Salutary Effects of Mindfulness Training On Alcohol Attentional Bias Moderated by Trauma History

Background: Persons who are dependent on alcohol often find their attention involuntarily biased toward and captured by alcohol cues, especially in the context of emotionally-distressing situations. This alcohol attentional bias (AB) ultimately contributes to appetitive impulses and may be associated with high-risk situation self-efficacy, i.e., the perceived ability to resist the urge to drink in high risk situations. Mindfulness training (MT), which has been shown to facilitate emotion regulation and strengthen attentional control, may reduce alcohol AB, particularly among persons with greater emotional reactivity to alcohol cues such as those with more extensive trauma histories. These hypotheses were tested with mediation and moderation analyses of data from a pilot randomized controlled trial.

Methods: 58 alcohol dependent inpatients were randomized to10 weeks of MT or an addiction support group (SG), and 37 completed the interventions (MT n = 18, SG n = 19). A performance-based task often used in cognitive neuroscience, the dot probe task, was used to quantify alcohol AB. Treatment by time interactions on alcohol AB were examined. Path analysis tested the relationships between trauma history, alcohol AB, and high-risk situation self-efficacy. Moderation analyses tested lifetime trauma history by treatment interactions on alcohol AB.

Results: At pre-treatment assessment, extent of prior traumatic experience was significantly negatively correlated with high-risk situation self-efficacy (p < .05). This relation was fully mediated by alcohol AB, such that persons with more extensive trauma histories had higher alcohol AB, which in turn was predictive of lower self-efficacy. For persons with pre-treatment AB toward alcohol, MT exerted significant quadratic effects on AB, p = .01. In contrast, no significant effects of MT were identified for those with pre-treatment AB away from alcohol. Furthermore, the test for moderation was significant (p =.02), such that MT participants with high levels of prior trauma experienced a pre-post treatment decrease in alcohol AB, whereas those with low levels of trauma experienced minimal change. Conversely, SG participants with low levels of prior trauma experienced a pre-post treatment decrease in alcohol AB, whereas those with high levels of trauma experienced a pre-post treatment increase in alcohol AB. Across the entire sample, decreases in alcohol AB over the course of treatment were significantly correlated with increases ability to resist the urge to drink alcohol in high-risk situations.

Discussion: MT modulated alcohol AB among recovering alcohol dependent persons with greater pre-treatment bias towards alcohol cues and those with more extensive trauma histories. In contrast, participation in a support group seemed to exacerbate alcohol AB for persons with a history of severe trauma. For such individuals, exposure to emotionally-distressing content during verbal processing of past drinking episodes may be counterproductive, especially in the absence of explicit emotion regulation skills training. Decreasing alcohol AB through treatment appears to increase self-efficacy in high-risk situations that might otherwise lead to relapse. MT may hold promise as a treatment for co-morbid trauma and alcohol dependence.