The Effectiveness of Mindfulness-Based Interventions for Depressive Symptoms and Their Relationship to Interoceptive Awareness: A Systematic Review

Longitudinal effects of interoceptive awareness training through mindful awareness in body-oriented therapy (MABT) as an adjunct to women’s substance use disorder treatment: A randomized controlled trial

Background: Sensory information gained through interoceptive awareness may play an important role in affective behavior and successful inhibition of drug use. This study examined the immediate pre-post effects of the mind-body intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to women’s substance use disorder (SUD) treatment. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation. Methods: Women in intensive outpatient treatment (IOP) for chemical dependency (N = 217) at 3 community clinics in the Pacific Northwest of the United States were recruited and randomly assigned to one of 3 study conditions: MABT + treatment as usual (TAU), women’s health education (WHE) +TAU (active control condition), and TAU only. At baseline and 3 months post-intervention, assessments were made of interoceptive awareness skills and mindfulness, emotion regulation (self-report and psychophysiological measures), symptomatic distress (depression and trauma-related symptoms), and substance use (days abstinent) and craving. Changes in outcomes across time were assessed using multilevel mixed-effects linear regression. Results: Findings based on an intent-to-treat approach demonstrated significant improvements in interoceptive awareness and mindfulness skills, emotion dysregulation (self-report and psychophysiology), and days abstinent for women who received MABT compared with the other study groups. Additional analyses based on participants who completed the major components of MABT (at least 75% of the intervention sessions) revealed these same improvements as well as reductions in depressive symptoms and substance craving. Conclusions: Findings that interoceptive training is associated with health outcomes for women in SUD treatment are consistent with emerging neurocognitive models that link interoception to emotion regulation and to related health outcomes, providing knowledge critical to supporting and improving SUD treatment.

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Emotion regulation involves a coherent relationship with the self, specifically effective communication between body, mind, and feelings. Effective emotion regulation involves the ability to accurately detect and evaluate cues related to physiological reactions to stressful events, accompanied by appropriate regulation strategies that temper and influence the emotional response. There is compelling evidence demonstrating links between poor or disrupted awareness of sensory information, or interoceptive awareness, and difficulties with emotion regulation. This paper presents a framework, based on psychological and neurobiological research, for understanding how interoceptive awareness facilitates regulation and an integrated sense of self, and thus contributes to health and well-being. A mind-body therapeutic approach called mindful awareness in body-oriented therapy (MABT), uniquely designed to teach fundamental skills of interoceptive awareness, is described. MABT develops the distinct interoceptive awareness capacities of identifying, accessing, and appraising internal bodily signals that are identified in physiological models as the critical components of interoception for emotion regulation. The explanatory model is that the development of these key interoceptive capacities improves sensory (physical and emotional) awareness, reduces distress, and improves regulation. Strategies for teaching and learning interoceptive awareness are not well-developed in mindfulness or psychotherapeutic approaches, particularly important for people who may have difficulty attending to interoceptive awareness due to stress, chronic pain or trauma. To address this issue, MABT provides an individualized protocol for scaffolding interoceptive awareness through a combination of psychoeducation and somatic approaches explicitly addressing difficulties with interoceptive processing. Clinical vignettes are included to provide exemplars of this approach and to highlight key components of the therapeutic process. Results from research are also included to highlight the acceptability, safety, health outcomes, and possible mechanisms underlying the MABT approach.

Mindfulness-based interventions for women victims of interpersonal violence: A systematic review

ObjectiveWhile effective, medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. This study examined the pre-post effects of the mindfulness-based intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation.MethodsPeople stabilized on medication for OUD (N = 303) from 6 community clinics in Northwestern United States were recruited and randomly assigned to MABT plus MOUD or MOUD only. In a mixed-methods study, we used an intent-to-treat approach to examine the proportion of days abstinent from non-prescribed opioids, and other substance use (primary outcomes) at baseline and 3 months post-intervention. Secondary outcomes included symptoms of mental health distress; emotional regulation difficulties; pain and physical symptom indicators; interoceptive awareness and mindfulness skills. Participant experience of MABT was collected through post-intervention surveys. Changes in outcomes were assessed using linear mixed models; content analysis was used to analyze the qualitative data.ResultsLevels of overall substance use were low and did not differ between groups. Significant improvements in PTSD symptoms, interoceptive awareness, pain severity, pain activity interference, and physical symptom frequency were found for those who received MABT compared to MOUD only.ConclusionIn this stable MOUD population, substance use outcomes were not improved, however MABT demonstrated significant positive changes across multiple health outcomes critical for improving MOUD treatment. Clinical Trials Registration: NCT04082637 on 9/3/2019

The need for improve medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health, and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD.ObjectivesWhile effective, medication for opioid use disorder (MOUD) treatment outcomes can be limited by co-occurring polysubstance use, mental health, and chronic pain conditions. Interoceptive training may facilitate well-being and support medication treatment for MOUD. This study examined the pre-post effects of the mindfulness-based intervention Mindful Awareness in Body-oriented Therapy (MABT) as an adjunct to MOUD. MABT teaches interoceptive awareness skills to promote self-care and emotion regulation.MethodParticipants stabilized on medication for opioid use disorder (OUD) (n = 303) from six community clinics in Northwestern United States were recruited and randomly assigned to MABT plus MOUD or MOUD only. In a mixed-methods study, we used an intent-to-treat approach (analyzing participants based on their assigned group, regardless of adherence) to examine the proportion of days abstinent from non-prescribed opioids, and other substance use (primary outcomes) at baseline and 3 months post-intervention. Secondary outcomes included symptoms of mental health distress, emotional regulation difficulties, pain and physical symptom indicators, interoceptive awareness, and mindfulness skills. Participant experience of MABT was collected through post-intervention surveys. Changes in outcomes were assessed using linear mixed models; content analysis was used to analyze the qualitative data.ResultsLevels of overall substance use were low and did not differ between groups. Significant improvements in PTSD symptoms, interoceptive awareness, pain severity, pain activity interference, and physical symptom frequency were found for those who received MABT compared to MOUD only.ConclusionsIn this stable MOUD population, substance use outcomes were not improved; however, MABT demonstrated significant positive changes across multiple health outcomes critical for improving MOUD treatment.PreregistrationClinicalTrials.gov identifer: NCT04082637.

Interoception, the representation of the body's internal state, is increasingly recognized for informing subjective wellbeing and promoting regulatory behavior. However, few empirical reports characterize interoceptive neural networks, and fewer demonstrate changes to these networks in response to an efficacious intervention. Using a two-group randomized controlled trial, this pilot study explored within-participant neural plasticity in interoceptive networks following Mindful Awareness in Body-oriented Therapy (MABT). Participants (N = 22) were assigned to either 8 weeks of MABT or to a no-treatment control and completed baseline and post-intervention assessments that included subjective interoceptive awareness (MAIA) and neuroimaging of an interoceptive awareness task. MABT was uniquely associated with insula deactivation, increased functional connectivity between the dorsal attention network and the somatomotor cortex, and connectivity changes correlated positively with changes in subjective interoception. Within the MABT group, changes in subjective interoception interacted with changes in a predefined anterior cingulate seed region to predict changes in right middle insula activity, a putative primary interoceptive representation region. While the small sample size requires the replication of findings, results suggest that interoceptive training enhances sensory-prefrontal connectivity, and that such changes are commensurate with enhanced interoceptive awareness.

Non-pharmacologic approaches are now considered best practice for the treatment of chronic pain. The purpose of this pilot study was to evaluate patient responses to a newly integrated clinic service called Mindful Awareness in Body-oriented Therapy (MABT) at a chronic pain clinic. MABT is designed to develop interoceptive sensibility for improved well-being and emotion regulation. A one-group repeated measures design was used to examine MABT referral and delivery follow-through feasibility and change on health outcomes among chronic pain patients. Upon referral, participants were scheduled for the MABT program involving eight individual sessions with one of the clinic massage therapists trained in MABT. Measures were administered at baseline, post-intervention (3 months) and at 6 month follow-up). Outcome measures assessed physical and mental health distress, interoceptive awareness, and emotional well-being. Analyses included descriptive statistics and repeated measures ANOVA. Seventy patients were referred and 41 received at least one MABT session. Thirty patients (73%) completed the MABT intervention. Statistically and/or clinically significant improvements were identified for most subscales of the PROMIS-29 (the primary outcome), including Physical Function, Fatigue, Anxiety, Sleep Disturbance, Social Roles, and Pain Interference. Improvements in interoceptive sensibility and emotion regulation difficulties also demonstrated statistically significant and large effects. This pilot study demonstrates the feasibility of MABT referral and delivery follow-through when delivered in a real-life context. Significant improvements with large effects on outcomes in response to the MABT intervention program offers a promising non-pharmacological approach for chronic pain patients.

Longitudinal effects of interoceptive awareness training as an adjunct to medication treatment for opioid use disorder: A randomized clinical trial of Mindful Awareness in Body-oriented Therapy.

A pilot study of mindful body awareness training as an adjunct to office-based medication treatment of opioid use disorder

It is postulated that interventions aimed at facilitating interoceptive awareness (i.e., awareness of inner body sensations) may facilitate regulation and improve substance use disorder (SUD) treatment outcomes. The aim of the study was to better understand the role of interoceptive training in SUD treatment, an identified gap in the literature. On the basis of a National Institute on Drug Abuse (NIDA)-funded pilot randomized clinical trial that used a two-group repeated measures design to examine mindful awareness in body-oriented therapy (MABT) for women in SUD treatment, this study examined the experience of a subset of participants that received and completed MABT intervention in the larger original study. In a qualitative study using a single focus group, participants were asked to respond to multiple questions regarding their current use of interoceptive awareness skills, perceived benefit, learning processes, and suggestions for program development. Interpretive analysis was used to describe the themes that emerged from the focus group responses. Participants consistently used interoceptive awareness self-care skills learned in MABT. Interoceptive awareness training and daily practice were perceived as critical for emotional awareness, regulation, and relapse prevention. In addition, findings highlight the relevance of MABT educational strategies such as touch and individual delivery to teach interoceptive awareness and self-care skills for women in SUD treatment. These findings suggest the positive role of interoceptive awareness in promoting relapse prevention among women in SUD treatment, important for guiding future research, and program development for this population that apply across healthcare disciplines.

Mindful awareness in body-oriented therapy as an adjunct to women's substance use disorder treatment: A pilot feasibility study

BackgroundAs regulation of opioid prescribing evolves, primary care and pain clinics are shifting to provide non-pharmacological and interdisciplinary chronic pain care. An under-utilized but growing area of health care for chronic pain is complementary and integrative health (CIH). However, there is limited availability of CIH approaches within the health care system. Mindful Awareness in Body-Oriented Therapy (MABT) is an evidence-based mind-body therapy, with a manualized protocol, that focuses on developing interoceptive sensibility for improved self-awareness and nervous system regulation. Prior MABT research shows MABT improves self-report and physiological indicators of interoception as well as mental and physical symptoms of distress.MethodsThis pilot single-group study used a hybrid implementation-effectiveness design and mixed methods to study implementation strategies and outcomes for bringing MABT into an integrative chronic pain clinic. Administrative data, staff surveys, and focus groups were used to understand the implementation process and outcomes (see Additional files 2, 3, and 4). Descriptive statistics were used to analyze survey and administrative data. A content analysis approach was used to analyze qualitative data from focus groups.Results7 staff surveys were administered over the 24-month study period and showed high acceptability and appropriateness that increased over time. Adoption, feasibility, and sustainability were also high. Clinicians made 70 referrals to MABT, 56 patients scheduled a session, 41 patients completed at least one session, and 71% of these completed the protocol. Focus groups identified MABT as a therapy that filled a gap in services, particularly for patients with a lack of body awareness and high emotion dysregulation.ConclusionImplementation of MABT was highly successful in an integrative health clinic focused on chronic pain treatment.ClinicalTrials.gov registrationNCT05289024 Registered March 11, 2022 https://clinicaltrials.gov/study/NCT05289024?term=NCT05289024&rank=1.

The purpose of this study was to examine the implementation and acceptability of Mindful Awareness in Body-oriented Therapy (MABT), a novel adjunctive approach to substance use disorder (SUD) treatment. The primary aims of the study were to examine implementation of MABT as an adjunct to addiction treatment, and MABT acceptability to study participants and treatment staff. MABT was delivered to participants randomly assigned to the intervention in a larger ongoing trial. This study focuses only on the implementation and acceptability of the intervention, as outcomes are not yet available. MABT was delivered once weekly for 8 weeks (1.5-hour sessions) and spanned inpatient and outpatient programs at a women-only treatment facility. Descriptive statistics were used to examine participant recruitment and retention to the intervention. To measure MABT acceptability, survey and written questionnaires were administered; analysis involved descriptive statistics and content analysis using Atlas.ti software. Thirty-one (31) of the women enrolled in the study were randomized to MABT. Eighteen (18) participants completed 75%-100% of the MABT sessions. Intervention implementation required flexibility on the part of both the researchers and the clinic staff, and minor changes were made to successfully implement MABT as an adjunct to usual care. MABT was perceived to increase emotional awareness and provide new tools to cope with stress, and to positively influence SUD treatment by facilitating emotion regulation. It was feasible to implement MABT and to recruit and retain women to MABT in women's chemical-dependency treatment. MABT acceptability and perceived benefit was high.