The relationship between the UPPS-P impulsive personality traits and substance use psychotherapy outcomes: A meta -analysis

Abstract

Background Although impulsive personality traits have been well implicated in substance use disorder (SUD) risk, little work has established how specific impulsive personality traits influence and are influenced by SUD psychotherapy outcomes. The purpose of this meta-analysis was to quantitatively review existing work to examine 1) how impulsive personality traits affect SUD psychotherapy outcomes and 2) reductions in impulsive personality traits during SUD psychotherapy. Methods Studies were identified by conducting a comprehensive review of the literature. Results For aim one (k =6), significant effects were found for lack of premeditation (g=0.60, SE=0.30, 95% CI 0.01 to 1.20; z=1.99, p = .05) and negative urgency (g=0.55, SE=0.17, 95% CI 0.22 to 0.88, z=3.30, p=.001), with trait scores related to poorer SUD psychotherapy outcomes. For aim two (k = 10), decreases in sensation seeking (g=−0.10, SE=0.05, 95% CI −0.20 to 0.004; z=−1.88, p=.02) and negative urgency (g=−0.25, SE=0.14, 95% CI −0.53 to 0.03; z=−1.75, p=.03) during SUD psychotherapy were significant. Conclusions Overall, our quantitative synthesis suggests that lack of premeditation and negative urgency are related to poorer SUD psychotherapy outcomes. Although negative urgency and sensation seeking are decreasing during SUD psychotherapy, the magnitude of the change is quite small. Overall, we suggest that the measurement and targeting of impulsive personality traits in psychotherapy has strong potential to improve clinical outcomes across SUDs and a wide range of clinical problems and disorders.

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program

“…In the present study, the magnitude of change in negative urgency was comparable to decreases reported in several previous studies in substance abusing samples [23, 26], providing more evidence that individuals assessed during the course of treatment report decreases in negative urgency. Together with the results of these previous studies, mounting evidence suggests there is some degree of change in how people rate their level of urgency while receiving clinical interventions.…”

“…In one study of patients with binge eating disorder, higher levels of Negative Urgency at the beginning of treatment was associated with worse clinical outcomes and a slower response to treatment over the course of acceptance-based group psychotherapy [22]. Somewhat more is known about how urgency affects the course of treatment for substance use disorders: a small meta-analysis of four studies found that among individuals receiving psychotherapy for substance use disorders, higher levels of Negative Urgency were associated with worse treatment outcomes [23]. Outside of substance use and binge eating disorder, no studies have evaluated how urgency relates to treatment outcomes for psychiatric disorders more broadly.…”

“…In one study of individuals enrolled in a residential substance use disorder treatment program, negative urgency scores significantly declined within four weeks of treatment, although positive urgency showed no significant change [26]. Similarly, Hershberger and colleagues’ meta-analysis of urgency and substance use psychotherapies found that negative urgency showed a small but significant decrease from pre- to post-treatment, with no significant change in positive urgency [23]. Outside of substance use disorder treatment, one study conducted in a non-clinical sample suggests that urgency is malleable via experimental intervention; in this study, undergraduate students receiving a single-session emotion regulation intervention reported significant decreases in both negative and positive urgency over one week [27].…”

Cortical Thickness Links Impulsive Personality Traits and Risky Behavior

“…First, impulsivity, cortical thickness, and past-month risky behaviors were assessed cross-sectionally, which limits our ability to make strong inferences about the causal relationships between these variables. However, our models are consistent with theoretical models that suggest that trait-level personality factors are relatively stable across the lifespan and, thus, drive engagement in risky behaviors [64,65]. Furthermore, cortical thickness is a relatively stable, and therefore trait-like, neurobiological indicator, which increases the likelihood that it predicts past month risky behavior (rather than recent behavior impacting thickness).…”

Personalised treatment for Alcohol Use Disorder: Identification and intervention of target mechanisms

“…Impulsivity is causally linked to heavier alcohol use (Gullo et al, 2017) and predictive of the development of alcohol misuse (George, Connor, Gullo, & Young, 2010;Moffitt et al, 2011). It is related to poorer SUD treatment outcomes (Charney et al, 2010;Hershberger, Um, & Cyders, 2017a;Loree et al, 2015;Rupp et al, 2016) and associated with enhanced relapse risk 12-months posttreatment (Evren et al, 2012;Müller et al, 2008). As impulsivity is widely considered a stable trait, the goal of intervention is to improve management and expression of impulsivity (Butz & Austin, 1993).…”