Body-Focused Mindfulness as an Add-on Intervention in Inpatient Alcohol Use Disorder Treatment (MBI-AUD-PL)

BACKGROUND Alcohol use disorder (AUD) is associated with impaired interoceptive awareness, bodily dissociation, alexithymia, and emotion dysregulation. These deficits are linked to elevated craving and relapse risk. Impaired body-self integration - the degree to which individuals identify with their own body - has been documented in AUD and is associated with emotional processing difficulties (Kopera et al., 2025). While mindfulness-based interventions have shown promise in AUD treatment, programs targeting bodily experience without direct reference to substance use have not been systematically evaluated in inpatient settings.

INTERVENTION The body-focused mindfulness intervention consists of 6 weekly 90-minute group sessions added to standard inpatient AUD treatment. Each session follows a structured format: check-in and review of home practice (10 min), breath-focused meditation (10 min), psychoeducation on mindfulness attitudes (15 min), main body-focused practice - body scan in lying or seated position, mindful walking and stretching (20 min), structured inquiry (15 min), weekly intention setting and home practice assignment (10 min), and 3-minute breathing space (5 min). Participants receive audio recordings of guided mindfulness exercises and are encouraged to practice independently (5-10 minutes daily) between sessions. The intervention does not include direct reference to alcohol use or relapse prevention content. Sessions are delivered by therapists trained in mindfulness-based approaches with personal meditation practice experience.

STRUCTURED INQUIRY Each session includes a structured inquiry component in which the therapist facilitates exploration of participants' bodily experience during practice through open, non-judgmental questions. Inquiry is anchored to bodily experience - the therapist actively returns the conversation to somatic sensations when participants shift toward narrative or abstract reflection.

CONTROL CONDITION The active comparator group receives 6 weekly 90-minute psychoeducation sessions added to the same standard inpatient AUD treatment. Sessions cover standard topics related to alcohol use disorder, recovery, and coping strategies. Delivered by the same therapists as the experimental group. All other components of the inpatient treatment program are identical between groups.

RANDOMIZATION Randomization occurs after 14 days of hospitalization, following completion of the standard introductory psychoeducation program. Computer-generated randomization with sequentially numbered sealed envelopes is used for allocation concealment. Randomization is performed by a person not involved in the delivery of the intervention or outcome assessment.

ASSESSMENT All assessments are conducted in paper-and-pencil format at five time points: baseline (T0, after 14 days of hospitalization, before randomization), post-intervention (T1, before discharge, approximately 6 weeks after T0), and follow-up at 4 weeks (T2), 6 months (T3), and 12 months (T4) post-discharge. After each session, participants in both groups complete a brief paper-based body map referring to their current bodily state. Between sessions, participants are asked to complete a body map when experiencing an episode of alcohol craving.

BODY MAPS Bodily sensation phenomenology is assessed using a paper-based body mapping measure adapted from the InteroMaps framework (Desmedt et al., 2025). Participants mark bodily regions on a printed body outline (front and back view) and rate overall intensity (0-10) and valence (-5 to +5). At T0 and T1, participants complete body maps for six emotions (anxiety, anger, shame, sadness, calm, happiness). After each session, participants complete a brief body map of their current bodily state. Between sessions, a body map is completed during episodes of alcohol craving, with additional ratings of craving intensity (0-10) and difficulty resisting (0-10).

SAMPLE SIZE Sample size was estimated based on Treves et al. (2025), a pre-registered meta-analysis of 29 RCTs (N=2,191) examining the effects of mindfulness-based interventions on self-reported interoception (primary outcome: MAIA-2 total score). The pooled effect across all mindfulness interventions was g=0.31 (95% CI \[0.21, 0.42\]); the effect for mindfulness-based programs incorporating body scan, breath awareness, mindful movement, and inquiry was g=0.41 (95% CI \[0.29, 0.54\]). Adopting g=0.41 as the primary assumption, with alpha=0.05 (two-tailed) and 80% statistical power, the required sample is 95 participants per group (N=190 total). Accounting for an anticipated 20% dropout rate, the adjusted target is 119 per group. The planned sample of N=240 (120 per group) provides 80% power at g=0.41 after accounting for dropout, with additional margin for feasibility.

FEASIBILITY REVIEW After enrollment of 100 participants, a feasibility review will assess recruitment rate, protocol adherence, and dropout rate. No interim efficacy analysis is planned. Sample size may be revised upward based on observed attrition. Recruitment will continue beyond N=240 if feasible within the planned recruitment period.

• Scale of Body Connection - Bodily Dissociation subscale (SBC-BD) [Time frame: Baseline and 6 weeks]
• Difficulties in Emotion Regulation Scale (DERS) - total score [Time frame: Baseline and 6 weeks]
• Toronto Alexithymia Scale (TAS-20) - total score [Time frame: Baseline and 6 weeks]
• Dissociative Experiences Scale (DES) - total score [Time frame: Baseline and 6 weeks]
• Penn Alcohol Craving Scale (PACS) [Time frame: Baseline and 6 weeks]
• Cognitive and Affective Mindfulness Scale Revised - Polish version (CAMS-R-PL) [Time frame: Baseline and 6 weeks]
• Reflective Functioning Questionnaire (RFQ) [Time frame: Baseline and 6 weeks]
• Beck Depression Inventory II (BDI-II) [Time frame: Baseline and 6 weeks]
• State-Trait Anxiety Inventory (STAI) [Time frame: Baseline and 6 weeks]
• Self-Body Identification - Circles measure [Time frame: Baseline and 6 weeks]
• Timeline Follow-Back (TLFB) - alcohol use [Time frame: 4 weeks, 6 months, and 12 months post-discharge]