Overview of Mindfulness-Based Relapse Prevention

In This Article

Mindfulness-based relapse prevention (MBRP) is a form of treatment for alcohol and substance addiction that focuses on the period after standard treatment when individuals are most likely to relapse. MBRP applies the concept of mindfulness to the management of urges that can derail sobriety or maintaining moderation.

It is an extension of regular treatment rather than a replacement for it. It takes over at the point where you've been through treatment and are now back to resuming life as normal; how do you cope? What do you do when an urge arises? Should you fight against it like you did in treatment, or is there some better way to manage how you are feeling? MBRP answers all of these questions for you in a simple way.

What Is MBRP?

Mindfulness-based relapse prevention was developed at the Addictive Behaviors Research Center at the University of Washington by G. Alan Marlatt and colleagues to help people in their recovery from addictive behaviors.

Overview of MBRP

Mindfulness-based relapse prevention helps those in recovery from addiction use mindful awareness to manage automatic and unhelpful reactions to triggers.

Through MBRP, individuals are taught how to take a step back, be present in the moment, and recognize that there are multiple possible outcomes to a situation over which they have a certain degree of control. In other words, it is possible to react to triggers in ways that serve you rather than contribute to poor health or destructive emotions.

MBRP is best suited to those who have already completed an initial treatment program and want to maintain the changes that they have implemented in their lives.

It helps you to create a practice of mindfulness that supports you in your recovery, rather than relapsing back into old habits when facing old and new triggers.

MBRP Techniques

The main technique used in MBRP is called "urge surfing" and refers to the use of mindfulness strategies to ride the wave of an urge rather than succumb to it. When you are practicing urge surfing, you are noticing your urges without acting on them; in this way, you are allowing the experience of an urge to pass over you like a wave.

Urge surfing also involves letting go of the idea that all of your emotions and experiences must be positive. There will be times when things are very hard or difficult, but you don't need to automatically fix your experience.

Instead, you can take a moment and respond with intention instead of jumping into an automatic emotional reaction to a trigger. By developing the ability to manage emotional distress, you will paradoxically experience less negative emotions because you won't make a difficult situation worse through your own actions.

For example, if you have an urge to have a drink, rather than telling yourself stories about how you are ashamed of your past or feel anxious about your ability to cope, instead you would recognize the original urge and allow it to pass over you as you ride it like a wave.

The same can be said for a range of emotions that might result from the urge to give in to a craving: depression, regret, shame, anger, fear, etc. When you are able to manage these emotional reactions, you will be less likely to fall into relapse.

This is in contrast to the natural impulse to deal with cravings: avoidance or suppression. How many times have you had a craving and thought that you must try to forget about it or work hard to suppress it? Ironically, it is this fight against the craving that gives it more strength and makes it last longer.

In this way, MBRP allows you to become separate from your addictive thoughts, as though you are watching them from a distance. Instead of judging your thoughts, MBRP allows you to change your perspective on discomfort.

Urge surfing has also been described as watching waves roll in and out at the ocean's edge. In the same way, cravings grow in intensity, reach a peak, and then fade away. This can be true for all ranges of addictive behaviors from shopping to alcohol. Most urges or cravings will recede within 20 minutes on their own.

Effectiveness of MBRP

What does research have to say about the effectiveness of MBRP? In a study that compared a standard relapse prevention program, 12-step program, and an MBRP, at six months the standard and MBRP conditions fared better than the 12-step program, while at 12 months the MBRP condition did better than the other two.

How to Practice MBRP

Below are the steps to practicing urge surfing if you'd like to incorporate this mindfulness technique into your daily life to manage urges or cravings. Remember though that this is a treatment technique that is best learned in the context of therapy with a mental health or addiction professional and perhaps even in a group setting.

Step One

Become aware of cravings or urges when they start. You can do this by staying connected to the present moment and recognizing shifts in your emotions as they happen in real-time.

Step Two

Name your experience as an urge or craving and notice it as an internal experience of thoughts and emotions and physical experience of sensations.

Step Three

Imagine your urge or craving as a wave that is going to roll in until it reaches a peak and then recedes from your experience.

Step Four

As you visualize your urge or craving rolling away, begin to focus on your breathing. Breathe in for a count of seven and out for a count of eleven to slow your breathing down.

Step Five

Watch as your urge or craving continues to peak while you continue to practice breathing slowly and allowing it to pass slowly over time without trying to control it.

Step Six

As the urge or craving passes, notice your experience and how you were able to make a different choice than in the past. Moving forward, it will become easier to see opportunities to practice mindfulness and reacting in this new way.

Step Seven

Repeat the above steps as necessary whenever you find yourself in a situation where your urges or cravings have been triggered and you feel the natural tendency to want to avoid or control the situation.

As you practice this more often, it will become easier to ride the wave of your urges or cravings as they peak and recede. You'll be able to recognize that these urges are temporary and that you can ride them out until they dissipate.

Who Should Use MBRP

While MBRP can be attempted by everyone, it might be easier for those who are more motivated to change or who naturally have a tendency to view their thoughts and emotions as observable experiences. In other words, it helps to have a thoughtful disposition and be willing to try something new and put in a strong effort to make it work.

A Word From Verywell

About half of those who complete treatment for addiction will relapse within a year. It is a natural tendency to want to avoid pain and move toward pleasure. However, using poor coping strategies such as addiction will only cause you more pain in the long run.

While traditional treatment focuses on avoiding triggers or controlling cravings, MBRP does the opposite and focuses on managing urges through thoughtful observation. In this way, you are taught to name and tolerate your experiences rather than fight against them. And, simply wait for them to pass and recognize that you have the freedom to respond in a different way than you have in the past.

MBRP is about self-compassion and is a tool that can be applied to all aspects of your life, which means that you will have more resiliency when facing new problems related to addiction. If you practice the skills of MBRP multiple times each day, over time they will become automatic, and serve you better than trying to resist or control urges.

This means that you've learned in a very deep way how to manage your emotional state, which is truly the key to getting a hold of your addiction. It's not about a drink, a cigarette, or a dessert—it's about how you are using those items to manage your emotional experience, and what you can do instead.

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  1. Bowen S, Witkiewitz K, Clifasefi SL, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547-556.

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