Mindfulness-Based Relapse Prevention for Substance Use Disorders: A Pilot Efficacy Trial

Addictive Behaviors Research Center, Department of Psychology, University of Washington, Seattle, Washington, USA.
Substance Abuse (Impact Factor: 1.62). 10/2009; 30(4):295-305. DOI: 10.1080/08897070903250084
Source: PubMed


The current study is the first randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (TAU). Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment. Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention. Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness as compared to TAU. Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders.

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    • "Alongside the development of mindfulness-based interventions , researchers have also studied mindfulness as a dispositional trait (Brown and Ryan 2003). Importantly, research indicates that meditation experience is positively related to trait mindfulness (Baer et al. 2008) and that trait mindfulness can be increased through mindfulness meditation training (Bowen et al. 2009; Carmody and Baer 2008). Furthermore, trait mindfulness has been shown to be related to decreased depressive symptoms, anxiety symptoms, stress, and alcoholrelated outcomes (Bowlin and Baer 2012; Cash and Whittingham 2010; Lyvers et al. 2013; Ostafin et al. 2013; Pearson et al. 2014; Weinstein et al. 2009). "
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    ABSTRACT: There has been an increasing focus on determining the psychological mechanisms underlying the broad effects of mindfulness on psychological health. Mindfulness has been posited to be related to the construct of reperceiving or decentering, defined as a shift in perspective associated with decreased attachment to one’s thoughts and emotions. Decentering is proposed to be a meta-mechanism that mobilizes four psychological mechanisms (cognitive flexibility, values clarification, self-regulation, and exposure), which in turn are associated with positive health outcomes. Despite preliminary support for this model, extant studies testing this model have not examined distinct facets of mindfulness. The present study used a multidimensional measure of mindfulness to examine whether this model could account for the associations between five facets of mindfulness and psychological symptoms (depressive symptoms, stress, anxiety symptoms, alcohol-related problems) in a sample of college students (N = 944). Our findings partially support this model. We found significant double-mediated associations in the expected directions for all outcomes (stress, anxiety symptoms, and depressive symptoms) except alcohol-related problems, and for each of the facets of mindfulness except observing. However, decentering and the specific mechanisms did not fully mediate the associations among mindfulness facets and psychological health outcomes. Experimental and ecological momentary assessment designs are needed to understand the psychological processes that account for the beneficial effects of mindfulness.
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    • "The ability to cope with feelings of frustration that may arise as task difficulty increases is important in working memory training, as is maintaining focus for prolonged periods. Thus, augmenting working memory training with training of coping skills, emotional regulation , or mindfulness may enhance both cognitive performance and psychosocial treatment outcomes (Bowen et al., 2009; Brewer et al., 2009; Desbordes et al., 2012; Garland et al., 2010; Sahdra et al., 2011; Witkiewitz et al., 2013). This tactic may be especially relevant for individuals with substance use disorders, who often exhibit deficits in emotion regulation (Gerra et al., 2003; Witkiewitz et al., 2012; Wong et al., 2013). "
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    ABSTRACT: Objective: Working memory impairment in individuals with chronic opioid dependence can play a major role in cognitive and treatment outcomes. Cognitive training targeting working memory shows promise for improved function in substance use disorders. To date, cognitive training has not been incorporated as an adjunctive treatment for opioid dependence. Methods: Methadone maintenance patients were randomly assigned to experimental (n=28) or active control (n=28) 25-session computerized training and run in parallel. Cognitive and drug use outcomes were assessed before and after training. Results: Participants in the experimental condition showed performance improvements on two of four working memory measures, and both groups improved on a third measure of working memory performance. Less frequent drug use was found in the experimental group than in the control group post-training. In contrast to previous findings with stimulant users, no significant effect of working memory training on delay discounting was found using either hypothetical or real rewards. There were no group differences on working memory outcome measures that were dissimilar from the training tasks, suggesting that another mechanism (e.g., increased distress tolerance) may have driven drug use results. Conclusions: Working memory training improves performance on some measures of working memory in methadone maintenance patients, and may impact drug use outcomes. Working memory training shows promise in patients with substance use disorders; however, further research is needed to understand the mechanisms through which performance is improved and drug use outcomes are impacted.
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    • "To test the hypothesized reductions in behaviors, we followed studies that compared a specific amount of time prior to treatment to the same amount of time after completion (Bowen et al., 2009; Wupperman et al., 2012). Table 1 provides the means and standard deviations for the primary variables across time. "
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    ABSTRACT: Objectives Disorders of behavioral dysregulation often involve more than one dsyregulated behavior (e.g., drug abuse and aggression, alcohol abuse and gambling). The high co-occurrence suggests the need of a transdiagnostic treatment that can be customized to target multiple specific behaviors.Method The current pilot study compared a 20-week, individual transdiagnostic therapy (mindfulness and modification therapy [MMT]) versus treatment as usual (TAU) in targeting alcohol problems, drug use, physical aggression, and verbal aggression in self-referred women. Assessments were administered at baseline, post-intervention, and 2-month follow-up.ResultsWilcoxon signed-ranked tests and multilevel modeling showed that MMT (n = 13) displayed (a) significant and large decreases in alcohol/drug use, physical aggression, and verbal aggression; (b) significantly greater decreases in alcohol/drug use and physical aggression than did TAU (n = 8); and (c) minimal-to-no deterioration of effects at follow-up. Both conditions showed significant decreases in verbal aggression, with no statistically significant difference between conditions. MMT also displayed greater improvements in mindfulness.Conclusions Preliminary findings support the feasibility and efficacy of MMT in decreasing multiple dysregulated behaviors.
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