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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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... GMT significantly improved performance on an information gathering (reflection impulsivity) task, but not on an attentional control (Stroop) task. Alfonso and colleagues [37] also delivered GMT and mindfulness meditation to individuals receiving outpatient care for polysubstance use (n = 34). GMT was compared against TAU, with non-random assignment. ...
... GMT participants showed significantly improved performance on an attentional control (Stroop) task and the Iowa Gambling Task, a decision-making task that requires learning to choose options with less immediate and longer-term reward outcomes (tapping into the feedback monitoring/shifting mechanism). Treatment outcomes were not assessed in the original GMT studies [36,37]. ...
... Program effects on attentional control and feedback monitoring/shifting were mixed. Two studies reported benefits on tasks of attentional control [22,37] reflecting an improved ability to engage and sustain cognitive resources to control automatic impulsive responses. However, three studies did not find notable improvements [35•, 36, 38]. ...
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Purpose of Review Impulsivity is a core feature underpinning addictive disorders linked to difficulties achieving and sustaining treatment goals. Cognitive remediation is a promising adjunct intervention approach to improve impulse control in addictive disorders, although evidence is still preliminary. This review summarizes available evidence and discusses opportunities to enhance the development and delivery of future interventions. Recent Findings We identified six studies that delivered cognitive remediation and assessed state impulsivity in substance use disorders. There was substantial heterogeneity in the intervention ingredients and delivery approaches. We identified key opportunities to enhance future cognitive remediation studies, including (1) co-designing interventions, (2) incorporating specific impulsivity training strategies, (3) increasing opportunities to practice skills, (4) supporting skill transfer to everyday settings, and (5) demonstrating clinician compassion. Summary Researchers should work alongside frontline clinicians and clients with addictive disorders to enhance the potential benefit of cognitive remediation interventions prior to high-quality trials.
... This is typically delivered in a group format over 9 weekly 2-h sessions that includes psychoeducation, group brain-storming activities and hands-on activities focused on building cognitive awareness, strategies and confidence (Levine et al., 2000). GMT has demonstrated positive preliminary findings when delivered in substance use disorder (SUD) residential and outpatient programs (Alfonso et al., 2011;Valls-Serrano et al., 2016). In residential settings, GMT was associated with reductions in impulsivity and time taken to plan tasks and an increase in working memory (Valls-Serrano et al., 2016). ...
... In residential settings, GMT was associated with reductions in impulsivity and time taken to plan tasks and an increase in working memory (Valls-Serrano et al., 2016). In outpatient settings, GMT was associated with improvements in inhibition and working memory (Alfonso et al., 2011). However, there remain gaps in the literature regarding the efficacy of GMT with respect to program adherence and client retention in an alcohol outpatient setting. ...
... However, there remain gaps in the literature regarding the efficacy of GMT with respect to program adherence and client retention in an alcohol outpatient setting. For instance, in Alfonso et al. (2011), people with comorbid DSM-IV Axis 1 disorders were excluded. Given psychiatric comorbidity is common in alcohol treatment populations (García-Carretero et al., 2017), it was of interest to pilot this program with more naturalistic inclusion criteria. ...
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People with alcohol use disorder (AUD) exhibit high rates of comorbidity with cognitive deficits, particularly for executive function (EF). Cognitive impairment has been related to poorer outcomes in substance use treatment. Goal management training (GMT), a structured, therapist-led manualised intervention targeting EF, has demonstrated positive preliminary results in substance use disorder (SUD) treatment programs.. However, these studies have had strict exclusion criteria (e.g. excluding clients with mental health disorders), and the feasibility of running such a program in a broader SUD outpatient setting is unclear. The primary aim of this study was to determine the outcomes and feasibility of a cognitive remediation intervention at an outpatient alcohol treatment service in Sydney, Australia. Clients were referred to the study based on risk of cognitive deficits (as indicated by objective cognitive impairment on a screening tool or relevant collateral clinical information). Eligibility criteria included diagnosis of a current alcohol use disorder and abstinence for 2 or more weeks. The intervention consisted of 9 weekly GMT sessions. Out of 34 clients referred, 11 were eligible to participate, and of these, five were allocated to the intervention group and two to a waitlist control group. Due to poor recruitment, statistical analyses between groups were not possible; instead, this study presents a case series of the five clients recruited to the 9-week group intervention using GMT. Clients engaged in the intervention presented with a range of deficits in their cognitive functioning at baseline. Despite positive comments from participants regarding the intervention, there was a high level of attrition; while four clients (80%) completed at least four sessions, only one participant remained until the end of the nine-session program. In its current form, this program is not suitable for this cohort in the outpatient setting. Suggestions are made for tailoring GMT and other approaches to increase engagement and retention in future interventions.
... Additionally, if a specific clinical condition is associated with impaired cognitive control, the Stroop task could be used to determine whether a mindfulness intervention might improve the cognitive symptoms of that condition. An example of this is provided by Alfonso et al. (2011) who assessed paper Stroop task performance in alcohol and polysubstance abusers with executive function impairments, before and after a 7-week mindfulness and goal management program in an outpatient setting. They compared changes in the mindfulness group's performance to a group that received standard psychotherapeutic treatment. ...
... They found that the mindfulness group showed a reduction in Stroop interference from before to after the intervention, but the standard treatment group did not. The improved Stroop task performance in the mindfulness group is particularly important, because impaired inhibitory processes measured by the Stroop task have been found to predict increases in addictive relapses (Alfonso et al., 2011). The authors suggested the reduced Stroop interference may reflect the improved recognition of interoceptive information produced by mindfulness. ...
... The authors suggested the reduced Stroop interference may reflect the improved recognition of interoceptive information produced by mindfulness. This change might also influence decisions about short-term and long-term goals in alcohol and polysubstance abusers, as the interaction between bodily sensations driving short-term craving and longer-term abstinence goals is thought to contribute to addiction behavior (Alfonso et al., 2011). As such, this strategic application of the Stroop task provided results that suggest a mindfulness training program can improve a critical symptom of alcohol/polysubstance abuse, in a manner that might improve outcomes. ...
... Different types of studies have been identified: 12 randomized control studies (RCT) (Amiri et al., 2016;Andersson et al., 2017;Carmody et al., 2012;Feldman et al., 2013;Ghasemi et al., 2014;Imani et al., 2015;Raes et al., 2011;Schuman et al., 2015;Tarp et al., 2017;Tiburcio et al., 2018;Walitzer et al., 2015;Wüsthoff et al., 2014), 6 quasiexperimental research designs with pre and post evaluation (Alfonso et al., 2011;Campbell et al., 2015;Khan et al., 2020;Tam et al., 2016;Wieben et al., 2018;Wodarski & Green, 2015), and 1 observational study (McKowen et al., 2018). Six of these studies were conducted in the United States of America (USA), three in Iran, two in Denmark, and the others in different countries. ...
... In 10 studies there was a significant improvement in the experimental group vs control group with usual treatment after the final evaluation of the intervention program (highlighted in Table 1). The most frequent outcomes are: less substance use (Amiri et al., 2016;Campbell et al., 2015;Imani et al., 2015;McKowen et al., 2018;Wieben et al., 2018;Wodarski & Green, 2015); improvement of general health (Alfonso et al., 2011;Ghasemi et al., 2014;Schuman et al., 2015;Wodarski & Green, 2015); more treatment adhering (Raes et al., 2011;Schuman et al., 2015;Wieben et al., 2018) and less depression (McKowen et al., 2018;Wodarski & Green, 2015). ...
... To face this need to help patients to deal step by step to multiple substances, is the reason why these studies highlight the applicability of CBT as one of the preferred theoretical references in substance use disorders (Mueller et al., 2012;NIDA, 2018). Others include interventions based on motivational strategies (McKowen et al., 2018;Wieben et al., 2018), relapse prevention (Campbell et al., 2015;Imani et al., 2015), psychoeducation (Campbell et al., 2015;McKowen et al., 2018), risk awareness, personal goals, decision-making skills, acceptance (Alfonso et al., 2011;Amiri et al., 2016;Imani et al., 2015), behavioural counselling, and feedback sessions (Schuman et al., 2015;Wodarski & Green, 2015), social support (Ghasemi et al., 2014;Imani et al., 2015) and relaxation and mindfulness (Alfonso et al., 2011;Imani et al., 2015;Walitzer et al., 2015), which have been highly recommended (NIDA, 2018). ...
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Structured intervention programs are an important resource for supporting people with substance addiction. Although evidence suggests that they improve health outcomes, such as specific symptoms, less is known about their impact on patients' ability to self-manage the consequences of substance addiction. The aim of this review is to scope outpatient intervention programs focused on the self-management of substance addiction consequences. Approach. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE and CINAHL (through Ebsco), Psychology & Behav-ioral Sciences Collection (including PsycINFO) and Web of Science were screened to identify articles published in the last 10 years. Only primary research was included. Out of 891 records, 19 were eligible for this review-12 randomized controlled trials (RCT), 6 quasi-experimental study and 1 observational study. Those studies reported group interventions (10), individual interventions (8) and 1 mixed approach. The most common interventions were based on motivational strategies, relapse prevention and definition of active plans for risky situations. 10 studies reported positive effects. The identification of structured programs may support the development of new approaches focused on empowerment and quality of life of people with substance addiction. Programs to empower patients for self-management of substance addiction consequences are often complex and rely on health professionals' commitment. Nevertheless, they are a feasible approach that seems to benefit patients managing chronic conditions associated with substance addiction.
... 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.
... 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.
... Importantly, psychosocial interventions can also constitute health promotion and support health autonomy, which may be of particular significance to young adults transitioning to adult care [23][24][25][26][27]. There is a small and heterogenous body of research examining the efficacy of psychosocial interventions in the management of physical health problems associated with ADHD [28][29][30][31][32][33]. However, this has not yet been synthesised to identify the nature and extent of existing research or indicate targets for future research and intervention development. ...
... Studies reporting physical activity or weight outcomes were much more heterogenous in their design, including two RCT protocols, two completed RCTs and two single group interventions (Table 5). Studies in this category had generally small sample sizes (n<50), except Lindvall et al (N=120) [71] and comprised a younger adult demographic (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Only two studies provided a rationale for intervention explicitly highlighting health in ADHD (both referencing poor health behaviour in ADHD) [54,71]. ...
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Background Young people and adults with ADHD are at risk of a range of physical health problems. There is limited guidance on how to approach health problems in ADHD, and especially around 16-25 year olds who will be transitioning from paediatric to adult care. The aim of this scoping review was to identify psychosocial interventions that target physical health in young people and adults with ADHD. Methods We constructed searches in MEDLINE, PsycInfo, EMBASE of adolescents, young people and adults. Inclusion criteria were; studies of psychosocial interventions examining a component of physical health, applicable to people aged 16-25, with clinical or research diagnoses of ADHD. Data were extracted using a data extraction tool and tabulated, including study intervention framing/aims, population, intervention, and relevant outcomes (including specific statistics where relevant). Results Our search identified 22 unique papers covering, psychosocial interventions targeting at least one of sleep (n=7), smoking (n=3), substance/alcohol use (n=4), physical health/exercise (n=6) and general health (n=3). Studies examined psychotherapy/behaviour interventions (n=12), psychoeducation (n=4), digital (n=2) and social interventions (n=4). There was significant heterogeneity in intervention framing, outcome measures and population. Conclusion Further work on the impact of targeted physical health interventions, with explicit reference to a conceptual framework of poor health in ADHD is required. Furthermore, future work standardising reporting of physical health outcomes in ADHD is crucial for the development of an evidence base in this field.
... Goal Management Training (GMT) is a cognitive remediation program originally designed to improve executive dysfunction after brain injury [21] and has shown early promise at improving executive functions in substance use disorders [22][23][24][25][26]. GMT trains executive functions via strategy learning and application of meta-cognitive skills to personal goals. ...
... Psychoeducation around healthy brain functioning, and the benefits of sleep, diet, and exercise also feature in existing treatment programs which have limited efficacy [3]. We have already seen preliminary evidence of the benefit of GMT on areas of executive functioning in earlier trials in substance use disorders [22,25], and the program has been further tailored to target the cognitive difficulties associated with MUD (i.e., attention problems, poor inhibition or difficulty controlling impulses, difficulty shielding goals from distractions, and preferencing short-term over long-term decisions) [9,29,54]. ...
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Background Methamphetamine use disorder (MUD) is associated with executive dysfunctions, which are linked with poorer treatment outcomes. However, current treatments for MUD do not directly address cognition. We recently modified Goal Management Training (now Goal Management Training⁺; GMT⁺), a group-based intervention originally designed to improve executive functions after brain injury, to enhance suitability for MUD. Here, we describe the rationale and design of a trial which aims to determine the acceptability and feasibility of GMT⁺ during residential rehabilitation for MUD, and its impact on executive functions and clinical outcomes. Methods We used a cluster randomised crossover design: participants are randomised at the cluster level to receive either GMT⁺ or psychoeducation-control (Brain Health Workshop; BHW). GMT⁺ is delivered in four 90-minute weekly sessions and includes a between-session journal with 10-minute daily activities. The program targets attention, impulse control, goal-setting, and decision-making. BHW is a health-oriented intervention that delivers information about the brain and promotes healthy exercise, diet, and sleep. It is matched to GMT⁺ on program format, length, and time with therapists. We will recruit forty-eight participants with MUD from residential treatment services. Our primary outcomes are acceptability, feasibility, and self-reported executive functioning. Secondary outcomes include craving, quality of life and cognitive performance. Outcome assessments are performed at baseline, post-interventions, 4-week follow-up, and 12-week follow-up. Conclusions This study will provide GMT ⁺ feasibility and acceptability data and will indicate initial efficacy on executive functions and clinical outcomes in residential treatment for MUD. Information from this pilot trial will inform a powered RCT.
... 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).
... 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
... 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.
... Executive functions, vital for reducing drug use and sustaining abstinence, are subject to enhancement through the reinforcement of top-down cognitive control by MBIs [89]. A quasi-experimental study focused on polysubstance use revealed substantial improvements in executive functioning, encompassing working memory, selective attention/response inhibition, and decision-making skills following mindfulness training [100]. The positive impact was replicated in a subsequent pilot RCT, emphasising the robustness of combined goal management and mindfulness training in both controlled laboratory settings and real-world decision-making scenarios [101]. ...
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Introduction: Methamphetamine is a highly stimulating psychoactive drug that causes life-threatening addictions and affects millions of people around the world. Its effects on the brain are complex and include disturbances in the neurotransmitter systems and neurotoxicity. There are several known treatment methods, but their effectiveness is moderate. It must be emphasised that no drugs have been approved for treatment. For this reason, there is an urgent need to develop new, effective, and safe treatments for methamphetamine. One of the potential treatments is mindfulness meditation. In recent years, this technique has been researched extensively in the context of many neurological and psychiatric disorders. Methods: This review explores the use of mindfulness in the treatment of methamphetamine addiction. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. Results: Seven studies were identified that used mindfulness-based interventions in the treatment of methamphetamine addiction. The results show that mindfulness is an effective form of reducing hunger, risk of relapses, stress indicators, depression, and aggression, alone or in combination with transcranial direct current stimulation (tDCS). Mindfulness also improved the cognitive function in addicts. The included studies used only behavioural measures. The potential mechanisms of mindfulness in addiction were explained, and it was proposed that it can induce neuroplasticity, alleviating the symptoms of addiction. Conclusions: Evidence from the studies suggest that mindfulness may be an effective treatment option for methamphetamine addiction, used alone or in combination with tDCS. However, further high-quality research is required to establish the role of this treatment option in this field. The use of neuroimaging and neurophysiological measures is fundamental to understand the mechanisms of mindfulness.
... Despite the positive sides, the highly controlled environment, a characteristic of the Therapeutic Community, is also a limitation of the study since the attended patients used to live alone or as homeless people, facing violence and financial/food deprivation daily. This fact has two possible important implications: patients were not exposed to triggering circumstances, unlike previous studies that reported effects on impulsivity in different settings [42]; and, for being there, patients had a different lifestyle than they used to, and had no access to the "real world" and usual context of the use of substances. ...
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This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD’s) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.
... MT is effective in older adults with subjective complaints of general cognitive or memory impairment, significantly improving their performance on simulated real-life tasks and reducing their self-reported executive failures in the short and long term (Levine et al., 2007). Furthermore, other findings indicate that when time spent on mindfulness in standard GMT increases, improvements are observed in working memory, inhibition, reflection-impulsivity, and decision-making (Alfonso et al., 2011;Valls-Serrano et al., 2016). ...
Article
Background: The risk of cognitive decline in older adults makes it necessary to design training programs for the improvement of cognition. Aims: To determine the efficacy of applying a combined program of computerized cognitive training (CCT) and mindfulness for improving cognition and mood and quality of life in people aged 60 years and older, compared with using both interventions separately. Methods: Adults, older than 95 years were assigned to groups that subsequently received one of the three interventions (CCT, mindfulness, and combined). Cognitive, emotional, and quality of life assessment instruments were administered pre- and post-intervention. The standardized individual change was determined, and one-factor ANOVAs and ANCOVAs were conducted to test between-group differences. Results: After controlling for confounding factors, greater significant improvements were obtained in the combined group compared with the CCT and mindfulness groups in selective attention (median effect size) and abstract reasoning (large effect size). No significant differences were found in the rest of cognitive variables, mood or quality of life. Conclusion: The findings indicate that, with the same investment of time, combining CCT and mindfulness effectively improves selective attention and abstract reasoning, in older adults. This combination of strategies might have implications for the improvement of cognitive impairment in older adults.
... Lo importante de este resultado es, en la importancia que se le da a nivel gerencial, los sistemas de valores personales, lo cual coincide con lo mencionado por Thierauf et al. (1977). Otra situación importante de resaltar es lo referente a las presiones relacionas a la gestión medioambiental, contribuyendo con poco o nada al desarrollo sostenible de estas organizaciones, resultando contradictorio con lo que mencionan Alfonso et al. (2011) en su estudio, el cual determina que es un factor relevante la gestión ambiental en una organización. No obstante, los estudios realizados por Bolívar (2011) concluyen que las competencias de liderazgo fortalecen la relaciones entre las prácticas ambientales y el desempeño sustentable. ...
Article
Objetivo. Demostrar cómo la gestión de la gerencia ambiental sistémico contribuye al incremento del desarrollo sostenible en pequeñas y medianas empresas del sector público y privado en región Piura. Materiales y método. Este trabajo se realizó bajo el paradigma hipotético deductivo, de tipo sustantiva básica y de diseño correlacional transversal. La muestra estuvo constituida por 159 entre gerentes y administradores de las entidades mencionadas. Se aplicó la técnica de encuestas a través de cuestionarios que comprendía las dimensiones de 1) dominio personal, 2) modelos mentales, 3) aprendizaje continuo y visión compartida, 4) pensamiento sistémico. En cuanto a metodología se empleó la prueba de análisis de Chi-Cuadrado con el fin de establecer los niveles de asociación a partir del análisis de tablas de contingencias dicotómicas. Resultados. Se determinó que existe para las dimensiones: dominio personal, modelos mentales, aprendizaje continuo y visión compartida y pensamiento sistémico una chi-cuadrada de 31.196, 40.789,51.078 y 38.330, las cuales resultaron ser mayores que la chi-cuadrado tabular o crítica, por lo tanto, existe un alto grado de relación significativa entre las dimensiones con la gestión del gerente ambiental sistémico. Conclusión. Existe un alto grado de correlación entre la gestión de la gerencia ambiental sistémica con el incremento del desarrollo sostenible.
... The important thing about this result is, in the importance given to it at a managerial level, personal value systems, which coincides with what was mentioned by Thierauf et al. (1977). Another important situation to highlight is regarding the pressures related to environmental management, contributing little or nothing to the sustainable development of these organizations, being contradictory with what Alfonso et al. (2011) in their study, which determines that environmental management in an organization is a relevant factor. However, the studies carried out by Bolívar (2011) conclude that leadership competencies strengthen the relationship between environmental practices and sustainable performance. ...
Article
Goal. Demonstrate how the management of systemic environmental management contributes to the growth of sustainable development in small and medium-sized companies in the public and private sectors in the Piura region. Material and method. This work was carried out under the deductive hypothetical paradigm, of a basic substantive type and of transversal correlational design. The study was made up of 159 managers and administrators of the entities mentioned. The survey technique was applied through questionnaires that comprised the dimensions of 1) personal domain, 2) mental models, 3) continuous learning and shared vision, 4) systemic thinking. While the methodology was used, the Chi-Square analysis problem was established to establish the association levels based on the analysis of dichotomous contingency tables. Results. It was determined that it exists for the dimensions: personal domain, mental models, continuous learning and shared vision and systemic thinking of a chi-cuadrada of 31,196, 40,789,51,078 and 38,330, as they turned out to be larger than the chi-cuadrado tabulate the criticism, for so much so, there is a high degree of significant relationship between the dimensions with the management of the systemic environmental manager. Conclusion. There is a high degree of correlation between the management of systemic environmental management and the increase in sustainable development.
... 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. ...
Article
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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.
... 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]. ...
Article
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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). ...
Chapter
Full-text available
Mindfulness training (MT) represents a family of contemplative practices aimed at promoting well-being. Despite growing evidence for the clinical efficacy of MT interventions across a range of mental health disorders, mechanistic theories of MT remain difficult to validate through self-report techniques alone. Neuroimaging investigations of MT complement self-report approaches by characterizing changes in information processing associated with MT. Such approaches may be used to analyze mindfulness at three levels: as a transient state, as the product of longitudinal MT, and as trait-like differences in the tendency to be mindful. This chapter synthesizes neuroimaging research at all three of these levels to propose a neural network model of mindfulness, relating MT to the interactions between three commonly characterized brain networks. Current contemplative neuroscience studies converge around findings that MT often involves a reconfiguration of mental habits supported by the default mode network (DMN), most commonly increasing DMN connectivity to both sensory representation areas and the brain’s central executive network (CEN). This DMN’s “dorsal shift” to the CEN from more ventral, affectively laden connections to the brain’s salience network (SLN) may reflect an increased ability to reflect upon events without lapsing into habitual ways of judging or responding. Together, this pattern of increased sensory access to the prefrontal cortex, coupled with a dorsal shift in prefrontal connectivity to regions associated with cognitive control, is suggestive of an emerging neurophenotype of capacity to access and sustain mindful states.KeywordsMindfulnessDefault mode network (DMN)Central executive network (CEN)Salience network (SLN)Mindfulness-based stress reduction (MBSR)Mindfulness-based cognitive therapy (MBCT)Dispositional or trait mindfulnessMindful Attention Awareness ScaleFive Facet Mindfulness Scale (FFMQ)DecenteringPainRewardEnhanced sensory processingEmotion regulation/emotion processingResting-state imagingAttention regulationSelf-regulation
... 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.
... 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
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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.
... 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). ...
Article
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Background: Adults with attention deficit/hyperactivity disorder (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 6 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 6-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 6-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 6 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. Clinical Trial Registration: The study is registered under ISRCTN.com (ISRCTN91988877; https://doi.org/10.1186/ISRCTN91988877).
... 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
Full-text available
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.
... 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). ...
Article
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
... 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). ...
Article
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Previous research shows that dispositional mindfulness is related to cognitive aspects. The relationship between executive functions and dispositional mindfulness is poorly studied. The aim of this work is to characterize the executive functioning associated with dispositional mindfulness. Dispositional mindfulness was evaluated in 90 undergraduates through the Mindful Attention Awareness Scale. In addition, inhibition (Stroop task), cognitive flexibility (rule shift cards), processing speed (digit symbol substitution test), planning (zoo map test) and abstract reasoning (similarities test) were used to evaluate executive function. A multiple hierarchical regression analysis was carried out to predict dispositional mindfulness based on performance in the executive function tests and the individual’s age and sex. Age and sex accounted for 0.7% of dispositional mindfulness. Inhibition and cognitive flexibility accounted for 10.8% and 6%, respectively, of dispositional mindfulness, while processing speed and abstract reasoning explained 3.5% and 0.8%, respectively. Lastly, planning accounted for 0% of dispositional mindfulness. Individual differences in self-reported dispositional mindfulness may be caused by differences in executive performance. The good management of cognitive flexibility, the ability to inhibit and the ability to process stimuli more quickly play a crucial role in attending to current experience.
... 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. ...
Article
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Substance use disorders are associated with diverse neuropsychological impairments, with deficits in memory and executive functioning commonly observed. Cognitive remediation has been shown to be effective in other populations with cognitive impairments in these domains, including those with psychiatric disorders and acquired brain injuries, and it has been hypothesised to be similarly effective for those in treatment for substance use disorders. We aimed to systematically review the evidence for cognitive remediation interventions administered as an adjunct treatment to substance use rehabilitation. Studies were included if participants were receiving substance use treatment, if improving cognitive functioning was the main focus of the intervention and if they used an experimental design with a control condition receiving treatment-as-usual or an active control intervention. Two independent reviewers agreed on the final selection of 32 studies, encompassing cognitive remediation for working memory, memory, executive functioning and general cognition. Significant differences between intervention and control groups for cognitive test results and treatment outcomes were extracted and compared across treatment approaches. The review found considerable heterogeneity across studies, including in the types of interventions, the nature of participants and the outcome measures used. Further, a lack of quality studies with sufficient power meant that limited conclusions could be drawn, highlighting a need for further replication and research. However, findings indicate that cognitive remediation remains a promising potential avenue for improving cognition and treatment outcomes for those in treatment for substance use disorders. Protocol submitted prospectively to PROSPERO 30.09.2019, CRD42020150978.
... 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
Full-text available
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.
... Lo importante de este resultado es, en la importancia que se le da a nivel gerencial, los sistemas de valores personales, lo cual coincide con lo mencionado por Thierauf et al. (1977). Otra situación importante de resaltar es lo referente a las presiones relacionas a la gestión medioambiental, contribuyendo con poco o nada al desarrollo sostenible de estas organizaciones, resultando contradictorio con lo que mencionan Alfonso et al. (2011) en su estudio, el cual determina que es un factor relevante la gestión ambiental en una organización. No obstante, los estudios realizados por Bolívar (2011) concluyen que las competencias de liderazgo fortalecen la relaciones entre las prácticas ambientales y el desempeño sustentable. ...
Article
Full-text available
Objetivo. Demostrar cómo la gestión de la gerencia ambiental sistémico contribuye al incremento del desarrollo sostenible en pequeñas y medianas empresas del sector público y privado en región Piura. Materiales y método. Este trabajo se realizó bajo el paradigma hipotético deductivo, de tipo sustantiva básica y de diseño correlacional transversal. La muestra estuvo constituida por 159 entre gerentes y administradores de las entidades mencionadas. Se aplicó la técnica de encuestas a través de cuestionarios que comprendía las dimensiones de 1) dominio personal, 2) modelos mentales, 3) aprendizaje continuo y visión compartida, 4) pensamiento sistémico. En cuanto a metodología se empleó la prueba de análisis de Chi-Cuadrado con el fin de establecer los niveles de asociación a partir del análisis de tablas de contingencias dicotómicas. Resultados. Se determinó que existe para las dimensiones: dominio personal, modelos mentales, aprendizaje continuo y visión compartida y pensamiento sistémico una chi-cuadrada de 31.196, 40.789,51.078 y 38.330, las cuales resultaron ser mayores que la chi-cuadrado tabular o crítica, por lo tanto, existe un alto grado de relación significativa entre las dimensiones con la gestión del gerente ambiental sistémico. Conclusión. Existe un alto grado de correlación entre la gestión de la gerencia ambiental sistémica con el incremento del desarrollo sostenible.
... 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.
... 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.
... Recently, training both cold, i.e. executive functions, and hot, i.e. positive and negative saliency mechanisms, is bringing interesting potentials to the field (for comprehensive information, see [84]). (7) Goal Management Training (GMT) is a manualised group intervention for executive dysfunction that has been shown to improve cognitive control and reduce stress in SUDs [4,95]. GMT uses instruction, discussion and mindfulness and cognitive exercises (e.g. ...
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.
Chapter
In the past two decades, a variety of cognitive training interventions have been developed to help people overcome their addictive behaviors. Conceptually, it is important to distinguish between programs in which reactions to addiction-relevant cues are trained (varieties of cognitive bias modification, CBM) and programs in which general abilities are trained such as working memory or mindfulness. CBM was first developed to study the hypothesized causal role in mental disorders: by directly manipulating the bias, it was investigated to what extent this influenced disorder-relevant behavior. In these proof-of-principle studies, the bias was temporarily modified in volunteers, either temporarily increased or decreased, with corresponding effects on behavior (e.g., beer consumption), in case the bias was successfully manipulated. In subsequent clinical randomized controlled trials (RCTs), training (away from the substance vs. sham training) was added to clinical treatment. These studies have demonstrated that CBM, as added to treatment, reduces relapse with a small effect of about 10% (similar effect size as for medication, with the strongest evidence for approach-bias modification). This has not been found for general ability training (e.g., working memory training), although effects on other psychological functions have been found (e.g., impulsivity). Mindfulness also has been found to help people overcome addictions, and different from CBM, also as stand-alone intervention. Research on (neuro-)cognitive mechanisms underlying approach-bias modification has pointed to a new perspective in which automatic inferences rather than associations are influenced by training, which has led to the development of a new variety of training: ABC training.KeywordsAddictionAlcohol use disorderApproach biasApproach bias retrainingCognitive-bias modificationCognitive trainingMindfulnessTreatmentWorking memory training
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Araştırmada Kabul ve Kararlılık Terapisi temelli geliştirilen karar verme becerisi psikoeğitim programının karar verme stilleri üzerindeki etkisi incelenmiştir. Araştırmada 2x3’lük split plot desen kullanılmıştır. Veri toplama aracı olarak Karar Verme Stilleri Ölçeği ve Kişisel Bilgi Formu uygulanmıştır. Ölçümlerden edinilen verilerin analizinde, tek faktör üzerinde tekrarlı ölçümler için iki faktörlü varyans analizi tekniği kullanılmıştır. Analiz sonucunda; Müdahale * zaman etkisinin Bağımlı ve Kaçınmacı Karar Verme Stilinde anlamlı olduğu; Anlık, Sezgisel ve Rasyonel Karar Verme Stillerinde anlamlı olmadığı belirlenmiştir. Bağımlı ve Kaçınmacı Karar Verme Stillerinde oluşan farklılaşmanın kaynağının belirlenmesi için Bonferonni testi ve varyans analizi kullanılmıştır. Edinilen bulgulara gore; psikoeğitim programının bireylerin Bağımlı Karar Verme Stillerinde anlamlı düşüşler oluşturduğu ve bu düşüşün izleme testinde de devam ettiği belirlenmiştir. Kaçınmacı Karar Verme Stili için uygulanan Bonferonni testi ve varyans analizi sonucunda ise psikoeğitim programının bireylerin Kaçınmacı Karar Verme Stilinde anlamlı düşüşler oluşturduğu ve bu düşüşlerin izleme sürecinde de devam ettiği belirlenmiştir.
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Background: Deficits in executive function are common in methamphetamine use disorder (MUD), likely contributing to difficulties in sustained treatment success. Cognitive remediation interventions are designed to treat such deficits but have not been adapted to the needs of people with MUD. This study presents a proof-of-concept trial to evaluate a new cognitive remediation program for MUD, Goal Management Training+ (GMT+). Methods: This was a cluster-randomised crossover trial comparing GMT+ with a psychoeducation-based control (Brain Health Workshop; BHW). GMT+ is a therapist-administered group-based cognitive remediation for executive dysfunction comprising four 90-minute weekly sessions and daily journal activities. BHW is a lifestyle psychoeducation program matched to GMT+ for therapist involvement, format, and duration. Participants (n = 36; GMT n = 17; BHW n = 19) were recruited from therapeutic communities in Victoria, Australia. Primary outcomes included intervention acceptability, feasibility, and improvements in self-reported executive function. Secondary outcomes included cognitive tests of executive function, severity of methamphetamine dependence, craving, and quality of life. We performed mixed linear modelling and calculated Hedges' g effect sizes. Results: GMT+ participant ratings and program retention indicated high acceptability. There was no difference between GMT+ and BHW on self-reported executive function (g = 0.06). Cognitive tasks suggested benefits of GMT+ on information gathering (g = 0.88) and delay-discounting (g = 0.80). Severity of methamphetamine dependence decreased more in GMT+ (g = 1.47). Conclusions: GMT+ was well-accepted but did not improve self-reported executive functioning. Secondary outcomes suggested GMT+ was beneficial for objective cognitive performance and severity of dependence.
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Objective: Substance use disorders (SUDs) are brain disorders associated with impairments resulting from the recurrent use of alcohol, drugs, or both. Though recovery is possible, SUDs are chronic, relapsing-remitting disorders, with estimates of SUD relapse at 40-60 %. Currently, we know little about the mechanisms underlying successful recovery processes and whether substance-specific mechanisms exist. The current study sought to examine delay discounting (a measure of future valuation), executive skills, abstinence duration, and health behaviors in a population of individuals in recovery from alcohol, stimulants, opioids, and other substances. Methods: In this observational study, we utilized a cohort of individuals (n = 238) from the International Quit and Recovery Registry, an online registry for those in recovery from SUDs around the world. We assessed delay discounting through a neurobehavioral task, and assessed abstinence duration, executive skills, and engagement in positive health behaviors through self-report measures. Results: We found that delay discounting, executive skills, and engagement in positive health behaviors were similar among individuals in recovery from different substances. Abstinence duration was associated with delay discounting and engagement in health behaviors. Additionally, executive skills and engagement in health behaviors were positively associated. Conclusion: These findings suggest that common behavioral mechanisms support recovery from misuse of various substances. As both delay discounting and executive skills are dependent upon executive brain centers, such as the prefrontal cortex, strategies that target executive functioning, such as episodic future thinking, meditation, or exercise, may be efficient strategies for optimizing recovery from SUDs.
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This pilot study aims to compare the effects of mindfulness and holotropic breathwork treatments on adolescents in the rehabilitation process for psychoactive substance use. Participants comprised 18 female adolescents aged 15–18 admitted to the Fundación Grupo de Apoyo, affiliated with the Colombian Family Welfare Institute. The Fundación is dedicated to rehabilitation from, detoxification from, and prevention of psychoactive substance use. The study utilizes a mixed methods approach with an exploratory design. Heart rate is used as an important indicator of psychological well-being and overall cardiovascular health, and the mean pretest/posttest heart rates of the control and experimental groups are compared quantitatively. The effects of both treatments on the study population are described qualitatively. The results show a reduction in heart rate in the mindfulness group compared to the control. The narratives of the participants and the institution’s workers show positive changes in emotional regulation and coping, better communication, and a reduction in stress and anxiety or the desire to use, as a result of both experimental treatments.
Chapter
Cognitive impairments (CI) are common in the context of substance use disorders (SUDs). In addition to the direct effects that substance can have upon the brain, there are a range of associated factors that may further compound cognitive deficits in SUD across the life span. Due to the high prevalence of CI in this cohort and negative impact CI can have upon treatment engagement, retention and outcomes as well as broader functioning and quality of life, its identification and management is critical. This chapter discusses factors that may be associated with CI in SUD, encouraging readers to employ a biopsychosocial lens to assessment and management. A variety of practical identification and screening methods are discussed, including factors to explore when taking a clinical history and self/informant questionnaires available for use. This chapter discusses ways in which CI may manifest behaviorally and explores cognitive screening tools and their suitability in the SUD context. Ultimately, the use of a combination of these methods in identification of CI in SUD is recommended, with neuropsychological assessment considered the “gold standard.” With a view to maximizing functioning and participation, cognitive rehabilitation in SUD ideally targets both implicit (“bottom-up”) as well as reflective cognitive control (“top-down”) processes, using both cognitive compensatory and remediation methods. In order to support individuals with CI, this chapter describes pragmatic adaptations to existing therapies, cognitive compensatory strategies, and the existing evidence base for a range of cognitive training programs in SUD, including working memory training, inhibitory control training, goal management training, and cognitive bias modification.
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A BSTRACT Evolution in technology is drastically becoming automatic and making life easier. Among those technologies, smartphones are fast-changing technology that is equipping humans to work from anywhere. Frequent usage and dependency on smartphones have increased, which in turn contributes to changes in psychosocial behavioral aspects. Addiction plays an important role in modifying the healthy habits of individuals. Problematic usage of smartphones affects both physical and psychosocial health and emerges as a cornerstone of psychosocial disorder. However, there is a dearth of data to understand the core concepts of smartphone addiction and there is a need to understand from the broader perspective. Yoga is considered one of the viable protocols to provide the way for digital detoxification from technology and smartphone addiction by promoting self-regulation. Yoga brings back a healthy living style, which allows individuals to have enough physical activity through asanas, emotional stability, and awareness through meditation and breathing practices. We hypothesize that a holistic approach to yoga can regulate the symptoms associated with smartphone addiction by increasing the stability of the body and mind and promoting emotional detachment and self-regulation, which play an important role in the de-addiction process.
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.
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.
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Aims To evaluate and compare the effects of three cognitive boosting intervention approaches (Computerised Cognitive Training, Cognitive Remediation, and Pharmacological Cognitive Enhancers) on measures of impulsive action and impulsive choice. Design Systematic review and meta‐analysis of publications that reported original controlled trials of cognitive boosting interventions. Setting Studies conducted anywhere in the world. No language restrictions were applied. Participants Treatment‐seeking adults with substance use disorder or gambling disorder. Measurements Our primary outcome was a reduction in impulsive action or choice on a validated cognitive measure post‐intervention. We assessed risk of bias using the Cochrane Collaboration tool and determined pooled estimates from published reports. We performed random‐effects analyses for impulsive action and impulsive choice outcomes and planned moderator analyses. Findings Of 2204 unique studies identified, 60 were included in the full‐text review. Twenty‐three articles were considered eligible for inclusion in the qualitative synthesis and 16 articles were included in our meta‐analysis. Articles eligible for pooled analyses included five Working Memory Training (Computerised Cognitive Training) studies with 236 participants, three Goal Management Training (Cognitive Remediation) studies with 99 participants, four modafinil (Cognitive Enhancer) studies with 160 participants and four galantamine (Cognitive Enhancer) studies with 131 participants. Study duration ranged from 5 days to 13 weeks, with immediate follow‐up assessments. There were no studies identified that specifically targeted gambling disorder. We only found evidence for a benefit on impulsive choice of Goal Management Training, although only in two studies involving 66 participants (SMD =0.86; 95% CI 0.49‐1.23; P =0.02; I² = 0%, P =0.95). Conclusion Cognitive Remediation, and specifically Goal Management Training, may be an effective treatment for addressing impulsive choice in addiction. Preliminary evidence does not support the use of Computerised Cognitive Training or Pharmacological Enhancers to boost impulse control in addiction.
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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.
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Several studies have shown alterations in different components of executive functioning in users of different drugs, including cannabis, cocaine and heroin. However, it is difficult to establish a specific association between the use of each of these drugs and executive alterations, since most drug abusers are polysubstance abusers, and alcohol is a ubiquitous confounding factor. Moreover, in order to study the association between consumption of different drugs and executive functioning, the patterns of quantity and duration of drugs used must be considered, given the association between these parameters and the executive functioning alteration degree. Based on the multicomponent approach to executive functions, the aims of the present study were: (i) to analyse the differential contribution of alcohol versus cocaine, heroin and cannabis use on executive functions performance; and (ii) to analyse the contribution made by the severity of the different drugs used (quantity and duration patterns) on these functions in a sample of polysubstance abusers that requested treatment for cannabis-, cocaine- or heroin-related problems. We administered measures of fluency, working memory, analogical reasoning, interference, cognitive flexibility, decision-making and self-regulation to two groups: 60 substance-dependent individuals (SDIs) and 30 healthy control individuals (HCIs). SDIs had significantly poorer performance than HCIs across all of the executive domains assessed. Results from hierarchical regression models showed the existence of common correlates of the use of alcohol, cannabis and cocaine on verbal fluency and decision-making; common correlates of quantity of cannabis and cocaine use on verbal working memory and analogical reasoning; common correlates of duration of cocaine and heroin use on shifting; and specific effects of duration of cocaine use on inhibition measures. These findings indicate that alcohol abuse is negatively associated with fluency and decision-making deficits, whereas the different drugs motivating treatment have both generalized and specific deleterious effects on different executive components.
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The current study is the first randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to treatment as usual (TAU). Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment. Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention. Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period. Additionally, MBRP participants demonstrated greater decreases in craving, and increases in acceptance and acting with awareness as compared to TAU. Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders.
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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. 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. 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. Community drug and alcohol services and a clinical research facility. 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). Self-ratings, facial electromyography, startle-elicited postauricular reflex, and event-related potentials combined with measures of heroin use at baseline and follow-up. 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. 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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Two studies assessed the effects of a training procedure (Goal Management Training, GMT), derived from Duncan's theory of goal neglect, on disorganized behavior following TBI. In Study 1, patients with traumatic brain injury (TBI) were randomly assigned to brief trials of GMT or motor skills training. GMT, but not motor skills training, was associated with significant gains on everyday paper-and-pencil tasks designed to mimic tasks that are problematic for patients with goal neglect. In Study 2, GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities. Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT. These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage.
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The Frontal Systems Behavior Scale (FrSBe), formerly called the Frontal Lobe Personality Scale (FLOPS), is a brief behavior rating scale with demonstrated validity for the assessment of behavior disturbances associated with damage to the frontal-subcortical brain circuits. The authors report an exploratory principal factor analysis of the FrSBe-Family Version in a sample including 324 neurological patients and research participants, of which about 63% were diagnosed with neurodegenerative diseases (Huntington's, Parkinson's, and Alzheimer's diseases). The three-factor solution accounted for a modest level of variance (41%) and confirmed a factor structure consistent with the three subscales proposed on the theoretical basis of the frontal systems. Most items (83%)from the FrSBe subscales of Apathy, Disinhibition, and Executive Dysfunction loaded saliently on three corresponding factors. The FrSBe factor structure supports its utility for assessing both the severity of the three frontal syndromes in aggregate and separately.
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Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups.
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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.
Article
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)
Article
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.
Article
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.
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
Treatment dropout is a problem of great prevalence and stands as an obstacle to recovery in cocaine-dependent (CD) individuals. Treatment attrition in CD individuals may result from impairments in cognitive control, which can be reliably measured by the Stroop color-word interference task. The present analyses contrasted baseline performance on the color-naming, word-reading, and interference subtests of the Stroop task in CD subjects who completed a cocaine treatment trial (completers: N=50) and those who dropped out of the trial before completion (non-completers: N=24). A logistic regression analysis was used to predict trial completion using three models with the following variables: the Stroop task subscale scores (Stroop model); the Hamilton depression rating scale (HDRS) scores (HDRS model); and both the Stroop task subscale scores and HDRS scores (Stroop and HDRS model). Each model was able to significantly predict group membership (completers vs non-completers) better than a model based on a simple constant (HDRS model p=0.02, Stroop model p=0.006, and Stroop and HDRS model p=0.003). Models using the Stroop preformed better than the HDRS model. These findings suggest that the Stroop task can be used to identify cocaine-dependent subjects at risk for treatment dropout. The Stroop task is a widely available, reliable, and valid instrument that can be easily employed to identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.
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
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  • I H Robertson
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Stroop Color and Word Test: A Manual for Clinical and Experi-mental Uses. Stoelting Co The Frontal Systems Behavior Scale (FrSBe)
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Goal Management Training Documento de consenso para un abordaje neuropsicológico de las adicciones
  • I H Robertson
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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
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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
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Stroop Color and Word Test: A Manual for Clinical and Experimental Uses
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Documento de consenso para un abordaje neuropsicológico de las adicciones
  • Sociedad Española De Toxicomanías
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