Amplification of Positivity Therapy for Co-occurring Alcohol Use Disorder with Depression and Anxiety Symptoms: Pilot Feasibility Study and Case Series

Abstract

Positive valence system dysregulation is a relatively unexplored transdiagnostic mechanism and potential treatment target underpinning alcohol use and anxiety and depression symptoms. The current study examined the feasibility and potential benefit of a behavioral intervention focused on amplification of positivity (AMP) with eight adults (five female) diagnosed with alcohol use disorder and clinically significant depression or anxiety (ClinicalTrials.gov: NCT04278365). AMP for alcohol use (AMP-A) was delivered in 11 individual sessions involving positive activity interventions integrated alongside psychoeducation and alcohol use monitoring. Case descriptions are provided to illustrate treatment implementation. Treatment credibility and acceptability, participant endorsement of the therapy, and homework compliance were rated moderate to high. Exploratory, intent-to-treat analyses suggested medium to large effect sizes for post-treatment improvements in alcohol use, depression, anxiety, and positive affect. Results provide initial evidence of feasibility and acceptability of AMP-A and will be useful for informing future randomized clinical trials to examine clinical efficacy.

Keywords: alcohol use; anxiety; cognitive-behavioral therapy; depression; positive affect.

Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Charles T. Taylor declares that in the past 3 years he has been a paid consultant for Homewood Health, and receives payment for editorial work for UpToDate. Dr. Paulus is an advisor to Spring Care, Inc., a behavioral health startup, he has received royalties for an article about methamphetamine in UpToDate. Elisabeth Akeman, Evan White, Kate Wolitzky-Taylor, Jessica Santiago, Timothy J. McDermott, Danielle C. DeVille, Jennifer Stewart, and Robin L. Aupperle have no competing interests to disclose.

Figures

Figure 1.

Group averages on measures relating to alcohol use (as measured by the Timeline Followback [TLFB], left panel), depression and anxiety (as measured by NIH PROMIS measures, middle panel), and positive affect (measured by NIH PROMIS measures) and social functioning (measured by the Sheehan Disability Scale, right panel).

Figure 2.

Trajectory of individual case responses on measures relevant for depression, anxiety, and positive affect and well-being (measured via NIH PROMIS scales) and alcohol use (as measured by the Timeline Followback [TLFB]).