Dundas Ingrid, Ravnanger Kari, Binder Per-Einar, Stige Signe Hjelen
Department of Clinical Psychology, University of Bergen, Bergen, Norway.
KOMPASSET, International Federation of the Blue Cross, Bergen, Norway.
Front Psychiatry. 2020 Nov 12;11:493349. doi: 10.3389/fpsyt.2020.493349. eCollection 2020.
The aim of this study was to study how participants used a mindfulness-based program-Mindfulness Based Relapse Prevention to reduce use of habit-forming prescription drugs after long-term use. We explored participants' descriptions of their post-intervention strategies for controlling medication intake. Eighteen participants provided semi-structured qualitative interviews shortly after completion of the program and 13 participants were also interviewed 1 year after completion. Participants were asked about the conditions that originally led to use of medication, how they had attempted prior to the course to cope with problems associated with these conditions and their prescription drug-use, and whether and how their coping strategies had changed after participation in the program. Thematic analysis was performed within the framework of a realist epistemology, with an emphasis on researcher reflexivity. The following themes were identified in the material: Increased present-moment sensory awareness, Observing without controlling, Self-acceptance, Making conscious choices, Non-judgmental self-guidance, Sense of control, and Challenges of learning and using mindfulness. Although these findings are closely related to the specific needs of our sample-mainly coping with tapering use of prescription drugs-they are largely in line with existing research on mindfulness interventions. An exception is the theme "Non-judgmental self-guidance," which encompasses change in individuals' inner dialogue and practical self-care. Analyses suggested that mindfulness might increase individuals' control over medication intake by shifting individuals' attention toward present-moment sensory awareness of concrete stimuli, thereby facilitating other kinds of control, such as non-judgmental inner self-guidance and more adaptive ways of reducing distress. We suggest that it is the moment-to-moment sensory awareness and non-controlling observation of distress, together with inner self-guidance, that differentiates mindful control from dysfunctional attempts at direct, top down control of medication-use.
本研究的目的是探究参与者如何使用一种基于正念的项目——预防复发正念训练，来减少长期使用后对成瘾性处方药的使用。我们探讨了参与者对干预后控制药物摄入策略的描述。18名参与者在项目结束后不久接受了半结构化定性访谈，13名参与者在项目结束1年后也接受了访谈。参与者被问及最初导致使用药物的情况、在课程之前他们如何尝试应对与这些情况及其处方药使用相关的问题，以及参与项目后他们的应对策略是否以及如何发生了变化。主题分析是在现实主义认识论的框架内进行的，重点是研究者的反思性。材料中确定了以下主题：增强当下感官意识、观察而不控制、自我接纳、做出有意识的选择、非评判性自我引导、控制感以及学习和使用正念的挑战。尽管这些发现与我们样本的特定需求密切相关——主要是应对逐渐减少处方药的使用——但它们在很大程度上与现有的关于正念干预的研究一致。一个例外是“非评判性自我引导”这一主题，它涵盖了个体内心对话和实际自我护理的变化。分析表明，正念可能通过将个体的注意力转向当下对具体刺激的感官意识，从而增强个体对药物摄入的控制，进而促进其他类型的控制，如非评判性的内心自我引导和更适应的减轻痛苦的方式。我们认为，正是对痛苦的即时感官意识、非控制性观察以及内心自我引导，将正念控制与对药物使用进行直接的、自上而下的功能失调尝试区分开来。
