Mindful attention reduces neural and self-reported cue-induced craving in smokers

Mindfulness and Emotion Regulation: Insights from Neurobiological, Psychological, and Clinical Studies

There is increasing interest in the beneficial clinical effects of mindfulness-based interventions (MBIs). Research has demonstrated their efficacy in a wide range of psychological conditions characterized by emotion dysregulation. Neuroimaging studies have evidenced functional and structural changes in a myriad of brain regions mainly involved in attention systems, emotion regulation, and self-referential processing. In this article we review studies on psychological and neurobiological correlates across different empirically derived models of research, including dispositional mindfulness, mindfulness induction, MBIs, and expert meditators in relation to emotion regulation. From the perspective of recent findings in the neuroscience of emotion regulation, we discuss the interplay of top-down and bottom-up emotion regulation mechanisms associated with different mindfulness models. From a phenomenological and cognitive perspective, authors have argued that mindfulness elicits a "mindful emotion regulation" strategy; however, from a clinical perspective, this construct has not been properly differentiated from other strategies and interventions within MBIs. In this context we propose the distinction between top-down and bottom-up mindfulness based emotion regulation strategies. Furthermore, we propose an embodied emotion regulation framework as a multilevel approach for understanding psychobiological changes due to mindfulness meditation regarding its effect on emotion regulation. Finally, based on clinical neuroscientific evidence on mindfulness, we open perspectives and dialogues regarding commonalities and differences between MBIs and other psychotherapeutic strategies for emotion regulation.

A translational neuroscience perspective on mindfulness meditation as a prevention strategy

Mindfulness meditation research mainly focuses on psychological outcomes such as behavioral, cognitive, and emotional functioning. However, the neuroscience literature on mindfulness meditation has grown in recent years. This paper provides an overview of relevant neuroscience and psychological research on the effects of mindfulness meditation. We propose a translational prevention framework of mindfulness and its effects. Drawing upon the principles of prevention science, this framework integrates neuroscience and prevention research and postulates underlying brain regulatory mechanisms that explain the impact of mindfulness on psychological outcomes via self-regulation mechanisms linked to underlying brain systems. We conclude by discussing potential clinical and practice implications of this model and directions for future research.

Mindfulness Interventions

Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.

Design and Feasibility of a Hatha Yoga Intervention for Smoking Cessation

Introduction:Effective interventions for smoking cessation are critically needed. Yoga has only begun to be evaluated for smoking cessation.

Aims:The primary aim was to assess participant satisfaction and perceived benefit of Hatha yoga. Secondary aims were to test evaluation tools, recruitment and retention techniques, and to generate preliminary effect size for a randomized trial.

Methods:This was a non-randomized, single-group, pilot study. Thirty-one participants entered the study and received group behavioural therapy followed by 30 minutes of Hatha yoga instruction. Participant satisfaction was assessed at the conclusion of eight sessions. Point prevalence smoking abstinence was assessed at the end of the intervention period.

Results:Participants were 36% male with an average age of 47 years (range 22–72) and a mean of 12.7 ± 5.6 cigarettes per day. Mean duration of smoking was 26.1 ± 15 years. Participant satisfaction was very high (88% very satisfied). Smoking abstinence at the end of the intervention was 29%.

Conclusions:Hatha yoga is acceptable and feasible to aid in smoking cessation. A regimen that includes breathing, postures, and meditation has been developed for testing in a randomized trial.

Task-related functional connectivity of the caudate mediates the association between trait mindfulness and implicit learning in older adults

Accumulating evidence shows a positive relationship between mindfulness and explicit cognitive functioning, i.e., that which occurs with conscious intent and awareness. However, recent evidence suggests that there may be a negative relationship between mindfulness and implicit types of learning, or those that occur without conscious awareness or intent. Here we examined the neural mechanisms underlying the recently reported negative relationship between dispositional mindfulness and implicit probabilistic sequence learning in both younger and older adults. We tested the hypothesis that the relationship is mediated by communication, or functional connectivity, of brain regions once traditionally considered to be central to dissociable learning systems: the caudate, medial temporal lobe (MTL), and prefrontal cortex (PFC). We first replicated the negative relationship between mindfulness and implicit learning in a sample of healthy older adults (60-90 years old) who completed three event-related runs of an implicit sequence learning task. Then, using a seed-based connectivity approach, we identified task-related connectivity associated with individual differences in both learning and mindfulness. The main finding was that caudate-MTL connectivity (bilaterally) was positively correlated with learning and negatively correlated with mindfulness. Further, the strength of task-related connectivity between these regions mediated the negative relationship between mindfulness and learning. This pattern of results was limited to the older adults. Thus, at least in healthy older adults, the functional communication between two interactive learning-relevant systems can account for the relationship between mindfulness and implicit probabilistic sequence learning.

Food-Specific Decentering Experiences Are Associated with Reduced Food Cravings in Meditators: A Preliminary Investigation

This study examined the association of food-specific decentering experiences with food cravings in a sample of meditators. Decentering refers to viewing one's thoughts as transient mental events and thus experiencing them as less subjectively real. This process has been suggested to be a key mechanism underlying the effects of mindfulness and many contemplative practices. Although most earlier studies have focused on the effects of decentering with regard to negative affect, some studies have shown that brief inductions of decentering among non-meditators reduce food cravings as well as unhealthy food choices. Here, we report a preliminary investigation of whether the food-specific decentering experiences that meditators have in daily life are associated with fewer food cravings. A small sample of meditators (N = 33, female = 15) answered a number of questions about decentering experiences with regard to thoughts about food, and they completed the short version of the Food Cravings Questionnaire-Trait and a measure of meditation experience. Results confirmed that both more meditation experience and more food-specific decentering experiences were associated with fewer food cravings in daily life. In addition, results suggested that when participants had stronger decentering experiences, they experienced fewer food cravings, regardless of their level of meditation experience. Exploratory analyses further revealed that decentering was more strongly associated with reduced cravings in women than in men. These preliminary findings suggest that food-specific decentering experiences indeed help meditators deal with food desires, and thus extend the evidence for decentering effects into the domain of reward. Future research might investigate this in larger samples, validate a food-specific measure of decentering, and consider the broader implications of decentering experiences in daily life.

Physical Aggression and Mindfulness among College Students: Evidence from China and the United States

Background: The link between trait mindfulness and several dimensions of aggression (verbal, anger and hostility) has been documented, while the link between physical aggression and trait mindfulness remains less clear. Method: We used two datasets: one United States sample from 300 freshmen males from Clemson University, South Carolina and a Chinese sample of 1516 freshmen students from Shanghai University of Finance and Economics. Multiple regressions were conducted to examine the association between mindfulness (measured by Mindful Attention and Awareness Scale (MAAS)) and each of the four subscales of aggression. Results: Among the Clemson sample (N = 286), the mindfulness scale had a significant negative association with each of the four subscales of aggression: Hostility: β = −0.62, p < 0.001; Verbal: β = −0.37, p < 0.001; Physical: β = −0.29, p < 0.001; Anger: β = −0.44, p < 0.001. Among the Shanghai male subsample, the mindfulness scale had a significant negative association with each of the four subscales of aggression: Hostility: β = −0.57, p < 0.001; Verbal: β = −0.37, p < 0.001; Physical: β = −0.35, p < 0.001; Anger: β = −0.58, p < 0.001. Among the Shanghai female subsample (N = 512), the mindfulness scale had a significant negative association with each of the four subscales of aggression: Hostility: β = −0.62, p < 0.001; Verbal: β = −0.41, p < 0.001; Physical: β = −0.52, p < 0.001; and Anger: β = −0.64, p < 0.001. Discussion: Our study documents the negative association between mindfulness and physical aggression in two non-clinical samples. Future studies could explore whether mindfulness training lowers physical aggression among younger adults.

Mindfulness training for adolescents: A neurodevelopmental perspective on investigating modifications in attention and emotion regulation using event-related brain potentials

Mindfulness training is increasingly being introduced in schools, yet studies examining its impact on the developing brain have been scarce. A neurodevelopmental perspective on mindfulness has been advocated as a powerful tool to enhance our understanding of underlying neurocognitive changes that have implications for developmental well-being research and the implementation of mindfulness in education. To stimulate more research in the developmental cognitive neuroscience of mindfulness, this article outlines possible indexes of mindfulness-based change in adolescence, with a focus on event-related brain potential (ERP) markers. We provide methodological recommendations for future studies and offer examples of research paradigms. We also discuss how mindfulness practice could impact on the development of prefrontal brain structures and enhance attention control and emotion regulation skills in adolescents, impacting in turn on their self-regulation and coping skills. We highlight advantages of the ERP methodology in neurodevelopmental research of mindfulness. It is proposed that research using established experimental tasks targeting ERP components such as the contingent negative variability, N200, error-related negativity and error positivity, P300, and late positive potential could elucidate developmentally salient shifts in the neural plasticity of the adolescent brain induced by mindfulness practice.

Functional neuroanatomy of meditation: A review and meta-analysis of 78 functional neuroimaging investigations

Meditation is a family of mental practices that encompasses a wide array of techniques employing distinctive mental strategies. We systematically reviewed 78 functional neuroimaging (fMRI and PET) studies of meditation, and used activation likelihood estimation to meta-analyze 257 peak foci from 31 experiments involving 527 participants. We found reliably dissociable patterns of brain activation and deactivation for four common styles of meditation (focused attention, mantra recitation, open monitoring, and compassion/loving-kindness), and suggestive differences for three others (visualization, sense-withdrawal, and non-dual awareness practices). Overall, dissociable activation patterns are congruent with the psychological and behavioral aims of each practice. Some brain areas are recruited consistently across multiple techniques-including insula, pre/supplementary motor cortices, dorsal anterior cingulate cortex, and frontopolar cortex-but convergence is the exception rather than the rule. A preliminary effect-size meta-analysis found medium effects for both activations (d=0.59) and deactivations (d=-0.74), suggesting potential practical significance. Our meta-analysis supports the neurophysiological dissociability of meditation practices, but also raises many methodological concerns and suggests avenues for future research.

Positive Associations of Dispositional Mindfulness with Cardiovascular Health: the New England Family Study

BACKGROUND

Mindfulness (the ability to attend nonjudgmentally to one's own physical and mental processes) is receiving substantial interest as a potential determinant of health. However, little is known whether mindfulness is associated with cardiovascular health.

PURPOSE

The aim of this study is to evaluate whether dispositional mindfulness is associated with cardiovascular health.

METHOD

Study participants (n = 382) were from the New England Family Study, born in Providence, RI, USA, with mean age 47 years. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS). Cardiovascular health was assessed based on American Heart Association criteria. Cross-sectional multivariable-adjusted log binomial regression analyses were performed.

RESULTS

Analyses demonstrated that those with high vs. low MAAS had prevalence ratio (PR) for good cardiovascular health of 1.83 (95 % confidence interval (CI) 1.07, 3.13), adjusted for age, gender, and race/ethnicity. There were significant associations of high vs. low mindfulness with nonsmoking (PR = 1.37, 95 % CI 1.06, 1.76), body mass index <25 kg/m(2) (PR = 2.17, 95 % CI 1.16, 4.07), fasting glucose <100 mg/dL (PR = 1.47, 95 % CI 1.06, 2.04), and high physical activity (PR = 1.56, 95 % CI 1.04, 2.35), but not blood pressure, total cholesterol, or fruit/vegetable consumption. Exploratory mediation analyses suggested that sense of control and depressive symptomatology may be mediators.

CONCLUSION

This study demonstrated preliminary cross-sectional evidence that dispositional mindfulness is positively associated with cardiovascular health, with the associations particularly driven by smoking, body mass index, fasting glucose, and physical activity. If in future research mindfulness-based practices are found to consistently improve cardiovascular disease risk factors, such interventions may have potential to strengthen effects of cardiovascular health promotion programs.

See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity

BACKGROUND

This paper presents the protocol for an ongoing research study to develop and test the feasibility of a multi-behavioral mHealth app. Approximately 27 million women smoke in the US, and more than 180,000 women die of illnesses linked to smoking annually. Women report greater difficulties quitting smoking. Concerns about weight gain, negative body image, and low self-efficacy may be key factors affecting smoking cessation among women. Recent studies suggest that a multi-behavioral approach, including diet and physical activity, may be more effective at helping women quit. Guided imagery has been successfully used to address body image concerns and self-efficacy in our 3 target behaviors-exercise, diet and smoking cessation. However, it has not been used simultaneously for smoking, diet, and exercise behavior in a single intervention. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in person, which limits reach. mHealth apps delivered via smart phones offer a unique channel through which to distribute imagery-based interventions.

OBJECTIVE

The objective of our study is to evaluate the feasibility of an mHealth app for women designed to simultaneously address smoking, diet, and physical activity behaviors. The objectives are supported by three specific aims: (1) develop guided imagery content, user interface, and resources to reduce weight concern, and increase body image and self-efficacy for behavior change among women smokers, (2) program a prototype of the app that contains all the necessary elements of text, graphics, multimedia and interactive features, and (3) evaluate the feasibility, acceptability, and preliminary efficacy of the app with women smokers.

METHODS

We created the program content and designed the prototype application for use on the Android platform in collaboration with 9 participants in multiple focus groups and in-depth interviews. We programmed and tested the application's usability with 6 participants in preparation for an open, pre- and posttest trial. Currently, we are testing the feasibility and acceptability of the application, evaluating the relationship of program use to tobacco cessation, dietary behaviors, and physical activity, and assessing consumer satisfaction with approximately 70 women smokers with Android-based smart phones.

RESULTS

The study was started January 1, 2014. The app was launched and feasibility testing began in April 1, 2015. Participants were enrolled from April 1-June 30, 2015. During that time, the app was downloaded over 350 times using no paid advertising. Participants were required to use the app "most days" for 30 days or they would be dropped from the study. We enrolled 151 participants. Of those, 78 were dropped or withdrew from the study, leaving 73 participants. We have completed the 30-day assessment, with a 92% response rate. The 90-day assessment is ongoing. During the final phase of the study, we will be conducting data analyses and disseminating study findings via presentations and publications. Feasibility will be demonstrated by successful participant retention and a high level of app use. We will examine individual metrics (eg, duration of use, number of screens viewed, change in usage patterns over time) and engagement with interactive activities (eg, activity tracking).

CONCLUSIONS

We will aggregate these data into composite exposure scores that combine number of visits and overall duration to calculate correlations between outcome and measures of program exposure and engagement. Finally, we will compare app use between participants and non-participants using Google Analytics.

Effect of Brief Mindfulness Practice on Self-Reported Affect, Craving, and Smoking: A Pilot Randomized Controlled Trial Using Ecological Momentary Assessment

INTRODUCTION

Despite efficacious pharmacological and behavioral treatments, most smokers attempt to quit without assistance and fail to quit. Mindfulness practice may be useful in smoking cessation.

METHODS

This ecological momentary assessment (EMA) study was a pilot parallel group randomized controlled trial of a brief mindfulness practice (Brief-MP) intervention on self-reported smoking behavior delivered to smokers on a Personal Digital Assistant (PDA) in the field. Adult community smokers (N = 44) were randomly assigned to a Brief-MP (n = 24) or Control (sham meditation; n = 20) group. Participants were instructed to smoke as much or as little as they liked. Participants carried a PDA for 2 weeks and were instructed to initiate 20 minutes of meditation (or control) training on the PDA daily, completing an assessment of cognitive and affective processes immediately afterwards. Additionally, they completed assessments at random times up to four times per day. Primary outcome variables were negative affect, craving, and cigarettes smoked per day, all self-reported.

RESULTS

Thirty-seven participants provided EMA data totaling 1874 assessments. Linear Mixed Model analyses on EMA data revealed that Brief-MP (vs. Control) reduced overall negative affect, F(1, 1798) = 13.8, P = .0002; reduced craving immediately post-meditation, (Group × Assessment Type interaction, F(2, 1796) = 12.3, P = .0001); and reduced cigarettes smoked per day over time (Group × Day interaction, F(1, 436) = 5.50, P = .01).

CONCLUSIONS

Brief-MP administered in the field reduced negative affect, craving, and cigarette use, suggesting it may be a useful treatment.

Better control with less effort: The advantage of using focused-breathing strategy over focused-distraction strategy on thought suppression

It has been suggested that unwanted thoughts usually intrude during mind wandering due to a shortage of mental resources. However, strategies for suppressing such thoughts have never been examined from a mind wandering perspective. Here, we compare the effectiveness of two types of attention distraction strategies that either redirect users' attention to their own breathing (focused-breathing strategy, FBS) or to a mental image (focused-distraction strategy, FDS) as related to working memory capacities. Eighty-two undergraduates were randomly assigned into a FBS or FDS group. They completed a concentration task and a thought suppression task, in which mind wandering and thought intrusions were each measured. Our results support the hypothesis that mind wandering is positively correlated to thought intrusions and shows that FBS is more effective than FDS in reducing mind wandering and thought intrusions. Moreover, in contrast to FDS, the effect of FBS is independent of users' mental resources.

Neuroscience of drug craving for addiction medicine: From circuits to therapies

Drug craving is a dynamic neurocognitive emotional-motivational response to a wide range of cues, from internal to external environments and from drug-related to stressful or affective events. The subjective feeling of craving, as an appetitive or compulsive state, could be considered a part of this multidimensional process, with modules in different levels of consciousness and embodiment. The neural correspondence of this dynamic and complex phenomenon may be productively investigated in relation to regional, small-scale networks, large-scale networks, and brain states. Within cognitive neuroscience, this approach has provided a long list of neural and cognitive targets for craving modulations with different cognitive, electrical, or pharmacological interventions. There are new opportunities to integrate different approaches for carving management from environmental, behavioral, psychosocial, cognitive, and neural perspectives. By using cognitive neuroscience models that treat drug craving as a dynamic and multidimensional process, these approaches may yield more effective interventions for addiction medicine.

Boundary conditions of methamphetamine craving

Methamphetamine use has increased significantly and become a global health concern. Craving is known to predict methamphetamine use and relapse following abstinence. Some have suggested that cravings are automatic, generalized, and uncontrollable, but experimental work addressing these claims is lacking. In 2 exploratory studies, we tested the boundary conditions of methamphetamine craving by asking: (a) is craving specific to users' preferred route of administration?, and (b) can craving be regulated by cognitive strategies? Two groups of methamphetamine users were recruited. In Study 1, participants were grouped by their preferred route of administration (intranasal vs. smoking), and rated their craving in response to photographs and movies depicting methamphetamine use (via the intranasal vs. smoking route). In Study 2, methamphetamine smokers implemented cognitive regulation strategies while viewing photographs depicting methamphetamine smoking. Strategies involved either focusing on the positive aspects of smoking methamphetamine or the negative consequences of doing so-the latter strategy based on treatment protocols for addiction. In Study 1, we found a significant interaction between group and route of administration, such that participants who preferred to smoke methamphetamine reported significantly stronger craving for smoking stimuli, whereas those who preferred the intranasal route reported stronger craving for intranasal stimuli. In Study 2, participants reported significantly lower craving when focusing on the negative consequences associated with methamphetamine use. Taken together, these findings suggest that strength of craving for methamphetamine is moderated by users' route of administration and can be reduced by cognitive strategies. This has important theoretical, methodological, and clinical implications.

Cognitive interventions for addiction medicine: Understanding the underlying neurobiological mechanisms

Neuroimaging provides a tool for investigating the neurobiological mechanisms of cognitive interventions in addiction. The aim of this review was to describe the brain circuits that are recruited during cognitive interventions, examining differences between various treatment modalities while highlighting core mechanisms, in drug addicted individuals. Based on a systematic Medline search we reviewed neuroimaging studies on cognitive behavioral therapy, cognitive inhibition of craving, motivational interventions, emotion regulation, mindfulness, and neurofeedback training in addiction. Across intervention modalities, common results included the normalization of aberrant activity in the brain's reward circuitry, and the recruitment and strengthening of the brain's inhibitory control network. Results suggest that different cognitive interventions act, at least partly, through recruitment of a common inhibitory control network as a core mechanism. This implies potential transfer effects between training modalities. Overall, results confirm that chronically hypoactive prefrontal regions implicated in cognitive control in addiction can be normalized through cognitive means.

Individual variables related to craving reduction in cue exposure treatment

INTRODUCTION

Although extensive research has demonstrated that cigarette craving can be effectively attenuated, very few studies have explored associations between individual variables and craving reduction. This study explored whether individual characteristics predict craving decreases during virtual reality cue exposure treatment (VR-CET).

METHOD

Participants were 41 treatment-seeking smokers (73% women) with a mean age of 39.4 (SD=13.2), who had been smoking 15.0 (SD=7.1) cigarettes per day for 20.0 (SD=10.7) years. Their mean score on the Fagerström Test of Nicotine Dependence (FTND) was 4.8 (SD=2.3). Participants completed five cue exposure sessions using virtual reality for smoking cessation over a five-week period. The percentage of reduction in craving was calculated by comparing self-reported craving after the first and last exposure sessions. Sociodemographic characteristics (gender, age, years of education and marital status), tobacco-related [duration of daily smoking, cigarettes per day, FTND and Nicotine Dependence Syndrome Scale (NDSS)] and psychological characteristics [depressive symptoms (Beck's Depression Inventory-Second Edition, BDI-II), impulsiveness (delay discounting) and anxiety (State-Trait Anxiety Inventory, STAI)] were examined as possible predictors for craving reductions.

RESULTS

Multiple regression revealed that greater decreases in craving were associated with younger age (β=-.30, p=.043), cigarettes smoked per day (β=.30, p=.042), higher values on delay discounting (β=.34, p=.020) and higher BDI-II scores (β=.30, p=.035).

CONCLUSION

These findings suggest that smokers with certain individual characteristics may benefit most from interventions aimed at reducing craving through VR-CET.

Investigating the phenomenological matrix of mindfulness-related practices from a neurocognitive perspective

There has been a great increase in literature concerned with the effects of a variety of mental training regimes that generally fall within what might be called contemplative practices, and a majority of these studies have focused on mindfulness. Mindfulness meditation practices can be conceptualized as a set of attention-based, regulatory, and self-inquiry training regimes cultivated for various ends, including wellbeing and psychological health. This article examines the construct of mindfulness in psychological research and reviews recent, nonclinical work in this area. Instead of proposing a single definition of mindfulness, we interpret it as a continuum of practices involving states and processes that can be mapped into a multidimensional phenomenological matrix which itself can be expressed in a neurocognitive framework. This phenomenological matrix of mindfulness is presented as a heuristic to guide formulation of next-generation research hypotheses from both cognitive/behavioral and neuroscientific perspectives. In relation to this framework, we review selected findings on mindfulness cultivated through practices in traditional and research settings, and we conclude by identifying significant gaps in the literature and outline new directions for research.

Calm and smart? A selective review of meditation effects on decision making

Over the past two decades, there has been a growing interest in the use of meditation to improve cognitive performance, emotional balance, and well-being. As a consequence, research into the psychological effects and neural mechanisms of meditation has been accumulating. Whether and how meditation affects decision making is not yet clear. Here, we review evidence from behavioral and neuroimaging studies and summarize the effects of meditation on social and non-social economic decision making. Research suggests that meditation modulates brain activities associated with cognitive control, emotion regulation and empathy, and leads to improved non-social and social decision making. Accordingly, we propose an integrative model in which cognitive control, emotional regulation, and empathic concern mediate the effects of meditation on decision making. This model provides insights into the mechanisms by which meditation affects the decision making process. More evidence is needed to test our explanatory model and to explore the function of specific brain areas and their interactive effects on decision making during meditation training.

A shift in perspective: Decentering through mindful attention to imagined stressful events

Ruminative thoughts about a stressful event can seem subjectively real, as if the imagined event were happening in the moment. One possibility is that this subjective realism results from simulating the self as engaged in the stressful event (immersion). If so, then the process of decentering--disengaging the self from the event--should reduce the subjective realism associated with immersion, and therefore perceived stressfulness. To assess this account of decentering, we taught non-meditators a strategy for disengaging from imagined events, simply viewing these events as transient mental states (mindful attention). In a subsequent neuroimaging session, participants imagined stressful and non-stressful events, while either immersing themselves or adopting mindful attention. In conjunction analyses, mindful attention down-regulated the processing of stressful events relative to baseline, whereas immersion up-regulated their processing. In direct contrasts between mindful attention and immersion, mindful attention showed greater activity in brain areas associated with perspective shifting and effortful attention, whereas immersion showed greater activity in areas associated with self-processing and visceral states. These results suggest that mindful attention produces decentering by disengaging embodied senses of self from imagined situations so that affect does not develop.

Mindfulness training for smokers via web-based video instruction with phone support: a prospective observational study

BACKGROUND

Many smokers are unable to access effective behavioral smoking cessation therapies due to location, financial limitations, schedule, transportation issues or other reasons. We report results from a prospective observational study in which a promising novel behavioral intervention, Mindfulness Training for Smokers was provided via web-based video instruction with telephone-based counseling support.

METHODS

Data were collected on 26 low socioeconomic status smokers. Participants were asked to watch eight video-based classes describing mindfulness skills and how to use these skills to overcome various core challenges in tobacco dependence. Participants received eight weekly phone calls from a smoking cessation coach who provided general support and answered questions about the videos. On the quit day, participants received two weeks of nicotine patches.

RESULTS

Participants were a mean of 40.5 years of age, smoked 16.31 cigarettes per day for 21.88 years, with a mean of 6.81 prior failed quit attempts. Participants completed a mean of 5.55 of 8 online video classes with a mean of 23.33 minutes per login, completed a mean of 3.19 of 8 phone coach calls, and reported a mean meditation practice time of 12.17 minutes per day. Smoking abstinence was defined as self-reported abstinence on a smoking calendar with biochemical confirmation via carbon monoxide breath-test under 7 parts per million. Intent-to-treat analysis demonstrated 7-day point prevalence smoking abstinence at 4 and 6-months post-quit of 23.1% and 15.4% respectively. Participants showed a significant pre- to post-intervention increase in mindfulness as measured by the Five-Factor Mindfulness Questionnaire, and a significant pre- to post-intervention decrease in the Anxiety Sub-scale of the Depression Anxiety and Stress Scale.

CONCLUSIONS

Results suggest that Mindfulness Training for Smokers can be provided via web-based video instruction with phone support and yield reasonable participant engagement on intervention practices and that intervention efficacy and mechanism of effect deserve further study.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02164656 , Registration Date June 13, 2014.

EEG-guided meditation: A personalized approach

The therapeutic potential of meditation for physical and mental well-being is well documented, however the possibility of adverse effects warrants further discussion of the suitability of any particular meditation practice for every given participant. This concern highlights the need for a personalized approach in the meditation practice adjusted for a concrete individual. This can be done by using an objective screening procedure that detects the weak and strong cognitive skills in brain function, thus helping design a tailored meditation training protocol. Quantitative electroencephalogram (qEEG) is a suitable tool that allows identification of individual neurophysiological types. Using qEEG screening can aid developing a meditation training program that maximizes results and minimizes risk of potential negative effects. This brief theoretical-conceptual review provides a discussion of the problem and presents some illustrative results on the usage of qEEG screening for the guidance of mediation personalization.

Neuroimaging craving: urge intensity matters

Functional neuroimaging has become an increasingly common tool for studying drug craving. Furthermore, functional neuroimaging studies, which have addressed an incredibly diverse array of questions regarding the nature and treatment of craving, have had a substantial impact on theoretical models of addiction. Here, we offer three points related to this sizeable and influential body of research. First, we assert that the craving most investigators seek to study represents not just a desire but a strong desire to use drugs, consistent with prominent theoretical and clinical descriptions of craving. Secondly, we highlight that, despite the clear conceptual and clinical emphasis on craving as an intense desire, brain imaging studies often have been designed explicitly in a way that reduces the ability to generate powerful cravings. We illustrate this point by reviewing the peak urge levels endorsed by participants in functional magnetic resonance imaging (fMRI) studies of cigarette craving in nicotine-deprived versus non-deprived smokers. Thirdly, we suggest that brain responses measured during mild states of desire (such as following satiety) differ in fundamental ways from those measured during states of overpowering desire (i.e. craving) to use drugs. We support this position by way of a meta-analysis revealing that fMRI cue exposure studies using nicotine-deprived smokers have produced different patterns of brain activation to those using non-deprived smokers. Regarding brain imaging studies of craving, intensity of the urges matter, and more explicit attention to urge intensity in future work has the potential to yield valuable information about the nature of craving.

Potential self-regulatory mechanisms of yoga for psychological health

Research suggesting the beneficial effects of yoga on myriad aspects of psychological health has proliferated in recent years, yet there is currently no overarching framework by which to understand yoga’s potential beneficial effects. Here we provide a theoretical framework and systems-based network model of yoga that focuses on integration of top-down and bottom-up forms of self-regulation. We begin by contextualizing yoga in historical and contemporary settings, and then detail how specific components of yoga practice may affect cognitive, emotional, behavioral, and autonomic output under stress through an emphasis on interoception and bottom-up input, resulting in physical and psychological health. The model describes yoga practice as a comprehensive skillset of synergistic process tools that facilitate bidirectional feedback and integration between high- and low-level brain networks, and afferent and re-afferent input from interoceptive processes (somatosensory, viscerosensory, chemosensory). From a predictive coding perspective we propose a shift to perceptual inference for stress modulation and optimal self-regulation. We describe how the processes that sub-serve self-regulation become more automatized and efficient over time and practice, requiring less effort to initiate when necessary and terminate more rapidly when no longer needed. To support our proposed model, we present the available evidence for yoga affecting self-regulatory pathways, integrating existing constructs from behavior theory and cognitive neuroscience with emerging yoga and meditation research. This paper is intended to guide future basic and clinical research, specifically targeting areas of development in the treatment of stress-mediated psychological disorders.

Common prefrontal regions activate during self-control of craving, emotion, and motor impulses in smokers

It has been posited that self-regulation of behaviors, emotions, and temptations may all rely on a common resource. Recent reviews suggest this common resource may include the inferior frontal cortex (IFC). However, to our knowledge no single functional neuroimaging study has tested this hypothesis. We obtained fMRI scans as 25 abstinent treatment-seeking cigarette smokers completed motor, affective, and craving self-control tasks before smoking cessation treatment. We identified two regions in left IFC and a region in pre-supplementary motor area (preSMA) that were commonly activated in all three tasks. Further, PPI analyses suggest that IFC may involve dissociable pathways in each self-control domain. Specifically, the IFC showed negative functional connectivity with large portions of the thalamus and precentral gyrus during motor stopping, with the insula and other portions of the thalamus during craving regulation, and potentially with a small limbic region during emotion regulation. We discuss implications for understanding self-control mechanisms.

Cocaine dependent individuals with attenuated striatal activation during reinforcement learning are more susceptible to relapse

Cocaine-dependent individuals show altered brain activation during decision making. It is unclear, however, whether these activation differences are related to relapse vulnerability. This study tested the hypothesis that brain-activation patterns during reinforcement learning are linked to relapse 1 year later in individuals entering treatment for cocaine dependence. Subjects performed a Paper-Scissors-Rock task during functional magnetic resonance imaging (fMRI). A year later, we examined whether subjects had remained abstinent (n=15) or relapsed (n=15). Although the groups did not differ on demographic characteristics, behavioral performance, or lifetime substance use, abstinent patients reported greater motivation to win than relapsed patients. The fMRI results indicated that compared with abstinent individuals, relapsed users exhibited lower activation in (1) bilateral inferior frontal gyrus and striatum during decision making more generally; and (2) bilateral middle frontal gyrus and anterior insula during reward contingency learning in particular. Moreover, whereas abstinent patients exhibited greater left middle frontal and striatal activation to wins than losses, relapsed users did not demonstrate modulation in these regions as a function of outcome valence. Thus, individuals at high risk for relapse relative to those who are able to abstain allocate fewer neural resources to action-outcome contingency formation and decision making, as well as having less motivation to win on a laboratory-based task.

Metacognitive model of mindfulness

Mindfulness training has proven to be an efficacious therapeutic tool for a variety of clinical and nonclinical health problems and a booster of well-being. In this paper we propose a multi-level metacognitive model of mindfulness. We postulate and discuss following hypothesis: (1) mindfulness is related to the highest level of metacognition; (2) mindfulness depends on dynamic cooperation of three main components of the metacognition (metacognitive knowledge, metacognitive experiences and metacognitive skills); (3) a mindful meta-level is always conscious while the other meta-cognitive processes can occur implicitly; (4) intentionally practiced mindfulness decreases dissociations between awareness and meta-awareness; (5) components of mindful meta-level develop and change during continuous practice. The current model is discussed in the light of empirical data and other theoretical approaches to mindfulness concept. We believe that presented model provides some helpful avenues for future research and theoretical investigations into mindfulness and the mechanisms of its actions.

Randomized trial comparing mindfulness training for smokers to a matched control

Smoking continues to take an enormous toll on society, and although most smokers would like to quit, most are unsuccessful using existing therapies. These findings call on researchers to develop and test therapies that provide higher rates of long-term smoking abstinence. We report results of a randomized controlled trial comparing a novel smoking cessation treatment using mindfulness training to a matched control based on the American Lung Association's Freedom From Smoking program. Data were collected on 175 low socioeconomic status smokers in 2011-2012 in a medium sized midwestern city. A significant difference was not found in the primary outcome; intent-to-treat biochemically confirmed 6-month smoking abstinence rates were mindfulness=25.0%, control=17.9% (p=0.35). Differences favoring the mindfulness condition were found on measures of urges and changes in mindfulness, perceived stress, and experiential avoidance. While no significant differences were found in quit rates, the mindfulness intervention resulted in positive outcomes.

Is meditation associated with altered brain structure? A systematic review and meta-analysis of morphometric neuroimaging in meditation practitioners

Numerous studies have begun to address how the brain's gray and white matter may be shaped by meditation. This research is yet to be integrated, however, and two fundamental questions remain: Is meditation associated with altered brain structure? If so, what is the magnitude of these differences? To address these questions, we reviewed and meta-analyzed 123 brain morphology differences from 21 neuroimaging studies examining ∼300 meditation practitioners. Anatomical likelihood estimation (ALE) meta-analysis found eight brain regions consistently altered in meditators, including areas key to meta-awareness (frontopolar cortex/BA 10), exteroceptive and interoceptive body awareness (sensory cortices and insula), memory consolidation and reconsolidation (hippocampus), self and emotion regulation (anterior and mid cingulate; orbitofrontal cortex), and intra- and interhemispheric communication (superior longitudinal fasciculus; corpus callosum). Effect size meta-analysis (calculating 132 effect sizes from 16 studies) suggests a global 'medium' effect size (Cohen's d¯=0.46; r¯=.19). Publication bias and methodological limitations are strong concerns, however. Further research using rigorous methods is required to definitively link meditation practice to altered brain morphology.

Are mindfulness-based interventions effective for substance use disorders? A systematic review of the evidence

Mindfulness-based interventions (MBIs) are increasingly suggested as therapeutic approaches for effecting substance use and misuse (SUM). The aim of this article is to review current evidence on the therapeutic efficacy of MBIs for SUM. A literature search was undertaken using four electronic databases and references of retrieved articles. The search included articles written in English published up to December 2011. Quality of included trials was assessed. In total, 24 studies were included, three of which were based on secondary analyses of previously investigated samples. Current evidence suggests that MBIs can reduce the consumption of several substances including alcohol, cocaine, amphetamines, marijuana, cigarettes, and opiates to a significantly greater extent than waitlist controls, non-specific educational support groups, and some specific control groups. Some preliminary evidence also suggests that MBIs are associated with a reduction in craving as well as increased mindfulness. The limited generalizability of the reviewed findings is noted (i.e., small sample size, lack of methodological details, and the lack of consistently replicated findings). More rigorous and larger randomized controlled studies are warranted.

Cognitive and affective mechanisms linking trait mindfulness to craving among individuals in addiction recovery

The present study aimed to identify affective, cognitive, and conative mediators of the relation between trait mindfulness and craving in data culled from an urban sample of 165 persons (in abstinence verified by urinalysis) entering into residential treatment for substance use disorders between 2010 and 2012. Multivariate path analysis adjusting for age, gender, education level, employment status, and substance use frequency indicated that the association between the total trait mindfulness score on the Five Facet Mindfulness Questionnaire and alcohol/drug craving was statistically mediated by negative affect (measured by the PANAS, beta = -.13) and cognitive reappraisal (measured by the CERQ, beta = -.08), but not by readiness to change (measured by the URICA, beta = -.001). Implications for mindfulness-oriented treatment of persons with substance use disorders are discussed. The study's limitations are noted.

Mindfulness-based treatment to prevent addictive behavior relapse: theoretical models and hypothesized mechanisms of change

Mindfulness-based treatments are growing in popularity among addiction treatment providers, and several studies suggest the efficacy of incorporating mindfulness practices into the treatment of addiction, including the treatment of substance use disorders and behavioral addictions (i.e., gambling). The current paper provides a review of theoretical models of mindfulness in the treatment of addiction and several hypothesized mechanisms of change. We provide an overview of mindfulness-based relapse prevention (MBRP), including session content, treatment targets, and client feedback from participants who have received MBRP in the context of empirical studies. Future research directions regarding operationalization and measurement, identifying factors that moderate treatment effects, and protocol adaptations for specific populations are discussed.

Randomized trial on mindfulness training for smokers targeted to a disadvantaged population

We report the results of a randomized trial comparing a novel smoking cessation treatment Mindfulness Training for Smokers (MTS) to a usual care therapy (Controls), which included the availability of a tobacco quit line and nicotine patches. Data were collected from 196 low socioeconomic status smokers in 2010-2011 in Madison, Wisconsin. Participants were randomized to either MTS or a telephonic quit line. The primary outcome was 6-month smoking abstinence measured by carbon monoxide breath testing and Time-Line Follow-Back. Among treatment initiators (randomized participants who participated in the intervention), abstinence rates were significantly different between the MTS (38.7%) and control (20.6%, p = .05) groups. Study limitations are also discussed. Results suggest that further study is warranted.

Addiction and the brain-disease fallacy

From Brainwashed: The Seductive Appeal of Mindless Neuroscience by Sally Satel and Scott Lilienfeld, copyright © 2013. Reprinted by permission of Basic Books, a member of The Perseus Books Group. The notion that addiction is a "brain disease" has become widespread and rarely challenged. The brain-disease model implies erroneously that the brain is necessarily the most important and useful level of analysis for understanding and treating addiction. This paper will explain the limits of over-medicalizing - while acknowledging a legitimate place for medication in the therapeutic repertoire - and why a broader perspective on the problems of the addicted person is essential to understanding addiction and to providing optimal care. In short, the brain-disease model obscures the dimension of choice in addiction, the capacity to respond to incentives, and also the essential fact people use drugs for reasons (as consistent with a self-medication hypothesis). The latter becomes obvious when patients become abstinent yet still struggle to assume rewarding lives in the realm of work and relationships. Thankfully, addicts can choose to recover and are not helpless victims of their own "hijacked brains."

Examine the Relationship between Mindfulness and Drug Craving in Addicts Undergoing Methadone Maintenance Treatment

BACKGROUND

The aim of this study was examination the relationship between mindfulness and drug craving in addicts undergoing methadone maintenance treatment.

METHODS

The subjects of this research were 80 addicts undergoing methadone maintenance treatment selected through available sampling from four addiction treatment center in Ahvaz from March 2012 to September 2012. Two questionnaires to examine the variables of this study were the five facets mindfulness questionnaire (FFMQ) and hero-in craving questionnaire (HCQ). The data were analyzed using SPSS version 16.

RESULTS

The Pearson correlational results indicated significant reverse relation between mindfulness factors and craving sub scales (P<0.05). Besides, the regression results indicated that four factors of mindfulness such as observation, describing, acting with awareness and non-reactivity to inner experience can totally predict 48 percent of craving variance (P<0.01 ).

CONCLUSION

There is a reverse relation between mindfulness and craving. Therefore we advise the researchers in addiction fields that in line with various studies that indicated effectiveness of mindfulness based interventions in improving various psychological problems, be researcher in effectiveness of this intervention in addiction fields. Moreover, we advise the addiction therapists to use mindfulness based interventions and technics in order to reduction of emotional and cognitive problems co morbidities with addiction such as craving that is one of potential factors affecting survival and relapse to drug abuse.

Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface

Prominent neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. This review describes how MBIs may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.

The Addict in Us all

In this paper, we contend that the psychology of addiction is similar to the psychology of ordinary, non-addictive temptation in important respects, and explore the ways in which these parallels can illuminate both addiction and ordinary action. The incentive salience account of addiction proposed by Robinson and Berridge (1-3) entails that addictive desires are not in their nature different from many of the desires had by non-addicts; what is different is rather the way that addictive desires are acquired, which in turn affects their strength. We examine these "incentive salience" desires, both in addicts and non-addicts, contrasting them with more cognitive desires. On this account, the self-control challenge faced by addicted agents is not different in kind from that faced by non-addicted agents - though the two may, of course, differ greatly in degree of difficulty. We explore a general model of self-control for both the addict and the non-addict, stressing that self-control may be employed at three different stages, and examining the ways in which it might be strengthened. This helps elucidate a general model of intentional action.

A triadic neurocognitive approach to addiction for clinical interventions

According to the triadic neurocognitive model of addiction to drugs (e.g., cocaine) and non-drugs (e.g., gambling), weakened "willpower" associated with these behaviors is the product of an abnormal functioning in one or more of three key neural and cognitive systems: (1) an amygdala-striatum dependent system mediating automatic, habitual, and salient behaviors; (2) a prefrontal cortex dependent system important for self-regulation and forecasting the future consequences of a behavior; and (3) an insula dependent system for the reception of interoceptive signals and their translation into feeling states (such as urge and craving), which in turn plays a strong influential role in decision-making and impulse control processes related to uncertainty, risk, and reward. The described three-systems account for poor decision-making (i.e., prioritizing short-term consequences of a decisional option) and stimulus-driven actions, thus leading to a more elevated risk for relapse. Finally, this article elaborates on the need for "personalized" clinical model-based interventions targeting interactions between implicit processes, interoceptive signaling, and supervisory function aimed at helping individuals become less governed by immediate situations and automatic pre-potent responses, and more influenced by systems involved in the pursuit of future valued goals.

A brief mindfulness intervention reduces unhealthy eating when hungry, but not the portion size effect

OBJECTIVE

The present research examined the effects of a mindfulness-based intervention to foster healthy eating. Specifically, we tested whether a brief mindfulness manipulation can prevent the portion size effect, and reduce overeating on unhealthy snacks when hungry.

METHODS

110 undergraduate participants (MAge=20.9±2.3; MBMI=22.3±2.5) were served a small or a large portion of chocolate chip cookies after listening to an audio book or performing a mindfulness exercise (i.e., body scan). Current level of hunger was assessed unobtrusively on a visual analog scale before the eating situation.

MAIN OUTCOME MEASURE

Calorie intake from chocolate chip cookies.

RESULTS

When presented with a large compared to a small portion, participants consumed more cookies (+83kcal). This was not affected by the mindfulness intervention or by hunger. However, while control participants ate more unhealthy food when hungry than when not hungry (+67kcal), participants in the mindfulness condition did not (+1kcal).

CONCLUSIONS

Findings confirm the prevalence and robustness of the portion size effect and suggest that it may be independent from awareness of internal cues. Prevention strategies may benefit more from targeting awareness of the external environment. However, mindfulness-based interventions may be effective to reduce effects of hunger on unhealthy food consumption.

Factors modulating neural reactivity to drug cues in addiction: a survey of human neuroimaging studies

Human neuroimaging studies suggest that neural cue reactivity is strongly associated with indices of drug use, including addiction severity and treatment success. However, little is known about factors that modulate cue reactivity. The goal of this review, in which we survey published fMRI and PET studies on drug cue reactivity in cocaine, alcohol, and tobacco cigarette users, is to highlight major factors that modulate brain reactivity to drug cues. First, we describe cue reactivity paradigms used in neuroimaging research and outline the brain circuits that underlie cue reactivity. We then discuss major factors that have been shown to modulate cue reactivity and review specific evidence as well as outstanding questions related to each factor. Building on previous model-building reviews on the topic, we then outline a simplified model that includes the key modulatory factors and a tentative ranking of their relative impact. We conclude with a discussion of outstanding challenges and future research directions, which can inform future neuroimaging studies as well as the design of treatment and prevention programs.

Treatment approaches for interoceptive dysfunctions in drug addiction

There is emerging evidence that individuals with drug addiction have dysfunctions in brain systems that are important for interoceptive processing, which include, among others, the insular and the anterior cingulate cortices. These individuals may not be expending sufficient neural resources to process perturbations of the interoceptive state but may exert over-activation of these systems when processing drug-related stimuli. As a consequence, insufficient detection and processing of interoceptive state changes may result in inadequate anticipation and preparation to adapt to environmental challenges, e.g., adapt to abstinence in the presence of withdrawal symptoms. Here, we integrate interoceptive dysfunction in drug-addicted individuals, with the neural basis for meditation and exercise to develop a heuristic to target the interoceptive system as potential treatments for drug addiction. First, it is suggested that mindfulness-based approaches can modulate both interoceptive function and insular activation patterns. Second, there is an emerging literature showing that the regulation of physical exercise in the brain involves the insula and anterior cingulate cortex and that intense physical exercise is associated with a insula changes that may provide a window to attenuate the increased interoceptive response to drug-related stimuli. It is concluded that the conceptual framework of interoceptive dysfunctions in drug addiction and the experimental findings in meditation and exercise provide a useful approach to develop new interventions for drug addiction.

Mind-body practices: an alternative, drug-free treatment for smoking cessation? A systematic review of the literature

OBJECTIVE

The limited success of current smoking cessation therapies encourages research into new treatment strategies. Mind-body practices such as yoga and meditation have the potential to aid smoking cessation and become an alternative drug-free treatment option. The aim of this article is to assess the efficacy of yoga and other meditation-based interventions for smoking cessation, to identify the challenges of clinical trials applying mind-body treatments, and to outline directions for future research on these types of therapies to assist in smoking cessation.

METHODS

A systematic review of the scientific literature.

RESULTS

Fourteen clinical trials met the inclusion criteria defined for this review. Each article was reviewed thoroughly, and evaluated for quality, design, and methodology. Although primary outcomes differed between studies, the fourteen articles, most with limitations, reported promising effects supporting further investigation of the use of these practices to improve smoking cessation.

CONCLUSIONS

The literature supports yoga and meditation-based therapies as candidates to assist smoking cessation. However, the small number of studies available and associated methodological problems require more clinical trials with larger sample sizes and carefully monitored interventions to determine rigorously if yoga and meditation are effective treatments.

The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways

Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.