxification treatment attendance. DESIGN AND METHODS: The sample consisted of 220 substance-dependent individuals participating in short-term detoxification programs provided by The Australian Salvation Army. The Theory of Planned Behaviour and Implementation Intentions were used to predict attendance at subsequent treatment. RESULTS: Follow-up data were collected for 177 participants (81%), with 104 (80%) of those participants reporting that they had either attended further formal treatment (e.g. residential rehabilitation programs, outpatient counselling) or mutual support groups in the 2 weeks after leaving the detoxification program. Logistic regression examined the predictors of further treatment attendance. The full model accounted for 21% of the variance in treatment attendance, with attitude and Implementation Intentions contributing significantly to the prediction. DISCUSSION AND CONCLUSIONS: Findings from the present study would suggest that assisting clients to develop a specific treatment plan, as well as helping clients to build positive perceptions about subsequent treatment, will promote greater attendance at further treatment following detoxification. [Kelly PJ, Leung J, Deane FP, Lyons GCB. Predicting client attendance at further treatment following drug and alcohol detoxification: Theory of Planned Behaviour and Implementation Intentions. Drug Alcohol Rev 2016;35:678-685].

Factor analysis and validity of a short six-item version of the Desires for Alcohol Questionnaire.

Reductions in cravings have been associated with improved recovery from alcohol and other drug use problems. Self-report assessments of cravings provide a way of monitoring progress over the course of treatment particularly in residential settings. There is a need to develop brief craving measures suitable for repeat administration. The aim of the study was to assess the reliability and validity of a six-item version of the Desires for Alcohol Questionnaire (DAQ-6). In study 1 exploratory factor analysis involving 710 participants attending residential treatment revealed two factors: 'expectancy of negative reinforcement' and 'strong desires and intentions'. In study 2 confirmatory factor analysis replicated this factor structure in an independent sample of 116 participants. Both studies provided evidence for convergent and discriminant validity of the DAQ-6 when compared to other measures. The DAQ-6 shows promise as a brief self-report measure of cravings but the utility of the separate subscales in treatment contexts requires further research.

Clinical and reliable change in an Australian residential substance use program using the Addiction Severity Index.

Although the Addiction Severity Index (ASI) is one of the most frequently used measures in alcohol and other drug research, it has rarely been used to assess clinical and reliable change. This study assessed clients' clinical and reliable change at The Salvation Army residential substance abuse treatment centers in Australia. A total of 296 clients completed ASI interviews on admission to treatment and 3 months after discharge from treatment. Clients demonstrated significant improvement on all seven ASI composites. The range of reliable change for each ASI composite varied from 30% to 70%. More than two-thirds of clients experienced clinically significant improvement for alcohol and drug problems. Psychiatric distress was clinically reduced in 44% of clients. This research indicates that residential substance abuse treatment can make important differences in client's lives at a clinical and functional level. However, the research highlights the challenge of effectively targeting psychiatric comorbidity within alcohol and other drug abuse populations.