Effectiveness of Emotion Regulation Group Therapy on Craving, Emotion Problems, and Marital Satisfaction in Patients with Substance Use Disorders: A Randomized Clinical Trial

  • Fatemeh Zargar assistant profesor
  • Nasim Bagheri Department of Clinical Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.
  • Mohammad Javad Tarrahi
  • Mehrdad Salehi
Keywords: Craving; Emotion; Marital Relationship; Substance Use Disorder

Abstract

Objective: Psychological and environmental factors, such as difficulties in emotion regulation (ER) and marital problems, are involved in relapse and craving in patients with substance use disorders. Emotional regulation therapy can help maintain opioid withdrawal and improve marital relations by focusing on appropriate adjustment of emotions. This study aimed to evaluate the effectiveness of emotion regulation therapy on craving, emotion regulation, and marital satisfaction in patients with substance use disorders. 

Method: This randomized controlled clinical trial with pretest and posttest was performed in 2014 in Noor hospital, Isfahan, Iran. In this study, 30 patients who were admitted to the addiction center of Noor hospital were selected using purposive sampling. They were assigned into 2 groups randomly: (1) 15 patients in treatment as usual (TAU group); (2) 15 patients in emotion regulation group therapy (ERGT). The ERGT group received 8 weekly treatments, based on Gross model, to learn recognize emotions and their effects, overcome obstacles of positive emotions, accept emotions, identify regulatory maladaptive and adaptive strategies of emotions, and modify behavior. Before and after the emotion regulation sessions in experimental group, Craving Beliefs Questionnaire (CBQ), Emotion Regulation Questionnaire, and Dyadic Adjustment Scale (DAS) were administered in both groups.

Results: The results of analysis of variance indicated that mean scores of marital adjustment increased in ERGT (93.66 ± 15.81) compared to TAU group (55.26 ± 20.98) and the mean scores of craving were decreased in ERGT compared to TAU group (56.66 ± 18.39 and 105.2 ± 34.5, respectively). Also, most aspects of ER improved in ERGT compared to TAU group, and the total score of ER was increased in ERGT significantly (96.69 ± 5.38 in ERGT versus 73.70 ± 5.05 in TAU).

Conclusion: Based on the findings of this study, emotion regulation group therapy has a significant effect on reducing Craving and improving marital adjustment and emotion regulation in Patients with Substance Use Disorders. So, it can use as a useful psychotherapy in addiction treatment centers.  

 

Author Biography

Fatemeh Zargar, assistant profesor

deparment of psychiatry

References

1. Edition F. Diagnostic and Statistical Manual of Mental Disorders. Am Psychiatric Assoc; 2013.
2. Fox HC, Axelrod SR, Paliwal P, Sleeper J, Sinha R. Difficulties in emotion regulation and impulse control during cocaine abstinence. Drug Alcohol Depend. 2007;89(2-3):298-301
3. Fox HC, Hong KA, Sinha R. Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Addict Behav. 2008;33(2):388-94.
4. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clin Psychol Rev. 2010;30(2):217-37.
5. Gross JJ. Emotion regulation: affective, cognitive, and social consequences. Psychophysiology. 2002;39(3):281-91.
6. Kober H, Kross EF, Mischel W, Hart CL, Ochsner KN. Regulation of craving by cognitive strategies in cigarette smokers. Drug Alcohol Depend. 2010;106(1):52-5.
7. Rogojanski J, Vettese LC, Antony MM. Role of sensitivity to anxiety symptoms in responsiveness to mindfulness versus suppression strategies for coping with smoking cravings. J Clin Psychol. 2011;67(4):439-45.
8. Szasz PL, Szentagotai A, Hofmann SG. The effect of emotion regulation strategies on anger. Behav Res Ther. 2011;49(2):114-9.
9. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85(2):348-62.
10. Carver CS, Johnson SL, Joormann J. Serotonergic function, two-mode models of self-regulation, and vulnerability to depression: what depression has in common with impulsive aggression. Psychol Bull. 2008;134(6):912-43.
11. Brown RA, Lejuez CW, Kahler CW, Strong DR, Zvolensky MJ. Distress tolerance and early smoking lapse. Clin Psychol Rev. 2005;25(6):713-33.
12. Terry-McElrath YM, Emery S, Wakefield MA, O'malley PM, Szczypka G, Johnston LD. Effects of tobacco-related media campaigns on smoking among 20–30-year-old adults: longitudinal data from the USA. Tob Control. 2013;22(1):38-45.
13. Mudar P, Cooper M, Russell M, Frone M. Drinking to Regulate Positive and Negative Emotions: A Motivational Model of Alcohol Use. 1995.
14. Doran N, McChargue D, Cohen L. Impulsivity and the reinforcing value of cigarette smoking. Addict Behav. 2007;32(1):90-8.
15. DiFranza JR, Wellman RJ. A sensitization-homeostasis model of nicotine craving, withdrawal, and tolerance: integrating the clinical and basic science literature. Nicotine Tob Res. 2005;7(1):9-26.
16. Doherty K, Kinnunen T, Militello FS, Garvey AJ. Urges to smoke during the first month of abstinence: relationship to relapse and predictors. Psychopharmacology (Berl). 1995;119(2):171-8.
17. Skinner MD, Aubin H-J. Craving's place in addiction theory: contributions of the major models. Neurosci Biobehav Rev. 2010;34(4):606-23.
18. Choopan H, Kalantarkousheh SM, Aazami Y, Doostian Y, Farhudian A, Massah O. Effectiveness of Emotion Regulation Training on the Reduction of Craving‎ in Drug Abusers. Addict Health. 2016; 8(2): 68–75.
19. Otto MW, Powers MB, Fischmann D. Emotional exposure in the treatment of substance use disorders: Conceptual model, evidence, and future directions. Clin Psychol Rev. 2005;25(6):824-39.
20. Nadimi M. Efficacy of dialectical behavior group therapy on increasing distress tolerance and improving emotion regulation in substance abusers [In Persian]. Research on Addiction. 2016;9(36):141-60.
21. Azizi A, Borjali A, Golzari M. The effectiveness of emotion regulation training and cognitive therapy on the emotional and addictional problems of substance abusers. Iran J Psychiatry. 2010;5(2):60-5.
22. Massah O, Sohrabi F, A’azami Y, Doostian Y, Farhoudian A, Daneshmand R. Effectiveness of gross model-based emotion regulation strategies training on anger reduction in drug-dependent individuals and its sustainability in follow-up. Int J High Risk Behav Addict. 2016;5(1):e24327.
23. Bloch L, Haase CM, Levenson RW. Emotion regulation predicts marital satisfaction: More than a wives’ tale. Emotion. 2014;14(1):130-44.
24. Homish GG, Leonard KE, Cornelius JR. Illicit drug use and marital satisfaction. Addict Behav. 2008;33(2):279-91
25. Fitness J. Emotional intelligence and intimate relationships. Emotional intelligence in everyday life. 2001:98-112.
26. Aazami Y, Sohrabi F, Borjali A, Chopan H. The effectiveness of teaching emotion regulation based on gross model in reducing impulsivity in drug-dependent people [In Persian]. 2014.
27. Najafi M, Soleimani A, Ahmadi K, Javidi N, Hoseni E, Pirjavid F. The study of the effectiveness of couple emotionally focused therapy (EFT) on increasing marital adjustment and improving the physical and psychological health of the infertile couples. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2015;17(133):8-21.
28. Schreiber LR, Grant JE, Odlaug BL. Emotion regulation and impulsivity in young adults. J Psychiatr Res. 2012;46(5):651-8.
29. Valipoursheikhi Z, Mirederikvand F. The Effectiveness of Emotion Regulation Instruction on Increasing of Marital Adjustment in Couples with Marital Conflict [ In Persian]. Journal of Nursing Education. 2019;7(1):75-81.
30. Gross JJ, Thompson RA. Emotion regulation: Conceptual foundations. In: Gross JJ, editor. Handbook of Emotion Regulation: Guilford Press; 2007.
31. Tull MT, Gratz KL, Salters K, Roemer L. The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. J Nerv Ment Dis. 2004;192(11):754-61.
32. Mirzaei M, Gharraee B, Birashk B. The Role of Positive and Negative Perfectionism, Self-Efficacy, Worry and Emotion Regulation in Predicting Behavioral and Decisional Procrastination[In Persian]. Iranian Journal of Psychiatry and Clinical Psychology. 2013;19(3):230-40.
33. Spanier GB. The measurement of marital quality. J Sex Marital Ther. 1979;5(3):288-300.
34. Zargar F. Impact of Psychological Problems and Marital Adjustment of Iranian Veterans on Their Children's Quality of Life and Happiness. Arch Trauma Res. 2014 Sep 29;3(3):e15840.
35. Torkan H, Kalantari Mehrdad, Moulavi H. The Efficacy Of Transactional Analysis Group Therapy In Marital Satisfaction[ In Persian]. Journal of Family Research. 2007; 2(8): 383-403.
36. Beck AT, Clark DA. An information processing model of anxiety: automatic and strategic processes. Behaviour research and therapy. 1997;35(1):49-58.
37. MohammadKhani S, Sadegi N, Farzad V. The Causal Model of Relationships of Negative Emotions, Core Beliefs, Substance-related Beliefs, Craving and Emotion Regulation with Substance Abuse Relapse [In Persian]. J Psychol. 2011; 6 (23):155-81.
38. Rahmanian M, MirJafari A, Hasani J. Relationship between Craving and Attentional Bias in patients with Opioid-dependency in relapse and withdrawal phase. Psychiatry and clinical psychology. 2006;12(3):216-22.
39. Sher KJ and Grekin ER. Alcohol and Affect Regulation. In: Gross JJ, Ed., Handbook of Emotion Regulation: Guilford Press; 2007.
40. Tice DM, Bratslavsky E, Baumeister RF. Emotional distress regulation takes precedence over impulse control: if you feel bad, do it! J Pers Soc Psychol. 2001;80(1):53-67.
41. Suh JJ, Ruffins S, Robins CE, Albanese MJ, Khantzian EJ. Self-medication hypothesis: Connecting affective experience and drug choice. Psychoanalytic psychology. 2008;25(3):518-532.
42. English T, John O, Gross J. Emotion regulation in close relationships. The Oxford handbook of close relationships. 2013:500-13.
43. Levenson RW, Carstensen LL, Gottman JM. Influence of age and gender on affect, physiology, and their interrelations: A study of long-term marriages. J Pers Soc Psychol. 1994;67(1):56-68.
Published
2019-11-23
How to Cite
1.
Zargar F, Bagheri N, Tarrahi MJ, Salehi M. Effectiveness of Emotion Regulation Group Therapy on Craving, Emotion Problems, and Marital Satisfaction in Patients with Substance Use Disorders: A Randomized Clinical Trial. Iran J Psychiatry. 14(4):283-290.
Section
Original Article(s)