In a recent bibliometric analysis of mindfulness research published over the past 55 years, I was found to be the most prolific author of mindfulness research in the world. While I’m truly honored and humbled by this achievement, the real meaning of this body of work goes beyond numbers and world records. My deepest aspiration is that the scientific discoveries I’ve made over the past 15 years will reduce suffering and advance human flourishing.
Are you a behavioral health clinician (social worker, psychologist, counselor, etc.) looking for a job centered on mindfulness? Here’s a full-time job opportunity delivering Mindfulness-Oriented Recovery Enhancement (MORE) to active duty military personnel undergoing knee replacement surgery for a new research study funded by the Department of Defense. I am the PI on the study, but the position is through the Geneva Foundation. If you are interested, please reach out to me (firstname.lastname@example.org), or apply at the link below:
On May 4, I had the honor of giving an invited lecture for the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health, entitled “Healing the Opioid Crisis with Mindfulness-Oriented Recovery Enhancement: Clinical Efficacy and Neurophysiological Mechanisms.” The full video of this lecture can be found here. In this lecture, I described my decade-long research program focused on developing and testing MORE as a treatment for chronic pain, opioid misuse, and addiction, and reported results from the largest clinical trial of MORE to date.
I began the talk discussing the destructive processes that unwittingly propel a person suffering from prolonged pain down the path toward an eventual loss of control over opioid use. I have been studying these risk mechanisms undergirding opioid misuse and OUD in people with chronic pain for more than a decade, and the discoveries I have made, along with great science from the field, informed the development of MORE. Then I described the Mindfulness-to-Meaning Theory, a key theoretical framework underlying MORE, as well as MORE’s treatment components, including mindfulness meditation, reappraisal, and savoring. Finally, I detailed MORE’s clinical outcomes and mechanisms of action across four randomized controlled trials involving nearly 500 patients. MORE works by strengthening self-control, reducing the brain’s reactivity to drug cues, increasing the brain’s response to natural, healthy rewards, enhancing meaning in life, and eliciting experiences of self-transcendence.
Following the lecture, I had a fascinating dialogue with the Director of NCCIH, Dr. Helene Langevin, and the Deputy Director of NCCIH, Dr. David Shurtleff about the emergence of self-transcendence in biological systems and its impact on health, and the use of mindfulness as a prevention and treatment strategy. This dialogue then opened up into a fantastic question and answer period. After the talk, I had the honor of discussing my research with multiple program directors and branch chiefs at NIH. If you didn’t have a chance to listen in, you can still watch the videocast here!
The National Center for Complementary and Integrative Health (NCCIH) invites you to join us this spring for exciting lectures on the theme of “Novel Approaches at the Intersection of Mental Health and Pain.” These virtual talks, part of our Integrative Medicine Research Lecture Series will take place on Tuesday, May 4, 2021, and Tuesday, June 8, 2021. The lectures, rescheduled from spring 2020, will be streamed live on NIH VideoCast.
May 4 Lecture Featuring Eric Garland, Ph.D., L.C.S.W.
On Tuesday, May 4 from noon to 1 p.m. ET, Eric Garland, Ph.D., L.C.S.W., will present “Healing the Opioid Crisis with Mindfulness-Oriented Recovery Enhancement (MORE): Clinical Efficacy and Neurophysiological Mechanisms.” Dr. Garland is professor and associate dean for research at the University of Utah College of Social Work and director of the Center on Mindfulness and Integrative Health Intervention Development (C-MIIND).
Dr. Garland notes that some of our most pressing “diseases of despair,” such as addiction and chronic pain, disrupt the brain’s capacity to experience healthy pleasure and extract meaning from naturally rewarding events and experiences. Prolonged opioid use, for example, in the context of chronic pain and distress can blunt positive emotions and compel opioid misuse as a way to hold on to the shrinking sense of well-being. Dr. Garland will describe development and testing of MORE, an integrative treatment strategy.
In anticipation of the lecture, the Blog Team asked Dr. Garland a couple of questions.
1) What are the building blocks of MORE?
Dr. Garland: MORE unites complementary aspects of training in several skill areas:
- Mindfulness skills enhance self-awareness, alleviate pain, and strengthen self-control over automatic, addictive habits.
- Reappraisal skills facilitate reframing of adverse life events as a potential source of psychological growth.
- Savoring skills increase a healthy sense of pleasure, joy, and meaning in life and elicit experiences of self-transcendence—the sense of being connected to something greater than oneself.
2) What are some of the insights from affective neuroscience that inform MORE?
Dr. Garland: First, the brain’s reward system computes the relative value of competing rewards. As addiction progresses, the brain’s reward system changes to become more sensitive to drug-related rewards and less sensitive to natural, healthy pleasures. MORE incorporates mindfulness, reappraisal, and savoring skills to reverse this process. A second fundamental insight is that the brain constructs the pain experience from bodily signals. In MORE, we teach patients to use mindfulness to view their chronic pain as harmless sensory information, not a threat to bodily well-being. This approach reduces the emotional suffering associated with pain, which in turn can decrease the severity of pain.
My new theory paper was just published online in Current Opinion in Behavioral Sciences. This paper outlines my recent ideas about how an addictions treatment approach based on mindfulness can enhance healthy pleasure, joy, and meaning in life. Most addictions treatments are focused on decreasing negative psychological experiences (e.g., stress, craving) and unhealthy behaviors. Few have focused on increasing positive psychological experiences as a core treatment approach. This oversight ignores fundamental discoveries from addiction neuroscience that demonstrate the plasticity of the brain reward circuitry underlying addiction. Therapies that use mindfulness techniques to savor natural rewarding objects and events, self-generate internal reward responses, and access self-transcendence may remediate the dysfunction in the reward system and thereby reduce addictive behavior.
The abstract is below:
Chronic drug use is theorized to induce cortico-striatal neuroplasticity, driving an allostatic process marked by increased sensitivity to drug-related cues and decreased sensitivity to natural rewards that results in anhedonia and a dearth of positive affect. As such, positive emotion regulation represents a key mechanistic target for addictions treatment. This paper provides a conceptual model detailing how mindfulness may synergize a range of positive affective mechanisms to reduce addictive behavior, from savoring the hedonic pleasure derived from natural rewards, to self-generating interoceptive reward responses, and ultimately to cultivating self-transcendent meaning. These therapeutic processes may restructure reward processing from overvaluation of drug-related rewards back to valuation of natural rewards, and hypothetically, ‘reset’ the default mode network dysfunction that undergirds addiction.
The National Institutes of Health (NIH) MedlinePlus Magazine covered my research on Mindfulness-Oriented Recovery Enhancement (MORE), by focusing on the personal story of one of the participants in my recently completed R01-funded clinical trial of MORE. Also, NIH MedlinePlus did a story on MORE and how it can help people reduce chronic pain while taking fewer opioids. It’s always a huge honor for my work to be recognized by the leading health science organzation in the world. Thank you NIH!!!
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!
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!
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!
The next Mindfulness-Oriented Recovery Enhancement (MORE) training will be held online via Zoom on October 15-16, 2021.
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), Essentia Health (Minnesota, Wisconsin, and North Dakota), 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 (Switzerland), among others.
The cost of the training is $500 for 13 NASW-approved CEUs (with a 20% discount for graduate students). Register here.