Comparing the Effectiveness of Cognitive-Behavioral Group Therapy and Mindfulness-Based Cognitive Therapy in Reducing Relapse Among Individuals with Opioid Dependence

Document Type : Original Article

Author

Assistant Professor, Department of Counseling, Faculty of Educational Sciences and Psychology, Shahid Beheshti University, Tehran, Iran.

10.22075/jcp.2025.35881.3045

Abstract

Background: Opioid relapse remains one of the major challenges in the treatment of addiction. Effective therapeutic methods can play a significant role in reducing relapse rates. This study aimed to compare the effectiveness of cognitive-behavioral group therapy (CBT) and mindfulness-based cognitive therapy (MBCT) in reducing relapse rates among individuals with opioid dependence.
Method: A quasi-experimental design with pre-test, post-test, and control groups was employed. The statistical population included individuals with opioid dependence who attended an addiction treatment center in Sarpol-e Zahab during the first half of 2017. Among eligible volunteers, 36 participants diagnosed with opioid dependence were randomly assigned to three groups of 12 (CBT, MBCT, and control). Data were collected using the Relapse Prediction Scale. The MBCT intervention consisted of eight 2-hour sessions, while CBT was delivered in twelve 90-minute sessions.
Results: Analysis revealed significant differences between the three groups in terms of their effects on craving intensity (η²= 0.36, p< 0.001), likelihood of substance use (η²= 0.41, p< 0.001), and the linear combination of craving intensity and likelihood of use (η²= 0.77, p< 0.001). The MBCT group showed significantly lower scores in craving intensity and likelihood of substance use compared to the CBT and control groups.
Conclusion: Both CBT and MBCT are effective in reducing relapse among individuals with opioid dependence. However, MBCT demonstrated superior effectiveness, highlighting the importance of incorporating mindfulness-based interventions in addiction treatment programs.

Keywords

Main Subjects

References

  1. Wise RA, Koob GF. The development and maintenance of drug addiction. Neuropsychopharmacology. 2014;39(2):254-62.
  2. Takahashi TT, Ornello R, Quatrosi G, Torrente A, Albanese M, Vigneri S, et al. Medication overuse and drug addiction: a narrative review from addiction perspective. J Headache Pain. 2021;22(1):32.
  3. Feltenstein MW, See RE, Fuchs RA. Neural substrates and circuits of drug addiction. Cold Spring Harb Perspect Med. 2021;11(4):a039628.
  4. Chou T, D’Orsogna MR. A mathematical model of reward-mediated learning in drug addiction. Chaos. 2022;32(2).
  5. Bozarth MA. Drug addiction as a psychobiological process. In: Addiction controversies. CRC Press; 2023. p. 112-34.
  6. World Health Organization. Exposure to lead: a major public health concern. Preventing disease through healthy environments. Geneva: World Health Organization; 2023.
  7. Mancinelli E, Ruocco E, Silvia N. A network analysis on self-harming and smartphone addiction: The role of self-control, internalizing and externalizing problems in a sample of self-harming adolescents. Compr Psychiatry. 2022;112:152285.
  8. Zhou Z. Drug abuse and adolescents’ cognitive development. In: 2021 International Conference on Education, Language and Art (ICELA 2021). Atlantis Press; 2022. p. 590-595.
  9. World Health Organization. Global status report on alcohol and health. Geneva: World Health Organization; 2018. ISBN 978-92-4-156563-9.
  10. Sadock BJ, Sadock VA. Kaplan and Sadock’s comprehensive textbook of psychiatry. 10th ed. Vol. 1. Philadelphia: Lippincott Williams & Wilkins; 2016.
  11. Dawe S, Gullo MJ, Loxton NJ. Reward drive and rash impulsiveness as dimensions of impulsivity: implications for substance misuse. Addict Behav. 2004;29(7):1389-1405.
  12. MacKillop J, Kenna GA, Leggio L, Ray LA, editors. Integrating psychological and pharmacological treatments for addictive disorders: an evidence-based guide. Taylor & Francis; 2017.
  13. Rostaminejad Sh, Arabi M, Khademi A. Effectiveness of cognitive-behavioral therapy on addiction propensity components in high school students. J Disabil Stud. 2020;10(32):1-8. [Persian]
  14. Rahimian Boogar I, Tabatabaee SM, Tosi J. Attitude to substance abuse: do personality and socio-demographic factors matter? Int J High Risk Behav Addict. 2014 Sep 1;3(3):e16712. doi: 10.5812/ijhrba.16712. PMID: 25593892; PMCID: PMC4286919.
  15. Mohammadi MR, Akbari AA, Hatami N, Mokri A, Kaviani H, Salmani M, Sohrat M. Investigation of the effects of spiritual psychotherapy on patients with opioid dependence. J Hakim Res. 2011;3(14):144-150. [Persian]
  16. Barati M, Vardipoor H, Moeini B, Farhadi Nasab A, Mahjoob H, Jalilian F. The effectiveness of assertiveness training in reducing abstract norms encouraging drug abuse among students. Sci J Hamadan Univ Med Sci. 2011;18(3):40-49. [Persian]
  17. Bahari F. Addiction, counseling, and treatment. Tehran: Danjeh; 2009. [Persian]
  18. O'Donohue W, Fisher JE. Cognitive Behavior Therapy. New Jersey: Wiley & Sons Press; 2008.
  19. Carroll KM. A practical guide to cognitive-behavioral therapy for substance dependence. Translated by Bakhshipour Roodsari A, Mohammadkhani S. Tehran: Espand Honar; 2002. [Persian]
  20. Kamerzarin H, Zare H, Borouki Milan H. Effectiveness of cognitive-behavioral therapy in enhancing self-efficacy and improving addiction symptoms among substance-dependent patients. Addict Res Q. 2011;6(22):75-85. [Persian]
  21. Behrouzian F, Nokani M, Mohajerani HR. Effectiveness of group cognitive-behavioral therapy in preventing relapse in methamphetamine-dependent individuals. Andisheh Va Raftar Clin Psychol. 2013;8(30):57-66. [Persian]
  22. Didonna F. General handbook of mindfulness. New York: Springer; 2009.
  23. Segal ZV, Williams JM, Teasdale JD. Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. 1st ed. New York: Guilford Press; 2002.
  24. Elliott JG. Practitioner review: School refusal: Issues of conceptualisation, assessment, and treatment. J Child Psychol Psychiatry Allied Discipl. 1999;40(7):1001-1012.
  25. Raadi M. The effectiveness of cognitive-behavioral group counseling on reducing relapse in self-referred addicts in the Welfare Organization of Kermanshah Province [Dissertation]. Isfahan: University of Isfahan; 2001. [Persian]
  26. Johnson S, Hoffart A. Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial. J Anxiety Disord. 2017;50:103-112.
  27. Jenood P, Mohammadian Shirmohaleh F, Hosseinzadeh Taghvaeey M, Peyvandi P. Effectiveness of mindfulness-based relapse prevention therapy on addiction symptoms and negative emotions in men dependent on stimulant drugs (methamphetamine). J Fac Med Univ Mashhad. 2020;63(5):2940-2953. doi: 10.22038/mjms.2020.18534.
  28. Ghorbani T, Saffarinia M, Zare H, Alipour A. Effectiveness of mindfulness-based relapse prevention therapy in social well-being and relapse prevention in crystal users. Etiad Pajohi. 2018;12(45):151-168.
  29. Maredpour A, Najafy M, Amiri F. The effectiveness of mindfulness-based relapse prevention on the prevention of relapse, craving, and self-control in opiate-dependent individuals. Etiad Pajohi. 2015;8(32):87-104.
  30. Sedaghat Zadeh A, Imani S, Shokri O. Comparison of the effectiveness of group cognitive-behavioral therapy and mindfulness-based cognitive therapy in the reduction of craving in opiate addicts. Etiad Pajohi. 2019;12(49):243-268. [Persian]
  31. Fornam A, Barjali A, Sohrabi F, Falsafi Nejad MR. The effectiveness of Mindfulness-Based Relapse Prevention (MBRP) in preventing relapse and increasing coping skills in opioid-dependent individuals. Clin Psychol Stud. 2014;5(16):79-99.
  32. Carroll H, Lustyk MKB. Mindfulness-based relapse prevention for substance use disorders: effects on cardiac vagal control and craving under stress. Mindfulness. 2018;9(2):488-499.
  33. Greenfield BL, Roos C, Hagler KJ, Stein E, Bowen S, Witkiewitz KA. Race/ethnicity and racial group composition moderate the effectiveness of mindfulness-based relapse prevention for substance use disorder. Addict Behav. 2018;81:96-103.
  34. Yaghubi M, Zargar F. Effectiveness of mindfulness-based relapse prevention on quality of life and craving in methadone-treated patients: A randomized clinical trial. Addict Health. 2018;10(4):250-259.
  35. Behrouzian F, Nokani M, Mohajerani HR. Effectiveness of group cognitive-behavioral therapy in preventing relapse in methamphetamine-dependent individuals. Andisheh Va Raftar Clin Psychol. 2013;8(30):57-66. [Persian]
  36. Taherifard M, Abolghasemi A. The role of mindfulness, distress tolerance, and emotional memory in predicting relapse and treatment adherence among substance abusers. J Subst Abuse Res. 2017;11(43):211-234. [Persian]
  37. Jahangir AH, Imani S, Masjedi Arani A, Mojtahedi SH. Comparison of group-based mindfulness and methadone therapy on mental health in traditional drug addicts. J Clin Psychol. 2016;4(1):55-66. [Persian]
  38. Wright, F. D., Beck, A. T., Newman, C. F., & Liese, B. S. (2001). Cognitive therapy of substance abuse,IN: Ali Goudarzi, Shiraz: Publishers of Rahgosha.
  39. Mehrabi H, Neshatdoost H, Molavi H. Evaluation of the effectiveness of structured group therapy and family education in reducing relapse among substance-dependent patients in Isfahan. J Soc Sci Humanit Shiraz Univ. 2005;22(4):1-8. [Persian]
  40. Bowen S, Chawla N, Marlatt GA. Mindfulness-based relapse prevention for addictive behaviors. New York, London: The Guilford Press; 2011.
  41. Monti PM, Kadden R, Rohsenow DJ, Cooney N, Abrams D. Treating alcohol dependence: A coping skills training guide. 2nd ed. New York: Guilford Press; 2002.
  42. Imani S, Atef Vahid MK, Gharraee B, Noroozi A, Habibi M, Bowen S. Effectiveness of Mindfulness-Based Group Therapy Compared to the Usual Opioid Dependence Treatment. Iran J Psychiatry. 2015 Jun;10(3):175-84. PMID: 26877751; PMCID: PMC4749687.
  43. Bowen S, Chawla N, Collins SE, Witkiewitz K, Hsu S, Grow J, Clifasefi S, Garner M, Douglass A, Larimer ME, Marlatt A. Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Subst Abus. 2009 Oct-Dec;30(4):295-305. doi: 10.1080/08897070903250084. PMID: 19904665; PMCID: PMC3280682.
  44. Brady KT, Killeen T, Baker NL. Efficacy of mindfulness-based relapse prevention in veterans with substance use disorders: Design and methodology of a randomized clinical trial. Contemp Clin Trials. 2021;105:106393.
  45. Grabovac AD, Lau MA, Willett BR. Mechanisms of mindfulness: A Buddhist psychological model. Mindfulness. 2011;2(3):154-166.
  46. Garland EL, Schwarz NR, Kelly A, Whitt A, Howard MO. Mindfulness-oriented recovery enhancement for alcohol dependence: Therapeutic mechanisms and intervention acceptability. J Soc Work Pract Addict. 2012;12(3):242-263.
  47. Baer RA. Mindfulness training as a clinical intervention: A conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125-143.
  48. Kabat-Zinn J, Massion AO, Kristeller J, Peterson LG, Fletcher KE, Pbert L, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992;149(7):936-943.
  49. Goldstein RZ, Bechara A, Garavan H, Childress AR, Paulus MP, Volkow ND. The neurocircuitry of impaired insight in drug addiction. Trends Cogn Sci. 2009;13(9):372-380.
  50. Azimi H, Jannati Y, Mahmoudi G. Textbook of mental health nursing. Tehran: Salemi Publication; 2002. [Persian]
  51. Gunaratana H. Mindfulness in plain English. Boston, MA: Wisdom Publications; 2002.
  52. Kabat-Zinn J. Coming to our senses. New York: Hyperion; 2005.
  53. Brewer JA, Bowen S, Smith JT, Marlatt GA, Potenza MN. Mindfulness-based treatments for co-occurring depression and substance use disorders: What can we learn from the brain? Addiction. 2010;105:1698-1706.
Journal of Clinical Psychology
Volume 16, Issue 3 - Serial Number 63
September 2024
Pages 33-46

Files

History

  • Receive Date: 11 November 2024
  • Revise Date: 15 January 2025
  • Accept Date: 05 February 2025

Share

How to cite

Statistics