JAMA: Mindfulness-Based Relapse Prevention Beats CBT and 12-Step
Have you ever tried counting to ten? Not in a superficial way in which numbers spool through your mind like a stock market ticker, but really counting to ten – slowly and without letting other thoughts creep in? Try it. It’s surprisingly hard. If you made it to double-digits without thinking about everything else you have to do today or whether there might be another splash of coffee still in the pot in the kitchen, you’re farther along the path of mindfulness than I am.
Simply, mindfulness means attending to experiences in the moment in a non-judgmental state of awareness; it means recognizing, processing and managing your experiences. And a study published in the March issue of the Journal of the American Medical Association (JAMA) shows that mindfulness-based training may be the best way to avoid relapse after substance abuse treatment.
But before we get to mindfulness, let’s take a quick look the two major models of relapse prevention currently in use. First, the strategy referred to in the study as “treatment as usual” uses 12-step programming and educational materials. And second, approaches based on cognitive-behavioral therapy (CBT) teach people in recovery from addiction to recognize and avoid cues that could trigger relapse.
But the study points out that “Shortcomings of [CBT] have been identified, including focus on avoidance-based goals vs. approach-based goals and on controlling causes of negative affect or craving vs. learning to tolerate these states.” In other words, CBT teaches people recovering from addiction what not to do and provides little resilience if impulse happens to sneak through this wall of avoidance.
So maybe there’s room for improvement? To find out, let’s take a look at what this randomized clinical trial of 286 people published in the United States’ top medical journal has to say about these three relapse-prevention strategies.
First, both CBT and mindfulness beat treatment-as-usual at the 6-month mark – both new-ish strategies delayed the time between the end of treatment and first drug use (i.e. relapse), and also resulted in fewer heavy drinking days in people recovering from alcohol addiction. But at the 12-month mark, the benefits of the mindfulness-based training remained, whereas the protection of the CBT training sank back into the range of treatment-as-usual. By the numbers, people who received mindfulness-based training had “31 percent fewer drug use days and a significantly higher probability of not engaging in any heavy drinking,” a year removed from the end of inpatient treatment, the authors write.
The researchers from the University of Washington Center for the Study of Health and Risk Behaviors point out that the difference may be in the distinction between trained reactions and real, long-term behavior change. CBT teaches people to recognize and manage external cues. For example, you’ve probably heard about the famous experiment in which a dog is trained to drool at the sound of a bell; CBT relapse prevention strategies teach people in recovery to avoid the bell. But mindfulness teaches people to recognize and manage internal cues – it teaches you to hear the bell but to manage the impulse to drool.
The researchers say it this way: “Mindfulness-based treatments teach patients to remain in contact with and relate differently to challenging affective or physical states, use alternatives to avoidant-based coping, recognize underlying reasons for maladaptive behaviors, and identify and increase contact with natural contingencies.”
Again, the major difference is avoiding cues that could create relapse (CBT) vs. managing the internal states that crave relapse (mindfulness). And in this important study, it seems as if recovery is most effective when people learn to listen to, respect and consciously manage their impulses rather than avoiding or blunting these impulses.
After addiction, recovery requires a new way of being. And according to this research, “exposure to and acceptance of [impulses] may be mechanisms of behavioral change.”
Eric Schmidt is the CEO of New Roads Treatment Centers, affordable drug treatment programs for young adults.
Schmidt, E. (2014). JAMA: Mindfulness-Based Relapse Prevention Beats CBT and 12-Step. Psych Central. Retrieved on October 4, 2015, from http://blogs.psychcentral.com/addiction-under-30/2014/03/jama-mindfulness-based-relapse-prevention-beats-cbt-and-12-step/