201
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Kelly A, Garland EL. Trauma-Informed Mindfulness-Based Stress Reduction for Female Survivors of Interpersonal Violence: Results From a Stage I RCT. J Clin Psychol 2017; 72:311-28. [PMID: 27002222 DOI: 10.1002/jclp.22273] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/30/2015] [Accepted: 12/31/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This pilot randomized controlled trial evaluated a novel trauma-informed model of mindfulness-based stress reduction (TI-MBSR) as a phase I trauma intervention for female survivors of interpersonal violence (IPV). METHOD A community-based sample of women (mean age = 41.5, standard deviation = 14.6) with a history of IPV was randomly assigned to an 8-week TI-MBSR intervention (n = 23) or a waitlist control group (n = 22). Symptoms of posttraumatic stress disorder (PTSD) and depression as well as anxious and avoidant attachment were assessed pre- and postintervention. RESULTS Relative to the control group, participation in TI-MBSR was associated with statistically and clinically significant decreases in PTSD and depressive symptoms and significant reductions in anxious attachment. Retention in the intervention was high, with most participants completing at least 5 of the 8 sessions for the intervention. Minutes of mindfulness practice per week significantly predicted reductions in PTSD symptoms. CONCLUSION TI-MBSR appears to be a promising and feasible phase I intervention for female survivors of interpersonal trauma.
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Abstract
Opioid dependence is an epidemic in the United States, and the percentage of pregnant women who are opioid dependent has increased dramatically in the last decade. Pain management, already a concern for intrapartum and postpartum care, is complicated in the context of opioid dependence. This clinical review surveys the literature on pain management in opioid-dependent pregnant women to summarize current consensus and evidence to guide clinical practice. Points of consensus for pain management in opioid-dependent pregnant women include continual opioid maintenance therapy throughout the pregnancy and the postpartum period; adequate management of acute pain; the contraindication of opioid agonist-antagonists for pain management; and the need for interdisciplinary teams using a multimodal approach to provide optimal care to opioid-dependent pregnant women.
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203
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Garland EL, Howard MO, Zubieta JK, Froeliger B. Restructuring Hedonic Dysregulation in Chronic Pain and Prescription Opioid Misuse: Effects of Mindfulness-Oriented Recovery Enhancement on Responsiveness to Drug Cues and Natural Rewards. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:111-112. [PMID: 28183077 PMCID: PMC5331925 DOI: 10.1159/000453400] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 11/09/2016] [Indexed: 12/26/2022]
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204
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Abstract
Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.
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Affiliation(s)
- J David Creswell
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213;
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205
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Vinci C, Peltier M, Waldo K, Kinsaul J, Shah S, Coffey SF, Copeland AL. Examination of trait impulsivity on the response to a brief mindfulness intervention among college student drinkers. Psychiatry Res 2016; 242:365-374. [PMID: 27344030 PMCID: PMC4975969 DOI: 10.1016/j.psychres.2016.04.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 04/29/2016] [Accepted: 04/29/2016] [Indexed: 11/30/2022]
Abstract
Mindfulness-based strategies show promise for targeting the construct of impulsivity and associated variables among problematic alcohol users. This study examined the moderating role of intervention (mindfulness vs relaxation vs control) on trait impulsivity and three outcomes examined post-intervention (negative affect, positive affect, and urge to drink) among 207 college students with levels of at-risk drinking. Moderation analyses revealed that the relationship between baseline impulsivity and the primary outcomes significantly differed for participants who underwent the mindfulness versus relaxation interventions. Notably, simple slope analyses revealed that negative urgency was positively associated with urge to drink following the mindfulness intervention. Among participants who underwent the relaxation intervention, analysis of simple slopes revealed that negative urgency was negatively associated with urge to drink, while positive urgency was positively associated with positive affect following the relaxation intervention. Findings suggest that level (low vs high) and subscale of impulsivity matter with regard to how a participant will respond to a mindfulness versus relaxation intervention.
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Affiliation(s)
- Christine Vinci
- Rice University, Psychology Department, 6100 Main St., Houston, TX 77005, United States.
| | - MacKenzie Peltier
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, United States
| | - Krystal Waldo
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, United States
| | - Jessica Kinsaul
- Durham Veteran Affairs Medical Center, Mental Health Service Line, Um 508 Fulton St, Durham, NC 27705, United States
| | - Sonia Shah
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, United States
| | - Scott F. Coffey
- University of Mississippi Medical Center, Department of Psychiatry and Human Behavior, 2500 North State St., Jackson, MS 39216, United States
| | - Amy L. Copeland
- Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA 70803, United States
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206
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Garland EL, Riquino MR, Priddy SE, Bryan CJ. Suicidal ideation is associated with individual differences in prescription opioid craving and cue-reactivity among chronic pain patients. J Addict Dis 2016; 36:23-29. [PMID: 27644963 DOI: 10.1080/10550887.2016.1220800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Given that chronic pain patients experience significant rates of suicidal ideation and suicide attempts, access to prescription opioids compounds the risk of death by suicide. These patients may experience heightened opioid craving and exhibit increased cue-reactivity to stimuli associated with past opioid use when suicidal ideation produces negative affective states. Because both opioids and suicidal behavior are used to alleviate emotional and physical pain through a process of negative reinforcement, elucidating factors that mediate this association may yield insight into suicide risk among chronic pain patients. This study examined the relationship between suicidal ideation and opioid craving and cue-reactivity, and tested opioid self-medication as a mediator of associations between those factors after controlling for the impact of pain severity. A sample of 115 chronic pain patients provided demographic and clinical information on the Obsessive Compulsive Drug Use Scale, the Current Opioid Misuse Measure, and the Brief Pain Inventory before completing an opioid dot probe task in which heart rate variability was recorded. As hypothesized, suicidal ideation was positively correlated with subjective opioid craving and physiological cue-reactivity. Self-medication significantly mediated the association between suicidal ideation, craving, and cue-reactivity. As opioids relieve the emotional pain linked with suicidal thoughts, chronic pain patients with higher levels of suicidal ideation may experience more intense opioid craving and exhibit heightened physiological cue-reactivity when compared to patients with low levels of suicidal ideation.
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207
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Zgierska AE, Burzinski CA, Cox J, Kloke J, Singles J, Mirgain S, Stegner A, Cook DB, Bačkonja M. Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy. J Altern Complement Med 2016; 22:610-20. [PMID: 27267151 DOI: 10.1089/acm.2015.0314] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Although mindfulness meditation (MM) is increasingly used for chronic pain treatment, limited evidence supports its clinical application for opioid-treated chronic low back pain (CLBP). The goal of this study was to determine feasibility, acceptability, and safety of an MM-based intervention in patients with CLBP requiring daily opioid therapy. DESIGN 26-week pilot randomized controlled trial comparing MM-based intervention, combined with usual care, to usual care alone. SETTING Outpatient. PATIENTS Adults with CLBP treated with ≥30 mg of morphine-equivalent dose (MED) per day for 3 months or longer. INTERVENTIONS Targeted MM-based intervention consisted of eight weekly 2-hour group sessions and home practice (30 minutes/d, 6 days/wk) during the study. "Usual care" for opioid-treated CLBP was provided to participants by their regular clinicians. OUTCOME MEASURES Feasibility and acceptability of the MM intervention were assessed by adherence to intervention protocol and treatment satisfaction among experimental participants. Safety was evaluated by inquiry about side effects/adverse events and opioid dose among all study participants. RESULTS Thirty-five participants enrolled during the 10-week recruitment period. The mean age (±standard deviation) was 51.8 ± 9.7 years; the patients were predominantly female, with substantial CLBP-related pain and disability, and treated with 148.3 ± 129.2 mg of MED per day. All participants completed baseline assessments; none missed both follow-up assessments or withdrew. Among experimental participants (n = 21), 19 attended 1 or more intervention sessions and 14 attended 4 or more. They reported, on average, 164.0 ± 122.1 minutes of formal practice per week during the 26-week study and 103.5 ± 111.5 minutes of brief, informal practice per week. Seventeen patients evaluated the intervention, indicating satisfaction; their qualitative responses described the course as useful for pain management (n = 10) and for improving pain coping skills (n = 8). No serious adverse events or safety concerns occurred among the study participants. CONCLUSIONS MM-based intervention is feasible, acceptable, and safe in opioid-treated CLBP.
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Affiliation(s)
- Aleksandra E Zgierska
- 1 Department of Family Medicine and Community Health, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - Cindy A Burzinski
- 1 Department of Family Medicine and Community Health, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - Jennifer Cox
- 1 Department of Family Medicine and Community Health, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - John Kloke
- 2 Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - Janice Singles
- 3 Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - Shilagh Mirgain
- 3 Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI
| | - Aaron Stegner
- 4 Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI.,5 Department of Kinesiology, University of Wisconsin-Madison , School of Education, Madison, WI
| | - Dane B Cook
- 4 Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI.,5 Department of Kinesiology, University of Wisconsin-Madison , School of Education, Madison, WI
| | - Miroslav Bačkonja
- 6 Department of Neurology, University of Wisconsin-Madison , School of Medicine and Public Health, Madison, WI.,7 PRAHS Clinical Research Company Lifetree , Salt Lake City, UT
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208
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Garland EL. Restructuring reward processing with Mindfulness-Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Ann N Y Acad Sci 2016; 1373:25-37. [PMID: 27037786 PMCID: PMC4940274 DOI: 10.1111/nyas.13034] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Though valuation processes are fundamental to survival of the human species, hedonic dysregulation is at the root of an array of maladies, including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders. To address this crucial problem, novel interventions are needed to restore hedonic regulatory processes gone awry in persons exhibiting addictive behaviors. This article describes a theoretical rationale and empirical evidence for the effects of one such new intervention, Mindfulness-Oriented Recovery Enhancement (MORE), on top-down and bottom-up mechanisms implicated in cognitive control and hedonic regulation. MORE is innovative and distinct from extant mindfulness-based interventions in that it unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction-a mechanistic target that no other behavioral intervention has been designed to address. Though additional studies are needed, clinical and biobehavioral data from several completed and ongoing trials suggest that MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.
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Affiliation(s)
- Eric L Garland
- College of Social Work, University of Utah, and Supportive Oncology and Survivorship, Huntsman Cancer Institute, Salt Lake City, Utah
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209
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Treatment Approaches for Patients With Opioid Use Disorder and Chronic Noncancer Pain: a Literature Review. ADDICTIVE DISORDERS & THEIR TREATMENT 2016. [DOI: 10.1097/adt.0000000000000078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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210
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Nam S, Toneatto T. The Influence of Attrition in Evaluating the Efficacy and Effectiveness of Mindfulness-Based Interventions. Int J Ment Health Addict 2016. [DOI: 10.1007/s11469-016-9667-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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211
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Barrett K, Chang YP. Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care. J Nurs Scholarsh 2016; 48:345-53. [DOI: 10.1111/jnu.12213] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Kathleen Barrett
- Beta Omicron , Adjunct Assistant Professor, College of Health Sciences, Lienhard School of Nursing; Pace University; Pleasantville NY USA
| | - Yu-Ping Chang
- Gamma Kappa , Associate Professor, School of Nursing; The State University of New York at Buffalo; Buffalo NY USA
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212
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Martel MO, Finan PH, McHugh RK, Issa M, Edwards RR, Jamison RN, Wasan AD. Day-to-day pain symptoms are only weakly associated with opioid craving among patients with chronic pain prescribed opioid therapy. Drug Alcohol Depend 2016; 162:130-6. [PMID: 27021805 PMCID: PMC4833606 DOI: 10.1016/j.drugalcdep.2016.02.047] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 02/15/2016] [Accepted: 02/28/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Over the past decade, there has been a substantial rise in the use of opioids for the treatment of chronic noncancer pain. Despite the potential benefits of opioid therapy, the rise in the use of opioids has been accompanied by escalating rates of prescription opioid misuse and addiction. There is now a growing body of evidence indicating that opioid craving (i.e., the subjective desire to consume opioids) is one of the strongest determinants of opioid misuse among patients with chronic pain prescribed opioids. Although research has elucidated some of the factors associated with opioid craving, the contribution of patients' levels of pain to opioid craving remains unclear. OBJECTIVE The main objective of this study was to examine the day-to-day association between pain and opioid craving. METHODS In this longitudinal cohort study, patients with chronic pain prescribed opioid therapy completed baseline measures and were then asked to provide daily reports of pain intensity and opioid craving for a period of 14 days. RESULTS Multilevel analyses indicated that day-to-day elevations in patients' levels of pain were associated with heightened opioid craving. That is, on more painful days, patients reported higher levels of craving. Within-person changes in pain intensity, however, explained less than 5% of the variance in patients' reports of craving. CONCLUSION Findings from this study suggest that patients with chronic pain do not crave their opioid medications simply because they experience high levels of pain. The theoretical and clinical implications of our findings are discussed.
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Affiliation(s)
- Marc O. Martel
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA,Corresponding author at: Department of Anesthesiology, Harvard Medical School, Brigham and Women’s Hospital. 850 Boylston St. Chestnut Hill, MA 02467, USA. (M.O. Martel)
| | - Patrick H. Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R. Kathryn McHugh
- Division of Alcohol and Drug Abuse, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Mohammed Issa
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA
| | - Robert R. Edwards
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA
| | - Robert N. Jamison
- Department of Anesthesiology, Harvard Medical School, Brigham & Women’s Hospital, Boston, MA, USA
| | - Ajay D. Wasan
- Departments of Anesthesiology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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213
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Li MJ, Black DS, Garland EL. The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016; 93:6-15. [PMID: 26858469 DOI: 10.1016/j.paid.2015.10.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Mindfulness-based interventions (MBIs) include the application of meditation and mind-body practices used to promote mindful awareness in daily life. Operationalizing the construct of mindfulness is important in order to determine mechanisms of therapeutic change elicited by mindfulness practice. In addition to existing state and trait measures of mindfulness, process measures are needed to assess the ways in which individuals apply mindfulness in the context of their practice. METHOD This report details three independent studies (qualitative interview, N = 8; scale validation, N = 134; and replication study, N = 180) and the mixed qualitative-quantitative methodology used to develop and validate the Applied Mindfulness Process Scale (AMPS), a 15-item process measure designed to quantify how mindfulness practitioners actively use mindfulness to remediate psychological suffering in their daily lives. RESULTS In Study 1, cognitive interviewing yielded a readily comprehensible and accessible scale of 15 items. In Study 2, exploratory factor analysis derived a potential three-factor solution: decentering, positive emotion regulation, and negative emotion regulation. In Study 3, confirmatory factor analysis verified better model fit with the three-factor structure over the one-factor structure. CONCLUSIONS AMPS functions as a measure to quantify the application of mindfulness and processes of change in the context of MBIs and general mindfulness practice.
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Affiliation(s)
- Michael J Li
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - David S Black
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Eric L Garland
- College of Social Work & Huntsman Cancer Institute, University of Utah
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214
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Abstract
Mindfulness is a multi-faceted construct, and research suggests that certain components (e.g., Acting with Awareness, Nonjudging) are associated with less problematic alcohol use. Recent research has examined whether specific drinking motives mediate the relationship between facets of mindfulness and alcohol use. The current study sought to extend this research by examining whether certain drinking motives would mediate the relationship between facets of mindfulness and problematic alcohol use in a sample of 207 college students classified as engaging in problematic drinking. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ), Drinking Motives Questionnaire-Revised (DMQ-R), and Alcohol Use Disorders Identification Test (AUDIT). Results indicated that lower levels of Coping motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score and between greater Nonjudging and lower AUDIT score. Lower levels of Conformity motives significantly mediated the relationship between greater Acting with Awareness and lower AUDIT score. These findings offer insight into specific mechanisms through which mindfulness is linked to less problematic drinking, and also highlight associations among mindfulness, drinking motives, and alcohol use among a sample of problematic college student drinkers. Future research should determine whether interventions that emphasize Acting with Awareness and Nonjudging facets of mindfulness and/or target coping and conformity motives could be effective for reducing problematic drinking in college students.
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215
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Garland EL, Kiken LG, Faurot K, Palsson O, Gaylord SA. Upward Spirals of Mindfulness and Reappraisal: Testing the Mindfulness-to-Meaning Theory with Autoregressive Latent Trajectory Modeling. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9768-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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216
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Zgierska AE, Burzinski CA, Cox J, Kloke J, Stegner A, Cook DB, Singles J, Mirgain S, Coe CL, Bačkonja M. Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. PAIN MEDICINE 2016; 17:1865-1881. [PMID: 26968850 DOI: 10.1093/pm/pnw006] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP). DESIGN 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone). SETTING Outpatient. SUBJECTS Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months. METHODS The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein). RESULTS Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen's d = 0.86), and decreased pain sensitivity to thermal stimuli (P < 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits. CONCLUSIONS Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP.
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Affiliation(s)
| | | | - Jennifer Cox
- Department of *Family Medicine and Community Health
| | - John Kloke
- Department of Biostatistics and Medical Informatics
| | - Aaron Stegner
- Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dane B Cook
- Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | - Christopher L Coe
- Department of Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Bačkonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison,Wisconsin.,Department of **PRAHS Clinical Research Company Lifetree, Salt Lake City, Utah, USA
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217
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Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KMG. Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther 2016; 45:5-31. [DOI: 10.1080/16506073.2015.1098724] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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218
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Garland EL, Thielking P, Thomas EA, Coombs M, White S, Lombardi J, Beck A. Linking dispositional mindfulness and positive psychological processes in cancer survivorship: a multivariate path analytic test of the mindfulness-to-meaning theory. Psychooncology 2016; 26:686-692. [PMID: 26799620 DOI: 10.1002/pon.4065] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/10/2015] [Accepted: 12/09/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Research indicates that dispositional mindfulness is associated with positive psychological functioning. Although this disposition has been linked with beneficial outcomes in the broader mental health literature, less is known about dispositional mindfulness in cancer survivors and how it may be linked with indices of psychological and physical health relevant to cancer survivorship. METHODS We conducted a multivariate path analysis of data from a heterogeneous sample of cancer patients (N = 97) to test the Mindfulness-to-Meaning Theory, an extended process model of emotion regulation linking dispositional mindfulness with cancer-related quality of life via positive psychological processes. RESULTS We found that patients endorsing higher levels of dispositional mindfulness were more likely to pay attention to positive experiences (β = .56), a tendency which was associated with positive reappraisal of stressful life events (β = .51). Patients who engaged in more frequent positive reappraisal had a greater sense of meaning in life (β = .43) and tended to savor rewarding or life affirming events (β = .50). In turn, those who engaged in high levels of savoring had better quality of life (β = .33) and suffered less from emotional distress (β = -.54). CONCLUSIONS Findings provide support for the Mindfulness-to-Meaning Theory and help explicate the processes by which mindfulness promotes psychological flourishing in the face of cancer. IMPLICATIONS FOR CANCER SURVIVORSHIP Cancer survivors may benefit from enhancing mindfulness, reappraisal, and savoring. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eric L Garland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Paul Thielking
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Mary Coombs
- College of Social Work, University of Utah, Salt Lake City, UT, USA
| | - Shelley White
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Joy Lombardi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Anna Beck
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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219
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Hanley AW, Abell N, Osborn DS, Roehrig AD, Canto AI. Mind the Gaps: Are Conclusions About Mindfulness Entirely Conclusive? JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12066] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Adam W. Hanley
- Educational Psychology and Learning Systems; Florida State University
| | - Neil Abell
- College of Social Work; Florida State University
| | - Debra S. Osborn
- Educational Psychology and Learning Systems; Florida State University
| | - Alysia D. Roehrig
- Educational Psychology and Learning Systems; Florida State University
| | - Angela I. Canto
- Educational Psychology and Learning Systems; Florida State University
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220
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Garland EL, Roberts-Lewis A, Tronnier CD, Graves R, Kelley K. Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial. Behav Res Ther 2015; 77:7-16. [PMID: 26701171 DOI: 10.1016/j.brat.2015.11.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 11/15/2015] [Accepted: 11/24/2015] [Indexed: 01/01/2023]
Abstract
In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.
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Affiliation(s)
| | | | | | - Rebecca Graves
- Triangle Residential Options for Substance Abusers, Inc., USA
| | - Karen Kelley
- Triangle Residential Options for Substance Abusers, Inc., USA
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Garland EL, Farb NA, Goldin PR, Fredrickson BL. The Mindfulness-to-Meaning Theory: Extensions, Applications, and Challenges at the Attention–Appraisal–Emotion Interface. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.1092493] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Garland EL, Farb NA, Goldin P, Fredrickson BL. Mindfulness Broadens Awareness and Builds Eudaimonic Meaning: A Process Model of Mindful Positive Emotion Regulation. PSYCHOLOGICAL INQUIRY 2015; 26:293-314. [PMID: 27087765 DOI: 10.1080/1047840x.2015.1064294] [Citation(s) in RCA: 274] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Contemporary scholarship on mindfulness casts it as a form of purely non-evaluative engagement with experience. Yet, traditionally mindfulness was not intended to operate in a vacuum of dispassionate observation, but was seen as facilitative of eudaimonic mental states. In spite of this historical context, modern psychological research has neglected to ask the question of how the practice of mindfulness affects downstream emotion regulatory processes to impact the sense of meaning in life. To fill this lacuna, here we describe the Mindfulness-to-Meaning Theory, from which we derive a novel process model of mindful positive emotion regulation informed by affective science, in which mindfulness is proposed to introduce flexibility in the generation of cognitive appraisals by enhancing interoceptive attention, thereby expanding the scope of cognition to facilitate reappraisal of adversity and savoring of positive experience. This process is proposed to culminate in a deepened capacity for meaning-making and greater engagement with life.
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Low dispositional mindfulness predicts self-medication of negative emotion with prescription opioids. J Addict Med 2015; 9:61-7. [PMID: 25469652 DOI: 10.1097/adm.0000000000000090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Although evidence is mounting that opioids are abused to self-medicate negative emotions, little is known about the traits and factors linked to opioid self-medication. One potentially crucial psychological correlate is dispositional mindfulness. Thus, the purpose of this study was to describe the prevalence of opioid self-medication among a treatment-seeking sample of prescription opioid-dependent individuals and specifically examine the relationship between dispositional mindfulness and opioid self-medication. METHODS Participants in acute detoxification or intensive outpatient treatment for prescription opioid dependence (n = 79) were recruited from a regional hospital's addictions treatment unit for this cross-sectional study. Sociodemographic data were collected along with surveys of opioid self-medication, pain level, and dispositional mindfulness. RESULTS Self-medication of negative affective states with opioids was quite common, with 94.9% of individuals sampled reporting self-medication behaviors. In adjusted analyses, individuals engaging in more frequent opioid use tended to self-medicate negative emotions with opioids more often than those engaging in more intermittent opioid use (β = 0.33; P < 0.05). Importantly, irrespective of opioid use frequency and other clinical and sociodemographic covariates, dispositional mindfulness was inversely associated with opioid self-medication (β = -0.42; P < 0.001), such that less mindful individuals reported using opioids more frequently to self-medicate negative emotions. CONCLUSIONS Self-medication of negative emotions with opioids was prevalent in this sample and related to low dispositional mindfulness. Plausibly, increasing mindfulness may decrease opioid self-medication. Addictive automaticity and emotion regulation are discussed as potential mechanisms linking low dispositional mindfulness and self-medication.
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224
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A systematic review of the neurophysiology of mindfulness on EEG oscillations. Neurosci Biobehav Rev 2015; 57:401-10. [DOI: 10.1016/j.neubiorev.2015.09.018] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/23/2015] [Accepted: 09/30/2015] [Indexed: 01/24/2023]
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Abstract
Mindfulness-based interventions (MBIs) are at a pivotal point in their future development. Spurred on by an ever-increasing number of studies and breadth of clinical application, the value of such approaches may appear self-evident. We contend, however, that the public health impact of MBIs can be enhanced significantly by situating this work in a broader framework of clinical psychological science. Utilizing the National Institutes of Health stage model (Onken, Carroll, Shoham, Cuthbert, & Riddle, 2014), we map the evidence base for mindfulness-based cognitive therapy and mindfulness-based stress reduction as exemplars of MBIs. From this perspective, we suggest that important gaps in the current evidence base become apparent and, furthermore, that generating more of the same types of studies without addressing such gaps will limit the relevance and reach of these interventions. We offer a set of 7 recommendations that promote an integrated approach to core research questions, enhanced methodological quality of individual studies, and increased logical links among stages of clinical translation in order to increase the potential of MBIs to impact positively the mental health needs of individuals and communities.
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Affiliation(s)
- Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Zindel V Segal
- Department of Psychology, University of Toronto Scarborough
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226
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Thought suppression as a mediator of the association between depressed mood and prescription opioid craving among chronic pain patients. J Behav Med 2015; 39:128-38. [PMID: 26345263 DOI: 10.1007/s10865-015-9675-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/26/2015] [Indexed: 12/17/2022]
Abstract
Emerging research suggests that prescription opioid craving is associated with negative mood and depression, but less is known about cognitive factors linking depressive symptoms to opioid craving among adults with chronic pain. The present cross-sectional study examined thought suppression as a mediator of the relation between depression and prescription opioid craving in a sample of chronic pain patients receiving long-term opioid pharmacotherapy. Data were obtained from 115 chronic pain patients recruited from primary care, pain, and neurology clinics who had taken prescription opioids daily or nearly every day for ≥90 days prior to assessment. In this sample, 60 % of participants met DSM-IV criteria for current major depressive disorder. Depressed mood (r = .36, p < .001) and thought suppression (r = .33, p < .001) were significantly correlated with opioid craving. Multivariate path analyses with bootstrapping indicated the presence of a significant indirect effect of thought suppression on the association between depressed mood and opioid craving (indirect effect = .09, 95 % CI .01, .20). Sensitivity analyses showed a similar indirect effect of suppression linking major depressive disorder diagnosis and opioid craving. Attempts to suppress distressing and intrusive thoughts may result in increased craving to use opioids among chronic pain patients with depressive symptoms. Results highlight the need for interventions that mitigate thought suppression among adults with pain and mood disorders.
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Abstract
OBJECTIVE This narrative review summarizes and integrates the available literature on positive affect (PA) and pain to: (1) provide a brief overview of PA and summarize the key findings that have emerged in the study of PA and pain; (2) provide a theoretical foundation from which to understand how PA operates in the context of chronic pain (CP); and (3) highlight how the prevailing psychosocial treatments for CP address PA in the therapeutic context, and offer suggestions for how future treatment development research can maximize the benefit of PA for patients with CP. RESULTS In experimental studies, the evidence suggests PA is analgesic. In clinical studies, the association of PA and pain is dynamic, time variant, and may be best considered in context of its interacting role with negative affect. DISCUSSION We offer an "upward spiral" model of PA, resilience and pain self-management, which makes specific predictions that PA will buffer maladaptive cognitive and affective responses to pain, and promote active engagement in valued goals that enhance CP self-management.
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Kaiser RS, Mooreville M, Kannan K. Psychological Interventions for the Management of Chronic Pain: a Review of Current Evidence. Curr Pain Headache Rep 2015. [DOI: 10.1007/s11916-015-0517-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bruehl S, Burns JW, Passik SD, Gupta R, Buvanendran A, Chont M, Schuster E, Orlowska D, France CR. The Contribution of Differential Opioid Responsiveness to Identification of Opioid Risk in Chronic Pain Patients. THE JOURNAL OF PAIN 2015; 16:666-75. [PMID: 25892658 PMCID: PMC4486517 DOI: 10.1016/j.jpain.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/16/2015] [Accepted: 04/10/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED The Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) predicts increased risk of opioid misuse in chronic pain patients. We evaluated whether higher SOAPP-R scores are associated with greater opioid reinforcing properties, potentially contributing to their predictive utility. Across 2 counterbalanced laboratory sessions, 55 chronic low back pain sufferers completed the SOAPP-R at baseline and measures of back pain intensity, evoked pain responsiveness (thermal, ischemic), and subjective opioid effects after receiving intravenous morphine (.08 mg/kg) or saline placebo. Morphine effect measures were derived for all outcomes, reflecting the difference between morphine and placebo condition values. Higher SOAPP-R scores were significantly associated with greater desire to take morphine again, less feeling down and feeling bad, and greater reductions in sensory low back pain intensity following morphine administration. This latter effect was due primarily to SOAPP-R content assessing medication-specific attitudes and behavior. Individuals exceeding the clinical cutoff (18 or higher) on the SOAPP-R exhibited significantly greater morphine liking, desire to take morphine again, and feeling sedated; less feeling bad; and greater reductions in sensory low back pain following morphine. The SOAPP-R may predict elevated opioid risk in part by tapping into individual differences in opioid reinforcing effects. PERSPECTIVE Based on placebo-controlled morphine responses, associations were observed between higher scores on a common opioid risk screener (SOAPP-R) and greater desire to take morphine again, fewer negative subjective morphine effects, and greater analgesia. Opioids may provide the best analgesia in those patients at greatest risk of opioid misuse.
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Affiliation(s)
- Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - John W Burns
- Department of Behavioral Science, Rush University, Chicago, Illinois
| | | | - Rajnish Gupta
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Melissa Chont
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Erik Schuster
- Department of Behavioral Science, Rush University, Chicago, Illinois
| | - Daria Orlowska
- Department of Behavioral Science, Rush University, Chicago, Illinois
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Shorey RC, Anderson S, Stuart GL. Trait mindfulness and early maladaptive schemas in women seeking residential substance use treatment: A preliminary investigation. ADDICTION RESEARCH & THEORY 2015; 23:280-286. [PMID: 26366142 PMCID: PMC4565622 DOI: 10.3109/16066359.2014.981810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mindfulness has received an abundance of research attention in recent years, largely due to mindfulness-based interventions demonstrating positive mental and physical health outcomes. However, less research has examined individual's trait levels of mindfulness and how it is related to mental health, particularly among individuals seeking substance use treatment. Therefore, in the current study, we examined the relation between trait mindfulness and early maladaptive schemas (EMS), which are dysfunctional cognitive and behavioural patterns that theoretically underlie the development of mental health problems, among women seeking residential substance use treatment. Pre-existing, adult female, patient records from a residential substance abuse treatment facility were reviewed (N = 67). Results demonstrated that higher trait mindfulness was negatively associated with 12 of the 18 EMS. Moreover, patients who endorsed multiple EMS reported lower trait mindfulness than patients who endorsed zero (or one) EMS. These findings are the first to examine the relation between trait mindfulness and EMS among women seeking substance use treatment. Findings suggest that EMS and trait mindfulness are robustly related and future research should examine whether mindfulness-based interventions reduce EMS.
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Affiliation(s)
- Ryan C. Shorey
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Gregory L. Stuart
- Department of Psychology, University of Tennessee, Knoxville, TN, USA
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231
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Witkiewitz K, McCallion E, Vowles KE, Kirouac M, Frohe T, Maisto SA, Hodgson R, Heather N. Association between physical pain and alcohol treatment outcomes: The mediating role of negative affect. J Consult Clin Psychol 2015; 83:1044-57. [PMID: 26098375 DOI: 10.1037/ccp0000033] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Physical pain and negative affect have been described as risk factors for alcohol use following alcohol treatment. The current study was a secondary analysis of 2 clinical trials for alcohol use disorder (AUD) to examine the associations between pain, negative affect and AUD treatment outcomes. METHOD Participants included 1,383 individuals from the COMBINE Study (COMBINE Pharmacotherapies and Behavioral Interventions for Alcohol Dependence; COMBINE Study Research Group, 2003; 31% female, 23% ethnic minorities, average age = 44.4 [SD = 10.2]), a multisite combination pharmacotherapy and behavioral intervention study for AUD in the United States, and 742 individuals from the United Kingdom Alcohol Treatment Trial (UKATT Research Team, 2001; 25.9% female, 4.4% ethnic minorities, average age = 41.6 [SD = 10.1]) a multisite behavioral intervention study for AUD in the United Kingdom. The Form-90 was used to collect alcohol use data, the Short Form Health Survey and Quality of Life measures were used to assess pain, and negative affect was assessed using the Brief Symptom Inventory (COMBINE) and the General Health Questionnaire (UKATT). RESULTS Pain scores were significantly associated with drinking outcomes in both datasets. Greater pain scores were associated with greater negative affect and increases in pain were associated with increases in negative affect. Negative affect significantly mediated the association between pain and drinking outcomes and this effect was moderated by social behavior network therapy (SBNT) in the UKATT study, with SBNT attenuating the association between pain and drinking. CONCLUSION Findings suggest pain and negative affect are associated among individuals in AUD treatment and that negative affect mediated pain may be a risk factor for alcohol relapse.
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Affiliation(s)
| | | | | | | | - Tessa Frohe
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
| | | | | | - Nick Heather
- Department of Psychology, Northumbria University
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Martinez ME, Kearney DJ, Simpson T, Felleman BI, Bernardi N, Sayre G. Challenges to Enrollment and Participation in Mindfulness-Based Stress Reduction Among Veterans: A Qualitative Study. J Altern Complement Med 2015; 21:409-21. [PMID: 26133205 DOI: 10.1089/acm.2014.0324] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mindfulness-Based Stress Reduction (MBSR) is associated with reduced depressive symptoms, quality of life improvements, behavioral activation, and increased acceptance among veterans. This study was conducted to increase the reach and impact of a veterans' MBSR program by identifying barriers to enrollment and participation to inform modifications in program delivery. OBJECTIVE Verify or challenge suspected barriers, and identify previously unrecognized barriers, to enrollment and participation in MBSR among veterans. DESIGN A retrospective qualitative analysis of semistructured interviews. SETTING/LOCATION VA Puget Sound Health Care System (Seattle, WA). SUBJECTS 68 interviewed, and 48 coded and analyzed before reaching saturation. APPROACH Content analysis of semistructured interviews. RESULTS Of the participants who enrolled, most (78%) completed the program and described MBSR positively. Veterans identified insufficient or inaccurate information, scheduling issues, and an aversion to groups as barriers to enrollment. Participants who discontinued the program cited logistics (e.g., scheduling and medical issues), negative reactions to instructors or group members, difficulty understanding the MBSR practice purposes, and struggling to find time for the practices as barriers to completion. Other challenges (cohort dynamics, teacher impact on group structure and focus, instructor lack of military service, and physical and psychological challenges) did not impede participation; we interpreted these as growth-facilitating challenges. Common conditions among veterans (chronic pain, posttraumatic stress disorder, and depression) were not described as barriers to enrollment or completion. CONCLUSIONS Women-only MBSR groups and tele-health MBSR groups could improve accessibility to MBSR for veterans by addressing barriers such as commute anxiety, time restrictions, and an aversion to mixed gender groups among women. Educating MBSR teachers about veteran culture and health challenges faced by veterans, adding psychoeducation materials that relate mindfulness practice to conditions common among veterans, and improving visual aids for mindful movement exercises in the workbook could better accommodate veterans who participate in MBSR.
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Affiliation(s)
| | - David J Kearney
- 2 Department of Medicine, VA Puget Sound Health Care System , Seattle, WA.,3 Department of Medicine, University of Washington School of Medicine , Seattle, WA
| | - Tracy Simpson
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA.,5 Department of Mental Health, VA Puget Sound Health Care System , Seattle, WA
| | | | | | - George Sayre
- 1 VA Puget Sound Health Care System , Seattle, WA.,6 Department of Health Services, University of Washington School of Public Health , Seattle, WA
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Garland EL. Dismantling mindfulness-based cognitive therapy for recurrent depression implicates lack of differential efficacy for mindfulness training. EVIDENCE-BASED MENTAL HEALTH 2015; 17:94. [PMID: 25043437 DOI: 10.1136/eb-2014-101856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Eric L Garland
- College of Social Work and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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Garland EL, Froeliger B, Howard MO. Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT. J Behav Med 2015; 38:327-36. [PMID: 25385024 PMCID: PMC4355224 DOI: 10.1007/s10865-014-9607-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/30/2014] [Indexed: 12/20/2022]
Abstract
Dysregulated processing of natural rewards may be a central pathogenic process in the etiology and maintenance of prescription opioid misuse and addiction among chronic pain patients. This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs). Participants were chronic pain patients at risk for opioid misuse who were randomized to 8 weeks of MORE (n = 11) or a support group control condition (n = 18). ERPs to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and neutral images were measured before and after 8 weeks of treatment. Analyses focused on the late positive potential (LPP)--an ERP response in the 400-1,000 ms time window thought to index allocation of attention to emotional information. Treatment with MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli which were correlated with enhanced positive affective cue-responses and reductions in opioid craving from pre- to post-treatment. Findings suggest that cognitive training regimens centered on strengthening attention to natural rewards may remediate reward processing deficits underpinning addictive behavior.
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Affiliation(s)
- Eric L Garland
- University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA,
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235
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Garland EL, Geschwind N, Peeters F, Wichers M. Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses. Front Psychol 2015; 6:15. [PMID: 25698988 PMCID: PMC4313604 DOI: 10.3389/fpsyg.2015.00015] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/06/2015] [Indexed: 01/01/2023] Open
Abstract
Recent theory suggests that positive psychological processes integral to health may be energized through the self-reinforcing dynamics of an upward spiral to counter emotion dysregulation. The present study examined positive emotion-cognition interactions among individuals in partial remission from depression who had been randomly assigned to treatment with mindfulness-based cognitive therapy (MBCT; n = 64) or a waitlist control condition (n = 66). We hypothesized that MBCT stimulates upward spirals by increasing positive affect and positive cognition. Experience sampling assessed changes in affect and cognition during 6 days before and after treatment, which were analyzed with a series of multilevel and autoregressive latent trajectory models. Findings suggest that MBCT was associated with significant increases in trait positive affect and momentary positive cognition, which were preserved through autoregressive and cross-lagged effects driven by global emotional tone. Findings suggest that daily positive affect and cognition are maintained by an upward spiral that might be promoted by mindfulness training.
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Affiliation(s)
- Eric L Garland
- College Of Social Work, University of Utah, Salt Lake City UT, USA ; Integrative Medicine - Supportive Oncology, Huntsman Cancer Institute, University of Utah Salt Lake City, UT, USA
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Hearn JH, Cotter I, Fine P, A. Finlay K. Living with chronic neuropathic pain after spinal cord injury: an interpretative phenomenological analysis of community experience. Disabil Rehabil 2015; 37:2203-11. [DOI: 10.3109/09638288.2014.1002579] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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237
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Garland EL, Thomas E, Howard MO. Mindfulness-oriented recovery enhancement ameliorates the impact of pain on self-reported psychological and physical function among opioid-using chronic pain patients. J Pain Symptom Manage 2014; 48:1091-9. [PMID: 24780180 PMCID: PMC4209314 DOI: 10.1016/j.jpainsymman.2014.03.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Abstract
CONTEXT Chronic pain impacts one-third of the U.S. population, and its effects are debilitating for individuals and costly to the medical system. Although opioids are commonly prescribed to address chronic pain, they confer risk for misuse and addiction in some patients and may not fully restore life function-particularly with regard to psychosocial factors. Because of the multiplicity of impacts that chronic pain may have on daily functioning, broad-spectrum behavioral interventions are needed. OBJECTIVES The purpose of this study was to conduct follow-up analyses from a pilot randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE) to assess specific effects of MORE on various biopsychosocial aspects of pain-related impairment. METHODS Chronic pain patients (N = 115; mean age, 48 ± 14 years; 68% female) were randomly assigned to either eight weeks of MORE or a support group. Domains of pain-related functional interference were measured with the Brief Pain Inventory at pre- and post-treatment and at a three-month follow-up. Treatment effects were analyzed with multivariate intention-to-treat models. RESULTS MORE participants reported significantly greater reductions in functional interference than support group participants at post-treatment across all domains, including general activity, mood, walking ability, normal work, relationships, sleep, and enjoyment of life. These effects were largely maintained by the three-month follow-up; however, general activity level and walking ability were no longer significant, indicating differential long-term effects between physiological and psychological functioning. CONCLUSION Findings demonstrate preliminary efficacy of MORE as a treatment for pain-related functional impairments and suggest that effects may be more pronounced and durable for aspects of psychological function.
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Affiliation(s)
- Eric L Garland
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA; College of Social Work, University of Utah, Salt Lake City, Utah, USA.
| | - Elizabeth Thomas
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Matthew O Howard
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
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238
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Garland EL, Howard MO. Opioid attentional bias and cue-elicited craving predict future risk of prescription opioid misuse among chronic pain patients. Drug Alcohol Depend 2014; 144:283-7. [PMID: 25282309 PMCID: PMC4252536 DOI: 10.1016/j.drugalcdep.2014.09.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Some chronic pain patients receiving long-term opioid analgesic pharmacotherapy are at risk for misusing opioids. Like other addictive behaviors, risk of opioid misuse may be signaled by an attentional bias (AB) towards drug-related cues. The purpose of this study was to examine opioid AB as a potential predictor of opioid misuse among chronic pain patients following behavioral treatment. METHODS Chronic pain patients taking long-term opioid analgesics (n=47) completed a dot probe task designed to assess opioid AB, as well as self-report measures of opioid misuse and pain severity, and then participated in behavioral treatment. Regression analyses examined opioid AB and cue-elicited craving as predictors of opioid misuse at 3-month posttreatment follow-up. RESULTS Patients who scored high on a measure of opioid misuse risk following treatment exhibited significantly greater opioid AB scores than patients at low risk for opioid misuse. Opioid AB for 200 ms cues and cue-elicited craving significantly predicted opioid misuse risk 20 weeks later, even after controlling for pre-treatment opioid dependence diagnosis, opioid misuse, and pain severity (Model R(2)=.50). CONCLUSION Biased initial attentional orienting to prescription opioid cues and cue-elicited craving may reliably signal future opioid misuse risk following treatment. These measures may therefore provide potential prognostic indicators of treatment outcome.
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Affiliation(s)
- Eric L Garland
- Integrative Medicine, Huntsman Cancer Institute, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States; College of Social Work & Huntsman Cancer Institute, University of Utah, 395 South, 1500 East, Salt Lake City, UT 84112, United States
| | - Matthew O Howard
- University of North Carolina, Chapel Hill, Tate Turner Kuralt Bldg. 325 Pittsboro St. no. 3550, Chapel Hill, NC 27599, United States
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Hanley AW, Garland EL. Dispositional Mindfulness Co-varies with Self-Reported Positive Reappraisal. PERSONALITY AND INDIVIDUAL DIFFERENCES 2014; 66:146-152. [PMID: 24904191 DOI: 10.1016/j.paid.2014.03.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Emerging research suggests that mindfulness is associated with positive reappraisal and that mindfulness practice may be a means of encouraging positive reappraisal capacities. These findings, linking mindfulness with the promotion of cognitive coping strategies, challenge traditional Western conceptualizations of mindfulness as non-discursive. This study explored the relationship between dispositional mindfulness and self-reported positive reappraisal across five distinct samples: a general sample of American adults, contemplative practitioners, college students chronic pain outpatients, and alcohol dependent inpatient. Results indicate that dispositional mindfulness is positively related with self-reported positive reappraisal in all five studies as well as in an aggregated analysis combining all five studies. Furthermore, a second set of analyses statistically controlling for factors previously associated with positive reappraisal (i.e., psychological well-being, positive affect, and positive refocusing), provided evidence that mindfulness is uniquely associated with self-reported positive reappraisal. While more research is needed to refine our understanding of the relationship between mindfulness and positive reappraisal, the present investigation contributes to the growing evidence base supporting the hypothesized link between dispositional mindfulness and self-reported reappraisal by demonstrating a significant association between these constructs across a variety of samples and in the largest combined dataset on this phenomenon collected to date (N=819).
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Garland EL, Froeliger B, Howard MO. Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity. Psychopharmacology (Berl) 2014; 231:3229-38. [PMID: 24595503 PMCID: PMC4111972 DOI: 10.1007/s00213-014-3504-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/08/2014] [Indexed: 12/17/2022]
Abstract
RATIONALE Dysregulated reward processing is a hallmark feature of drug addiction; however, scant research has evaluated restructuring reward processing in the context of addiction treatment. OBJECTIVES We examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on reward responsiveness (RR) and opioid cue-reactivity in a sample of chronic pain patients with opioid use problems. We previously reported that MORE decreased pain, opioid misuse, and craving relative to a social support control group (SG). Here, we examined whether these outcomes were linked to changes in RR in a subset of participants. METHODS Participants were chronic pain patients (71 % women, age 46.6 ± 13.9) who received MORE (n = 20) or SG (n = 29). RR was measured before and after 8 weeks of treatment via heart rate (HR) and heart rate variability (HRV) responses during a dot probe task that included opioid-related, pain-related, and natural reward stimuli, as well as craving ratings. RESULTS The MORE group, who reported decreased opioid misuse and opioid craving during treatment, evidenced less subjective opioid cue-reactivity, greater HR decelerations, and greater increases in HRV to all cues after treatment compared to the SG; HR and HRV effects were most pronounced for natural reward cues. Within the MORE group, HR deceleration to natural reward cues was correlated with increased subjective arousal to the cues, whereas HR deceleration to opioid cues was correlated with decreased subjective arousal. Effects of MORE on craving were mediated by enhanced RR. CONCLUSIONS Results suggest that during treatment with MORE, cardiac-autonomic responsiveness to non-drug reward increases, while reactivity to opioid reward decreases. Studies are needed to discern whether changes in RR were a result or a determinant of reductions in opioid misuse and craving. RR may play a role in addiction treatment.
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Affiliation(s)
- Eric L Garland
- College of Social Work and Huntsman Cancer Institute, University of Utah, 395 South, 1500 East, Salt Lake City, UT, 84112, USA,
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Abstract
Chronic pain is a prevalent problem that exacts a significant toll on society. The medical system has responded to this issue by implementing pain management services centered on opioid pharmacotherapy. However, for many chronic pain patients, the analgesic efficacy of long-term opioids is limited. Moreover, chronic exposure to opioids can result in opioid misuse, addiction, and risk of overdose. As such, non-opioid treatment options are needed. This article first provides a selective review of cognitive, affective, and psychophysiological mechanisms implicated in chronic pain to be targeted by novel non-opioid treatments. Next, it briefly details one such treatment approach, Mindfulness-Oriented Recovery Enhancement, and describes evidence suggesting that this intervention can disrupt the risk chain linking chronic pain to prescription opioid misuse.
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Affiliation(s)
- Eric L Garland
- Integrative Medicine, Supportive Oncology Program, Huntsman Cancer Institute, 395 South, 1500 East, Salt Lake City, UT 84112, USA
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Garland EL, Froeliger B, Howard MO. Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Front Psychiatry 2014; 4:173. [PMID: 24454293 PMCID: PMC3887509 DOI: 10.3389/fpsyt.2013.00173] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/08/2013] [Indexed: 12/12/2022] Open
Abstract
Prominent neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. This review describes how MBIs may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.
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Affiliation(s)
- Eric L Garland
- Supportive Oncology and Survivorship Program, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT , USA ; College of Social Work, University of Utah , Salt Lake City, UT , USA
| | - Brett Froeliger
- Department of Neuroscience, Hollings Cancer Center, Medical University of South Carolina , Charleston, SC , USA
| | - Matthew O Howard
- School of Social Work, University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
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Garland EL, Froeliger B, Zeidan F, Partin K, Howard MO. The downward spiral of chronic pain, prescription opioid misuse, and addiction: cognitive, affective, and neuropsychopharmacologic pathways. Neurosci Biobehav Rev 2013; 37:2597-607. [PMID: 23988582 DOI: 10.1016/j.neubiorev.2013.08.006] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/15/2013] [Indexed: 12/19/2022]
Abstract
Prescription opioid misuse and addiction among chronic pain patients are emerging public health concerns of considerable significance. Estimates suggest that more than 10% of chronic pain patients misuse opioid analgesics, and the number of fatalities related to nonmedical or inappropriate use of prescription opioids is climbing. Because the prevalence and adverse consequences of this threat are increasing, there is a pressing need for research that identifies the biobehavioral risk chain linking chronic pain, opioid analgesia, and addictive behaviors. To that end, the current manuscript draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to prescription opioid misuse and addiction among chronic pain patients receiving opioid analgesic pharmacotherapy. Addictive use of opioids is described as the outcome of a cycle initiated by chronic pain and negative affect and reinforced by opioidergic-dopamingeric interactions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. Implications for clinical practice are discussed; multimodal, mindfulness-oriented treatment is introduced as a potentially effective approach to disrupting the downward spiral and facilitating recovery from chronic pain and opioid addiction.
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Affiliation(s)
- Eric L Garland
- Supportive Oncology & Survivorship Program, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States; College of Social Work, University of Utah, Salt Lake City, UT, United States.
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