The effect of mindfulness on decision-making, inhibitory control, and impulsivity of substance use disorder in-treatment patients: A randomized clinical trial.

This study aimed to investigate the effects of Mindfulness-Based Relapse Prevention (MBRP) in decision-making, inhibitory control and impulsivity compared to Treatment as Usual (TAU) for individuals with Substance Use Disorders (SUD's) in Brazil. A randomized clinical trial was conducted with participants from a therapeutic community (n = 122). Decision-making (Iowa Gambling Task), impulsivity dimensions (UPPS-P Scale), and inhibitory control (Stroop Color-Word Test) were assessed before and after the MBRP 8-week intervention. GLM Multivariate analysis was used to evaluate the effects of MBRP on different impulsivity measures. The results showed that MBRP+TAU improved the general decision-making score (p = 0,008) compared to TAU. However, no significant effects were found in impulsivity dimensions and inhibitory control in individuals with SUDs in the therapeutic community. This study found improvement in decision-making in the total IGT score; however, no effect for self-reported impulsivity and inhibitory control among middle-aged patients after an 8-weeks intervention of MBRP protocol in an inpatient setting. It adds information to the subject, with implications and possible directions to be followed by the next clinical trials with patients with SUDs in treatment. Trial registration: EnsaiosClinicos.gov.br: RBR-6c9njc.

A randomized controlled trial of mindfulness: effects on university students' mental health.

BACKGROUND: The development of mental health disorders is common in the university population, and mindfulness-based interventions (MBIs) seem to be effective in addressing them in different contexts. Thus, this study investigated the impact of an 8-week MBI adapted to university students from the Mindfulness-Based Relapse Prevention (MBSR) on different symptoms related to mental health problems, specifically symptoms of anxiety, depression, stress and insomnia. METHODS: University students (n = 136) were randomized into MBI group (n = 71) or wait-list group (n = 65). All participants completed self-administered questionnaires before and after the intervention, and the experimental group answered questionnaires weekly during intervention. Generalized mixed models were used to assess the effects of the intervention. RESULTS: There were improvements in the symptoms of stress (B = 5.76, p < 0.001), depression (B = 1.55, p < 0.01) and insomnia (B = 1.35, p = 0.020) from the beginning of the intervention to the final assessment when it was compared to the control group. No effect was found in respect of trait anxiety. The MBI was found to be effective in reducing important symptoms related to university students' mental health, possibly grounding further research on the intervention's potential of preventing the development of mental disorders. TRIAL REGISTRATION: The research was registered in the Brazilian Registry of Clinical Trials (ReBEC) - number RBR-63qsqx, approved at 09/16/2019.

Mindfulness-based interventions in inpatient treatment for Substance Use Disorders: A systematic review.

Inpatient treatment for Substance Use Disorder (SUD), such as Therapeutic Communities and Residential Treatment has been used to test the effect of Mindfulness-Based Interventions (MBI) over different outcomes. Although there is evidence of the effectiveness of MBIs, little is known about the particularities that the place may have in the outcomes. The main objective of this Systematic Review was to evaluate the effectiveness of MBIs for SUDs performed in the inpatient context. PubMed, Web of Science and PsycInfo were used for the search. Quantitative and qualitative studies with no control, usual treatment or other active comparator intervention for SUDs inpatient treatment from 1980 to 2020 were included. From 21 selected studies, 18 were quantitative and 3 qualitative; 12 studies were RCT. Most samples were comprised with women. Based on characteristics of outcomes, we were able to divide them into: Substance Use and Associated Outcomes, Stress, Impulsivity e Evaluation of the MBI protocol. Results suggest that stress assessment is a determining factor for treatment success in these settings. Regarding substance use, although several outcomes have been assessed, the most remarkable results were craving reduction and improvement in treatment adherence. There is evidence that MBIs in inpatient settings benefited those who participated in the experimental groups on some outcomes, such as stress and substance use. Little is mentioned about the impact of the environment over the outcomes and short follow-ups were a relevant limitation of most of the studies. Future assessments must increase follow-up time and evaluate the relationship between the context and the MBI.

Psychometric properties of the short version of the Five Facets of Mindfulness Questionnaire in brazilian portuguese / Propriedades psicométricas da versão curta do Questionário das Cinco Facetas de Mindfulness em português / Propiedades psicométricas de la versión corta del Cuestionario de las Cinco Facetas de Mindfulness en portugués

The aims of the current study were to evaluate the psychometric properties of a short version of the Five Facet Mindfulness Questionnaire (FFMQ-SF-BR) and verify if the addition of wording mechanisms (positive or negative) contributes to the fit of the shortened Brazilian Portuguese version of the FFMQ. Four hundred eight participants answered self-report measurements. Structural equation modelling was employed for both objectives. Adequate model fit was found for the 5-factor FFMQ-SF-BR model, with significant improvements arising from the addition of wording mechanism effects. No evidences of differential item functioning and population heterogeneity were found. Bifactor analysis showed that latent traces are preferred overusing raw sum scores. The FFMQ-SF-BR is suitable to measure mindfulness in the Brazilian population and has the benefits of decreasing data collection length without losing content coverage. (AU)

O presente estudo objetivou avaliar as propriedades psicométricas de uma versão curta em português do Questionário das Cinco Facetas de Mindfulness (FFMQ-SF-BR) e verificar se a adição de mecanismos de formulação dos itens (positivos ou negativos) contribui para o ajuste do modelo em cinco fatores. Quatrocentos e oito participantes preencheram instrumentos de autorrelato. Modelagem de equações estruturais foi aplicada em ambos os objetivos. Índices adequados de ajuste foram encontrados para o modelo em cinco fatores, com melhorias significativas advindas da adição dos mecanismos de formulação dos itens. Não foram encontradas evidências de funcionamento diferencial dos itens ou heterogeneidade populacional. A análise de um modelo bifator demonstrou que valores de traços latentes são preferíveis à soma da pontuação. A FFMQ-SF-BR é adequada para mensurar mindfulness na população brasileira, com os benefícios de diminuir o tempo de coleta sem perda de conteúdo. (AU)

El presente estudio tuvo como objetivo evaluar las propiedades psicométricas de una versión corta del Cuestionario de las Cinco Facetas de Mindfulness (FFMQ-SF-BR) en portugués y verificar si la adición de mecanismos de formulación de ítems (positivos o negativos) contribuye al ajuste del modelo de cinco factores. Cuatrocientos ocho participantes completaron instrumentos de autoinforme. Se aplicó el modelo de ecuaciones estructurales a ambos objetivos. Se encontraron índices de ajuste adecuados para el modelo en cinco factores, con mejoras significativas derivadas de los mecanismos de formulación de ítems. No hubo evidencias de funcionamiento diferencial de los ítems o heterogeneidad de la población. El análisis de un modelo bifactorial mostró que los valores de los rasgos latentes son preferibles a la suma puntuaciones. La FFMQ-SF-BR es adecuada para medir el mindfulness en la población brasileña, reduciendo el tiempo de recolección de datos sin pérdida de contenido. (AU)

Effects of Mindfulness-Based Relapse Prevention on the Chronic use of Hypnotics in Treatment-Seeking Women with Insomnia: a Randomized Controlled Trial.

BACKGROUND: Hypnotics are one of the most frequently prescribed drugs worldwide, especially for women, and their chronic use may lead to tolerance, dosage escalation, dependence, withdrawal syndrome, and cognitive impairments, representing a significant public health problem. Consistent evidence from previous studies shows benefits of mindfulness-based interventions (MBIs) for substance use disorders (SUD) and insomnia. However, to date, there is a lack of research about effects of MBIs on reduction/cessation of chronic hypnotic use among women with insomnia. METHOD: The present randomized trial evaluated the efficacy of the 8-week group-delivered mindfulness-based relapse prevention (MBRP) program in an intervention group (IG, n = 34) compared with weekly phone monitoring only in the control group (CG, n = 36) in reducing hypnotic use and insomnia severity over a 6-month follow-up period. RESULTS: There were significant differences between groups at baseline regarding hypnotic use but not insomnia. Group effects on hypnotic use were found immediately after the intervention (bT1 = 2.01, p < 0.001) and at the 2-month follow-up (bT2 = 2.21, p < 0.001), favoring the IG. The IG also had a greater reduction from baseline levels than the control group in insomnia severity at the 4-month (bT3 = 0.21, p = 0.045) and 6-month (bT4 = 0.32, p = 0.002) follow-ups. CONCLUSIONS: The findings provide preliminary evidence of benefits of MBRP for reducing insomnia severity and potentially chronic hypnotic use. However, IG effects on chronic hypnotic use may have resulted from IG and control group differences in chronic hypnotic use at baseline. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02127411.

Impulsivity and Mindfulness among Inpatients with Alcohol Use Disorder.

BACKGROUND: Impulsivity is both a risk factor for and a consequence of alcohol use disorder (AUD), for which mindfulness-based approaches have been proven to be effective. However, the specific relationship between mindfulness and impulsivity has been little explored in the literature, especially in people with AUD. This study aims to investigate the relationship between different facets of dispositional mindfulness and impulsivity among people with AUD in an inpatient setting in Brazil. Methods: Participants (n = 165) completed the following self-report measures: the Alcohol Use Disorders Identification Test (AUDIT), the Five Facets of Mindfulness Questionnaire (FFMQ-SF), and the Short UPPS-P Impulsive Behavior Scale (SUPPS-P). Multiple imputation techniques and linear models were employed to assess the relationships between dispositional mindfulness and impulsivity. Results: In complete case analysis, the UPPS-P facet "lack of premeditation" was inversely related to the FFMQ facet "non-reactivity" (B = -0.17; p = 0.01); and "positive urgency" was inversely related to "act with awareness" (B = -0.27, p = 0.02) and "non-reactivity" (B = -0.17, p = 0.01). Conclusion: Relationships of varying magnitudes between dispositional mindfulness and impulsivity domains among people with AUD were found, suggesting that higher mindfulness skills are related to less impulsive traits. Our results encourage further longitudinal studies evaluating the potential of specific mindfulness components to decrease impulsivity among AUD inpatients, including its underlying mechanisms.

Effectiveness of Mindfulness-Based Relapse Prevention Program as an Adjunct to the Standard Treatment for Smoking: A Pragmatic Design Pilot Study.

INTRODUCTION: Posttreatment relapse is a major roadblock to stemming the global epidemic of tobacco-related illness. This article presents results from a pilot trial evaluating the feasibility and initial efficacy of Mindfulness-Based Relapse Prevention (MBRP) as an adjunct to standard relapse prevention treatment (ST) for smoking cessation. AIMS AND METHODS: Smokers (n = 86) in the maintenance phase of treatment were randomized to receive either ST plus MBRP (MBRP) (n = 44) or ST alone (ST) (n = 42). Data were collected at baseline and at 4-, 12-, and 24-week follow-up points. We evaluated the feasibility of the protocol with frequency analysis, and the efficacy with both intention to treat and complete case analyses of the effects of MBRP on abstinence. Secondary outcomes included mindfulness, craving, depression, anxiety, and positive/negative affect. RESULTS: High adherence suggested MBRP is acceptable and feasible. Participants in the MBRP group reported increases in mindfulness (M = -7.833, p = .016), and reductions in craving (M = 17.583, p = .01) compared with the ST group. Intention to treat analysis found that, compared with MBRP (36.4%), ST (57.1%) showed trend-level superiority in abstinence at Week 4 (Prevalence Ratio = 0.63, p = .06); however at Week 24, the ST group (14.3%) demonstrated a twofold greater decrease in abstinence, compared with the MBRP group (20.1%) (Prevalence Ratio = 2.25, p = .08). Therefore, the MBRP group maintained a higher abstinence rate for longer. Reported effects were greater in the complete case analysis. CONCLUSIONS: MBRP holds promise for preventing relapse after aided tobacco quit attempts. IMPLICATIONS: Findings suggest that MBRP is acceptable, feasible, and valued by participants. At 24-week follow-up, there was a large effect size and a statistical trend toward fewer MBRP patients relapsing compared with ST patients. MBRP conferred ancillary benefits including reductions in craving and increases in levels of mindfulness. MBRP for tobacco cessation is highly promising and merits further research. TRIAL REGISTRATION: clinicaltrials.gov. IDENTIFIER: NCT02327104.

OMEGA-3 Interventions in Alcohol Dependence and Related Outcomes: A Systematic Review and Propositions.

BACKGROUND: Pharmacological treatment for alcohol dependence has only three approved drugs: disulfiram, naltrexone and acamprosate. The effects of these drugs are, however, limited, presenting several side effects and a modestly higher efficacy compared to placebo. The administration of omega-3 might bring new perspectives to relapse prevention. METHODS: This systematic review aimed to analyze the available literature, compiling the studies that used omega-3 to prevent relapse in alcohol dependents. RESULTS: The databases used were PubMed and Web of Science. We identified 2,231 studies and only five articles addressed the administration of omega-3 and alcoholism. Preclinical studies evaluating the effects of PUFAs related to chronic alcohol administration showed improvements in behavioral, cellular and molecular levels. The clinical trial yielded inconclusive results. CONCLUSION: Despite the reduced number of studies, omega-3 interventions seem to be promising for controlling issues related to alcohol dependence.

Dispositional mindfulness, affect and tobacco dependence among treatment naive cigarette smokers in Brazil.

INTRODUCTION: The current study examined associations between affective and smoking-related factors, and dispositional mindfulness among smokers seeking enrollment in a cessation program in Brazil. METHODS: Participants were first-time treatment seeking adult smokers (N=90) on a waiting list for a government-sponsored cessation program. Pearson's bivariate correlations assessed relationships between the primary outcome variable (dispositional mindfulness) and each explanatory variable (nicotine dependence, depression, anxiety, and state positive/negative affect). Linear regression analyses evaluated the unique contribution of each explanatory variable when controlling for the others. RESULTS: The sample (N=90) was predominantly female (n=71) and most (79%) had 11 or fewer years of education. In the final regression model, a total of 36.2% of the variance in dispositional mindfulness was accounted for by positive affect (B=0.81, p<0.001), negative affect (B= -0.44, p=0.02), and level of nicotine dependence (B=1.48, p=0.007). CONCLUSIONS: Positive and negative affect, as well as nicotine dependence, account for a significant and sizable amount of the variance in dispositional mindfulness. Future mindfulness interventions for smoking cessation should be designed to address individual differences in affect, as well as nicotine dependence, in order to better tailor treatment to address baseline differences in mindfulness.

The Role of Mindfulness in the Insomnia Severity of Female Chronic Hypnotic Users.

PURPOSE: To investigate dispositional mindfulness, psychiatric symptoms, and their relationship with insomnia severity among female chronic hypnotic users. METHODS: Observational, cross-sectional study, including 76 women with chronic hypnotic use. Participants completed several self-report questionnaires: sociodemographic characteristics, depressive symptoms (CES-D), anxiety levels (STAI-T), dispositional mindfulness (FFMQ), and insomnia severity (ISI). Exploratory linear regression models were used to identify factors related to insomnia severity. RESULTS: Multiple linear regression models showed that, for the total sample (N = 76), age (B = - 0.14, p = 0.003), depressive symptoms (B = 0.16, p = 0.005), and the mindfulness facets "observe" (B = 0.21. p = 0.013) and "act with awareness-auto pilot" (B = - 0.48, p = 0.017) were correlated to insomnia severity. CONCLUSION: Results confirm a relationship between mindfulness and insomnia among female chronic hypnotic users, specifically regarding the ability to observe and act with awareness. A higher score on the "observe" facet was positively correlated with insomnia. This may be because the skill of observing itself, isolated from other mindfulness precepts, does not provide sufficient strategies to cope with the observed discomfort. Increased "acting with awareness-autopilot" was negatively correlated with insomnia severity, arguably because it stimulates breaking automatic patterns of thoughts and behaviors that contribute to the perpetuation of the insomnia cycle.

Dispositional mindfulness, anticipation and abstinence symptoms related to hypnotic dependence among insomniac women who seek treatment: A cross-sectional study.

INTRODUCTION: Dispositional mindfulness can be described as the mental ability to pay attention to the present moment, non-judgmentally. There is evidence of inverse relation between dispositional mindfulness and insomnia and substance use, but as of yet, no studies evaluating the specific association between dispositional mindfulness and the components of hypnotic use disorder. OBJECTIVE: To evaluate the association between dispositional mindfulness and the components of dependence among female chronic hypnotic users. DESIGN AND METHOD: Seventy-six women, chronic users of hypnotics, who resorted to Mindfulness-Based Relapse Prevention for the cessation of hypnotic use were included in the study. The Five Facet Mindfulness Questionnaire (FFMQ) evaluated the levels and facets of mindfulness, and the subscales of the Benzodiazepine Dependence Questionnaire (BENDEP) assessed dependence on hypnotics. We also evaluated sociodemographic variables and symptoms of insomnia and anxiety. The associations between the FFMQ facets and the BENDEP subscales were evaluated with binomial logistic regression, adjusted for income, schooling, anxiety, and insomnia. RESULTS: We observed associations between facets of the FFMQ and specific aspects of hypnotic dependence. The facet "observing" was inversely associated with the "concern about lack of availability of the hypnotic" [aOR = 0.87 95% CI (0.79-0.97)], and the facet "non-reacting to inner experience" with "noncompliance with the prescription recommendations" [aOR = 0.86 95% CI (0.75-0.99)]. The total score of the FFMQ was inversely associated to those two dependence subscales [aOR = 0.94 95% CI (0.89-0.99)]. "Observing" and "non-reactivity to inner experience" were also inversely associated with the "impairments related to the withdrawal symptoms" [aOR = 0.84 95% CI (0.73-0.97)] and [aOR = 0.78 95% CI (0.63-0.96)], respectively. The FFMQ was not associated with "awareness of problematic hypnotic use". CONCLUSION: Dispositional mindfulness, specifically the facets "observing" and "non-reactivity to inner experience, were inversely associated with the components of hypnotic dependence related to the anticipation of having the substance, its expected effect, and the impairments caused by the abstinence. We discuss the implications of those results for the clinical practice and future investigations.

Mindfulness-based interventions for the treatment of smoking: a systematic literature review.

OBJECTIVES: Smoking is a chronic process in which craving and negative affect are considered the main barriers to maintaining abstinence in patients who have gone through treatment. Mindfulness-based interventions have presented encouraging preliminary results in follow-up lasting up to 6 months. The aim of this study was to perform a systematic literature review on the effects of mindfulness-based interventions for the treatment of smoking. METHODS: Of 198 articles on mindfulness and smoking, 13 controlled empirical studies were selected for the analysis. The search included papers published through April 14, 2014. The databases used were Cochrane Central Register of Controlled Trials, PsycINFO, PubMed, and Scopus. RESULTS: Scientific interest on mindfulness-based interventions for the treatment of smoking has increased over the past decade. All articles reported promising results, especially for smoking cessation, relapse prevention, number of cigarettes smoked, the moderation of mindfulness on the strength of relationship between craving and smoking, and the development of coping strategies to deal with triggers to smoke. Most of the articles corresponded to pilot or feasibility randomized controlled trials with low risk of bias regarding random sequence generation, attrition, and reporting. However, few articles reported sufficient data on selection, performance, and detection bias. CONCLUSIONS: Mindfulness appears to induce positive effects on mental health, which might contribute to the maintenance of tobacco abstinence. Despite the promising results regarding the responses of tobacco smokers to mindfulness-based interventions, additional well-designed clinical studies are needed.