Psychological flexibility-based interventions versus first-line psychosocial interventions for substance use disorders: Systematic review and meta-analyses of randomized controlled trials

Abstract

The third-wave cognitive behavioral therapies (CBTs), such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT), have been shown to be effective treatments for individuals with substance use disorders (SUD). Given their conceptual and methodological heterogeneity, however, it is difficult to categorize these third-wave CBTs and examine their clinical outcomes. One proposed method is to identify and categorize treatments based on their intended mechanisms of change, and then systematically examine their clinical effects. Psychological flexibility is theorized to be a potential process of change in many third-wave CBTs. In this study, we first identified third-wave CBTs that deliberately target psychological flexibility and categorized them as psychological flexibility–based interventions (PF interventions). PF interventions included ACT, DBT, mindfulness-oriented recovery enhancement, and distress tolerance therapy. We then conducted a meta-analysis of randomized controlled trials (RCT) that compared PF interventions to first-line psychosocial interventions. From a total of 2781 citations, our search identified 10 RCTs including a total of 658 participants. Compared to the first-line psychosocial interventions recommended for SUD treatment (e.g., brief motivational interventions, 12-step groups, and the like), PF interventions demonstrated a higher rate of substance discontinuation (33.6% vs 24.8%). There was no significant difference in dropout rate between the two groups of interventions. Third-wave CBT methods that target psychological flexibility are promising interventions for SUDs. Meta-analyses of this kind are a useful first step in taking a process-based therapy approach to the current evidence on psychosocial interventions.