Mindfulness-based interventions in the treatment of behavioral addictions

Abstract

Mindfulness is defined as nonjudgmental, nonreactive, metacognitive attention focused on the experience of the present moment, without being caught up in thoughts about the past or future (Garland, 2007). Mindfulness-based interventions are gaining growing interest in the field of clinical psychology. This third-wave cognitive behavioral therapy (CBT) has been shown to be effective in the treatment of various psychological disorders such as depression, anxiety, and substance use and addictive disorders. Mindfulness-based interventions are not condition-centered but aim to modify, from a trans-diagnostic perspective, key psychological processes—such as experiential avoidance or rumination—involved in the etiology of various psychopathological disorders. In this regard, mindfulness-based approaches are particularly relevant in the case of comorbid disorders, which are the rule rather than the exception in patients presenting with addictive behaviors. Individuals with addictive behaviors frequently exhibit a tendency toward avoidant coping styles. These coping styles have notably been linked to the severity of substance use disorders and the experience of cravings. Unlike classic CBT, mindfulness-based therapies do not aim to modify thoughts or emotions, but to change one’s relationship to them. Essentially, rather than adjusting or modifying thoughts or emotions to prevent the manifestation of a particular behavior with the aim of suppressing the mental activity, mindfulness entails stepping aside and observing mental activity without judgment, refraining from the automatic need to react. Attempts to suppress emotions and thoughts might paradoxically heighten their intrusion. Learning the skills of accepting and nonreactively dealing with internal discomfort has the potential to enhance the management of negative emotions, which seems to be a particularly efficient approach in the treatment of patients with addictive disorders. In this chapter, we give a presentation of evidence-based mindfulness interventions, their indications, and their postulated mechanisms of action. We outline the interest in these interventions more specifically in the treatment of behavioral addictions and their complementarity with classic CBT approaches. We provide a detailed description of the Mindfulness-Based Relapse Prevention (MBRP) program (Bowen et al., 2011), which was designed specifically for the treatment of substance use disorders but is also relevant in the context of behavioral addictions (von Hammerstein et al., 2018). Finally, we describe a detailed case of a patient with gambling disorder who was provided with MBRP.