Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT

Garland, Eric L.; Froeliger, Brett; Howard, Matthew O.

doi:10.1007/s10865-014-9607-0

Cited by 136Opioid Use Disorder TreatmentMindfulness and Compassion InterventionsSubstance Abuse Treatment and Outcomes

Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT

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Garland, Eric L., Froeliger, Brett, Howard, Matthew O.·2015·Journal of Behavioral Medicine

DOI 10.1007/s10865-014-9607-0PMC PMC4355224

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Abstract

Dysregulated processing of natural rewards may be a central pathogenic process in the etiology and maintenance of prescription opioid misuse and addiction among chronic pain patients. This study examined whether a Mindfulness-Oriented Recovery Enhancement (MORE) intervention could augment natural reward processing through training in savoring as indicated by event-related brain potentials (ERPs). Participants were chronic pain patients at risk for opioid misuse who were randomized to 8 weeks of MORE (n = 11) or a support group control condition (n = 18). ERPs to images representing naturally rewarding stimuli (e.g., beautiful landscapes, intimate couples) and neutral images were measured before and after 8 weeks of treatment. Analyses focused on the late positive potential (LPP)--an ERP response in the 400-1,000 ms time window thought to index allocation of attention to emotional information. Treatment with MORE was associated with significant increases in LPP response to natural reward stimuli relative to neutral stimuli which were correlated with enhanced positive affective cue-responses and reductions in opioid craving from pre- to post-treatment. Findings suggest that cognitive training regimens centered on strengthening attention to natural rewards may remediate reward processing deficits underpinning addictive behavior.

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MORE did not significantly increase self-reported mindfulness, nor did it result in significant decrements in craving, but it significantly reduced symptoms associated with chronic pain and prescription opioid misuse.
“Contrary to their hypotheses, MORE did not significantly increase self-reported mindfulness, nor did it result in significant decrements in craving, but significantly reduced symptoms associated with chronic pain and prescription opioid misuse.”
From Mindfulness-Based Interventions for the Treatment of Substance and Behavioral Addictions: A Systematic Review (2018) · cites this paper as [57]
The paper’s introductory account of the earlier RCT reports that MORE significantly reduced opioid craving relative to a support group, directly contrary to the claim that craving did not significantly decrease. That passage also supports the reported reductions in pain and opioid misuse; the passages reviewed do not establish the claimed nonsignificant change in self-reported mindfulness. The paper’s Results further associate increased reward-related brain responses with decreases in craving. (LLM, conf=0.90)
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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.
“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 [31]
Taking part in MORE was linked to stronger electrocortical markers of natural reward processing, specifically the late positive potential.
“electrocortical indices of natural reward processing (i.e., late positive potential (LPP).47”
From Restructuring reward processing with Mindfulness‐Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain (2016) · cites this paper as [47]
MORE's effects of raising autonomic and electroencephalographic responses to natural reward stimuli were linked to lower drug craving.
“MORE’s effects on increasing autonomic and electroencephalographic responses to natural reward stimuli were associated with reductions in drug craving,46,47”
From Restructuring reward processing with Mindfulness‐Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain (2016) · cites this paper as [47]

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Self-citation
Upward spirals of mindfulness and reappraisal: testing the mindfulness-to-meaning theory with autoregressive latent trajectory modeling.
Garland, E. L., Kiken, L. G., Faurot, K., Palsson, O., & Gaylord, S. A. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9768-y · Cited by 82 · see citing works
Self-citation
Deficits in autonomic indices of emotion regulation and reward processing associated with prescription opioid use and misuse
Garland, E. L., Bryan, C. J., Nakamura, Y., Froeliger, B., & Howard, M. O. (2016) · Psychopharmacology · doi:10.1007/s00213-016-4494-4 · Cited by 82 · see citing works
Self-citation
Anhedonia in chronic pain and prescription opioid misuse
Garland, E. L., Trøstheim, M., Eikemo, M., Ernst, G., & Leknes, S. (2019) · Psychological Medicine · doi:10.1017/s0033291719002010 · Cited by 72 · see citing works
Self-citation
Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients
Garland, E. L., Bryan, C. J., Finan, P. H., Thomas, E. A., Priddy, S. E., Riquino, M. R., & Howard, M. O. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.07.033 · Cited by 71 · see citing works
Self-citation
The Cambridge Handbook of Substance and Behavioral Addictions
Sussman, S. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591 · Cited by 63 · see citing works
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
Cooperman, N. A., Hanley, A. W., Kline, A., & Garland, E. L. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108468 · Cited by 61 · see citing works
Self-citation
Mindfulness is Associated With Increased Hedonic Capacity Among Chronic Pain Patients Receiving Extended Opioid Pharmacotherapy
Thomas, E. A., & Garland, E. L. (2017) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000379 · Cited by 61 · see citing works
Self-citation
Biobehavioral Mechanisms of Mindfulness as a Treatment for Chronic Stress: An RDoC Perspective
Garland, E. L., Hanley, A. W., Baker, A. K., & Howard, M. O. (2017) · Chronic Stress · doi:10.1177/2470547017711912 · Cited by 62 · see citing works
Self-citation
Mindfulness is associated with psychological health and moderates pain in knee osteoarthritis
Lee, A. C., Harvey, W. F., Price, L. L., Morgan, L. P. K., Morgan, N. L., & Wang, C. (2017) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2016.06.017 · Cited by 57 · see citing works
Emotion regulation as a transdiagnostic factor underlying co-occurring chronic pain and problematic opioid use.
Aaron, R. V., Finan, P. H., Wegener, S. T., Keefe, F. J., & Lumley, M. A. (2020) · American Psychologist · doi:10.1037/amp0000678 · Cited by 57 · see citing works
Modeling the mindfulness‐to‐meaning theory's mindful reappraisal hypothesis: Replication with longitudinal data from a randomized controlled study
Hanley, A. W., de Vibe, M., Solhaug, I., Farb, N., Goldin, P. R., Gross, J. J., & Garland, E. L. (2021) · Stress and Health · doi:10.1002/smi.3035 · Cited by 56 · see citing works
Self-citation
Mindfulness in Treatment Approaches for Addiction — Underlying Mechanisms and Future Directions
Rosenthal, A., Levin, M. E., Garland, E. L., & Romanczuk-Seiferth, N. (2021) · Current Addiction Reports · doi:10.1007/s40429-021-00372-w · Cited by 54 · see citing works
“Mindfulness mediation also had positive effects on behavioral inhibition, which were associated with improved conflict and response monitoring measured by neurophysiological parameters in EEG [69, 70].”
MethodSelf-citation
Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards
Garland, E. L., Fix, S. T., Hudak, J., Bernat, E. M., Nakamura, Y., Hanley, A. W., Donaldson, G. W., Marchand, W. R., & Froeliger, B. (2021) · Psychological Medicine · doi:10.1017/s0033291721003834 · Cited by 51 · see citing works
Self-citation
Behavioral Interventions Targeting Chronic Pain, Depression, and Substance Use Disorder in Primary Care
Barrett, K., & Chang, Y. (2016) · Journal of Nursing Scholarship · doi:10.1111/jnu.12213 · Cited by 49 · see citing works
Behavioral Economic Considerations of Novel Addictions and Nonaddictive Behavior: Research and Analytic Methods
Reed, D. D., Naudé, G. P., Gelino, B. W., & Amlung, M. T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.011 · Cited by 48 · see citing works
Effects of a brief mindfulness-meditation intervention on neural measures of response inhibition in cigarette smokers
Andreu, C. I., Cosmelli, D., Slagter, H. A., & Franken, I. H. A. (2018) · PLOS ONE · doi:10.1371/journal.pone.0191661 · Cited by 47 · see citing works
“Although there are theoretical proposals regarding the tentative psychological and neurobiological mechanisms underlying the effects of mindfulness training on addiction [21–24], few studies have so far empirically examined the neurocognitive effects of mindfulness-based practices on addiction [25, 26].”
Background
Rethinking Research on Prediction and Prevention of Psychotherapy Dropout: A Mechanism-Oriented Approach
Cooper, A. A., Kline, A. C., Baier, A. L., & Feeny, N. C. (2018) · Behavior Modification · doi:10.1177/0145445518792251 · Cited by 48 · see citing works
Integrating mindfulness into the extended process model of emotion regulation: The dual-mode model of mindful emotion regulation.
Raugh, I. M., & Strauss, G. P. (2024) · Emotion · doi:10.1037/emo0001308 · Cited by 47 · see citing works
The Prevention and Treatment of Gambling Disorders: Some Art, Some Science
Derevensky, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.024 · Cited by 45 · see citing works
Allostatic dysregulation of natural reward processing in prescription opioid misuse: Autonomic and attentional evidence
Garland, E. L., Froeliger, B., & Howard, M. O. (2015) · Biological Psychology · doi:10.1016/j.biopsycho.2015.01.005 · Cited by 46 · see citing works
Self-citation
Telehealth Mindfulness-Oriented Recovery Enhancement vs Usual Care in Individuals With Opioid Use Disorder and Pain: A Randomized Clinical Trial
Cooperman, N. A., Lu, S.-E., Hanley, A. W., Puvananayagam, T., Dooley-Budsock, P., Kline, A., & Garland, E. L. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2023.5138 · Cited by 44 · see citing works
Self-citation
Considering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
Blum, A. W., & Grant, J. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.038 · Cited by 44 · see citing works
Neurobiological Foundations of Behavioral Addictions
Vaccaro, A. G., & Potenza, M. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.016 · Cited by 45 · see citing works
Neurobiology of Substance Addictions
Christie, N. C., & Bechara, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.015 · Cited by 44 · see citing works
Sensitization of Incentive Salience and the Transition to Addiction
Warlow, S. M., Baumgartner, H. M., Freeland, C. M., Naffziger, E. E., Olney, J. J., Berridge, K. C., & Robinson, M. J. F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.006 · Cited by 45 · see citing works
Mindfulness-Based Interventions Applied to Addiction Treatments
Kechter, A., & Black, D. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.040 · Cited by 43 · see citing works
Multiple Memory Systems, Addiction, and Health Habits: New Routes for Translational Science
Stacy, A. W., Pike, J. R., & Lee, A. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.017 · Cited by 43 · see citing works
Tanning as an Addiction: The State of the Research and Implications for Intervention
Miller, K. A., & Mays, D. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.037 · Cited by 43 · see citing works
Food versus Eating Addictions
Schulte, E. M., Schiestl, E. T., & Gearhardt, A. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.035 · Cited by 43 · see citing works
Craving behavioral intervention for internet gaming disorder: remediation of functional connectivity of the ventral striatum
Zhang, J., Ma, S., Li, C.-S. R., Liu, L., Xia, C., Lan, J., Wang, L., Liu, B., Yao, Y., & Fang, X. (2016) · Addiction Biology · doi:10.1111/adb.12474 · Cited by 43 · see citing works
Behavioral Economics and Addictive Disorders
Jarmolowicz, D. P., & Schneider, T. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.005 · Cited by 42 · see citing works
Prevention and Treatment of Compulsive Buying Disorder
Galimov, A., & Black, D. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.027 · Cited by 42 · see citing works
Precision Behavioral Management (PBM): A Novel Genetically Guided Therapy to Combat Reward Deficiency Syndrome (RDS) Relevant to the Opiate Crisis
Blum, K., Roy, A. K., Podesta, A., Modestino, E. J., Steinberg, B., Gondré-Lewis, M. C., Baron, D. A., Thanos, P. K., Lott, L., Badgaiyan, S., et al. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.031 · Cited by 42 · see citing works
Prevention and Treatment of “Food Addiction”
Davis, C., & Mason, A. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.023 · Cited by 42 · see citing works
Human Neurobiological Approaches to Hedonically Motivated Behaviors
Burger, K. S., Shearrer, G. E., & Sadler, J. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.009 · Cited by 42 · see citing works
Feedback Models for Gambling Control: The Use and Efficacy of Online Responsible Gambling Tools
Griffiths, M. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.034 · Cited by 42 · see citing works
Psychosocial intervention and the reward system in pain and opioid misuse: new opportunities and directions
Garland, E. L. (2020) · Pain · doi:10.1097/j.pain.0000000000001988 · Cited by 36 · see citing works
Self-citation
Mindfulness, Mechanisms and Meaning: Perspectives From the Cognitive Neuroscience of Addiction
McConnell, P. A., & Froeliger, B. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2015.1076701 · Cited by 37 · see citing works
Self-citation
Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial
Thomas, E. A., Mijangos, J. L., Hansen, P. A., White, S., Walker, D., Reimers, C., Beck, A. C., & Garland, E. L. (2019) · Integrative Cancer Therapies · doi:10.1177/1534735419855138 · Cited by 36 · see citing works
Self-citation
Savor the moment: Willful increase in positive emotion and the persistence of this effect across time
Wilson, K. A., & MacNamara, A. (2020) · Psychophysiology · doi:10.1111/psyp.13754 · Cited by 36 · see citing works
Sensate Focus for Sexual Concerns: an Updated, Critical Literature Review
Avery‐Clark, C., Weiner, L., & Adams-Clark, A. A. (2019) · Current Sexual Health Reports · doi:10.1007/s11930-019-00197-9 · Cited by 34 · see citing works
Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study
Garland, E. L., Bryan, M. A., Priddy, S. E., Riquino, M. R., Froeliger, B., & Howard, M. O. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kay096 · Cited by 31 · see citing works
Self-citation
Emotion dysregulation as a transdiagnostic mechanism of opioid misuse and suicidality among chronic pain patients
Riquino, M. R., Priddy, S. E., Howard, M. O., & Garland, E. L. (2018) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/s40479-018-0088-6 · Cited by 28 · see citing works
Self-citation
Day-to-day hedonic and calming effects of opioids, opioid craving, and opioid misuse among patients with chronic pain prescribed long-term opioid therapy
Frimerman, L., Verner, M., Sirois, A., Scott, K., Bruneau, A., Pérez, J., Shir, Y., & Martel, M. O. (2021) · Pain · doi:10.1097/j.pain.0000000000002220 · Cited by 26 · see citing works
The risk for problematic opioid use in chronic pain: What can we learn from studies of pain and reward?
Finan, P. H., Remeniuk, B., & Dunn, K. E. (2017) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.07.029 · Cited by 26 · see citing works
Toward a Refined Mindfulness Model Related to Consciousness and Based on Event-Related Potentials
Verdonk, C., Trousselard, M., Canini, F., Vialatte, F., & Ramdani, C. (2020) · Perspectives on Psychological Science · doi:10.1177/1745691620906444 · Cited by 23 · see citing works
Enhancing Natural Reward Responsiveness Among Opioid Users Predicts Chronic Pain Relief: EEG Analyses From a Trial of Mindfulness-Oriented Recovery Enhancement
Garland, E. L., & Howard, M. O. (2018) · Journal of the Society for Social Work and Research · doi:10.1086/697685 · Cited by 22 · see citing works
Self-citation
Best Practices and Innovations for Managing Codeine Misuse and Dependence
Norman, I. J., Bergin, M., Parry, C. D. H., & Hout, M. C. V. (2016) · Journal of Pharmacy & Pharmaceutical Sciences · doi:10.18433/j3t89k · Cited by 22 · see citing works
Bouncing back: Brain rehabilitation amid opioid and stimulant epidemics
Stewart, J. L., May, A. C., & Paulus, M. P. (2019) · NeuroImage Clinical · doi:10.1016/j.nicl.2019.102068 · Cited by 23 · see citing works
Dispositional mindfulness and prescription opioid misuse among chronic pain patients: Craving and attention to positive information as mediating mechanisms
Priddy, S. E., Hanley, A. W., Riquino, M. R., Platt, K. A., Baker, A. K., & Garland, E. L. (2018) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2018.03.040 · Cited by 19 · see citing works
Self-citation
The Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM): Development and Validation of a New Tool to Assess Therapist Adherence and Competence
Hanley, A. W., & Garland, E. L. (2021) · Journal of Evidence-Based Social Work · doi:10.1080/26408066.2020.1833803 · Cited by 16 · see citing works
Self-citation
Potential Biological Markers and Treatment Implications for Binge Eating Disorder and Behavioral Addictions
Mestre‐Bach, G., & Potenza, M. N. (2023) · Nutrients · doi:10.3390/nu15040827 · Cited by 18 · see citing works
Mindfulness‐Oriented Recovery Enhancement: Implementing an evidence‐based intervention for chronic pain, opioid use, and opioid addiction in clinical settings
Garland, E. L. (2024) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.16147 · Cited by 17 · see citing works
Self-citation
Mapping the Affective Dimension of Embodiment With the Sensation Manikin: Validation Among Chronic Pain Patients and Modification by Mindfulness-Oriented Recovery Enhancement
Hanley, A. W., & Garland, E. L. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000725 · Cited by 17 · see citing works
Self-citation
Mindfulness-based neurofeedback: A systematic review of EEG and fMRI studies
Treves, I. N., Greene, K. D., Bajwa, Z., Wool, E., Kim, N., Bauer, C. C. C., Bloom, P. A., Pagliaccio, D., Zhang, J., Whitfield, S., et al. (2024) · Imaging Neuroscience · doi:10.1162/imag_a_00396 · Cited by 20 · see citing works
Mindfulness-based interventions modulate structural network strength in patients with opioid dependence
Fahmy, R., Wasfi, M., Mamdouh, R., Moussa, K., Wahba, A., Wittemann, M., Hirjak, D., Kubera, K. M., Wolf, N. D., Sambataro, F., et al. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.02.013 · Cited by 16 · see citing works
Mind-body approaches targeting the psychological aspects of opioid use problems in patients with chronic pain: evidence and opportunities
Martel, M. O., Bruneau, A., & Edwards, R. R. (2021) · Translational research · doi:10.1016/j.trsl.2021.02.013 · Cited by 14 · see citing works
Using Cognitive Neuroscience to Improve Mental Health Treatment: A Comprehensive Review
Wojtalik, J. A., Eack, S. M., Smith, M. J., & Keshavan, M. S. (2018) · Journal of the Society for Social Work and Research · doi:10.1086/697566 · Cited by 16 · see citing works
Mindfulness training applied to addiction therapy: insights into the neural mechanisms of positive behavioral change
Garland, E. L., Howard, M. O., Priddy, S. E., McConnell, P. A., Riquino, M. R., & Froeliger, B. (2016) · Neuroscience and Neuroeconomics · doi:10.2147/nan.s89257 · Cited by 13 · see citing works
Self-citation
Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder
Roos, C. R., Kiluk, B., Carroll, K. M., Bricker, J. B., Mun, C. J., Sala, M., Kirouac, M., Stein, E., John, M., Palmer, R., et al. (2024) · Annals of Medicine · doi:10.1080/07853890.2024.2315228 · Cited by 12 · see citing works
Appetitive Needs and Addiction
Sussman, S. Y., & Pakdaman, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.004 · Cited by 12 · see citing works
Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions
Larsen, J. K., Hollands, G. J., Garland, E. L., Evers, A. W. M., & Wiers, R. W. H. J. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105408 · Cited by 12 · see citing works
Self-citation
The Effects of Mindfulness-Based Intervention on Emotion-Related Impulsivity in Addictive Disorders
Parisi, A. B., Hudak, J., & Garland, E. L. (2023) · Current Addiction Reports · doi:10.1007/s40429-023-00501-7 · Cited by 12 · see citing works
Self-citation
Behavioral therapies targeting reward mechanisms in substance use disorders
Wardle, M. C., Webber, H. E., Yoon, J. H., Heads, A. M. B., Stotts, A. L., Lane, S. D., & Schmitz, J. M. (2024) · Pharmacology Biochemistry and Behavior · doi:10.1016/j.pbb.2024.173787 · Cited by 10 · see citing works
Mindfulness-to-Meaning Theory - Mindfulness Broadens Awareness and Builds Eudaimonic Meaning: A Process Model of Mindful Positive Emotion RegulationPreprint
Garland, E. L., Farb, N. A. S., Goldin, P. R., & Fredrickson, B. L. (2017) · doi:10.31231/osf.io/ea2q4 · Cited by 10 · see citing works
Self-citation
The effects of mindfulness-based interventions on different components of impulsivity: From the perspective of dual-process theories
一方面, 不., & Hong, Z. (2022) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2023.00274 · Cited by 9 · see citing works
Attentional bias modification with a new paradigm: The effect of the Detection Engagement and Savoring Positivity (DESP) task on eye-tracking of attention.
Corman, M., Aubret, D., Ghazal, J., Berthon, M., Chausse, P., Lohou, C., & Dambrun, M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101525 · Cited by 6 · see citing works
Does pain catastrophizing and distress intolerance mediate the relationship between PTSD and prescribed opioid misuse in people with chronic noncancer pain?
López-Martínez, A. E., Sainero-Tirado, G., Esteve, R., Reyes-Pérez, Á., Ruiz-Párraga, G. T., de la Vega, R., Serrano‐Ibáñez, E. R., & Ramírez‐Maestre, C. (2022) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001269 · Cited by 8 · see citing works
Performance of healthy persons under pain in different cognitive load tasks: An event‐related potential study on experimental pain individuals
Wang, K., Cai, G., Huang, S., Li, Y., Li, R., & Wu, W. (2020) · Brain and Behavior · doi:10.1002/brb3.1713 · Cited by 8 · see citing works
Qualitative Approaches to the Study of Substance and Behavioral Addictions
Simpson, K. A., & Bluthenthal, R. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.013 · Cited by 8 · see citing works
Understanding and restoring dopaminergic function in fibromyalgia patients using a mindfulness-based psychological intervention: a [18F]-DOPA PET study. Study protocol for the FIBRODOPA study—a randomized controlled trial
Ledermann, K., von Känel, R., Berna, C., Sprott, H., Burckhardt, M., Jenewein, J., Garland, E. L., & Martin-Sölch, C. (2021) · Trials · doi:10.1186/s13063-021-05798-1 · Cited by 7 · see citing works
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The 2019 Addiction Health Services Research Conference: Insights, Review, and Abstracts
Garets, M., Archer, S., Kitchens, C., Cochran, G., & Gordon, A. J. (2019) · Substance Abuse · doi:10.1080/08897077.2019.1688221 · Cited by 6 · see citing works
Development and feasibility of a mindfulness-based dance/movement therapy intervention for chronic low back pain
Shim, M., Gaydos, M. F., Goldstein‐Levitas, N., Musalo, N., Prakash, N., Bradt, J., Zhang, F., Wenger, S., & Gonzalez, A. (2024) · Frontiers in Pain Research · doi:10.3389/fpain.2024.1281085 · Cited by 5 · see citing works
Substance and Behavioral Addictions Assessment Instruments
Grigsby, T. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.012 · Cited by 5 · see citing works
The late positive potential predicts contingency management outcomes for cocaine use disorder
Webber, H. E., Calvillo, D. J., Versace, F., de Dios, C., Suchting, R., Green, C. E., Lane, S. D., & Schmitz, J. M. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112750 · Cited by 4 · see citing works
Prevention and Treatment of Sex Addiction
Reid, R. C., Grubbs, J. B., & Kraus, S. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.025 · Cited by 4 · see citing works
Chronic Pain, Dopamine and Depression: Insights from Research on Fibromyalgia
Ledermann, K., & Martin-Söelch, C. (2019) · IntechOpen eBooks · doi:10.5772/intechopen.82576 · Cited by 4 · see citing works
Gaming Disorder and Its Treatment
Griffiths, M. D., Kuss, D. J., & Pontes, H. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.029 · Cited by 4 · see citing works
Misinterpreting Electrophysiology in Human Cognitive Neuroscience
Popov, T. G. (2026) · Psychophysiology · doi:10.1111/psyp.70303 · Cited by 3 · see citing works
Treatment of Alcohol, Tobacco, and Other Drug (ATOD) Misuse
Sussman, S. Y., & Bolshakova, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.022 · Cited by 3 · see citing works
The Role of Culture in Addiction
Hoffman, B. R., & Unger, J. B. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.018 · Cited by 3 · see citing works
Cortico-striatal engagement during cue-reactivity, reappraisal, and savoring of drug and non-drug stimuli predicts craving in heroin addictionPreprint
Huang, Y., Ceceli, A. O., Kronberg, G., King, S. G., Malaker, P., Nelly Alia-klein, A., Garland, E. L., & Goldstein, R. Z. (2022) · medRxiv · doi:10.1101/2022.05.27.22275628 · Cited by 3 · see citing works
Self-citation
Factors associated with opioid craving, opioid intake, and opioid misuse in patients with chronic pain: insights from an ecological momentary assessment study
Bruneau, A., Sirois, A., Spiegler, G., Bi, J., Petkau, S., Djoudi, Y.-L., Ware, J., Alghamdi, R. I. A. D. N. A., Nipa, N., Perreault, M., et al. (2025) · Pain · doi:10.1097/j.pain.0000000000003753 · Cited by 2 · see citing works

Enhancing Natural Reward Responsiveness Among Opioid Users Predicts Chronic Pain Relief: EEG Analyses From a Trial of Mindfulness-Oriented Recovery Enhancement
Garland, E. L., & Howard, M. O. (2018) · Journal of the Society for Social Work and Research · doi:10.1086/697685 · Cited by 22 · see citing works
Self-citation
Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity
Garland, E. L., Froeliger, B., & Howard, M. O. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3504-7 · Cited by 216 · see citing works
Self-citation
Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards
Garland, E. L., Fix, S. T., Hudak, J., Bernat, E. M., Nakamura, Y., Hanley, A. W., Donaldson, G. W., Marchand, W. R., & Froeliger, B. (2021) · Psychological Medicine · doi:10.1017/s0033291721003834 · Cited by 51 · see citing works
Self-citation
Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement
Garland, E. L., Atchley, R., Hanley, A. W., Zubieta, J.-K., & Froeliger, B. (2019) · Science Advances · doi:10.1126/sciadv.aax1569 · Cited by 100 · see citing works
Self-citation
Mindfulness-Oriented Recovery Enhancement Reduces Opioid Attentional Bias Among Prescription Opioid-Treated Chronic Pain Patients
Garland, E. L., Baker, A. K., & Howard, M. O. (2017) · Journal of the Society for Social Work and Research · doi:10.1086/694324 · Cited by 47 · see citing works
Self-citation

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.
ORCID: Garland, Eric L.
Froeliger, Brett
Howard, Matthew O.
Venue: Journal of Behavioral Medicine
Publisher: Springer Science and Business Media LLC
Published: 2014-11-11
Volume: 38
Issue: 2
Pages: 327-336
ISSN: 0160-7715 (ISSN-L)
1573-3521
DOI: 10.1007/s10865-014-9607-0
PMC: PMC4355224
OpenAlex: W2064349719
Cited by: 136
References: 59
Citations by year: 2026: 6 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 5 · 2021: 7 · 2020: 50 · 2019: 16 · 2018: 11 · 2017: 6 · 2016: 9 · 2015: 7 · 2014: 1
FWCI: 7.63
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Journal of Behavioral Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
UNC Libraries
Funders: Fahs-Beck Fund for Research and Experimentation
National Institutes of Health
National Institute on Drug Abuse (DA 032517, R03DA032517, R01DA042033, R34DA037005, DA037005)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: Mindfulness-Oriented Recovery Enhancement, chronic pain, prescription opioid misuse, opioid use disorder, savoring, late positive potential, event-related potentials, positive affect, opioid craving, mindfulness-based interventions
MeSH terms: Analgesics, Opioid, Evoked Potentials, Visual, Female, Humans, Individuality, Male, Middle Aged, Opioid-Related Disorders, Pilot Projects, Reward, Chronic Pain, Mindfulness

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Neurophysiological evidence for remediation of reward processing deficits in chronic pain and opioid misuse following treatment with Mindfulness-Oriented Recovery Enhancement: exploratory ERP findings from a pilot RCT

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