T H O M A S L Y O N S , P H . D .
L O Y O L A N E U R O S C I E N C E S E M I N A R
M A R C H 1 8 , 2 0 1 4

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What is mindfulness?
Enhancement of mindfulness through meditation training
Neurobiology of meditation and drug addiction
Mindfulness Based Relapse Prevention
Addiction and the criminal justice system: mindfulness programs in jails and prisons
Research program at Chicago State University
Summary and conclusions

“Life is available only in the present moment.”
― Thích Nh ấ t H ạ nh

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“Paying attention in a particular way; on purpose, in the present moment, and non-judgmentally.”
(Kabat-Zinn)
Attention to thoughts, emotions and feelings in the present moment
Attitude of acceptance/non-reactivity and non-judgement
A very old concept
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Sati in Sanskrit means “awareness”, also remembrance, an important concept in Buddhism
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Came into Western languages in the 1970s through work of
Vietnamese monk Thich Nhat Hanh and others

 Can be conceptualized as
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A mental state that varies from moment to moment in an individual
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A personality trait or disposition perduring over time that can be measuring with personality inventories
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The goal of mindfulness practice

(Baer et al
2006)

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Dispositional mindfulness is associated with adaptive functioning
(Baer et al 2006).
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Anxiety levels and history of depression (Grossman et al 2004) less severe gambling outcomes (Lakey et al 2007) .
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 diabetes self-management (Gregg et al 2007).
Many other cross-sectional studies
Difficulties with the construct of mindfulness as a trait
(Grossman 2011)
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Self reports may not be accurate
Experienced meditators may be more aware of their own limitations and rate themselves as less mindful

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Among college age drinkers, relationship to alcohol use is
“paradoxical” (Eisenlohr-Moul et al 2012)
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Higher levels of awareness
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Lower levels of non-reactivity
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Lower levels acting with awareness
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Sample in drug treatment
(Bowen and Enkema, 2014)
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Mindfulness inversely related to severity of dependence

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Meditation
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Types of meditation
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Concentration or focused meditation, including TM
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Insight or mindfulness meditation
Certain types of Hatha Yoga

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Various eastern traditions including Zen, Vipassana and Tibetan traditions can be grouped under mindfulness meditation
Often builds from awareness of the breath to awareness of the whole field of phenomena at the present moment
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Can include sitting, walking meditation
 Short demonstration: Mindfulness Based Cognitive
Therapy (0:39:00)
 Several short term or medium term interventions but for many, a lifetime practice http://www.youtube.com/watch?v=6-91LUJZoHo

 Types of studies:
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Measurement of brain state changes during meditation vs. rest or other activities
Cross sectional comparison between long term meditators, short term participants in interventions, and/or nonmeditation control groups
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Neural correlates of meditation/mindful states in these groups
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Or response to a stimulus such as pain stimulus, emotional triggers
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Longitudinal studies before and after meditation training
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Comparisons to control group

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Structural vs. functional studies
Healthy samples vs. clinical samples (with symptoms of depression, addiction etc)
Evidence from EEG, PET, fMRI, and SPECT

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Prefrontal cortex
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Somatosensory regions
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Dorsolateral PFC
Hippocampus
Insulae
Amygdala
Functional networks
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Eg insula plus somatosensory regions
Cortex plus limbic system

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Cross sectional comparison of long term meditator vs non meditators show enhanced activity in the PFC, right anterior insula and right hippocampus
(Chiesa &
Seretti, 2010)
Eight week meditation training increases grey matter density in hippocampus, cerebellum compared to controls
(Hölzel et al 2010)
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Specific or non-specific effect?

 “Third wave” of therapeutic interventions based on
acceptance of negative thoughts and emotions rather than attempts to manage or control them.
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Mindfulness-based Stress Reduction for chronic pain (Kabat-
Zinn 1980)
Acceptance and Commitment Therapy for depression and anxiety (Hays et al 2006)
Mindfulness-based Cognitive Therapy for depression (Segal et al 2002)
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Dialectical Behavior Therapy for borderline personality disorder (Hays et al 2004)

Strengthening connectivity between the cortex and limbic system
(Chiesa, 2013)
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Dampen automatic amygdala activation
 stress response,
 anxiety and other emotional states
 pain perception
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May be interpreted as an increased conscious control
 Increasing grey matter density in specific regions
(Hö lzel et al 2010)

Before meditation, high emotional reactivity is observed. The amygdala easily activates in response to negative stimuli and the PFC is not able to inhibit the amygdala. (Chiesa et al. 2010)

After meditation training, amygdala activity is usually reduced. If amygdala activates in response to negative stimuli,
PFC is engaged in order to dampen automatic amygdala responses. (Chiesa et al 2010)

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Effect of drugs of abuse is related to the mesolimbic reward system: ventral tegmental area, ventral striatum, amygdala and medial PFC – the “reward circuit”.
Compulsive use also involves the dorsal striatum –
“habit circuit”
Addiction also involves dysfunction in the cortex, including dlPFC and activation of subgenual ACC

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Mindfulness training primarily targets the cortex; at least initially, a “top down” process of improving control over functioning
Self referential thinking and rumination activate midline PFC areas in both depression and addiction
(Brewer et al. 2009)
Mindfulness practice may shift activation from midline PCC to dlPCC – more objective awareness
Lateralization of brain activation

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47 treatment-seeking smokers (12-h abstinent from smoking) viewed images while undergoing fMRI
(Westbrook et al 2011).
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Passively vs. trained to engage in mindful attention
Mindful attention reduced neural activity in subgenual anterior cingulate cortex (sgACC)
Reduced connectivity with other craving related regions including insula and ventral striatum
Also reduced self-reported craving
(Westbrook et al. 2011)

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47 treatment-seeking smokers (12-h abstinent from smoking) viewed images while undergoing fMRI
(Westbrook et al 2011).
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Passively vs. trained to engage in mindful attention
Mindful attention reduced neural activity in subgenual anterior cingulate cortex (sgACC)
Reduced connectivity with other craving related regions including insula and ventral striatum
Also reduced self-reported craving
(Westbrook et al. 2011)

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Experienced meditators exhibit changes in limbic system functioning during meditation that are independent of cortical control
.(Chiesa et al 2013)
May depend on length of involvement in meditation
May depend on type of sample: healthy vs. clinical samples (eg smokers trying to quit)

(Chawla et al
2011)
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Based on Mindfulness Based Stress Reduction
An eight week course including meditation, yoga, and discussion of relapse, triggers, and relapse prevention
Designed for individuals coming out of drug treatment

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In a randomized controlled trial (RCT), significant reductions in substance use and craving were observed in the MBRP group compared to treatment as usual
(Bowen et al, 2009b)
A second RCT compared mindfulness meditation to cognitive behavioral therapy for substance use and found reduced craving and physiological stress indices in the treatment group
(Zgierska et al 2010)

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Might have particularly long-lasting effects on reducing drug use (Zgierska et al 2009).
However, strong evidence for effectiveness of mindfulness-based treatment for substance use disorders is still lacking. (Zgierska et al 2009)

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Anxiety in early withdrawal
(Vallejo et al 2009)
Restlessness/agitation
History of trauma
An adjunct, not a substitute for drug treatment
May require a period of abstinence from substances

 Urban Mindfulness and Addictions Research
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MBRP in jail drug treatment
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Mindfulness with case managers: enhancing the working alliance and therapeutic outcomes
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Mindfulness, substance abuse, and medication adherence
Drug discovery program as adjunct to mindfulness therapy

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More than 60% of prisoners are estimated to have a substance use disorder(National Center on Addiction and Substance Abuse 2010)
In Cook County the majority of detainees are charged with low level drug offenses(Lyons et al 2013)

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Five fold growth in incarceration rates among people of color since 1980 has largely been a result of drug related arrests and convictions(Alexander 2010).
African Americans are 54% of those incarcerated for drug offenses and are 10 times more likely than whites to be sentenced to prison for a drug law violation(Human Rights Watch 2000).
Cycles of repeated arrest and imprisonment for drug related crimes often reflect untreated addiction(Langan and Levin 2002).

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Much mindfulness meditation research has been with white, middle class patients.
No studies of mindfulness meditation that focus on cultural adaptations for African American men.
Meditation training in a jail context
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Limited in duration
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Linked to post-release services
Participants should be over the acute withdrawal stage

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7x as many individuals released annually from jails as from prisons
Many jails have existing drug treatment programs
Enforced abstinence may promote benefit of mindfulness training
Mindfulness training may promote engagement in aftercare

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Culturally tailor the MBRP intervention for an urban, primarily African American population of inmates
Test efficacy via a quasi-experimental clinical trial within a men’s drug treatment program at the Cook
County Jail.

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At 5-month intervals over the course of 36 months, successive cohorts will be given either mindfulness training or an attention control communication skills intervention.
Pre- and post-test assessments, at an equivalent interval, of mindfulness, psychological symptoms, and PTSD symptoms.
Participants in the experimental condition will be referred to post-release meditation groups

 To assess the efficacy of the intervention,
 rearrest and reincarceration data will be compared for the treatment and control groups at a minimum of 12 months post release.
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Contact participants by telephone 3 months post release and obtain self reported substance use data qualitative interviews with a subset of participants in the experimental group one month post-release will explore whether and how they implemented mindfulness

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Focus group
Working with African American, culturally competent trainers
Adapting and simplifying manual Mindfulness Based
Relapse Prevention: A Clinician’s Guide (Chawla et al. 2011)

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Mindfulness as an attentional state, personality trait, and goal of meditation practice
As a trait, mindfulness is probably important for understanding addiction, but research is just beginning
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Related to deficits in executive functioning, impulsiveness, and sensation seeking

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Meditation practice changes brain structure and functional circuits
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Most studies cross sectional and involve small samples
Prospective studies with appropriate control groups needed
Meditation training may be a potent tool in drug addiction treatment
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May have long lasting effects
Stage and context of recovery important
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Linking behavioral and pharmacological treatment

t l y o n s 2 0 @ c s u . e d u

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Hö lzel, B. K., Carmody, J., Vangel, M., Congleton, C., Yerramsetti, S. M., Gard, T., & Lazar, S. W. (January 01, 2011). Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research, 191, 1, 36-43
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