Saturday, September 20, 2014

Integrative Body-Mind Training to Address Nicotine Cravings

Addiction to smoking and other substances involves a particular set of brain areas related to self-control, according to numerous researches. For a new study, researchers wondered if a training approach designed to influence this addiction pathway could influence smokers to reduce their tobacco use -- even if smokers did not intend to do so.

Just 2 weeks of mindfulness meditation training help reduce smoking and craving for cigarettes, new research suggests.

Results from a study conducted by investigators at the University of Oregon in Eugene showed that integrative body-mind training (IBMT) helped curtail cigarette consumption by up to 60% in smokers who underwent 5 hours of training during a 2-week period. In comparison, a control group who underwent relaxation therapy showed no reduction in smoking.

"We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes," study coauthor Yi-Yuan Tang, MD, PhD, formerly a research professor at the University of Oregon and current director of the Neuroimaging Institute in Amarillo, Texas, said in a release.

"Because mindfulness meditation promotes personal control and has been shown to positively affect attention and openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction," Dr. Tang added.

Self-control Deficit

With more than 5 million deaths a year attributable to tobacco smoking, effective, short-term interventions to reduce smoking and cravings are urgently needed, the researchers note.

One reason for substance abuse and addiction may involve a lack of self-control, which raises the question of whether an intervention to improve self-control could change smoking behavior.

The researchers point out that mindfulness training has shown some proof of efficacy in substance abuse, but a lack of adequate control conditions, failure to randomize participants, and a failure to assess biological markers of change have limited the research.

IBMT has been shown to reduce stress, increase positive emotion, and improve attention and self-control after a few hours of practice compared with the same amount of relaxation training.

To determine whether IBMT could influence self-control via the anterior cingulate cortex (ACC) and adjacent prefrontal cortex function (PFC) and help smokers reduce tobacco use, the investigators conducted a randomized controlled trial. They advertised for volunteers who wished to reduce stress and improve performance.

Among the respondents were 27 smokers and 33 nonsmokers. All participants were randomly assigned to receive either IBMT or relaxation training. Both groups received 2 weeks of training for a total of 5 hours.

All participants were tested for carbon monoxide levels before and after the study interventions. The researchers also used functional magnetic resonance imaging (fMRI) to identify brain mechanisms related to smoking reduction.

Imaging Results

Imaging revealed that before IBMT, smokers had a reduction in activity in the ACC and PFC as well as other brain areas. However, after 2 weeks, activity in the ACC, the medial PFC, and the inferior frontal gyrus/ventrolateral PFC increased.

At 2- and 4-week follow-up, 5 of the responding smokers whose smoking had been significantly reduced after IBMT reported that the effect had been maintained.

The researchers note that IBMT's ability to enhance self-control may make it a useful tool to reduce smoking and craving "even in those who have no intention to quit smoking."

Many of the participants only recognized that they had reduced smoking after an objective test using measured exhaled carbon monoxide showed the reduction. While previous studies have suggested such meditation may mediate several forms of addiction such as those tied to alcohol, cigarettes and cocaine, they have not been approached with a randomized controlled design with an active relaxation control, the researchers noted.

Before and after the experiments, all participants were tested for carbon monoxide levels. To identify brain mechanisms that may underlie smoking reduction, the researchers also used functional magnetic resonance imaging (fMRI) during rest to understand the brain areas involved.

IBMT "does not force participants to resist craving or quit smoking; instead, it focuses on improving self-control capacity to handle craving and smoking behavior."

However, these are early findings, and more research is needed.

"We cannot say how long the effect of reduced smoking will last," said study coauthor Michael Posner, MD.

"This is an early finding, but an encouraging one. It may be that for the reduction or quitting having a lasting effect, smokers will need to continue to practice meditation for a longer time period," he added.

About IBMT

Developed from traditional Chinese Medicine by Dr. Yi-Yuan Tang, founding director of the Institute of Neuroinformatics and Laboratory of Body and Mind since 2001, Integrative Body-Mind Training is a specific meditation and relaxation technique based on the Taoist and Confucian concepts of harmony with nature.

Unlike other mind-body disciplines which often take years to produce the desired physiological and psychological changes, IBMT can be learned through training, deep meditation and stress reduction in just five days.

IBMT was shown to produce specific physiological changes – altered blood flow, brain electrical activity, breathing quality and skin conductance – that led to the psychological relaxation of the meditative state.
The "state of ah" is the relaxed, calm surrender that meditative adepts take years to develop. It is a state that results from integration, a connection between brain and body that is revealed through SPECT scans as an increased blood flow to the right anterior cingulate cortex, a region associated with self-regulation of cognition and emotion.

Unlike other meditative techniques that focus on thought control, Integrative Body-Mind Training focuses on a state of restful alertness and body mind awareness developed by instructions from a trained IBMT coach. The usual struggle for thought control is replaced by body postures and balanced breathing which eventually help students achieve thought control.

This less stressful approach is validated by physiological tests in the laboratory showing IBMT students achieving lower heart rates, skin conductance responses and deeper chest breathing amplitudes – all telltale signs of less effort, less stress and more relaxation. Tests have also shown that doing IBMT prior to a mental math test produced lower levels of stress hormone cortisol in the body.

Integrative Body-Mind Training, with its short training schedule and obvious effectiveness in producing physical and mental changes, seems well suited to the frenetic pace of modern culture.

How it is done?

Integrated Body Mind Training is a holistic form of meditation based on both traditional Chinese medicine and Western Techniques. It includes four parts: body relaxation, breath adjustment, mental imagery, and mindfulness.  IBMT helps improve self-regulation in cognition, emotion, and social behavior.  IBMT is practiced while listening to an audio compact disc (CD) and being physically coached by an experienced IBMT mentor.

IBMT has recently been coupled with nature exposure to help improve attention state.  Chinese mind body training such as Tai Chi, Qigong, and meditation have often been done in nature. Being in harmony with nature has been a central feature in Chinese philosophy.  Western psychological practices have come to understand that nature exposure helps restore directed attention.   However, unlike other nature exposure therapies, IBMT has the subject close his eyes and visualize nature. 

IBMT and nature exposure are both techniques that have been categorized as attention state training models.  Attention state training (AST) pertains to a change in conscious awareness that may result from meditative or nature exposure experiences.  Attention training (AT), comparatively, involves executive control mechanisms and may, for example, include mental effort and control on a working memory task. 

Nature exposure is based on Kaplan’s attention restoration theory, which posits that mental fatigue may occur following a person’s sustained effort to maintain focused attention over time on cognitive tasks.  The premise of the attention restoration theory model is that a person can restore mental efficiency by decreasing directed, voluntary attention, and by increasing involuntary attention.  In other words, a person may become mentally fatigued as he or she sustains effortful attention on work-related tasks (computer, e-mail, documents, meetings, etc.), but can restore mental efficiency by increasing the involuntary attention that occurs via nature exposure. 

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