Addiction Treatment Research
Cornerstone of Recovery is committed to helping patients achieve treatment success by following the most up-to-date scientific research on substance use disorders. As such, we are also committed to bridging the gap that sometimes exists between science and practice by conducting research with our patient populations.
Teaming with researchers from the University of Tennessee, Ohio University, and other institutions across the country, we have published over 30 empirical articles on correlates of substance misuse and changes in mental health during the course of treatment. Our research has focused on identifying and examining potential risk factors for substance misuse, including early maladaptive schemas and mental health symptoms (e.g., depression, post-traumatic stress), as well as protective factors for substance use (e.g., mindfulness, spirituality).
The research conducted at Cornerstone of Recovery helps to guide the selection of treatment focus for our patients, which is crucial to helping our patients achieve successful recovery.
The integration of empirically-supported treatment principals is essential to the mission of Cornerstone of Recovery, and it is our hope that these efforts will also assist other professionals who are working to improve the chances of long term recovery for individuals suffering from the disease of addiction.
PUBLISHED IN PEER-REVIEWED JOURNALS (N = 41)
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019).
Exploring gender differences in the relationship between dispositional mindfulness and compulsive sexual behavior among adults in residential substance use treatment. Mindfulness. doi: 10.1007/s12671-019-01117-7.
Objectives: Compulsive sexual behavior (CSB) is overrepresented among adults with substance use disorders (SUD), yet there is no empirically supported CSB treatment for this population. Cross-sectional and single case designs supported dispositional mindfulness as a potential CSB intervention target. However, the relations between CSB and each of the five dispositional mindfulness facets remain unknown. Methods: Extending prior research to inform intervention efforts, we reviewed medical records for 1993 adults (77.6% male) in residential treatment for SUD to examine gender differences in the relations between dispositional mindfulness facets (acting with awareness, observation of experience, describing with words, non-judging of inner experience, and non-reactivity to inner experience) and five CSB indicators (loss of control, relationship disturbance, preoccupation, affect disturbance, and internet problems). Results: For men, path analyses revealed that acting with awareness, nonjudging of inner experience, describing with words, non-reactivity to inner experience, alcohol/drug use and problems, and depression and anxiety symptoms related to CSB (p range: .00-.04). For women, acting with awareness, non-judging of inner experience, alcohol/drug use and problems, and depression symptoms related to several CSB indicators (p range: .00-.04). Conclusions: Mindfulness-based CSB interventions should evaluate the benefit of increasing intentional responses towards present-moment experiences among adults with SUD. Targeting alcohol/drug misuse, negative affect, and judgement towards thoughts and emotions may be beneficial.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2018).
Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behavior among women in substance use treatment? Clinical Psychology and Psychotherapy, 25(5), 692-700. doi: 10.1002/cpp.2300.
Objective: Untreated compulsive sexual behavior (CSB) poses a risk to efficacious substance use disorder (SUD) treatment. Yet, the ways in which CSB manifests in women with SUDs remains poorly understood. Shame and trauma exposure are well-documented correlates for women’s CSB. Prior theory suggested women with shame and trauma-related symptoms may engage in CSB in an effort to escape aversive internal experiences. Thus, the present study examined experiential avoidance as a mediator of the relationship between defectiveness/shame beliefs, post-traumatic stress disorder (PTSD) symptoms, and CSB in a sample of women with SUDs. Method: Cross-sectional, self-report data were collected from 446 women (M age = 37.40) in residential treatment for SUDs. Results: Experiential avoidance partially mediated the relationship between both PTSD symptoms and defectiveness/shame beliefs and CSB. Conclusions: These results extend theoretical conceptualizations of women’s CSB to a treatment population. CSB intervention efforts may benefit from targeting women’s avoidance of painful experiences.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2018).
Dispositional mindfulness and compulsive sexual behavior among women in residential treatment for substance use disorders. Mindfulness, 9(1), 98-104. doi: 10.1007/s12671-017-0748-4.
Compulsive sexual behaviors (CSB) are prevalent among populations with substance use disorders (SUD). The risk of relapse following SUD treatment is increased if CSB are not addressed. Despite this risk, few studies have examined protective factors for CSB among individuals with SUD, and none have examined protective factors unique to women with CSB and SUD. Women’s CSB are believed to be motivated by efforts to avoid painful affective experiences (e.g., trauma symptoms, loneliness, and shame). Dispositional mindfulness was shown to reduce one’s risk for engaging in maladaptive responses to aversive experiences. Thus, we hypothesized that dispositional mindfulness would negatively relate to CSB among women with SUD. For the present study, we reviewed cross-sectional, self-report measures which were included in the medical records of 429 women in residential treatment for SUD. Results of hierarchical multiple regression analyses revealed that, controlling for age, and drug, and alcohol problems and use, dispositional mindfulness negatively related to the core dimensions of CSB. These findings suggest that women with CSB and SUD are less likely to willingly approach present-moment experiences with acceptance. These preliminary findings suggest that researchers and clinicians should consider the utility of mindfulness-based approaches in treating women with CSB and SUD.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017).
Experiential avoidance as a mediator of the relationship between dispositional mindfulness and compulsive sexual behaviors among men in residential substance use treatment. Sexual Addiction and Compulsivity, 24(4), 257-269. doi: 10.1080/10720162.2017.1365315.
The present study sought to extend compulsive sexual behavior (CSB) and mindfulness research by testing whether dispositional mindfulness negatively related to CSB among men with substance use disorders (SUD) through experiential avoidance. Dispositional mindfulness is believed to decrease experiential avoidance, a correlate of CSB. We therefore hypothesized that dispositional mindfulness would relate to CSB indirectly through experiential avoidance. We reviewed medical records from 175 men in residential treatment for SUD. Results revealed significant indirect effects of dispositional mindfulness on CSB through experiential avoidance. Results provided preliminary support for developing mindfulness-based CSB interventions that target experiential avoidance.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017).
Dispositional mindfulness, shame, and compulsive sexual behaviors among men in residential treatment for substance use disorders. Mindfulness, 8(6), 1552-1558. doi: 10.1007/s12671-017-0723-0.
Approximately, 31% of men in treatment for a substance use disorders (SUD) engage in compulsive sexual behavior (CSB). Shame, a well-documented consequence of CSB, increases the likelihood of relapse following treatment for SUDs. Despite the risk of relapse, prior research has not investigated factors that may attenuate the relation between CSB and shame. Dispositional mindfulness is one such factor known to mitigate shame. However, researchers have yet to examine dispositional mindfulness as a moderator of the relationship between CSB and shame among a sample of men in treatment for SUDs. In an effort to inform intervention efforts, the present study aimed to investigate the hypothesis that CSB would not relate to shame among men with high, as opposed to low, levels of dispositional mindfulness. The present study reviewed medical records of 184 men in residential treatment for SUDs who completed cross-sectional measures of shame, CSB, dispositional mindfulness, and substance use problems. Results demonstrated a significant interaction between CSB and dispositional mindfulness such that CSB positively related to shame at low, but not mean or high, levels of dispositional mindfulness. These results support and extend previous mindfulness and CSB treatment research. Findings suggested that intervention efforts for CSB may benefit from increasing dispositional mindfulness in an effort to reduce shame-related cognitions.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017).
Depression, anxiety, and compulsive sexual behavior among men in residential treatment for substance use disorders: The role of experiential avoidance. Clinical Psychology and Psychotherapy, 24, 1246-1253. doi: 10.1002/cpp.2085.
Nearly one-third of individuals in treatment for substance use disorders endorse at-risk levels of compulsive sexual behaviors (CSBs). Untreated sexual compulsivity may facilitate relapse for treatment-seeking men. Previous research and theory suggest that CSBs are maintained by efforts to escape or alter negative affect (e.g., depression and anxiety). However, this hypothesis has not been examined within a sample of men in treatment for substance use disorders. In an effort to better understand CSBs within a population of men with substance use disorders, the present study is the first to examine experiential avoidance as one potential mechanism underlying the relation between men’s symptoms of depression and anxiety and their use of CSBs. The present study reviewed medical records of 150 men in residential treatment for substance use disorders. Structural equation modelling was used to examine pathways from men’s depression and anxiety symptoms to CSBs directly and indirectly through experiential avoidance while controlling for alcohol/drug problems and use. Results revealed significant indirect effects of both depression and anxiety symptoms on CSB through experiential avoidance. These results support and extend existing research on CSB in a treatment population. Findings suggest that intervention efforts for CSB may benefit by targeting men’s avoidance of painful internal events.
Shorey, R. C., Gawrysiak, M. J., Elmquist, J., Brem, M. J., Anderson, S., & Stuart, G. L. (2017).
Experiential avoidance, distress tolerance, and substance use cravings among adults in residential treatment for substance use disorders. Journal of Addictive Diseases, 36(3), 151-157.
Substance use cravings are a known predictor of relapse to substance use following treatment for a substance use disorder. Thus, research on factors that may be correlated with cravings, and could then be targeted in substance use treatment, is needed. Both distress tolerance and experiential avoidance, similar but distinct constructs, are independently associated with substance use cravings. However, no known research has examined these constructs as simultaneous predictors of substance use cravings, which may have important implications for treatment. The current study examined this in a sample of men and women in residential substance use treatment (n = 117). The authors used pre-existing data from a larger study where men and women were recruited for participation from a residential substance use treatment facility. The majority of the sample was male (n = 87; 74.3%) and Caucasian (92.2%). The mean age was 41.27 (standard deviation = 10.68). Better distress tolerance and lower experiential avoidance were negatively and significantly associated with alcohol and drug cravings, but only experiential avoidance remained significantly and negatively associated with cravings when both predictors were examined simultaneously. The current findings provide preliminary support for the importance of decreasing experiential avoidance in substance use treatment, which may result in reduced substance use cravings.
Shorey, R. C., Strauss, C., Elmquist, J., Anderson, S., Cornelius, T. L., & Stuart, G. L. (2017).
Distress tolerance and intimate partner violence among men in substance use treatment. Journal of Family Violence, 32(3), 317-324.
The current study examined the relationship between distress tolerance and intimate partner violence among men in substance use treatment. Results demonstrated that distress tolerance was negatively associated with physical and psychological IPV perpetration. After controlling for age and substance use and problems, distress tolerance remained associated with psychological, but not physical, IPV perpetration. These findings suggest that distress tolerance may be an important component of treatments for IPV, particularly for psychological aggression.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017).
A preliminary investigation of the relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment. Addiction Research and Theory, 25(1), 67-73.
The comorbidity between eating disorders (EDs) and substance use disorders (SUDs) is of particular concern given the high rates of mortality, relapse and poor treatment outcomes associated with both disorders. As a result, there has been a growing impetus within the field to elucidate factors that might influence and aid treatment for this comorbidity. One such factor is dispositional mindfulness, as past literature has demonstrated a significant relationship between mindfulness and both EDs and SUDs. However, we are unaware of any research that has examined the relationship between dispositional mindfulness and ED symptoms in a sample of men in residential treatment for SUDs. Medical records from 152 men were included in the current study. Alcohol and drug use and problems, ED symptoms and dispositional mindfulness were assessed with self-report measures. Hierarchical regression analysis indicated that dispositional mindfulness was inversely related to ED symptoms after controlling for alcohol use, drug use and age. Although results are preliminary and continued research in this area is needed, our findings suggest that there may be potential usefulness in targeting and enhancing mindfulness among patients in residential treatment for SUDs with co-occurring psychiatric symptoms (e.g., EDs).
Lookatch, S. J., Elledge, L. C., Anderson, S., Shorey, R. C., Stuart, G. L., & Moore, T. M. (2017).
Cognitive and psychological changes during a 28-day residential substance use treatment. Addiction Research and Theory, 25(4), 334-341.
Alcohol use disorder is widespread in the United States and research suggests that significant neuropsychological damage can result from prolonged and/or excessive alcohol use. Neuropsychological and affective effects of prolonged and/or excessive alcohol use include memory deficits, limited emotional expression and recognition, and impairments in executive functioning. Research has yielded mixed results on the improvement of these deficits once alcohol use is discontinued. The aim of this study was to assess psychological changes during an approximately 28-day residential substance use treatment program among adults diagnosed with an alcohol use disorder (N = 122). Patients were predominantly White (91.8%) and male (77.9%). Cognitive, psychological and affective functioning were measured utilizing WebNeuro, a computer-based assessment of four specific domains (Feeling, Self-Regulation, Emotion, and Thinking). Time 1 assessments were completed following alcohol detoxification and Time 2 assessments were conducted upon discharge from the treatment facility, approximately 28-days after Time 1. Results revealed significant increases across all four domains at Time 2, suggesting that there were significant improvements in cognitive and psychological functioning over time. The effect of Time was qualified by a significant Time × AUDIT score interaction in predicting the Feeling and Self-Regulation domains, indicating the more severe the alcohol use, the greater the psychological improvement. Continued research is needed to determine whether functioning continues to improve following treatment for an alcohol use disorder.
Shorey, R. C., Elmquist, J., Gawrysiak, M. J., Anderson, S., & Stuart, G. L. (2016).
The relationship between mindfulness and compulsive sexual behavior in a sample of men in treatment for substance use. Mindfulness, 7(4), 866-873.
Substance use is a serious worldwide problem. One factor that may complicate substance use treatment for some patients is compulsive sexual behavior. Factors that are related to both substance use and compulsive sexual behavior could be targeted in substance use treatment. In the current study, we examined dispositional mindfulness, a protective factor for a range of mental health problems, and its relationship to compulsive sexual behavior in a substance use treatment sample. Findings demonstrated dispositional mindfulness to be negatively associated with a variety of indicators of compulsive sexual behavior. After controlling for alcohol and drug use, which were both associated with compulsive sexual behaviors, dispositional mindfulness remained negatively associated with all of the compulsive sexual behavior indicators. Findings may suggest that substance use treatment for individuals with comorbid compulsive sexual behavior may want to include mindfulness-based interventions as part of treatment.
Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (2016).
The relationship between eating disorder symptoms and treatment rejection among young adult men in residential substance use treatment. Substance Abuse: Research and Treatment, 10, 39-44.
This manuscript examined the relationship between eating disorder symptoms and treatment rejection among a sample of 68 young adult men in residential substance use treatment. Results from hierarchical regression analyses indicated that eating disorder symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems. Although this a preliminary study, results add to a growing body of research examining the comorbidity between substance use disorders and eating disorder symptomatology. Future research examining this relationship is needed to further elucidate treatment patterns among individuals with comorbid eating disorder symptoms and substance use diagnoses.
Elmquist, J., Shorey, R., Anderson, S., & Stuart, G.L. (2016).
Are borderline features associated with compulsive sexual behaviors among women in treatment for substance use disorders? Journal of Clinical Psychology, 17(10), 1077-1087.
In this study, we examined the relationship between compulsive sexual behaviors (CSBs) and borderline features in a sample of women seeking residential treatment for substance use disorders ( N = 120). Hierarchical regression analysis demonstrated that borderline features were significantly associated with CSBs after controlling for alcohol use, drug use, age, and impression management. Results from this study provide potentially important research and clinical implications, which could ultimately aid treatment and reduce relapse. However, continued research is needed to further examine the relationship between borderline features and CSBs.
Shorey, R. C., Strauss, C., Elmquist, J., Anderson, S., & Stuart, G. L. (In Press).
Examining the reactions to intimate partner violence research participation among women in substance use treatment: Does shame-proneness matter? Partner Abuse.
This study examines the research reactions of women (N = 64) in substance use treatment who completed a self-report measure on their psychological, physical, and sexual IPV victimization. We also examined whether shame-proneness moderated the association between reports of IPV and negative emotional research reactions. This information is important for Institutional Review Boards (IRBs) and researchers in determining the most ethical and appropriate protections for participants of IPV research. Findings demonstrated victims of all three types of IPV did not differ from non-victims on negative emotional research reactions. Victims of psychological aggression reported more positive research experiences than non-victims. More frequent psychological victimization was associated with more negative emotional reactions. Shame-proneness did not moderate the relationship between IPV reports and negative emotional reactions, although shame-proneness did exert a main effect on negative emotional research reactions.
Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (2016).
The relationship between generalized anxiety symptoms and treatment dropout among women in residential treatment. Substance Use and Misuse, 51(7), 835-839.
In the current study, we examined the relationship between leaving treatment against medical advice (AMA) and symptoms of generalized anxiety disorder (GAD) in a sample of women seeking treatment for substance use disorders. Results demonstrated that GAD symptoms were significantly associated with the decision to leave treatment AMA after controlling for age, education, alcohol use, and drug use. Our finding indicates the importance of assessing and targeting GAD and the comorbidity between GAD and SUDs in treatment for substance dependence, which may increase treatment compliance.
Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (2016).
The relation between compulsive sexual behaviors and aggression in a substance-dependent population. Journal of Aggression, Maltreatment, & Trauma, 25(1), 110-124. http://www.tandfonline.com/doi/abs/10.1080/10926771.2015.1081664#.VvWGXVJTa7Y
In the current study, we examined the relationship between compulsive sexual behaviors and aggression in men and women in treatment for substance dependence. Results indicated that even after controlling for alcohol and drug use and problems, gender, age, and years of education, CSBs were significantly associated with total aggression, aggressive attitudes, and physical aggression.
Shorey, R. C., Elmquist, J., Anderson, S., & Stuart, G. L. (2016).
The relationship between antisocial and borderline features and aggression in young adult men in treatment for substance use. Journal of Psychoactive Drugs, 48(2), 115-123. http://www.tandfonline.com/doi/abs/10.1080/02791072.2015.1130885#.VvWGhlJTa7Y
This study examined the associations between antisocial and borderline features and aggression in young adult men in treatment for substance use (N = 79). Controlling for age, education, alcohol and drug use, antisocial features was positively associated with various indicators of aggression (e.g., physical, verbal, attitudinal), whereas borderline features was only associated with physical aggression. These findings suggest that substance use treatment centers have the difficult task of not only treating substance use disorders, but should also focus attention on ASPD and BPD features as a means to reduce aggressive behavior. Continued research in this area is needed, including research on effective interventions for aggression among young adult men in substance use treatment.
Shorey, R.C., Elmquist, J., Wolford-Clevenger, C., Gawrysiak, M.J., Anderson, S., & Stuart, G.L. (2016).
The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation: An examination in a sample of women in residential substance use treatment. Psychiatry Research, 238, 122-128. http://www.sciencedirect.com/science/article/pii/S016517811630292X
Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation to support their associations, which was the purpose of the present study. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features (affective instability, identity problems, negative relationships, and self-harm) and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. These findings add to the growing body of literature on dispositional mindfulness and BPD features and suicidal ideation. This was the first study to examine these relationships in a substance use sample. Future research should replicate and extend these findings, and examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.
Shorey, R.C., Elmquist, J., Strauss, C., Anderson, S., & Stuart, G.L. (2016).
Research reactions following participation in intimate partner violence research: An examination with men in substance use treatment. Journal of Interpersonal Violence, 0886260515584345. http://jiv.sagepub.com/content/31/19/3196
The current study examined the research reactions of men in substance use treatment who completed a self-report measure of IPV perpetration and victimization. We also examined whether distress tolerance moderated the relationship between reports of IPV and negative emotional research reactions. Consistent with previous research, after accounting for distress tolerance, substance use, and demographic control variables, IPV was unrelated to negative emotional research reactions. Distress tolerance did not moderate the association between IPV and research reactions. Findings add to a growing body of literature suggesting that IPV research meets IRB requirements for minimal risk research.
Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (2016).
A preliminary investigation of the relationship between early maladaptive schemas and compulsive sexual behaviors n a substance-dependent population. Journal of Substance Use, 1-6. http://www.tandfonline.com/doi/abs/10.3109/14659891.2015.1029021#.VvWFqVJTa7Y
This study examine the relationship between compulsive sexual behaviors and early maladaptive schemas (EMS) among men and women seeking residential treatment for substance use disorders. Findings demonstrated that the five EMS domains were positively associated with CSBs. Results further demonstrated that patients meeting the cutoff score for CSBs scored significantly higher than patients not meeting the cutoff score for CSBs on 3 of the 5 EMS domains.
Shorey, R. C., Anderson, S., Lookatch, S.J., Moore, T.M., & Stuart, G. L. (2015).
The relation between moment-to-moment mindful attention and anxiety among young adults seeking substance use treatment. Substance Abuse, 36(3), 374-379. http://www.tandfonline.com/doi/abs/10.1080/08897077.2014.935841#.VvWE91JTa7Y
The current study examined the relation between trait mindfulness and anxiety among young adult substance use treatment seekers, in addition to exploring differences in trait mindfulness between gender differences. Results demonstrated that trait mindfulness was associated with symptoms of panic disorder and generalized anxiety disorder even after controlling for gender, age, education, alcohol use, drug use, and comorbid anxiety symptoms. These findings provide preliminary evidence that trait mindfulness is associated with mental health in young adults seeking substance use treatment.
Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (2015).
The relationship between early maladaptive schemas and eating disorder symptomatology among individuals seeking treatment for substance dependence. Addiction Research & Theory, 23(5), 429-436. http://www.tandfonline.com/doi/abs/10.3109/16066359.2015.1025063#.VvWFmVJTa7Y
This manuscript is the first investigation of the relationship between early maladaptive schemas (EMS) and eating disorder symptomatology among men and women in residential treatment for substance use disorders. Results demonstrated that 11 of the 18 EMS were significantly associated with ED. Moreover, patients with a probable ED scored significantly higher than patients without a probable ED on 8 of the 18 EMS.
Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2015).
The relation between trait mindfulness and early maladaptive schemas in men seeking substance use treatment. Mindfulness, 6(2), 348-355. http://link.springer.com/article/10.1007/s12671-013-0268-9
In this manuscript, we present the first study to have examined the relationship between male substance users’ mindfulness and early maladaptive schemas. Results indicated strong relationships between mindfulness and 15 of the 18 early maladaptive schemas. Further, individuals who endorsed many early maladaptive schemas were less mindful than those who endorsed fewer.
Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L. (2015).
Dispositional mindfulness and aggression among women in residential substance use treatment. Substance Use and Misuse, 50(14), 1840-1844. http://www.tandfonline.com/doi/abs/10.3109/10826084.2015.1050112
The current study examined whether dispositional mindfulness was associated with aggression, above and beyond substance use and demographic characteristics, in women in residential substance misuse treatment. Results showed that lower dispositional mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relationship between dispositional mindfulness and aggression remained even after controlling for alcohol use, drug use, and age, all known predictors of aggression. Our results provide the first empirical evidence that dispositional mindfulness is negatively associated with aggression in women in treatment for substance misuse.
Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L. (2015).
Early maladaptive schemas and aggression in men seeking residential substance use treatment. Personality and Individual Differences, 83, 6-12. http://www.sciencedirect.com/science/article/pii/S0191886915002184
Social-cognitive theories of aggression postulate that individuals who perpetrate aggression are likely to have high levels of maladaptive cognitive schemas that increase risk for aggression. Indeed, recent research has begun to examine whether early maladaptive schemas may increase the risk for aggression. However, no known research has examined this among individuals in substance use treatment, despite aggression and early maladaptive schemas being more prevalent among individuals with a substance use disorder than the general population. Toward this end, we examined the relationship between early maladaptive schemas and aggression in men in a residential substance use treatment facility (N = 106). Results demonstrated unique associations between early maladaptive schema domains and aggression depending on the type of aggression and schema domain examined, even after controlling for substance use, antisocial personality, age, and education. The Impaired Limits domain was positively associated with verbal aggression, aggressive attitude, and overall aggression, whereas the Disconnection and Rejection domain was positively associated with physical aggression.
Shorey, R.C., Elmquist, J., Anderson, S., & Stuart, G.L. (2015).
The relationship between early maladaptive schemas, depression, and generalized anxiety among adults seeking residential treatment for substance dependence. Journal of Psychoactive Drugs, 47(3), 230-238. http://www.tandfonline.com/doi/abs/10.1080/02791072.2015.1050133
This manuscript is the first examination of the relationship between symptoms of generalized anxiety disorder, major depressive disorder, and early maladaptive schemas among adults with a primary diagnosis of alcohol dependence. Findings demonstrated that the EMS domains of disconnection and rejection and impaired limits were associated with symptoms of MDD and the domain of impaired autonomy and performance was associated with symptoms of GAD even after controlling for age, gender, years of education, alcohol use, drug use, and symptoms of MDD (when predicting GAD) and GAD (when predicting MDD).
Elmquist, J., Shorey, R.C., Anderson, S.E., & Stuart, G.L. (2015).
Eating disorder symptoms and length of stay in residential treatment for substance use: A brief report. Journal of Dual Diagnosis, 11, 233-237. http://www.tandfonline.com/doi/abs/10.1080/15504263.2015.1104480
In the current study, we examine the relationship between eating disorder symptoms and the length of stay and/or decisions to leave treatment against medical advice among women in residential treatment for substance use disorders. Results demonstrated that ED symptoms were associated with a shorter length of treatment and decisions to leave treatment AMA after controlling for age, years of education, alcohol problems, and drug problems.
Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2014).
Differences in trait mindfulness across mental health symptoms among adults in substance abuse treatment. Substance Use and Misuse, 49, 595-600. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990007/
This manuscript is the first study to examine trait mindfulness among ARP patients and whether those with a comorbid diagnosis of depression or PTSD reported lower trait mindfulness than those without a comorbid diagnosis. Results indicated that lower trait mindfulness was associated with increased substance use, depression, and PTSD. Those with probable diagnoses of depression or PTSD reported lower mindfulness than patients without these disorders.
Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2014).
Mindfulness deficits in a sample of substance abuse treatment seeking adults: A descriptive investigation. Journal of Substance Use, 19, 194-198. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972764/
This manuscript is the first study to examine differences in mindfulness between a sample of substance abuse treatment seeking adults and normative data on mindfulness from healthy adults. Results indicated that substance users seeking residential treatment may have lower levels of mindfulness relative to their healthy counterparts, thus supporting the implementation of mindfulness-based interventions with this population.
Shorey, R. C., Anderson, S., & Stuart, G. L. (2013).
The relation between antisocial and borderline personality symptoms and early maladaptive schemas in a treatment seeking sample of male substance users. Journal of Clinical Psychology & Psychotherapy Online First. DOI: 10.1002/cpp.1843. http://europepmc.org/articles/pmc4092040
This manuscript has found that, among male ARP patients, early maladaptive schema significantly predict ASPD and BPD symptomatology even after controlling for other personality traits, substance use, and age. These findings indicate that early maladaptive schemas likely underlie personality symptoms, which future supports targeting early maladaptive schemas in treatment.
Shorey, R. C., Brasfield, H. Anderson, S., & Stuart, G. L. (2013).
Early maladaptive schemas of substance users and their intimate partners. Journal of Psychoactive Drugs, 45, 266-275. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971914/
This manuscript is the first study to examine the early maladaptive schemas of airline pilots seeking substance use treatment. In this study, we compared pilots to demographically matched patients on early maladaptive schemas. Results indicated that pilots scored higher than non-pilots on the early maladaptive schema of unrelenting standards, whereas non-pilots scored higher on insufficient self-control. These results support the focus on early maladaptive schemas within this population.
Shorey, R. C., Stuart, G. L., Anderson, S., & Strong, D. R. (2013).
Changes in early maladaptive schemas after residential treatment for substance use. Journal of Clinical Psychology, 69, 912-922. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049341/
This manuscript found that at the end of ARP treatment, male patients are reporting reductions in 13 of the 18 early maladaptive schemas, and this does not vary by type of substance use diagnosis (alcohol or opioid).
Shorey, R. C., Stuart, G. L., & Anderson, S. (2013).
Early maladaptive schemas among young adult male substance users: A comparison with a non-clinical group. Journal of Substance Abuse Treatment, 44, 522-527. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602221/
This manuscript, similar to its female counterpart paper, is examining whether male YA patients score higher on early maladaptive schemas than a non-clinical control group of UT male college students.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2013).
Do gender differences in depression remain after controlling for early maladaptive schemas? An examination in a sample of opioid dependent treatment seeking adults. Clinical Psychology & Psychotherapy, 20, 401-410. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463763/
This study found that early maladaptive schemas were a better predictor of depression than gender in a sample of ARP opioid dependent men and women. This suggests that schemas are an important correlate of depression, in addition to substance use, in substance use patients.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2013).
Differences in early maladaptive schemas in a sample of alcohol and opioid dependent women: Do schemas vary across disorders? Addiction Research and Theory, 21, 132-140. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3593736/
This study found that ARP opioid dependent women scored higher than ARP alcohol dependent women on only two schemas. This suggests that the schemas that are most problematic are similar across diagnostic groups, and that specific substances may not be related to specific schemas. This speaks to the need to individually tailor treatment.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2012)
Differences in early maladaptive schemas among a sample of young adult female substance users and non-clinical controls. Clinical Psychology & Psychotherapy. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463747/
This paper found YA female patients score higher on almost every schema than non-clinical college students. This suggests that schemas may be a cause of, or maintenance of, problematic substance use.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2012).
An examination of early maladaptive schemas among substance use treatment seekers and their parents. Contemporary Family Therapy, 34, 429-441. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3496288/
This manuscript has found that patients scored higher on 17 of the 18 early maladaptive schemas, with the only schema not differing between patients and parents being self-sacrifice. These differences were quite large in magnitude, suggesting that early maladaptive schemas may not have a large intergenerational component.
Shorey, R. C., Anderson, S., & Stuart, G. L. (2012).
Gender differences in early maladaptive schemas in a treatment seeking sample of alcohol dependent adults. Substance Use and Misuse, 47, 108-116. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382082/
This study found that ARP female alcohol-dependent patients scored higher than ARP male alcohol-dependent patients on 14 of the 18 early maladaptive schemas. This suggests that schemas may be more relevant for female alcohol patients than male alcohol patients. Self-sacrifice, unrelenting standards, insufficient self-control, and punitiveness were the most common schemas.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2012).
The early maladaptive schemas of an opioid dependent sample of treatment seeking young adults: A descriptive investigation. Journal of Substance Abuse Treatment, 42, 271-278. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3265617/
This study found that YA opioid dependent women scored higher than YA opioid dependent men on 11 of the 18 early maladaptive schemas. Insufficient self-control was the most common schema. These findings indicate schemas may be more relevant for YA women and that insufficient self-control may be an important treatment target.
Shorey, R. C., Anderson, S., & Stuart, G. L. (2012).
Gambling and early maladaptive schemas in a treatment seeking sample of male substance users: A preliminary investigation. Addictive Disorders & Their Treatment, 11, 173-182. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595176/
This study found that male ARP patients with a potential gambling problem scored higher than ARP male patients without a gambling problem on 11 of the 18 early maladaptive schemas. These findings suggest that as the number of addiction problems increases, the worse one’s early maladaptive schemas. Dual-diagnosis patients (substance use and gambling) may need more intensive focus on schemas.
Shorey, R. C., Anderson, S., & Stuart, G. L. (2011).
Early maladaptive schemas in substance use patients and their intimate partners: A preliminary investigation. Addictive Disorders & Their Treatment, 10, 169-179. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3382969/
This study found that ARP patients scored higher than their intimate partners (e.g., husbands, wives, girlfriends, boyfriends) on 5 of the 18 schemas, with intimate partners scoring higher on self-sacrifice. This study suggests that family therapists should discuss schemas with intimate partners and determine how schemas interact to create dynamics in couples.
UNDER REVIEW AT PEER-REVIEWED JOURNALS (N = 3)
Grigorian, H., Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019).
Mindfulness and Early Maladaptive Schemas among Men in Treatment for Substance Misuse. Manuscript under review.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2018).
The relationship between dispositional mindfulness and aggression among adults in residential treatment for opioid use disorder. Manuscript under review.
Slepian, P. M., Brem, M. J., Anderson, S., Stuart, G. L., & Shorey, R. C. (2017).
A mindfulness and acceptance adjunct to inpatient substance use treatment reduces pain: A secondary analysis of a randomized controlled trial. Manuscript under review.
IN PREPARATION FOR SUBMISSION TO PEER-REVIEWED JOURNALS (N = 4)
Grigorian, H., Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019).
Mindfulness and Early Maladaptive Schemas among Women in Treatment for Substance Misuse. (Manuscript in preparation).
Grigorian, H., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019).
Treatment Rejection and Substance Use Treatment Dropout among Men with Alcohol Use Disorder. (Manuscript in preparation).
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2018).
Distress tolerance as a protective factor against sexual compulsivity among adults with substance use disorders. (Manuscript in preparation).
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2018).
Distress tolerance, depression, and alcohol cravings among adults in residential treatment for alcohol disorder. (Manuscript in preparation).
PRESENTATIONS AT NATIONAL CONFERENCES (N = 15)
PRESENTED
Brem, M. J., Grigorian, H., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019, June).
Alcohol use disorder with and without co-occurring compulsive sexual behavior: Differences in clinically-relevant factors. Poster accepted for presentation at the 42nd Annual Research Society on Alcoholism Scientific Meeting, Minneapolis, MN.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017, November).
Experiential avoidance mediates the relationship between dispositional mindfulness and compulsive sexual behaviors among men in residential treatment for substance use disorders. Poster presented at the 51st Annual Convention of the Association for Behavioral and Cognitive Therapies, San Diego, CA.
Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017, June).
Depression, anxiety, and compulsive sexual behavior among men in residential treatment for alcohol use disorders: The role of experiential avoidance. Poster presented at the 40th Annual Scientific Meeting of the Research Society on Alcoholism, Denver, CO.
Bomar, G., Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017, February).
Does experiential avoidance explain the relationships between shame, PTSD symptoms, and compulsive sexual behavior among women in substance use treatment? Poster presented at the Mid-South Psychological Conference, Morris, TN.
Cannon, C., Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2016, October).
Dispositional mindfulness, shame, and compulsive sexual behaviors among adults in residential treatment for substance use disorders. Poster presented at the Tennessee Psychological Association Annual Convention, Nashville, TN.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2016, October).
The relationship between dispositional mindfulness and eating disorder symptoms among men in residential substance use treatment. Poster presented at the 50th annual convention of the Association for Behavioral and Cognitive Therapies, New York, NY.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (August 2016).
Relationship between Generalized Anxiety Disorder and Length of Stay in Substance Use Treatment. Poster presented at the 124th Annual Convention of the American Psychological Association, Denver, CO.
Elmquist, J., Shorey, R.C., Anderson, S., & Stuart, G.L. (2016, June).
Are borderline features associated with compulsive sexual behaviors among substance dependent women? Poster presented at the 39th annualconvention of the Research Society on Alcoholism, New Orleans, LA.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2015, November).
The relationship between eating disorder symptoms and length of stay in residential treatment for substance use. Poster presented at the 49th annual meeting of the Association for Behavioral and Cognitive Therapies.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2015, August).
Are early maladaptive schemas associated with eating disorder symptoms in a substance dependent population. Poster presented at the 123rd annual meeting of the American Psychological Association.
Elmquist, J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2015, June).
The relationship between early maladaptive schemas and eating disorder symptomatology among individuals seeking treatment for substance dependence. Poster presented at the 38th annual meeting of the Research Society on Alcoholism.
Lookatch, S. J., Katz. E. C., Moore, T. M., Anderson, S., & Stuart, G. L. (2014).
Neuropsychological changes during residential substance use treatment. Poster presented at the 46th annual convention of The College on Problems of Drug Dependence, San Juan, Puerto Rico.
Brasfield, H., Shorey, R. C., Anderson, S., & Stuart, G. L. (2013, November).
Alcohol use, anxiety, and depression among adults seeking residential treatment for alcohol dependence: The importance of early maladaptive schemas. Poster presented at the 47th annual convention of the Association for Behavioral and Cognitive Therapies, Nashville, Tennessee.
Shorey, R. C., Anderson, S., & Stuart, G. L. (2011, June).
Early maladaptive schemas in an alcohol dependent treatment seeking sample. Poster presented at the 34th annual convention of the Research Society on Alcoholism, Atlanta, GA.
Shorey, R. C., Stuart, G. L., & Anderson, S. (2011, November).
The early maladaptive schemas of opioid dependent treatment seeking adults: Does controlling for psychopathology reduce gender differences in schemas? Poster presented at the 45th annual convention of the Association for Behavioral and Cognitive Therapies, Toronto, Canada.