Mindfulness-Based Relapse Prevention: Efficacy and Mechanisms

描述（由申请人提供）：拟议的随机临床试验的广泛，长期目标是评估与社区提供的标准善后护理（SA）相比，两种认知行为善后护理治疗酒精和其他药物（AOD）使用障碍在预防AOD复发方面的疗效，调节因子和变化机制。这两种认知行为善后治疗是复发预防（RP; Daley & Marlatt，2006）和基于正念的复发预防（MBRP），它整合了正念冥想和RP善后部分。拟议的研究计划将涉及三个具体目标。第一个目的是检查MBRP和RP与SA相比在预防强化住院（IP）和门诊（IOP）AOD治疗后的AOD复发方面的疗效。将从IP和IOP治疗中招募受试者，并随机分配至8周MBRP、RP或SA组。将在治疗后和3、6、9和12个月随访评估时评价治疗疗效（定义为AOD使用和相关后果的减少）。据推测，与SA相比，MBRP和RP将导致显著更少的AOD使用和相关后果。第二个具体目标是评估MBRP和RP治疗疗效的潜在介质。有人建议，MBRP和RP干预措施将是不同的有效减少AOD的使用和后果的基础上，每种治疗方法的独特目标。因此，假设MBRP功效将由元认知过程、控制点、正念、思维抑制、科普渴望和负面影响的能力、经验回避、情绪调节和冥想练习强度介导。本研究进一步假设，RP效能将由消极情感、积极期望、自我效能和应对能力介导。最终的目的是测试治疗效果的潜在调节剂。据推测，参与者具有较高的基线水平的回避应对，经验回避和较低水平的情绪调节将受益于MBRP与RP治疗;而参与者在基线时具有较低的自我效能和较高的积极期望将受益于RP与MBRP治疗。在实现这些具体目标，拟议的研究将解决NIDA的使命为第二阶段的治疗研究，通过检查的疗效，调节剂和不同的机制变化的各种AOD善后处理。公共卫生相关性：鉴于酒精和其他药物（AOD）滥用在一般人群中的高患病率以及AOD治疗后的高复发率，拟议的研究将提供一个有价值的下一步，以评估两种认知行为治疗的有效性，复发预防和基于正念的复发预防，作为与社区提供的标准善后护理相比，AOD疾病的善后治疗。此外，拟议的研究旨在更好地了解这些治疗方法为什么有效以及对谁有效。

DESCRIPTION (provided by applicant): The broad, long-term objective of the proposed randomized clinical trial is to evaluate the efficacy, moderators and mechanisms of change of two cognitive-behavioral aftercare treatments for alcohol and other drug (AOD) use disorders in preventing AOD relapse compared to standard aftercare (SA) offered in the community. The two cognitive-behavioral aftercare treatments are relapse prevention (RP; Daley & Marlatt, 2006) and Mindfulness-Based Relapse Prevention (MBRP), which integrates mindfulness meditation and RP aftercare components. The proposed research plan will address three specific aims. The first aim is to examine the efficacy of MBRP and RP compared to SA in preventing AOD relapse following intensive inpatient (IP) and outpatient (IOP) AOD treatment. Participants will be recruited from IP and IOP treatment and randomized to 8 weeks of MBRP, RP or SA. Treatment efficacy, as defined by reductions in AOD use and related consequences, will be evaluated at posttreatment and 3-, 6-, 9- and 12- month follow-up assessments. It is hypothesized that both MBRP and RP will result in significantly less AOD use and related consequences compared to SA. The second specific aim is to evaluate potential mediators of MBRP and RP treatment efficacy. It is proposed that the MBRP and RP interventions will be differentially effective in reducing AOD use and consequences based on the unique objectives of each treatment approach. It is therefore hypothesized that MBRP efficacy will be mediated by metacognitive processes, locus of control, mindfulness, thought suppression, ability to cope with craving and negative affect, experiential avoidance, emotion regulation and intensity of meditation practice. It is further hypothesized that RP efficacy will be mediated by negative affect, positive expectancies, self-efficacy and coping abilities. The final aim is to test potential moderators of treatment efficacy. It is hypothesized that participants with higher baseline levels of avoidant coping, experiential avoidance and lower levels of emotion regulation will benefit more from MBRP vs. RP treatments; whereas participants with lower self-efficacy and higher positive expectancies at baseline will benefit more from RP vs. MBRP treatments. In fulfilling these specific aims, the proposed research will address the NIDA mission for Stage II treatment research by examining the efficacy, moderators and differential mechanisms of change of various AOD aftercare treatments. PUBLIC HEALTH RELEVANCE: Given the high prevalence of alcohol and other drug (AOD) abuse in the general population and the high rates of relapse following AOD treatment, the proposed research will provide a valuable next step in evaluating the efficacy of two cognitive-behavioral treatments, relapse prevention and mindfulness-based relapse prevention, as aftercare treatments for AOD disorders in comparison to standard aftercare offered in the community. Further, the proposed research is designed to gain a better understanding of why these treatments work and for whom.