Date of Award

9-11-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Judson Brewer, MD, PhD

Abstract

MINDFULNESS TRAINING AND STRESS REACTIVITY IN SUBSTANCE ABUSE: A RANDOMIZED, CONTROLLED PILOT STUDY. Justin A. Chen, Judson A. Brewer. Department of Psychiatry, Yale University, School of Medicine, New Haven, CT. There is substantial evidence for the central role of stress in the inception and maintenance of substance use disorders. The use of mindfulness training (MT) has demonstrated promise in a number of stress-related conditions. However, no studies to date have compared MT to empirically validated treatments such as cognitive behavioral therapy (CBT) for substance use disorders or assessed its impact on response to stress provocation. The specific aim of this investigation was to engage in the first randomized, controlled trial of a manualized mindfulness based therapy for the treatment of substance use disorders. The hypotheses to be tested were: (1) MT would be tolerated equally as effectively as CBT in terms of retention rates and subjective measures of treatment tolerability; (2) Participants undergoing MT would demonstrate reduced reactivity on both subjective and objective measures during stress provocation as compared with CBT; and (3) Participants undergoing MT would have reduced substance use as compared with CBT following completion of the intervention. 36 individuals with alcohol and/or cocaine use disorders were randomly assigned to receive group MT or CBT in an outpatient community setting. After treatment completion, subjective and physiologic responses to personalized stress provocation were measured by self report, skin conductance, heart rate, and heart rate variability. Subjects exposed to MT demonstrated reduced psychological and physiological indices of stress during provocation compared with subjects exposed to CBT, as evidenced by the laboratory paradigm conducted post-treatment among treatment completers. There were no significant differences in retention, treatment satisfaction, or abstinence rates between individuals assigned to MT versus CBT. This pilot study provides preliminary evidence for the use of MT in targeting stress for substance use disorders.

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This is an Open Access Thesis.

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