Shame is an emotion that is exhibited by many people with addictions and substance use issues. “Shame is also the emotional core of self-stigma, which has been associated with treatment-seeking delays, treatment dropout, and poorer social functioning,” said Jason B. Luoma, of the Portland Psychotherapy Clinic, Research, and Training Center in Portland, Oregon. “Shame has long been seen as relevant to substance use disorders and their treatment, but the precise nature of the relationship and how best to address it clinically are controversial.” Luoma, lead author of a recent study, believes that Acceptance and Commitment Therapy (ACT) may be helpful in addressing shame for people struggling with substance use issues. “For substance abusers, acceptance and mindfulness might be adaptive responses to difficult internal experiences such as shame or negative self-judgment,” said Luomo, “In an ACT approach, rather than trying to reduce or eliminate shame, psychological acceptance techniques encourage participants to notice and experience shame and other difficult feelings more fully, while reducing their conditioned link to overt action.”
For his study, Luomo enrolled 133 adults in either an ACT intervention, or treatment at usual (TAU), as part of a 28-day in-patient substance use treatment program. Although the ACT group only attended three, two hour sessions, the intervention had a significant impact. “As predicted, the ACT intervention led to higher levels of outpatient treatment attendance during follow-up, which in turn were functionally related to lower levels of substance use,” said Luomo. “Across the board, participants in the ACT condition showed a pattern of continuous treatment gains, especially on psychosocial measures, rather than the boom and bust cycles seen in TAU,” said Luomo, referring to the gradual decreases in shame seen by the ACT group. He added, “It seems highly unlikely that a 6-hr group alone was responsible for the gains seen, but rather something in the 6 hours spent in the ACT group changed the overall effect of this residential program.” Luomo hopes these findings will expand the use of ACT for people seeking help with substance use. He said, “Results of this study suggest that acceptance and mindfulness-based interventions may help people to step out of a cycle of avoidance and shame and move toward a path of successful recovery that leads to more stable reductions in shame and to more functional ways of living.”
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2011, October 31). Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0026070
© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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