The Effect of a Self-Forgiveness Model on Self-Stigma in Individuals Diagnosed With Substance Use Disorder.

Participants of this study will consist of individuals 18 years of age or older, who have been admitted to the short-term rehabilitation program affiliated with UPMC and have agreed to take part in research designed to examine the relationship between self-forgiveness and self-stigma in individuals with SUD.

Patients will be made aware of the study by the principal investigator during an initial, in-person assessment that will occur within 48 hours of their admission to the unit. All patient rooms on this unit are limited to one patient which allows for privacy. Those who express interest, will be provided a copy of the Informed Consent Form and made aware of their right to decline participation or withdraw at any time, the limits of confidentiality, and that a lack of participation will not affect the level of care they receive. Patients who choose to participate in the study will be required to agree to the terms detailed in the consent form by signing and dating the form. Patients will then be assigned a participant number which be recorded on a link sheet only available to the principal investigator. Randomization software developed by GraphPad Software, Inc. will be used to randomly assign participants to either the experimental group or control group and that group assignment will be recorded on the link sheet. Participants will not be made aware of the group to which they have been assigned.

Prior to administering the SFPDS and SASSS to the participant, the principal investigator will write the corresponding participant number and group assignment on the top right-hand corner of the assessments. The participant will be asked to recall an event from their past that currently evokes feelings of regret. The participant will then be provided a copy of the SFDPS and SASSS. Because cultural and demographic factors such as level of education and physical disabilities are more common with this population, participants can choose to have the assessments administered orally. It is estimated that combined, the assessments will take 30 to 40 minutes to administer. To increase validity, participants will be informed that their answers will not be shared with other participants or members of the treatment team. Completed assessments will be collected and placed in an individual participant folder accessible only to the principal investigator. SFDPS and SASSS scores will be recorded on the link sheet in the pre-test columns.

Over the next 14 days, in addition to treatment as usual (TAU), participants in the experimental group will be introduced to techniques based on a six-step model of self-forgiveness during six individual sessions facilitated solely by the principal investigator. Participants in the control group will participate in the daily TAU schedule which includes four group therapy sessions facilitated by the social services team (counselors and social workers), two 12-step meetings facilitated by outside representatives of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), dietary, spirituality, medical care including vital signs and the administration of prescribed medication by the nursing staff, and individual needs assessment with a recommendation of appropriate aftercare. The six-step model includes a workbook that applies Worthington's conceptualization of self-forgiveness and guides the practitioner and participant through the self-forgiveness process. Each step provides a framework for techniques and includes psychoeducation, interventions, and "homework" to be completed in between sessions. The individual sessions will not conflict with the timing or content of the unit's regular treatment schedule, thus, participation in the study will not affect a patient's ability to participate in TAU. All interventions will be done individually to ensure that participant confidentiality is respected throughout the therapeutic process. After the sixth session, participants will be administered the SFDPS and SASSS for a second time. Scores will be recorded on the link sheet in the post-test columns. Participants who were in the control group will be offered a copy of the self-forgiveness workbook and provided additional support if requested.

Power analysis was performed utilizing G*Power 3.1, a stand-alone power analysis program for statistical tests used in the social, behavioral, and biomedical sciences. Using a desired power of .8 and a p-value of <.05, it was determined that an appropriate sample size to detect a significant difference in pre-test and post-test scores on the SFDPS and SASSS between the experimental group and control group is N=128 participants. Thus, the selection process will be repeated until a minimum of 64 experimental group participants and a minimum of 64 control group participants have completed the study.