Sage Journals: Discover world-class research

Abstract

This study aimed at investigating the effect of cognitive-behavioral therapy on reducing depression, anxiety, and stress levels of Iranian males with addiction. The participants included 24 Iranian males with addiction selected through convenience sampling and randomly assigned to the experimental (n = 12) and control (n = 12) groups. Then, Depression Anxiety and Stress Scale was used as the pretest, posttest, and follow-up tests to assess participants’ levels of depression, anxiety, and stress. The experimental group received eight sessions of cognitive-behavioral therapy, while the control group did not. The findings of the study showed that cognitive-behavioral therapy was effective in reducing participants’ levels of depression, anxiety, and stress. Thus, the findings indicate that the cognitive-behavioral therapy reduced the depression, anxiety, and stress of Iranian males with addiction.

Keywords

cognitive-behavioral therapy stress anxiety depression Iranian males with addiction

Introduction

Addiction and substance abuse are among the most severe psychosocial traumas posing environmental, psychological, behavioral, and emotional challenges to people. They can lead to problems for individuals, seriously undermine family and cultural foundations, and endanger countries’ dynamics (Lander, Howsare, & Byrne, 2013; Sword et al., 2013). Drug addiction is a type of brain disorder which can affect an individual’s behavior; be identified with mental, behavioral, and physiological symptoms; and be persisting for a long period of time despite its harmful and detrimental consequences. Substance abuse is also dangerous for individuals and can disturb their social and intellectual lives and affect their compatibility with others. It can cause major hazards to individuals’ health and lead to negative financial and social consequences which are beyond health care system. For instance, it can decrease economic efficiency, as a result of one’s exit from labor market; can increase crime rates; can cause malfunction and/or disability; and can, finally, lead to death (Volkow, 2014). Drug addiction is a serious problem that can be cured and overcome. Cognitive-behavioral therapy (CBT) is one of the non-medical therapies used to cure addiction. This form of therapy has been used to cure addicts in various clinical studies, and its clinical effectiveness has been proved (Marlatt & Range, 2008; McHugh, Hearon, & Otto, 2010).

Treatment of substance abuse disorders can be a complex and multi-dimensional process and often requires long-term efforts and specialized care because addiction has high comorbidity with other psychiatric disorders, such as anxiety and depression. Thus, these disorders should also be considered in treating addiction. For this reason, the therapeutic process meets three important targets, namely, stopping physical and psychological dependence on drugs, decreasing such non-physical consequences as anxiety and depression associated with drug abuse, and ultimately preventing relapse of disease (Momeni, Moshtagh, & Purshahbaz, 2010; Volkow, 2014). Based on the previous relevant literature, approximately 90% of drug addicts suffer from mood disorders, and especially depression, anxiety, and stress, which are among the most common psychiatric complications (Charney, Palacias-Boix, Negrete, Dobkin, & Gill, 2005; Hanter, Paddock, Zhou, Watkins, & Hepner, 2013; Hunter, Witkiewitz, Watkins, Paddock, & Hepner, 2012; Sareen, Chartier, Paulus, & Stein, 2006; Tatalovic Vorkapic, Dadic-Hero, & Ruzic, 2013). Stress refers to a real or imagined threat to human physical/mental homeostasis. Disturbed homeostasis causes stress and activation of the central and peripheral neuroendocrine mechanisms responsible for different adaptive behaviors and responses. Today, stress is considered as an inevitable and inseparable part of human life. It can steadily increase vulnerability to addiction (Andreou et al., 2011; Goeders, 2003; Schwabe, Dickinson, & Wolf, 2011; Sinha, 2001). The relationship between stress and addiction is highly complex. Indeed, evidence suggests that there is a bidirectional causal relationship between the two, that is, internal and external stress can result in addiction, as one tries to avoid an unpleasant state, and addiction, in turn, can cause an unpleasant state and lead to internal stress (Wand, 2008).

Depression is also another disorder which has high comorbidity with addiction and can be regarded as the principal cause of disability and social harm in the world. Based on Beck’s Cognitive Theory of Depression, depression is a pathological disorder that causes a change in the emotional, motivational, behavioral, cognitive, and physical aspects of one’s life. It is one of the most prevalent psychiatric disorders with a lifetime prevalence of 15.8% and is identified with low levels of positive emotions, such as happiness and confidence (Tran, Tran, & Fisher, 2013). Anxiety, with a lifetime prevalence of 28.8%, is yet another common psychiatric disorder. It is an unpleasant feeling of vague fear of an unknown origin experienced by the individual and encompasses uncertainty, helplessness, and physiological arousal. Worrisome and concern are common symptoms of anxiety, while depression is characterized by a deep decline in one’s willingness to be involved in daily activities, be socialized, recreate, play sports, eat, and have sexual desire (Hofmann, Wu, & Boettcher, 2014; Khaledian, Kamar Zarin, & Jalalian, 2014). Concerning the comorbidity of depression and anxiety with addiction, three factors can be simultaneously solved through CBT. Results of studies by Hamzeh Pour (2014); Hoffman and Smits (2008); Hollon, Stewart, and Strunk (2006); Jayasvasti et al. (2011); Momeni et al. (2010); Riper et al. (2014); Toneatto and Calderwood (2015); and Watkins et al. (2011) reveal that CBT can be effective in reducing depression and anxiety. Furthermore, researchers have also shown that CBT can reduce stress, anxiety, and depression in people with addiction (McHugh et al., 2010; Osilla, Hepner, Muñoz, Woo, & Watkins, 2009; Sugarman, Nich, & Carroll, 2010).

It is assumed in cognitive behavioral theory that depression can be caused by negative schemas about the self, the world, and the future created in the early stages of an individual’s life as a result of traumatic experiences. Accordingly, the therapy in the present study aimed at removing negative schemas and replacing them with positive ones. In this regard, cognitive restructuring, which implies replacing dysfunctional thoughts with efficient beliefs, can be effective in treating depression. In addition, learning new and appropriate behaviors can develop a sense of mastery and empowerment in people, which, in turn, can help people to adopt positive perspectives in dealing with problematic issues. From this point of view, familiarity of clients with problem-solving skills can help them to recognize that consideration of most of contextual factors and the major steps leading to the final solution are mostly based on their instincts, feelings, and emotions (Johnco, Wuthrich, & Rapee, 2014; Taylor & Marshall, 1997; Weersing & Brent, 2006).

One of the reasons for the effectiveness of CBT is that it emphasizes identification and correction of cognitive deviations, application of correct thinking, and development of necessary skills for carrying out assessment and making accurate judgment of negative thoughts which can help reduce levels of anxiety, depression, and other psychological disorders (Hamzeh Pour, 2014).

It is assumed in CBT that psychological problems are the result of negative schemas (Christner, Stewart, & Freeman, 2007; Moore & Garland, 2003) and persist by processing biased and negative information and dysfunctional beliefs. This therapy is designed to help patients to think more adaptively, and thus to improve their behaviors. Such patients are taught how to recognize their negative thoughts and how to explore the relationship between their thoughts and their behaviors. During the treatment schedule, patients gradually learn to identify and assess their dysfunctional assumptions and decide if they are valid or not. In addition, the therapist teaches them some adaptive skills, such as how to break major problems down into smaller and more manageable problems. Indeed, decision making based on loss–profit analysis, timing of activities, and step-by-step tasks can help patients overcome their problems and difficulties (Butler & Beck, 1995; Parker, Roy, & Eyers, 2003). Different techniques are used in CBT. For instance, behavioral techniques mainly entail avoidance of anxiety-provoking situations and/or effective changes in response to such stimuli. The use of muscle relaxation techniques and new and appropriate reinforcement methods at the time of severe anxiety, instead of taking drugs, are also recommended in this treatment. These techniques are taught to help clients look at these relationships and the situations from a new point of view (Momeni et al., 2010).

Based on the aforementioned materials, it can be claimed that CBT is effective in reducing depression and anxiety in individuals with drug abuse. In addition, treatment of depression is highly important in patients with addiction because depression may be one of the high-risk factors or even an obstacle to abstinence in addiction treatment and may lead to addiction relapse (Khaledian et al., 2014). Accordingly, this study is to answer the following research question:

Research Question 1: Does CBT significantly affect depression, anxiety, and stress in Iranian males with addiction?

Method

Population, Sample, and Sampling Procedure

The participants of this study were 24 males selected from all 20- to 40-year-old Iranian males with addiction (N = 89) who were going to addiction treatment centers in Tehran, Iran, in 2016. The participants were selected through convenience sampling and randomly assigned to the experimental (n = 12) and control (n = 12) groups. The Ethical Review Board of the Regional Welfare Organization approved the research.

Depression Anxiety and Stress Scale (DASS)

Lovibond and Lovibond (1995) developed a 21-item Depression Anxiety and Stress Scale (DASS-21). The DASS-21 is self-report questionnaire which is designed to measure severity of some symptoms common to both depression and anxiety. The participants were required to indicate severity of symptoms over the week before filling out the questionnaire. The items were designed on a 3-point Likert-type scale, from 0, indicating that the participant had not experienced the symptom over the last week at all, to 3, indicating that the participant had experienced the symptom commonly or most of the time over the past week (Gomez, 2014). Tran et al. (2013) reported Cronbach’s alpha coefficients of .72, .77, and .70 for the subscales of Depression, Anxiety, and Stress, respectively. Viqnola and Tucci (2014) also obtained the Cronbach’s alpha coefficients of .92, .90, and .86 for the subscales of Depression, Anxiety, and Stress, respectively. In addition, Asghari, Saed, and Dibajnia (2008) reported Cronbach’s alpha coefficients of .85, .85, and .87 for the subscales of Depression, Anxiety, and Stress, respectively. They also found the test–retest reliability of .77, .89, and .85 for the subscales of Depression, Anxiety, and Stress, respectively.

Procedure for CBT

CBT program consists of two components: anger management programs based on cognitive-behavioral theory (Reilly & Shopshire, 2014), and practical stress management program (McNamara, 2000, 2003). To implement the two aforementioned programs, the selected participants were randomly assigned to the experimental and control groups, first. The DASS (Lovibond & Lovibond, 1995) was administered to both groups as a pretest. Next, the experimental group was given CBT during eight 45-min sessions (two sessions per week, for a total duration of 4 weeks). The control group, however, received no intervention. After eight sessions, the DASS was administered to both groups, as a post-test this time. Furthermore, the two groups received third administration of the test, as a follow-up measurement to examine sustainability of changes in behaviors, 1 month later. The obtained data were then statistically analyzed. It should be noted here that, in an attempt to adhere to ethical principles, the control group also received the treatment after the completion of this study. It is also noteworthy that the intervention program was run by the present researchers. Table 1 presents summaries of the therapy sessions.

Table 1.

Summary of Therapy Sessions.

Session	Content
First	Introduction of the members to each other and presentation of the group rules; definition of depression, anxiety, and stress; explanation of wrong beliefs about stress and anxiety; conduct of the relevant tests
Second	Explanation of the events stimulating depression, stress, and anxiety; somatic, behavioral, emotional, and cognitive symptoms of depression; identification of the factors stimulating stress; performing stress removal program based on Benson’s method; break and gravity; homework assignment
Third	Checking homework, stress control program, pause and relaxation, explaining negative self-representation and an analysis of its reasons, homework assignment
Fourth	Checking homework, explaining periods of depression as well as stress and anxiety, break and gravity, guided image, discussions and exchange of ideas, and homework assignment
Fifth	Checking assignments, progressive relaxation of muscles, discussion of the proposed points, thought interruption, and homework assignment
Sixth	Checking homework, discussion of the proposed points, training of Albert Ellis’s ABCD model, exercising decisiveness as well as self-esteem and self-respect, homework assignment
Seventh	Checking assignments, reviewing learned materials, training of coping methods, break and gravity, and homework assignment
Eighth	Evaluation, review of the proposed points, discussion and exchange of ideas, test administration, break and gravity, improving concentration, conclusion of all sessions

Results

Table 2 shows the mean values for severity of depression, anxiety, and stress for the experimental and control groups.

Table 2.

The Effect of Cognitive-Behavioral Therapy on the Level of Depression, Anxiety, and Stress in Iranian Males With Addiction.

Variable	Groups	Descriptive statistics		Follow-up
		Pretest	Posttest	Follow-up
		M (SD)	M (SD)	M (SD)
Depression	Experimental	17.50 (2.19)	8.83 (2.20)	9.66 (2.18)
Depression	Control	14.41 (2.06)	12.83 (1.94)	11.16 (3.01)
Anxiety	Experimental	17.16 (2.55)	10.50 (2.31)	8.33 (1.37)
Anxiety	Control	13.83 (1.85)	12.16 (1.33)	11.00 (2.13)
Stress	Experimental	17.00 (3.04)	9.16 (2.40)	9.58 (1.92)
Stress	Control	13.58 (2.15)	12.66 (1.77)	12.58 (3.26)

To determine whether changes in the mean values were statistically significant or not, a MANCOVA was run. Accordingly, the pretest scores were considered as covariates. Prior to running MANCOVA, the Levene test was used to examine whether the assumptions of homogeneity of variance were proved or not. The result was not statistically significant for any of the variables (stress: F = 2.65, p > .05; anxiety: F = 2.38, p > .05; depression: F = 0.48, p > .05). Therefore, MANCOVA could be run. Furthermore, to study homogeneity of covariance matrices, the Box’s M Test was used. The result was statistically significant (M Box = 11.00, F = 1.56, p > .05). Therefore, the variance–covariance matrices of the dependent variables were equal in the two groups.

MANCOVA results (Table 3) showed a significant difference in the posttest mean scores of the variables of depression, anxiety, and stress between the two groups after removing the pretest effect (Wilks’s lambda = 0.467; F = 6.48; p < .0001).

Table 3.

MANCOVA Results for Depression, Anxiety, and Stress in Experimental Group and Control Group in Post-test.

Dependent variable	Sum of squares	Degrees of freedom	M of sum of squares	F	Significant
Depression	29.74	1	29.74	8.35	.001
Anxiety	20.34	1	20.34	7.20	.001
Stress	58.69	1	58.69	11.95	.001

As one can see from Table 3, the groups were different in severity of depression, anxiety, and stress. Therefore, based on the descriptive and inferential statistical results, CBT was effective in reducing depression, anxiety, and stress.

In addition, follow-up measurement was performed and MANCOVA was run to investigate differences between the groups in severity of the relevant variables. To this end, prior to running MANCOVA, the Levene test was used to examine if the assumptions of homogeneity of variance were proved. The results were not statistically significant for any of the variables (stress: F = 0.925, p > .05; anxiety: F = 1.25, p > .05; depression: F = 0.418, p > .05); therefore, MANCOVA could be run. In addition, to examine homogeneity of covariance matrices, Box’s M test was performed. The result was not statistically significant (M Box = 11.00, F = 1.56, p > .05). Accordingly, the variance–covariance matrices of the dependent variables were equal in the two groups.

MANCOVA results (Table 4) showed a significant difference in severity of depression, anxiety, and stress between the two groups after removing the pretest effect (Wilks’s lambda = 0.489; F = 5.92; p < .0001).

Table 4.

MANCOVA Results for Depression, Anxiety, and Stress in Experimental Group and Control Group in Follow-up.

Dependent variable	Sum of squares	Degrees of freedom	M of sum of squares	F	Significant
Depression	40.48	1	40.48	8.04	.01
Anxiety	37.22	1	37.22	6.67	.01
Stress	41.10	1	41.10	5.21	.03

Table 4, on the results of follow-up measurement, shows that there have been significant differences between the groups in severity of depression, anxiety, and stress after controlling for the effect of the pretest.

Discussion

The main objective of this study was to investigate the effect of CBT on depression, anxiety, and stress levels in Iranian males with addiction. The result revealed that the use of CBT led to a reduction in the levels of depression, anxiety, and stress of the participants. This was in line with the findings of Hamzeh Pour (2014); Hoffman and Smits (2008); Hollon et al. (2006); Jayasvasti et al. (2011); Momeni et al. (2010); Riper et al. (2014); and Watkins et al. (2011). The researchers reported that CBT, whether of individuals or groups, was effective in reducing depression.

In fact, research results has indicated that CBT is highly effective in reducing depression in the experimental group, as compared to the control group (Beltman, Oude Voshaar, & Speckens, 2010; van Straten, Geraedts, Verdonck-de Leeuw, Andersson, & Cuijpers, 2010). The reason might be that CBT can be effective in Iranian males with addiction who are changing attitudes and beliefs of people with addiction, in increasing their self-esteem, and in developing their logical thinking (Khodai, Khazai, Kazemi, & Aliabadi, 2012; McGinn, 2000; Momeni et al., 2010; Okunna, Rodriguez-Monguio, Smelson, & Volberg, 2015; Schwartz & Petersen, 2009). Iranian males with addiction can learn to modify their negative thoughts and internalize behavioral planning skills, social skills, and self-assertiveness through the use of CBT techniques. These can help them to overcome their depression (Hunter et al., 2012; Khaledian et al., 2014; McGinn, 2000).

Concerning the effectiveness of CBT on reducing anxiety levels in Iranian males with addiction, it should be stated that CBT is the first treatment option for treating anxiety disorders and has been considered very effective in this regard (Ghahramanlou, 2003; Hofmann & Smits, 2008). Indeed, CBT can help Iranian males with addiction to create new thinking networks and adapt behaviors which can challenge maladaptive networks and memories. CBT benefits from such techniques as relaxation and cognitive restructuring. By cognitive restructuring, Iranian males with addiction can learn how to challenge the truth of anxiety-producing thoughts through considering some pieces of evidence against those thoughts (Arch & Craske, 2008). Moreover, relaxation exercises decrease muscle tension, heart rate, and breathing rate of Iranian males with addiction. Iranian males with addiction who produce these bodily responses report a decrease in their anxiety level (Miltenberger, 2011). In addition, promoting relaxation can improve blood circulation and brain function, and thus reduce anxiety (Shaw et al., 2013).

The results of this study also showed that CBT was effective in reducing stress levels in Iranian males with addiction. In general, many previous studies have confirmed that CBT can be extremely effective in reducing stress (Kim, 2007; Richardson & Rothstein, 2008; van der Klink, Blonk, Schene, & van Dijk, 2001). Regarding this, CBT can help Iranian males with addiction learn coping strategies. Developing coping styles can develop individuals’ ability to adapt to stressful situations and to reduce their stress. Besides, CBT can reduce levels of stress in Iranian males with addiction through supporting them and helping them to understand that they are not left alone with their problems. Moreover, CBT includes stress management training because stress managing can reduce anxiety and stress (Shaw et al., 2013).

The overall results of this study showed that CBT can be effective in reducing depression, anxiety, and stress. However, to conclude that CBT was definitely effective in reducing depression, anxiety, and stress, more studies are needed. With regard to the high comorbidity of these disorders with substance abuse and considering the fact that these factors can be posed as obstacles to drug abuse treatment, it is necessary for professionals to consider them in the healing process.

The present study was conducted on Iranian males with addiction; it is suggested that future studies be done to examine the effect of CBT on depression, anxiety, and stress levels in Iranian females with addiction. The sample size of this study was small. This can threaten generalizability of the study’s findings. It is recommended, therefore, that future studies benefit from more participants.

Convenience sampling was used for the selection of participants of this study. Therefore, generalizability of the results to the statistical population should be made with caution.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,authorship,and/or publication of this article.

Funding

The author(s) received no financial support for the research,authorship,and/or publication of this article.

Author Biographies

Ghorban Hemati Alamdarloo earned a PhD in special education from Tehran University. He is an associate professor in department of special education at Shiraz University,Shiraz,Iran. He teaches courses in special education,intellectual and developmental disabilities,and learning disabilities. He has scholarly publications on issues around people with special needs.

Soheila Moradzadh Khorassani earned a MA in general psychology from Semnan Branch,Islamic Azad University. She has scholarly publications on issues around addiction.

Mahmoud Najafi earned a PhD in psychology from Allameh Tabataba’i University. He is an assistant professor in department of clinical psychology at Semnan University,Semnan,Iran. He teaches courses in personality and developmental psychology. He has scholarly publications on issues around addiction and positive psychology.

Fatemeh Soosan Jabbari earned a PhD in curriculum development from Shiraz University. She is an assistant professor in department of special education at Shiraz University,Shiraz,Iran. She teaches courses in curriculum and special education,learning disabilities and emotional and behavioral disorders. She has scholarly publications on issues around children with special needs and curriculum development.

Setareh Shojaee earned a PhD in special education from Tehran University. She is an assistant professor in department of special education at Shiraz University,Shiraz,Iran. She teaches courses in special education,intellectual and developmental disabilities,and learning disabilities. She has scholarly publications on issues around people with special needs.

References

Andreou

Alexopoulos

E. C.

Lionis

Varvogli

Gnardellis

Chrousos

G. P.

Darviri

(2011). Perceived stress scale: Reliability and validity study in Greece. International Journal of Environmental Research and Public Health, 8, 3287-3298.

Arch

J. J.

Craske

(2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology: Science and Practice, 15, 263-279.

Asghari

Saed

Dibajnia

(2008). Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. International Journal of Psychology, 2, 82-102.

Beltman

M. W.

Oude Voshaar

R. C.

Speckens

A. E.

(2010). Cognitive-behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomised controlled trials. The British Journal of Psychiatry, 197, 11-19.

Butler

A. C.

Beck

A. T.

(1995). Cognitive therapy for depression. The Clinical Psychologist, 48(3), 3-5.

Charney

D. A.

Palacias-Boix

Negrete

J. C.

Dobkin

P. L.

Gill

K. J.

(2005). Association between concurrent depression and anxiety and six-month outcome of addiction treatment. Psychiatric Services, 56, 926-933.

Christner

R. W.

Stewart

J. L.

Freeman

(2007). Cognitive-behavior group therapy with children and adolescents: Specific settings and presenting problems. New York, NY: Taylor & Francis.

Ghahramanlou

(2003). Cognitive behavioral treatment efficacy for anxiety disorders: A meta-analytic review (Doctoral dissertation). Teaneck, NJ: Fairleigh Dickinson University.

Goeders

N. E.

(2003). The impact of stress on addiction. European Neuropsychopharmacology, 13, 435-441.

10.

Gomez

(2014). A guide to the Depression, Anxiety and Stress Scale. Retrieved from http://www.academia.edu/25177167/A_Guide_to_the_Depression_Anxiety_and_Stress_Scale_DASS_21

11.

Hamzeh Pour

. (2014). The effect of cognitive behavioural therapy on anxiety in infertile women. European Journal of Experimental Biology, 4, 415-419.

12.

Hanter

S. B.

Paddock

S. M.

Zhou

Watkins

K. E.

Hepner

K. A.

(2013). Do client attributes moderate the effectiveness of a group cognitive behavioral therapy for depression in addiction treatment? The Journal of Behavioral Health Services & Research, 40, 57-70.

13.

Hofmann

S. G.

Smits

J. A. J.

(2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69, 621-632.

14.

Hofmann

S. G.

J. Q.

Boettcher

(2014). Effect of cognitive behavioral therapy for anxiety disorders on quality of life: A meta-analysis. Journal of Consulting and Clinical Psychology, 82, 375-391.

15.

Hollon

S. D.

Stewart

M. O.

Strunk

(2006). Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology, 57, 285-315.

16.

Hunter

S. B.

Witkiewitz

Watkins

K. E.

Paddock

S. M.

Hepner

K. A.

(2012). The moderating effects of group cognitive behavioral therapy for depression among substance users. Psychology of Addictive Behaviors, 26, 906-916.

17.

Jayasvasti

Hiransuthikui

Pityaratstian

Lohsoonthorn

Kanchanatawan

Triruangworawat

(2011). The effect of cognitive behavioral therapy and changes of depressive symptoms among Thai adult HIV-infected patients. World Journal of AIDS, 1(2), 15-22.

18.

Johnco

Wuthrich

V. M.

Rapee

R. M.

(2014). The influence of cognitive flexibility on treatment outcome and cognitive restructuring skill acquisition during cognitive behavioural treatment for anxiety and depression in older adults: Results of a pilot study. Behaviour Research and Therapy, 57, 55-64.

19.

Khaledian

Kamar Zarin

Jalalian

(2014). The effectiveness of group cognitive behavior therapy on reduction of addicts’ depression. Addiction Research, 8(29), 77-88.

20.

Khodai

Khazai

Kazemi

Aliabadi

(2012). Effect of cognitive–behavioral group therapy on the depression and anxiety in patients with myocardial infarction. Modern Care Journal, 9, 364-370.

21.

Kim

J. H.

(2007). A meta-analysis of effects of job stress management interventions. Journal of Korean Academy of Nursing, 37, 529-539.

22.

Lander

Howsare

Byrne

(2013). The impact of substance use disorders on families and children: From theory to practice. Social Work in Public Health, 28, 194-205.

23.

Lovibond

(1995). Manual for the Depression Anxiety Stress Scales (DASS). Sydney NSW: Psychology Foundation Monograph.

24.

Marlatt

G. A.

Range

B. P.

(2008). Cognitive-behavioral therapy for alcohol and drug use disorders. Revista Brasileira de Psiquiatria, 30, 588-595.

25.

McGinn

L. K.

(2000). Cognitive behavioral therapy of depression: Theory, treatment and empirical status. American Journal of Psychotherapy, 54, 257-262.

26.

McHugh

R. K.

Hearon

B. A.

Otto

M. W.

(2010). Cognitive behavioral therapy for substance use disorders. Psychiatric Clinics of North America, 33, 511-525.

27.

McNamara

(2000). Stress in young people: What’s new and what to do. New York, NY: A&C Black.

28.

McNamara

(2003). Stress management programme for secondary school students: A practical resource for schools. New York, NY: Routledge.

29.

Miltenberger

R. G.

(2011). Behavior modification: Principles and procedures. Belmont, CA: Thomson Wadsworth.

30.

Momeni

Moshtagh

Purshahbaz

(2010). Effectiveness of cognitive-behavioral group therapy on craving, depression & anxiety among the opiate abusers under MMT. Iranian Rehabilitation Journal, 8(11), 19-23.

31.

Moore

R. G.

Garland

(2003). Cognitive therapy for chronic and persistent depression. Hoboken, NJ: John Wiley.

32.

Okunna

N. C.

Rodriguez-Monguio

Smelson

D. A.

Volberg

R. A.

(2015). An evaluation of substance abuse, mental health disorders, and gambling correlations: An opportunity for early public health intervention. International Journal of Mental Health and Addiction, 14, 618-633.

33.

Osilla

K. C.

Hepner

K. L.

Muñoz

R. F.

Woo

Watkins

(2009). Developing an integrated treatment for substance use and depression using cognitive behavioral therapy. Journal of Substance Abuse Treatment, 37, 412-420.

34.

Parker

Roy

Eyers

(2003). Cognitive behavior therapy for depression? Choose horses for courses. The American Journal of Psychiatry, 160, 825-834.

35.

Reilly

P. M.

Shopshire

M. S.

(2014). Anger management for substance abuse and mental health clients: A cognitive behavioral therapy manual. Journal of Drug Addiction, Education and Eradication, 10, 199-238.

36.

Richardson

K. M.

Rothstein

H. R.

(2008). Effects of occupational stress management intervention programs: A meta-analysis. Journal of Occupational Health Psychology, 13, 69-93.

37.

Riper

Andersson

Hunter

S. B.

de Wit

Berking

Cuijpers

(2014). Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: A meta-analysis. Addiction, 109, 394-406.

38.

Sareen

Chartier

Paulus

M. P.

Stein

M. B.

(2006). Illicit drug use and anxiety disorders: Findings from two community surveys. Psychiatry Research, 142, 11-17.

39.

Schwabe

Dickinson

Wolf

O. T.

(2011). Stress, habits, and drug addiction: A psychoneuroendocrinological perspective. Experimental and Clinical Psychopharmacology, 19, 53-63.

40.

Schwartz

T. L.

Petersen

T. J.

(2009). Depression: Treatment strategies and management. New York, NY: Informal Health Care.

41.

Shaw

R. J.

Sweester

C. J.

St. John

Lilo

Corcoran

J. B.

. . . Horwitz

S. M.

(2013). Prevention of postpartum traumatic stress in mothers with preterm infants: Manual development and evaluation. Issues in Mental Health Nursing, 34, 578-586.

42.

Sinha

(2001). How does stress increase risk of drug abuse and relapse? Psychopharmacology, 158, 343-359.

43.

Sugarman

D. E.

Nich

Carroll

K. M.

(2010). Coping strategy use following computerized cognitive-behavioral therapy for substance use disorders. Psychology of Addictive Behaviors, 24, 689-695.

44.

Sword

Niccols

Yousefi-Nooraie

Dobbins

Lipman

Smith

(2013). Partnerships among Canadian agencies serving women with substance abuse issues and their children. International Journal of Mental Health and Addiction, 11, 344-357.

45.

Tatalovic Vorkapic

Dadic-Hero

Ruzic

. (2013). The relationship between personality traits and anxiety/depression levels in different drug abusers’ groups. Annali dell’Istituto Superiore di Sanità, 49, 365-369.

46.

Taylor

F. G.

Marshall

W. L.

(1997). Experimental analysis of a cognitive-behavioral therapy for depression. Cognitive Therapy and Research, 1, 59-72.

47.

Toneatto

Calderwood

(2015). Cognitive-behavior therapy for concurrent anxiety and alcohol use disorder: A randomized control trial. International Journal of Mental Health and Addiction, 13, 297-306.

48.

Tran

T. D.

Tran

Fisher

(2013). Validation of the Depression Anxiety Stress Scales (DASS) 21 as a screening instrument for depression and anxiety in a rural community-based cohort of northern Vietnamese women. BMC Psychiatry, 13, Article 24.

49.

van der Klink

J. J.

Blonk

R. W.

Schene

A. H.

van Dijk

F. J

. (2001). The benefits of interventions for work-related stress. American Journal of Public Health, 91, 270-276.

50.

van Straten

Geraedts

Verdonck-de Leeuw

Andersson

Cuijpers

. (2010). Psychological treatment of depressive symptoms in patients with medical disorders: A meta-analysis. Journal of Psychosomatic Research, 69, 23-32.

51.

Viqnola

R. C.

Tucci

A. M.

(2014). Adaptation and validation of the Depression, Anxiety and Stress Scale (DASS) to Brazilian Portuguese. Journal of Affective Disorders, 155, 104-109.

52.

Volkow

N. D.

(2014). Principles of adolescent substance use disorder treatment: A research-based guide. Baltimore, MD: National Institute on Drug Abuse.

53.

Wand

(2008). The influence of stress on the transition from drug use to addiction. Alcohol Research & Health, 31, 119-136.

54.

Watkins

K. E.

Hunter

S. B.

Hepner

K. A.

Paddock

S. M.

de la Cruz

Zhou

A. J.

Gilmore

(2011). An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Archives of General Psychiatry, 68, 577-584.

55.

Weersing

V. R.

Brent

D. A.

(2006). Cognitive behavioral therapy for depression in youth. Child and Adolescent Psychiatric Clinics of North America, 15, 939-957.

The Effect of Cognitive-Behavioral Therapy on Depression,Anxiety,and Stress Levels in Iranian Males With Addiction

Abstract

Keywords

Introduction

Method

Population, Sample, and Sampling Procedure

Depression Anxiety and Stress Scale (DASS)

Procedure for CBT

Results

Discussion

Footnotes

Declaration of Conflicting Interests

Funding

Author Biographies

References