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Sacchet MD, Fava M, Garland EL. Modulating self-referential processing through meditation and psychedelics: is scientific investigation of self-transcendence clinically relevant? World Psychiatry 2024; 23:298-299. [PMID: 38727064 PMCID: PMC11083968 DOI: 10.1002/wps.21214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Affiliation(s)
- Matthew D Sacchet
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maurizio Fava
- Meditation Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, USA
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De Oliveira P, Juneau C, Stinus C, Corman M, Michelli N, Pellerin N, Shankland R, Dambrun M. Cultivating Self-Transcendence Through Meditation Practice: A Test of the Role of Meta-Awareness, (Dis)identification and Non-Reactivity. Psychol Rep 2024:332941241246469. [PMID: 38669443 DOI: 10.1177/00332941241246469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
In this paper, we present a study comprising two distinct stages to examine the extent to which metacognitive processes of decentering facilitate the emergence of self-transcendence experiences in everyday life (i.e., the frequency of self-transcendent emotions, flow proneness, and adopting an interconnected identity). In the course of conducting this research, the first stage (N = 374) focused on assessing the structure and validity of the French version of the Metacognitive Processes of Decentering Scale (MPoD-t). Building on this, the second stage (N = 294) examined the potential relationship between meditative practices and psychological decentering processes (i.e., meta-awareness, (dis)identification with internal experiences, and (non)reactivity to thought content) and explored whether these mechanisms explain the association between meditative practices and the experience of self-transcendent states. Overall, the results demonstrated satisfactory psychometric properties of the French version of the MPoD and provided enhanced insights into the distinct mediating roles played by various decentering components in the manifestation of self-transcendence experiences in daily life. Indeed, the findings revealed that the relationship between practice and the occurrence of self-transcendent emotions or flow was mediated by the meta-awareness component, while the association between practice and the development of an interconnected identity was explained by the (dis)identification with internal experiences component. The implications of these findings are discussed.
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Affiliation(s)
| | | | - Céline Stinus
- C2S, Université de Reims Champagne-Ardenne, Reims, France
| | - Maya Corman
- LAPSCO CNRS, Université Clermont Auvergne (UCA), Clermont-Ferrand, France
| | - Noemi Michelli
- LabPsy UR 4139, Université de Bordeaux, Bordeaux, France
| | | | | | - Michael Dambrun
- LAPSCO CNRS, Université Clermont Auvergne (UCA), Clermont-Ferrand, France
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Cooperman NA, Lu SE, Hanley AW, Puvananayagam T, Dooley-Budsock P, Kline A, Garland EL. Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial. JAMA Psychiatry 2024; 81:338-346. [PMID: 38061786 PMCID: PMC10704342 DOI: 10.1001/jamapsychiatry.2023.5138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Importance Methadone treatment (MT) fails to address the emotion dysregulation, pain, and reward processing deficits that often drive opioid use disorder (OUD). New interventions are needed to address these factors. Objective To evaluate the efficacy of MT as usual (usual care) vs telehealth Mindfulness-Oriented Recovery Enhancement (MORE) plus usual care among people with an OUD and pain. Design, Setting, and Participants This study was a randomized clinical trial conducted from August 2020 to June 2022. Participants receiving MT for OUD and experiencing chronic pain were recruited at 5 clinics in New Jersey. Interventions In usual care, participants received MT, including medication and counseling. Participants receiving MORE plus usual care attended 8 weekly, 2-hour telehealth groups that provided training in mindfulness, reappraisal, and savoring in addition to usual care. Main Outcomes and Measure Primary outcomes were return to drug use and MT dropout over 16 weeks. Secondary outcomes were days of drug use, methadone adherence, pain, depression, and anxiety. Analyses were based on an intention-to-treat approach. Results A total of 154 participants (mean [SD] age, 48.5 [11.8] years; 88 female [57%]) were included in the study. Participants receiving MORE plus usual care had significantly less return to drug use (hazard ratio [HR], 0.58; 95% CI, 0.37-0.90; P = .02) and MT dropout (HR, 0.41; 95% CI, 0.18-0.96; P = .04) than those receiving usual care only after adjusting for a priori-specified covariates (eg, methadone dose and recent drug use, at baseline). A total of 44 participants (57.1%) in usual care and 39 participants (50.6%) in MORE plus usual care returned to drug use. A total of 17 participants (22.1%) in usual care and 10 participants (13.0%) in MORE plus usual care dropped out of MT. In zero-inflated models, participants receiving MORE plus usual care had significantly fewer days of any drug use (ratio of means = 0.58; 95% CI, 0.53-0.63; P < .001) than those receiving usual care only through 16 weeks. A significantly greater percentage of participants receiving MORE plus usual care maintained methadone adherence (64 of 67 [95.5%]) at the 16-week follow-up than those receiving usual care only (56 of 67 [83.6%]; χ2 = 4.49; P = .04). MORE reduced depression scores and ecological momentary assessments of pain through the 16-week follow-up to a significantly greater extent than usual care (group × time F2,272 = 3.13; P = .05 and group × time F16,13000 = 6.44; P < .001, respectively). Within the MORE plus usual care group, EMA pain ratings decreased from a mean (SD) of 5.79 (0.29) at baseline to 5.17 (0.30) at week 16; for usual care only, pain decreased from 5.19 (0.28) at baseline to 4.96 (0.29) at week 16. Within the MORE plus usual care group, mean (SD) depression scores were 22.52 (1.32) at baseline and 18.98 (1.38) at 16 weeks. In the usual care-only group, mean (SD) depression scores were 22.65 (1.25) at baseline and 20.03 (1.27) at 16 weeks. Although anxiety scores increased in the usual care-only group and decreased in the MORE group, this difference between groups did not reach significance (group × time unadjusted F2,272 = 2.10; P= .12; Cohen d = .44; adjusted F2,268 = 2.33; P = .09). Within the MORE plus usual care group, mean (SD) anxiety scores were 25.5 (1.60) at baseline and 23.45 (1.73) at 16 weeks. In the usual care-only group, mean (SD) anxiety scores were 23.27 (1.75) at baseline and 24.07 (1.73) at 16 weeks. Conclusions and Relevance This randomized clinical trial demonstrated that telehealth MORE was a feasible adjunct to MT with significant effects on drug use, pain, depression, treatment retention, and adherence. Trial Registration ClinicalTrials.gov Identifier: NCT04491968.
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Affiliation(s)
- Nina A Cooperman
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Shou-En Lu
- Rutgers School of Public Health, Piscataway, New Jersey
| | - Adam W Hanley
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
| | - Thanusha Puvananayagam
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Patricia Dooley-Budsock
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Anna Kline
- Department of Psychiatry, Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Eric L Garland
- College of Social Work, University of Utah, Salt Lake City
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City
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Garland EL, Jinpa T. Mindfulness-induced self-transcendence promotes universal love with consequent effects on opioid misuse. Behav Res Ther 2024; 175:104494. [PMID: 38395015 DOI: 10.1016/j.brat.2024.104494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
In addition to its health benefits, mindfulness has been theorized in classical contemplative frameworks to elicit self-transcendent experiences as a means of promoting universal love and compassion. Increasing feelings of love may be especially clinically relevant for the treatment of opioid misuse, in that addictive use of opioids dysregulates neurobiological processes implicated in the experience of love. Here we tested these hypotheses in a secondary analysis (n = 187) of data from a randomized clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) versus supportive psychotherapy for comorbid opioid misuse and chronic pain. At pre- and post-treatment, participants completed a measure of state self-transcendence immediately following a laboratory-based mindfulness task. Through 9-month follow-up, we assessed changes in universal love and opioid misuse. Participants also completed ecological momentary assessments of opioid craving during the 8-week study interventions and for the following month. Compared to supportive psychotherapy, participants in MORE reported significantly greater increases in mindfulness-induced self-transcendence, which mediated the effect of MORE on increased feelings of universal love. In turn, increases in universal love significantly predicted decreased opioid craving and lower odds opioid misuse through 1- and 9-month follow-ups, respectively. Findings suggest mindfulness-induced self-transcendence may promote feelings of universal love, with possible downstream benefits on reducing addictive behavior.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA.
| | - Thupten Jinpa
- School of Religious Studies, McGill University, Canada
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Tap SC. The potential of 5-methoxy-N,N-dimethyltryptamine in the treatment of alcohol use disorder: A first look at therapeutic mechanisms of action. Addict Biol 2024; 29:e13386. [PMID: 38600715 PMCID: PMC11007263 DOI: 10.1111/adb.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/24/2023] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Alcohol use disorder (AUD) remains one of the most prevalent psychiatric disorders worldwide with high economic costs. Current treatment options show modest efficacy and relapse rates are high. Furthermore, there are increases in the treatment gap and few new medications have been approved in the past 20 years. Recently, psychedelic-assisted therapy with psilocybin and lysergic acid diethylamide has garnered significant attention in the treatment of AUD. Yet, they require significant amounts of therapist input due to prolonged subjective effects (~4-12 h) leading to high costs and impeding implementation. Accordingly, there is an increasing interest in the rapid and short-acting psychedelic 5-methoxy-N,N-dimethyltryptamine (5-MeO-DMT). This paper offers a first look at potential therapeutic mechanisms for AUD by reviewing the current literature on 5-MeO-DMT. Primarily, 5-MeO-DMT is able to induce mystical experiences and ego-dissolution together with increases in psychological flexibility and mindfulness. This could decrease AUD symptoms through the alleviation of psychiatric mood-related comorbidities consistent with the negative reinforcement and self-medication paradigms. In addition, preliminary evidence indicates that 5-MeO-DMT modulates neural oscillations that might subserve ego-dissolution (increases in gamma), psychological flexibility and mindfulness (increases in theta), and the reorganization of executive control networks (increases in coherence across frequencies) that could improve emotion regulation and inhibition. Finally, animal studies show that 5-MeO-DMT is characterized by neuroplasticity, anti-inflammation, 5-HT2A receptor agonism, and downregulation of metabotropic glutamate receptor 5 with clinical implications for AUD and psychiatric mood-related comorbidities. The paper concludes with several recommendations for future research to establish the purported therapeutic mechanisms of action.
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Affiliation(s)
- Stephan C. Tap
- Department of PsychiatryGroningen University Medical CenterGroningenThe Netherlands
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Garland EL, Nakamura Y, Bryan CJ, Hanley AW, Parisi A, Froeliger B, Marchand WR, Donaldson GW. Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. Am J Psychiatry 2024; 181:125-134. [PMID: 38196335 DOI: 10.1176/appi.ajp.20230272] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE This randomized clinical trial evaluated the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) among past and present U.S. military personnel with prescriptions for long-term opioid therapy for chronic pain. METHODS In this clinical trial, 230 past and present military personnel with prescriptions for long-term opioid therapy were randomized in a 1:1 ratio to MORE or supportive psychotherapy (initially delivered in person and then via videoconferencing after the onset of the COVID-19 pandemic). Primary outcomes were chronic pain, measured by the Brief Pain Inventory, and aberrant drug-related behaviors, measured by the Current Opioid Misuse Measure, through 8 months of follow-up. Opioid dose was a key secondary outcome. Other outcomes included psychiatric symptoms, catastrophizing, positive affect, ecological momentary assessments of opioid craving, and opioid attentional bias. RESULTS MORE was superior to supportive psychotherapy through the 8-month follow-up in reducing pain-related functional interference, pain severity, and opioid dose. MORE reduced daily opioid dose by 20.7%, compared with a dose reduction of 3.9% with supportive psychotherapy. Although there was no overall between-group difference in opioid misuse, the in-person MORE intervention outperformed supportive psychotherapy for reducing opioid misuse. MORE reduced anhedonia, pain catastrophizing, craving, and opioid attentional bias and increased positive affect to a greater extent than supportive psychotherapy. MORE also modulated therapeutic processes, including mindful reinterpretation of pain sensations, nonreactivity, savoring, positive attention, and reappraisal. CONCLUSIONS Among past and present U.S. military personnel, MORE led to sustained decreases in chronic pain, opioid use, craving, and opioid cue reactivity. MORE facilitated opioid dose reduction while preserving adequate pain control and preventing mood disturbances, suggesting its utility for safe opioid tapering.
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Affiliation(s)
- Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Yoshio Nakamura
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Craig J Bryan
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Adam W Hanley
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Brett Froeliger
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - William R Marchand
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
| | - Gary W Donaldson
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City (Garland, Nakamura, Hanley, Parisi); Veterans Health Care Administration VISN 19 Whole Health Flagship Site, VA Salt Lake City Health Care System, Salt Lake City (Garland, Marchand); Pain Research Center, Division of Pain Medicine, Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City (Nakamura, Donaldson); Department of Psychiatry and Behavioral Health, Ohio State University, Columbus (Bryan); Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia (Froeliger); Department of Psychiatry, University of Utah School of Medicine, Salt Lake City (Marchand)
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Larsen JK, Hollands GJ, Garland EL, Evers AWM, Wiers RW. Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions. Neurosci Biobehav Rev 2023; 153:105408. [PMID: 37758008 DOI: 10.1016/j.neubiorev.2023.105408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/01/2023] [Accepted: 09/22/2023] [Indexed: 09/29/2023]
Abstract
This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.
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Affiliation(s)
- Junilla K Larsen
- Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, the Netherlands.
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, UK
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, USA
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, NL, and Medical Delta, Leiden University, TU Delft and Erasmus University, UK
| | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT)-lab, Department of Psychology, University of Amsterdam and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
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Giommi F, Bauer PR, Berkovich-Ohana A, Barendregt H, Brown KW, Gallagher S, Nyklíček I, Ostafin B, Raffone A, Slagter HA, Trautwein FM, Vago DR. The (In)flexible self: Psychopathology, mindfulness, and neuroscience. Int J Clin Health Psychol 2023; 23:100381. [PMID: 36969914 PMCID: PMC10033904 DOI: 10.1016/j.ijchp.2023.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
Clinical and neuroscientific evidence indicates that transdiagnostic processes contribute to the generation and maintenance of psychopathological symptoms and disorders. Rigidity (inflexibility) appears a core feature of most transdiagnostic pathological processes. Decreasing rigidity may prove important to restore and maintain mental health. One of the primary domains in which rigidity and flexibility plays a role concerns the self. We adopt the pattern theory of self (PTS) for a working definition of self. This incorporates the pluralist view on self as constituted by multiple aspects or processes, understood to constitute a self-pattern, i.e. processes organized in non-linear dynamical relations across a number of time scales. The use of mindfulness meditation in the format of Mindfulness Based Interventions (MBIs) has been developed over four decades in Clinical Psychology. MBIs are promising as evidence-based treatments, shown to be equivalent to gold-standard treatments and superior to specific active controls in several randomized controlled trials. Notably, MBIs have been shown to target transdiagnostic symptoms. Given the hypothesized central role of rigid, habitual self-patterns in psychopathology, PTS offers a useful frame to understand how mindfulness may be beneficial in decreasing inflexibility. We discuss the evidence that mindfulness can alter the psychological and behavioral expression of individual aspects of the self-pattern, as well as favour change in the self-pattern as a whole gestalt. We discuss neuroscientific research on how the phenomenology of the self (pattern) is reflected in associated cortical networks and meditation-related alterations in cortical networks. Creating a synergy between these two aspects can increase understanding of psychopathological processes and improve diagnostic and therapeutic options.
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Affiliation(s)
- Fabio Giommi
- NOUS-School of Specialization (PsyD) in Psychotherapy, Milano, Italy
- Insight Dialogue Community [insightdialogue.org/teachers]
| | - Prisca R. Bauer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Aviva Berkovich-Ohana
- Edmond Safra Brain Research Center, Faculty of Education, University of Haifa, Israel
- Faculty of Education, Department of Learning and Instructional Sciences, University of Haifa, Israel
- The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Israel
- Faculty of Education, Department of Counseling and Human Development, University of Haifa, Israel
| | - Henk Barendregt
- Faculty of Science, Radboud University, Nijmegen, the Netherlands
| | | | - Shaun Gallagher
- Department of Philosophy, University of Memphis, USA and SOLA, University of Wollongong, Australia
| | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Brian Ostafin
- Department of Clinical Psychology, University of Groningen, the Netherlands
| | - Antonino Raffone
- Department of Psychology, Sapienza University of Rome, Italy
- School of Buddhist Studies, Philosophy and Comparative Religions, Nalanda University, India
| | | | - Fynn-Mathis Trautwein
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - David R. Vago
- Contemplative Sciences Center, University of Virginia
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Meng Q, Zhu Y, Yuan Y, Yang L, Liu J, Zhang X, Bu J. Resting-state electroencephalography theta predicts neurofeedback treatment 4-month follow-up response in nicotine addiction. Gen Psychiatr 2023; 36:e101091. [PMID: 37663053 PMCID: PMC10471848 DOI: 10.1136/gpsych-2023-101091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Background The high rate of long-term relapse is a major cause of smoking cessation failure. Recently, neurofeedback training has been widely used in the treatment of nicotine addiction; however, approximately 30% of subjects fail to benefit from this intervention. Our previous randomised clinical trial (RCT) examined cognition-guided neurofeedback and demonstrated a significant decrease in daily cigarette consumption at the 4-month follow-up. However, significant individual differences were observed in the 4-month follow-up effects of decreased cigarette consumption. Therefore, it is critical to identify who will benefit from pre-neurofeedback. Aims We examined whether the resting-state electroencephalography (EEG) characteristics from pre-neurofeedback predicted the 4-month follow-up effects and explored the possible mechanisms. Methods This was a double-blind RCT. A total of 60 participants with nicotine dependence were randomly assigned to either the real-feedback or yoked-feedback group. They underwent 6 min closed-eye resting EEG recordings both before and after two neurofeedback sessions. A follow-up assessment was conducted after 4 months. Results The frontal resting-state theta power spectral density (PSD) was significantly altered in the real-feedback group after two neurofeedback visits. Higher theta PSD in the real-feedback group before neurofeedback was the only predictor of decreased cigarette consumption at the 4-month follow-up. Further reliability analysis revealed a significant positive correlation between theta PSD pre-neurofeedback and post-neurofeedback. A leave-one-out cross-validated linear regression of the theta PSD pre-neurofeedback demonstrated a significant correlation between the predicted and observed reductions in cigarette consumption at the 4-month follow-up. Finally, source analysis revealed that the brain mechanisms of the theta PSD predictor were located in the orbital frontal cortex. Conclusions Our study demonstrated changes in the resting-state theta PSD following neurofeedback training. Moreover, the resting-state theta PSD may serve as a prognostic marker of neurofeedback effects. A higher resting-state theta PSD predicts a better long-term response to neurofeedback treatment, which may facilitate the selection of individualised interventions. Trial registration number ChiCTR-IPR-17011710.
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Affiliation(s)
- Qiujian Meng
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
- Department of Psychology, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Ying Zhu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Ye Yuan
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Li Yang
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Jiafang Liu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
| | - Xiaochu Zhang
- Department of Psychology, School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, China
- Department of Radiology, the First Affiliated Hospital of USTC, Hefei National Research Center for Physical Sciences at the Microscale and School of Life Science, Division of Life Science and Medicine, University of Science & Technology of China, Hefei, Anhui, China
- Application Technology Center of Physical Therapy to Brain Disorders, Institute of Advanced Technology, University of Science & Technology of China, Hefei, Anhui, China
- Institute of Health and Medicine, Hefei Comprehensive Science Center, Hefei, Anhui, China
| | - Junjie Bu
- Department of Intelligent Medical Engineering, School of Biomedical Engineering, Anhui Medical University, Hefei, Anhui, China
- Department of Psychology, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
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Verdejo-Garcia A. Searching for biomarkers in the fluidity of mental ill-health. World Psychiatry 2023; 22:268-270. [PMID: 37159347 PMCID: PMC10168163 DOI: 10.1002/wps.21083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 05/12/2023] Open
Affiliation(s)
- Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia
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Parisi A, Zgierska AE, Burzinski CA, Lennon RP, Jamison RN, Nakamura Y, Barrett B, Edwards RR, Garland EL. To be aware, or to accept, that is the question: Differential roles of awareness of automaticity and pain acceptance in opioid misuse. Drug Alcohol Depend 2023; 247:109890. [PMID: 37167796 PMCID: PMC10714486 DOI: 10.1016/j.drugalcdep.2023.109890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Individuals with chronic low back pain (CLBP) are commonly prescribed long-term opioid therapy (LTOT) for analgesia, placing this population at increased risk for opioid misuse and opioid use disorder. Acceptance of aversive experiences (e.g., chronic pain) and awareness of automatic thoughts and behaviors (i.e., automaticity) are two facets of dispositional mindfulness that may serve as protective mechanisms against opioid misuse risk. Therefore, the aim of the current study was to examine the differential contributions of these constructs to opioid misuse risk among adults with CLBP receiving LTOT. METHODS Data were obtained from a sample of 770 adults with opioid-treated CLBP. Bivariate correlations and hierarchical linear regression analyses were used to determine whether chronic pain acceptance and awareness of automatic thoughts and behaviors explained a statistically significant portion of variance in opioid misuse risk after accounting for the effects of other relevant confounders. RESULTS Hierarchical regression results revealed that chronic pain acceptance and awareness of automatic thoughts and behaviors contributed a significant portion in the variance of opioid misuse risk. Awareness of automatic thoughts and behaviors was negatively associated with opioid misuse risk, such that individuals with lower levels of awareness of automaticity were at higher risk of opioid misuse. By contrast, pain acceptance was not associated with opioid misuse. CONCLUSIONS Findings suggest that awareness of automaticity may buffer against opioid misuse risk. Interventions designed to strengthen awareness of automaticity (e.g., mindfulness-based interventions) might be especially efficacious among this population.
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Affiliation(s)
- Anna Parisi
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States
| | - Aleksandra E Zgierska
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Cindy A Burzinski
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert P Lennon
- Pennsylvania State University College of Medicine Department of Family and Community Medicine, 90 Hope Drive, Hershey, PA17033, United States
| | - Robert N Jamison
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Yoshio Nakamura
- University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research Center, 615 Arapeen Drive, Suite 200, Salt Lake City, UT84108, United States
| | - Bruce Barrett
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Family Medicine and Community Health, 1100 Delaplaine Court, Madison, WI53715, United States
| | - Robert R Edwards
- Harvard Medical School, Brigham and Women's Hospital, Departments of Anesthesiology, Perioperative and Pain Medicine and Psychiatry, 850 Boylston Street, Chestnut Hill, MA02467, United States
| | - Eric L Garland
- University of Utah, Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, 395 1500 E, Salt Lake City, UT84112, United States.
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Garland EL. Mindfulness-Oriented Recovery Enhancement: An Evidence-Based Social Work Intervention for Addiction, Stress, and Chronic Pain. SOCIAL WORK 2023; 68:171-174. [PMID: 36728495 DOI: 10.1093/sw/swad008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 06/18/2023]
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Redwine LS, Schwartz ER, Garland EL. Mindfulness Promotes Positive Health Behaviors by Enhancing Self-Regulation, Motivation, and Learning: Perspectives from Research and Clinical Care. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:847-850. [PMID: 36342808 PMCID: PMC9839340 DOI: 10.1089/jicm.2022.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Laura S. Redwine
- Osher Center for Integrative Health, Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - E. Robert Schwartz
- Osher Center for Integrative Health, Department of Family Medicine and Community Health, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City, UT, USA
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