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

Mindfulness-Oriented Recovery Enhancement (MORE) Recognized by U.S. Dept. of Veterans Affairs

Mindfulness-Oriented Recovery Enhancement (MORE) was included on a U.S. Department of Veterans Affairs website describing mindfulness meditation interventions. According to a VA literature review, MORE and other evidence-based mindfulness programs (e.g., MBSR, MBCT) demonstrated sufficient effectiveness to be recommended as appropriate components of care for veterans. In a clinical trial published in 2024 in the American Journal of Psychiatry, MORE was shown to be an efficacious therapy for relieving chronic pain and reducing opioid use in veterans and active duty service members.

Mindfulness-Oriented Recovery Enhancement (MORE) reduced opioid use to a significantly greater extent than standard group (SG) therapy. Garland et al. (2024). Amer J Psychiatry.

drericgarland Addiction, Chronic Pain, Media, Mental Health, MORE, Training

New Mindfulness-Oriented Recovery Enhancement (MORE) Book Published July 2024 by Guilford Press

The opioid crisis arose in part due to the attempt to relieve chronic pain. Meeting a huge need, this is the authoritative presentation of Mindfulness-Oriented Recovery Enhancement (MORE) for chronic pain and opioid use by Guilford Press. MORE is one of the few evidence-based treatments shown to simultaneously reduce opioid use and/or addiction, pain, and co-occurring emotional distress. MORE integrates mindfulness training with principles of cognitive-behavioral therapy and positive psychology. In a convenient large-size format, this book provides everything needed to set up and run MORE groups. This new book by Guilford Press offers session-by-session guidelines, sample scripts, clinical pointers, guided practices, and psychoeducational resources, including 15 reproducible handouts that can be photocopied or downloaded. To pre-order the book, click this link and receive a 15% discount.

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

MORE Reduces Opioid Use and Chronic Pain in Veterans and Military Personnel: New Publication in American Journal of Psychiatry

Results from a 6-year clinical trial of Mindfulness-Oriented Recovery Enhancement (MORE) funded by the U.S. Department of Defense Congressionally Directed Medical Research Program (CDMRP) were recently published in the American Journal of Psychiatry, the most widely read psychiatric journal in the world and one of the 100 Most Influential Journals in Biology & Medicine over the last 100 Years. In the article, entitled “Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial,” my colleagues and I showed that MORE was superior to supportive psychotherapy through an 8-month follow-up in reducing chronic pain symptoms and opioid use among 230 veterans and military personnel. MORE reduced opioid use by 20.7%, compared with a 3.9% reduction in supportive psychotherapy.

MORE also reduced illicit substance use, anhedonia, catastrophizing, craving, and opioid cue-reactivity and increased positive emotions to a greater extent than supportive psychotherapy. In summary, MORE facilitated opioid dose reduction while preserving adequate pain control and preventing mood disturbances, suggesting that MORE can support safe opioid tapering among patients who are interested in reducing their opioid use. These findings replicate results from another clinical trial of MORE published in JAMA Internal Medicine demonstrating MORE’s efficacy for reducing chronic pain and opioid misuse. This study was highlighted in the AJP Editor’s Spotlight.

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

New Publication in Nature Mental Health: MORE Treats PTSD, Chronic Pain, and Opioid Misuse Simultaneously

My colleagues and I had a new paper published in the top scientific journal Nature Mental Health showing that Mindfulness-Oriented Recovery Enhancement (MORE) led to clinically significant reductions in post-traumatic stress symptoms in 59% of patients with comorbid PTSD, chronic pain, and opioid misuse. In this NIH-funded study involving 241 patients, MORE significantly reduced PTSD symptoms by increasing the capacity to regulate negative emotions through reappraisal. In turn, the effects of MORE on reducing opioid misuse were statistically mediated by decreases in PTSD symptoms. This study is important because PTSD is highly prevalent among people with chronic pain and addiction, yet there are no evidence-based treatments for this complex comorbidity. These data suggest that MORE is a highly effective therapy that can simultaneously treat traumatic stress, chronic pain, and addictive behavior.

Mindfulness-Oriented Recovery Enhancement (MORE) reduced PTSD symptoms to a significantly greater extent than supportive group (SG) psychotherapy.
drericgarland Addiction, Chronic Pain, Media, Mental Health, MORE, Opioids, Research

MORE’s Efficacy for Opioid Misuse and Chronic Pain Shown in JAMA

The largest trial of Mindfulness-Oriented Recovery Enhancement (MORE) ever conducted “Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial” was just published in JAMA Internal Medicine! The results of this $2.8 million NIH-funded clinical trial (N=250) for people with chronic pain and opioid misuse were outstanding: MORE reduced opioid misuse by 45%, more than doubling the effect of standard supportive therapy.This is one of the strongest effect sizes ever shown for a treatment for opioid misuse among people with chronic pain. MORE also reduced opioid use; 36% of patients treated with MORE were able to reduce their opioid dose in half or greater. At the same time, 50% of patients treated with MORE experienced clinically significant reductions in pain severity. And, although nearly 70% of patients met criteria for major depressive disorder (MDD) at the beginning of the trial, the mean depression symptom severity score for patients treated with MORE no longer surpassed the threshold for MDD by the end of the study. These therapeutic effects lasted for 9 months after the end of treatment, demonstrating the sustained efficacy of MORE. We followed patients for almost a year after they enrolled in the study, representing the longest follow-up ever conducted for the MORE intervention.

MORE resulted in long-term reductions in chronic pain and emotional distress.

The timing of this publication is highly serendipitous, given that the opioid pharmaceutical settlements are just now reaching the states. My hope is that governors and legislators will consider using MORE as part of the solution to help stem the tide of the opioid crisis. Please help me get the word out! #MOREworks!

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

Healing Pain and the Opioid Crisis with Mindfulness-Oriented Recovery Enhancement

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.

Dr. Garland presents his research on Mindfulness-Oriented Recovery Enhancement to NIH Leadership

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!

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

Mindful positive emotion regulation as a treatment for addiction: from hedonic pleasure to self-transcendent meaning

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.

drericgarland Addiction, Chronic Pain, Media, Mental Health, Opioids

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.
Eric Garland – Working with Addiction & Pain

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!

 

drericgarland Addiction, Chronic Pain, Mental Health

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!

drericgarland Addiction, Chronic Pain, MORE, Training

Next MORE Training March 5-6, 2022

The next Mindfulness-Oriented Recovery Enhancement (MORE) training will be held online via Zoom on March 5-6, 2022.

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 >475 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.

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

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.

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

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.

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

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.

drericgarland Addiction, Chronic Pain, Media, MORE, Research

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.

drericgarland Addiction, Chronic Pain, MORE, Opioids, Research

Dr. Garland Appointed to NIH HEAL Multi-disciplinary Workgroup

Eric Garland, PhD has been appointed by Francis Collins, MD, PhD, Director of the National Institutes of Health, to the NIH HEAL Multidisciplinary Working Group focused on a $1.1 billion federal effort to speed scientific solutions to stem the opioid crisis.

The Helping to End Addiction Long-term (HEAL) Initiative’s working group—comprised of 16 national experts on issues of pain and addiction research—is part of NIH’s efforts to “bring the very best science to the task of addressing our national crisis of opioid addiction and chronic pain,” explained Collins.

The working group is charged with providing input on HEAL research, drafting recommendations for various NIH institute and federal advisory committees, prioritizing future research areas, increasing harmonization across HEAL research projects, offering input on proposed funding plans and providing a public venue for discussion of HEAL research by stakeholders, among other tasks.

Garland is director of the Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) and the developer of Mindfulness-Oriented Recovery Enhancement (MORE), an innovative mind-body therapy designed to address addiction, pain and stress.

His current research program, supported by nearly $50 million in grant funding, focuses on testing MORE and other behavioral therapies for chronic pain and opioid misuse. In addition to providing care to hundreds of study participants, his work is also contributing to a deeper understanding of the neuroscience behind pain, addictive behaviors and their effects on reward processing in the brain.

“I am deeply humbled by the opportunity to serve on this national working group,” said Garland. “The current opioid crisis is one of the greatest and most urgent public health issues confronting society today. I’m tremendously honored to work closely with NIH and contribute what I’ve learned to advance scientific solutions to this grand challenge.”