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

“Suicidality was assessed using the suicide section of the Hamilton Depression Inventory (39), and a single item from the Brief Symptom Inventory (40) (“How much were you distressed by thoughts of ending your life?”).”

“A substantial body of literature documents harmful effects of suppression or avoidance of cognitive and affective responses on a variety of psychological and health outcomes ( 59 , 60 , 61 , 62 , 63 ).”

“Population-averaged generalized estimating equations (52) were conducted to test treatment effects on substance-use and process outcomes using STATA-10 statistical program (53).”

“The FFMQ has demonstrated good internal consistency (46).”

“Suicidality was assessed using the suicide section of the Hamilton Depression Inventory (39), and a single item from the Brief Symptom Inventory (40) (“How much were you distressed by thoughts of ending your life?”).”

“Lower scores have been associated with increased levels of psychopathology and decreased quality of life (48).”

“As an alternative to 12-step programs, Relapse Prevention (RP) (7), a cognitive-behavioral treatment, focuses on responses to high-risk situations, combining skills-training with cognitive interventions to prevent or limit relapse.”

“A substantial body of literature documents harmful effects of suppression or avoidance of cognitive and affective responses on a variety of psychological and health outcomes ( 59 , 60 , 61 , 62 , 63 ).”

“Theoretical foundations for integration of mindfulness with traditional cognitive-behavioral relapse prevention (34) suggest that mindfulness may help develop a detached and de-centered relationship to thoughts and feelings, preventing escalation of thought patterns that may lead to relapse (35,36).”

“The Penn Alcohol Craving Scale (PACS) (43) was adapted to include both alcohol and drug craving.”

“To accommodate the longitudinal and incomplete data, an exchangeable correlation structure was used, and bootstrapping was applied to correct standard errors (55).”

“The TLFB has demonstrated good reliability and validity with both online and in-person administration (42).”

“Further, results are consistent with neurobiological research indicating associations between mindfulness practice and changes in brain regions involved in modulation of arousal and emotion regulation (65,66).”

“Further, results are consistent with neurobiological research indicating associations between mindfulness practice and changes in brain regions involved in modulation of arousal and emotion regulation (65,66).”

“Research on mindfulness in the treatment of substance use disorders is beginning to receive attention in scientific literature ( 31 , 32 , 33 ).”

“Participation in12-step programs is associated with greater abstinence (5); however, these approaches may not be clinically indicated for individuals adverse to the disease model of addiction (6) or whose spiritual beliefs and/or lifestyle are in conflict with the 12-step philosophy.”

“Integration of further efficacious treatment components may enhance RP treatment effects (18).”

“The 15-item Short Inventory of Problems (SIP-AD) (44), adapted from the Inventory of Drug Use Consequences-2R (InDUC-2R) (45), assessed impulse control, social responsibility, and physical, interpersonal, and intrapersonal consequences.”

“Participation in12-step programs is associated with greater abstinence (5); however, these approaches may not be clinically indicated for individuals adverse to the disease model of addiction (6) or whose spiritual beliefs and/or lifestyle are in conflict with the 12-step philosophy.”

“Theoretical foundations for integration of mindfulness with traditional cognitive-behavioral relapse prevention (34) suggest that mindfulness may help develop a detached and de-centered relationship to thoughts and feelings, preventing escalation of thought patterns that may lead to relapse (35,36).”

“A substantial body of literature documents harmful effects of suppression or avoidance of cognitive and affective responses on a variety of psychological and health outcomes ( 59 , 60 , 61 , 62 , 63 ).”

“In the event of a lapse, awareness and acceptance fostered by mindfulness may aid in recognition and minimization of the blame, guilt, and negative thinking that increase risk of relapse ( 37 ).”

“The correlation between InDUC and SIP-AD has been shown to be strong (r = .96) (44), and internal consistency in the current study was .96.”

“The count, integer, or continuous nature of the outcome variables precluded the use of intent-to-treat analyses; however, recent simulation studies have shown that the estimation method employed in this study (ie, maximum likelihood estimation) is less biased and more precise in dealing with missing data than traditio…”

“Research on mindfulness in the treatment of substance use disorders is beginning to receive attention in scientific literature ( 31 , 32 , 33 ).”

“Poisson distributions were specified for the positively skewed substance-use outcomes (54).”

“Theoretical foundations for integration of mindfulness with traditional cognitive-behavioral relapse prevention (34) suggest that mindfulness may help develop a detached and de-centered relationship to thoughts and feelings, preventing escalation of thought patterns that may lead to relapse (35,36).”

“Although RP suggests promising advancement in treatment, relapse remains a significant problem for 44% to 70% of clients (21).”

“Although attrition in the current study is comparable to studies in similar populations (67), conclusions that can be drawn about treatment effects for the complete sample are limited.”

“With rates of relapse following substance abuse treatment estimated at over 60% (1), substance use disorders are often described as “chronic relapsing conditions” (2,3).”

“Future studies may benefit from inclusion of continuing, intervention-consistent support, which has been found to improve treatment efficacy in substance use disorders (57,58).”

“Future studies may benefit from inclusion of continuing, intervention-consistent support, which has been found to improve treatment efficacy in substance use disorders (57,58).”

“The most commonly available treatments in many developed countries are 12-step or mutual support groups ( 4 ).”

“With rates of relapse following substance abuse treatment estimated at over 60% (1), substance use disorders are often described as “chronic relapsing conditions” (2,3).”

“…colleagues developed an 8-week mindfulness-based relapse prevention (MBRP) program, which integrates mindfulness meditation practices from MBSR with CBT techniques for drug relapse prevention, including practices focused on mindfully attending to cravings (e.g., urge surfing) (Bowen et al. 2009).”

“Clinically, mindfulness training has shown benefit for the treatment of pain (13), substance-use disorders (15, 17), anxiety disorders (18), and depression (14), and also helps to increase psychological well-being in nonclinical populations (19).”

“…in this paper are what have retrospectively become termed ‘ fi rst-generation ’ MBPs – i.e. MBSR and MBCT (which represent the strongest evidence within the fi eld), and the range of programs which have developed out of these (e.g. Bowen et al. 2009; Duncan & Bardacke, 2010; Kristeller et al. 2012).”

“Initial evidence of beneficial outcomes led to the standardization of the Mindfulness-Based Stress Reduction (MBSR) training program (Kabat-Zinn, 1990), followed by the development of more specialized programs for persons with clinical disorders like Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams, & Teasda…”

“Mindfulness-based treatment approaches are increasingly recognized as having value in addressing a wide range of dysregulation disorders, including anxiety and depression, and addictions (Bowen et al. 2009; Davis and Hayes 2011; Grossman et al. 2004; Hofmann et al. 2010; Kabat-Zinn et al. 1992; Keng et al. 2011; Marla…”

“More recently, a randomized controlled trial compared an eight-week MBRP course to treatment as usual (TAU), which consisted of 12-step-based processoriented discussion and psychoeducation groups [117].”

“The current study followed up on the significant mediating effect of craving that was reported by Bowen et al. (2009) and was designed to further examine one hypothesized mechanism of change following MBRP.”

“In that regard, Mindfulness-Based Relapse Prevention has been shown to reduce substance craving (Bowen et al., 2009).”

“…cognitive therapy (MBCT: Segal, Williams, & Teasdale, 2002), acceptance and commitment therapy (ACT: Hayes et al., 1999), and relapse prevention for substance abuse (MBRP: Bowen et al., 2009; Witkiewitz & Bowen, 2010; see also Marlatt & Gordon, 1985; Parks, Anderson, & Marlatt, 2001).”

“…such as cognitive therapy (Mindfulness-based Cognitive Therapy (Segal, 2002)) and relapse prevention (Mindfulnessbased Relapse Prevention (Bowen et al., 2009; Brewer et al., 2009), as well as ACT, to our knowledge, its efficacy as a stand-alone treatment (i.e., not as a component of or…”

“In line with this conclusion, CBT-based treatments that incorporate mindfulness interventions have shown promise for treating both alcohol-use and drug-use disorders (Bowen et al., 2009; Hofmann, Sawyer, Witt, & Oh, 2010; Witkiewitz, Marlatt, & Walker, 2005).”

“However, contrasting results have also been reported (Garland et al., 2010) and positive effects can decrease over time (Bowen et al., 2009).”

“Pilot Randomized Trial of Mindfulness-Based Relapse Prevention—A randomized pilot trial was conducted to assess feasibility and establish initial efficacy of the MBRP treatment protocol (Bowen et al., 2009).”

“clude programs derived from or inspired by MBSR, such as MBCT, MBCP, mindfulness-based relapse prevention (Bowen et al., 2009), mindfulness-based eating awareness training (Kristeller, Wolever, & Sheets, 2014), and others, but not programs such as dialectical behavior therapy (DBT; Linehan, 2015) and acceptance and co…”

“Derived from Buddhist practices, MT has been adapted for use in Western cultures, taking forms such as Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy (combined with Cognitive Therapy for depression relapse prevention), and Mindfulness-Based Relapse Prevention (combined with Relapse Prevention…”

“T2 translation research has been defined and classified in various ways in the health research literature (Bowen et al. 2009; Fixsen et al. 2005; Kerner et al. 2005), reflecting both its relatively recent appearance on the health-related research agenda and the diversity of disciplines contributing to it (Rabin et al.”

“Research Article State and Training Effects of Mindfulness Meditation on Brain Networks Reflect Neuronal Mechanisms of Its Antidepressant Effect Chuan-Chih Yang,1,2,3 Alfonso Barrós-Loscertales,1 Daniel Pinazo,4 Noelia Ventura-Campos,1,5 Viola Borchardt,2,3 Juan-Carlos Bustamante,6 Aina Rodríguez-Pujadas,1 Paola Fuent…”

“Psychopharmacology (2012) 220(4):707–18.”

“MBRP specifically has been evaluated in several randomized controlled trials (RCTs) (Bowen et al., 2009; Witkiewitz and Bowen, 2010; Lee et al., 2011).”

“, 2009): While five of the six with per-protocol data gave positive differential effects on substance use, only two of the four that used a more stringent intention-to-treat approach to the analysis did so A later study (Bowen et al., 2009) examined a treatment combining mindfulness with cognitive-behavioral relapse p…”

“…help individuals with a number of issues, including but not limited to eating disorders (Kristeller, Wolever, & Sheets, 2013), substance use (Bowen et al., 2009), recurrent depression (Teasdale et al., 2000), chronic depression (Barnhofer et al., 2009), generalised anxiety (Hoge et al.,…”

“These ‘contextual CBTs’, such as Mindfulness Based Relapse Prevention (MBRP; Bowen et al., 2009), Dialectical Behavior Therapy (DBT; Linehan, 1993), and Acceptance and Commitment Therapy (ACT; Hayes, Luoma, Bond, Masuda, & Lillis, 2006), fit within a transdiagnostic approach to mental health and…”

“For example, in the SOBER space exercise (see Bowen et al., 2009; Bowen et al., 2010), the clients are taught to “Stop,” “Observe,” “Breathe”, “Expand awareness,” and “Respond mindfully.””

“Similar to a cognitive-behavioral approach to addiction, mindfulness-based treatments include examination of thoughts related to triggers, cravings, and urges (Bowen et al., 2009).”

“…empirical research on the effects of mindfulness-based interventions on behavioural health domains has tended to show that engaging in mindfulness-meditation increases engagement in health behaviours (Bowen et al., 2009, 2014; Hülsheger, Feinholdt, & Nübold, 2015; Ong, Shapiro, & Manber, 2008).”

“Mindfulness-based relapse prevention (MBRP), a manualized treatment that has demonstrated modest efficacy for substance use disorders (13, 14),may be especiallywell suited as a behavioral counterpart to ketamine.”

“Importantly, research indicates that meditation experience is positively related to trait mindfulness (Baer et al. 2008) and that trait mindfulness can be increased through mindfulness meditation training (Bowen et al. 2009; Carmody and Baer 2008).”

“Likewise, preliminary data (Bowen et al., 2008; Hsu et al., 2008) from an efficacy trial of mindfulness-based relapse prevention indicated that mindfulness training significantly moderated the relationship between posttreatment BDI scores and posttreatment alcohol use (control group, r = .50, p <…”

“…principles with mindfulness-meditation in an attempt to prevent relapse of major depressive episodes; Mindfulness-Based Relapse Prevention (MBRP; Bowen et al. 2009), which argets alcohol and other substance abuse relapse prevention; andMindfulness-Based Eating Awareness Training (MB-EAT;…”

“, 2011), and, more convincingly, from a randomized controlled trial of mindfulness-based relapse prevention for the treatment of AUD (Bowen et al., 2009) that demonstrated the efficacy of an 8-week mindfulness-based relapse prevention training.”

“On the other hand, mindfulness training has shown promise for treating substance use and binge eating disorders and may be particularly apt to improve self-regulation and eating in response to cravings and negative emotions (Bowen et al., 2009; Kristeller & Hallett, 1999b; Kristeller & Wolever, 2011).”

“Interestingly, mindfulness interventions have been shown to improve symptoms associated with each of these conditions (Bowen et al., 2009; Daubenmier et al., 2011; Grossman, Niemann, Schmidt, & Walach, 2004; Hofmann, Sawyer, Witt, & Oh, 2010; Keng, Smoski, & Robins, 2011; Ma & Teasdale, 2004).”

“The concept of mindfulness has increasingly been featured in models of psychopathology (Chambers et al. 2009) and recent evidence suggests that it may also contribute to understanding impulsive behaviours such as PG, and by extension, CB. Mindfulness has been broadly defined as a process of…”

“In another sample [55], participants with high SUD severity and high anxiety/depression or high SUD severity and low anxiety/depression that received MBRP reported 99% fewer alcohol and other drug use days than TAU participants.”

“Three studies reported insufficient information to estimate the effect size (i.e., Bowen et al., 2006, 2009; Liehr & Diaz, 2010) and thus were omitted from the review.”

“pared to a treatment-as-usual method [31], and that the treatment may lessen the relation between depressive”

“In summary, there are promising results from prior studies of MBRP in the treatment of substance use disorders, (Bowen et al., 2009) as well as evidence indicating that mindfulness meditation may be beneficial to criminal offenders (Bowen et al., 2006).”

“For particular populations, other programs have been adapted from MBSR, such as Mindfulness-Based Cognitive Therapy (MBCT), shown to be effective in reducing depression recurrences, and one focused on addiction triggers, Mindfulness Based Relapse Prevention (MBRP) [46,47].”

“…components, making it difficult to unequivocally attribute any changes in craving to the mindfulness-based elements of the intervention (e.g., Bowen et al., 2009; Bricker et al., 2014; Garland, Robert-Lewis, Tronnier, Graves & Kelly, 2016; Zemestani & Ottaviani, 2016; see also Tapper, 2017).”

“Examples of more recently formulated mindfulness-based interventions (MBIs) include techniques known as “Mindfulness-Based Relapse Prevention” (Bowen et al. 2009) for the treatment of substance-use disorders and “Mindfulness-Based Childbirth and Parenting” (Duncan and Bardacke 2010).”

“Indeed, this practice is used with some success in treating drug addiction [83], presumably because it renders decision making under a biological domain, dominated by the OFC, where values assigned to predictive stimuli are not potentiated by drugs themselves and behaviors are less sensitive to stimulus-driven influen…”

“Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2012, Article ID 680407, 9 pages doi:10.1155/2012/680407”

“Similarly, intervention packages such as acceptance and commitment therapy (ACT; Dixon & Wilson, 2014; Hayes, Strosahl, & Wilson, 1999), dialectical behavior therapy (DBT; Linehan & Dimeff, 2001), mindfulness-based relapse prevention (MBRP; Bowen, Chawla, & Marlatt, 2010), and mindfulnessbased cognitive therapy (MBCT;…”

“Mindfulness-based SUD research has demonstrated reductions in substance use and related health outcomes (Bowen et al., 2009; Witkiewitz and Bowen, 2010; Brewer et al., 2011; Garland et al., 2016).”

“Two of these studies found that the mindfulness-based treatments evaluated were associated with significantly lower rates of substance use (Bowen et al., 2009; Bowen et al., 2014), whereas the other study found no differences in substance use outcomes between a mindfulness-based treatment and a standard CBT-based cont…”

“These two components ofmindfulness have been applied clinically as integral parts of different training programs: (a) Mindfulness Based Stress Reduction (Kabat Zinn, 1982), (b) Dialectic Behavioral Therapy (Linehan, 1993), (c) Mindfulness-based Cognitive Therapy (Segal et al., 2002), (d) Acceptance and Commitment Ther…”

“…with six RCTS reporting mindfulness (eg, MBRP, MORE, and Mindful Awareness in Body-Oriented Therapy) significantly reduced substance use compared to a control group 21,35–39 ; four reported mindfulness reduced craving relative to controls, 21,40–42 and two reported reductions in relapse risk.”

“…an approach pioneered by Kabat-Zinn and colleagues in 1979, continues to grow in popularity; its original focus on chronic pain and illness has been extended to problems such as insomnia, alcohol and drug abuse and eating disorders (Bowen et al. 2009; Kristeller and Hallett 1999; Ong et al. 2008).”

“Four (24% of those reporting any aspect of enactment) articles reported collecting both practice logs and FFMQ or MAAS (Bowen et al. 2009; de Vibe et al. 2013; Gross et al. 2010; Eisendrath et al. 2016).”

“Age (median, range) 35 (22–61) 36 (20–59) 35 (22–57) 35 (20–61) Race White 56 (76) 37 (80) 47 (70) 140 (75) Mixed race 7 (9) 4 (9) 8 (12) 19 (10) African American 5 (7) 0 4 (6) 9 (5) Other (filled in ethnicity) 2 (3) 1 (2) 6 (9) 9 (5) Native American 3 (4) 3 (7) 2 (3) 8 (4) Asian 1 (1) 1 (2) 0 2 (1) Ethnicity: Hispani…”

“E-mail: nchawla@u.washington.edu ISSN 1050-3307 print/ISSN 1468-4381 online # 2010 Society for Psychotherapy Research DOI: 10.1080/10503300903544257 treatment-as-usual control (TAU) group (Bowen et al., 2009).”

“Consistent with this idea, a recently developed intervention, mindfulness-based relapse prevention (MBRP; Bowen et al., 2009), designed to target client responses to emotional states and craving, has shown promise in disrupting the relations among negative affect, craving, and substance use…”

“…severity of factors related to relapse such as anxiety, depression, and stress (e.g., Zgierska et al., 2009), decreases in both craving (e.g., Bowen et al., 2009; Brewer et al., 2012; Garland et al., 2012; Zgierska et al., 2009) and reactivity to craving (e.g., Bowen & Marlatt, 2009), and an…”

“However, the FFMQ was also not sensitive to differences in a prior study of involving mindfulness meditation for SUD treatment (Bowen et al., 2009).”

“However, in the smaller MBRP study (Bowen et al., 2009), we were limited to examining only substance use outcomes measured at the end-of-treatment assessment, which therefore included only within-treatment substance use behavior.”

“An emerging body of controlled trials indicates that mindfulness-based interventions (MBIs), includingMindfulness-Based Relapse Prevention [14] and MindfulnessOriented Recovery Enhancement (MORE) [15], may produce significant therapeutic effects among those struggling with drug addiction, including dependence on alcoh…”

“Mindfulness-based approaches have been successfully applied to the treatment of substance abuse and addiction (see Zgierska et al., 2009 for review; Bowen et al., 2009; Brewer et al., 2009; Britton et al., 2010; Liehr et al., 2010; Marcus & Zgierska, 2009; Marcus et al., 2009; Vieten, Astin, Buscemi, & Galloway 2010;…”

“, “booster sessions”) to facilitate longer-term mindfulness practice (Bowen et al., 2009).”

“In a recent, randomized pilot study of MBRP, Bowen et al. (2009) found that MBRP participants experienced fewer and shorter relapses compared to control participants.”

“Mindfulness-Based Relapse Prevention (MBRP) for SUD (51) was developed as an intervention to facilitate coping with urges to use substances follow-”