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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.

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.” 

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.

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.”

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.”

I am pleased to announce that my colleague Matthew Howard and I had a new, invited manuscript accepted in the journal Addiction Science and Clinical Practice, an open access forum for clinically-relevant research that was previously published by the National Institute on Drug Abuse. The abstract for this paper (which is freely available to the public), entitled Mindfulness-Based Treatment of Addiction: Current State of the Field and Envisioning the Next Wave of Research is appended below:

“Contemporary advances in addiction neuroscience have paralleled increasing interest in the ancient mental training practice of mindfulness meditation as a potential therapy for addiction. In the past decade, mindfulness-based interventions (MBIs) have been studied as a treatment for an array addictive behaviors, including drinking, smoking, opioid misuse, and use of illicit substances like cocaine and heroin. This article reviews current research evaluating MBIs as a treatment for addiction, with a focus on findings pertaining to clinical outcomes and biobehavioral mechanisms. Studies indicate that MBIs reduce substance misuse and craving by modulating cognitive, affective, and psychophysiological processes integral to self-regulation and reward processing. This integrative review provides the basis for manifold recommendations regarding the next wave of research needed to firmly establish the efficacy of MBIs and elucidate the mechanistic pathways by which these therapies ameliorate addiction. Issues pertaining to MBI treatment optimization and sequencing, dissemination and implementation, dose–response relationships, and research rigor and reproducibility are discussed.”

I participated in the invitation-only NIH meeting “Contributions of Social and Behavioral Research in Addressing the Opioid Crisis” on March 5-6, 2018 (for a link to the webcast of the entire meeting, click here).  This meeting was part of the series of NIH meetings on Cutting Edge Science to End the Opioid Crisis.  The goals of this meeting were to: 1) specify the key social and behavioral science findings that can be brought to bear immediately to address the opioid crisis and 2) identify critical short-term research priorities that have to the potential to improve the opioid crisis response. The meeting participants represented some of the most accomplished researchers involved in the social and behavioral research relevant to the opioid crisis as well as senior leaders of various federal agencies and national organizations. I was tremendously honored to be invited as a subject matter expert to present my research to inform real-world policy and practice initiatives to address the opioid crisis.

I spoke on a panel entitled “Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management” along with luminaries in the pain research field including Francis Keefe (Duke University), Dennis Turk (University of Washington), and Dan Cherkin (Kaiser Permanente). In my talk, I discussed my research on Mindfulness-Oriented Recovery Enhancement (MORE) as a treatment for chronic pain and opioid misuse, and emphasized hedonic dysregulation (e.g., anhedonia) as a pathogenic process in opioid misuse/addiction and a key mechanistic target for novel behavioral therapies.

We presented our work to federal administrators including Francis Collins (Director of the National Institutes of Health), Nora Volkow (Director of the National Institute on Drug Abuse), Eliseo Pérez Stable (Director of the National Institute on Minority Health and Health Disparities), William Riley (Director of the Office of Behavioral and Social Science Research), David Shurtleff (Acting Director of the National Center for Complementary and Integrative Health), David Atkins (Director of Health Services Research and Development Service, U.S. Department of Veteran Affairs), and Sherry Ling (Deputy Chief Medical Officer of the Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services).

Areas of focus at the meeting included discussion of 1) Sociocultural and Socioeconomic Underpinnings of the Opioid Crisis in the United States; 2) Behavioral and Social Factors Preventing Opioid Initiation and Mitigating the Transition from Acute to Chronic Opioid Use; 3) Incorporating Nonpharmacologic Approaches to the Treatment of Opioid Abuse and Chronic Pain Management; 4) Prevention, Treatment and Recovery: Challenges and Barriers to Implementation; and 5) Effective Models of Integrated Approaches.

To summarize the meeting, research leaders and healthcare policy makers were highly focused on implementation and dissemination of evidence-based interventions and practices to target opioid misuse in chronic pain patients and to prevent/treat opioid addiction among those who have transitioned to illicit opioid use. There was much emphasis on the role of negative affect (e.g., despair), suicidality, and trauma as precipitants and correlates of opioid addiction, and the role of social support and meaningful engagement as protective factors against opioid addiction. Non-pharmacologic approaches (specifically, mindfulness and cognitive-behavioral therapy) were directly highlighted as empirically supported means of treating chronic pain and preventing opioid addiction. Finally, there was much discussion of the need to advance integrative treatment models that combine medication assisted treatment (e.g., buprenorphine, methadone) with behavioral interventions (e.g., mindfulness, exercise/physical therapy) to stop the crisis.

I was particularly struck by the framing of the opioid crisis as a “disease of despair” driven by socioeconomic disparity and disenfranchisement. Early in the morning on March 5, Nobel Prize winning economist Angus Deaton presented his work showing that mortality by opioids, alcohol, and suicide is differentially elevated in U.S. counties struck by structural inequalities. If opioid misuse and addiction are diseases of despair, then therapies like Mindfulness-Oriented Recovery Enhancement that aim to enhance joy and meaning in life may be a key part of the much-needed multifaceted solution to the greatest public health crisis of our era.

 

My colleagues and I just published a new paper in the Journal of General Internal Medicine demonstrating that mindfulness training and hypnotic suggestion significantly reduced acute pain experienced by hospital inpatients.  After participating in a single, 15-minute session of one of these mind-body therapies, patients reported an immediate decrease in pain levels similar to what one might expect from an opioid painkiller.

This study is the first to compare the effects of mindfulness and hypnosis on acute pain in the hospital setting.

The yearlong study’s 244 participants were patients at the University of Utah Hospital in Salt Lake City who reported experiencing unmanageable pain as the result of illness, disease, or surgical procedures.  Willing patients were randomly assigned to receive a brief, scripted session in one of three interventions: mindfulness, hypnotic suggestion or pain coping education.  Hospital social workers who completed basic training in each scripted method provided the interventions to patients.

While all three types of intervention reduced patients’ anxiety and increased their feelings of relaxation, patients who participated in the hypnotic suggestion intervention experienced a 29% reduction in pain, and patients who participated in the mindfulness intervention experienced a 23% reduction in pain, compared to a 9% reduction experienced by those who participated in the pain coping intervention. Patients receiving the two mind-body therapies also reported a significant decrease in their perceived need for opioid medication.

About a third of the study participants receiving one of the two mind-body therapies achieved close to a 30% reduction in pain intensity. This clinically significant level of pain relief is roughly equivalent to the pain relief produced by five milligrams of oxycodone.

My previous research has indicated that an 8-week long course of Mindfulness-Oriented Recovery Enhancement can be an effective way to reduce chronic pain symptoms and decrease prescription opioid misuse.  This new study added a new dimension to my work by revealing the promise of brief mind-body therapies for acute pain patients.

It was really exciting and quite amazing to see such dramatic results from a single mind-body session. Given our nation’s current opioid epidemic, the implications of this study are potentially huge. These brief mind-body therapies could be cost-effectively and feasibly integrated into standard medical care as useful adjuncts to pain management.

My interdisciplinary team at Center for Mindfulness and Integrative Health Intervention Development plan to continue to investigate mind-body therapies as non-opioid means of alleviating pain by conducting a national replication study in a sample of thousands of patients in multiple hospitals around the country.

Because of its public health relevance, so far the study has been covered by more than 40 television stations around the country. Here is a brief clip about the study.

 

Please join us for the University of Utah’s new Center on Mindfulness and Integrative Health Intervention Development’s (C-MIIND) first symposium, which focuses on “Translating Basic Biobehavioral Science into Integrative Health.”

The keynote will be delivered by Susan Bauer-Wu, PhD, RN, FAAN, President of the Mind & Life Institute, the world’s premier multidisciplinary organization for the scientific study of mindfulness and meditation, founded in 1991 by the Dalai Lama and neurobiologist Francisco Varela. Dr. Bauer-Wu will discuss how scientific research on ancient contemplative practices is positively impacting healthcare, education, and society.

Next, Brett Froeliger, PhD, Associate Professor of Neuroscience at the Medical University of South Carolina, will discuss the neural mechanisms of emotion dysregulation in addiction as a target for treatment development research.

Finally, C-MIIND Director Eric Garland, PhD, LCSW, Associate Dean for Research at the University of Utah College of Social Work, will discuss the latest discoveries from his psychophysiological research on mind-body interventions for addiction, stress, and chronic pain, with a specific focus on addressing the prescription opioid epidemic.

This event is free and lunch is included, however pre-registration is requested: http://bit.ly/cmiind2017symposium

Wednesday, July 26, 2017

11:30 am –  12:00 pm

Lunch & Networking

12:00 pm – 1:30 pm

Keynote & Presentations

Okazaki Community Meeting Room (155)

University of Utah College of Social Work

395 South 1500 East, Salt Lake City

 

The University of Utah has launched a new center dedicated to providing a transformative influence on healthcare by unifying research on mindfulness and other integrative behavioral health interventions.

Eric Garland, Associate Dean for Research at the U’s College of Social Work, will serve as Director of the new Center on Mindfulness and Integrative Health Intervention Development (C-MIIND). The Center, which will assume oversight of more than $17 million in federal research grants, will be housed in the College of Social Work.

“The center will advance a vision of a new model of healthcare, in which behavioral health experts work in tandem with medical providers to address the physical, psychological and social needs of people suffering from an array of health conditions,” said Garland, whose research focuses on using mindfulness to help individuals who experience chronic pain.

The center will bring together researchers and clinicians from across main campus and University of Utah Health, including faculty in social work, psychiatry, primary care, anesthesiology, neuroscience, oncology, psychology, and health, who are pioneering integrative interventions aimed at improving physical and mental well-being. C-MIIND will strive to attract top faculty and provide research opportunities for undergraduate, graduate and post-doctoral fellows interested in studying mindfulness and integrative behavioral health.

A focus of the center also will be to train post-graduates and health care providers in innovative therapies to be used in primary care clinics, hospitals, community mental health centers and addiction treatment facilities.

News coverage of the Center launch can be found here.

An NPR interview with Dr. Garland about the Center can be found here.