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Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity
Open accessAbstract
Rationale Dysregulated reward processing is a hallmark feature of drug addiction; however, scant research has evaluated restructuring reward processing in the context of addiction treatment.Objectives We examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on reward responsiveness (RR) and opioid cue-reactivity in a sample of chronic pain patients with opioid use problems. We previously reported that MORE decreased pain, opioid misuse, and craving relative to a social support control group (SG). Here, we examined whether these outcomes were linked to changes in RR in a subset of participants.Methods Participants were chronic pain patients (71 % women, age 46.6 ± 13.9) who received MORE (n = 20) or SG (n = 29). RR was measured before and after 8 weeks of treatment via heart rate (HR) and heart rate variability (HRV) responses during a dot probe task that included opioid-related, pain-related, and natural reward stimuli, as well as craving ratings.Results The MORE group, who reported decreased opioid misuse and opioid craving during treatment, evidenced less subjective opioid cue-reactivity, greater HR decelerations, and greater increases in HRV to all cues after treatment compared to the SG; HR and HRV effects were most pronounced for natural reward cues. Within the MORE group, HR deceleration to natural reward cues was correlated with increased subjective arousal to the cues, whereas HR deceleration to opioid cues was correlated with decreased subjective arousal. Effects of MORE on craving were mediated by enhanced RR.Conclusions Results suggest that during treatment with MORE, cardiac-autonomic responsiveness to non-drug reward increases, while reactivity to opioid reward decreases. Studies are needed to discern whether changes in RR were a result or a determinant of reductions in opioid misuse and craving. RR may play a role in addiction treatment.
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“In mechanistic analyses from a RCT of MORE as a treatment for prescription opioid misuse among chronic pain patients, MORE produced significant increases in cardiac-autonomic and electrocortical responses to natural reward stimuli that were, in turn, associated with decreases in opioid craving [30, 31]”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [30]
In the citing paper
“decreased cue-reactivity was observed in an RCT in which MORE was shown to significantly reduce attentional bias toward opioid cues [52] and decrease subjective craving responses during an opioid cue-reactivity protocol [30].”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [30]
In the citing paper
“Similarly, evidence that increasing physiological responsiveness to natural rewards via mindful savoring predicts decreased prescription opioid misuse [75] and craving [30] has led to an enriched emphasis on mindful savoring practice in the MORE intervention.”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [30]
In the citing paper
“enhanced cardiac46 and electrocortical indices of natural reward processing”
In the citing paper
“MORE’s effects on increasing autonomic and electroencephalographic responses to natural reward stimuli were associated with reductions in drug craving,46,47”
In the citing paper
“improved parasympathetically mediated HRV during attention to emotional information,46”
In the citing paper
“reducing drug cue reactivity,46”
In the citing paper
“Study heterogeneity was investigated using Baujat plots in conjunction with the Q and I 2 statistics.52,53”
From Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis (2020) · cites this paper as [53]
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Metadata
- Authors
- Garland, E. L., Froeliger, B., & Howard, M. O.
- Affiliations
- University of Utah (US)
- Medical University of South Carolina (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Garland, Eric L.
- Venue
- Psychopharmacology
- Published
- 2014-03-05
- Volume
- 231
- Issue
- 16
- Pages
- 3229-3238
- ISSN
- 0033-3158 (ISSN-L)
- 1432-2072
- PMC
- PMC4111972
- OpenAlex
- W2064924323
- Cited by
- 216
- References
- 72
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 13 · 2023: 14 · 2022: 19 · 2021: 19 · 2020: 54 · 2019: 23 · 2018: 14 · 2017: 15 · 2016: 8 · 2015: 15 · 2014: 6
- FWCI
- 17.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Fahs-Beck Fund for Research and Experimentation
- National Institutes of Health
- National Institute on Drug Abuse (DA 032517, R03DA032517, R34DA037005, DA037005)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- Mindfulness-Oriented Recovery Enhancement, reward responsiveness, opioid use disorder, chronic pain, opioid misuse, opioid craving, heart rate variability, natural reward, addiction treatment, mindfulness-based interventions
- MeSH terms
- Adult, Affect, Arousal, Attention, Cues, Female, Heart Rate, Humans, Male, Middle Aged, Opioid-Related Disorders, Reward, Self Report, Chronic Pain, Prescription Drug Misuse, Mindfulness
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