Jake H. Davis

Craving to quit: psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions.

Humans suffer heavily from substance use disorders and other addictions. Despite much effort that has been put into understanding the mechanisms of the addictive process, treatment strategies have remained suboptimal over the past several decades. Mindfulness training, which is based on ancient Buddhist models of human suffering, has recently shown preliminary efficacy in treating addictions. These early models show remarkable similarity to current models of the addictive process, especially in their overlap with operant conditioning (positive and negative reinforcement). Further, they may provide explanatory power for the mechanisms of mindfulness training, including its effects on core addictive elements, such as craving, and the underlying neurobiological processes that may be active therein. In this review, using smoking as an example, we will highlight similarities between ancient and modern views of the addictive process, review studies of mindfulness training for addictions and their effects on craving and other components of this process, and discuss recent neuroimaging findings that may inform our understanding of the neural mechanisms of mindfulness training.

Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness.

Buddhist meditation practices have become a topic of widespread interest in both science and medicine. Traditional Buddhist formulations describe meditation as a state of relaxed alertness that must guard against both excessive hyperarousal (restlessness) and excessive hypoarousal (drowsiness, sleep). Modern applications of meditation have emphasized the hypoarousing and relaxing effects without as much emphasis on the arousing or alertness‐promoting effects. In an attempt to counterbalance the plethora of data demonstrating the relaxing and hypoarousing effects of Buddhist meditation, this interdisciplinary review aims to provide evidence of meditations arousing or wake‐promoting effects by drawing both from Buddhist textual sources and from scientific studies, including subjective, behavioral, and neuroimaging studies during wakefulness, meditation, and sleep. Factors that may influence whether meditation increases or decreases arousal are discussed, with particular emphasis on dose, expertise, and contemplative trajectory. The course of meditative progress suggests a nonlinear multiphasic trajectory, such that early phases that are more effortful may produce more fatigue and sleep propensity, while later stages produce greater wakefulness as a result of neuroplastic changes and more efficient processing.

Can enlightenment be traced to specific neural correlates, cognition, or behavior? No, and (a qualified) Yes

A NEUROSCIENCE OF ENLIGHTENMENT? The field of contemplative science is rapidly growing and integrating into the basic neurosciences, psychology, clinical sciences, and society-at-large. Yet the majority of current research in the contemplative sciences has been divorced from the soteriological context from which these meditative practices originate and has focused instead on clinical applications with goals of stress reduction and psychotherapeutic health. In the existing research on health outcomes of mindfulness-based clinical interventions, for example, there have been almost no attempts to scientifically investigate the goal of enlightenment. This is a serious oversight, given that such profound transformation across ethical, perceptual, emotional, and cognitive domains are taken to be the natural outcome and principle aim of mindfulness practice in the traditional Buddhist contexts from which these practices are derived. If short-term interventions as short as a few sessions are now beginning to produce neuroplastic changes (Tang et al., 2010; Zeidan et al., 2010; Xue et al., 2011), it may be that even in secular contexts, practitioners are already developing states and traits that are associated with progress toward enlightenment. In order to carefully assess the potential effects of meditative interventions it is of singular importance to ask whether enlightenment can be traced to specific neural correlates, cognition, or behavior.

Dismantling Mindfulness-Based Cognitive Therapy: Creation and validation of 8-week focused attention and open monitoring interventions within a 3-armed randomized controlled trial

BACKGROUND While mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage. METHODS Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training). RESULTS The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired). CONCLUSIONS These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.

Development and Validation of the Behavioral Tendencies Questionnaire.

At a fundamental level, taxonomy of behavior and behavioral tendencies can be described in terms of approach, avoid, or equivocate (i.e., neither approach nor avoid). While there are numerous theories of personality, temperament, and character, few seem to take advantage of parsimonious taxonomy. The present study sought to implement this taxonomy by creating a questionnaire based on a categorization of behavioral temperaments/tendencies first identified in Buddhist accounts over fifteen hundred years ago. Items were developed using historical and contemporary texts of the behavioral temperaments, described as “Greedy/Faithful”, “Aversive/Discerning”, and “Deluded/Speculative”. To both maintain this categorical typology and benefit from the advantageous properties of forced-choice response format (e.g., reduction of response biases), binary pairwise preferences for items were modeled using Latent Class Analysis (LCA). One sample (n1 = 394) was used to estimate the item parameters, and the second sample (n2 = 504) was used to classify the participants using the established parameters and cross-validate the classification against multiple other measures. The cross-validated measure exhibited good nomothetic span (construct-consistent relationships with related measures) that seemed to corroborate the ideas present in the original Buddhist source documents. The final 13-block questionnaire created from the best performing items (the Behavioral Tendencies Questionnaire or BTQ) is a psychometrically valid questionnaire that is historically consistent, based in behavioral tendencies, and promises practical and clinical utility particularly in settings that teach and study meditation practices such as Mindfulness Based Stress Reduction (MBSR).

Mindfulness and the Addictive Process: Psychological Models and Neurobiological Mechanisms

Few conditions cause as much suffering on a personal and societal level as addictions. Though efforts have helped to delineate the neurobiological mechanisms of the addictive process, treatment strategies have lagged behind. Mindfulness training, which is based on ancient Buddhist psychological models of human suffering, has recently shown promise in the treatment of addictions. Interestingly, these early models are remarkably similar to modern-day models, namely in their overlap with positive and negative reinforcement (operant conditioning). Remarkably, the early Buddhist models may take it one step further, both in explaining the psychological mechanisms of mindfulness and importantly also pointing to key elements of the addictive process, such as craving as essential targets of treatment. In this chapter, we describe the overlap and similarities between early and contemporary models of the addictive process, review studies of mindfulness training for addictions and their mechanistic effects on the relationship between craving and behavior, and discuss recent neuroimaging studies that help to inform our understanding of underlying neural mechanisms of mindfulness.