Do psychological inflexibility and self-criticism mediate the relationship between depression and addiction severity?

Do psychological inflexibility and self-criticism mediate the relationship between depression and addiction severity?

Objective: Self-related problems and psychological inflexibility, which can also lead to a vulnerability to depression, often accompany substance use disorders. This study examined whether psychological inflexibility and self-criticism mediated the relationship between depression and addiction severity. Method: We examined 111 patients with Substance use disorders (SUDs) using the Addiction Profile Index (API), Beck Depression Inventory (BDI), Forms of Self-criticizing/Attacking and Self-reassuring Scale (FSCRS), and Acceptance and Action Questionnaire-Substance Abuse (AAQ-SA). Mediation analysis was conducted to examine the mediating role of psychological inflexibility on the relationship between depression and addiction severity. Results: API total score was negatively correlated with AAQ-SA and positively correlated with BDI and FSCRS. Because FSCRS did not have a significant predictive effect on addiction severity (p=0.966), only AAQ-SA was included in the mediation analysis. According to the results of the mediation analysis, depression was found to directly affect addiction severity (direct effect, p=0.007), and it constitutes 54.5% of the total effect. Also, depression predicted addiction severity (indirect effect, p

___

  • 1. Evren C, Durkaya M, Dalbudak E, Celik S, Cetin R, Cakmak D. Factors related with relapse in male alcohol dependents: 12 months follow-up study. Dusunen Adam 2010; 2:92-99.
  • 2. Connors GJ, Maisto SA, Zywiak WH. Understanding relapse in the broader context of post-treatment functioning. Addiction 1996; 91(Suppl):173-189.
  • 3. Hayes SC, Hofmann SG. The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry 2017; 16:245-246.
  • 4. Stotts AL, Northrup TF. The promise of third-wave behavioral therapies in the treatment of substance use disorders. Curr Opin Psychol 2015; 2:75-81.
  • 5. Yavuz KF, Alptekin FB. Functional analysis of behavior and its clinical application. J Cogn-Behav Psychother Res 2017; 6:88-94.
  • 6. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K. Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 1996; 64:1152-1168.
  • 7. Westrup, D. Experiential avoidance and alcohol dependence relapse. Doctoral Dissertation, West Virginia University, Austin, 1999.
  • 8. Cooper ML, Russell M, Skinner JB, Frone MR, Mudar P. Stress and alcohol use: Moderating effects of gender, coping. and alcohol expectancies. J Abnorm Psychol 1992; 101:139-152.
  • 9. Forsyth JP, Parker JD, Finlay CG. Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans. Addict Behav 2003; 28:851-870.
  • 10. Thorberg FA, Lyvers M. Negative mood regulation (NMR) expectancies, mood, and affect intensity among clients in substance disorder treatment facilities. Addict Behav 2006; 31:811-820.
  • 11. Charney DA, Palacios-Boix J, Negrete JC, Dobkin PL, Gill KJ. Association between concurrent depression and anxiety and six-month outcome of addiction treatment. Psychiatr Serv 2005; 56:927-933.
  • 12. Ireland SJ, McMahon RC, Malow RM, Kouzekanani K. Coping style as a predictor of relapse to cocaine abuse. Problems of Drug Dependence 1993; 159.
  • 13. Cheung MS-P, Gilbert P, Irons C. An exploration of shame, social rank and rumination in relation to depression. Pers Individ Differ 2004; 36: 1143-1153.
  • 14. Kannan D, Levitt HM. A review of client self-criticism in psychotherapy. J Psychother Integr 2013; 23:166-178.
  • 15. Hull JG. A self-awareness model of the causes and effect of alcohol consumption. J Abnorm Psychol 1986; 90:586-600.
  • 16. Brooks M, Kay-Lambkin F, Bowman J, Childs S. Self-compassion amongst clients with problematic alcohol use. Mindfulness 2012; 3:308-317.
  • 17. Santanello AW, Gardner FL. The role of experiential avoidance in the relationship between maladaptive perfectionism and worry. Cogn Ther Res 2007; 31:319-332.
  • 18. Beck AT, Epstein N, Harrison RP, Emery G. Development of the sociotropy-autonomy scale: A measure of personality factors in psychopathology. Unpublished manuscript, University of Pennsylvania, Philadelphia, 1983. https://beckinstitute.org/ wp-content/uploads/2021/06/SAS-Full-Documents.pdf
  • 19. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 2006; 44:1-25.
  • 20. Venta A, Sharp C, Hart J. The relation between anxiety disorder and experiential avoidance in inpatient adolescents. Psychol Assess 2012; 24:240-248.
  • 21. Twohig MP, Shoenberger D, Hayes SC. A preliminary investigation of acceptance and commitment therapy as a treatment for marijuana dependence in adults. J Appl Behav Anal 2007; 40:619- 632.
  • 22. Ostafin BD, Marlatt GA. Surfing the urge: Experiential acceptance moderates the relation between automatic alcohol motivation and hazardous drinking. J Soc Clin Psychol 2008; 27:404-418.
  • 23. Rawal A, Park RJ, Williams JMG.Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behav Res Ther 2010; 48:851-859.
  • 24. Goldstone E, Farhall J, Ong B. Life hassles, experiential avoidance and distressing delusional experiences. Behav Res Ther 2011; 49:260-266.
  • 25. Wilson KG, Hayes SC, Byrd MR. Exploring compatibilities between acceptance and commitment therapy and 12-step treatment for substance abuse. J Ration-Emot Cogn-Behav Ther 2000; 18: 209–234.
  • 26. Ii T, Sato H, Watanabe N, Kondo M, Masuda A, Hayes SC, et al. Psychological flexibility-based interventions versus first- line psychosocial interventions for substance use disorders: Systematic review and meta-analyses of randomized controlled trials. J Contextual Behav Sci 2019; 13:109-120.
  • 27. Heffner M, Eifert GH, Parker BT, Hernandez DH, Sperry JA. Valued directions: Acceptance and commitment therapy in the treatment of alcohol dependence. Cogn Behav Pract 2003; 10:378–383.
  • 28. Hayes SC, Wilson KG, Gifford EV, Bissett R, Piasecki M, Batten SV, et al. A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance- abusing methadone-maintained opiate addicts. Behav Ther 2004; 35:667-688.
  • 29. Smout MF, Longo M, Harrison S, Minniti R, Wickes W, White JM. Psychosocial treatment for methamphetamine use disorders: A preliminary randomized controlled trial of cognitive behavior therapy and Acceptance and Commitment Therapy. Subst Abus 2010; 31:98-107.
  • 30. Ogel K, Evren C, Karadag F, Gurol D. The development, validity, and reliability of the Addiction Profile Index (API). Turk J Psychiatry 2012; 23:264-273. [Turkish]
  • 31. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.
  • 32. Hisli N. Use of the Beck Depression Inventory with Turkish university students: reliability, validity and factor analysis. Turk Psikoloji Dergisi 1989; 7:3-13. [Turkish]
  • 33. Baião R, Gilbert P, McEwan K, Carvalho S. Forms of self- criticising/attacking & self-reassuring scale: Psychometric properties and normative study. Psychol Psychother 2015; 88:438-452.
  • 34. Bellur Z, Alpay EH, Aydin A. Reliability and validity of the Turkish version of forms of self-criticizing/attacking and self- reassuring scale (FSCRS) in clinical and non-clinical samples. Curr Psychol 2021:1-12.
  • 35. Fritzsche MF. The validity of the forms of self-criticizing/ attacking & self-reassuring scale in comparison to the self- compassion scale. Master Thesis, University of Twente, 2016.
  • 36. Luoma JB, Drake CE, Kohlenberg BS, Hayes SC. Substance abuse and psychological flexibility: The development of a new measure. Addict Res Theory 2011; 19:3-13.
  • 37. Uygur H, Yavuz KF, Eren I, Uygur OF, Selcuk M, Varsak N, et al. Reliability and validity of the Turkish version of the acceptance and action questionnaire-substance abuse (AAQ-SA) on a clinical sample. Psychiatry Clin Psychopharmacol 2020; 30:47-54.
  • 38. Swendsen JD, Merikangas KR. The comorbidity of depression and substance use disorders. Clin Psychol Rev 2000; 20:173-189.
  • 39. Leventhal AM, Mooney ME, DeLaune KA, Schmitz JM. Using addiction severity profiles to differentiate cocaine-dependent patients with and without comorbid major depression. Am J Addict 2006; 15:362-369.
  • 40. Gilman SE, Abraham HD. A longitudinal study of the order of onset of alcohol dependence and major depression. Drug Alcohol Depend 2001; 63:277-286.
  • 41. Skinner KD, Veilleux, J.C. The interactive effects of drinking motives, age, and self-criticism in predicting hazardous drinking. Subs Use Misuse 2016; 51:1342-1352.
  • 42. Bond FW, Hayes SC, Barnes-Holmes D. Psychological flexibility, ACT, and organizational behavior. J Organ Behav Manag 2006; 26:25-54.
  • 43. Wolgast M. What does the acceptance and Action Questionnaire (AAQ-II) really Measure? Behav Ther 2014; 45:831-839.
  • 44. Chawla N, Ostafin B. Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. J Clin Psychol 2007; 63:871-890.
  • 45. Ruiz FJ. A review of acceptance and commitment therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. Int J Psychol Psychol Ther 2010; 10:125-162.
  • 46. Zettle RD. ACT for depression: A Clinician’s Guide to Using Acceptance and Commitment Therapy in Treating Depression. Oakland, CA: New Harbinger Publications, 2007.
  • 47. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking rumination. Perspect Psychol Sci 2008; 3:400-424.
  • 48. Williams JMG. Mindfulness, depression and modes of mind. Cogn Ther Res 2008; 32:721-733.
  • 49. Ferster CB. A functional analysis of depression. Am Psychol 1973; 28:857-870.
  • 50. Levin ME, Lillis J, Seeley J, Hayes SC, Pistorello J, Biglan A. Exploring the relationship between experiential avoidance, alcohol use disorders and alcohol-related problems among first- year college students. J Am Coll Health 2012; 60:443-448.
  • 51. Bricker JB, Schiff L, Comstock BA. Does avoidant coping influence young adults' smoking? A ten-year longitudinal study. Nicotine Tob Res 2011; 13:998-1002.
  • 52. Stewart SH, Zvolensky MJ, Eifert GH. The relations of anxiety sensitivity, experiential avoidance, and alexithymic coping to young adults’ motivations for drinking. Behav Modif 2002; 26:274-296.
  • 53. Witkiewitz K, Bowen S, Harrop EN, Douglas H, Enkema M, Sedgwick C. Mindfulness-based treatment to prevent addictive behavior relapse: theoretical models and hypothesized mechanisms of change. Subst Use Misuse 2014; 49:513-524.
  • 54. Wilson KG, Byrd MR, Hayes SC, Strosahl KD. ACT for substance abuse and dependence: In Hayes SC, Strosahl KD (editors). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer Science Business Media, 2005, 153-184.
  • 55. Baker TB, Piper ME, McCarthy DE, Majeskie MR, Fiore MC. Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychol Rev 2004; 111:33-51.
  • 56. Levin ME, MacLane C, Daflos S, Seeley JR, Hayes SC, Biglan A, et al. Examining psychological inflexibility as a transdiagnostic process across psychological disorders. J Contextual Behav Sci 2014; 3:155-163.
  • 57. Luoma JB, Platt MG. Shame, self-criticism, self-stigma, and compassion in acceptance and commitment therapy. Curr Opin Psychol 2015; 2:97-101.
  • 58. Bushman BJ, Baumeister RF. Threatened egotism, narcissism, self-esteem, and direct and displaced aggression: does self-love or self-hate lead to violence? J Pers Soc Psychol 1998; 75:219-229.
  • 59. Rendon, KP. Understanding alcohol use in college students: A study of mindfulness, self -compassion, and psychological symptoms. Dissertation Thesis. The University of Texas, Austin, 2006.
Düşünen Adam - Psikiyatri ve Nörolojik Bilimler Dergisi-Cover
  • ISSN: 1018-8681
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 1984
  • Yayıncı: Kare Yayıncılık
Sayıdaki Diğer Makaleler

Is samidorphan adjunction a beacon of hope for olanzapine-induced metabolic syndrome?

Izgi BAYRAKTAR, Yasin Hasan BALCİOGLU

Turkish version of the Reinforcement Sensitivity Theory of Personality Questionnaire: Adaptation study

Omer Taha SOZER, Gamze SENER, Cigdem DEREBOY

Do psychological inflexibility and self-criticism mediate the relationship between depression and addiction severity?

Sevinc ULUSOY, Enver Denizhan RAMAKAN, Veysel GULEC, Izgi ALNİAK, Kaasim Fatih YAVUZ

Motor skills in children with specific learning disorder: A controlled study

Onur Tugce POYRAZ FİNDİK, Ayse Burcu ERDOGDU, Eray FADİLOGLU

Predictors of social functioning in people with antisocial personality disorder

Oktay SAHİN, Ahmet NALBANT, Kaasim Fatih YAVUZ

Investigation of the effect of electroconvulsive treatment on serum glial cell line-derived neurotrophic factor levels in patients with schizophrenia and bipolar disorder

Mustafa AKKUS, Tevfik KALELİOGLU, Hicret KAN, Nesrin KARAMUSTAFALİOGLU, Mehmet Cem ILNEM

Complementary and alternative medicine use and its association with clinical features and functioning in patients with bipolar I disorder: A cross-sectional study

Gulin OZDAMAR UNAL, Inci Meltem ALTAY

Analysis of posttraumatic embitterment disorders by machine learning: Could sullenness be a predictor of posttraumatic embitterment disorder?

Bahar KİLİC, Mustafa KARAKAPLAN, Suheyla UNAL

Interventional psychiatry for schizophrenia: The role of transcranial direct current stimulation

Ganesan VENKATASUBRAMANİAN