Mindfulness and craving: effects and mechanisms

Evaluation of a digital tool for detecting stress and craving in SUD recovery: An observational trial of accuracy and engagement

BACKGROUND

Digital health interventions offer opportunities to expand access to substance use disorder (SUD) treatment, collect objective real-time data, and deliver just-in-time interventions: however implementation has been limited. RAE (Realize, Analyze, Engage) Health is a digital tool which uses continuous physiologic data to detect high risk behavioral states (stress and craving) during SUD recovery.

METHODS

This was an observational study to evaluate the digital stress and craving detection during outpatient SUD treatment. Participants were asked to use the RAE Health app, wear a commercial-grade wrist sensor over a 30-day period. They were asked to self-report stress and craving, at which time were offered brief in-app de-escalation tools. Supervised machine learning algorithms were applied retrospectively to wearable sensor data obtained to develop group-based digital biomarkers for stress and craving. Engagement was assessed by number of days of utilization, and number of hours in a given day of connection.

RESULTS

Sixty percent of participants (N=30) completed the 30-day protocol. The model detected stress and craving correctly 76 % and 69 % of the time, respectively, but with false positive rates of 33 % and 28 % respectively. All models performed close to previously validated models from a research grade sensor. Participants used the app for a mean of 14.2 days (SD 10.1) and 11.7 h per day (SD 8.2). Anxiety disorders were associated with higher mean hours per day connected, and return to drug use events were associated with lower mean hours per day connected.

CONCLUSIONS

Future work should explore the effect of similar digital health systems on treatment outcomes and the optimal dose of digital interventions needed to make a clinically significant impact.

A clinical trial protocol of a single-session self-guided acceptance-based online intervention targeting food cravings as predictors of disordered eating in pregnant people

BACKGROUND

Pregnancy is a time of heightened risk for disordered eating behaviors, which are linked to adverse health outcomes in gestation, delivery, and the postpartum. These adverse outcomes may be partially mediated by greater rates of deviation from recommended weight gain trajectories, especially in those who engage in binge and loss of control (LOC) eating. Food cravings are powerful and highly modifiable triggers of binge and LOC eating in non-pregnant populations with preliminary evidence linking cravings to disordered eating behaviors in pregnancy as well. Acceptance-based approaches have been shown to be feasible and effective in reducing the adverse impact of cravings on behavior.

PURPOSE

To test the feasibility, acceptability, and preliminary efficacy of a single-session, self-guided, acceptance-based online workshop targeting food cravings as predictors of binge and LOC eating in pregnancy.

METHODS

We will conduct a pilot randomized controlled trial of a single-session, self-guided online acceptance-based workshop targeting food cravings in pregnancy. Pregnant individuals in the second trimester (n ≥ 74) endorsing current food cravings will be randomly assigned to the intervention or an untreated control group. The intervention group will participate in a one-hour workshop that imparts skills grounded in Acceptance and Commitment Therapy, including acceptance, defusion, and present-moment awareness. Both groups will complete comprehensive self-report assessments of primary outcomes and hypothesized mediators and moderators of intervention efficacy at baseline, one-month follow-up, and at full-term.

CONCLUSION

Results will inform integration of acceptance-based skills targeting food cravings into routine prenatal care to prevent adverse outcomes associated with disordered eating behaviors in pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT06129461; registered on November 10, 2023.

High-mind wandering correlates with high risk for problematic alcohol use in China and Germany

Everyone experiences the natural ebb and flow of task-unrelated thoughts. Given how common the fluctuations in these thoughts are, surprisingly, we know very little about how they shape individuals' responses to alcohol use. Here, we investigated if mind wandering is associated with a risk of developing problematic alcohol use. We undertook an online survey among the general population in China (N = 1123) and Germany (N = 1018) from December 2021 to February 2022 and examined the subjective experience of mind wandering and problematic alcohol use through the Mind Wandering Questionnaire (MWQ) and the Alcohol Use Disorders Identification Test (AUDIT). We compared mind wandering and problematic alcohol use between two countries and investigated the association between MWQ scores with AUDIT scores. We found higher scores on the MWQ and a high percentage of problematic alcohol use (i.e., AUDIT score ≥ 8) in Germany (22.5%) as compared to in China (14.5%). Higher self-reported mind wandering was associated with higher AUDIT scores. AUDIT scores were increased mostly in male, elder, and high-mind wandering people. Our findings highlight that mind wandering and problematic alcohol use enhanced in Germany as compared to in China. Our study sheds light on the relationship between mind wandering and problematic alcohol use that may help to further investigate causal effects of interventions.

Ultra-Brief Breath Counting (Mindfulness) Training Abolishes Negative Affect-Induced Alcohol Motivation in Hazardous Community Drinkers

Objectives

Mindfulness therapy improves drinking outcomes arguably by attenuating negative mood-induced drinking, but this mechanism has not been demonstrated in hazardous community drinkers. To address this, three studies tested whether a key ingredient of mindfulness, breath counting, would attenuate the increase in motivation for alcohol produced by experimentally induced negative mood, in hazardous community drinkers.

Method

In three studies, hazardous community drinkers were randomized to receive either a 6-min breath counting training or listen to a recited extract from a popular science book, before all participants received a negative mood induction. Motivation for alcohol was measured before and after listening to either the breath counting training or the control audio files, with a craving questionnaire in two online studies (n = 122 and n = 111), or an alcohol versus food picture choice task in a pub context in one in-person study (n = 62).

Results

In Study 1, breath counting reduced alcohol craving. However, since the mood induction protocol did not increase craving, the effect of breath counting in reversing such increase could not be demonstrated. Online breath counting eliminated the increase in alcohol craving induced by negative mood (Study 2) and eliminated the stress-induced increase in alcohol picture choice in the pub environment (Study 3).

Conclusions

Briefly trained breath counting attenuated negative mood-induced alcohol motivation in hazardous community drinkers. These results suggest that breath counting is a reliable and practical method for reducing the impact of negative emotional triggers on alcohol motivation.

Preregistration

These studies are not preregistered.

A prevention program for binge drinking among students based on mindfulness and implementation intention (ALCOMEDIIT): a randomized controlled trial

BACKGROUND

The emergence of new problematic alcohol consumption practices among young people requires new dynamics in prevention strategies. In this context, the ADUC project (Alcohol and Drugs at the University of Caen) aims to develop a better understanding of alcohol consumption, and in particular the practice of binge drinking (BD) in students, in order to develop relevant and adapted prevention tools. The ALCOMEDIIT study (Rin Normandie and IRESP funding; Agreement 20II31-00 - ADUC part 3) is a randomized controlled trial that focuses on the specific determinant of impulsivity. The main objective of this experiment is to assess a program for the prevention of BD practices based on motivational interviewing (MI) associated with implementation intention (II) and mindfulness meditation (MBM) in a student environment.

METHODS

This study will include 170 healthy subjects who will be students at the university, alcohol users, with a BD score > 1 in the month preceding the inclusion but not presenting any specific disorder. The trial will be proposed by e-mail and students who meet the inclusion criteria will join either a control group which will benefit from a MI or an experimental group which will additionally benefit from an initiation to MBM with II (initial visit T0). In order to measure the effectiveness of the prevention program in terms of BD decrease, a follow-up at 1 month (T1) as well as a follow-up at 6 months (T6; exploratory) will be proposed to all participants. The total duration of this research protocol is 21 months.

DISCUSSION

The purpose of this study is to evaluate the interest of associating mindfulness meditation practices and implementation of self-regulation strategies to optimize their use, with a motivational interview in an innovative prevention program aiming at reducing alcohol use and BD practice in the student population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05565989, September 30, 2022. https://clinicaltrials.gov/study/NCT05565989 Protocol version 2.0 (September 2022) No.

ID-RCB

2022-A00983-40.

Motives and food craving: Associations with frequency of hyper-palatable food intake among college students

BACKGROUND

College food environments provide wide access to hyper-palatable foods (HPF). Palatable eating motives and craving are individual factors that may impact HPF intake. Nevertheless, no study to date has examined the relationship between these factors and frequency of HPF intake in a dormitory all-you-can-eat-style cafeteria meal, a typical college food setting.

METHODS

College students (N = 218) self-reported frequency of HPF intake at a college cafeteria meal and their frequency of HPF intake in the overall diet. Quasipoisson and logistic regression models tested whether palatable eating motives (assessed via the Palatable Eating Motives Scale) and craving (assessed via the Food Craving Inventory) were associated with the rate of HPF intake during the cafeteria meal and excess frequency of HPF intake in the overall diet.

RESULTS

Craving was associated with a 19% higher rate of HPF intake during the cafeteria meal (RR = 1.19; p = .015) and a >2-fold higher likelihood of excess frequency of HPF intake the overall diet (OR = 2.69; p < .001). Coping motive was associated with an 87% higher likelihood of excess frequency of HPF intake in the overall diet (OR = 1.87; p = .002), but not in the cafeteria meal. Reward enhancement, social and conformity motives were not significantly associated with the frequency of HPF intake in either setting.

CONCLUSIONS

Results highlight the role of craving and coping motive in the frequency of HPF intake among college students. Prevention efforts may consider targeting craving and eating to cope to potentially address frequency of HPF intake among college students.

Mindfulness interventions for craving reduction in substance use disorders and behavioral addictions: systematic review and meta-analysis of randomized controlled trials

BACKGROUND

High-quality evidence is still required to affirm the efficacy of mindfulness-based interventions (MBIs) in craving reduction. MBIs may be particularly appropriate for this purpose given the neurobiological mechanisms of addiction with automatic behavior in response to the negative affect. In this systematic review and meta-analysis, we aimed to study the efficacy of MBIs in craving reduction and to synthetize the newly published data.

METHODS

We searched four databases and three clinical trial registries for randomized controlled trials (RCTs) up to August 2023, including studies with MBIs in all types of substance use disorders or behavioral addictions. We chose as our outcome of interest the change from the baseline of craving measures at posttreatment. Standardized mean difference was used as an effect size estimator.

RESULTS

We included 17 RCTs with 1228 participants. The overall effect size was estimated at -0.70 (95% CI -1.15, -0.26) in favor of MBIs.

CONCLUSION

Due to the high inconsistency (I2 = 92%), we were unable to conclude that there is a medium to large effect size. Overall risk of bias was high for most studies, and the GRADE approach detected a low quality of evidence. Previous clinical and fundamental research suggest that MBIs have a promising potential in addiction medicine. However, further investigation of whether MBIs effectively reduce craving is needed, and innovative solutions for resolving methodological limitations in MBI research are warranted.

TRIAL REGISTRATION

PROSPERO registration ID CRD42020221141.

Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial

BACKGROUND

Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity.

OBJECTIVE

This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ≥25 kg/m2) to improve health outcomes.

METHODS

The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews.

RESULTS

We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language.

CONCLUSIONS

This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women.

Can mindful eating buffer against the influence of neighbourhood fast food exposure on unhealthy food intake?

A food-abundant environment is associated with unhealthy food intake, but not everyone is affected to the same degree. Mindful eating, which is eating with attention and awareness, has been associated with less external eating and less food cravings, and could act as a protective factor against influences from the food environment. The current study aimed to investigate whether the association between exposure to fast-food around the home and unhealthy food intake was moderated by mindful eating. The study was conducted in 1086 Dutch adults of 55 years and older of the Longitudinal Aging Study Amsterdam study. The mindful eating domains (Mindful Eating Behavior Scale) were tested as moderating variables in the linear regression models with absolute and relative density of fast-food outlets in the neighbourhood (400, 800 and 1600m) as independent variables and unhealthy food intake (snacks (g/d)) and saturated fat as a percentage of total energy intake (en%)) as dependent variable. Bootstrapping with 5000 samples using the pick-a-point approach showed that after adjustments, only two out of 48 interactions terms were statistically significant: Eating with Awareness (EwA) and Eating without Distraction (EwD) moderated the positive association between the relative density of fast-food outlets and saturated fat (en%) respectively in a buffer of 800m (interaction EwA: B = -0.84, 95% CI [-1.46; -0.22]) and in a buffer of 1600m (interaction EwD: B = -0.82, 95% CI [-1.61; -0.04]). The results of the current study indicate that mindful eating cannot buffer against the influence of the fast-food abundant environment on unhealthy food intake. Future research is needed to confirm these findings, for example in younger populations.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

"I see myself": Craving imagery among individuals with addictive disorders

Craving has been put forward as a core feature of addictive disorders.

The present qualitative study investigated the experience of craving among individuals with addictive disorders and recent experiences of cravings.

Eleven individuals with Gambling Disorder and ten with Alcohol Use Disorder (n = 21) were recruited. A semi-structured interview explored: (1) modes of thought during craving (mental imagery or verbal thoughts), (2) craving content, (3) coping strategies and (4) craving context.

The thematic analysis showed that cravings were initially dominated by imagery, with a subsequent conflict between imagery and verbal thoughts. Craving content included imagery of preparative rituals, anticipation, and sensory activation, imagery of the addictive behavior "me, there and then imagery" and anticipating that "something good will come out of it." Some participants related to craving as a symptom of sickness, and coping with craving were through distraction, reminding oneself of negative consequences, or via sensory control: avoiding stimuli associated with the addiction. Craving contexts included typical settings of drinking or gambling and engagement of both positive and negative emotions. Alcohol craving was described as an expected relief from internal stimuli, such as anxiety or stress, whereas gambling craving was more often described as an expectancy of financial reward.

Craving was experienced mainly through imagery containing the preparative routines and expected outcomes. Future research and clinical practice should incorporate mode of thought in cravings to better understand its role in the maintenance of the disorders and their treatment.

Supplemental data for this article is available online at https://doi.org/10.1080/10550887.2022.2058299 .

Neurobiological mechanisms and related clinical treatment of addiction: a review

Drug addiction or substance use disorder (SUD), has been conceptualized as a three-stage (i.e. binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation/craving) recurring cycle that involves complex changes in neuroplasticity, reward, motivation, desire, stress, memory, and cognitive control, and other related brain regions and brain circuits. Neuroimaging approaches, including magnetic resonance imaging, have been key to mapping neurobiological changes correlated to complex brain regions of SUD. In this review, we highlight the neurobiological mechanisms of these three stages of addiction. The abnormal activity of the ventral tegmental, nucleus accumbens, and caudate nucleus in the binge/intoxication stage involve the reward circuit of the midbrain limbic system. The changes in the orbitofrontal cortex, dorsolateral prefrontal cortex, amygdala, and hypothalamus emotional system in the withdrawal/negative affect stage involve increases in negative emotional states, dysphoric-like effects, and stress-like responses. The dysregulation of the insula and prefrontal lobes is associated with craving in the anticipation stage. Then, we review the present treatments of SUD based on these neuroimaging findings. Finally, we conclude that SUD is a chronically relapsing disorder with complex neurobiological mechanisms and multimodal stages, of which the craving stage with high relapse rate may be the key element in treatment efficacy of SUD. Precise interventions targeting different stages of SUD and characteristics of individuals might serve as a potential therapeutic strategy for SUD.

Metacognition, Desire Thinking and Craving in Problematic Video Game Use

Gaming addiction is now a prevalent and persistent phenomenon in modern society. This study aimed to assess the metacognitive model of desire thinking and craving in explaining problematic video game use and to examine the role that specific motives for gaming have towards positive metacognitions about desire thinking. A sample of participants (N = 186) aged between 18 and 58 years old, who were primarily male (81.8%), played online games and met the inclusion criteria for Internet gaming disorder, completed an online survey, and the data were cross-sectionally analysed. Specifically, path analysis confirmed that the metacognitive model of desire thinking and craving was predictive of gaming-related cognitions and cravings. Furthermore, an expanded model, which included measures of psychopathology, suggested that anger and anxiety may magnify the driving metacognitive and cognitive processes underlying cravings. Finally, a multiple regression revealed that gaming for escapism, coping and skill development associated with stronger positive metacognitions about desire thinking. The findings of this study reinforced the importance of understanding motive when exploring problematic gaming and provided support for the role of metacognitions about desire thinking in shaping video game use cravings. Such findings could benefit both research and practice in their approach to understanding and intervening on problematic gaming behaviours.

Mindfulness as a Protective Factor Against Increased Tobacco and Alcohol Use in Hospital Workers Following the First COVID-19-Related Lockdown: a Study in Southern France

COVID-19-related national lockdowns worldwide have had repercussions on people's well-being and have led to increased substance use. Mindfulness has previously been associated with reduced psychological distress and benefits in terms of addictive behaviors. We aimed to assess whether dispositional mindfulness protected against increased tobacco and alcohol use in hospital workers after France's first lockdown started. All workers in two French hospitals were contacted by email to participate in an online survey. Three hundred eighty-five workers answered. We ran two separate logistic regression models to test for associations between the level of dispositional mindfulness and both increased tobacco and alcohol use, after adjusting for affect deterioration. Dispositional mindfulness was associated with a lower likelihood of increased tobacco (adjusted odds ratio (AOR) [95% CI] 0.71 [0.51; 0.99], p = 0.046) and alcohol (0.66 [0.50; 0.87], p = 0.004) use. The effect of mindfulness on tobacco use was partially mediated by affect deterioration. Dispositional mindfulness appeared to be a protective factor against lockdown-related tobacco and alcohol use increases in French hospital workers.

Cognitive Defusion as Strategy to Reduce the Intensity of Craving Episodes and Improve Eating Behavior

The elaborated intrusion theory of desire proposes that craving is a cognitive motivational process involving intrusive thoughts. Changing the way we react to them, cognitive defusion (CD), should limit thought elaboration and craving. We induced chocolate craving in female chocolate cravers before CD (Study 1). A decrease in craving measured by a single-item scale, Visual Analogical Scale (VAS; p < .001, ηp2 = .449) and as a state, State Food Craving Questionnaire (FCQ-S; p = .029, ηp2 = .106) were found in the experimental group, while similar results were also found in group control. The reduction in craving (VAS) in group CD correlated negatively with chocolate consumption on a bogus taste test (r = –.439, p = .036), while the correlation was positive in the case of group control (r = .429, p = .047). Food craving as a trait, measured by the Trait Food Craving Questionnaire (FCQ-T), showed negative correlations with measures of CD and mindfulness skills (lowest r = –.313, p = .018). In Study 2 participants made use of a smartphone application implementing the CD procedure in real contexts whenever they experienced food craving. A corresponding decline in self-reported craving was found, as well as in consumption of the craved food (indulgence) compared with the control condition. Our findings indicate that CD may be a promising intervention for tackling the elaboration of intrusive thoughts and eating behavior in young female food cravers, both in a controlled laboratory environment after a cue-food exposure craving induction procedure, as well as responding to naturally occurring food cravings in real-life settings.

Decision-making, interoceptive awareness and mindful attention awareness in male patients with alcohol use disorder

INTRODUCTION

Decision-making deficits in individuals with alcohol use disorder (AUD) may be partly related to their decreased interoceptive awareness (IA), which is associated with some aspects of mindfulness.

METHODS

52 abstinent male inpatients with AUD (current severity: moderate or severe) and 52 healthy male volunteers performed the heart rate tracking task and a computerised version of the Iowa gambling task (IGT). Trait mindfulness was evaluated with the mindful attention awareness scale (MAAS).

RESULTS

Heartbeat perception (HBP), MAAS, and IGT scores of patients with AUD were significantly lower than those of healthy controls. The difference between groups with respect to IGT scores did not remain significant after controlling for the covariates, and HBP scores were linked significantly to the subjects' IGT performance. HBP scores significantly predicted IGT scores of both the overall sample and patients. MAAS scores did not correlate significantly with HBP and IGT scores in either the patient or control group.

CONCLUSION

It is possible that IA plays a role in decision-making and decreased interoceptive accuracy is a predictor of impaired decision-making in individuals with AUD. More empirical data are needed to develop a better insight into the relationship between IA and multi-dimensional nature of mindfulness.

Examining the Relationships between Mindfulness and Tobacco Craving Factors

BACKGROUND

Relationships between mindfulness and general craving have been documented. However, there is still no data regarding relationships between mindfulness and the different craving factors.

METHODS

Using data from an online survey among hospital workers smoking tobacco in France (n = 127), we performed linear regression models with the four craving factors as outcomes, and dispositional mindfulness as explanatory variable.

RESULTS

After adjusting for nicotine dependence, mindfulness was negatively associated with general craving and three out of four craving factors (emotionality, compulsivity and purposefulness, but not expectancy).

CONCLUSIONS

These results support the implementation of mindfulness-based interventions in the context of tobacco cessation attempt.

Does an acute bout of moderate exercise reduce alcohol craving in university students?

Craving is considered to be a vital contributor to the onset and maintenance of alcohol misuse. However, there is little known about its potential moderators and there are few interventions that specifically target these cravings. Exercise generates multiple psychological and physiological effects that in theory may reduce craving, and therefore we hypothesised that a short exercise circuit may potentially alter reward circuits. Recent research centred around neuroimaging studies suggests that similar reward circuits in the brain stimulated through exercise are also found to be activated by commonly misused substances such as alcohol. Peripheral levels of dopamine, norepinephrine, and serotonin, as well as the release of endorphins that would otherwise be artificially stimulated using alcohol are hypothesised to increase via alternate substitution induced by exercise. Exercise would thus replace effects of alcohol use to a substantial extent, and therefore was theorised to decrease craving and subsequently reduce hazardous alcohol use. A university student sample who reported hazardous drinking levels participated in either an exercise, colouring (as an active control) or a passive control intervention, and self-reported alcohol craving, mood, anxiety, and positive and negative affect scores were assessed. The present study found that a short exercise circuit significantly reduced alcohol craving, whilst also eliciting beneficial effects on mood and anxiety. This knowledge will help aid the utilisation of exercise as a potential therapeutic tool to reduce alcohol craving, prevent hazardous alcohol use and develop a greater understanding of the mechanisms that underlie addictive behaviour.

Mindfulness buffers the influence of stress on cue-induced craving for Internet among Chinese colleges with problematic Internet use

BACKGROUND AND AIMS

Stress is a common experience among college students with problematic Internet use, and it may exacerbate their cue-induced Internet craving. This study aimed to examine the influence of stress on cue-induced craving for the Internet among subjects with problematic Internet use and the buffering effect of mindfulness.

METHODS

Sixty-eight college students with problematic Internet use were assigned to groups with a 2 (stress vs. no-stress) × 2 (high vs. low mindfulness) between-subject design.

RESULTS

It was deduced that stress could significantly enhance cue-induced craving for the Internet, and mindfulness could buffer this effect. Specifically, the effect of stress on cue-induced craving for the Internet was weaker among subjects with high mindfulness as compared to subjects with low mindfulness.

DISCUSSION AND CONCLUSIONS

These findings contribute to understanding of the factors influencing problematic Internet use and how such factors interact. It also provides recommendations on how to prevent the progression of problematic Internet use and suggests possible interventions.

The SEEKING Drive and Its Fixation: A Neuro-Psycho-Evolutionary Approach to the Pathology of Addiction

Neuro-ethological studies conducted by Panksepp and his colleagues have provided an understanding of how the activity of the mesolimbic dopaminergic (ML DA) system leads to the emotional disposition to SEEK/Explore, which is involved in all appetitive motivated behavior and mental activity. In pathological addiction phenomena, this emotional disposition “fixes” itself on certain obsessive-compulsive habits, losing its versatility and its natural predisposition to spontaneous and unconditioned activation. Overall, the result is a consistent disinterest in everything that is not the object of addiction. From a neuro-psycho-evolutionary point of view, the predisposition to develop addictive behavior can be attributed to a loss of “functional autonomy” of the SEEKING/Explorative disposition. Indeed, as shown by animal and human studies, the tendency to be conditioned by situations and contexts that provide an immediate reward can be closely related to a deficit in the tonic endogenous activity of the ML DA-SEEKING system.

Craving mediates the association between momentary pain and illicit opioid use during treatment for opioid-use disorder: an ecological momentary assessment study

AIM

To assess the role of momentary pain on opioid craving and illicit opioid use among individuals receiving opioid agonist treatment.

DESIGN

Observational study using ecological momentary assessment.

SETTING

The National Institute of Drug Abuse Intramural Research Program in the United States.

PARTICIPANTS

Fifty-six adults who qualified for opioid agonist treatment.

MEASUREMENTS

Participants completed randomly prompted assessments of pain severity, stress, negative mood, opioid craving and illicit opioid use for a mean of 66 days [standard deviation (SD) = 27]. Urine samples were collected two to three times/week throughout.

FINDINGS

Almost 70% of participants reported moderate average pain severity in the past 24 hours at intake and 35% of participants reported chronic pain. There were no significant differences in percent of opioid-positive urine samples (P = 0.73) and average level of opioid craving during the study period (P = 0.91) among opioid agonist treatment only patients versus opioid agonist treatment patients with chronic pain. However, momentary pain severity significantly predicted concurrent opioid craving [B = 0.02, 95% confidence interval (CI) = 0.01, 0.04], over and above stress and negative mood. Momentary opioid craving, in turn, significantly predicted illicit opioid use that was assessed in the next moment [odds ratio (OR) = 1.72, 95% CI = 1.12, 2.64), while controlling for autocorrelation and the effects of pain, negative mood and stress. Momentary opioid craving significantly mediated the prospective association between momentary pain and illicit opioid use (95% CI = 0.003, 0.032). Exploratory analysis revealed that momentary pain severity also significantly moderated the momentary association between stress and opioid craving (B = 0.02, 95% CI = 0.00, 0.04), such that when momentary pain severity increased, the association between the two intensified.

CONCLUSIONS

Among people receiving opioid agonist treatment, momentary pain appears to be indirectly associated with illicit opioid use via momentary opioid craving.

The effect of visualisation and mindfulness-based decentering on chocolate craving

According to the elaborated intrusion (EI) theory of desire, loading visual working memory should help prevent and reduce cravings because cravings occur when intrusive thoughts are elaborated upon in working memory, often as vivid mental images. Mindfulness-based decentering strategies may also help prevent and reduce cravings since they may divert attention away from craving-related thoughts and mental imagery. To compare the effects of visualisation versus decentering on cravings, participants (N = 108) were randomly assigned to one of three conditions: (a) decentering, (b) visualisation, (c) mind-wandering control. Participants in each condition received two audio exercises: (1) a 2-min exercise, preceding a craving induction but after initial deprivation and cue exposure, (2) a 4-min exercise, following a craving induction. The audios instructed participants to look at a plate of chocolate that was in front of them whilst either (a) decentering from their thoughts and feelings, (b) engaging in visualisation or (c) letting their mind wander. Participants were asked to rate the strength of their cravings at four time points (Time 1, baseline; Time 2, after the 2-min audio; Time 3, post-craving induction; Time 4, post-4 minute audio). Frequency of craving-related thoughts was also measured at Time 4. Compared to the control condition, results showed a significant reduction in strength of cravings for the decentering condition after both the 2-min audio and the 4-min audio. Decentering was superior to visualisation only after the 2-min audio. Participants in both the visualisation and decentering conditions also had significantly lower frequencies of craving-related thoughts compared to control participants. The findings support EI theory and suggest that mindfulness-based decentering strategies may be useful for both the prevention and reduction of cravings. Pre-registration: https://osf.io/jv3pq.

Realize, Analyze, Engage (RAE): A Digital Tool to Support Recovery from Substance Use Disorder

Background:

Substance use disorders are a highly prevalent group of chronic diseases with devastating individual and public health consequences. Current treatment strategies suffer from high rates of relapse, or return to drug use, and novel solutions are desperately needed. Realize Analyze Engage (RAE) is a digital, mHealth intervention that focusses on real time, objective detection of high-risk events (stress and drug craving) to deploy just-in-time supportive interventions. The present study aims to (1) evaluate the accuracy and usability of the RAE system and (2) evaluate the impact of RAE on patient centered outcomes.

Methods:

The first phase of the study will be an observational trial of N = 50 participants in outpatient treatment for SUD using the RAE system for 30 days. Accuracy of craving and stress detection algorithms will be evaluated, and usability of RAE will be explored via semi-structured interviews with participants and focus groups with SUD treatment clinicians. The second phase of the study will be a randomized controlled trial of RAE vs usual care to evaluate rates of return to use, retention in treatment, and quality of life.

Anticipated findings and future directions:

The RAE platform is a potentially powerful tool to de-escalate stress and craving outside of the clinical milieu, and to connect with a support system needed most. RAE also aims to provide clinicians with actionable insight to understand patients’ level of risk, and contextual clues for their triggers in order to provide more personalized recovery support.

An Eight-Week Mindful Eating Program Applied in a Mediterranean Population With Overweight or Obesity: The EATT Intervention Study

BACKGROUND

Overweight and obesity are important public health priorities. Mindful eating can contribute in preventing automatic eating behavior and emotional dysregulation, both being primary causes of overeating and negative body image. This research outlines an eight-week mindful eating intervention (i.e., project EATT) focusing on people with overweight or obesity in assisting positive behavioral, psychological and physiological change.

METHODS

Fifty-seven people residing in Athens were recruited to participate in this research, where participants were allocated to either an experimental or a waitlist condition. Changes in body weight, and eating attitude, mindfulness, self-compassion, anxiety questionnaires were administered at baseline and post-intervention, and at a 14-month follow-up.

RESULTS

Results indicated that mindfulness and self-compassion increased significantly, while anxiety symptoms decreased. Significance was also observed in reduction of overeating symptoms and oral control. While a negative relationship was observed between anxiety and mindfulness, and anxiety and self-compassion, self-compassion was negatively associated with overeating episodes.

CONCLUSIONS

The intervention improved participants' relationship with food and enabled changes towards successful weight regulation.

Targeting automatic processes to reduce unhealthy behaviours: a process framework

While previous frameworks to address health behaviours through targeting underlying automatic processes have stimulated an improved understanding of related interventions, deciding between intervention strategies often remains essentially arbitrary and atheoretical. Making considered decisions has likely been hampered by the lack of a framework that guides the selection of different intervention strategies targeting automatic processes to reduce unhealthy behaviours. We propose a process framework to fulfil this need, building upon the process model of emotion regulation. This framework differentiates types of intervention strategies along the timeline of the unfolding automatic response, distinguishing between three broad classes of intervention strategies - direct antecedent, indirect antecedent, and response-focused. Antecedent-focused strategies aim to prevent the exposure to or activation of automatic responses directly through the avoidance of unwanted stimulus-response associations (i.e., situation modification or situation-specific response selection), or indirectly through automatising self-control (i.e., attentional deployment or cognitive change). Response-focused strategies aim to directly downregulate automatic unwanted responses (i.e., response modulation). Three main working hypotheses derived from this process framework provide practical guidance for selecting interventions, but await direct testing in future studies.

Coping With COVID-19: Mindfulness-Based Approaches for Mitigating Mental Health Crisis

The novel coronavirus disease COVID-19 that first emerged in Wuhan, China, in Nov-Dec 2019 has already impacted a significant proportion of the world population. Governments of many countries imposed quarantines and social distancing measures in 2020, many of which remain in place, to mitigate the spread of the SARS-Cov-2 virus causing the COVID-19 disease. The direct impact of COVID-19 on people infected with the virus, their families and the health care workers, as well as the impact of the mitigation measures such as quarantine, social distancing, and self-isolation on the rest of the population have contributed to a global mental health pandemic, including anxiety, depression, panic attacks, posttraumatic stress symptoms, psychosis, addiction, obsessive-compulsive disorder, and suicidality. These effects are present acutely (for example, due to fear of contamination or losing loved ones, effects of quarantine/isolation, withdrawal of community and social services, etc.) and may continue long after the pandemic is over (for example, due to bereavement, unemployment, financial losses, etc). The COVID-19 pandemic has triggered mental health problems in people without previous history of mental illness, as well as worsened the symptoms in those with pre-existing psychiatric diagnosis. Therefore, the global effort is called for to deal with this mental health pandemic secondary to COVID-19 itself to address the emergence of new as well as the exacerbation of the existing mental health issues. Conversely, this global context provides an extraordinary opportunity for studying individual differences in response to and resilience in the face of physical and psychological threat, challenge to "normal" way of life, and long-term uncertainty. In this viewpoint article we outline the particular suitability of mindfulness, its skills and mechanisms, as an approach to the prevention and management of mental health issues, as well as to the promotion of well-being and building the foundations of adaptability and flexibility in dealing with the long-term uncertainty and profound changes to the social, economic, and possibly political systems as this pandemic continues to unfold.

Desire thinking promotes decisions to game: The mediating role between gaming urges and everyday decision-making in recreational gamers

INTRODUCTION

Desire thinking is a voluntary cognitive process that involves the imaginal forecast of a desired activity and the verbal perseveration with plans and good reasons for engaging in it. Considering theoretical models arguing that specific decision-making processes may be involved in the development of gaming disorder, we hypothesized that an initial urge to game might be accelerated by desire thinking, leading to the decision to game in an everyday setting although the gaming behavior may conflict with another activity or certain other goals.

METHODS

A pre-study helped developing a catalogue of situations that provides forced-choice scenarios warranting a decision for or against gaming. To explore the postulated sequence of cognitive and affective events, a serial mediation model with urge to game as predictor, decision to game as dependent variable, and imaginal prefiguration and verbal perseveration as mediators was tested in a sample of 118 recreational gamers with varying degrees of gaming intensity.

RESULTS

The pre-study revealed a catalogue of 18 conflicting situations that likely happen in the daily life of gamers, containing conflicting activities such as job/educational performance and meeting friends/family/acquaintances. In the sequential mediation model, the desire thinking facets imaginal prefiguration and verbal perseveration fully mediated the relation between an initial urge and the decision to game.

CONCLUSIONS

The mediation model emphasizes the serial ordinance of desire thinking facets and their role in motivating decisions to game after an initial urge has been experienced. Results may indicate that desire thinking plays a considerable role in problematic gaming tendencies.

Mindfulness, mood, and food: The mediating role of positive affect

With rates of overweight and obesity rising worldwide, it is important to examine psychological factors associated with food intake. Previous research has shown that mindfulness may serve as a protective factor against overconsumption of food. Some studies have posited that mindfulness addresses unhealthy eating by promoting the increased awareness of, and decreased responsiveness to, internal emotional cues. The present study investigated the effects of a brief mindfulness induction on positive and negative affect and subsequent energy intake in a sample of undergraduate students (N = 126). After exposure to a negative mood induction, 63 participants were randomly assigned to a brief mindfulness intervention, while the remaining participants listened to a news article. Subsequently all participants were offered healthful and unhealthful snack foods. Although there was not a significant between-group difference in intake, a multiple mediation model indicated that positive affect, but not negative affect, significantly mediated the association between condition and food intake. Relative to controls, those in the experimental condition reported higher positive affect after the mindfulness induction, which in turn reduced their energy intake. Further exploratory analyses indicated that positive affect in the experimental group was associated with reduced consumption of unhealthful food. These findings provide insight into how mindfulness-based interventions may target unhealthy eating behaviors.

The Psychology of Food Cravings: the Role of Food Deprivation

PURPOSE OF REVIEW

Dieting is often blamed for causing food cravings. Such diet-induced cravings may be mediated by physiological (e.g., nutritional deprivation) or psychological (e.g., ironic effects of food thought suppression) mechanisms. However, this notion is often based on cross-sectional findings and, thus, the causal role of food deprivation on food cravings is unclear.

RECENT FINDINGS

Experimental studies suggest that a short-term, selective food deprivation seems to indeed increase cravings for the avoided foods. However, experimental studies also show that food craving can be understood as a conditioned response that, therefore, can also be unlearned. This is supported by intervention studies which indicate that long-term energy restriction results in a reduction of food cravings in overweight adults. Dieting's bad reputation for increasing food cravings is only partially true as the relationship between food restriction and craving is more complex. While short-term, selective food deprivation may indeed increase food cravings, long-term energy restriction seems to decrease food cravings, suggesting that food deprivation can also facilitate extinction of conditioned food craving responses.

Chronic stress, executive functioning, and real-life self-control: An experience sampling study

OBJECTIVE

To test the hypothesis that chronic stress impairs the use of cognitive control for self-control, we examined how chronic stress affects the relation between individual differences in general executive functioning (GEF) and self-control in real-life situations.

METHOD

About 338 young adults with varying degrees of chronic stress underwent experience sampling of real-life self-control for 7 days and completed a battery of nine executive function tasks from which a latent variable representing individual differences in GEF was derived.

RESULTS

Structural equation models showed that higher levels of chronic stress were associated with stronger desires and a less negative relationship between GEF and desire strength. Chronic stress and GEF did not predict desire enactment in situations where effortful resistance was attempted.

CONCLUSIONS

These findings suggest that chronic stress may impair self-control by reducing the use of cognitive control for "early" desire regulation strategies while leaving "late" resistance strategies unaffected. That relationships between executive functioning and real-life self-control can be moderated by third factors such as chronic stress may to some extent explain the common finding of weak or missing associations between laboratory measures of executive functioning and real-life self-control.

Self-Regulation Without Force: Can Awareness Leverage Reward to Drive Behavior Change?

To reach longer-term goals and live aligned with their values, people typically must regulate their behavior. Effortful self-control is one way to achieve this and is usually framed as a forceful struggle between lower-level impulses and higher-level cognitive control processes. For example, people may restrain themselves from eating cake in order to lose weight. An alternative avenue of self-regulation draws on autonomous motivation: Individuals eat healthfully because it is values-congruent or intrinsically satisfying. Recent advances in the understanding of reward valuation on a neural level (e.g., ventromedial prefrontal cortex/orbitofrontal cortex) and emerging treatments on a clinical level (e.g., mindfulness training) suggest a possible mechanistic convergence between brain and behavior that is consistent with a shift from forced to unforced behavior change. Here we propose how an overlooked aspect of reinforcement learning can be leveraged using a simple yet critical feature of experience that is not reliant on willpower: Bringing awareness to one's subjective experience and behavior can produce a change in valuation of learned but unhealthy behaviors, leading to self-regulatory shifts that result in sustainable behavior change without force.

Does food intake mediate the association between mindful eating and change in depressive symptoms?

OBJECTIVE

To examine mediation by (i) diet quality and (ii) diet quantity in the associations of mindful eating domains with 3-year change in depressive symptoms.

DESIGN

Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale at baseline and 3-year follow-up. Four mindful eating domains (Focused Eating; Eating in response to Hunger and Satiety Cues; Eating with Awareness; Eating without Distraction) were measured with the Mindful Eating Behavior Scale. Food intake was measured with a 238-item FFQ. Diet quality was defined as the Mediterranean Diet Score (MDS). Diet quantity was defined as total energy intake (kcal/d; 1 kcal = 4·184 kJ). Mediation analyses with percentile-corrected bootstrap confidence intervals were conducted to calculate indirect effects.

SETTING

Longitudinal Aging Study Amsterdam.

PARTICIPANTS

Adults aged 55 years or above (n 929).

RESULTS

Diet quality (MDS) did not mediate associations of any of the four mindful eating domains with change in depressive symptoms. In contrast, total energy intake did mediate the associations with change in depressive symptoms for the mindful eating domains Eating with Awareness (indirect effects fully adjusted models: B = -0·014, 95 % CI -0·037, -0·002) and Eating without Distraction (B = -0·013, 95 % CI -0·033, -0·001), but not for the other two domains. Post hoc multiple mediation analyses showed similar results.

CONCLUSIONS

Higher scores on two mindful eating domains were associated with a decrease in depressive symptoms through lower total energy intake. Diet quantity, but not diet quality, could be a possible underlying mechanism in the associations between mindful eating and change in depressive symptoms.

Stress Allostasis in Substance Use Disorders: Promise, Progress, and Emerging Priorities in Clinical Research

Clinicians and researchers alike have long believed that stressors play a pivotal etiologic role in risk, maintenance, and/or relapse of alcohol and other substance use disorders (SUDs). Numerous seminal and contemporary theories on SUD etiology posit that stressors may motivate drug use and that individuals who use drugs chronically may display altered responses to stressors. We use foundational basic stress biology research as a lens through which to evaluate critically the available evidence to support these key stress-SUD theses in humans. Additionally, we examine the field's success to date in targeting stressors and stress allostasis in treatments for SUDs. We conclude with our recommendations for how best to advance our understanding of the relationship between stressors and drug use, and we discuss clinical implications for treatment development.

Wearable sensor-based detection of stress and craving in patients during treatment for substance use disorder: A mixed methods pilot study

AIMS

To determine the accuracy of a wearable sensor to detect and differentiate episodes of self-reported craving and stress in individuals with substance use disorders, and to assess acceptability, barriers, and facilitators to sensor-based monitoring in this population.

METHODS

This was an observational mixed methods pilot study. Adults enrolled in an outpatient treatment program for a substance use disorder wore a non-invasive wrist-mounted sensor for four days and self-reported episodes of stress and craving. Continuous physiologic data (accelerometry, skin conductance, skin temperature, and heart rate) were extracted from the sensors and analyzed via various machine learning algorithms. Semi-structured interviews were conducted upon study completion, and thematic analysis was conducted on qualitative data from semi-structured interviews.

RESULTS

Thirty individuals completed the protocol, and 43 % (N = 13) were female. A total of 41 craving and 104 stress events were analyzed. The differentiation accuracies of the top performing models were as follows: stress vs. non-stress states 74.5 % (AUC 0.82), craving vs. no-craving 75.7 % (AUC 0.82), and craving vs. stress 76.8 % (AUC 0.8). Overall participant perception was positive, and acceptability was high. Emergent themes from the exit interviews included a perception of connectedness and increased mindfulness related to wearing the sensor, both of which were reported as helpful to recovery. Barriers to engagement included interference with other daily wear items, and perceived stigma.

CONCLUSIONS

Wearable sensors can be used to objectively differentiate episodes of craving and stress, and individuals in recovery from substance use disorder are accepting of continuous monitoring with these devices.

Psychometric properties of the transaddiction craving triggers questionnaire in alcohol use disorder

OBJECTIVES

We aimed to develop the transaddiction craving triggers questionnaire (TCTQ), which assesses the propensity of specific situations and contexts to trigger craving and to test its psychometric properties in alcohol use disorder (AUD).

METHODS

This study included a sample of 111 AUD outpatients. We performed exploratory factor analysis (EFA) and calculated item-dimension correlations. Internal consistency was measured with Cronbach's alpha coefficient. Construct validity was assessed through Spearman correlations with craving, emotional symptoms, impulsivity, mindfulness, and drinking characteristics.

RESULTS

The EFA suggested a 3-factor solution: unpleasant affect, pleasant affect, and cues and related thoughts. Cronbach's coefficient alpha ranged from .80 to .95 for the three factors and the total score. Weak positive correlations were identified between the TCTQ and drinking outcomes, and moderate correlation were found between the TCTQ and craving strength, impulsivity, anxiety, depression, and impact of alcohol on quality of life.

CONCLUSIONS

The 3-factor structure is congruent with the well-established propensity of emotions and cues to trigger craving. Construct validity is supported by close relations between the TCTQ and psychological well-being rather than between the TCTQ and drinking behaviors. Longitudinal validation is warranted to assess sensitivity to change of the TCTQ and to explore its psychometric properties in other addictive disorders.

Ultra-brief breath counting (mindfulness) training promotes recovery from stress-induced alcohol-seeking in student drinkers

The therapeutic effect of mindfulness interventions on problematic drinking is thought to be driven by increased resilience to the impact of stress on negative mood and alcohol-seeking behaviour, but this claim needs empirical support. To address this hypothesis, the current study tested whether brief training of one component of mindfulness - breath counting - would reduce drinkers' sensitivity to the effect of noise stress on subjective mood and alcohol-seeking behaviour. Baseline alcohol-seeking was measured by choice to view alcohol versus food thumbnail pictures in 192 student drinkers. Participants then received a 6-minute audio file which either trained breath counting or recited a popular science extract, in separate groups. All participants were then stressed by a loud industrial noise and alcohol-seeking was measured again simultaneously to quantify the change from baseline. Subjective mood was measured after all three stages (baseline, post intervention, post stress test). The breath counting group were instructed to deploy this technique during the stress test. Results showed that the breath counting versus control intervention improved subjective mood relative to baseline, attenuated the worsening of subjective mood produced by stress induction, and accelerated recovery from a stress induced increase in alcohol-seeking behaviour. Exploratory moderation analysis showed that this accelerated recovery from stress induced alcohol-seeking by breath counting was weaker in more alcohol dependent participants. Mindfulness therapies may improve problematic drinking by increasing resilience to stress induced negative mood and alcohol-seeking, as observed in this study. The weaker therapeutic effect of breath counting in more dependent drinkers may reveal limitations to this intervention strategy.

Reducing Risky Alcohol Use via Smartphone App Skills Training Among Adult Internet Help-Seekers: A Randomized Pilot Trial

Alcohol is one of the leading risk factors for global disease burden and overconsumption leads to a wide variety of negative consequences in everyday life. Digital interventions have shown small positive effects in contributing to reductions in problematic use. Specific research on smartphone apps is sparse and the few studies published indicate effects ranging from negative or null to small or moderate. TeleCoach™, a web-based skills training smartphone app, has shown positive effects in non-treatment-seeking university students with excessive drinking. This pilot trial aimed to evaluate app effects in a sample of internet help-seekers from the general population in Sweden. A total of 89 participants were recruited via online advertisement. Following baseline assessment for hazardous use, they were randomized to TeleCoach or a web-based control app offering brief information and advice regarding problematic alcohol use. The primary outcome was number of standard drinks per week; secondary outcomes included drinking quantity and frequency, binge drinking and blood alcohol count measures as well as app user data and comorbidity related to depression, anxiety, and drug use. Analysis of baseline and 6-week follow-up outcomes showed significant within-group effects on alcohol consumption but no significant between-group differences. Effect sizes for the within-group changes in the primary outcome over time were significant [F(1, 55)=43.98; p < 0.001], with a Cohen's d of 1.37 for the intervention group and 0.92 for the control group. This difference in effect sizes indicated that continuation of the study as a large randomized, controlled trial with up to 1,000 participants could be worthwhile.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier NCT03696888.

Beyond path diagrams: Enhancing applied structural equation modeling research through data visualization

INTRODUCTION

Structural equation modeling (SEM) is a multivariate data analytic technique used in many domains of addictive behaviors research. SEM results are usually summarized and communicated through statistical tables and path diagrams, which emphasize path coefficients and global fit without showing specific quantitative values of data points that underlie the model results. Data visualization methods are often absent in SEM research, which may limit the quality and impact of SEM research by reducing data transparency, obscuring unexpected data anomalies and unmodeled heterogeneity, and inhibiting the communication of SEM research findings to research stakeholders who do not have advanced statistical training in SEM.

METHODS AND RESULTS

In this report, we show how data visualization methods can address these limitations and improve the quality of SEM-based addictive behaviors research. We first introduce SEM and data visualization methodologies and differentiate data visualizations from model visualizations that are commonly used in SEM, such as path diagrams. We then discuss ways researchers may utilize data visualization in SEM research, including by obtaining estimates of latent variables and by visualizing multivariate relations in two-dimensional figures. R syntax is provided to help others generate data visualizations for several types of effects commonly modeled in SEM, including correlation, regression, moderation, and simple mediation.

DISCUSSION

The techniques outlined here may help spur the use of data visualization in SEM-based addictive behaviors research. Using data visualization in SEM may enhance methodological transparency and improve communication of research findings.

The (Lack of) Replication of Self-Reported Mindfulness as a Mechanism of Change in Mindfulness-Based Relapse Prevention for Substance Use Disorders

The development and evaluation of mindfulness-based interventions for a variety of psychological and medical disorders has grown exponentially over the past 20 years. Yet, calls for increasing the rigor of mindfulness research and recognition of the difficulties of conducting research on the topic of mindfulness have also increased. One of the major difficulties is the measurement of mindfulness, with varying definitions across studies and ambiguity with respect to the meaning of mindfulness. There is also concern about the reproducibility of findings given few attempts at replication. The current secondary analysis addressed the issue of reproducibility and robustness of the construct of self-reported mindfulness across two separate randomized clinical trials of mindfulness-based relapse prevention (MBRP), as an aftercare treatment for substance use disorder. Specifically, we tested the robustness of our previously published findings, which identified a latent construct of mindfulness as a significant mediator of the effect of MBRP on reducing craving following treatment. First, we attempted to replicate the findings in a separate randomized clinical trial of MBRP. Second, we conducted sensitivity analyses to test the assumption of the no-omitted confounder bias in a mediation model. The effect of MBRP on self-reported mindfulness and overall mediation effect failed to replicate in a new sample. The effect of self-reported mindfulness in predicting craving following treatment did replicate and was robust to the no-omitted confounder bias. The results of this work shine a light on the difficulties in the measurement of mindfulness and the importance of examining the robustness of findings.

Implicit evaluation of chocolate and motivational need states interact in predicting chocolate intake in everyday life

Snack food consumption has a high relevance for health and is partially controlled by implicit, motivational processes that make self-control difficult at certain times. Specifically, research suggests that individuals with a more positive implicit food evaluation consume more snack foods in the laboratory under conditions of high motivational needs (e.g., hunger and food craving). Yet, no study investigated if and under which circumstances implicit evaluation of food predicts snack food intake in real life. In the present study, 60 female undergraduate students (mean age: 22.3 ± 2.34 years) at the University of Salzburg, Austria, completed a chocolate-related Single Category Implicit Association Test in the laboratory and then reported snack food intake during seven days of signal-contingent Ecological Momentary Assessment. Results showed that a more positive implicit evaluation of chocolate was associated with a higher likelihood of consuming chocolate in states of high hunger and high momentary chocolate craving, whereas no such modulatory pattern was found in states of low hunger or low chocolate craving. Therefore, interventions targeting daily chocolate craving and consumption may be particularly beneficial in specific situations (i.e., in states of high hunger and craving) and also in vulnerable populations (e.g., those with a more positive implicit food evaluation).

A Critical Examination of the Practical Implications Derived from the Food Addiction Concept

PURPOSE OF REVIEW

Adopting an addiction perspective on eating disorders and obesity may have practical implications for diagnostic classification, prevention, and treatment of these disorders. The present article critically examines these implications derived from the food addiction concept.

RECENT FINDINGS

Introducing food addiction as a new disorder in diagnostic classification system seems redundant as most individuals with an addiction-like eating behavior are already covered by established eating disorder diagnoses. Food addiction may be a useful metaphor in the treatment of binge eating, but would be inappropriate for the majority of obese individuals. Implying an addiction to certain foods is not necessary when applying certain approaches inspired by the addiction field for prevention and treatment of obesity. The usefulness of abstinence models in the treatment of eating disorders and obesity needs to be rigorously tested in future studies. Some practical implications derived from the food addiction concept provide promising avenues for future research (e.g., using an addiction framework in the treatment of binge eating or applying abstinence models). For others, however, the necessity of implying an addiction to some foods needs to be scrutinized.

Mindfulness Meditation and Psychopathology

Mindfulness meditation is increasingly incorporated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology. Here, we review the current understanding of mindfulness meditation through the lens of clinical neuroscience, outlining the core capacities targeted by mindfulness meditation and mapping them onto cognitive and affective constructs of the Research Domain Criteria matrix proposed by the National Institute of Mental Health. We review efficacious applications of mindfulness meditation to specific domains of psychopathology including depression, anxiety, chronic pain, and substance abuse, as well as emerging efforts related to attention disorders, traumatic stress, dysregulated eating, and serious mental illness. Priorities for future research include pinpointing mechanisms, refining methodology, and improving implementation. Mindfulness meditation is a promising basis for interventions, with particular potential relevance to psychiatric comorbidity. The successes and challenges of mindfulness meditation research are instructive for broader interactions between contemplative traditions and clinical psychological science.

Can Mindfulness Address Maladaptive Eating Behaviors? Why Traditional Diet Plans Fail and How New Mechanistic Insights May Lead to Novel Interventions

Emotional and other maladaptive eating behaviors develop in response to a diversity of triggers, from psychological stress to the endless external cues in our modern food environment. While the standard approach to food- and weight-related concerns has been weight-loss through dietary restriction, these interventions have produced little long-term benefit, and may be counterproductive. A growing understanding of the behavioral and neurobiological mechanisms that underpin habit formation may explain why this approach has largely failed, and pave the way for a new generation of non-pharmacologic interventions. Here, we first review how modern food environments interact with human biology to promote reward-related eating through associative learning, i.e., operant conditioning. We also review how operant conditioning (positive and negative reinforcement) cultivates habit-based reward-related eating, and how current diet paradigms may not directly target such eating. Further, we describe how mindfulness training that targets reward-based learning may constitute an appropriate intervention to rewire the learning process around eating. We conclude with examples that illustrate how teaching patients to tap into and act on intrinsic (e.g., enjoying healthy eating, not overeating, and self-compassion) rather than extrinsic reward mechanisms (e.g., weighing oneself), is a promising new direction in improving individuals' relationship with food.

The effect of a mindfulness-based decentering strategy on chocolate craving

According to the elaborated-intrusion theory of desire, strategies that load visual working memory will reduce cravings. According to the grounded cognition theory of desire, cravings will be reduced with mindfulness-based decentering strategies that encourage individuals to see their thoughts as thoughts. However, decentering strategies also tend to load visual working memory making it difficult to test the latter prediction. This study addressed this issue by matching visualization across decentering and guided imagery tasks. Male and female participants (n = 101) underwent a chocolate craving induction before listening to a 4-min audio recording that guided them to (a) decenter from their thoughts and feelings, (b) engage in visualization, or (c) let their mind wander. Participants reported on chocolate craving before and after the craving induction and following the 4-min recording. They also provided retrospective reports of craving during the recording, reported on the extent to which they had adhered to the audio instructions and briefly indicated what they had been thinking about during the recording. Results showed a significant reduction in cravings to baseline following the recording across all three conditions (p < .001), but no significant differences between conditions or in the retrospective reports of craving. There was some evidence to suggest that participants in the mind wandering condition had been thinking about alternate goals, which may have inhibited thoughts about chocolate and been just as effective at reducing craving as the imagery and decentering strategies. Exploratory analyses showed a trend toward decentering being more effective than imagery where participants reported higher task adherence throughout the 4 min (p = .067). This raises the possibility that decentering effects may be improved with better strategy adherence, which might be achieved through practice or increased motivation.