The following is a description of the process of adapting the Mindfulness-Based Stress Reduction program (MBSR) to work with women in early recovery from drug and alcohol addiction, enrolled in three residential substance abuse treatment programs, and in one outpatient program, located in an urban center in Massachusetts. Most participants started the intervention two to three weeks after detoxification treatment. A total of 318 women (45% Latina, 35% Black, 20% White) completed baseline interviews. Two hundred and sixty-two women enrolled in the classes, and 61% completed the intervention. The aim was to provide skills training for relapse prevention.
The most important change was the redirecting of MBSR into a program focused on the role of stress in relapse. This was accomplished in part by teaching the participants to become aware of the cravings and urges, with the intention to observe them with a certain spaciousness and affectionate curiosity.
A drawing of a triangle with thoughts, feelings/emotions, and body sensations represented in a corresponding apex was presented in every class and created a visual tool that the women remembered easily. By separating the emotions, bodily sensations, and thoughts, and paying attention to each one individually in a systematic way, with moment-to-moment awareness, intending to hold judgments lightly, participants gradually began to feel freedom in choosing their responses instead of continuing with their habitual automatic ways of reacting. Most participants found this visual exercise and the freedom experienced very helpful.
Each class had a theme related to areas that were meaningful to the participants. Some of the class themes included intra- and interpersonal mindfulness, understanding how perceptions could compromise treatment and lead to relapse, and learning how to use mindfulness skills to relate differently to feelings of anxiety, panic attacks, fear, guilt, and shame.
The four practices employed in the traditional MBSR classes were used but the length, sequence, and ways of presenting them varied substantially. The body scan was shortened to reduce potential interference from trauma experience. It was performed in a sitting or standing position, non-sequentially, and interspersed with yoga movements. The eyes were open to promote a sense of safety. The scan began with the feet and legs, followed by yoga for the feet and legs. This process was repeated for all the different parts of the body. Instead of a detailed scan of the pelvic area and breasts, the revised body scan focused on the abdominal area and front of the chest. At times, movement took place first followed by the scanning in order to enhance connectivity with the body. Though the participants did not do a lengthy body scan they would usually practice daily a two or three minute scanning of the body.
Walking meditation was preceded by very fast walking, decreasing the speed gradually and ending in the mountain pose. After that the participants could do walking meditation at a slow pace. The goal was to meet the women where they were, matching the movement to the agitation and pent-up energy they would exhibit and then progressively slow down.
Sounds were an easier gateway to awareness than the breath. Sitting meditation started with sounds, progressed to body sensations, and then the breath. Participants initially experienced the breath as boring and abstract. At times, it also triggered flashbacks for some of the women with trauma histories that included choking or a hand being held over their mouths. Interestingly, even though the breath was very difficult to connect with at the beginning, when asked in six and twelve month follow-up interviews, the women often reported that awareness of breath was the 'tool' that they practiced on a regular basis and the most helpful to ride cravings, urges, and impulses.
Hatha yoga, called mindful stretching exercises to avoid connotation of a religious nature that exists in some Spanish speaking regions, was the basic staple, and it was performed in any of the segments if the mood of the participants was too lethargic or too distracted. Participants enjoyed both the floor and standing yoga and often mentioned how helpful it was for lower back pain, shoulder and neck pain, and to release tension.
It must be noted that these adaptations were temporary 'bridges' until the women had the internal resources to do the practice similarly to the regular MBSR program. For example, during the half day retreat on week seven, women were able to do a body scan lying down on the floor for 45 minutes with no perceived adverse reactions.
The most important change was reframing the approach to focus on relapse prevention.
Due to the participants’ trauma histories, short attention span, and low literacy, the language needed to be simplified and more visual components added. The length of the practices was shortened and the sequence and ways of presenting them were changed substantially.
In summary, MBSR is beneficial as an adjunct intervention in residential treatment facilities with individuals in early recovery. However, we found that adaptations were needed in order for the participants to see the program as relevant to their recovery. The participants needed to understand how the skills and tools learned could help them hold or relate to the stress in their daily life with less suffering and more compassion for themselves and those around them.