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Mindfulness-Based Relapse Prevention

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					                        Mindfulness-Based Relapse Prevention Course
           An Adjunct Intervention to Traditional Relapse Prevention Strategies

                                   Jaime Carlo-Casellas, Ph.D.

                                           Introduction

Mindfulness is an intentional, nonjudgmental, present-moment awareness of the full range of
ongoing experiences—thoughts, emotions, sensations and events.1 It is simply observing and
accepting life as it is in the present moment.

Interest in mindfulness as an adjunct intervention in the treatment of addictive behavior was
sparked by the findings that mindfulness interrupts the craving for the sought-after bliss of the
substance and/or behavior.2, 3 This is so because mindfulness heightens an awareness and
acceptance of the initial cues and triggers without judging, analyzing, or reacting to urges and
temptations.

Empirical findings support the hypothesis that this awareness may be attributable to the
neuroplasticity4 (change in the structure and function of the brain) induced by mindfulness and
the release of neurotransmitters associated with feelings of pleasure. The results of these
neurobiological phenomena is an enhancement of mental acuity, information processing, and
attentional control—alternatives to the mindless, autopilot thinking that propels obsessive and
compulsive behaviors.

One approach to develop and cultivate mindfulness is the practice of Vipassana meditation.
(Vipassana is a Sanskrit word that means: “seeing things the way they are.”) From the vantage
point of Western psychology, Vipassana Meditation enhances an awareness of ongoing behavior
and cognitions. From the physiological perspective, this form of meditation induces
neurobiological, functional and structural changes—changes that allow the individual to
modulate the inescapable, chronic stress associated with addictive behavior.

                        Mindfulness-Based Relapse Prevention Course

The adjunct intervention course is offered by Jaime Carlo-Casellas, Ph.D., at the Stress
Management & Prevention Clinic in Rancho Mirage, California. It is modeled on the
Mindfulness-Based Stress Reduction Program established by Jon Kabat-Zinn, Ph.D., at the


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University of Massachusetts Medical School and is rooted in the findings of G. Alan Marlatt,
Ph.D., et al.2, 3 It also encompasses the precepts of the mindfulness-based cognitive therapy of
Zindel V. Segal, Ph.D., et al.5 Taken together, their work and findings validate the effectiveness
of mindfulness in the treatment and management of addictive behaviors.

The intent of the course is to offer a potpourri of mindfulness practices—given that some
practices work better for some individuals than others. These include Vipassana meditative
practices: introspective breathing, compassion meditation (metta Bhavana), body scan
meditation, walking meditation, Mindfulness Yoga6, Reiki (healing touch)7, progressive muscle
relaxation, mindful listening, mindful eating, and autogenics. As to a common denominator, all
practices focus on awareness of the breath and present-moment ongoing thoughts, emotions and
the physical sensations perceived through the five senses.

The course consists of eight, two-hour weekly experiential practice sessions. In addition to the
formal sessions, the participants are given CD recordings of guided meditation and a workbook
for home practice.

This adjunct intervention is designed to complement the services of healing arts professionals
and can be offered at sites other than the Stress Management & Prevention Clinic.

Results

The effectiveness and impact of this course is supported by statements in a follow-up survey of a
cohort study group of 12 participants who participated in the Mindfulness-Based Relapse
Prevention Course offered in 2006. The group included three workaholics, one gambling/alcohol
addict, three obese individuals, one cocaine addict, one methamphetamine addict, a nicotine gum
addict, one smoker, and one gay sex addict.

Workaholic 1:          “I am now putting in fewer hours at work, but think I‟m getting more
                       done. Besides that, I‟m not taking as many Rolaids® as I used to.”

Workaholic 2:          “I‟ve been mindful that I have to start taking care of myself. I thought I
                       loved my work, but now I see that by working so much I didn‟t have to
                       deal with how much I hated my sister. She and I are getting along much
                       better. The loving kindness exercise [compassion meditation] you
                       showed us is very helpful. I do it often. I‟ve also come to accept that my


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                     sister is sick and that I have to treat her as a sick person.” (In class this
                     participant indicated that her sister sees a therapist for depression.)

Workaholic 3:        Because of a “busy” schedule, this participant could not find the time to
                     do the home assignments. “I still work more than ten hours per day, not
                     including the time I have to spend at home doing what I couldn‟t finish
                     [at work]. My work is very important and I‟m the only one who can do it.
                     I haven‟t been able to find the time or place to practice the techniques.”

Gambler/alcoholic:   “When I go to my GA meeting all we do is talk about gambling, and as
                     soon as the meeting is over, I‟d head straight for the casino. Since I took
                     the course I‟ve only had one slip. And, whenever I feel like a drink, I do
                     the body-scan and I feel so relaxed that I don‟t really have to drink.”

Obese 1:             “I continue to live to the best of my ability in the moment. I have found it
                     is just my way of life now. I feel so blessed for having learned this from
                     you. Can you believe I have lost 70 pounds! I have been told how „at
                     peace‟ I appear outwardly. How I wish I had the time and the money to
                     get to your classes. More people I know should take this course.”

Obese 2:             “Let‟s say that I am aware of what I shove down my throat, but I still eat
                     a lot. However…I don‟t eat as much white stuff and candy as I used to,
                     and I have lost a few pounds.” (It is important to note that this individual
                     is, and continues to be morbidly obese. He was referred to a therapist.)

Obese 3:             “For one thing, the 45 pounds I gained was because I lost my partner to
                     breast cancer. Being aware of that, and my yoga, I have managed to lose
                     quite a bit. I really feel much, much better.”

Cocaine:             “I‟ve noticed that my trigger is money in my pocket. So when I have cash
                     I know I‟d better be careful. I find that I can stay away from the old
                     stomping grounds where I used to get high with my buddies. I stop and
                     do a mini body scan and breathe.”

Cigarette:           “I practice what you‟ve assigned to us religiously, but I‟m having a hard
                     time quitting…although, I‟m aware that every time I have a cup of



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                        coffee, I have to have the cigarette. So when I get ready for my coffee, I
                        ask my husband to hang on to the pack [of cigarettes] so I don‟t smoke.
                        The breathing helps a lot.”

Nicoret® addict:        “I‟ve really cut down on my chewing, but until this divorce is over, I
                        don‟t know if I can kick the habit completely. Actually, the only
                        meditation I do is the body scan and the loving kindness. It helps me see
                        my husband‟s point of view. I think the walking meditation is worthless.”

Sex addict:             “Controlling myself continues to be so hard, but I am making progress,
                        I‟ve been able to control the cruising [looking for sexual encounters in
                        public places]. The yoga classes really help so much.”

Amphetamine:            This participant dropped out of the course after the first session. In the
                        follow-up survey he indicated: “It is going to take more than what this
                        course has to offer to help me kick the habit.”

Based on these statements, 10 of the twelve participants benefited, at least to some degree, from
the course.

Further, the participants reported a better understanding of the factors that led to “acting out,” the
ability to recognize and manage the craving, an increased ability to cope with stress, decreases in
the physical and psychological symptoms of addiction, greater energy and enthusiasm for life,
and improved self-esteem.

Comparable benefits were reported also by individuals who took a similar course (Mindfulness-
Based Stress Prevention Course). These included an increased ability to relax, an ability to cope
more effectively with stressful situations, lasting decreases in physical and psychological
symptoms, reductions in pain levels and the ability to manage residual pain, stabilized
respiratory and cardiac activity, greater energy and enthusiasm for life, and improved self-
respect.

                                            Conclusion

The findings and observations recapitulated here add to the bank of evidence that mindfulness
practices are valuable adjunct interventions to traditional relapse prevention strategies, such as



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twelve-steps programs, neuro- and biofeedback, hypnosis, psychotherapy and psycho-
pharmacotherapy.

                                                        Summary

By definition, mindfulness is an intentional, nonjudgmental, awareness of the full range of
present-moment experiences—thoughts, emotions, sensations and events.

Mindfulness practices include, among others, Vipassana meditation, compassion meditation
(metta Bhavana), body scan meditation, walking meditation, Mindfulness Yoga, Reiki,
progressive muscle relaxation, mindful listening, mindful eating, and autogenics.

The release of neurotransmitters associated with feelings of pleasure, as well as an enduring
positive neuroplasticity induced by these practices support the hypothesis that mindfulness lets
the addict modulate the obsessive and compulsive behavior associated with a craving brain, and
thus prevent the pernicious effects of relapse.

Although many rehabilitation and detoxification centers offer Yoga, its effects often fall short of
expectations. This might be because the Yoga instructors at these centers lack the experience
necessary to teach Mindfulness Yoga or other methodologies such as those taught and practiced
as part of the Mindfulness-Based Relapse Prevention Course.

Putatively, mindfulness meditation enhances an awareness of ongoing behavior and cognitions,
giving the addict a greater capacity to think clearly. In time, the addict begins to perceive and
accept life as it is, without any judgment, and sets in motion the process of replacing thrill-
provoking behaviors with healthier, more authentic coping mechanisms.

Jaime Carlo-Casellas, Ph.D. is a Stress Management Specialist who has been teaching and practicing Mindfulness-Based Stress
Reduction techniques and Yoga for over 25 years. He holds a doctorate in Experimental Immunopathology and trained in the
practice of mindfulness at the University of Massachusetts Medical School under the supervision of Jon Kabat-Zinn, Ph.D.,
author of Full Catastrophe Living and Wherever You Go, There You Are. He received his training in Yoga at the Kripalu Center
for Yoga and Health in Lenox, Massachusetts. He is certified as a Yoga Instructor by the Yoga Alliance and is a member of the
International Association of Yoga Therapists. Dr. Carlo-Casellas is the founding director of the Stress Management & Prevention
Clinic in Rancho Mirage, California. Contact information: P.O. Box 1135, Palm Desert, CA 92261 • (760) 464-2150 •
casellas@stressprevention.org • www.stressprevention.org.




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                                            CITATIONS



1
    Kabat-Zinn, Jon: Full Catastrophe Living—Using the Wisdom of Your Body and Mind to Face
Stress, Pain, and Illness. Delta, New York, 1999.
2
    Witkiewitz, K., Marlatt, G. A., & Walker, D. D.: Mindfulness-based relapse prevention for
alcohol use disorders: The meditative tortoise wins the race. Journal of Cognitive Psychotherapy,
19 (3), 221-228, 2005.
3
    Marlatt, G. Alan, et. al: Vipassana Meditation as a Treatment for Alcohol and Drug Use
Disorders, in Mindfulness and Acceptance: Expanding the Cognitive-Behavioral Tradition, Eds.
Hayes, Stephen, C., Follette Victoria, M and Linehan, Marsha, M. Guilford, New York, 2004.
4
    Begley, Sharon: Train Your Mind, Change Your Brain—How a New Science Reveals our
Extraordinary Potential to Transform Ourselves. Bellantine, 2007.
5
    Segal, Zindel, Williams, J. Mark, G and Teasdale, Jonh D.: Mindfulness-Based Cognitive
Therapy for Depression—A New Approach to Preventing Relapse Guilford, New York, 2002.
6
    Mindfulness Yoga is a form of meditation taught and practiced at the Stress Management &
Prevention Clinic, Palm Desert, California. It is a meditational practice that focuses on a
nonjudgmental, present-moment awareness of all thoughts, feelings, and sensations induced by
Yoga postures (asanas). Although it would be disingenuous to deny its physical benefits, the
ultimate goal of Mindfulness Yoga is to gain freedom from mental impressions—cleaning up of
emotional anguish and improving mental health. Mindfulness Yoga is a complementary
alternative medical intervention. It is not intended to be a primary intervention for treating any
disease or illness.
7
    Authors note: Hypothetically, the calming and therapeutic effects of Reiki are attributable to
the release of oxytocin, ß endorphins, and other “feel-good” neuropeptides.




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