Research Papers

Research Papers

Publications of the PROMIS Research Group and Affiliates

Stephenson, G.M. & Zygouris, N. (2007). Effects of self reflection on engagement in a 12-step addiction treatment programme: A linguistic analysis of diary entries. Addictive Behaviors, 32, 416-424.

Thirty clients receiving Twelve-Step Facilitation Therapy in a rehabilitation setting formed the intervention group. They were asked to complete in third person a weekly evaluation of progress based on reading personal “Feelings” diaries they had written on a daily basis over a period of one week, starting 3 weeks previously. The diaries of the clients and of a further 60 clients in two matched control groups were compared.

One control group consisted of clients receiving treatment before the intervention was introduced, and clients in the second control group received treatment after the intervention was terminated. Clients in the control groups were matched to the intervention group according to presenting disorder (alcohol, drugs or food), gender and age.

Analysis of the number of words written and diaries produced suggested that the experimental group’s productivity was enhanced. Linguistic and cluster analyses indicated that the clients in the Intervention group referred more frequently to key elements of the programme (steps and spirituality) and responded in a more integrated way to the major aspects of their treatment regime. The study supported the expectation that by promoting self-reflection on progress in therapeutic settings, an increase in programme engagement can be expected.

Haylett, S.A., Stephenson, G.M. & Lefever, R.M.H. (2004). Covariation in addictive behaviours: A study of addictive orientations using the Shorter PROMIS Questionnaire. Addictive Behaviors, 29(1), 61-71.

Previous research has suggested that different addictive behaviours are linked, such that decreases in one may lead to compensatory increases in another, or even that one addiction may lead to another. Such views on cross addiction are encouraged by the prevailing tendency amongst researchers from very different theoretical backgrounds to view different addictions as serving a common function, such as mood alteration, or the management of hedonic tone. “Previous studies have suggested that different addictions may usefully be grouped according to how they covary.

The present study, using factor and cluster analyses, confirms the importance of a division between “hedonistic” and “nurturant” addictions, but with the need for further subdivisions within those categories. Hedonism comprises a drug use factor and an interpersonal dominance factor. Nurturance comprises both “self-regarding” and other-regarding factors. Theoretically, the results suggest that different addictions illustrate contrasting techniques of interpersonal manipulation. Clinically, the results indicate the drawbacks of addressing addictive behaviours singly, and the potential importance of addictive orientations in treatment, and relapse prevention.

Christo, G., Jones, S., Haylett, S. & Stephenson, G. (2003). The Shorter PROMIS Questionnaire: Further validation of a tool for simultaneous assessment of multiple addictive behaviours. Addictive Behaviors, 28(2), 225-248.

There is both a theoretical and clinical need to develop a questionnaire that assesses a range of addictive behaviours. The Shorter PROMIS Questionnaire (SPQ) is a 16-scale self-report instrument assessing the use of nicotine, recreational drugs, prescription drugs, gambling, sex, caffeine, food bingeing, food starving, exercise, shopping, work, relationships dominant and submissive, and compulsive helping dominant and submissive. Clinical cut-off scores using the 90th percentile were derived from a normative group of 508 individuals.

These cut-offs correctly identified 78%-100% of cases within clinical criterion groups of specific disorders. The clinical sample also completed other validated scales assessing gambling, eating, alcohol, and drug use. Correlations were typically .7 with relevant SPQ scales. The SPQ food, drug, and alcohol scales were at least equivalent to validated comparison scales in the strength of their relationship to relevant clinical criterion groups. Internal consistency was high for all scales, and test-retest reliability was generally good. This clinically useful instrument provides a broad assessment of addictive problems, thereby benefiting both the treatment provider and the client.

Hope, L.C., Cook, C.C.H. & Stephenson, G.M. (2002). Exploration of the perceptions of social climate for three types of substance abuse treatment programmes in England. Therapeutic Communities: International Journal for Therapeutic and Supportive Organizations, 23(1), 17-32.

This study explores the social climate of three different types of substance abuse treatment centres in England representing a diversity of treatment philosophies, namely an NHS day unit and two types of non-statutory residential units. Both staff and patient perceptions of the social climate were assessed four times over a 12 month period using the Community Oriented Programs Environment Scale (COPES) self-report questionnaire.

Contrary to expectations the only staff to show consistency over time in their perceptions were those at the day unit and this group had the longest service, while for patients those at the two residential centres with the shortest programmes demonstrated such consistency. As in previous research, staff perceptions were generally more favourable than patients’ perceptions, though few significant differences were found and in some cases patients were significantly more positive than staff. Comparison between centres highlights the individual nature of the social climate with differences seeming to reflect their different treatment practices and philosophical approaches to treatment.

Stephenson, G.M. & Haylett, S. (2000). Self Narrative Framing: The effects of systematic written reflections on personal progress in 12-step facilitation therapy. Journal of Constructivist Psychology, 13(4), 313-319.

Examined whether systematic written reflection on past writings about self (Self Narrative Framing) may positively enhance the awareness of subsequent personal progress, as revealed in an analysis of diary content. Clients receiving 12-step facilitation therapy in a residential setting were asked to complete, in the 3rd person, a weekly evaluation of progress based on reading personal “Feelings” diaries they had written on a daily basis over a period of 1 wk starting 3 wks previously.

12 patients who had been in treatment for addiction problems for 4 wks prior to the intervention took part in this study. Controlled analyses of subsequent narrative content of the diaries indicated no change in focus, temporal orientation or referent, but did show a marked increase in their positivity. This was verified by a computer analysis of positive feelings words. The intervention also appeared to bring about a decrease in the consistency of feelings about personal progress. Findings suggests that clients who responded positively to the intervention tended to do well in recovery.

Stephenson, G.M., Laszlo, J., Ehmann, B.,Lefever, R.M.H. & Lefever, R. (1997). Diaries of significant events: Socio-linguistic correlates of therapeutic outcomes in patients with addiction problems.Journal of Community and Applied Social Psychology, 7(5), 389-411.

Examined the relationship between the linguistic content of diaries and progress in treatment. Complete sets of daily diaries of ‘significant events’ written by 16 patients receiving treatment for drug, alcohol and food addictions at a residential center, using the 12-step approach of the Anonymous fellowships, were typed up for analysis. Three forms of socio-linguistic enquiry were employed: narrative characterization, evaluative statement coding, and computer analysis of word strategies.

Results indicated that success in treatment as rated by counseling and psychiatric staff was associated with the following characteristics of diary narratives. They are (1) focused on individual progress, whether adopting a ‘positive interpretative’ or ‘negative reactive’ style, (2) less critical of self over time and more positive about others external to the treatment center, (3) both positive about the treatment programme and critical of self, (4) using words indicative of ‘insight’ and ‘negativity’ as assessed by J. W. Pennebaker’s Linguistic Inquiry and Word Count program. It is concluded that autobiographical material can usefully be employed to assess progress in treatment, and that its intrinsic value in effecting change should be further explored.

Stephenson, G.M., Maggi, P. & Lefever, R.M.H. (1997). Some antecendents of hedonistic and nurturant addictive orientations in relation to gender: An archival study. Issues in Criminological and Legal Psychology¸ 27, 23-33.

Examined relationships between archival autobiographical information and scores on the factors labeled hedonism and nuturance in the results of a previous factor analytic study (G. M. Stephenson et al, 1995) of 16 scales measuring a range of addictive behaviors in a sample of 190 male and 281 female patients from an addictions treatment center. The factor analysis of the previous study was repeated using the 12 substance and activity scales.

Present results indicate that gender is an important predictor of scores on both factors, and support the following conclusions: (1) there is an essential similarity in patterns of addictive behaviors in men and women seeking treatment, with the principal exception of alcohol consumption, (2) the association of criminality with hedonism is apparent in both male and female samples, although strongest in the males, and (3) of the social background factors, a history of family addiction, physical and sexual abuse, and criminal offending are all of predictive importance in the cross-sectional analysis of hedonism and/or nurturance.

Stephenson, G.M., Maggi, P., Lefever, R.M.H. & Morojele, N.K. (1995). Excessive behaviours: An archival study of behavioural tendencies reported by 417 patients admitted to an addiction treatment centre. Addiction Research, 3(3), 245-265.

We report a factor analytic study of the Promis questionnaires, designed to evaluate addiction in 16 behavioural areas. Data were taken from the clinical records of 191 men and 281 women (aged 16-72 yrs) admitted to the Promis Recovery Centre for treatment of addictions. Primary scale factor scores were obtained for each patient and subjected to factor analysis. A two-factor solution (oblique rotation) was indicated. Factor 1 (“Nurturance”) included Caffeine, Work, Exploitative relationships (submissive), Shopping, Exercise, Food bingeing, Food starving and Compulsive helping (dominant and submissive).

Factor 2 (“Hedonism”) comprised Alcohol, Nicotine, Recreational Drugs, Gambling, Exploitative relationships (dominant), Sex and Prescription drugs. Factor 1 was strongly associated with primary diagnoses of Overeating, Bulimia and Anorexia, and Factor 2 with Drug problems, and to a lesser extent Alcohol. When controlling for the effects of diagnosis women generally scored high on Nurturance, but were no less Hedonistic than men. Men and women share broadly the same factor structures.

Morojele, N.K. & Stephenson, G.M. (1994). Addictive behaviours: Predictors of abstinence and expectations in the Theory of Planned Behaviour. In D. R. Rutter & L. Quine (Eds.), Social psychology and health: European perspectives (pp. 47-70). Brookfield, VT, US: Avebury/Ashgate Publishing Co.

(from the chapter) consider the ways in which the [Theory of Reasoned Action] has been modified in order to account for . . . non-volitional, non-reasoned actions / refer specifically to I. Ajzen’s Theory of Planned Behaviour (I. Ajzen, 1985, 1987, 1988) and to P. Warshaw and F. Davis’ approach (P. Warshaw and F. Davis, 1985), in which a distinction is made between behavioural expectation and behavioural intention / these modifications are particularly pertinent to addictive behaviours and to attempts to control them, where there is a strongly non-volitional, non-rational element / it is proposed that Ajzen’s Theory of Planned Behaviour is more appropriate for the prediction of addictive behaviours than is the Theory of Reasoned Action, and furthermore that behavioural expectation is a required construct within Ajzen’s framework, as the most immediate predictor of behavioural performance /// participants in the present study were [87 16-67 yr olds] in treatment at . . . an addiction programme for alcohol, drugs, and eating disorders / the target behavioral outcome . . . is abstinence and/or sensible eating.

Morojele, N.K. & Stephenson, G.M. (1992). The Minnesota Model in the treatment of addictions: A social psychological assessment of changes in beliefs and attributions. Journal of Community and Applied Social Psychology, 2(1), 25-41.

Changes in beliefs and attitudes that accompany Minnesota Model (MM) treatment are examined in terms of the Compensatory Model of Coping of P. Brickman et al’s (see record 1982-30315-001), and I. Azjen’s (1985, 1988) theory of planned behavior. 61 patients who had successfully completed treatment at a residential MM facility were administered questionnaires on intake and at discharge.

The questionnaires measured the Ss’ attributions of responsibility for the cause of, and for recovery from, their addictions, and their beliefs about outcomes, normative pressures, and personal control with respect to their abstinence. Between intake and discharge there was a marked reduction in the patients’ feelings of personal responsibility for their addiction, while their sense of personal control over their recovery increased significantly.

How to obtain copies of our reports

If you wish to obtain copies of any of the above reports, or to be placed on our mailing list for future publications please write to:

Should you wish to ask more about the results of our work, please write to the chairman of the PROMIS Research Group Professor Geoffrey Stephenson at the same address, or at:

University of Kent,
Department of Psychology
Keynes College
The University

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