Dissertation Chapter 3 – Psychoanalysis and Addiction

CHAPTER 3: RESEARCH METHOD
3.1. Chapter Overview
This chapter describes the research methodology that would be implemented for the proposed study. The chapter initiates with a restatement of the problem statement and purpose for which the study would be undertaken. The initial section also highlighted the justification for exploring the effectiveness of psychoanalysis approach as the treatment modality for managing substance abuse in preference to other psychotherapy approaches. The subsequent sections describe the study population and sampling strategies that would be undertaken for selecting and analyzing the necessary data. The first section described the study design and sampling procedure for collecting the relevant data. This section also described the theoretical and conceptual framework for selecting the specific study design. In this study, a mixed methodology approach would be undertaken. Under this section, power analysis subsection provided the framework for estimating the sample size and power for the study.
The next section described the instruments that would be used to collect the necessary data. The section too was backed by the framework based on which the data collection procedures were selected. Both primary and secondary data would be critiqued to answer the research questions of this study. Psychoanalysis-based therapies help to unfold the root cause of any psychopathic disorder. Although different psychotherapy approaches are based on the behavioral outcomes across concerned stakeholders, psychoanalysis based therapy is centered on the diagnosis of the background that prompt such behaviors.

Hence, the primary facet of psychoanalysis based therapy is to manage an individual based on the root-cause of a psychopathic disorder rather than its content or context. 
The subsequent section would involve the metrics that would be used to conduct data analysis for this study. The data analysis would pivot around the exploration of the cause-and -effect relations between the dependent and independent variables considered in this study. The data analysis section involved the construction of various regression models based on such variables. Both qualitative and quantitative data would be appraised separately in this section. The data analysis section would be followed-up by research questions and hypothesis testing section. The section also defined and highlighted the rationality of different statistical software that would be considered for appraising the qualitative and quantitative data respectively. The research questions and hypothesis testing section would test the hypothesis for each secondary research question that would be explored in this study.
However, an interpretive approach would be adopted to integrate the primary and secondary data before answering the research questions. Such approach would be also undertaken to substantiate the reliability and reproducibility of qualitative or quantitative data. The interpretive approach would be based on preconceived conceptual frameworks that were otherwise stated or explored elsewhere on the same perspective. The inferential statistics would be backed by reliability analysis for sampling adequacy and appropriateness of the variables that will be considered for the proposed study. The final sections of this chapter would portray the ethical principles that govern research with human subjects and a critique of the proposed methodology.
3.2. Background of the Proposed Research
3.2.1: Introduction
Substance abuse is a serious social, economic, and health burden that not only impact the concerned stakeholders but also the society that surrounds them. The domain of substance abuse includes abuse of alcohol, addiction to narcotics (such as heroin, marijuana, ecstatic drugs) , and abuse of tobacco. The major symptoms of substance abuse include increase in the episodes of cravings, the reduction in period in reverting to abuse after therapy, and increased frequency of abuse. The negative outcomes of substance abuse include increased incidences of emergency visits, accidental injuries, family and domestic violence, and psychopathic disorders. Since there are different facets and symptoms of substance abuse, the condition is jointly referred as “substance abuse disorders” (SUDs). In this regard, psychoanalysis based therapy has generated a lot of interests in effectively managing individuals who are affected with substance abuse.
Sigmund Freud introduced the concept of psychoanalytic psychotherapy where the authors contended that the power of the human brain may be used to overcome its problems. As a result, it would help the concerned stakeholders to overcome substance abuse behaviors. Psychoanalysis not only helps to identify the appropriate coping strategy for the concerned stakeholders but is also effective in understanding the psychodynamics and developmental influence that predisposes the risk of substance abuse in various individuals. For example, personality structure and ego functioning are two intrinsic attributes that predispose the risk of drug abuse. Hence, the prognosis of substance abuse-affected individuals would depend on the degree to which their ego and personality traits are preserved through the psychodynamic approaches. Hence, there has been a controversy regarding psychoanalysis as a universal therapeutic modality for substance abuse. On the contrary, various studies have endorsed the benefits of relational psychoanalysis in managing individuals presenting with substance abuse. Relational psychoanalysis a robust approach that aim to identify the multiple meanings, functions, and context of abuse that becomes manifested in patients relationships to self and others. Relational psychoanalysis speculate that human behaviors are not just the outbursts of their intra-psychic attributes, but also the relationships that are necessary for their living where the substance itself plays a significant role in modulating the relations. Psychoanalysis and relational psychoanalysis-based interventions are highly individualistic. These approaches contend that substance abuse behavior is rooted in the developmental expectations across the concerned individuals. Hence, psychotherapeutic approaches involve the identification of multiple symbolic and interpersonal meanings that are associated with substance abuse.
3.2.2: Problem Statement
Although different types of therapeutic interventions (either pharmacological or non-pharmacological) are indicated for managing substance use disorders, none of them are found to be universally effective. The major issues that lead to treatment failure with such interventions are the lack of compliance and will of the respective individuals in aligning themselves with the therapeutic regimes. It is often contended that substance abuse is stringently driven by specific psychosocial factors that are intrinsic within the respective individuals. Hence, the current treatment modalities for SUDs are focusing on individualistic and psychotherapeutic approaches that aim to improve coping across the concerned stakeholders.
3.2.3: Purpose Statements
The proposed study would analyze the facets and influence of substance abuse and drug addiction across at-risk individuals. The study will also explore the role of psychoanalysis in managing substance abuse or SUDs. The proposed study would incorporate a mixed-methodology approach whereby qualitative data would be integrated with quantitative findings to answer the research questions. The primary research question that would be investigated in this study is “To what extent does psychoanalysis have the ability to control substance abuse?” The study will explore different SRQs (secondary research questions) to answer the primary research question comprehensively. The proposed study would help the healthcare providers to understand the effectiveness of psychoanalytical psychotherapy during the different phases of psychotherapy.
3.3. Research Methodology
The research methodology section would involve an interpretive approach based on the integration of primary and secondary data. Both qualitative and quantitative end-points would be considered that would stem from the data sources (either primary or secondary or both). The interpretive approach would critique the relevant data so as to draw conclusive evidence regarding the effectiveness or the limitations of psychoanalytic psychotherapy in respect to other psychotherapy approaches that are administered alone or in combination with other therapeutic modalities for managing substance abuse and its complications across concerned stakeholders. The methodology triad for the proposed study is portrayed in Fig 1.
Findings based on Statistical Analysis and Phenomenological Data (Interpretive Approach)
Primary Data
(Qualitative and Quantitative)
Secondary Data
(Qualitative and Quantitative)

Fig 1: Reflects the methodology that would be adopted for the proposed study
3.3.1. Theoretical and Conceptual Framework: Mixed-Methodology Approach
Qualitative study design in psychology research involves the descriptive analysis of any phenomenon within a specific field that is identified and explored by the researcher. Hence, qualitative research paves the way for obtaining phenomenological data through an in depth and descriptive analysis. However, qualitative study designs are primarily implemented to explore the cause-and-effect relationships for any novel phenomenon. The data is primarily obtained through observations by the researcher or open ended interviews with the study participants. Qualitative study design provides an opportunity to access different facets of a novel and observed phenomenon from the perspective of individuals who are associated with such phenomenon. Hence, qualitative research pivots around subjective meanings and verbatim. Since subjective end-points are best understood through dialogue and open ended questions with the concerned stakeholders, qualitative research methods are considered arguably superior to the close-ended quessstionaires. Subjective analysis is essential for exploring the perspectives of marginalized groups or rare phenomenon that are either unexplained or differently explained. Moreover, subjective data also provide useful insights to a psychologist that is not speculated before the study is initiated. Apart from exploratory analysis, narrative analysis also provides a robust basis for obtaining quality qualitative data.
Different authors have highlighted that narrative analysis provide important subjective data that could be validated across different cross-cultural populations. However, the data that are explored through qualitative studies are often immeasurable and suffer from subjective bias. Hence, the reliability of qualitative studies is often questioned. On the contrary, quantitative studies are implemented to undertake objective analysis that enhances the reliability of an observed phenomenon. Moreover, quantitative studies reduce the probability of subjective bias. However, the translation and uniformity of quantitative data across difference cross-cultural groups are often contradictory. Likewise, quantitative studies that are conducted in the field of psychology lack the necessary conceptual framework and the metric equivalents of research instruments. Therefore, the reproducibility of quantitative studies is often questioned. In this regard, mixed methodology studies that involve the integration of qualitative and quantitative data have gained popularity in the field of psychology research. It is suggested that a mixed methodology approach enhance the reliability and reproducibility of different studies. Mixed methodology studies ensure that the findings are translated across various populations by implementing standardized metrics for data collection and analysis.
3.3.2. The Rationale for Selecting Psychoanalytic Psychotherapy as the Intervention Option
Different authors have highlighted the limitations of other psychotherapy approaches (those including behavioral and cognitive interventions) in improving health outcomes across substance abuse patients. For example, one study showed that such interventions were primarily effective in managing substance abuse across concerned stakeholders during the action and maintenance phases of psychotherapy only. On the contrary, psychoanalytic-based approaches were more effective during the contemplation and pre-contemplation phases of psychotherapy. However, such conclusions pivoted around the management of opiod abuse. Nevertheless, the theoretical framework and principles underpinning psychoanalytic approaches provide grounded support for their effectiveness in managing various types of substance abuse both during the pre-contemplation and contemplation phases as well as during the action and maintenance phases. The present study would provide conclusive evidence on the role of psychoanalytic psychotherapy in improving health outcomes across substance abuse-affected individuals during the different phases of psychotherapy. Psychoanalytic approaches are based on the speculation that unless the cause and root of substance abuse remains unaddressed, it would be difficult to improve health outcomes across the at-risk individuals neither during the contemplation and pre-contemplation phase nor during the action and maintenance phases. 
Psychoanalytic psychotherapy helps the concerned stakeholders to achieve deeper self-insights that include self-awareness, the unconscious desires, the motivations, and the conflicts that are not apparently visible. Although psychoanalytic approaches do not bring about the desired change itself, it certainly helps to avoid repetition of self-harming and unhelpful behaviors. Psychoanalytic approaches are based on the principles of Sigmund Freud, Melanie Klein, and Donald Winnicott. These authors contended that the transfer of relationship between the clinician and patient is essential for improving health outcomes in the respective stakeholders.
Although the philosophy of psychoanalytic psychotherapy in managing addictive disorders is promising, but there is a lack of conclusive evidence over such speculations. Taylor et al. (2012) highlighted that the lack of evidence was primarily due to the implementation of non-randomized study designs. On the other hand, higher and lower effect sizes also confounded the findings of previous studies those explored the effectiveness of short-term and long-term psychoanalytic approaches in managing substance use disorders. Hence, Verma & Vijaykrishnan (2018) stated “establishing the efficacy and effectiveness of psychoanalytic psychotherapy would require the standards of control that are more difficult to maintain in long-term and open-ended therapies.” The authors further contended that the inclusion of psychoanalytic approaches in non-psychoanalytic interventions significantly improved prognosis in individuals exhibiting a history of substance abuse.
Yalisove (1989) mandated modifications in traditional psychoanalytic approaches that include initial phases of therapy which is more supportive and didactic followed by a more traditional mode of psychoanalysis with the therapist playing an active role in the rehabilitation process could justify the effectiveness of “Alcoholics Anonymous” initiatives. Prochaska & Diclemente (1992) highlighted that the changes associated with experiential, cognitive, and psychoanalytic traditions are more helpful during the contemplation and pre-contemplation phases, while those involving behavioral and existential processes are effective during the action and maintenance phases of psychotherapy. Moreover, Rosenthal (2008) highlighted that the number of drop-outs were more for cognitive therapy and pharmacological-based interventions for substance abuse compared to psychoanalysis-based approaches.
3.3. Population and Sample
3.3.1. Study Design and Sampling `
A mixed-methodology approach would be considered as the study design for the proposed research. A mixed-methodology approach involves the integration of qualitative and quantitative data for answering the research questions that are explored through a study. Mixed-methodology approach could involve collection of qualitative data and interpreting the same in quantitative terms or vice-versa. The qualitative and quantitative end-points for the proposed study would be determined and fine-tuned post-appraisal of primary and secondary data. The primary data would be based on a prospective and cross-sectional study design involving human subjects. The primary data would be collected from psychologists and allied healthcare providers (who administer psychoanalysis-based therapy, n=50) and on individuals (those who are diagnosed with different forms of substance abuse; n=160). The psychologists (n=50) who participating in the proposed study would be selected through a snowball sampling. On the contrary, purposive sampling would be administered to select individuals presenting with a history of substance abuse. These individuals would be further selected through stratified random sampling (SRS) based on the type of substance that is abused by the respective patient participant. Although there are different forms of substance abuse, the proposed study would only include individuals exhibiting a history of abuse with either alcohol (n=40), or narcotics (n=40), or smoking (n=40) or mixed abuse (n=40).
The respective individuals would be further allocated into two different subgroups for each category of abuse. The subgroups would comprise of individuals who either received or did not receive psychoanalysis-based therapy for overcoming their substance abuse behavior. The subgroups would be considered as experimental dummies and will be coded as “1” and “0” for “psychoanalysis offered” and “no psychoanalysis offered” categories respectively. Likewise, the individuals who received other treatment modalities apart from psychoanalysis will be coded alphanumerically based on the numbers of therapeutic modalities (that might include pharmacological and non-pharmacological interventions). Finally, the mental health status of the participants would be classified based on the diagnosis of psychopathic disorders (such as major depressive disorder, anxiety disorders, and bipolar disorder). The mental health status of the respective participants would also be alphanumerically coded as “1’ and “0” based on the presence or the absence of such disorders respectively. All participants included for the study must exhibit psychoanalysis-based therapy as one of the therapeutic modalities in their treatment regime. The participants would be further stratified based on their age, socioeconomic status, type of abuse, number of substances used, severity of abuse, abstinence from abuse, frequency of abuse and demographic background. The effectiveness of psychoanalysis would be based on two end-points; abstinence from abuse and frequency of abuse.
3.3.2. Power Analysis
A power analysis is generally undertaken to enhance the reproducibility of a proposed study in subsequent or parallel studies. The present study would be conducted with a power of 70%. This means that the overall findings of the study to be undertaken would be reproducible in 70 out of 100 such studies. The power of this study was intentionally kept low compared to the standards that are generally considered for clinical trials (0.7 versus 0.8). Such assumptions were backed by the finding that the reproducibility of qualitative studies are often confounded by the subjective bias of the participants. On the other hand, psychopathic disorders are often confounded by various psychological, physiological, sociological, and economic variables. Hence, a further reliability analysis based on KMO and Bartlett’s analysis would be undertaken apart from the power analysis-based reproducibility. With a power of 0.7 and 0.05 level of statistical significance, the sample size was worked out to be 210 participants. Hence, the sample size for the proposed study was based on power analysis
3.3.3. Data Collection
Collection of Primary Data
Data Collection from the Psychologists on Psychoanalysis-based therapeutic regimes
The primary data from the psychologists would be obtained through semi-structured interviews. The respective professionals would be invited to answer a few questions that will be both narrative and objective in nature. The narrative responses would form the source of qualitative data while the objective responses would form the basis of quantitative data for this study. The respective individuals would be interviewed through a face-to-face manner and the interview transcripts would be recorded (based on their informed consent) over the digital media. In case the respective professional does not provide informed consent to document their verbatim on the digital media, the responses would be documented in a self-reported fashion. The psychologists should neither be prompted nor forced to share their responses on the questions that are incorporated in the semi-structured interviews. The semi-structured questionnaire that would be used to obtain the subjective responses of the psychologists is presented in Table 1.
Table 1: Data Collection from Psychologists (Semi-structured questionnaire)
(Please share your ratings for rating-based questions on a 10-point Likert Scale )
Years of Professional Practice: Age:
Q1. How do you rate the effectiveness of psychoanalysis in managing substance abuse behavior? Please rate the effectiveness of such approaches with respect to the period of abstinence and episodes of cravings for the respective substance.
Q2. What are the major facilitators and barriers that are associated with this therapeutic modality?
Q3. Does psychoanalysis-based therapy differs in their effectiveness according to the type of abuse? If so, how?
Q4. Does psychoanalysis-based therapy differs in their effectiveness according to the severity of abuse? If so, how?
Q5. Whether the presence of comorbid psychopathic disorders (such as major depressive disorder, anxiety disorders, and bipolar disorder) influences the prognosis of psychoanalysis-based management of substance abuse behavior? If so, how?
Q6. Whether the effectiveness of psychoanalysis based therapy depends
upon the age, socioeconomic status, demographic and ethnic background of the concerned stakeholders? If so, how?
Q7. How do you rate the effectiveness of psychoanalysis-based therapeutic approaches compared to other forms of psychotherapy that are recommended for the management of substance abuse behavior?
Q8. Are there any end points apart from the period of abstinence (POA) and episodes of cravings (ECRA) for defining substance abuse behavior? If so, what are those?
Q9. What are the major predisposing risk factors for substance abuse behavior? Please share your thoughts according to the age and type of abuse.
Q10. Which are the pharmacological and non-pharmacological interventions that you feel are effective and compatible with psychoanalysis-based approaches in managing substance abuse behavior?
Q11. What are the outcomes of substance abuse on the health and social behaviors across concerned stakeholders? Please share your thoughts with special emphasis on anti-social behavior (including family violence) and debility and academic/professional performance in the concerned stakeholders?
Q12. Whether psychoanalysis or other psychodynamic therapies help to alleviate such behaviors? If so, how and to what extent?
The primary data for the patients would be obtained from their electronic health records. However, the specific patient should be either recommended or endorsed by the respective psychologists t o participate in the proposed study. The end-points such as abstinence from substance abuse and episodes of cravings for the respective participants would be obtained from the psychologists who were responsible or would be responsible for managing their clinical condition. Moreover, the parameters that reflect would also be obtained from the respective psychologists. However, neither the patients nor their family members should be approached directly by the researchers for the purpose of the proposed study. The patients (based on the verbatim of the concerned psychologist and the electronic health records) would be initially followed up at an interval of four months post- initiation of psychoanalytic psychotherapy. However, the subsequent follow ups would be undertaken at an interval of six moths. The period of follow ups were so selected to facilitate the evaluation of psychoanalytic psychotherapy over the short and long terms. 
Data Collection from the Psychologists on patient-related outcomes
The verbatim of the psychologists and the electronic health records were analyzed before substantiating patient-related data that is considered for the proposed study (Table 2).
Table 2: Patient-related data that is considered for the proposed study
Age of the Patient (years)
Socioeconomic status: For the purpose of assessing this question collect the total per capita income of the family (including the income of the patient affected with substance abuse) and add the income of the individual with the family income.
Severity of abuse: Please report the number of times the individual abused a specific substrate or a combination of substrates per day and multiply the same with the period of abuse (in days)
Demographic background: Collect the data on gender, ethnic background, and cultural background
Mental health status: Please mention whether the individual exhibited signs and symptoms of MDD or Anxiety Disorders or Bipolar disorders when he was diagnosed with substance abuse behavior.
Type of abuse (TOA): Please mention the types of substance the individual abused. For example, if the individual abused two types of substrate then rate the TOA value=2
Therapeutic Modality: Describe the principle underpinning the therapeutic regime for the concerned stakeholder. Whether the individual is administered psychoanalytic psychotherapy with or without other therapeutic modalities? Keys: If the individual is administered psychoanalytic psychotherapy, please rate him or her as “1” and if they are not administered psychoanalytic psychotherapy, please rate him or her as “0.”
Collection of Secondary Data
The secondary data for the proposed analysis would involve the findings of previous studies that explored psychoanalysis-based approaches for managing different types of substance abuse over the short and long terms. The studies that involved either a systematic review-based analysis or a meta-analysis or those that include randomized controlled and prospective study designs would be prioritized for analyzing the secondary data. A keyword search strategy would be implemented to collect the relevant secondary data for the proposed study. The keywords would be connected with appropriate Boolean connectors to conduct a scoping search. The keywords and Boolean connectors that would be used to retrieve the relevant articles would include “Psychoanalysis” OR “Psychoanalysis-based approach” OR “Psychoanalytic psychotherapy” AND “management” OR “effectiveness” OR “efficacy” AND “substance abuse” OR “addictive behavior” OR “substance use disorders” AND “alcoholics” OR “smokers” OR “opiod use.” The MeSH terms (constructed through the combination of keywords and Boolean connectors) will be used to access different clinical and psychology websites such as PsychInfo, MEDLINE, OVID Online, Cochrane database, and Pubmed Central for selecting the relevant articles. A few articles (table 3) have been already identified as the source of secondary data. However, more studies would get incorporated in the table (Table 2) once the proposed study is initiated.
The secondary data would include evidence-based literature in the form of systematic reviews, meta-analysis, cohort trials, and randomized-controlled trials primarily from the perspective of quantitative analysis. On the contrary, case studies would be considered for the purpose of qualitative analysis only. According to Joanna Briggs Institute systematic reviews and meta-analysis are acknowledged as the highest levels of evidence (Level-1 Evidence) in the field of medical research, while RCT and non-randomized controlled trials are considered as Level-2 and Level-3 evidences respectively in the field of clinical research. Although case studies are recognized as the lowest level of evidence (Level-7 evidence) in the field of clinical research, they are important in the field of phenomenological research. Case studies help to identify the causal relationship for an observed phenomenon through an in-depth analysis of the respective case that is presented through the case study. Each evidence-based literature would be appraised based on the CASP (Critical Appraisal Skills Program) tool.
Various authors suggest that CASP tools are effective in appraising both quantitative and qualitative studies. Moreover, such tools are also effective in critiquing mixed-methodology studies. The CASP tool consist a list of questions that help to evaluate the relevance and reliability of a specific published study. These questions pertain primarily to the background based on which the authors of the respective article conducted the study, the methodology adopted for the reported study, the statistical tests of inference and conclusion that are used to report and interpret the findings of the study. The proposed secondary data analysis would only incorporate such studies with a CASP score of at least eight. The details of the CASP tool that would be considered for the analysis of secondary data is presented in Appendix-I.
The secondary data would be critiqued based on the statistical findings as reported by the respective authors in their studies. However, the descriptive statistics of such studies might be extrapolated to report newer findings apart from those that were reported by the concerned authors to compare or substantiate and for critiquing the findings of the proposed study. The secondary data would be also critiqued to identify the relevant variables that could influence the dependent that are planned for the present study. The dependent variables were so chosen to explore the effectiveness of psychoanalytic psychotherapy on both contemplation and pre-contemplation phases as well as on the action and maintenance phases of psychotherapy. The number of craving episodes would be considered as the end-point for assessing the effectiveness of psychotherapy approaches during the contemplation and pre-contemplation phases. On the contrary, abstinence from substance abuse would be considered as the end-point for assessing the effectiveness of psychotherapy approaches during the contemplation and pre-contemplation phases.
Study Objectives
Leichsenring & Rabung (2011) Explored the effectiveness of long term psychodynamic psychotherapy through a meta-analysis approach.
de Maat et al. (2009) Explored the effectiveness of long term psychodynamic psychotherapy through a systematic review-based analysis
Blomberg, Lazaar, & Sandell (2001) Explored the effectiveness of long term psychodynamic psychotherapy in the long term through an observational analysis.
Verma & Vijaykrishnan (2018) Conducted a systematic review to explore the effectiveness of short term and long term psychotherapy in managing addictive disorders.
Yalisove (1989) Explored modifications in traditional psychoanalytic approaches in managing individuals presenting with a history of alcohol abuse.
Prochaska, Diclemente, & Norcross (1992) Compared the role of psychoanalytic psychotherapy and behavioral psychotherapies during the different aspects of psychotherapy that include the contemplation, pre-contemplation, action, and maintenance phases.
Table 3: Appraisal of secondary data
3.3.4. Reliability Analysis
The data that would be collected for this study would be validated through KMO analysis, the Bartlett’s test, the Kolmogorov-Smirnov test, and the Shapiro-Wilk test. The Kolmogorov-Smirnov and the Shapiro-Wilk tests would evaluate whether the variables that were considered for any study exhibit a normal distribution. As per the standard convention for normality, the p-value for both these tests for the specific variable should be greater than 0.05 (p>0.05). In case the p-values for the referred tests for the specific variables are less than 0.05 (p<0.05), the scores are appropriately transformed to ensure a normal distribution. The KMO analysis signifies whether the sample that was considered for a study was statistically adequate. A KMO value of >0.6 would signify that the sample that was considered for the study was statistically adequate and appropriate. Likewise, the Bartlett’s test reflects whether the variables that were considered for the study were statistically relevant. A p-value of less than 0.05 for the Bartlett’s test would signify that the variables that were considered for the study were significantly relevant.
3.3.5; Data Analysis and Statistical Software
Analysis of Qualitative Data
The qualitative data would be appraised from two perspectives; converting the qualitative data into quantitative data by transforming it through dummy variables and incorporating a phenomenological and epistemological approach to gain an in-depth understanding of such data.
Analysis of Quantitative Data
Statistical Measures
Both descriptive and inferential statistics would be used to interpret the qualitative and quantitative data that would be appraised in this study. The descriptive statistics such as mean, median, mode, and standard deviation would be used to present the summary of the raw data and also for conducting the inferential statistics. The inferential statistics that would be considered for the study will include statistical tests of comparison (such as the t-tests and chi-square tests), correlation analysis (such as the Pearson’s and Spearman’s correlation coefficient), and logistic regression analysis. The logistic regression models would explore whether psychoanalysis-based therapies are effective alone or confounded by age (AGE), socioeconomic status (SES), and the severity of abuse (SOA), demographic background (DB), mental health status (MHS), type of abuse (TOA), and other treatment modalities (OTM) across the study participants.
Regression Models; Dependent and Independent variables
Two separate stepwise regression models would be constructed with episodes of cravings (ECRA) and the period of abstinence (POA) as the dependent variables. However, the independent variables for both the regression models would include age, socioeconomic status,, severity of abuse, demographic background, mental health status, type of abuse, number of substances used, and other treatment modalities across the study participants. The severity of abuse would be estimated from the time an individual recognized his or her habit forming properties with the respective substance prior to psychoanalysis. On the contrary, episodes of cravings (ECRA) would be considered the number of times in a month the respective individual abused the specific substance or substances, while the period of abstinence (POA) would be considered as that period during which an individual did not revert o substance abuse post-psychoanalysis. The regression models would help to identify whether the independent variables interacted with each other in influencing ECRA and POA across individuals who were extended psychoanalysis. The two regression models that would be constructed for the proposed study are as follows:
Model 1
POA= B1+ B2*AGE + B3*SES + B4* SOA + B5* DB + B6 * MHS+ B7* TOA + B8*OTM
Model 2
ECRA= B1+ B2*AGE + B3*SES + B4* SOA + B5* DB + B6 * MHS+ B7* TOA + B8*OTM
Each regression model would be appraised from three perspectives; p-value of the ANOVA related to the model, the coefficient of determination (R2) and the adjusted coefficient of determination (adjusted-R2) of the regressions, and the p-value of the y-intercept of the regression. The p-value of the ANOVA reflects the significance of the overall regression analysis. The p-value signifies that extent to which the different independent variables interact with each other or in an independent manner in influencing the dependent variable. The coefficient of determination (R2) and the adjusted coefficient of determination (adjusted-R2) of the regressions signify the proportion of changes in the dependent variable that could be explained by the proportion of changes in the independent variable for the sample and the target population respectively. The p-value of the y-intercept signifies whether there are other independent variables that could influence the direction and magnitude of dependent variables apart from those that are considered for the proposed regression models.
3.3.6. Software for the Quantitative and Qualitative Analysis
The qualitative data would be analyzed through the MAXQDA software and interpretive approaches, while the SPSS software (IBM; version 14) would be used to analyze the quantitative data that would be considered to address the research questions that are considered for the proposed study.
3.3.7. Secondary Research Questions & Hypothesis Testing
The research questions for the proposed study would be appraised based on the acceptance or rejection of the null (H0) and the alternative (H1) hypothesis respectively. The H0 and H1 for each secondary research question would be interpreted at the 0.05 level of significance (p=0.05). The p-value for the chosen level of significance reflects the probability of chance that might have influenced an observed experimental phenomenon. For example, the chosen level of significance 0.05 signifies that five out of 100 observations have occurred due to the chance factors that are associated with random sampling. A p-value lesser than the chosen level of significance reflect that the probability of chance associated with any experimental observation is very low. In such situations, the changes in the magnitude of the dependent variable are not considered to be related with the changes in the magnitude of the independent variables. Likewise, a p-value greater than the chosen level of significance reflect that the probability of chance associated with any experimental observation is very high. In such situations, the changes in the magnitude of the dependent variable are not considered to be related with the changes in the magnitude of the independent variables (Branch, 2014).
The H0 for statistical tests of comparison contends that there is no significant difference between the means of any variable across two or more groups. Any observed difference between such means is speculated to have stemmed from the chance factors that are associated with random sampling. The H0 is accepted if the p-value for the statistical tests of comparison are greater than 0.05 (p >0.05). The H1 for statistical tests of comparison contends that there is significant difference between the means of any variable across two or more groups. Any observed difference between such means is not speculated to have stemmed from the chance factors that are associated with random sampling. The H0 is accepted if the p-value for the statistical tests of comparison are lesser than 0.05 (p<0.05) (Branch, 2014).
The H0 for correlation analysis contends that there is no significant correlation between two or more variables that are considered for the analysis. Any observed correlation between such variables is speculated to have stemmed from the chance factors that are associated with random sampling. The H0 is accepted if the p-value for the correlation coefficients are greater than 0.05 (p >0.05). The H1 for correlation analysis contends that there is significant correlation between two or more variables that are considered for the analysis. Any observed correlation between such variables is not speculated to have stemmed from the chance factors that are associated with random sampling. The H1 is accepted if the p-value for the correlation coefficients are greater than 0.05 (p<0.05) (Branch, 2014).
The H0 for the regression analyses contends that the direction and magnitude of the dependent variable cannot be significantly predicted from the direction and magnitude of the independent variables. Any observed prediction between such variables is speculated to have stemmed from the chance factors that are associated with random sampling. The H0 for the regression analysis is accepted if the p-value for the ANOVA is greater than 0.05 (p >0.05). The H1 for the regression analyses contends that the direction and magnitude of the dependent variable cannot be significantly predicted from the direction and magnitude of the independent variables. Any observed prediction between such variables is speculated not to have stemmed from the chance factors that are associated with random sampling. The H1 for the regression analysis is accepted if the p-value for the ANOVA is lesser than 0.05 (p <0.05) (Branch, 2014).
The secondary research questions and their respective hypothesis that would be explored in this study are presented in Table 4.
Table 4: secondary research questions and their respective hypothesis
Secondary Research Questions Hypothesis testing Inferential Statistics
SRQ1: Whether psychoanalysis-based therapy is effective alone in managing individuals presenting with substance abuse? H0: Psychoanalysis-based therapy is not significantly effective in managing individuals presenting with substance abuse (p>0.05).
H1: Psychoanalysis-based therapy is significantly effective in managing individuals presenting with substance abuse (p<0.05). The verbatim of the participants (psychologists only) would be codified in terms of effectiveness of psychoanalysis (yes=effective alone, No=not effective alone, cannot say= possibility of psychoanalysis interacting with other treatment modalities in affecting outcomes in substance abuse patients. A chi-square analysis would be conducted based on the percentage of responses obtained for the three different groups.
SRQ2: To what extent is psychoanalysis effective in managing substance abuse across concerned stakeholders? H0: psychoanalysis is not effective to a significant extent in managing substance abuse across concerned stakeholders (p>0.05).
H1: psychoanalysis is effective to a significant extent in managing substance abuse across concerned stakeholders (p<0.05). The verbatim of the participants (psychologists only) would be collected on the 10-point Likert Scale (with higher alphanumeric scores signifying that psychoanalysis is effective to a large extent in managing substance abuse in concerned stakeholders and vice-versa. The responses of the participants would be obtained for the other forms of psychotherapy on the same 10-point Likert scale. A two-tailed students t-test would be conducted to compare the responses of the participants on the 10-point Likert scale between psychoanalysis-based therapy and other psychotherapy regimes.
SRQ3: Whether psychoanalysis-based therapy is effective alone in increasing the period of abstinence in individuals presenting with substance abuse? H0: psychoanalysis-based therapy is not significantly effective in increasing the period of abstinence in individuals presenting with substance abuse (p>0.05)
H1: psychoanalysis-based therapy is significantly effective in increasing the period of abstinence in individuals presenting with substance abuse (p<0.05) Logistic regression model with period of abstinence as the dependent variable and age (AGE), socioeconomic status (SES), and the severity of abuse (SOA), demographic background (DB), mental health status (MHS), type of abuse (TOA), and other treatment modalities (OTM) across the study participants as the independent variables.
SRQ4: Whether psychoanalysis-based therapy is effective alone in reducing the episodes of cravings in individuals presenting with substance abuse? H0: psychoanalysis-based therapy is not significantly effective alone in reducing the episodes of cravings in individuals presenting with substance abuse (p>0.05)
H1: psychoanalysis-based therapy is significantly effective alone in reducing the episodes of cravings in individuals presenting with substance abuse (p<0.05) Logistic regression model with episodes of cravings as the dependent variable and age (AGE), socioeconomic status (SES), and the severity of abuse (SOA), demographic background (DB), mental health status (MHS), type of abuse (TOA), and other treatment modalities (OTM) across the study participants as the independent variables.
SRQ5: Whether psychoanalysis-based therapy significantly reduces the episodes of cravings in individuals presenting with substance abuse than other psychotherapy approaches? H0: psychoanalysis-based therapy does not significantly reduce the episodes of cravings in individuals presenting with substance abuse than other psychotherapy approaches (p>0.05).
H1: psychoanalysis-based therapy does not significantly reduce the episodes of cravings in individuals presenting with substance abuse than other psychotherapy approaches (p<0.05). A two-tailed students-t test would be conducted to compare the episodes of cravings in individuals who received psychoanalysis and those who did not.
SRQ6:Whether psychoanalysis-based therapy significantly increases the period of abstinence in individuals presenting with substance abuse H0: psychoanalysis-based therapy does not significantly increase the period of abstinence in individuals presenting with substance abuse (p>0.05).
H1: psychoanalysis-based therapy significantly increase the period of abstinence in individuals presenting with substance abuse (p<0.05).
A two-tailed students-t test would be conducted to compare the periods of abstinence in individuals who received psychoanalysis and those who did not
SRQ7: Whether psychoanalysis-based therapy is effective alone in reducing the prevalence of cravings across concerned stakeholders after controlling for the confounding variables? H0: psychoanalysis-based therapy is not effective alone in reducing the prevalence of cravings across concerned stakeholders after controlling for the confounding variables (p>0.05).
H1: psychoanalysis-based therapy is effective alone in reducing the prevalence of cravings across concerned stakeholders after controlling for the confounding variables (p<0.01) A step-wise regression involving the y-intercept and psychoanalysis as the independent variables and the prevalence of cravings as the dependent variable to be constructed. The regression would explore the extent to which the variations in the prevalence of cravings could be explained by psychoanalytical psychotherapy.
SRQ8: Whether psychoanalysis-based therapy is effective alone in reducing the period of abstinence across the concerned stakeholders after controlling for the confounding variables? H0: psychoanalysis-based therapy is not effective alone in reducing the period of abstinence across the concerned stakeholders after controlling for the confounding variables (p>0.05).
H1: psychoanalysis-based therapy is effective alone in reducing the period of abstinence across the concerned stakeholders after controlling for the confounding variables (p<0.05) A step-wise regression involving the y-intercept and psychoanalysis as the independent variables and the period of abstinence as the dependent variable to be constructed. The regression would explore the extent to which the variations in the period of abstinence could be explained by psychoanalytical psychotherapy.
SRQ9: Whether psychoanalytical psychotherapy predisposes the risk of other type of substance abuse compared to the one for which an individual was administered such therapy? H0: Psychoanalytical psychotherapy does not predispose the risk of other type of substance abuse compared to the one for which an individual was administered such therapy (p>0.05)
H1: Psychoanalytical psychotherapy does predispose the risk of other type of substance abuse compared to the one for which an individual was administered such therapy (p<0.05).
A paired two-tailed t-test would be conducted to compare the type of abuse before and after psychoanalytical psychotherapy.
SRQ 10: Whether psychoanalytical psychotherapy predisposes the risk of psychopathic disorders compared to those that was exhibited by the respective individual before the initiation of such therapy? H0: psychoanalytical psychotherapy does not predispose the risk of psychopathic disorders compared to those that was exhibited by the respective individual before the initiation of such therapy (p>0.05).
H1: psychoanalytical psychotherapy significantly predisposes the risk of psychopathic disorders compared to those that was exhibited by the respective individual before the initiation of such therapy (p<0.05). A paired two-tailed t-test would be conducted to compare the type of psychopathic disorder before and after psychoanalytical psychotherapy
3.3.8. Framework for Interpreting the Secondary Research Questions
The SRQs (1 to 8) are framed to explore the effectiveness of psychoanalytical psychotherapy either alone or in association with different confounding variables while the SRQs 9 and 10 are framed to explore the complications of psychoanalytical psychotherapy in terms of substance abuse or development of different psychopathic disorders.
3.4. Ethical Considerations for the Proposed Study
Since there would be no risk of physical harm to the study participants, the ethical principles of beneficence and non-malificence would not be violated in the proposed study. On the contrary, all participants for the proposed study would be only included after they provide informed consent for participating in the study. Moreover, the respective participants would be allowed to leave the study at any moment without any prior consent. Moreover, the proposed study would be only undertaken after obtaining the necessary approval from the Institutional Ethical Committee that governs research with human subjects. Finally, the data that would be used for the present study will be appropriately cited both as in-text and in the bibliography section. Since the patients will not be interviewed directly, the probability of erosion of self-respect and confidentiality of the participants would not arise in the proposed study.
3. 5. Reproducibility of the Findings: Possible Strength and Limitations
Strengths
The major strength of the proposed study is that it would be conducted with a sample size that would adequately and appropriately represent the target population. Moreover, the study would also ensure that appropriate variables that are considered for answering the research questions are appropriate and adequate. On the other hand, the subjective data obtained for the proposed study would be validated against objective data. Hence, the chances of subjective and experimental bias would be minimized for the study. Finally, an interpretive approach would be implemented to analyze any anomalies between the primary and the secondary data. Likewise, all the research questions that would be explored in this study would be backed by appropriate statistical tests of inference and chosen level of significance. On the other hand, the confounding effects of different variables that might stem in the proposed study would be either controlled at baseline or would be incorporated in the regression analysis. Therefore, the proposed study could be considered both reliable and reproducible.
Limitations
Since the responses of the participants (psychologists only) would be primarily based on the 10-point Likert scale, the chances of subjective bias may reduce the reliability of the study. Likewise, the chances of type-1 and type-11 errors might also reduce the reliability of the findings (Armstrong, 2007). Lastly, the demographic bias of the participants could reduce the reproducibility of the study. In the future, the study may be conducted as a cross-sectional, multi-centric, and multinational study. Moreover, stringent clinical criteria should be standardized for reporting the effectiveness of psychotherapy approaches. Hence, a psychologist should be involved in interpreting the verbatim of the participants (psychologists only) in relation to the effectiveness of different psychotherapy approaches (including psychoanalysis). Nevertheless, sampling adequacy and power of the study might voice for the viability of the findings that would be reported through the proposed study.
References
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Taylor D, Carlyle J, McPherson S, Rost F, Thomas R, Fonagy P. Tavistock (2012). Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression. BMC Psychiatry [Internet] 12(1), http://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-12-60
Verma, M., & Vijayakrishnan, A. (2018). Psychoanalytic psychotherapy in addictive disorders. Indian journal of psychiatry, 60(Suppl 4), S485-S489.Yalisove DL (1989). Psychoanalytic approaches to alcoholism and addiction: Treatment and research. Psychol Addict Behav. 3(3), 107–113
Appendix-1 (CASP Tool)