Mindfulness-based relapse prevention

1. Introduction

Version followed: the 8-session group programme in Bowen, Chawla, Grow & Marlatt, Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide, 2nd ed. (Guilford, 2021), using its session titles. The book text itself is not drawn on. Session-level practices come from published session tables based on the manual: MBRP-A (2017), MBRP-SA (2020) and a 2020 systematic review. These use the 1st-edition (2010) session names. Where the editions may differ, it is flagged [uncertain].

Mindfulness-Based Relapse Prevention (MBRP) is an aftercare group for people who have already started recovery from substance use or other addictive behaviours. It combines the meditation practices of MBSR and MBCT with the cognitive-behavioural relapse prevention (RP) model of Marlatt and Gordon. [source: Chawla 2018 webinar; Grow 2011 slides; Marlatt PSU slides]

How change happens: relapse often follows reactive, automatic attempts to escape discomfort such as craving, negative mood, pain or interpersonal stress. MBRP has three main aims [source: Chawla 2018 webinar; Witkiewitz, Marlatt & Walker 2005]:

• Participants learn to notice triggers, sensations, thoughts and urges as they arise.
• They learn to stay with discomfort instead of fighting it, avoiding it or trying to fix it.
• They learn to pause and choose a response instead of reacting on "automatic pilot".

Repeated mindful contact with cues and urges without using is expected to weaken the conditioned link and build self-efficacy. Relating to thoughts as passing mental events, rather than changing their content, loosens the hold of craving-related thinking. Craving reduction mediated outcomes in the pilot trial. [source: Witkiewitz et al. 2005; Chawla 2018 webinar]

2. Framework

Format. MBRP is a closed group of 8 weekly sessions of about 2 hours, with daily home practice supported by audio recordings. It has three components: formal practice, informal practice and coping strategies. [source: Chawla 2018 webinar; Grow 2011 slides; Guilford 2021 TOC]

• Group size and staffing: in the pilot, 5–12 participants per group with two master's-level co-facilitators. [source: Marlatt PSU slides]
• Shorter formats: a 4-session, 90-minute version has been used inside a combined protocol. [source: NCT02423772 protocol]
• Other formats: the 2nd edition adds alternative formats and settings, dual-diagnosis groups, behavioural addictions and technology. The details are not drawn on [uncertain].
• Rolling admission: a rolling-admission version exists (seen only as a search-result title) [uncertain].

Phases. The developers group the 8 sessions into three arcs [source: Chawla 2018 webinar]:

• Building awareness (Sessions 1–3): recognise automatic pilot, triggers and craving, and extend mindfulness into daily life.
• High-risk situations and relapse (Sessions 4–6): stay present in personal high-risk situations, balance acceptance with skilful action, and see thoughts as thoughts within the relapse cycle.
• Self-care and maintenance (Sessions 7–8): lifestyle balance, kindness, support networks and a plan for continuing practice.

Session map. Session titles are from the 2nd edition (1st-edition titles in brackets). The content column is compiled from the MBRP-A, MBRP-SA and review tables. Exact 2nd-edition placement of each practice is [uncertain].

[source: Guilford 2021 TOC; Zgierska et al. 2017 MBRP-A table; MBRP-SA 2020 table; BMC 2020 review table]

Within-session shape. Each session usually follows this order:

1. Opening practice.
2. Inquiry into the practice.
3. Review of home practice.
4. The session theme, with new practices and inquiry.
5. An exercise or discussion.
6. Setting the home practice for the coming week.
7. A very brief closing practice.

[source: MBRP-SA 2020 table for opening/closing and home practice; ordering partly synthesis]

Moving between phases. MBRP is a fixed curriculum for a closed group. No source describes criteria for progressing; the group moves forward weekly. [source: all session tables] My own [synthesis] for practice:

• Screen before Session 1. Check that the person has a recovery goal they have chosen (abstinence, or moderation where your service allows it). Check that they are medically stable after withdrawal, can sit in a group for 2 hours, and agree to daily practice.
• Later sessions build on earlier skills, so cover any missed session in a brief individual catch-up before the next group. In particular, a participant needs SOBER space (Session 3) before the high-risk work in Session 4.

Safety rules [source: NCT02423772 protocol]:

• If a participant arrives intoxicated, reschedule them and advise them not to drive.
• If a participant arrives in crisis, set the curriculum aside and manage the crisis, with an on-call clinician available.
• Explain the limits of confidentiality in Session 1.
• Trials have excluded people with current psychotic or dissociative disorders and those with a recent suicide attempt. Treat these as cautions for open groups, not as rules from the manual [synthesis].

Facilitator training. The UC San Diego Center for Mindfulness pathway asks for the following [source: UCSD MBRP landing page]:

• A mental-health degree, or current clinical training.
• An established daily meditation practice, with Vipassana/Insight preferred.
• A teacher-led silent residential retreat of 5–10 days, already attended or planned.
• Familiarity with CBT and addiction models.
• Experience running groups.

The current 12-week online training is led by Bowen. [source: UCSD 12-week training page] Trials also used fidelity rating with the MBRP Adherence and Competence Scale and weekly supervision. The 2nd edition includes an MBRP Fidelity Scale. [source: NCT02423772 protocol; Guilford 2021 TOC]

3. Guiding principles

• The facilitator practises what they teach. Keep a daily personal practice so that you guide and inquire from your own experience, not from a script. [source: Chawla 2018 webinar; Grow 2011 slides; Marlatt PSU slides]
• Elicit rather than teach. Ask, reflect and draw learning out of participants' own experience. The developers present the resources for change as lying within the person. [source: Chawla 2018 webinar]
• Motivational Interviewing spirit. Be collaborative, accepting, compassionate and evocative, with a person-centred, Rogerian warmth, and avoid confrontation. [source: Chawla 2018 webinar; Marlatt PSU slides]
• Embodied qualities. Nonjudgment, openness, curiosity, kindness, authenticity, humour, spontaneity and creativity. Your manner is part of the teaching. [source: Chawla 2018 webinar; Grow 2011 slides; Marlatt PSU slides]
• Experience before story. In inquiry, steer gently from the narrative and judgements ("I'm hopeless at this", "I need a drink") back to direct experience: sensations, emotions and thoughts noticed as thoughts. [source: Chawla 2018 webinar; Grow 2011 slides]
• Respond rather than react. Every practice trains a pause between trigger and action, which gives more freedom and choice. [source: Chawla 2018 webinar; UCSD MBRP landing page]
• A new relationship to discomfort. The aim is to be with craving and distress, not to fight, avoid or fix them. Do not offer practices as ways to make urges go away. [source: Chawla 2018 webinar; Marlatt PSU slides]
• Acceptance plus skilful action. Acceptance of inner experience is the basis for choosing wise action, not resignation. [source: session theme 5; Chawla 2018 webinar]
• Relapse is human, not personal. Normalise triggers, craving and lapses as shared human experience, which reduces shame and isolation. [source: Chawla 2018 webinar]
• A lapse is not a relapse. Teach that a lapse is a learning event, which counters the abstinence violation effect (seeing a lapse as an irreparable personal failure). [source: Witkiewitz et al. 2005; MBRP-A table, Session 6]
• Return without judgement. The practice is the returning of wandering attention, however often it wanders. [source: Grow 2011 slides, quoting the mindfulness tradition]
• Change the relationship to thoughts, not their content. Unlike standard cognitive therapy, MBRP does not dispute craving thoughts. Treat them as mental events. [source: Witkiewitz et al. 2005]
• Exposure without using builds self-efficacy. Staying mindfully present with cues and urges without acting on them is a core mechanism. Build it gradually and with consent. [source: Witkiewitz et al. 2005]
• Validate difficulty and praise effort. Meditation is hard for this population, so reinforce small steps and effort, not "good" meditations. [source: Witkiewitz et al. 2005]
• Formal, informal and daily practice. Skills generalise only through daily home practice and brief in-the-moment practices. Review home practice every session. [source: Chawla 2018 webinar; MBRP-SA 2020 table]
• Manual fidelity with flexibility. Follow the session structure and intentions, but be spontaneous and creative within those limits. [source: Marlatt PSU slides; Guilford 2021 TOC (fidelity scale, session-intentions guide)]
• Lifestyle balance and self-care. Recovery is supported by balancing nourishing and depleting activities, not only by managing urges. [source: Chawla 2018 webinar; Witkiewitz et al. 2005]
• Cultural responsiveness. Adapt language, examples and practices to the group's culture and context. The 2nd edition adds culturally responsive adaptations; their details are not drawn on [uncertain]. [source: Guilford 2021 TOC; UCSD MBRP landing page]

4. Intervention inventory

The sources name the practices and exercises listed below and say which session each belongs to. The manual's own step-by-step scripts are not drawn on. Steps below are written in my own words from the practice descriptions, the MBSR/MBCT lineage the developers cite, and the RP model. Wherever a step is not attested in an MBRP source, it is marked [synthesis]. All example language is illustrative. Guided audio for the core practices comes with the 2nd edition: body scan, urge surfing, mountain, breath sitting, SOBER space, sound-breath-sensation-thought-emotion sitting, mindful movement, thoughts sitting, and kindness. [source: Guilford 2021 TOC]

A. Group structure and facilitation methods

4.1 Orientation, group agreements and intentions (Session 1)

• Purpose: create safety and set up the course. Use it at the start of Session 1, and refresh the agreements at the start of Session 2. [source: MBRP-SA 2020 table]
• Steps:
  1. Introduce the facilitators and the course structure: 8 sessions, practice in sessions, daily home practice.
  2. Each person gives their name and briefly says what brought them and what they hope for. Some versions also ask for current use goals.
  3. Agree confidentiality and privacy, and state the limits of confidentiality.
  4. Agree attendance, punctuality, and what happens if someone arrives intoxicated: they are rescheduled, not shamed. [source: NCT02423772 protocol]
  5. Present practice as an experiment. Participants may sit or lie as they wish, keep eyes open or closed, and stop any practice. [synthesis]
• Example language (illustrative): "Over the next eight weeks we'll practise noticing what happens just before the old habits kick in. You don't have to like the practices. We just ask you to try them and be curious."
• Watch for: ambivalence about the use goal, mandated attendance, and fear of being judged. It is working when participants talk honestly about cravings and lapses.

4.2 Mindfulness inquiry (after every practice)

• Purpose: turn practice into learning. This is the core teaching method, used after every formal and informal practice and in home-practice review. [source: Chawla 2018 webinar; Grow 2011 slides; psychotherapy.net Vol. II description]
• Steps:
  1. Open with a broad question about what people noticed.
  2. Explore direct experience in layers: sensations, emotions, thoughts, urges. Gently separate experience from story and judgement. [source: Chawla 2018 webinar]
  3. Widen the lens. Ask how this experience relates to relapse or recovery, whether it feels personal, and whether it is familiar. [source: Grow 2011 slides]
  4. Reflect, normalise and link to the session theme. Avoid lecturing, fixing or praising some experiences over others. [source: Chawla 2018 webinar (elicit, not teach)]
  5. Keep each exchange brief, and invite others in. [synthesis]
• Example language (illustrative): "What did you notice?" "Where did you feel that in your body?" "And what did the mind say about it?" "Is that familiar from times you used?" "Did anyone notice something different?"
• Watch for: your own urge to teach or reassure, and participants who stay in long stories. It is working when participants start describing experience in present-tense, body-based terms, and link it themselves to their relapse patterns.

4.3 Home practice: assignment, logs and review

• Purpose: daily practice is how skills generalise. Set it at the end of every session and review it near the start of the next. [source: Chawla 2018 webinar; MBRP-SA 2020 table; NCT02423772 protocol (audio provided)]
• Steps:
  1. Give audio recordings and a simple log for each week's formal practice, plus one informal practice. The handouts and logs are in the book's reproducible materials; do not copy them, use your own simple record. [source: Guilford 2021 TOC]
  2. Ask each person to choose a realistic time and place to practise. [synthesis]
  3. In review, ask what actually happened, including not practising, and explore the obstacles with curiosity rather than as compliance. [synthesis consistent with Witkiewitz et al. 2005]
• Example language (illustrative): "What was it like to practise this week, or to not practise? What got in the way? What did you notice when you did sit down?"
• Watch for: practice that fades over time; in the pilot, weekly practice fell after the course ended. [source: Marlatt PSU slides] It is working when practice is regular, even if short, and when participants report using SOBER or urge surfing on their own.

B. Formal meditation practices

4.4 Raisin exercise (Session 1)

• Purpose: show the difference between automatic pilot and mindful attention, using an ordinary object, such as a raisin or other small food. [source: BMC 2020 review table; MBRP-A and MBRP-SA tables]
• Steps [synthesis based on standard MBSR/MBCT form]:
  1. Give one raisin to each person. Ask them to explore it as if they had never seen one: by sight, touch, smell and sound near the ear.
  2. Ask them to place it in the mouth without chewing, notice it there, then chew slowly, noticing taste and the urge to swallow.
  3. Ask them to notice the moment of swallowing and any after-effects.
  4. Inquiry: what was different from usual eating, and what is automatic pilot. Link this to how using became automatic.
• Example language (illustrative): "Just notice any impulse to hurry up and eat it. What does wanting feel like right now?"
• Watch for: eating-disorder history; offer a non-food object instead [synthesis]. It is working when participants spontaneously link the exercise to automatic consumption and to the gap between impulse and action.

4.5 Body scan (Sessions 1, 2, 8; audio about 23 minutes)

• Purpose: train sustained, nonjudging attention to sensation. It is the base for noticing the bodily signs of craving and distress. [source: Guilford 2021 TOC; MBRP-A table; Marlatt PSU slides (based on Vipassana, adapted from Kabat-Zinn)]
• Steps [synthesis following the MBSR form]:
  1. Participants lie down or sit. Bring attention to breathing and to points of contact.
  2. Move attention systematically through the body, region by region, noticing sensation, absence of sensation, tension and comfort.
  3. When the mind wanders, notice where it went and return.
  4. Finish with awareness of the whole body.
  5. Inquiry: what was noticed, including boredom, restlessness, sleepiness and pain.
• Example language (illustrative): "There's nothing you need to feel. If there's no sensation in a place, that's what you notice."
• Watch for:
  • Trauma-related distress with eyes closed or lying down: offer sitting and eyes open. [synthesis]
  • Pain: treat pain as an object of attention, not a failure.
  • Sleepiness.
  • It is working when participants describe sensations in more detail and feel less alarm about unpleasant ones.

4.6 Breath (sitting) meditation (Sessions 1/3 onward; audio about 16 minutes)

• Purpose: establish the breath as an anchor that can be used at any time. It underpins the B step of SOBER. [source: Witkiewitz et al. 2005 (directing attention to the breath); Marlatt PSU slides; MBRP-A table]
• Steps [synthesis]:
  1. Take an upright, dignified posture.
  2. Rest attention on breath sensations at the nostrils, chest or belly.
  3. Each time the mind wanders, note briefly where it went and return without judgement, however many times.
  4. Inquiry.
• Example language (illustrative): "Noticing you've wandered is a moment of mindfulness. Gently come back."
• Watch for: breath-focused anxiety or panic. Offer another anchor, such as the feet or the hands, or open eyes. [synthesis] It is working when participants recognise wandering sooner and with less self-criticism.

4.7 Mountain meditation (Session 2, abbreviated; audio about 10 minutes)

• Purpose: imagery for stability: staying grounded while experiences, including urges, change like weather around a mountain. [source: MBRP-A table; Guilford 2021 audio list] The 2020 review lists a "grounding meditation" in Session 2, probably this one [uncertain].
• Steps [synthesis following the Kabat-Zinn form]:
  1. Sit upright.
  2. Picture a mountain in detail and its steadiness through seasons and weather.
  3. Invite participants to sense that steadiness in their own posture while thoughts, feelings and cravings come and go.
  4. Inquiry.
• Example language (illustrative): "Storms pass over the mountain. Can you let this feeling be weather?"
• Watch for: participants who cannot visualise; they can use posture or a felt sense instead. It is working when they report a sense of steadiness in the middle of difficulty.

4.8 Awareness of hearing and seeing (Sessions 3–4)

• Purpose: practise noticing sense experience without labelling or judging it. This prepares for open awareness in high-risk situations. [source: MBRP-A table (mindful hearing or seeing); MBRP-SA 2020 table]
• Steps [synthesis]:
  1. With eyes closed, receive sounds as they arrive: their pitch, volume and duration. Notice the mind naming them and its likes and dislikes.
  2. Alternatively, look out of a window or at the room, seeing colours, shapes and movement before naming them.
  3. Inquiry: the difference between raw perception and the story added to it.
• Example language (illustrative): "See if you can hear the sound before the mind tells you what it is."
• Watch for: hypervigilance to sounds in traumatised participants; keep eyes open if needed. It is working when participants can describe a sound or sight separately from their reaction to it.

4.9 Sitting meditation with expanding awareness (Sessions 4–5; audio about 10 minutes)

• Purpose: widen attention in stages: sound, breath, body sensation, thoughts, then emotions in Session 5. Participants practise staying present with whatever arises. This leads into open awareness. [source: MBRP-A table; MBRP-SA 2020 table; Guilford 2021 audio list; BMC 2020 review (open awareness)]
• Steps [synthesis]:
  1. Begin with sounds, then the breath, then the whole body.
  2. Then treat thoughts as events coming and going.
  3. In Session 5, add emotions: notice where each is felt in the body and allow it.
  4. End with choiceless awareness of whatever is most present.
  5. Inquiry.
• Example language (illustrative): "If an emotion is here, see where it lives in the body. Can you let it be here for these few breaths?"
• Watch for: being flooded by emotion. Show how to return to the breath or to the feet as an anchor. It is working when participants can name and stay with an emotion without acting it out.

4.10 Sitting with acceptance, with a Rumi poem (Session 5)

• Purpose: support allowing unwanted states. MBRP-A pairs the Session 5 sitting with a reading of a Rumi poem. [source: MBRP-A table] Which poem is used is not stated. MBCT commonly uses "The Guest House" [uncertain]. Do not reproduce the text in handouts without checking permissions.
• Steps [synthesis]:
  1. Read the poem aloud after the sitting meditation.
  2. Let it rest for a moment.
  3. Run inquiry on how the theme of welcoming difficult visitors relates to craving and to painful moods.
• Example language (illustrative): "What would it be like to treat a craving as a visitor rather than an enemy, or a boss?"
• Watch for: hearing "accept" as "give in to using". Clarify that you accept the experience, not the action. [synthesis; consistent with session theme "Acceptance and Skillful Action"]

4.11 Sitting meditation on thoughts (Session 6; audio about 12 minutes)

• Purpose: see thoughts as mental events, not facts or commands, including craving thoughts and self-critical thoughts. The 2020 review calls it "acknowledgment of thinking". [source: MBRP-A table ("Are thoughts facts?"); BMC 2020 review; Witkiewitz et al. 2005]
• Steps [synthesis]:
  1. Anchor on the breath.
  2. Turn attention to thoughts themselves. Notice them arising and passing, perhaps with a light label such as "planning", "judging" or "wanting". Imagery can help, such as watching thoughts like clouds or like images on a screen.
  3. Notice being pulled into a thought, then step back.
  4. Inquiry: what happened when a thought was believed, compared with when it was seen as a thought.
• Example language (illustrative): "The mind just said 'one won't hurt.' Can you notice that as a thought, here, now, and see what happens next?"
• Watch for: intrusive or psychotic-like content (screen beforehand) and rumination spirals. Shorten the practice and return to the body. It is working when participants say "I had the thought that…" spontaneously.

4.12 Walking meditation / mindful walking (Sessions 3–5, 7)

• Purpose: bring mindfulness into movement for restless participants and as a bridge to daily life. [source: MBRP-A table; MBRP-SA 2020 table; BMC 2020 review; Marlatt PSU slides]
• Steps [synthesis]:
  1. Walk slowly over a short path.
  2. Attend to the lifting, moving and placing of each foot, and to balance.
  3. When the mind wanders, return to the feet.
  4. Optionally, walk at a normal pace while keeping awareness.
  5. Inquiry.
• Example language (illustrative): "Feel the whole foot meet the floor. There's nowhere to get to."
• Watch for: mobility limits; adapt to standing or seated foot awareness. It is working when participants use it on their own to settle agitation.

4.13 Mindful movement / mindful stretching (Sessions 4–6; audio about 16 minutes)

• Purpose: notice sensation, limits and reactions in gentle movement. This works on striving and on reactions to discomfort. [source: Guilford 2021 audio list; MBRP-A table; MBRP-SA 2020 table]
• Steps [synthesis]:
  1. Guide simple standing stretches that can be done gently.
  2. Ask participants to respect their limits and notice the edge between intensity and strain.
  3. Pause between movements to sense the after-effects.
  4. Inquiry: striving, judging and comparing.
• Example language (illustrative): "Notice the urge to push further. Can you honour your body's limit today?"
• Watch for: injury and pain conditions. Offer every movement as optional, with a chair-based alternative. It is working when participants notice striving and back off kindly.

4.14 Kindness (loving-kindness) meditation (Session 7; audio about 16 minutes)

• Purpose: build self-compassion and kindness to counter shame and self-judgement, which feed relapse. [source: MBRP-A table; BMC 2020 review; Guilford 2021 audio list; Chawla 2018 webinar]
• Steps [synthesis following the general metta form]:
  1. Settle and recall a sense of warmth, for example toward a being who is easy to care for.
  2. Offer simple well-wishes silently to yourself.
  3. Then extend them to others: a friend, a neutral person, a difficult person, all beings.
  4. Notice resistance or numbness without forcing feelings.
  5. Inquiry.
• Example language (illustrative): "You might silently offer: may I be safe, may I be at ease. If nothing is felt, that's fine; it's the intention that counts."
• Watch for: grief, unworthiness or anger, especially when the practice turns toward the self. Let participants start with a pet or a friend, and normalise difficulty. It is working when self-talk in the group softens. MBRP-A allows a "Let go of struggle" meditation as an alternative; its content was not found [uncertain].

4.15 Concluding meditation and closing circle (Session 8)

• Purpose: consolidate what has been learned and set intentions for continuing practice. MBRP-SA follows it with a closing circle. [source: MBRP-A table; MBRP-SA 2020 table; BMC 2020 review]
• Steps [synthesis]:
  1. After a final body scan, lead a short guided reflection on why each person came, what they learned, and what they want to keep.
  2. Go round the circle; each person says one intention or one thing they are taking away.
  3. Facilitators close.
  4. Some groups give a small token as a reminder. This is not confirmed in the sources [uncertain].
• Example language (illustrative): "What would you like to remember from these eight weeks, a year from now?"
• Watch for: anxiety about the group ending. Name aftercare options.

C. Informal practices and relapse-prevention exercises

4.16 Walking-down-the-street exercise (Session 2)

• Purpose: show how quickly the mind interprets an ambiguous event and how interpretation drives emotion and action. It helps participants see reactions to triggers and their own judgements. [source: MBRP-A table; MBRP-SA 2020 table] The sources name it only. The procedure below follows the version of this exercise in the MBCT lineage [synthesis; uncertain whether MBRP's scenario differs].
• Steps:
  1. Ask participants to close their eyes and imagine walking down a familiar street. They see someone they know on the other side, call out or wave, and get no response; the person walks on.
  2. Pause, then ask them to notice thoughts, emotions, body sensations and urges.
  3. Inquiry: list the different interpretations and feelings across the group, and note that the same event led to different reactions.
  4. Link this to triggers: what happens next depends on how the event is read, and on whether we notice the reading.
• Example language (illustrative): "Same street, same person. What did your mind say? What did you feel like doing?"
• Watch for: participants insisting that their interpretation is the true one. Use this gently to show that thoughts are not facts. It is working when participants can describe the chain: event, interpretation, feeling, urge.

4.17 Noticing triggers (trigger-awareness exercise) (Session 2)

• Purpose: break a past trigger down into its parts so the reaction becomes visible and can be interrupted. [source: Chawla 2018 webinar; Grow 2011 slides]
• Steps:
  1. Each person recalls a recent trigger situation.
  2. They record it in columns: situation, emotions, body sensations, thoughts, and what they did. [source: Chawla 2018 webinar] A worked example from the slides: an argument with a partner leads to anger, a tight chest, the thought "I need a drink", and shouting then leaving. [source: Grow 2011 slides]
  3. In pairs or in the group, look for the earliest point where awareness could have created a pause. [synthesis]
  4. Home practice: track triggers as they happen during the week. [synthesis]
• Example language (illustrative): "Before 'I need a drink' showed up, what was in the body?"
• Watch for: vivid recall triggering craving in the room. Close with a short breath practice. It is working when participants catch triggers earlier in the sequence.

4.18 Urge surfing (Session 2; then used throughout; audio about 6 minutes)

• Purpose: be with a craving without acting on it, watching it rise, peak and fall like a wave, using the breath to stay steady. This changes how urges are related to and weakens them over time. Use it whenever cravings are present, and as practice with an imagined trigger. [source: Chawla 2018 webinar; Grow 2011 slides; Marlatt PSU slides ("observe and accept" rather than "fight or control")]
• Consent and safety (exposure element):
  • Explain that the practice may bring up craving on purpose.
  • Get agreement, and let participants choose a milder trigger.
  • Do not use real substances or paraphernalia in group [synthesis].
  • Contraindicated for anyone currently intoxicated or in acute withdrawal.
  • Leave time to settle before people leave, and check how they are before they go. [synthesis]
• Steps:
  1. Settle with the breath.
  2. Recall a mild-to-moderate trigger situation in imagery until some urge is present. [synthesis on imagery induction]
  3. Notice where the urge is felt in the body: location, temperature, tension, pulsing. Notice the thoughts that come with it as thoughts.
  4. Use the breath as a surfboard to stay with the wave as it builds and peaks, without pushing it away or feeding it. [source: wave imagery from Chawla 2018 webinar]
  5. Keep observing as the intensity changes and falls.
  6. Inquiry: did the urge stay constant, and what was it made of?
  7. Home practice: use urge surfing with real urges, and log them. [source: NCT02423772 protocol (urge surfing home practice)]
• Example language (illustrative): "See if you can ride this, letting the breath carry you. You don't have to do anything about it, just watch what it does."
• Watch for:
  • Using surfing to get rid of the urge, which is subtle avoidance. Name it kindly.
  • Urges that do not fall within the practice time. Normalise this; the practice is not acting on the urge, not the urge disappearing.
  • It is working when participants report urges as changing, bearable sensations and delay or decline acting on them.

4.19 SOBER breathing space (introduced Session 3; used in every session afterwards; audio about 3 minutes)

• Purpose: a brief, portable pause to step out of automatic pilot in daily life and in high-risk moments. It is MBRP's adaptation of the MBCT 3-minute breathing space. [source: Chawla 2018 webinar; Marlatt PSU slides; MBRP-A table ("SOBER minimeditation")]
• Steps (the acronym from the sources; my wording):
  1. S – Stop: pause wherever you are.
  2. O – Observe: notice what is happening now in body, emotions and thoughts.
  3. B – Breath: gather attention on the breath as an anchor.
  4. E – Expand: widen awareness to the whole body and the situation.
  5. R – Respond: choose a mindful response rather than an automatic one.
  6. Practise it first in calm conditions. Then use it several times a day at set cues, then in difficult moments. [synthesis on cueing]
• Example language (illustrative): "Stop. What's here right now? Find the breath. Now take in the whole body, the whole room. Given all this, what do you want to do next?"
• Watch for: rushing through it as a ritual, or using it to suppress feelings. It is working when participants use it unprompted between sessions and describe a choice point they did not have before.

4.20 SOBER space in a challenging situation, alone and in pairs (Sessions 4–5)

• Purpose: rehearse the pause under realistic pressure, both imagined and interpersonal. [source: MBRP-A table; MBRP-SA 2020 table (paired SOBER, SOBER in challenging situations); NCT02423772 protocol (role-plays)]
• Steps [synthesis on procedure]:
  1. Each person picks a personal high-risk scene and imagines it vividly, stopping at the point just before they would usually react.
  2. Guide SOBER at that point.
  3. Imagine responding in the way they chose.
  4. Paired version: one partner briefly role-plays a mild pressure situation, such as an offer or a criticism, while the other practises SOBER, then they swap.
  5. Inquiry: what changed when they paused?
  6. Consent and safety: as for urge surfing (4.18). Keep role-plays mild, with a clear stop signal.
• Example language (illustrative): "Freeze the scene just before you usually react. Now: stop, observe…"
• Watch for: role-plays escalating into real conflict. It is working when participants can name a concrete alternative response they could carry out.

4.21 Mindfulness of daily activities (from Session 3)

• Purpose: carry awareness into ordinary routines such as brushing teeth, washing dishes or walking to the car, so that mindfulness is available outside formal practice. [source: Chawla 2018 webinar; Grow 2011 slides; MBRP-A table]
• Steps [synthesis]:
  1. Each person picks one routine activity for the week and does it with full attention to the senses.
  2. They note when automatic pilot takes over.
  3. Review it in the next session.
• Example language (illustrative): "Pick one thing you do every day without thinking, and this week do it as if for the first time."
• Watch for: choosing something too demanding. It is working when participants notice moments of autopilot in daily life.

4.22 Identifying personal high-risk situations (Session 4)

• Purpose: map each person's individual and shared relapse risks, and the sensations, emotions and thoughts that come with them. [source: MBRP-A table; MBRP-SA 2020 table] RP background: risks can be within the person, such as negative emotions, urges or physical states, or between people, such as social pressure or conflict. [source: Marlatt PSU slides]
• Steps [synthesis]:
  1. Each person lists a few situations where they have used or nearly used.
  2. For each, they note the place, the people, the internal states and the time.
  3. In the group, collect common themes on a board, such as negative mood, conflict, celebrations or being offered.
  4. Each person names the inner signals that tell them they are in such a situation.
  5. They plan where SOBER or urge surfing could fit.
• Example language (illustrative): "How does your body let you know you're heading into one of these?"
• Watch for: only listing external places. Push gently toward internal states. It is working when each person has a personal list that includes internal triggers.

4.23 The relapse cycle (Session 6)

• Purpose: map how triggers, unobserved reactions and believed thoughts lead to use, and where awareness can interrupt the sequence. [source: Chawla 2018 webinar; MBRP-A and MBRP-SA tables; NCT02423772 protocol]
• Steps:
  1. Build the chain on a board with the group: trigger, then observing and reacting, then believing the thought (for example, "I can't stand this" or "just one"), then the lapse, then the abstinence violation effect, which drives further use. [source: Chawla 2018 webinar] The NCT protocol frames the cycle as discomfort, difficult sensations or emotions and negative thoughts leading to craving and use. [source: NCT02423772 protocol]
  2. Each person fills it in with a real episode. [synthesis]
  3. Mark the earliest points where SOBER, urge surfing or seeing thoughts as thoughts could have created a choice; the developers' slide marks this with a stop point. [source: Chawla 2018 webinar]
• Example language (illustrative): "Where in this chain did the thought turn into an instruction?"
• Watch for: shame while reviewing past episodes. Keep the tone that this is human, not personal. It is working when participants place their own stop points early in the chain.

4.24 Lapse versus relapse and the abstinence violation effect (Session 6)

• Purpose: prevent a single lapse from becoming a full relapse by changing how the lapse is interpreted. [source: MBRP-A table; Witkiewitz et al. 2005]
• Steps [synthesis from RP]:
  1. Define a lapse (a single use or episode) and a relapse (return to the previous pattern).
  2. Describe the abstinence violation effect: the all-or-nothing, self-blaming reading that fuels further use.
  3. Ask the group what thoughts follow a lapse, and practise seeing them as thoughts.
  4. Agree a lapse plan: stop, step away, SOBER, contact support, and treat the lapse as information about a high-risk situation.
• Example language (illustrative): "If you slip, the mind may say 'I've blown it, may as well keep going.' That's a thought too. What would a kind, practical next step be?"
• Watch for: participants or services hearing this as permission to use. Be clear about each person's own goal. It is working when lapses are disclosed openly and are followed by a quick return to the goal.

4.25 "False refuge" discussion (Session 3, MBRP-SA)

• Purpose: explore how substances and other behaviours offer a temporary refuge from discomfort that is not a real one. [source: MBRP-SA 2020 table] The content is not given in the sources; the term echoes Buddhist-informed recovery writing on the course reading list [uncertain].
• Steps [synthesis]:
  1. Ask what people turn to when uncomfortable.
  2. Explore what each refuge gives in the short term and what it costs.
  3. Contrast this with refuges that support recovery, such as practice, people and values.
• Example language (illustrative): "What has this given you in the moment, and what has it taken?"
• Watch for: moralising. Stay curious and nonjudgemental.

4.26 Acceptance and skilful action discussion (Session 5)

• Purpose: clarify that accepting inner experience is the starting point for wise action, including in difficult interpersonal situations, and is not passivity. [source: Guilford 2021 TOC; MBRP-A table; MBRP-SA 2020 table]
• Steps [synthesis]:
  1. After the Session 5 sitting, ask what accepting a feeling did and did not mean.
  2. Take a real difficult interaction from a participant.
  3. Separate what can be accepted (feelings, thoughts, the facts) from what can be acted on (a skilful response).
  4. Practise the response using SOBER (see 4.20).
• Example language (illustrative): "Accepting that you're furious doesn't mean accepting how you're being treated. With the anger fully acknowledged, what response would you stand behind tomorrow?"
• Watch for: confusing acceptance with approval. It is working when participants describe acting after allowing a feeling rather than to get rid of it.

4.27 Daily activities exercise: nourishing versus depleting (Session 7)

• Purpose: apply the RP principle of lifestyle balance by increasing nourishing activities and reducing depleting or triggering ones. [source: MBRP-SA 2020 table; NCT02423772 protocol; Witkiewitz et al. 2005]
• Steps:
  1. Each person lists a typical day's activities.
  2. They mark each as nourishing, depleting or neutral, and notice the balance. [source: NCT02423772 protocol (nurturing versus depleting)]
  3. Each person picks one small nourishing addition and one depleting item to reduce or approach more mindfully. [synthesis]
• Example language (illustrative): "Which of these leaves you more alive, and which leaves you more drained? What's one small shift for this week?"
• Watch for: perfectionist overhauls; keep changes small. It is working when participants report a concrete change made.

4.28 Personal warning signs ("where relapse begins") and action plan (Session 7)

• Purpose: identify each person's early warning signs, such as changes in mood, sleep, isolation or skipping practice, and plan responses. [source: MBRP-A table; MBRP-SA 2020 table]
• Steps [synthesis]:
  1. Ask: "Looking back, when did relapse really start?"
  2. Each person lists their earliest signs.
  3. For each sign, write a specific response: a practice, a person, an activity.
  4. Each person writes this into a short personal plan.
• Example language (illustrative): "Long before the drink, what had already changed?"
• Watch for: generic signs. Ask for personal ones. It is working when the plan is specific and named in the person's own words.

4.29 Reminder cards (Session 7)

• Purpose: a pocket card to use in high-risk moments when thinking is narrowed. [source: MBRP-SA 2020 table; NCT02423772 protocol]
• Steps:
  1. Each person writes on a card the people to call and alternative activities. [source: NCT02423772 protocol]
  2. They may add reasons for their recovery, or a cue for SOBER [synthesis].
  3. They keep it in a wallet or on their phone.
• Example language (illustrative): "What would you want to read in the moment when you're about to use?"
• Watch for: cards that are never carried. Check in Session 8.

4.30 Support networks (Session 8)

• Purpose: strengthen social support for recovery and work through barriers to asking for help. [source: Guilford 2021 TOC; MBRP-A table; MBRP-SA 2020 table]
• Steps [synthesis]:
  1. Each person maps their current supports and the gaps.
  2. Discuss barriers to reaching out, such as shame, not wanting to burden people, or past let-downs.
  3. Each person picks one support action, for example a call, a mutual-help meeting or a practice group.
• Example language (illustrative): "What gets in the way of picking up the phone? What might make it 10% easier?"
• Watch for: isolated participants; link them to services. It is working when concrete contacts are named.

4.31 Continuing-practice plan and course review (Session 8)

• Purpose: keep practice going after the course, since practice tends to fall off over time. [source: Guilford 2021 TOC; Marlatt PSU slides (practice declined over 4 months)]
• Steps [synthesis]:
  1. Review all the practices.
  2. Each person chooses a realistic daily formal practice, using the audio, and at least one informal practice, such as SOBER.
  3. Name the cues and supports that will keep it going, for example drop-in groups, apps or a buddy.
• Example language (illustrative): "What's the smallest practice you could keep up even on a bad week?"

4.32 Adaptation-specific elements

• Mindful smoking (MBRP-SA, for smoking cessation): participants smoke with full attention to sensation, as a form of mindful exposure, before quit day. Use it only within that adaptation and with consent. [source: MBRP-SA 2020 table; Moffitt handouts]
• Gratitude (Session 8 in a 9-session smoking/alcohol version): one adaptation adds a "Working with What Is" session on gratitude and deepening acceptance. [source: Moffitt MBRP-SA handout] This is not part of the standard 8-session programme.
• Pain adaptation (4-session MBRP within a combined protocol): automatic pilot is extended to pain and negative emotion as triggers. [source: NCT02423772 protocol]

5. Handling problems

The sources say little about troubleshooting. Most guidance below is [synthesis], informed by the stated principles. Items backed by sources are tagged.

• Arriving intoxicated: do not run the session for that person. Reschedule privately and arrange safe transport. [source: NCT02423772 protocol] Afterwards, explore it as a lapse, following 4.24, without shaming. [synthesis]
• Arriving in crisis, or high distress mid-group: set the curriculum aside for that person. A co-facilitator steps out with them for risk assessment following your service's standard suicide and self-harm protocol, with on-call clinician backup. [source: NCT02423772 protocol (crisis procedure, on-call psychologist)] Remove lethal means and plan safety in line with standard practice. [synthesis]
• Overwhelm during practice (panic, flashback, dissociation):
  • In advance, offer eyes open, sitting rather than lying, and anchors other than the breath (feet, hands, sounds). Tell people they can stop at any time.
  • If it happens, use the person's name and orient them to the room. Shorten the practice and ground through the senses. Check in after the group.
  • Consider individual work before the group for people with marked trauma symptoms. [synthesis]
• Craving provoked by in-session cue work (urge surfing, high-risk imagery, role-plays):
  • Use graded intensity, with the participant choosing the trigger.
  • Allow time to settle, and check in with each person before they leave.
  • Agree a plan for the journey home if craving is still high. [synthesis consistent with 4.18]
• "It doesn't work, the urge didn't go away": the aim is not to remove the urge but to change how one relates to it and to not act on it. [source: Chawla 2018 webinar; Marlatt PSU slides] Ask what happened when they watched it, and celebrate any delay. [synthesis]
• Non-adherence to home practice:
  • Explore obstacles with curiosity. Reduce the dose, for example 5 minutes or a single SOBER a day. Link practice to existing routines.
  • Validate how hard it is and praise effort. [source: Witkiewitz et al. 2005 (validate difficulty, praise effort)]
  • Don't make attendance depend on practice. [synthesis]
• Sleepiness, boredom, restlessness: treat them as objects of inquiry. Offer sitting upright, eyes open, or walking or movement practices. [synthesis; standard in MBSR/MBCT lineage]
• Resistance to "meditation" (religious concerns, scepticism, "woo"): present practices as attention training. Use secular language, and emphasise experiment and the participant's own data. Adapt to the group's culture. [synthesis; Guilford 2021 TOC on culturally responsive adaptations]
• Ambivalence about the goal, or mandated participants: respond in the MI spirit. Reflect both sides and elicit the person's own reasons. Avoid arguing. [source: Chawla 2018 webinar; Marlatt PSU slides]
• Participants dominating with stories or advice-giving: gently redirect to direct experience ("and what did you notice in the body as you said that?"), then invite others in. [synthesis; Chawla 2018 webinar (experience over story)]
• Ruptures (a participant feels judged, shamed or pushed):
  • Name what happened, acknowledge your part, and ask how they experienced it.
  • Re-establish choice, for example by saying they can always opt out of a practice.
  • Use co-facilitator debriefs to spot patterns. [synthesis]
• Lapse disclosed in group:
  • Thank them for their honesty and normalise lapses.
  • Use the relapse-cycle and abstinence-violation-effect framework (4.23–4.24) to learn from it.
  • Check that they have support. Avoid group pile-on. [synthesis; Chawla 2018 webinar (relapse not personal)]
• Self-criticism about "bad" meditation: reframe wandering and returning as the practice itself. [source: Grow 2011 slides] Use kindness practice. [synthesis]
• Psychosis, severe dissociation or acute suicidality: trials excluded these. Prefer individual treatment and stabilisation before group MBRP. [source: NCT02423772 protocol (exclusions); synthesis]
• Cognitive impairment or literacy limits: shorten practices, use more movement, and give oral rather than written home practice. [synthesis]
• Facilitator drift (teaching from the head): keep up daily personal practice, a silent retreat, supervision and fidelity self-rating. [source: UCSD MBRP landing page; NCT02423772 protocol; Guilford 2021 TOC (MBRP Fidelity Scale)]

Sources

Sources (short tag used in text):

• Mindfulness-Based Relapse Prevention for Addictive Behaviors, 2nd ed. – Guilford product page (TOC, audio list) – Guilford 2021 TOC
• Chawla N. MBRP webinar slides, NW ATTC, Nov 2018 – Chawla 2018 webinar
• Grow J. MBRP presentation slides, UW Addictive Behaviors Research Center, 2011 – Grow 2011 slides
• Marlatt GA. Relapse prevention and MBRP slides (Penn State Prevention Research Center) – Marlatt PSU slides
• Witkiewitz K, Marlatt GA, Walker D. Mindfulness-based relapse prevention for alcohol and substance use disorders. J Cogn Psychother 2005 (reprint) – Witkiewitz et al. 2005
• MBRP-A intervention session summary, Table 1 (2017; doi:10.1155/2017/9716586) – MBRP-A table
• Session content of MBRP-SA, Table 1 (Contemp Clin Trials 2020;100:106218) – MBRP-SA 2020 table
• Mindfulness-based programs for substance use disorders: a systematic review of manualized treatments, Table 1 (Subst Abuse Treat Prev Policy 2020) – BMC 2020 review
• MBRP-SA handout: overview of sessions (Moffitt Cancer Center) – Moffitt handouts
• Pilot study of combined treatment for veterans with chronic pain and opiate misuse – protocol (NCT02423772) – NCT02423772 protocol
• MBRP at UC San Diego – facilitator training eligibility and reading – UCSD MBRP landing page
• UCSD Center for Mindfulness – MBRP overview / 12-week facilitator training – UCSD 12-week training page
• Mindfulness-Based Relapse Prevention for Addictions: Volume II (psychotherapy.net video description) – psychotherapy.net Vol. II description

Books cited:

• Bowen S, Chawla N, Grow J, Marlatt GA (2021). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide (2nd ed.). Guilford. (Version followed; text not drawn on.)
• Bowen S, Chawla N, Marlatt GA (2010/2011). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician's Guide (1st ed.). Guilford.
• Marlatt GA, Gordon JR (eds.) (1985). Relapse Prevention. Guilford.
• Segal ZV, Williams JMG, Teasdale JD (2013). Mindfulness-Based Cognitive Therapy for Depression (2nd ed.). Guilford.
• Kabat-Zinn J (1990). Full Catastrophe Living. Delacorte.

Further reading (not drawn on):

• The mindfulrp.com site and the Recovery Research Institute summary are not drawn on here.
• The Bowen et al. 2009 pilot trial.

The manual's own session scripts, handouts and fidelity scale were therefore not consulted [uncertain].