title: Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders.
abstract: OBJECTIVE
  Shame has long been seen as relevant to substance use disorders, but interventions have not been tested in randomized trials. This study examined a group-based intervention for shame based on the principles of acceptance and commitment therapy (ACT) in patients (N = 133; 61% female; M = 34 years old; 86% Caucasian) in a 28-day residential addictions treatment program.
  
  
  METHODS
  Consecutive cohort pairs were assigned in a pairwise random fashion to receive treatment as usual (TAU) or the ACT intervention in place of 6 hr of treatment that would have occurred at that same time. The ACT intervention consisted of three 2-hr group sessions scheduled during a single week.
  
  
  RESULTS
  Intent-to-treat analyses demonstrated that the ACT intervention resulted in smaller immediate gains in shame, but larger reductions at 4-month follow-up. Those attending the ACT group also evidenced fewer days of substance use and higher treatment attendance at follow-up. Effects of the ACT intervention on treatment utilization at follow-up were statistically mediated by posttreatment levels of shame, in that those evidencing higher levels of shame at posttreatment were more likely to be attending treatment at follow-up. Intervention effects on substance use at follow-up were mediated by treatment utilization at follow-up, suggesting that the intervention may have had its effects, at least in part, through improving treatment attendance.
  
  
  CONCLUSIONS
  These results demonstrate that an approach to shame based on mindfulness and acceptance appears to produce better treatment attendance and reduced substance use.
authors: Portland Psychotherapy Clinic, Research, and Training Center, 1830 Northeast Grand Avenue, Portland, OR 97212, USA. jbluoma@gmail.com
authors: Jason B
authors: JB
authors: Luoma
authors: Barbara S
authors: BS
authors: Kohlenberg
authors: Steven C
authors: SC
authors: Hayes
authors: Lindsay
authors: L
authors: Fletcher
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007600:Judgment; D008297:Male; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D012114:Residential Treatment / Q000379:methods / Q000706:statistics & numerical data; D012649:Self Concept; D012752:Shame; D013240:Stereotyping; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*