Thursday, September 23, 2010

Mindfulness-Based Relapse Prevention: A Pilot Efficacy Study

In a previous post last week, I wrote a about Mindfulness-Based Relapse Prevention (MBRP), offering an introduction to the treatment and some background information. In this post, I’d like to report in detail about the results of the first randomized controlled trial of MBRP. (For those without a research background, randomized controlled trials or RCT’s are considered the gold standard of research.)

A few years ago, when I was a psychology intern at the Portland Veterans Affairs Medical Center in Portland, OR, I had the opportunity to conduct an MBRP group in the Substance Abuse Treatment Program. It was the first time MBRP had been offered at the VA. The veterans I worked with appeared to really like the program, and some continued to speak fondly of it for weeks after it ended. (I think my involvement may have even raised my own stature as an intern in their eyes!) I wasn’t able to collect any outcome data myself, but I’ve been interested in additional research on the effectiveness of MBRP.

From 2007-2008, a randomized pilot study was conducted with MBRP for the first time. Participants were recruited from a private, nonprofit agency, with 168 total. They were randomly assigned to either MBRP or the agencies standard treatment, which was process-oriented and based on the 12-step model (i.e., Alcoholics Anonymous). Outcome measures were administered at baseline, immediately after the 8-week MBRP program, and at 2- and 4-month follow-ups after the end of the 8 weeks.

Results were published across two articles.

According to Bowen (2009), people who completed MBRP had fewer days of use, fewer cravings, and greater awareness and acceptance compared to those who completed the agency’s standard program. However, when the researchers looked at the follow-up 4 months after MBRP ended, there was little difference in days of substance use between those who had completed MBRP and those who had completed the standard treatment. The authors suggest the reason for this is that those in MBRP returned to the standard program after completing the 8-week MBRP; however, it still doesn’t indicate the treatment gains of MBRP are maintained very well following the end of the 8-week program. In a sense, it suggests the gains associated with MBRP may not stick.

In the second article, Witkiewitz and Bowen (2010), the authors ran additional statistical analyses on the data from the first study to test some other hypothesis. The most interesting finding from these analyses related to differences in the experience of depression. For people who received standard care, there was a relationship between depressive symptoms and cravings; for example, more depressed people reported greater craving for drugs and alcohol. Additionally, as you might expect, those who were more depressed were more likely to use drugs and alcohol. For those who completed MBRP, however, there was no relationship between depression and cravings—those who were more depressed were no more likely to use than those who were less depressed.

What’s really fascinating about this second article is that results suggest depressed people who completed MBRP were less likely to use substances than depressed people who completed the agency’s regular program. It indicates mindfulness may make people more resilient to using drugs or alcohol even when their moods drop. Additional analyses indicated that everyone from the MBRP group who continued meditating (63%) remained abstinent. Although we cannot make causal attributions of this latter finding—those who continue meditating may be more motivated in general than those who stopped—it is promising. This is evidence that MBRP may help to “erase” the relationship between depression and substance use for many who complete the program.

Overall, these results suggest that MBRP is different than standard substance abuse treatment, but it is not clear how much better it is. For me, the most interesting finding is that those who participated in MBRP were less likely to use when depressed. This suggests MBRP may be particularly useful in helping substance abusers learn to tolerate negative moods. I look forward to what additional studies of MBRO may find.

For full citation:

Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., Clifasefi, S., et al. (2009). Mindfulness-based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295-305.

Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362-374.

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