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.
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.”
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.
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.
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.
Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain
I am pleased to anno
unce 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
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“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
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“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
Recovery from Addiction, Stress, and Pain through Mindfulness and Social Support
I am honored to have the opportunity to discover new ways of helping people heal and recover from the challenges in their lives. For the past several years, I have been busily engaged in developing a new therapy for people struggling with chronic pain and problems with prescription opioid painkillers through a study funded by the National Institute on Drug Abuse. I first developed this new therapeutic approach, which I call Mindfulness-Oriented Recovery Enhancement, for an earlier study I conducted on alcoholism that was funded by a Francisco Varela Award from Mind and Life Institute. Mindfulness is an expansive and fundamental concept that has been pursued for millennia as a means of ameliorating suffering – look for more posts here soon about it. I am studying how this new treatment compares to a conventional support group. Support groups are a widely-used form of psychological support for people dealing with health and mental health issues that can be extremely helpful.
My approach to helping people is focused on promoting the basic goodness and inherent capacity for growth that lies within each person. I have a lot to say on this topic, but my latest thoughts can be summed up with an image:
In a way, this upward spiral of mindfulness, meaning, and positive emotion may be viewed as the converse of the downward spirals of addiction, stress, and pain that have become a modern day epidemic.
