Cognitive‐behavioural therapy for heroin and cocaine use: Ecological momentary assessment of homework simplification and compliance

Abstract

Objectives: The purpose of this study was to evaluate the effects of homework-task difficulty and electronic-diary reminders on written homework completion during cognitive-behavioral therapy (CBT) for addiction. Completion of homework is an important element in CBT that may affect outcome. Design: All participants received all combinations of our two interventions in a factorial 2×2 counterbalanced Latin-square design. Methods: Methadone-maintained cocaine and heroin users were given homework between each of 12 weekly CBT sessions and carried electronic diaries that collected ecological momentary assessment (EMA) data on craving and exposure to drug-use triggers in four 3-week blocks assessing two levels of homework difficulty and prompted and unprompted homework. Results: Neither simplified (picture-based) homework nor electronic reminders increased homework completion. In EMA reports, standard but not simplified homework seemed to buffer the craving that followed environmental exposure to drug cues. EMA recordings before and after the CBT intervention confirmed a decrease over time in craving for cocaine and heroin. Conclusions: These findings demonstrate the utility of EMA to assess treatment effects. However, the hypothesis that simplified homework would increase compliance was not supported.

The use of Latin-square designs in educational and psychological research

“…administration of a number of assessment tasks. Three publications described studies in which 3 × 3 Latin squares had been used to counterbalance the order of administration of different conditions (Schippers, Schetters, De Vries, & Pattij, 2016;Yang, McClelland, & Furnham, 2016;Zack, Cho, Parlee, Jacobs, Li, Boileau, & Strafella, 2016), and two publications described studies in which 4 × 4 Latin squares had been used for this purpose (Agoglia, Holstein, Eastman, & Hodge, 2016;Willner-Reid, Whitaker, Epstein, Phillips, Pulaski, Preston, & Willner, 2016 In these last five publications, none of the authors disclosed how they had selected the Latin squares that they had used, which leaves open the possibility that they were systematic arrangements rather than truly random Latin-square designs as prescribed by Fisher (1926Fisher ( , 1937 and later by Winer (1962Winer ( , 1971. In short, Tabachnick and Fidell's (2007)…”

“…The number of participants should ideally be a multiple of the number of treatments (although cf. Willner-Reid et al, 2016). There may well be situations where within-subjects designs are simply not practicable because of subject attrition or carryover effects.…”

“…In both the abstract and the text of the article byWillner-Reid et al (2016), it is stated that a 2 × 2 Latin-square design was used. The independent variables in their study did indeed define a 2 × 2 repeated-measures design, but the order of administration of the four resulting conditions was counterbalanced by means of a 4 × 4 Latin square (K. L. Preston, personal communication, January 26, 2017).…”

Medications for substance use disorders (SUD): emerging approaches

“…Therefore, other than for medications which act at the main PD site of action of the drug of abuse (e.g., with “agonist-based” or “antagonist-based” approaches), target selection for therapeutic mechanisms remains a high-risk process. Recent studies have also examined how specific behavioral processes interact with the neurobiological effects of drugs of abuse themselves, and of SUD medications [124,187]. Behavioral research techniques, including ecological momentary assessment, can also allow a detailed examination of a participant’s behavior in her environment [188].…”

Predictors of Treatment Attendance and Adherence among Individuals Receiving Cognitive Behavioral Therapy for Insomnia

“…In addition to negatively impacting treatment attendance, limited enabling resources such as lack of social support, lack of self-efficacy, financial limitations have been hypothesized to negatively impact treatment adherence (Bosworth et al, 2006;Martin et al,2010). CBT treatment studies typically do not assess for common enabling factors such as social support, socioeconomic status, and self-efficacy in relation to adherence (e.g., Fehm & Mrose, 2008;Rees, McEvoy, & Nathan, 2005;Sachsenweger, Fletcher, & Clarke, 2015;Willner-Reid et al, 2016). Enabling factors with respect to adherence thus represents a large gap in the literature that needs to be addressed.…”