Mindfulness Therapy for Treating Impulsive Behavior - Essay Example

?Interim Report The Role of Mindfulness, Personality and Negative Effect in Relation to Substance use Natalija Rascotina K1161154 MSc Clinical Applications of Psychology Kingston University, Kingston, UK Introduction This research study investigates the role of mindfulness, personality and negative effect in relation to substance use. In this regard, mindfulness refers to the ability to direct attention to one’s surroundings and existing events (LePera, 2012). Therefore researchers have found that mindfulness therapy is useful for treating impulsive behavior which includes substance abuse (Stratton, 2006). Mindfulness-based therapeutic treatment is therefore perceived as an effective method for redirecting attention, sensations thoughts and feelings in the present as a means of reducing and preventing cravings for illicit substances, and relapse after successful rehabilitation (Bowen, Witkiewitz, Dillworth, et.al., 2006). Therefore the value of mindfulness techniques in treating substance use relies on the user’s ability to focus and redirect attention. However, given findings in the literature that persistent substance use can negatively impact levels of concentration, attention and focus (Wills, 2001), further research into the role of mindfulness in substance abuse is warranted. Personality traits have also been identified as significant for understanding and treating substance use as an indication of impulsive behavior (Sher, Bartholow, & Wood, 2000). Studies have persistently found a link between teen substance use and personality traits such as hyperactivity, sensation seeking, impulsiveness, aggressiveness, and low concentration abilities (Merenakk, Harro, Kiive, Laidra, Eensoo, Allik, Oreland, & Harro, 2003). Researchers generally conclude that specific personality traits can predict vulnerability to certain substances and can be helpful in devising treatment conducive to the user’s personality type (Terracciano, Lockenhoff, Crum, Bienvenu, & Costa, 2008). However, research has found that although certain personality traits predispose individuals to substance abuse, environmental factors and developmental paradigms interact with personality traits to predict substance abuse (Tarter, 1988). Moreover, Cox (1985) informs that personality disorders may be a result of substance abuse. Therefore the role of personality in substance use is not altogether clear since it is also a side effect of substance use. This research study will attempt to differentiate between the causative role of personality traits in substance abuse and personality trait effects of substance abuse. Researchers and scholars argue that when an individual is unable to cope with the negative incidents of life, he or she is more vulnerable to substance use (Hsu, Collins, & Marlatt, 2013). Mindfulness-based therapy is thought to be one method of heightening “distress tolerance” and thus reducing the risk of substance use as a means of avoiding negative stressors (Hsu, et. al., 2013, p. 1852). Studies have also found that negative dimensions of personality traits such as depression and negative emotions increase the risk of substance use (Measelle, Stice, & Springer, 2006). Although the effectiveness of mindfulness-based therapy has not been significantly tested for validity, there is a support for its usefulness in helping patients cope with negative effects (Leign, Bown & Marlatt, 2005). Obviously, an individual is predisposed to some form of personality trait that leads to what is described as self-medication in which an individual uses substances to relieve or escape the negative effects of emotional and/or physical distress (Khantzian, 1997). This study will examine the utility of mindfulness-based therapy in self-regulating as a means of controlling the negative effects associated with personality traits and the vulnerability to substance use. Specifically, this research study investigates the feasibility of meditation strategies in mindfulness-based therapy as an effective method for regulating coping with and tolerance to stressors heightened by negative emotions related to personality traits associated with vulnerability to substance use. A Review of Literature There is evidence in the literature that mindfulness-based treatment can help substance abusers cope with cravings and prevent relapse. Bowen, Chawla, Collins, et. al., (2009) conducted a randomized-controlled trial in which the effectiveness of a two-month Mindfulness-Based Relapse Prevention (MBRP) program was compared to the effectiveness of traditional treatment. The study involved 168 adults diagnosed with substance abuse problems. Assessments were made prior to beginning the programmes and 2 and 4 months after treatment started. Initial results demonstrated that adults in the MBRP programme were more committed to attending their programmes and were more satisfied with their programme than adults in the traditional substance abuse treatment programme. Subsequent assessments also found that adults in the MBRP programme demonstrated “lower rates of substance use” than those participating in traditional treatment programmes (Bowen, et. al., 2009, p. 295). Adults in the MBRP programme also demonstrated more reduced cravings than adults in the traditional programme (Bowen, et. al., 2009). Bowen, et. al.’s (2009) study does not reveal however, whether or not mindfulness-based therapy is mediated by other factors such as the adult’s social environment or personality traits. As Staiger, Kambouropoulos and Dawe, (2007) note, the interaction between personality traits and the environment is significant for gaining insight into vulnerability to substance abuse and use. For example, impulsive disorders including sensation-seeking, “novelty-seeking, reward-sensitivity and behavioural disinhibition” are associated with substance abuse and “almost certainly play a critical role in the maintenance of substance use disorder” and has an impact on how effective treatment is (Staiger, et.al., 2007, p. 17). In other words, personality traits play a significant role in the development and maintenance of substance abuse and substance use and also impacts treatment effectiveness. Yet, Staiger, et. al. (2007) point out that personality traits are not usually matched to treatment programmes. Breslin, Zack and McMain (2002) argue that while mindfulness meditation has been used to prevent relapse in connection with substance abuse treatment, its usefulness in treating addiction is not well researched and understood. For example, although Bowen, et. al.’s (2009) study produced encouraging results for mindfulness-based therapy for substance users, a study conducted by Alterman, Koppenhaver, Mulholland, Ladden and Baime (2004) produced different results. The study conducted by Alterman, et. al., (2004) involved 18 substance users in recovery programme who were administered two months of mindfulness meditation and traditional treatment. The results of this treatment was compared to the results of 13 patients under a traditional treatment programme (Alterman, et. al., 2004). The results of the study demonstrated that in a five month follow-up assessment the group receiving meditation treatment showed significant improvement in medical difficulties on the Addiction Severity Index. However there were no other appreciable differences in outcomes. For example, psychological health was no different between the groups. Moreover, urinalysis results were relatively similar for both groups (Alterman, et. al., 2004). Although Alterman et.al.’s (2004) study can be distinguished from Bowen, et. al.’s (2009) study in terms of sample size and programme, there is a need for further research. Bowen, et. al. (2009) used a very large sample size compared to Alterman, et. al., (2004) and Bowen, et. al. (2009) studied a mindfulness-based approach to substance use therapy which was not combined with traditional treatment. This raises a number of questions for further investigation. Does the mindfulness-based approach have greater effectiveness when used alone? Is mindfulness-based treatment lose its effectiveness when combined with traditional treatment programmes? Did the sample used in Bowen, et. al.’s (2009) study suffer from impulisivity personality traits? In other words, it is quite possible that personality traits may have influenced the different outcomes in both groups. Regardless, there is a need for further research on the utility of mindfulness-based treatment for substance users. Bowen and Marlatt (2009) conducted a study on mindfulness-based approaches to substance use which demonstrates a need for further research. The study involved 123 undergraduate students who were addicted to smoking. The students were chosen on the basis that they wanted to quit smoking but had not engaged in a programme for doing so. The students were divided into two groups. One group were provided with a brief mindfulness-based instructional programme and the other group received no treatment. The results of the study demonstrated that those in the mindfulness-based instructional programme and those receiving no instructions did not show any appreciable differences in cravings. However, a follow-up initiative within a week showed that the students who had received the mindfulness-based instructions had smoked less than those who had received no treatment (Bowen & Marlatt, 2009).Given the brevity of the mindfulness-based instruction in the study conducted by Bowen and Marlatt (2009), its effectiveness after seven days was phenomenal although initial findings were disappointing. However, more intense and longer mindfulness-based treatment programme may have produced more impressive results. Rationale Clearly, there is evidence that mindfulness-based treatment can be effective. However, there are gaps in the literature. Specifically, administering the programme in ways that can maximize outcomes and confirm its effectiveness requires further research. Although studies have so far demonstrated some degree of success, a number of questions remain unanswered. For example, the use of the treatment in ways that address personality traits, the use of mindfulness-based treatment alone or in connection with a traditional treatment programme and the use of the treatment as a means of controlling negative effects might tell us more about the effectiveness of mindfulness-based treatment programmes for substance users. In order to expand existing knowledge and contribute to filling the identified gaps in the literature, the following hypotheses were developed to guide this study: Hypothesis 1. Mindfulness-based therapy can be effective for treating substance use when used alone. The rationale for this hypothesis is based on the different results in Alterman, et. al.’s (2004) study and Bowen, et. al.’s (2009) study. Alterman, et. al.’s (2004) study demonstrated discouraging results when mindfulness-based therapy was administered in combination with traditional treatment. Bowen, et. al.’s (2009) study demonstrated encouraging results when administered alone. Hypothesis 2. Mindfulness-based therapy can be more effective for treating substance use because it specifically addresses impulse control. The rationale for this hypothesis is based on Staiger, et. al.’s (2007) argument that effective substance abuse treatment should be matched to personality traits. Moreover, it is well-documented in the literature that certain personality traits are linked to vulnerability to substance use. In particular, personality traits characterized by impulsivity, anxiety and depression are said to be linked to poor control, coping and tolerance to negative effects. Mindfulness meditation is said to be effective for improving control, coping and tolerance to negative effects. Hypothesis 3. Personality traits such as neuroticism, agreeableness, openness to experiences, hyperactivity, impulsiveness, extroversion, and sensation-seeking are linked to substance use and abuse. Therefore, mindfulness-based therapy is effective for reducing relapse. The rationale for hypothesis 3 is based on the idea that mindfulness-based meditation can redirect attention and awareness to more productive and controlled behaviour. Hypothesis 4. Controlling for negative affect and the relevant personality domains, mindfulness will be effective for treating a propensity for addictive behaviours such as smoking and excessive drinking. Hypothesis 4 is based on findings in the literature that mindfulness treatment is effective for addressing personality traits that reveal an impulsive and attention deficit disorder that lead to substance use as a means of coping with negative effects. Hypothesis 5. Substance use is a result of an inability to cope with negative effects and the resulting depression and anxiety personality traits give way to an impulse to self-medicate. Therefore therapy focusing on personality traits is more effective for substance use treatment than mindfulness-based therapy. Hypothesis 5 is rationalized on the basis that it has been documented in the literature that personality traits such as depression and anxiety and impulsivity disorders are linked to substance use and misuse. Method Design Cross sectional correlational design using survey methodology will be used. Materials Participants will be given Neo five factor inventory (NEO-FFI) (Costa and McCrae) that measures the "Big Five" factors - five broad dimensions of personality that are used to describe personality (openness, conscientiousness, extraversion, agreeableness and neuroticism) and consists of 60 items, 12 items per each domain using 5-point ratings (1-strongly disagree; 2-disagree; 3-neural; 4-agree; 5-strongly agree). The Mindfulness Attention Awareness Scale (MAAS) (Brown & Ryan, 2003) measures tendency to be mindful of moment to moment experience. The instrument focuses on the presence or absence of attention and awareness of what occurs in the present. Scale consists of 15 statements with answers scored using a 6-point Likert scale (1-almost always; 2-very frequently; 3-somewhat frequently; 4-somewhat infrequently; 5-very infrequently; 6-almost never). Respondents will be asked to indicate how frequently they have the experience described in each of statements where higher scores reflect more mindfulness. Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983) measures individual’s levels of anxiety and depression at present moment. Instrument consists of 14 statements of which 7 statements related to anxiety and 7 to depression. Each statement on the questionnaire is scored on 3-point Likert scale (0-no, not at all; 1-no, not much; 2-yes sometimes; 3-yes definitely). Higher scores indicate higher levels of distress. Fagerstrom Test for Nicotine Dependence (FTND) (Heatherton, Kozlowski , Frecker , Fagerstrom, 1978) consists of 6 questions measuring levels of smoking dependence with possible score range 0-10 where scores below 5 indicate low dependence, scores between 5-7 moderate dependence and scores above 7 indicate high level of dependence. The quantity frequency scale (QFS) (Cahalan, Cisin, Crossley, 1969). American drinking practices: a national survey of drinking behaviors and attitudes. Each adolescent is scored from 0 to 6 by the QF Scale, which is composed of scores of drinking quantities and frequencies. Participants One hundred Kingston University students including undergraduates and postgraduates of different disciplines, ages 18-30 will participate in the study as a partial fulfillment of course requirements, all data will be collected and stored anonymous. The number of participants will allow for more reliable results of the analysis. Potential participants will be recruited via Sona Systems (web-based human subject pool management software for universities). In this way improving the efficiency of the research participation pool, while reducing administrative burden. Students will be invited to sign up for online participation and immediately receive credit for participation. Participants will be automatically assigned a code so that their name will never be a attached to the data collected form them. Procedure Participants will be given information sheet, consent form and verbal debrief after begin asked to complete 5 brief questionnaires via web-based software Sona system. Students will be asked to state their age, gender and country of origin. Participant will be asked if he/she would like to fill in questionnaires at present time followed by immediate credits for participation. Questionnaires include The quantity frequency scale (QFS); Neo five factor inventory (NEO-FFI); The Mindfulness Attention Awareness Scale (MAAS); Hospital Anxiety and Depression Scale (HADS); Fagerstrom Test for Nicotine Dependence (FTND). Collection of the actual data with further analysis will commence after the research project has passed an ethics review with a regular supervisor progress review. 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