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Cited by 353Mindfulness and Compassion InterventionsSubstance Abuse Treatment and OutcomesMental Health Treatment and Access

Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes

Open access
Luoma, Jason B., Kohlenberg, Barbara S., Hayes, Steven C., Bunting, Kara, Rye, Alyssa K.·2008·Addiction Research & Theory
DOI 10.1080/16066350701850295PMC PMC5064952
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Abstract

Little is known about the assessment and treatment of self-stigma in substance abusing populations. This article describes the development of an acceptance based treatment (Acceptance and Commitment Therapy - ACT) for self-stigma in individuals in treatment for substance use disorder. We report initial outcomes from a study with 88 participants in a residential treatment program. The treatment involves 6 h of a group workshop focused on mindfulness, acceptance, and values work in relation to self-stigma. Preliminary outcomes showed medium to large effects across a number of variables at post-treatment. Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.

Integrity signals

Registry

Crossref · 10.1080/16066350701850295

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

18 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 50 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At post-treatment, the preliminary outcomes showed medium to large effects across several variables.

    “Preliminary outcomes showed medium to large effects across a number of variables at post-treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    Change scores increased over time for overall mental health, F(1, 7, 39) = 4.17, p = 0.048.

    “and for overall mental health, F(1, 7, 39) = 4.17, p = 0.048.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Believability of stigmatizing attitudes did not change significantly, t(47) = 0.35, p = 0.73.

    “Believability of stigmatizing attitudes was available for all nine cohorts and did not change significantly, t(47) = 0.35, p = 0.73.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants showed significant improvement in general mental health on the GHQ, t(47) = 3.79, p = 0.001, d = 0.49.

    “Participants showed a significant improvement in general mental health as measured by the GHQ, t(47) = 3.79, p = 0.001, d = 0.49”
    Quote in the paperNot a substantial claim
  • Findingown data

    There was no significant change in social support from family, t(16) = 0.91, p = 0.376.

    “but not on subscales measuring social support from family t(16) = 0.91, p = 0.376”
    Quote in the paperNot a substantial claim
  • May combine two claims. 18
  • Classified as probably not a substantial claim. 36

  • May combine two claims.

    Findingown data

    Experiential avoidance behaved as expected as a potential process of change, while results for other potential mediators were mixed.

    “Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Seven percent said they had encountered none of the listed stigma experiences.

    “Seven percent (n = 6) reported no experiences with stigma on these questions”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixty-seven percent of participants reported that some friends rejected them after learning of their substance use.

    “Sixty-seven percent (N = 16) reported having had some of their friends reject them when they found out they were using substances.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Seventy-one percent reported they would be interested in returning to the same workshop if seeking help again.

    “About the same number, 71%, reported that were they to seek help again, they would be interested in returning to this same workshop.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    At pre-intervention, completers averaged 69.07 (SD = 18.0) on the QOLS, between 'mixed' and 'mostly satisfied'.

    “At pre-intervention, completers scored an average of 69.07 (SD = 18.0) on the QOLS. This corresponds to an average rating somewhere between ‘‘mixed’’ and ‘‘mostly satisfied’’ on ratings of different domains of life.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixty-four percent reported that some people feared them after learning of their substance use.

    “Sixty-four percent (N = 16) reported that some people were afraid of them when they found out they were using substances.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Across the nine items, 18.9% on average reported frequently, almost always, or always experiencing the listed forms of rejection.

    “On average across the 9 items, 18.9% of respondents reported ‘‘frequently’’, ‘‘almost always’’ or ‘‘always’’ experiencing the various forms of rejection listed in the scale.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Thirteen percent reported that employers paid them a lower wage because of their substance use history.

    “Thirteen percent (N = 4) reported that employers had paid them a lower wage because they knew they had a substance use history.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among the 27 participants who attended less than 4 hours of intervention, 7 completed follow-up, and this subgroup did not significantly improve on any measure.

    “Of the 27 who attended less than 4 h of intervention, 7 completed follow-up assessments enabling assessment of treatment outcomes. This subgroup did not significantly improve on any measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The mean item score on the stigma-related rejection measure was 3.14 (SD = 1.61), corresponding to 'seldom'.

    “On our measure of stigma-related rejection, the mean item score was 3.14 (SD = 1.61), which corresponds to ‘‘seldom’’ on the scale.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixty-three percent reported unfair treatment because others knew about their substance use.

    “Sixty-three percent (N = 19) reported unfair treatment because others knew they were using substances.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixty-five percent reported that some family members gave up on them after learning of their substance use.

    “Sixty-five percent (N = 17) reported that some of their family gave up on them when they found out they were using substances.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    More than 61% reported three or more types of rejection.

    “over 61% (n = 50) reported 3 or more types of rejection.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Visual inspection showed that Dr Hayes co-led the first two groups and that these groups had shame effect sizes similar to some later groups.

    “Visual inspection of the data showed an interesting pattern. Dr Hayes, the creator of ACT, was one of the co-leaders of the first two groups and these groups showed effect sizes on shame that corresponded to those of some of the later groups.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    After other leaders took over, outcomes first had lower effect sizes but later recovered above those of Dr Hayes's initial two groups.

    “Once others were leading the groups, the outcomes were initially of lower effect size, but later recovered to levels higher than those obtained by Dr Hayes in the initial two groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Substance abuse tends to evoke more negative social attitudes than schizophrenia.

    “These problems are particularly severe in the area of substance abuse, which tends to evoke even greater negative social attitudes than schizophrenia (Corrigan et al. 2000; Crisp et al. 2000).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Corrigan et al. 2000

      Not checked in the free run.

    • cites Crisp et al. 2000

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Across many studies, measures such as the AAQ and believability of negative thoughts have mediated ACT outcomes, suggesting that changes in the function rather than the form of private experiences explain ACT effects.

    “Across a range of studies these measures have proven to mediate outcomes in ACT, indicating that changes in the function of private experiences, and not their form explains ACT outcomes (Hayes et al. 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes et al. 2006

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Believability of stigmatizing attitudes mediated follow-up outcomes for ACT but not for Multicultural Training.

    “What is perhaps most important for present purposes, a measure of believability of stigmatizing attitudes successfully mediated follow-up outcomes (i.e., burnout and the frequency of stigmatizing attitudes) for ACT, but not Multicultural Training.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hayes et al. 2004d

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among people with serious mental illness, self-stigma has been linked to delayed treatment seeking, lower self-esteem or self-efficacy, and poorer quality of life.

    “In this population, self-stigma has been associated with delays in treatment seeking (Kushner and Sher 1991; Scambler 1998; Starr et al. 2002), diminished self-esteem/self-efficacy (Wright et al. 2000; Corrigan and Watson 2002; Link et al. 2002) and lower quality of life (Rosenfield 1997).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Kushner and Sher 1991

      Not checked in the free run.

    • cites Wright et al. 2000

      Not checked in the free run.

    • cites Rosenfield 1997

      Not checked in the free run.

  • May combine two claims.

    Premisenone given

    The evidence on self-stigma's impact is most extensive for people with serious mental illness, most of whom also have substance use problems.

    “The data on the impact of self-stigma are most extensive with the seriously mentally ill, the majority of whom also have substance use problems.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The strongest evidence for stigma reduction comes from interventions that create positive personal contact between stigmatizers and stigmatized people.

    “The strongest evidence is found for interventions that focus on creating personal contact between stigmatizers and those stigmatized, in a positive context (Link et al. 2002; Couture et al. 2006).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Link et al. 2002 source

      Not checked in the free run.

    • cites Couture et al. 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    It may be less useful to try to eliminate stereotypes directly and more effective to modify the functional link between thoughts, feelings, and overt behavior.

    “This suggests that it may be less fruitful to directly attempt to eliminate particular stereotypes, but rather that it may be a more effective strategy to modify the functional link between thoughts, feelings and overt behavior rather than the content or frequency of those thoughts and feelings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    On a measure of frequency of stigmatizing attitudes, multicultural training improved more than the educational control from pre- to post-treatment, while ACT did not.

    “On a measure of the frequency of stigmatizing attitudes, multicultural training improved more than the educational control from pre- to post-treatment while ACT did not.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al. 2004d

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    ACT is based on Relational Frame Theory, a behavior analytic theory of language and cognition that distinguishes contextual events changing cognitive structure from those changing function.

    “The treatment we chose to apply to self-stigma, ACT, is based on a contemporary behavior analytic theory of language and cognition called Relational Frame Theory (Hayes et al. 2001), which differentiates between contextual events that change the structure of cognitive networks and those that change their function.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al. 2001

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In what appears to be the only controlled intervention study on enacted substance abuse stigma, ACT was used with substance abuse counselors.

    “In what appears to be the only controlled intervention study to date on enacted substance abuse stigma, ACT was applied as an intervention for substance abuse counselors (Hayes et al. 2004d).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hayes et al. 2004d

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Mindfulness and acceptance procedures appear helpful across many behavioral problems, and DBT and ACT have shown effects in addictions.

    “Mindfulness and acceptance procedures appear to be helpful across a wide range of behavioral problems (Hayes et al. 2004c), and both DBT (Linehan et al. 1999, 2002), and ACT (Gifford et al. 2004; Hayes et al. 2004e), have demonstrated impact in the area of addictions.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Hayes et al. 2004c

      Not checked in the free run.

    • cites Linehan et al. 1999

      Not checked in the free run.

    • cites Gifford et al. 2004 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In that study, pre-treatment correlations between feeling set apart or different and depression and self-esteem appeared lower at 2-year follow-up, which the authors interpreted as possible change in the relationship between stigmatizing beliefs and psychological health.

    “Pre-treatment correlations between feeling set apart or different (two components of stigma) and depression (r = 0.57) and self esteem (r = 0.49) appeared to be lower at the 2 year follow-up (depression, r = 0.27; self-esteem, r = −0.14)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Link et al. 2002 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Although the ISS and ISSA do not perfectly match the paper's definition of self-stigma, they appear to capture a substantial part of the phenomena of interest.

    “While neither of these measures conforms perfectly to our definition of self-stigma, they do appear to capture a good part of phenomena of interest so that treatment develop can continue while we are developing a better measure of self-stigma.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The ISS and ISSA, despite not perfectly matching the paper's definition of self-stigma, capture a substantial part of the phenomena of interest.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The stigma-related rejection measure had coefficient alphas of 0.83 at pre- and 0.91 at post-assessment.

    “Estimates of internal consistency (coefficient alpha) of 0.83 at pre- and 0.91 at post-assessment were obtained in the current study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Of 88 participants who completed the preassessment, 55 (63%) completed follow-up, and 48 (55%) attended at least 4 hours of intervention and were defined as completers.

    “Of the 88 participants who completed the preassessment, 55 (63%) completed follow up. Of these, 48 participants (55%) also attended at least 4 h of the intervention and were therefore defined as completers.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Client Satisfaction Questionnaire-3 had an internal consistency estimate of 0.84 (coefficient alpha) in the present study.

    “The present study obtained an adequate internal consistency estimate of 0.84 (coefficient alpha).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Quality of Life Scale had a coefficient alpha of 0.93 in the present study.

    “The coefficient alpha estimate obtained in the present study was 0.93.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The perceived stigma measure had Cronbach's alphas of 0.91 at pre-assessment and 0.92 at post-assessment.

    “The present study obtained Cronbach’s alphas of 0.91 at pre-assessment and 0.92 at post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These QOLS scores were about one standard deviation worse than those of a sample with chronic physical illnesses.

    “These scores are fairly low, that is, about one standard deviation worse than a sample of patients with chronic physical illnesses (Burckhardt et al. 1989).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Burckhardt et al. 1989

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Changing the stigma-related rejection scale from a 5-point to a 7-point Likert scale limits direct comparisons with mental health consumer samples but is unlikely to affect the measure's validity for this study.

    “While this change limits our ability to make direct comparisons with mental health consumer samples, it seems unlikely to affect the validity of this measure for the purposes of our study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The total Multidimensional Scale of Perceived Social Support had coefficient alphas of 0.92 and 0.95 at pre- and post-assessment.

    “The total scale obtained high coefficient alphas, with reliability estimates of 0.92 and 0.95 at pre- and post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Self-Concealment Scale had coefficient alphas of 0.92 at pre-assessment and 0.95 at post-assessment in the present study.

    “The present study obtained a coefficient alpha of 0.92 at pre-assessment and 0.95 at post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Rosenberg Self-Esteem Scale had coefficient alphas of 0.91 at pre-assessment and 0.85 at post-assessment in the current study.

    “The current study obtained coefficient alphas of 0.91 at pre-assessment and 0.85 at post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Working Alliance Inventory-Short Form had a coefficient alpha of 0.92 in the present study.

    “An estimate of 0.92 (coefficient alpha) was obtained in the present study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The GHQ-12 had Cronbach's alphas of 0.91 at pre- and 0.92 at post-assessment in the current study.

    “The current study obtained slightly higher estimates, obtaining a Cronbach’s alpha of 0.91 at pre- and 0.92 at post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Believability of Reasons Scale had coefficient alphas of 0.95 at pre- and 0.97 at post-assessment in the present study.

    “Cronbach’s alphas indicate high internal validity; the present study obtained coefficient alphas at 0.95 at pre- and 0.97 at post-assessment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Because the trial was exploratory, no adjustment for experiment-wise alpha was made.

    “Given the exploratory purposes of this preliminary trial, no attempt was made to adjust for experiment-wise alpha.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Prior work also found that ACT reduced substance use itself.

    “and to reduce actual substance use (Hayes et al. 2004e, 2004f)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hayes et al. 2004e

      Not checked in the free run.

    • cites Hayes et al. 2004f

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    This initial pilot study produced a manual that shows promise for reducing self-stigma.

    “This initial pilot study resulted in a manual that has promise in the reduction of self-stigma.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    ACT mainly aims to modify two processes: experiential avoidance and cognitive fusion.

    “As reviewed above, ACT largely attempts to modify two specific processes, experiential avoidance and cognitive fusion.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Stigmatizing Attitudes-Believability Scale was developed by asking drug and alcohol counselors to describe common stigmatizing attitudes toward clients.

    “The Stigmatizing Attitudes-Believability Scale was developed by asking drug and alcohol counselors to describe common stigmatizing attitudes towards clients”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Those counselor-described attitudes may differ from the thoughts people in recovery have about themselves.

    “but these may not be the same thoughts that people in recovery have about themselves.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Several theorists have proposed that treatment should directly target shame.

    “a number of theorists have suggested that shame needs to be directly targeted in treatment (Dearing et al. 2005; Wiechelt 2007)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Dearing et al. 2005

      Not checked in the free run.

    • cites Wiechelt 2007 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    At least one study has shown that the AAQ mediates ACT outcomes.

    “and the AAQ has even been shown to mediate ACT outcomes in at least one study (Bond and Bunce, 2000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bond and Bunce, 2000

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The addictions field commonly holds that shame plays an important role in addiction.

    “It is common lore in the addictions field that shame is an important part of addiction”
    Quote in the paperNot a substantial claim
50 of 50

  • The paper relies on this without support.

    Little is known about the assessment and treatment of self-stigma in substance-abusing populations.

    “Little is known about the assessment and treatment of self-stigma in substance abusing populations.”

  • The paper relies on this without support.

    The ISS and ISSA, despite not perfectly matching the paper's definition of self-stigma, capture a substantial part of the phenomena of interest.

    “While neither of these measures conforms perfectly to our definition of self-stigma, they do appear to capture a good part of phenomena of interest so that treatment develop can continue while we are developing a better measure of self-stigma.”

  • The paper relies on this without support.

    The working alliance scale had not previously been used to assess brief group therapies.

    “However, the comparison may not be apt since this scale has apparently not been previously used to assess brief group therapies.”

  • The paper relies on this without support.

    ACT had not previously been applied to self-stigma in any population.

    “it has not previously been applied to self-stigma in any population.”

  • The paper relies on this without support.

    The concurrent treatment program had no significant changes.

    “since no significant changes occurred in the concurrent treatment program.”

  • The paper relies on this without support.

    No other study in the literature has shown improved outcomes over time during a manual development process.

    “We are not aware of any other study in the literature that has shown improved outcomes over time during a manual development process.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Because of its transdiagnostic nature, Acceptance and Commitment Therapy can effectively target common comorbid psychological disorders such as depression and anxiety.

    “Because of the transdiagnostic nature of ACT, it can effectively target common comorbid psychological disorders such as depression and anxiety.85–87”

    From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [86]

    The Introduction’s stigma intervention research section (page not provided) says mindfulness and acceptance procedures appear helpful across a wide range of behavioral problems, supporting the broad cross-problem premise. The paper’s pilot outcomes concern self-stigma in people receiving substance-use treatment; they do not establish that ACT effectively treats comorbid depression or anxiety. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Internalized stigma is associated with feeling shame regarding one's stigmatized condition.

    “Internalized stigma, where an individual identifies with a stigmatized group (such as a chronic illness population), is associated with feeling shame regarding one's stigmatized condition (Akbari, Mohammadi, and Hosseini 2023;Earnshaw et al. 2022;Luoma et al. 2008; The Public Health Agency of Sweden 2024).”

    From Illness Stigma and Shame in People With Chronic Illnesses vs. SARS‐CoV‐2 Survivors: Associations With Psychological Distress Through Psychological Flexibility and Self‐Compassion. (2024) · cites this paper as Luoma et al. 2008

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: t(16) = 2.56, p = .038

    Minor

    The paper reports p = .038 here; recomputing from the test statistic and its degrees of freedom gives p = .021 (two-tailed). The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p = .038 · recomputed p = .021

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upt(16) = 2.56reported p = .038 · recomputed p = .021

    “t(16) = 2.56, p = .038”

  • Consistentt(47) = 4.59reported p < .001 · recomputed p < .001

    “t(47) = 4.59, p < .001”

  • Consistentt(17) = 2.39reported p = .029 · recomputed p = .029

    “t(17) = 2.39, p = .029”

  • Consistentt(47) = 3.79reported p = .001 · recomputed p < .001

    “t(47) = 3.79, p = .001”

    The paper prints p at a floor (such as p < .001)

  • Consistentt(47) = 0.89reported p = .38 · recomputed p = .378

    “t(47) = 0.89, p = .38”

  • Consistentt(29) = 1.53reported p = .14 · recomputed p = .137

    “t(29) = 1.53, p = .14”

  • Consistentt(16) = 2.66reported p = .017 · recomputed p = .017

    “t(16) = 2.66, p = .017”

  • Consistentt(14) = 3.68reported p = .002 · recomputed p = .002

    “t(14) = 3.68, p = .002”

  • Consistentt(16) = 0.91reported p = .376 · recomputed p = .376

    “t(16) = 0.91, p = .376”

  • Consistentt(16) = 1.04reported p = .31 · recomputed p = .314

    “t(16) = 1.04, p = .31”

  • Consistentt(47) = 0.35reported p = .73 · recomputed p = .728

    “t(47) = 0.35, p = .73”

  • Consistentt(29) = 3.07reported p = .005 · recomputed p = .005

    “t(29) = 3.07, p = .005”

  • Consistentt(29) = 0.36reported p = .72 · recomputed p = .721

    “t(29) = 0.36, p = .72”

  • Consistentt(17) = 3.56reported p = .002 · recomputed p = .002

    “t(17) = 3.56, p = .002”

  • ConsistentF(1, 46) = 16.54reported p < .001 · recomputed p < .001

    “F(1, 46) = 16.54, p < .001”

  • ConsistentF(1, 44) = 9.66reported p = .003 · recomputed p = .003

    “F(1, 44) = 9.66, p = .003”

  • Consistentr(29) = 0.7reported p < .0001 · recomputed p < .001

    “r(29) = 0.70, p < .0001”

  • Consistentr(29) = 0.51reported p < .01 · recomputed p = .003

    “r(29) = 0.51, p < .01”

18 of 18

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Perceived stigma is treated as both a nine-cohort and a five-cohort measure

    Minor

    The cohort analysis says it used variables available for all nine cohorts and then reports an effect for perceived stigma. Elsewhere, the paper says that measure was available only for the first five cohorts.

  • Two differently titled references occupy the same journal pages

    Minor

    The 2004e and 2004f entries have different titles but assign both papers the same authors, journal, volume, and page range. They cannot be distinct articles at the same location.

  • Counselor intervention is assigned the wrong reference label

    Minor

    The text attributes the substance-abuse-counselor intervention to Hayes et al. 2004d, but the reference labeled 2004d is about measuring experiential avoidance. The counselor intervention appears in the reference list as 2004a.

3 of 3

Cites

Flagged first, then by citations

2 of the 80 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Bissett RT, 2002, ProQuest Information & Learning, 63, 10146
  2. Hayes SC, 2005, Get out of your mind and into your life: The new acceptance and commitment therapy
  3. 10.1016/S0005-7894(04)80014-5 · DOI · Paper page
  4. Vieweg BW, 1983, Journal of Operational Psychiatry, 14, 74

Cited by

Sorted by citations

Related

Authors
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K.
Affiliations
University of Nevada, Reno (US)
Corresponding author
Luoma, Jason B.
ORCID
Venue
Addiction Research & Theory
Publisher
Informa UK Limited
Published
2008-01
Volume
16
Issue
2
Pages
149-165
ISSN
  • 1058-6989 (ISSN-L)
  • 1606-6359
  • 1476-7392
DOI
10.1080/16066350701850295
PMC
PMC5064952
OpenAlex
W2100867996
Cited by
353
References
80
Citations by year
2026: 10 · 2025: 23 · 2024: 24 · 2023: 30 · 2022: 30 · 2021: 33 · 2020: 21 · 2019: 25 · 2018: 19 · 2017: 23 · 2016: 11 · 2015: 16 · 2014: 24 · 2013: 19 · 2012: 9
FWCI
12.64
Type
journal article
Language
en
Open access
Locations
  • Addiction Research & Theory (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (R21DA017644)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
self-stigma, substance use disorders, acceptance and commitment therapy, treatment manual development, residential addiction treatment, group workshops, mindfulness, values work, experiential avoidance, change processes, stigma reduction

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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