Exploring agency, communion and narrative foreclosure in cognitive behavioural therapy for substance use disorders

Q1 Psychology

Addictive Behaviors Reports Pub Date : 2025-07-24 DOI:10.1016/j.abrep.2025.100626

Mark de Lange , Job van der Palen , Hein de Haan

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引用次数: 0

Abstract

Introduction

Substance use disorders (SUDs) are a significant societal concern, negatively impacting self-worth, hope, and interpersonal connectedness. SUD recovery involves a transformation of one’s ‘life-story’ or ‘narrative identity’. ‘Narrative foreclosure’ (NF) impedes this process by disconnecting past, present, and future narratives, hindering the rewriting of SUD-related identities. We investigate the impact of SUD-based cognitive behavioural therapy (CBT) on narrative identity transformation and hypothesise NF as a potential factor in post-treatment relapse.

Methods

107 patients referred to an outpatient clinic for adults with SUDs in the Netherlands were included. Participants completed the “Agency and Communion Inventory” (translated and validated in Dutch), the Narrative Foreclosure Scale (NFS) and the “Measurement of Addiction for Triage and Evaluation” (MATE), including the Depression, Anxiety, and Stress-Scale (DASS-21). Data collection occurred at the start of treatment, post-treatment (+3 months), and during a follow-up measure (+6 months).

Results

While participants showed a substantial reduction in substance use frequency and DASS-21 sum scores during CBT-treatment, no such differences were found in narrative themes. Multivariate models revealed that baseline communion and past-directed NF predicted ’substance-use reduction’ during treatment, while ’cannabis use,’ communion and future directed NF were predictors of ’DASS-21 sum score reduction’. Baseline communion showed a moderate positive relation to post-treatment relapse, while ’NFS: Future’ exhibited a moderate inverse relation. These findings remained robust even when altering the criteria for defining ’post-treatment relapse.’ They indicate that a stronger identification with communal themes serve as a protective factor against relapse, while future directed NF is associated with higher relapse rates.

Conclusion

this study provides valuable insights into the interplay between narrative themes and treatment outcome(s) in SUD recovery. Notably, our findings underscore the significance of future-directed narrative foreclosure in the recovery process and found that CBT for SUDs does not appear to significantly facilitate narrative identity transformation. These results suggest that existing addiction treatments could be enhanced through the integration of narrative-focused interventions.

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探索物质使用障碍认知行为疗法中的代理、共融和叙事丧失

物质使用障碍（SUDs）是一个重要的社会问题，对自我价值、希望和人际关系产生负面影响。SUD的恢复涉及到一个人的“生活故事”或“叙事身份”的转变。“叙事止赎”（NF）通过断开过去、现在和未来的叙述来阻碍这一过程，阻碍了与sud相关的身份的重写。我们研究了基于sud的认知行为疗法（CBT）对叙事身份转换的影响，并假设NF是治疗后复发的潜在因素。方法纳入107例荷兰成人SUDs门诊患者。参与者完成了“代理和交流量表”（荷兰语翻译和验证），叙述丧失抵押品赎回权量表（NFS）和“成瘾分类和评估测量”（MATE），包括抑郁，焦虑和压力量表（DASS-21）。数据收集发生在治疗开始、治疗后（+3个月）和随访期间（+6个月）。结果在cbt治疗期间，受试者在药物使用频率和DASS-21总分方面均有显著降低，但在叙事主题方面没有发现这种差异。多变量模型显示，基线交流和过去指向性NF预测治疗期间“物质使用减少”，而“大麻使用”，交流和未来指向性NF是“DASS-21总评分降低”的预测因子。基线共融与治疗后复发呈中度正相关，而NFS: Future呈中度负相关。即使改变了定义“治疗后复发”的标准，这些发现仍然是强有力的。“他们指出，对共同主题的强烈认同是防止复发的保护因素，而面向未来的NF则与更高的复发率有关。”结论本研究为SUD康复中叙事主题与治疗结果之间的相互作用提供了有价值的见解。值得注意的是，我们的研究结果强调了未来导向的叙事止赎在恢复过程中的重要性，并发现对sud的CBT似乎并没有显著促进叙事身份的转变。这些结果表明，现有的成瘾治疗可以通过整合以叙事为中心的干预措施来加强。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addictive Behaviors Reports Medicine-Psychiatry and Mental Health

CiteScore

6.80

自引率

0.00%

发文量

审稿时长

71 days

期刊介绍： Addictive Behaviors Reports is an open-access and peer reviewed online-only journal offering an interdisciplinary forum for the publication of research in addictive behaviors. The journal accepts submissions that are scientifically sound on all forms of addictive behavior (alcohol, drugs, gambling, Internet, nicotine and technology) with a primary focus on behavioral and psychosocial research. The emphasis of the journal is primarily empirical. That is, sound experimental design combined with valid, reliable assessment and evaluation procedures are a requisite for acceptance. We are particularly interested in ''non-traditional'', innovative and empirically oriented research such as negative/null data papers, replication studies, case reports on novel treatments, and cross-cultural research. Studies that might encourage new lines of inquiry as well as scholarly commentaries on topical issues, systematic reviews, and mini reviews are also very much encouraged. We also welcome multimedia submissions that incorporate video or audio components to better display methodology or findings.