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!
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.
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.
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.
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
“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
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.”
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.
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.
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.
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.”
The National Institute on Drug Abuse (NIDA) covered a recently published study of Mindfulness-Oriented Recovery Enhancement (MORE) on their NIDA Notes page. NIDA Notes has provided in-depth coverage of research findings on drug abuse and addiction for the past 25 years. Each month, 2-4 research articles from the entirety of addiction science are covered on NIDA’s webpage, so this is great recognition for the MORE research program.
We previously demonstrated that MORE can reduce chronic pain patients’ misuse of opioids (Garland et al., 2014, Journal of Consulting and Clinical Psychology). Now, a follow-up analysis of data from that study found these reductions in opioid misuse to be associated with an increase in patients’ cardiac-autonomic responsiveness to cues for natural rewards relative to cues for drug rewards (Garland et al., 2017, Psychotherapy and Psychosomatics). This is one of the most important discoveries I have made in the past decade, and suggests that MORE may reduce risk for opioid misuse by increasing physiological sensitivity to natural rewards. Thus, using mindfulness to amplify savoring of natural, healthy pleasures and promote meaning in life may be an antidote to opioid misuse, a condition that has been called a “disease of despair.”