Mindfulness-Based Interventions Modulate Structural Network Strength In Patients With Opioid Dependence

In the past years, mindfulness-based treatment has attracted substantial clinical and scientific interest. Defined as bringing one’s complete attention to the experiences occurring in the present moment in a non-judgmental and accepting manner, mindfulness-based practices enhance discriminative awareness while responding to uncomfortable states or challenging situations with complete acceptance, thus discouraging the brain’s automatic responses and giving way to a novel form of thought and behavior.

Mindfulness-based interventions are increasingly used in the treatment of patients with various mental disorders, including depression, ADHD, personality disorders with high levels of impulsivity and/or mood instability, and substance-use disorders.

The current study is the first to show that mindfulness-based treatment has an impact on brain structure in patients with opioid dependence.

Why are these findings significant?

Mindfulness-based treatment can be offered to individuals with substance use disorders, and current data suggest that such interventions can beneficially modify addictive behavior. Over both long- and short-term periods mindful meditation practice can change brain structure and function, as a result of neural plasticity.

Opioid dependence is a severe mental disorder that is associated with high subjective impairment, loss of functioning, and high societal costs. This preliminary study shows that mindfulness-based treatment, when offered to individuals with opioid dependence in addition to a standard in-patient treatment program, has a beneficial impact on distress tolerance and mindfulness levels. Moreover, mindfulness-based treatment in persons with opioid dependence is associated with changes in specific brain systems (“structural networks,” according to the study’s data analysis approach) that are integral components of attention, decision-making, and salience attribution. Such systems are critically involved in the pathophysiology of addictive behavior.

The study sheds light on putative neural mechanisms underlying therapeutic effects of mindfulness-based treatment. Treatment-related neural changes may reflect objective markers of clinical response or even long-term predictors of relapse. Both assumptions need to be explicitly tested by future research.

How was this study conducted?

The study was carried out in the Cairo University Faculty of Medicine (Kasr Alainy Hospital) Addiction Psychiatry inpatient unit over a period of six months. Twenty-eight patients were enrolled in the study and received an initial clinical assessment, as well as a structural magnetic resonance imaging scan. The patients selected were all opiate-dependent patients with no history of neurological disorder or significant head trauma or other co-morbid mental disorders.

Of the initial sample, nineteen patients resumed the accounted-for duration to receive a second clinical assessment and a second magnetic resonance imaging scan. Following their admission, patients were enrolled in two groups. One group received treatment as usual, i.e. these individuals took part in a standard in-patient treatment program. Another group additionally received mindfulness-based treatment. Both groups were offered medical treatment for withdrawal as needed. Total treatment duration was approximately four weeks.

“Treatment as usual” included various therapeutic groups offered by the hospital, including group cognitive behavioral therapy together with motivational and social support groups. Mindfulness-based treatment included formal and informal exercises which were either coupled with theoretical sessions or given separately. Theoretical topics included: (1) introduction to mindfulness; (2) mental attitudes during mindfulness and mindful breathing; (3) mental traps; (4) impact of stress and anxiety;  (5) stop stress technique; (6) mindful self-awareness and dealing with difficult emotions; (7) inner rules and mindful self-inquiry; (8) transforming fear into loving-kindness; (9) working with resistance; (10) mind and body awareness. Informal sessions included mindful eating, stress reduction, and reappraisal techniques. Formal sessions were audio-recorded five basic guided meditation techniques, including mindful breathing, mindful sitting, body scanning, mindful self-inquiry, and loving kindness.

Participants of both groups were required to complete several clinical scales at the beginning and at the end of the treatment program. The psychometric instruments captured various clinically relevant aspects such as mindfulness and distress tolerance levels as well as different facets of impulsiveness.

Data analysis included the evaluation of symptom changes following treatment, the analysis of structural neuroimaging data using multivariate statistical techniques and univariate correlations between symptom and “structural network” strength change after treatment.

The findings of this study are described in the article entitled Mindfulness-based interventions modulate structural network strength in patients with opioid dependence, recently published in the journal Addictive Behaviors. This work was conducted by Reham Ashraf Fahmy, Maha Wasfi Mobasher, Rania Mamdouh, and Kareem Moussa  from Cairo University, Ahmed Wahba from the Psychiatric Hospital Rickling, Miriam Wittemann from Saarland University, Dusan Hirjak from the Central Institute for Mental Health, Fabio Sambataro from Udine University, and Katharina Kubera, Nadine Wolf, and Robert Christian Wolf from Heidelberg University.