Associations of Momentary Mindfulness with Affect and Cannabis Desire in a Trial of Cannabis Use Interventions with and without Momentary Assessment

Abstract

Background. Mindfulness, a state of awareness that results from intentionally attending to the present moment without judgment, has been associated with improved health. In substance use treatment, mindfulness-based interventions (MBIs) improve mood and emotional regulation, possibly through increased positive affect and effective coping with negative affect. MBIs may also decrease substance cravings and use. Because affect, substance desire, and mindfulness vary moment-to-moment in daily life contexts, examining their associations may improve understanding of how MBIs reduce substance use. Momentary effects of mindfulness also have implications for ecological momentary assessment (EMA) and interventions (EMIs) for substance use. EMA samples momentary experience and EMIs administer treatment in real-time, real-life contexts. In bringing attention to thoughts and feelings at the time of the report, EMA can raise self-awareness. EMIs can provide content tailored to time or situation. EMA studies have shown that increased momentary negative affect predicts momentary cannabis desire and use events. If mindfulness decreases momentary negative affect, then EMA to raise awareness of momentary states and EMIs to prompt mindfulness practice in daily life may be effective cannabis use treatment. We examined whether momentary mindfulness changed after cannabis use interventions that included EMA, and explored associations with momentary negative affect, positive affect, and cannabis desire. Methods. Hospital clinic outpatients 15-24 years using cannabis ≥3 times per week were randomized to one of three interventions to reduce cannabis use. All interventions included two weekly 1-hour motivational enhancement therapy (MET) sessions. In two interventions, participants also received two weeks of EMA with or without supportive messages following report of contexts personally triggering for cannabis use. We used EMA to measure cannabis-related momentary states, contexts, and behavior 4-6x/day for one week at baseline and three months post-intervention. Of 70 participants enrolled, 68 (MET+EMA, n=40; MET-Only, n=28) contributed momentary data (N=1,971 reports) to these analyses. We calculated individual-level mean scores for the continuous momentary variables and normalized them using z-score or Blom transformation, as appropriate. Using generalized linear mixed effects models, we examined momentary mindfulness trends from baseline to 3-month follow-up, and whether changes differed by study group (MET+EMA vs. MET-Only) via phase-by-group interaction. We then examined associations of momentary mindfulness with negative affect, positive affect, and cannabis desire in separate models. We ran models unadjusted and adjusted for momentary contexts, group, phase, and mean reports/day in phase. Results. Mean momentary mindfulness was significantly higher at follow-up, compared to baseline (adjusted βdifference=0.146, SE=0.034, p<.0005). Momentary mindfulness increased from baseline to follow-up in the MET+EMA group, but did not change significantly in the MET-Only group (βEMA_difference=0.237, SE=0.045, p<.0005; βMET-Only_difference=0.055, SE=0.050, p=0.269; βphase_x_group =0.182, SE=0.066, p=.006). Higher momentary mindfulness was associated with lower negative affect (adjusted βmindfulness=-0.526, SE=0.045, p<.0005) and with lower cannabis desire (adjusted βmindfulness=-0.521, SE=0.044, p<.0005). Momentary mindfulness was not significantly associated with momentary positive affect (adjusted βmindfulness =0.013, SE=0.035, p=.712). Conclusions. Among youth using cannabis frequently, momentary mindfulness increased following interventions with EMA after counseling, and was inversely associated with negative affect and cannabis desire. Mindfulness may be a useful target for momentary intervention.