Transcript MBCT and Addiction :Developing Compassionate Mind

MBCT and Addiction :Developing
Compassionate Mind
Amanda Burden.
In loving memory of Professor
Alan Marlatt 1941-2011
A Gentle Warrior.
Background to study
• First UK study to adapt MBCT within substance
dependency and negative affect based at Nelson
trusts Gloucestershire : Duration :3Years,including
pilot study
• USA :Mindfulness based relapse prevention
(MBRP) was being developed.
• Began to establish professional links with
Professor Marlatt team USA
• Returned to UCSD for MBRP professional training.
Two research questions
• 1. Could MBCT support clients in remaining
experientially present to high risks situations
both interpersonal and intrapersonal
• How could we help ?By developing greater
self- efficacy and self compassion for
depression and anxiety symptomology
• 2 If approaches do show affect what can be
understood about the mechanisms by which
they work ? and the role of self -compassion ?
Causation ?
• Research evidence: Negative affect identified
as a primary predictor of relapse (Wikiewitz & Marlatt
2004; Shiffman et al 1996 )
• The inner critic and shame self to self relating
are high with substance misuses’ (Bien,2006)
• Emotional deregulation is the core underlying
pathology and is seen Co morbid with
substance abuse (Linehan,1993)
Two camps in addiction.
Treatment Gap ?
• Camps “ its part of the addiction process only natural they
will feel depressed anxious “ “ not enough being done to
combat underlying pathology to much focus on the
substance dependency”
•
• Regardless of causation Negative affect is accepted but no
specific treatments to support reduction and management
of symptomology
• Problem: not uncommon at the end of treatment that
clients are still presenting with high symptoms of
depression and anxiety. (Dodge ,2005)
Maladaptive Coping
Mechanisms
• Between childhood neglect and substance
dependency : Mediated by emotional
dysregulation and the inability to self sooth.
• Loving versus abusive environments.
Validates childhood experience and offers
optimum support in develop internal self
soothing skills to regulate emotion. Contrast
External ways of dealing with emotion(drink,
drugs, self harm behavioural impulsivity) (Maguire
2009)
Trying to think/drink our way out of
affective states
•
•
•
•
Judging our experience: inner critic
Constant comparison across states and time
Automatic habitual “Well worn records”
Leads to problem solving thinking about
feelings “Why do I feel sad today”
• Rumination leads to conditioned response of
craving and cues i.e. high risk situations
Mindfulness in action (MIA) and how does it work
approaching negative affect (NA)?
MIA
Sensory
cues
Affective
interlock
situation
NA
Rumination
Story
Can lead to
Conditioned
response : Craving
Memory
Cognitive cues
Substance use to
alleviate negative
affective state
What we did
Model in practice
• Meets: 2 hours for 8 week plus a retreat day
• Working with high risk situations i.e. interpersonal,
anxiety, low mood which may lead to relapse “how do
they relate to the situation/ feeling
• Changing the relationship to the thought Decentering
cultivating self soothing emotional regulation and selfefficacy ability to approach negative affect .
• Mechanisms by which Mindfulness may work
mediated by Augmented Self-Compassion Kuyken 2009,
Burden 2010
Results
What we found
n= 74 n=56 completed . No significant difference between
alcohol and poly substance use or on gender . However,
drop outs pre scores were lower for symptoms of anxiety
depression .
•
Results
Decrease in depression anxiety symptomology
Increase in self- efficacy, mindfulness and self- compassion
• N=56, Predictor variables (MAAS) mindfulness attention
awareness Scale: (HADS) Hospital Anxiety Depression Scale:
(AASE ) Alcohol Abstinence Self Efficacy (SCS) Self
compassion scale all ANOVAs significant at p<0.001
Results
Mechanisms behind how it works
• Four stages of mediation Model : Augmented
Self Compassion . HADS, AASE
•
•
•
•
Stage 1. Mindfulness is predictive of Anxiety
Stage 2.Self-Compassion is predictive of Anxiety.
Stage 3. Mindfulness is predictive of self-compassion
Stage 4. Mindfulness is not significantly related to
Anxiety in the presence of self-compassion, but Self
compassion remains predictive.
New frontiers in research
Augmented self- compassion
• SC: full mediation for Alcohol abstinence self
efficacy
• SC: Partial mediation for Anxiety .
• No mediation for depression.
• Possible reasons Depression pre scores lower
Anxiety seemed more problematic .
• Augmented self-compassion is an important
process mechanisms behind how mindfulness
may work : results support Kuykens findings:
Voices from the course
• “First time ever being able to distinguish my emotions
and thoughts . More mindful how I interact with
others, I often tell myself that thoughts are not facts”.
• “Three minute breathing space has stopped me
reacting and acting on impulses giving me time to step
away and be kind to myself, without big stick “.
• “Not so hard on me . Not so frightened of unpleasant
feelings, I can manage feelings of cravings and
reminded of the words that this too shall pass “
Where are we now
• This study adds value and support for
mindfulness and addiction as a valuable
clinical intervention .
• New model to the UK Mindfulness based
relapse prevention (Bowen Chawla Marlatt 2010)
• New training possibilities for 2011
• Funding for RCT being investigated .
Self-compassion
therapeutic relationship
Mindful therapy is a therapy in which the
therapists produces true presence and deep
listening . “It is not technique driven” . It
begins with ones own self – compassion
( Bien 2006 )