Study tests CBT adjunct for addressing negative emotions

Negative emotions such as sadness and frustration are seen as responsible for around 40% of relapses to substance use after a period of abstinence. This creates urgency around helping individuals find alternative ways to manage these emotions. Recent research funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) showed promising results for a therapeutic strategy designed as an adjunct to cognitive-behavioral therapy (CBT) for patients who cite dealing with unpleasant emotions as their primary reason for drinking.

The research, which found a higher percentage of abstinent days and fewer heavy-drinking days through use of “affect regulation training” (ART), was published last December in the Journal of Substance Abuse Treatment. Paul Stasiewicz, study director and developer of ART, explains that the treatment consolidates techniques from Dialectical Behavior Therapy (DBT), mindfulness-based therapies, and Exposure and Response Prevention techniques.

“We took the best of what they were doing,” says Stasiewicz, senior research scientist at the University at Buffalo Research Institute on Addictions. “The one thing in common is the idea that in order to get better at dealing with negative emotions, you have to go through it. Rather than avoidance, escape, or suppression, you have to confront it and tolerate it. It's kind of like, 'Bring it on.'”

Scenario with patient

In use of ART, Stasiewicz explains, a patient who describes drinking heavily when confronting unpleasant emotions is asked to cite their highest-risk situations. Examples of these events might include an argument with one's spouse, or the drive home from work after a stressful day at the office. The therapist then walks the patient through the sensations and thoughts they experience during these times, recounting the external cues from their surroundings at that moment.

“We place them in the scene, and ask them, 'What are you feeling now?' Stasiewicz says. “We want them to stay with their emotion.”

As the scenario is revisited and played out multiple times in therapy, the emotional response on the patient's part will gradually lessen. Stasiewicz says the technique is carried out carefully and compassionately. Sometimes this kind of approach is mistakenly characterized as akin to rubbing the patient's face in the uncomfortable situation, he says. “It is so not that,” he says.

ART builds additional skills for the patient, in the area of alternative responses to negative emotional states. Deep breathing techniques, for example, will allow the patient to reduce uncomfortable sensations further, helping him/her to come to the eventual understanding that the immediate feelings that are experienced in these situations will pass.

Stasiewicz emphasizes the synergy between ART and CBT. ART “doesn't teach [patients] how to be abstinent,” he says. “It teaches them how to manage the negative emotions associated with drinking. CBT teaches the other skills.”

While some modules in a typical course of CBT treatment focus on dealing with anger and other negative emotions, there has not been to this point one self-contained curriculum focused specifically on helping substance use patients in this important area, says Stasiewicz.

He says past research has shown that about 40 to 45% of individuals cite dealing with unpleasant emotions as their primary reason for drinking, ahead of other factors such as responding to positive emotions or having enjoyable times with others.

Study results

The newly published research encompassed 77 individuals who drank mainly because of negative emotions. Use of ART in conjunction with CBT was compared with a health and wellness intervention used in combination with CBT.

Stasiewicz says the study group receiving ART showed a higher percentage of days abstinent, fewer drinks per drinking day, and fewer heavy drinking days than the comparison group.

He said in a news release about the study, “The results show promise and should be of interest to treatment providers who are seeking additional strategies to help those who drink in negative emotional situations.”