ObjectiveA large body of literature discusses change mechanisms underlying psychotherapy with an ... more ObjectiveA large body of literature discusses change mechanisms underlying psychotherapy with an emphasis on common factors. The present study examined how different comprehensive common factors change over the course of therapy and whether this change was associated with clinical outcome at discharge.MethodThree hundred forty‐eight adults (mean age = 32.1, SD = 10.6; 64% female) attended a standardized 14‐week day‐clinic psychotherapy program. They provided longitudinal data on common factors based on weekly assessments. Additionally, pre‐ and post‐assessment questionnaires on clinical outcome were completed. Using multilevel modelling, we predicted common factors by time (week in therapy). Multiple linear regression models tested the association between changes in common factors and clinical outcome.ResultsThe common factor ‘Therapeutic Alliance’ was best fitted by linear growth models, whereas models for the common factors ‘Coping’, ‘Cognitive Integration’ and ‘Affective Processing’ indicated logarithmic changes over time. ‘Coping’, that is change in patients' ability to cope with their individual problems, was most closely linked with outcome.ConclusionsThe present study provides evidence for the changeability of common factors over the course of therapy as well as their specific contributions to psychotherapeutic progress.
Introduction: In individuals with alcohol use disorder (AUD), the brain areas underlying cue-indu... more Introduction: In individuals with alcohol use disorder (AUD), the brain areas underlying cue-induced reactions (e.g., cingulum, striatum, thalamus) and altered activation of these regions have been identified by functional neuroimaging. Neuronal responses to a complex alcohol-related context are yet to investigate. To better understand contextual effects as well as the interplay of cue-induced neural reactions and context exposure, the present study implemented an imagination procedure during functional magnetic resonance imaging (fMRI). Methods: Thirteen patients with AUD and 13 healthy controls completed two rounds of a cue-reactivity paradigm inside an MRI scanner. Two individualized imagination tasks were conducted before each of the two cue reactivity tasks. A 2 (group) × 2 (imagination) × 2 (picture-type) analysis of variance (ANOVA) was performed. Results: The ANOVA revealed a main effect for imagination with higher activation in bilateral thalamus and right caudate nucleus and an interaction effect between imagination and group in right thalamus and left caudate nucleus, due to the patient group reacting stronger during alcohol-related imagination. These structures are involved in relaying sensory information and habit learning. No main or interaction effects of picture type were observed. Conclusions: These results support the view that context effects alter the neural responses in thalamus and nucleus caudatus in patients with AUD, and that imagination tasks are suited to incorporate contextual influences in neurophysiological research designs. Future research needs to investigate whether the failure to observe a picture-type effect was due to limited statistical power and omission to individualize picture set, or whether an imagination procedure interferes with the evocation of picture-type effects.
When individuals vote, decide on what to wear or what to eat, they do not do so in a societal vac... more When individuals vote, decide on what to wear or what to eat, they do not do so in a societal vacuum; rather, their actions are influenced and affected by society’s values, trends, commercials, and campaigns. From our daily experience, it seems plausible that social and cognitive processes are intertwined. However, in the area of natural recovery research, decisional processes of
IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prev... more IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prevalence rates for substance use disorders (SUD).ObjectivesFew longitudinal studies have been conducted to observe the course of substance use among adults with ADHD.AimsThis study examined the predictive value of ADHD symptoms during the course of substance use in a population sample.MethodsIn two waves data from a representative sample of 5103 Swiss men in their early 20s were collected (baseline and 15-month follow-up) in the longitudinal “Cohort Study on Substance Use Risk Factors” (C-SURF). ADHD symptoms and substance use were assessed using the adult ADHD Self-Report Scale (ASRS-v1.1) and self-administered SUD questionnaires, respectively. Individuals who screened positive for ADHD (ADHD+) were compared to those who screened negative (ADHD−).ResultsAt baseline, the 215 individuals in the ADHD+ group (4.2%) showed considerably higher prevalence and frequency of substance use and prevalence of alcohol, tobacco, and cannabis use disorders relative to the ADHD− group. While alcohol, tobacco, cannabis, and heroin use remained stable from baseline to follow-up, the ADHD+ group was more likely to begin using illicit drugs (i.e. amphetamines, speed, ecstasy, hallucinogens, and cocaine) and initiate nonmedical use of prescription drugs (i.e. stimulants/amphetamines, hypnotics, and tranquilizers) relative to the ADHD− group.ConclusionsYoung men with ADHD symptoms displayed more severe substance use patterns and were at a high risk of initiating drug use within 15 months. The identification of ADHD symptoms during early adulthood may be relevant in early interventions to lower the risk of drug use.Disclosure of interestThe author has not supplied his declaration of competing interest.
Einleitung: Neurowissenschaftliche Modelle postulieren, dass Subtanzabhangigkeit mit einem gestei... more Einleitung: Neurowissenschaftliche Modelle postulieren, dass Subtanzabhangigkeit mit einem gesteigerten Ansprechen auf suchtbezogene Reize (Cue Reactivity) und einem heftigen Verlangen zu konsumieren (Craving) einhergeht. Gleichzeitig ist das Kontrollsystem, welches Craving und Konsum unterdruckt, geschwacht. Die vorliegende Studie untersucht die neurophysiologischen Korrelate von einerseits Cue Reactivity und andererseits geschwachter Kontrolle bei Alkoholabhangigkeit sowie den Zusammenhang zwischen diesen neurophysiologischen Prozessen und subjektiv erlebtem Craving. Methode: 15 entgiftete Patienten mit Alkoholabhangigkeit und 15 gesunde Kontrollpersonen gaben per Fragebogen Auskunft uber ihr subjektiv empfundenes Craving nach Alkohol und bearbeiteten eine Cue Reactivity- und eine Go-NoGo-Aufgabe – beide mit sowohl alkoholbezogenen als auch neutralen Bildern als Stimuli. Wahrenddessen zeichnete ein 70-Kanal-Elektroenzephalogramm (EEG) die Hirnaktivitat auf. Ereigniskorrelierte Potentiale (ERPs) wurden berechnet und mittels randomisierungsbasierten Testverfahren zwischen den beiden Personengruppen und den verschiedenen experimentellen Bedingungen verglichen sowie mit subjektiven Craving-Scores korreliert. Ergebnisse: In der Cue Reactivity-Aufgabe war bei Patienten die neurophysiologische Verarbeitung bereits auf Wahrnehmungsebene (P1-Komponente) reduziert. Wahrend bei Gesunden die P1 zwischen alkoholbezogenen und neutralen Reizen unterschied, fand die Differenzierung bei Patienten erst spater in der Reizverarbeitungskette statt. In der Gesamtstichprobe korrelierte die Starke der P1 negativ mit subjektivem Craving. In der Go-NoGo-Aufgabe zeigten sich bei der Unterdruckung einer Reaktion (NoGo) in den ERPs Korrelate von kognitivem Konflikt (NoGo-N2). Die Starke des NoGo-N2-Effekts korrelierte mit subjektiven Craving-Impulsen. Bei Personen mit starkerem Craving differenzierte die NoGo-N2 starker zwischen alkoholbezogenen und neutralen Reizen als bei Personen mit wenig Craving. Schlussfolgerung: Bei Patienten mit Alkoholabhangigkeit ist die neurophysiologische Reizverarbeitung auf hoch automatisierter Wahrnehmungsebene (P1) geschwacht. Neurophysiologische Defizite in der Wahrnehmung gehen mit gesteigertem Craving einher. Der kognitive Konflikt bei der Unterdruckung einer Reaktion auf alkoholbezogene Reize verbraucht bei Personen mit hohem Alkohol-Craving besonders viele neurophysiologische Ressourcen.
As we have already seen, the idea of ‘natural recovery’ or’ spontaneous remission’ from various s... more As we have already seen, the idea of ‘natural recovery’ or’ spontaneous remission’ from various states of addiction is a poorly understood and much contested concept. Some commentators in the field of alcohol and drug studies accept that it happens, while others remain skeptical. Given the nature of this debate occurring within Anglo-European societies, it is not surprising to find that the idea of natural recovery becomes even more problematic and unclear when considering other non-Western societies. Regrettably, little cross-cultural research has been done on these issues, so we lack specific knowledge. Indeed, Klingemann [1, p. 155] notes the dominance of the USA in the literature — of 80 works reviewed on environmental influences impeding or promoting change in substance behavior by adolescents, seven came from outside the US and only one from a non-anglophone country.
Introduction: Alcohol-dependency is a common disease with many negative consequences in the daily... more Introduction: Alcohol-dependency is a common disease with many negative consequences in the daily life. A typical symptom of alcoholic-patients is the persistent and uncontrollable desire to consume alcohol. Inspite of different treatments, alcohol-dependency has a relapse rate of about 85%. This high rate is facilitated by a dysfunction of cognitive control-processes. In order to understand this disease sustaining factor, the present study investigated the neurophysiological correlates of inhibition of alcoholic-patients in a neutral as well as an alcohol-related context. Methods: A total of 18 participants, (9 alcohol-dependent-patients (age range: 27-62 years), 9 healthy controls (age range: 29-60 years)) have been measured with functional magnetic resonance imaging while they participated in an alcohol-specific Go/NoGo-Task. Neurophysiological correlates of inhibition in an alcohol-related as well as a neutral context were compared in both groups. Results: When comparing correct stop-trials in alcohol-related to neutral context, only alcohol-dependent patients showed significant hyperactivation in frontal regions (superior and medial gyrus frontalis, anterior gyrus cinguli, gyrus paracentralis and the gyrus praecentralis). No significant differences were found in any of the behavioral analyses. Discussion: These preliminary results thus indicate that successful inhibition in a drug-related context demands additional resources in patients. Especially the hyperactivation of the anterior gyrus cinguli might be important because of its involvement in decision-processes. In the absent of deficits in behavioral data, this suggests that alcohol-dependent patients need more neuronal activity to achieve the same performance-level like healthy controls.
This book and the literature it reviews show the broad range and impressive development of resear... more This book and the literature it reviews show the broad range and impressive development of research into the self-change process over the past decade. In particular, general population studies have shown that self-change is a major pathway to recovery. This last chapter draws together the core findings and tailors them into a ‘What I would tell my neighbor’ format.
We should also consider those who have a more fleeting contact with deviance, whose careers lead ... more We should also consider those who have a more fleeting contact with deviance, whose careers lead them away from it into conventional ways of life. Thus, for example, studies of delinquents who fail to become adult criminals might teach us even more than studies of delinquents who progress in crime [1, pp. 24–25].
BackgroundIncreased mindfulness is associated with reduced alcohol consumption in patients with a... more BackgroundIncreased mindfulness is associated with reduced alcohol consumption in patients with alcohol use disorder (AUD) after residential treatment. However, the underlying neurobiological mechanism of mindfulness in AUD is unclear. Therefore, we investigate the structural and functional alterations of the thalamocortical system with a focus on the mediodorsal thalamic nucleus (MD-TN), the default mode and the salience network (DMN/SN) which has previously been associated with mindfulness in healthy subjects. We hypothesized lower mindfulness and reduced structural and functional connectivity (FC) of the thalamocortical system, particularly in the DMN/SN in AUD. We assumed that identified neurobiological alterations in AUD are associated with impairments of mindfulness.MethodsForty-five abstinent patients with AUD during residential treatment and 20 healthy controls (HC) were recruited. Structural and resting-state functional MRI-scans were acquired. We analysed levels of mindful...
ObjectiveA large body of literature discusses change mechanisms underlying psychotherapy with an ... more ObjectiveA large body of literature discusses change mechanisms underlying psychotherapy with an emphasis on common factors. The present study examined how different comprehensive common factors change over the course of therapy and whether this change was associated with clinical outcome at discharge.MethodThree hundred forty‐eight adults (mean age = 32.1, SD = 10.6; 64% female) attended a standardized 14‐week day‐clinic psychotherapy program. They provided longitudinal data on common factors based on weekly assessments. Additionally, pre‐ and post‐assessment questionnaires on clinical outcome were completed. Using multilevel modelling, we predicted common factors by time (week in therapy). Multiple linear regression models tested the association between changes in common factors and clinical outcome.ResultsThe common factor ‘Therapeutic Alliance’ was best fitted by linear growth models, whereas models for the common factors ‘Coping’, ‘Cognitive Integration’ and ‘Affective Processing’ indicated logarithmic changes over time. ‘Coping’, that is change in patients' ability to cope with their individual problems, was most closely linked with outcome.ConclusionsThe present study provides evidence for the changeability of common factors over the course of therapy as well as their specific contributions to psychotherapeutic progress.
Introduction: In individuals with alcohol use disorder (AUD), the brain areas underlying cue-indu... more Introduction: In individuals with alcohol use disorder (AUD), the brain areas underlying cue-induced reactions (e.g., cingulum, striatum, thalamus) and altered activation of these regions have been identified by functional neuroimaging. Neuronal responses to a complex alcohol-related context are yet to investigate. To better understand contextual effects as well as the interplay of cue-induced neural reactions and context exposure, the present study implemented an imagination procedure during functional magnetic resonance imaging (fMRI). Methods: Thirteen patients with AUD and 13 healthy controls completed two rounds of a cue-reactivity paradigm inside an MRI scanner. Two individualized imagination tasks were conducted before each of the two cue reactivity tasks. A 2 (group) × 2 (imagination) × 2 (picture-type) analysis of variance (ANOVA) was performed. Results: The ANOVA revealed a main effect for imagination with higher activation in bilateral thalamus and right caudate nucleus and an interaction effect between imagination and group in right thalamus and left caudate nucleus, due to the patient group reacting stronger during alcohol-related imagination. These structures are involved in relaying sensory information and habit learning. No main or interaction effects of picture type were observed. Conclusions: These results support the view that context effects alter the neural responses in thalamus and nucleus caudatus in patients with AUD, and that imagination tasks are suited to incorporate contextual influences in neurophysiological research designs. Future research needs to investigate whether the failure to observe a picture-type effect was due to limited statistical power and omission to individualize picture set, or whether an imagination procedure interferes with the evocation of picture-type effects.
When individuals vote, decide on what to wear or what to eat, they do not do so in a societal vac... more When individuals vote, decide on what to wear or what to eat, they do not do so in a societal vacuum; rather, their actions are influenced and affected by society’s values, trends, commercials, and campaigns. From our daily experience, it seems plausible that social and cognitive processes are intertwined. However, in the area of natural recovery research, decisional processes of
IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prev... more IntroductionAdults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prevalence rates for substance use disorders (SUD).ObjectivesFew longitudinal studies have been conducted to observe the course of substance use among adults with ADHD.AimsThis study examined the predictive value of ADHD symptoms during the course of substance use in a population sample.MethodsIn two waves data from a representative sample of 5103 Swiss men in their early 20s were collected (baseline and 15-month follow-up) in the longitudinal “Cohort Study on Substance Use Risk Factors” (C-SURF). ADHD symptoms and substance use were assessed using the adult ADHD Self-Report Scale (ASRS-v1.1) and self-administered SUD questionnaires, respectively. Individuals who screened positive for ADHD (ADHD+) were compared to those who screened negative (ADHD−).ResultsAt baseline, the 215 individuals in the ADHD+ group (4.2%) showed considerably higher prevalence and frequency of substance use and prevalence of alcohol, tobacco, and cannabis use disorders relative to the ADHD− group. While alcohol, tobacco, cannabis, and heroin use remained stable from baseline to follow-up, the ADHD+ group was more likely to begin using illicit drugs (i.e. amphetamines, speed, ecstasy, hallucinogens, and cocaine) and initiate nonmedical use of prescription drugs (i.e. stimulants/amphetamines, hypnotics, and tranquilizers) relative to the ADHD− group.ConclusionsYoung men with ADHD symptoms displayed more severe substance use patterns and were at a high risk of initiating drug use within 15 months. The identification of ADHD symptoms during early adulthood may be relevant in early interventions to lower the risk of drug use.Disclosure of interestThe author has not supplied his declaration of competing interest.
Einleitung: Neurowissenschaftliche Modelle postulieren, dass Subtanzabhangigkeit mit einem gestei... more Einleitung: Neurowissenschaftliche Modelle postulieren, dass Subtanzabhangigkeit mit einem gesteigerten Ansprechen auf suchtbezogene Reize (Cue Reactivity) und einem heftigen Verlangen zu konsumieren (Craving) einhergeht. Gleichzeitig ist das Kontrollsystem, welches Craving und Konsum unterdruckt, geschwacht. Die vorliegende Studie untersucht die neurophysiologischen Korrelate von einerseits Cue Reactivity und andererseits geschwachter Kontrolle bei Alkoholabhangigkeit sowie den Zusammenhang zwischen diesen neurophysiologischen Prozessen und subjektiv erlebtem Craving. Methode: 15 entgiftete Patienten mit Alkoholabhangigkeit und 15 gesunde Kontrollpersonen gaben per Fragebogen Auskunft uber ihr subjektiv empfundenes Craving nach Alkohol und bearbeiteten eine Cue Reactivity- und eine Go-NoGo-Aufgabe – beide mit sowohl alkoholbezogenen als auch neutralen Bildern als Stimuli. Wahrenddessen zeichnete ein 70-Kanal-Elektroenzephalogramm (EEG) die Hirnaktivitat auf. Ereigniskorrelierte Potentiale (ERPs) wurden berechnet und mittels randomisierungsbasierten Testverfahren zwischen den beiden Personengruppen und den verschiedenen experimentellen Bedingungen verglichen sowie mit subjektiven Craving-Scores korreliert. Ergebnisse: In der Cue Reactivity-Aufgabe war bei Patienten die neurophysiologische Verarbeitung bereits auf Wahrnehmungsebene (P1-Komponente) reduziert. Wahrend bei Gesunden die P1 zwischen alkoholbezogenen und neutralen Reizen unterschied, fand die Differenzierung bei Patienten erst spater in der Reizverarbeitungskette statt. In der Gesamtstichprobe korrelierte die Starke der P1 negativ mit subjektivem Craving. In der Go-NoGo-Aufgabe zeigten sich bei der Unterdruckung einer Reaktion (NoGo) in den ERPs Korrelate von kognitivem Konflikt (NoGo-N2). Die Starke des NoGo-N2-Effekts korrelierte mit subjektiven Craving-Impulsen. Bei Personen mit starkerem Craving differenzierte die NoGo-N2 starker zwischen alkoholbezogenen und neutralen Reizen als bei Personen mit wenig Craving. Schlussfolgerung: Bei Patienten mit Alkoholabhangigkeit ist die neurophysiologische Reizverarbeitung auf hoch automatisierter Wahrnehmungsebene (P1) geschwacht. Neurophysiologische Defizite in der Wahrnehmung gehen mit gesteigertem Craving einher. Der kognitive Konflikt bei der Unterdruckung einer Reaktion auf alkoholbezogene Reize verbraucht bei Personen mit hohem Alkohol-Craving besonders viele neurophysiologische Ressourcen.
As we have already seen, the idea of ‘natural recovery’ or’ spontaneous remission’ from various s... more As we have already seen, the idea of ‘natural recovery’ or’ spontaneous remission’ from various states of addiction is a poorly understood and much contested concept. Some commentators in the field of alcohol and drug studies accept that it happens, while others remain skeptical. Given the nature of this debate occurring within Anglo-European societies, it is not surprising to find that the idea of natural recovery becomes even more problematic and unclear when considering other non-Western societies. Regrettably, little cross-cultural research has been done on these issues, so we lack specific knowledge. Indeed, Klingemann [1, p. 155] notes the dominance of the USA in the literature — of 80 works reviewed on environmental influences impeding or promoting change in substance behavior by adolescents, seven came from outside the US and only one from a non-anglophone country.
Introduction: Alcohol-dependency is a common disease with many negative consequences in the daily... more Introduction: Alcohol-dependency is a common disease with many negative consequences in the daily life. A typical symptom of alcoholic-patients is the persistent and uncontrollable desire to consume alcohol. Inspite of different treatments, alcohol-dependency has a relapse rate of about 85%. This high rate is facilitated by a dysfunction of cognitive control-processes. In order to understand this disease sustaining factor, the present study investigated the neurophysiological correlates of inhibition of alcoholic-patients in a neutral as well as an alcohol-related context. Methods: A total of 18 participants, (9 alcohol-dependent-patients (age range: 27-62 years), 9 healthy controls (age range: 29-60 years)) have been measured with functional magnetic resonance imaging while they participated in an alcohol-specific Go/NoGo-Task. Neurophysiological correlates of inhibition in an alcohol-related as well as a neutral context were compared in both groups. Results: When comparing correct stop-trials in alcohol-related to neutral context, only alcohol-dependent patients showed significant hyperactivation in frontal regions (superior and medial gyrus frontalis, anterior gyrus cinguli, gyrus paracentralis and the gyrus praecentralis). No significant differences were found in any of the behavioral analyses. Discussion: These preliminary results thus indicate that successful inhibition in a drug-related context demands additional resources in patients. Especially the hyperactivation of the anterior gyrus cinguli might be important because of its involvement in decision-processes. In the absent of deficits in behavioral data, this suggests that alcohol-dependent patients need more neuronal activity to achieve the same performance-level like healthy controls.
This book and the literature it reviews show the broad range and impressive development of resear... more This book and the literature it reviews show the broad range and impressive development of research into the self-change process over the past decade. In particular, general population studies have shown that self-change is a major pathway to recovery. This last chapter draws together the core findings and tailors them into a ‘What I would tell my neighbor’ format.
We should also consider those who have a more fleeting contact with deviance, whose careers lead ... more We should also consider those who have a more fleeting contact with deviance, whose careers lead them away from it into conventional ways of life. Thus, for example, studies of delinquents who fail to become adult criminals might teach us even more than studies of delinquents who progress in crime [1, pp. 24–25].
BackgroundIncreased mindfulness is associated with reduced alcohol consumption in patients with a... more BackgroundIncreased mindfulness is associated with reduced alcohol consumption in patients with alcohol use disorder (AUD) after residential treatment. However, the underlying neurobiological mechanism of mindfulness in AUD is unclear. Therefore, we investigate the structural and functional alterations of the thalamocortical system with a focus on the mediodorsal thalamic nucleus (MD-TN), the default mode and the salience network (DMN/SN) which has previously been associated with mindfulness in healthy subjects. We hypothesized lower mindfulness and reduced structural and functional connectivity (FC) of the thalamocortical system, particularly in the DMN/SN in AUD. We assumed that identified neurobiological alterations in AUD are associated with impairments of mindfulness.MethodsForty-five abstinent patients with AUD during residential treatment and 20 healthy controls (HC) were recruited. Structural and resting-state functional MRI-scans were acquired. We analysed levels of mindful...
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