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探索物质使用障碍认知行为疗法中的能动性、共融性和叙事性阻断。

Exploring agency, communion and narrative foreclosure in cognitive behavioural therapy for substance use disorders.

作者信息

de Lange Mark, van der Palen Job, de Haan Hein

机构信息

Tactus Addiction Treatment, Deventer, The Netherlands.

Present: Trajectum, Zwolle, The Netherlands.

出版信息

Addict Behav Rep. 2025 Jul 24;22:100626. doi: 10.1016/j.abrep.2025.100626. eCollection 2025 Dec.


DOI:10.1016/j.abrep.2025.100626
PMID:40756504
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12314327/
Abstract

INTRODUCTION: Substance use disorders (SUDs) are a significant societal concern, negatively impacting self-worth, hope, and interpersonal connectedness. SUD recovery involves a transformation of one's 'life-story' or 'narrative identity'. 'Narrative foreclosure' (NF) impedes this process by disconnecting past, present, and future narratives, hindering the rewriting of SUD-related identities. We investigate the impact of SUD-based cognitive behavioural therapy (CBT) on narrative identity transformation and hypothesise NF as a potential factor in post-treatment relapse. METHODS: 107 patients referred to an outpatient clinic for adults with SUDs in the Netherlands were included. Participants completed the "Agency and Communion Inventory" (translated and validated in Dutch), the Narrative Foreclosure Scale (NFS) and the "Measurement of Addiction for Triage and Evaluation" (MATE), including the Depression, Anxiety, and Stress-Scale (DASS-21). Data collection occurred at the start of treatment, post-treatment (+3 months), and during a follow-up measure (+6 months). RESULTS: While participants showed a substantial reduction in substance use frequency and DASS-21 sum scores during CBT-treatment, no such differences were found in narrative themes. Multivariate models revealed that baseline communion and past-directed NF predicted 'substance-use reduction' during treatment, while 'cannabis use,' communion and future directed NF were predictors of 'DASS-21 sum score reduction'. Baseline communion showed a moderate positive relation to post-treatment relapse, while 'NFS: Future' exhibited a moderate inverse relation. These findings remained robust even when altering the criteria for defining 'post-treatment relapse.' They indicate that a stronger identification with communal themes serve as a protective factor against relapse, while future directed NF is associated with higher relapse rates. CONCLUSION: this study provides valuable insights into the interplay between narrative themes and treatment outcome(s) in SUD recovery. Notably, our findings underscore the significance of future-directed narrative foreclosure in the recovery process and found that CBT for SUDs does not appear to significantly facilitate narrative identity transformation. These results suggest that existing addiction treatments could be enhanced through the integration of narrative-focused interventions.

摘要

引言:物质使用障碍(SUDs)是一个重大的社会问题,对自我价值、希望和人际关系产生负面影响。SUD康复涉及个人“生活故事”或“叙事身份”的转变。“叙事 foreclosure”(NF)通过切断过去、现在和未来的叙事,阻碍了这一过程,妨碍了与SUD相关身份的重写。我们研究基于SUD的认知行为疗法(CBT)对叙事身份转变的影响,并假设NF是治疗后复发的一个潜在因素。 方法:纳入了107名被转介到荷兰一家成人SUD门诊诊所的患者。参与者完成了“能动性与共融性量表”(已翻译成荷兰语并验证)、叙事 foreclosure 量表(NFS)和“分诊与评估成瘾量表”(MATE),包括抑郁、焦虑和压力量表(DASS-21)。数据收集在治疗开始时、治疗后(+3个月)和随访测量期间(+6个月)进行。 结果:虽然参与者在CBT治疗期间物质使用频率和DASS-21总分有显著降低,但在叙事主题方面未发现此类差异。多变量模型显示,基线共融性和过去导向的NF预测了治疗期间的“物质使用减少”,而“大麻使用”、共融性和未来导向的NF是“DASS-21总分降低”的预测因素。基线共融性与治疗后复发呈中度正相关,而“NFS:未来”呈中度负相关。即使改变定义“治疗后复发”的标准,这些发现仍然稳健。它们表明,更强的对共融主题的认同是防止复发的保护因素,而未来导向的NF与更高的复发率相关。 结论:本研究为SUD康复中叙事主题与治疗结果之间的相互作用提供了有价值的见解。值得注意的是,我们的研究结果强调了未来导向的叙事 foreclosure 在康复过程中的重要性,并发现针对SUD的CBT似乎并没有显著促进叙事身份的转变。这些结果表明,现有的成瘾治疗可以通过整合以叙事为重点的干预措施来加强。

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本文引用的文献

[1]
Is the relapse concept in studies of substance use disorders a 'one size fits all' concept? A systematic review of relapse operationalisations.

Drug Alcohol Rev. 2022-5

[2]
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Alcohol Res. 2020

[3]
Substance related disorders are associated with impaired valuation of delayed gratification and feedback processing: A multilevel meta-analysis and meta-regression.

Neurosci Biobehav Rev. 2019-11-25

[4]
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Addict Health. 2018-4

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Eur J Cardiothorac Surg. 2019-2-1

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J Psychoactive Drugs. 2018-9-11

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