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Transdiagnostic and Self-Compassionate Innovations in Relapse Prevention

Brian Berman, PsyD – Psychologist, Retreat Behavioral Health

Kris Kurlancheek, MA – Clinical Specialist, Retreat Behavioral Health

Bill Hartranft, MA, LPC – Therapist, Retreat Behavioral Health


Introduction: Substance use disorders (SUD) negatively impact productivity, health-care, and crime, while costing the U.S. $600 billion annually (SAMHSA, 2014). At least 21.5 million people are identified as having an SUD, while up to 95% of those in recovery are expected to relapse (Hendershot et al., 2011; SAMHSA, 2014). Due to high relapse rates and complicated co-occurring disorders, innovative treatment approaches are urgently needed (Roos, Bowen & Witkiewitz, 2017).

Increasing evidence suggests that transdiagnostic approaches which target disorders co-occurringly are best suited for relapse prevention (Lee, An, Leven & Twohig, 2015). Acceptance and Commitment Therapy (ACT) is one such approach and has demonstrated superior long-term outcomes compared to several established treatments (Lee et al., 2015). ACT aims to reduce psychological inflexibility by altering internal avoidance patterns, while increasing valued-action and self-compassion (Dindo, Van Liew & Arch, 2017; Yadavaia, Hayes & Vilardaga, 2014).

Objectives: This study aimed to examine the extent which psychological inflexibility, valued-action, and self-compassion are related to warning signs of relapse. It was hypothesized that psychological inflexibility would be positively associated with relapse signs, while valued-action and self-compassion would be negatively related to relapse signs. This study will add to a limited but growing body of literature examining the contribution of transdiagnostic processes in recovery. To our knowledge, this is also the first investigation into the relation between self-compassion and warning signs of relapse following SUD inpatient treatment.

Methods: This study was part of a larger 16-session investigation into the effectiveness of the Choice Point Model of ACT (CPM-ACT) in an inpatient SUD setting. Twenty-nine participants (N = 29) were assessed using a bivariate correlational analysis to assess the extent to which warning signs of relapse were related to psychological inflexibility, valued-action, and self-compassion at three months post-treatment. Assessment questionnaires included the Advanced Warning of Relapse Questionnaire (AWARE), Acceptance and Action Questionnaire-II (AAQ-II), Valued Living Questionnaire (VLQ), and the Self-Compassion Scale (SCS). The AAQ-II measures psychological inflexibility and the VLQ measures weekly valued-action.

Results: Results indicated that self-compassion, psychological inflexibility, and valued-action were each significantly associated with warning signs of relapse, p < .01. Self-compassion demonstrated the strongest association and was negatively correlated with signs of relapse r(27) = -.68, p < .001. Psychological inflexibility also displayed a significantly strong positive relationship with signs of relapse r(27) = .66, p < .001. Valued-action showed a strong negative association with signs of relapse r(27) = -.58, p = .001. All self-compassion subscales were also significant, p < .05.

Conclusions: These findings suggest that patients who demonstrated greater self-compassion following treatment completion also exhibited fewer signs of relapse. Those who attempted to avoid distressing internal states showed greater relapse signs, while engagement with valued-action was consistent with fewer relapse signs. This study has important implications for the advancement of relapse prevention protocols. Self-compassion, psychological flexibility, and valued-action appear to provide important contributions to addiction recovery. Modern approaches focusing on transdiagnostic processes may be key to altering perpetual relapse patterns, while helping forge a new unified model of addiction.

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