McHugh, R. K., McCarthy, M. D., Bichon, J. A., Nguyen, M. D., Kneeland, E. K., Ellis, R. A., Dillon, D. G., & Fitzmaurice, G. M. (2024). Effects of behavioral interventions on stress reactivity in adults with substance use disorders. Psychology of Addictive Behaviors, 38(8), 819–826. https://doi.org/10.1037/adb0001032

Key Takeaways

Focus: The study investigated the effects of cognitive reappraisal and affect labeling on stress reactivity in adults with substance use disorders (SUDs).
Aims: The primary aim was to compare the effectiveness of cognitive reappraisal and affect labeling, compared to a psychoeducational control condition, in reducing stress reactivity in individuals with SUDs.
Key Findings: Both cognitive reappraisal and affect labeling were found to significantly reduce stress reactivity compared to the control group, as measured by self-reported negative affect, substance craving, and physiological indicators.
Implications: These findings suggest that incorporating cognitive reappraisal and affect labeling training into treatment programs could help individuals with SUDs manage stress and reduce the risk of relapse, ultimately improving treatment outcomes.

Rationale

Substance use disorders (SUDs) are a significant public health concern, characterized by chronic relapse patterns (National Institute on Drug Abuse, 2023).

Stress is a well-established trigger for relapse in individuals with SUDs (Sinha, 2001). Therefore, effective management of stress is crucial for successful treatment and long-term recovery.

Behavioral interventions, such as cognitive reappraisal and affect labeling, have shown promise in reducing stress reactivity in various populations (Webb, Miles, & Sheeran, 2012).

Cognitive reappraisal involves reinterpreting the meaning of a stressful situation, while affect labeling involves putting one’s feelings into words.

What’s the next step?

This study aimed to investigate whether these behavioral interventions could effectively reduce stress reactivity in individuals with SUDs.

By examining the impact of cognitive reappraisal and affect labeling on stress responses, the research sought to identify potential strategies for enhancing stress management and relapse prevention in this population.

Method

The study used a randomized controlled trial design with three intervention groups: cognitive reappraisal, affect labeling, and a psychoeducational control group.

Procedure

Participants were first trained in their assigned intervention strategy.

They then underwent a standardized stress induction task, and measures of stress reactivity were collected before and after the task.

Sample

The study included 119 treatment-seeking adults with substance use disorders (SUDs).

Age: The average age of the participants was 38.1 years (SD = 11.8).
Gender: 69 (58%) participants identified as male and 50 (42%) identified as female.
Race/Ethnicity: The sample was predominantly White (83.2%), with smaller percentages of Black/African American (9.2%), Hispanic/Latinx (4.2%), and other racial/ethnic groups (3.4%).

Measures

Negative Affect: Self-reported negative affect was measured using the Positive and Negative Affect Schedule (PANAS).
Substance Craving: Substance craving was measured using the Brief Substance Craving Scale.
Physiological Measures: Physiological measures of stress reactivity included skin conductance and heart rate.

Statistical Measures

Data were analyzed using mixed-effects models to compare the changes in stress reactivity measures across the three intervention groups.

Results

Hypothesis 1: Cognitive reappraisal and affect labeling would be more effective than the control condition in reducing stress reactivity.

Result: Supported. Both cognitive reappraisal and affect labeling led to greater reductions in self-reported negative affect and craving, compared to the control condition.

Hypothesis 2: Cognitive reappraisal would be more effective than affect labeling in reducing self-reported negative affect and substance craving.

Result: Supported. Participants in the cognitive reappraisal condition reported greater reductions in negative affect and craving compared to those in the affect labeling condition.

Hypothesis 3: There would be no significant differences between cognitive reappraisal and affect labeling in reducing physiological arousal.

Result: Supported. No significant differences were found between the two active conditions in terms of their effects on physiological arousal (skin conductance level).

Insight

This study provides compelling evidence that cognitive reappraisal and affect labeling can effectively reduce stress reactivity in individuals with SUDs.

This is particularly informative because it highlights specific, teachable skills that can be integrated into treatment programs to help individuals manage stress, a major contributor to relapse.

These findings extend previous research by demonstrating the efficacy of these behavioral interventions in a population with SUDs, who often experience heightened stress reactivity and vulnerability to relapse.

The study underscores the importance of addressing emotional regulation as a key component of SUD treatment.

Future research could investigate the long-term impact of these interventions on relapse rates and explore the optimal methods for integrating these techniques into diverse treatment settings.

Clinical Implications

By demonstrating the effectiveness of cognitive reappraisal and affect labeling in reducing stress reactivity, the research provides valuable tools that can be readily integrated into clinical practice.

For practitioners:

Incorporate Training: Therapists and counselors can incorporate training in cognitive reappraisal and affect labeling techniques into their sessions with clients. This can involve psychoeducation about the stress response, guided practice in identifying and challenging unhelpful thoughts, and instruction in labeling emotions.
Tailor to Individual Needs: Practitioners should tailor the application of these techniques to the individual needs and preferences of their clients. Some individuals may find cognitive reappraisal more helpful, while others may benefit more from affect labeling.
Integrate with Existing Therapies: These techniques can be integrated with other evidence-based therapies, such as cognitive-behavioral therapy (CBT) or mindfulness-based interventions, to enhance their overall effectiveness.

For policymakers:

Promote Training and Implementation: Policymakers can promote the training of practitioners in cognitive reappraisal and affect labeling techniques through continuing education programs and workshops. They can also encourage the implementation of these techniques in various treatment settings, such as outpatient clinics, residential programs, and criminal justice settings.
Resource Allocation: Policymakers can allocate resources to support the development and dissemination of materials and programs that promote the use of these techniques in SUD treatment.

Potential Benefits:

Improved Treatment Outcomes: By helping individuals manage stress, these techniques can contribute to improved treatment outcomes, including reduced relapse rates and increased long-term recovery.
Cost-Effectiveness: These interventions are relatively low-cost and easy to implement, making them a cost-effective addition to existing treatment programs.
Empowerment: These techniques empower individuals to take an active role in managing their stress and recovery, which can increase their self-efficacy and motivation for change.

Potential Challenges:

Training and Implementation: Ensuring that practitioners receive adequate training and are able to effectively implement these techniques may require additional resources and support.
Client Engagement: Some clients may be resistant to or struggle with these techniques, requiring practitioners to adapt their approach and provide additional support.
Sustainability: Maintaining the use of these techniques over the long term may require ongoing training and supervision for practitioners.

By addressing these potential challenges and embracing the potential benefits, practitioners and policymakers can harness the findings of this study to improve the lives of individuals with SUDs and promote their successful recovery.

Strengths

Randomized Controlled Trial: The use of a randomized controlled trial design strengthens the internal validity of the study.
Multiple Measures: The study used multiple measures of stress reactivity, including self-report, physiological, and substance craving measures.

Limitations

Short Follow-Up: The study had a relatively short follow-up period, limiting the ability to assess the long-term effects of the interventions.
Specific Population: The study focused on treatment-seeking adults with SUDs, limiting the generalizability of the findings to other populations.

References