drericgarland Addiction, Chronic Pain, MORE, Neuroscience, Opioids, Research

Neurophysiological Evidence for Remediation of Reward Processing Deficits in Chronic Pain and Opioid Misuse Following Treatment with Mindfulness-Oriented Recovery Enhancement

A new and important research study from my lab was recently accepted for publication in the respected Journal of Behavioral Medicine. This paper, which I wrote with my colleagues Brett Froeliger, Ph.D., and Matthew Howard, Ph.D., describes neurophysiological findings from a pilot randomized controlled trial (RCT) of Mindfulness-Oriented Recovery Enhancement (MORE) for chronic pain patients who had been prescribed long-term opioids for pain management. To my knowledge, this exploratory study is the first in the scientific literature to demonstrate that a mindfulness-based intervention can increase electroencephalographic (EEG) responses to natural, healthy pleasures in life.

MORE Reward ERPIn this study, individuals suffering from various chronic pain conditions were randomly assigned to participate in MORE or a social support group led by a therapist. Participants in the MORE group received 8 weeks of instruction in applying mindfulness-oriented techniques to alleviate pain and craving while strengthening positive emotions and the sense of reward and meaning in  life. This latter aspect of MORE may be critically important. A large body of research suggests that as chronic pain and addiction progresses, people may become less physiologically responsive to natural pleasure. As their brains become less sensitive to naturally-rewarding experiences, they get less enjoyment out of life. In the absence of positive feelings, they suffer worse from emotional and physical pain, and ultimately may feel compelled to take drugs (such as opioids) to achieve a normal sense of well-being.

055_55
Savoring the majestic beauty of the wilderness.

To enhance the sense of reward in life, participants were taught a mindful savoring practice, which involved focusing attention intensely on the sensory features (e.g., sight, sound, smell, or touch) of a pleasant experience or object (e.g., a beautiful nature scene like a sunset or the feeling of connection with a loved one) while noticing, appreciating, and absorbing any positive emotions arising in response to the pleasant event. For example, in one meditation session, participants were taught to mindfully focus on the colors, textures, and scents of a bouquet of fresh flowers, and to absorb and appreciate the emotions of contentment and joy arising from this savoring practice. Participants were asked to practice savoring in everyday life as part of a weekly homework assignment (along with a daily practice of mindful breathing meditation).

Although people tend to savor beauty naturally, we hoped that training in MORE could enhance savoring, and thereby increase the sensitivity of the brain to naturally-rewarding experiences. As an indicator of this enhanced savoring ability, we hypothesized that MORE would increase brain responses to images representing such positive experiences. To measure this in the lab, we used a computer to present participants with a series of positive photos representing naturally-rewarding objects and events (e.g., smiling babies, beautiful nature scenes, intimate couples in love) and a series of neutral photos (e.g., kitchen items, household objects, neutral faces) presented for 6 seconds each. During this task, we measured EEG brain activity at the scalp (the parietal site Pz) that were time-locked to the onset of the image. We were particularly interested in the component of the EEG known as the late positive potential (LPP), a brain response that tends to occur between 400 – 1000 ms after an emotional image is displayed. The LPP is known to be enhanced to positive images relative to neutral images in healthy individuals, whereas opiate addicts show reduced EEG brain responses to positive images (Lubman et al., 2008; 2009). In addition to measuring brain activity, we also asked participants to rate how positive they felt after viewing each photograph, and how much they desired or craved opioids in general.

In line with our hypothesis, we found that relative to the control group, MORE significantly increased the LPP brain activity to positive images relative to neutral images. In other words, participants showed enhanced brain responses while viewing naturally-rewarding stimuli following treatment with MORE. In addition, patients who exhibited the largest increases in LPP brain response to positive images experienced the greatest increases in positive emotions while viewing those images. Also, individuals who experienced the biggest increases in brain response to positive images experienced the greatest reduction in craving for opioids. These findings are important because they suggest 1) that MORE may help people to become more sensitive to naturally-rewarding objects and events, and 2) as people learn to experience greater pleasure from healthy and meaningful experiences in life, they may feel less of a need to take addictive drugs.

C_UnregAff
Brain regions involved in emotional experience like the ventral striatum (VS), amygdala (Amy) and anterior cingulate cortex (ACC) become dysregulated in addiction.

My colleagues and I recently advanced a neurocognitive model that suggests that MORE may alter the function of the mesocorticolimbic dopamine system, and in particular, target activity in the ventral striatum, a brain structure involved in experiencing both natural pleasure and pleasure associated with drug use. Numerous studies have shown that the ventral striatum functions abnormally in people suffering from addiction. MORE may restore normal function in this brain area, although studies using functional magnetic resonance imaging (fMRI) are needed to test this hypothesis.

Taken together, results from this new study, in combination with my previously published findings on cardiac-autonomic responses to positive stimuli, suggest that MORE may ameliorate deficits in natural reward processing among chronic patients taking long-term opioids by strengthening their ability to pay attention to healthy objects and events. Restoration of the ability to extract a sense of reward, fulfillment, and meaning out of everyday pleasures may be crucial to the ability to self-generate positive emotions and to resilience itself (Garland, Fredrickson, et al., 2010). More rigorous and larger-scale research is needed to test my hypothesis that focusing one’s attentional lens to more richly process the pleasurable, interesting, and meaningful experiences in life may make the painful and dissatisfying ones insignificant by comparison.

 Eric Garland

drericgarland Mental Health, MORE

“Savoring the Good Life” with Mindfulness-Oriented Recovery Enhancement

A new and exciting research study from my lab was recently accepted for publication in the esteemed journal Psychopharmacology. This paper describes a subset of findings from a randomized controlled trial (RCT) of Mindfulness-Oriented Recovery Enhancement (MORE) for chronic pain patients who had been prescribed long-term opioid treatment (e.g., oxycontin, vicodin) for pain management. To my knowledge, the study is the first in the scientific literature to demonstrate that a mindfulness-based intervention can increase physiological sensitivity to natural, healthy pleasures in life.

In this study, individuals suffering from low back pain, neck pain, arthritis, fibromyalgia, and other pain conditions were randomly assigned to participate in the experimental MORE treatment or a control condition consisting of a social support group led by a therapist. Participants in the MORE group received 8 weeks of instruction in applying mindfulness and other psychological techniques to alleviate pain and craving while strengthening positive emotions and a sense of meaningfulness in life.

In that regard, parti2 (6)cipants were taught a savoring practice, which involved using mindfulness to intentionally focus on the sensory features (e.g., sight, sound, smell, or touch) of a pleasant experience or object (e.g., a beautiful nature scene like a sunset or the feeling of connection with a loved one) while noticing, appreciating, and absorbing any positive emotions arising in response to the pleasant event. For example, in one meditation session, participants were taught to mindfully focus on the colors, textures, and scents of a bouquet of fresh flowers, and to absorb and appreciate the emotions of contentment and joy arising from this savoring practice. Participants were asked to practice savoring in everyday life as part of a weekly homework assignment (along with a daily practice of mindful breathing meditation).

Due to its emphasis on savoring naturally rewarding experiences, we hypothesized that MORE would increase the sensitivity of the autonomic nervous system to images representing such positive experiences. To measure this in the lab, we used a computerized task, in which participants were asked to pay attention to series of pain-related (e.g., a picture of someone grimacing in pain), opioid-related (e.g., a picture of a bottle of prescription painkillers), or pleasure-related images (e.g., a picture of a smiling baby) rapidly presented for 200 – 1000 milliseconds. During this task, we measured heart rate variability – that is, the beat-to-beat changes in heart rate controlled by the parasympathetic nervous system, the branch of the nervous system responsible for rest and recovery from stress. We also asked participants to rate how much they desired or craved their opioids before and after the task.

In summary of our study results, we found that MORE significantly decreased the desire to take opioids and led to large heart rate decelerations while participants focused their attention on the pain-, opioid-, and pleasure-related photographs. In other words, after completing the MORE training, participants’ heart rates slowed down from resting levels while they were paying attention. Heart rate variability analysis indicated that this heart rate slowing was caused by increased activation of the parasympathetic nervous system following MORE. The heart rate decelerations were dramatic, and particularly so for the pleasure photos; on average, the heart rate of participants in the MORE intervention dropped 10 beats per minute while they focused on the pleasure photos! Importantly, although heart rate slowed to all three types of photos, only the heart rate slowing to pleasure photographs was related to changes in opioid craving. Participants who experienced the most heart rate slowing to pleasure photographs experienced the greatest reduction in the desire to take opioids.

This finding is extremely important. A large body of research suggests that as chronic pain and addiction progresses, people may become less physiologically responsive to natural pleasure. As their brains become less sensitive to naturally-rewarding experiences, they get less enjoyment out of life. Consequently, they may feel more compelled to take drugs (such as opioids) to achieve a normal sense of well-being.

Results from this new study suggest that through mindful savoring practices, MORE may help people to become more sensitive to healthy, positive experiences in everyday life, and in doing so, assist them to become freer from the clutches of addiction.

2 (11)

drericgarland Chronic Pain

Chronic Pain Treatment, Neuroscience, and Genetics – Mindfulness-Oriented Recovery Enhancement on the Radio

Today I had the opportunity to speak about the treatment, neuroscience, and genetics of chronic pain with Dr. Dan Gottlieb, host of Voices in the Family, and Dr. Jeffrey Mogil, head of the Pain Genetics Lab at McGill University, on radio station WHYY in Philadelphia (a local NPR station). I spoke about how negative emotions and stress can influence pain processing in the brain, and about how Mindfulness-Oriented Recovery Enhancement can reduce the harmful impact of negative emotions on pain by teaching people to change the way they focus their attention and to reinterpret chronic pain as innocuous sensory signals from the body. 

The entire interview can be found here:

drericgarland Addiction, Chronic Pain, Media, MORE, Opioids, Research

Research on MORE Highlighted in the News

With the advance online publication of “Mindfulness-Oriented Recovery Enhancement for Chronic Pain and Prescription Opioid Misuse: Results from an Early Stage Randomized Controlled Trial” in the Journal of Consulting and Clinical Psychology on February 3rd, over 10 news stories have covered this work. For example, the study was covered by the University of Utah news department in the story  “Mind Over Matter: Beating Pain and Painkillers”, by Medical Daily in “Pain Management: M.O.R.E. Therapy uses Mental Interventions to Combat Chronic Pain, Opioid Painkillers Misuse”, by Science World Report in “New Pain Treatment Aims to Reduce Prescription Opioids”  and by Healthline in “A Mindful Way to Beat Chronic Pain.” It is my sincere hope that this news coverage will ultimately help more people suffering from chronic pain to find the relief and comfort they are seeking.

drericgarland Addiction, Neuroscience, Research

New Paper Accepted for Publication: Mindfulness Training Targets Neurocognitive Mechanisms of Addiction at the Attention-Appraisal-Emotion Interface

mindfulness centered regulation
Neurocognitive Model of Mindfulness-Centereted Regulation (Garland, Froeliger, & Howard, 2014)

My colleagues Brett Froeliger, Matthew Howard, and I recently authored an invited conceptual review paper (FREE TO DOWNLOAD) for a special issue of Frontiers in Psychiatry: Addictive Disorders and Behavioral Dyscontrol. Prominent neuroscience models suggest that addictive behavior occurs when environmental stressors and drug-relevant cues activate a cycle of cognitive, affective, and psychophysiological mechanisms, including dysregulated interactions between bottom-up and top-down neural processes, that compel the user to seek out and use drugs. Mindfulness-based interventions (MBIs) target pathogenic mechanisms of the risk chain linking stress and addiction. This review describes how MBIs may target neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface. Empirical evidence is presented suggesting that MBIs ameliorate addiction by enhancing cognitive regulation of a number of key processes, including: clarifying cognitive appraisal and modulating negative emotions to reduce perseverative cognition and emotional arousal; enhancing metacognitive awareness to regulate drug-use action schema and decrease addiction attentional bias; promoting extinction learning to uncouple drug-use triggers from conditioned appetitive responses; reducing cue-reactivity and increasing cognitive control over craving; attenuating physiological stress reactivity through parasympathetic activation; and increasing savoring to restore natural reward processing. Treatment and research implications of our neurocognitive framework are presented. We conclude by offering a temporally sequenced description of neurocognitive processes targeted by MBIs through a hypothetical case study. Our neurocognitive framework has implications for the optimization of addiction treatment with MBIs.

The conceptual framework outlined in this paper clarifies and contextualizes the recent results from our randomized controlled trial of Mindfulness-Oriented Recovery Enhancement as a treatment for prescription opioid misuse and chronic pain.

drericgarland Addiction, Chronic Pain, MORE, Opioids, Research

New Paper Accepted for Publication: Mindfulness-Oriented Recovery Enhancement for Chronic Pain and Prescription Opioid Misuse – Results from an Early Stage Randomized Controlled Trial

Results from my NIH-funded clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and prescription opioid misuse were recently accepted for publication in the prestigious, top-tier Journal of Consulting and Clinical Psychology. Study findings demonstrated that MORE significantly reduced chronic pain, pain-related impairment, and stress while decreasing craving and opioid misuse among a sample of 115 people who had taken prescription opioid painkillers for more than three months. The effects of MORE on reducing pain severity and pain-related impairment were maintained for 3 months after the end of treatment, and MORE reduced disordered opioid use by 63%. These positive outcomes were linked with the development of mindfulness skills that are specifically strengthened by MORE, like the ability to “step back” and objectively observe negative thoughts and feelings in a non-reactive manner,  the ability to reinterpret pain sensations as harmless sensory information, and the ability to reappraise adverse life events as opportunities for personal growth and meaning.  In addition, participation in MORE weakened the link between desire for opioids and opioid misuse, suggesting that people who learned to use mindfulness to deal with craving were less likely to take inappropriate doses of opioids or to use opioids to self-medicate stress and negative emotions.

In some circumstances, opioids may be medically necessary for individuals experiencing prolonged and intractable pain, and most patients take medicine as prescribed. Nonetheless, opioids rarely completely alleviate chronic pain, and may lead to serious side effects, including death by overdose, as well as risk for developing opioid-related problems and addiction. As such, new interventions are needed to target chronic pain and prevent opioid misuse. Study findings indicate that MORE is a promising treatment for this growing problem. Over the next few years, additional social, psychological, and neuroscientific studies will reveal the many pathways by which MORE produces its therapeutic effects.

drericgarland Mental Health, Research

New Paper Accepted for Publication: State Mindfulness During Meditation Predicts Enhanced Cognitive Reappraisal

My colleagues Adam Hanley (Florida State University), Norm Farb (University of Toronto), Brett Froeliger (Medical University of South Carolina), and I had a new research paper accepted for publication in the journal Mindfulness. In a sample of people receiving brief mindfulness training (one to four sessions delivered by audio CD), we found that the state of mindfulness achieved during the act of mindfulness meditation predicted enhanced cognitive reappraisal over the following week. In other words, people who attained deeper states of mindfulness during meditation experienced an increased tendency to think in more helpful and healthy ways about the stressors in their lives over the following week. This research finding suggests that the state of mindfulness may enhance cognitive flexibility and allow individuals to adopt a broadened perspective on their current life challenges. Study results provide support for a theoretical model I developed, the Mindful Coping Model, and reveal one more piece of the puzzle linking mindfulness with human flourishing. More experimental tests of this theory are needed to replicate and expand these results.mind-reappraise-savor

drericgarland Addiction, Chronic Pain, Mental Health, Neuroscience, Opioids, Research

New Paper Accepted for Publication! The Downward Spiral of Chronic Pain, Prescription Opioid Misuse, and Addiction: Cognitive, Affective, and Neuropsychopharmacologic Pathways

My colleagues and I recently had a new paper accepted for publication in the highly esteemed, international journal Neuroscience and Biobehavioral Reviews. This paper draws upon current neuropsychopharmacologic research to provide a conceptual framework of the downward spiral leading to opioid misuse and addiction among chronic pain patients taking prescription opioids for pain relief. In brief, we theorize that addictive use of opioids is the outcome of a cycle initiated by chronic pain and negative emotions, leading to attentional hypervigilance for pain and drug cues, dysfunctional connectivity between self-referential and cognitive control networks in the brain, and allostatic dysregulation of stress and reward circuitry. We conclude the paper by introducing Mindfulness-Oriented Recovery Enhancement (MORE) as a potentially effective approach to disrupting the downward spiral. This is a particularly exciting publication for our research team, because it lays the theoretical groundwork for developing new and innovative efforts to help people recover from chronic pain and opioid addiction.

drericgarland Mental Health

Mindfulness and Reappraisal

Inevitably, we encounter hardship in our lives. We become ill, fall into debt, are subject to criticism, harried by rumor and jealousy, and assailed by the many challenges and unrelenting demands of the world. Yet, individuals differ to the extent to which they remain resilient in the face of such stressors.  One key to resilience is positive reappraisal – the capacity to reframe or re-interpret difficult life experiences such that they become imbued with personal meaning. For instance, after facing a stressor, one might come to believe, “Dealing with this experience has made me a stronger person,” or, “I have grown and learned from adapting to this situation,” or even, “I would not be who I am today without this experience, no matter how difficult it has been.” Through positive reappraisal, we come to find meaning in the face of adversity.

Such positive reappraisals may be essential means of adapting to the rigors of life. People often believe that they have personally grown or learned from dealing with the stressful events of their lives. For example, over half of 2000 survivors of the devastating 2008 earthquake in Sichuan province, China, which reached 8.0 on the Richter scale, reported having experienced a form of meaningful growth in its wake, such as developing personal strength, a sense of appreciation of life, or an opening to new possibilities (Xiu & Liao, 2011). Similarly, after a deadly tornado struck Madison, Florida in 1998 and obliterated over 100 homes and business, 9 out of 10 survivors reported experiencing psychological benefits from the event, such as greater appreciation for others and a deepened sense of personal growth (McMillen, Smith, & Fisher, 1997). Innumerable examples may be found in the annals of history. Every time another tragedy is announced on the news, from devastating floods to acts of savage terrorism, positive reappraisals emerge during the interviews of survivors. The common theme echoed such tragic incidents is “This experience brought our community closer” and “This experience is a reminder of what is really important in life.”

At the same time, finding positive meaning in adversity does not only occur in the aftermath of large scale disasters; it is also commonly occurs in the face of daily stressors. For example, after being snubbed and disrespected by a work supervisor, one might reappraise the mistreatment into an opportunity to realize the importance of being sensitive to the opinions and viewpoints of others.  And after a long, exhausting day at the office, being treated rudely by the clerk at the grocery checkout line might be seen as an opportunity to feel empathy for the fact that she was probably standing on aching feet for more than eight hours. Similarly, a person stricken with a non-fatal heart attack might positively reappraise the event as a chance to change their diet and start exercising more. A person who has recovered from a vicious rape might view their survival of the assault as evidence of their strength and resilience, and they might decide to dedicate their life to helping others make similar recoveries. A person entangled in a fight with her spouse might initially villanize him and recoil from his attempts to resolve the conflict, and then, after recognizing his unwavering devotion to their relationship, redouble her efforts to understand his point of view.

Though reappraisal is well-known to enhance resilience and help individuals cope with stress, less is known about how this strategy works and how it can be strengthened. It is my contention that mindfulness promotes reappraisal. Mindfulness is a state of mind in which one observes his or her mental experiences without becoming “stuck in” or “trapped by” them. In the state of mindfulness, you become aware of thoughts, feelings, sensations, and perceptions without trying to hold on to them, and without trying to push them away. As the state mindfulness deepens, you not only become aware of where your mind is in the moment (i.e., on what content is it focused), you also become aware of the quality of that observing mind itself.  At the deepest levels of mindfulness practice, this metacognitive observation can be a bit like a mirror mirroring mirrors – being aware of being aware (and maybe, if you are really good, being aware of being aware of being aware!). Some neuroscientists suppose that the folds of the prefrontal cortex have evolved over millennia to allow for this metacognitive reflection.

So what do these abstract ideas have to do with reappraisal? Well, to make a positive reappraisal, one must first be aware of the initial negative or stressful appraisal (e.g., “This situation is horrible!”). Next, one must “step back” or disengage from that reappraisal. My colleagues and I (Garland, 2007; Garland, Gaylord, & Park, 2009) have argued that mindfulness affords that mental shifting function – allowing one to decenter from a given thought about one’s life, into the openly observing, metacognitive mode of awareness. Once the mind has stepped back from the stress appraisal into this state of mindfulness, attention broadens to encompass previously unattended details about one’s life circumstance – you begin to notice things about yourself and your situation that you had overlooked or ignored because you were so stressed and upset. For example, bad feedback from a boss might lead you to think, “I always screw up and my boss hates me.” However, if you were to engage mindfulness, you might be able to step back from this thought and then begin to notice the ways in which you have been successful at work and the recent times when your boss has given you praise. After which you might think, “Well, that’s not really true. Usually I do a good job at work and that’s why my boss is giving me this critical feedback – she believes that I can take my career to the next level!” This positive reappraisal might then motivate you to take constructive action at work. Thus, the metacognitive aspect of mindfulness allows us to see that our thoughts are not necessarily facts. By becoming aware of awareness, we come to realize that who we are is much bigger than any one thought, feeling, or stressful life event, and that ultimately, we are free to choose the meaning of our lives.

In these ways, mindfulness helps us to disrupt habits of negative thinking, allowing the mind to naturally expand to consider new possibilities and novel ways of seeing the world. When, through mindfulness, we suspend our preconceived notions and assumptions about the difficult aspects of our lives, we are able to bring increased awareness to the richly woven tapestry of life that unfolds all around us, allowing us to draw out innumerable golden threads. The smiling face of a passerby, the song of a bird perched in a nearby tree, the trill of insects on a warm summer evening, a tiny flower blossoming from a crack in a sidewalk, the laughter of children, or even the ever-constant companion of one’s own breath can become sources of wonder and delight to savor, in spite of and perhaps because of the stressors and challenges we face. Facing bitter hardship and adversity can help us to truly taste and appreciate the moments of sweetness that surround us. Through mindfulness and reappraisal we can learn to widen the scope of our awareness to encompass more of the meaningful and beautiful experiences in life, making the painful and dissatisfying ones smaller by comparison.

drericgarland Chronic Pain, MORE, Research

New Paper Accepted for Publication: Mindfulness-Oriented Recovery Enhancement Reduces Pain Attentional Bias in Chronic Pain Patients

My colleague Matthew Howard and I recently had a paper accepted for publication in the internationally-recognized journal, Psychotherapy and Psychosomatics. This paper describes a subset of findings from a randomized controlled trial (RCT) of Mindfulness-Oriented Recovery Enhancement for chronic pain patients who have been prescribed long-term opioid treatment (e.g., oxycontin, vicodin) for pain management. The study is the first in the scientific literature to demonstrate that a mindfulness-oriented intervention can reduce the pain attentional bias. In this study, 67 individuals suffering from low back pain, neck pain, arthritis, fibromyalgia, and other pain conditions were randomly assigned to participate in MORE or a support group and began treatment.

Participants in the MORE group received instruction in applying mindfulness and other psychological techniques to: discriminate between nociception (i.e., the signal that the body is being damaged), pain, and suffering; become aware of their automatic pain coping habits; disrupt the link between negative emotions, fear of pain, and catastrophizing; refocus attention from pain and stress to savor pleasant experiences; manage pain and opioid dependence; reduce stress; promote acceptance versus suppression of difficult experiences; and develop a mindful recovery plan. Mindfulness training involved meditation on breathing and body sensations, with an emphasis on metacognitive awareness and shifting from affective to sensory processing of pain sensations. In other words, participants learned to step back and observe their pain as innocuous sensory information rather than as an emotionally-anguishing event – e.g., seeing their pain as “sensations of heat, tightness, tingling, or coolness” rather than “terrible agony.”

reinterpreting_pain_sensations

Participants in the support group were led to disclose their feelings and thoughts about topics related to chronic pain and opioid-related problems, as well as to provide advice and emotional support for their peers. The format of the support group was similar to conventional support groups used in many medical and psychotherapy settings.

We hypothesized that MORE would help participants to fixate less on their pain – freeing them to refocus on the meaningful, beautiful, or rewarding aspects of their lives. To measure attentional fixation on pain, or pain attentional bias, we used a dot probe task. In this task, participants were presented with two images, side by side, on a computer screen. One of the images was a pain-related image – the other was a neutral image. The images were presented for either 2 seconds or 200 milliseconds, and then were replaced with a dot. Participants were asked to press a button to indicate location of the the dot. Previous research demonstrates that chronic pain patients are faster to respond to pain images than neutral images, indicating that they exhibit an attentional bias, or attentional fixation, on pain-related information. Hence, people in chronic pain tend to automatically focus their attention on pain and things related to pain. This attentional fixation might occur unconsciously, without a person intending to focus on pain or even realizing that it is happening.

pain_dotprobe

In summary of our study results, we found that MORE led to significant reductions in the pain attentional bias, whereas the support group did not have any effect on pain attentional bias. Importantly, participants in MORE who experienced the largest decreases in the pain attentional bias felt like they had greater control over their pain following treatment. In addition, those people who felt that MORE had helped them to become less reactive to negative thoughts and feelings also had less pain attentional bias following treatment.

MORE_reduces_pain_AB

In conclusion, MORE appears to help people suffering from chronic pain and opioid-related problems learn to free their minds from fixating on pain, and in so doing, empower them to regain control of their lives.

drericgarland Addiction, Chronic Pain, Mental Health, MORE, Research

Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain

I am pleased to annoMOREcvrspreadunce the publication of my new book, Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain, by NASW Press. This book is a treatment manual that describes the step-by-step implementation of Mindfulness-Oriented Recovery Enhancement (MORE), as well as the theoretical framework and growing evidence base underlying this new form of therapy.

From the press release:

“Human existence can be beset by a variety of negative mental states such that life seems devoid of meaning, but it can also be liberated—a meaningful life reclaimed and savored through cultivation of a higher kind of mind. This quality, mindfulness, refers to both a set of contemplative practices and certain distinct psychological states and traits, and it can be cultivated through intentional effort and training.

In Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain, Eric L. Garland presents an innovative program of intervention that can be put into practice by therapists working with people struggling with addiction and the conditions that underlie it. Unlike other substance abuse treatment modalities, which focus largely on relapse prevention, Mindfulness-Oriented Recovery Enhancement (MORE) concentrates on helping people to recover a sense of meaning and fulfillment in everyday life, embracing its pleasures and pain without avoiding challenges by turning to substance use.

Along with chapters on the bipsychosocial model underlying MORE and the current state of research on mindfulness, this book includes a complete treatment manual laying out for clinicians, step by step, how to run MORE groups—including adaptations to address chronic pain and prescription opioid misuse—and enhance the holistic recovery process for people striving to overcome addiction.

With addiction a widespread and growing problem in our society, Mindfulness-Oriented Recovery Enhancement could not be more timely or needed. It integrates the latest research on addiction, cognitive neuroscience, positive psychology, and mindfulness into a practice that has garnered empirical support and holds the promise of release and fulfillment for those who suffer from addiction.”

For more information or to purchase the book, go to http://www.naswpress.org/publications/clinical/mindfulness-oriented-recovery.html

Testimonials

“In this work, Dr. Garland lays out a novel and timely behavioral approach for the treatment of substance abuse disorders. This treatment Mindfulness-Oriented Recovery Enhancement (MORE), is grounded in ancient philosophy and the most up-to-date, empirically driven models of drug addiction that stem from the social and neurobiological sciences. Dr. Garland successfully tackles the task of synthesizing the principles of these diverse fields, provides empirical support for MORE’s effectiveness, and delivers a concise and clear message that will surely appeal to clinicians, researchers, students, and the general public. Anyone who holds an interest in the dilemma of drug addiction and its treatment will benefit from reading Mindfulness-Oriented Recovery Enhancement for Addiction, Stress and Pain.”

Brett Froeliger, PhD

Department of Neurosciences
Medical University of South Carolina

—————————–

“Eric L. Garland’s exciting book, Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain is a ground-breaking new contribution to addiction treatment literature. Dr. Garland, a licensed clinical social worker with more than a decade of experience in delivering evidence-based interventions based on contemporary cognitive—affective neuroscience, offers a clearly articulated 10-session model for intervening with substance dependent clients. The treatment approach presented in Garland’s book is inexpensive, research based, broadly applicable to substance-dependent people of all types, and readily adopted by student and experienced practitioners. Although mindfulness interventions are rooted in ancient Buddhist traditions, psychophysiological and clinical assessments suggest that they are among the most efficacious treatments currently available for a range of modern-day maladies. I strongly encourage clinicians and therapists working with substance-dependent clients to read Mindfulness-Oriented Recovery Enhancement.”

Matthew Owen Howard, PhD

School of Social Work
University of North Carolina at Chapel Hill

—————————–

“Mindfulness-Oriented Recovery Enhancement for Addiction, Stress and Pain is a wonderful addition to the growing array of treatment manuals that are clinically informed, research—based, and focused on helping individuals who abuse substances to achieve long-term sobriety and improvements in overall life functioning. This book is written by an experienced psychotherapist who has developed and empirically evaluated the MORE model during the past decade. Dr. Eric L. Garland skillfully integrates mainstream cognitive–behavioral therapies with the much older spiritual traditions of meditative mindfulness to create a comprehensive treatment manual describing a semi-structured, 10–session approach to helping substance abusers. A later section of this book contains an eight-session protocol for using the MORE approach with patients experiencing chronic pain. Like the treatment model for substance abusers, the chronic pain protocol is thoroughly based in solid research findings, including clinical outcome studies. The book concludes with an array of client handouts for data collection and providing information. I highly recommend this treatment manual for therapists looking to learn more about the empirically-grounded research findings pertaining to mindfulness meditation and how they can be effectively used to help clients.”

Bruce A. Thyer, PhD, LCSW, BCBA-D

College of Social Work
Florida State University

drericgarland Mental Health, Neuroscience, Research

Leading-Edge Science Supports the Notion of Recovery

Image By Sandy Burns

Over the past several decades there has been an explosion of research demonstrating that our feelings and thoughts are closely tied to the function of our brains, so much so that the 1990s were heralded as the “Decade of the Brain” by the Library of Congress and the National Institutes of Health. Neuroscience has come to have a powerful influence on our concepts of mental health, leading many people to believe that forms of psychological suffering like depression, anxiety, and addiction are caused by “biochemical brain imbalances.” While this view has removed a great deal of the stigma that was once associated with chronic mental health problems, it also may send the implicit and unfortunate message that change and recovery is not possible. If depression, anxiety, and addiction are diseases of the brain, how can anyone possibly change their brain? Isn’t the function and structure of the brain, like any other organ, determined by genes and fixed from birth?

The answer emerging from neuroscience research of the past decade is an unequivocal “NO!” We now know that the brain grows and changes throughout childhood, adolescence, and even into adulthood and old age! A number of factors can stimulate changes in the brain, known as neuroplasticity, including stress, diet, exercise, and even learning experiences. So, if chronic states of depression, anxiety, and addiction are partially the result of brain dysfunction (and, to be clear, a number of scholars have raised serious and important challenges to the neurobiological model of mental illness), many scientific studies demonstrate that learning and practicing new ways of thinking, acting, and responding to the challenges in our lives can change the way our brains function! Research is beginning to demonstrate that the very structure of our brains can be modified by mental training, not unlike the way people lift weights to build the size and strength of their muscles through physical training.

So what does all this groundbreaking and fascinating science mean for the idea of recovery from mental health and substance abuse problems? It explains how addiction treatment and mental health services can help people who have been diagnosed with a mental and/or substance use disorder to transcend their challenges to live a healthy and meaningful life. Innovative ways of helping people recover are continually being developed and tested, with promising results. The Trinity Institute for the Addictions at the FSU College of Social Work is dedicated to advancing new methods of promoting recovery.  Through my work at Trinity and through my prior work at the University of North Carolina at Chapel Hill, I have developed a new type of mental training program for people struggling with addiction, mental health problems, and chronic pain called Mindfulness-Oriented Recovery Enhancement, or MORE. MORE combines mindfulness training, cognitive-behavior therapy, and positive psychological principles into an integrative treatment strategy designed to help people increase self-control over their unhealthy habits and/or addictive behaviors, reduce their negative emotions (like feelings of anxiety, anger, and hopelessness), and improve their psychological well-being. I am currently conducting a clinical trial to test MORE as a way to combat chronic pain and problems related to prescription painkiller use – a growing epidemic in the U.S. and a frequent headliner in Florida’s news media.

Although this study is still in process, other studies suggest that mental training programs can be very helpful. For example, in previous research my colleagues and I found that mindfulness training reduced chronic pain symptoms by 38 percent and psychological stress by 31 percent! Another one of our studies indicated that mindfulness training helped people struggling with alcoholism to recover after being exposed to addictive triggers by calming their nervous system reactivity back towards baseline levels.  Other research suggests that mental training programs including cognitive-behavior therapy and mindfulness training can alter brain function and significantly reduce the symptoms of depression and anxiety, often with lasting positive effects.

The Substance Abuse and Mental Health Services Administration defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (SAMHSA, 2011). The latest neuroscience findings on neuroplasticity and results from clinical research on psychological therapies like mindfulness training and cognitive-behavior therapy provide strong evidence for the notion that recovery from mental health problems and substance abuse is possible. Time and time again, cutting-edge science and clinical findings reveal a simple, hopeful, and powerful truth: treatment is effective, and people do recover.

drericgarland Addiction, Research

New Paper Published! “Mindfulness Is Inversely Associated with Alcohol Attentional Bias Among Recovering Alcohol Dependent Adults”

An article written by my colleagues Charlotte Boettiger, Susan Gaylord, Vicki West Chanon, and Matthew Howard and I was recently published in the journal Cognitive Therapy and Research. This article describes the relationship between the tendency to be mindful in everyday life and the alcohol attentional bias among people in recovery from alcoholism. As described in the post below, attentional bias is the phenomena in which a person’s attention may be automatically captured by or fixated on an emotionally-significant object or event. Among alcoholics, cues associated with drinking tend to have a strong emotional importance – the sight of a bottle of liquor, an old drinking buddy, or familiar bar can automatically grab their attention and trigger the urge or craving to drink. This alcohol attentional bias can be measured in the laboratory using a dot probe task very similar to the one pictured in the post below, by asking participants to press a button to indicate the location of a target that replaces either an alcohol-related or neutral photo.

In the study described in our paper, we tested 58 people in long-term treatment for alcoholism with a dot probe task to measure their alcohol attentional bias. We also gave them questionnaires assessing their former drinking behavior, their level of craving, and the extent to which they reported to be mindful. These people had never received formal mindfulness training, but instead had received standard substance abuse treatment services. We found that individuals who classified themselves as having higher mindfulness actually had less attentional bias towards alcohol cues than people who classified themselves as being less mindful, regardless of how much they drank in the past or how much they craved alcohol.

Why is this important? The trait of mindfulness, that is, the tendency to be mindful in everyday life, is thought to involve being less reactive to difficult thoughts and feelings, less judgmental of yourself and others, more in touch with your emotions, more observant of sensory experiences (like the feeling of the wind in your hair or the sun on your face), and being aware of when you are acting out of habit or on “auto-pilot.”  What makes the study findings so compelling is that the recovering alcoholics who thought they were more mindful (i.e., more aware of their habitual responses and less reactive to strong emotions) were the ones who were best able to shift their attention away from alcohol cues. In other words, they were better able to “disengage” their attention from addictive temptations and refocus on other things.

If people in recovery who are more mindful are less perturbed by addictive triggers, would explicit mindfulness training help them to overcome addiction? It’s not a wild stretch of the imagination to make this supposition. Indeed, my research on Mindfulness-Oriented Recovery Enhancement shows that mindfulness has great promise as a treatment for alcoholism and other forms of addiction. But more research is needed!