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Approach Coping and Substance Use Outcomes Following Mindfulness-Based Relapse Prevention Among Individuals with Negative Affect Symptomatology

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Abstract

Objectives

Mindfulness-based relapse prevention (MBRP) for substance use disorders (SUDs) appears to be particularly effective among individuals with high levels of co-occurring affective symptoms. We sought to understand whether changes in approach and avoidance coping may explain the effects of MBRP among this subpopulation.

Methods

The sample included 286 individuals with SUDs randomized to MBRP, relapse prevention (RP), or treatment as usual (TAU) as an aftercare treatment. We conducted conditional indirect effect models with treatment condition as the predictor, baseline affective symptoms as the moderator, changes in approach and avoidance coping over time from baseline through 6 months post-treatment as mediators, and substance use and substance-related problems at 12 months post-treatment as the outcome. Affective symptomatology at baseline was modeled as a latent factor indicated by depression, anxiety, and PTSD symptoms. Change in approach and avoidance coping were modeled using latent growth curve analyses.

Results

We found significant conditional indirect effects of MBRP, such that the interaction of MBRP vs. TAU by affective symptoms predicted increases in approach coping, which in turn predicted fewer heavy drinking days and substance-related problems at month 12. Follow-up analyses showed that increases in approach coping mediated the therapeutic effect of MBRP on these outcomes among those with high, but not low or moderate, affective symptoms. We did not find indirect or conditional indirect effects when comparing RP with TAU, or when avoidance coping was the mediator.

Conclusions

The pronounced therapeutic effects of MBRP among individuals with SUD and relatively higher negative affective symptoms may be due to increases in approach coping over time.

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Acknowledgments

During the preparation of this manuscript, Dr. Roos was supported by a training grant through the National Institute on Drug Abuse (grant number T32DA007238-29).

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Authors and Affiliations

  1. Department of Psychiatry, Yale University School of Medicine, 40 Temple Street, Ste Suite 6C, New Haven, CT, 06510, USA

    Corey Roos

  2. School of Professional Psychology, Pacific University, 190 SE 8th Avenue, Hillsboro, OR, 97123, USA

    Sarah Bowen

  3. Department of Psychology, University of New Mexico, MSC 03-2220, Albuquerque, NM, 87131, USA

    Katie Witkiewitz

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  1. Corey Roos
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Contributions

All authors contributed to the study conceptualization and design. CRR conducted the data analyses and wrote the initial drafts of the results and discussion sections. KW and SB contributed the oversight of the data analyses and study execution, and the writing and editing of the final manuscript.

Corresponding author

Correspondence to Corey Roos.

Ethics declarations

This paper is a secondary analysis of data from a clinical trial. The original clinical trial was approved by the University of Washington Institutional Review Board. All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants enrolled in the study gave their informed consent prior to their inclusion in the study.

Conflict of Interest

Drs Bowen and Witkiewitz conduct MBRP trainings for which they receive monetary incentives, although the findings presented in this article have not yet been presented as part of these trainings. No other authors have conflicts, and there has been no significant financial support for this work that could have influenced its outcome.

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Roos, C., Bowen, S. & Witkiewitz, K. Approach Coping and Substance Use Outcomes Following Mindfulness-Based Relapse Prevention Among Individuals with Negative Affect Symptomatology. Mindfulness 11, 2397–2410 (2020). https://doi.org/10.1007/s12671-020-01456-w

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