Mindfulness-Based Relapse Prevention for Alcohol Use Disorders in Remission
| Status: | Completed |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 4/2/2016 |
| Start Date: | August 2012 |
| End Date: | January 2016 |
| Contact: | Jennifer K Penberthy, Ph.D. |
| Email: | jkp2n@virginia.edu |
| Phone: | 804 564 1589 |
Mindfulness-Based Relapse Prevention and Stress Reactivity in Alcohol Dependent Individuals: A Pilot Study
We propose to conduct a pilot study that will examine the utility and mechanisms of
Mindfulness-Based Relapse Prevention in reducing alcohol consumption, relapse rates, and
physiological arousal to stress in adults 21 years of age and older who have met DSM-IV-TR
diagnostic criteria for alcohol dependence within the past year but have abstained from
drinking for the last thirty days. MBRP is designed to improve one's ability to
self-regulate emotions, thoughts and physical states, thus reducing the need to alleviate
associated discomfort through substance use. Participants assigned to the intervention group
will receive an 8-week training course of MBRP over a period of nine weeks; participants
assigned to the Treatment As Usual (TAU) group will continue treatment as usual, which
includes utilizing their own effective strategies to refrain from alcohol use. All
participants will be assessed for pretreatment severity of psychological abuse/trauma as
well as pre and posttreatment psychosocial functioning (e.g., alcohol consumption, symptoms
of depression and anxiety, emotion regulation/coping). The outcome of treatment will be
evaluated using a) Timeline Followback drinking data and b) self-report ratings of
acquisition of MBRP skills (e.g., state/trait mindfulness, acceptance and awareness, and
perceived stress) and depressive and anxiety symptom severity. We hypothesize that
participants who receive MBRP training will demonstrate greater acceptance and awareness,
reduced cravings, and have a lower likelihood of relapse than participants in the TAU group.
It is also expected that MBRP participants will demonstrate greater improvements on
psychological measures of depression, anxiety, emotion regulation and coping, and show less
perceived stress and physiological arousal to stress compared to TAU participants. Finally,
little is known about which types of individuals are most likely to benefit from MBRP. Thus,
secondary analyses will help to clarify for whom MBRP may be most effective.
Mindfulness-Based Relapse Prevention in reducing alcohol consumption, relapse rates, and
physiological arousal to stress in adults 21 years of age and older who have met DSM-IV-TR
diagnostic criteria for alcohol dependence within the past year but have abstained from
drinking for the last thirty days. MBRP is designed to improve one's ability to
self-regulate emotions, thoughts and physical states, thus reducing the need to alleviate
associated discomfort through substance use. Participants assigned to the intervention group
will receive an 8-week training course of MBRP over a period of nine weeks; participants
assigned to the Treatment As Usual (TAU) group will continue treatment as usual, which
includes utilizing their own effective strategies to refrain from alcohol use. All
participants will be assessed for pretreatment severity of psychological abuse/trauma as
well as pre and posttreatment psychosocial functioning (e.g., alcohol consumption, symptoms
of depression and anxiety, emotion regulation/coping). The outcome of treatment will be
evaluated using a) Timeline Followback drinking data and b) self-report ratings of
acquisition of MBRP skills (e.g., state/trait mindfulness, acceptance and awareness, and
perceived stress) and depressive and anxiety symptom severity. We hypothesize that
participants who receive MBRP training will demonstrate greater acceptance and awareness,
reduced cravings, and have a lower likelihood of relapse than participants in the TAU group.
It is also expected that MBRP participants will demonstrate greater improvements on
psychological measures of depression, anxiety, emotion regulation and coping, and show less
perceived stress and physiological arousal to stress compared to TAU participants. Finally,
little is known about which types of individuals are most likely to benefit from MBRP. Thus,
secondary analyses will help to clarify for whom MBRP may be most effective.
Stress exposure increases psychological and physiological arousal and can lead to negative
health outcomes. An impaired ability to self-regulate in response to stress contributes to
the development of alcohol use disorders and relapse. Mindfulness, a state of
present-focused attention and awareness, can be systematically learned through meditative
practice to improve self-regulation of emotional, physiological and behavioral responses to
stress. Mindfulness meditation further facilitates a balance of mind and body thereby
increasing one's ability to respond proactively and effectively to daily events. Research
evidence suggests a strong association between mindfulness and positive indicators of
well-being which include reductions in fear, anxiety, anger, and better physiological
recovery from stress.
Given the importance of self-regulation in the development and progression of alcohol use
disorders and relapse, a new approach to substance use treatment, Mindfulness-Based Relapse
Prevention (MBRP), was developed. Traditionally, MBRP is an eight-week outpatient treatment
program, which integrates core aspects of Relapse Prevention (RP) practices with practices
adapted from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive
Therapy. The mindfulness practices in MBRP are designed to increase acceptance and tolerance
of negative emotions, thoughts and physical states thus reducing the need to alleviate
associated discomfort through substance use. MBRP also focuses on increasing awareness of
triggers and developing more effective coping behaviors in high-risk situations. Among
adults with substance use disorders, MBRP has been found to lead to significantly lower
rates of substance use, greater decreases in cravings and greater increases in acceptance
and acting with awareness than treatment as usual. MBRP has also been found to facilitate
more effective coping and self-regulation of negative emotions during early abstinence.
While research indicates that MBRP is effective in reducing substance use relapse, only
preliminary research has examined the influence of MBRP on the physiological mechanisms
involved in emotion regulation after exposure to stress. Examining these physiological
mechanisms is essential because the central and autonomic nervous systems work together to
coordinate the self-regulation of attention, cognition and emotion when stressful cues are
encountered, such as when a substance dependent individual is exposed to stressful and/or
substance related stimuli. Heart rate variability (HRV) is generally seen as an index of
emotion regulation. High frequency HRV reflects parasympathetic activation of the autonomic
nervous system and the body's ability to exert cognitive control over attention and
emotional responding. Higher levels of HRV are associated with greater emotional and
behavioral flexibility, and tend to be associated with better mental and physical health
outcomes. In contrast, lower levels of HRV are associated with a wide range of medical and
psychiatric disorders, including acute and chronic alcohol ingestion, anxiety and
depression. Among alcohol dependent individuals, mindfulness training has been found to
increase HRV and lower subjective levels of psychological distress in response to stressful
cues in the short-term. The proposed study will be the first to examine the long-term
effects of MBRP on HRV and self-reported psychological/behavioral functioning. The results
will provide a better understanding of the interplay between the psychological and physical
mechanisms involved in relapse and help determine whether MBRP has lasting psychological and
physiological benefits. In other words, assessing both the psychological and physiological
effects of MBRP will provide a more accurate and comprehensive understanding of how
mindfulness aids in promoting self-regulation and relapse prevention. Finally, little is
known about which types of individuals are most likely to benefit from MBRP. It is necessary
to examine individual characteristics (i.e., baseline levels of HRV, trait mindfulness,
substance use, anxiety, depression) to determine which characteristics are associated with
positive treatment outcomes in both the short and long-term. This knowledge will enable more
efficient and effective delivery of the MBRP treatment.
health outcomes. An impaired ability to self-regulate in response to stress contributes to
the development of alcohol use disorders and relapse. Mindfulness, a state of
present-focused attention and awareness, can be systematically learned through meditative
practice to improve self-regulation of emotional, physiological and behavioral responses to
stress. Mindfulness meditation further facilitates a balance of mind and body thereby
increasing one's ability to respond proactively and effectively to daily events. Research
evidence suggests a strong association between mindfulness and positive indicators of
well-being which include reductions in fear, anxiety, anger, and better physiological
recovery from stress.
Given the importance of self-regulation in the development and progression of alcohol use
disorders and relapse, a new approach to substance use treatment, Mindfulness-Based Relapse
Prevention (MBRP), was developed. Traditionally, MBRP is an eight-week outpatient treatment
program, which integrates core aspects of Relapse Prevention (RP) practices with practices
adapted from Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive
Therapy. The mindfulness practices in MBRP are designed to increase acceptance and tolerance
of negative emotions, thoughts and physical states thus reducing the need to alleviate
associated discomfort through substance use. MBRP also focuses on increasing awareness of
triggers and developing more effective coping behaviors in high-risk situations. Among
adults with substance use disorders, MBRP has been found to lead to significantly lower
rates of substance use, greater decreases in cravings and greater increases in acceptance
and acting with awareness than treatment as usual. MBRP has also been found to facilitate
more effective coping and self-regulation of negative emotions during early abstinence.
While research indicates that MBRP is effective in reducing substance use relapse, only
preliminary research has examined the influence of MBRP on the physiological mechanisms
involved in emotion regulation after exposure to stress. Examining these physiological
mechanisms is essential because the central and autonomic nervous systems work together to
coordinate the self-regulation of attention, cognition and emotion when stressful cues are
encountered, such as when a substance dependent individual is exposed to stressful and/or
substance related stimuli. Heart rate variability (HRV) is generally seen as an index of
emotion regulation. High frequency HRV reflects parasympathetic activation of the autonomic
nervous system and the body's ability to exert cognitive control over attention and
emotional responding. Higher levels of HRV are associated with greater emotional and
behavioral flexibility, and tend to be associated with better mental and physical health
outcomes. In contrast, lower levels of HRV are associated with a wide range of medical and
psychiatric disorders, including acute and chronic alcohol ingestion, anxiety and
depression. Among alcohol dependent individuals, mindfulness training has been found to
increase HRV and lower subjective levels of psychological distress in response to stressful
cues in the short-term. The proposed study will be the first to examine the long-term
effects of MBRP on HRV and self-reported psychological/behavioral functioning. The results
will provide a better understanding of the interplay between the psychological and physical
mechanisms involved in relapse and help determine whether MBRP has lasting psychological and
physiological benefits. In other words, assessing both the psychological and physiological
effects of MBRP will provide a more accurate and comprehensive understanding of how
mindfulness aids in promoting self-regulation and relapse prevention. Finally, little is
known about which types of individuals are most likely to benefit from MBRP. It is necessary
to examine individual characteristics (i.e., baseline levels of HRV, trait mindfulness,
substance use, anxiety, depression) to determine which characteristics are associated with
positive treatment outcomes in both the short and long-term. This knowledge will enable more
efficient and effective delivery of the MBRP treatment.
Inclusion Criteria:
- Males and females who have given written informed consent
- 21 years of age or older
- DSM-IV-TR diagnosis of alcohol dependence within the last year, but have abstained
from drinking for the last thirty days
- Literate in English and able to read, understand, and complete the rating scales and
questionnaires accurately, follow instructions, and make use of mindfulness
techniques
- Express a wish to remain abstinent from drinking
- Willingness to participate in mindfulness techniques
- Able to attend all clinic visits without interruption
Exclusion Criteria:
- Any current Axis I DSM-IV-TR psychiatric disorder other than alcohol or nicotine
dependence that, in the clinician's opinion, warrants treatment or would preclude
safe participation in the protocol, including, but not limited to: psychosis,
schizophrenia, dementia, schizotypal personality disorder, borderline personality
disorder, bipolar disorder, primary diagnosis of eating disorder, or chronic
suicidality or homicidality
- Current use of Antabuse (Disulfiram) to pharmacologically treat alcohol dependence
- Serious medical comorbidity requiring medical intervention or close supervision,
including a history of dangerous symptoms of withdrawal from alcohol (e.g.,
seizures), pacemakers, heart transplant, severe arrhythmias, or active atrial
fibrillation
- Suicide attempt in the last thirty days
- Gross neurological disease
- Mental retardation, which will be assessed by the PI, postdoctoral fellows, and
doctoral students in clinical psychology)
- Minors below the legal drinking age will not be included.
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