Examining the Effectiveness of Emotion-Focused Therapy on Self-criticism and Feeling of Shame in Patients Undergoing Methadone Maintenance Therapy

Drug abuse is a psychiatric disorder involving various biological, psychological, and social dimensions. As a result of its detrimental effects on emotions and feelings, the addict continues to use drugs. Given the negative effects of drug abuse on people, society, and the economy, it is important to implement more affordable therapies and prevention measures. As one of the therapy methods for substance abuse disorders, methadone maintenance therapy involves drug therapy combined with psychological therapy to reduce or eliminate the harm and problems associated with substance abuse. Studies indicate that methadone maintenance therapy is more effective when accompanied by psychotherapy. Emotion–focused therapy aims to improve the emotional skills of individuals and treat psychological disorders. Therefore, this study aimed to investigate the effectiveness of emotion–focused therapy on self–criticism and shame among patients receiving methadone maintenance therapy.

A quasi–experimental study was conducted with a pretest–posttest and a three–month follow–up design with a control group. The statistical population included all of the clients of addiction therapy clinics in the fifth district of Tehran, Iran, from 2021 to 2022 who were under maintenance therapy with methadone. A total of 30 individuals were selected from that group by random cluster sampling and divided equally into experimental and control groups (15 people each). In the initial screening, only people who used heroin, opium, juice or crack for five to ten years and only through smoking were selected. In this study, all subjects received maintenance methadone therapy for one year and did not use any other drugs. The study tools were the Self–criticism Scale (Gilbert et al., 2004) and the Guilt and Shame Proneness Scale (GASP) (Cohen et al., 2011) to measure the study variables. For the experimental group, twelve 50–minute sessions of Emotion–focused therapy were conducted over a 6–week period. The control group, however, did not receive any therapy sessions. Data analysis was done using descriptive (mean and standard deviation) and inferential statistics (analysis of variance with repeated measures and Bonferroni's post hoc test) in SPSS version 22. The significance level of statistical tests was set at 0.05.

According to the results, the effect of time and the interaction of time and group on the components of the self–criticism variable (self–confidence and self–criticism) and the variable of shame and its components (negative self–evaluation and withdrawal behavior) were significant in patients undergoing methadone maintenance therapy (p<0.05). Also, the effect of the group on the aforementioned variables was significant (p<0.05) except for the self–confidence component (p>0.05). In the emotion–focused therapy group, the posttest and follow–up scores of the self–criticism component and the shame variable and its components (negative self–evaluation and withdrawal behavior) decreased significantly compared to the pretest scores (p<0.05). Also, the posttest and follow–up scores of the self–confidence component increased significantly compared to the pretest (p<0.001). There was no significant difference in the scores of the mentioned variables between the posttest and follow–up stages, which indicated the continued effectiveness of the intervention in the follow–up stage (p>0.05).

Considering the effectiveness of emotion–focused therapy in reducing self–criticism and shame and its components in the experimental compared to the control group, this therapy can be used as an intervention method in patients undergoing maintenance treatment with methadone.