Recent craving research has focused on individuals' beliefs about cravings. Yet, measures about craving beliefs have rarely been compared with other craving belief measures or measures of craving ...itself. We aimed to develop a craving metacognition measure with a simple factor structure that could be used by people with a range of alcohol use patterns. This article introduces the Craving Metacognition Scale, a measure of individuals' craving metacognitions.
Items were generated based on specific beliefs and attitudes related to craving and drinking, sourced from existing questionnaires and edited to emphasise metacognitive appraisal. Two samples tested the scale: one of individuals seeking treatment for alcohol use issues (n = 115) and the other of undergraduate students who drank regularly (n = 92). The items were refined based on contribution to the total score and divergence from existing measures.
The final 13-item scale showed strong internal consistency (α = .93) and good convergence with existing measures, such as the Jellinek Alcohol Craving Questionnaire-now (Pearson's r = .698) and the Metacognition Questionnaire for Alcohol Abusers subscales (between r = .602 and r = .811).
The Craving Metacognition Scale shows preliminary evidence of psychometric validity. It has a simple factor structure that measures craving metacognitions reported by individuals with a range of drinking habits.
The aim of the current study was to integrate recent developments in the retraining of attentional biases towards threat into a standard cognitive behavioural treatment package for social phobia.
134 ...participants (M age – 32.4: 53% female) meeting DSM-IV criteria for social phobia received a 12-week cognitive behavioural treatment program. They were randomly allocated to receive on a daily basis using home practice, either an additional computerised probe procedure designed to train attentional resource allocation away from threat, or a placebo variant of this procedure. Measures included diagnostic severity, social anxiety symptoms, life interference, and depression as well as state anxiety in response to a laboratory social threat.
At the end of treatment there were no significant differences between groups in attentional bias towards threat or in treatment response (all p's > 0.05). Both groups showed similar and highly significant reductions in diagnostic severity, social anxiety symptoms, depression symptoms, and life interference at post-treatment that was maintained and in most cases increased at 6 month follow-up (uncontrolled effect sizes ranged from d = 0.34 to d = 1.90).
The current results do not indicate that integration of information processing-derived attentional bias modification procedures into standard treatment packages as conducted in this study augments attentional change or enhances treatment efficacy. Further refinement of bias modification techniques, and better methods of integrating them with conventional approaches, may be needed to produce better effects.
► Treatment for social phobia was successful through a comprehensive cognitive behavioural package of 12 sessions. ► Attentional bias modification integrated into the homework component of treatment failed to change attentional biases. ► Attentional bias modification conducted in this way also failed to increase the efficacy of the basic treatment package.
Background and aims
Alcohol use and anxiety often co‐occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and ...cost‐effectiveness of a web‐based, self‐guided alcohol and anxiety‐focused program, compared with a web‐based brief alcohol‐focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects.
Design
This RCT will be conducted with a 1:1 parallel group.
Setting
The study will be a web‐based trial in Australia.
Participants
Individuals aged 17–30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks.
Intervention and comparator
Participants will be randomly allocated to receive a web‐based, integrated alcohol‐anxiety program plus technical and motivational telephone/e‐mail support (intervention) or a web‐based brief alcohol‐feedback program (control).
Measurements
Clinical measures will be assessed at baseline, post‐intervention (2 months), 6 months (primary end‐point), 12 months and 18 months. Co‐primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge‐drinking frequency; alcohol‐related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post‐intervention), health‐care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention‐to‐treat framework. The economic evaluation will analyze individual‐level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change.
Comments
This will be the first trial to test whether a developmentally targeted, web‐based, integrated alcohol‐anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol‐anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost.
Summary of recommendations and levels of evidence
Chapter 2: Screening and assessment for unhealthy alcohol use
Screening
Screening for unhealthy alcohol use and appropriate interventions should be ...implemented in general practice (Level A), hospitals (Level B), emergency departments and community health and welfare settings (Level C).
Quantity–frequency measures can detect consumption that exceeds levels in the current Australian guidelines (Level B).
The Alcohol Use Disorders Identification Test (AUDIT) is the most effective screening tool and is recommended for use in primary care and hospital settings. For screening in the general community, the AUDIT‐C is a suitable alternative (Level A).
Indirect biological markers should be used as an adjunct to screening (Level A), and direct measures of alcohol in breath and/or blood can be useful markers of recent use (Level B).
Assessment
Assessment should include evaluation of alcohol use and its effects, physical examination, clinical investigations and collateral history taking (Level C).
Assessment for alcohol‐related physical problems, mental health problems and social support should be undertaken routinely (GPP).
Where there are concerns regarding the safety of the patient or others, specialist consultation is recommended (Level C).
Assessment should lead to a clear, mutually acceptable treatment plan which specifies interventions to meet the patient’s needs (Level D).
Sustained abstinence is the optimal outcome for most patients with alcohol dependence (Level C).
Chapter 3: Caring for and managing patients with alcohol problems: interventions, treatments, relapse prevention, aftercare, and long term follow‐up
Brief interventions
Brief motivational interviewing interventions are more effective than no treatment for people who consume alcohol at risky levels (Level A).
Their effectiveness compared with standard care or alternative psychosocial interventions varies by treatment setting. They are most effective in primary care settings (Level A).
Psychosocial interventions
Cognitive behaviour therapy should be a first‐line psychosocial intervention for alcohol dependence. Its clinical benefit is enhanced when it is combined with pharmacotherapy for alcohol dependence or an additional psychosocial intervention (eg, motivational interviewing) (Level A).
Motivational interviewing is effective in the short term and in patients with less severe alcohol dependence (Level A).
Residential rehabilitation may be of benefit to patients who have moderate‐to‐severe alcohol dependence and require a structured residential treatment setting (Level D).
Alcohol withdrawal management
Most cases of withdrawal can be managed in an ambulatory setting with appropriate support (Level B).
Tapering diazepam regimens (Level A) with daily staged supply from a pharmacy or clinic are recommended (GPP).
Pharmacotherapies for alcohol dependence
Acamprosate is recommended to help maintain abstinence from alcohol (Level A).
Naltrexone is recommended for prevention of relapse to heavy drinking (Level A).
Disulfiram is only recommended in close supervision settings where patients are motivated for abstinence (Level A).
Some evidence for off‐label therapies baclofen and topiramate exists, but their side effect profiles are complex and neither should be a first‐line medication (Level B).
Peer support programs
Peer‐led support programs such as Alcoholics Anonymous and SMART Recovery are effective at maintaining abstinence or reductions in drinking (Level A).
Relapse prevention, aftercare and long‐term follow‐up
Return to problematic drinking is common and aftercare should focus on addressing factors that contribute to relapse (GPP).
A harm‐minimisation approach should be considered for patients who are unable to reduce their drinking (GPP).
Chapter 4: Providing appropriate treatment and care to people with alcohol problems: a summary for key specific populations
Gender‐specific issues
Screen women and men for domestic abuse (Level C).
Consider child protection assessments for caregivers with alcohol use disorder (GPP).
Explore contraceptive options with women of reproductive age who regularly consume alcohol (Level B).
Pregnant and breastfeeding women
Advise pregnant and breastfeeding women that there is no safe level of alcohol consumption (Level B).
Pregnant women who are alcohol dependent should be admitted to hospital for treatment in an appropriate maternity unit that has an addiction specialist (GPP).
Young people
Perform a comprehensive HEEADSSS assessment for young people with alcohol problems (Level B).
Treatment should focus on tangible benefits of reducing drinking through psychotherapy and engagement of family and peer networks (Level B).
Aboriginal and Torres Strait Islander peoples
Collaborate with Aboriginal or Torres Strait Islander health workers, organisations and communities, and seek guidance on patient engagement approaches (GPP).
Use validated screening tools and consider integrated mainstream and Aboriginal or Torres Strait Islander‐specific approaches to care (Level B).
Culturally and linguistically diverse groups
Use an appropriate method, such as the “teach‐back” technique, to assess the need for language and health literacy support (Level C).
Engage with culture‐specific agencies as this can improve treatment access and success (Level C).
Sexually diverse and gender diverse populations
Be mindful that sexually diverse and gender diverse populations experience lower levels of satisfaction, connection and treatment completion (Level C).
Seek to incorporate LGBTQ‐specific treatment and agencies (Level C).
Older people
All new patients aged over 50 years should be screened for harmful alcohol use (Level D).
Consider alcohol as a possible cause for older patients presenting with unexplained physical or psychological symptoms (Level D).
Consider shorter acting benzodiazepines for withdrawal management (Level D).
Cognitive impairment
Cognitive impairment may impair engagement with treatment (Level A).
Perform cognitive screening for patients who have alcohol problems and refer them for neuropsychological assessment if significant impairment is suspected (Level A).
Summary of key recommendations and levels of evidence
Chapter 5: Understanding and managing comorbidities for people with alcohol problems: polydrug use and dependence, co‐occurring mental disorders, and physical comorbidities
Polydrug use and dependence
Active alcohol use disorder, including dependence, significantly increases the risk of overdose associated with the administration of opioid drugs. Specialist advice is recommended before treatment of people dependent on both alcohol and opioid drugs (GPP).
Older patients requiring management of alcohol withdrawal should have their use of pharmaceutical medications reviewed, given the prevalence of polypharmacy in this age group (GPP).
Smoking cessation can be undertaken in patients with alcohol dependence and/or polydrug use problems; some evidence suggests varenicline may help support reduction of both tobacco and alcohol consumption (Level C).
Co‐occurring mental disorders
More intensive interventions are needed for people with comorbid conditions, as this population tends to have more severe problems and carries a worse prognosis than those with single pathology (GPP).
The Kessler Psychological Distress Scale (K10 or K6) is recommended for screening for comorbid mental disorders in people presenting for alcohol use disorders (Level A).
People with alcohol use disorder and comorbid mental disorders should be offered treatment for both disorders; care should be taken to coordinate intervention (Level C).
Physical comorbidities
Patients should be advised that alcohol use has no beneficial health effects. There is no clear risk‐free threshold for alcohol intake. The safe dose for alcohol intake is dependent on many factors such as underlying liver disease, comorbidities, age and sex (Level A).
In patients with alcohol use disorder, early recognition of the risk for liver cirrhosis is critical. Patients with cirrhosis should abstain from alcohol and should be offered referral to a hepatologist for liver disease management and to an addiction physician for management of alcohol use disorder (Level A).
Alcohol abstinence reduces the risk of cancer and improves outcomes after a diagnosis of cancer (Level A).
The Female Sexual Function Index (FSFI; Rosen et al.,
2000
) and International Index of Erectile Function (IIEF; Rosen et al.,
1997
) are two of the most widely used measures of sexual dysfunction. ...However, they have potential measurement and psychometric flaws that have not been addressed in the literature. This article examines the measurement capabilities of these measures based on data collected from an online study in 2010. A convenience sample of 518 sexually active adults (65% female) drawn from the general community were included in the analyses. Both measures displayed critical theoretical and measurement problems for the assessment of sexual problems beyond sexual arousal, and for the sexual desire domains in particular. Based on these results, we encourage clinicians and researchers to think critically about whether the FSFI and IIEF are appropriate measures for their practice and research. In particular, these measures are inappropriate for use among individuals who are not currently sexually active, and research with a focus other than sexual arousal should consider supplementary measures of sexual function. The psychometric properties of these measures should be reassessed in clinical samples, but the theoretical issues with the measures raised in this article are relevant across clinical and research contexts.
Much of the knowledge about the relationships among domains of psychopathology is built on the diagnostic categories described in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and ...relatively little research has examined the symptom-level structure of psychopathology. The aim of this study was to delineate a detailed hierarchical model of psychopathology—from individual symptoms up to a general factor of psychopathology—allowing both higher- and lower-order dimensions to depart from the structure of the DSM. We explored the hierarchical structure of hundreds of symptoms spanning 18 DSM disorders in two large samples—one from the general population in Australia (n = 3,175) and the other a treatment-seeking clinical sample from the United States (n = 1,775). There was marked convergence between the two samples, offering new perspectives on higher-order dimensions of psychopathology. We also found several noteworthy departures from the structure of the DSM in the symptom-level data.
•We compared adults with social anxiety disorder from Japan (J) and Australia (A).•Measurement equivalent (ME) social anxiety measures allow accurate J/A comparisons.•Two popular social anxiety ...measures were not ME across the J/A groups.•We identified a subset of ME social anxiety items for accurate J/A comparisons.•J < A for fear of attracting attention and J = A for other facets of social anxiety.
Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan.
Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework.
The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants.
We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture.
When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD.
There is a paucity of translational research programmes to improve implementation of evidence-based care in drug and alcohol settings. This systematic review aimed to provide a synthesis and ...evaluation of the effectiveness of implementation programmes of treatment for patients with drug and alcohol problems using the Consolidated Framework for Implementation Research (CFIR).
A comprehensive systematic review was conducted using five online databases (from inception onwards). Eligible studies included clinical trials and observational studies evaluating strategies used to implement evidence-based psychosocial treatments for alcohol and substance use disorders. Extracted data were qualitatively synthesised for common themes according to the CFIR. Primary outcomes included the implementation, service system or clinical practice. Risk of bias of individual studies was appraised using appropriate tools. A protocol was registered with (PROSPERO) (CRD42019123812) and published previously (Louie et al. Systematic 9:2020).
Of the 2965 references identified, twenty studies were included in this review. Implementation research has employed a wide range of strategies to train clinicians in a few key evidence-based approaches to treatment. Implementation strategies were informed by a range of theories, with only two studies using an implementation framework (Baer et al. J Substance Abuse Treatment 37:191-202, 2009) used Context-Tailored Training and Helseth et al. J Substance Abuse Treatment 95:26-34, 2018) used the CFIR). Thirty of the 36 subdomains of the CFIR were evaluated by included studies, but the majority were concerned with the Characteristics of Individuals domain (75%), with less than half measuring Intervention Characteristics (45%) and Inner Setting constructs (25%), and only one study measuring the Outer Setting and Process domains. The most common primary outcome was the effectiveness of implementation strategies on treatment fidelity. Although several studies found clinician characteristics influenced the implementation outcome (40%) and many obtained clinical outcomes (40%), only five studies measured service system outcomes and only four studies evaluated the implementation.
While research has begun to accumulate in domains such as Characteristics of Individuals and Intervention Characteristics (e.g. education, beliefs and attitudes and organisational openness to new techniques), this review has identified significant gaps in the remaining CFIR domains including organisational factors, external forces and factors related to the process of the implementation itself. Findings of the review highlight important areas for future research and the utility of applying comprehensive implementation frameworks.
Abstract
Research investigating social anxiety and the impacts on romantic relationships remains scarce. An online questionnaire examining romantic relationship status, social anxiety and depression ...symptomology, relationship satisfaction, and several relationship processes was completed by 444 adults. Individuals with higher social anxiety were less likely to be in romantic relationships. For the 188 adults in our sample in current relationships, relationship satisfaction was not influenced by social anxiety when controlling for depression. Although it was proposed that self-disclosure, social support, trust, and conflict initiation might influence romantic relationship satisfaction, none of these mechanisms interacted with social anxiety to explain additional variance in relationship satisfaction. These findings indicate that depression symptomology may be a treatment target for socially anxious individuals wishing to improve romantic relationship satisfaction.
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