其他摘要 | Substance Use Disorder (SUD) is a global problem. In the year 2021,a total of 63.5 million individuals worldwide fulfilled the DSM一5 criteria for being diagnosed with SUD. Despite receiving treatment, more than 50% of individuals with SUD experience relapse. Craving serves as a significant factor that maintains SUD and it is a common precipitant of relapse. Therefore, addressing craving presents a significant challenge in treating SUD. Craving is often associated with multiple factors, and individuals with SUD who exhibit high impulsivity and have comorbid disorders such as depression, anxiety, and insomnia, are at a higher risk of relapse and treatment drop-out. Mindfulness-Based Relapse Prevention (MBRP) has demonstrated effectiveness in reducing cravings and other psychopathological symptoms across various studies. Despite its effectiveness, the implementation of the program remains a challenge. The therapeutic needs of individuals with SUD are not being met, and treatment resources are scarce. This problem has become more apparent during the COVID-19 pandemic. To address this issue, there is a need to prioritize the expansion of treatment options and the development of innovative approaches to treating SUD. Research has shown that digital interventions, mainly CBT-based, are effective for screening, assessment, and treatment of SUD. To date, only one study has provided preliminary evidence on the efficacy of online-delivered MBRP for individuals with concurrent smoking and alcohol use, and its early results are promising. Given the high prevalence of SUD and their associated high relapse rates, as well as the burden they impose on both individuals and society, it is imperative to gain a deeper understanding of the psychological characteristics of individuals with SUD and to develop and test innovative treatment delivery approaches that can improve access to effective interventions for SUD, especially in light of the evidence gathered during the COVID-19 era. Therefore, the present project has three main objectives centered around online Mindfulness-Based Relapse Prevention (MBRP). Firstly, it aims to conduct a systematic review to determine whether mindfulness, as a trait or state, can function as a protective factor against addictions and related psychopathology. Secondly, the unique network present in individuals with SUD will be identified, with a focus on pinpointing the key variables that have the most significant impact on the SUD network. Thirdly, the effect of MBRP training on key variables within the SUD network will be assessed. In addition, given the growing acceptance of remote interventions and the importance of addressing treatment barriers, the project aims to investigate the effectiveness of delivering MBRP intervention online.
Methods and Materials
Study 1:The main goal of this study was to systematically review whether mindfulness, in both a trait and state form, can serve as a protective factor against addictive behaviors during the COVID-19 period. We also aimed to investigate if there has been an increase in the adoption and acceptance of Mindfulness-Based Interventions (MBIs) in online settings during the pandemic. We followed PRISMA guidelines for systematic reviews and meta-analyses. We searched the following databases: Embase, Cochrane Library, PubMed, and ProQuest. Empirical studies published in English from 1 January 2020 to 14 August 2023 on the topic of mindfulness and mindfulness-based interventions for substance use and behavioral addictions during the COVID-19 pandemic were searched.
Study 2: The main goal of this study was to conduct the network analysis and examine the specific psychological network of individuals with SUD and to identify the central nodes and unique finks that are characteristic of this network. In addition, through cluster analysis, the study aimed to establish specific groups based on the outcomes from network analysis and examine the unique connections between particular clusters and their association with craving. We examined 171 individuals with SUD in the Monar inpatient rehabilitation center in Poland. The following outcomes were assessed: craving measured by the Penn Alcohol Craving Scale, impulsivity measured by the Barrat Impulsiveness Scale, insomnia measured by the Athens Insomnia Scale, depression and anxiety measured by the Hospital Anxiety and Depression Scale, mindfulness measured by the Five Facets Mindfulness Questionnaire, metacognition measured by the Metacognitions Questionnaire, emotional regulation measured by the Difficulties in Emotional Regulation Scale, and coping orientation measured by the Brief-COPE, satisfaction with life measured by the Satisfaction with Life Questionnaire. Firstly, we conducted the Network Analysis using R language in order to draw inferences about relationships between variables tested at the baseline. A simple correlation method was chosen to estimate the structure of the network between variables. We aimed to assess the role of particular variables in the tested network, with three measures being calculated, including Strength, Closeness, and Betweenness. Secondly, utilizing Network Analysis, we partitioned the dataset into clusters by identifying similarities among the groups. Subsequently, we calculated the variations between the groups in relation to clinical variables.
Study 3: The main goal of this randomized controlled trial (RCT) was to evaluate the efficacy of an online-delivered MBRP program in treating SUD. The study aimed to determine whether remotely delivered MBRP can mitigate cravings and other psychopathological symptoms such as impulsivity, depression, anxiety, and insomnia. Additionally, the study sought to establish whether the program has an impact on coping orientation in individuals with SUD. We designed the RCT examining the effectiveness of the online delivered MBRP, employing a stepped-wedge design protocol. Deeply paraphrased and scientifically changed: A total of 171 participants (147 males and 24 females) were carefully selected from the MONAR inpatient treatment facility centers in Poland. They were then randomly assigned to two groups: Group 1 (n=92), which received an eight-week online-delivered MBRP intervention, and Group 2 (n=79), which served as a waitlist control and received the standard eight-week treatment as usual (TAU). During Phase I (eight weeks), Group 1 underwent the MBRP intervention, while Group 2 remained in TAU. In Phase II (eight weeks), Group 2 received the MBRP intervention, while Group 1 continued with TAU. Assessments were conducted at baseline, post-intervention (after 8 weeks), and follow-up (after 8 weeks) to evaluate the outcomes of the interventions. We selected craving, impulsivity, depression and anxiety, insomnia, coping orientation, mindfulness, metacognition, emotional regulation as evaluation indicators. The measurement methods were the same as in Study 2.
Results
Study 1:twelve studies were selected for this systematic review, seven investigating trait mindfulness and five exploring MBIs. The results indicated that higher levels of trait mindfulness were associated with lower addiction levels in most studies, except for one study, where the opposite outcome was observed. Conversely, lower levels of trait mindfulness were found to be correlated with higher levels of psychopathological symptoms, including depression, anxiety, and poor attentional control, across all seven studies. In terms of the efficacy of MBIs, four studies demonstrated significant improvements in addiction levels and abstinence. Two studies evaluated anxiety and depression, with one showing a decrease in symptoms, while the other did not find any significant differences. Finally, one study measured positive and negative coping, and the outcomes indicated a significant improvement for both variables. Results indicated that individuals were receptive to remote delivery of programs, such as online and text messaging.
Study 2: The estimated network included twelve nodes of SUD variables
including craving, impulsivity, depression and anxiety, insomnia, mindfulness, metacognition, emotional regulation, coping orientation such as emotion-focused, avoidant coping, problem-focused, and satisfaction with life. The central node in the SUD network was emotion-focused coping, which had a key role in the network of SUD-related variables. Closer links were observed with problem-oriented and avoidant coping, insomnia, and anxiety. Based on the data from network analysis, we carried out a cluster analysis and subsequently divided the data into clusters based on coping orientation: emotion-focused (BC1), problem-focused (BC2), and avoidant coping (BC3). Results from the four cluster solution showed that Group 1 scored the highest in avoidant coping (BC3, M=0.75), with the following results in problem-focused coping (BC1,M=-0.15), and emotion-focused coping (BC2, M=0.06). Group 2 scored very low in all categories of coping orientation, including problem-focused coping (BC1,M=-0.96), emotion-focused coping (BC2, M=-0.90), and avoidant coping (BC3, M=-0.74). Group 3 can be characterized by their predominant use of problem-oriented coping (BC1,M=0.71), as opposed to emotion-focused coping (BC2, M=0.09) or avoidant coping (BC3, M=-0.77). Group 4, had all the coping orientation strategies increased in comparison to other groups, but the most increased variable was emotional-focused coping (BC2, M=1.63) with the following results in problem-focused coping (BC1,M=1.18), and avoidant coping (BC3, M=0.99). Furthermore, we aimed to investigate the relationship between the coping orientation as the central node of the network and craving. The subsequent analysis revealed that in the cluster with the highest levels particularly of emotion-focused coping (M=1.63) in comparison to other forms of coping orientation including problem-focused (M=1 .18), and avoidant coping (M=0.99), the higher levels of cravings were observed (M=13.41,SD=5.53). Conversely, in the cluster characterized by problem-oriented coping, the levels of craving were significantly lower (M=9.88, S.D=2.13).
Study 3: The results of the post-term evaluations indicated that MBRP had a meaningful impact on reducing craving, insomnia, anxiety (p<0.05), impulsivity (p<0.001), and increasing mindfulness (p<0.001).However, there was no significant effect on depression (p>0.05) and emotional-focused coping (p>0.05). The findings also revealed that the effects of online-delivered MBRP were sustained at the 8-week follow-up on craving, insomnia, and impulsivity and mindfulness (p>0.05).
The results of the mediation analysis demonstrated significant mediation effects of insomnia between the MBRP and impulsivity (p<0.01) as well as emotion regulation (p<0.05). Impulsivity was a significant mediator between the MBRP and insomnia切<0.01), as well as anxiety切<0.05). Finally, anxiety was a significant mediator between MBRP and impulsivity (p<0.05).
The results of the moderation analysis demonstrated that psychiatric comorbidity was a significant moderator of insomnia in terms of post-test切<0.001) and follow-up (p<0.05), as well as mindfulness in terms of post-test (p<0.001) and follow-up (p<0.001). The abstinence period was a significant moderator of problem-focused coping in terms of post-test (p<0.05), as well as emotion-focused coping (p<0.05).
Conclusions
Based on the results of a systematic review that emphasized the potential role of mindfulness as a protective factor against addiction and associated psychopathology, as well as its acceptance through remote delivery, we conducted an RCT to evaluate the efficacy of MBRP administered online. Before the trial, we used network analysis to identify the central node of the SUD network and found a strong correlation between emotion-focused coping and other variables such as anxiety and insomnia. We then used cluster analysis to group participants based on their coping orientation and assessed their relationship to craving. Results showed that the group with heightened emotion-focused coping had the highest level of craving, while the group with problem-focused coping had the lowest. Our findings suggest the need for further examination of the link between coping orientation and craving in SUD. In the trial, we aimed to assess the effects of online-delivered MBRP training on key variables in the SUD network. MBRP was found to effectively reduce cravings and improve outcomes related to insomnia, impulsivity, and anxiety in individuals with SUD. The benefits of mindfulness practice appeared to be sustained over time. Even though the program did not show any direct effect on emotion-focused coping, additional analysis revealed that the experimental group with a high score in emotion-focused coping exhibited lower levels of craving compared to the control group with a high score in emotion-focused coping. As a result, we can infer that undergoing the MBRP training in the experimental condition serves as a protective measure against the adverse effects of emotional-oriented coping. Future research should explore MBRP's efficacy in this domain. Insomnia, impulsivity, and anxiety were found to mediate the relationship between MBRP and certain study outcomes. Psychiatric comorbidity and abstinence period were identified as significant moderators of the relationship between MBRP and treatment outcomes. While the study on MBRP's digital delivery is preliminary, the findings suggest that it can be effectively delivered through online platforms without compromising its effectiveness. With further research to validate and extend these results, the online-delivered MBRP could become a widely accessible resource for individuals seeking assistance and potentially open up new avenues for innovative mental health treatment approaches. |
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