SOBER Breathing Space Stop step out of automatic pilot mode Observe what is happening for you Breath focus simply on your breathing Expand be aware of mind, body & situation Respond notice that you can respond with awareness.
What is mindfulness? Translation of ancient Pali word sati - awareness direct, open-hearted knowing Traditionally cultivated by meditation practices Learning to pay attention Moment by moment Intentionally With curiosity and compassion
Applications of mindfulness in the addictions Mindfulness-based Relapse Prevention (MBRP) / Mindfulness-based Addiction Recovery (MBAR) Dialectical Behavior Therapy (DBT) Acceptance & Commitment Therapy (ACT)
ABC of Mindfulness-Based Approaches Develop Awareness Learn to Be with experience Making skilful Choices
Internal trigger External trigger M1 M1 cocktail party effect Memory: substancerelated action plans; automatic substancerelated thoughts mindless obsessing M2 Conscious substance-related thoughts if resist M1 Self-efficacy; outcome expectancies SUBSTANCE USE M3 Urges
Traditional RP vs MBRP: Similarities Both teach specific RP strategies to: increase understanding of individual relapse cycles (high risk situations, substance-related cognitions etc) enhance self-efficacy develop effective cognitive and behavioural coping responses to triggers.
Traditional RP vs MBRP: Differences Learning style: MBRP focuses more on experiential learning Responding to thoughts & feelings: Traditional RP focus on changing the content of thoughts vs MBRP s focus on changing the relationship to thoughts MBRP focuses more on being with experience.
Bowen et al (2011) MBRP programme eight 2 hour sessions, each including: 1. formal mindfulness practices 2. exercises and skills designed to bring these practices into daily life, specifically into situations in which an individual is at high risk for relapse.
Bowen et al s MBRP Session Structure 1) Automatic Pilot and Relapse 2) Awareness of Triggers and Craving 3) Mindfulness in Daily Life 4) Mindfulness in High Risk Situations 5) Acceptance and Skilful Action 6) Seeing Thoughts as Thoughts 7) Self-care and Lifestyle Balance 8) Social Support and Continuing Practice
SOBER Breathing Space Adaptation of the 3 minute breathing space. Simple technique, using acronym SOBER. Can be used anywhere, particularly in high risk situations, to help step out of automatic mode and become more aware of our actions
SOBER Breathing Space Stop step out of automatic pilot mode Observe what is happening for you Breath focus simply on your breathing Expand be aware of mind, body & situation Respond notice that you can respond with awareness.
Is mindfulness the same as relaxation? Mindfulness v relaxation v control Both reduced psychological distress > control Mindfulness also reduced rumination and distraction Jain, S., Shapiro, S. L., Swanick, S., Roesch, S. C., Mills, P. J., Bell, I., & Schwartz, G. E. R. (2007). A Randomized controlled trial of mindfulness meditation versus relaxation training: Effects on distress, positive states of mind, rumination, and distraction. Annals of Behavioral Medicine, 33(1), 11 21.
Research Evidence Review by Zgierska (2009) 7 RCTs: 5 showed improved substance use, 2 similar to control High patient satisfaction Between half and 80% continued to practise mindfulness after the programme had finished Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness meditation for substance use disorders: A systematic review. Substance Abuse, 30(4), 266 294.
Pilot efficacy trial Aftercare following intensive substance misuse treatment MBRP v TAU Reduced substance use & craving (especially in response to depression) Increased acceptance & reduced experiential avoidance Bowen et al (2009), Witkiewitz et al (2010)
Parents under Pressure RCT 64 methadone maintained patients Parenting intervention including mindfulness v conventional parenting programme v tau Improved parenting, child behaviour and dose of methadone Dawe et at (2007)
Women Offenders RCT MBRP v RP Residential addiction treatment At 15 weeks follow-up fewer drug use days and fewer medical and legal problems Witkiewitz, K., Warner, K., Sully, B., Barricks, A., Stauffer, C., Steckler, G.,... Luoma, J. (2014). Randomized trial comparing mindfulness based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use and Misuse, 49:536 546.
Mindfulness for dual diagnosis? Mindfulness appears to help depression, anxiety, stress, poor emotional regulation & avoidance coping Helps cope with risk factors to relapse (e.g. depression) Commonality of rumination & stress vulnerability
Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Luoma JB; Kohlenberg BS; Hayes SC; Fletcher L Journal of Consulting & Clinical Psychology. 80(1):43-53, 2012 Feb. 2012 by the American Psychological Association. 2
2012 by the American Psychological Association. 2