Transcript Document

Donna Mullen, Maria Higgins, Alistair Wilson, Iain Smith, Gartnavel Royal Hospital, NHS Greater Glasgow & Clyde
Kenneth Mullen, University of Glasgow
Introduction
Recent innovations in psychological treatments have successfully integrated Mindfulness
meditation techniques (Kabat-Zinn et al 1986) with traditional cognitive behavioural therapies to
prevent relapse in people with recurrent depression (Teasdale et al 2000). In the treatment of
substance use disorders preventing relapse is a central challenge. It has been suggested that
a therapy combining mindfulness techniques with cognitive behavioural therapy for relapse
prevention may be effective in treatment of substance use disorders (Marlatt & Gordon 1985).
Recent studies from America (Bowen et al 2009. Garland et al 2010. Bowen et al 2014) give
promising results but to date there are no UK based studies published on Mindfulness Based
Relapse Prevention. This pilot study was designed to assess whether or not MBRP may be an
acceptable and effective treatment for patients in Glasgow.
“It’s almost as if there’s no divide there.
The nurses are doing it as well, it’s just
a group doing a group, there was no
“you’re a nurse and I’m a patient” kind
of thing. Everybody was doing it
together and I think that was really
encouraging. ” (Gp 2. Pt 2)
Gosh
aye.
You
know
it’s
remembering the bits that come back
to you and I suppose other ones
remember totally different bits from
me and then when you sit down you
say oh that was at the group, that
was at the mindfulness you know
what I mean, so aye there is wee bits
that I will carry on with me. (Gp 1.
Pt1)
Aims
To allow participants to describe their own experiences of the effectiveness of Mindfulness
Based Relapse Prevention (MBRP) groups and also cover several pre-determined domains
developed from the literature on alcohol misuse and mindfulness based approaches.
Intervention
An eight week group programme combining Mindfulness techniques and Relapse Prevention
delivered by an experienced Mindfulness Based Cognitive Therapy (MBCT) practitioner.
Session
Main topic
Homework
1
Introduction to Mindfulness
Body scan
Everyday mindfulness
Body scan CD
Eating Mindfully
2
Dealing with barriers
Body scan/Settling Mind CD
Pleasant Events Diary
3
Staying in the Body
Mindful Movement
Breathing Space
Mindful Movement CD
3 Breathing Spaces per day
Unpleasant Events Diary
4
Staying Present
Noticing How we Shut Down
Guided Sitting Meditation
Guided Sitting meditation
10 mins Mindful stretching OR Mindful
Movement CD
Breathing Space during unpleasant
feelings
5
Allowing/Letting Be
Responding versus Reacting
Mountain Meditation
Choice of practices so far.
Reflections on provided poems/
recommended reading
6
Thoughts Are Not Facts
Draining Thought Patterns
Choice of practices so far
Record common thinking errors
7
Mindful Action
Working with the Difficult
8
Overall review
Choice of practices so far
Record Nourishing and Draining Items
Fig 1. The MBRP 8 week group programme.
Methods
The study was a qualitative study using semi structured interviews following a pre-determined
interview schedule. It focused on the clients’ experiences of the course and the impact it had on
their daily lives. Participants recruited had attended an eight week MBRP course run for
abstinent patients with a history of alcohol dependence. All participants from the two groups run
to date were invited to take part in the study.
Eleven patients were interviewed from a total of sixteen participants in the two groups. The
interviews were digitally recorded and transcribed verbatim. Transcripts were then analysed by
two researchers following an established methodology of the grounded theory approach
(Chamaz, 2006).
Results
Attendance was generally high, 80-100% with one exception who attended 60% of the course.
Group 1- 8 participants. 7 completed. 5 interviewed, including 1 who had dropped out.
Group 2- 8 participants. All completed. 6 interviewed.
There was a mixed response in how respondents initially related to the course dependent on
their expectations. Most were comfortable with the group format. Some were initially sceptical
about how the group could help but developed an understanding as the group progressed.
Those expecting a cure or those with strong expectations such as regaining previous
meditation skills were disappointed. Those with more modest expectations showed higher
satisfaction in what they learned.
The degree to which participants saw their alcohol use as a disease process, over which they
had no control, directly influenced their experience of the course. Those who were only slightly
familiar with meditation and were looking for something to bolster their recovery seemed to
benefit most. We give some illustrative quotes below.
“I’ve looked into it before- Buddhism
and stuff. I had a rough idea how it
would go kind of thing but I was quite
surprised at how much of an effect it
had” (Gp 1. Pt 2)
“ I mean basically what he
done was he gave us a CD and
each time he was doing it
rather than putting a CD on.
Which made a difference. I
don’t know why but it made a
difference”. (Gp 1. Pt 4)
That the facilitator was experienced in mindfulness practice personally was a significantly
engaging factor and added value to the course. The participation of staff in the mindfulness
practices and the secular context of the MBRP course in an NHS setting were also popular
themes.
Respondents listed a number of difficulties following through the practice at home. Some
had integrated it into their daily life with regular practice. Those who had felt benefits early
on were motivated to engage fully with the course resulting in a strong positive feedback
loop. Some substituted mindfulness practice for alcohol use in high risk situations. Others
had selected and modified bits of the course which they adapted for their own use. Most
respondents listened to and used the CDs. Some had sought further mindfulness classes
and one planned to start up a group.
Individual respondents reported benefits to their mood, improved control over cravings,
improved control over anxiety and anger, improved family relationships.
The patient who had dropped out of group 1 reported improved motivation to seek further
detoxification.
“ To me the mindfulness is now that’s
my drug. Because my body is telling me
to do that the body scan and I think
I’ve substituted that for the alcohol.
The alcohol is gone. Where there
would be a trigger before telling me to
drink alcohol its now a trigger for the
mindfulness. So with the body
language signs, the mood going down,
the thought processes going haywirethat would have been alcohol time now
its mindfulness time.” (Gp 2. Pt 5)
“It’s something I would like to continue, to
find a class because I like it in the class
environment...I’ve not seen it anywhere, even
round about all the gyms I go to, and
community centres, I’ve not seen anywhere
that does it.” (Gp 2. Pt 3)
But I think it’s quite hard, I don’t really know
how to explain it but I would say it was
beneficial because it made me, as soon as I
left I contacted my CAT team worker and
says I’m kidding myself on here and I don’t
think, if it wasn’t for Alistair’s emm class or
mindfulness class I don’t think I would have
been back for a detox. (Gp 1. Pt. 4)
Conclusions
This pilot study demonstrated that MBRP is an acceptable and potentially a useful
treatment option for patients. All patients interviewed showed at least some compatibility
with the intervention and a desire to continue with mindfulness techniques after the end of
the course. The self-monitoring component of the MBRP course seemed to provide some
participants with both a way of identifying high risk situations and a new approach to
processing cues. Ideas relating to self-compassion seemed to have potential to impact on
feelings of self-worth which sometimes led to behavioural change. MBRP is potentially an
important development in treatment of alcohol dependence and could offer an alternative to
current standard treatments. Further, quantitative studies of MBRP are indicated to identify
the efficacy of the treatment and to identify which patients may benefit most from this
therapy.
References
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