1. Donna Mullen, Maria Higgins, Alistair Wilson, Iain Smith, Gartnavel Royal Hospital, NHS Greater Glasgow & Clyde Kenneth Mullen, University of Glasgow Introduction Recent innovations in psychological treatments have successfully integrated Mindfulness meditation techniques (Kabat-Zinn et al 1986) with traditional cognitive behavioural therapies to prevent relapse in people with recurrent depression (Teasdale et al 2000). In the treatment of substance use disorders preventing relapse is a central challenge. It has been suggested that a therapy combining mindfulness techniques with cognitive behavioural therapy for relapse prevention may be effective in treatment of substance use disorders (Marlatt & Gordon 1985). Recent studies from America (Bowen et al 2009. Garland et al 2010. Bowen et al 2014) give promising results but to date there are no UK based studies published on Mindfulness Based Relapse Prevention. This pilot study was designed to assess whether or not MBRP may be an acceptable and effective treatment for patients in Glasgow. Aims To allow participants to describe their own experiences of the effectiveness of Mindfulness Based Relapse Prevention (MBRP) groups and also cover several pre-determined domains developed from the literature on alcohol misuse and mindfulness based approaches. Intervention An eight week group programme combining Mindfulness techniques and Relapse Prevention delivered by an experienced Mindfulness Based Cognitive Therapy (MBCT) practitioner. Fig 1. The MBRP 8 week group programme. Methods The study was a qualitative study using semi structured interviews following a pre-determined interview schedule. It focused on the clients’ experiences of the course and the impact it had on their daily lives. Participants recruited had attended an eight week MBRP course run for abstinent patients with a history of alcohol dependence. All participants from the two groups run to date were invited to take part in the study. Eleven patients were interviewed from a total of sixteen participants in the two groups. The interviews were digitally recorded and transcribed verbatim. Transcripts were then analysed by two researchers following an established methodology of the grounded theory approach (Chamaz, 2006). Results Attendance was generally high, 80-100% with one exception who attended 60% of the course. Group 1- 8 participants. 7 completed. 5 interviewed, including 1 who had dropped out. Group 2- 8 participants. All completed. 6 interviewed. There was a mixed response in how respondents initially related to the course dependent on their expectations. Most were comfortable with the group format. Some were initially sceptical about how the group could help but developed an understanding as the group progressed. Those expecting a cure or those with strong expectations such as regaining previous meditation skills were disappointed. Those with more modest expectations showed higher satisfaction in what they learned. The degree to which participants saw their alcohol use as a disease process, over which they had no control, directly influenced their experience of the course. Those who were only slightly familiar with meditation and were looking for something to bolster their recovery seemed to benefit most. We give some illustrative quotes below. That the facilitator was experienced in mindfulness practice personally was a significantly engaging factor and added value to the course. The participation of staff in the mindfulness practices and the secular context of the MBRP course in an NHS setting were also popular themes. Respondents listed a number of difficulties following through the practice at home. Some had integrated it into their daily life with regular practice. Those who had felt benefits early on were motivated to engage fully with the course resulting in a strong positive feedback loop. Some substituted mindfulness practice for alcohol use in high risk situations. Others had selected and modified bits of the course which they adapted for their own use. Most respondents listened to and used the CDs. Some had sought further mindfulness classes and one planned to start up a group. Individual respondents reported benefits to their mood, improved control over cravings, improved control over anxiety and anger, improved family relationships. The patient who had dropped out of group 1 reported improved motivation to seek further detoxification. Conclusions This pilot study demonstrated that MBRP is an acceptable and potentially a useful treatment option for patients. All patients interviewed showed at least some compatibility with the intervention and a desire to continue with mindfulness techniques after the end of the course. The self-monitoring component of the MBRP course seemed to provide some participants with both a way of identifying high risk situations and a new approach to processing cues. Ideas relating to self-compassion seemed to have potential to impact on feelings of self-worth which sometimes led to behavioural change. MBRP is potentially an important development in treatment of alcohol dependence and could offer an alternative to current standard treatments. Further, quantitative studies of MBRP are indicated to identify the efficacy of the treatment and to identify which patients may benefit most from this therapy. References Bowen, S., Chawia, N., Collins, S. E., Witkiewitz, K., Hsu. S., Grow, G., Clifasefi, S., Garner, M., Douglass, A., Larimer, M. E., Marlatt, A. (2009) Mindfulness-based relapse prevention for substance use disorders: a pilot efficacy trial. Substance Abuse. 30, 4, 295-305. Bowen, S., Witkiewitz, K., Clifasefi, S., Grow, G., Chawla, N., Hsu, S. H., Carroll, H. A., Harrop, E., Collins, S. E., Lustyk, M. K., Larimer, M. E. (2014) Relative Efficacy of Mindfulness-based Relapse Prevention, Standard Relapse Prevention, and Treatment as Usual for Substance Use Disorders: A Randomised Clinical Trial. JAMA Psychiatry. 71 (5):547-56. Chamaz, K. (2006). Constructing grounded theory. London: Sage. Kabat-Zinn, J., Lipworth, I., Burney, R. & Sellers, W. (1986). Four year follow up on a meditation- based program for self-regulation of chronic pain. Clinical journal of pain, 2, 159-173. Marlatt, G. A., & Gordon, J. R. (1985). Relapse Prevention: Maintenance strategies in the treatment of addictive behaviours. New York: Guilford Press. Teasdale, J. D., Williams J. M., Soulsby, J. M., Segal, Z. V., Ridgeway, V. A., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68, 615-623. SessionMain topicHomework 1 Introduction to Mindfulness Body scan Everyday mindfulness Body scan CD Eating Mindfully 2 Dealing with barriersBody scan/Settling Mind CD Pleasant Events Diary 3 Staying in the Body Mindful Movement Breathing Space Mindful Movement CD 3 Breathing Spaces per day Unpleasant Events Diary 4 Staying Present Noticing How we Shut Down Guided Sitting Meditation Guided Sitting meditation 10 mins Mindful stretching OR Mindful Movement CD Breathing Space during unpleasant feelings 5 Allowing/Letting Be Responding versus Reacting Mountain Meditation Choice of practices so far. Reflections on provided poems/ recommended reading 6 Thoughts Are Not Facts Draining Thought Patterns Choice of practices so far Record common thinking errors 7 Mindful Action Working with the Difficult Choice of practices so far Record Nourishing and Draining Items 8 Overall review “I’ve looked into it before- Buddhism and stuff. I had a rough idea how it would go kind of thing but I was quite surprised at how much of an effect it had” (Gp 1. Pt 2) “ I mean basically what he done was he gave us a CD and each time he was doing it rather than putting a CD on. Which made a difference. I don’t know why but it made a difference”. (Gp 1. Pt 4) “It’s almost as if there’s no divide there. The nurses are doing it as well, it’s just a group doing a group, there was no “you’re a nurse and I’m a patient” kind of thing. Everybody was doing it together and I think that was really encouraging. ” (Gp 2. Pt 2) Gosh aye. You know it’s remembering the bits that come back to you and I suppose other ones remember totally different bits from me and then when you sit down you say oh that was at the group, that was at the mindfulness you know what I mean, so aye there is wee bits that I will carry on with me. (Gp 1. Pt1) But I think it’s quite hard, I don’t really know how to explain it but I would say it was beneficial because it made me, as soon as I left I contacted my CAT team worker and says I’m kidding myself on here and I don’t think, if it wasn’t for Alistair’s emm class or mindfulness class I don’t think I would have been back for a detox. (Gp 1. Pt. 4) “It’s something I would like to continue, to find a class because I like it in the class environment...I’ve not seen it anywhere, even round about all the gyms I go to, and community centres, I’ve not seen anywhere that does it.” (Gp 2. Pt 3) “ To me the mindfulness is now that’s my drug. Because my body is telling me to do that the body scan and I think I’ve substituted that for the alcohol. The alcohol is gone. Where there would be a trigger before telling me to drink alcohol its now a trigger for the mindfulness. So with the body language signs, the mood going down, the thought processes going haywire- that would have been alcohol time now its mindfulness time.” (Gp 2. Pt 5)