Psychological and Neural Mechanisms of Mindfulness and Cognitive Retraining
There has been a growing interest in understanding the mechanisms of behavior change (MOBC) following treatments for alcohol use disorders (AUDs). However, there are few studies that use either cognitive neuroscience or ecological momentary assessment (EMA) methods to probe MOBC in the addiction field. In the proposed study, a research team with complementary expertise will combine the prudent use of EMA data and functional magnetic resonance imaging (fMRI) techniques to uncover the psychological and neurobiological MOBC following two novel, promising interventions, mindfulness based intervention and attentional bias modification. Despite the likelihood that both of these interventions likely influence alcohol craving, a hallmark symptom of AUD and an important predictor of relapse, we posit distinct mechanisms through which this effect will be observed. Specifically, the mindfulness based intervention is expected to decouple the associations (i.e., reduce the positive associations) between stress/negative affect and alcohol craving as well as alcohol craving and alcohol use, whereas the attentional bias modification is expected to decouple the association between conditioned cues (i.e., cue exposure) and alcohol craving. We expect that these behavioral effects are a consequence of the modification of the functioning of two neural circuits that have been implicated in the development and maintenance of addictive behaviors, the mesocorticolimbic reward circuits and limbic-HPA axis stress circuits. Specifically, the mindfulness based intervention is expected to result in decreased functional connectivity between the insula and other reward/craving-related brain regions in response to stress, whereas the attentional bias modification is expected to result in decreased functional connectivity between hippocampus/basolateral amygdala and other reward/craving-related brain regions in response to alcohol cues. To examine three specific aims, approximately 120 individuals meeting criteria for AUD will be randomly assigned to 8 sessions (over 4 weeks) of mindfulness based intervention, attentional bias modification, or an active control group. The proposed study takes advantage of the underutilized measurement burst design by obtaining near real-time EMA data prior to, during, and following the interventions to fully explore the proposed psychological MOBC. In addition, pre-post fMRI scans are obtained to identify the neurobiological MOBC. The proposed study will examine the efficacy (Aim 1), psychological MOBC using EMA methods (Aim 2), and neurobiological MOBC using fMRI methods (Aim 3) of these two novel treatments for AUD with the long-term goal of optimizing these treatments so they can be disseminated on a large-scale.