Publications by authors named "Eric L Garland"

129 Publications

Effects of Video-Guided Group vs. Solitary Meditation on Mindfulness and Social Connectivity: A Pilot Study.

Clin Soc Work J 2021 Jun 24:1-9. Epub 2021 Jun 24.

College of Social Work, University of Utah, Salt Lake City, USA.

Interest in mindfulness meditation continues to grow as accumulating evidence suggests mindfulness training encourages more positive functioning. However, basic questions about the conditions best suited for realizing mindful states remain unanswered. Prominent among these is whether a group mindfulness practice setting is more effective for novice meditators than a solitary practice setting. Answering this question has assumed new urgency due to the imposition of physical distancing measures designed to stop the spread of COVID-19. In a time of limited social contact, is a simulated group practice setting better than practicing alone? This preliminary study investigated whether environmental setting impacted mindfulness practice experience by examining the effects of three simulated meditation practice environments (1. group practice, 2. nature practice, and 3. solitary practice) on state mindfulness and perceived social connectivity in a sample of novice meditators. Significant differences emerged across the three simulated practice settings. Findings suggest watching others meditate while meditating appears to most effectively induce a state of mindfulness and strengthen feelings of social connectivity. This study supports traditional beliefs about the benefits of group mindfulness practice. These findings also have implications for social workers struggling to stretch limited resources to address growing mental health demands, especially during times of heightened social isolation due to COVID-19. If a simulated group practice confers the same cognitive benefits as solitary practice while also conferring social benefits, simulated group instruction may be preferable for therapeutic and economic reasons.
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http://dx.doi.org/10.1007/s10615-021-00812-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224259PMC
June 2021

To be mindful of the breath or pain: Comparing two brief preoperative mindfulness techniques for total joint arthroplasty patients.

J Consult Clin Psychol 2021 Jun 24. Epub 2021 Jun 24.

Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah.

Objective: Total joint arthroplasty (TJA) often reduces pain and improves function, but it is also a risk factor for the development of chronic pain and postoperative opioid use. To protect against these untoward postsurgical outcomes, TJA patients need better, non-pharmacological pain management strategies. This study compared two, promising, mindfulness-based pain management techniques.

Method: We conducted a single-site, three-arm, parallel-group randomized controlled study conducted at an orthopedic clinic among patients undergoing TJA of the knee or hip. TJA patients (N = 118, M age = 65, female = 73, Caucasian = 110) were randomized to either a preoperative mindfulness of breath (MoB), mindfulness of pain (MoP), or cognitive-behavioral pain psychoeducation (CB) intervention, approximately 3 weeks before surgery. Each intervention was delivered in a single, 20-min session during a 2-hr, preoperative education program. Change in pain intensity was the sole preoperative outcome. The postoperative outcomes, pain intensity, pain interference, and opioid use were assessed on the 2nd, 3rd, 7th, 14th, 21st, and 28th postoperative days.

Results: MoB was found to most effectively decrease preoperative pain scores, F(2, 89) = 5.28, p = .007, while MoP resulted in the least amount of postoperative pain intensity, F(8, 94) = 3.21, p = .003, and interference, F(8, 94) = 2.52, p = .016). Both MoB and MoP decreased postoperative opioid use relative to CB, F(8, 83) = 16.66, p < .001.

Conclusion: A brief preoperative MBI may be able to prevent both postoperative pain and opioid use. Moreover, the MBIs used in this study are highly feasible, capable of being delivered by nearly any healthcare provider, and requiring minimal clinic time given their brevity. As such, embedding MBIs in surgical care pathways has considerable potential. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000657DOI Listing
June 2021

A pilot randomized clinical trial of mindfulness-oriented recovery enhancement as an adjunct to methadone treatment for people with opioid use disorder and chronic pain: Impact on illicit drug use, health, and well-being.

J Subst Abuse Treat 2021 Aug 8;127:108468. Epub 2021 May 8.

College of Social Work, University of Utah, Goodwill Humanitarian Building, 395 South, 1500 East, Room 273, Salt Lake City 84108, USA; Center on Mindfulness and Integrative Health Intervention Development, University of Utah, 395 South, 1500 East, Room 273, Salt Lake City 84108, USA.

Background: Chronic pain is highly prevalent among people in methadone maintenance treatment (MMT) for opioid use disorder and is known to be an important contributor to treatment discontinuation and opioid relapse. Mindfulness-Oriented Recovery Enhancement (MORE) is one of the few interventions developed and tested as an integrated treatment to simultaneously address both pain and illicit opioid use; however, this study is the first to evaluate MORE as an adjunct to MMT.

Methods: Randomized individuals in MMT (N = 30) received MORE plus methadone TAU (n = 15) or methadone TAU, only (n = 15). Participants in the MORE arm received their MMT, as usual, and attended eight, weekly, two-hour MORE groups at their MMT clinics. Participants in the TAU arm received their MMT, as usual, and group or individual counseling, as required by the clinic. TAU counseling consisted of relapse prevention, cognitive-behavioral therapy, and supportive treatment. TAU participants did not receive any mindfulness-based intervention. Participants completed assessments at baseline, post-treatment (i.e., 8-weeks post-baseline), and follow-up (i.e., 16-weeks post-baseline).

Results: Participants in MORE evidenced significantly fewer baseline adjusted days of illicit drug use and significantly lower levels of craving through 16-week follow-up compared to TAU. Also, Participants in MORE reported significantly lower levels of pain, physical and emotional limitations, depression, and anxiety through 16-week follow-up compared to TAU. Conversely, participants in MORE reported significantly higher levels of well-being, vitality, and social functioning through 16-week follow-up compared to TAU.

Conclusion: MORE could be an effective adjunct to MMT, and larger trials are warranted.
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http://dx.doi.org/10.1016/j.jsat.2021.108468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281569PMC
August 2021

Reply to Riddle.

Pain 2021 07;162(7):2145

Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, UT, United States.

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http://dx.doi.org/10.1097/j.pain.0000000000002251DOI Listing
July 2021

Mindful Positive Emotion Regulation as a Treatment for Addiction: From Hedonic Pleasure to Self-Transcendent Meaning.

Authors:
Eric L Garland

Curr Opin Behav Sci 2021 Jun 24;39:168-177. Epub 2021 Apr 24.

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA.

Chronic drug use is theorized to induce cortico-striatal neuroplasticity, driving an allostatic process marked by increased sensitivity to drug-related cues and decreased sensitivity to natural rewards that results in anhedonia and a dearth of positive affect. As such, positive emotion regulation represents a key mechanistic target for addictions treatment. This paper provides a conceptual model detailing how mindfulness may synergize a range of positive affective mechanisms to reduce addictive behavior, from savoring the hedonic pleasure derived from natural rewards, to self-generating interoceptive reward responses, and ultimately to cultivating self-transcendent meaning. These therapeutic processes may restructure reward processing from over-valuation of drug-related rewards back to valuation of natural rewards, and hypothetically, "reset" the default mode network dysfunction that undergirds addiction.
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http://dx.doi.org/10.1016/j.cobeha.2021.03.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8168946PMC
June 2021

Effects of Mindfulness Meditation on Self-Transcendent States: Perceived Body Boundaries and Spatial Frames of Reference.

Mindfulness (N Y) 2020 May 14;11(5):1194-1203. Epub 2020 Feb 14.

Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah.

Objectives: Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: 1) perceived body boundary dissolution, and 2) more allocentric spatial frames of reference.

Methods: A sample of healthy, young adults (n=45) were randomized to five sessions of mindfulness training or an active listening control condition.

Results: Results indicated mindfulness training decreased perceived body boundaries ( =6.010, <.001, =.12) and encouraged more allocentric frames of reference ( =2.586, =.039, =.06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference ((=-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries (=.24, =.17, : 0.11 to 0.78).

Conclusions: Taken together, study results suggest that mindfulness training alters practitioners' experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences.
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http://dx.doi.org/10.1007/s12671-020-01330-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968136PMC
May 2020

Mindfulness-based waiting room intervention for osteopathic manipulation patients: a pilot randomized controlled trial.

J Osteopath Med 2021 02 24;121(4):337-348. Epub 2021 Feb 24.

Division of Physical Medicine and Rehabilitation and the Huntsman Cancer Institute Wellness and Integrative Health Center, University of Utah, Salt Lake City, Utah, USA.

Context: Osteopathic manipulative treatment (OMT) and mindfulness-based interventions are both efficacious pain management strategies. Combining these two therapeutic approaches may offer added benefits to pain patients.

Objectives: To determine whether engaging in a mindfulness-based intervention before an OMT session improved OMT session outcomes.

Methods: Patients seeking OMT care from a single osteopathic physician at an integrative health clinic were recruited for this pilot randomized, controlled trial at an academic hospital. All patients scheduled for osteopathic structural evaluation and treatment with the provider from March 2019 to September 2019 were eligible and invited to participate during the reminder call before their visit. Participants were randomly assigned to listen to one of two audio recordings matched for length: (1) the history of osteopathic medicine, or (2) a guided mindfulness meditation practice. Patients completed surveys including numeric rating scales to measure mindfulness and embodied safety (a self-reported feeling that the patient's body was in a safe place) immediately before and after listening to the audio recording. A global pain rating report along with a sensation manikin (a digital human figure silhouette overlaid with a grid of 786 "sensation" pixels) capturing both pleasant and unpleasant sensation were collected before and after the OMT session. Session satisfaction was also assessed with a single survey item.

Results: A total of 57 participants were enrolled in the study; however, 18 were unable to listen to the full audio recording and were excluded from further analysis. The final study sample consisted of 39 patients, with 19 (48.7%) randomized to the history audio recording and 20 (51.3%) randomized to the mindfulness recording. The mean age of patients was 57 years (standard deviation, 11.75 years); 25 (64.1%) were women and 14 (35.9%) were men. The most common primary pain location was the neck (16; 41.0%), followed by back (12; 30.8%) and joint (5; 12.8%). Twenty (51.3%) participants were cancer patients; 19 (48.8%) did not have a cancer diagnosis. Practicing mindfulness before OMT increased patients' sense of mindful connection to (p=0.036) and safety within (p=0.026) their bodies as well as their overall session satisfaction (p=0.037). Additionally, OMT paired with either study condition (mindfulness vs. history) decreased pain (p<0.001) and increased the ratio of pleasant to unpleasant sensations reported by patients (p<0.001). Finally, regardless of experimental condition (mindfulness vs. history), increased safety within the body predicted greater pain relief (=-0.33, p=0.035) and larger sensation ratio changes (=0.37, p=0.030) at the OMT session's end. Additionally, increased mindful connection to the body predicted less pain (=-0.41, p=0.005) at the session's end.

Conclusions: This study demonstrated the feasibility of integrating a mindfulness-based intervention with OMT and results suggest that having patients listen to an audio-guided mindfulness practice while waiting for their OMT session may increase their mindful connection to and safety within their bodies as well as their session satisfaction. This study also provides empirical evidence that OMT may increase the distribution of pleasant sensations reported by pain patients while decreasing the distribution of unpleasant sensations reported.
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http://dx.doi.org/10.1515/jom-2020-0186DOI Listing
February 2021

Modeling the mindfulness-to-meaning theory's mindful reappraisal hypothesis: Replication with longitudinal data from a randomized controlled study.

Stress Health 2021 Feb 19. Epub 2021 Feb 19.

College of Social Work, University of Utah, Salt Lake City, Utah, USA.

The Mindfulness to Meaning Theory provides a detailed process model of the mechanisms by which mindfulness may promote well-being. Central to the Mindfulness to Meaning Theory is the mindful reappraisal hypothesis (MRH), which suggests mindfulness training promotes well-being by facilitating positive reappraisal. Emerging evidence from interconnected domains of research supports the MRH. However, it remains unclear whether mindful reappraisal continues to develop after a mindfulness training course and whether this continued development encourages well-being over time. As such, this randomized controlled study compared participants receiving a mindfulness-based stress reduction (MBSR) course with participants receiving no mindfulness training on positive reappraisal use and well-being over the course of 6 years. Latent growth curve modeling revealed that mindfulness training increased well-being by significantly increasing the trajectory of positive reappraisal over time. The MRH was then unpacked by examining whether MBSR also stimulated decentering and broadened awareness, core components of the MRH. Multivariate path analysis revealed that mindfulness training increased decentering, which in turn broadened awareness, which was then associated with positive reappraisal, ultimately promoting well-being. Taken together, these findings suggest that MBSR cultivates a downstream cascade of adaptive psychological processes that continue to promote quality of life 6-years after mindfulness training.
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http://dx.doi.org/10.1002/smi.3035DOI Listing
February 2021

Brief preoperative mind-body therapies for total joint arthroplasty patients: a randomized controlled trial.

Pain 2021 06;162(6):1749-1757

Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah College of Social, Salt Lake City, UT, United States.

Abstract: Although knee and hip replacements are intended to relieve pain and improve function, up to 44% of knee replacement patients and 27% of hip replacement patients report persistent postoperative joint pain. Improving surgical pain management is essential. We conducted a single-site, 3-arm, parallel-group randomized clinical trial conducted at an orthopedic clinic, among patients undergoing total joint arthroplasty (TJA) of the hip or knee. Mindfulness meditation (MM), hypnotic suggestion (HS), and cognitive-behavioral pain psychoeducation (cognitive-behavioral pain psychoeducation) were each delivered in a single, 15-minute group session as part of a 2-hour, preoperative education program. Preoperative outcomes-pain intensity, pain unpleasantness, pain medication desire, and anxiety-were measured with numeric rating scales. Postoperative physical functioning at 6-week follow-up was assessed with the Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test. Total joint arthroplasty patients were randomized to preoperative MM, HS, or cognitive-behavioral pain psychoeducation (n = 285). Mindfulness meditation and HS led to significantly less preoperative pain intensity, pain unpleasantness, and anxiety. Mindfulness meditation also decreased preoperative pain medication desire relative to cognitive-behavioral pain psychoeducation and increased postoperative physical functioning at 6-week follow-up relative to HS and cognitive-behavioral pain psychoeducation. Moderation analysis revealed the surgery type did not differentially impact the 3 interventions. Thus, a single session of a simple, scripted MM intervention may be able to immediately decrease TJA patients' preoperative clinical symptomology and improve postoperative physical function. As such, embedding brief MM interventions in surgical care pathways has the potential to improve surgical outcomes for the millions of patients receiving TJA each year.
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http://dx.doi.org/10.1097/j.pain.0000000000002195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119303PMC
June 2021

Prescription opioid misusers exhibit blunted parasympathetic regulation during inhibitory control challenge.

Psychopharmacology (Berl) 2021 Mar 7;238(3):765-774. Epub 2021 Jan 7.

University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Rationale: Among opioid-treated chronic pain patients, response inhibition deficits in emotional contexts may contribute to opioid misuse.

Objectives: Using high-frequency heart rate variability (HF-HRV) to index-impaired response inhibition, we examined associations between opioid misuse and response inhibition in emotional and neutral contexts in a sample of opioid-treated chronic pain patients.

Method: Chronic pain patients taking opioid analgesics (N = 97) for ≥ 90 days completed an Emotional Go/NoGo task that presented an inhibitory control challenge in the context of neutral, opioid, negative affective, and positive affective background images while HF-HRV was computed. Opioid misuse and craving were assessed. Using a validated cut-point on the Current Opioid Misuse Measure, participants were classified as opioid misusers or non-misusers. Opioid misuse was examined as a predictor of behavioral and HF-HRV metrics of response inhibition.

Results: Negative affective and opioid images elicited more errors of commission (p = .002, η = .16) and slowed reaction times (p = .045, η = .09) compared to neutral and positive affective images, respectively. Though no between-group behavioral differences were observed on the task, opioid misusers exhibited significantly blunted phasic HF-HRV during the task relative to non-misusers (p = .027, η = .11). HF-HRV during the task was significantly inversely associated with opioid craving. It was not clear whether these autonomic findings reflected a durable phenotypic difference between groups or between-group differences in opioid dosing and withdrawal.

Conclusion: Reduced parasympathetic regulation during inhibitory control challenge may indicate heightened opioid misuse risk among opioid-treated chronic pain patients.
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http://dx.doi.org/10.1007/s00213-020-05729-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7914222PMC
March 2021

A Sequential Multiple-Assignment Randomized Trial (SMART) for Stepped Care Management of Low Back Pain in the Military Health System: A Trial Protocol.

Pain Med 2020 12;21(Suppl 2):S73-S82

University of Utah, Salt Lake City, Utah.

Background: The Defense Health Agency has prioritized system-level pain management initiatives within the Military Health System (MHS), with low back pain as one of the key focus areas. A stepped care model focused on nonpharmacologic treatment to promote self-management is recommended. Implementation of stepped care is complicated by lack of information on the most effective nonpharmacologic strategies and how to sequence and tailor the various available options. The Sequential Multiple-Assignment Randomization Trial for Low Back Pain (SMART LBP) is a multisite pragmatic trial using a SMART design to assess the effectiveness of nonpharmacologic treatments for chronic low back pain.

Design: This SMART trial has two treatment phases. Participants from three military treatment facilities are randomized to 6 weeks of phase I treatment, receiving either physical therapy (PT) or Army Medicine's holistic Move2Health (M2H) program in a package specific to low back pain. Nonresponders to treatment in phase I are again randomized to phase II treatment of combined M2H + PT or mindfulness-based treatment using the Mindfulness-Oriented Recovery Enhancement (MORE) program. The primary outcome is the Patient-Reported Outcomes Measurement Information System pain interference computer-adapted test score.

Summary: This trial is part of an initiative funded by the National Institutes of Health, Veterans Affairs, and the Department of Defense to establish a national infrastructure for effective system-level management of chronic pain with a focus on nonpharmacologic treatments. The results of this study will provide important information on nonpharmacologic care for chronic LBP in the MHS embedded within a stepped care framework.
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http://dx.doi.org/10.1093/pm/pnaa338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734656PMC
December 2020

Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions.

Authors:
Eric L Garland

Pain 2020 12;161(12):2659-2666

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, United States.

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http://dx.doi.org/10.1097/j.pain.0000000000001988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678811PMC
December 2020

The Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM): Development and Validation of a New Tool to Assess Therapist Adherence and Competence.

J Evid Based Soc Work (2019) 2021 May-Jun;18(3):308-322. Epub 2020 Nov 8.

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, Utah, USA.

Objective: Mindfulness-Oriented Recovery Enhancement (MORE) is a mind-body therapy that unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative treatment for addiction and its comorbidities. As interest in MORE has grown among researchers and clinicians, there is an increasing need to provide quality assurance measures to ensure treatment integrity during implementation of MORE. Here, we describe the development and validation of the Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM).

Method: We developed a 17-item scale assessing therapist competence and adherence to the MORE treatment manual, which was then used for fidelity monitoring of 40 MORE treatment sessions across two Stage 2 and two Stage 1 RCT for addictive behaviors (e.g., opioid misuse, obesity) involving a total N = 295.

Results: Internal consistency for the Adherence (=.89) and Competence subscales (=.92) was high, and interrater reliability was adequate (Adherence subscale ICC =.77; Competence subscale ICC =.51), with therapists exhibiting good-to-excellent levels of fidelity across all trials. Importantly, linear mixed modeling indicated that higher levels of overall fidelity were associated with greater reductions in opioid misuse across two Stage 2 RCTs ( = 7.38, =.009), indicating that the MORE-FM is a valid measure of treatment fidelity that can predict clinical outcomes.

Conclusions: Findings from this study yielded insights for future iterations of the MORE-FM. In sum, the MORE-FM is a valuable tool for assessing and enhancing the integrity of MORE in future research trials and clinical applications.
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http://dx.doi.org/10.1080/26408066.2020.1833803DOI Listing
November 2020

Salivary measurement and mindfulness-based modulation of prescription opioid cue-reactivity.

Drug Alcohol Depend 2020 12 12;217:108351. Epub 2020 Oct 12.

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, United States; College of Social Work, University of Utah, United States; Salt Lake City Veterans Administration Medical Center, United States. Electronic address:

Background: Chronic pain patients on long-term opioid therapy (LTOT) may be at elevated risk for developing conditioned opioid cue-reactivity as their prescribed dosing schedules simultaneously function as fixed reinforcement schedules. Since opioids are typically consumed orally during LTOT, it stands to reason that opioid cue exposure might elicit conditioned salivary responses. However, no study has examined salivary cue-reactivity among opioid users during in-vivo exposure to their own prescription opioid medication.

Methods: Two samples (N = 68, N = 39) of chronic pain patients on LTOT were recruited from primary care and specialty care clinics. Study 1 aimed to determine whether chronic pain patients receiving LTOT exhibited salivary cue-reactivity to their prescribed opioid. Study 2 was a pilot study that aimed to assess the effects of behavioral treatment on chronic pain patients' salivary cue-reactivity.

Results: In Study 1, exposure to the patient's own prescribed opioid resulted in significantly greater increases in salivation and cue-elicited craving than exposure to a neutral cue. In Study 2 participants who were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement intervention evidenced significantly greater decreases in opioid cue-reactivity than participants in an active control condition as evidenced by both reduced salivation and craving ratings.

Conclusions: Study findings demonstrate salivation may serve as a useful, objective index of opioid cue-reactivity. With further refinement of this task, conditioned salivary response could be used to identify especially vulnerable patients, who then could be targeted with a personalized medicine approach for selective and intensive prevention/treatment interventions to preempt escalation of opioid use to opioid misuse and OUD.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736195PMC
December 2020

Endogenous theta stimulation during meditation predicts reduced opioid dosing following treatment with Mindfulness-Oriented Recovery Enhancement.

Neuropsychopharmacology 2021 03 12;46(4):836-843. Epub 2020 Sep 12.

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, Salt Lake City, UT, USA.

Veterans experience chronic pain at greater rates than the rest of society and are more likely to receive long-term opioid therapy (LTOT), which, at high doses, is theorized to induce maladaptive neuroplastic changes that attenuate self-regulatory capacity and exacerbate opioid dose escalation. Mindfulness meditation has been shown to modulate frontal midline theta (FMT) and alpha oscillations that are linked with marked alterations in self-referential processing. These adaptive neural oscillatory changes may promote reduced opioid use and remediate the neural dysfunction occasioned by LTOT. In this study, we used electroencephalography (EEG) to assess the effects of a mindfulness-based, cognitive training intervention for opioid misuse, Mindfulness-Oriented Recovery Enhancement (MORE), on alpha and theta power and FMT coherence during meditation. We then examined whether these neural effects were associated with reduced opioid dosing and changes in self-referential processing. Before and after 8 weeks of MORE or a supportive psychotherapy control, veterans receiving LTOT (N = 62) practiced mindfulness meditation while EEG was recorded. Participants treated with MORE demonstrated significantly increased alpha and theta power (with larger theta power effect sizes) as well as increased FMT coherence relative to those in the control condition-neural changes that were associated with altered self-referential processing. Crucially, MORE significantly reduced opioid dose over time, and this dose reduction was partially statistically mediated by changes in frontal theta power. Study results suggest that mindfulness meditation practice may produce endogenous theta stimulation in the prefrontal cortex, thereby enhancing inhibitory control over opioid dose escalation behaviors.
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http://dx.doi.org/10.1038/s41386-020-00831-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026958PMC
March 2021

Mindfulness-oriented recovery enhancement reduces opioid dose in primary care by strengthening autonomic regulation during meditation.

Am Psychol 2020 09;75(6):840-852

Center on Mindfulness and Integrative Health Intervention Development, University of Utah.

The current opioid crisis was fueled by escalation of opioid dosing among patients with chronic pain. Yet, there are few evidence-based psychological interventions for opioid dose reduction among chronic pain patients treated with long-term opioid analgesics. Mindfulness-Oriented Recovery Enhancement (MORE), which was designed to target mechanisms underpinning chronic pain and opioid misuse, has shown promising results in 2 randomized clinical trials (RCTs) and could facilitate opioid sparing and tapering by bolstering self-regulation. Here we tested this hypothesis with secondary analyses of data from a Stage 2 RCT. Chronic pain patients (N = 95) on long-term opioid therapy were randomized to 8 weeks of MORE or a support group (SG) control delivered in primary care. Opioid dose was assessed with the Timeline Followback through 3-month follow-up. Heart rate variability (HRV) during mindfulness meditation was quantified as an indicator of self-regulatory capacity. Participants in MORE evidenced a greater decrease in opioid dosing (a 32% decrease) by follow-up than did the SG, F(2, 129.77) = 5.35, p = .006, d = 1.07. MORE was associated with a significantly greater increase in HRV during meditation than was the SG. Meditation-induced change in HRV partially mediated the effect of MORE on opioid dose reduction (p = .034). MORE may boost self-regulatory strength via mindfulness and thereby facilitate self-control over opioid use, leading to opioid dose reduction in people with chronic pain. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/amp0000638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490853PMC
September 2020

Assessment of Anhedonia in Adults With and Without Mental Illness: A Systematic Review and Meta-analysis.

JAMA Netw Open 2020 08 3;3(8):e2013233. Epub 2020 Aug 3.

Department of Psychology, University of Oslo, Oslo, Norway.

Importance: Anhedonia, a reduced capacity for pleasure, is described for many psychiatric and neurologic conditions. However, a decade after the Research Domain Criteria launch, whether anhedonia severity differs between diagnoses is still unclear. Reference values for hedonic capacity in healthy humans are also needed.

Objective: To generate and compare reference values for anhedonia levels in adults with and without mental illness.

Data Sources: Web of Science, Scopus, PubMed, and Google Scholar were used to list all articles from January 1, 1995 to July 2, 2019, citing the scale development report of a widely used anhedonia questionnaire, the Snaith-Hamilton Pleasure Scale (SHAPS). Searches were conducted from April 5 to 11, 2018, and on July 2, 2019.

Study Selection: Studies including healthy patients and those with a verified diagnosis, assessed at baseline or in a no-treatment condition with the complete 14-item SHAPS, were included in this preregistered meta-analysis.

Data Extraction And Synthesis: Random-effects models were used to calculate mean SHAPS scores and 95% CIs separately for healthy participants and patients with current major depressive disorder (MDD), past/remitted MDD, bipolar disorder, schizophrenia, substance use disorders, Parkinson disease, and chronic pain. SHAPS scores were compared between groups using meta-regression, and traditional effect size meta-analyses were conducted to estimate differences in SHAPS scores between healthy and patient samples. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Main Outcomes And Measures: Self-reported anhedonia as measured by 2 different formats of the SHAPS (possible ranges, 0-14 and 14-56 points), with higher values on both scales indicating greater anhedonia symptoms.

Results: In the available literature (168 articles; 16 494 participants; 8058 [49%] female participants; aged 13-72 years), patients with current MDD, schizophrenia, substance use disorder, Parkinson disease, and chronic pain scored higher on the SHAPS than healthy participants. Within the patient groups, those with current MDD scored considerably higher than all other groups. Patients with remitted MDD scored within the healthy range (g = 0.1). This pattern replicated across SHAPS scoring methods and was consistent across point estimate and effect size analyses.

Conclusions And Relevance: The findings of this meta-analysis indicate that the severity of anhedonia may differ across disorders associated with anhedonia. Whereas anhedonia in MDD affects multiple pleasure domains, patients with other conditions may experience decreased enjoyment of only a minority of life's many rewards. These findings have implications for psychiatric taxonomy development, where dimensional approaches are gaining attention. Moreover, the SHAPS reference values presented herein may be useful for researchers and clinicians assessing the efficacy of anhedonia treatments.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.13233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7116156PMC
August 2020

The Metacognitive Processes of Decentering Scale: Development and initial validation of trait and state versions.

Psychol Assess 2020 Oct 23;32(10):956-971. Epub 2020 Jul 23.

College of Social Work.

The ability to decenter from internal experiences is important for mental health. Consequently, improving decentering is a common therapeutic target, particularly for mindfulness-based interventions. However, extant decentering measures are limited as they fail to directly assess all 3 metacognitive processes recently theorized to subserve decentering. We thus conducted 4 studies to develop and test the Metacognitive Processes of Decentering-Trait (MPoD-t) and State (MPoD-s) scales. Consistent with the metacognitive processes model, exploratory factor analysis ( = 355) and then bifactor exploratory structural equation modeling ( = 275) indicated the MPoD-t was composed of three independent yet interrelated lower-order factors, metaawareness, (dis)identification with internal experience, and (non)reactivity to internal experience, which subserved an emergent, higher-order, decentering factor. We next found evidence of the MPoD-t's convergent validity; as well as known-groups criterion validity, wherein mindfulness practitioners reported higher MPoD-t scores than nonpractitioners. Item response theory analyses were then used to identify a subset of 3 MPoD-t items for the MPoD-s. Finally, we found evidence that the MPoD-s was sensitive to changes in state decentering following a brief mindfulness induction relative to an active control condition; and that MPoD-s changes mediated the effect of mindfulness on levels of pain and related outcomes among a sample of preoperative surgery patients ( = 82). These studies indicate the trait and state versions of the MPoD may prove useful for the study of decentering and its constituent metacognitive processes. As such, the MPoD may help advance our understanding of how the metacognitive processes of decentering support mental health and well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000931DOI Listing
October 2020

The temporal dynamics of emotion dysregulation in prescription opioid misuse.

Prog Neuropsychopharmacol Biol Psychiatry 2021 01 24;104:110024. Epub 2020 Jun 24.

Center on Mindfulness and Integrative Health Intervention Development, University of Utah, United States of America; College of Social Work, University of Utah, United States of America; Veterans Health Care Administration VISN 19 Whole Health Flagship site, VA, Salt Lake City Healthcare System, United States of America. Electronic address:

Background: Opioid misuse is theorized to compromise the capacity to regulate positive and negative emotions. Yet, the temporal dynamics of emotion dysregulation in opioid misuse remain unclear.

Methods: Patients with chronic pain on long-term opioid therapy (N = 71) participated in an experiment in which they completed an event-related emotion regulation task while heart rate (HR) and galvanic skin responses (GSR) were recorded over a 5 s emotional picture viewing period. Participants were asked to passively view the images or to proactively regulate their emotional responses via reappraisal (i.e., negative emotion regulation) and savoring (i.e., positive emotion regulation) strategies. Using a validated cutpoint on the Current Opioid Misuse Measure, participants were classified as medication-adherent or opioid misusers.

Results: Medication-adherent patients were able to significantly decrease GSR and HR during negative emotion regulation, whereas opioid misusers exhibited contradictory increases in these autonomic parameters during negative emotion regulation. Furthermore, GSR during positive emotion regulation increased for non-misusers, whereas GSR during positive emotion regulation did not increase for misusers. These autonomic differences, which remained significant even after controlling for a range of covariates, were evident within 1 s of emotional stimulus presentation but reached their maxima 3-4 s later.

Conclusions: Opioid misuse among people with chronic pain is associated with emotion dysregulation that occurs within the first few seconds of an emotional provocation. Treatments for opioid misuse should aim to remediate these deficits in emotion regulation.
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http://dx.doi.org/10.1016/j.pnpbp.2020.110024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484236PMC
January 2021

The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain.

BMC Musculoskelet Disord 2020 May 11;21(1):293. Epub 2020 May 11.

Department of Physical Therapy and Athletic Training, University of Utah, 201 Presidents' Cir, Salt Lake City, UT, 84112, USA.

Background: Low back pain is a prevalent condition that causes a substantial health burden. Despite intensive and expensive clinical efforts, its prevalence is growing. Nonpharmacologic treatments are effective at improving pain-related outcomes; however, treatment effect sizes are often modest. Physical therapy (PT) and cognitive behavioral therapy (CBT) have the most consistent evidence of effectiveness. Growing evidence also supports mindfulness-based approaches. Discussions with providers and patients highlight the importance of discussing and trying options to find the treatment that works for them and determining what to do when initial treatment is not successful. Herein, we present the protocol for a study that will evaluate evidence-based, protocol-driven treatments using PT, CBT, or mindfulness to examine comparative effectiveness and optimal sequencing for patients with chronic low back pain.

Methods: The Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back Pain (OPTIMIZE) Study will be a multisite, comparative effectiveness trial using a sequential multiple assessment randomized trial design enrolling 945 individuals with chronic low back pain. The co-primary outcomes will be disability (measured using the Oswestry Disability Index) and pain intensity (measured using the Numerical Pain Rating Scale). After baseline assessment, participants will be randomly assigned to PT or CBT. At week 10, participants who have not experienced at least 50% improvement in disability will be randomized to cross-over phase-1 treatments (e.g., PT to CBT) or to Mindfulness-Oriented Recovery Enhancement (MORE). Treatment will consist of 8 weekly sessions. Long-term outcome assessments will be performed at weeks 26 and 52.

Discussion: Results of this study may inform referring providers and patients about the most effective nonoperative treatment and/or sequence of nonoperative treatments to treat chronic low back pain.

Trial Registration: This study was prospectively registered on March 1, 2019, with Clinicaltrials.gov under the registration number NCT03859713 (https://clinicaltrials.gov/ct2/show/NCT03859713).
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http://dx.doi.org/10.1186/s12891-020-03324-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216637PMC
May 2020

Does mindfulness practice promote psychological functioning or is it the other way around? A daily diary study.

Psychotherapy (Chic) 2020 09 30;57(3):310-322. Epub 2020 Apr 30.

Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah.

Mindfulness-based interventions are commonly used to reduce psychological symptoms and enhance positive qualities of human functioning. However, the influence of mindfulness practice dosage remains poorly understood, limiting dissemination and implementation efforts. The current study examined the association between practice dosage and several constructs related to psychological functioning (positive and negative affect, state mindfulness) over the course of a standardized mindfulness-based intervention (Mindfulness-Oriented Recovery Enhancement). Twenty-five participants completed daily diary assessments for 12 weeks. Two-part gamma regression models examined the dichotomous (did practice occur?) and continuous (how much practice?) components of practice minutes. Practice time and outcomes showed same-day relationships in the expected directions. Lagged models, however, showed no evidence that current day practice time predicts subsequent day outcomes. In contrast, higher current day negative affect predicted less subsequent day practice time, and higher current day mindfulness predicted more subsequent day practice time. In a post hoc analysis, practice time moderated the link between day-to-day affect, strengthening the link for positive affect and weakening the link for negative affect. Collectively, these findings suggest that the causal direction linking practice time and outcome may flow from outcome to practice time, rather than the reverse-with potential recursive relationships between these factors. Further examination of lagged relationships between practice time and outcome as well as random assignment of participants to varying practice dosages (e.g., in within-person microrandomized trials) may help clarify the influence of this central treatment ingredient within mindfulness-based interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pst0000286DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484416PMC
September 2020

Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.

JAMA Intern Med 2020 Jan;180(1):91-105

Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.

Importance: Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

Objective: To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain.

Data Sources: For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched.

Study Selection: Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain.

Data Extraction And Synthesis: Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs.

Main Outcomes And Measures: The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function.

Results: Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = -0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d = -0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = -0.70), hypnosis (Cohen d = -0.54), suggestion (Cohen d = -0.68), and cognitive behavioral therapy (Cohen d = -0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias.

Conclusions And Relevance: The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.
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http://dx.doi.org/10.1001/jamainternmed.2019.4917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441PMC
January 2020

Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.

Sci Adv 2019 10 16;5(10):eaax1569. Epub 2019 Oct 16.

Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA.

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users ( = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE's therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.
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http://dx.doi.org/10.1126/sciadv.aax1569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512PMC
October 2019

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial.

J Consult Clin Psychol 2019 Oct;87(10):927-940

School of Social Work, University of North Carolina at Chapel Hill.

Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health.

Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up.

Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02).

Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/ccp0000390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764586PMC
October 2019

Anhedonia in chronic pain and prescription opioid misuse.

Psychol Med 2020 09 19;50(12):1977-1988. Epub 2019 Aug 19.

Department of Psychology, University of Oslo, Norway.

Background: Both acute and chronic pain can disrupt reward processing. Moreover, prolonged prescription opioid use and depressed mood are common in chronic pain samples. Despite the prevalence of these risk factors for anhedonia, little is known about anhedonia in chronic pain populations.

Methods: We conducted a large-scale, systematic study of anhedonia in chronic pain, focusing on its relationship with opioid use/misuse, pain severity, and depression. Chronic pain patients across four distinct samples (N = 488) completed the Snaith-Hamilton Pleasure Scale (SHAPS), measures of opioid use, pain severity and depression, as well as the Current Opioid Misuse Measure (COMM). We used a meta-analytic approach to determine reference levels of anhedonia in healthy samples spanning a variety of countries and diverse age groups, extracting SHAPS scores from 58 published studies totaling 2664 psychiatrically healthy participants.

Results: Compared to healthy samples, chronic pain patients showed higher levels of anhedonia, with ~25% of patients scoring above the standard anhedonia cut-off. This difference was not primarily driven by depression levels, which explained less than 25% of variance in anhedonia scores. Neither opioid use duration, dose, nor pain severity alone was significantly associated with anhedonia. Yet, there was a clear effect of opioid misuse, with opioid misusers (COMM ⩾13) reporting greater anhedonia than non-misusers. Opioid misuse remained a significant predictor of anhedonia even after controlling for pain severity, depression and opioid dose.

Conclusions: Study results suggest that both chronic pain and opioid misuse contribute to anhedonia, which may, in turn, drive further pain and misuse.
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http://dx.doi.org/10.1017/S0033291719002010DOI Listing
September 2020

Mindfulness-Oriented Recovery Enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment: Ecological momentary assessments from a stage 1 randomized controlled trial.

Drug Alcohol Depend 2019 10 5;203:61-65. Epub 2019 Aug 5.

Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W, Piscataway, NJ 08854 USA.

Background: Methadone maintenance therapy (MMT) is an efficacious form of medication assisted treatment for opioid use disorder (OUD), yet many individuals on MMT relapse. Chronic pain and deficits in positive affective response to natural rewards may result in dysphoria that fuels opioid craving and promotes relapse. As such, behavioral therapies that ameliorate chronic pain and enhance positive affect may serve as useful adjuncts to MMT. This analysis of ecological momentary assessment (EMA) data from a Stage 1 randomized clinical trial examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on opioid craving, pain, and positive affective state.

Methods: Participants with OUD and chronic pain (N = 30) were randomized to 8 weeks of MORE or treatment as usual (TAU). Across 8 weeks of treatment, participants completed up to 112 random EMA measures of craving, pain, and affect, as well as event-contingent craving ratings. Multilevel models examined the effects of MORE on craving, pain, and affect, as well as the association between positive affect and craving.

Results: EMA showed significantly greater improvements in craving, pain unpleasantness, stress, and positive affect for participants in MORE than for participants in TAU. Participants in MORE reported having nearly 1.3 times greater self-control over craving than those in TAU. Further, positive affect was associated with reduced craving, an association that was significantly stronger among participants in MORE than TAU.

Conclusion: MORE may be a useful non-pharmacological adjunct among individuals with OUD and chronic pain in MMT.
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http://dx.doi.org/10.1016/j.drugalcdep.2019.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939880PMC
October 2019

The Role of Heart Rate Variability in Mindfulness-Based Pain Relief.

J Pain 2020 Mar - Apr;21(3-4):306-323. Epub 2019 Aug 1.

Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Anesthesiology, University of California San Diego, San Diego, California. Electronic address:

Mindfulness meditation is a self-regulatory practice premised on sustaining nonreactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential nonspecific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high-frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a 4-session (25 min/session) mindfulness or sham-mindfulness training regimen. Before and after each group's respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = -.82, P = .04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = -.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < .05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques. Perspective: Mindfulness has been shown to engage multiple mechanisms to reduce pain. The present study extends on this work to show that higher HRV is associated with mindfulness-induced reductions in pain unpleasantness, but not pain intensity ratings, when compared to sham-mindfulness meditation. These findings warrant further investigation into the mechanisms engaged by mindfulness as compared to placebo.
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http://dx.doi.org/10.1016/j.jpain.2019.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994350PMC
August 2019

Mapping the Affective Dimension of Embodiment With the Sensation Manikin: Validation Among Chronic Pain Patients and Modification by Mindfulness-Oriented Recovery Enhancement.

Psychosom Med 2019 09;81(7):612-621

From the College of Social Work (Hanley, Garland), University of Utah, Salt Lake City, UT.

Objective: Mindfulness-based interventions target novel pain relief mechanisms not captured by legacy pain scales, including 1) cultivating awareness of pleasant and neutral sensations proximal to unpleasant sensations and 2) interoceptively mapping sensation location and spatial distribution.

Methods: We created a digital sensation manikin (SM) by overlaying a human figure silhouette with a grid of 469 "sensation" pixels. A series of five research questions examined the SM's discriminant validity, construct validity, incremental validity, convergence with an objective measure of pain attentional bias, and sensitivity to a mindfulness-based psychological treatment, Mindfulness-Oriented Recovery Enhancement (MORE). A sample of opioid treated chronic pain patients (n = 108; age, 53.79 (12.94) years; female, 65%) was recruited to answer research questions 1 to 5, and a sample of healthy controls (n = 91; age, 36.47 (13.50) years; female, 55%) was recruited as the comparison group for research question 1.

Results: Chronic pain patients reported significantly more unpleasant sensations than did healthy controls (p < .001, d = 1.23) and significantly fewer pleasant sensations (p = .001, d = 0.50). The SM also evidenced expected relationships with multiple measures of pain (r = 0.26-0.29) and well-being (r = -0.21 to 0.28), uniquely predicted pain interference (β = -0.18), and exhibited a significant association with pain attentional bias (r = 0.25). Finally, mindfulness-based intervention via MORE significantly increased the ratio of pleasant to unpleasant sensations reported by chronic pain patients relative to an active control condition (p = .036, d = 0.51).

Conclusions: This study supports the SM's validity and indicates that assessing both pleasant and unpleasant sensations broadens the scope of pain measurement. Although the SM would benefit from further optimization, its continued use is likely to contribute to improved assessment and treatment options for chronic pain patients.
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http://dx.doi.org/10.1097/PSY.0000000000000725DOI Listing
September 2019

Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial.

Integr Cancer Ther 2019 Jan-Dec;18:1534735419855138

2 Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.

Introduction: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial.

Methods: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: ( a) exercise and nutrition counseling or ( b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms.

Results: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias-the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards.

Conclusions And Implications: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.
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http://dx.doi.org/10.1177/1534735419855138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552347PMC
December 2019
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