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!

Research on MORE and Mindfulness Covered in the News

Results from a new Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), to be published later this summer in the Journal of Consulting and Clinical Psychology, have been covered in a news story that also details findings from a recently published study of the effects of mindfulness on deautomatization of habit behaviors. A second news story also did a really nice job describing results from this study.

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.

Mindfulness-Oriented Recovery Enhancement Covered on NPR

National Public Radio recently covered a story on Mindfulness-Oriented Recovery Enhancement (MORE) as an intervention for chronic pain and prescription opioid-related problems. The story details new discoveries about the biobehavioral mechanisms of this novel therapy, as well as how mindfulness can be used to improve well-being in individuals suffering from chronic pain.

The NPR story can be found here.

 

 

First fMRI Pilot Study Published on the Effects of Mindfulness-Oriented Recovery Enhancement on Reward Processing in Addiction

IMORE-fMRI-SB‘m pleased to announce that the first fMRI brain imaging study of Mindfulness-Oriented Recovery Enhancement (MORE) has been published in the open-access journal Evidence-Based Complementary and Alternative Medicine (Froeliger et al., 2017). My colleague Brett Froeliger and I conducted this proof-of-concept pilot study at his TRAIN Lab at the Medical University of South Carolina to examine the effects of MORE on reward processes in the brains of people addicted to cigarettes. A sample of 13 smokers participated in a study testing MORE versus a comparison group. All participants underwent two fMRI scans 8 weeks apart. Between the first and second fMRI scan, participants in the MORE group learned mindfulness and reappraisal skills to decrease addictive reactions to cigarettes and savoring skills to increase responsiveness to natural rewards (e.g., social connection, natural beauty, healthy behaviors). Participants in the comparison group completed research measures but did not receive any treatment. Relative to the comparison group, MORE was associated with significant decreases in smoking (66% decrease) and significant increases in positive emotions. Crucially, MORE participants evidenced significant decreases in neural activity while viewing cigarette images in reward-related brain regions including the ventral striatum and ventromedial prefrontal cortex. MORE participants also demonstrated significant increases in neural activity in these same reward-related brain regions while they savored positive, natural-reward related images. Importantly, increases in brain activity during savoring were significantly correlated with smoking reduction and increased positive affect. These pilot findings provide preliminary evidence that MORE may facilitate the restructuring of reward processes and play a role in treating the pathophysiology of nicotine addiction. These findings converge with results from our other psychophysiological studies indicating that MORE may restructure reward processes in prescription opioid misuse (Garland, Froeliger, & Howard, 2014; Garland, Froeliger, & Howard, 2015; Garland, Howard, Zubieta, & Froeliger, 2017). Taken together, these data provide initial support for my restructuring reward hypothesis which asserts that mindfulness training may enhance a domain-general cognitive resource for restructuring reward learning from valuation of drug-related rewards to valuation of natural rewards and thereby reverse the downward spiral of addiction.

Recovery from Addiction, Stress, and Pain through Mindfulness and Social Support

I am honored to have the opportunity to discover new ways of helping people heal and recover from the challenges in their lives. For the past several years, I have been busily engaged in developing a new therapy for people struggling with chronic pain and problems with prescription opioid painkillers through a study funded by the National Institute on Drug Abuse. I first developed this new therapeutic approach, which I call Mindfulness-Oriented Recovery Enhancement, for an earlier study I conducted on alcoholism that was funded by a Francisco Varela Award from Mind and Life Institute. Mindfulness is an expansive and fundamental concept that has been pursued for millennia as a means of ameliorating suffering – look for more posts here soon about it. I am studying how this new treatment compares to a conventional support group. Support groups are a widely-used form of psychological support for people dealing with health and mental health issues that can be extremely helpful.

My approach to helping people is focused on promoting the basic goodness and inherent capacity for growth that lies within each person. I have a lot to say on this topic, but my latest thoughts can be summed up with an image:

In a way, this upward spiral of mindfulness, meaning, and positive emotion may be viewed as the converse of the downward spirals of addiction, stress, and pain that have become a modern day epidemic.

Downward Spiral of Pain and Prescription Opioid Misuse, Abuse, Dependence, and Addiction