Mindfulness-Based Relapse Prevention for Substance Use Disorders: Effects on Cardiac Vagal Control and Craving Under Stress
Mindfulness-based relapse prevention (MBRP) is a therapy for addictive behaviors that incorporates cognitive-behavioral relapse prevention (RP) skills with mindfulness training to increase awareness and skillful action in high-risk situations. Stress is a common reason reported for substance use relapse, and using physiological measures to measure stress engagement may help us identify mechanisms of clinical improvement. Specifically, salutatory changes in HF-HRV post-treatment may serve as a marker of treatment efficacy. We investigated tonic and phasic heart rate variability (HRV) to a cognitive stressor (i.e., arithmetic challenge) following 8 weeks of RP, MBRP, or post-detox treatment known as treatment as usual (TAU; n = 34). MBRP was related to higher levels of tonic and phasic HF-HRV, lower levels of anxiety, and lower heart rate reactivity (than TAU only) compared to RP and TAU. This suggests that those who completed MBRP are engaging with stress, but perhaps in a more adaptive, flexible manner. MBRP is associated with higher cardiac vagal control and lower stress/anxious reactivity. Given that negative emotions are an important component of relapse, these results lend further support to say that mindfulness may be helpful for those with substance use disorders.
KeywordsMindfulness Substance use Cardiac vagal control Heart rate variability Stress
HAC: assisted in design of the study, executed the study, and collaborated in the writing of the study. MKBL: designed the study, analyzed the data, and collaborated in the writing of the study.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Aiken, L., & West, S. (1991). Multiple regression: testing and interpreting interactions. Newbury Park: Sage Publications.Google Scholar
- Allen, J. J. B., Chambers, A. S., & Towers, D. N. (2007). The many metrics of cardiac chronotropy: a pragmatic primer and a brief comparison of metrics. Biological Psychology, 74(2), 243–262. doi: https://doi.org/10.1016/j.biopsycho.2006.08.005.
- Bai, X., Li, J., Zhou, L., & Li, X. (2009). Influence of the menstrual cycle on nonlinear properties of heart rate variability in young women. AJP: Heart and Circulatory Physiology, 297(2), H765–H774. doi: https://doi.org/10.1152/ajpheart.01283.2008.
- Bernston, G. G., Bigger, T., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M., … Van de Molen, M. W. (1997). Heart rate variability: origins, methods, and interpretive caveats. Psychophsyiology, 34, 623–648.Google Scholar
- Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B. D., … Marlatt, G. A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343–347. doi: https://doi.org/10.1037/0893-164X.20.3.343.
- Bowen, S., Chawla, N., Collins, S. E., Witkiewitz, K., Hsu, S., Grow, J., … Marlatt, A. (2009). Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Substance Abuse, 30(4), 295–305. doi: https://doi.org/10.1080/08897070903250084.
- Bowen, S., Chawla, N., Marlatt, G. A., & Parks, G. A. (2010). Mindfulness-based relapse prevention. New York: Guilford.Google Scholar
- Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., et al. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry, 71(5), 547–556. doi: https://doi.org/10.1001/jamapsychiatry.2013.4546.
- Brewer, J. A., Sinha, R., Chen, J. A., Michalsen, R. N., Babuscio, T. A., Nich, C., … Rounsaville, B. J. (2009). Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study. Substance Abuse, 30(4), 306–317. doi: https://doi.org/10.1080/08897070903250241.
- Chalmers, J. A., Quintana, D. S., Maree, J., Abbott, A., & Kemp, A. H. (2014). Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Frontiers in Psychiatry, 5(80), 1–11.Google Scholar
- Chambers, A. S., & Allen, J. (2002). Vagal tone as an indicator of treatment response in major depression. Psychophysiology, 39(6), 861–864. doi: https://doi.org/10.1017/S0048577202010442.
- Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington DC: American Psychiatric Association.Google Scholar
- Friedman, B., & Thayer, J. F. (1998). Autonomic balance revisited: panic anxiety and heart rate variability. Journal of Psychiatric Research, 44, 133–151.Google Scholar
- Garland, E. L. (2011). Trait mindfulness predicts attentional and autonomic regulation of alcohol cue-reactivity. Journal of Psychophysiology, 25(4), 180–189. doi: https://doi.org/https://doi.org/10.1027/0269-8803/a000060.
- Ingaldsson, J. T., Laberg, J. C., & Thayer, J. F. (2003). Reduced heart rate variability in chronic alcohol abuse: relationship with negative mood, chronic thought suppression, and compulsive drinking. Biological Psychiatry, 54, 1427–1436. doi: https://doi.org/10.1016/s0006-3223(02)01926-1.
- Kabat-Zinn, J. (1990). Full catastrophe living: using the wisdom of your mind and body to face stress, pain, and illness. New York: Delacorte.Google Scholar
- Koob, G. F. (2008). A role for brain stress systems in addiction. Psychology, 83, 84–92.Google Scholar
- Libby, D. J., Worhunsky, P. D., Pilver, C. E., & Brewer, J. A. (2012). Meditation-induced changes in high-frequency heart rate variability predict smoking outcomes. Frontiers in Human Neuroscience, 6(54), 1–8. doi: https://doi.org/10.3389/fnhum.2012.00054.
- Lustyk, M. K. B., Olson, K. C., Gerrish, W. G., Holder, A., & Widman, L. (2010). Psychophysiological and neuroendocrine responses to laboratory stressors in women: implications of menstrual cycle phase and stressor type. Biological Psychology, 83(2), 84–92. doi: https://doi.org/10.1016/j.biopsycho.2009.11.003.
- Lustyk, M. K. B., Gerrish, W. G., Douglas, H., Bowen, S., & Marlatt, G. A. (2011). Relationships among premenstrual symptom reports, menstrual attitudes, and mindfulness. Mindfulness, 2(1), 37–48. doi: https://doi.org/10.1007/s12671-011-0041-x.
- Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford.Google Scholar
- Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: a self-control strategy for the maintenance of behavior change. New York: Guilford.Google Scholar
- Porges, S. W. (2005). A phylogenetic perspective. In C. S. Carter, L. Ahnert, K. E. Grossmann, & S. B. Hrdy (Eds.), Attachment and bonding: A new synthesis (pp. 33–54). Cambridge: MIT Press.Google Scholar
- Porges, S. W. (2007). A phylogenetic journey through the vague and ambiguous Xth cranial nerve: a commentary on contemporary heart rate variability research. Biological Psychology, 74(2), 301–307. doi: https://doi.org/10.1016/j.biopsycho.2006.08.007.
- Quintana, D. S., Guastella, A. J., McGregor, I. S., Hickie, I. B., & Kemp, A. H. (2013). Heart rate variability predicts alcohol craving in alcohol dependent outpatients: further evidence for HRV as a psychophysiological marker of self-regulation. Drug and Alcohol Dependence, 132, 395–398.CrossRefPubMedGoogle Scholar
- Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of national findings. Office of Applied Studies, NSDUH Series H-38A, HHS. (2010) (Vol. Publication, No. SMA 10–4586). Rockville, MD: SAMSHA.Google Scholar
- Sinha, R. (2001). How does stress increase risk of drug abuse and relapse? Psychopharmacology, 158, 343–359. doi: https://doi.org/10.1007/s002130100917.
- Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1982). Manual for the STAI. Google Scholar
- Tang, Y.-Y., Ma, Y., Fan, Y., Feng, H., Wang, J., Feng, S., … ... & Zhang, Y. (2009). Central and autonomic nervous system interaction is altered by short-term meditation. Proceedings of the National Academy of Sciences, 106(22), 8865–8870.Google Scholar
- Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart–brain connection: further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews, 33(2), 81–88. doi: https://doi.org/10.1016/j.neubiorev.2008.08.004.
- Westbrook, C., Creswell, J. D., Tabibnia, G., Julson, E., Kober, H., & Tindle, H. A. (2013). Mindful attention reduces neural and self-reported cue-induced craving in smokers. Social Cognitive and Affective Neuroscience, 8(1), 73–84. doi: https://doi.org/10.1093/scan/nsr076.
- Witkiewitz, K., & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362–374. doi: https://doi.org/10.1037/a0019172.