Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface.
Prominent neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. This review describes how MBIs may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.
Supportive Oncology and Survivorship Program, Huntsman Cancer Institute, University of Utah , Salt Lake City, UT , USA ; College of Social Work, University of Utah , Salt Lake City, UT , USA.
Eric L
EL
Garland
Department of Neuroscience, Hollings Cancer Center, Medical University of South Carolina , Charleston, SC , USA.
Brett
B
Froeliger
School of Social Work, University of North Carolina at Chapel Hill , Chapel Hill, NC , USA.
Matthew O
MO
Howard
addiction; automaticity; mindfulness; neurocognitive; reappraisal vs. suppression; reward; stress; substance dependence