Title: Acceptance Therapy During Methadone Detoxification Funding Agency: NIDA (Behavioral Therapies Development Program) PI: Angela L. Stotts, University of Texas-Houston Medical School Dates: Fall 2005 through 2008 Abstract: Opiate dependence is a severe and costly societal problem. While methadone maintenance (MM) is effective for managing this disorder, as many as 70% of MM clients are interested in detoxification in order to achieve a drug-free life. To date, however, success rates for opiate detoxification are very low, in part, due to physical and psychological symptoms and fears associated with opiate withdrawal. Few behavior therapies have been developed to promote abstinence during and subsequent to opiate dose reduction and even fewer treatment models have devoted sufficient attention to the distressing experiences specific to methadone withdrawal. A novel behavioral treatment, Acceptance and Commitment Therapy (ACT) is based on the idea that attempts to avoid private experience (thoughts, feelings, memories, bodily sensations) are ubiquitous yet often pathogenic. Given that opiate dependent individuals in detoxification often resort to opiate use to reduce, escape or avoid commonly experienced fear, anxiety, and physical symptoms, ACT seems uniquely applicable to the opiate detoxification experience. By decreasing experiential avoidance during dose reduction, ACT has the potential to significantly increase methadone detoxification success rates. The proposed Stage I research will develop and test an innovative ACT-based opiate detoxification behavioral therapy within the context of a long-term methadone dose reduction program. In Phase 1, investigators will develop the new therapy based on previous ACT protocols, focus groups, and expert knowledge. Phase 2 will consist of a pilot trial to evaluate the ACT-based opiate detoxification therapy. A randomized, controlled, between groups design will be used in which opiate dependent patients (N=70) motivated for detoxification are assigned to one of two treatment conditions: ACT or Drug Counseling. A 4-week stabilization period will precede a 5-month dose reduction period using an inverse exponential dosing strategy, with 1-month follow-up. Behavioral treatments will consist of 24 weekly sessions beginning in stabilization. Specific aims are to test the feasibility and acceptability of ACT for opiate detoxification, to assess patient improvement (e.g., drug use, HIV/Hepatitis C risk behavior, psychosocial functioning), to generate sufficient data to provide a basis for a power analysis, and to evaluate the active mechanisms of change in ACT: experiential avoidance as a mediator of treatment effects and a moderator of the impact of withdrawal symptoms, negative affect and detoxification fear. The work will be conducted using the rigorous procedures of our Treatment Research Clinic (SARC, UT-Health Science Center-Houston) in collaboration with experts in behavior therapy development and the originators of ACT. The research will contribute both theoretically and empirically to a rather sparse literature concerning effective behavior therapy for opiate detoxification. Effective treatment provided in conjunction with detoxification from agonist medication could result in significant decreases in the substantial health and social costs associated with chronic opiate dependence. Contact information: Angela L. Stotts, Ph.D. Assistant Professor University of Texas-Houston Medical School Department of Psychiatry and Behavioral Sciences 1300 Moursund Ave. Houston, TX 77030 713-500-2720 713-500-2849 fax Angela.L.Stotts@uth.tmc.edu

Tapper, K., Shaw, C. & Moore, L. Development and piloting of a mindfulness-based intervention for overweight and obese women. Welsh Office of Research and Development. March 2006 – May 2007, £58,912. For further details please contact Katy Tapper at TapperK@cf.ac.uk.

Title: Development of a Psychosocial Treatment for Psychotic Depression Funding Agency: National Institute of Mental Health Grant Number: K23 MH076937 Principle Investigator: Brandon Gaudiano, PhD (Brown University/Butler Hospital) Period: 2007-2012 Description: The aim of this project is to conduct a pilot study of a novel psychosocial treatment for patients with Major Depressive Disorder, severe with psychotic features. The proposed treatment will integrate behavioral activation therapy and ACT.

The National Institute on Drug Abuse has awarded a $1.1 M grant to University of Nevada, Reno to study burnout in addiction counselors. Housed in the Department of Psychology at UNR under Dr. Steven Hayes's direction, the three year study will examine the relative impact of various methods for alleviating stress and burnout. Co-investigators are UNR faculty Nancy Roget (Center for the Application of Substance Abuse Technologies), Barbara Kohlenberg (Psychiatry), and Jason Luoma (Psychology).

Substance abuse is one of the most difficult problems to treat, and addiction counselors are not immune to the negative attitudes and feelings that comes from working with difficult clients. Reducing providers entanglement with their own negative thoughts may be particularly important because there is evidence that these processes contribute to provider burnout, job turnover, and to decreased effectiveness in working with people in need.

There are few well developed methods for the alleviation of entanglement with negative attitudes toward recipients of care, however. This grant will evaluate two methods for the reduction of the harmful impact of thoughts of this kind: Multicultural Training and Acceptance and Commitment Training (ACT). Alone and in combination these will be compared to training in the biological processes that underlying addiction since it has been argued that understanding that addiction is a disease reduces bias toward people suffering from addition.

Multicultural Training is widely used to help providers be more aware of their biases and to see the world to the eyes of others. Usually this approach is applied to cultural or racial bias, but it seems equally applicable to appreciating the inside world of people with addictions.

ACT, developed here at UNR by Dr. Hayes, is an increasingly popular new form of therapy is based on mindfulness, acceptance, and values. In this study it will be used to teach providers to notice their difficult thoughts and feelings more the way a meditator might notice thoughts that comes up during meditation, and then to focus on what they can do with actual behavior to further their values.

Multicultural knowledge is known to be important when working with clients who comes from different cultural group, but there is also some evidence that providers sometimes feel guilty about their own biases when they learn to detect them. This study will see if the combination mindfulness and multicultural training can reduce this problem, allowing providers to use multicultural knowledge more effectively.

In workshops conducted across the country about 300 providers will be randomly assigned to the four conditions and will be trained in two day workshops. Pre, post, and follow-up measures will be taken on stress and burnout, and providers entanglement with negative thoughts about difficult clients, among other measures. It is expected that both treatments will have initially positive effects on stigma and burnout, but based on previous research it is expected that acceptance and mindfulness may have a longer term impact on the burnout provides feel as a result of working with such difficult cases.

This study is the largest randomized study ever done on multicultural training, It is also one of the larger randomized trials ever done on therapists burnout, and on mindfulness-based training. The study is funded by the National Institute on Substance Abuse, which has supported several other successful studies on ACT over the last decade.

For additional information, contact Steve Hayes at hayes@unr.edu

Grant Title: Treatment Development for Comorbid Major Depression and Social Phobia Funding Agency: National Institute of Mental Health Grant Number: K23 MH085730 Principal Investigator: Kristy Dalrymple, Ph.D. Institution: Rhode Island Hospital/Alpert Medical School of Brown University Period: 1/2010 - 12/2014 Description: A Mentored Patient-Oriented Career Development Award to develop and pilot test an acceptance-based behavioral intervention for adults with comorbid major depression and social phobia.