My research program is centered on translating findings from cognitive, affective, and social neuroscience into novel interventions (e.g., mindfulness training) that effectively target transdiagnostic mechanisms underpinning stress-related, biobehavioral conditions such as addiction, chronic pain syndromes, and emotion dysregulation. I have a broad background in interdisciplinary clinical research on psychosocial interventions for stress-related conditions, with specific training and expertise in biobehavioral research methodologies. I was trained in intervention research and psychophysiology at the University of North Carolina at Chapel Hill, where I completed my PhD and was awarded Ruth L. Kirschstein pre- and post-doctoral fellowships in integrative medicine from the National Institutes of Health to conduct clinical trials at the University of North Carolina at Chapel Hill School of Medicine.
Current Research Projects
MORE as an Intervention Chronic Pain, Opioid Use, and Opioid Misuse.
Opioid misuse is a public health threat that is being addressed with heightened urgency at both clinical and policy levels. In primary care settings, where chronic pain is commonly treated with long-term opioid therapy, as many as one-in-four chronic pain patients misuse opioids, evidenced by aberrant drug-related behaviors such as dose escalation or use of opioids to self-medicate negative emotions. Extant therapies for opioid misuse and chronic pain may have limited efficacy because they fail to directly target the maladaptive emotion-cognition interactions and hedonic dysregulation inherent in these co-occurring problems. To meet this need, I developed Mindfulness-Oriented Recovery Enhancement (MORE). MORE is innovative in that it aims to modify associative learning mechanisms hijacked during the allostatic process of opioid misuse by strengthening top-down cognitive control to restructure bottom-up reward learning from valuation of drug reward to natural reward – something that no other behavioral intervention for opioid misuse has been designed to do. I have conducted multiple randomized controlled trials of MORE for people with chronic pain on long-term opioid therapy. These trials have clearly demonstrated the efficacy of MORE as a treatment for chronic pain and opioid misuse.
Now, I am moving this research program forward towards implementation science to test how to best deliver MORE as an insurance-reimbursable, accessible service in the healthcare system. We are studying MORE for civilian patients receiving chronic pain management in the primary care setting, and are also studying MORE for military service members undergoing knee replacement surgery. At the same time, my colleagues and I are delving deeper into the therapeutic mechanisms of MORE, using functional magnetic resonance imaging (fMRI) to understand how MORE changes the brain to relieve pain and reduce opioid use.
MORE as a Treatment for Addiction.
I have also expanded this line of research to test MORE as an intervention for people with illicit opioid use disorder (OUD). My colleagues and I have shown that adding MORE to standard addictions care significantly improves addiction treatment outcomes among people receiving medications for OUD. Now, we are conducting several implementation-effectiveness trials to study how to best deliver MORE in the “real world” addiction clinic setting. In these studies, we are training addiction counselors to deliver MORE as part of standard of care.
We are also actively examining the neural mechanisms of MORE as a treatment for addiction. Two groundbreaking neuroimaging trials are using fMRI to test MORE’s effects on brain reward circuitry in people with illicit OUD and nicotine dependent individuals who are trying to quit smoking. The results of these studies, two of the largest neuroscientific studies of mindfulness as treatment of addiction, are forthcoming.
Integrating MORE with Psychedelics and Other Neuroscience-Informed Therapeutics.
Another direction of my research is focused on combining MORE with other neuroscience-informed therapeutics, including neurofeedback, neuromodulation, virtual reality, and psychedelics. Although MORE has demonstrated significant clinical efficacy, not every patient responds to this evidence-based treatment. Therefore, adjunctive interventions are needed to improve treatment outcomes. My colleagues and I are actively studying whether integrating neurofeedback and psychedelics with MORE can boost clinical outcomes in people with chronic pain and addiction. We are also studying whether MORE is an efficacious treatment for OUD when delivered through virtual reality.
Mindfulness and Positive Emotion Regulation.
I am pursuing experimental research in the laboratory, as well as observational studies and clinical trials, to explore the effects of mindfulness on positive emotion regulation. Specifically, I am interested in how mindfulness and related psychological factors may influence two key positive emotional processes: positive reappraisal coping and savoring. These forms of positive emotion regulation are closely linked to mental health and well-being. Finding ways to promote these processes may be the key to ameliorating conditions that involve reward dysregulation (i.e., being unable to receive pleasure healthful objects and events in the natural environment – think smiling babies and sunsets) such as addiction and chronic negative mood states. This line of research informs my theory development efforts.
Cognitive, Affective, and Psychophysiological Mechanisms in Health and Mental Health.
I also study basic cognitive, emotional, and psychophysiological processes implicated in mental health problems and addiction. For instance, I conduct research on the attentional bias – that is, the phenomenon by which people more rapidly detect and focus on objects and events that are congruent with their current mood than those that are not congruent with their current emotional state. Thus, individuals in a negative mood state tend to pay attention to objects, persons, and events that they construe as disappointing, upsetting, or frightening, while overlooking or ignoring what is beautiful, affirming, or pleasurable. Attentional bias is particularly evident in addiction when people with addiction are “triggered” and find their attention automatically captured by drug-related cues (such as the sight of a cigarette, pill, or bottle of liquor) even when they want to stay clean and sober. I am also interested in studying how the brain modulates the heart beat when people are paying attention to emotional stimuli and experiences. My studies and the studies of others have shown that rapid, beat-to-beat changes in heart rate, known as heart rate variability, are significantly associated with emotional states and degree of mental focus.
Mind-Body Interventions in Supportive Oncology and Survivorship.
I conduct research on the therapeutic effects of mind-body interventions for cancer and their mechanisms of action. New research efforts are focused on testing MORE as an intervention to address cancer pain. I have also conducted research on mindfulness training and clinical hypnosis, as well as their integration with other complementary therapies, including acupuncture, osteopathy, and exercise. This area of research is particularly fertile ground for studies on the cognitive, affective, and psychophysiological pathways linking mindfulness to positive reappraisal coping, the capacity to find meaning and purpose in the face of adversity.
Research Conflict of Interest Disclosure
Eric Garland, PhD, LCSW is the Director of UCSD ONEMIND (Optimized Neuroscience-Enhanced Mindfulness Intervention Design). UCSD ONEMIND provides Mindfulness-Oriented Recovery Enhancement (MORE), meditation-based interventions, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in MORE), including those sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland is Founder of MORE Science Institute.