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Cited by 209Substance Abuse Treatment and OutcomesMindfulness and Compassion InterventionsOpioid Use Disorder Treatment

Retraining the addicted brain: A review of hypothesized neurobiological mechanisms of mindfulness-based relapse prevention.

Open access
Witkiewitz, Katie, Lustyk, M. Kathleen B., Bowen, Sarah·2013·Psychology of Addictive Behaviors
DOI 10.1037/a0029258PMC PMC3699602
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Abstract

Addiction has generally been characterized as a chronic relapsing condition (Leshner, 1999). Several laboratory, preclinical, and clinical studies have provided evidence that craving and negative affect are strong predictors of the relapse process. These states, as well as the desire to avoid them, have been described as primary motives for substance use. A recently developed behavioral treatment, mindfulness-based relapse prevention (MBRP), was designed to target experiences of craving and negative affect and their roles in the relapse process. MBRP offers skills in cognitive-behavioral relapse prevention integrated with mindfulness meditation. The mindfulness practices in MBRP are intended to increase discriminative awareness, with a specific focus on acceptance of uncomfortable states or challenging situations without reacting "automatically." A recent efficacy trial found that those randomized to MBRP, as compared with those in a control group, demonstrated significantly lower rates of substance use and greater decreases in craving following treatment. Furthermore, individuals in MBRP did not report increased craving or substance use in response to negative affect. It is important to note, areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training. Drawing from the neuroimaging literature, we review several plausible mechanisms by which MBRP might be changing neural responses to the experiences of craving and negative affect, which subsequently may reduce risk for relapse. We hypothesize that MBRP may affect numerous brain systems and may reverse, repair, or compensate for the neuroadaptive changes associated with addiction and addictive-behavior relapse.

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Registry

Crossref · 10.1037/a0029258

Cites

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Claims the paper makes

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  • Premisecitation

    Increasing evidence shows that both novice and experienced mindfulness practitioners differ structurally and functionally in the brain compared with nonmeditators.

    “As reviewed in more detail below, there is increasing evidence that both novice mindfulness practitioners (e.g., Farb et al., 2010; Kilpatrick et al., 2011; Tang et al., 2010) and experienced mindfulness practitioners (e.g., Luders, Toga, Lepore, & Gaser, 2009; Lutz et al., 2004) show structural and functional neurobiological differences, in comparison to non-meditators.”
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    • cites Farb et al., 2010

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    • cites Kilpatrick et al., 2011

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    • cites Tang et al., 2010

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  • Premisecitation

    Craving strongly predicts relapse for all major drugs of abuse.

    “Craving, the subjective experience of an urge or desire to use substances (Kozlowski & Wilkinson, 1987), has been shown to strongly predict relapse for all major drugs of abuse (e.g., Hartz, Frederick-Osborne, & Galloway, 2001; Hopper et al. 2006; Shiffman et al., 2002), as well as gambling behavior (Young & Wohl, 2009).”
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    • cites Hartz, Frederick-Osborne, & Galloway, 2001

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    • cites Hopper et al. 2006

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    • cites Shiffman et al., 2002

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  • Premisereasoning

    Through repeated exposure and nonreaction, MBRP clients can build a repertoire of alternative responses to cues.

    “Through repeated exposure and non-reaction, clients are able to build a repertoire of alternative responses to the cues.”
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  • Study design and conductcitation

    In that trial, treatment retention rates did not significantly differ between MBRP and treatment-as-usual.

    “Of the 168 participants randomized to treatment, 133 (79%) completed a postintervention survey and the treatment retention rates did not significantly differ by treatment condition (MBRP: 82.7%; TAU: 74.7%).”
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    • cites Bowen and colleagues (2009)

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  • Premisecitation

    MBRP was created to target craving and negative affect and their roles in relapse.

    “A recently developed cognitive behavioral treatment for addiction, Mindfulness-Based Relapse Prevention (MBRP; Bowen, Chawla, & Marlatt, 2010; Witkiewitz, Marlatt, & Walker, 2005), was designed to target experiences of craving and negative affect and their role in the relapse process.”
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    • cites Bowen, Chawla, & Marlatt, 2010

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    • cites Witkiewitz, Marlatt, & Walker, 2005

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    Findingown data

    In preliminary analyses of an ongoing MBRP study, individuals treated with MBRP showed significantly less heart rate reactivity and increased high-frequency heart rate variability in response to a laboratory stressor compared to those in treatment as usual.

    “In preliminary analyses of an ongoing MBRP study, we found significantly less heart rate reactivity and increased high-frequency heart rate variability (HF-HRV), a measure of cardiac vagal control and an indicator of self-regulation (Thayer & Lane, 2009), in response to a laboratory stressor among those treated with MBRP compared to those in treatment as usual (unpublished data).”
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    • cites unpublished data

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    Premisecitation

    MBRP combines mindfulness meditation with cognitive behavioral relapse prevention skills and keeps mindfulness practice as its main focus.

    “MBRP integrates mindfulness meditation practices with cognitive behavioral relapse prevention skills (e.g., identifying high-risk situations; coping skills training; Marlatt & Gordon, 1985), retaining mindfulness practice as its primary focus (Bowen et al., 2010).”
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    • cites Marlatt & Gordon, 1985

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    • cites Bowen et al., 2010

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    Premisecitation

    People who received these mindfulness-based treatments reported reduced substance use or related improvements, including less craving and less reactivity to substance use cues.

    “Individuals who received these treatments reported reduced substance use or related improvements, such as reductions in craving and reduced reactivity to substance use cues (Bowen et al., 2009; Brewer et al., 2009; Vieten, Astin, Buscemi, & Galloway, 2010; Zgierska et al., 2008; see Bowen, Witkiewitz, Chawla, & Grow, 2011 for a review).”
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    • cites Bowen et al., 2009

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    • cites Brewer et al., 2009

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    • cites Vieten, Astin, Buscemi, & Galloway, 2010

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    Premisereasoning

    MBRP practices emphasize intentional awareness and acceptance of all experiences, including uncomfortable ones, and teach skills for relating to them.

    “MBRP practices emphasize intentional awareness and acceptance of all experiences, including those that are uncomfortable or unwanted, and teach skills to better relate to these experiences.”
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    Premisenone given

    Across animal and human relapse studies, craving and negative affect are the two most commonly endorsed relapse risk factors.

    “Across numerous investigations of relapse precipitants in both animal and human models, two factors have emerged as the most commonly endorsed relapse risk factors: craving and negative affect.”
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    Premisenone given

    These MBRP skills can be practiced regardless of what caused the negative affect.

    “Importantly, these skills can be practiced regardless of the underlying cause of negative affect (e.g., acute withdrawal, drug-induced mood disorder, or depressive disorders).”
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    Premisecitation

    In the largest controlled trial of mindfulness-based treatment for substance use disorders, Bowen and colleagues randomized 168 participants to eight weeks of MBRP or treatment-as-usual and assessed substance use outcomes up to four months after aftercare.

    “In the largest controlled trial of mindfulness-based treatment for substance abuse disorders conducted to date, Bowen and colleagues (2009) present pilot efficacy data on MBRP delivered as an aftercare program following inpatient and intensive outpatient treatment. Substance use outcomes were assessed up to four months following aftercare treatment among participants randomly assigned to either”
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    • cites Bowen and colleagues (2009)

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    Premisecitation

    MBRP mindfulness practices aim to increase awareness of external triggers and internal cognitive and affective processes, tolerance of challenging experiences, and metacognitive abilities.

    “The mindfulness practices in MBRP are intended to increase awareness of external triggers and internal cognitive and affective processes, increase the clients’ ability to tolerate challenging cognitive, affective, and physical experiences (Bowen et al., 2009), as well as enhance the clients’ metacognitive abilities (Teasdale et al., 2002).”
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    • cites Bowen et al., 2009

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    • cites Teasdale et al., 2002

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    Premisecitation

    Addiction is generally described as a chronic condition with relapses.

    “Addiction has generally been characterized as a chronic relapsing condition (Leshner, 1999), with relapse defined as the process of returning to a problematic addictive behavior following a period of abstinence or moderation.”
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    • cites Leshner, 1999

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    Interpretationcitation

    Because executive cognitive control is associated with craving, MBRP may improve higher-order executive control over automatic reactions to discomfort such as craving.

    “Given the association between executive cognitive control and craving (Blume & Marlatt, 2009), it may be that MBRP improves higher-order executive control of typically “automatic” reactions to discomfort (e.g., craving).”
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    • cites Blume & Marlatt, 2009

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    Premisereasoning

    MBRP meditation exercises were included to help clients increase present-moment awareness and attentional control, improve self-regulation by not engaging in a prepotent response, and approach discomfort nonjudgmentally and nonreactively.

    “More generally, as summarized in Table 1, the mindfulness meditation exercises used in MBRP were incorporated to help clients increase present-moment awareness and attentional control, improve their ability to observe and regulate their behavior (i.e., self-regulation) by not engaging in a prepotent response (e.g., using substances to alleviate craving), and approach discomfort from a nonjudg”
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    Premisereasoning

    MBRP clients learn a curious and nonjudgmental approach to discomfort, investigating emotional, physical, and cognitive components rather than suppressing or reducing discomfort, which fosters approach-based coping.

    “MBRP clients are taught to practice a curious and nonjudgmental approach to discomfort, learning to investigate emotional, physical and cognitive components of experience as they occur in the present moment rather than attempting to suppress or ameliorate the discomfort, fostering approach- vs. avoidance-based coping.”
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    Premisecitation

    Two candidate neural pathways have been proposed to explain the link between mindful attention and substance craving: a top-down pathway reflecting executive control over craving and a bottom-up pathway involving changes in the subjective experience of craving.

    “Two candidate neural pathways have been proposed that may help explain the association between mindful attention and substance craving (Westbrook et al., in press), with the top-down pathway reflecting executive control over craving and the bottom-up pathway involving changes in the subjective experience of craving.”
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    • cites Westbrook et al., in press

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    Interpretationreasoning

    Hypothesized improvements in top-down modulation may allow exposure to previously avoided discomfort without habitual substance use responses.

    “As such, hypothesized improvements in top-down modulation may ultimately allow for exposure to previously avoided experiences that cause discomfort (e.g. negative mood or drug cues) without habitual substance use responses.”
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    Premisecitation

    Compared with treatment-as-usual, MBRP participants reported significant increases in mindful awareness and acceptance and decreases in experiential avoidance.

    “Compared to TAU, MBRP participants also reported significant increases in mindful awareness, acceptance, and decreases in experiential avoidance.”
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    • cites Bowen and colleagues (2009)

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    Interpretationreasoning

    Neural reductions in reactivity to craving cues were observed without prefrontal top-down modulation, which supports bottom-up changes.

    “Thus, neural reductions in reactivity to craving cues were observed without prefrontal top-down modulation of responses, supporting bottom-up changes.”
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    Premisecitation

    Naqvi and Bechara proposed that the insula influences pleasurable bottom-up interoceptive effects of drug-taking, the representation of drug-taking as pleasurable in conscious memory, and top-down decision-making when deciding to use versus not use.

    “Recently, Naqvi and Bechara (2010) proposed that the insula influences pleasurable bottom-up interoceptive effects of drug-taking, the representation of drug-taking as pleasurable in conscious memory, and top-down decision-making when confronted with the decision to use (invoking pleasurable memories) against the decision to not use (invoking negative interoceptive consequences of drug use).”
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    • cites Naqvi and Bechara (2010)

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    Premisecitation

    The MBRP group showed significant decreases in self-reported craving over the four-month follow-up, while the treatment-as-usual group did not show a significant decrease.

    “Finally, the MBRP group displayed significant decreases in self-reported craving over the 4-month follow-up period, whereas the TAU group did not evince a significant decrease in craving.”
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    • cites Bowen and colleagues (2009)

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    Interpretationreasoning

    These results suggest that nonjudgmental mindful attention to smoking cues may temper craving in a bottom-up manner by decreasing subgenual anterior cingulate cortex activity and reducing functional coupling with other craving-related regions.

    “These results suggest that nonjudgmental mindful attention to smoking cues may temper craving in a bottom-up fashion resulting in decreased activity in the subgenual ACC and by reducing functional coupling with other craving-related regions.”
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    Interpretationcitation

    Together these analyses suggest that MBRP may work in part by reducing the subjective experience of craving through changes in present-moment awareness, increased nonreactivity to craving cues via acceptance and nonjudgment, and altered responding to negative affect.

    “Together, these analyses (Witkiewitz & Bowen, 2010; Witkiewitz et al., in press) suggest that MBRP might be effective in part by reducing the subjective experience of craving potentially via changes in present moment awareness, increased non-reactivity to salient craving cues by practicing acceptance (accepting the craving state) and nonjudgment (being non-critical of craving; Witkiewitz et al.,”
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    • cites Witkiewitz & Bowen, 2010

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    • cites Witkiewitz et al., in press

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    Premisecitation

    Research suggests that the insula plays a role in self-awareness and in bodily experiences that occur in response to various stimuli, including emotional stimuli.

    “More generally, research suggests that the insula plays a role in self-awareness and experiences that occur within the body in response to various stimuli, including emotional stimuli (Craig, 2009; Critchley et al., 2004; Damasio, 2000).”
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    • cites Craig, 2009

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    • cites Critchley et al., 2004

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    • cites Damasio, 2000

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    Premisecitation

    Prefrontal cortex dysfunction is associated with drug abuse, and greater drug use severity is correlated with top-down prefrontal dysfunction including poor inhibitory control and decision-making.

    “There is consistent evidence across multiple drugs of abuse that PFC dysfunction is associated with abuse, and severity of drug use is correlated with top-down PFC dysfunction, including lack of inhibitory control and poor decision-making (for a review see Feil et al., 2010).”
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    • cites Feil et al., 2010

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    Premisecitation

    Volkow and colleagues propose that compulsive drug seeking and addiction likely result from bottom-up and top-down disruptions in the reward system interacting with deficits in motivation, drive, conditioning, and inhibitory control aspects of executive functioning coordinated by the prefrontal cortex.

    “Volkow and colleagues (2011) offer that compulsive drug seeking and addiction is likely the result of bottom-up and top-down disruptions in the reward system as a whole, interacting with deficits in motivation, drive, conditioning, and inhibitory control aspects of executive functioning as coordinated by the prefrontal cortex”
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    • cites Volkow and colleagues (2011)

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    Study design and conductcitation

    Findings from these structural studies are strictly relative to the samples obtained, and volumetric decreases cannot always be directly linked to behavioral deficits, nor do volumetric increases necessarily indicate better functioning.

    “That is to say, the findings from these studies (Cardenas et al., 2011; Durazzo et al., 2011; Rando et al., 2011) are strictly relative to the samples obtained, and it is not always the case that volumetric decreases can be directly linked to behavioral deficits or that volumetric increases indicate better functioning (see Nuñez, Rousotte, & Sowell, 2011 for a discussion of this issue).”
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    • cites Nuñez, Rousotte, & Sowell, 2011

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    Premisecitation

    All drugs of abuse affect the nucleus accumbens, which is associated with reward-related processing.

    “While the neuropharmacological profiles of drugs of abuse are varied, they all share in common their ability to affect the nucleus accumbens, which is associated with reward-related processing (Di Chiara et al., 2004).”
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    Interpretationcitation

    Volume deficits in medial frontal and parietal-occipital regions could potentially explain deficits in cognitive and impulse control and difficulty inhibiting prepotent responses to alcohol cues.

    “The authors concluded that volume deficits in these regions could potentially explain deficits in cognitive and impulse control, as well as difficulty in inhibiting prepotent responses to environmental alcohol cues.”
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    • cites Rando and colleagues (2011)

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    Study design and conductnone given

    Brain structure studies are correlational, and their findings can only be evaluated within the specific context examined in each study.

    “It is important to note that studies of brain structure are correlational and the findings can only be evaluated within the specific context examined in the particular study.”
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    Premisecitation

    Cortical areas activated during craving include the dorsolateral prefrontal cortex, ventral prefrontal cortex including ventromedial and orbitofrontal areas, and cingulate cortex including the anterior portion.

    “The cortical areas include: the dorsolateral PFC (dlPFC) known for its role in working memory, top-down cognitive control over behavior, and executive cognitive functioning; the ventral PFC including both the ventromedial area and the orbitofrontal cortex (OFC) which are involved in evaluation and inhibition of behavior; and the cingulate cortex including the anterior portion”
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    • cites Heinz et al., 2008

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    • cites Naqvi& Bechara, 2010

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    • cites Sinha & Li, 2007

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    Premisecitation

    Among treatment-as-usual participants, craving mediated the relation between depression scores and posttreatment alcohol and other drug use days, but this mediation was not present among MBRP participants.

    “In addition, the relation between depression scores and posttreatment alcohol and other drug use days was mediated by craving among TAU participants, but not among the MBRP group.”
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    • cites Witkiewitz and Bowen (2010)

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    Premisecitation

    Individuals who relapsed after alcohol treatment had significantly smaller white matter volumes in the bilateral orbitofrontal cortex and smaller white and gray matter volumes extending into the posterior temporal-parietal region compared with abstainers.

    “Individuals who relapsed had significantly smaller white matter volumes in the bilateral orbitofrontal cortex and smaller white matter and gray matter volumes extending into the posterior temporal-parietal region.”
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    • cites Cardenas and colleagues (2011)

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    Premisecitation

    Imaging results indicated significant dorsolateral prefrontal cortex activity, and regulation-related decreases in craving were mediated by ventral striatum activity.

    “Imaging results indicated significant dlPFC activity (as measured by BOLD) and regulation-related decreases in craving was mediated by ventral striatum activity.”
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    • cites Kober and colleagues (2010)

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    Premisecitation

    Studies investigating long-term practitioners evince prefrontal differences and insular differences.

    “Yet, studies investigating long-term practitioners did evince prefrontal differences (Lazar et al., 2005, Hölzel et al., 2008, Luders et al., 2009) as well as insular differences (Lazar et al., 2005, Hölzel et al., 2008).”
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    • cites Lazar et al., 2005

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    • cites Hölzel et al., 2008

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    • cites Luders et al., 2009

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    Interpretationreasoning

    Increased gray matter in brain regions implicated in top-down executive functions (prefrontal cortex) and emotional saliency (insula) has the potential to repair or compensate for addiction-induced gray matter loss.

    “Increased gray matter in brain regions implicated in top-down executive functions (PFC) as well as emotional saliency (insula) has the potential to repair or compensate for addiction induced gray matter loss.”
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    Premisecitation

    Naqvi and Bechara further theorize that this modulation may affect striatum activation and thus motivation for drug-seeking behavior, potentially leading to a habitual stimulus-response cycle.

    “Naqvi and Bechara further theorize that this modulation may ultimately affect the activation of the striatum and thus the motivation for drug-seeking behavior, which may lead to a habitual stimulus-response cycle.”
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    • cites Naqvi and Bechara (2010)

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    Premisecitation

    When experienced meditators indicate awareness of mind wandering during breath meditation, there are robust activations in the anterior insula and dorsal anterior cingulate cortex, and these regions are highly correlated, suggesting neural integration.

    “When participants indicated awareness of mind wandering, there were robust activations in the anterior insula and dorsal ACC. The anterior insula and dorsal ACC were highly correlated, suggesting neural integration.”
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    • cites Hasenkamp et al., 2012

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    Study design and conductreasoning

    Volumetric studies are limited in that changes in function cannot be directly ascertained from volumetric assessment; greater gray matter concentration does not necessarily imply improved functioning.

    “volumetric studies are limited in that changes in function cannot be directly ascertained from volumetric assessment; in other words greater gray matter concentration does not necessarily imply improved functioning.”
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    Interpretationnone given

    Lack of insight among individuals who relapse to substance use may be explained by choice selection involving the anterior cingulate cortex and automaticity of drug seeking in the presence of drug cues involving the dorsal striatum.

    “choice selection (involving the ACC), and the automaticity of drug seeking behavior in the presence of drug-cues or stimuli (involving the dorsal striatum) may explain lack of insight among individuals who relapse to substance use.”
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    Premisecitation

    Mindfulness practice is associated with deactivation of the left amygdala while viewing positive or negative emotional stimuli among individuals who practiced meditation for a week, whereas experienced meditators did not show such deactivation.

    “Taylor and colleagues (2011) found that mindfulness practice was associated with deactivation of the left amygdala while viewing either positive or negative emotional stimuli among a group of individuals who practiced meditation for a week prior to the study, whereas experienced meditators did not show such deactivation.”
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    • cites Taylor et al., 2011

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    Premisecitation

    Increases in phasic high-frequency heart rate variability during stress have been observed with mindfulness and are interpreted as a more adaptive, self-regulatory response to stress.

    “Increases in phasic HF-HRV during stress has been observed with mindfulness and is interpreted as a more adaptive, self-regulatory response to stress (e.g., Ditto, Eclache, & Goldman, 2006;Tang, et al., 2007).”
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    • cites Ditto et al., 2006

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    • cites Tang et al., 2007

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    Premisecitation

    Goldstein and colleagues suggest that interoceptive awareness of subjective drug craving involving the insula, disadvantageous choice selection involving the anterior cingulate cortex, and automaticity of drug seeking in the presence of drug cues or stimuli are linked.

    “Similarly, Goldstein and colleagues (2009) suggest that interoceptive awareness of the subjective experiences of drug craving (involving the insula), disadvantageous choice selection (involving the ACC), and the automaticity of drug seeking behavior in the presence of drug-cues or stimuli (involving”
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    • cites Goldstein and colleagues (2009)

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    Premisecitation

    The posterior insula provides interoceptive representation of physiological sensations, and the anterior insula is activated during subjective experiences of bodily sensations such as craving and emotions such as negative affect.

    “The posterior insula provides the interoceptive representation of physiological sensations and the anterior insula is activated during subjective experiences of bodily sensations (e.g., craving) and emotions (e.g., negative affect; Craig, 2009; Kurth, Zilles, Fox, Laird, & Eickhoff, 2010).”
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    • cites Craig, 2009

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    • cites Kurth, Zilles, Fox, Laird, & Eickhoff, 2010

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    Premisecitation

    Both inexperienced and experienced meditators rated emotional stimuli as less intense during mindfulness practice, suggesting that mindfulness may be associated with improved bottom-up emotion regulation, but the neural mechanisms involved varied according to level of experience.

    “Both the inexperienced and experienced meditators rated the emotional stimuli as less intense during mindfulness practice, suggesting that mindfulness may be associated with improved bottom-up emotion regulation, however the neural mechanisms involved in regulation varied according to level of experience.”
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    • cites Taylor et al., 2011

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    Premisecitation

    Recent evidence shows that mindfulness may be more effective than thought suppression or distraction in reducing negative affect and substance use.

    “Given recent evidence that mindfulness may be more effective than thought suppression or distraction in reducing negative affect (Huffziger & Kuehner, 2009; Rogojanski, Vettese, & Antony, 2011) and substance use (Bowen & Marlatt, 2009)”
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    • cites Huffziger & Kuehner, 2009

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    • cites Rogojanski et al., 2011

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    • cites Bowen & Marlatt, 2009

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    Premisecitation

    Resting state connectivity analyses indicated that the anterior insula is functionally connected to the anterior cingulate cortex and mid-cingulate cortex, which together may form an emotional salience monitoring system.

    “Results from resting state connectivity analyses indicated that the anterior insula is functionally connected to the ACC and mid-cingulate cortex, which together may form an emotional salience monitoring system (Taylor, Seminowicz, & Davis, 2009).”
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    • cites Taylor, Seminowicz, & Davis, 2009

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    Premisecitation

    Naqvi and Bechara theorize that the insula may modulate associations between brain regions activated during craving, such as the anterior cingulate cortex, amygdala, and dorsomedial and ventromedial prefrontal cortex.

    “As such, Naqvi and Bechara (2010) theorize that the insula may modulate the associations between brain regions activated during craving such as the ACC, amygdala, and the dorsomedial and ventromedial PFC.”
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    • cites Naqvi and Bechara (2010)

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    Interpretationreasoning

    Concomitant activity in the anterior cingulate cortex and prefrontal cortex could allow one to filter incoming information and inhibit inappropriate emotional or behavioral responses.

    “Concomitant activity in the ACC and PFC could allow one to filter incoming information and inhibit inappropriate emotional or behavioral responses.”
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  • May combine two claims.

    Premisecitation

    Functional connectivity studies have found altered connectivity between meditators and non-meditators during a resting state, suggesting that connectivity changes are maintained outside of meditative states.

    “Studies on functional connectivity have found altered connectivity between meditators and non-meditators during a “resting state,” suggesting that connectivity changes are maintained outside of meditative states”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Brewer et al., 2011

      Not checked in the free run.

    • cites Hasenkamp & Barsalou, 2012

      Not checked in the free run.

    • cites Xue et al., 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    One of the first skills practiced in MBRP is focused attention on the breath, which often helps people feel more relaxed and focused on present experience.

    “Interestingly, one of the first skills practiced in MBRP is focused attention on the breath, which often helps people feel more relaxed and focused on present experience (Brown, Davis, LaRocco, & Strasburger, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Brown et al., 2010

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Nearly all of the studies presented in the current review relied on correlational data, which precludes any causal inferences.

    “Nearly all of the studies presented in the current review relied on correlational data, which precludes any causal inferences.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Cue-induced or mindfulness-induced activations/deactivations could be partially explained by differences in brain volume.

    “Thus, cue-induced or mindfulness-induced activations/deactivations could be partially explained by differences in brain volume.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Preliminary evidence from studies examining mindfulness training for substance use disorders, alongside own preliminary data from MBRP participants, suggests that mindfulness practice influences bottom-up responding, particularly by reducing responsivity to stressors and by decreasing bottom-up reactivity to craving cues.

    “Preliminary evidence from studies examining mindfulness training for substance use disorders, alongside our own preliminary data from MBRP participants, suggests that mindfulness practice influences bottom-up responding, particularly by reducing responsivity to stressors (unpublished data; Brewer et al., 2009) and by decreasing bottom-up reactivity to craving cues (Westbrook et al., in press).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Brewer et al., 2009

      Not checked in the free run.

    • cites Westbrook et al., in press

      Not checked in the free run.

    • cites unpublished data

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    Neuroimaging studies of mechanisms of change face potential limitations including participant retention, intoxication, scanning contraindications, and limited generalizability from scanner to real-world responses.

    “In addition to logistical barriers (e.g., scanning time, costs), researchers may have to contend with numerous potential limitations of neuroimaging for examining mechanisms of change, such as participant retention, potential intoxication, scanning contraindications, and the generalizability of responses in the scanner environment to real-world responses.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The HRV data reveal that from the bottom-up there is a shift to a more favorable (less reactive) stress response in the MBRP group, and the concomitant increase in HF-HRV suggests that top-down processes are also being recruited to manage the stress response post-MBRP.

    “Thus, while the HRV data reveal that from the bottom-up there is a shift to a more favorable (less reactive) stress response in the MBRP group, the concomitant increase in HF-HRV suggests top-down processes are also being recruited to manage the stress response post-MBRP”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    It is not clear whether top-down and bottom-up changes after mindfulness training occur in a temporal order.

    “Similarly, it is unclear to whether there could be a temporal ordering of top-down and bottom-up changes following mindfulness training.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hölzel et al., 2011b

      Not checked in the free run.

    • cites Westbrook et al., in press

      Not checked in the free run.

    • Rests on an assumption: Mindfulness training affects both bottom-up and top-down processing.

  • May combine two claims.

    Premisenone given

    Published MBRP findings have been limited to the self-reported experiences of study participants, and it is unclear to what extent self-reported changes in craving, negative affect, and relapse will be observed at the neurobiological level.

    “Second, the published MBRP findings have been limited to the self-reported experiences of study participants and it is unclear to what extent the self-reported changes in craving, negative affect, and relapse will be observed at the neurobiological level.”
    Quote in the paperSubstantial claim
55 of 55

  • The paper relies on this without support.

    Craving, negative affect, and the desire to avoid them are primary motives for substance use.

    “These states, as well as the desire to avoid them, have been described as primary motives for substance use.”

  • The paper relies on this without support.

    Self-reported changes in craving, negative affect, and mindfulness after MBRP correspond to changes in the underlying neurobiological processes.

    “Although these changes have been observed at the level of self-reported behavior, it is hypothesized that the effects of MBRP may be observable at a neurobiological level (as outlined in Table 1), via both top-down and bottom-up processes.”

  • The authors state this as an assumption.

    BOLD fMRI signal represents increased neuronal activation in a particular brain region.

    “numerous studies assume that BOLD fMRI signal represents increased neuronal activation in a particular brain region”

  • The paper relies on this without support.

    The medial prefrontal cortex and rostral anterior cingulate cortex have roles in emotional processing and regulation.

    “Given the roles of the mPFC and the rACC in emotional processing and regulation”

  • The paper relies on this without support.

    The orbitofrontal cortex has top-down roles in appraisal of emotional stimuli and behavioral inhibition.

    “which is noteworthy given the top-down roles of the OFC in appraisal of emotional stimuli and behavioral inhibition”

  • The paper relies on this without support.

    The anterior cingulate cortex and prefrontal cortex are involved in filtering incoming information and inhibiting inappropriate emotional or behavioral responses.

    “Concomitant activity in the ACC and PFC could allow one to filter incoming information and inhibit inappropriate emotional or behavioral responses.”

  • The paper relies on this without support.

    The dorsal striatum is involved in automaticity of drug seeking behavior in the presence of drug cues.

    “the automaticity of drug seeking behavior in the presence of drug-cues or stimuli (involving the dorsal striatum)”

  • The paper relies on this without support.

    The amygdala is part of the emotional salience monitoring system.

    “the emotional salience monitoring system (including insula/ACC circuitry and the amygdala)”

  • The paper relies on this without support.

    As people become more mindful, they may become more aware of their wandering mind and thus report lower mindfulness than those with less meta-cognitive awareness.

    “Also, as individuals develop mindfulness skills, they develop greater awareness of their wandering mind and may report lower levels of mindfulness than an individual who has lower meta-cognitive awareness.”

  • The paper relies on this without support.

    Mindfulness training affects both bottom-up and top-down processing.

    “Given that mindfulness training appears to target both bottom-up and top-down processing”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Active participation in MBRP results in fewer and less severe relapses and improvements in overall quality of life.

    “However, active participation in MBRP results in fewer and less severe relapses and improvements in overall quality of life. 9”

    From Enhancing Emotion Regulation and Overcoming Craving in Alcohol Dependence Syndrome Through Mindfulness-based Relapse Prevention (2025) · cites this paper as [9]

    The “Mindfulness-Based Relapse Prevention: Efficacy and Mechanisms of Change” section (page unavailable) reports substantially lower alcohol and other drug use in an MBRP group than in treatment as usual, supporting a reduction in substance use. It does not establish that active participation produces fewer and less severe relapses, and the passages found do not report an improvement in overall quality of life. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • MBRP addresses negative mood without automatically reacting and reduces craving by recognizing these factors as critical factors in the relapse process.

    “MBRP addresses negative mood without automatically reacting and reduces craving by recognizing these factors as critical factors in the relapse process. 9”

    From Enhancing Emotion Regulation and Overcoming Craving in Alcohol Dependence Syndrome Through Mindfulness-based Relapse Prevention (2025) · cites this paper as [9]

  • The neurobiological basis of mindfulness in substance use and craving has been described in recent literature.

    “The neurobiological basis of mindfulness in substance use and craving have also been described in recent literature40.”

    From Cognitive behavioural interventions in addictive disorders (2018) · cites this paper as [40]

  • Though various conceptual models have been advanced, few tests of these specific neural hypotheses have been conducted.

    “Though various conceptual models have been advanced [22, 23, 73], few tests of these specific neural hypotheses have been conducted.”

    From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [73]

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Drummond DC Tiffany ST Glautier S Remington B Addictive behavior: cue exposure theory and practice 1995 Sussex Wiley
  2. Kuhn CM Koob GF Advances in the Neuroscience of Addiction 2010 Boca Raton, FL CRC Press 21656974
  3. Linehan MM Skills training manual for treating borderline personality disorder 1993 New York, NY Guilford Press
  4. Marlatt GA Gordon JR Relapse prevention: Maintenance strategies in the treatment of addictive behaviors 1985 New York, NY Guilford Press
  5. Segal ZV Williams JMG Teasdale JD Mindfulness-based cognitive therapy for depression 2002 New York Guilford Press

Cited by

Sorted by citations

Related

Authors
Witkiewitz, K., Lustyk, M. K. B., & Bowen, S.
Affiliations
  • Washington State University (US)
  • Seattle Pacific University (US)
ORCID
Venue
Psychology of Addictive Behaviors
Publisher
American Psychological Association (APA)
Published
2013-06
Volume
27
Issue
2
Pages
351-365
ISSN
  • 0893-164X (ISSN-L)
  • 1939-1501
DOI
10.1037/a0029258
PMC
PMC3699602
OpenAlex
W2063446314
Cited by
207
References
134
Citations by year
2026: 6 · 2025: 13 · 2024: 13 · 2023: 14 · 2022: 10 · 2021: 13 · 2020: 17 · 2019: 19 · 2018: 24 · 2017: 21 · 2016: 12 · 2015: 13 · 2014: 21 · 2013: 11
FWCI
10.74
Type
journal article
Language
en
Open access
Locations
  • Psychology of Addictive Behaviors (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (K18DA031464)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
mindfulness-based relapse prevention, addiction, relapse, craving, negative affect, neurobiological mechanisms, mindfulness meditation, substance use, brain systems
MeSH terms
Adaptation, Psychological, Awareness, Brain, Chronic Disease, Humans, Neurobiology, Behavior, Addictive, Treatment Outcome, Substance-Related Disorders, Secondary Prevention, Mindfulness

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Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

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