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

Speak and you shall predict: evidence that speech at initial cocaine abstinence is a biomarker of long-term drug use behavior

BACKGROUND

Valid scalable biomarkers for predicting longitudinal clinical outcomes in psychiatric research are crucial for optimizing intervention and prevention efforts. Here we recorded spontaneous speech from initially abstinent individuals with cocaine use disorder (iCUD) for use in predicting drug use outcomes.

METHODS

At baseline, 88 iCUD provided 5-minute speech samples describing the positive consequences of quitting drug use and negative consequences of using drugs. Outcomes, including withdrawal, craving, abstinence days, and recent cocaine use, were assessed at three-month intervals up to one year (57 iCUD included in analyses). Predictive modeling compared natural language processing (NLP) techniques, specifically sentence embeddings with established inventories as targets, with models utilizing standard demographic and baseline psychometric variables.

RESULTS

At short time intervals, maximal predictive power was obtained with non-NLP models that also incorporated the same drug use measures (as the outcomes) obtained at baseline, potentially reflecting their slow rate of change, which could be estimated by linear functions. However, for longer-term predictions, speech samples alone demonstrated statistically significant results, with Spearman r ≥ 0.46 and 80% accuracy for predicting abstinence. Hence speech samples may capture non-linear dynamics over extended intervals more effectively than traditional measures. These results need to be replicated in larger and independent samples.

CONCLUSIONS

Compared to the common outcome measures used in clinical trials, speech-based measures could be leveraged as better predictors of longitudinal drug use outcomes in initially abstinent iCUD, as potentially generalizable to other subgroups with cocaine addiction, and to additional substance use disorders and related comorbidity.

Mindfulness-based relapse prevention targeting psychological craving and trait mindfulness in young Chinese women with methamphetamine dependence: a randomized controlled trial

Methods

We recruited 58 MA-dependent young adult females from a compulsory isolation drug rehabilitation center in Sichuan Province and randomly divided them into an MBRP group (n = 29) and a control group (n = 29) according to their degree of psychological craving. The MBRP group received 2 hours of MBRP training twice a week for 4 weeks, alongside routine treatment at the drug rehabilitation center. Meanwhile, the control group solely received routine treatment at the drug rehabilitation center without any additional interventions. The assessment was conducted before and immediately after the intervention, with the Compulsive Drug Use Scale (OCDUS) used to assess craving and the Five-Factor Mindfulness Scale (FFMQ) used to assess trait mindfulness. Also, a "mental feedback monitoring balance" instrument was used to assess concentration and relaxation during some training sessions. This randomized trial was conducted to evaluate the effectiveness of decreasing psychological craving and increasing trait mindfulness.

Results

At baseline, there were no significant differences in total or dimension scores for FFMQ or OCDUS between the two groups (all P > 0.05). After the intervention, the repeated measures ANOVA showed a significant time main effect on changes in observing, non-judging, and non-reacting scores (all P < 0.05), and a significant interaction effect between time and group on both FFMQ total score and OCDUS score (P < 0.01 or P < 0.05). Mental feedback monitoring indicated significant improvement in concentration and relaxation after breath meditation exercises (P < 0.05 or P < 0.001). Additionally, the MBRP group showed improved relaxation during the body scan exercise (P < 0.01).

Conclusion

MBRP training can improve the trait mindfulness of MA addicts and reduce psychological cravings effectively.

Coping-strategies as a mediator between emotional disorders and problematic alcohol use

BACKGROUND

Epidemiological studies reveal a high prevalence of alcohol use and comorbidity rates with emotional disorders. This study aims to explore the possible mediational effect of stress-coping strategies on the relationship between symptoms of emotional disorders and problematic alcohol use.

METHODS

The sample included 1014 participants (33.82% male, 66.17% female) aged 18-75 years (M = 33.0, SD = 15.15). Three mediation analyzes were carried out, for depressive, anxious and somatization symptomatology measured with the LSB-50 in which they acted as an independent variable, the coping strategies of the CSQ as a mediating variable and the problematic alcohol use, measured with AUDIT, as a dependent variable. Additionally, sex, age, educational level, and socioeconomic status were entered as covariates.

RESULTS

In all the models, problematic alcohol use was mediated by Problem-Solving Focus and Open Emotional Expression. However, while in depressive symptoms was a fully mediation, in anxious and somatization symptomatology was partially mediated.

CONCLUSIONS

The similarities found may be due to shared variance between emotional disorders. Interventions focused on Problem-Solving Focus could improve the emotional symptoms and the problematic alcohol use.

The circular argument relationship between mindfulness and mobile phone addiction: evidence based on the diary method

The link between civilization and technology has long been a hotspot of research around the world. Mobile phone addiction has become a common social phenomenon with advances in society and technology, wreaking havoc on people's emotional health, physical fitness, and personal connections. Considering the positive effects of mindfulness, this study used the diary method to explore the relationship between mindfulness and mobile phone addiction based on the mindfulness reperceiving model. We conducted a 14-day diary study among 198 Chinese youth participants. The results showed that there was a circular argument relationship between mindfulness and mobile phone addiction: mindfulness of the previous day could significantly negatively predict mobile phone addiction of the following day, and vice versa. These results, based on the mindfulness reperceiving model, effectively extend theories and profoundly reveal the circular argument relationship between mindfulness and mobile phone addiction. Besides, it also provides new thought for the mechanism of the interrelationship between mindfulness and mobile phone addiction, as an important theoretical support for the intervention of mobile phone addiction from the perspective of mindfulness.

Change motivation and mindfulness in individual psychotherapy: Examining a sample of adult outpatients with depression and/or anxiety

OBJECTIVES

Existing literature has demonstrated that both motivation to change and mindfulness are associated with therapy outcomes in samples with mental disorders. Between the constructs of mindfulness and motivation to change occurs some theoretical-related and empirical overlap. However, it is still little known about the association of these two constructs. For this reason, we investigated the relationship of motivation to change and mindfulness in a sample of 116 adult outpatients with a primary diagnosis of depression or anxiety.

METHODS

An outpatient sample of 116 depressive and/or anxious patients filled in the German short version of the University of Rhode Island Change Assessment (URICA-S) and the German version of the Kentucky Inventory of Mindfulness Skills (KIMS) before the start of cognitive-behavioral therapy (pre) and after the 25th cognitive-behavioral therapy session (post). To assess the association between change motivation and mindfulness, we calculated correlations, hierarchical regressions and cross-lagged panel models (CLPM).

RESULTS

Several positive and negative significant correlations at the premeasurement time point, at the postmeasurement time point, and over time (from pre to postmeasurement time point) demonstrated a relation between the KIMS and the URICA-S. Hierarchical regression analyses and CLPM pointed towards relations between mindfulness and change motivation over time and in both directions for some subscales of the KIMS and the URICA-S.

CONCLUSION

A bidirectional relation between motivation to change and mindfulness was supported in our naturalistic psychotherapy setting for several subscales. For a better understanding of the interconnection between the two constructs, future research should focus on the application of interventions to improve either mindfulness or motivation to change in psychotherapy. Additionally, the interactional effects of mindfulness and change motivation on therapy outcomes should be investigated.

Storing, Not Reading: Investigating the Link Between Upward Social Comparison via Social Media and Digital Hoarding Behavior in Chinese Youth

Background

Digital hoarding has emerged as a pervasive psychological phenomenon and behavioral challenge among contemporary youth. This study focused on exploring the relationship between upward social comparison via social media, fear of missing out (FoMO), mindfulness, digital hoarding behavior, and its underlying mechanisms.

Methods

A total of 927 young people participated in this cross-sectional study. Research instruments included the Social Comparison Scale, the Fear of Missing Out Scale, the Mindfulness Measure, and the Digital Hoarding Behavior Questionnaire. The data analysis comprised descriptive statistics and correlation analyses. Advanced analyses were conducted using Model 4 for mediation and Model 8 for moderation from the PROCESS macro.

Results

(1) Upward social comparison via social media was a strong predictor of digital hoarding behavior, even after controlling for variables such as gender, age, and education. (2) FoMO mediated the relationship between upward social comparison via social media and digital hoarding. (3) Mindfulness moderated both the direct effect of upward social comparison via social media on digital hoarding and the first segment of the mediating role of FoMO.

Discussion

The study further clarified the antecedents and psychological mechanisms that drive digital hoarding behavior. The findings contribute new perspectives for understanding the emerging concept of digital hoarding, while providing empirical evidence and valuable guidance for encouraging young adults to use social media responsibly and reduce impulsive hoarding tendencies.

Speak and you shall predict: speech at initial cocaine abstinence as a biomarker of long-term drug use behavior

Importance

Valid biomarkers that can predict longitudinal clinical outcomes at low cost are a holy grail in psychiatric research, promising to ultimately be used to optimize and tailor intervention and prevention efforts.

Objective

To determine if baseline linguistic markers in natural speech, as compared to non-speech clinical and demographic measures, can predict drug use severity measures at future sessions in initially abstinent individuals with cocaine use disorder (iCUD).

Design

A longitudinal cohort study (August 2017 - March 2020), where baseline measures were used to predict outcomes collected at three-month intervals for up to one year of follow-up.

Participants

Eighty-eight initially abstinent iCUD were studied at baseline; 57 (46 male, age 50.7+/-7.9 years) came back for at least another session.

Main Outcomes and Measures

Outcomes were self-reported symptoms of withdrawal, craving, abstinence duration and frequency of cocaine use in the past 90 days at each study session. The predictors were derived from 5-min recordings of vocal descriptions of the positive consequences of abstinence and the negative consequences of using cocaine; the baseline cocaine and other common drug use measures, demographic and neuropsychological variables were used for comparison.

Results

Models using the non-speech variables showed the best predictive performance at three(r>0.45, P<2×10-3) and six months follow-up (r>0.37, P<3×10-2). At 12 months, the natural language processing-based model showed significant correlations with withdrawal (r=0.43, P=3×10-2), craving (r=0.72, P=5×10-5), days of abstinence (r=0.76, P=1×10-5), and cocaine use in the past 90 days (r=0.61, P=2×10-3), significantly outperforming the other models for abstinence prediction.

Conclusions and Relevance

At short time intervals, maximal predictive power was obtained with models that used baseline drug use (in addition to demographic and neuropsychological) measures, potentially reflecting a slow rate of change in these measures, which could be estimated by linear functions. In contrast, short speech samples predicted longer-term changes in drug use, implying deeper penetrance by potentially capturing non-linear dynamics over longer intervals. Results suggest that, compared to the common outcome measures used in clinical trials, speech-based measures could be leveraged as better predictors of longitudinal drug use outcomes in initially abstinent iCUD, as potentially generalizable to other substance use disorders and related comorbidity.

Substance Use Disorders and Role of Complementary and Integrative Medicine/Functional Medicine

Substance use disorders are a growing concern for all ages, including adolescents. Even though there is an increase in recreational substance use and a wider variety of drugs is available to this young population, treatment options remain scarce. Most medications have limited evidence in this population. Few specialists treat individuals struggling with addiction along with mental health disorders. As the evidence grows, these treatments are usually included in complementary and integrative medicine. This article discusses available evidence for many complementary and integrative treatment approaches while briefly describing existing psychotherapeutic and psychotropic medications.

An Overview of Mindfulness-Oriented Addiction and Pain Recovery

There is evidence that mindfulness-based interventions are effective as stress-reduction techniques in people with various stressor-related disorders. Research also shows overall improvement in mental health well-being in practitioners of mindfulness. However, there is limited literature probing the potential negative impacts of mindfulness practice. Relapse is a major challenge in substance use disorders (SUDs), particularly for people with chronic pain. There is an overlap between SUDs and chronic pain, which share common pathophysiological pathways that could contribute to poor pain control and mental instability. In this report, we discuss the possible effects of mindfulness on specified aspects of substance craving and chronic pain perception. We propose future directions for research in mindfulness practices to maximize the potential for relapse prevention and pain control.

The mediating role of positive reappraisal and self-compassion on the relationship between mindfulness and posttraumatic growth in patients with cancer

The beneficial effect of mindfulness in promoting posttraumatic growth has been well established in research, but it remains unclear what psychological mechanisms mediate it. This study examined the mediating roles of positive reappraisal and self-compassion on the relationship between mindfulness and posttraumatic growth in patients with cancer. A random sample of 550 patients drawn from two medical health care institutions in southeast, Nigeria participated in this study. Results of mediation analysis showed that positive reappraisal and self-compassion independently mediated the relationship between mindfulness and posttraumatic growth. These findings underscore the usefulness of mindfulness-based therapies in promoting cognitive emotional processes such as positive reappraisal abilities and self-compassion, which are essential in facilitating posttraumatic growth in patients with cancer.

Relationship between levels of mindfulness and substance use pattern

ABSTRACT Objective Evaluate the association between levels of mindfulness and sociodemographic characteristics and pattern of drug use of individuals seeking treatment in a University Service Specialized in Substance Use Disorders. Methods This is a cross-sectional study with 164 individuals over 18 years of age seeking treatment for the use of psychoactive substances in the June 2018-December 2019 period, using a questionnaire for sociodemographic data, the Mindful Attention Awareness Scale (MAAS) self-reporting instrument, and the Alcohol, Smoking, and Substance Involvement Screening Test. Results An association was found between low levels of mindfulness mainly with the individual risk of being a medium/high-risk user of sedative-hypnotic drugs (p = 0.020). A borderline association was also found between MAAS and the risk of the individual being a medium/high risk of alcohol (p = 0.053) and with a more severe pattern of substance use (p = 0.065). Conclusion Individuals seeking treatment for substance use presented impairments in the attentional aspect of mindfulness and levels of mindfulness seem to protect against behaviors related to substance use, especially against the use of high/moderate risk of sedative-hypnotics.

Mindfulness and Savoring: A Commentary on Savoring Strategies and Their Implications for Addiction Treatment

Background: A central facet of the popular understanding of mindfulness practice is the non-judgmental observation of all thoughts and feelings. Savoring is a cognitive practice developed out of economics and positive psychology, which involves the conscious mental engagement with positively-valenced interoceptive and exteroceptive stimuli, which in turn amplifies the derived pleasure experience. Results: When incorporated into mindfulness-based interventions (MBIs), savoring holds promise in improving outcomes related to reward processing, such as positive affect and well-being. The growing body of mindfulness literature also suggests that the inclusion of savoring in MBIs may be key in treating disorders of reward dysregulation, such as addiction. If savoring does indeed reduce craving, this phenomenon offers a point of union for divergent neurobiological theories of addiction. Conclusion: In this commentary, we explore the existing literature on savoring and mindfulness practices as it relates to addictive disorders, posit underlying neurocognitive mechanisms, and present future areas of research.

Self-concept clarity and Internet addiction disorder among junior high school students: A moderate mediation model

INTRODUCTION

As the epidemic spreads, the problem of Internet addiction disorder (IAD) stand out and getting serious. The present study aimed to investigate IAD among junior high school students during the spread of the COVID-19, and to explore the mediating role of cognitive failure between self-concept clarity and IAD, and the moderating role of mindfulness.

METHODS

A sample of 1,153 junior high school students from two randomly selected junior high schools in Henan Province were surveyed anonymously with Self-concept Clarity Scale (SCCS), Cognitive Failure Questionnaire (CFQ), Mindfulness Attention Awareness Scale (MAAS) and Internet Addiction disorder Test (IAT). The sample was obtained through random cluster sampling, taking classes as the clusters and students as the elements.

RESULTS

(1) Self-concept clarity was negatively correlated with Internet addiction disorder; (2) Self-concept clarity not only had a direct effect on Internet addiction disorder, but also indirectly affect Internet addiction disorder through cognitive failure; (3) Mindfulness moderates the relationship between self-concept clarity and Internet addiction disorder, as well as the relationship between cognitive failure and Internet addiction disorder. Compared with low levels of mindfulness, both the protective effect of self-concept clarity and the effect of cognitive failure on Internet addiction disorder were stronger among junior high school students who were at high levels of mindfulness.

CONCLUSION

This study constructs a moderated mediation model to explain the effect of self-concept clarity on Internet addiction disorder. It is effective to alleviate Internet addiction disorder by improving self-concept clarity and mindfulness level of the junior school students.

Advancing our understanding of the intersection between emotion regulation and alcohol and drug use problems: Dyadic analysis in couples with intimate partner violence and alcohol use disorder

BACKGROUND

An extensive body of literature has linked emotion regulation to alcohol and drug use problems, including among populations characterized by intimate partner violence (IPV). Advancing this research, the goal of the current study was to examine cognitive emotion regulation strategies and alcohol and drug use problems within a dyadic framework. Specifically, we examined actor and partner effects of maladaptive and adaptive cognitive emotion regulation strategies on alcohol and drug use problems.

METHODS

Eighty-four romantic couples (N = 168 total participants) participating in a randomized controlled trial who reported physical IPV and an alcohol use disorder completed self-reported measures of cognitive emotion regulation as well as alcohol and drug use problems.

RESULTS

Regarding actor effects, men's greater use of maladaptive cognitive emotion regulation strategies was positively related to their alcohol use problems (p < .001), whereas both women's (p = .02) and men's (p = .047) greater use of adaptive cognitive emotion regulation strategies was negatively related to their own alcohol use problems. In terms of partner effects, men's greater use of maladaptive cognitive emotion regulation strategies (p = .001) and less use of adaptive cognitive emotion regulation strategies (p = .017) was related to their partners' greater drug use problems.

CONCLUSIONS

Findings replicate and extend existing work in this area, showing that men's and women's emotion regulation strategies are related to their own alcohol and drug use problems and that men's cognitive emotion regulation strategies are also related to their partners' drug use problems.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

A mindfulness-based, stress and coping model of craving in methamphetamine users

There is increasing interest in the role of mindfulness and mindfulness-based interventions to optimize recovery from a substance use disorder (SUD). However, relatively little is known about the theory-based psychological and social pathways whereby mindfulness could have beneficial effects for managing a chronic, relapsing SUD. Informed by Revised Stress and Coping Theory, the present cross-sectional study examined affective, cognitive, and social pathways whereby mindfulness is associated with lower methamphetamine craving. A total of 161 HIV-positive, methamphetamine-using sexual minority men completed a screening visit for a randomized controlled trial. Using a hybrid structural equation model, we examined pathways whereby mindfulness is associated with lower methamphetamine craving. We found that greater mindfulness was directly associated with lower negative affect and higher positive affect as well as indirectly associated with less methamphetamine craving. Interestingly, the indirect association between mindfulness and methamphetamine craving appeared to be uniquely attributable to positive affect. Only positive affect was indirectly associated with lower methamphetamine craving via higher positive re-appraisal coping and greater self-efficacy for managing triggers for methamphetamine use. Methamphetamine craving was supported by moderate associations with greater substance use severity and more frequent methamphetamine use. These findings support the role of mindfulness in cultivating positive affect, which could be crucial to build the capacity of individuals to manage methamphetamine craving as a chronic stressor that threatens recovery from SUD.

Examining the Role of Craving, Mindfulness, and Psychological Flexibility in a Sample of Individuals with Substance Use Disorder

Substance Use Disorder (SUD) continues to represent a significant public health crisis in the United States. Purpose: Novel and effective treatments are needed, and third wave behavioral approaches focused on increasing mindfulness and psychological flexibility appear promising. However, the unique and shared impact of mindfulness and psychological flexibility on substance craving is not well understood. Methods: The current study explores how mindfulness and psychological flexibility predict substance craving while controlling for severity of substance dependence in a sample (N = 284) of treatment-seeking adults with SUD. Results and Discussion: Results suggest that mindfulness and psychological flexibility each account for unique variance in substance craving over and above the other. Implications and limitations are discussed.

Disrupting the path to craving: Acting without awareness mediates the link between negative affect and craving

Low treatment utilization, relapse, and chronicity are characteristic of substance use disorders (SUDs). Craving is an important predictor of relapse. Individuals with an SUD report using various coping strategies in response to negative affect, two of which are investigated in the current study: suppression and acting with awareness. Suppression is typically understood to be avoidance of unwanted experience through turning attention away from unwanted stimuli. Acting with awareness (AWA) is a facet of mindfulness, which includes turning toward experience with kindness and curiosity, even when the experience is unwanted. Evidence suggests mindfulness may reduce craving, while suppression has been associated with increased craving. In the current study, participants (N = 210) had recently completed inpatient or intensive outpatient SUD treatment followed by a randomized controlled trial of aftercare. Participants completed measures within 2 weeks following the completion of the aftercare intervention. Negative affect and severity of dependence were both positively associated with craving. Structural equation modeling evaluated AWA and suppression as partial mediators of the link between negative affect and craving. Suppression was positively associated and AWA was negatively associated with craving. Mediation analyses revealed the indirect effect of negative affect on craving through AWA was significant, but the path through suppression was not. These findings suggest that AWA may inhibit the development of craving from negative affect, but further research is needed. Future research should investigate the path from negative affect to craving with greater temporal resolution to evaluate how these phenomena function with increased ecological validity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

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.

Autonomic and affective mediators of the relationship between mindfulness and opioid craving among chronic pain patients

Prescription opioid misuse among chronic pain patients is undergirded by self-regulatory deficits, affective distress, and opioid-cue reactivity. Dispositional mindfulness has been associated with enhanced self-regulation, lower distress, and adaptive autonomic responses following drug-cue exposure. We hypothesized that dispositional mindfulness might serve as a protective factor among opioid-treated chronic pain patients. We examined heart-rate variability (HRV) during exposure to opioid cues and depressed mood as mediators of the association between dispositional mindfulness and opioid craving. Data were obtained from a sample of chronic pain patients (N = 115) receiving long-term opioid pharmacotherapy. Participants self-reported opioid craving and depression, and HRV was measured during an opioid-cue dot-probe task. Dispositional mindfulness was significantly positively correlated with HRV, and HRV was significantly inversely associated with opioid craving. Dispositional mindfulness was significantly negatively correlated with depression, and depression was significantly positively correlated with opioid craving. Path analysis revealed significant indirect effects of dispositional mindfulness on craving through both HRV and depression. Dispositional mindfulness may buffer against opioid craving among chronic pain patients prescribed opioids; this buffering effect may be a function of improved autonomic and affective responses. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science

Studies of substance misuse prevention generally focus on characteristics that typify risk, with the assumption that the prevalence of the problem will be optimally reduced by identifying, targeting, and reducing or eliminating risk factors. However, this risk-centered approach neglects variations in individual-level and environmental characteristics that portend differential pathways that are distinguishable by timing of substance use initiation (e.g., early versus delayed), the likelihood of use escalation versus eventual desistance, and enduring abstinence, despite exposure to significant risk factors. Considering the various underpinnings of these distinct substance use trajectories is critical to a more nuanced understanding of the effects, potency, and malleability of factors that are known to increase risk or confer protection. Here, we discuss three pathways relative to substance use patterns and predictors in the context of adversity, a well-known, highly significant influence on propensity for substance misuse. The first pathway is designated as "high risk" based on early onset of substance use, rapid escalation, and proneness to substance use disorders. Individuals who defy all odds and eventually exhibit adaptive developmental outcomes despite an initial maladaptive reaction to adversity, are referred to as "resilient." However, another categorization that has not been adequately characterized is "resistant." Resistant individuals include those who do not exhibit problematic substance use behaviors (e.g., early onset and escalation) and do not develop substance use disorders or other forms of psychopathology, despite significant exposure to factors that normally increase the propensity for such outcomes (e.g. trauma and/or adversity). In this paper, we apply this conceptualization of risk, resistance, and resilience for substance misuse to a more fine-grained analysis of substance use pathways and their corresponding patterns (e.g., non-use, initiation, escalation, desistance). The significance of the progression of neurocognitive functioning over the course of development is discussed as well as how this knowledge may be translated to make a science-based determination of intervention targets. This more encompassing theoretical model has direct implications for primary prevention and clinical approaches to disrupt risk pathways and to optimize long-term outcomes.

Psychological and Autonomic Correlates of Emotion Dysregulation among Women in Substance Use Disorder Treatment

BACKGROUND

Emotion regulation is increasingly recognized as important for the prevention and treatment of substance use disorder (SUD). However, there is an identified lack of physiological indexes of emotion dysregulation in SUD treatment studies, critically needed to better understand the link between emotion regulation capacity (measured physiologically) and self-report health outcomes among individuals in SUD treatment.

OBJECTIVE

To examine the association between respiratory sinus arrhythmia (RSA) and self-report health outcomes among women in SUD treatment.

METHODS

This is a cross-sectional study based on baseline data from 217 women enrolled in a randomized control trial to study a mind-body intervention as an adjunct to SUD treatment. All participants were enrolled in community-based outpatient treatment. Participants were administered questionnaires to examine sample characteristics, mental health symptoms, and interoceptive awareness and mindfulness skills. RSA data was gathered as an index of emotion dysregulation. Descriptive statistics, bivariate correlations, and regression were used in the analyses.

RESULTS

Findings highlight the extensive trauma histories, low SES, and the high symptoms of distress in this sample. RSA was only significantly correlated with interoceptive awareness after controlling for age and BMI. Measures of symptomatic distress and mindfulness were not correlated with RSA. Conclusions/Importance: Results provide the first evidence of RSA as an index of interoceptive awareness in this population. The inclusion of biomarkers such as RSA in SUD clinical studies may help identify individuals that are in need of targeted treatments that include interoceptive awareness training focused on improving emotion regulation.

Neural mechanisms supporting the relationship between dispositional mindfulness and pain

Interindividual differences in pain sensitivity vary as a function of interactions between sensory, cognitive-affective, and dispositional factors. Trait mindfulness, characterized as the innate capacity to nonreactively sustain attention to the present moment, is a psychological construct that is associated with lower clinical pain outcomes. Yet, the neural mechanisms supporting dispositional mindfulness are unknown. In an exploratory data analysis obtained during a study comparing mindfulness to placebo analgesia, we sought to determine whether dispositional mindfulness is associated with lower pain sensitivity. We also aimed to identify the brain mechanisms supporting the postulated inverse relationship between trait mindfulness and pain in response to noxious stimulation. We hypothesized that trait mindfulness would be associated with lower pain and greater deactivation of the default mode network. Seventy-six meditation-naive and healthy volunteers completed the Freiburg Mindfulness Inventory and were administered innocuous (35°C) and noxious stimulation (49°C) during perfusion-based functional magnetic resonance imaging. Higher Freiburg Mindfulness Inventory ratings were associated with lower pain intensity (P = 0.005) and pain unpleasantness ratings (P = 0.005). Whole brain analyses revealed that higher dispositional mindfulness was associated with greater deactivation of a brain region extending from the precuneus to posterior cingulate cortex during noxious heat. These novel findings demonstrate that mindful individuals feel less pain and evoke greater deactivation of brain regions supporting the engagement sensory, cognitive, and affective appraisals. We propose that mindfulness and the posterior cingulate cortex should be considered as important mechanistic targets for pain therapies.

Mindfulness meditation in the treatment of substance use disorders and preventing future relapse: neurocognitive mechanisms and clinical implications

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.

Immediate effects of interoceptive awareness training through Mindful Awareness in Body-oriented Therapy (MABT) for women in substance use disorder treatment

Background: Sensory information gained through interoceptive awareness may play an important role in affective behavior and successful inhibition of drug use. This study examined the immediate pre-post effects of the mind-body intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women's substance use disorder (SUD) treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods: Women in intensive outpatient treatment (IOP) for chemical dependency (N = 217) at 3 community clinics in the Pacific Northwest of the United States were recruited and randomly assigned to one of 3 study conditions: MABT + treatment as usual (TAU), women's health education (WHE) +TAU (active control condition), and TAU only. At baseline and 3 months post-intervention, assessments were made of interoceptive awareness skills and mindfulness, emotion regulation (self-report and psychophysiological measures), symptomatic distress (depression and trauma-related symptoms), and substance use (days abstinent) and craving. Changes in outcomes across time were assessed using multilevel mixed-effects linear regression. Results: Findings based on an intent-to-treat approach demonstrated significant improvements in interoceptive awareness and mindfulness skills, emotion dysregulation (self-report and psychophysiology), and days abstinent for women who received MABT compared with the other study groups. Additional analyses based on participants who completed the major components of MABT (at least 75% of the intervention sessions) revealed these same improvements as well as reductions in depressive symptoms and substance craving. Conclusions: Findings that interoceptive training is associated with health outcomes for women in SUD treatment are consistent with emerging neurocognitive models that link interoception to emotion regulation and to related health outcomes, providing knowledge critical to supporting and improving SUD treatment.

Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research

Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing. This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose–response relationships, and research rigor and reproducibility are discussed.

Efficacy of 8- and 4-Session Mindfulness-Based Interventions in a Non-clinical Population: A Controlled Study

Background: Many attempts have been made to abbreviate mindfulness programmes in order to make them more accessible for general and clinical populations while maintaining their therapeutic components and efficacy. The aim of this study was to assess the efficacy of an 8-week mindfulness-based intervention (MBI) programme and a 4-week abbreviated version for the improvement of well-being in a non-clinical population.

Method: A quasi-experimental, controlled, pilot study was conducted with pre-post and 6-month follow-up measurements and three study conditions (8- and 4-session MBI programmes and a matched no-treatment control group, with a sample of 48, 46, and 47 participants in each condition, respectively). Undergraduate students were recruited, and mindfulness, positive and negative affect, self-compassion, resilience, anxiety, and depression were assessed. Mixed-effects multi-level analyses for repeated measures were performed.

Results: The intervention groups showed significant improvements compared to controls in mindfulness and positive affect at the 2- and 6-month follow-ups, with no differences between 8- vs. 4-session programmes. The only difference between the abbreviated MBI vs. the standard MBI was found in self-kindness at 6 months, favoring the standard MBI. There were marginal differences in anxiety between the controls vs. the abbreviated MBI, but there were differences between the controls vs. the standard MBI at 2- and 6-months, with higher levels in the controls. There were no differences in depression between the controls vs. the abbreviated MBI, but differences were found between the controls vs. the standard MBI at 2- and 6-months, favoring the standard MBI. There were no differences with regard to negative affect and resilience.

Conclusion: To our knowledge, this is the first study to directly investigate the efficacy of a standard 8-week MBI and a 4-week abbreviated protocol in the same population. Based on our findings, both programmes performed better than controls, with similar effect size (ES). The efficacy of abbreviated mindfulness programmes may be similar to that of a standard MBI programme, making them potentially more accessible for a larger number of populations. Nevertheless, further studies with more powerful designs to compare the non-inferiority of the abbreviated protocol and addressing clinical populations are warranted.

Clinical Trials.gov Registration ID: NCT02643927

Biobehavioral Mechanisms of Mindfulness as a Treatment for Chronic Stress: An RDoC Perspective

Mindfulness-based interventions have been heralded as promising means of alleviating chronic stress. While meta-analyses indicate that mindfulness-based interventions significantly reduce global measures of stress, how mindfulness-based interventions modulate the specific mechanisms underpinning chronic stress as operationalized by the National Institute of Mental Health research domain criteria (RDoC) of sustained threat has not yet been detailed in the literature. To address this knowledge gap, this article aims to (1) review evidence that mindfulness-based interventions ameliorate each of the 10 elements of behavioral dysregulation characterizing sustained threat via an array of mindful counter-regulatory strategies; (2) review evidence that mindfulness-based interventions modify biological domains implicated in sustained threat, such as the hypothalamic–pituitary–adrenal axis, as well as brain circuits involved in attentional function, limbic reactivity, habit behavior, and the default mode network; and (3) integrate these findings into a novel conceptual framework of mindful self-regulation in the face of stress—the Mindfulness-to-Meaning Theory. Taken together, the extant body of scientific evidence suggests that the practice of mindfulness enhances a range biobehavioral factors implicated in adaptive stress coping and induces self-referential plasticity, leading to the ability to find meaning in adversity. These mechanistic findings can inform the treatment development process to optimize the next generation of mindfulness-based interventions for greater therapeutic efficacy.

Mindfulness and emotion regulation in older and young adults

OBJECTIVES

Research shows that dispositional mindfulness is associated with metrics of overall well-being, with enhanced emotion regulation potentially underlying these salutary effects. However, the role of regulation strategy use remains poorly understood. In this study, we examined age-variant associations between dispositional mindfulness, emotion regulation strategies, and emotion dysregulation.

METHOD

Self-report data were collected from 50 older and 50 young adults on mindfulness, emotion dysregulation, and recent strategy use. For the current study, we examined if cognitive reappraisal, experiential suppression, and thought avoidance use mediated the association between mindfulness and emotion dysregulation.

RESULTS

Thought avoidance, but not reappraisal or suppression strategies, partially mediated the association between mindfulness and emotion dysregulation. Age group moderated the observed mediation, such that for young adults, lower mindfulness was associated with greater use of thought avoidance, and in turn with greater emotion dysregulation (e.g., difficulties engaging in goal-directed behavior in the face of strong emotions).

CONCLUSION

The current cross-sectional study suggests that reduced avoidance of thoughts may partially explain the relationship between trait mindfulness and enhanced emotion regulation, with this mediational pathway being stronger for young compared with older adults.

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

Mindfulness Broadens Awareness and Builds Eudaimonic Meaning: A Process Model of Mindful Positive Emotion Regulation

Contemporary scholarship on mindfulness casts it as a form of purely non-evaluative engagement with experience. Yet, traditionally mindfulness was not intended to operate in a vacuum of dispassionate observation, but was seen as facilitative of eudaimonic mental states. In spite of this historical context, modern psychological research has neglected to ask the question of how the practice of mindfulness affects downstream emotion regulatory processes to impact the sense of meaning in life. To fill this lacuna, here we describe the Mindfulness-to-Meaning Theory, from which we derive a novel process model of mindful positive emotion regulation informed by affective science, in which mindfulness is proposed to introduce flexibility in the generation of cognitive appraisals by enhancing interoceptive attention, thereby expanding the scope of cognition to facilitate reappraisal of adversity and savoring of positive experience. This process is proposed to culminate in a deepened capacity for meaning-making and greater engagement with life.

Low dispositional mindfulness predicts self-medication of negative emotion with prescription opioids

OBJECTIVES

Although evidence is mounting that opioids are abused to self-medicate negative emotions, little is known about the traits and factors linked to opioid self-medication. One potentially crucial psychological correlate is dispositional mindfulness. Thus, the purpose of this study was to describe the prevalence of opioid self-medication among a treatment-seeking sample of prescription opioid-dependent individuals and specifically examine the relationship between dispositional mindfulness and opioid self-medication.

METHODS

Participants in acute detoxification or intensive outpatient treatment for prescription opioid dependence (n = 79) were recruited from a regional hospital's addictions treatment unit for this cross-sectional study. Sociodemographic data were collected along with surveys of opioid self-medication, pain level, and dispositional mindfulness.

RESULTS

Self-medication of negative affective states with opioids was quite common, with 94.9% of individuals sampled reporting self-medication behaviors. In adjusted analyses, individuals engaging in more frequent opioid use tended to self-medicate negative emotions with opioids more often than those engaging in more intermittent opioid use (β = 0.33; P < 0.05). Importantly, irrespective of opioid use frequency and other clinical and sociodemographic covariates, dispositional mindfulness was inversely associated with opioid self-medication (β = -0.42; P < 0.001), such that less mindful individuals reported using opioids more frequently to self-medicate negative emotions.

CONCLUSIONS

Self-medication of negative emotions with opioids was prevalent in this sample and related to low dispositional mindfulness. Plausibly, increasing mindfulness may decrease opioid self-medication. Addictive automaticity and emotion regulation are discussed as potential mechanisms linking low dispositional mindfulness and self-medication.

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

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

State Mindfulness During Meditation Predicts Enhanced Cognitive Reappraisal

Putatively, mindfulness meditation involves generation of a state of "nonappraisal", yet, little is known about how mindfulness may influence appraisal processes. We investigated whether the state and practice of mindfulness could enhance cognitive reappraisal. Participants (N = 44; M age = 24.44, SD = 4.00, range 19 - 38, 82.2% female) were randomized to either 1) mindfulness, 2) suppression, or 3) mind-wandering induction training conditions. Cognitive reappraisal was assessed with the Emotion Regulation Questionnaire (ERQ) prior to experimental induction, and state mindfulness was assessed immediately following induction using the Toronto Mindfulness Scale (TMS). Participants practiced their assigned strategy for one week and then were reassessed with the ERQ reappraisal subscale. Participants receiving mindfulness training reported significantly higher levels of state mindfulness than participants in the thought suppression and mind wandering conditions. Although brief mindfulness training did not lead to significantly greater increases in reappraisal than the other two conditions, state mindfulness during mindfulness meditation was prospectively associated with increases in reappraisal. Path analysis revealed that the indirect effect between mindfulness training and reappraisal was significant through state mindfulness. Degree of state mindfulness achieved during the act of mindfulness meditation significantly predicted increases in reappraisal over time, suggesting that mindfulness may promote emotion regulation by enhancing cognitive reappraisal.