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!

Dr. Garland presents to NIH on May 4

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.

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.

Mindfulness-Oriented Recovery Enhancement Covered by NIH Magazine

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!!!

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

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

We cover some fascinating topics including:

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

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

 

New Podcast Interview on Mindfulness, Pain, and Addiction

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

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

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

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

A registration link can be found here.

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

Participants receive intensive didactic and experiential instruction in implementing specialized mindfulness techniques and other clinical skills integral to Mindfulness-Oriented Recovery Enhancement (MORE). Research evidence on the MORE model will be presented, along with a review of the latest discoveries in neuroscience and basic biobehavioral science about mindfulness, addiction, and chronic pain.

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

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

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

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

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

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

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

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

Eric Garland Interviewed on Groundless Ground Podcast by Lisa Dale Miller

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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