The substance abuse literature consistently shows that negative emotional states and subjective stress are highly predictive of relapse and significantly influence behavioral motivation (Baker et al, 2004; Quigley & Marlatt, 1999). Further, cognitive control resources (i.e., cognitive coping skills/relapse prevention training) have been shown to exert minimal impact on behavioral decision-making when in the presence of intense affective material (“interoceptive cues”) (Metcalf & Mischel, 1999). It is critical to address negative emotional states and affect regulation, as they are significant precipitants to substance relapse. In addition, research shows that mental health disorders caused by extreme stress conditions, such as trauma and addiction, have in common impaired hemispheric integration (e.g., see Teicher and Schiffer work), which may cause precipitous shifting from left-right dominated states with limited mood stability. Together, these findings suggest that integrated multi-sensory treatments, like that found in expressive therapies programs, are needed to offer opportunities for dual activation of these different brain regions to create the context for cognitive-affective balance in behavioral decision-making.

This exploratory study is the first to assess the effectiveness of a newly developed 12-week manualized dual processing protocol on client emotional regulation capacities in a small sample (N=11) of adult inpatients being treated for substance abuse. The study employed a two-group quasi-experimental program evaluation design, with clients participating in either a dual processing (verbal + visual) treatment protocol or a regular verbal (CBT) treatment group. Two mental health clinicians rated all clients' behavior at the beginning and end of the 12-week treatment cycle, and all clients were asked to self-rate on several emotional regulation dimensions. Correlation between the two independent clinician raters was .69 (pretest) and .86 (posttest).

Study results showed that participants in the dual processing expressive therapies treatment group improved (p<.05) along the following key emotional regulation dimensions: Ability to tolerate strong negative emotions (Effect Size (ES) = 1.08); Ability to effectively interact with others (ES = 1.2); Ability to express emotions about substance use (ES = 1.06); Verbalization about emotions related to substance use (ES = 1.4); and client report “Urge to Use” (ES = 1.3). Findings suggest that including a visual processing component to traditional verbal based cognitive-behavioral treatment protocols may be particularly useful for shoring up emotional regulation capacities in chronic substance dependent treatment populations. More work is ongoing, with larger samples and different comparison group treatment conditions.