الفهرس | Only 14 pages are availabe for public view |
Abstract Abuse of illicit substances is widespread in Egypt, especially in young age groups. Stigma and negative emotions among substance using population are intense to a degree that can prevent help seeking, hinder recovery, and accelerate relapse. Expressive disclosure writing (EDW) is considered a simple and cheap therapy that focuses on expression of deep thoughts and feelings associated traumatic experience, which leads to reorganization of self evaluations and less psychological distress. This study aimed to evaluate the effect of expressive disclosure writing (EDW) on self stigma and depression, anxiety, and stress symptoms among substance dependent clients. Materials & Method The current study was conducted at the inpatient rehabilitation unit of the addiction center of Al Maamoura hospital of psychiatric medicine, in Alexandria. This study comprised 165 participants: aged 18 years or older, free from major mental disorders (schizophrenia, suicide, etc), could read and write. A number of 79 attended the posttest while complete case analysis was done for 45 participants. The following tools were used for data collection 1- Sociodemographic and clinical data structured interview schedule was used to elicit the sociodemographic and clinical characteristics of the participants. 2- Self Stigma in Alcohol Dependence Scale (SSAD) Schomerus et al., (2011) is a 5 point response Likert scale that consists of 4 subscales 16 items each, which measured self stigma. 3- Depression Anxiety Stress Scale–21 (DASS–21) Lovibond & Lovibond (1995) is a 4 point response scale that consists of 3 subscales 7 items each, which measured symptoms of depression, anxiety, and stress. The SSAD and the DASS–21 were translated into Arabic and back translated into English. The content validity was examined by 5 experts in the field of psychiatric nursing. A pilot study was conducted, and translated scales showed accepted internal consistency reliability. A short preliminary session was held to orient potential participants with the study, verbal informed consent was obtained, and baseline measures were done on the same day or the day after depending on the available time and willingness of the participants. Data collection from the control group took place first. Then the interventional section was performed. Participants in the intervention group received intervention in 2 parts. Part I comprised a CBT psycho-education component provided in two 60-minutes group sessions as a preparation for the EDW phase i.e. both involved illustrations about the connection and interchangeable effect of thoughts, emotions, and behavior as well harmful effects of negative thoughts and emotions, how to decrease defensiveness and be more in touch with one’s life events and experiences, how to identify and name thoughts and emotions, and how to use EDW to actively disclose distressful experience. Part II comprised 15-minutes sessions of EDW on 5 consecutive days. Before the start of each session, Pennebaker’s writing instructions were read loudly to participants. Self stigma and depression, anxiety, and stress were measured at baseline and at posttreatment. The following are the main results obtained from the study: - Participants were an average of 32.3 (SD = 6.723) years old, 95.5% were men, the 49.9% were single, 77.5% had secondary education or less, 63% had occupational work, and 65.5% had sufficient income. There were significant statistical baseline differences between the intervention and control groups as related to gender of participants, marital status, and the number of days after hospital admission. - Most participants were dependent on more than one substance with heroin and opioid chemical preparations were reported by 78.6% of the participants. - Participants had an average abuse duration of 14.3 (SD = 8.9) years, an average number of hospital admission of 3.9 (SD = 4.8) times, and an average of 38.5 (SD= 49.3) days since last hospital admission. - Participants included in the final analysis in the control group had no statistically significant baseline differences compared with those excluded from the analysis because of incomplete records except for having a fewer number of days since hospital admission t (75.28) = 2.85, p = .006, Cohen’s d = 0.71. - Participants included in the final analysis in the EDW group had no statistically significant baseline differences compared with those excluded from the analysis because of incomplete records except for scores of applying stigma to oneself that were significantly lower at pretest in the included participants than in participants excluded from the analysis because of incomplete observations t (44.00) = 3.387, p = .001, Cohen’s d = 0.86. - For only all intervention participants who attended the posttest, mean scores of all self stigma variables showed no change whereas mean scores of depression, anxiety, stress, and overall distress were significantly less at posttreatment (means ranged between 5.5 and 18.0) than at pre treatment (means ranged between 8.4 and 24.7). - For participants included in the complete case analysis, the mean scores of self stigma variables and depression, anxiety, and stress scores had insignificant improvement from pre to posttreatment within both groups. - In crude analysis of all participants who attended the posttest, t-test indicated no significant effect of EDW on self stigma (Cohen’s d ranged between 0.03 and - 0.44) and depression, anxiety, and stress (Cohen’s d ranged between 0.05 and - 0.18). - No significant effect of EDW on all self stigma subscales for the complete case analysis except for scores of ”applying stigma to oneself” which significantly decreased from pre to posttreatment in the EDW group as indicated by the independent t-test, and the effect size was medium (Cohen’s d = -0.6). - ANCOVA analysis adjusted for baseline scores revealed no significant group differences at posttreatment in scores of applying stigma to oneself F (1, 42) = 0.262, p = .612, and Cohen’s d = 0.16. - ANCOVA analysis adjusted for baseline scores revealed no significant pre to posttreatment effect of EDW on scores of depression, anxiety, stress, or the total psychological distress. All effect sizes were small to moderate (Cohen’s d ranged from -0.03 to -0.45). Accordingly the following are the main recommendations of the present study: - There is a need to identify factors that moderate the effect of EDW on stigma. - Moreover, the program should be further enhanced so as to boost effects of EDW. Modifications may involve using techniques such as response training, positive writing and finding meaning in the experience of substance use, group discussions of written content, and providing support for less expressive and illiterate individuals to do it orally or symbolically (through drawing and painting). Further randomized control trials are needed to test the effectiveness of EDW on self stigma and depression, anxiety, and stress symptoms among substance users. |