Interoceptive attention or merely distraction? An examination of the effects of brief breath counting training on stress-induced alcohol-seeking behavior.

Prior research suggests brief mindfulness (breath counting) interventions may be effective at attenuating stress-induced alcohol-related cravings. However, it remains unclear whether this reduction in craving is due to increased state mindfulness or mere distraction. To test this, the present study examined whether brief breath counting would attenuate a stress-induced increase in the relative value of alcohol in young adult alcohol users, and whether this therapeutic effect was superior to simple distraction (cross counting). University students from England and the United States (N = 278, Mage = 20.2 years, 56.5% females) were randomly assigned to one of four conditions: breath counting, distraction, stress-only, no-stress. Participants first listened to a 6-min audio file training the breath counting technique or control audio, before exposure to 2-min noise stress induction or no-stress during which participants engaged in breath counting, cross counting (distraction), or nothing. The relative value of alcohol was then assessed by preferential choice of alcohol versus food pictures. Results indicated that stress-only augmented alcohol picture choice compared to no-stress, and that this stress induction effect was attenuated to a comparable extent by breath counting and distraction. Group differences in alcohol picture choice washed out in the second half of the choice test. The results suggest that the therapeutic effect of breath counting (interoceptive attention) on stress-induced alcohol-seeking may stem from distraction (cognitive load) rather than a unique state of mindful acceptance. The implications of this lab study for mindfulness therapy are considered.