title: Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial.
abstract: In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.
authors.affiliation: University of Utah, USA. Electronic address: eric.garland@socwk.utah.edu.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Garland
authors.affiliation: University of North Carolina at Chapel Hill, USA.
authors.forename: Amelia
authors.initials: A
authors.lastname: Roberts-Lewis
authors.affiliation: Smith College, USA.
authors.forename: Christine D
authors.initials: CD
authors.lastname: Tronnier
authors.affiliation: Triangle Residential Options for Substance Abusers, Inc., USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Graves
authors.affiliation: Triangle Residential Options for Substance Abusers, Inc., USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Kelley
mesh_terms: D000328:Adult; D001364:Awareness; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000379:methods*; D011615:Psychotherapy, Group; D040921:Stress Disorders, Traumatic / Q000523:psychology / Q000628:therapy*; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Addiction; Emotion regulation; Mindfulness; PTSD; Reappraisal; Savoring; Transdiagnostic