Mindfulness-Oriented Recovery Enhancement (MORE)
An Overview
Mindfulness-Oriented Recovery Enhancement (MORE) is an evidence-based therapy, supported by more than 12 clinical trials and over $60 million in federal research grants (e.g., National Institutes of Health, Department of Defense, Patient-Centered Outcomes Research Institute), that unites complementary aspects of mindfulness training, “third wave” cognitive-behavioral therapy, and principles from positive psychology into an integrative therapeutic approach. The MORE program is detailed in a treatment manual designed for use by therapists (and patients). Eric Garland, PhD, LCSW developed MORE by translating fundamental discoveries from cognitive and affective neuroscience into therapeutic strategies that reduce addictive behavior, emotional distress, and chronic pain, while simultaneously increasing healthy pleasure, meaning in life, and self-transcendence. MORE has been shown to be nearly three times as effective as standard therapy for treating addiction and chronic pain.
The History of MORE
To learn about the history of MORE, listen to this Mind and Life Podcast interview with Dr. Garland.
Training and Certification in MORE
Training in MORE is available for health care professionals, psychotherapists, addiction treatment providers, and graduate students through various formats (e.g., in-person, online). Training involves: a) experiential skill practice in multiple mind-body techniques; b) live feedback/supervision to hone intervention delivery and processing; and c) education in the conceptual frameworks underlying the MORE intervention. A certification process is underway. Certification involves completion of basic and advanced training in MORE, plus demonstration of therapist adherence and competence using the validated MORE Fidelity Measure (Hanley & Garland, 2020).
Implementing MORE in Health Care
Eric Garland, PhD, LCSW has trained individual clinicians (e.g., social workers, psychologists, physicians, nurses, counselors, physical therapists, etc.) and health care systems to implement MORE as an intervention for people with complex, chronic, and overlapping health and mental health conditions. To date, Dr. Garland has provided training in MORE to over 800 clinicians from a range of settings (e.g., medical centers, addiction treatment, behavioral health, community-based clinics, institutions of higher education, state and local government, the military health system), including…
John Hopkins Medical School Maryland
Mt. Sinai Hospital New York
Intermountain Health Care Utah
Southwest Care Center New Mexico
New Roads Behavioral Health Utah
Medical University of South Carolina South Carolina
University of Utah Health Utah
Philadelphia Veterans Affairs Medical Center Pennsylvania
Turning Point Center Utah
Ralph H. Johnson Veterans Affairs Medical Center South Carolina
Kaiser Permanente Washington
Essentia Health Minnesota
Hennepin Healthcare Minnesota
Neuroscience Associates of New York New York
Triangle Options for Substance Abusers North Carolina
Saint Luke’s Cancer Institute Kansas
Brooke Army Medical Center Texas
Darnall Army Medical Center Texas
Madigan Army Medical Center Washington
Wilford Hall Hospital Texas
Tripler Army Medical Center Hawaii
Schofield Barracks Hawaii
The University of Zurich Switzerland
The University of Fribourg Switzerland
and others.
In January 2021, Essentia Health, a large integrated healthcare organization serving over 670,000 patients across three states (MN, WI, ND), began implementing MORE as an insurance-reimbursable service through group medical visits delivered by primary care providers – a signal moment in the dissemination of MORE. In other health systems, MORE has also been delivered as an insurance-reimbursable service via group and individual psychotherapy formats, as well as through Health Behavior Assessment and Intervention (HBAI) procedure codes. Pioneers like Essentia are paving the way for other large scale health systems to integrate this highly efficacious, evidence-based practice into standard medical care and reach the greatest number of people in need.
Providers have been trained in MORE across multiple cities in the U.S. and internationally:
Research Evidence on MORE
Over the past decade, MORE’s therapeutic outcomes and mechanisms have been studied in multiple Stage 1, Stage 2, and Stage 3 randomized clinical trials supported by a $50+ million treatment development research program funded by the National Institutes of Health, the Department of Defense, and the Patient Centered Outcomes Research Institute.
In 2022, the largest clinical trial of MORE for patients with opioid-treated chronic pain (N=250) was published in a leading medical journal, JAMA Internal Medicine. In this trial, MORE was shown to decrease opioid misuse by 45% nine months after the end of the treatment, nearly tripling the effect of standard psychotherapy (Odds Ratio 2.94 at 9-month follow-up). In addition, 50% of patients treated with MORE achieved clinically-significant reductions in pain severity. Finally, although nearly 70% of patients met criteria for major depressive disorder at the beginning of the trial, the mean depression symptom severity score for patients treated with MORE no longer surpassed the threshold for major depression by the end of the study.
In 2023, two randomized clinical trials were completed demonstrating the efficacy of MORE: a) as an intervention to reduce chronic pain and opioid use among veterans and military personnel, and b) as an intervention for patients with illicit opioid use disorder being treated with methadone. With respect to illicit opioid use disorder, adding MORE to standard addictions treatment was shown to significantly reduce the risk of addiction relapse and decrease days of drug use relative to standard addictions treatment without MORE. Multiple additional RCTs are now underway in the United States and Europe to test the efficacy and mechanisms of MORE as a intervention for: c) heroin addiction; d) chronic low back pain in civilians and active duty military personnel; e) chronic knee pain in active duty military personnel undergoing knee replacement surgery; f) fibromyalgia, and g) smoking cessation. These studies include full-scale efficacy trials and later stage comparative effectiveness trials that will help to advance the implementation and dissemination of MORE as an empirically-supported intervention, as well as neuroscientific investigations to understand how MORE changes the brain and body.
Dr. Eric Garland and his colleagues have published numerous scientific studies about MORE. To access research publications on MORE, read below.
Research Conflict of Interest Disclosure
Eric Garland, PhD, LCSW is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in MORE and mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland is also a consultant and licensor to BehaVR, LLC.