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Combined Goal Management Training and Mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusers

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... The extent to which cognitive control can be affected by training or other means is an important question, as is the question of which criteria should be adopted to evaluate the effects and efficacy of a chosen intervention. Since cognitive control intervention may affect functional changes both with and without structural alterations [8][9][10][11][12], in this review, we do not strictly distinguish the intervention gains derived from plasticity or flexibility. We will discuss intervention improvements at three levels. ...
... Meditation is also thought to improve cognitive control by changing the state of the brain's network connections. Through methods such as mindfulness meditation, individuals' overall attention state can be autonomously adjusted to promote their metacognition and cognitive flexibility, which improves cognitive control [8,80,81]. This ability is based on the voluntary control of attentional focus, and it involves maintaining attention on the immediate experience, away from distractions such as self-referential thinking and mind wandering [82]. ...
... Despite considerable disputes over whether cognitive control is plastic or not, and how much room there is for any effect of cognitive control interventions, there still have been significant attempts to improve cognitive control through different methods and over various time periods [8,34,120]. The results of these studies showed that cognitive control was not always unchangeable, and numerous interventions effectively improved this ability [6,34,60]. ...
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Although the intervention effectiveness of cognitive control is disputed, some methods, such as single-task training, integrated training, meditation, aerobic exercise, and transcranial stimulation, have been reported to improve cognitive control. This review of recent advances from evaluation to prediction of cognitive control interventions suggests that brain modularity may be an important candidate marker for informing clinical decisions regarding suitable interventions. The intervention effect of cognitive control has been evaluated by behavioral performance, transfer effect, brain structure and function, and brain networks. Brain modularity can predict the benefits of cognitive control interventions based on individual differences and is independent of intervention method, group, age, initial cognitive ability, and education level. The prediction of cognitive control intervention based on brain modularity should extend to task states, combine function and structure networks, and assign different weights to subnetwork modularity.
... The TPN is a hub for executive function and attentional networks recruited for attentional control, and research using fMRI has documented increased TPN activation in response to MBIs (Fransson, 2005;Hasenkamp et al., 2012). Thus, measurement of neural networks associated with AC may provide objective indicators of TPN related cognitive and neural changes supported by MBIs (Alfonso et al., 2011;Petersen & Posner, 2012). ...
... Thus, research on novice meditators engaged in the same uniform type of practice may enable researchers to gain insight and better understand the mechanisms of change associated with MBIs. Indeed, there is a growing body of research that suggests that even shortterm mindfulness meditation practice may help improve the neurophysiological stress response (Bergen-Cico et al, 2014), psychological well-being (Possemato et al., 2016), and executive attention (Tang et al., 2007), with benefits to WM being expressed with continued mindfulness practice (Alfonso et al., 2011). ...
... Decreased inhibitory control involving the FP and OFC can be measured through response inhibition tasks (e.g., Go/No Go task) and poor response inhibition is correlated with higher levels of PTSD (Swick et al., 2012;Uddo et al., 1993;Wilkins et al., 2011). Moreover, MBIs have been shown to increase performance on response inhibition tasks (Alfonso et al., 2011;Tang et al., 2007) and modulate negative emotional responses through cognitive reappraisal (Doi, et al., 2013;Garland, et al., 2009). ...
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Objectives This research aimed to examine the mechanisms of change associated with mindfulness-based interventions (MBI) and test the feasibility of using functional near-infrared spectroscopy (fNIRS) to objectively measure MBI-responsive neuro-cognitive functions impaired by stress and trauma: attentional control (AC), emotional regulation (ER), and working memory (WM).MethodsfNIRS data were collected from 31 female participants during AC, ER, and WM cognitive tasks. Measurements were conducted at baseline and follow-up. Half of participants (n = 16) engaged in a 6-week MBI, whereas the active control group (n = 15) did not. fNIRS measures blood oxygenation (HbO) and deoxygenation (HbR) in specific brain regions as changes in activation of neural networks.ResultsAfter using general linear modeling to isolate the hemodynamic response in the fNIRS data, group-level statistical analyses revealed significant (p ≤ .05) changes among the MBI group for AC tasks in the frontopolar area (FP), orbitofrontal cortex (OFC), and premotor cortex (PMC); these changes were accompanied by significant improvements in AC performances. Among the control group, there was a significant decline in AC task performance and significant decreased OFC activation. Among the MBI group, there were also significant changes in FP and OFC activation during ER tasks and significant changes in OFC and PMC activation during WM tasks. Performance changes for ER and WM tasks were mixed.ConclusionsfNIRS is a viable means of measuring MBI-related changes in neuro-cognitive activity and MBIs yield significant changes in attentional performance and activation of FP, OFC, and PMC.
... Moreover, in line with the idea that emotional factors are crucial to effective DM, these interventions could include additional emotional and motivational components. To our knowledge, limited studies have applied GMT in SUD and reported interesting effects at the EFs level (Alfonso et al., 2011;Casaletto et al., 2016;Gonçalves et al., 2014;Valls-Serrano et al., 2016). ...
... An intervention combining GMT and mindfulness was applied in alcohol and stimulant outpatients following TAU (Alfonso et al., 2011). GMT consisted of a therapist-assisted community intervention including seven to eight 2-h sessions directed to sustained focus and EFs' improvements, as well as their translation to goal-related activities of real-life (Levine et al., 2011). ...
... In this case, the training also incorporated mindfulness to promote the switch between habit-based responses and goal-related activities. Confronted with TAU, the intervention was linked to substantial positive results in WM (measured by Letter Number Sequencing task), cognitive control (according to Stroop results) and DM (through the Iowa Gambling Task) (Alfonso et al., 2011;Verdejo-García et al., 2018). ...
Chapter
Currently, cognitive neuroscience and innovation technology provide various tools that can be used both for cognitive rehabilitation and for functional neuroenhancement of executive functions (EFs) in the context of addiction, such as computer-based cognitive training, non-invasive brain stimulation through neuromodulation techniques and other promising tools such as serious games and virtual reality-based approaches. The most common cognitive training adopted in substance use disorder can be clustered in two classes and has been here described in parallel with their neurocognitive findings: Cognitive Bias Modification and response inhibition training, which have shown to operate via reorientation of stimulus–action approach biases and rewiring of the medial Prefrontal Cortex (PFC) and the amygdala; Working Memory and Goal Management interventions, which have been associated with improvements in stimulus–outcome representations, for example, increased future-based delay-discounting and decision-making, and rewiring of the dorsolateral and ventral PFC. The use and efficacy data of these four cognitive training programmes in behavioural addictions are still missing. The combination of various neuroscience-informed interventions that synergistically tap into bottom-up versus top-down cognitive processes, together with phenotype-matched cognitive approaches for precision medicine, are two intriguing emerging approaches for finding the best way to empower EFs in addiction.
... Previous studies provide substantial evidence that trait mindfulness enhances individuals' mental well-being and promotes and strengthens their interpersonal relationships (Chen & Murphy, 2019;Koopmann-Holm et al., 2019;Voci et al., 2019). Trait mindfulness has also been shown to improve executives' decision-making (Alfonso et al., 2011) and help financial investors execute trading decisions according to their trading plan (Charoensukmongkol & Aumeboonsuke, 2017). Furthermore, trait mindfulness helps individuals improve their task performance, particularly for complex tasks that require cognitive effort (Dane, 2011;Lomas et al., 2017). ...
... Given the role of trait mindfulness in enhancing individuals' decision-making and task performance (Alfonso et al., 2011), it should also contribute to helping salespeople to develop crucial sales behaviours that would improve their performance in unfamiliar cross-cultural environments. This research identifies sales planning as a sales behaviour that allows salespeople who possess trait mindfulness to enhance their effectiveness when dealing with foreign customers. ...
Article
This research examines the effect of trait mindfulness on cross-cultural sales performance through the mediating effect of sales planning. Moreover, this research examines whether the direct effect of trait mindfulness on sales planning can be moderated by perceived cultural distance between foreign customers and the salespeople. The hypotheses were developed based on cognitive resource theory. This research collected survey data from 282 Thai salespeople at trade shows in Vietnam, India, and Japan and analyzed them using Partial Least Squares Structural Equation Modeling. The results indicate that sales planning fully mediated the direct association between trait mind-fulness and cross-cultural selling performance, while perceived cultural distance also positively moderated the effect of trait mindfulness on sales planning. K E Y W O R D S competence, cross-cultural selling, international business, job performance, mindfulness Résumé Cette recherche porte sur l'effet de la pleine conscience sur la performance de vente interculturelle à travers l'effet médiateur de la planification des ventes. Elle cherche également à déterminer si la distance culturelle perçue entre les
... It is reasonable to think that cognitive variability occurs in people over the passage of time, which should be revealed in measures of cognitive functioning (McKinney et al., 2020). However, whilst some authors have found DDT scores to be stable over time (De Wilde et al., 2013;Kirby, 2009;Odum, 2011), IGT scores, in contrast, have been found to be sensitive to treatment (Alfonso et al., 2011;De Wilde et al., 2013). In our study, DAYH scores were found to increase between baseline assessment and three-month follow-up. ...
... In our study, DAYH scores were found to increase between baseline assessment and three-month follow-up. This change is in line with what might be expected on the basis of decisionmaking that is less impulsive and more reflective, as other authors have found when using IGT for patients in treatment (Alfonso et al., 2011;De Wilde et al., 2013). Further, in the case of Block 1, it was observed that patients who performed the task better were less likely to relapse. ...
Article
Objective The Iowa Gambling Task (IGT) and the Delay Discounting Test (DDT) are two of the most widely used decision-making tests within the field of addiction research. The IGT creates a context of uncertainty where immediate rewards or long-term benefits are chosen, whilst the DDT measures the change in value of a reward as the time taken to obtain it increases. The objective of this study was to analyze the psychometric properties of a new task: Deciding about your health (DAYH), which integrates both components. Method Longitudinal observational study. The sample was composed of 97 patients being treated for cocaine use disorder. The DAYH, IGT, DDT and other instruments for measuring dependence severity were administered. Relapse was evaluated within 3 and 6 months after the baseline assessment. Results Reliability was indicated by an intraclass correlation coefficient (r) of. 80. DAYH scores showed significant relationships with IGT (r = −.237; p <.05), although not with DDT (r =.048) scores. A relationship was also found between DAYH and dependency severity (r = −.213; p <.05) and craving (r = −.231; p <.05). The DAYH scores showed sensitivity to change, and the capacity to predict relapse. Conclusions These findings indicate the utility of DAYH for exploring decision-making in patients with substance use disorders. The relationships with IGT and DDT also indicate the need to further investigate how decisions are made in various contexts of choice.
... Witkiewitz et al. (2013) signified a positive association between mindfulness-based relapse prevention and substance craving in substance abusers. Moreover, our findings on the effects of MT on drug craving were in line with those of Salimi et al. (2016), Kiani, Ghasemi & Pourabbas (2013), as well as Alfonso et al. (2011). Salimi et al. (2016) stated that mindfulness-based cognitive therapy has reduced drug craving in the heroin addicts who were referred to substance abuse treatment centers. ...
... Kiani, Ghasemi and Pourabbas (2013) documented that MT has reduced craving and cognitive ER in methamphetamine dependents. Alfonso et al. (2011) declared that goal management training and mindfulness interventions are effective in reducing executive and decision-making deficits in polysubstance abusers. Accordingly, drug users exploit the biopsychological properties of drugs to reach emotional stability. ...
Article
Background: Drug craving is a strong and resistant yearn to consume drugs; if not met, his condition would be followed by biopsychological issues, such as fatigue, anxiety, aggression, and depression. This study determined the effects of mindfulness training and Dialectical Behavior Therapy (DBT) on drug craving and emotion regulation in clients with substance dependence. Methods: This was a quasi-experimental study with a pre-test, post-test and a control group design. The research population included all the clients with drug use disorders, referring to midterm substance-dependence treatment centers in Baghmalek City, Iran, in 2018. Using a convenience sampling method, 60 clients with drug use disorders, willing to participate in the project were selected. Accordingly, they were randomly assigned into two experimental groups (mindfulness training & dialectical behavior therapy), and a control group (n=20/group). The research instruments included the Substance Craving Questionnaire-NOW (SCQ-NOW) and the Emotion Regulation Questionnaire (ERQ). The first experimental group underwent twelve 45-minute weekly sessions of mindfulness training. Besides, the second experimental group received twelve 45-minute weekly sessions of dialectical behavior therapy. The control group received no treatment. Multivariate Analysis of Covariance (MANCOVA) was applied in SPSS to analyze the obtained data. Results: The Mean±SD post-test scores of drug craving for mindfulness training, dialectical behavior therapy, and control groups were 130.02±8.01, 124.75±7.58, and 212.19±12.32, respectively. The collected results suggested that the provided intervention programs effectively reduced drug craving and improved emotion regulation in the examined clients (P=0.0001). Additionally, there was no significant difference between the effects of mindfulness training and dialectical behavior therapy on drug craving and emotion regulation. Conclusion: In addition to decreasing drug craving, mindfulness training and dialectical behavior therapy can improve emotion regulation in subjects with drug use disorders.
... Others have also found that non-posture-related training, as compared to karate training (motor control training), has no effect on verbal working memory (Jansen et al., 2017). Non-posturerelated training combined with goal training for substance abuse also reveals no improvement to verbal working memory among a trained group (Alfonso et al., 2011), or there is a weak link between posture control and verbal working memory (Telles et al., 2007(Telles et al., , 2008. However, studies using a combined analysis of postures and breathing make it difficult to delineate training-induced improvement in verbal working memory (e.g., Purohit and Pradhan, 2017). ...
... Further, regulation of the speed-accuracy tradeoff within the three components of executive control might be the unifying mechanism through which yoga training is influential. Studies examining the effect of mindfulness-related practice on cognitive task performance report either speed (RT) or accuracy, but not both, as in the case with working memory tasks (e.g., Jella and Shannahoff-Khalsa, 1993;Jyothsna and Rao, 2014;Sharma et al., 2014;Johnson et al., 2015;Jansen et al., 2017;Purohit and Pradhan, 2017;Crivelli et al., 2018), planning and cognitive flexibility (e.g., Levine et al., 2011;Kiani et al., 2016), and inhibitory control (e.g., Lakey et al., 2007;Semple, 2010;Alfonso et al., 2011;Moore et al., 2012;Kiani et al., 2016;Wimmer et al., 2016). Results suggest that analyzing speedaccuracy tradeoff might be useful in exploring the unifying mechanism by which yoga and other mindfulness practices might enhance executive control. ...
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Malleability of executive control and its enhancement through yoga training is unclear. In Study 1, participants (yoga group; n = 27, mean = 23.27 years) were tested on executive control tasks pre and post 8 weeks of yoga training. The training focused on attention to postural control during yoga asanas and respiratory control during pranayama-breathing (30 min each of postural and breath-control training, biweekly). Yoga training was assessed via performance ratings as to how well a posture was executed and by examining errors that reflected inattention/failures in postural and breath control. We also explored whether attentional demands on motor and respiratory control were associated with three components of executive control (working memory, cognitive flexibility, and inhibition) during nine executive control tasks. Partial correlation results revealed that the three components of executive control might be differentially impacted by postural and breath control, and selectively associated with either speed or accuracy (except for cognitive flexibility). Attentional demands influenced the link between postural, breath, and cognitive control. In Study 2, comparisons between a yoga group and a gender-matched control group (control group; n = 27, mean = 23.33 years) pointed towards higher working memory accuracy and a better speed-accuracy tradeoff in inhibitory control in the yoga group. A ceiling-practice effect was addressed by examining yoga practice learning (i.e., practice-induced change in postural and breath control reflected in ratings and errors) on executive control performance across two sets of tasks: repeatedly tested (pre and post-8 weeks) and non-repeatedly tested (post-8 weeks). Attention to motor and respiratory control during yoga might be considered as a potential mechanism through which specific components of executive control in young adults might be enhanced potentially via altering of speed-accuracy tradeoff.
... In relation to the improvement of executive component of updating, the results of the present work are consistent with previous studies in which improvements in working memory are reported after the completion of a specialized rehabilitation program (2,7,11,50,51). Different studies show that the specific work of working memory is a facilitator of cognitive functions such as learning, verbal comprehension, thinking, reasoning or decision-making and a generator of an efficient buffering effect against attentional bias toward salient stimuli related to substance use (52,53). Similar results to those obtained in the present study have been found in other populations with psychiatric pathologies (54,55). ...
... These results are in line with other studies conducted with SRD patients, after the completion of a rehabilitation program such as Goal Management Training, one of the best validated interventions for executive dysfunction (47). Intervention program that has demonstrated its efficacy alone or in combination with other types of interventions such as mindfulness (11,50). On the other hand, the control group obtained a worse performance in the cognitive inhibition task of the STROOP test. ...
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Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients’ quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of “Trisquel,” an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that “Trisquel” is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).
... Mind is a combination of characters, thoughts and feelings. It is an important element of the body and experiences to think and feel the faculty of consciousness and thought (Happé 1994 Earlier Vedic report [1][2][3][4] suggest that the human being is composed of three bodies namely causal, subtle or astral body and physical or gross body (Fig. 2). The five sheaths (bliss, discernment, mind, energy and body) reside in these three bodies (Satpathy 2018). ...
... It increases the creativity (Ostafin and Kassman 2012) and the ability to memorize things and to store and consolidate new information (Manjunath and Telles 2004). Studies suggested that transcendental and mindfulness meditation help to make better decisions by improving the brain's decision-making centers ( Alfonso et al. 2011), to overcome powerful alcohol and drug related addictions ( Zgierska et al. 2008) and improve the cardiovascular health (Paul-Labrador et al. 2006). Additionally, meditation strengthen the human immune system, provide resistance from infections and viruses (Morgan et al. 2014) and reduce the mental and physical pain better than morphine (Siegel and Barros 2009). ...
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A human system is a tri-unity with soul, mind and body comprises with various integrated organ system. Soul and mind are the main source of energy that control the physiological and spiritual processes of the human body in which the brain is regarded as microprocessor and worked together with mind. The soul is considered as super-controller and universal consciousness energy state in the body. The present study is designed to understand the quantum states of soul and mind of embedded human system and their relationships. The quantum states and flow of energy are illustrated using band theory and feedback circuit. The role, effect and relationships of yoga, meditation and spirituality were also analyzed. It has been found that soul is an ultimate source of positive energy, modulates the mind and physiological functions of the body and helps to establish a secure communication with the spirituality. The mind with both positive and negative energies, plays an important role for controlling the physiological processes of the body. The yoga, meditation and spirituality provides positive energy to the body, mind and soul and helps to eliminate the negative energy generated by the components of the embedded human body. The study provides deep insight about the relationship, interaction and coordination of soul, mind and body. We hope that the present study will provide a support in understanding the scientific basis of internal energy and informational knowledge to bridge the gap between modern and Vedic sciences in overall integrated multidimensional function of the human system.
... Moreover, treatment approaches may need to directly target the tendency of individuals with methamphetamine dependence to make impulsive decisions. In this context, there is emerging evidence that goalbased cognitive remediation interventions can improve decisionmaking (Alfonso et al., 2011;Valls-Serrano et al., 2016). Similarly, individuals entering treatment with high levels of disinhibition may benefit from psychological treatments that focus initially on behaviour and contingency management strategies rather than traditional cognitive re-structuring interventions, so as to build their capacity in inhibiting drug-related impulsive behaviours. ...
Article
Background: Methamphetamine's effects on brain function have been associated with cognitive deficits, which have a negative impact on clinical outcomes. However, it remains unclear if cognitive deficits relate to methamphetamine dependence (potentially amenable to abstinence and retraining) or background characteristics, mental health and other drug use. We tested the association between methamphetamine dependence and cognitive performance, while factoring in the impact of background characteristics, depressive symptoms and tobacco, alcohol and cannabis use. Method: The sample comprised 108 treatment-seeking participants who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV TR) criteria for methamphetamine dependence and 50 socio-demographically matched controls. We administered a comprehensive neuropsychological test battery (delay discounting, decision making, disinhibition, episodic and working memory) and examined cognitive deficits in methamphetamine users after taking into account socio-demographic characteristics, tobacco, alcohol and cannabis use, and depressive symptoms. Results: Hierarchical multiple regression analyses showed that methamphetamine dependence was associated with poorer performance in decision-making and disinhibition over and above other predictors, while IQ better explained performance in episodic and working memory. Although duration of methamphetamine use was linked to disinhibition, other patterns of methamphetamine use (including dose and frequency) were not consistently related to performance. Conclusions: Methamphetamine dependence impacts inhibitory control and decision-making, whereas lower IQ associates with memory/working memory deficits among methamphetamine users. Findings suggest the need to target disinhibition and impulsive decision-making as part of methamphetamine dependence treatment, while buffering the impact of IQ on memory systems.
... As such, a willingness to change may be a strong caveat in the case for attention and approach bias modification, especially since the same interventions did not show significant results when tested in a diverse community sample (Clerkin et al., 2016). It has been further suggested that some degree of abstinence may also be a pre-requisite for these treatments to work (Verdejo-García, Alcázar-Córcoles & Albein-Urios, 2019), a state more readily achievable within in-patient rehabilitation centres (Alfonso et al., 2011;Tavakolian & Abolghasemi, 2016;Valls-Serrano, Caracuel & Verdejo-Garcia, 2016). Despite the limitations, these findings highlight the potential ability to rescue of the brain's decision-making system from the influence of drugs, possibly by drawing attention to the benefits of a drug-free life to enhance a rehabilitating dependents' willingness to change. ...
Article
Over the years, various models have been proposed to explain the psychology and biology of drug addiction, built primarily around the habit and compulsion models. Recent research indicates drug addiction may be goal-directed, motivated by excessive valuation of drugs. Drug consumption may initially occur for the sake of pleasure but may transition to a means of escaping withdrawal, stress and negative emotions. In this hypothetical paper, we propose a value-based neurobiological model for drug addiction. We posit that during dependency, the value-based decision-making system in the brain is not inactive but has instead prioritized drugs as the reward of choice. In support of this model, we consider the role of valuation in choice, its influence on pleasure and punishment, and how valuation is contrasted in impulsive and compulsive behaviours. We then discuss the neurobiology of value, beginning with the dopaminergic system and its relationship with incentive salience before moving to brain-wide networks involved in valuation, control and prospection. These value-based neurobiological components are then integrated into the cycle of addiction as we consider the development of drug dependency from a valuation perspective. We conclude with a discussion of cognitive interventions utilizing value-based decision-making, highlighting not just advances in recalibrating the valuation system to focus on non-drug rewards, but also areas for improvement in refining this approach.
... 29 Mindfulness-based interventions and goal management training may improve executive function and realign risk perceptions among people with SUDs. 30,31 Given the high prevalence of violence, trauma, and posttraumatic stress disorder (PTSD) among women with SUD, 1,8,9 2 upcoming trials are adapting mindfulness-based interventions for women with SUD with a history of trauma. 32,33 These interventions may also be effective at increasing PrEP uptake or engagement in harm reduction programs, though further research is needed. ...
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Despite pre-exposure prophylaxis’s (PrEP) efficacy for HIV prevention, uptake has been low among women with substance use disorders (SUDs) and attributed to women’s lack of awareness. In semistructured interviews with 20 women with SUD and 15 key stakeholders at drug treatment centers, we assessed PrEP awareness and health-related decision-making. Women often misestimated their own HIV risk and were not aware of PrEP as a personally relevant option. Although women possessed key decision-making skills, behavior was ultimately shaped by their level of motivation to engage in HIV prevention. Motivation was challenged by competing priorities, minimization of perceived risk, and anticipated stigma. Providers were familiar but lacked experience with PrEP and were concerned about women’s abilities to action plan in early recovery. HIV prevention for women with SUD should focus on immediately intervenable targets such as making PrEP meaningful to women and pursuing long-term systemic changes in policy and culture. Efforts can be facilitated by partnering with drug treatment centers to reach women and implement PrEP interventions.
... There is increasing evidence to support the clinical use of MBIs for both physical and psychological conditions, including chronic pain and psoriasis [15,[17][18][19], cancer [20,21], diabetes [22], depression [23] substance abuse [24,25] and anxiety [26]. Programs such as the mindfulness-based eating program (MB-EAT- [27,28]), mindfulness-based relationships enhancement (MBRE − [29]) have been developed for specific issues and are based on the MBSR or MBCT protocols. ...
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Background: Effective transdiagnostic treatments for patients presenting with principal or comorbid symptoms of anxiety and depression enable more efficient provision of mental health care and may be particularly suitable for the varied population seen in primary healthcare settings. Mindfulness-integrated cognitive behavior therapy (MiCBT) is a transdiagnostic intervention that integrates aspects of CBT, including exposure skills targeting avoidance, with training in mindfulness meditation skills adopted from the Vipassana or insight tradition taught by the Burmese teachers U Ba Khin and Goenka. MiCBT is distinguished from both cognitive therapy and mindfulness-based cognitive therapy by the use of a theoretical framework which proposes that the locus of reinforcement of behavior is the interoceptive experience (body sensations) that co-arises with self-referential thinking. Consequently, MiCBT has a strong focus on body scanning to develop interoceptive awareness and equanimity. Designed for clinical purposes, the four-stage systemic approach of MiCBT, comprising intra-personal (Stage 1) exposure (Stage 2), interpersonal (Stage 3), and empathic (Stage 4) skillsets, is a distinguishing feature among other mindfulness-based interventions (MBIs). The aim of this study is to investigate whether and how group MiCBT decreases depression and anxiety symptoms for patients with a range of common mental health conditions. Methods: Participants (n = 120) recruited via medical practitioner referral will be randomized to MiCBT or a wait-list control. Inclusion criteria are age 18-75; fluent in English and having a Kessler Psychological Distress Scale (K10) score of 20 or more. The MiCBT treatment group receive an 8-week MiCBT intervention delivered in a private psychology practice. Participants complete a suite of online self-report measures and record the amount of meditation practice undertaken each week. The control group receive usual treatment and complete the measures at the same time points. Primary outcome measures are the Depression Anxiety Stress Scale-21 (DASS-21) and K10. Analysis will use mixed-model repeated measures. Discussion: The potential ability of MiCBT to provide a comprehensive therapeutic system that is applicable across diagnostic groups would make it an attractive addition to the available MBIs. Trial registration: This trial is registered with the Australia and New Zealand Clinical Trials Registry: ACTRN12617000061336; Date of registration: 11th January 2017.
... Other interventions have been developed to improve cognitive functioning in AUD patients. For example, treatments validated in other diseases for the rehabilitation of executive function, such as Goal Management Training (GMT) (Levine et al., 2011) and a combination of GMT with mindfulness-based meditation, improve working memory, inhibition, and decision-making abilities in AUD patients compared with treatment as usual (Alfonso et al., 2011;Valls-Serrano et al., 2016). In the same vein, studies showed that patients in such rehabilitation group not only improve cognitive functioning but also present decreased craving, affective distress, and psychological symptoms compared with patients who received usual treatment (Marceau et al., 2017;Rupp et al., 2012). ...
... Another manualized therapist-assisted group intervention is Goal Management Training (GMT), which trains EF and sustained attention and emphasizes the transfer of these skills to goal-related tasks and projects in everyday life. When combined with mindfulness meditation, GMT has been found to significantly improve WM, response inhibition and decisionmaking in alcohol and stimulant outpatients relative to TAU (158) and more recently also in polysubstance users in a therapeutic community (159). A meta-analysis of GMT more broadly concluded that it provides small to moderate improvements in EF which are consistently maintained at 1-6 month followups (160). ...
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Although there is general consensus that altered brain structure and function underpins addictive disorders, clinicians working in addiction treatment rarely incorporate neuroscience-informed approaches into their practice. We recently launched the Neuroscience Interest Group within the International Society of Addiction Medicine (ISAM-NIG) to promote initiatives to bridge this gap. This article summarizes the ISAM-NIG key priorities and strategies to achieve implementation of addiction neuroscience knowledge and tools for the assessment and treatment of substance use disorders. We cover two assessment areas: cognitive assessment and neuroimaging, and two interventional areas: cognitive training/remediation and neuromodulation, where we identify key challenges and proposed solutions. We reason that incorporating cognitive assessment into clinical settings requires the identification of constructs that predict meaningful clinical outcomes. Other requirements are the development of measures that are easily-administered, reliable, and ecologically-valid. Translation of neuroimaging techniques requires the development of diagnostic and prognostic biomarkers and testing the cost-effectiveness of these biomarkers in individualized prediction algorithms for relapse prevention and treatment selection. Integration of cognitive assessments with neuroimaging can provide multilevel targets including neural, cognitive, and behavioral outcomes for neuroscience-informed interventions. Application of neuroscience-informed interventions including cognitive training/remediation and neuromodulation requires clear pathways to design treatments based on multilevel targets, additional evidence from randomized trials and subsequent clinical implementation, including evaluation of cost-effectiveness. We propose to address these challenges by promoting international collaboration between researchers and clinicians, developing harmonized protocols and data management systems, and prioritizing multi-site research that focuses on improving clinical outcomes.
... It also helps them to think about the negative life events that are here and now instead of the past or future (Fjorback et al. 2011). Mindfulness can affect cognition in people with distressing hallucinations (Alfonso et al. 2011). Hallucination also has a negative correlation with mindfulness (Úbeda-Gómez et al. 2015). ...
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As a risk factor of hallucination proneness, the level of mindfulness has not yet been investigated in non-clinical participants. Other potential mediators, such as mental distress (depression, anxiety, and stress) which contribute to hallucination proneness also need to be assessed. This study investigated the mediating effect of mental distress in predicting hallucination proneness based on mindfulness. A number of 168 Iranian university students completed three questionnaires: (1) the five-facet mindfulness questionnaire, (2) the depression, anxiety and stress scale; and (3) the revised hallucination scale. The results showed that there was a significant association between levels of mindfulness and hallucination proneness. Mental distress has a significant effect on four facets of mindfulness questionnaire and an insignificant effect on one facet (awareness) in predicting hallucination. These effects were both direct and indirect. The indirect effect was developed by the mediating role of mental distress.
... The findings of our study support the fact that insufficiency in maintaining attention towards healthy internal and external stimuli that will continue to motivate substance abstinence may be effective in relapse. In addition, computerized cognitive training and cognitive rehabilitation programs have been designed to help patients retain impulsive behavior, use caution to align their sources of attention with their own goals (e.g., deprivation), and select behaviors that comply with these objectives (51,52). A recent meta-analysis about substance use disorders has shown that there are important deficits related to emotion recognition and the Theory of Mind, which are critical components of social cognition (53). ...
... and positive effects on decision-making neuropsychological tasks linked with basic emotion regulation(Alfonso, Caracuel, Delgado- Pastor, & Verdejo-García, 2011).Third, intervening on planning executive functions is likely to benefit gamblers in the low end of the elaboration-self deception continuum (as it has been shown with SUDs patients, Verdejo-Garcia, 2016), whereas people in the high end would probably benefit more from metacognitive training skills aimed at making them aware of the connection between their dysfunctional beliefs and their motives to gamble (seeLindberg, Fernie, & Spada, 2011).Complementarily, secondary prevention efforts in community populations could also be enriched with this dimensional-psychobiological vision, through the implementation of screening techniques aimed at identifying high-risk profiles (although we are aware that extra measures must be taken to avoid stigmatisation and stereotyping; O'Leary-Barrett et al., 2013). ...
Chapter
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Gambling disorder (GD) is now recognized as a behavioral addiction. Evidence has shown that GD and substance use disorders (SUDs) have shared vulnerability factors, similar clinical characteristics, and neurobiological overlaps. However, these similarities have somewhat overshadowed the specificities that account for the differences between GD and SUDs, as well as the considerable heterogeneity of patients with gambling disorder (PGD). In this chapter, we aim to disentangle the key neurocognitive components involved in GD, as well as those underlying heterogeneity among PGD. Core components include the brain mechanisms for gambling reinforcement, and their association with incentive sensitization and craving. With regard to heterogeneity, we will focus on specific gambling-related rewards, and automatic (model-free) versus strategic (model-based) emotion regulation processes. These components are integrated into a psychobiologically-informed, multidimensional model for gamblers’ characterization. In such model, individual differences in sensitivity to gambling reinforcement, basic emotion regulation mechanisms, and strategic emotion regulation are used to explain heterogeneity within the GD population, and serve to re-conceptualize previous attempts to cluster GD phenotypes based on clinical observations and empirical research. The proposed model has a number of implications for policy, prevention, and treatment. First, the consideration of GD as an addiction provides ground for harm-reduction approaches. Second, the transdiagnostic nature of key vulnerability factors justifies profiling of high-risk individuals for secondary prevention of disordered gambling (along with other externalizing problems). Third, understanding individual differences within the population of disordered gamblers yields a practical avenue for health services to incorporate tailored treatment protocols.
... There are two main methods to improve cognitive deficits in individuals who use substances: computerized training through exercises with specific software such as cognitive bias modification (CBM) and cognitive rehabilitation focused on improving the functioning in real life tasks. Other useful interventions are Goal Management Training (GMT), which helps to improve decision-making (Alfonso et al. 2011;Valls-Serrano et al. 2016) and working memory training (WM training). Likewise, there appears to be some evidence for the advantages of using a combination of these three interventions to improve efficacy (CBM, GMT and WM training; Verdejo, Garc ıa-Fernandez et al. 2019). ...
Article
Background Cocaine use has increased worldwide in recent years. However, the specific effects of smoking coca paste and its consequences on the cognitive functioning of individuals are unknown. The purposes of this study were to compare the neuropsychological functioning of a group of 163 individuals with coca-paste use disorder (CPUD) to that of a group of 162 healthy controls (HC) and to examine the relationship between cognitive performance and sociodemographic characteristics of these groups. Methods Participants were administered a comprehensive neuropsychological battery that included tests of learning and memory, language and executive functions. Results Although there were no significant differences in age and educational level between the groups, individuals with CPUD had significantly lower cognitive performance on the tests of learning and memory, language and executive functions compared with HC. An interaction effect was observed between group (CPUD versus HC) and educational level in the cognitive domains of learning and memory and language, such that more years of education was associated with better performance in these domains only in the HC. Conclusions Deficits in learning and memory, language and executive functions are common in individuals with CPUD. Cognitive rehabilitation programs have been shown to improve these functions in individuals with CPUD. Therefore, this study reinforces the necessity of including such programs as part of the holistic intervention plan for these individuals.
... In a recent meta-analysis of cognitive-boosting interventions for addiction treatment, we showed that Goal Management Training (GMT) is the most promising approach to ameliorate executive deficits in this context (15). GMT was originally developed to improve executive functions in brain injury populations (16), but its active ingredients, such as strategies to prevent disinhibited responses and manage complex tasks, are well-suited for substance use disorders (17)(18)(19)(20). However, the original GMT presents three key limitations in the context of MUD treatment. ...
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Background Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction, although required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to (1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; (2) explore consumers' (people with MUD) engagement with the revised program; (3) implement a prototype of the program with consumers; and (4) present the manualized standard administration to clinical service providers. Methods We followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4). Results Findings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualize cognitive strategies and to guide consumers in applying these strategies in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided clinicians support for the revised program but indicated an opportunity to minimize unintended effects. We present the intervention materials for the final revised program, Goal Management Training ⁺ (GMT ⁺ ), in line with TIDieR guidelines. Conclusions GMT ⁺ targets key cognitive processes and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the active ingredients and materials for GMT ⁺ , and indicated initial consumer and provider acceptability prior to conducting a clinical trial.
... Psychological treatments can be used to strengthen top-down impulse control or weaken bottom-up drive (Verdejo-Garcia et al., 2019). A recent example of the former is Goal Management Training, which is a therapist-guided cognitive remediation training that instructs participants to implement a meta-cognitive strategy to decision-making (Levine et al., 2011), and has also been shown to improve executive function in alcohol and stimulant polysubstance users (Alfonso et al., 2011;Valls-Serrano et al., 2016) as well as in HIV+ participants with SUDs (Casaletto et al., 2016). However, in spite of the positive effects on cognitive measures, the effect on alcohol and substance use reduction could not be demonstrated. ...
Article
Aim Impulsivity has been identified as a key relapse risk factor in patients with alcohol use disorder (AUD); however, the inherent characteristics of this relationship have been largely understudied. The heterogeneity of AUD and variation in impulsivity constructs require careful consideration to inform future work examining the relationship. This study sought to review empirical findings examining facets of impulsivity and AUD relapse. Methods A systematic search strategy was employed to capture studies on impulsivity measures related to AUD relapse. Impulsivity measures were qualitatively organized in terms of ‘trait impulsivity’—typically measured by self-report questionnaires—and ‘behavioural impulsivity’, i.e. ‘motor impulsivity’, ‘impulsive choice’ and ‘reflection impulsivity, assessed with cognitive–behavioural tasks. Results Seventeen peer-reviewed papers were identified. Relapse outcomes varied substantially in relation to impulsivity measures. Twelve papers included aspects of ‘trait impulsivity’, and nine studies included ‘behavioural impulsivity’ measures, from which five studies dealt with the ‘impulsive choice’ subcategory. The Barratt Impulsivity Scale was the self-report questionnaire that was most frequently used. Conclusions All three included facets of impulsivity (‘trait-, motor- and impulsive choice impulsivity’) were associated with AUD relapse, but none seemed to be superior to another. This study confirmed that research on the relation between impulsivity and AUD relapse is relatively scarce. Future research and treatment options are proposed.
... For example, in a previous study with the same qEEGscreening procedure it has been shown that meditation can effectively improve the "Internal attention" metric during 4-month training in 90% of novices -persons who have never meditated before (Fingelkurts et al., 2015). Further, it has been documented that participating in the mindfulness program significantly improves different aspect of individual performance, including decision-making (Alfonso, Caracuel, Delgado-Pastor, & Verdejo-García, 2011). ...
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The rapid growth of coaching practices has outpaced the current best-practice empirical research and created a difficult landscape to navigate for coaches and consumers alike. To overcome these challenges the present study proposed to employ the neuro-screening measure to develop and monitor an individually tailored coaching intervention for training senior-managers' inspirational leadership. We have used the quantitative electroencephalogram (qEEG) screening to build the individual profiles of every coachee to assess their baseline (trait) characteristics in order to develop the coaching interventions to enhance effective and minimize ineffective behavior. The qEEG-screening profile resulted in nine metrics characterizing different traits and features of every coachee. Based on these profiles individualized 4-month coaching programs were suggested to coachees. The results indicated that participation in the individually designed 4-month coaching program was associated with significant improvement (70.7%) or optimization (55.6%) of metrics in the 71.7% of coachees. This was paralleled by reduced scores in independent Beck Anxiety Inventory and Beck Depression Inventory scales. We concluded that the employment of qEEG-screening profiling allows coaches and trainers to assess deep dynamic neurological mechanisms that underpin baseline traits and features essential for effective, flexible and sustainable leadership, as well as track their development over time.
... The research on GMT as an intervention for ADHD is still limited, with one pilot study showing an improvement in cognitive functioning as rated by a clinician through a structured interview [23]. However, GMT has been shown to improve inhibitory control and executive functioning in other diagnostic groups, such as substance abuse [26], acquired brain injury [24], and spina bifida [27]. GMT has also been shown to improve other measures, such as emotional health and coping [28]. ...
Article
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Background: There is growing evidence for the efficacy of group-based interventions for adults with ADHD. However, there is still a lack of research investigating how clients experience participating in such interventions. The aim of the current study was to explore how adults with ADHD experience participating in a group-based intervention (Goal Management Training) for ADHD. Method: We conducted individual, semi-structured, interviews with ten adults with ADHD who had participated in Goal Management Training administered as a group intervention. The interviews were transcribed verbatim and analyzed using thematic analysis within a hermeneutic phenomenological framework. Results: Our analysis identified three main themes. The participants’ starting point captured the participants’ motivation and expectations prior to treatment. The ambiguity of the group – the various meanings of the group consisted of three sub-themes (The group created a sense of belonging - “I am not alone”; The personal cost of participating in the group - “At times it was a hot mess”; and The group supported the learning experience - “We worked with it together”). The group promoted positive change – How the group affected the participants’ everyday lives consisted of two sub-themes (Managing ADHD in daily life - “It’s much easier to handle everyday life”, and Personal growth - “Gaining new perspectives”). Conclusion: The group format was experienced as a valuable aspect of treatment. The structure provided by Goal Management Training allowed participants to expand their perspectives and experience improved management of ADHD, as well as personal growth. The opportunity to exchange experiences with others in similar situations was seen as particularly beneficial and brought feelings of recognition and belonging. However, some also experienced the group as a burden at times, for instance by stealing one’s focus. This study expands existing knowledge by exploring clients’ experiences of participating in group-based interventions for ADHD and shows how the group format allowed participants to take away more than they had hoped for. While expecting a more instrumental outcome of treatment, such as tools to manage ADHD, participants also gained a welcomed, but unexpected outcome of personal growth.
... The GMT combines cognitive techniques with Mindfulness and has demonstrated its efficacy in the rehabilitation of executive disorders due to brain injuries (Krasny-Pacini et al., 2014), in the adult population (Stamenova & Levine, 2019) and specifically in healthy older people aged 55 years and over (van Hooren et al., 2007). when the standard time of Mindfulness practice in GMT tripled, the results in the executive functioning of people with addictions were significantly higher (Alfonso et al., 2011;valls-Serrano et al., 2016). Given that the effects of the interventions gathered under the category of cognitive training in the meta-analysis of Gavelin et al. (2020) were not large (g = .32 in healthy adults aged 50 years or above; g = .40 in those with MCi), it would be worth exploring the option of adding MBi to the cognitive training. ...
Article
Objectives The main objective was to determine the efficacy of Mindfulness-Based Interventions in improving the cognitive function of older adults (healthy adults or adults with mild cognitive impairment). Methods A search was conducted in 4 databases. The effect sizes were extracted to perform a meta-analysis of the cognitive functions, as well as subgroup meta-analyses according to each domain: attention, memory and executive function. Results The meta-analysis of cognitive functions showed an average effect size of g = .07, 95% CI [−.013; .160], p = .09, with the following values for each domain: g = .02, 95% CI [−.167; .204] for attention; g = .06, 95% CI [−.148; .262] for memory; and g = .14, 95% CI [−.042; .329] for executive function. Conclusion The MBI had a null global effect. The attention and memory results showed a null effect size and a small effect size was found for executive function. The methodological quality of the studies, however, was poor, so the results need to be interpreted with caution.
... GMT has been used to addresses cognitive difficulties across a variety of medical and neuropsychiatric disorders, including traumatic brain injury (TBI) [59], attention deficit hyperactivity disorder (ADHD) [94], substance abuse [95], and spina bifida [96]. It consists of nine two-hour, group-based sessions that provide individuals with psychoeducation, self-monitoring, and mindfulness-based strategies, as well as other skills to reduce the frequency and severity of cognitive difficulties, including difficulties with planning, organizing, attention, and memory [89]. ...
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Post-traumatic stress disorder (PTSD) is a severe psychiatric illness that disproportionately affects military personnel, veterans, and public safety personnel (PSP). Evidence demonstrates that PTSD is significantly associated with difficulties with emotion regulation (ER) and difficulties with cognitive functioning, including difficulties with attention, working memory, and executive functioning. A wide body of evidence suggests a dynamic interplay among cognitive dysfunction, difficulties with ER, and symptoms of PTSD, where numerous studies have identified overlapping patterns of alterations in activation among neuroanatomical regions and neural circuitry. Little work has examined interventions that may target these symptoms collectively. The primary objective of this pilot randomized controlled trial (RCT) with a parallel experimental design was to assess the effectiveness of goal management training (GMT), a cognitive remediation intervention, in reducing difficulties with cognitive functioning, and to determine its effects on PTSD symptoms and symptoms associated with PTSD, including difficulties with ER, dissociation, and functioning among military personnel, veterans, and PSP. Forty-two military personnel, veterans, and PSP between the ages of 18 and 70 with symptoms of PTSD were recruited across Ontario, Canada between October 2017 and August 2019. Participants were randomized to either the waitlist (WL) (n = 18) or the GMT (n = 22) condition. Participants in both conditions received self-report measures and a comprehensive neuropsychological assessment at baseline, post-intervention, and 3-month follow-up. Following their completion of the 3-month follow-up, participants in the WL condition were given the opportunity to participate in GMT. Assessors and participants were blind to intervention allocation during the initial assessment. A series of 2 (time) × 2 (group) ANOVAs were conducted to assess the differences between the WL and GMT conditions from pre- to post-intervention for the self-report and neuropsychological measures. The results demonstrated significant improvements in measures of executive functioning (e.g., verbal fluency, planning, impulsivity, cognitive shifting, and discrimination of targets) and trending improvements in short-term declarative memory for participants in the GMT condition. Participants in the GMT condition also demonstrated significant improvements from pre- to post-testing in measures of subjective cognition, functioning, PTSD symptom severity, difficulties with ER, dissociative symptom severity, and depression and anxiety symptoms. No adverse effects were reported as a result of participating in GMT. The results of this pilot RCT show promise that GMT may be a useful intervention to improve symptoms of cognitive dysfunction, symptoms of PTSD, and symptoms associated with PTSD within military personnel, veterans, and PSP. Future work is needed to address the small sample size and the durability of these findings.
... Given the apparent association between the CEN and mindful awareness, mindfulness meditation could also have implications for the treatment of stress-related conditions associated with CEN dysfunction (Alfonso et al., 2011;Crowe & McKay, 2016). For instance, the CEN is found to have fewer connections in children diagnosed with PTSD, while the DMN is hyper-connected, possibly reflecting their inability to disentangle themselves from ruminative thinking processes (Suo et al., 2015). ...
... Little research has been done on the effectiveness of ACT in depression and anxiety in people with substance use disorder. For example, Alfonso et al.'s study (2011) (22) showed that group therapy based on acceptance and commitment effectively reduced cravings, stress, and anxiety in people with substance use disorder. Kiani et al. (2012) (23) also showed the effectiveness of ACT in the cognitive regulation of methamphetamine abusers, reducing stress and anxiety in people with substance use disorders. ...
Article
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Background: The comorbidity of substance use, mood disorders, and anxiety has been proven in various studies, leading to many clinical implications. Objectives: This study aimed to evaluate the effectiveness of acceptance and commitment therapy (ACT) in depression and anxiety in individuals with substance use disorder. Methods: This quasi-experimental study utilized a pretest-posttest design with a control group. The statistical population consisted of all people with substance abuse in Urmia in 2019, including 220 subjects. The sample consisted of 50 individuals with substance use disorders selected by purposive sampling and randomly assigned to experimental and control groups. The experimental group was trained in eight sessions, each lasting 90 min, based on the ACT protocol by Hayes et al. (2004), while the control group did not receive any intervention. The data were obtained using the Beck Depression Inventory and Beck Anxiety Inventory. Pretest and posttest were performed in both groups. The collected data were analyzed by multivariate analysis of covariance (MANCOVA) using SPSS23 software. Results: The results showed that after controlling for the pretest effects, a significant difference was observed between the mean posttest scores of the two groups in both depression and anxiety (P < 0.05). Conclusions: Acceptance and commitment therapy is an appropriate strategy to effectively improve depression and anxiety in people with substance use disorder.
... Although home exercise completion varied, attendance of sessions was good (80-100%), and all outcome assessments were completed. Compared to earlier studies (Van Hooren et al., 2007;Alfonso et al., 2011;Levine et al., 2011;Boyd et al., 2019), the number of sessions in the current study was fewer (five sessions) and sessions were stretched out over a longer time period (3 months). This session structure (i.e., five group sessions) was employed to reduce traveling in this geographically dispersed population. ...
Article
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Neurocognitive late effects following the diagnosis and treatment of childhood acute lymphoblastic leukemia (ALL) commonly include impaired executive functions (EFs), with negative consequences for one’s health-related quality of life and mental health. However, interventions for EF impairments are scarce. Thus, the aims of this study were to (1) explore the feasibility and acceptability of the cognitive rehabilitation program Goal Management Training (GMT) and (2) examine whether GMT is associated with positive outcomes across cases of ALL survivors with EF complaints. Four participants (median age 31.5 years) underwent nine GMT modules in a total of five group sessions. Rehabilitation was focused on compensatory strategies to improve real-life EFs. Participants were evaluated at 2-week and 6-month follow-ups. Evaluation of feasibility and acceptability included adherence, a semi structured interview, self-reports, and safety. Additionally, therapists’ experience with implementation was evaluated. Outcome measures included self-reports and neurocognitive tests of attention, EF, and processing speed. All participants completed GMT and rated the intervention as useful, suitable, and satisfactory. The reliable change index showed improved daily life EFs (two participants) and neurocognitive performance (three participants) at 6-month follow-up. Additionally, all participants improved on a “real-life” task involving EF. A future randomized controlled trial is recommended.
... According to this, the recent study of Wang et al.'s [165] described that moderate and high-intensity aerobic exercises, designed according to the Guidelines of American College of Sports Medicine, can be an effective and persistent treatment for those individuals with SUD. Similarly, enrolling in leisure activities such as mindfulness, play music and art have shown to induce benefits not only on drug related measures (craving: [166,167,168], psychological well-being: [169,170,171], treatment adherence and reduction of drug use: [166,170,172], relapse prevention: [166,172], but also in cognitive performance: [173]. ...
Article
Background: Cognitive reserve (CR) refers to the ability of an individual to cope with brain pathology remaining free of cognitive symptoms. This protective factor has been related to compensatory and more efficient brain mechanisms involved in resisting brain damage. For its part, Brain reserve (BR) refers to individual differences in the structural properties of the brain which could also make us more resilient to suffer from neurodegenerative and mental diseases. Objective: This review summarizes how this construct, mainly mediated by educational level, occupational attainment, physical and mental activity, as well as successful social relationships, has gained scientific attention in the last years with regard to diseases, such as neurodegenerative diseases, stroke or traumatic brain injury. Nevertheless, although CR has been studied in a large number of disorders, few researches have addressed the role of this concept in drug addiction. Methods: We provide a selective overview of recent literature about the role of CR and BR in preventing substance use onset. Likewise, we will also discuss how variables involved in CR (healthy leisure, social support or job-related activities, among others) could be trained and included as complementary activities of substance use disorder treatments. Results: Evidence about this topic suggests a preventive role of CR and BR on drug use onset and when drug addiction is established, these factors led to less severe addiction-related problems, as well as better treatment outcomes. Conclusion: CR and BR are variables not taken yet into account in drug addiction. However, they could give us a valuable information about people at risk, as well as patient's prognosis.
... GMT can be complemented with mindfulness practice to increase emotional awareness, bolster sustained attention and reinstate cognitive control (Levine et al., 2011;Verdejo-Garcia, Alcázar-Córcoles, & Albein-Urios, 2018). A combined GMT+Mindfulness approach showed significant effects on working memory, attention/response inhibition, decision-making and reflection impulsivity among polydrug users (Alfonso, Caracuel, Delgado-Pastor, & Verdejo-García, 2011;Valls-Serrano, Caracuel, Verdejo-García, 2016). Finally, CRT has shown preliminary evidence to improve cognitive functions in dependent individuals, including cognitive bias modification (Challet-Bouju, Bruneau, IGNACE Group, Victorri-Vigneau, & Grall-Bronnec, 2017). ...
... Thus, the choice of GMT in the current study was based on the fact that poor inhibitory control has been described as a predominant causal factor of ADHD (e.g., Barkley, 1997;Sonuga-Barke et al., 2010), in addition to being conceptualized as a core component of executive functioning (Badre, 2011;Miyake and Friedman, 2012). It is also a strength that GMT has been shown to ameliorate executive dysfunction, including inhibitory control, in other groups (e.g., older adults, patients with substance use disorders) experiencing some of the same challenges as adults with ADHD (van Hooren et al., 2007;Alfonso et al., 2011;Stamenova and Levine, 2019). To the best of our knowledge, GMT for adults with ADHD has only been tested in a small-scale pilot study (In de Braek et al., 2017). ...
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Background: Adults with ADHD are predominantly treated with medication. However, there is also a need for effective, psychologically based interventions. As ADHD is strongly associated with reduced inhibitory control, cognitive remediation approaches should be efficient. Goal Management Training (GMT) aims at enhancing inhibitory control and has shown positive effects on inhibitory control in non-ADHD patient groups. The aim of the current study was to explore whether GMT would specifically enhance inhibitory control in adults with ADHD, and if such an enhancement would lead to secondary improvements in self-reported everyday functioning. Methods: Twenty-one participants with ADHD (mean age: 39.05 years [SD 11.93]) completed the intervention and assessments pre-, post- and six months after the intervention. Measures included neuropsychological tests and self-report questionnaires pertaining to cognitive- and executive functioning, emotion regulation, quality of life, and ADHD symptoms. Results: Compared to baseline, the participants showed enhanced inhibitory control on performance-based measures at post-assessment and six-month follow-up. The participants also reported increased productivity and reduced cognitive difficulties in everyday life at both assessments post-treatment, as well as improvements in aspects of emotion regulation and a reduction in the severity of core ADHD-symptoms at six-month follow-up. Conclusion: Our exploratory study showed that GMT seems to specifically improve one of the core executive dysfunctions in ADHD, namely inhibitory control, with a positive effect lasting at least six months post-treatment. The adults with ADHD also reported improved self-regulation in their everyday life after completing GMT, providing strong arguments for further investigations of GMT as a treatment option for this group of adults.
... Taken together, the above results suggest that people with a remote history of multiple concussions sustained in contact sports contend with non-trivial neuropsychiatric symptoms and should be considered for comprehensive neuropsychiatric assessment. Many efficacious treatments exist for neuropsychiatric dysfunction, both psychological (e.g., cognitive behavior therapy) and pharmacological (55,56). Research is needed to evaluate the extent to which those with a remote history of multiple concussions sustained outside of contact sport may be suffering the same neuropsychiatric burden. ...
Article
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Objectives: To identify novel targets for neurorehabilitation of people with a remote history of multiple concussions by: (1) comprehensively characterizing neuropsychiatric and cognitive functioning in former professional football players, with a focus on executive functions; (2) distinguishing concussion-related findings from pre-morbid/cohort characteristics of professional football players; and, (3) exploring the relationship between executive functions and neuropsychiatric symptoms. Participants: Sixty-one high-functioning former professional football players and 31 age- and sex-matched control participants without history of concussion or participation in contact sports. Design: Between-groups analyses. Main measures:Neuropsychiatric. Personality Assessment Inventory (PAI) clinical scales plus the Aggression treatment consideration scale; the Mini International Neuropsychiatric Interview (MINI). Cognitive. Comprehensive clinical neuropsychological battery assessing domains of verbal and visuospatial attention; speed of processing and memory; current and estimated pre-morbid IQ; and, executive functioning, including two experimental measures that were novel for this population (i.e., response inhibition and inconsistency of responding on a go/no-go task). Results: (1) Compared to control participants, former professional football players scored significantly higher on the PAI Depression, Mania, and Aggression scales, and significantly lower on response inhibition. (2) Relative to controls, former players with >3 concussions ( x ¯ = 6 . 1 ), but not former players with ≤ 3 concussions ( x ¯ = 2 . 0 ), showed (i) significantly higher scores on the PAI Depression scale, (ii) significantly more MINI clinical diagnoses overall, and manic/hypomanic episodes specifically, and (iii) significantly poorer executive function. (3) Mediation analysis revealed that concussion exposure had a significant indirect effect on PAI Depression, Mania, and Aggression via inconsistency of responding on the go/no-go task. Conclusions: Notable impairments to neuropsychiatric functioning and worse performance on a sensitive experimental measure of executive function were observed; these were related to both concussion history and pre-morbid (cohort) factors. Therefore, neuropsychiatric and executive functioning should be carefully assessed in those with a remote history of multiple concussions. Moreover, former players' neuropsychiatric symptoms were associated with inconsistency of responding; this suggests that treatments targeted at response inconsistency could help to mitigate neuropsychiatric dysfunction.
... In a recent meta-analysis of cognitive-boosting interventions for addiction treatment, we showed that Goal Management Training (GMT) is the most promising approach to ameliorate executive deficits in this context 15 . GMT was originally developed to improve executive functions in brain injury populations 16 , but its active ingredients, such as mindfulness and strategies to prevent disinhibited responses and manage complex tasks, are well suited for substance use disorders 17,18,19,20 . However, the original GMT presents three key limitations in the context of MUD treatment. ...
Preprint
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Background Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes including earlier drop out and relapse. However, current treatments for MUD do not address executive functions. Goal Management Training (GMT) is an evidence-based cognitive remediation program for executive dysfunction but required modifications to enhance its relevance and application within addiction treatment settings. This study aimed to 1) tailor GMT to the key cognitive deficits and typical treatment duration of MUD; 2) explore consumers’ (people with MUD) engagement with the revised program; 3) implement a protocol of the program with consumers; and 4) present the manualised standard administration to clinical service providers. Methods We followed the Medical Research Council Complex Interventions Framework and employed an evidence- and person-based intervention development process. We used a four-phased approach and collaborated with neuropsychology experts, design researchers in healthcare, consumers with MUD, and clinical service providers. Each aim was addressed in a separate study phase; including content refinement and review with neuropsychology experts (phase 1), intervention design and collaboration with consumers (phase 2), prototype development and review with consumers (phase 3), and final program modifications and review with clinical stakeholders (phase 4). Results Findings from phase 1 indicated support for targeting four cognitive processes (attention, impulse control, goal setting, and decision-making). Key feedback included the need to help habitualise program strategies and guide consumers in applying them in emotionally salient situations. Findings from phases 2 and 3 indicated consumer support for the program strategies and materials but highlighted the need to further enhance the personal relevance of specific content and journal activities. Findings from phase 4 provided overall clinical support for the revised program but indicated an opportunity to minimise unintended effects. We present the intervention materials for the revised program, Goal Management Training ⁺ (GMT ⁺ ), in line with TIDieR guidelines. Conclusions GMT ⁺ targets tailored cognitive processes, includes reimagined materials and activities, and is sensitive to the clinical needs of people with MUD. Our intervention development process was important for informing the training components, design and intervention materials, and indicating initial acceptability prior to conducting a clinical trial.
... This is usually accomplished via self-monitoring (e.g., of cues, emotions, behaviors), identifying alternative behaviors to drug use, planning and goal-setting, and reviewing progress (Kliemann et al., 2017;McGowan, 2013). One such strategy for enhancing planning and problem-solving is goal management training (Alfonso, Caracuel, Delgado-Pastor, & Verdejo-Garcia, 2011). Realistic expectations and patient motivation are crucial for successful implementation of these interventions (Gardner, Lally, & Wardle, 2012). ...
Chapter
Recent advances in the neuroscience of drug addiction motivates questions concerning whether and how clinical practice may be based on or inspired by these new advances. In this chapter, we will provide a framework for summarizing novel, neuroscience-informed, cognitive interventions that are under investigation and/or in the process of translation to clinical practice. We will provide more specific information concerning our experience in developing a new integrative package of interventions inspired by this framework. At the end of the chapter, we will discuss the next steps in the clinical translation and implementation of neuroscience-based cognitive interventions.
... In a general view, meta-analytic studies have concluded that mindfulness is moderately effective in reducing anxiety and depression (16). In recent years, many studies have examined the effect of mindfulness on neuropsychological functions of the mind (17)(18)(19)(20)(21)(22), and many studies in clinical works used various meditation such as (Mindfulness Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), etc ) on cognitive functions (19,20,(23)(24)(25). ...
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Background: The experience of cognitive deficits is common among patients with degenerative and psychiatric disorders. Objective: The present study aimed to evaluate the effect of the empirical literature of mindfulness intervention on cognitive functions. Methods: This study was conducted in June 2020 by using the scientific records were retrieved by a systematic search of several bibliographic databases on the Medline, Scopus, ISI Web of Sciences, Google scholar database from 2000 to 2020 for testing the effect of mindfulness intervention on cognitive functions. For data analysis CMA2 software were used. Heterogeneity assessed by Cochran’s Q statistics test. Publication Bias assessed by Orwin fail safe N, Begg’s method kendall’s Tau, Egger’s method intercept and funnel plot. Results: from 17 initial studies, 28 effect sizes were calculated. Among the 28 effect sizes, 6 indicators were negative and 22 indicators were positive. key results from the meta-analysis, Compared to healthy controls showed that people were receive mindfulness intervention significantly improved in working memory and attention function, with this enhance medium magnitude (Hedges’ g = 0.32, 0.35 respectively, see Figure 2). There was no significant improve by use mindfulness intervention on executive function. Conclusions: The results prove the initial evidence that mindfulness intervention can improve some neurocognitive processing such as attention function and working memory
... This concerns, for example, working memory training [76][77][78] or other process-based EF training procedures that target general capacities such as inhibition or mental flexibility [76], multi-domain training (e.g. video-game training) [79][80][81] and strategy-based training [82], as well as indirect approaches such as intense physical exercise [83] and music training [84]. It must be said, however, that positive training effects do not always remain over time, the generalizability to other cognitive domains is limited and transfer to daily life still remains unclear [76,78]. ...
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... There are few investigations that relate dispositional mindfulness to planning and abstract reasoning. Several works show that intervention through mindfulness training does not improve performance in planning tasks (Alfonso et al., 2011), but slightly improves abstract reasoning (Gard et al., 2014;So & Orme-Johnson, 2001;Wen et al., 2013). ...
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... The potential generalisation of executive functioning training has previously been examined in studies of Goal Management Training combined with mindfulness meditation, which was outside the scope of the current review. In both inpatient and outpatient SUD treatment settings, seven weeks of Goal Management Training plus mindfulness meditation was associated with positive outcomes on measures of executive functioning, including the ecologically valid 'Multiple Errands Test' (Alfonso et al., 2011;Valls-Serrano et al., 2016). Given that mindfulness meditation alone appears to have some benefit for cognition (Gallant, 2016), future research could examine the degree to which training in goal management strategies specifically can improve executive functioning in SUD treatment populations. ...
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... While CBT may have produced some neurocognitive changes which were not documented pre-post in this case, our client had already undergone approximately 20 sessions of CBT, but had continued to complain of significant cognitive and functional impairments. Other studies have used combined mindfulness and goal management training and shown improvements on measures of working memory, response inhibition, and decision-making, in comparison to standard psychotherapeutic intervention in abstinent polysubstance users (Alfonso, Caracuel, Delgado-Pastor, & Verdejo-García, 2011). The effects of CBT and mindfulness in comparison to the current intervention cannot be satisfactorily answered in a single case report, and require further investigation with a control group. ...
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Chapter
Chronic use of different substances is associated with neural dysfunctions and related cognitive deficits. Neurocognitive disorders encompass reward, negative affect and control deficits underlying core addiction symptoms, and broader cognitive sequela affecting everyday functioning. In the first part of this chapter, we summarise the theoretical models posited to understand the nature and course of addiction-related cognitive deficits, with special emphasis on dual and tripartite models and recent international consensus. Then, we review the specific neurocognitive disorders associated with chronic use of different drugs, including alcohol, cannabis, opioids and stimulants, while acknowledging the role of premorbid cognitive alterations and polysubstance use. In the last part of the chapter, we analyse the neural dynamics underlying these deficits, including development-related changes underpinning the transition between recreational and chronic use and neuroplasticity-related changes that can be achieved via pharmacological enhancement, cognitive remediation and neuro-stimulation. We conclude by providing a critical view of the strengths and weaknesses of current frameworks and assessment and intervention approaches and a perspective of future horizons for neurocognitive research and clinical applications in addiction medicine.
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Chapter
Addiction is a chronic relapsing disorder. Despite pharmacological and psychological interventions during rehabilitation, a majority of patients still relapse. In this seventh chapter, we present neuromodulation techniques as a complementary intervention for addiction. Firstly, while deep brain stimulation (DBS) has shown promising results, its cost–benefit–risk ratio is nonetheless too high to be implemented in routine clinical care. Secondly, repeated transcranial magnetic stimulation (rTMS) and transcranial direct courant stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) have shown reduced craving and relapses, but the results are mixed. To improve efficacy, new perspectives envisioned that the insula could be a promising target for rTMS and DBS in combination with cognitive remediation and while participants are exposed to key conditioned stimuli. Additionally, neurofeedback could be a useful tool in teaching patients to actively regulate their neural activity, although better controlled experimental designs and rigorous measures of brain changes are needed. Despite the heterogeneity of studies, neuromodulation techniques as complementary tools to conventional care seem to constitute a turning point in the management of addictions.
Chapter
Deepening the underlying basis of the link between mindfulness and neural correlates in addiction can inform the refinement of Mindfulness-Based Interventions (MBIs) to produce larger clinical effects and additional long-term therapeutic benefits. An emerging body of research suggests that MBIs have so far proved effective in reducing craving, reward sensitivity, stress reactivity and negative affect on a general level in substance use disorder (SUD). Regarding executive functions (EFs), MBIs may act on the deautomatization of addictive responses, decision-making, reaction inhibition, self-control and attention regulation. The reason for focusing on neurocognitive correlates of the intervention is that they constitute the target neurophysiological basis for protocols that combine neuroscientific tools with MBIs for boosting EFs in addiction-related disorders. In fact, the last paragraphs of this chapter discussed the proposal of combining the application of MBIs supported by neurofeedback (NF) devices, describing how to promote behavioural self-regulation through the self-regulation of cortical activity. The training MBI + NF protocol described here has been validated by previous research in both experimental and applied contexts and showed promising results whose extension deserves to be tested in addicted populations.
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Decision-making deficits are a robust cognitive correlate of substance abuse, but few studies have addressed the long-term differential associations of cocaine use and marijuana (MJ) use on decision-making. This study utilized the Iowa Gambling Task (IGT), a widely used measure of decision-making, to investigate the relationship between cocaine and MJ use and IGT learning. We analyzed between and within group differences across two consecutive testing sessions in abstinent users of either MJ or cocaine. We assessed long-term correlates of the use of these drugs by evaluating users after 25 days of enforced abstinence. Results showed that both cocaine users and MJ users performed worse than controls on the total IGT net score. All groups showed learning between Session 1 and Session 2, but the cocaine users showed the smallest increase in performance. The pattern of learning from the beginning to the end (block x block) of the IGT (Session 2) was different for the drug groups, with the cocaine group showing more learning than the MJ group. Dose-related measures of cocaine use (g/week) and MJ use (joints/week) predicted IGT performance (the heavier the drug use the lower the performance). Differential correlates of cocaine use and MJ use on decision-making learning may have important implications for the development of novel treatment interventions.
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Patients with acquired brain injury affecting the frontal cortex and individuals with substance use disorders share a range of behavioral problems, including apathy, poor self-control, and executive dysfunction. The Frontal Systems Behavioral Scale (FrSBe) is a self-report instrument designed to measure behavioral problems resulting from damage to the frontal-striatal neural systems, involved both in brain insult and addiction. The aim of this study was twofold: (1) to compare the scores from the Spanish version of the FrSBe with the norms collected for American, English-speaking population; and (2) to examine the ability of the FrSBe to discriminate between two clinical populations (acquired brain injury (ABI) and addiction) with putative frontal dysfunction, as compared to a group of healthy participants. A total of 139 volunteers participated including 46 patients with frontal ABI (F-ABI), 57 abstinent substance abusers, and 36 healthy controls from the Spanish population. A Spanish version of the FrSBe was administered to all participants. We conducted multivariate analyses of variance to examine group differences across the three subscales: apathy, disinhibition, and executive dysfunction; and in the FrSBe total score. F-ABI and substance abusers had higher scores (i.e., greater impairment) than controls on the FrSBe total score; F-ABI patients scored significantly higher than substance abusers, and substance abusers significantly higher than controls. For specific subscales, F-ABI patients had higher scores than substance abusers and controls in the subscales of apathy, disinhibition and executive dysfunction, whereas substance abusers had greater executive dysfunction than controls. The Spanish version of the FrSBe is a useful instrument for the detection of behavioral problems associated with frontal systems dysfunction in two clinical samples of Spanish-speakers.
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Context: Although drug cues reliably activate the brain's reward system, studies rarely examine how the processing of drug stimuli compares with natural reinforcers or relates to clinical outcomes. Objectives: To determine hedonic responses to natural and drug reinforcers in long-term heroin users and to examine the utility of these responses in predicting future heroin use. Design: Prospective design examining experiential, expressive, reflex modulation, and cortical/attentional responses to opiate-related and affective stimuli. The opiate-dependent group was reassessed a median of 6 months after testing to determine their level of heroin use during the intervening period. Setting: Community drug and alcohol services and a clinical research facility. Participants: Thirty-three opiate-dependent individuals (mean age, 31.6 years) with stabilized opiate-substitution pharmacotherapy and 19 sex- and age-matched healthy non-drug users (mean age, 30 years). Main Outcome Measures: Self-ratings, facial electromyography, startle-elicited postauricular reflex, and event-related potentials combined with measures of heroin use at baseline and follow-up. Results: Relative to the control group, the opiate-dependent group rated pleasant pictures as less arousing and showed increased corrugator activity, less postauricular potentiation, and decreased startle-elicited P300 attenuation while viewing pleasant pictures. The opiate-dependent group rated the drug-related pictures as more pleasant and arousing, and demonstrated greater startle-elicited P300 attenuation while viewing them. Although a startle-elicited P300 amplitude response to pleasant (relative to drug-related) pictures significantly predicted regular (at least weekly) heroin use at follow-up, subjective valence ratings of pleasant pictures remained the superior predictor of use after controlling for baseline craving and heroin use. Conclusions: Heroin users demonstrated reduced responsiveness to natural reinforcers across a range of psychophysiological measures. Subjective rating of pleasant pictures robustly predicted future heroin use. Our findings highlight the importance of targeting anhedonic symptoms within clinical treatment settings.
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Relapse is a common clinical problem in individuals with substance dependence. Previous studies have implicated a multifactorial process underlying relapse; however, the contribution of specific neural substrates has not yet been examined. To determine whether results from functional magnetic resonance imaging (fMRI) shortly after drug cessation could predict relapse in stimulant-dependent individuals. Treatment-seeking methamphetamine-dependent males (N = 46) underwent fMRI 3 to 4 weeks after cessation of drug use. Of the 40 subjects who were followed up a median of 370 days, 18 relapsed and 22 did not. Blood oxygen level-dependent fMRI activation during a simple 2-choice prediction task. The fMRI activation patterns in right insular, posterior cingulate, and temporal cortex obtained early in recovery correctly predicted 20 of 22 subjects who did not relapse and 17 of 18 subjects who did. A Cox regression analysis revealed that the combination of right middle frontal gyrus, middle temporal gyrus, and posterior cingulate activation best predicted the time to relapse. To our knowledge, this is the first investigation to show that fMRI can be used to predict relapse in substance-dependent individuals.
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The revision of the Wechsler-Bellevue Adult Intelligence Scale retains the type of item categories but has numerous changes in the items. Standardization is based on a stratified sample of 1700 adults ages 16 to 64. Additional norms are given for ages above 64 based on a different group of subjects. Reliabilities for verbal, performance and full scale IQ's are .96, .93, and .97, and for the subtests range from .65 to .96. Manual includes directions for administering, IQ tables, and scaled score tables. Officially the title is to be abbreviated WAIS. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Cognitive behavioral and related therapies for cocaine dependence may exert their effects, in part, by enhancing cognitive control over drug use behavior. No prior studies have systematically examined the neural correlates of cognitive control as related to treatment outcomes for cocaine dependence. Twenty treatment-seeking cocaine-dependent individuals performed a Stroop color-word interference task while undergoing functional magnetic resonance imaging (fMRI) prior to initiating treatment. The primary outcome measures were percent of urine drug screens negative for cocaine, percent days abstinent, and treatment retention. Correlations between regional brain activation during Stroop task performance and treatment outcome measures were analyzed. During Stroop performance, individuals activated brain regions similar to those reported in nonaddicted individuals, including the anterior cingulate cortex, dorsolateral prefrontal cortex, parietal lobule, insula, and striatum. Activations at treatment onset correlated differentially with specific outcomes: longer duration of self-reported abstinence correlated with activation of ventromedial prefrontal cortex, left posterior cingulate cortex, and right striatum; percent drug-free urine screens correlated with striatal activation; and treatment retention correlated with diminished activation of dorsolateral prefrontal cortex. A modest correlation between Stroop effect and treatment retention was found. The functions of specific brain regions underlying cognitive control relate differentially to discrete outcomes for the treatment of cocaine dependence. These findings implicate neurocircuitry underlying cognitive control in behavioral treatment outcome and provide insight into the mechanisms of behavioral therapies for cocaine dependence. They also suggest neural activation patterns during cognitive control tasks are more sensitive predictors of treatment response than behavioral measures.
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Most substance abusers simultaneously use and abuse more than one substance, even when there is a clear drug of choice. This pattern creates a great challenge in relating neuropsychological findings in drug users to a certain drug. This review aims to: (i) discuss results from neuropsychological studies using different research methodologies that may improve our understanding of specific vs. generalized effects of different drugs on neuropsychological performance; and (ii) determine which neuropsychological mechanisms are impaired in the same way by the use of different drugs, and which impairments are specific to certain substances, including cannabis, psychostimulants, opioids and alcohol. We review evidence from human studies in chronic substance abusers using three methodologies: (i) studies on 'pure' users of one particular substance, (ii) studies that methodologically control the effects of drugs co-abused, and (iii) studies contrasting subgroups of polysubstance users with different drugs of choice. Converging evidence from these approaches indicates that all the drugs studied are commonly associated with significant alterations in the neuropsychological domains of episodic memory, emotional processing, and the executive components of updating and decision-making. However, there is evidence of a greater reliability in the association of certain substances with specific neuropsychological domains. Specifically, there are relatively more robust effects of psychostimulants and alcohol use on impulsive action and cognitive flexibility, of alcohol and MDMA use on spatial processing, perceptual speed and selective attention, cannabis and methamphetamine on prospective memory deficits, and cannabis and MDMA on processing speed and complex planning. The magnitude of both generalized and specific neuropsychological effects is overall attenuated in samples achieving long-term abstinence, but there are persistent psychostimulant-related effects on updating, inhibition, flexibility and emotional processing, and opioid-related effects on updating and decision-making.
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The current study investigates effects of a brief mindfulness-based instruction set, based on Marlatt's "urge surfing" technique (Marlatt & Gordon, 1985), on smoking-related urges and behavior. Undergraduate smokers (N = 123) who were interested in changing their smoking, but not currently involved in a cessation program, participated in a cue exposure paradigm designed to elicit urges to smoke. They were randomly assigned either to a group receiving brief mindfulness-based instructions or to a no-instruction control group. Results suggest that groups did not differ significantly on measures of urges. However, those in the mindfulness group smoked significantly fewer cigarettes over a 7-day follow-up period as compared to those in the control group. These findings suggest that the mindfulness techniques may not initially reduce urges to smoke but may change the response to urges. The study provides preliminary data for future studies examining both mechanisms and effectiveness of mindfulness-based interventions for cigarette smoking.
Article
Similar to patients with ventromedial prefrontal cortex (VMPC) lesions, substance abusers show altered decision-making, characterized by a tendency to choose the immediate reward, at the expense of negative future consequences. The somatic marker model proposes that decision-making depends on neural substrates that regulate homeostasis, emotion and feeling. According to this model, there should be a link between alterations in processing emotions in substance abusers, and their impairments in decision-making. Growing evidence from neuroscientific studies indicate that core aspects of addiction may be explained in terms of abnormal emotional/homeostatic guidance of decision-making. Behavioral studies have revealed emotional processing and decision-making deficits in substance abusers. Neuroimaging studies have shown that altered decision-making in addiction is associated with abnormal functioning of a distributed neural network critical for the processing of emotional information, and the experience of "craving", including the VMPC, the amygdala, the striatum, the anterior cingulate cortex, and the insular/somato-sensory cortices, as well as non-specific neurotransmitter systems that modulate activities of neural processes involved in decision-making. The aim of this paper is to review this growing evidence, and to examine the extent to which these studies support a somatic marker theory of addiction. We conclude that there are at least two underlying types of dysfunction where emotional signals (somatic markers) turn in favor of immediate outcomes in addiction: (1) a hyperactivity in the amygdala or impulsive system, which exaggerates the rewarding impact of available incentives, and (2) hypoactivity in the prefrontal cortex or reflective system, which forecasts the long-term consequences of a given action.
Article
A decision-making instrument known as the "gambling task" was used, which has been shown to be sensitive to the decision-making impairment of patients with bilateral lesions of the ventromedial prefrontal cortex (VM). Three groups of subjects were tested, substance dependent individuals (SD) (n=41), normal controls (n=40), and VM patients (n=5). All SD met the DSM-IV criteria for dependence, with either alcohol or stimulants (metamphetamine or cocaine) as the primary substance of choice. The results revealed a significant impairment in the performance of SD relative to normal controls. A significantly high proportion of SD (61 vs. only 32.5% of normal controls) performed within the range of the VM patients, while the rest performed within the range of normal controls. General demographic factors such as age, sex, and level of education could not explain these differences in performance. As well, differences in performance were not explained by intelligence (IQ), memory, or performance on standard executive function/frontal lobe tests. Performance on the gambling task was best predicted by a combination of factors, including duration of abstinence, years of abuse, relapses and times in treatment, and the ability to hold gainful employment. The results support the hypothesis that impairment in decision-making linked to a dysfunctional VM cortex is associated with at least a sub-group of SD.
Article
The present study investigated neuroendocrine and cardiovascular changes during experimentally-induced affective states in abstinent heroin-dependent subjects and healthy controls. The procedure for eliciting emotions in all subjects used pleasant and unpleasant stimuli that did not differ in subjective arousal properties. We investigated whether the valence of the stimuli differentially affected neuroendocrine responses by comparing neutral, pleasant and unpleasant pictures on heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP), methyl-OH-phenyl-glycol (MHPG), norepinephrine (NE), epinephrine (EPI), adrenocorticotrophic hormone (ACTH) and cortisol (CORT) plasma levels. Twelve abstinent heroin-dependent subjects, in comparison with 12 control subjects, were submitted to three experimental sessions, each on one of three experimental days a week apart, in counterbalanced order: day 1=unpleasant pictures, day 2=pleasant pictures, day 3=neutral pictures. In the rating of subjective arousal pleasant and unpleasant stimuli received the same high score in comparison with neutral stimuli; a different cardiovascular and neuroendocrine pattern was obtained in healthy subjects: unpleasant stimuli elicited increases in HR, SBP, MHPG, NE, ACTH, CORT, whereas neutral and pleasant stimuli did not induce any significant response in hormonal levels. In contrast, in heroin addicts, despite increased perceptions of unpleasantness, HR, SBP, MHPG and NE levels did not increase after disliked stimuli; these subjects also reported increased arousal during exposure to neutral stimuli. In comparison with controls, addicted individuals showed higher CORT and ACTH basal levels, and a consequent lack of response to unpleasant stimuli. The results indicate that neuroendocrine and cardiovascular systems respond selectively to affective, motivationally relevant stimuli, and that substance use disorders may be associated with dysregulation of emotion-processing mechanisms.
Article
There is emerging evidence that suggests emotional processes may be involved in the development of addiction, and that emotional alterations may compromise the effectiveness of treatment approaches in substance abuse. Nonetheless, there is a dearth of studies that have examined the experience of emotions in substance abusers, especially with regard to natural affective stimuli that are motivationally relevant for the normal population. The main aims of this study are: (a) to examine possible differences in the experience of emotions of drug-free substance abusers exposed to images containing motivationally relevant stimuli, with regard to a normal population and (b) to examine possible differences in the experience of emotions of substance abusers depending on their drug of choice. We used 25 images from the International Affective Picture System (IAPS) to elicit different emotional states, and the Self Assessment Manikin (SAM) to record participants' subjective experience on three emotional dimensions: valence, arousal, and dominance. We used bifactorial MANOVA to examine subjective emotional ratings as a function of group, and as a function of the kind of image shown. Results showed a differential emotional profile of substance abusers with regard to healthy controls; and different emotional profiles between abusers of a number of substances. These results suggest the experience of emotions may be significantly altered in substance abusers, and that these alterations may play an important role in drug abuse treatment course and results.
Article
There are few investigations of the potential recovery of neurocognitive function in chronic alcoholic samples after very-long-term abstinence. The current study examined cognitive abilities in middle-aged (mean age 46.8 years), long-term abstinent alcoholic individuals (LTAA). Twenty-five LTAA men and 23 LTAA women abstinent for an average of 6.7 years were compared with an equal number of gender and age-comparable normal controls (NC). We examined the association of neurocognitive variables with age, duration of abstinence, alcohol use measures, and the density of a family history of problem drinking. Long-term abstinent alcoholic individuals and NC underwent comprehensive neuropsychological assessment. Performance was measured in the following 9 domains: abstraction/cognitive flexibility, attention, auditory working memory, immediate memory, delayed memory, psychomotor function, reaction time, spatial processing, and verbal skills. Long-term abstinent alcoholic individuals performed similarly to NC, except for deficits in the spatial processing domain. The spatial processing results must be interpreted with caution because of multiple comparison issues; however, spatial processing deficits are among the impairments most often reported in abstinent alcoholic individuals. None of the cognitive measures were associated with length of abstinence, any alcohol use variable, or family history measure. Very-long-term abstinence resolves most neurocognitive deficits associated with alcoholism, except for the suggestion of lingering deficits in spatial processing.
Article
The objective of this study was to investigate the effects of a structured 6-week neuropsychological course on the executive functioning of older adults with cognitive complaints. A randomised controlled design was used involving 69 community dwelling individuals aged 55 years and older. Both objective and subjective measures were included to assess executive functioning. General linear model with repeated measures analysis of variance was used to examine the intervention effects. After the intervention, the participants in the intervention group were significantly less annoyed by their cognitive failures, were better able to manage their executive failures and reported less anxiety symptoms than those in the waiting list control group. These findings indicate that a combination of psycho-education and training has the potential to change the attitude of older individuals towards their cognitive functioning. Because this training focussed on cognitive functions that are among the first to decline in older adults and the subjective evaluation of the people after training was quite favourable, the proposed intervention may be considered a valuable contribution to cognitive interventions for older adults.
Article
Structure of executive function was examined and we contrasted performance of substance dependent individuals (polysubstance users) and control participants on neuropsychological measures assessing the different executive components obtained. Additionally, we contrasted performance of polysubstance users with preference for cocaine vs heroin and controls to explore possible differential effects of the main substance abused on executive impairment. Two groups of participants were recruited: abstinent polysubstance users and controls. Polysubstance users were further subdivided based on their drug of choice (cocaine vs heroin). We administered to all participants a comprehensive protocol of executive measures, including tests of fluency, working memory, reasoning, inhibitory control, flexibility, and decision making. Consistent with previous models, the principal component analysis showed that executive functions are organized into four separate components, three of them previously described: updating, inhibition, and shifting; and a fourth component of decision making. Abstinent polysubstance users had clinically significant impairments on measures assessing these four executive components (with effect sizes ranging from 0.5 to 2.2). Cocaine polysubstance users had more severe impairments than heroin users and controls on measures of inhibition (Stroop) and shifting (go/no go and category test). Greater severity of drug use predicted poorer performance on updating measures. Executive functions can be fractionated into four relatively independent components. Chronic drug use is associated with widespread impairment of these four executive components, with cocaine use inducing more severe deficits on inhibition and shifting. These findings show both common and differential effects of two widely used drugs on different executive components.
Article
Substance dependence is associated with executive function deficits. However, most available studies have examined the performance of substance dependent individuals (SDI) on traditional laboratory measures of executive functions, whereas few studies have used ecologically valid assessments with SDI. Our aim was to examine the performance of 37 SDI (poly-substance users) and 37 matched controls on an ecologically valid measure of executive function (the Behavioural Assessment of the Dysexecutive Syndrome - BADS). We also administered the Wisconsin Card Sorting Test (WCST) to investigate whether ecological measures were more discriminative than traditional tests in detecting SDI deficits. A related aim was to examine the ability of the BADS (and the WCST) to predict everyday executive problems. Results showed that SDI had widespread deficits on ecological measures of executive function. Conversely, we found no differences between groups on the WCST. Furthermore, the BADS (but not the WCST) predicted everyday problems related to apathy, disinhibition, and executive dysfunction.
Article
A growing literature supports a role for neurocognitive deficits such as impaired decision-making in the development and maintenance of addictive behaviour. On the basis of these findings, it has been suggested that measures of neurocognitive functioning may be applied to the task of predicting clinical outcome in drug addiction. This in turn may have relevance for differentiating treatment based on individual patient needs. To explore this hypothesis we obtained neurocognitive measures of planning, impulsivity and decision-making from 37 opiate dependent individuals within 6 weeks of starting a community drug treatment programme and we followed them up 3 months into the programme. Performance on two tests of decision-making, but not on tests of planning, motor inhibition, reflection impulsivity or delay discounting, was found to predict abstinence from illicit drugs at 3 months with high specificity and moderate sensitivity. In particular, two thirds of the participants performing normally on the Cambridge Gamble Task and the Iowa Gambling Task, but none of those impaired on both, were abstinent from illicit drugs at follow up. Other neuropsychological, psychiatric or psychosocial factors measured in this sample did not explain this finding. The results are discussed in terms of the brain circuitry involved and the potential implications for the planning of treatment services for opiate dependence.
Comprehensive Norms for an Expanded Halstead-Reitan Battery La práctica de la atención plena Cognitive rehabilitation in the elderly: effects on strate-gic behavior in relation to goal management
  • R K Heaton
  • I Grant
  • C G Matthews
  • Fl Odessa
  • J Kabat-Zinn
  • Kairós
  • Barcelona
  • B Levine
  • D T Stuss
  • G Winocur
  • M A Binns
  • L Fahy
  • M Mandic
  • K Bridges
  • I H Robertson
Heaton, R.K., Grant, I., Matthews, C.G., 1991. Comprehensive Norms for an Expanded Halstead-Reitan Battery. Psychological Assessment Resources, Odessa, FL. Kabat-Zinn, J., 2007. La práctica de la atención plena. Kairós, Barcelona. Levine, B., Stuss, D.T., Winocur, G., Binns, M.A., Fahy, L., Mandic, M., Bridges, K., Robertson, I.H., 2007. Cognitive rehabilitation in the elderly: effects on strate-gic behavior in relation to goal management. J. Int. Neuropsychol. Soc. 13, 143– 152.
El error de Descartes: Emoción y razonamiento en el cerebro humano. Crítica
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Damasio, A., 1994. El error de Descartes: Emoción y razonamiento en el cerebro humano. Crítica, Barcelona.
Stroop Color and Word Test: A Manual for Clinical and Experi-mental Uses. Stoelting Co The Frontal Systems Behavior Scale (FrSBe)
  • C J Golden
Golden, C.J., 1978. Stroop Color and Word Test: A Manual for Clinical and Experi-mental Uses. Stoelting Co., Wood Dale, IL. Grace, J., Malloy, P.F., 2002. The Frontal Systems Behavior Scale (FrSBe). Psychological Assessment Resources, Odessa, FL.
Goal Management Training Documento de consenso para un abordaje neuropsicológico de las adicciones
  • I H Robertson
  • B Levine
  • T Manly
  • C C Streeter
  • D B Terhune
  • T H Whitfield
  • S Gruber
  • O Sarid-Segal
  • M M Silveri
  • G Tzilos
  • M Afshar
  • E D Rouse
  • H Tian
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Robertson, I.H., Levine, B., Manly, T., 2005. Goal Management Training. Baycrest Rotman Research Institute. Sociedad Espã nola de Toxicomanías, 2009. Documento de consenso para un abordaje neuropsicológico de las adicciones. Streeter, C.C., Terhune, D.B., Whitfield, T.H., Gruber, S., Sarid-Segal, O., Silveri, M.M., Tzilos, G., Afshar, M., Rouse, E.D., Tian, H., Renshaw, P.F., Ciraulo, D.A., Yurgelun-Todd, D.A., 2008. Performance on the Stroop predicts treatment compliance in cocaine-dependent individuals. Neuropsychopharmacology 33, 827–836.
Goal Management Training
  • I H Robertson
  • B Levine
  • T Manly
Robertson, I.H., Levine, B., Manly, T., 2005. Goal Management Training. Baycrest Rotman Research Institute.
001) (GMT + MF) POST > PRE (STx) POST = PRE Zoo Map (raw score) 10
  • Stroop Color
Stroop Color*Words 36.89 (13.54) 45.17 (11.42) 38.00 (9.02) 37.43 (11.40) 13.46 (0.001) (GMT + MF) POST > PRE (STx) POST = PRE Zoo Map (raw score) 10.06 (4.08) 12.22 (3.98) 7.94 (5.30) 9.31 (4.68) 0.23 (0.638) Key Search (raw score) 9.61 (3.81) 8.56 (3.45) 8.06 (3.62) 9.06 (3.70) 2.26 (0.143)
La práctica de la atención plena
  • J Kabat-Zinn
Kabat-Zinn, J., 2007. La práctica de la atención plena. Kairós, Barcelona.
Principles of Drug Addiction Treatment, second edition
National Institute on Drug Abuse, 2009. Principles of Drug Addiction Treatment, second edition. National Institutes of Health. U.S. Department of Health and Human Services.
Stroop Color and Word Test: A Manual for Clinical and Experimental Uses
  • C J Golden