The (Lack of) Replication of Self-Reported Mindfulness as a Mechanism of Change in Mindfulness-Based Relapse Prevention for Substance Use Disorders
- 185 Downloads
The development and evaluation of mindfulness-based interventions for a variety of psychological and medical disorders have grown exponentially over the past 20 years. Yet, calls for increasing the rigor of mindfulness research and recognition of the difficulties of conducting research on the topic of mindfulness have also increased. One of the major difficulties is the measurement of mindfulness, with varying definitions across studies and ambiguity with respect to the meaning of mindfulness. There is also concern about the reproducibility of findings given few attempts at replication. The current secondary analysis addressed the issue of reproducibility and robustness of the construct of self-reported mindfulness across two separate randomized clinical trials of mindfulness-based relapse prevention (MBRP), as an aftercare treatment for substance use disorder. Specifically, we tested the robustness of our previously published findings, which identified a latent construct of mindfulness as a significant mediator of the effect of MBRP on reducing craving following treatment. First, we attempted to replicate the findings in a separate randomized clinical trial of MBRP. Second, we conducted sensitivity analyses to test the assumption of the no-omitted confounder bias in a mediation model. The effect of MBRP on self-reported mindfulness and overall mediation effect failed to replicate in a new sample. The effect of self-reported mindfulness in predicting craving following treatment did replicate and was robust to the no-omitted confounder bias. The results of this work shine a light on the difficulties in the measurement of mindfulness and the importance of examining the robustness of findings.
KeywordsMindfulness Craving Substance use disorder Replicability Reproducibility Mediation Sensitivity analyses Mindfulness-based relapse prevention
YYH conducted the data analyses and wrote the results. DT collaborated with the design and execution of the study and conceptualizing the analyses. ESK, MLVH, and DPM collaborated with the analyses and editing of the final manuscript. KW designed and executed the study and wrote the introduction and discussion sections of the manuscript. All authors contributed to the final editing of the manuscript.
The current study was funded by NIAAA R01 AA025539 (Witkiewitz and Tofighi, MPIs) and NIDA R37DA09757 (MacKinnon, PI).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in our study were approved by the institutional review board at the University of Washington.
Informed consent was obtained from all participants in the present study.
- Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Keil, T. F., Henley, W., & Kuyken, W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: a systematic review. Clinical Psychology Review, 55, 74–91. https://doi.org/10.1016/j.cpr.2017.04.008.CrossRefGoogle Scholar
- Bowen, S., Chawla, N., & Marlatt, G. A. (2011a). Mindfulness-based relapse prevention for addictive behaviors: a clinician’s guide. New York, NY: Guilford Press.Google Scholar
- Bowen, S., Witkiewitz, K., Chawla, N., & Grow, J. (2011b). Integrating mindfulness meditation and cognitive behavioral traditions for the long-term treatment of addictive behaviors. Journal of Clinical Outcomes Management, 18, 473–479.Google Scholar
- Bowen, S., Witkiewitz, K., Clifasefi, S. L., Grow, J., Chawla, N., Hsu, S. H., et al. (2014). Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders. JAMA Psychiatry, 71, 547–556. https://doi.org/10.1001/jamapsychiatry.2013.4546.CrossRefGoogle Scholar
- Bravo, A. J., Pearson, M. R., Wilson, A. D., & Witkiewitz, K. (2018). When traits match states: examining the associations between self-report trait and state mindfulness following a state mindfulness induction. Mindfulness, 9, 199–211. https://doi.org/10.1007/s12671-017-0763-5.CrossRefGoogle Scholar
- Brown, T.A. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York: Guilford Press.Google Scholar
- Browne, M. W., & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Beverly Hills, CA: Sage.Google Scholar
- Chawla, N. (2010). Experiential avoidance and substance use relapse. ProQuest Dissertation Publishing & Theses Global.Google Scholar
- Chawla, N., Collin, S., Bowen, S., Hsu, S., Grow, J., Douglass, A., & Marlatt, G. A. (2010). The mindfulness-based relapse prevention adherence and competence scale: development, interrater reliability, and validity. Psychotherapy Research, 20, 388–397. https://doi.org/10.1080/10503300903544257.CrossRefGoogle Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Erlbaum.Google Scholar
- Costa, J., Marôco, J., Pinto-Gouveia, J., & Galhardo, A. (2014). Validation of the psychometric properties of Acceptance and Action Questionnaire-II in clinical and nonclinical groups of Portuguese population. International Journal of Psychology and Psychological Therapy, 14, 353–364.Google Scholar
- Garland, E. L. (2016). Restructuring reward processing with mindfulness-oriented recovery enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain. Annals of the New York Academy of Sciences, 1373, 25–37. https://doi.org/10.1111/nyas.13034.CrossRefGoogle Scholar
- Grossman, P. (2011). Defining mindfulness by how poorly I think I pay attention during everyday awareness and other intractable problems for psychology’s (re) invention of mindfulness: comment on Brown et al. (2011). Psychological Assessment, 23, 1034-40-6. https://doi.org/10.1037/a0022713
- Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clincal Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006.CrossRefGoogle Scholar
- Gu, J., Strauss, C., Crane, C., Barnhofer, T., Karl, A., Cavanagh, K., & Kuyken, W. (2016). Examining the factor structure of the 39-item and 15-item versions of the Five Facet Mindfulness Questionnaire before and after mindfulness-based cognitive therapy for people with recurrent depression. Psychological Assessment, 28, 791–802. https://doi.org/10.1037/pas0000263.CrossRefGoogle Scholar
- Holland, P.W. (1988). Causal inference, path analysis, and recursive structural equations models. Sociological Methodology, 18, 449–484. doi: https://doi.org/10.2307/271055.
- Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspective on Psychological Science: A Journal of the Association for Psychological Science, 6, 537–559.CrossRefGoogle Scholar
- Kabat-Zinn, J. (2013). Full catastrophe living: using the wisdom of the body and mind to face stress, pain, and illness. New York: Bantam.Google Scholar
- Kline, R. B. (2016). Principle and practice of structural equation modeling (4th ed.). New York, NY, US: Guilford Press.Google Scholar
- Langer, E. F. (1989). Mindfulness. Cambridge: De Capo Press.Google Scholar
- MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Taylor & Francis Group.Google Scholar
- Medvedev, O. N., Siegert, R. J., Kersten, P., & Krägeloh, C. U. (2017). Improving the precision of the Five Facet Mindfulness Questionnaire using a Rasch approach. Mindfulness. https://doi.org/10.1007/s12671-016-0676-8.
- Muthén, L. K., & Muthén, B. O. (1998-2017). Mplus user's guide (8th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
- Paterson, J., Medvedev, O. N., Sumich, A., Tautolo, E., Krägeloh, S. U., Sisk, R., McNamara, R., Berk, M., Narayanan, A., & Siegert, R. J. (2017). Distinguishing transient versus stable aspects of depression in New Zealand Pacific Island children using generalizability theory. Journal of Affective Disorders, 227, 698–704.CrossRefGoogle Scholar
- Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80, 1007–1020. https://doi.org/10.1037/a0028329.CrossRefGoogle Scholar
- Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York, NY, US: Guilford Press.Google Scholar
- Tofighi, D., Hsiao, Y. Y., Kruger, E. S., MacKinnon, D. P., Van Horn, M. L., & Witkiewitz, K. (in press). Sensitivity analysis in latent growth curve mediation models. Structural Equation Modeling: A Multidisciplinary Journal.Google Scholar
- Van Dam, N.T., van Vugt, M.K., Vago, D.R., Schmalzl, L., Saron, C.D., Olendzki, A., … Meyer, D.E. (2018). Mind the hype: a critical evaluation and prescriptive agenda for research on mindfulness and meditation. Perspectives on Psychological Science: A Journal of the Association for Psychological Science, 13, 36–61. https://doi.org/10.1177/1745691617709589.
- van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., et al. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychological Review, 37, 26–39. https://doi.org/10.1016/j.cpr.2015.02.001.CrossRefGoogle Scholar
- Witkiewitz, K., Bowen, S., Harrop, E. N., Douglas, H., Enkema, M., & Sedgwick, C. (2014a). Mindfulness-based treatment to prevent addictive behavior relapse: theoretical models and hypothesized mechanisms of change. Substance Use & Misuse, 49, 513–524. https://doi.org/10.3109/10826084.2014.891845.CrossRefGoogle Scholar
- Witkiewitz, K., Warner, K., Sully, B., Barricks, A., Stauffer, C., Thompson, B. L., & Luoma, J. B. (2014b). Randomized trial comparing mindfulness-based relapse prevention with relapse prevention for women offenders at a residential addiction treatment center. Substance Use & Misuse, 49, 536–546. https://doi.org/10.3109/10826084.2013.856922.CrossRefGoogle Scholar
- Young, K. S., van der Velden, A. M., Craske, M. G., Pallesen, K. J., Fjorback, L., Roepstorff, A., & Parsons, C. E. (2018). The impact of mindfulness-based interventions on brain activity: a systematic review of functional magnetic resonance imaging studies. Neuroscience and Biobehavioral Reviews, 84, 424–433. https://doi.org/10.1016/j.neubiorev.2017.08.003.CrossRefGoogle Scholar