It is my pleasure to announce that the very first review paper summarizing the theoretical rationale and empirical evidence for Mindfulness-Oriented Recovery Enhancement (MORE) has been accepted for publication in the prestigious journal Annals of the New York Academy of Sciences. In this paper, I review data from multiple clinical studies on the biobehavioral mechanisms of MORE, and articulate a hedonic regulatory model of the intervention – proposing that restructuring reward processing is the final common pathway through which MORE ameliorates addiction, stress, and pain. I map this novel theoretical model onto an earlier conceptual framework of the neural circuitry underlying mindfulness-centered regulation of addiction (Garland, Froeliger, & Howard, 2014) and then describe new neuroimaging and psychophysiological data in support of the model. The paper abstract is as follows:
“Though valuation processes are fundamental to survival of the human species, hedonic dysregulation is at the root of an array of clinical disorders including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders. To address this crucial clinical issue, novel interventions are needed to restore hedonic regulatory processes gone awry in persons exhibiting addictive behaviors. This article describes theoretical rationale and empirical evidence for the effects of one such new intervention, Mindfulness-Oriented Recovery Enhancement (MORE), on top-down and bottom-up mechanisms implicated in cognitive control and hedonic regulation. MORE is innovative and distinct from extant mindfulness-based interventions in that in unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction – something that no other behavioral intervention has been designed to do. Though additional studies are needed, clinical and biobehavioral data from several completed and ongoing trials suggest that MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.”
I am feeling particularly thankful today to my colleagues Norman Farb (University of Toronto), Philippe Goldin (University of California – Davis), and Barbara Fredrickson (University of North Carolina – Chapel Hill), with whom I wrote and recently published the target article for the December issue of the esteemed, international journal Psychological Inquiry. Our target article, entitled “Mindfulness Broadens Awareness and Builds Eudaimonic Meaning: A Process Model of Mindful Positive Emotion Regulation,” articulates the Mindfulness-to-Meaning Theory, a new conceptual model of the cognitive, emotional, and neurobiological processes by which mindfulness might stimulate positive psychological states and lead to a sense of meaning in the face of adversity. In brief, the Mindfulness-to-Meaning Theory asserts that mindfulness allows one to decenter from stress appraisals into a metacognitive state of awareness that broadens attention to previously unnoticed pieces of information about one’s life, accommodating a reappraisal (i.e., a reframing) of adverse circumstances that reduces distress and promotes positive emotions. This reappraisal is then deepened and enriched when one savors what is pleasant, growth promoting, or meaningful in life, a process which motivates values-driven behavior and engenders a deeper sense of purpose and self-actualization.
The entire journal issue is devoted to the discussion of our new Mindfulness-to-Meaning Theory. Our work was the subject of 10 erudite commentaries from leading scholars in the fields of contemplative science, addiction neuroscience, clinical psychology, affective science, psycho-oncology, social psychology, and consciousness studies, who extended, challenged, and pushed our theory into new and wider applications. We responded to the commentaries with our own article “The Mindfulness-to-Meaning Theory: Extensions, Applications, and Challenges at the Attention–Appraisal–Emotion Interface,” which broadens the theory to address how mindfulness re-configures structures within working memory, describes mindfulness as a domain general resource for promoting emotion regulation flexibility, and suggests future directions to be pursued toward the establishment of a more comprehensive contemplative science.
May our work help advance the field to promote human flourishing!
Earlier this year, along with colleagues Marieke Wichers, Nicole Geschwind, and Frenk Peeters (Maastrict University and University of Groningen), I published a paper on the effects of mindfulness training on the dynamic change trajectories of positive emotions and thoughts over time. This study analyzed data from a randomized controlled study of 110 individuals with histories of depression who were randomly assigned to receive an 8-week Mindfulness-Based Cognitive Therapy intervention or a control condition. Study participants rated their experiences of positive emotions and thoughts on a daily basis using a method called “experience sampling” (also known as ecological momentary assessment, or EMA), in which they were prompted at random times throughout the day to describe their mental state in the midst of everyday life activities. To analyze this data, we employed a sophisticated statistical technique called multivariate autoregressive latent trajectory modeling (see the Figure above). We found that mindfulness training significantly enhanced positive emotions and positive thoughts from moment-to-moment. Importantly, we also found evidence that mindfulness training may stimulate an upward spiral of positivity, such that increasing experiences of positive emotions on one day stimulated positive emotions and thoughts on the following day, and so forth. In other words, it appears as mindfulness training can enhance positive emotion-cognition interactions that may be important to psychological flourishing (and physical health). These data provide support for my new Mindfulness-to-Meaning Theory (see the Figure above), which will be featured on this website in a month or two when my paper about this theory will be published as the target article of the December issue of the esteemed international journal Psychological Inquiry and receive commentary by some of the leading contemplative scientists in the world. Stay tuned!
A research paper I published along with Adam Hanley (first author) in the journal Mindfulness has received an astounding amount of press, including coverage by the Wall Street Journal, Time Magazine, and television outlets like the Today Show! This deceptively simple study involved randomly assigning college students to read a passage by Thich Nhat Hanh on mindful dishwashing or a textual description of dishwashing procedures like what might be found in a home economics textbook, Then students washed a sink full of dirty dishes, and then completed state measures of mindfulness and positive and negative emotions. After controlling for differences in baseline tendencies towards mindfulness and well-being, we found that individuals who received the mindful dishwashing induction reported significantly deeper states of mindfulness, as well as some improvements in positive and negative emotions following dishwashing. Perhaps most interestingly, people who engaged in mindful dishwashing reported a slowing of perceived time (that is, they overestimated the length of time they spent washing dishes) – a finding that is consistent with research on “flow states” and other studies of mindfulness (e.g., Berkovitch-Ohana et al., 2012). As we note in the published paper, it is fascinating to observe “that a task potentially construed as unpleasant or a “chore” can be experienced as reducing nervousness and being inspirational by simply shifting one’s approach to the task and the quality of attention” (Hanley et al., 2015, p. 1101). This simple study has implications for research on mindfulness, suggesting that the informal practice of mindfulness during everyday life activities may be an important means of cultivating attention and awareness in much the same way as formal mindfulness meditation. More research is needed to outline the differences and similarities between formal and informal mindfulness practices.
I have been honored by being selected as a University of Utah Presidential Scholar. According to the press release, “the Presidential Scholar award was created to support the work of exceptionally promising mid-career faculty at the University of Utah.” The purpose of the award is to honor “individuals who are significant contributors to scholarship, education, and outreach at the University of Utah.” The Presidential Scholar awards provide three years of support for scholarly, teaching, and/or outreach activities. I intend to use this award to support my research on Mindfulness-Oriented Recovery Enhancement as a treatment for addiction, stress, and pain.
2-day MORE Basic Training Workshop July 11-12, 2015
Huntsman Cancer Institute, Wellness and Integrative Health Center, Salt Lake City, UT
A 2-day training workshop in Mindfulness-Oriented Recovery Enhancement will be held July 18-19, 2014, at the Huntsman Cancer Institute Wellness and Integrative Health Center in Salt Lake City, UT. This training is designed for licensed health care professionals (social workers, psychologists, counselors, physicians, nurses, etc.) working with clients suffering from addiction, chronic pain, and stress-related conditions.
During this state-of-the-art two-day basic training workshop, participants will learn to use mindfulness and related therapeutic skills to address substance use disorders, psychological distress, and chronic pain conditions. Dr. Eric Garland, PhD, LCSW, one of the world’s leading experts on mindfulness and the developer of Mindfulness-Oriented Recovery Enhancement (MORE), will explain the techniques, theory, and science behind this innovative, evidence-based treatment approach which has been tested in clinical trials funded by the National Institutes of Health. Research evidence on the MORE model will be presented, along with a review of the latest discoveries in neuroscience and basic biobehavioral science about mindfulness, stress, addiction, and chronic pain. Applications to cancer survivorship will also be discussed.
Participants will practice the therapeutic techniques outlined in the MORE treatment manual (Garland, 2013) via clinical role plays. Participants will receive live supervision in delivery of therapeutic techniques by Dr. Garland, who will observe participants and provide continual, real-time feedback to optimize the delivery of therapeutic interventions.
At the completion of this 2-day workshop, participants will have a basic level of competency to use the MORE treatment manual to implement MORE for persons suffering from addictive behaviors, stress-related conditions, and/or chronic pain.
Participants must be graduate-level mental health or health care providers. This training is also open to graduate students in mental health and health care fields.
$500 registration fee includes breakfast and lunch both days, as well as 13 CEUs endorsed by the Utah National Association of Social Workers (NASW). University of Utah employees will receive a 20% discount. A portion of the proceeds will be donated to the Wellness and Integative Health Center at Huntsman Cancer Institute.
To register now (space is limited), go to https://squareup.com/market/drericgarland
I recently learned that my research on Mindfulness-Oriented Recovery Enhancement (MORE) was highlighted on the National Institute on Drug Abuse website. The NIDA news story, entitled “Mindfulness training may reduce deficits in natural reward processing during chronic pain or drug addiction” details a study I conducted with my colleagues Brett Froeliger (Neuroscience, Medical University of South Carolina) and Matthew Howard (Social Work, University of North Carolina at Chapel Hill) that was published in April in the Journal of Behavioral Medicine. According to the excellent summary of this research on the NIDA website,
“Drug-dependent people show decreased behavioral and brain reactivity to natural rewards compared to non-drug users. As a result, drug-dependent users increasingly focus their attention on obtaining the drug instead of attending to natural rewards. Recent research shows that a cognitive-based intervention may help restore natural reward processing in opioid-dependent participants.
In this study, chronic pain patients at risk for opioid misuse were randomized to either eight weeks of a Mindfulness-Oriented Recovery Enhancement (MORE) intervention or to an eight-week support group (control). Participants in the MORE intervention used mindfulness meditation to focus on all sensory features of a pleasant experience or object (for example, a beautiful nature scene like a sunset), while reflecting on any positive emotions arising in response to the pleasant event. The support group discussed topics and emotions related to chronic pain and opioid use/misuse. Following these interventions, all participants were shown images representing natural rewards (such as endearing animals, appealing foods, landscapes) or neutral images (furniture, neutral facial expressions, or household items). Researchers measured late positive potential (LPP) brain activity, which reflects attention to emotionally salient information, while participants viewed these images. In comparison to the control group, participants completing the MORE intervention showed greater LPP responses to natural reward images relative to neutral images and greater the LPP responses predicted reduced opioid cravings as reported by the participants.”
These results suggest that teaching people who misuse opioids to mindfully attend to positive aspects of their life may increase the perceived value of natural rewards – processes that may be diminished in those facing chronic pain or addiction – which may in turn help them to control opioid cravings.”
It is thrilling to see that this line of research is making a positive impact on the scientific community, and of course, the ultimate aim of this work is to alleviate human suffering.