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Psychological flexibility-based interventions versus first-line psychosocial interventions for substance use disorders: Systematic review and meta-analyses of randomized controlled trials. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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152
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Bai CF, Cui NX, Xu X, Mi GL, Sun JW, Shao D, Li J, Jiang YZ, Yang QQ, Zhang X, Cao FL. Effectiveness of two guided self-administered interventions for psychological distress among women with infertility: a three-armed, randomized controlled trial. Hum Reprod 2019; 34:1235-1248. [PMID: 31242506 DOI: 10.1093/humrep/dez066] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/03/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract
STUDY QUESTION
What is the effect of two guided self-administered interventions on psychological distress in women undergoing IVF or ICSI?
SUMMARY ANSWER
A brief mindfulness intervention significantly reduced depression and improved sleep quality, while the gratitude journal intervention showed no significant effect on any outcome variables.
WHAT IS KNOWN ALREADY
Mindfulness and gratitude journal interventions have been found to be beneficial in reducing negative affect and improving well-being. However, there are very few mental health professionals who implement such interventions in low- and middle-income countries. Therefore, two guided self-administered interventions for women with infertility were designed to help them cope with their psychological distress.
STUDY DESIGN, SIZE, DURATION
A three-armed, randomized controlled trial was designed to evaluate the mindfulness and gratitude journal interventions for women undergoing IVF/ICSI. Between May 2016 and November 2017, at the reproductive center in a public hospital, 234 women were randomly assigned to the brief mindfulness group (BMG, n = 78), gratitude journal group (GJG, n = 78) or control group (CG, n = 78). The inclusion criteria were being a woman undergoing her first cycle of IVF, having at least junior middle school education and having no biological or adopted children.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Female infertility patients (n = 346) were approached, and 112 did not meet the inclusion criteria. All three randomized groups completed questionnaires on the day of down-regulation (T1), the day before embryo(s) transfer (T2), and 3 days before the pregnancy test (T3). The BMG completed four sessions and listened to a 20-minute audio daily, including guided mindfulness breathing and body scan. The GJG completed four sessions and wrote three gratitude journals daily. The CG received routine care. A generalized estimating equation was used in an intention-to-treat analysis. The primary outcome was depression. Secondary outcomes were anxiety, sleep quality, infertility-related stress, mindfulness and gratitude.
MAIN RESULTS AND THE ROLE OF CHANCE
Participants of the BMG showed decreased depression (mean difference (MD) = −1.69, [−3.01, −0.37], d = 0.44) and improved sleep quality (MD = −1.24, [−1.95, −0.39], d = 0.43) compared to the CG, but the effect was not significant for anxiety, Fertility Problem Inventory totals, mindfulness, gratitude scores or pregnancy rates. The BMG showed a significant reduction in depression and improvement in sleep quality between T1 and T2, a continuous significant reduction between T1 and T3 and no reduction between T2 and T3. There were no significant effects on any of the variables for the GJG.
LIMITATIONS, REASONS FOR CAUTION
The inclusion criteria may result in bias because some participants with low education were excluded and only women with infertility were included. A low compliance rate occurred in the gratitude journals group. Moreover, men were not included in this study. Further research should consider including spouses of the target population.
WIDER IMPLICATIONS OF THE FINDINGS
The brief mindfulness intervention was beneficial in decreasing depression and improving sleep quality. Implementation of guided self-administered mindfulness could make the psychological counseling service more accessible for patients with infertility in resource-poor settings. The efficiency and feasibility of the gratitude journal intervention needs to be investigated further.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the National Social Science Foundation (17BSH054). The authors have no conflicts of interest.
TRIAL REGISTRATION NUMBER
ChiCTR-IOR-16008452.
TRIAL REGISTRATION DATE
9 May 2016
DATE OF FIRST PATIENT’S ENROLMENT
15 May 2016.
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Affiliation(s)
- Cai-Feng Bai
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan 750004, China
| | - Nai-Xue Cui
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Xian Xu
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Guang-li Mi
- Nursing Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Ji-Wei Sun
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Di Shao
- School of Health Care Management, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Jie Li
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Yin-Zhi Jiang
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan 750004, China
| | - Qian-Qian Yang
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Xuan Zhang
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
| | - Feng-Lin Cao
- School of Nursing, Shandong University, No. 44 Wenhua Xi Road, Jinan 250012, China
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153
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Haun JN, Ballistrea LM, Melillo C, Standifer M, Kip K, Paykel J, Murphy JL, Fletcher CE, Mitchinson A, Kozak L, Taylor SL, Glynn SM, Bair M. A Mobile and Web-Based Self-Directed Complementary and Integrative Health Program for Veterans and Their Partners (Mission Reconnect): Protocol for a Mixed-Methods Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e13666. [PMID: 31094345 PMCID: PMC6535978 DOI: 10.2196/13666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 12/13/2022] Open
Abstract
Background Complementary and integrative health (CIH) is a viable solution to PTSD and chronic pain. Many veterans believe CIH can be performed only by licensed professionals in a health care setting. Health information technology can bring effective CIH to veterans and their partners. Objective This paper describes the rationale, design, and methods of the Mission Reconnect protocol to deliver mobile and Web-based complementary and integrative health programs to veterans and their partners (eg, spouse, significant other, caregiver, or family member). Methods This three-site, 4-year mixed-methods randomized controlled trial uses a wait-list control to determine the effects of mobile and Web-based CIH programs for veterans and their partners, or dyads. The study will use two arms (ie, treatment intervention arm and wait-list control arm) in a clinical sample of veterans with comorbid pain and posttraumatic stress disorder, and their partners. The study will evaluate the effectiveness and perceived value of the Mission Reconnect program in relation to physical and psychological symptoms, global health, and social outcomes. Results Funding for the study began in November 2018, and we are currently in the process of recruitment screening and data randomization for the study. Primary data collection will begin in May 2019 and continue through May 2021. Projected participants per site will be 76 partners/dyads, for a total of 456 study participants. Anticipated study results will be published in November 2022. Conclusions This work highlights innovative delivery of CIH to veterans and their partners for treatment of posttraumatic stress disorder and chronic pain. Trial Registration ClinicalTrials.gov NCT03593772; https://clinicaltrials.gov/ct2/show/NCT03593772 (Archived by WebCite at http://www.webcitation.org/77Q2giwtw) International Registered Report Identifier (IRRID) PRR1-10.2196/13666
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Affiliation(s)
- Jolie N Haun
- Rehabilitation Outcomes Research Section, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Lisa M Ballistrea
- Rehabilitation Outcomes Research Section, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Christine Melillo
- Rehabilitation Outcomes Research Section, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Maisha Standifer
- Rehabilitation Outcomes Research Section, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Kevin Kip
- Rehabilitation Outcomes Research Section, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States.,College of Public Health, University of South Florida, Tampa, FL, United States
| | - Jacquelyn Paykel
- Whole Health Service, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Jennifer L Murphy
- Mental Health and Behavioral Sciences Service, James A Haley Veterans' Hospital and Clinics, Veterans Health Administration, Tampa, FL, United States
| | - Carol E Fletcher
- Veterans Affairs Ann Arbor Healthcare System, Veterans Health Administration, Ann Arbor, MI, United States
| | - Allison Mitchinson
- Veterans Affairs Ann Arbor Healthcare System, Veterans Health Administration, Ann Arbor, MI, United States
| | - Leila Kozak
- Department of Family Medicine, University of Washington School of Medicine, University of Washington, Seattle, WA, United States.,Veterans Affairs Puget Sound Health Care System, Veterans Health Administration, Seattle, WA, United States.,Integrative Health Coordinating Center, Office of Patient Centered Care and Cultural Transformation, Veterans Health Administration, Washington, DC, United States
| | - Stephanie L Taylor
- Health Services Research and Development, Veterans Health Administration, Los Angeles, CA, United States.,Department of Health Policy and Research, University of California - Los Angeles, Los Angeles, CA, United States
| | - Shirley M Glynn
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System at West Los Angeles, Los Angeles, CA, United States
| | - Matthew Bair
- School of Medicine, Indiana University, Indianapolis, IN, United States.,Regenstrief Institute, Inc, Indianapolis, IN, United States.,Center for Health Information and Communication, Veterans Affairs, Indianapolis, IN, United States
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154
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Adverse childhood experiences predict autonomic indices of emotion dysregulation and negative emotional cue-elicited craving among female opioid-treated chronic pain patients. Dev Psychopathol 2019; 31:1101-1110. [DOI: 10.1017/s0954579419000622] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractThrough autonomic and affective mechanisms, adverse childhood experiences (ACEs) may disrupt the capacity to regulate negative emotions, increasing craving and exacerbating risk for opioid use disorder (OUD) among individuals with chronic pain who are receiving long-term opioid analgesic pharmacotherapy. This study examined associations between ACEs, heart rate variability (HRV) during emotion regulation, and negative emotional cue-elicited craving among a sample of female opioid-treated chronic pain patients at risk for OUD. A sample of women (N= 36, mean age = 51.2 ± 9.5) with chronic pain receiving long-term opioid analgesic pharmacotherapy (mean morphine equivalent daily dose = 87.1 ± 106.9 mg) were recruited from primary care and pain clinics to complete a randomized task in which they viewed and reappraised negative affective stimuli while HRV and craving were assessed. Both ACEs and duration of opioid use significantly predicted blunted HRV during negative emotion regulation and increased negative emotional cue-elicited craving. Analysis of study findings from a multiple-levels-of-analysis approach suggest that exposure to childhood abuse occasions later emotion dysregulation and appetitive responding toward opioids in negative affective contexts among adult women with chronic pain, and thus this vulnerable clinical population should be assessed for OUD risk when initiating a course of extended, high-dose opioids for pain management.
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155
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Mindfulness-based therapy modulates default-mode network connectivity in patients with opioid dependence. Eur Neuropsychopharmacol 2019; 29:662-671. [PMID: 30926325 DOI: 10.1016/j.euroneuro.2019.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/15/2019] [Accepted: 03/02/2019] [Indexed: 01/05/2023]
Abstract
Recently, mindfulness-based programs have shown promising clinical effects in the treatment of substance-use disorders (SUD). While several studies linked mindfulness to decreased default mode network (DMN) connectivity in meditators, only a few studies investigated its effects in patients with SUD. This study aimed to detect changes in DMN connectivity in opiate dependent patients receiving mindfulness based therapy (MBT) during their first month of treatment. Data from 32 patients that were assigned to MBT or treatment as usual (TAU) groups was investigated using resting-state functional MRI at 1.5 T before and after four weeks of treatment. Independent Component Analysis was used to investigate distinct (anterior vs. posterior) DMN subsystems. Connectivity changes after treatment were related to measures of impulsivity, distress tolerance and mindfulness. Increased mindfulness scores after treatment were found in patients receiving MBT compared to TAU. Within the anterior DMN, decreased right inferior frontal cortical connectivity was detected in patients who received MBT compared to TAU. In addition, within the MBT-group decreased right superior frontal cortex connectivity was detected after treatment. Inferior frontal cortex function was significantly associated with mindfulness measures. The data suggest that MBT can be useful during abstinence from opiates. In opiate-dependent patients distinct functional connectivity changes within the DMN are associated with MBT.
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156
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Abstract
OBJECTIVE There has been substantial research and public interest in mindfulness interventions, biological pathways, and health for the past two decades. This article reviews recent developments in understanding relationships between mindfulness interventions and physical health. METHODS A selective review was conducted with the goal of synthesizing conceptual and empirical relationships between mindfulness interventions and physical health outcomes. RESULTS Initial randomized controlled trials in this area suggest that mindfulness interventions can improve pain management outcomes among chronic pain populations, and there is preliminary evidence for mindfulness interventions improving specific stress-related disease outcomes in some patient populations (i.e., clinical colds, psoriasis, irritable bowel syndrome, posttraumatic stress disorder, diabetes, HIV). We offer a stress-buffering framework for the observed beneficial effects of mindfulness interventions and summarize supporting biobehavioral and neuroimaging studies that provide plausible mechanistic pathways linking mindfulness interventions with positive physical health outcomes. CONCLUSIONS We conclude with new opportunities for research and clinical implementations to consider in the next two decades.
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157
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Rogers AH, Kauffman BY, Bakhshaie J, McHugh RK, Ditre JW, Zvolensky MJ. Anxiety sensitivity and opioid misuse among opioid-using adults with chronic pain. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2019; 45:470-478. [PMID: 30896985 DOI: 10.1080/00952990.2019.1569670] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: The opioid epidemic is a significant public health crisis, and this problem is particularly prevalent among individuals with chronic pain. Accordingly, there is an urgent need for interventions to mitigate the risk for opioid misuse and opioid use disorder among people with pain. Given that mental health problems, specifically anxiety, are common among people who misuse opioids, it is important to examine factors that link mental health problems with opioid misuse to ultimately inform the development of novel interventions. Anxiety sensitivity, a transdiagnostic vulnerability factor defined as the fear of anxiety-related physical sensations, may be one important mechanism in elevated opioid misuse among persons with chronic pain. Objective: Therefore, the current cross-sectional study examined anxiety sensitivity (and construct sub-facets) as a predictor of opioid misuse among adults with chronic pain. Method: Adults reporting chronic pain and prescription opioid use completed an online survey. Results: Anxiety sensitivity was associated with multiple aspects of opioid misuse, including current opioid misuse, severity of opioid dependence, and number of opioids used to get high. The magnitude of effects ranged from medium to large. Associations between anxiety sensitivity and opioid misuse were observed over and above the variance accounted for by age, sex, income, education, perceived health, and pain severity. Conclusion: These findings suggest that anxiety sensitivity may be an important treatment target among adults with chronic pain who misuse opioids. Future research should continue to explore the explanatory relevance of anxiety sensitivity in opioid misuse among individuals with chronic pain.
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Affiliation(s)
- Andrew H Rogers
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Brooke Y Kauffman
- a Department of Psychology, University of Houston , Houston , TX , USA
| | - Jafar Bakhshaie
- a Department of Psychology, University of Houston , Houston , TX , USA
| | | | - Joseph W Ditre
- c Department of Psychology, Syracuse University , Syracuse , NY , USA
| | - Michael J Zvolensky
- a Department of Psychology, University of Houston , Houston , TX , USA.,d Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston , TX , USA.,e HEALTH Institute, University of Houston , Houston , TX , USA
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158
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McClintock AS, McCarrick SM, Garland EL, Zeidan F, Zgierska AE. Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review. J Altern Complement Med 2019; 25:265-278. [PMID: 30523705 PMCID: PMC6437625 DOI: 10.1089/acm.2018.0351] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Nonpharmacologic approaches have been characterized as the preferred means to treat chronic noncancer pain by the Centers for Disease Control and Prevention. There is evidence that mindfulness-based interventions (MBIs) are effective for pain management, yet the typical MBI may not be feasible across many clinical settings due to resource and time constraints. Brief MBIs (BMBIs) could prove to be more feasible and pragmatic for safe treatment of pain. The aim of the present article is to systematically review evidence of BMBI's effects on acute and chronic pain outcomes in humans. METHODS A literature search was conducted using PubMed, PsycINFO, and Google Scholar and by examining the references of retrieved articles. Articles written in English, published up to August 16, 2017, and reporting on the effects of a BMBI (i.e., total contact time <1.5 h, with mindfulness as the primary therapeutic technique) on a pain-related outcome (i.e., pain outcome, pain affect, pain-related function/quality of life, or medication-related outcome) were eligible for inclusion. Two authors independently extracted the data and assessed risk of bias. RESULTS Twenty studies meeting eligibility criteria were identified. Studies used qualitative (n = 1), within-group (n = 3), or randomized controlled trial (n = 16) designs and were conducted with clinical (n = 6) or nonclinical (i.e., experimentally-induced pain; n = 14) samples. Of the 25 BMBIs tested across the 20 studies, 13 were delivered with audio/video recording only, and 12 were delivered by a provider (participant-provider contact ranged from 3 to 80 min). Existing evidence was limited and inconclusive overall. Nevertheless, BMBIs delivered in a particular format-by a provider and lasting more than 5 min-showed some promise in the management of acute pain. CONCLUSIONS More rigorous large scale studies conducted with pain populations are needed before unequivocally recommending BMBI as a first-line treatment for acute or chronic pain.
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Affiliation(s)
- Andrew S. McClintock
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Athens, Ohio
| | - Fadel Zeidan
- Department of Neurobiology and Anatomy, Center of Integrative Medicine, Wake Forrest School of Medicine, Winston-Salem, North Carolina
| | - Aleksandra E. Zgierska
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, Wisconsin
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159
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Luo C, Sanger N, Zielinski L, Bhatt M, Shahid H, Shams I, Mouravska N, Luetam S, Hudson J, Thabane L, Samaan Z. Sociodemographic characteristics of patients with children in a methadone maintenance program: a cross-sectional study. Harm Reduct J 2019; 16:13. [PMID: 30744638 PMCID: PMC6371427 DOI: 10.1186/s12954-019-0283-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/30/2019] [Indexed: 01/12/2023] Open
Abstract
Background Ever-increasing numbers of opioid use disorder (OUD) in Canada has created the recent opioid crisis. One common treatment for OUD is methadone maintenance treatment (MMT). Various factors, including being a parent which entails specific stressors, may increase susceptibility to negative treatment outcomes. This study aims to investigate differences between OUD patients with and without children in socio-demographic and clinical outcomes. Methods Data for this study are part of a larger program. All participants are 18+ years old with OUD, provided consent, and receiving MMT. We performed a multivariable logistic regression to examine the differences between participants’ parental status, sociodemographic variables, and clinical parameters including MMT outcomes. We performed subgroup analyses on individuals with children younger than 18. Results A total of 1099 participants were included, with 64% having children. Participants with children were older (OR 1.06, 95% CI 1.04, 1.08), more likely to be female (OR 2.39, 95% CI 1.75, 3.27), living with a partner (OR 1.75, 95% CI 1.27, 2.41), first exposed to opioids through a prescription (OR 1.517, 95% CI 1.13, 2.04) and had lower levels of education (OR 1.86, 95% CI 1.20, 2.87). There was no significant difference in illicit opioid use patterns between groups. Same results held true in the subgroup analyses based on the age of the children except for participant age. Conclusion Our results demonstrate social and demographic differences between parents and non-parents receiving MMT. These differences highlight the need to understand necessary additional support for parents such as child support and other necessary therapies.
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Affiliation(s)
- Candice Luo
- Bachelor of Health Sciences Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Nitika Sanger
- Medical Sciences Graduate Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Laura Zielinski
- MiNDS Graduate Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Meha Bhatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Hamnah Shahid
- Arts and Science Program, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Ieta Shams
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Natalia Mouravska
- Hamilton Health Sciences, 237 Barton St. E., Hamilton, Ontario, L8L 2X2, Canada
| | - Sabrina Luetam
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Jackie Hudson
- Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, 100th West 5th St., Hamilton, Ontario, L8N 3K7, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Peter Boris Centre for Addictions Research, St Joseph's Healthcare Hamilton, 100th West 5th St., Hamilton, Ontario, L8N 3K7, Canada. .,Populaton Genomics Program, Chanchlani Research Centre, McMaster University, 1280 Main St. W., Hamilton, Ontario, L8S 4L8, Canada. .,Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th St., Hamilton, Ontario, L8N 3K7, Canada.
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160
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Baker AK, Garland EL. Autonomic and affective mediators of the relationship between mindfulness and opioid craving among chronic pain patients. Exp Clin Psychopharmacol 2019; 27:55-63. [PMID: 30265061 PMCID: PMC6355352 DOI: 10.1037/pha0000225] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Prescription opioid misuse among chronic pain patients is undergirded by self-regulatory deficits, affective distress, and opioid-cue reactivity. Dispositional mindfulness has been associated with enhanced self-regulation, lower distress, and adaptive autonomic responses following drug-cue exposure. We hypothesized that dispositional mindfulness might serve as a protective factor among opioid-treated chronic pain patients. We examined heart-rate variability (HRV) during exposure to opioid cues and depressed mood as mediators of the association between dispositional mindfulness and opioid craving. Data were obtained from a sample of chronic pain patients (N = 115) receiving long-term opioid pharmacotherapy. Participants self-reported opioid craving and depression, and HRV was measured during an opioid-cue dot-probe task. Dispositional mindfulness was significantly positively correlated with HRV, and HRV was significantly inversely associated with opioid craving. Dispositional mindfulness was significantly negatively correlated with depression, and depression was significantly positively correlated with opioid craving. Path analysis revealed significant indirect effects of dispositional mindfulness on craving through both HRV and depression. Dispositional mindfulness may buffer against opioid craving among chronic pain patients prescribed opioids; this buffering effect may be a function of improved autonomic and affective responses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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161
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Brewer J. Mindfulness training for addictions: has neuroscience revealed a brain hack by which awareness subverts the addictive process? Curr Opin Psychol 2019; 28:198-203. [PMID: 30785066 DOI: 10.1016/j.copsyc.2019.01.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 12/01/2022]
Abstract
Addiction is an age-old problem with desire pitted against self-control and will-power. In modern day substances (including food) and experiences (e.g. social media, internet gaming) are being increasingly engineered to get individuals 'hooked'. Current cognitive control and reason-based paradigms may be losing a battle with urges, cravings and triggers that are more ubiquitous than ever (e.g. our smartphones). Yet, these methodologies may be overlooking basic reward-based learning paradigms (operant conditioning) that not only perpetuate addictive behaviors, but may also be the key to their undoing. Understanding core brain systems, including the role of the orbitofrontal cortex (OFC) in reward value comparison as part of this learning system may give fresh insight into not only the automaticity and perpetuation of addictions but also how they can be overcome (potentially without relying on cognitive control). Importantly, awareness and mindfulness in particular may be paramount to unlocking the power of reward-based learning to change addictive habit patterns.
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Affiliation(s)
- Judson Brewer
- Mindfulness Center, Brown University School of Public Health and Warren Alpern School of Medicine, 121 S Main St, Providence, RI 02903, United States.
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162
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Garland EL, Fredrickson BL. Positive psychological states in the arc from mindfulness to self-transcendence: extensions of the Mindfulness-to-Meaning Theory and applications to addiction and chronic pain treatment. Curr Opin Psychol 2019; 28:184-191. [PMID: 30763873 DOI: 10.1016/j.copsyc.2019.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
The Mindfulness-to-Meaning Theory (MMT) is a temporally dynamic process model of mindful positive emotion regulation that elucidates downstream cognitive-affective mechanisms by which mindfulness promotes health and resilience. Here we review and extend the MMT to explicate how mindfulness fosters self-transcendence by evoking upward spirals of decentering, attentional broadening, reappraisal, and savoring. Savoring is highlighted as a key, potential means of inducing absorptive experiences of oneness between subject and object, amplifying the salience of the object while imbuing the sensory-perceptual field with affective meaning. Finally, this article provides new evidence that inducing self-transcendent positive emotions and nondual states of awareness through mindfulness-based interventions may restructure reward processing and thereby produce therapeutic effects on addictive behavior (e.g. opioid misuse) and chronic pain syndromes.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, United States; College of Social Work, University of Utah, United States.
| | - Barbara L Fredrickson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
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163
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Finan PH, Remeniuk B, Dunn KE. The risk for problematic opioid use in chronic pain: What can we learn from studies of pain and reward? Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:255-262. [PMID: 28778406 PMCID: PMC5821601 DOI: 10.1016/j.pnpbp.2017.07.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022]
Abstract
Problematic prescription opioid use is cited as a primary contributor to the current 'opioid epidemic' in the United States, which is characterized by recent rapid increases in individuals seeking treatment for opioid dependence and staggering rates of opioid overdose deaths. Individuals with chronic pain are commonly prescribed opioids to treat pain, and by this mere exposure are at increased risk for the development of problematic opioid use. However, the factors contributing to variation in risk across patients have only recently begun to be unraveled. In the present review, we describe the recent and expanding literature on interactions between pain and reward system function in an effort to inform our understanding of risk for problematic opioid use in chronic pain. To that end, we describe the limited experimental evidence regarding opioid abuse liability under conditions of pain, and offer suggestions for how to advance a research agenda that better informs clinicians about the factors contributing to opioid addiction risk in patients with chronic pain. We raise mechanistic hypotheses by highlighting the primary conclusions of several recent reviews on the neurobiology of pain and reward, with an emphasis on describing dopamine deficits in chronic pain, the role of the reward system in mediating the affective and motivational components of pain, and the role of opponent reward/anti-reward processes in the perpetuation of pain states and the development of problematic opioid use behaviors. Finally, we also argue that positive affect-which is directly regulated by the mesolimbic reward system-is a key pain inhibitory factor that, when deficient, may increase risk for problematic opioid use, and present a model that integrates the potential contributions of pain, reward system function, and positive affect to problematic opioid use risk.
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Affiliation(s)
- Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States.
| | - Bethany Remeniuk
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, United States
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Guarino H, Fong C, Marsch LA, Acosta MC, Syckes C, Moore SK, Cruciani RA, Portenoy RK, Turk DC, Rosenblum A. Web-Based Cognitive Behavior Therapy for Chronic Pain Patients with Aberrant Drug-Related Behavior: Outcomes from a Randomized Controlled Trial. PAIN MEDICINE (MALDEN, MASS.) 2018; 19:2423-2437. [PMID: 29346579 PMCID: PMC6294413 DOI: 10.1093/pm/pnx334] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective There is high unmet need for effective behavioral treatments for chronic pain patients at risk for or with demonstrated histories of opioid misuse. Despite growing evidence supporting technology-based delivery of self-management interventions for chronic pain, very few such programs target co-occurring chronic pain and aberrant drug-related behavior. This randomized controlled trial evaluated the effectiveness of a novel, web-based self-management intervention, grounded in cognitive behavior therapy, for chronic pain patients with aberrant drug-related behavior. Methods Opioid-treated chronic pain patients at a specialty pain practice who screened positive for aberrant drug-related behavior (N = 110) were randomized to receive treatment as usual plus the web-based program or treatment as usual alone. The primary outcomes of pain severity, pain interference, and aberrant drug-related behavior, and the secondary outcomes of pain catastrophizing and pain-related emergency department visits, were assessed during the 12-week intervention and at one and three months postintervention. Results Patients assigned to use the web-based program reported significantly greater reductions in aberrant drug-related behavior, pain catastrophizing, and pain-related emergency department visits-but not pain severity or pain interference-relative to those assigned to treatment as usual. The positive outcomes were observed during the 12-week intervention and for three months postintervention. Conclusions A web-based self-management program, when delivered in conjunction with standard specialty pain treatment, was effective in reducing chronic pain patients' aberrant drug-related behavior, pain catastrophizing, and emergency department visits for pain. Technology-based self-management tools may be a promising therapeutic approach for the vulnerable group of chronic pain patients who have problems managing their opioid medication.
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Affiliation(s)
- Honoria Guarino
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Chunki Fong
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - Michelle C Acosta
- National Development and Research Institutes (NDRI), Inc., New York, New York
| | - Cassandra Syckes
- National Development and Research Institutes (NDRI), Inc., New York, New York
- U.S. Sentencing Commission, Washington, DC
| | | | - Ricardo A Cruciani
- Department of Neurology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | | | - Dennis C Turk
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Andrew Rosenblum
- National Development and Research Institutes (NDRI), Inc., New York, New York
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165
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Priddy SE, Howard MO, Hanley AW, Riquino MR, Friberg-Felsted K, Garland EL. Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Subst Abuse Rehabil 2018; 9:103-114. [PMID: 30532612 PMCID: PMC6247953 DOI: 10.2147/sar.s145201] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Substance use disorders (SUDs) are a pervasive public health problem with deleterious consequences for individuals, families, and society. Furthermore, SUD intervention is complicated by the continuous possibility of relapse. Despite decades of research, SUD relapse rates remain high, underscoring the need for more effective treatments. Scientific findings indicate that SUDs are driven by dysregulation of neural processes underlying reward learning and executive functioning. Emerging evidence suggests that mindfulness training can target these neurocognitive mechanisms to produce significant therapeutic effects on SUDs and prevent relapse. The purpose of this manuscript is to review the cognitive, affective, and neural mechanisms underlying the effects of mindfulness-based interventions (MBIs) on SUDs. We discuss the etiology of addiction and neurocognitive processes related to the development and maintenance of SUDs. We then explore evidence supporting use of MBIs for intervening in SUDs and preventing relapse. Finally, we provide clinical recommendations about how these therapeutic mechanisms might be applied to intervening in SUDs and preventing relapse.
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Affiliation(s)
- Sarah E Priddy
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | - Matthew O Howard
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Adam W Hanley
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | - Michael R Riquino
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | | | - Eric L Garland
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
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Vieten C, Wahbeh H, Cahn BR, MacLean K, Estrada M, Mills P, Murphy M, Shapiro S, Radin D, Josipovic Z, Presti DE, Sapiro M, Chozen Bays J, Russell P, Vago D, Travis F, Walsh R, Delorme A. Future directions in meditation research: Recommendations for expanding the field of contemplative science. PLoS One 2018; 13:e0205740. [PMID: 30403693 PMCID: PMC6221271 DOI: 10.1371/journal.pone.0205740] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023] Open
Abstract
The science of meditation has grown tremendously in the last two decades. Most studies have focused on evaluating the clinical effectiveness of mindfulness-based interventions, neural and other physiological correlates of meditation, and individual cognitive and emotional aspects of meditation. Far less research has been conducted on more challenging domains to measure, such as group and relational, transpersonal and mystical, and difficult aspects of meditation; anomalous or extraordinary phenomena related to meditation; and post-conventional stages of development associated with meditation. However, these components of meditation may be crucial to people's psychological and spiritual development, could represent important mediators and/or mechanisms by which meditation confers benefits, and could themselves be important outcomes of meditation practices. In addition, since large numbers of novices are being introduced to meditation, it is helpful to investigate experiences they may encounter that are not well understood. Over the last four years, a task force of meditation researchers and teachers met regularly to develop recommendations for expanding the current meditation research field to include these important yet often neglected topics. These meetings led to a cross-sectional online survey to investigate the prevalence of a wide range of experiences in 1120 meditators. Results show that the majority of respondents report having had many of these anomalous and extraordinary experiences. While some of the topics are potentially controversial, they can be subjected to rigorous scientific investigation. These arenas represent largely uncharted scientific terrain and provide excellent opportunities for both new and experienced researchers. We provide suggestions for future directions, with accompanying online materials to encourage such research.
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Affiliation(s)
- Cassandra Vieten
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
| | - Helané Wahbeh
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - B. Rael Cahn
- Department of Psychiatry, University of Southern California, Los Angeles, California, United States of America
| | - Katherine MacLean
- Center for Optimal Living, New York, New York, United States of America
| | - Mica Estrada
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Paul Mills
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, United States of America
| | - Michael Murphy
- Center for Theory and Research, Esalen Institute, Big Sur, California, United States of America
| | - Shauna Shapiro
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, United States of America
| | - Dean Radin
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
| | - Zoran Josipovic
- Department of Psychology, New York University and Nonduality Institute, New York, New York, United States of America
| | - David E. Presti
- Department of Molecular and Cell Biology, University of California, Berkeley, California, United States of America
| | - Michael Sapiro
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
| | - Jan Chozen Bays
- Randall Children’s Hospital, Portland, Oregon, United States of America
| | - Peter Russell
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
| | - David Vago
- Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Fred Travis
- Center for Brain, Consciousness and Cognition, Maharishi University of Management, Fairfield, Iowa, United States of America
| | - Roger Walsh
- School of Medicine, University of California, Irvine, California, United States of America
| | - Arnaud Delorme
- Research Department, Institute of Noetic Sciences, Petaluma, California, United States of America
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, United States of America
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Stuart GL, Shorey RC, France CR, Macfie J, Bell K, Fortner KB, Towers CV, Schkolnik P, Ramsey S. Empirical Studies Addressing the Opioid Epidemic: An Urgent Call for Research. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2018; 12:1178221818784294. [PMID: 30127614 PMCID: PMC6090487 DOI: 10.1177/1178221818784294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/23/2018] [Indexed: 11/29/2022]
Abstract
Opioid misuse has become one of the most pressing public health problems facing
the country. In this article, we briefly review literature regarding the opioid
epidemic in the United States and the negative consequences of opioid use
disorder. We provide information regarding treatment and relapse using a variety
of intervention approaches. We call for research on people with opioid use
disorder that can contribute to a variety of areas: improving
medication-assisted treatment, addressing chronic pain, examination of
adjunctive behavioral interventions, overdose, high risk behaviors and
infections, pregnancy, diverse populations, and other psychological factors.
Collectively addressing these crucial areas of research will advance the field
and help alleviate suffering and prevent death from opioid use disorder.
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Affiliation(s)
- Gregory L Stuart
- Department of Psychology, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | - Jenny Macfie
- Department of Psychology, The University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Kathryn Bell
- Department of Psychology, Capital University, Columbus, OH, USA
| | - Kimberly B Fortner
- The Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Craig V Towers
- The Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, TN, USA
| | | | - Susan Ramsey
- Departments of Psychiatry & Human Behavior and Medicine, The Warren Alpert Medical School of Brown University, and Rhode Island Hospital, Providence, RI, USA
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Priddy SE, Hanley AW, Riquino MR, Platt KA, Baker AK, Garland EL. Dispositional mindfulness and prescription opioid misuse among chronic pain patients: Craving and attention to positive information as mediating mechanisms. Drug Alcohol Depend 2018; 188:86-93. [PMID: 29754031 DOI: 10.1016/j.drugalcdep.2018.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/26/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Opioid-treated chronic pain patients may be at risk for prescription opioid misuse due to heightened opioid craving coupled with deficits in attention to naturally rewarding, positive stimuli. Conversely, dispositional mindfulness, which is associated with reduced craving and increased responsiveness to natural rewards, may serve as a protective factor and buffer opioid misuse risk. The current investigation aimed to examine the association between mindfulness and opioid misuse, and to test opioid craving and attention to positive information as mediators of this relationship. METHODS This cross-sectional analysis examined data obtained from a sample of civilian opioid-treated chronic pain patients in the Southeastern U.S. (Sample 1: N = 115), as well as civilian (Sample 2: N = 141) and military samples in the Intermountain West (Sample 3: N = 44). Pearson correlations and path analyses were employed to test relations among participant self-reports on the Current Opioid Misuse Measure (COMM), the Five Facet Mindfulness Questionnaire (FFMQ), two measures of opioid craving, and the Attention to Positive and Negative Information Scale (APNIS). RESULTS Across all three samples, dispositional mindfulness was significantly inversely associated with opioid misuse (N = 300, r = -0.36, p < .001). Reduced opioid craving and increased attention to positive information mediated the association between dispositional mindfulness and opioid misuse. DISCUSSION Dispositional mindfulness may buffer opioid misuse risk by attenuating opioid craving and enhancing attention to naturally rewarding stimuli.
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Affiliation(s)
- Sarah E Priddy
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Michael R Riquino
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Keith A Platt
- Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431, United States
| | - Anne K Baker
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, 395 South, 1500 East, University of Utah, Salt Lake City, UT 84112, United States; College of Social Work, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States; Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr., Salt Lake City, UT 84103, United States.
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Hu Y, Hoover DR. Power Estimation in Planning Randomized Two-Arm Pre-Post Intervention Trials with Repeated Longitudinal Outcomes. ACTA ACUST UNITED AC 2018; 9. [PMID: 30386678 PMCID: PMC6207205 DOI: 10.4172/2155-6180.1000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Intervention effect on ongoing medical processes is estimated from clinical trials on units (i.e. persons or facilities) with fixed timing of repeated longitudinal measurements. All units start out untreated. A randomly chosen subset is switched to the intervention at the same time point. The pre-post switch change in the outcome between these units and unswitched controls is compared using Generalized Least Squares models. Power estimation for such studies is hindered by lack of available GLS based approaches and normative data. Methods: We derive Generalized Least Squares variance of the intervention effect. For the commonly assumed compound symmetry correlation structure, this leads to simple power formulas with important optimality properties. To maximize power given a constrained number of total time points, we investigate on the optimal pre-post allocation with the local minimization of variance. Results: In four examples from nursing home and HIV patients, the Toepltiz within-unit correlation of repeated measures differed from compound symmetry. We applied empirical Toeplitz based calculations for variance of the estimated intervention effect to these examples (each with up to seven longitudinal measures). Unlike what happened under compound symmetry, where power was often maximized with multiple observations being pre-intervention, for these examples, having one pre-intervention measure tended to maximize power. Attempts to approximate the Toeplitz variance structures with compound symmetry (to take advantage of the simpler formulas) resulted in overestimation of power for these examples. Conclusions: While compound symmetry correlation among repeated within-unit measures leads to simple power estimation formulas, this structure often did not hold. There may be strong underestimation of variance of the intervention effect estimate from incorporating short-term within-unit correlation estimates as a common compound symmetry correlation to approximate an unknown Toeplitz correlation without adequately accounting for the correlation between repeated measures declining with time.
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Affiliation(s)
- Yirui Hu
- Biomedical and Translational Informatics, Geisinger, Danville, 17821, USA
| | - Donald R Hoover
- Department of Statistics and Biostatistics and the Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, 08854, USA
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Riquino MR, Priddy SE, Howard MO, Garland EL. Emotion dysregulation as a transdiagnostic mechanism of opioid misuse and suicidality among chronic pain patients. Borderline Personal Disord Emot Dysregul 2018; 5:11. [PMID: 29992025 PMCID: PMC5989346 DOI: 10.1186/s40479-018-0088-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/17/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Chronic pain is a prevalent condition that causes functional impairment and emotional suffering. To allay pain-induced suffering, opioids are often prescribed for chronic pain management. Yet, chronic pain patients on opioid therapy are at heightened risk for opioid misuse-behaviors that can lead to addiction and overdose. Relatedly, chronic pain patients are at elevated risk for suicidal ideation and suicidal behaviors. MAIN BODY Opioid misuse and suicidality are maladaptive processes aimed at alleviating the negative emotional hyperreactivity, hedonic hyporeactivity, and emotion dysregulation experienced by chronic pain patients on opioid therapy. In this review, we explore the role of emotion dysregulation in chronic pain. We then describe why emotionally dysregulated chronic pain patients are vulnerable to opioid misuse and suicidality in response to these negative affective states. CONCLUSION Emotion dysregulation is an important and malleable treatment target with the potential to reduce or prevent opioid misuse and suicidality among opioid-treated chronic pain patients.
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Affiliation(s)
- Michael R. Riquino
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Sarah E. Priddy
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
| | - Matthew O. Howard
- University of North Carolina at Chapel Hill, Tate Turner Kuralt Building, Chapel Hill, NC 25799 USA
| | - Eric L. Garland
- University of Utah College of Social Work, 395 South 1500 East, Salt Lake City, UT 84112 USA
- Center on Mindfulness and Integrative Health Intervention Development, 395 South 1500 East, Salt Lake City, UT 84112 USA
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Garland EL, Hanley AW, Bedford CE, Zubieta JK, Howard MO, Nakamura Y, Donaldson GW, Froeliger B. Reappraisal deficits promote craving and emotional distress among chronic pain patients at risk for prescription opioid misuse. J Addict Dis 2018; 37:14-22. [PMID: 29863439 DOI: 10.1080/10550887.2018.1459148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: A subset of chronic pain patients misuse prescription opioids as a means of regulating negative emotions. However, opioid misuse may result in deficits in emotion regulation strategies like reappraisal by virtue of the deleterious effects of chronic opioid exposure. Aims: The aim of this study was to characterize differences in reappraisal use among chronic pain patients at risk for opioid misuse and those who report taking opioids as prescribed. Methods: A sample of 127 pain patients receiving chronic opioid analgesic pharmacotherapy were classified as at risk for opioid misuse (n = 62) or taking opioids as prescribed (n = 65) using the Current Opioid Misuse Measure (COMM). The Emotion Regulation Questionnaire (ERQ) characterized use of emotion regulation strategies including reappraisal and expressive suppression. Participants also reported levels of opioid craving, emotional distress, and pain severity. Results: Patients at risk for opioid misuse reported significantly less reappraisal use (M = 25.31, SD = 7.33) than those who reportedly took opioids as prescribed (M = 30.28, SD = 7.50), p<.001, but did differ with regard to suppression strategies. Reduced reappraisal use was associated with higher opioid craving and emotional distress that mediated the association between reappraisal deficits and opioid misuse risk. Further, there was a significant indirect effect of opioid misuse on emotional distress via reappraisal use. Discussion: Opioid misuse risk was associated with reduced use of reappraisal, which in turn was associated with dysregulated negative emotions and increased appetitive drive towards consuming opioids. Studying individual differences in emotion regulation may yield efficacious intervention and prevention approaches to stem the rising tide of the prescription opioid crisis.
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Affiliation(s)
- Eric L Garland
- a College of Social Work , Center for Mindfulness and Integrative Health Intervention Development, University of Utah , Salt Lake City , Utah , USA
| | - Adam W Hanley
- a College of Social Work , Center for Mindfulness and Integrative Health Intervention Development, University of Utah , Salt Lake City , Utah , USA
| | - Carter E Bedford
- a College of Social Work , Center for Mindfulness and Integrative Health Intervention Development, University of Utah , Salt Lake City , Utah , USA
| | - Jon-Kar Zubieta
- b Department of Psychiatry , University of Utah , Salt Lake City , Utah , USA
| | - Matthew O Howard
- c School of Social Work , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Yoshio Nakamura
- d Pain Research Center , University of Utah , Salt Lake City , Utah , USA
| | - Gary W Donaldson
- d Pain Research Center , University of Utah , Salt Lake City , Utah , USA
| | - Brett Froeliger
- e Department of Neuroscience , Medical University of South Carolina , Charleston , South Carolina , USA
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Christopher MS, Hunsinger M, Goerling LRJ, Bowen S, Rogers BS, Gross CR, Dapolonia E, Pruessner JC. Mindfulness-based resilience training to reduce health risk, stress reactivity, and aggression among law enforcement officers: A feasibility and preliminary efficacy trial. Psychiatry Res 2018; 264:104-115. [PMID: 29627695 PMCID: PMC6226556 DOI: 10.1016/j.psychres.2018.03.059] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/16/2018] [Accepted: 03/22/2018] [Indexed: 01/13/2023]
Abstract
The primary objective of this study was to assess feasibility and gather preliminary outcome data on Mindfulness-Based Resilience Training (MBRT) for law enforcement officers. Participants (n = 61) were randomized to either an 8-week MBRT course or a no intervention control group. Self-report and physiological data were collected at baseline, post-training, and three months following intervention completion. Attendance, adherence, post-training participant feedback, and interventionist fidelity to protocol all demonstrated feasibility of MBRT for law enforcement officers. Compared to no intervention controls, MBRT participants experienced greater reductions in salivary cortisol, self-reported aggression, organizational stress, burnout, sleep disturbance, and reported increases in psychological flexibility and non-reactivity at post-training; however, group differences were not maintained at three-month follow-up. This initial randomized trial suggests MBRT is a feasible intervention. Outcome data suggest MBRT targets key physiological, psychological, and health risk factors in law enforcement officers, consistent with the potential to improve officer health and public safety. However, follow-up training or "booster" sessions may be needed to maintain training gains. A fully powered longitudinal randomized trial is warranted.
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Affiliation(s)
| | - Matthew Hunsinger
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Lt Richard J Goerling
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA; Mindful Badge Initiative, Hillsboro, OR, USA
| | - Sarah Bowen
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Brant S Rogers
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA; Stress Reduction Clinic, Hillsboro, OR, USA
| | - Cynthia R Gross
- College of Pharmacy and School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Eli Dapolonia
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Jens C Pruessner
- Departments of Psychology, Psychiatry, Neurology and Neurosurgery, Douglas Institute, McGill University, Montreal, Quebec, Canada
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Baseman J, Revere D, Painter I, Stangenes S, Lilly M, Beaton R, Calhoun R, Meischke H. Impact of new technologies on stress, attrition and well-being in emergency call centers: the NextGeneration 9-1-1 study protocol. BMC Public Health 2018; 18:597. [PMID: 29728094 PMCID: PMC5936032 DOI: 10.1186/s12889-018-5510-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Our public health emergency response system relies on the "first of the first responders"-the emergency call center workforce that handles the emergency needs of a public in distress. Call centers across the United States have been preparing for the "Next Generation 9-1-1" initiative, which will allow citizens to place 9-1-1 calls using a variety of digital technologies. The impacts of this initiative on a workforce that is already highly stressed is unknown. There is concern that these technology changes will increase stress, reduce job performance, contribute to maladaptive coping strategies, lower employee retention, or change morale in the workplace. Understanding these impacts to inform approaches for mitigating the health and performance risks associated with new technologies is crucial for ensuring the 911 system fulfills its mission of providing optimal emergency response to the public. METHODS Our project is an observational, prospective cohort study framed by the first new technology that will be implemented: text-to-911 calling. Emergency center call takers will be recruited nationwide. Data will be collected by online surveys distributed at each center before text-to-911 implementation; within the first month of implementation; and 6 months after implementation. Primary outcome measures are stress as measured by the Calgary Symptoms of Stress Index, use of sick leave, job performance, and job satisfaction. Primary analyses will use mixed effects regression models and mixed effects logistic regression models to estimate the change in outcome variables associated with text-to-911 implementation. Multiple secondary analyses will examine effects of stress on absenteeism; associations between technology attitudes and stress; effects of implementation on attitudes towards technology; and mitigating effects of job demands, job satisfaction, attitudes towards workplace technology and workplace support on change in stress. DISCUSSION Our public health dependence on this workforce for our security and safety makes it imperative that the impact of technological changes such as text-to-911 are researched so appropriate intervention efforts to can be developed. Failing to protect our 9-1-1 call takers from predictable health risks would be similar to knowingly exposing field emergency responders to a toxic situation without following OSHA required training and practice standards assuring their protection.
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Affiliation(s)
- Janet Baseman
- Department of Epidemiology, University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St., Suite 400, Seattle, WA, 98105, USA
| | - Debra Revere
- Department of Health Services, University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St., Suite 400, Seattle, WA, 98105, USA.
| | - Ian Painter
- Department of Health Services, University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St., Suite 400, Seattle, WA, 98105, USA
| | - Scott Stangenes
- Department of Health Services, University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St., Suite 400, Seattle, WA, 98105, USA
| | - Michelle Lilly
- Department of Psychology, Northern Illinois University, Psychology-Computer Science Building, DeKalb, IL, 60115, USA
| | - Randal Beaton
- Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA, 98195-7263, USA
| | - Rebecca Calhoun
- Center for Child and Family Well-Being, University of Washington, Box 351525, Seattle, WA, 98195-1525, USA
| | - Hendrika Meischke
- Department of Health Services, University of Washington, Northwest Center for Public Health Practice, 1107 NE 45th St., Suite 400, Seattle, WA, 98105, USA
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Meischke H, Lilly M, Beaton R, Calhoun R, Tu A, Stangenes S, Painter I, Revere D, Baseman J. Protocol: a multi-level intervention program to reduce stress in 9-1-1 telecommunicators. BMC Public Health 2018; 18:570. [PMID: 29716576 PMCID: PMC5930694 DOI: 10.1186/s12889-018-5471-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nationwide, emergency response systems depend on 9-1-1 telecommunicators to prioritize, triage, and dispatch assistance to those in distress. 9-1-1 call center telecommunicators (TCs) are challenged by acute and chronic workplace stressors: tense interactions with citizen callers in crisis; overtime; shift-work; ever-changing technologies; and negative work culture, including co-worker conflict. This workforce is also subject to routine exposures to secondary traumatization while handling calls involving emergency situations and while making time urgent, high stake decisions over the phone. Our study aims to test the effectiveness of a multi-part intervention to reduce stress in 9-1-1 TCs through an online mindfulness training and a toolkit containing workplace stressor reduction resources. METHODS/DESIGN The study employs a randomized controlled trial design with three data collection points. The multi-part intervention includes an individual-level online mindfulness training and a call center-level organizational stress reduction toolkit. 160 TCs will be recruited from 9-1-1 call centers, complete a baseline survey at enrollment, and are randomly assigned to an intervention or a control group. Intervention group participants will start a 7-week online mindfulness training developed in-house and tailored to 9-1-1 TCs and their call center environment; control participants will be "waitlisted" and start the training after the study period ends. Following the intervention group's completion of the mindfulness training, all participants complete a second survey. Next, the online toolkit with call-center wide stress reduction resources is made available to managers of all participating call centers. After 3 months, a third survey will be completed by all participants. The primary outcome is 9-1-1 TCs' self-reported symptoms of stress at three time points as measured by the C-SOSI (Calgary Symptoms of Stress Inventory). Secondary outcomes will include: perceptions of social work environment (measured by metrics of social support and network conflict); mindfulness; and perceptions of social work environment and mindfulness as mediators of stress reduction. DISCUSSION This study will evaluate the effectiveness of an online mindfulness training and call center-wide stress reduction toolkit in reducing self-reported stress in 9-1-1 TCs. The results of this study will add to the growing body of research on worksite stress reduction programs. TRIAL REGISTRATION ClinicalTrials.gov Registration Number: NCT02961621 Registered on November 7, 2016 (retrospectively registered).
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Affiliation(s)
- Hendrika Meischke
- Northwest Center for Public Health Practice, University of Washington, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA
| | - Michelle Lilly
- Department of Psychology, Psychology-Computer Science Building, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Randal Beaton
- Department of Psychosocial and Community Health, University of Washington, Box 357263, Seattle, WA, 98195, USA
| | - Rebecca Calhoun
- Center for Child and Family Well-Being, University of Washington, Box 351525, Seattle, WA, 98195, USA
| | - Ann Tu
- OEM Program, University of Washington, Box 359739, 325 9th Ave, Seattle, WA, 98104, USA
| | - Scott Stangenes
- Northwest Center for Public Health Practice, University of Washington, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA.
| | - Ian Painter
- Northwest Center for Public Health Practice, University of Washington, 1107 NE 45th St. Suite 400, Seattle, WA, 98105, USA
| | - Debra Revere
- Department of Health Services, University of Washington, Box 354809, Seattle, WA, 98195, USA
| | - Janet Baseman
- Department of Epidemiology, University of Washington, Box 354809, Seattle, WA, 98195, USA
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Çeri V, Aykutlu HC, Görker I, Akça ÖF, Tarakçıoğlu MC, Aksoy UM, Kaya H, Sertdemir M, İnce E, Kadak MT, Yalçın GY, Guliyev C, Bilgiç A, Çiftçi E, Tekin K, Tuna ZO, Oğuzdoğan B, Duman NS, Semerci B, Üneri ÖŞ, Karabekiroglu K, Mutluer T, Nebioglu M, Başgül ŞS, Naharcı Mİ, Maden Ö, Hocaoğlu Ç, Durmaz O, Usta H, Boşgelmez Ş, Puşuroğlu M, Eser HY, Kaçar M, Çakır M, Karatepe HT, Işık Ü, Kara H, Yeloğlu ÇH, Yazıcı E, Gündüz A, Karataş KS, Yavlal F, Uzun N, Yazici AB, Bodur Ş, Aslan EA, Batmaz S, Çelik F, Açıkel SB, Topal Z, Altunsoy N, Tulacı ÖD, Demirel ÖF, Çıtak S, Çak HT, Artık AB, Özçetin A, Özdemir I, Çelik FGH, Kültür SEÇ, Çipil A, Ay R, Arman AR, Yazıcı KU, Yuce AE, Yazıcı İP, Kurt E, Kaçar AŞ, Erbil N, Poyraz CA, Altın GE, Şahin B, Kılıç Ö, Turan Ş, Aydın M, Kuru E, Bozkurt A, Güleç H, İnan MY, Şevik AE, Baykal S, Karaer Y, Yanartaş O, Aksu H, Ergün S, Görmez A, Yıldız M, Bag S, Özkanoğlu FK, Caliskan M, Yaşar AB, Konuk E, Altın M, Bulut S, Bulut GÇ, Tulacı RG, Küpeli NY, Enver N, Tasci İ, Kani AS, Bahçeci B, Oğuz G, Şenyuva G, Ünal GT, Yektaş Ç, Örüm MH, Göka E, Gıca Ş, Şahmelikoğlu Ö, Dinç GŞ, Erşan S, Erşan E, Ceylan MF, Hesapçıoğlu ST, Solmaz M, Balcioglu YH, Cetin M, Tosun M, Yurteri N, Ulusoy S, Karadere ME, Kivrak Y, Görmez V. Symposium Oral Presentations. PSYCHIAT CLIN PSYCH 2018. [DOI: 10.1080/24750573.2018.1464274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Veysi Çeri
- Marmara University Pendik Research and Training Hospital, Child and Adolescent Psychiatry Clinic, Istanbul, Turkey
| | - Hasan Cem Aykutlu
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, Edirne, Turkey
| | - Işık Görker
- Department of Child and Adolescent Psychiatry, Trakya University School of Medicine, Edirne, Turkey
| | - Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Health Sciences University Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Umut Mert Aksoy
- Health Sciences University Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Heysem Kaya
- Department of Computer Engineering, Çorlu Faculty of Engineering, Namık Kemal University, Çorlu, Tekirdağ, Turkey
| | - Merve Sertdemir
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Ezgi İnce
- Department of Psychiatry, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Muhammed Tayyib Kadak
- Department of Child and Adolescent Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | | | | | - Ayhan Bilgiç
- Department of Child and Adolescent Psychiatry, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Elvan Çiftçi
- Department of Psychiatry, Erenkoy Research and Training Hospital, Istanbul, Turkey
| | | | | | | | | | - Bengi Semerci
- Department of Psychology, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Özden Şükran Üneri
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | | | - Tuba Mutluer
- Koç University Hospital, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Melike Nebioglu
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | | | - Mehmet İlkin Naharcı
- Division of Geriatrics, Department of Internal Medicine, Health Sciences University, Ankara, Turkey
| | - Özgür Maden
- SBÜ Sultan Abdülhamid Han Education and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Çiçek Hocaoğlu
- Department of Psychiatry, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Onur Durmaz
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Haluk Usta
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | - Şükriye Boşgelmez
- Kocaeli Derince Research and Training Hospital, Psychiatry Clinic, Kocaeli, Turkey
| | | | - Hale Yapıcı Eser
- KOÇ University School of Medicine, Istanbul, Turkey
- KOÇ University Research Center FOR Translational Medicine (Kuttam), Istanbul, Turkey
- Koç University School of Medicine Department of Psychiatry, Istanbul, Turkey
- Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Murat Kaçar
- Department of Child and Adolescent Psychiatry, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Mahmut Çakır
- Child Psychiatry Clinic, Health Sciences University, Amasya Research and Training Hospital, Amasya, Turkey
| | - Hasan Turan Karatepe
- Department of Psychiatry, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ümit Işık
- Department of Child and Adolescent Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Halil Kara
- Department of Child and Adolescent Psychiatry, Aksaray University Research and Training Hospital, Aksaray, Turkey
| | | | - Esra Yazıcı
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
| | - Anıl Gündüz
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Kader Semra Karataş
- Recep Tayyip Erdogan University School of Medicine Psychiatry Department, Rize, Turkey
| | - Figen Yavlal
- Department of Neurology, School of Medicine, Bahcesehir University, Istanbul, Turkey
- Department of Neurology, Bahcesehir University School of Medicine, Istanbul, Turkey
| | - Necati Uzun
- Department of Child and Adolescent Psychiatry, Elazığ Psychiatry Hospital, Elazığ, Turkey
| | - Ahmet Bulent Yazici
- Department of Psychiatry, Sakarya University School of Medicine, Sakarya, Turkey
| | - Şahin Bodur
- Health Sciences University, Gulhane Research and Training Hospital, Child and Adolescent Psychiatry Clinic, Ankara, Turkey
| | - Esma Akpınar Aslan
- Department of Psychiatry, Gaziosmanpaşa University School of Medicine, Tokat, Turkey
| | - Sedat Batmaz
- Department of Psychiatry, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Feyza Çelik
- Department of Psychiatry, Dumlupınar University School of Medicine, Evliya Çelebi Research and Training Hospital, Kütahya, Turkey
| | - Sadettin Burak Açıkel
- Dr. Sami Ulus Research and Training Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey
| | | | | | | | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Serhat Çıtak
- Department of Psychiatry, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Halime Tuna Çak
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdül Baki Artık
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Adnan Özçetin
- Department of Psychiatry, Duzce University School of Medicine, Duzce, Turkey
| | - Ilker Özdemir
- Giresun University Prof. Dr. A. İlhan Özdemir Research and Training Hospital, Giresun, Turkey
| | | | | | - Arif Çipil
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Rukiye Ay
- Malatya Research and Training Hospital, Malatya, Turkey
| | - Ayşe Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University School of Medicine, Istanbul
| | - Kemal Utku Yazıcı
- Department of Child and Adolescent Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | | | - İpek Perçinel Yazıcı
- Department of Child and Adolescent Psychiatry, Firat University School of Medicine, Elazig, Turkey
| | - Emel Kurt
- Psychiatry Clinic, Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Anıl Şafak Kaçar
- Koc University, Research Center for Translational Medicine, Istanbul, Turkey
| | - Nurhan Erbil
- Department of Biophysics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | | | - Berkan Şahin
- Iğdır State Hospital, Child and Adolescent Psychiatry Clinic, Iğdır, Turkey
| | - Özge Kılıç
- Department of Psychiatry, Koç University Hospital, Istanbul, Turkey
| | - Şenol Turan
- Department of Psychiatry, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Memduha Aydın
- Department of Psychiatry, Selçuk University School of Medicine, Konya, Turkey
| | - Erkan Kuru
- Özel Boylam Psychiatry Hospital, Ankara, Turkey
| | - Abdullah Bozkurt
- Department of Child and Adolescent Psychiatry, Konya Research and Training Hospital, Konya, Turkey
| | - Hüseyin Güleç
- Erenköy Mental Health and Neurology Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
| | | | - Ali Emre Şevik
- Department of Psychiatry, Çanakkale 18 Mart University School of Medicine, Çanakkale, Türkiye
| | - Saliha Baykal
- Department of Child and Adolescent Psychiatry, Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - Yusuf Karaer
- Department of Child and Adolescent Psychiatry, Hacettepe University School of Medicine, Ankara, Turkey
| | - Omer Yanartaş
- Department of Psychiatry, Marmara Medical School, Istanbul, Turkiye
| | - Hatice Aksu
- Department of Child and Adolescent Psychiatry, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Serhat Ergün
- Department of Psychiatry, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Aynur Görmez
- Department of Child and Adolescent Psychiatry, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey
| | - Mesut Yıldız
- Department of Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sevda Bag
- Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | | | - Mecit Caliskan
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
| | - Alişan Burak Yaşar
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
- Behavioral Sciences Institute, Istanbul, Turkey
| | - Emre Konuk
- Health Sciences University, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey
- Behavioral Sciences Institute, Istanbul, Turkey
| | - Murat Altın
- Istinye University Hospital, Psychiatry Clinic, Istanbul, Turkey
| | - Serkut Bulut
- Psychiatry Clinic, Health Sciences University Sakarya Research and Training Hospital, Sakarya, Turkey
| | | | - Rıza Gökçer Tulacı
- Uşak University School of Medicine Research and Training Hospital, Uşak, Turkey
| | - Neşe Yorguner Küpeli
- Department of Psychiatry, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - İlker Tasci
- Health Sciences University, Gulhane School of Medicine, Department of Internal Medicine, Ankara, Turkey
| | - Ayşe Sakallı Kani
- Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Bülent Bahçeci
- Department of Psychiatry, Recep Tayyip Erdogan University, Rize, Turkey
| | | | | | - Gülşen Teksin Ünal
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Çiğdem Yektaş
- Duzce University School of Medicine, Department of Child and Adolescent Psychiatry, Duzce, Turkey
| | - Mehmet Hamdi Örüm
- Department of Psychiatry, Adiyaman University School of Medicine, Adiyaman, Turkey
| | - Erol Göka
- SBÜ Ankara Numune Eğitim ve Araştırma Hastanesi
| | - Şakir Gıca
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Özge Şahmelikoğlu
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - Gülser Şenses Dinç
- Department of Child and Adolescent Psychiatry, Ankara Children’s Hematology Oncology Research and Training Hospital, Ankara Turkey
| | - Serpil Erşan
- Cumhuriyet University Advanced Technology Research and Application Center, Sivas, Turkey
| | - Erdal Erşan
- Sivas Numune Hospital, Community Mental Health Center, Sivas, Turkey
| | - Mehmet Fatih Ceylan
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Selma Tural Hesapçıoğlu
- Department of Child and Adolescent Psychiatry, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mustafa Solmaz
- Health Sciences University Bagcilar Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
- Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Forensic Psychiatry Unit, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Health Sciences University Bagcilar Research and Training Hospital, Department of Psychiatry, Istanbul, Turkey
- Bakirkoy Prof. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Forensic Psychiatry Unit, Istanbul, Turkey
| | | | - Musa Tosun
- Istanbul University Cerrahpaşa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
| | - Nihal Yurteri
- Duzce University School of Medicine, Department of Child and Adolescent Psychiatry, Duzce, Turkey
| | - Sevinc Ulusoy
- Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry and Neurology, Istanbul, Turkey
| | | | - Yüksel Kivrak
- Department of Psychiatry, Kafkas University School of Medicine, Kars, Turkey
| | - Vahdet Görmez
- Bezmialem Vakif University, Department of Child and Adolescent Psychiatry, Istanbul, Turkey
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Garland EL, Howard MO. Enhancing Natural Reward Responsiveness Among Opioid Users Predicts Chronic Pain Relief: EEG Analyses From a Trial of Mindfulness-Oriented Recovery Enhancement. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2018; 9:285-303. [PMID: 30854168 PMCID: PMC6402811 DOI: 10.1086/697685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Although opioid-treated chronic pain patients evidence blunted responsiveness to natural rewards, focusing on naturally rewarding stimuli can produce analgesia in these patients. A prior randomized controlled trial (RCT) demonstrated that a social work intervention-Mindfulness-Oriented Recovery Enhancement (MORE)-enhanced natural reward processing as indicated by event-related brain potentials (ERPs). The aim of the present study was to perform a secondary data analysis on ERPs collected in this RCT to explore whether improvements in electrocortical response to natural reward predicted pain relief. METHOD The sample for this secondary analysis included opioid-treated chronic pain patients with complete ERP data (N = 29). Participants were randomized to 8 weeks of MORE or a support group control condition, and ERPs to images representing naturally rewarding stimuli were measured before and after 8 weeks of treatment. We explored associations between changes in brain reward response, chronic pain symptoms, and pain coping. RESULTS Increases in ERP reward response were significantly associated with decreased pain severity from pretreatment to posttreatment (β = -.48, p = .007) and improvements in pain catastrophizing (β = -.36, p = .05) and diverting attention as a means of pain coping (β = .38, p = .043). Increased ERP reward response predicted decreased pain interference by 3-month follow-up (β = -.37, p = .048). CONCLUSIONS Chronic pain may be alleviated by enhancing brain response to natural rewards.
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Garland EL, Howard MO. Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research. Addict Sci Clin Pract 2018; 13:14. [PMID: 29669599 PMCID: PMC5907295 DOI: 10.1186/s13722-018-0115-3] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/07/2018] [Indexed: 01/04/2023] Open
Abstract
Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing. This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose–response relationships, and research rigor and reproducibility are discussed.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA.
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Zgierska AE, Ircink J, Burzinski CA, Mundt MP. Cost of opioid-treated chronic low back pain: Findings from a pilot randomized controlled trial of mindfulness meditation-based intervention. J Opioid Manag 2018; 13:169-181. [PMID: 28829518 PMCID: PMC5836724 DOI: 10.5055/jom.2017.0384] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP. DESIGN Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone. SETTING Outpatient. PARTICIPANTS Thirty-five adults with opioid-treated CLBP (≥30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew. INTERVENTION Eight weekly therapist-led MM sessions and at-home practice. OUTCOME MEASURES Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups. RESULTS Participants (21 MM; 14 control) were 20 percent men, age 51.8 ± 9.7 years, with severe disability, opioid dose of 148.3 ± 129.2 morphine-equivalent mg/d, and individual annual income of $18,291 ± $19,345. At baseline, total costs were estimated at $15,497 ± 13,677 (direct: $10,635 ± 9,897; indirect: $4,862 ± 7,298) per participant. Although MM group participants, compared to controls, reduced their pain severity ratings and pain sensitivity to heat stimuli (p < 0.05), no statistically significant within-group changes or between-group differences in direct and indirect costs were noted. CONCLUSIONS Adults with opioid-treated CLBP experience a high burden of disability despite the high costs of treatment. Although this pilot study did not show a statistically significant impact of MM on costs related to opioid-treated CLBP, MM can improve clinical outcomes and should be assessed in a larger trial with long-term follow-up.
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Affiliation(s)
- Aleksandra E. Zgierska
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family, Medicine and Community Health, 1100 Delaplaine Court, Madison, WI 53715, , Office: 608 263 7882; Fax: 608 263 5813
| | - James Ircink
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family, Medicine and Community Health
| | - Cindy A. Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family, Medicine and Community Health
| | - Marlon P. Mundt
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family, Medicine and Community Health, Department of Population Health Sciences
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Li W, Garland EL, Howard MO. Therapeutic mechanisms of Mindfulness-Oriented Recovery Enhancement for internet gaming disorder: Reducing craving and addictive behavior by targeting cognitive processes. J Addict Dis 2018; 37:5-13. [PMID: 29565776 DOI: 10.1080/10550887.2018.1442617] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
: Findings suggest that effects of mindfulness treatment in reducing maladaptive gaming-related cognitions might lead to reductions in IGD severity and cravings for video game playing. This cognitive mechanism should be evaluated in a future, full-scale RCT.
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Affiliation(s)
- Wen Li
- a School of Social Work, Rutgers , The State University of New Jersey , New Jersey , USA
| | - Eric L Garland
- b Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) & College of Social Work , University of Utah , Salt Lake City , Utah , USA
| | - Matthew O Howard
- c School of Social Work , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
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181
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Pogrebtsova E, Craig J, Chris A, O'Shea D, González-Morales MG. Exploring daily affective changes in university students with a mindful positive reappraisal intervention: A daily diary randomized controlled trial. Stress Health 2018; 34:46-58. [PMID: 28512859 DOI: 10.1002/smi.2759] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 03/27/2017] [Accepted: 04/04/2017] [Indexed: 12/31/2022]
Abstract
Brief and cost-effective interventions focused on emotion regulation techniques can buffer against stress and foster positive functioning. Mindfulness and positive reappraisal are two techniques that can mutually enhance one another to promote well-being. However, research testing the effectiveness of interventions combining mindfulness and reappraisal is lacking. The current pilot examined the effect of a combined mindful-reappraisal intervention on daily affect in a 5-day diary study with 106 university students. Participants were randomized to a mindful-reappraisal intervention (n = 36), a reappraisal-only intervention (n = 34), or an active control activity (n = 36). All participants described a negative event each day but only reappraised the event in the intervention conditions. Using multilevel growth modelling, results indicated that negative affect in both interventions declined over 5 days compared to the control; however, there were no differences in the growth of positive affect. Compared to reappraisal-only, the mindful-reappraisal group reported overall lower daily negative affect and marginally higher daily positive affect over the 5-day intervention. These findings suggest that brief daily practice combining mindfulness and positive reappraisal can be trained as a self-regulatory resource to promote positive affect and buffer negative affect above and beyond reappraisal practice alone.
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Affiliation(s)
| | - Jacqueline Craig
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Alexandra Chris
- Department of Psychology, University of Guelph, Guelph, Canada
| | - Deirdre O'Shea
- Department of Personnel & Employment Relations, Kemmy Business School, University of Limerick, Limerick, Ireland
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Sancho M, De Gracia M, Rodríguez RC, Mallorquí-Bagué N, Sánchez-González J, Trujols J, Sánchez I, Jiménez-Murcia S, Menchón JM. Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review. Front Psychiatry 2018; 9:95. [PMID: 29651257 PMCID: PMC5884944 DOI: 10.3389/fpsyt.2018.00095] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 03/07/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Emotion (dys)regulation as well as the interventions for improving these difficulties are receiving a growing attention in the literature. The aim of the present paper was to conduct a systematic review about the efficacy of mindfulness-based interventions (MBIs) in both substance and behavioral addictions (BAs). METHOD A literature search was conducted using Cochrane, PubMed, and Web of Science. Fifty-four randomized controlled trials published in English since 2009 to April 2017 were included into a narrative synthesis. RESULTS Mindfulness-based interventions were applied in a wide range of addictions, including substance use disorders (from smoking to alcohol, among others) and BAs (namely, gambling disorder). These treatments were successful for reducing dependence, craving, and other addiction-related symptoms by also improving mood state and emotion dysregulation. The most commonly used MBI approaches were as follows: Mindfulness-Based Relapse Prevention, Mindfulness Training for Smokers, or Mindfulness-Oriented Recovery Enhancement, and the most frequent control group in the included studies was Treatment as Usual (TAU). The most effective approach was the combination of MBIs with TAU or other active treatments. However, there is a lack of studies showing the maintenance of the effect over time. Therefore, studies with longer follow-ups are needed. CONCLUSION The revised literature shows support for the effectiveness of the MBIs. Future research should focus on longer follow-up assessments as well as on adolescence and young population, as they are a vulnerable population for developing problems associated with alcohol, drugs, or other addictions.
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Affiliation(s)
- Marta Sancho
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marta De Gracia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Rita C Rodríguez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
| | | | - Joan Trujols
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Jose M Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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Hilton L, Hempel S, Ewing BA, Apaydin E, Xenakis L, Newberry S, Colaiaco B, Maher AR, Shanman RM, Sorbero ME, Maglione MA. Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis. Ann Behav Med 2017; 51:199-213. [PMID: 27658913 PMCID: PMC5368208 DOI: 10.1007/s12160-016-9844-2] [Citation(s) in RCA: 458] [Impact Index Per Article: 65.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic pain patients increasingly seek treatment through mindfulness meditation. PURPOSE This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults. METHOD We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use. RESULTS Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life. CONCLUSIONS While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.
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Affiliation(s)
- Lara Hilton
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Eric Apaydin
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Lea Xenakis
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Ben Colaiaco
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Alicia Ruelaz Maher
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Roberta M Shanman
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Melony E Sorbero
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Margaret A Maglione
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Mindfulness is Associated With Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy. Clin J Pain 2017; 33:166-173. [PMID: 28060783 DOI: 10.1097/ajp.0000000000000379] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Chronic pain and long-term opioid use may lead to a persistent deficit in hedonic capacity, characterized by increased sensitivity to aversive states and insensitivity to natural rewards. Dispositional mindfulness has been linked with improved emotion regulation and pain coping. The aim of the current study was to examine associations between dispositional mindfulness, hedonic capacity, and pain-related interference in an opioid-using chronic pain sample. METHODS Data were obtained from a sample of 115 chronic pain patients on long-term opioid therapy (68% females, M age=48.3, SD=13.6) who completed the Five Facet Mindfulness Questionnaire (FFMQ), the Snaith-Hamilton Anhedonia and Pleasure Scale (SHAPS), the Brief Pain Inventory, and a psychiatric assessment of major depression. Bivariate correlations, hierarchical multiple regression, and path analysis were used to determine whether dispositional mindfulness scores (FFMQ) predicted variance in hedonic capacity (SHAPS), and whether hedonic capacity mediated the association between mindfulness and pain interference. RESULTS We observed a significant positive correlation between dispositional mindfulness and hedonic capacity scores (r=0.33, P<0.001). Hierarchical regression indicated that after controlling for pain interference and major depressive disorder diagnosis, dispositional mindfulness explained a significant portion of variance in hedonic capacity (β=0.30, P<0.01). The association between dispositional mindfulness and pain interference was mediated by hedonic capacity (b=-0.011, SE=0.005; 95% CI, -0.004 to -0.024, full model R=0.39). DISCUSSION Findings indicate that dispositional mindfulness was associated with hedonic capacity among this chronic pain sample. In light of this association, it is plausible that interventions that increase mindfulness may reduce pain-related impairment among opioid-using patients by enhancing hedonic capacity.
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185
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Garland EL, Hanley AW, Goldin PR, Gross JJ. Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One 2017; 12:e0187727. [PMID: 29211754 PMCID: PMC5718463 DOI: 10.1371/journal.pone.0187727] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/29/2017] [Indexed: 12/25/2022] Open
Abstract
Background and objective The Mindfulness to Meaning Theory (MMT) provides a detailed process model of mindful positive emotion regulation. Design We conducted a post-hoc reanalysis of longitudinal data (N = 107) derived from a RCT of mindfulness-based stress reduction (MBSR) versus cognitive-behavioral therapy (CBT) for social anxiety disorder to model the core constructs of the MMT (attentional control, decentering, broadened awareness, reappraisal, and positive affect) in a multivariate path analysis. Results Findings indicated that increases in attentional control from baseline to post-training predicted increases in decentering by 3 months post-treatment (p<.01) that in turn predicted increases in broadened awareness of interoceptive and exteroceptive data by 6 months post-treatment (p<.001). In turn, broadened awareness predicted increases in the use of reappraisal by 9 months post-treatment (p<.01), which culminated in greater positive affect at 12 months post-treatment (p<.001). MBSR led to significantly greater increases in decentering (p<.05) and broadened awareness than CBT (p<.05). Significant indirect effects indicated that increases in decentering mediated the effect of mindfulness training on broadening awareness, which in turn mediated enhanced reappraisal efficacy. Conclusion Results suggest that the mechanisms of change identified by the MMT form an iterative chain that promotes long-term increases in positive affectivity. Though these mechanisms may reflect common therapeutic factors that cut across mindfulness-based and cognitive-behavioral interventions, MBSR specifically boosts the MMT cycle by producing significantly greater increases in decentering and broadened awareness than CBT, providing support for the foundational assumption in the MMT that mindfulness training may be a key means of stimulating downstream positive psychological processes.
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Affiliation(s)
- Eric L. Garland
- College of Social Work, University of Utah, Salt Lake City, Utah, United States of America
- Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Adam W. Hanley
- College of Social Work, University of Utah, Salt Lake City, Utah, United States of America
- Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, Utah, United States of America
| | - Phillipe R. Goldin
- Betty Irene Moore School of Nursing, University of California – Davis, Sacramento, California, United States of America
| | - James J. Gross
- Stanford University, Stanford, California, United States of America
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Eccleston C, Fisher E, Thomas KH, Hearn L, Derry S, Stannard C, Knaggs R, Moore RA. Interventions for the reduction of prescribed opioid use in chronic non-cancer pain. Cochrane Database Syst Rev 2017; 11:CD010323. [PMID: 29130474 PMCID: PMC6486018 DOI: 10.1002/14651858.cd010323.pub3] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This is the first update of the original Cochrane Review published in 2013. The conclusions of this review have not changed from the 2013 publication. People with chronic non-cancer pain who are prescribed and are taking opioids can have a history of long-term, high-dose opioid use without effective pain relief. In those without good pain relief, reduction of prescribed opioid dose may be the desired and shared goal of both patient and clinician. Simple, unsupervised reduction of opioid use is clinically challenging, and very difficult to achieve and maintain. OBJECTIVES To investigate the effectiveness of different methods designed to achieve reduction or cessation of prescribed opioid use for the management of chronic non-cancer pain in adults compared to controls. SEARCH METHODS For this update we searched CENTRAL, MEDLINE, and Embase in January 2017, as well as bibliographies and citation searches of included studies. We also searched one trial registry for ongoing trials. SELECTION CRITERIA Included studies had to be randomised controlled trials comparing opioid users receiving an intervention with a control group receiving treatment as usual, active control, or placebo. The aim of the study had to include a treatment goal of dose reduction or cessation of opioid medication. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. We sought data relating to prescribed opioid use, adverse events of opioid reduction, pain, and psychological and physical function. We planned to assess the certainty of the evidence using the GRADE approach, however, due to the heterogeneity of studies, we were unable to combine outcomes in a meta-analysis and therefore we did not assess the evidence with GRADE. MAIN RESULTS Three studies are new to this update, resulting in five included studies in total (278 participants). Participants were primarily women (mean age 49.63 years, SD = 11.74) with different chronic pain conditions. We judged the studies too heterogeneous to pool data in a meta-analysis, so we have summarised the results from each study qualitatively. The studies included acupuncture, mindfulness, and cognitive behavioral therapy interventions aimed at reducing opioid consumption, misuse of opioids, or maintenance of chronic pain management treatments. We found mixed results from the studies. Three of the five studies reported opioid consumption at post-treatment and follow-up. Two studies that delivered 'Mindfulness-Oriented Recovery Enhancement' or 'Therapeutic Interactive Voice Response' found a significant difference between groups at post-treatment and follow-up in opioid consumption. The remaining study found reduction in opioid consumption in both treatment and control groups, and between-group differences were not significant. Three studies reported adverse events related to the study and two studies did not have study-related adverse events. We also found mixed findings for pain intensity and physical functioning. The interventions did not show between-group differences for psychological functioning across all studies. Overall, the risk of bias was mixed across studies. All studies included sample sizes of fewer than 100 and so we judged all studies as high risk of bias for that category. AUTHORS' CONCLUSIONS There is no evidence for the efficacy or safety of methods for reducing prescribed opioid use in chronic pain. There is a small number of randomised controlled trials investigating opioid reduction, which means our conclusions are limited regarding the benefit of psychological, pharmacological, or other types of interventions for people with chronic pain trying to reduce their opioid consumption. The findings to date are mixed: there were reductions in opioid consumption after intervention, and often in control groups too.
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187
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Goldberg SB, Tucker RP, Greene PA, Simpson TL, Kearney DJ, Davidson RJ. Is mindfulness research methodology improving over time? A systematic review. PLoS One 2017; 12:e0187298. [PMID: 29088283 PMCID: PMC5663486 DOI: 10.1371/journal.pone.0187298] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/17/2017] [Indexed: 01/16/2023] Open
Abstract
Background Despite an exponential growth in research on mindfulness-based interventions, the body of scientific evidence supporting these treatments has been criticized for being of poor methodological quality. Objectives The current systematic review examined the extent to which mindfulness research demonstrated increased rigor over the past 16 years regarding six methodological features that have been highlighted as areas for improvement. These feature included using active control conditions, larger sample sizes, longer follow-up assessment, treatment fidelity assessment, and reporting of instructor training and intent-to-treat (ITT) analyses. Data sources We searched PubMed, PsychInfo, Scopus, and Web of Science in addition to a publically available repository of mindfulness studies. Study eligibility criteria Randomized clinical trials of mindfulness-based interventions for samples with a clinical disorder or elevated symptoms of a clinical disorder listed on the American Psychological Association’s list of disorders with recognized evidence-based treatment. Study appraisal and synthesis methods Independent raters screened 9,067 titles and abstracts, with 303 full text reviews. Of these, 171 were included, representing 142 non-overlapping samples. Results Across the 142 studies published between 2000 and 2016, there was no evidence for increases in any study quality indicator, although changes were generally in the direction of improved quality. When restricting the sample to those conducted in Europe and North America (continents with the longest history of scientific research in this area), an increase in reporting of ITT analyses was found. When excluding an early, high-quality study, improvements were seen in sample size, treatment fidelity assessment, and reporting of ITT analyses. Conclusions and implications of key findings Taken together, the findings suggest modest adoption of the recommendations for methodological improvement voiced repeatedly in the literature. Possible explanations for this and implications for interpreting this body of research and conducting future studies are discussed.
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Affiliation(s)
- Simon B. Goldberg
- VA Puget Sound Health Care System–Seattle Division, Seattle, Washington, United States of America
- Center for Healthy Minds, University of Wisconsin—Madison, Madison, WI, United States of America
- Department of Counseling Psychology, University of Wisconsin—Madison, Madison, WI, United States of America
- * E-mail:
| | - Raymond P. Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States of America
| | - Preston A. Greene
- VA Puget Sound Health Care System–Seattle Division, Seattle, Washington, United States of America
| | - Tracy L. Simpson
- VA Puget Sound Health Care System–Seattle Division, Seattle, Washington, United States of America
- Center for Excellence in Substance Abuse Treatment & Education, VA Puget Sound Health Care System–Seattle Division, Seattle, Washington, United States of America
| | - David J. Kearney
- VA Puget Sound Health Care System–Seattle Division, Seattle, Washington, United States of America
| | - Richard J. Davidson
- Center for Healthy Minds, University of Wisconsin—Madison, Madison, WI, United States of America
- Department of Psychology, University of Wisconsin—Madison, Madison, WI, United States of America
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189
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Wilson AD, Roos CR, Robinson CS, Stein ER, Manuel JA, Enkema MC, Bowen S, Witkiewitz K. Mindfulness-based interventions for addictive behaviors: Implementation issues on the road ahead. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:888-896. [PMID: 29072477 DOI: 10.1037/adb0000319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past 35 years, mindfulness meditation practices have increasingly been integrated into Western medical settings. Research into the benefits of mindfulness-based interventions (MBIs) continues to expand, such that there are currently more than a dozen different protocolled MBIs for patients suffering from a variety of physical and psychological disorders. In the last decade, a number of MBIs specifically designed to treat addictive behaviors have been developed and tested. This review first provides a brief overview of the current state of the science with respect to the efficacy of MBIs for addictive behaviors, and some of the proposed mechanisms underlying the efficacy of MBIs. Second, the review highlights unresolved implementation issues and provides suggestions for how future research can address the implementation challenges to advance the delivery of MBIs. Specifically, this review focuses on the lack of clear empirical guidelines in the following areas: (a) effective training for MBI treatment providers; (b) adaptations of the traditional 2-hr closed-cohort group format; (c) delivery of MBIs in 1-on-1 treatment contexts; (d) delivery of MBIs at different points in the change process; (e) delivery of MBIs via technology-based platforms; and (f) facilitation of precision medicine in the delivery of MBIs. Specific research directions are suggested with an eye toward a meaningful increase in access to MBIs for front-line clinicians and clients. (PsycINFO Database Record
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Affiliation(s)
| | - Corey R Roos
- Department of Psychology, University of New Mexico
| | | | | | | | | | - Sarah Bowen
- Department of Psychology, Pacific University
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190
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Enkema MC, Bowen S. Mindfulness practice moderates the relationship between craving and substance use in a clinical sample. Drug Alcohol Depend 2017; 179:1-7. [PMID: 28734167 DOI: 10.1016/j.drugalcdep.2017.05.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 12/19/2022]
Abstract
Relapse following treatment for substance use disorders is highly prevalent, and craving has been shown to be a primary predictor of relapse. Mindfulness-Based Relapse Prevention (MBRP) is a psychosocial aftercare program integrating mindfulness and cognitive-behavioral approaches, aimed at reducing the risk and severity of relapse. Results from a recent randomized clinical trial demonstrate enhanced remission resilience for MBRP participants versus both cognitive-behavioral and treatment-as-usual controls. The current study investigated between-session formal and informal mindfulness practice, a hypothesized primary mechanism of action in this treatment, as an attenuating factor in the relationship between craving and substance use. Participants in this secondary analysis were 57 eligible adults who completed either inpatient treatment or intensive outpatient treatment for substance use disorders, were randomized in the parent study to receive MBRP, and completed relevant follow-up assessments. For formal mindfulness practice at post-intervention, both number of days per week and number of minutes per day significantly moderated the relationship between craving at post-intervention and number of substance use days at 6-month follow up. Informal practice did not significantly influence the craving-use relationship in this analysis. These results indicate that increasing formal mindfulness practice may reduce the link between craving and substance use for MBRP participants and enhance remission resiliency.
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Affiliation(s)
- Matthew C Enkema
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry, University of Washington, Box 354944, 1100 NE 45th St., Suite 300, Seattle, WA 98105, United States.
| | - Sarah Bowen
- Pacific University, 190 SE 8th Avenue, Suite 260, Hillsboro, OR 97123, United States.
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191
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Garland EL, Baker AK, Larsen P, Riquino MR, Priddy SE, Thomas E, Hanley AW, Galbraith P, Wanner N, Nakamura Y. Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. J Gen Intern Med 2017; 32:1106-1113. [PMID: 28702870 PMCID: PMC5602767 DOI: 10.1007/s11606-017-4116-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/15/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions. OBJECTIVE We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition. METHODS This three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting "intolerable pain" or "inadequate pain control." Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85). KEY RESULTS Participants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001). CONCLUSIONS Brief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management. TRIAL REGISTRATION Trial Registry: ClinicalTrials.gov ; registration ID number: NCT02590029 URL: https://clinicaltrials.gov/ct2/show/NCT02590029.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA.
| | - Anne K Baker
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
| | - Paula Larsen
- Social Work Department, University of Utah Hospital, Salt Lake City, UT, USA
| | - Michael R Riquino
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
| | - Sarah E Priddy
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
| | - Elizabeth Thomas
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
| | - Patricia Galbraith
- Social Work Department, University of Utah Hospital, Salt Lake City, UT, USA
| | - Nathan Wanner
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Yoshio Nakamura
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA
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192
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Shorey RC, Elmquist J, Gawrysiak MJ, Strauss C, Haynes E, Anderson S, Stuart GL. A Randomized Controlled Trial of a Mindfulness and Acceptance Group Therapy for Residential Substance Use Patients. Subst Use Misuse 2017; 52:1400-1410. [PMID: 28430015 PMCID: PMC6080615 DOI: 10.1080/10826084.2017.1284232] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substance use disorders are understood as a chronically relapsing condition that is difficult to treat. However, in recent years there have been promising developments in the treatment of substance use disorders, specifically with interventions based on mindfulness and acceptance and commitment therapy. Little research has examined whether these types of interventions may positively impact residential substance use treatment outcomes. OBJECTIVES Thus, in the current study we developed and examined, in a randomized controlled trial, a 4-week, eight-session, adjunctive mindfulness and acceptance group therapy for patients in residential substance use treatment. Our primary outcomes were substance use cravings, psychological flexibility, and dispositional mindfulness at treatment discharge. METHODS Patients (N = 117) from a private residential substance use facility were randomized to receive the adjunctive mindfulness and acceptance group or treatment-as-usual. Patients were assessed at treatment intake and at discharge from a 28-30-day residential program. RESULTS Although treatment groups did not statistically differ at discharge on any primary outcome, small effect sizes favored the mindfulness and acceptance group on cravings and psychological flexibility. Conclusions/Importance: Continued research is needed to determine whether the addition of mindfulness and acceptance-based interventions improve outcomes long term following residential substance use treatment.
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Affiliation(s)
- Ryan C Shorey
- a Department of Psychology , Ohio University , Athens , Ohio , USA
| | | | - Michael J Gawrysiak
- c Department of Psychology , Delaware State University , Dover , Delaware , USA
| | | | - Ellen Haynes
- a Department of Psychology , Ohio University , Athens , Ohio , USA
| | - Scott Anderson
- d Cornerstone of Recovery , Louisville , Tennessee , USA
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193
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Zeidan F, Vago DR. Mindfulness meditation-based pain relief: a mechanistic account. Ann N Y Acad Sci 2017; 1373:114-27. [PMID: 27398643 DOI: 10.1111/nyas.13153] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 12/15/2022]
Abstract
Pain is a multidimensional experience that involves interacting sensory, cognitive, and affective factors, rendering the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms-an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.
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Affiliation(s)
- Fadel Zeidan
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David R Vago
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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194
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Abid Azam M, Weinrib AZ, Montbriand J, Burns LC, McMillan K, Clarke H, Katz J. Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service. Can J Pain 2017; 1:37-49. [PMID: 35005340 PMCID: PMC8730651 DOI: 10.1080/24740527.2017.1325317] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/01/2022]
Abstract
Background: Chronic postsurgical pain (CPSP) and associated long-term opioid use are major public health concerns. Aims: The Toronto General Hospital Transitional Pain Service (TPS) is a multidisciplinary, hospital-integrated program developed to prevent and manage CPSP and support opioid tapering. This clinical practice-based study reports on preliminary outcomes of the TPS psychology program, which provides acceptance and commitment therapy (ACT) to patients at risk for CPSP and persistent opioid use. Methods: Ninety-one patients received ACT, whereas 252 patients did not (no ACT group). Patient outcomes were compared for the two groups at first and last TPS visits. Pain, pain interference, sensitivity to pain traumatization, pain catastrophizing, anxiety, depression, and opioid use were analyzed using two-way (Group [ACT, no ACT] × Time [first, last visit]) analyses of variance (ANOVAs). Results: Patients referred to ACT were more likely to report a mental health condition preoperatively (P < 0.001), had higher opioid use (P < 0.001) at the first postsurgical visit, and reported higher sensitivity to pain traumatization (P < 0.05) and anxiety (P < 0.05) than the no ACT group at both time points. Both groups showed reductions in pain, pain interference, pain catastrophizing, anxiety, and opioid use by the last TPS visit (P < 0.05). The ACT group demonstrated greater reductions in opioid use and pain interference and showed reductions in depressed mood (P = 0.001) by the end of treatment compared to the no ACT group. Conclusion: Preliminary outcomes suggest that ACT was effective in reducing opioid use while pain interference and mood improved.
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Affiliation(s)
- Muhammad Abid Azam
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Aliza Z. Weinrib
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Janice Montbriand
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lindsay C. Burns
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Kayla McMillan
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Hance Clarke
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joel Katz
- Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
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195
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Garland EL, Hanley AW, Baker AK, Howard MO. Biobehavioral Mechanisms of Mindfulness as a Treatment for Chronic Stress: An RDoC Perspective. CHRONIC STRESS 2017; 1. [PMID: 28840198 PMCID: PMC5565157 DOI: 10.1177/2470547017711912] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mindfulness-based interventions have been heralded as promising means of alleviating
chronic stress. While meta-analyses indicate that mindfulness-based interventions
significantly reduce global measures of stress, how mindfulness-based interventions
modulate the specific mechanisms underpinning chronic stress as operationalized by the
National Institute of Mental Health research domain criteria (RDoC) of sustained threat
has not yet been detailed in the literature. To address this knowledge gap, this article
aims to (1) review evidence that mindfulness-based interventions ameliorate each of the 10
elements of behavioral dysregulation characterizing sustained threat via an array of
mindful counter-regulatory strategies; (2) review evidence that mindfulness-based
interventions modify biological domains implicated in sustained threat, such as the
hypothalamic–pituitary–adrenal axis, as well as brain circuits involved in attentional
function, limbic reactivity, habit behavior, and the default mode network; and (3)
integrate these findings into a novel conceptual framework of mindful self-regulation in
the face of stress—the Mindfulness-to-Meaning Theory. Taken together, the extant body of
scientific evidence suggests that the practice of mindfulness enhances a range
biobehavioral factors implicated in adaptive stress coping and induces self-referential
plasticity, leading to the ability to find meaning in adversity. These mechanistic
findings can inform the treatment development process to optimize the next generation of
mindfulness-based interventions for greater therapeutic efficacy.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Anne K Baker
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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196
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Mindfulness-Oriented Recovery Enhancement for Video Game Addiction in Emerging Adults: Preliminary Findings from Case Reports. Int J Ment Health Addict 2017. [DOI: 10.1007/s11469-017-9765-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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197
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Li W, Garland EL, McGovern P, O'Brien JE, Tronnier C, Howard MO. Mindfulness-oriented recovery enhancement for internet gaming disorder in U.S. adults: A stage I randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:393-402. [PMID: 28437120 DOI: 10.1037/adb0000269] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Empirical studies have identified increasing rates of Internet gaming disorder (IGD) and associated adverse consequences. However, very few evidence-based interventions have been evaluated for IGD or problematic video gaming behaviors. This study evaluated Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for IGD. Thirty adults (Mage = 25.0, SD = 5.4) with IGD or problematic video gaming behaviors were randomized to 8 weeks of group-based MORE or 8 weeks of a support group (SG) control condition. Outcome measures were administered at pre- and posttreatment and 3-months following treatment completion using self-report instruments. Linear mixed models were used for outcome analyses. MORE participants had significantly greater reductions in the number of Diagnostic and Statistical Manual of Mental Disorders-5 IGD criteria they met, craving for video gaming, and maladaptive cognitions associated with gaming than SG participants, and therapeutic benefits were maintained at 3-month follow-up. MORE is a promising treatment approach for IGD. (PsycINFO Database Record
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Affiliation(s)
- Wen Li
- School of Social Work, Rutgers, The State University of New Jersey
| | | | | | | | | | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill
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Garland EL, Bryan CJ, Finan PH, Thomas EA, Priddy SE, Riquino MR, Howard MO. Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients. Drug Alcohol Depend 2017; 173 Suppl 1:S65-S72. [PMID: 28363322 DOI: 10.1016/j.drugalcdep.2016.07.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/11/2016] [Accepted: 07/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Given the risk of opioid misuse among chronic pain patients being treated with long-term opioid pharmacotherapy, non-pharmacological treatments are needed. Further, in light of hedonic deficits in this population, therapies that enhance positive affect may be useful. The purpose of this study was to examine effects of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention on ecological momentary assessments (EMA) of pain and positive affective experience, and to determine if changes in pain, affect, and their interaction were associated with opioid misuse at post-treatment. METHODS This study examined unpublished EMA data from a subset of participants (N=55) in a previously published RCT (NCT01505101) of MORE versus a support group (SG) control. Across 8 weeks of treatment, patients completed up to 224 EMA measures of pain and affect. Multilevel models and generalized estimating equations examined effects of treatment on momentary pain and positive affect, and generalized linear models examined associations between pain and affect and changes in opioid misuse by post-treatment. RESULTS Patients in MORE reported significantly greater improvements in momentary pain (p=0.01) and positive affect (p=0.004) than patients in the SG. Further, over the entire course of treatment, patients in MORE were significantly more likely to exhibit positive affect regulation (OR=2.75) than patients in the SG. Finally, improvements in positive affect (but not pain) over the course of intervention were associated with reduced risk of misusing opioids by post-treatment (p=0.02). CONCLUSION MORE may be a useful non-pharmacological treatment for pain and hedonic deficits among chronic pain patients at risk for opioid misuse.
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199
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Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness-Oriented Recovery Enhancement for Cigarette Smokers. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7018014. [PMID: 28373890 PMCID: PMC5360937 DOI: 10.1155/2017/7018014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/29/2017] [Indexed: 12/28/2022]
Abstract
The primary goal of this pilot feasibility study was to examine the effects of Mindfulness-Oriented Recovery Enhancement (MORE), a behavioral treatment grounded in dual-process models derived from cognitive science, on frontostriatal reward processes among cigarette smokers. Healthy adult (N = 13; mean (SD) age 49 ± 12.2) smokers provided informed consent to participate in a 10-week study testing MORE versus a comparison group (CG). All participants underwent two fMRI scans: pre-tx and after 8-weeks of MORE. Emotion regulation (ER), smoking cue reactivity (CR), and resting-state functional connectivity (rsFC) were assessed at each fMRI visit; smoking and mood were assessed throughout. As compared to the CG, MORE significantly reduced smoking (d = 2.06) and increased positive affect (d = 2.02). MORE participants evidenced decreased CR-BOLD response in ventral striatum (VS; d = 1.57) and ventral prefrontal cortex (vPFC; d = 1.7) and increased positive ER-BOLD in VS (dVS = 2.13) and vPFC (dvmPFC = 2.66). Importantly, ER was correlated with smoking reduction (r's = .68 to .91) and increased positive affect (r's = .52 to .61). These findings provide preliminary evidence that MORE may facilitate the restructuring of reward processes and play a role in treating the pathophysiology of nicotine addiction.
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200
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Mindfulness treatment for substance misuse: A systematic review and meta-analysis. J Subst Abuse Treat 2017; 75:62-96. [PMID: 28153483 DOI: 10.1016/j.jsat.2017.01.008] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/09/2016] [Accepted: 01/18/2017] [Indexed: 01/19/2023]
Abstract
High rates of relapse following substance misuse treatment highlight an urgent need for effective therapies. Although the number of empirical studies investigating effects of mindfulness treatment for substance misuse has increased dramatically in recent years, few reviews have examined findings of mindfulness studies. Thus, this systematic review examined methodological characteristics and substantive findings of studies evaluating mindfulness treatments for substance misuse published by 2015. The review also includes the first meta-analysis of randomized controlled trials of mindfulness treatments for substance misuse. Comprehensive bibliographic searches in PubMed, PsycInfo, and Web of Science, identified 42 pertinent studies. Meta-analytic results revealed significant small-to-large effects of mindfulness treatments in reducing the frequency and severity of substance misuse, intensity of craving for psychoactive substances, and severity of stress. Mindfulness treatments were also effective in increasing rates of posttreatment abstinence from cigarette smoking compared to alternative treatments. Mindfulness treatment for substance misuse is a promising intervention for substance misuse, although more research is needed examining the mechanisms by which mindfulness interventions exert their effects and the effectiveness of mindfulness treatments in diverse treatment settings.
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