Evaluation of a Brief Surf the Urge Intervention
Condition: Substance Use; Deliberate Self-harm; Trichotillomania; Aggression; Stealing; Eating Pathology; Gambling
MeSH terms: Substance-Related Disorders; Self Mutilation; Aggression; Gambling; Self-Injurious Behavior; Trichotillomania
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the effectiveness of a brief "Surf the Urge"
      intervention to reduce adolescent and young adult (i.e., 14 to 24 years old) urge-related
      behaviors. These behaviors will include, but not be limited to, substance use, deliberate
      self-harm, aggressive behavior, pulling out hair, and loosing control when eating.The
      intervention will utilize mindfulness skills (i.e., awareness, acceptance, nonjudgment) to
      assist in reducing these risky behaviors.
    

Detailed description: 
      Empirical research has not specifically examined the effectiveness of the Surf the Urge
      intervention with an adolescent and young adult sample. Additionally, the value of this
      intervention with urge-related behaviors besides smoking (e.g., substance use, purging,,
      deliberate self-harm) is unclear. The current study will examine the efficacy of the Surf the
      Urge intervention in a sample of 14 to 24-year-olds who engage in a diverse array of
      urge-related behaviors. To aid participants in reducing their urge-related behavior, and
      coping with urges, the investigators will cue urges during the intervention by utilizing a
      cue exposure script. Urge-related behaviors to examine include alcohol use, drug use, tobacco
      use, deliberate self-harm, and self-induced vomiting. Additionally, only participants who
      experience urges or engage in the urge-related behavior a minimum of one time per week will
      be included. If participants report engaging in several urge-related behaviors, or
      experiencing varying urges, throughout a one-week period, they will be prompted to report the
      urge engaged in, or experienced, more frequently.purging, restrictive eating, violent actions
      (e.g., punching someone), gambling, stealing, trichotillomania, etc.

      Additionally, the duration of the study will consist of a 6-week time-period, with the
      intervention occurring at either 2- or 4-weeks, creating a mixed-design model. This model
      will require fewer participants and allow the evaluation of individual differences related to
      intervention effectiveness. Additionally, this will enable the comparison of whether
      participants who were provided with the intervention at 2-weeks, compared to 4-weeks, were
      able to reduce their urge-related behaviors earlier. It is hypothesized that:

        1. The Surf the Urge mindfulness intervention will decrease various urge-related behaviors
           (e.g., substance use, deliberate self-harm); however, this intervention will not
           directly affect a participant's self reported urge levels. Furthermore, individuals in
           the 2- week intervention group will reduce their urge-related behaviors sooner than
           those in the 4-week intervention group.

        2. Participants who score higher on a self-report mindfulness questionnaire (Five Facet
           Mindfulness Questionnaire) will show greater reductions in their urge-related behaviors
           (e.g., substance use, deliberate self-harm).

        3. Participants who demonstrate the greatest change from their pre- to post- assessment
           mindfulness self-report scores (Five Facet Mindfulness Questionnaire) will show the
           greatest changes in urge-related behaviors. They will also rate the Surf the Urge
           intervention as more satisfying (Client Satisfaction Questionnaire-8).

        4. Participants who rate the Surf the Urge intervention as more satisfying (Client
           Satisfaction Questionnaire-8) will demonstrate a greater reduction in their urge-related
           behaviors.

        5. There will be a 95% adherence rate to both the cue exposure and Surf the Urge protocols
           demonstrating proper implementation. When assessing intervention integrity, there will
           be no statistically significant difference in adherence between trained therapists and
           myself.

      This study will provide information on the effectiveness of a brief mindfulness intervention
      to reduce various urge-related behaviors in a high-risk population (i.e., adolescents). It
      will provide additional information on a growingly popular intervention technique in a newly
      studied population and with newly examined problem behaviors. These results may lead to
      further information on the effectiveness of mindfulness interventions with adolescents and
      have implications for future treatment modalities. Additionally, it will also provide
      information on the characteristics of individuals who may be more responsive to briefer
      urge-behavior reduction interventions.
    

Intervention name(s): Surf the Urge
Intervention type(s): Behavioral
Intervention description(s): The intervention teaches clients to be aware of and accept their feelings, thoughts, and sensations in a non-judgmental manner. Clients learn to remain present within the moment, become aware of their urges, and focus on accepting thoughts and feelings rather than suppressing or changing them. It utilizes visual imagery to assist clients in utilizing more acceptance skills; the client imagines his urges as waves within the ocean and then imagines surfing the waves.
Some interventionists also provide psychoeducation. Clients learn that urges will not last forever; clients are also taught information about reinforcing urges. The interventionist explains that if clients do not reinforce urges (e.g., do not smoke when an urge to smoke arises) they will eventual subside; however, reinforcing urges (smoke when an urge to smoke arises) will produce stronger urges. Emphasis is placed on the belief that clients have the choice to refrain from engaging in urge-related behaviors.
Other intervention name(s): Surfing the Urge
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: mindfulness; urges; adolescents; risk behaviors; therapy intervention