Research Article
A preliminary study of spiritual self-schema (3-S+) therapy for reducing impulsivity in HIV-positive drug users
Arthur Margolin,
Zev Schuman-Olivier, Mark Beitel, Ruth M. Arnold, Carl E. Fulwiler, S. Kelly Avants,
Corresponding Author
Arthur Margolin
Yale University School of Medicine
Yale University School of Medicine, Welch Center, 495 Congress Avenue, New Haven, CT 06519Search for more papers by this authorArthur Margolin,
Zev Schuman-Olivier, Mark Beitel, Ruth M. Arnold, Carl E. Fulwiler, S. Kelly Avants,
Corresponding Author
Arthur Margolin
Yale University School of Medicine
Yale University School of Medicine, Welch Center, 495 Congress Avenue, New Haven, CT 06519Search for more papers by this authorAbstract
The purpose of this study was twofold. First, pretreatment correlations are presented among impulsivity, intoxicant use, HIV risk behavior, spirituality, and motivation in a sample of 38 HIV-positive drug users. Second, treatment outcomes are presented from a preliminary study of spiritual self-schema (3-S+) therapy—a manual-guided psychotherapy integrating cognitive and Buddhist psychologies—for increasing motivation for abstinence, HIV prevention, and medication adherence. Impulsivity was negatively correlated with spiritual practices and motivation for recovery, and was positively related to intoxicant use and HIV risk behavior. Relative to a standard care comparison condition, patients completing 3-S+ therapy reported greater decreases in impulsivity and intoxicant use, and greater increases in spiritual practices and motivation for abstinence, HIV prevention, and medication adherence. © 2007 Wiley Periodicals, Inc. J Clin Psychol 63: 979–999, 2007.
References
- Acton, G. S. ( 2003). Measurement of impulsivity in a hierarchical model of personality traits: Implications for substance use. Substance Use & Misuse, 36, 67–83.
- Alterman, A. I., Koppenhaven, J. M., Mulholland, E., Ladden, L. J., & Blaime, M. J. ( 2004). Pilot trial of effectiveness of mindfulness meditation for substance abuse patients. Journal of Substance Abuse, 9(6), 259–268.
- American Psychiatric Association. ( 1994). Diagnostic and statistical manual of mental disorders ( 4th ed.). Washington, DC: Author.
-
Avants, S. K.,
Beitel, M., &
Margolin, A. (
2005).
Making the shift from ‘addict self’ to ‘spiritual self’: Results from a Stage I study of Spiritual Self-Schema (3-S) therapy for the treatment of addiction and HIV risk behavior.
Mental Health, Religion, & Culture, 8(3), 167–177.
10.1080/13694670500138924 Google Scholar
- Avants, S. K., & Margolin, A. ( 1995). “Self” and addiction: The role of imagery in self-regulation. The Journal of Alternative and Complementary Medicine, 1(4), 339–345.
-
Avants, S. K., &
Margolin, A. (
2004).
Development of spiritual self-schema therapy for the treatment of addictive and HIV risk behavior: A convergence of cognitive and Buddhist psychology.
Journal of Psychotherapy Integration, 14(3), 253–289.
10.1037/1053-0479.14.3.253 Google Scholar
- Avants, S. K., Margolin, A., Warburton, L. A., Hawkins, K. A., & Shi, J. ( 2001). Predictors of nonadherence to HIV-related medication regimens during methadone stabilization. The American Journal on Addictions, 10, 1–10.
- Avants, S. K., Warburton, L. A., Hawkins, K. A., & Margolin, A. ( 2000). Continuation of high risk behaviors by HIV-positive drug users: Treatment implications. Journal of Substance Abuse Treatment, 19(1), 15–22.
- Beitel, M., Genova, M., Schuman-Olivier, Z., Arnold, R., Avants, S. K., & Margolin, A. ( 2007). Reflections by inner-city drug users on a Buddhist-based spirituality-focused therapy: A qualitative study. American Journal of Orthopsychiatry, 77(1), 1–9.
- Bell, R. ( 1997). The correlates of student marijuana use: results of a U.S. National Survey. Addiction, 92, 571–581.
- CDC. ( 2001). HIV Prevention Strategic Plan through 2005. Washington, DC: Centers for Disease Control and Prevention.
-
Coulter, A. H. (
2002).
Healing behind bars: Meditation for rehabilitation.
Alternative & Complementary Therapies, 8(1), 10–16.
10.1089/107628002753447879 Google Scholar
- DeGenova, M. K., Patton, D., Jurich, J., & MacDermid, S. M. ( 1994). Ways of coping among HIV-infected individuals. Journal of Social Psychology, 134(5), 655–663.
- Des Jarlais, D. C., Vanichseni, S., Marmor, M., Buavirat, A., Titus, S., Raktham, S., et al. ( 1997). “Why I am not infected with HIV”: Implications for long-term HIV risk reduction and HIV vaccine trials. Journal of Acquired Immune Deficiency Syndrome, 16(5), 393–399.
- Evenden, J. L. ( 1999). Varieties of impulsivity. Psychopharmacology, 146, 348–361.
- Fetzer Institute. ( 1999). Multidimensional measurement of religiousness/spirituality for use in health research. Dearborn, MI: Fetzer Institute/National Institute on Aging Working Group.
- Fulwiler, C., Eckstine, J., & Kalsy, S. ( 2005). Impulsive-aggressive traits, serotonin function, and alcohol-enhanced aggression. Journal of Clinical Pharmacology, 45(1), 94–100.
- Galanter, M. ( 1997). Spiritual recovery movements and contemporary medical care. Psychiatry, 60(3), 211–223.
-
Grassi, L.,
Caloro, G.,
Zamorani, M., &
Ramelli, E. (
1997).
Psychological morbidity and psychosocial variables associated with life-threatening illness: A comparative study of patients with HIV infection or cancer.
Psychology, Health & Medicine, 2(1), 29–39.
10.1080/13548509708400558 Google Scholar
- Hyman, S. E. ( 2005). Addiction: A disease of learning and memory. American Journal of Psychiatry, 162(8), 1414–1422.
- Kalichman, S. C. ( 1996). Continued sexual risk behavior among HIV seropositive, drug-using men. Mobidity and Mortality Weekly Reports, 45, 151–152.
- Kendler, K. S., Gardner, C. O., & Prescott, C. A. ( 1997). Religion, psychopathology, and substance use and abuse: A multimeasure, genetic-epidemiologic study. American Journal of Psychiatry, 154(3), 322–329.
- Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., et al. ( 2006). The Toronto Mindfulness Scale: Development and validation. Journal of Clinical Psychology, 62(2), 1445–1467.
- Majjhima Nikaya. ( 2001). (Bhikku Nanamoli & Bhikkhu Bodhi, Trans.) ( 2nd ed.). Somerville, MA: Wisdom Publications.
- Margolin, A., Beitel, M., Schuman-Olivier, Z., & Avants, S. K. ( 2006). A controlled study of a spirituality-focused intervention for increasing motivation for HIV prevention among drug users. AIDS Education & Prevention, 18(4), 311–322.
-
Marlatt, G. A. (
2002).
Buddhist philosophy and the treatment of addictive behavior.
Cognitive and Behavioral Practice, 9(1), 44–50.
10.1016/S1077-7229(02)80039-6 Google Scholar
- Marlatt, G. A., Witkiewitz, K., Dillworth, T. M., Bowen, S. W., Parks, G. A., & Macpherson, L. M. ( 2004). Vipassana meditation as a treatment for alcohol and drug use disorders. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive-behavioral tradition (pp. 261–287). New York: Guilford Press.
- Martin, E. M., Pitrak, D. L., Weddington, W., Rains, N. A., Nunnally, G., Nixon, H., et al. ( 2004). Cognitive impulsivity and HIV serostatus in substance dependent males. Journal of the International Neuropsychological Society, 10, 931–938.
- McCown, W. ( 1989). The relationship between impulsivity, empathy and involvement in Twelve Step self-help substance abuse treatment groups. Addiction, 84(4), 391–393.
- Metzger, D., Woody, G. E., Navaline, H., McLellan, A. T., Meyers, K., Boney, T., et al. ( 1993, October-November). The Risk Assessment Battery (RAB): Validity and reliability. Paper presented at the Sixth Annual Meeting of National Cooperative Vaccine Development Group for AIDS, Alexandria, VA.
- Miller, W. R. ( 1998). Researching the spiritual dimensions of alcohol and other drug problems. Addiction, 93(7), 979–990.
- Ng, C. ( 2000). A path analysis of self-schema, goal orientations, learning approaches and performance. Journal of Psychology in Chinese Societies, 1(2), 93–121.
- Pargament, K. I. ( 1997). The psychology of religion and coping: Theory, research, practice. New York: Guilford Press.
-
Pargament, K. I.,
Koenig, H. G., &
Perez, L. M. (
2000).
The many methods of religious coping: Development and initial validation of the RCOPE.
Journal of Clinical Psychology, 56(4), 519–543.
10.1002/(SICI)1097-4679(200004)56:4<519::AID-JCLP6>3.0.CO;2-1 CAS PubMed Web of Science® Google Scholar
- Pargament, K. I., McCarthy, S., Shah, P., Ano, G., Tarakeshwar, N., Wachholtz, A. B., et al. ( 2004). Religion and HIV: A review of the literature and clinical implications. Southern Medical Journal, 97(12), 1201–1209.
- Parsons, S. K., Cruise, P. L., Davenport, W. M., & Jones, V. ( 2006). Religious beliefs, practices and treatment adherence among individuals with HIV in the Southern United States. AIDS Patient Care & STDs, 20(2), 97–111.
- Patkar, A. A., Murray, H. W., Mannelli, P., Gottheil, E., Weinstein, S. P., & Vergare, M. J. ( 2004). Pre-treatment measures of impulsivity, aggression and sensation seeking are associated with treatment outcome for African-American cocaine-dependent patients. Journal of Addictive Diseases, 23(2), 109–122.
- Patterson, T. L., Semple, S. J., Zians, J. K., & Strathdee, S. A. ( 2005). Methamphetamine-using HIV-positive men who have sex with men: Correlates of polydrug use. Journal of Urban Health, 82(Suppl. 1), 120–126.
-
Patton, J. H.,
Stanford, M. S., &
Barratt, E. S. (
1995).
Factor structure of the Barratt Impulsiveness Scale.
Journal of Clinical Psychology, 51(6), 768–774.
10.1002/1097-4679(199511)51:6<768::AID-JCLP2270510607>3.0.CO;2-1 CAS PubMed Web of Science® Google Scholar
-
Richards, P. S., &
Bergin, A. E. (
1997).
A spiritual strategy for counseling and psychotherapy.
Washington, DC:
American Psychological Association.
10.1037/10241-000 Google Scholar
- Robinson, F. P., Mathews, H. L., & Witek-Janusek, L. ( 2003). Psycho-endocrine-immune response to mindfulness-based stress reduction in individuals infected with the human immunodeficiency virus: A quasiexperimental study. Journal of Alternative and Complementary Medicine, 9(5), 683–694.
- Rounsaville, B. J., Carroll, K. M., & Onken, L. S. ( 2001). NIDA's stage model of behavioral therapies research: Getting started and moving on from Stage I. Clinical Psychology: Science and Practice, 8, 133–142.
- Schank, R., & Abelson, R. P. ( 1977). Scripts, plans, goals, and understanding. Hillsdale, NJ: Erlbaum.
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. ( 2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.
- Segall, S. R. ( 2005). Mindfulness and self-development in psychotherapy. Journal of Transpersonal Psychology, 37(2), 143–163.
- Semple, S. J., Zians, J. K., Grant, I., & Patterson, T. L. ( 2005). Impulsivity and methamphetamine use. Journal of Substance Abuse Treatment, 29(2), 85–93.
- Semple, S. J., Zians, J. K., Grant, I., & Patterson, T. L. ( 2006). Methampethetamine use, impulsivity, and sexual risk behavior among HIV-positive men who have sex with men. Journal of Addictive Diseases, 25(4), 105–114.
- Singer, J. L., & Salovey, P. ( 1991). Organized knowledge structures and personality: Person schemas, self-schemas, prototypes, and scripts. In M. Horowitz (Ed.), Person schemas and recurrent maladaptive interpersonal patterns (pp. 33–79). Chicago: University of Chicago Press.
- Singh, N., Squier, C., Sivek, C., & Wagener, M. ( 1996). Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8(3), 261–269.
-
Strauman, T. J., &
Segal, Z. V. (
2001).
The cognitive self in basic science, psychopathology, and psychotherapy. In
J. C. Muran (Ed.),
Self-relations in the psychotherapy process (pp. 241–258).
Washington, DC:
American Psychological Association.
10.1037/10391-010 Google Scholar
- Swindells, S., Mohr, J., Justis, J. C., Berman, S., Squier, C., Wagener, M. M., et al. ( 1999). Quality of life in patients with human immunodeficiency virus infection: Impact of social support, coping style and hopelessness. International Journal of STD & AIDS, 10(6), 383–391.
- Tsevat, J. ( 2006). Spirituality/religion and quality of life in patients with HIV/AIDS. Journal of General Internal Medicine, 21(Suppl. 5), S1–S2.
- Volkow, N. D., & Li, T. K. ( 2004). Drug addiction: The neurobiology of behaviour gone awry. Nature Reviews Neuroscience, 5, 963–970.
- Wachholtz, A. B., & Pargament, K. I. ( 2005). Is spirituality a critical ingredient of meditation? Comparing the effects of spiritual meditation, secular meditation, and relaxation on spiritual, psychological, cardiac, and pain outcomes. Journal of Behavioral Medicine, 28(4), 369–384.
- Williams, A. L., Selwyn, P. A., Liberti, L., Molde, S., Njike, V. Y., McCorkle, R., et al. ( 2005). A randomized controlled trial of meditation and massage effects on quality of life in people with late-stage disease: A pilot study. Journal of Palliative Medicine, 8(5), 939–952.
-
Witkiewitz, K.,
Marlatt, G. A., &
Walker, D. D. (
2005).
Mindfulness-based relapse prevention for alcohol use disorders: The meditative tortoise wins the race.
Journal of Cognitive Psychotherapy, 19, 211–230.
10.1891/jcop.2005.19.3.211 Google Scholar
- Woods, T. E., Antoni, M. H., Ironson, G. H., & Kling, D. W. ( 1999). Religiosity is associated with affective and immune status in symptomatic HIV-infected gay men. Journal of Psychosomatic Research, 46(2), 165–176.
Citing Literature
