Assignment 1: Quantitative Journal Article Review The Role of Emotion Regulation in Alcohol Use Disorder Lindsay Dragland Yorkville University PSYC 6213: Research Methods Dr. Penny Lane Hamblin July 25, 2021 1 Abstract This assignment is comprised of a Journal Article Review (JAR) related to the topic chosen for the Final Project: The role of Emotion Regulation in Alcohol Use Disorder. This article, Deficits in Emotion-Regulation Skills Predict Alcohol Use During and After Cognitive–Behavioral Therapy for Alcohol Dependence, employs a correlational quantitative design and is relevant to the topic of the Final Project because it examines the relationship between emotion regulation and maladaptive alcohol use. Specifically, this article demonstrates how deficits in emotion regulation skills maintain alcohol dependence and predict relapse to maladaptive drinking. This finding is central to the Final Project, which will further analyze the importance of emotion regulation in the treatment of alcohol use disorder. Keywords: emotion regulation, alcohol dependence, treatment, relapse 2 The Role of Emotion Regulation in Alcohol Use Disorder Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive– behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318. https://doi.org/10.1037/a0023421 Statement of Problem The research problem being addressed concerns the urgent need to improve the efficacy of treatment for AD, as about 75% of clients relapse within a year after terminating treatment despite the implementation of numerous empirically supported treatments (Miller, Walters, & Bennett, 2001). With this problem in mind, the researchers investigate the association between emotion regulation skills and alcohol dependence (AD), and whether these skills predict alcohol use during and after treatment of AD. Specifically, the researchers attempt to discover whether AD is maintained by deficits in emotion regulation skills, with the goal of establishing these skills as crucial targets in the treatment of AD. The purpose of this goal is to improve the efficacy of treatment for AD and lower the rate of relapse for individuals during and after treatment. Literature Review Berking et al. (2011) highlight several studies that provide extensive evidence establishing negative affect as a crucial factor in alcohol misuse, as well as numerous theoretical models which assert that emotion regulation is a primary motive for alcohol use and therefore is crucial for the prevention of AD relapse (e.g., Baker, Piper, McCarthy, Majeskie, & Fiore, 2004; Cooper, Frone, Russell, & Mudar, 1995; Khantzian, 1997). Despite these findings, the role of emotion regulation skills in predicting alcohol use during and after treatment of AD has yet to be 3 investigated (Berking et al., 2011). Given that only about a quarter of clients remain abstinent after terminating treatment for AD (Miller, Walters, & Bennett, 2001), improving the effectiveness and expanding on these empirically supported treatments is imperative for bettering the lives of those affected by AD. Therefore, Berking et al. (2011) attempt to establish particular skills as crucial targets in the treatment of AD, as this may prove to be an essential component in enhancing the efficacy of treatment. Hypotheses To Be Tested Berking et al. (2011) test their primary hypotheses that (a) pre-treatment emotion regulation skills negatively predict alcohol use during treatment, and (b) post-treatment emotion regulation skills negatively predict alcohol use after treatment. Method Participants Participants were 116 predominantly male (84%) inpatients with an average age of 43.10 years, all of whom were Caucasian, met criteria for AD. Selection criteria included a diagnosis of alcohol dependence, completion of detoxification, intent to remain in cognitive behavioural therapy (CBT) for at least six weeks, and sufficient German spelling skills; and excluded individuals with a significant risk for suicide. Materials Self-report measures were used to assess emotion regulation, severity of AD symptoms, and alcohol use three months after CBT treatment. Measurement of alcohol use during CBT treatment included urine and breath-analyzer tests. Procedure 4 Participants in the AD sample received CBT treatment for an average of 98 days. Pretreatment emotion regulation skills of individuals with AD were compared to the skills of a nonclinical control group. The researchers used a matching procedure to match the individuals in the AD sample and control sample based on gender and age. Statistics The researchers used multivariate binary logistic regression analyses to test their primary hypothesis, with indicators of symptom severity, cognitive capacities, negative mood, and emotion regulation. Pearson’s correlations were used to test whether pre-treatment emotion regulation skills questionnaire (ERSQ) scores predict symptom severity. The researchers used “one-tailed tests when testing directional hypotheses and report Cohen’s d (Cohen, 1988), pointbiserial correlation coefficients, odds ratios, and Nagelkerke’s R2 as effect sizes” (Berking et al., 2011, p. 311). Results Compared to participants who remained abstinent during treatment (n=77), those who consumed alcohol during treatment (n=39) had significantly lower pre-treatment ERSQ scores. Post-treatment ERSQ scores of participants who were non-abstinent at the time of follow-up assessment (n=58) were significantly lower than the scores of abstinent participants (n=58). These results were produced even when controlling for potential confounds (i.e., symptom severity, comorbid disorders, cognitive capacities, and negative affect). Implications Implications for Counselors, Clients, and Counselling The findings that deficits in emotion regulation skills predict alcohol use and effective emotion regulation skills reduce alcohol use have important implications regarding the treatment 5 of AD. The findings indicate that these skills work to reduce the negative affect that motivates alcohol use, and likely provide individuals with productive ways to deal with negative affect, thereby helping to decrease the rate of relapse even when individuals are faced with negative emotions (Berking et al., 2011). This study establishes emotion regulation skills as crucial targets in the treatment of AD and demonstrates that by focusing on the enhancement of these skills, we can work towards the enhancement of AD treatment efficacy. Ultimately, improving the efficacy of AD treatment will help clients maintain abstinence and thus significantly improve the lives of those affected by AD. Discussion Summary The result that participants who consumed alcohol during treatment had significantly lower pre-treatment ERSQ scores compared to participants who remained abstinent during treatment supports the first hypothesis that pre-treatment emotion regulation skills negatively predict alcohol use during treatment. The result that the post-treatment ERSQ scores of nonabstinent participants were significantly lower than the scores of abstinent participants supports the second hypothesis that post-treatment emotion regulation skills negatively predict alcohol use after treatment. Interpretation Participant gender could have influenced the results, as the AD sample was predominantly male and the control group was predominantly female. This study implements a quasi-experimental design, which is valuable in applied research because it allows researchers to investigate the factors that maintain AUD when ethical problems make randomly assigning their participants impossible (Goodwin & Goodwin, 2017). Furthermore, the results of this quasi- 6 experimental study have implications that will clearly benefit the lives of many people (Goodwin & Goodwin, 2017). Informed consent entails the participant intelligently, knowingly, and voluntarily agreeing to take part in the study (CCPA, 2020). Therefore, participants must have the capacity to make rational decisions, must be able to comprehend exactly what they are consenting to, and must not be coerced or pressured into consenting. These notions are accompanied by various ethical dilemmas, especially when dealing with special populations such as individuals with alcohol use disorder (Anderson & McNair, 2018; Goodwin & Goodwin, 2017). The comprehension and decision-making capacity of individuals with SUDs in general raises some issues, as their capacity may be impaired because of intoxication or withdrawal, or the potential cognitive disturbances from long-term substance use; this is concerning, especially when only about half of all participants comprehend the information presented during the consent process (Anderson & McNair, 2018). Therefore, researchers should continuously assess the cognitive capacity of participants to ensure they are able to give informed consent intelligently, knowingly, and voluntarily. Self-report measures were used to assess emotion regulation and severity of AD symptoms. Such measures are accompanied by various types of biases and other influences that can lower the reliability and validity of a study, such as social desirability bias and issues with memory recall. The researchers also did not have an untreated control condition, as assigning participants with AD to a group that receives no therapy would be unethical. While this avoids ethical issues pertaining to the duty to do no harm, the lack of an untreated group to compare treatment results to means that we need to interpret the changes in emotional regulation skills during treatment with caution (Berking et al., 2011). However, Berking et al. (2011) provide 7 evidence supporting the observed changes, as their findings are consistent with other research results demonstrating the increase in emotion regulation skills during CBT. For Further Study This study provides support for the association between emotion regulation skills and alcohol dependence (AD), and the notion that these skills predict alcohol use during and after treatment of AD. However, because of the lack of matching samples and the absence of an untreated AD control sample, the reliability and validity of this study could be improved. Future research could implement a quasi-experimental non-equivalent control group design, as by having a control group, we can determine if the changes in emotion regulation during treatment were a result of CBT treatment and rule out other variables that threaten internal validity (Goodwin & Goodwin, 2017). The control group could receive a form of treatment for AD that is not associated with enhancement of emotion regulation skills, so if these skills increased in the treatment group but not in the control group, we could attribute this increase to CBT treatment. Furthermore, if a significant number of participants remained abstinent after being in the treatment group but not in the control group, then we could attribute this maintained abstinence to enhanced emotion regulation skills as a result of CBT treatment. Continuing to investigate the relationship between emotion regulation and alcohol use disorder can help improve the efficacy of treatment for AD and lower the rate of relapse for individuals during and after treatment, thereby bettering the lives of those affected by AD. 8 References Anderson, E., & McNair, L. (2018). Ethical Issues in Research Involving Participants With Opioid Use Disorder. Therapeutic Innovation & Regulatory Science, 52(3), 280–284. https://doi.org/10.1177/2168479018771682 Berking, M., Margraf, M., Ebert, D., Wupperman, P., Hofmann, S. G., & Junghanns, K. (2011). Deficits in emotion-regulation skills predict alcohol use during and after cognitive– behavioral therapy for alcohol dependence. Journal of Consulting and Clinical Psychology, 79(3), 307–318. https://doi.org/10.1037/a0023421 Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111, 33–51. doi:10.1037/0033-295X.111.1.33 Canadian Counselling and Psychotherapy Association (2020) Canadian Code of Ethics for Psychologists (3rd ed.). https://www.ccpa-accp.ca/wp-content/uploads/2020/05/CCPA2020-Code-of-Ethics-E-Book-EN.pdf Cooper, M. L., Frone, M. R., Russell, M., & Mudar, P. (1995). Drinking to regulate positive and negative emotions: A motivational model of alcohol use. Journal of Personality and Social Psychology, 69, 990–1005. doi:10.1037/0022-3514.69.5.990 Goodwin, K. A., & Goodwin, C. J. (2017). Research in psychology: Methods and designs (8th ed.). Hoboken, NJ: John Wiley & Sons. 9 Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A reconsideration and recent applications. Harvard Review of Psychiatry, 4, 231–244. doi:10.3109/10673229709030550 Marlatt, G., & Witkiewitz, K. (2005). Relapse prevention for alcohol and drug problems. In G. Marlatt & D. Donovan (Eds.), Relapse prevention: Maintenance strategies in the treatment of addictive behaviors (2nd ed., pp. 1–44). New York, NY: Guilford Press. Miller, W. R., Walters, S. T., & Bennett, M. E. (2001). How effective is alcoholism treatment in the United States? Journal of Studies on Alcohol, 62, 211–220.
