New Interview on Working with Addiction and Pain for the Mind & Life Podcast

I’m excited to share my recent interview with my good colleague Wendy Hasenkamp on the Mind & Life podcast!

We cover some fascinating topics including:

  • how my clinical psychotherapy practice informed my scientific research;
  • the power of mindfulness meditation to heal and restore well-being;
  • self-transcendence and non-dual states of consciousness;
  • how addiction changes reward processing and attention in the brain;
  • Mindfulness-Oriented Recovery Enhancement (MORE), and its application to treating addiction and chronic pain;
  • how reappraisal can help in difficult situations;
  • the role of savoring and reconnecting with natural rewards;
  • deconstructing pain;
  • the effects of mindfulness meditation on brain function;
  • and exciting results from a large clinical trial showing how effective MORE is, and how it might work.

Click here to listen now: https://podcast.mindandlife.org/eric-garland/ or you can subscribe to the show on Spotify or other preferred players. I hope you enjoy it!

 

Mindfulness-Oriented Recovery Enhancement as a Treatment for Pain and Addiction: From Hedonic Pleasure to Self-Transcendent Meaning

In December 2020, I gave a lecture on my research entitled “Mindfulness-Oriented Recovery Enhancement Heals Opioid Misuse and Chronic Pain by Restructuring Reward: From Hedonic Pleasure to Self-Transcendent Meaning” to the Brown University Contemplative Studies Initiative. Following this talk, I enjoyed a fascinating dialogue about the relationship between mindfulness and self-transcendence with a leading scholar of Classical Chinese Philosophy and Taoism, Hal Roth, PhD. The video of my talk is below. Enjoy!

New Podcast Interview on Mindfulness, Pain, and Addiction

I had a great podcast with Dr. Santosh Rao, Medical Director of the James M Cox Foundation Center for Cancer Prevention and Integrative Oncology at Banner MD Anderson for his Integrative Oncology Talk – a podcast of the Society for Integrative Oncology.

We had a fantastic conversation ranging from how chronic pain and cancer pain are distinct at the neurophysiological and psychological levels, to how mindfulness can be used to modify how pain is experienced in the brain, to the problem of opioid misuse and how it leads to inability to regulate positive and negative emotions, and finally, to how finding meaning in the face of adversity can culminate in the experience of self-transcendence – an crucial pathway to recovery. We focused heavily on my research on Mindfulness-Oriented Recovery Enhancement as well as my clinical experiences at Huntsman Cancer Institute treating cancer patients with mind-body therapies. Thanks Santosh for an excellent interview!

Learn to Use Mindfulness for Pain and Addiction: MORE Training September 25-26

We are 10 days away from the next Mindfulness-Oriented Recovery Enhancement (MORE) training! There are still a few seats left. The training will be held online via Zoom on September 25-26, 2020.

A registration link can be found here.

MORE is an evidence-based, transdiagnostic therapy that unites complementary aspects of mindfulness training, third-wave CBT, and principles from positive psychology into an integrative treatment approach for addiction, stress, and chronic pain. MORE’s therapeutic effects have been demonstrated in ten clinical trials, and the MORE research program is currently supported by more than $25 million in federal research grants from the National Institutes of Health (NIH), the Department of Defense (DOD), and the Patient Centered Outcomes Research Institute (PCORI). Rigorous experiments have demonstrated effects of MORE on modifying neurophysiological reactivity to drug cues and natural rewards – indicating that MORE leads to therapeutic changes in the brain.

Participants receive intensive didactic and experiential instruction in implementing specialized mindfulness techniques and other clinical skills integral to Mindfulness-Oriented Recovery Enhancement (MORE). 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, addiction, and chronic pain.

Participants will practice the therapeutic techniques outlined in the MORE treatment manual (Garland, 2013) via clinical role plays. Participants will receive live supervision from Dr. Garland in the delivery of therapeutic techniques via real-time feedback to optimize the delivery of the MORE intervention.

Unique mind-body therapy techniques, advanced cognitive-behavioral skills, and strategies from positive psychology will be presented to address common clinical problems including:

  • Craving and unhealthy habit behaviors
  • Physical and emotional pain
  • Catastrophizing and rumination
  • Stress reactivity and anhedonia

At the completion of the training workshop, participants will have a basic level of competency to use the MORE treatment manual to implement MORE for persons suffering from addictive behaviors and chronic pain conditions.

Training in MORE is provided at institutions of higher education, government agencies, academic teaching hospitals, and medical centers. To date, Dr. Garland has provided training in MORE to >200 clinicians from a range of settings, including Johns Hopkins Medical School (Maryland), Mt. Sinai Hospital (New York), Medical University of South Carolina (South Carolina), Intermountain Healthcare (Utah), Southwest Care Center (New Mexico), New Roads Behavioral Health (Utah), Philadelphia Veterans Affairs Medical Center (Pennsylvania), Neuroscience Associates of New York (New York), Triangle Options for Substance Abusers (North Carolina), the University of Zurich, among others.

The cost of the training is $500 for 13 NASW-approved CEUs (with a 20% discount for graduate students). Register here.

Dr. Garland Discusses MORE for Chronic Pain and Addiction, Mindfulness Neuroscience, and Self-Transcendence – Full Podcast

I was recently interviewed by renowned psychotherapist Lisa Dale Miller for her Groundless Ground Podcast about a range of topics. It was definitely my favorite interview I’ve had to date. Lisa and I had a really fun conversation ranging from the treatment of chronic pain and addiction with mindfulness, to the neuroscience of reward, to Buddhist philosophy, to self-transcendence, and finally, to the arcane Tantric notion that the dynamic Primordial Bliss of Consciousness lies at the heart of all experience.

Eric Garland Interviewed on Groundless Ground Podcast by Lisa Dale Miller

Using my research on Mindfulness-Oriented Recovery Enhancement (MORE) as a launchpad, Lisa and I delve into specific clinical issues around the use of meditation as a means of alleviating physical pain and drug craving, providing mindfulness instruction to people suffering trauma, and how to enhance the sense of meaning and joy in life through reappraisal and savoring. We dig deep into the science of restructuring reward processes in the brain as novel approach to addictions treatment. Finally, we give a brief history of the science of mindfulness and how it developed from a core of mechanistic cognitive psychology to begin to explore the outer edge of meditative states of consciousness – including the study of how people can transcend their limited sense of self and come to feel intimately interconnected with the world around them.

We let it all hang out! Come check it out! The podcast is also available on Spotify.

New Science Advances Publication on the Neuroscience of MORE Covered by News Outlets

Effect of MORE on Neural Indices of Opioid Cue-Reactivity Revealed by EEG

My new paper published in the prestigious journal Science Advances reporting effects of Mindfulness-Oriented Recovery Enhancement on brain reward responses among chronic opioid users has been covered by multiple news outlets, including the Los Angeles Times, the Durham Herald-Sun, the Fort Worth Star Telegram, Science Daily, and the American Association for the Advancement of Science, among others. The paper can be downloaded for free here.

Cultivating Joy through Mindfulness: An Antidote to Opioid Misuse, the Disease of Despair

New research shows that a specific mind-body therapy, Mindfulness-Oriented Recovery Enhancement (MORE), increases the brain’s response to natural, healthy rewards while also decreasing the brain’s response to opioid-related cues.

Brain function during viewing of opioid- and natural reward-related images was assessed with EEG

The study, published today in the journal Science Advances, examined data from four experiments involving 135 adults who took opioids daily for chronic pain. The study participants were randomly assigned to two groups where they participated in eight weeks of MORE or eight weeks of a therapist-led support group. At the beginning and end of the study period, researchers collected electroencephalogram (EEG) data, which measures brain function through electrical activity at the scalp.

The results showed that over the course of the study, the brains of the study participants in the MORE group became significantly less reactive to cues related to their opioid medications, while also becoming significantly more responsive when participants used mindfulness to savor natural pleasure.

“Previous research shows that prolonged use of opioids makes our brains more sensitive to pain and less receptive to the joy one might normally experience from natural rewards, like spending time with loved ones or appreciating a beautiful sunset,” explained Eric Garland, associate dean for research at the University of Utah College of Social Work and lead author of the study. “This blunted ability to experience natural positive feelings leads people to take higher and higher doses of opioids just to feel okay, and ultimately propels a downward spiral of opioid dependence and misuse. Because of this downward spiral, scholars are increasingly referring to chronic pain and opioid misuse as ‘diseases of despair.’” 

“The results of this study show that MORE can actually reverse that devastating trajectory,” said Garland.

In addition to these objective EEG findings, participants in MORE also reported feeling enhanced joy and more meaning in life, results which Garland detailed in a paper published earlier this month in the Journal of Consulting and Clinical Psychology. They also reported experiencing significantly less pain and greater positive psychological health (positive emotions, the ability to savor natural pleasure and self-transcendence) than those in the support group. The study concluded that three months after treatment, MORE reduced risk of opioid misuse by increasing positive psychological health and decreasing pain. 

Garland developed MORE as an integrative mind-body therapy designed to promote positive psychological health while simultaneously addressing addiction, pain and stress. MORE teaches mental training techniques to help people to find meaning in the face of adversity while simultaneously alleviating physical and emotional pain by cultivating positive feelings and experiences.

“MORE teaches people to better notice, appreciate and amplify the good things in life, while also deriving meaning and value from difficult situations,” said Garland.

Taken together, Garland explains, these studies indicate that by changing brain function and promoting positive psychological health, MORE may increase happiness and an enhanced sense of meaningfulness in the face of adversity. These positive psychological effects, in turn, appear to reduce pain and prevent the misuse of opioids. Thus, enhancing joy and meaning in life through mindfulness may be an antidote to diseases of despair, Garland explains.

It is estimated that approximately 20-30 percent of U.S. adults experience chronic pain. Opioid painkillers are often prescribed to these patients, but a quarter of those who take these powerful drugs long-term end up misusing them. With opioids accounting for 63 percent of all drug overdose deaths in 2015, the widespread misuse of this class of drugs has been deemed a public health crisis. 

“Our nation’s opioid crisis kills more than 100 people a day,” said Garland. “So it is critical that we help develop new and effective ways to prevent opioid misuse. The data shows that MORE can play that key role.” 

MORE Reduces Opioid Craving and Pain Among People on Medication Assisted Treatment for Opioid Use Disorder: NIH Spotlight

Results from a research study on Mindfulness-Oriented Recovery Enhancement have been covered as a research spotlight on the webpage of the National Institutes of Health – National Center for Complementary and Integrative Health (NCCIH). This randomized controlled pilot study, funded by NCCIH, tested the effects of MORE among individuals receiving medication assisted treatment (MAT) for opioid use disorder (OUD). Participants received 112 random assessments delivered by smartphone over the course of 8 weeks of treatment with MORE or treatment as usual (TAU). Compared to TAU, participants in the MORE intervention reported a 50% reduction in the intensity of their opioid cravings, as well as significantly greater self-control over cravings. In addition, participants reported significant improvements in pain unpleasantness, stress, and positive emotions. Although participants in TAU received more than 6 hours of therapy per week, the effects of MORE were evident above and beyond that intensive degree of treatment, suggesting that MORE may be a useful adjunct to community-based MAT. The full study results were published in the flagship addictions journal Drug and Alcohol Dependence.

New Research Funding: Understanding the Neural Mechanisms of MORE as a Treatment for Smoking Cessation

Along with my colleagues Drs. Brett Froeliger and nidaMichael Saladin (Medical University of South Carolina), I was recently awarded a 5-year, $2.3 million grant from the National Institute on Drug Abuse to study the neural mechanisms of Mindfulness-Oriented Recovery Enhancement (MORE) as a smoking cessation intervention. In this study, 100 smokers will be randomly assigned to receive eight sessions of MORE or eight sessions of cognitive-behavioral therapy (CBT) to assist them in quitting smoking. Before and after the eight session intervention, participants will complete a task while their brain activity is being recorded in a fMRI scanner to measure their neural response natural rewards and cigarette cues. According to the allostatic model of addiction, as addiction progresses, the brain becomes hypersensitive to drug-related cues and triggers, and insensitive to natural, healthy rewards and pleasures, resulting in a lack of hedonic pleasure and dysphoria that pushes the individual to take higher and higher doses of the drug just to feel okay. This study is designed to test my restructuring reward hypothesis, which states that mindful savoring can reduce addictive behaviors by causing a shift in brain reward circuitry from valuing of drug-related rewards back to valuing natural rewards – reversing the allostatic process of addiction. This new research grant builds upon our earlier published proof-of-concept study showing that MORE increases savoring-related neural activation in the MORE-fMRI-SBmedial prefrontal cortex and ventral striatum – key reward-related brain areas. This increase in brain activity was associated with significant reductions in cigarette smoking. Here we will seek to replicate this finding using a rigorous, randomized clinical trial design. It is my sincere hope that this work will help to free people from smoking – the leading cause of preventable death in the United States.

Research on MORE and Mindfulness Covered in the News

Results from a new Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), to be published later this summer in the Journal of Consulting and Clinical Psychology, have been covered in a news story that also details findings from a recently published study of the effects of mindfulness on deautomatization of habit behaviors. A second news story also did a really nice job describing results from this study.

Results from this study, conducted in 95 people with chronic pain who had been prescribed long-term opioid therapy, demonstrate that MORE significantly decreased chronic pain intensity and significantly decreased the risk of future opioid misuse. Further, MORE boosted a range of positive psychological functions, including positive emotions, savoring, meaning in life, and the sense of self-transcendence. Importantly, the MORE’s effects on reducing pain and opioid misuse were linked with these increases in positive psychological functioning, suggesting that teaching people to “savor the good” and increase the sense of joy, meaningfulness, and natural healthy pleasure in life may be an antidote to the current pain and opioid crises in America – modern epidemics that have been termed “diseases of despair.”

This is the second randomized controlled trial to demonstrate therapeutic effects of MORE on chronic pain symptoms and opioid misuse, providing compelling evidence of MORE’s efficacy as a means of alleviating the suffering caused by the opioid crisis.