Improve Emotional Response Inhibition in Patients with Chronic Pain and Opioid Use with Mindfulness

Improve Emotional Response Inhibition in Patients with Chronic Pain and Opioid Use with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation could represent a viable alternative to opioid-based therapy for chronic pain, and may be useful in helping patients taper their use of high doses of opioid-acting agents.” – Hymie Anisman

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. In today’s Research News article “Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735955/), Garland and colleagues examine the mechanisms by which mindfulness reduces perceived pain.

 

They recruited adult patients with non-cancer related chronic pain who were taking daily opioids. They were randomly assigned to receive 8-weeks of a Mindfulness-Oriented Recovery Enhancement (MORE) program or to an 8-week support groups meeting. Mindfulness-Oriented Recovery Enhancement (MORE) involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. The patients were measured before and after treatment and 3 months later for pain severity and the mindfulness facet of nonreactivity. The patients also performed a go – no-go task. They viewed either neutral or pain related images in which was embedded either the letter “M” or “W”. They were asked to press a key a quickly as possible when the letter “M” was present.

 

They found that in comparison to baseline and the support group, after the mindfulness treatment there was a significant reduction in pain severity and increase in nonreactivity and improvement in go – no-go task accuracy. These changes were maintained 3 months after the completion of th treatment. In addition, they found that the higher the levels of nonreactivity and the greater the amount of meditation practice, the fewer errors occurred in the go – no-go task with pain-related images. In other words, the greater the improvement in response inhibition to emotional stimuli. Finally, they found that the greater the reductions in go – no-go task errors with pain related images, the greater the reduction in pain severity.

 

The results are complicated and so are the conclusions. Nevertheless, the results suggest that mindfulness training reduces pain severity and increases the mindfulness facet of nonreactivity. This suggests that the mindfulness training improves the patient’s ability to not react to pain stimuli and thereby reduce the perceived severity of the pain. This increase in nonreactivity would also explain why the patients didn’t react to pain related distractors in the go – no-go task and thereby improve their accuracy.

 

These results suggest that Mindfulness-Oriented Recovery Enhancement (MORE) enhances the chronic pain patient’s ability to inhibit emotional responses in the presence of pain related stimuli. This ability in turn reduces perceived pain. It remains to be seen if these improvements make it easier for the patients to wean off of opiates.

 

So, improve emotional response inhibition in patients with chronic pain and opioid use with mindfulness.

 

Meditation teaches patients how to react to the pain. People are less inclined to have the ‘Ouch’ reaction, then they are able to control the emotional reaction to pain.” – Fadel Zeidan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Garland, E. L., Bryan, M. A., Priddy, S. E., Riquino, M. R., Froeliger, B., & Howard, M. O. (2019). Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 53(10), 865–876. doi:10.1093/abm/kay096

 

Abstract

Background

Among opioid-treated chronic pain patients, deficient response inhibition in the context of emotional distress may contribute to maladaptive pain coping and prescription opioid misuse. Interventions that aim to bolster cognitive control and reduce emotional reactivity (e.g., mindfulness) may remediate response inhibition deficits, with consequent clinical benefits.

Purpose

To test the hypothesis that a mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), can reduce the impact of clinically relevant, negative affective interference on response inhibition function in an opioid-treated chronic pain sample.

Methods

We examined data from a controlled trial comparing adults with chronic pain and long-term prescription opioid use randomized to either MORE (n = 27) treatment or to an active support group comparison condition (n = 30). Participants completed an Emotional Go/NoGo Task at pre- and post-treatment, which measured response inhibition in neutral and clinically relevant, negative affective contexts (i.e., exposure to pain-related visual stimuli).

Results

Repeated-measures analysis of variance indicated that compared with the support group, participants in MORE evidenced significantly greater reductions from pre- to post-treatment in errors of commission on trials with pain-related distractors relative to trials with neutral distractors, group × time × condition F(1,55) = 4.14, p = .047, η2partial = .07. Mindfulness practice minutes and increased nonreactivity significantly predicted greater emotional response inhibition. A significant inverse association was observed between improvements in emotional response inhibition and treatment-related reductions in pain severity by 3-month follow-up.

Conclusions

Study results provide preliminary evidence that MORE enhances inhibitory control function in the context of negative emotional interference.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735955/

 

Spirituality Interferes with Successful Treatment of Cannabis Abuse in Adolescents

Spirituality Interferes with Successful Treatment of Cannabis Abuse in Adolescents

 

By John M. de Castro, Ph.D.

 

“there are three main reasons that cannabis is seen as a spiritual tool. First, “It is a light intoxicant and can therefore be used fairly frequently and without the kinds of impairment associated with major hallucinogens.” Second, cannabis is conducive to group social use and fosters conversation about philosophical and theological matters. Finally, cannabis weakens our ability for sustained attention. . . . it’s great for aiding in shifts of perspective and giving experiences a more pluralistic character.” – Robert Fuller

 

Drug and alcohol addictions are very difficult to kick and if successful about half the time the individual will relapse. So, there have been developed a number of programs to help the addict recover and prevent relapse. The 12 step programs of Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, etc. have been as successful as any programs in treating addictions. These programs insist that spirituality is essential to recovery.

 

Marijuana use can lead to the development of problem use, known as a marijuana use disorder, which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use marijuana may have some degree of marijuana use disorder. People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.” National Institute of Drug Abuse.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. Spirituality has been shown to assist in addiction recovery. So, it would make sense to investigate the relationship of spirituality with the ability of adolescents to recover from cannabis abuse.

 

In today’s Research News article “”God put weed here for us to smoke”: A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430642/), Yeterian and colleagues recruited adolescents, aged 14 to 21 years, who were undergoing a 12-step program for the treatment of cannabis abuse. The adolescents were measured before treatment and at 3 and 6-month follow-ups for religiosity, spirituality, and substance abuse. They also underwent interviews about their substance use and the program.

 

They found at follow-up that the higher the levels of spirituality the greater the increase in the use of cannabis by the adolescents, while the higher the levels of spirituality at baseline, the lower the levels of alcohol consumption. The results of the interviews suggested that the relationship of spirituality with increased cannabis use was due to the adolescents believing that cannabis deepened the sense of their spirituality.

 

Twelve-step programs emphasize spirituality and the current results suggest that this may be useful in treating alcohol abuse. But it may be counterproductive in treating cannabis abuse, contributing to greater use. The adolescents appear to see cannabis use as enhancing their spirituality and thus spiritual youths are susceptible to continued and increased cannabis use. This suggests that treatment programs for cannabis abuse should not include spirituality as part of the treatment.

 

So, spirituality interferes with successful treatment of cannabis abuse in adolescents.

 

“It is important for clinicians to be aware of the dynamics of spirituality and religion in the cause, maintenance, and treatment of substance misuse problems.” – John Allen

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Yeterian, J. D., Bursik, K., & Kelly, J. F. (2018). “God put weed here for us to smoke”: A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders. Substance abuse, 39(4), 484–492. doi:10.1080/08897077.2018.1449168

 

Abstract

Background:

A growing literature on adults with substance use disorders (SUD) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately.

Methods:

The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice. Qualitative data were used to contextualize the quantitative findings.

Results:

Results showed that higher levels of spirituality at post-treatment predicted increased cannabis use at 6-month follow-up (β = .237, p = .043), whereas higher levels of baseline spirituality predicted a lower likelihood of heavy drinking at post-treatment (OR = .316, p = .040). Religiosity did not predict substance use outcomes at later timepoints. When asked to describe the relation between their religious/spiritual views and their substance use, adolescents described believing that they had a choice about their substance use and were in control of it, feeling more spiritual when under the influence of cannabis, and being helped by substance use.

Conclusions:

Together, findings suggest that for adolescents with SUD, religion and spirituality may not counteract the use of cannabis, which may be explained by adolescents’ views of their substance use as being consistent with their spirituality and under their control.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430642/

 

Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Trying to harness the mind in meditation is a bit like holding a water wiggly—those tubular, slippery, jelly-filled toys that leap out of your hand whenever you try to hold onto them. With the addition of a psychedelic state of mind, it could be like grasping with a greased hand.” – Paul Austin

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).” Since the effects of meditation and psilocybin appear similar, it’s important to look at the effects of the combination of meditation with psilocybin.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/ ), Smigielski and colleagues recruited experienced adult meditators participating in a 5-day meditation retreat and randomly assigned them to receive either a high dose of psilocybin or a placebo. The participants were matched for age, gender, mindfulness level, and meditation experience. They were administered psilocybin or placebo on the fourth day of the retreat. Before and after and on each day of the retreat they were measured for mindfulness and meditation depth. Six hours after psilocybin or placebo administration they were measured for altered states of consciousness and mystical experiences. Four months after the retreat they were evaluated for changes in behavior by self-report and that of a significant other. They did not observe any adverse events associated with psilocybin administration.

 

They found that on the day of administration the psilocybin group had significantly greater depth of meditation and after the retreat significantly higher mindfulness. While the drugs were in effect the psilocybin group had large significant increases in altered states of consciousness, including unity, spiritual experience, blissfulness, insightfulness, and disembodiment and large significant increases in mystical experiences, including complex imagery, elementary imagery, audiovisual synesthesia, and changed meaning of percepts. Four months after the retreat the participants who were administered psilocybin had significant changes in behavior documented by themselves and a significant other including significantly greater appreciation for life, self-acceptance, quest for meaning/sense of purpose, and appreciation of death.

 

Meditation retreats have been shown to increase meditation depth, mindfulness, mystical experiences, and to produce changes in consciousness. The present results suggest that psilocybin administration produces large and significant amplifications of these effects. In fact, the participants who received psilocybin reported that the experience was equivalent to the greatest mystical experiences that they have ever had. Remarkably, the effects of the single administration were enduring, altering and deepening their acceptance of themselves as they are, their appreciation of life and death, and their sense of meaning and purpose. These results suggest that the combination of meditation with psilocybin may be a safe and effective means to improve psychological and spiritual health and well-being.

 

So, augment mystical experiences in meditation and long-term well-being with psilocybin.

 

“After the retreat, mushroom-assisted meditators reported less self-consciousness and more illusions and hallucinations than the control group. What’s more, their brains showed alterations in the functioning of the default mode network—a group of interacting brain regions linked to self-awareness and rumination—during open awareness meditation. . . . What is even more remarkable is that experienced meditators in the psilocybin group reported better social functioning four months later.” – Grace Bullock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Smigielski, L., Kometer, M., Scheidegger, M., Krähenmann, R., Huber, T., & Vollenweider, F. X. (2019). Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat. Scientific reports, 9(1), 14914. doi:10.1038/s41598-019-50612-3

 

Abstract

Meditation and psychedelics have played key roles in humankind’s search for self-transcendence and personal change. However, neither their possible synergistic effects, nor related state and trait predictors have been experimentally studied. To elucidate these issues, we administered double-blind the model psychedelic drug psilocybin (315 μg/kg PO) or placebo to meditators (n = 39) during a 5-day mindfulness group retreat. Psilocybin increased meditation depth and incidence of positively experienced self-dissolution along the perception-hallucination continuum, without concomitant anxiety. Openness, optimism, and emotional reappraisal were predictors of the acute response. Compared with placebo, psilocybin enhanced post-intervention mindfulness and produced larger positive changes in psychosocial functioning at a 4-month follow-up, which were corroborated by external ratings, and associated with magnitude of acute self-dissolution experience. Meditation seems to enhance psilocybin’s positive effects while counteracting possible dysphoric responses. These findings highlight the interactions between non-pharmacological and pharmacological factors, and the role of emotion/attention regulation in shaping the experiential quality of psychedelic states, as well as the experience of selflessness as a modulator of behavior and attitudes. A better comprehension of mechanisms underlying most beneficial psychedelic experiences may guide therapeutic interventions across numerous mental conditions in the form of psychedelic-assisted applications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/

 

Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

 

By John M. de Castro, Ph.D.

 

“mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain. Individuals with an opioid addiction could also be taught to change their negative thoughts and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment.” – Science News

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids, and another 13,000 deaths from heroin overdose. These statistics, although startling are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can render the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not.

 

An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates. Recent research is indicating that mindfulness has been found to be effective in treating addictionsMindfulness-Oriented Recovery Enhancement (MORE) was specifically developed to employ mindfulness training along with other proven methods to assist addicts in remaining off of drugs. MORE involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion.

 

One method to observe reward processing in the brain is to measure the changes in the electrical activity that occur in response to specific reward related stimuli. These are called event-related potentials or ERPs. The signal following a stimulus changes over time. The fluctuations of the signal after specific periods of time are thought to measure different aspects of the nervous system’s processing of the stimulus. The Late Positive Potential (LPP) response in the evoked potential (ERP) is a positive going electrical response occurring between a 4 to 8 tenths of a second following the target stimulus presentation. The LPP is thought to reflect attention to the emotional features of a stimulus.

 

In today’s Research News article “Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/), Garland and colleagues recruited chronic pain patients who were opioid users. They were randomly assigned to receive 8 weeks of either Mindfulness-Oriented Recovery Enhancement (MORE) or a therapist led support group. They were measured for brain activity with an electroencephalogram (EEG) before and after treatment and opioid use at 3-month follow-up. In one experiment they measure the EEG response (Late Positive Potential (LPP)) while being presented with opioid cues (pictures of pills and pill bottles) or a neutral picture either normally or while attempting to not react or judge the stimuli. In a separate experiment with a similar procedure except that the participants were presented with natural reward pictures (e.g., social affiliation, natural beauty, and athletic victories) or neutral pictures.

 

They found that before treatment opioid and natural reward stimuli reliably produced significantly larger Late Positive Potentials (LPP) indicating that the LPP reflected emotional responses to rewards. After treatment the group that received Mindfulness-Oriented Recovery Enhancement (MORE) had significantly smaller LPP responses to opioid related cues than the support group. When the participants were asked to not react or judge the stimuli the MORE group had significantly greater reductions in the LPP. Importantly, the participants in the MORE group had a significantly larger LPPs to natural reward stimuli and when the participants were asked to not react or judge the natural reward stimuli the MORE group had a significantly larger increases in the LPP.

 

They also investigated the subjective emotional responses of the participants to the opioid and natural reward stimuli and found that after Mindfulness-Oriented Recovery Enhancement (MORE) the participants had larger increases in response to natural reward stimuli and smaller responses to opioid related stimuli. At the 3 month follow-up they found that MORE reduced the use of opioids to a greater extent than the support group and that it did so directly and also indirectly by increasing natural reward responses which, in turn, reduced opioid use.

 

These results suggest that responses to the rewarding aspects of stimuli is important in opioid addiction and that Mindfulness-Oriented Recovery Enhancement (MORE) reduces opioid use in addicted individuals they demonstrate that MORE reduces emotional responses to opioid cues while amplifying responses to natural rewards. This suggests that mindfulness treatment reduces opioid use by altering the addict’s responses to stimuli related to the addiction and naturally rewarding stimuli; amplifying natural reward while suppressing opioid rewards. This makes opioids less rewarding and natural stimuli more rewarding.

 

So, mindfulness reduces addiction by altering pleasure appreciation in opioid users.

 

Mindfulness-Oriented Recovery Enhancement (MORE), increases the brain’s response to natural, healthy rewards while also decreasing the brain’s response to opioid-related cues.” – University of Utah

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Garland, E. L., Atchley, R. M., Hanley, A. W., Zubieta, J. K., & Froeliger, B. (2019). Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement. Science advances, 5(10), eaax1569. doi:10.1126/sciadv.aax1569

 

Abstract

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE’s therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/

 

Help Withdraw from Antidepressant Drugs with Mindfulness

Help Withdraw from Antidepressant Drugs with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness can help you deal with emotional symptoms of SSRI withdrawal. Techniques such as meditation and deep breathing can help you reduce levels of irritability by reminding you to slow down and step back from a situation before you react.” – Sarah Fader

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

It seems reasonable to use antidepressant drugs initially in the treatment of depression but then withdraw the drugs. But withdrawal effects can occur. Symptoms of antidepressant withdrawal are anxiety, insomnia or vivid dreams, headaches, dizziness, tiredness, irritability, flu-like symptoms, including achy muscles and chills, nausea, electric shock sensations, return of depression symptoms. Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. And can help with antidepressant withdrawal.

 

Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Hence, there is a need to study the application of MBCT to assist in the withdrawal of antidepressant medication.

 

In today’s Research News article “Managing Antidepressant Discontinuation: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/), Maund and colleagues review and summarize the published research studies of the effectiveness of various therapies including Mindfulness-Based Cognitive Therapy (MBCT) to assist in the withdrawal of patients from antidepressants. They found 15 published randomized controlled trials with 3 employing MBCT.

 

They report that the randomized controlled trials found that tapering off antidepressant drugs was far more successful than abrupt withdrawal and that psychological therapies significantly assisted in the success of the process, with successful cessation rates of 40% to 95% compared to 6% to 7% when the physician sent a letter recommending withdrawal. Mindfulness-Based Cognitive Therapy (MBCT) was found to have successful cessation rates of 55% to 75%. MBCT also did not increase relapse/recurrence rates with 44% to 48% relapse.

 

There were only three randomized controlled trials that employed Mindfulness-Based Cognitive Therapy (MBCT) to aid in antidepressant withdrawal and there were no studies that included discontinuation symptoms. So, conclusions must be tempered and measured. But the published research suggests that MBCT is is safe and effective in improving the likelihood of successful withdrawal from antidepressants without increasing the likelihood of relapse.

 

So, help withdraw from antidepressant drugs with mindfulness.

 

Psychiatric medication is designed to alleviate suffering. Mindfulness can function in this way too. However, psychiatric medication is not generally designed to promote flourishing. . . . Mindfulness can alleviate distress, but it can also lead us states of flourishing and a sense of the deep completeness of the moment.” – Matthew Brensilver

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A., Dawson, S., & Kendrick, T. (2019). Managing Antidepressant Discontinuation: A Systematic Review. Annals of family medicine, 17(1), 52–60. doi:10.1370/afm.2336

 

Abstract

PURPOSE

We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS

We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS

Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18–0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS

Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/

 

Improve the Psychological Health of Cancer Patients with Psilocybin

Improve the Psychological Health of Cancer Patients with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Our research has shown that, in a medically controlled setting with expert screening and preparation, psilocybin can relieve the symptoms of anxiety and depression often found in patients with a cancer diagnosis.” – Heffter Research Institute

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).”

 

In today’s Research News article “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/), Griffiths and colleagues recruited patients with a potentially life threatening cancer diagnosis and high levels of anxiety and/or a mood disorder. They were randomly assigned to receive psilocybin in the lab in a living room type highly supportive environment with either a low dose in the first session and the high dose in the second 5 weeks later or in reverse order with the high dose first followed by low dose. Doses were administered double blind.

 

They were measured during the session for heart rate and respiration and ratings by attending monitors. After the drug effects subsided (7 hours after administration) they were measured for hallucinogen ratings, altered states of consciousness, mystical experiences, states of consciousness, and mysticism. They were also measured at baseline and five weeks after each session and 6 months later for anxiety, depression, mood, psychiatric symptoms, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, life coherence, and persisting effects of psilocybin. Family friends, and co-workers were also asked to rate the participant’s behavior and attitudes.

 

After the sessions no continuing adverse events were detected. During the sessions there were significant dose dependent increases in heart rate, blood pressure, joy and happiness, and visual experiences, and all ratings by the session monitors of behavior and mood. These effects all dissipated by the end of the session.

 

In comparison to baseline at all time points after psilocybin administration there were clinically significant decreases in anxiety, depression, psychiatric symptoms and significant increases in mood, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, and life coherence. Family friends, and co-workers also reported significant improvements in mood and behavior in the cancer patients. They also found that the greater the mystical experiences that the cancer patients had during the sessions the greater the levels of meaningfulness, spiritual significance, increased life satisfaction, meaningful existence, death acceptance, death transcendence, purpose in life, and coherence and the lower the levels of anxiety and depression.

 

The results suggest that psilocybin administration to patients with life threatening cancer diagnoses who also had high levels of anxiety and/or mood disturbance produced large and clinically significant improvements in their psychological and spiritual well-being. These benefits were observed by clinicians, session monitors, family, friend, and co-workers, and the patients themselves. These results are remarkable particularly due to the magnitude of the effects, the breadth of the benefits, their obviousness to all concerned, and the persistence of the effects, generally still large and significant 6 months after the session. This suggests that psilocybin treatment may be greatly beneficial to relieve the psychological suffering and the spiritual difficulties precipitated by cancer diagnosis.

 

So, improve the psychological health of cancer patients with psilocybin.

 

a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.” – Vanessa McMains

 

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Study Summary

 

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., … Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology (Oxford, England), 30(12), 1181–1197. doi:10.1177/0269881116675513

 

Abstract

Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/

 

Spirituality Improves Health Behaviors Particularly When Coupled with Religion

Spirituality Improves Health Behaviors Particularly When Coupled with Religion

 

By John M. de Castro, Ph.D.

 

Spirituality is a universal phenomenon and an inherent aspect of human nature that unfolds during adolescence as the individual searches for transcendence, meaning, and purpose in life.” – Sangwon Kim

 

We tend to think that illness is produced by physical causes, disease, injury, viruses, bacteria, etc. But many health problems are behavioral problems or have their origins in maladaptive behavior. This is evident in car accident injuries that are frequently due to behaviors, such as texting while driving, driving too fast or aggressively, or driving drunk. Other problematic behaviors are cigarette smoking, alcoholism, drug use, or unprotected sex. It is well established that if patterns and habits of healthy behaviors can be established early in life, long-term health can be promoted and ill health can be prevented. Adolescence is a time when these behavioral causes of health problems usually develop.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental healthReligiosity is also known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the influence of spirituality and religiosity on the ability of adolescents to develop positive health behaviors.

 

In today’s Research News article “”I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/), Malinakova and colleagues obtained data from a Czechoslovakian survey of a representative sample of adolescents aged 11, 13, and 15 years. Among other measures the youths completed measures of religious attendance, spirituality, tobacco, alcohol, and cannabis use, drug use experience, and sexual intercourse.

 

They found that either religious attendance or high spirituality was associated with a lower risk of smoking while only high spirituality was associated with lower alcohol use and only religious attendance appeared to be associated with lower early sexual intercourse. But when the combination of religious attendance and high spirituality was looked at, there were large significantly lower levels of tobacco, alcohol, and cannabis use and lifetime drug use.

 

These results are interesting but correlational. So, caution must be exercised in making conclusions about causality. They suggest, though, that individually religious attendance and spirituality only have limited associations with lower levels of health risk behaviors in adolescents. But in combination they have a strong association with lower levels of these behaviors. This suggests that just attending religious services doesn’t impact health risk behaviors unless it is combined with spirituality. It would appear that when youths are religious and also spiritual, they are much less likely to engage in behaviors that may damage their health.

 

So, spirituality improves health behaviors particularly when coupled with religion.

 

The results also showed a consistent relationship between high levels of spiritual health and positive overall self-rated health. Overall, while the perceived importance of spiritual health declined by age, for adolescents who maintain a strong sense of the importance of self-perceived spiritual health, the possible benefits are striking.” – HBSC News

 

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Study Summary

 

Malinakova, K., Kopcakova, J., Madarasova Geckova, A., van Dijk, J. P., Furstova, J., Kalman, M., … Reijneveld, S. A. (2019). “I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?. International journal of public health, 64(1), 115–124. doi:10.1007/s00038-018-1116-4

 

Abstract

Objectives

Spirituality and religious attendance (RA) have been suggested to protect against adolescent health-risk behaviour (HRB). The aim of this study was to explore the interrelatedness of these two concepts in a secular environment.

Methods

A nationally representative sample (n = 4566, 14.4 ± 1.1 years, 48.8% boys) of adolescents participated in the 2014 Health Behaviour in School-aged Children cross-sectional study. RA, spirituality (modified version of the Spiritual Well-Being Scale), tobacco, alcohol, cannabis and drug use and the prevalence of sexual intercourse were measured.

Results

RA and spirituality were associated with a lower chance of weekly smoking, with odds ratios (OR) 0.57 [95% confidence interval (CI) 0.36–0.88] for RA and 0.88 (0.80–0.97) for spirituality. Higher spirituality was also associated with a lower risk of weekly drinking [OR (95% CI) 0.91 (0.83–0.995)]. The multiplicative interaction of RA and spirituality was associated with less risky behaviour for four of five explored HRB. RA was not a significant mediator for the association of spirituality with HRB.

Conclusions

Our findings suggest that high spirituality only protects adolescents from HRB if combined with RA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/

 

Students and Military who are High in All Facets of Mindfulness Have Better Psychological Health

Students and Military who are High in All Facets of Mindfulness Have Better Psychological Health

 

By John M. de Castro, Ph.D.

 

“The research is strong for mindfulness’ positive impact in certain areas of mental health, including stress reduction, emotion and attention regulation, reduced rumination, for reducing mild to moderate depression and anxiety, and preventing depressive relapse.“ – Kelle Walsh

 

Mindfulness training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, mindfulness training has been called the third wave of therapies.

 

One of the premiere measurement tools for mindfulness is the Five Factors of Mindfulness Questionnaire. It measures overall mindfulness and also five facets; observing, describing, acting with awareness, non-judgement, and non-reactivity. People differ and an individual can be high or low on any of these facets and any combination of facets. It is not known what pattern of mindfulness facets are most predictive of good mental health.

 

In today’s Research News article “Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800780/ ), Bravo and colleagues recruited active and retired military personnel and college students. They were measured online for mindfulness, depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms.

 

They found that overall, the greater the levels of mindfulness, the better the mental health of the participants including lower depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms. The military personnel were higher on all measures except rumination than the college students.

 

For the college students latent profile analysis revealed 4 mindfulness profiles ““high mindfulness” group (i.e., moderately high on all facets of mindfulness), a “low mindfulness” group (i.e., relatively low-to-average on all facets of mindfulness), a “judgmentally observing” group (i.e., high on observing facet, low on non-judging of inner experience and acting with awareness) and a “non-judgmentally aware” group (i.e., low on observing, high on non-judging of inner experience and acting with awareness).” For the military personnel latent profile analysis revealed 3 mindfulness profiles “high mindfulness” group (i.e., moderately high on all facets of mindfulness), a “low mindfulness/ judgmentally observing” group (i.e., relatively low-to-average on describing, and non-reacting facets of mindfulness and  high on observing facet, low on non-judging of inner experience and acting with awareness) and a “non-judgmentally aware” group (i.e., low on observing, high on non-judging of inner experience and acting with awareness).

 

For both the military personnel and the students, the participants with the “high mindfulness” profile had significantly better mental health than those with the other profiles including lower depression, anxiety, rumination, suicidality, post-traumatic stress disorder, alcohol and drug abuse symptoms. It is important to note that the results were similar in very different participant populations, suggesting that the results are generalizable.

 

The results further suggest that with mindfulness there are very different types of people, expressing mindfulness in different ways and this makes a difference in the relationship of mindfulness to mental health. The results suggest that overall being mindful is associated with good mental health. They further suggest that being generally high on all facets of mindfulness is an even better predictor of good mental health. It may make sense in future research to pay more attention to these different mindfulness profile groups in investigating mindfulness relationships with mental and physical well-being.

 

It is clear that mindfulness is associated with better mental health.

 

“We’ve seen this in the clinical domain for many years. People, in concert with their physicians… actually going off their medications for pain, for anxiety, for depression, as they begin to learn the self-regulatory elements of mindfulness. They discover that the things that used to be symptomatically problematic for them are no longer arising at the same level.” – Jon Kabat-Zinn

 

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Study Summary

 

Bravo, A. J., Pearson, M. R., & Kelley, M. L. (2017). Mindfulness and Psychological Health Outcomes: A Latent Profile Analysis among Military Personnel and College Students. Mindfulness, 9(1), 258-270.

 

Abstract

Previous research on trait mindfulness facets using person-centered analyses (e.g., latent profile analysis [LPA]) has identified four distinct mindfulness profiles among college students: a high mindfulness group (high on all facets of the Five-Factor Mindfulness Questionnaire [FFMQ]), a judgmentally observing group (highest on observing, but low on non-judging of inner experience and acting with awareness), a non-judgmentally aware group (high on non-judging of inner experience and acting with awareness, but very low on observing), and a low mindfulness group (low on all facets of the FFMQ). In the present study, we used LPA to identify distinct mindfulness profiles in a community based sample of U.S. military personnel (majority veterans; n = 407) and non-military college students (n = 310) and compare these profiles on symptoms of psychological health outcomes (e.g., suicidality, PTSD, anxiety, rumination) and percentage of participants exceeding clinically significant cut-offs for depressive symptoms, substance use, and alcohol use. In the subsample of college students, we replicated previous research and found four distinct mindfulness profiles; however, in the military subsample we found three distinct mindfulness profiles (a combined low mindfulness/judgmentally observing class). In both subsamples, we found that the most adaptive profile was the “high mindfulness” profile (i.e., demonstrated the lowest scores on all psychological symptoms and the lowest probability of exceeding clinical cut-offs). Based on these findings, we purport that the comprehensive examination of an individual’s mindfulness profile could help clinicians tailor interventions/treatments that capitalize on individual’s specific strengths and work to address their specific deficits.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5800780/

 

Mindfulness is Associated with Fewer Worries about Cessation of the Use of Sleeping Pills for Insomnia

Mindfulness is Associated with Fewer Worries about Cessation of the Use of Sleeping Pills for Insomnia

 

By John M. de Castro, Ph.D.

 

“If insomnia is at the root of your sleepless nights, it may be worth trying meditation. The deep relaxation technique has been shown to increase sleep time, improve sleep quality, and make it easier to fall (and stay) asleep.” – National Sleep Foundation

 

It is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. Yet over 70 million Americans suffer from disorders of sleep and about half of these have a chronic disorder. It has been estimated that about 4% of Americans revert to sleeping pills. But, these do not always produce high quality sleep and can have problematic side effects. In addition, these medications can become addictive such that the individual cannot sleep without them. So, there is a need to find better methods to improve sleep.

 

Mindfulness-based practices have been reported to improve sleep amount and quality and to help treat addictions. Indeed, Mindfulness-based Relapse Prevention (MBRP) was developed to specifically assist in relapse prevention and has been shown to be effective. In today’s Research News article “Dispositional mindfulness, anticipation and abstinence symptoms related to hypnotic dependence among insomniac women who seek treatment: A cross-sectional study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856331/ ), Barros and colleagues examined the relationship between mindfulness and addiction to sleeping pills in women.

 

They recruited adult women who used sleeping pills on a daily basis and had them complete paper and pencil measures of mindfulness, insomnia severity, anxiety, and dependence on sleeping pills, including problematic use, preoccupation with availability, lack of compliance with prescription, and withdrawal symptoms. They performed a regression analysis to examine the relationships between these variables.

 

They found that the higher the levels of mindfulness and particularly the observing facet of mindfulness, the lower the preoccupation with the availability of sleeping pills. This preoccupation frequently involves anxiety about not having the medication available for use. In addition, the higher the levels of mindfulness and particularly the non-reacting facet of mindfulness, the lower the lack of compliance with prescription. The women with high mindfulness were less likely to use the sleeping pills more often or in different circumstances than prescribed by their physician. Finally, the higher the levels of the mindfulness facets of observing and non-reacting, the lower the belief that withdrawal would produce severe uncomfortable experiences.

 

This study was correlative and as such conclusions regarding causation cannot be reached, Nevertheless, the results suggest that the levels of mindfulness prior to treatment for sleeping pill addiction are associated with the characteristics of the addiction and the patients’ anxieties regarding the availability of the pills and the consequences of withdrawal. This suggests that more mindful women would find it easier to withdraw from their use and treatment for the addiction would be more likely to be effective. It remains for future research to examine whether high levels of mindfulness prior to treatment is predictive of greater success in treatment.

 

Imagine a country where we no longer have to depend on medication to help manage depression, chronic pain, or insomnia. . . mindfulness is just as effective as side-effect loaded medications. “ – Ruth Buczynski

 

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Study Summary

 

Barros, V. V., Opaleye, E. S., Demarzo, M., Bowen, S., Curado, D. F., Hachul, H., & Noto, A. R. (2018). Dispositional mindfulness, anticipation and abstinence symptoms related to hypnotic dependence among insomniac women who seek treatment: A cross-sectional study. PLoS ONE, 13(3), e0194035. http://doi.org/10.1371/journal.pone.0194035

 

Abstract

Introduction

Dispositional mindfulness can be described as the mental ability to pay attention to the present moment, non-judgmentally. There is evidence of inverse relation between dispositional mindfulness and insomnia and substance use, but as of yet, no studies evaluating the specific association between dispositional mindfulness and the components of hypnotic use disorder.

Objective

To evaluate the association between dispositional mindfulness and the components of dependence among female chronic hypnotic users.

Design and method

Seventy-six women, chronic users of hypnotics, who resorted to Mindfulness-Based Relapse Prevention for the cessation of hypnotic use were included in the study. The Five Facet Mindfulness Questionnaire (FFMQ) evaluated the levels and facets of mindfulness, and the subscales of the Benzodiazepine Dependence Questionnaire (BENDEP) assessed dependence on hypnotics. We also evaluated sociodemographic variables and symptoms of insomnia and anxiety. The associations between the FFMQ facets and the BENDEP subscales were evaluated with binomial logistic regression, adjusted for income, schooling, anxiety, and insomnia.

Results

We observed associations between facets of the FFMQ and specific aspects of hypnotic dependence. The facet “observing” was inversely associated with the “concern about lack of availability of the hypnotic” [aOR = 0.87 95% CI (0.79–0.97)], and the facet “non-reacting to inner experience” with “noncompliance with the prescription recommendations” [aOR = 0.86 95% CI (0.75–0.99)]. The total score of the FFMQ was inversely associated to those two dependence subscales [aOR = 0.94 95% CI (0.89–0.99)]. “Observing” and “non-reactivity to inner experience” were also inversely associated with the “impairments related to the withdrawal symptoms” [aOR = 0.84 95% CI (0.73–0.97)] and [aOR = 0.78 95% CI (0.63–0.96)], respectively. The FFMQ was not associated with “awareness of problematic hypnotic use”.

Conclusion

Dispositional mindfulness, specifically the facets “observing” and “non-reactivity to inner experience, were inversely associated with the components of hypnotic dependence related to the anticipation of having the substance, its expected effect, and the impairments caused by the abstinence. We discuss the implications of those results for the clinical practice and future investigations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5856331/

Reduce Use and Improve the Mental Health of Adults with Stimulant Addiction with Mindfulness

Reduce Use and Improve the Mental Health of Adults with Stimulant Addiction with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When stimulant users attempt to quit, some of the most frequent complaints have to do with intolerable feelings of depression, sadness, and anxiety, conditions that often lead people to drop out of treatment early. Mindfulness practice not only helps them to manage cravings and urges, but also enables them to better cope with the psychological discomfort that can precipitate a relapse.” – Suzette Glasner

 

Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse. Hence, it is important to find an effective method to treat substance abuse and prevent relapse.

 

Mindfulness practices have been shown to improve recovery from various addictions. Mindfulness-based Relapse Prevention (MBRP) has been developed to specifically assist in relapse prevention and has been shown to be effective. “MBRP integrates mindfulness practices with cognitive-behavioral Relapse Prevention therapy and aims to help participants increase awareness and acceptance of difficult thoughts, feelings, and sensations to create changes in patterns of reactive behavior that commonly lead to relapse. Mindfulness training in MBRP provides clients with a new way of processing situational cues and monitoring internal reactions to contingencies, and this awareness supports proactive behavioral choices in the face of high-risk relapse situation.” – Grow et al. 2015

 

In today’s Research News article “Mindfulness Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300086/ ), Glasner-Edwards and colleagues recruited stimulant (cocaine or amphetamine) dependent adults. All participants participated in a contingency management program which involved receiving rewards for drug clean urine samples. Participants were randomly assigned to receive an 8-week program of Mindfulness-based Relapse Prevention (MBRP) or health education. They were measured before and after treatment and 1 month later for stimulant use (urine test), stimulant dependence, anxiety disorders, depression, emotion regulation, thought suppression, and mindfulness.

 

They found that the (MBRP) program resulted in significantly lower levels of severity of psychiatric disorders, depression and anxiety at follow-up than those in the health education condition. In addition, for two psychiatric subgroups, participants with major depressive disorder or anxiety disorder, participation in the (MBRP) program resulted in significantly lower use of stimulants than those in the health education condition.

 

These are exciting results that suggest that participation in a Mindfulness-based Relapse Prevention (MBRP) can significantly improve psychiatric symptoms and mood in stimulant dependent individuals and reduce stimulant use participants who suffered from major depression or anxiety disorder. Drug abuse is difficult to treat and even when successful relapse is likely. So, programs like (MBRP) that can be of assistance in reducing the abuse and the mental health of the abusers may be very valuable. This program was far from a cure and much more research and development is needed.

 

So, reduce use and improve the mental health of adults with stimulant addiction with mindfulness.

 

“Incorporating mindfulness into cognitive-behavioral therapy may prove to be helpful for people looking to manage their drug addictions more successfully. . . it could be especially helpful for reducing stimulant relapse rates in people with anxiety and depression.” – Two Dreams

 

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Study Summary

 

Glasner-Edwards, S., Mooney, L. J., Ang, A., Garneau, H. C., Hartwell, E., Brecht, M.-L., & Rawson, R. A. (2017). Mindfulness Based Relapse Prevention for Stimulant Dependent Adults: A Pilot Randomized Clinical Trial. Mindfulness, 8(1), 126–135. http://doi.org/10.1007/s12671-016-0586-9

 

Abstract

In light of the known associations between stress, negative affect, and relapse, mindfulness strategies hold promise as a means of reducing relapse susceptibility. In a pilot randomized clinical trial, we evaluated the effects of Mindfulness Based Relapse Prevention (MBRP), relative to a health education control condition (HE) among stimulant dependent adults receiving contingency management. All participants received a 12-week contingency management (CM) intervention. Following a 4-week CM-only lead in phase, participants were randomly assigned to concurrently receive MBRP (n=31) or HE (n=32). Stimulant dependent adults age 18 and over. A university based clinical research center. The primary outcomes were stimulant use, measured by urine drug screens weekly during the intervention and at 1-month post-treatment, negative affect, measured by the Beck Depression Inventory and Beck Anxiety Inventory, and psychiatric severity, measured by the Addiction Severity Index. Medium effect sizes favoring MBRP were observed for negative affect and overall psychiatric severity outcomes. Depression severity changed differentially over time as a function of group, with MBRP participants reporting greater reductions through follow-up (p=0.03; Effect Size=0.58). Likewise, the MBRP group evidenced greater declines in psychiatric severity, (p=0.01; Effect Size=0.61 at follow-up). Among those with depressive and anxiety disorders, MBRP was associated with lower odds of stimulant use relative to the control condition (Odds Ratio= 0.78, p=0.03 and OR=0.68, p=0.04). MBRP effectively reduces negative affect and psychiatric impairment, and is particularly effective in reducing stimulant use among stimulant dependent adults with mood and anxiety disorders.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300086/