Indiana University-Purdue University Indianapolis (IUPUI) / Despite data suggesting that current substance use disorder treatments are largely effective in reducing substance use, most adolescents in SUD treatment experience relapse after finishing treatment. Understanding the factors proximal to relapse is crucial to understanding the course of substance use disorder and how best to improve recovery among adolescents. The current study represents part of a novel line of research using qualitative data analysis to examine these factors. Data for the present study were 200 de-identified node-maps, completed by high school students at Hope Academy, a recovery high school in Indianapolis, Indiana. The reported age in this sample ranged from 14-20 years (64.1% male, 89.1% White), with a mean age of 16.8 years (SD = 1.9 years). After a four-phase process of qualitative data sorting, primary people, places, and things most frequently described included using with others (n=153, 76.5%), away from home (n=156, 78.0%), and in response to negative affect (n=93, 48.4%). Eleven relapse pathways emerged: escaping (n=16), self-medicating (n=3), coping with tragedy (n=5), critical mass (n=6), unexpected activation (n=8), unexpected offer (n=22), planned use (n=19), resistant to recovery (n=5), not in recovery (n=22), passive agency (n=30), and acting out (n=15). Recovery is a system made up of many interrelated parts, including those related to the individual person in recovery, their thoughts, beliefs, feelings, and emotions; and those related to external factors, their environment, adverse life events, and the actions of other people. By considering the pathways together for their common features, they can each be said to represent one of three critical failures related to those three overarching facets of the system: failure to cope, failure to guard against temptation, and failure of belief. Identifying these overarching failures in the system is helpful because the failures contain in themselves the seeds of their solution, so by examining them as critical components to a relapse event, it may be possible to gain insight into how to prevent the same type of relapses from occurring in the future.

The present study was designed to test the efficacy of a bibliotherapy-relapse prevention (BT-RP) program for panic attacks in which the active BT-RP condition was compared to a waiting-list control condition. Prior to the administration of the six-month BT-RP program, all participants completed an initial BT intervention (Febbraro, 1997) based on the book Coping with Panic (Clum, 1990). The BT-RP program was designed to: (a) review major components of the initial intervention; (b) increase practice of panic coping skills and therapeutic self-exposure; (c) enhance social support for panic recovery; (d) teach cognitive restructuring skills related to relapse prevention; (e) provide a protocol to follow in the event of a setback; and (f) reduce overall levels of stress. Brief monthly phone contacts were included in the BT-RP condition. Thirty-six participants, 17 in the BT-RP condition and 19 in the WL control condition, completed the study. A 2 (Treatment condition: BT-RP versus WL control) X 2 (Time: Pre-BT-RP assessment versus Post-BT-RP assessment) mixed-model research design was used to analyze the results. Results indicted significant reductions from pre- to post-treatment in the BT-RP condition for panic cognitions, anticipatory anxiety, agoraphobic avoidance, and depression, but not in the WL condition. When statistically controlling for initial levels of these variables via analyses of covariance (ANCOVAs), significant post-treatment differences in the expected direction emerged for these four dependent measure and for state anxiety. In addition, the BT-RP group reported significantly fewer panic attacks during the six-month course of the treatment trial than the WL control group on a measure of retrospective recall of full-blown panic attacks. There was also a statistically significant proportional between-group difference in terms of clinically significant improvement for full-blown panic attacks and agoraphobic avoidance in favor of the BT-RP group. However, no significant between-group differences emerged for the maintenance of initial treatment gains for panic frequency, panic symptoms, panic cognitions, anticipatory anxiety, or agoraphobic avoidance. Results of the present study are discussed in the framework of benefits of the present BT-RP program, limitations of the findings, recommendations for future research in this area, and implications for BT treatments in general. / Ph. D.

The purpose of this research study was to determine the effects of Fostering Resilience™ (FR), a new integrative relapse prevention group protocol for improving relapse risk, internalized shame, and psychological well-being in adults with substance use disorders (SUD). This study also sought to identify any relationship among relapse risk, internalized shame, and psychological well-being. It is the first study to investigate the new FR manualized program model compared to treatment as usual (TAU). The FR model was created based upon direct client experience, the supposition of the intrinsic role shame plays in SUD, and the corresponding belief in the essential value of implementing shame reduction techniques for improving treatment outcomes. Participants were 43 adults with SUD (19 FR and 24 TAU) seeking outpatient treatment. All participants received the 8-week intensive outpatient (IOP) treatment, with the FR group receiving 16 sessions of the manualized FR relapse prevention group protocol in lieu of other TAU group options. Assessments were administered pre and postintervention. Results indicated that the FR treatment group produced a significant reduction in relapse risk (p = .002, ES = .825), shame (p = .004, ES = .763), and psychological wellbeing (p = .008, ES = .679) from baseline to post-intervention, while the TAU comparison group produced a non-significant improvement in relapse risk (p = .209, ES = .264), shame (p = 055, ES = .409) and psychological well-being (p = .088, ES = .456). Correlation results indicated highly significant correlations between all the dependent variables. All correlations dropped post-intervention, although remained significant. The strongest relationship was found between shame and relapse risk at baseline: ALL (n = 43, r = .880), FR (n = 19, r = .869), TAU (n = 24, r = .908). This preliminary study establishes support for the new FR model as a beneficial treatment for significantly improving relapse risk, internalized shame, and psychological well-being in adults with SUD. It also provides important knowledge and insight regarding the critical nature of shame and its role relative to relapse risk and psychological well-being in those with SUD. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

Bipolar disorder (BPD) is associated with negative health outcomes and high relapse rates and group psychoeducation (PE) is recognised as an effective intervention when used in conjunction with pharmacological treatment. Unhealthy beliefs and attitudes have not been measured or related to outcomes in group PE and the mechanism for how PE exerts its effect are unidentified. Aims: (a). An adapted group psychoeducation intervention will change (improve) unhealthy personal beliefs about illness and attitudes towards medication when compared to a treatment as usual group. (b). Changes in unhealthy personal beliefs and attitudes will be maintained overtime (a 12 month follow up period). (c). People who subsequently relapse compared to those who do not relapse, will have less improvement in their unhealthy personal beliefs about illness and attitudes towards medication from PE. (d). An evaluation of the efficacy of psychoeducation in a systematic review for bipolar disorder in preventing relapse and other outcomes will identify factors that relate to clinical outcomes. Methods: A 10 session PE intervention was adapted and 38 participants with bipolar disorder I or II (using DSM-IV criteria) were recruited from a Specialist Affective Disorders Service. A waiting list assessment time was used as a parallel group control and a longitudinal study took place over a 12 month follow up period in all participants once they had received the intervention. A mirror image study reviewed case notes to identify relapse 12 month pre versus post intervention. Assessments measuring, beliefs and attitudes, mood symptoms and satisfaction where carried out, 8 weeks prior to intervention (waiting list), pre intervention, and 6 and 12 months post intervention. Results Summary: The waiting list control comparison showed significant improvement in attitudes measured by the Personal Beliefs about Illness Questionnaire (PBIQ) and Drug attitude Inventory (DAI) and symptoms and functioning. Beliefs on all domains of the PBIQ improved significantly (p<0.001) as did attitudes toward medication (p<0.001) there were also small but significant improvements in mood symptoms. In all participants (n=38) improvements were maintained over the 12 month follow up period. Nine people relapsed in the 12 months after the intervention compared with 22 before (p<0.002) and relapsers improved significantly less than non-relapsers following PE on the PBIQ (p=0.012) and the DAI (p=0.046). Conclusions: A group PE intervention reduced unhealthy personal beliefs and attitudes, both manic and depressive relapse and improved functioning. Improvements are maintained over time except adherence which remained unchanged. The amount of improvement in the PBIQ and DAI is related to relapse with non relapsers improving more than relapsers. The systematic review provides reasonable evidence that psychoeducation is at least modestly effective in preventing relapse in bipolar disorder, with the strongest evidence for reducing overall and manic relapse.

This study explored reasons for relapse among a sample of 938 self-identified problematic pornography users. A combination of numeric content analysis and qualitative coding of responses to an open-ended question about pornography relapse revealed six main categories of reasons for relapse. The mental, emotional, and relational categories were then analyzed in detail, and this analysis revealed significant overlap of responses from the emotional and relational categories. Hence, a new category of relational-emotional reasons for relapse was created and analyzed. The findings from this study highlight the complex interactions of different types of factors driving relapse in self-perceived problematic pornography users and future research and clinical applications are discussed.

No description available.

The aim of this qualitative study was to map the preparation and process of relapse prevention programs in therapeutic community for treating addictions in Czech republic called Magdaléna o.p.s.. The next aim was to describe the specifics of these programs and analyse methods that are mostly applied. For fullfilling these aims, four methods were chosen: analisys of documents, semistructured interwiews with the members of the team of therapists, observation of the researcher in the specific relapse prevention program during her internship and one semistructured interview with client of this therapeutic community. The final number of respondents for this research was four therapists and one client. Three metodic relapse prevention documents were analysed and for setting the final outcomes of this research were also used the outputs from the observation of the researcher from the specific relapse prevention program. Based on this research it was found out, that the specific relapse prevention programs in Magdaléna have been part of the long-term structured schedule of the treatment. This program is on the schedule once per week in duration of one hour and it is managed by one of the therapists. The program have been carried out in group and it is always based on one specific topic. Educational and...

Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety. Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II. As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis. The Internet increases the possibilities for health care providers in the management of depression.

Thesis (DPhil (Social Work))--University of Stellenbosch, 2005. / It is generally accepted that pre-teen sexual offences are becoming a widespread problem in South Africa and social workers are ill-equipped to render a competent service to prevent these youth offenders from re-offending. To date, the social, judicial and legislative systems do not provide any definite guidelines to prevent pre-teen sexual offenders from re-offending. The purpose of this study was to present guidelines which could serve as a framework when designing prevention programmes for pre-teen sex offenders. With the results of the study an attempt will be made to augment the knowledge and skills in this area in the social service delivery system, in order to render a professional and effective service to prevent pre-teen sexual offenders from reoffending. The objectives of the study were: first, to explain policy under the South African criminal justice system regarding crime according to the Sexual Offences Act, no 23 of 1957, and the Child Care Act, no 74 of 1983, as well as government and non-government services available to children under the age of 13 who sexually offend; second, to describe the social and personal circumstances of pre-teen sexual offenders in order to illustrate the nature of the deviant sexual behaviour of these children and to determine the need for prevention programmes; third, to reflect on the nature and function of prevention programmes for pre-teen sexual offenders and to investigate the need for social workers to utilize these programmes in welfare agencies in South Africa; fourth, to determine the nature of social work programmes which social workers in welfare agencies are using to address the needs and/or problems of pre-teen sexual offenders; and finally, to describe the knowledge and practice skills needed by social workers to design prevention programmes for pre-teen sexual offenders. The literature review was focused on research findings relating to issues examined in this study. An exploratory research design for the study was confined to a purposive sample of 79 respondents who were identified from a universe of 130 social workers to assess their need to develop prevention programmes in order to render a competent service to pre-teen sex offenders and their families. The results were analysed mainly quantitatively. The empirical study enabled the researcher to draw certain conclusions. The main finding was that pre-teen sex offences were on the increase, and that social workers therefore required ever greater knowledge and skills to empower them to use existing prevention of re-offending programmes for preteen sexual offenders, or alternatively, needed to develop their own such programmes. A number of recommendations flowed from the findings. The main recommendation was that welfare organisations rendering child care service should ensure that social workers have at their disposal a diverse knowledge and skills base consisting of the most significant prevention models and approaches to enable them to design their own prevention programmes for pre-teen sexual offenders. The welfare organisations should further supply social workers with training opportunities to enable them to design prevention programmes, thereby empowering them to render a professional service to pre-teen sexual offenders and their families. Finally, preventing pre-teen sex offenders from reoffending should be a state-driven initiative and national and provincial governments should provide adequate policies and facilities for the implementation of prevention programmes for pre-teen sexual offenders.

Mindfulness-based Cognitive Therapy (MBCT) is a promising approach aimed at the prevention of relapse in people suffering from recurrent depression. However little is known about what factors support gains in the longer-term. This study examines participants’ experiences of the perceived benefits and barriers to MBCT reunion attendance. Thirteen people, who had participated in MBCT classes for recurrent depression within a primary care setting, were interviewed about their experiences of the reunion meetings or their reasons for not attending. Seven of these had completed their program within the previous 12 to 18 months at the time of interview, and six had completed their program between 20 months and 4 years prior to the time of the interview. Interpretative phenomenological analysis (IPA) was used to analyze participants’ accounts. Four themes highlighted the participants’ experiences: In terms of benefits, reunion attendees experienced the reunions as a booster reminding them of their mindfulness practices and as a sanctuary where these practices were further nurtured within an accepting and compassionate environment. Barriers to reunion attendance were difficulties around the group experience and wanting to put the experience behind them. This related to the memory of depression as well as to the program and group experience for some individuals. Theoretical, clinical and research implications are discussed.