Acceptance-based Interventions Research Articles

A pilot test of a mindfulness-based communication training to enhance resilience in palliative care professionals

Although many providers enter palliative medicine with the intention of helping others, working in this practice also entails that providers will be repeatedly exposed to the pain, trauma, and the death of their patients. These experiences may threaten the values of providers and evoke a range of avoidant coping behaviors that potentiate distress and erode the quality of care provided. This manuscript reports pilot findings from Aware Compassionate Communication: An Experiential Provider Training Series (ACCEPTS) for Palliative Care Providers that is informed by Mindfulness-Based Interventions and principles of Psychological Flexibility Theory. Providers participated in a group-based 8-week, 10-session training series that emphasized mindfulness and acceptance-based interventions as applied to the needs of those working with the chronically ill and dying. The program included formal meditation practice, communication role plays, and value clarification exercises. Participants completed measures of distress (i.e. Depression, PTSD, and Burnout), and potential mechanisms of change (i.e. cognitive fusion and experiential avoidance) at pre-training, mid-training and post-training. Significant reductions were observed in cognitive fusion (posttreatment d=−.54, p<.05), depressive symptoms (posttreatment d=−.64, p<.01), depersonalization (posttreatment d=−.83, p<.01), PTSD Re-experiencing (posttreatment d=−.34, p<.01). Results indicated that ACCEPTS is an acceptable and feasible intervention for providers that may enhance well-being. More research is needed to assess cognitive fusion as a potential mechanism of change in the program

A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery.

Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. A sample of bariatric surgery patients (n = 11) who regained at least 10% of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. The intervention was shown to be feasible and acceptable, with 72% retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02% throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.

Mindfulness- and Acceptance-based Interventions for Psychosis: A Systematic Review and Meta-analysis.

Background:Mindfulness- and acceptance-based interventions are increasingly studied as a potential treatment for a variety of mental conditions.Objective:To assess the effects of mindfulness- and acceptance-based interventions on psychotic symptoms and hospitalization in patients with psychosisMethods:MEDLINE/PubMed, Embase, the Cochrane Library, and PsycINFO were screened from inception through April 2015. Randomized controlled trials (RCTs) were analyzed when they assessed psychotic symptoms or hospitalization in patients with psychosis; affect, acceptance, mindfulness, and safety were defined as secondary outcomes.Results:Eight RCTs with a total of 434 patients comparing mindfulness-based (4 RCTs) or acceptance-based interventions (4 RCTs) to treatment as usual or attention control were included. Six RCTs had low risk of bias. Moderate evidence was found for short-term effects on total psychotic symptoms, positive symptoms, hospitalization rates, duration of hospitalization, and mindfulness and for long-term effects on total psychotic symptoms and duration of hospitalization. No evidence was found for effects on negative symptoms, affect, or acceptance. No serious adverse events were reported.Conclusion:Mindfulness- and acceptance-based interventions can be recommended as an additional treatment for patients with psychosis.

Current Status of the Anger Avoidance Model: Recent Empirical Findings and Treatment Considerations

The Anger Avoidance Model (AAM), a contemporary theoretical model for understanding the relationship between anger and violence, was presented first in 2008, and since, empirical research has been mostly supportive of its tenets. The AAM essentially purports that individuals prone to violent behaviour typically manifest an aversive developmental history; early maladaptive schemas, which serve as a lens through which one interprets life experience; and poorly developed emotion regulation skills. Such deficits in emotion regulation result in poor tolerance of emotions such as anger, and in turn frequently lead to efforts to avoid or escape the experience of negative emotion, particularly anger, with violent behaviour often the consequence. Based on supported principles within the AAM, contextual anger regulation therapy (CART) was developed specifically to treat clients exhibiting such anger-related violent behaviour. The current article provides a needed update on recent empirical findings that support the AAM, and subsequently discusses the relationship between the AAM and CART, an integrated acceptance-based behavioural intervention that the AAM directly generated.

Supplemental Material for A Longitudinal Examination of Positive Parenting Following an Acceptance-Based Couple Intervention

Supplemental Material for A Longitudinal Examination of Positive Parenting Following an Acceptance-Based Couple Intervention

Pilot testing of a mindfulness- and acceptance-based intervention for increasing cardiorespiratory fitness in sedentary adults: A feasibility study

ObjectiveVigorous physical activity (PA) has been promoted for improving cardiorespiratory fitness (CRF). However, therapeutic techniques designed to engage participants in vigorous PA have fallen short; one reason for this may be the unpleasant physical sensations associated with vigorous exercise (e.g., temporary shortness of breath and mild muscle soreness). Mindfulness and acceptance-based therapies such as Acceptance and Commitment Therapy (ACT) may be helpful at improving adherence to vigorous PA levels. In this open clinical trial, we sought to demonstrate the feasibility and acceptability of a mindfulness- and acceptance-based intervention for increasing CRF in sedentary adults and to generate initial outcomes data. DesignParticipants (N=24) engaged in a 10-week fitness walking program while attending regular group sessions based on ACT. Main outcome measures and resultsThe feasibility and acceptability of the intervention were demonstrated through high levels of walking adherence (89.30%) and group session attendance (85.50%). A large significant decrease in total 1-mile walk test time [t(18)=4.61, p=.0002, d=.64] and a moderate significant increase in estimated VO2max [t(18)=−4.05, p=.0007, d=−.43] were observed. Analyses indicated a large significant increase in exercise-related experiential acceptance [t(18)=−9.19, p<.0001, d=−2.09]. ConclusionThis study demonstrates the feasibility and acceptability of an ACT-based intervention for supporting participation in vigorous PA in sedentary individuals.

A systematic review of mindfulness and acceptance-based treatments for social anxiety disorder.

The cultivation of mindfulness and acceptance has been theoretically and empirically associated with psychological ancillary well-being and has demonstrated efficacy in the treatment of various disorders. Hence, mindfulness and acceptance-based treatments (MABTs) have recently been explored for the treatment of social anxiety disorder (SAD). This review aims to evaluate the benefits of MABTs for SAD. Systematic review of studies investigating an MABT for individuals with SAD, using PsycInfo, Medline, PubMed, and Cochrane Central Register of Controlled Trials. Nine studies were identified. Significant improvements in symptomatology were demonstrated following the MABT, but benefits were equivalent or less than yielded by cognitive-behavioral therapy (CBT). The few treatment studies available were compromised by significant methodological weaknesses and high risk of bias across domains. Studies were largely uncontrolled with small sample sizes. The hybrid nature of these interventions creates ambiguity regarding the specific utility of treatment components or combinations. MABTs demonstrate significant benefits for reducing SAD symptomatology; however, outcomes should be interpreted with caution until appropriate further research is conducted. Furthermore, the benefit of MABTs above and beyond CBT must be considered tentative at best; thus, CBT remains best practice for first-line treatment of SAD.

Brief acceptance-based intervention for increasing intake attendance at a community mental health center.

Intake no-show rates for psychotherapy vary from 20% to 57% (Swenson & Pekarik, 1988), and experiential avoidance may be related to failure to attend intake sessions. This pilot study attempted to increase intake attendance at a community mental health center by employing a brief experiential acceptance-based intervention. Those who scheduled intakes were randomly assigned to 1 of 2 groups: orientation letter or acceptance-enhanced orientation letter; rates from these conditions were compared with a retrospective comparison control group. Participants were randomized by way of an online random number generator. Persons assigned to the orientation group did not have a higher show rate than persons within the control group (∼48% compared with ∼52%). Persons assigned to the acceptance group did have higher show rates than persons in the other two groups (∼67% compared with ∼48% and ∼52%, respectively), however this difference was nonsignificant. Results suggest that brief acceptance-based interventions should be further studied for their potential value in maximizing client attendance.

Predictors of Painkiller Dependence among People with Pain in the General Population

Self-medication with painkillers is widespread and increasing, and evidence about influences on painkiller dependence is needed to inform efforts to prevent and treat problem painkiller use. Online questionnaire survey. People in the general population who had pain and used painkillers in the last month (N = 112). Pain frequency and intensity, use of over-the-counter and prescription painkillers, risk of substance abuse (Screener and Opioid Assessment for Patients with Pain [SOAPP] scale), depression, anxiety, stress, alexithymia, pain catastrophizing, pain anxiety, pain self-efficacy, pain acceptance, mindfulness, self-compassion, and painkiller dependence (Leeds Dependence Questionnaire). In multiple regression, the independent predictors of painkiller dependence were prescription painkiller use (β 0.21), SOAPP score (β 0.31), and pain acceptance (β -0.29). Prescription painkiller use mediated the influence of pain intensity. Alexithymia, anxiety, and pain acceptance all moderated the influence of pain. The people most at risk of developing painkiller dependence are those who use prescription painkillers more frequently, who have a prior history of substance-related problems more generally, and who are less accepting of pain. Based on these findings, a preliminary model is presented with three types of influence on the development of painkiller dependence: 1) pain leading to painkiller use, 2) risk factors for substance-related problems irrespective of pain, and 3) psychological factors related to pain. The model could guide further research among the general population and high-risk groups, and acceptance-based interventions could be adapted and evaluated as methods to prevent and treat painkiller dependence.

Altering Impulsive Decision Making With an Acceptance-Based Procedure

Delay discounting is one facet of impulsive decision making and involves subjectively devaluing a delayed outcome. Steeply discounting delayed rewards is correlated with substance abuse and other problematic behaviors. To the extent that steep delay discounting underlies these clinical disorders, it would be advantageous to find psychosocial avenues for reducing delay discounting. Acceptance-based interventions may prove useful as they may help to decrease the distress that arises while waiting for a delayed outcome. The current study was conducted to determine if a 60–90minute acceptance-based training would change delay discounting rates among 30 undergraduate university students in comparison to a waitlist control. Measures given at pre- and posttraining included a hypothetical monetary delay discounting task, the Acceptance and Action Questionnaire-II (AAQ-II), and the Distress Tolerance Scale. Those assigned to the treatment group decreased their discounting of delayed money, but not distress intolerance or psychological inflexibility when compared to the waitlist control group. After the waiting period, the control group received the intervention. Combining all participants’ pre- to posttreatment data, the acceptance-based treatment significantly decreased discounting of monetary rewards and increased distress tolerance. The difference in AAQ-II approached significance. Acceptance-based treatments may be a worthwhile option for decreasing delay discounting rates and, consequently, affecting the choices that underlie addiction and other problematic behaviors.

Mindfulness and acceptance-based group therapy versus traditional cognitive behavioral group therapy for social anxiety disorder: A randomized controlled trial

Recent research has supported the use of mindfulness and acceptance-based interventions for Social Anxiety Disorder (SAD). ObjectiveThe purpose of the present study was to compare mindfulness and acceptance-based group therapy (MAGT) with cognitive behavioral group therapy (CBGT) with respect to outcome. It was hypothesized that MAGT and CBGT would both be superior to a control group but not significantly different from one another. MethodIndividuals (N = 137, mean age = 34 years, 54% female, 62% White, 20% Asian) diagnosed with SAD were randomly assigned to MAGT (n = 53), CBGT (n = 53) or a waitlist control group (n = 31). The primary outcome was social anxiety symptom severity assessed at baseline, treatment midpoint, treatment completion, and 3-month follow-up. Secondary outcomes were cognitive reappraisal, mindfulness, acceptance, and rumination. Depression, valued living, and group cohesion were also assessed. ResultsAs hypothesized, MAGT and CBGT were both more effective than the control group but not significantly different from one another on social anxiety reduction and most other variables assessed. ConclusionsThe present research provides additional support for the use of mindfulness and acceptance-based treatments for SAD, and future research should examine the processes by which these treatments lead to change.

Individual experiences of an acceptance-based pain management programme: An interpretative phenomenological analysis

Acceptance of pain has been found to play an important role in adjusting to chronic pain, and the evidence-base is growing with regards to the effectiveness of acceptance-based interventions such as acceptance and commitment therapy, mindfulness and contextual cognitive behavioural therapy within pain management settings. Despite the growing interest in such interventions, previous studies into acceptance-based pain management programmes (PMPs) are quantitative and the exact processes at work during such programmes remain unknown. This study aims to add to previous quantitative research in the area by qualitatively exploring individual experiences of attending an acceptance-based PMP and identifying the key constituents of the programme that participants felt facilitated change. Semi-structured interviews (n = 6) were analysed using interpretative phenomenological analysis, and five themes emerged: I’m not alone, others understand my pain, Freedom from pain taking over, A new self – one with pain, Parts of the programme participants felt facilitated change and Exercise is possible. These findings are then considered in relation to past research and relevant constructs in the literature. Implications for future research and clinical practice are also discussed alongside participant reflections and suggested areas for improvement.

Self-compassion and intuitive eating in college women: Examining the contributions of distress tolerance and body image acceptance and action

Self-compassion has been linked to higher levels of psychological well-being. The current study evaluated whether this effect also extends to a more adaptive food intake process. More specifically, this study investigated the relationship between self-compassion and intuitive eating among 322 college women. In order to further clarify the nature of this relationship this research additionally examined the indirect effects of self-compassion on intuitive eating through the pathways of distress tolerance and body image acceptance and action using both parametric and non-parametric bootstrap resampling analytic procedures. Results based on responses to the self-report measures of the constructs of interest indicated that individual differences in body image acceptance and action (β=.31, p<.001) but not distress tolerance (β=.00, p=.94) helped explain the relationship between self-compassion and intuitive eating. This effect was retained in a subsequent model adjusted for body mass index (BMI) and self-esteem (β=.19, p<.05). Results provide preliminary support for a complementary perspective on the role of acceptance in the context of intuitive eating to that of existing theory and research. The present findings also suggest the need for additional research as it relates to the development and fostering of self-compassion as well as the potential clinical implications of using acceptance-based interventions for college-aged women currently engaging in or who are at risk for disordered eating patterns.

Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire

The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker–Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.

Mindfulness and acceptance models in sport psychology: A decade of basic and applied scientific advancements.

It has been over a decade since the mindfulness and acceptance-based practice models that were originally developed within the mainstream clinical psychology domain were first applied in the sport context in order to enhance the athletic performance and overall psychological and general well-being of competitive athletes. Since that time, as mindfulness and acceptance-based interventions gained empirical support for the treatment of a broad range of clinical syndromes and difficulties, numerous important theoretical and empirical developments have also added to the scientific base for these procedures with athletic clientele and have provided some empirical support for the use of these theoretical models and associated intervention procedures. Thus, the present article retraces the past 11 years to provide a comprehensive update on the state-of-the-science with respect to the use of mindfulness and acceptancebased interventions for the purpose of enhanced athletic performance. The article sequentially discusses the theoretical development of these procedures for use with athletic clientele, provides an overview of the empirical research in both basic and applied science with respect to mechanisms of action and intervention efficacy, and suggests future research directions that may aid in the evolution of this approach.Keywords: mindfulness, acceptance, mindfulness-acceptance-commitment, sport psychology, performance enhancementIt has now been more than a decade since mindfulness and acceptance-based interventions were proposed for the purpose of enhanced athletic performance and overall psychological and general well-being of athletic clientele (Moore & Gardner, 2001). Since then, theoretical and empirical developments have added to the knowledge base and have built a scientific foundation for the use of these models and procedures. The current article looks back over the past 1 1 years and provides a comprehensive update on the state-of-the-science with respect to the use of mindfulness and acceptance-based interventions for the purpose of athletic performance enhancement. The article begins with a discussion of the theoretical development of these procedures for use with athletic populations, follows with a discussion of empirical research in both basic and applied science with respect to mechanisms of action and intervention efficacy, and highlights future research directions that may prove fruitful in the evolution of this approach.Development of Mindfulness and Acceptance ModelsOver the last decade, based on contemporary research in clinical psychology and the emotion sciences that has challenged the notion that internal experiences (such as cognitions, emotions, and physiological sensations) need to be controlled or lessened in order to enhance psychological functioning (Hayes, Strosahl, & Wilson, 1999), mindfulness and acceptance-based models have been developed for the enhancement of performance with competitive athletes (Gardner & Moore, 2004; Moore & Gardner, 2001) just as they have with clients presenting with a broad range of clinical syndromes and difficulties (Fairholme, Boisseau, Ellard, Ehrenreich, & Barlow, 2010). The primary focus of mindfulness and acceptance-based models is to promote a modified relationship with internal experiences (i.e., cognitions, emotions, and physiological sensations), rather than seeking to change their form or frequency (Gardner & Moore, 2007). In direct contrast to the traditional control-based psychological skills training model developed by Meichenbaum (1977) more than 35 years ago, which views the attainment of an optimal internal state as necessary for peak athletic performance, the foundation of mindfulness and acceptance-based models suggests an essentially opposite perspective. The mindfulness and acceptance-based models suggest that optimal performance does not require the reduction or volitional control of internal states at all, but rather, requires (a) a nonjudging (i. …

Impact of Acceptance-Based Nursing Intervention on Postsurgical Recovery: Preliminary Findings

Research has shown that teaching individuals to experience pain and anxiety as inevitable products of the actions they freely and responsibly undertake yields healthier reactions to suffering. This preliminary study assesses whether a brief acceptance-based psychological intervention along with the usual presurgical protocol for a laparoscopic cholecystectomy will produce healthier reactions to postsurgical pain, and will reduce anxiety, duration of postsurgical hospitalization, and demand of analgesics. After admission, screening, and consent procedures, we assessed pain and anxiety. Patients in the experimental condition (n = 6) then received a brief acceptance-based nursing intervention addressing the individual meaning of surgery, and including a metaphor and defusion practice, along with routine care. Patients in the control condition (n = 7) received routine care only. Twenty-four hr following the intervention, surgery took place. Pain, anxiety, and patients' demand for analgesics were assessed 24 hr or 48 hr after surgery. All six experimental patients, as compared to three of seven control patients, demanded fewer analgesics and left the hospital within 24 hr or 48 hr from surgery even in the presence of frequent and/or intense pain. Anxiety slightly decreased in the experimental patients. The brief acceptance-based intervention was effective in improving postsurgical recovery. These preliminary findings support the potential of this type of intervention as a cost-effective strategy to be implemented in the sanitary context.

Perceived injustice in fibromyalgia: Psychometric characteristics of the Injustice Experience Questionnaire and relationship with pain catastrophising and pain acceptance

ObjectiveTo validate a Spanish version of the Injustice Experience Questionnaire (IEQ), a measure of perceived injustice, in a fibromyalgia sample and to examine its relationship with pain catastrophising and pain acceptance. MethodsThe IEQ was administered along with the Pain Visual Analogue Scale, the Fibromyalgia Impact Questionnaire, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale (PCS) and the Chronic Pain Acceptance Questionnaire (CPAQ) to 250 primary care patients with fibromyalgia. ResultsThe IEQ had good test–retest reliability (intraclass correlation coefficient=0.98) and internal consistency (Cronbach's α=0.92). The factor structure obtained was similar to the original validation study. The multiple regression analyses showed that perceived injustice (PI) accounted for significant pain-related outcomes after controlling pain intensity, PCS and CPAQ. Principal component analysis of both the IEQ and the CPAQ taken together showed that the two constructs do not represent opposite extremes of the same dimension. ConclusionThe IEQ is a reliable assessment tool for measuring PI among patients with fibromyalgia. PI seems to be distinct from catastrophising, although the two constructs are very similar. The factor analysis showed that PI and acceptance represent related constructs, and this entails relevant implications for therapy, as acceptance-based interventions would be appropriate.

The Association Between Acceptance and Mental Health While Living With HIV

Individuals who are HIV-positive may experience various types of stressors. Research shows that negative appraisals and avoidance coping in response to stress are associated with less adaptive functioning. As an alternative, acceptance may be related to better well-being. Several investigators have shown that acceptance is associated with healthier outcomes for various medical populations. However, acceptance has not been empirically examined within HIV-positive individuals. The aim of the present study was to evaluate the relationships among acceptance, avoidance coping, and multiple aspects of psychological functioning in military veterans receiving HIV-related care at a veterans affairs (VA) healthcare system. Seventy-six military veterans who were HIV-positive and receiving care at a local VA healthcare system completed a battery of questionnaires assessing the variables of interest. Results indicated that acceptance was related to better mental health variables. To continue this line of research, future investigations may want to replicate these findings with other HIV-populations, examine potential mechanisms that drive the relationships between acceptance and better mental health functioning, and study the impact of acceptance-based interventions.

Post-traumatic Stress Disorder: Cognitive Hypnotherapy, Mindfulness, and Acceptance-Based Treatment Approaches

In this article, we describe how cognitive hypnotherapy can be used in conjunction with evidence-based practices for the treatment of post-traumatic stress disorder (PTSD). We review cognitive-behavioral interventions for PTSD, including mindfulness and acceptance-based approaches, and contend that (a) empirical support for the use of hypnosis in treating a variety of conditions is considerable; (b) hypnosis is fundamentally a cognitive-behavioral intervention; (c) psychological interventions with a firm footing in cognitive-behavioral therapy (CBT) are well-suited to treat the symptoms of PTSD; and (d) hypnosis can be a useful adjunct to evidence-based cognitive-behavioral approaches, including mindfulness and acceptance-based interventions, for treating PTSD.

A compassionate approach to the treatment of addictive behaviors: The contributions of Alan Marlatt to the field of mindfulness-based interventions

Dr Alan Marlatt dedicated the last decade of his research career to development and assessment of mindfulness-based treatments for addictive behaviors. From his research in the 1970s on effects of transcendental meditation to several recent trials of vipassana and other mindfulness-based practices, Alan inspired and laid the foundation for the development of numerous interventions and studies on mindfulness and acceptance-based treatments for substance use disorders. In collaboration with his colleagues, Alan developed Mindfulness-Based Relapse Prevention (MBRP), an outpatient program that integrates skills from cognitive behavioral relapse prevention (RP) and training in mindfulness meditation practices. MBRP is designed to help clients increase awareness of triggers and subsequent physical, emotional, and cognitive experiences, learning to respond skillfully rather than react habitually. Aligned with Alan's previous work in harm reduction and RP, this approach offers a nonjudgmental, client-centered, and acceptance-based approach to the treatment of addictive behaviors. Research and foundational theory behind MBRP and similar mindfulness-based programs developed by other researchers in the field of addictive behaviors are reviewed.