ARTICLE SUMMARYThere have been many developments in mindfulness-based approaches (MBAs) since the original mindfulness-based stress reduction (MBSR) course was first delivered in the 1980s. There are now a variety of mindfulness approaches, which are used to good effect in a range of psychological and physical health disorders. The addictions field first witnessed the development of relapse prevention techniques more than 30 years ago. MBAs have been adapted for use in relapse prevention and can be offered as a mindfulness-based relapse prevention (MBRP) course. MBSR or mindfulness-based cognitive therapy (MBCT) courses may also be useful for those with addiction problems. In this article, we describe the MBAs that are commonly offered at present. We highlight ways in which these approaches may be useful in the addictions field. We also make suggestions for clinicians who may be interested in offering MBAs within their own service. LEARNING OBJECTIVES• Gain an understanding of the term 'mindfulness' and the increasing variety of mindfulness approaches• Gain an understanding of the use and development of mindfulness approaches in addiction services • Be better able to plan the introduction of mindfulness approaches in addiction services DECLARATION OF INTEREST D.J. is an MBA teacher. A.W. is a trustee of Mindfulness Scotland and an MBA teacher trainer 'Life moves pretty fast. If you don't stop and look around once in a while, you could just miss it' (Ferris Bueller's Day Off, 1986).There is broad agreement among addiction specialists that detoxification from most substances is relatively straightforward, but that maintaining abstinence is more problematic. A recent review of psychosocial treatments used in addiction services highlighted the low effect sizes seen in treatment outcomes and the minimal differences between these approaches (Luty 2015). It is well recognised, however, that individual therapist factors, such as empathy and the strength of the therapeutic relationship, can strongly influence outcomes (Miller 2015). With this in mind, there is scope to refine our existing treatments and develop new approaches for those with addictive behaviour problems. We will briefly outline trends in psychological treatments used in addictions, before describing mindfulness and its use in addictions. We then provide some practical information for interested clinicians on getting started. Mindfulness and mindfulness-based approachesMindfulness-based approaches (MBAs) were first popularised in the West by Jon Kabat-Zinn, who integrated meditation practices into a mindfulnessbased stress reduction (MBSR) course for people experiencing a range of chronic health problems.
Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6–77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people.Trial registrationClinicaltrials.gov (NCT01038583)
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