Changing Impulsivity With Mindful Breathing Therapy to Reduce Problem Drinking
Condition: Problem Drinking
MeSH terms: Alcoholism; Impulsive Behavior
Study type: Interventional

Summary: 
      The investigators plan to establish the efficacy of a novel breathing-based mindfulness
      training (BBMT, a much simplified, easy-to-use version of standard MM) for problem drinking,
      and test whether impulsivity mediates this effect among a sample of student problem drinkers
      (i.e., > 8 on AUDIT, the problem drinking Screening Test). The specific aims of this pilot
      study are as follows:

        1. to modify and further develop the easy-to-use BBMT program for directly targeting
           impulsivity to produce an indirect reduction in problem drinking among college students;

        2. to investigate the feasibility and preliminary efficacy of applying BBMT for reducing
           problem drinking with a pilot randomized controlled trial (RCT);

        3. to examine changes in impulsivity, as measured by both behavioral and self-report
           assessments, as one of the possible mediators in the effect of BBMT on problem drinking,
           with control for changes in perceived stress and anxiety.
    

Detailed description: 
      An efficacious strategy for addressing problem substance use among college student drinkers
      is to target core risk factors. Arguably one of the most clearly documented risk factors for
      problem drinking among college students is impulsivity, with the relationship holding across
      various dimensions of impulsivity. Available evidence supports the importance of intervening
      with impulsivity to limit problem drinking among college students, but there are few proven
      treatments for any dimension of impulsivity. This notable lack may be due to the traditional
      view of impulsivity as an unchangeable personality trait. However, recent research suggests
      personality can change and is sensitive to behavior manipulation. As a result there is clear
      need for novel approaches targeted at core changes in the individual and their behavior
      patterns. Mindfulness meditation (MM) is a unique option in this direction as MM is
      especially useful in reducing impulsive behaviors including problem drinking, but its exact
      role in affecting different dimensions of impulsivity and in effecting change in problem
      drinking has yet to be explored. Based on evidence from recent studies, as well as our own
      pilot work, the investigators hypothesize that one of the mechanisms by which MM reduces
      problem drinking among college students is by lessening impulsivity - moreover, the focus on
      changing college student problem drinking is done without any explicit focus on drinking
      behavior itself. The specific aims of this Stage 1 therapy development study are to: 1)
      modify and further develop a breathing-based mindfulness therapy (BBMT) for reducing
      impulsivity and problem drinking among college youth; 2) investigate the feasibility and
      preliminary efficacy of applying BBMT for reducing problem drinking with a pilot randomized
      controlled trial (RCT); 3) examine changes in impulsivity, as measured by both behavioral and
      self-report assessments, as one of possible mediators in the observed effect of BBMT on
      problem drinking. These aims will be achieved in two phases. In Phase 1 the investigators
      will expand and fully develop the existing BBMT program with manuals to determine the
      effective treatment dosage for both problem drinking and impulsivity in an open label trial
      (n = 10). Using the modified treatment materials from Phase 1, in Phase 2 the investigators
      will conduct a RCT comparing the effects of modified BBMT to a Supportive Counseling +
      Progressive Muscle Relaxation (SC + PMR) control condition (n = 36 each) on problem drinking,
      assessed at baseline, weeks 4 and 8, and a 3-month follow-up. Other potential mediators such
      as perceived stress and anxiety also will be examined in the final model. This study has
      great potential implications for reaching college students drinkers less willing to
      acknowledge their drinking problems as it addresses a core vulnerability (impulsivity) among
      at-risk students in a manner that limits stigma and may reduce resistance to change. A
      diverse team experienced in mindfulness, impulsivity and behavior therapy development has
      been assembled to conduct the proposed R34 project and prepare for a full therapy development
      study in the future.
    

Intervention name(s): Mindfulness Therapy
Intervention type(s): Behavioral
Intervention description(s): BBMT is a simplified form of MM. Its core components are near resonance-frequency breathing (RFB), mindfulness training, positivity and inward attention. A key component in BBMT is to be mindful of breathing whenever possible, and breathe at near resonance frequency (RF), known as heart rate variability biofeedback. The human cardiovascular system is known to have resonance characteristics, with the first RF at ~0.1 Hz. RF varies between 4.5 and 7 cycles per minute. Breathing at RF stimulates the cardiovascular system to oscillate at that frequency at a very high amplitude and greatly stimulates the baroreflex system. RFB is known to reduce depression and stress symptoms as well as various diseases related to malfunction of the autonomic nervous system, such as asthma and hypertension.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mindfulness; Therapy; Problem Drinking; Breathing-based mindfulness training