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Horvath M, Grutman A, O'Malley SS, Gueorguieva R, Khan N, Brewer JA, Garrison KA. Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial. JMIR Res Protoc 2021; 10:e32521. [PMID: 34783663 PMCID: PMC8663689 DOI: 10.2196/32521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods Daily smokers (N=100, ≥5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a “mindful smoking” exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a “RAIN” (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID) DERR1-10.2196/32521
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Affiliation(s)
- Mark Horvath
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | | | | | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Nashmia Khan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Judson A Brewer
- Department of Behavior and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Kathleen A Garrison
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
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Sala M, Roos CR, Brewer JA, Garrison KA. Awareness, affect, and craving during smoking cessation: An experience sampling study. Health Psychol 2021; 40:578-586. [PMID: 34570534 PMCID: PMC8629854 DOI: 10.1037/hea0001105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mindfulness has received attention in smoking cessation research, yet the mechanisms by which mindfulness may promote smoking cessation are not well understood. Mindfulness training may help individuals increase awareness and respond skillfully to processes that contribute to smoking, such as affective states and craving. This study used experience sampling (ES) to test how awareness was related to craving, positive and negative affect and smoking, in the moment, among smokers in treatment for smoking cessation. METHOD Participants (N = 228) were part of a clinical trial evaluating Craving to Quit, a smartphone app for mindfulness training for smoking cessation, compared to an app delivering only ES. All participants were asked to complete 22 days of ES, with up to 6 ES surveys per day, measuring awareness, craving, positive and negative affect and smoking. Data were analyzed using multilevel linear modeling. RESULTS Both at the within and between-person level, higher awareness was associated with higher positive affect, lower craving and lower negative affect. Lower within-person craving was associated with lower smoking. Within-person awareness, positive and negative affect were not significantly associated with smoking. At the between-person level, higher awareness and higher positive affect, and lower negative affect and lower craving were associated with lower smoking. CONCLUSIONS Awareness of current experience was related to key psychological variables linked to behavior change in smoking cessation, namely positive and negative affect and craving, among smokers trying to quit. Future studies should test whether learning to increase awareness, such as through mindfulness training, may benefit smokers in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Jean FAM, Sibon I, Husky M, Couffinhal T, Swendsen J. Feasibility and validity of Ecological Momentary Assessment in patients with acute coronary syndrome. BMC Cardiovasc Disord 2020; 20:499. [PMID: 33246420 PMCID: PMC7694267 DOI: 10.1186/s12872-020-01774-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 11/08/2020] [Indexed: 11/20/2022] Open
Abstract
Background In recent years, Ecological Momentary Assessment (EMA) has expanded rapidly in healthcare research but its application specifically to the field of cardiology has been limited. This study presents essential information concerning the feasibility and validity of EMA in patients with acute coronary syndrome. Methods Four months after a first-ever acute coronary syndrome, 47 patients completed EMA five times a day for seven consecutive days concerning their current activities, mood and perceived negativity or positivity of daily events. Results Compliance with the repeated electronic assessments was high, and no evidence was found for time-dependent biases such as fatigue or practice effects. The resulting EMA data were found to have high internal validity, high reliability when considering average scores, and low reliability when considering within-person variance. Conclusions We found evidence for the feasibility and intrinsic validity of EMA in patients with acute coronary syndrome. Research examining daily life experiences, symptoms and therapeutic adherence in this population can be reinforced through the use of mobile technologies.
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Affiliation(s)
- François A M Jean
- Department of Psychiatry, Dr Jean Eric Techer Hospital, Calais, France
| | - Igor Sibon
- Centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | | | - Thierry Couffinhal
- Institut national de la sante et de la recherche medicale (U1034), Bordeaux, France
| | - Joel Swendsen
- Centre national pour la recherche scientifique (INCIA, CNRS 5287), 146 rue Léo Saignat, Bordeaux, France. .,Ecole Pratiques de Hautes Etudes, PSL University, Paris, France.
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Staiger PK, O'Donnell R, Liknaitzky P, Bush R, Milward J. Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade. J Med Internet Res 2020; 22:e17156. [PMID: 33231555 PMCID: PMC7723745 DOI: 10.2196/17156] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled.
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Affiliation(s)
- Petra Karin Staiger
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia.,Centre for Drug Use, Addictive and Anti-social behaviour Research (CEDAAR), Deakin University, Geelong, Australia
| | - Renee O'Donnell
- Monash Centre of Health Research and Implementation, Monash University, Clayton, Australia
| | - Paul Liknaitzky
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia
| | - Rachel Bush
- School of Psychology, Deakin University, Faculty of Health, Geelong, Australia
| | - Joanna Milward
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
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Schwebel FJ, Korecki JR, Witkiewitz K. Addictive Behavior Change and Mindfulness-Based Interventions: Current Research and Future Directions. CURRENT ADDICTION REPORTS 2020; 7:117-124. [PMID: 33585158 PMCID: PMC7879483 DOI: 10.1007/s40429-020-00302-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Addictive behaviors are difficult to change and result in high rates of relapse following change attempts. A number of effective treatment approaches have been developed to treat addictive behaviors (e.g., cognitive behavioral therapies). More recently, there has been an increase in the development and evaluation of mindfulness-based interventions for addictive behaviors. This article discusses the history of mindfulness-based interventions for addictive behaviors and recent advances in treatment. RECENT FINDINGS Mindfulness-based interventions are as effective as existing evidence-based treatments for addictive behaviors. Further understanding of the neurobiological changes that occur could help identify the components of mindfulness-based interventions that are most helpful and which individuals may benefit most from mindfulness-based intervention. SUMMARY Additional large scale randomized controlled trials are needed for a better understanding of the effectiveness of mindfulness-based interventions. Future research should look at optimizing mindfulness-based interventions for specific settings and patient populations, as well as dissemination and implementation.
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Affiliation(s)
- Frank J. Schwebel
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, USA
| | | | - Katie Witkiewitz
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, USA
- Department of Psychology, University of New Mexico, Albuquerque, USA
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Bai S, Elavsky S, Kishida M, Dvořáková K, Greenberg MT. Effects of mindfulness training on daily stress response in college students: Ecological momentary assessment of a randomized controlled trial. Mindfulness (N Y) 2020; 11:1433-1445. [PMID: 33343764 DOI: 10.1007/s12671-020-01358-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Mindfulness training has been shown to reduce rates of depression, anxiety and perceived stress, but its impact on stress and emotion regulation in real-world settings in the college-aged population is unknown. This study examines the effect of an 8-session long mindfulness training on first-year college students' daily experiences of stress and emotion regulation. Methods Fifty-two first-year students were randomized to the mindfulness training or the waitlist-control group during the fall academic semester. Before, during and after the trial, students completed 10-days of ecological momentary assessments (EMA), reporting on family and school or work stress, negative emotion, rumination, and interference by unwanted thoughts and emotions up to four times a day. Multilevel regression analysis compared levels of momentary stress and emotion regulation difficulties, as well as the strength of the moment-level association between stress and emotion regulation, by intervention condition, before, during and after the trial. Results Controls showed an exacerbation of family stress related negative emotion, rumination and interference, across the fall semester. However, intervention youth showed stable levels of emotion regulation responses to family stress across the semester. Emotion regulation responses to school or work stress did not differ by intervention condition. Conclusions Mindfulness training helps to prevent the depletion of emotion regulation capacity in this sample of relatively healthy first-year college students. EMAs allow the assessment of emotion regulation in the context of naturally occurring stress, and enhances the specificity and external validity of evaluations of psychological interventions.
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Affiliation(s)
- Sunhye Bai
- Department of Human Development and Family Studies, The Pennsylvania State University.,Division of Child and Adolescent Psychiatry, University of California, Los Angeles
| | - Steriani Elavsky
- Institute for Research on Children, Youth and Family, Masaryk University, Czech Republic
| | - Moé Kishida
- College of Health Solutions, Arizona State University
| | - Kamila Dvořáková
- The Prevention Research Center, The Pennsylvania State University
| | - Mark T Greenberg
- Department of Human Development and Family Studies, The Pennsylvania State University.,The Prevention Research Center, The Pennsylvania State University
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Kang D, Fairbairn CE, Ariss TA. A meta-analysis of the effect of substance use interventions on emotion outcomes. J Consult Clin Psychol 2019; 87:1106-1123. [PMID: 31724427 PMCID: PMC6859954 DOI: 10.1037/ccp0000450] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. METHOD A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). RESULTS Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). CONCLUSIONS Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
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Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
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Lotfalian S, Spears CA, Juliano LM. The effects of mindfulness-based yogic breathing on craving, affect, and smoking behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:351-359. [PMID: 31750699 DOI: 10.1037/adb0000536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Breathing practices are often incorporated into treatments for tobacco dependence, but there is little direct research testing the efficacy of breathing practices. This study examined the effects of a mindfulness-based yogic breathing (MB) intervention versus active treatment (cognitive strategy [CS]) and no-treatment (NT) control groups on craving, affect, withdrawal, and smoking behavior. Smokers (N = 60; 50% female; 83% African American) were randomized to receive 20 min of MB, CS, or NT. Participants completed self-report measures before and after the manipulation and then took part in a 50-min smoking choice procedure. Afterward, participants were advised to use the techniques they learned and self-monitor smoking for 24 hr. They received 3 reminder text messages and returned to the lab the following day. MB and CS were more effective than NT in decreasing craving to smoke and perceived nicotine withdrawal. MB, but not CS, was more effective than NT in reducing negative affect. MB reduced the risk of smoking by more than twofold relative to both CS and NT during the smoking choice procedure. Participants in the MB condition smoked fewer cigarettes than those in the CS and NT conditions in the 24 hr following the manipulation. There were no differential effects of the manipulations on state mindfulness or positive affect. Mindful yogic breathing appears to be particularly effective in alleviating the acute negative effects of smoking abstinence and decreasing smoking behavior. Mindful breathing techniques are safe, simple, and cost-effective strategies that deserve additional research attention, especially among underserved populations of smokers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Claire A Spears
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University
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Schumer MC, Lindsay EK, Creswell JD. Brief mindfulness training for negative affectivity: A systematic review and meta-analysis. J Consult Clin Psychol 2019; 86:569-583. [PMID: 29939051 DOI: 10.1037/ccp0000324] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Over the last 10 years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multisession interventions lasting up to 2 weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity. METHOD PubMed, PsycINFO, and the Mindfulness Research Monthly Newsletter were systematically searched for brief mindfulness intervention RCTs assessing negative affectivity outcomes (e.g., depression, rumination, anxiety, stress). Sixty-five RCTs, including 5,489 participants predominantly without experience in meditation (64.64% female, mean age = 24.62), qualified for the meta-analytic review. RESULTS The meta-analysis revealed a small but significant effect of brief mindfulness training on reducing negative affectivity compared to control programs (g = .21, p < .001). The overall effect size was significantly moderated by participant characteristics: community samples (g = .41, p < .001) produced larger training effects compared to student samples (g = .14, p = .001; Qbetween p = .03). No significant effect size differences were found between clinical and nonclinical samples. However, when accounting for publication bias, the overall effect size of brief mindfulness training programs on negative affectivity was significantly reduced (g = .04). CONCLUSIONS Brief mindfulness training programs are increasingly popular approaches for reducing negative affectivity. This meta-analysis indicates that brief mindfulness training modestly reduces negative affectivity. Quantitative analyses indicated the presence of publication bias (i.e., unpublished null effect studies), highlighting the need to continue rigorous evaluation of brief mindfulness interventions. (PsycINFO Database Record
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Yaghubi M, Zargar F. Effectiveness of Mindfulness-based Relapse Prevention on Quality of Life and Craving in Methadone-treated Patients: A Randomized Clinical Trial. ADDICTION & HEALTH 2019; 10:250-259. [PMID: 31263524 PMCID: PMC6593172 DOI: 10.22122/ahj.v10i4.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Quality of life (QOL) is always considered as a final consequence of clinical trials, interventions, and health care. The results of studies indicate that addiction leads to lower QOL. However, studies have been conducted on the effectiveness of mindfulness-based interventions on improving QOL. The aim of this study was to investigate the efficacy of mindfulness-based relapse prevention (MBRP) on QOL and craving in methadone-treated patients. Methods This study was conducted in Qom, Iran, in 2017. A sample of 70 methadone-treated patients were randomly selected and assigned to two groups (intervention and control). Participants in both groups completed the 36-item Short Form (SF-36) QOL Questionnaire and Craving Beliefs Questionnaire (CBQ) at the beginning of the study (pre-test), 8 weeks after the study (post-test), and two months after the study (follow up). In this study, the experimental group received 8 training sessions on mindfulness prevention, while the control group did not receive general information about addiction and did not receive any psychological intervention. Finally, data of 63 patients were analyzed with the SPSS software, chi-square test, t-test, and repeated-measures ANOVA. Findings The results of repeated-measures ANOVA showed that there was no significant difference between intervention and control groups in the pre-test, but MBRP in the intervention group significantly increased the scores of QOL and decreased the scores of craving, significantly (P < 0.001). Conclusion The findings of present study indicate that MBRP training can increase the psychological and physical health in dependent methadone-treated patients and decrease craving. These findings suggest that mindfulness training can be used as an effective intervention for improving QOL and reducing craving.
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Affiliation(s)
- Mehdi Yaghubi
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Zargar
- Associate Professor, Department of Psychiatry, School of Medicine AND Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Priddy SE, Howard MO, Hanley AW, Riquino MR, Friberg-Felsted K, Garland EL. Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications. Subst Abuse Rehabil 2018; 9:103-114. [PMID: 30532612 PMCID: PMC6247953 DOI: 10.2147/sar.s145201] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Substance use disorders (SUDs) are a pervasive public health problem with deleterious consequences for individuals, families, and society. Furthermore, SUD intervention is complicated by the continuous possibility of relapse. Despite decades of research, SUD relapse rates remain high, underscoring the need for more effective treatments. Scientific findings indicate that SUDs are driven by dysregulation of neural processes underlying reward learning and executive functioning. Emerging evidence suggests that mindfulness training can target these neurocognitive mechanisms to produce significant therapeutic effects on SUDs and prevent relapse. The purpose of this manuscript is to review the cognitive, affective, and neural mechanisms underlying the effects of mindfulness-based interventions (MBIs) on SUDs. We discuss the etiology of addiction and neurocognitive processes related to the development and maintenance of SUDs. We then explore evidence supporting use of MBIs for intervening in SUDs and preventing relapse. Finally, we provide clinical recommendations about how these therapeutic mechanisms might be applied to intervening in SUDs and preventing relapse.
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Affiliation(s)
- Sarah E Priddy
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | - Matthew O Howard
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Adam W Hanley
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | - Michael R Riquino
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
| | | | - Eric L Garland
- College of Social Work, Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA,
- College of Social Work, University of Utah, Salt Lake City, UT, USA,
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13
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Nicotine dependence, internalizing symptoms, mood variability and daily tobacco use among young adult smokers. Addict Behav 2018; 83:87-94. [PMID: 28943065 DOI: 10.1016/j.addbeh.2017.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/07/2017] [Accepted: 09/13/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Cigarette use among young adults continues to rise. As young adults transition to college and assume other adult roles and responsibilities, they are at risk for the development of mental health problems and for the progression of substance use problems. Previous studies suggest that individual differences in negative and positive mood contribute to cigarette use in established college-aged smokers, but less is known whether fluctuations in mood influence daily cigarette use, controlling for trait levels of internalizing symptoms and nicotine dependence. METHODS Data for this study came from a sample of college students (N=39, 59% female, mean age 20.4years) who reported regular cigarette use and participated in a 21-day ecological momentary assessment (EMA) study assessing within-individual variation in cigarette use and mood. RESULTS A three-level hierarchical linear model accounting for the structure of 1896 occasions of cigarette use nested within days and individuals indicated that within-individual variability in positive mood was associated with cigarette use at each occasion, after taking into account baseline levels of nicotine dependence and internalizing problems. CONCLUSIONS Daily shifts in positive moods are importantly associated with consuming cigarettes throughout the day.
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Alayan N, Eller L, Bates ME, Carmody DP. Current Evidence on Heart Rate Variability Biofeedback as a Complementary Anticraving Intervention. J Altern Complement Med 2018; 24:1039-1050. [PMID: 29782180 DOI: 10.1089/acm.2018.0019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The limited success of conventional anticraving interventions encourages research into new treatment strategies. Heart rate variability biofeedback (HRVB), which is based on slowed breathing, was shown to improve symptom severity in various disorders. HRVB, and certain rates of controlled breathing (CB), may offer therapeutic potential as a complementary drug-free treatment option to help control substance craving. METHODS This review evaluated current evidence on the effectiveness of HRVB and CB training as a complementary anticraving intervention, based on guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies that assessed a cardiorespiratory feedback or CB intervention with substance craving as an outcome were selected. Effect sizes were calculated for each study. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to evaluate the quality of each study reviewed. RESULTS A total of eight articles remained for final review, including controlled studies with or without randomization, as well as noncontrolled trials. Most studies showed positive results with a variety of methodological quality levels and effect size. Current HRVB studies rated moderately on methodological rigor and showed inconsistent magnitudes of calculated effect size (0.074-0.727) across populations. The largest effect size was found in a nonclinical college population of high food cravers utilizing the most intensive HRVB training time of 240 min. CONCLUSIONS Despite the limitations of this review, there is beginning evidence that HRVB and CB training can be of significant therapeutic potential. Larger clinical trials are needed with methodological improvements such as longer treatment duration, adequate control conditions, measures of adherence and compliance, longitudinal examination of craving changes, and more comprehensive methods of craving measurement.
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Affiliation(s)
- Nour Alayan
- 1 Hariri School of Nursing, American University of Beirut , Beirut, Lebanon
| | - Lucille Eller
- 2 School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey
| | - Marsha E Bates
- 3 Department of Kinesiology and Health, Rutgers, The State University of New Jersey , Piscataway, New Jersey
| | - Dennis P Carmody
- 2 School of Nursing, Rutgers, The State University of New Jersey , Newark, New Jersey
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Andreu CI, Cosmelli D, Slagter HA, Franken IHA. Effects of a brief mindfulness-meditation intervention on neural measures of response inhibition in cigarette smokers. PLoS One 2018; 13:e0191661. [PMID: 29370256 PMCID: PMC5784955 DOI: 10.1371/journal.pone.0191661] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/09/2018] [Indexed: 12/11/2022] Open
Abstract
Research suggests that mindfulness-practices may aid smoking cessation. Yet, the neural mechanisms underlying the effects of mindfulness-practices on smoking are unclear. Response inhibition is a main deficit in addiction, is associated with relapse, and could therefore be a candidate target for mindfulness-based practices. The current study hence investigated the effects of a brief mindfulness-practice on response inhibition in smokers using behavioral and electroencephalography (EEG) measures. Fifty participants (33 females, mean age 20 years old) underwent a protocol of cigarette exposure to induce craving (cue-exposure) and were then randomly assigned to a group receiving mindfulness-instructions or control-instructions (for 15 minutes approximately). Immediately after this, they performed a smoking Go/NoGo task, while their brain activity was recorded. At the behavioral level, no group differences were observed. However, EEG analyses revealed a decrease in P3 amplitude during NoGo vs. Go trials in the mindfulness versus control group. The lower P3 amplitude might indicate less-effortful response inhibition after the mindfulness-practice, and suggest that enhanced response inhibition underlies observed positive effects of mindfulness on smoking behavior.
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Affiliation(s)
- Catherine I. Andreu
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Diego Cosmelli
- Escuela de Psicología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Heleen A. Slagter
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Ingmar H. A. Franken
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
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16
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MacIntyre JM, Ruscio AC, Brede E, Waters AJ. Emotion dysregulation and negative affect: Laboratory and EMA investigations in smokers. Addict Behav Rep 2018; 7:65-70. [PMID: 29687075 PMCID: PMC5910452 DOI: 10.1016/j.abrep.2018.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Difficulties in emotion regulation are associated with addictive behaviors, including smoking. Difficulties in emotion regulation may underlie large, rapid changes in negative affect that can increase likelihood of relapse. We investigated the association between emotion regulation ability and negative affect in smokers assessed both in the laboratory and in the field using Ecological Momentary Assessment. Methods Adult community smokers (N = 44) carried a personal digital assistant (PDA) for two weeks and were instructed to complete assessments of negative affect multiple times per day. Participants were instructed that they could smoke as much or as little as they liked. The Difficulties in Emotion Regulation Scale (DERS) and the Positive and Negative Affect Schedule (PANAS) were completed at three lab visits. Results Participants with higher average DERS scores reported greater negative affect at lab visits. When a participant reported a DERS score at a lab visit higher than their individual average, they also reported higher negative affect at that lab visit. Participants with higher baseline DERS scores reported more labile negative affect during EMA than those with lower baseline DERS scores, and they also reported a higher maximum level of negative affect during EMA. Discussion and conclusions Overall, the findings suggest that changes in emotion regulation are associated with negative affect and that emotion regulation ability is related to both the intensity and lability of negative affect. A better understanding of momentary changes in emotion regulation and negative affect may lead to improved interventions for preventing substance use relapse. Emotion regulation show variability, and changes in emotion regulation are associated with changes in negative affect Emotion regulation ability is associated with the intensity of negative affect assessed using EMA Emotion regulation ability is associated with the lability of negative affect assessed using EMA
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Affiliation(s)
- Jessica M MacIntyre
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Aimee C Ruscio
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Emily Brede
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Andrew J Waters
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Luberto CM, Wasson RS, Kraemer KM, Sears RW, Hueber C, Cotton S. Feasibility, Acceptability, and Preliminary Effectiveness of a 4-week Mindfulness-Based Cognitive Therapy Protocol for Hospital Employees. Mindfulness (N Y) 2017; 8:1522-1531. [PMID: 29335671 PMCID: PMC5766285 DOI: 10.1007/s12671-017-0718-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Hospital employees may experience occupational stress and burnout, which negatively impact quality of life and job performance. Evidence-based interventions implemented within the hospital setting are needed to promote employees' well-being. We offered a 4-week Mindfulness-Based Cognitive Therapy group program for hospital employees, and used a mixed-methods practice-based research approach to explore feasibility, acceptability, and effects on stress and burnout. Participants were 65 hospital employees (Mage = 44.06; 85% white) who participated between September 2015 and January 2016. Participants completed validated measures of stress and burnout before and after the program, and answered open-ended satisfaction questions after the program. Groups consistently enrolled at least 10 participants, but attendance rates declined across sessions (76% at session 2 vs. 54% at session 4) due primarily to work-related scheduling conflicts. The program content was acceptable as evidenced by high perceived value (M = 9.18 out of 10), homework compliance (51% practicing at least 3 times/week), and qualitative requests for program expansion. There were large, statistically significant decreases in stress (ΔM = 2.1, p < .001, d = .85) and medium decreases in burnout (ΔM = .46, p = .01, d = .57), which were supported by qualitative themes of improved self-regulation and mindfulness skills, stress reduction, emotional well-being, and improved work productivity and patient care skills. Findings suggest that 4-week MBCT is acceptable and useful for hospital employees, though research is needed to identify alternate delivery methods or strategies to enhance session attendance.
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Affiliation(s)
- Christina M. Luberto
- Harvard Medical School/Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114-3117
| | - Rachel S. Wasson
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, Division of Integrative Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
| | - Kristen M. Kraemer
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, Division of Integrative Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
| | - Richard W. Sears
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, Division of Integrative Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
| | - Carly Hueber
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, Division of Integrative Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
| | - Sian Cotton
- University of Cincinnati College of Medicine, Department of Family and Community Medicine, Division of Integrative Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
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Kamboj SK, Irez D, Serfaty S, Thomas E, Das RK, Freeman TP. Ultra-Brief Mindfulness Training Reduces Alcohol Consumption in At-Risk Drinkers: A Randomized Double-Blind Active-Controlled Experiment. Int J Neuropsychopharmacol 2017; 20:936-947. [PMID: 29016995 PMCID: PMC5737497 DOI: 10.1093/ijnp/pyx064] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 02/04/2023] Open
Abstract
Background Like other complex psychosocial interventions, mindfulness-based treatments comprise various modality-specific components as well as nonspecific therapeutic ingredients that collectively contribute to efficacy. Consequently, the isolated effects of mindfulness strategies per se remain unclear. Methods Using a randomized double-blind design, we compared the isolated effects of 11-minutes of "supervised" mindfulness instruction against a closely matched active control (relaxation) on subjective, physiological, and behavioral indices of maladaptive alcohol responding in drinkers at risk of harm from alcohol use (n = 68). Simple follow-up instructions on strategy use were provided, but practice was unsupervised and not formally monitored. Results Both groups showed acute reductions in craving after training, although a trend group x time interaction (P = .056) suggested that this reduction was greater in the relaxation group (d = 0.722 P < .001) compared with the mindfulness group (d = 0.317, P = .004). Furthermore, upregulation of parasympathetic activity was found after relaxation (d = 0.562; P < .001) but not mindfulness instructions (d = 0.08; P > .1; group x time interaction: P = .009). By contrast, only the mindfulness group showed a reduction in past-week alcohol consumption at 7-day follow-up (-9.31 units, d = 0.593, P < .001), whereas no significant reduction was seen in the relaxation group (-3.00 units, d = 0.268, P > .1; group x time interaction: P = .026). Conclusion Very brief mindfulness practice can significantly reduce alcohol consumption among at-risk drinkers, even with minimal encouragement to use this strategy outside of the experimental context. The effects on consumption may therefore represent a lower bound of efficacy of "ultra-brief" mindfulness instructions in hazardous drinkers, at least at short follow-up intervals.
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Affiliation(s)
- Sunjeev K Kamboj
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
| | - Damla Irez
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
| | - Shirley Serfaty
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
| | - Emily Thomas
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
| | - Ravi K Das
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
| | - Tom P Freeman
- Clinical Psychopharmacology Unit (Dr Kamboj, Ms Thomas, and Drs Das and Freeman); Research Department of Clinical, Educational and Health Psychology (Drs Kamboj, Irez, and Serfaty, Ms Thomas, and Drs Das and Freeman), University College London, United Kingdom
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Wilson AD, Roos CR, Robinson CS, Stein ER, Manuel JA, Enkema MC, Bowen S, Witkiewitz K. Mindfulness-based interventions for addictive behaviors: Implementation issues on the road ahead. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:888-896. [PMID: 29072477 DOI: 10.1037/adb0000319] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Over the past 35 years, mindfulness meditation practices have increasingly been integrated into Western medical settings. Research into the benefits of mindfulness-based interventions (MBIs) continues to expand, such that there are currently more than a dozen different protocolled MBIs for patients suffering from a variety of physical and psychological disorders. In the last decade, a number of MBIs specifically designed to treat addictive behaviors have been developed and tested. This review first provides a brief overview of the current state of the science with respect to the efficacy of MBIs for addictive behaviors, and some of the proposed mechanisms underlying the efficacy of MBIs. Second, the review highlights unresolved implementation issues and provides suggestions for how future research can address the implementation challenges to advance the delivery of MBIs. Specifically, this review focuses on the lack of clear empirical guidelines in the following areas: (a) effective training for MBI treatment providers; (b) adaptations of the traditional 2-hr closed-cohort group format; (c) delivery of MBIs in 1-on-1 treatment contexts; (d) delivery of MBIs at different points in the change process; (e) delivery of MBIs via technology-based platforms; and (f) facilitation of precision medicine in the delivery of MBIs. Specific research directions are suggested with an eye toward a meaningful increase in access to MBIs for front-line clinicians and clients. (PsycINFO Database Record
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Affiliation(s)
| | - Corey R Roos
- Department of Psychology, University of New Mexico
| | | | | | | | | | - Sarah Bowen
- Department of Psychology, Pacific University
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Serfaty S, Gale G, Beadman M, Froeliger B, Kamboj SK. Mindfulness, Acceptance and Defusion Strategies in Smokers: a Systematic Review of Laboratory Studies. Mindfulness (N Y) 2017; 9:44-58. [PMID: 29387264 PMCID: PMC5770486 DOI: 10.1007/s12671-017-0767-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The psychological flexibility model (PFM) provides a framework for understanding and treating behavioural dysregulation in addictions. Rather than modulating the intensity of subjective experience, interventions based on, or consistent with, the PFM (PFM interventions) seek to alter the individual's relationship to internal states, such as craving, negative affect and drug-related thoughts, using mindfulness, acceptance and related strategies. Experimental (non-clinical) studies in smokers have examined the effects of specific isolated strategies informed by or consistent with the PFM (PFM strategies). Here, we systematically review these studies and determine the extent to which they conform to methodological standards indicative of high levels of internal validity. Eligible studies were identified through electronic database searches and assessed for the presence of specific methodological features. Provisional aggregate effect sizes were determined depending on availability of data. Of 1499 screened publications, 12 met the criteria. All examined aspects of private subjective experience relevant to abstinence (craving n = 12; negative affect n = 10), demonstrating effects favouring PFM strategies relative to inactive control conditions. However, only six assessed outcome domains consistent with the PFM and provided no consistent evidence favouring PFM strategies. Overall, most studies had methodological limitations. As such, high-quality experimental studies continue to be needed to improve our understanding of necessary and/or sufficient constituents of PFM-guided smoking cessation interventions. Recommendations for future research are discussed.
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Affiliation(s)
- Shirley Serfaty
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Grace Gale
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Matthew Beadman
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brett Froeliger
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC USA
| | - Sunjeev K Kamboj
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Spears CA, Hedeker D, Li L, Wu C, Anderson NK, Houchins SC, Vinci C, Hoover DS, Vidrine JI, Cinciripini PM, Waters AJ, Wetter DW. Mechanisms underlying mindfulness-based addiction treatment versus cognitive behavioral therapy and usual care for smoking cessation. J Consult Clin Psychol 2017. [PMID: 28650195 DOI: 10.1037/ccp0000229] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To examine cognitive and affective mechanisms underlying mindfulness-based addiction treatment (MBAT) versus cognitive-behavioral therapy (CBT) and usual care (UC) for smoking cessation. METHOD Participants in the parent study from which data were drawn (N = 412; 54.9% female; 48.2% African American, 41.5% non-Latino White, 5.4% Latino, 4.9% other; 57.6% annual income <$30,000) were randomized to MBAT (n = 154), CBT (n = 155), or UC (n = 103). From quit date through 26 weeks postquit, participants completed measures of emotions, craving, dependence, withdrawal, self-efficacy, and attentional bias. Biochemically confirmed 7-day smoking abstinence was assessed at 4 and 26 weeks postquit. Although the parent study did not find a significant treatment effect on abstinence, mixed-effects regression models were conducted to examine treatment effects on hypothesized mechanisms, and indirect effects of treatments on abstinence were tested. RESULTS Participants receiving MBAT perceived greater volitional control over smoking and evidenced lower volatility of anger than participants in both other treatments. However, there were no other significant differences between MBAT and CBT. Compared with those receiving UC, MBAT participants reported lower anxiety, concentration difficulties, craving, and dependence, as well as higher self-efficacy for managing negative affect without smoking. Indirect effects of MBAT versus UC on abstinence occurred through each of these mechanisms. CONCLUSIONS Whereas several differences emerged between MBAT and UC, MBAT and CBT had similar effects on several of the psychosocial mechanisms implicated in tobacco dependence. Results help to shed light on similarities and differences between mindfulness-based and other active smoking cessation treatments. (PsycINFO Database Record
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Affiliation(s)
- Claire Adams Spears
- Division of Health Promotion and Behavior, Georgia State University School of Public Health
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago
| | - Liang Li
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | - Cai Wu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center
| | | | | | - Christine Vinci
- Department of Health Outcomes and Behavior, Moffitt Cancer Center
| | - Diana Stewart Hoover
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center
| | | | - Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center
| | - Andrew J Waters
- Department Medical and Clinical Psychology, Uniformed Services University of the Health Sciences
| | - David W Wetter
- Department of Population Health Sciences, University of Utah
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Efficacy of mindfulness meditation for smoking cessation: A systematic review and meta-analysis. Addict Behav 2017; 69:27-34. [PMID: 28126511 DOI: 10.1016/j.addbeh.2017.01.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Smokers increasingly seek alternative interventions to assist in cessation or reduction efforts. Mindfulness meditation, which facilitates detached observation and paying attention to the present moment with openness, curiosity, and acceptance, has recently been studied as a smoking cessation intervention. AIMS This review synthesizes randomized controlled trials (RCTs) of mindfulness meditation (MM) interventions for smoking cessation. METHODS Five electronic databases were searched from inception to October 2016 to identify English-language RCTs evaluating the efficacy and safety of MM interventions for smoking cessation, reduction, or a decrease in nicotine cravings. Two independent reviewers screened literature using predetermined eligibility criteria, abstracted study-level information, and assessed the quality of included studies. Meta-analyses used the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The quality of evidence was assessed using the GRADE approach. FINDINGS Ten RCTs of MM interventions for tobacco use met inclusion criteria. Intervention duration, intensity, and comparison conditions varied considerably. Studies used diverse comparators such as the American Lung Association's Freedom from Smoking (FFS) program, quitline counseling, interactive learning, or treatment as usual (TAU). Only one RCT was rated as good quality and reported power calculations indicating sufficient statistical power. Publication bias was detected. Overall, mindfulness meditation did not have significant effects on abstinence or cigarettes per day, relative to comparator groups. The small number of studies and heterogeneity in interventions, comparators, and outcomes precluded detecting systematic differences between adjunctive and monotherapy interventions. No serious adverse events were reported. CONCLUSIONS MM did not differ significantly from comparator interventions in their effects on tobacco use. Low-quality evidence, variability in study design among the small number of existing studies, and publication bias suggest that additional, high-quality adequately powered RCTs should be conducted.
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Loucks EB, Schuman-Olivier Z, Britton WB, Fresco DM, Desbordes G, Brewer JA, Fulwiler C. Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Curr Cardiol Rep 2015; 17:112. [PMID: 26482755 PMCID: PMC4928628 DOI: 10.1007/s11886-015-0668-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to provide (1) a synopsis on relations of mindfulness with cardiovascular disease (CVD) and major CVD risk factors, and (2) an initial consensus-based overview of mechanisms and theoretical framework by which mindfulness might influence CVD. Initial evidence, often of limited methodological quality, suggests possible impacts of mindfulness on CVD risk factors including physical activity, smoking, diet, obesity, blood pressure, and diabetes regulation. Plausible mechanisms include (1) improved attention control (e.g., ability to hold attention on experiences related to CVD risk, such as smoking, diet, physical activity, and medication adherence), (2) emotion regulation (e.g., improved stress response, self-efficacy, and skills to manage craving for cigarettes, palatable foods, and sedentary activities), and (3) self-awareness (e.g., self-referential processing and awareness of physical sensations due to CVD risk factors). Understanding mechanisms and theoretical framework should improve etiologic knowledge, providing customized mindfulness intervention targets that could enable greater mindfulness intervention efficacy.
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Affiliation(s)
- Eric B Loucks
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St., Providence, RI, 02906, USA.
| | - Zev Schuman-Olivier
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
| | - Willoughby B Britton
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - David M Fresco
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Gaelle Desbordes
- Harvard Medical School, Boston, MA, USA
- Massachussetts General Hospital, Boston, MA, USA
| | - Judson A Brewer
- Department of Medicine, University of Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
| | - Carl Fulwiler
- Department of Psychiatry, University of Massachusetts, Worcester, MA, USA
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Abstract
Obesity affects more than one-third of U.S. adults and is a major cause of preventable morbidity and mortality, primarily from cardiovascular disease. Traditional behavioral interventions for weight loss typically focus on diet and exercise habits and often give little attention to the role of stress and emotions in the initiation and maintenance of unhealthy behaviors, which may account for their modest results and considerable variability in outcomes. Stress eating and emotional eating are increasingly recognized as important targets of weight loss interventions. Mindfulness-based interventions were specifically developed to promote greater self-efficacy in coping with stress and negative emotions, and appear to be effective for a variety of conditions. In recent years researchers have begun to study mindfulness interventions for weight loss and CVD risk management. This review describes the rationale for the use of mindfulness in interventions for weight loss and CVD risk management, summarizes the research to date, and suggests priorities for future research.
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