Mindfulness-Based Relapse Prevention: why make relapse prevention more mindful?

Traditionally, relapse prevention for addictive disorders has been based on cognitive-behavioural therapy (CBT). The development of mindfulness-based relapse prevention (MBRP) by the University of Washington, which integrates core aspects of relapse prevention with mindfulness practices, has furthered the efforts of other evidence-based treatment and recovery maintenance strategies by acknowledging the physiological response of the human body to high-risk situations.

High-risk situations trigger the individual’s stress response, the magnitude of which is determined by an individual’s perception of the severity of the risk and self-efficacy, i.e. situation-specific confidence in one’s own ability to manage high-risk situations, cravings and urges, without relapsing to former pattern of compulsive use. Individual’s self-efficacy is, therefore, a key predictor of potential lapse or relapse to substance use.

The MBRP allows us to build a client’s self-efficacy by training the client’s ability to create a so-called “SOBER” breathing space:

• S – Stop: slow down and pause preventing habitual “automatic” response;
• O – Observe: register what is truly happening in the mind and body at the moment;
• B – Breath: be here and now by shifting your focus to your breath;
• E – Expand: see a complete picture of your body and surrounding environment;
• R – Respond: recognize the choice of response, therefore, acting with consciousness vs. impulse.

Neurobiological studies have demonstrated that MBRP:

• Facilitates the development of enhanced awareness of high risk-situations, cues and triggers;
• Helps develop conscious reactivity versus impulsive “automatic” response to high-risk situations (effective vs ineffective coping); and, thus, increases self-efficacy;
• Trains a non-judgmental attitude towards oneself and others.

MBRP can reduce the likelihood of relapse by facilitating a detached relationship with individual’s thoughts and emotions, changing one’s perception of self and the problem.

It cultivates the behaviour opposed to a compulsive one, therefore, facilitating individual’s emotional self-regulation, healthy coping and increase in self-efficacy.

Learn more about MBRP:

• Webinar on MBRP by Dr. Chawla, an MBRP Co-creator: https://www.youtube.com/watch?v=4n1bR-wQjg4&t=2688s
• From the Founders on cognitive-behavioral foundation of MBRP: Mindfulness-Based Relapse Prevention for Alcohol and Substance Use Disorders by G. Alan Marlatt, Denise Walker, University of Washington, Seattle, WA
• Practical Guide for Clinicians: Mindfulness-Based Relapse Prevention (MBRP) for Addictive Behaviors: A Clinician’s Guide, 2nd Edition, April 2021 by Sarah Bowen, Neha Chawla and G. Alan Marlatt.
• Witkiewitz, K., Bowen, S., Douglas, H., & Hsu, S. H. (2013). Mindfulness-based relapse prevention for substance craving. Addictive behaviors, 38(2), 1563–1571. https://doi.org/10.1016/j.addbeh.2012.04.001