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, participants 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.