Mindfulness decouples the relation between automatic alcohol motivation and heavy drinking - Ostafin, Bauer & Myxter (2012) - Article

In addiction research, dual-process models of mental processes are used to explain uncontrolled use of substances. According to these models, the reinforcing consequences following substance use increase the incentive of substance use cues so that they can automatically and unintentionally activate craving for the substance (appetitive motivation).Uncontrolled use might be evoked by lack of desire or ability to take action to overcome this automatic appetitive response. Current research tries to find ways to decrease the influence of an automatic response on behaviour.

The current research examined whether mindfulness training weakens the relation between automatic alcohol motivation and heavy drinking. To measure automatic associative process the Implicit Association Test is used (IAT). Recent research supports the dual-processes model in that controlled processes weaken the relation between automatic alcohol motivation and drinking. However, since self-control resources are limited it is not sufficient to rely on only controlled processes.

Mindfulness represents a new intervention strategy that focuses on changing the relation to thoughts and emotions instead of trying to control them. Mindfulness can be seen as consisting of: (1) awareness of immediate experiences, and (2) a non-judgemental and accepting attitude toward that experience which involves ‘’a conscious decision to abandon one’s agenda to have a different experience (Bishop et al. 2004, p.233). According to mindfulness, the individual is allowed to experience impulses but without acting upon them. This is in contrast to the perspective of traditional dual-process models. According to those models, overcoming the influence of automatic processes involves inhibiting them.

Little research on mindfulness and addiction has been conducted. One study did not find a relation (Waters et al., 2009) whereas another study did find one (Ostafin & Marlatt, 2008). This might be due to different factors that were actually assessed. Waters et al. (2009) examined ability to disengage from automatic attentional biases by assessing the extent to which smoking words slowed down response on subsequent trials. Ostafin and Marlatt examined automatic associative processes by reflecting the extent to which alcohol cues should automatically activate approach tendencies. Furthermore, the benefit may be a function of weakening the relation between automatic processes and behaviour rather than weakening the automatic processes themselves. In addition, self-report measures might have been inaccurate. In the current study it was predicted that compared to a control group, mindfulness training would result in a weaker relation between automatic alcohol motivation and heavy drinking.

Method

Regular drinking students who consumed alcohol at least once per month over the past 3 months participated in this study. A calendar-based measure was used to assess patterns of drinking. Each participant completed an IAT that was presented on a computer. The IAT is based on the idea that stronger stimulus-affect associations will lead to faster response times for both the target and attribute stimuli when they are paired on the same key. Participants have to categorize stimuli from four categories, two target categories (related to alcohol or water) and two attribute categories (related to approach or avoid). Participants listened to either mindfulness or control audiotapes in sessions 1-3. In session 1 mindfulness was focused on breathing, in session 2 the focus lay on breath, sounds, salient sensations in the body and thoughts. In session 3 the focus lay on the same aspects but the participants had to think of a difficult situation and had to bring mindfulness to bodily sensations that were evoked. In addition, they had to do mountain meditation in which one imagines the self as a mountain that experiences changes in seasons and weather (corresponding to thoughts and emotions) but that is nonetheless unmoving. A manipulation check of the mindfulness induction was done with questions from a mindfulness scale. Treatment credibility was assessed with two questions.

Procedure

The study consisted of 4 sessions. In the first session the participants completed the IAT and some questionnaires to measure among others drinking behaviour. In the following sessions the participants had to listen to the mindfulness or control audios, they were told that the audio was aimed to develop attention skills. In session 4 the participants had to report their drinking behaviour over the previous week.

Results

Heavy drinking from session 1 and 4 were correlated. There were no group differences in the heavy drink variable at either session 1 or session 4. A repeated measures analyses showed that mindfulness intervention did not lead to reductions in drinking behaviour although there was a trend in this direction with a small-to-medium effect size.

Interaction effect

The results indicated that the condition did not moderate the relation between automatic alcohol motivation and heavy drinking at baseline but did moderate this relation in the follow-up session. Automatic alcohol motivation was significantly related to heavy drinking in the control condition but not in the mindfulness condition.

Discussion

The results indicate that individuals who received mindfulness training demonstrated a weaker relation between automatic alcohol motivation and heavy drinking compared to the control group. Mindfulness differs from cognitive behavioural therapies in that mental content is not changed but the relation between the individual and the mental content. This is called decentering, the mental content is not acted upon. It has been suggested that acceptance or current experiencing allows such decentering. The mindfulness training moderated the relation between automatic alcohol motivation and alcohol but it did not reduce the levels of consumed alcohol. The researchers also did not expected this to be so, since the participants were not seeking treatment (students). This study examined whether mindfulness training could strengthen the opportunity element but did not examine the motivation element. Interventions that disconnect the link between automatic processes and behaviour should increase the likelihood of improvement in individuals who are motivated to change. Contrary to other studies this study made use of an adequate control group since the experimenter was blind to the condition, the conditions were structural equivalent, both treatments had equal effectiveness of to strengthen attentional skills.

The study had several methodological limitations. The sample was homogenous and nonclinical, making the results less generalizable. Furthermore the sample was small which could have caused too little power to find effects. The drinking behaviour variables should be of a broader range in a future study, for example also examining mediation of executive functions. It might be possible that mindfulness interventions may be especially useful in reducing drinking behaviour in those who drink to cope with negative emotions. In future studies more extended mindfulness training could be used. In addition, an objective measure instead of self-report might be better and a longer follow up period would give a more stable assessment of drinking behaviour.