Mindfulness training and stress reactivity in substance abuse: results from a randomized, controlled stage I pilot study

Abstract

Stress is important in substance use disorders (SUDs). Mindfulness training (MT) has shown promise for stress-related maladies. No studies have compared MT to empirically validated treatments for SUDs. The goals of this study were to assess MT compared to cognitive behavioral therapy (CBT) in substance use and treatment acceptability, and specificity of MT compared to CBT in targeting stress reactivity. Thirty-six individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient setting. Drug use was assessed weekly. After treatment, responses to personalized stress provocation were measured. Fourteen individuals completed treatment. There were no differences in treatment satisfaction or drug use between groups. The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT. This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress.

FIGURE 1

Flow of Participants Through the Study Protocol. CBT = Cognitive Behavioral Therapy, MT = Mindfulness Training. Laboratory session was performed within two weeks of treatment completion.

FIGURE 2

Anxiety and Drug Craving During Stress Provocation (MT, n = 8; CBT, n = 5). Y axis denotes reported anxiety scores after listening to personalized neutral or stressful stories. a) Anxiety severity scores: far right indicates normalized scores (stress minus neutral). b) Normalized drug craving severity scores (stress minus neutral). ** indicates p = .01 for the difference between treatment groups.

FIGURE 3

Emotional Responses During Stress Provocation (MT, n = 8; CBT, n = 5). Y axis denotes normalized Differential Emotion Scale scores after stress provocation (stress minus neutral). * indicates p ≤ .05 between treatment groups.

FIGURE 4

Maximum Heart Rate and Autonomic Nervous System Tone During Stress Provocation (MT, n = 8; CBT, n = 5). a) Maximum heart rate during neutral and stressful stories. b) Percent change in sympathetic/vagal ratio during stress versus neutral stories. * indicates F = 7.97 and p = .02 by treatment condition.