RANDOMIZED CONTROLLED TRIAL OF SHAME-FOCUSED PSYCHOTHERAPY FOR ALCOHOL ABUSE

Abstract

Prior studies have shown that mindfulness and acceptance therapies have reduced symptoms of substance abuse in affected populations. This proposed study builds on prior research regarding the relationship between substance abuse and feelings of shame by testing a shame-focused psychotherapy for alcohol abuse by comparing its effects on levels of shame and severity of symptoms relative to treatment as usual (TAU). The theory driving this treatment is that shame is a central experience of substance abuse, both a cause and effect. Thus, a psychotherapy focusing on patients experiencing and working through shame should be incredibly effective. The hypotheses are that: (1) the shame-focused treatment will reduce symptoms of alcohol abuse significantly more than TAU; (2) the treatment will reduce levels of shame significantly more than TAU; and that (3) the effects of the treatment on levels of shame will mediate the effects of the treatment on symptoms of alcohol abuse. Two hundred fifty participants with a DSM-V diagnosis of Substance Abuse - Alcohol will be recruited through targeted advertisements posted publicly, on social media, and at alcohol anonymous meetings. Recruited potential participants will undergo the Structured Clinical Interview of the DSM-V (SCID-V) to determine their eligibility for participation. Participants will be randomly assigned to either the shame-focused treatment or the TAU group. Participants will not be informed as to which treatment they are receiving. Sessions will be held once a week for 12 weeks, with a follow-up 8 weeks after treatment concludes. All therapists will follow a manualized structure for their respective forms of treatment. Their adherence to the manuals will be observed and rated three times by independent judges throughout treatment. Measures will include treatment attendance, levels of shame, and severity of alcohol abuse symptoms. The independent variable is the treatment condition, the dependent variable is the symptoms of alcohol abuse, and the mediating variable is levels of shame. If the results support the hypotheses, it will indicate that the shame-focused treatment reduces symptoms of alcohol abuse significantly more than TAU because it targets and reduces the feelings of shame. The theoretical and clinical implications of this potential finding are discussed.