Zoom-Based Mindfulness-Oriented Recovery Enhancement Plus Just-in-Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain

Garland, Eric L.; Gullapalli, Bhanu T.; Prince, Kort C.; Hanley, Adam W.; Sanyer, Mathias; Tuomenoksa, Mark; Rahman, Tauhidur

doi:10.1007/s12671-023-02137-0

Cited by 34Mindfulness and Compassion InterventionsOpioid Use Disorder TreatmentDigital Mental Health Interventions

Zoom-Based Mindfulness-Oriented Recovery Enhancement Plus Just-in-Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain

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Garland, Eric L., Gullapalli, Bhanu T., Prince, Kort C., Hanley, Adam W., Sanyer, Mathias, Tuomenoksa, Mark, Rahman, Tauhidur·2023·Mindfulness

DOI 10.1007/s12671-023-02137-0PMC PMC10205566

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Abstract

Objective The opioid crisis in the USA remains severe during the COVID-19 pandemic, which has reduced access to evidence-based interventions. This Stage 1 randomized controlled trial (RCT) assessed the preliminary efficacy of Zoom-based Mindfulness-Oriented Recovery Enhancement (MORE) plus Just-in-Time Adaptive Intervention (JITAI) prompts to practice mindfulness triggered by wearable sensors (MORE + JITAI).Method Opioid-treated chronic pain patients (n = 63) were randomized to MORE + JITAI or a Zoom-based supportive group (SG) psychotherapy control. Participants completed ecological momentary assessments (EMA) of craving and pain (co-primary outcomes), as well as positive affect, and stress at one random probe per day for 90 days. EMA probes were also triggered when a wearable sensor detected the presence of physiological stress, as indicated by changes in heart rate variability (HRV), at which time participants in MORE + JITAI were prompted by an app to engage in audio-guided mindfulness practice.Results EMA showed significantly greater reductions in craving, pain, and stress, and increased positive affect over time for participants in MORE + JITAI than for participants in SG. JITAI-initiated mindfulness practice was associated with significant improvements in these variables, as well as increases in HRV. Machine learning predicted JITAI-initiated mindfulness practice effectiveness with reasonable sensitivity and specificity.Conclusions In this pilot trial, MORE + JITAI demonstrated preliminary efficacy for reducing opioid craving and pain, two factors implicated in opioid misuse. MORE + JITAI is a promising intervention that warrants investigation in a fully powered RCT.Preregistration This study is registered on ClinicalTrials.gov (NCT04567043).

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The high acceptability and feasibility of the simple email delivery of the meditation videos reflects the growing recognition of the power of digital platforms for delivery of evidence-based mindfulness interventions.
“The high acceptability and feasibility of the simple email delivery of the meditation videos reflects the growing recognition of the power of digital platforms for delivery of evidence-based mindfulness interventions [14,33,34,45,46].”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [45]

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The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality
Torous, J., Linardon, J., Goldberg, S. B., Sun, S., Bell, I., Nicholas, J., Hassan, L., Hua, Y., Milton, A., & Firth, J. (2025) · World Psychiatry · doi:10.1002/wps.21299 · Cited by 323 · see citing works
Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder
Lord, S. E., & Rao, D. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2486585 · Cited by 1 · see citing works
“The high acceptability and feasibility of the simple email delivery of the meditation videos reflects the growing recognition of the power of digital platforms for delivery of evidence-based mindfulness interventions [14,33,34,45,46].”

[Mindfulness in addiction therapy].
Nallet, A., Briefer, J.-F., & Perret, I. (2015) · PubMed · Cited by 2 · see citing works
Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions.
Brewer, J. A., Elwafi, H. M., & Davis, J. H. (2013) · Psychology of Addictive Behaviors · doi:10.1037/a0028490 · Cited by 303 · see citing works
Opioid Misuse and Addiction Among Patients With Chronic Pain
Martel, M. O., & Jamison, R. N. (2019) · Oxford University Press eBooks · doi:10.1093/med/9780199768912.003.0021
Craving to quit: Psychological models and neurobiological mechanisms of mindfulness training as treatment for addictions.
(2014) · doi:10.1037/2332-2136.1.s.70 · Cited by 35 · see citing works
Effect and mechanism of mindfulness intervention in relieving chronic pain
Chi, H. (2019) · Zhonghua xingwei yixue yu naokexue zazhi · doi:10.3760/cma.j.issn.1674-6554.2019.09.008

Authors: Garland, E. L., Gullapalli, B. T., Prince, K. C., Hanley, A. W., Sanyer, M., Tuomenoksa, M., & Rahman, T.
Affiliations: University of Utah (US)
University of California San Diego (US)
Utah State University (US)
Corresponding author: Garland, Eric L.
ORCID: Garland, Eric L.
Hanley, Adam W.
Sanyer, Mathias
Rahman, Tauhidur
Venue: Mindfulness
Publisher: Springer Science and Business Media LLC
Published: 2023-05-24
Volume: 14
Issue: 6
Pages: 1329-1345
ISSN: 1868-8527 (ISSN-L)
1868-8535
DOI: 10.1007/s12671-023-02137-0
PMC: PMC10205566
OpenAlex: W4377943461
Cited by: 34
References: 72
Citations by year: 2026: 13 · 2025: 10 · 2024: 10 · 2023: 1
FWCI: 9.83
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springernature.com/gp/researchers/text-and-data-mining (tdm)
www.springernature.com/gp/researchers/text-and-data-mining (vor)
Locations: Mindfulness (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute on Drug Abuse (R01DA042033)
Topics: Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: Mindfulness-Oriented Recovery Enhancement, opioid craving, chronic pain, wearable sensors, just-in-time adaptive interventions, mindfulness practice, heart rate variability, physiological stress, positive affect, stress, opioid misuse, telemedicine, COVID-19 pandemic

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Zoom-Based Mindfulness-Oriented Recovery Enhancement Plus Just-in-Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain

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