A Transdiagnostic Approach to Interventions in Addictive Disorders- Third wave therapies and other current interventions

Abstract

Recent research points to a shift from categorical diagnoses to a dimensional understanding of psychopathology and mental health disorders. In parallel, there has been a rise in newer psychosocial treatment modalities, which are inherently transdiagnostic. Transdiagnostic approaches are those that identify core vulnerabilities and apply universal principles to therapeutic treatment. As treatment of substance use disorders (SUD) must invariably accommodate such vulnerabilities, clinicians are finding such interventions useful. Therapies like Acceptance and Commitment Therapy (ACT), Dialectical Behavioural Therapy (DBT), Metacognitive Therapy, Mindfulness-Based Relapse Prevention (MBRP) use a transdiagnostic framework and are backed by evidence in the last 3-5 years. In this paper we first highlight the conceptual understanding of SUD through these frameworks and then discuss their clinical applications along with specific techniques that have been particularly useful with this population.

Keywords: Acceptance Commitment Therapy; Dialectical behaviour therapy; Schema Therapy; Third wave interventions; dialectical abstinence; radical acceptance.

Figure 1

Levels of Intervention

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“Addict” mind, “Clean” mind and “Clear” mind

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Emotions on a continuum

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Emotion regulation using ABC PLEASE of DBT

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Urge Surfing

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Mindfulness

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Reality Orientation

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Dialectical Abstinence

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DCBA, DEARMAN, FAST, GIVE Skills of DBT