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Cited by 173Mindfulness and Compassion InterventionsSubstance Abuse Treatment and OutcomesPosttraumatic Stress Disorder Research

Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial

Open access
Garland, Eric L., Roberts-Lewis, Amelia, Tronnier, Christine D., Graves, Rebecca, Kelley, Karen·2016·Behaviour Research and Therapy
DOI 10.1016/j.brat.2015.11.012PMC PMC4752876
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Abstract

In many clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress. Novel therapies are needed to address these co-occurring issues efficiently. The aim of the present study was to conduct a pragmatic randomized controlled trial comparing Mindfulness-Oriented Recovery Enhancement (MORE) to group Cognitive-Behavioral Therapy (CBT) and treatment-as-usual (TAU) for previously homeless men residing in a therapeutic community. Men with co-occurring substance use and psychiatric disorders, as well as extensive trauma histories, were randomly assigned to 10 weeks of group treatment with MORE (n = 64), CBT (n = 64), or TAU (n = 52). Study findings indicated that from pre-to post-treatment MORE was associated with modest yet significantly greater improvements in substance craving, post-traumatic stress, and negative affect than CBT, and greater improvements in post-traumatic stress and positive affect than TAU. A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life. This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders. Results suggest that MORE, as an integrative therapy designed to bolster self-regulatory capacity, may hold promise as a treatment for intersecting clinical conditions.

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Crossref · 10.1016/j.brat.2015.11.012

Cites

58 of 58 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 53 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    MORE was associated with greater decreases in post-traumatic stress than CBT (p = .04).

    “MORE was associated with greater decreases in post-traumatic stress than CBT (p = .04)”
    Quote in the paperSubstantial claim
  • Findingown data

    A significant indirect effect of MORE on decreasing post-traumatic stress by increasing dispositional mindfulness was observed.

    “A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life.”
    Quote in the paperSubstantial claim
  • Findingown data

    In a sensitivity analysis controlling for pre-treatment polysubstance use, MORE reported significantly less craving than Seeking Safety (p = .02).

    “in a sensitivity analysis controlling for extent of polysubstance use at pre-treatment, participants in MORE reported significantly less craving than Seeking Safety (p = .02)”
    Quote in the paperNot a substantial claim
  • Findingown data

    MORE was associated with significantly greater decreases in craving than CBT (p = .03).

    “The treatment X time interaction term indicated that MORE was associated with significantly greater decreases in craving than CBT (p = .03).”
    Quote in the paperSubstantial claim
  • Findingown data

    A significant indirect effect of MORE on decreasing craving by increasing dispositional mindfulness was observed.

    “A significant indirect effect of MORE on decreasing craving and post-traumatic stress by increasing dispositional mindfulness was observed, suggesting that MORE may target these issues via enhancing mindful awareness in everyday life.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 38
  • May combine two claims. 29

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Alcohol dependence was the most common substance use disorder in the sample, affecting 45%, and cocaine dependence affected 44%.

    “The most prevalent substance use disorders in the sample were alcohol dependence (45%) and cocaine dependence (44%)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Participants had experienced on average 5.2 different categories of traumatic life events.

    “On average, participants had experienced 5.2 (SD = 1.7) different categories of traumatic life events”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Nearly half of participants (47%) had two or more substance use disorders, with a mean of 1.7 diagnoses.

    “Nearly half (47%) of participants had 2 or more substance use disorders (M = 1.7, SD = 0.8, range 1 – 4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In the sample, 25% met criteria for full PTSD and 37% met criteria for partial PTSD.

    “25% of participants met criteria for full PTSD and 37% met criteria for partial PTSD”
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    Findingown data

    The mean number of lifetime months spent incarcerated was 40.1.

    “the mean number of lifetime months spent incarcerated was 40.1 (SD = 55.9).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    All participants reported experiencing at least one type of traumatic event in their lives.

    “all participants reported experiencing at least one type of traumatic event in their lives.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    For MORE versus CBT, 4 of 7 outcomes were significantly different; for MORE versus TAU, 3 of 7 outcomes were significantly different.

    “With regard to the comparison of MORE and CBT, 4/7 outcomes were significantly different, and 3/7 outcomes were significantly different between MORE and TAU.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Among MORE participants, there were significant improvements in craving, post-traumatic stress, depression, anxiety, mindfulness, and positive and negative affect.

    “Among MORE participants, there were significant improvements in craving, post-traumatic stress, symptoms of depression and anxiety, mindfulness, and positive and negative affect.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the subsample meeting full PTSD criteria, MORE was associated with significantly greater reduction in PTSD symptoms than CBT, but not TAU.

    “Additional subanalyses of the sample meeting full PTSD criteria revealed the same pattern of results – MORE was associated with significantly greater reduction in PTSD symptoms than CBT, but not TAU.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    MORE was associated with significant within-group improvements in positive and negative affect, as well as in symptoms of depression and anxiety.

    “MORE was associated with significant within-group improvements in positive and negative affect, as well as in symptoms of depression and anxiety.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Co-occurring psychiatric and substance use disorders are linked to higher risk of relapse, recurring psychological symptoms, and worse prognosis.

    “The co-occurrence of psychiatric and substance use disorders is associated with increased risk of relapse, recurrent psychological symptoms, and poor prognosis (Flynn & Brown, 2008).”
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    • cites Flynn & Brown, 2008

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    Premisecitation

    Fewer than half of people with co-occurring disorders who need treatment actually receive it.

    “Despite having significant psychiatric needs, less than half of individuals with co-occurring disorders (COD) in need of treatment receive it (SAMHSA, 2015).”
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    • cites SAMHSA, 2015

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    Premisecitation

    Substance use disorders, psychiatric conditions, and traumatic stress frequently co-occur in clinical settings.

    “In clinical settings, there is a high comorbidity between substance use disorders, psychiatric disorders, and traumatic stress.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites SAMHSA, 2015

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    Premisecitation

    When psychoactive substances temporarily ease distress, self-medication can become negatively reinforced, entrenching the coping pattern as an addictive response that future stressors can reactivate.

    “To the extent that psychoactive agents may temporarily relieve distress, self-medication can become negatively reinforcing (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004), resulting in entrenchment of this coping pattern as an addictive response subject to reactivation by future stressors (Garland, Boettiger, & Howard, 2011).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Baker et al., 2004 source

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    • cites Garland, Boettiger, & Howard, 2011

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  • May combine two claims.

    Premisecitation

    People with co-occurring disorders often experience many stressful and traumatic life events and frequently use alcohol and drugs to self-medicate.

    “Individuals with COD tend to have high rates of exposure to stressful and traumatic life events with which they often cope through alcohol and drug use as a form of self-medication (Khantzian, 1997; Leeies, Pagura, Sareen, & Bolton, 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Khantzian, 1997 source

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    • cites Leeies et al., 2010 source

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    Premisecitation

    Craving together with negative affect may drive chronic substance use, which in turn makes a person more sensitive to stress and less responsive to pleasure from natural rewards.

    “In turn, craving coupled with negative affect may promote chronic substance use, which in turn renders the individual increasingly sensitized to stress and desensitized to pleasure from naturally-rewarding objects and events (Koob, 2008; Koob & Le Moal, 2001).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Koob, 2008 source

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    • cites Koob & Le Moal, 2001

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Substance use becomes compulsive as a conditioned response mediated by the mesocorticolimbic dopamine system and experienced as craving.

    “Consequently, substance use becomes compulsive, resulting in a powerful conditioned response mediated by the mesocorticolimbic dopamine system that is subjectively experienced as craving (Skinner & Aubin, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Skinner & Aubin, 2010 source

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    Premisecitation

    Among interventions for co-occurring disorders used in the U.S., Seeking Safety has perhaps the strongest evidence base.

    “Among interventions for COD currently employed in the U.S., Seeking Safety (Najavits, 2002; Najavits, Weiss, Shaw, & Muenz, 1998) has perhaps the strongest evidence base.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Najavits, 2002

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    • cites Najavits et al., 1998 source

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  • May combine two claims.

    Premisecitation

    Meta-analyses show that mindfulness-based interventions outperform non-specific active controls and significantly reduce depressive and anxious symptoms.

    “Meta-analyses have found MBIs to outperform non-specific active control conditions and produce significant effects on depressive and anxious symptomatology (Goyal et al., 2014).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Goyal et al., 2014 source

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  • Classified as probably not a substantial claim.

    Premisereasoning

    Allostasis produces an overall hedonic deficit expressed as negative affective states that push the person to use larger amounts of the substance for diminishing well-being.

    “This process, known as allostasis, results in an overall hedonic deficit, manifested in negative affective states which impel the individual to imbibe increasingly higher doses of the substance to achieve a dwindling sense of well-being.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Pragmatic trials evaluate the benefit of treatments as delivered in routine clinical practice, unlike explanatory trials that measure efficacy under ideal conditions.

    “In contrast to explanatory clinical trials which measure treatment efficacy under ideal conditions, pragmatic trials evaluate the benefit of treatments as delivered in routine clinical practice (Roland & Torgerson, 1998).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Roland & Torgerson, 1998

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Diagnostic criteria were assessed with a semi-structured psychiatric interview similar to the MINI, conducted by a psychiatrist and/or clinical social worker trained in addiction and psychiatric diagnoses.

    “Diagnostic criteria were assessed with a semi-structured psychiatric interview similar to the Mini-International Neuropsychiatric Interview (MINI) (Sheehan et al., 1998), which differed in that it included a broader array of DSM-IV TR categories not assessed by the MINI (e.g., dysthymia, specific phobia, etc.). Diagnostic interviews were conducted by a psychiatrist and/or clinical social worker”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Sheehan et al., 1998

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The first author, blinded to subjects' identities and uninvolved in research assessments, gave the random assignment table to the study coordinator, who assigned participants to treatment groups.

    “The first author, who was blinded to subjects’ identities and uninvolved in research assessments, gave the random assignment table to the study coordinator, who then assigned participants to treatment groups.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    Substance craving was assessed with an adapted version of the Penn Alcohol Craving Scale modified to include drug craving items, and this version has been validated in prior studies.

    “Substance craving was assessed with an adapted version of the Penn Alcohol Craving Scale (PACS) (Flannery, Volpicelli, & Pettinati, 1999), modified to assess craving for alcohol and other psychoactive substances. The original PACS includes five question items that assess the duration, frequency and intensity of craving for alcohol on a 7-point scale. In the version adapted for this study the item”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Flannery et al., 1999 source

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    • cites Garland & Roberts-Lewis, 2013

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    • cites Witkiewitz & Bowen, 2011 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Clinical supervisors reviewed audio-recorded sessions and debriefed therapists to monitor adherence; minor deviations were infrequent, adherence improved over time, and no major deviations were noted.

    “Clinical supervisors debriefed therapists and reviewed audio-recorded sessions to monitor therapist adherence to the MORE and Seeking Safety treatment manuals. Any deviations from the treatment manuals were communicated weekly prior to the next session during clinical supervision and corrected by the therapist in successive sessions. Minor deviations were observed infrequently, and adherence”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Intention-to-treat analyses were conducted on the entire randomized sample of 180 participants.

    “Intention-to-treat (ITT) analyses were conducted on the entire randomized sample (N=180).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Simple random assignment was conducted by the first author using Research Randomizer software.

    “Simple random assignment was conducted by the first author using Research Randomizer software (Urbaniak & Plous, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Urbaniak & Plous, 2011

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    Study design and conductcitation

    Post-traumatic stress symptoms were assessed with the 17-item PTSD Checklist-Civilian version.

    “Post-traumatic stress symptoms were assessed with the 17-item PTSD Checklist-Civilian version (PCL-C) (Weathers et al., 1993).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Weathers et al., 1993

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    Study design and conductcitation

    Dispositional mindfulness was measured with the Five Facet Mindfulness Questionnaire.

    “The Five Facet Mindfulness Questionnaire was used to measure dispositional mindfulness (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Baer et al., 2006 source

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    Study design and conductcitation

    Psychiatric distress was measured with the depression and anxiety subscales of the Brief Symptom Inventory.

    “The depression (α = .87) and anxiety subscales (α = .88) of the Brief Symptom Inventory (BSI) (Derogatis & Melisaratos, 1983) were used to measure to what degree participants were currently distressed by symptoms like “Feeling fearful” and “Feelings of guilt.””
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Derogatis & Melisaratos, 1983 source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    CBT fidelity was assessed with an adapted Seeking Safety Adherence Scale, and MORE fidelity was assessed with a comparable unpublished checklist.

    “Fidelity assessment for the CBT group included an adapted version of the Seeking Safety Adherence Scale (Najavits & Liese, 2000) and fidelity for MORE was assessed with a comparable unpublished fidelity checklist, which tapped the extent to which facilitators: provided information about using mindfulness and reappraisal skills to cope with addiction and psychological distress; followed a common”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Najavits & Liese, 2000

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  • May combine two claims.

    Study design and conductown data

    Outcome data were missing for 28.9% of participants due to study attrition, with no significant between-groups differences in dropout rate.

    “Outcome data were missing for 28.9% of participants due to study attrition (there were no significant between-groups differences in dropout rate).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Treatment fidelity was monitored similarly for MORE and CBT groups using structured manuals, fidelity checklists, and weekly clinical supervision.

    “Treatment fidelity was monitored in a similar fashion among the MORE and CBT groups. Group facilitators used structured manuals with treatment implementation protocols, completed fidelity assessment checklists after each session, and met weekly with clinical supervisors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Readiness to change was measured with the 32-item version of the University of Rhode Island Change Assessment.

    “Readiness to change was measured with the 32-item version of the University of Rhode Island Change Assessment (URICA; α = .72) (DiClemente, Schlundt, & Gemmell, 2004).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites DiClemente et al., 2004 source

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    Study design and conductown data

    Participants were randomly assigned to MORE, CBT, or TAU.

    “Participants in group cohorts were randomized with simple random assignment to MORE (N=64), CBT (N=64), or TAU (N=52).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Positive and negative affect were assessed with the Positive and Negative Affect Schedule.

    “The positive (α = .94) and negative affect subscales (α = .93) from the 20-item Positive and Negative Affect Schedule (PANAS) (Watson, Clark, & Tellegen, 1988) were used to assess the frequency of positive and negative affect “over the past week.””
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Watson et al., 1988 source

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    Study design and conductown data

    Post-treatment assessments were administered by a research assistant blinded to treatment allocation.

    “Following the 10-week intervention conditions, participants completed the same set of questionnaires in a post-treatment assessment session administered by a research assistant who was blinded to treatment allocation, after which they all received TAU.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders.

    “This pragmatic trial represents the first head-to-head comparison of MORE against an empirically-supported treatment for co-occurring disorders.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was no significant between-groups difference in the average number of substance use disorder diagnoses (p = .35).

    “There were no significant between-groups differences in the average number of substance use disorder diagnoses, p = .35.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Repeated-measures mixed models accounted for variability associated with nesting of observations within participants within group cohorts.

    “These mixed models accounted for the variability associated with the nesting of multiple observations (i.e., pre- and post-intervention assessments; Level 1) within participants (Level 2) within group cohorts (Level 3).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All models were estimated with maximum likelihood methods, which estimate the variance-covariance matrix for all available data, including cases assessed at only one time point.

    “All models were estimated with maximum likelihood methods, which estimate the variance-covariance matrix for all available data, including data from cases assessed at only one time point.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Sensitivity analyses controlled for between-groups differences in the number of pre-intervention substance use disorder diagnoses for craving and in pre-intervention PTSD diagnosis for traumatic stress symptoms.

    “Sensitivity analysis of treatment effects on craving controlled for between-groups differences in the number of pre-intervention substance use disorder diagnoses, and sensitivity analysis of treatment effects on traumatic stress symptoms controlled for between-groups differences in pre-intervention PTSD diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    There was no significant between-groups difference in trauma exposure (p = .17).

    “there were no significant between-groups differences in trauma exposure (p = .17).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Readiness to change was used as a covariate in subsequent analyses because participants had a wide range of motivations and great variation in readiness to change.

    “Given the wide range of motivations and the great variation in readiness to change (see Table 1), we used pre-intervention readiness to change as a covariate in subsequent analyses.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    People residing in therapeutic communities often show improvements in mental health and addiction symptoms.

    “people residing in therapeutic communities often evidence improvements in mental health and addiction symptoms (Magor-Blatch, Bhullar, Thomson, & Thorsteinsson, 2014)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Magor-Blatch, Bhullar, Thomson, & Thorsteinsson, 2014

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    MORE's dual-stage procedure may engage top-down conscious cognitive control over bottom-up automatic addictive impulses, subserved by prefrontal-striatal brain circuits.

    “This this dual-stage procedure may engage top-down, conscious cognitive control over bottom-up, automatic addictive impulses, subserved by activation of prefrontal-striatal brain circuits (Garland, Froeliger, & Howard, 2013).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Garland, Froeliger, & Howard, 2013

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  • May combine two claims.

    Study design and conductown data

    Attendance was high and did not significantly differ between groups; CBT participants attended on average 9.1 sessions and MORE participants 9.0 sessions.

    “attendance was high and there were no significant between-groups differences observed: CBT participants attended on average 9.1 (SD = 1.9) sessions, whereas MORE participants attended on average 9.0 (SD = 2.0) sessions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    MORE fidelity adherence was adequate, with mean intervention item score 2.9 and process item score 2.8 on a 0-3 scale.

    “Regarding scores on the MORE fidelity checklist, adherence was also adequate, with means as follows on a 0–3 scale: on intervention items, 2.9 (SD = 0.2); on process items, 2.8 (SD = 0.3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    MORE was associated with modest yet statistically significant improvements in craving, post-traumatic stress symptoms, and positive and negative affect from pre- to post-treatment.

    “Results from this trial indicate that MORE was associated with modest yet statistically significant improvements in craving, post-traumatic stress symptoms, and positive and negative affect from pre- to post-treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    CBT fidelity adherence was adequate, with mean intervention item score 2.5 and process item score 2.7 on a 0-3 scale.

    “Regarding CBT fidelity scores, adherence was adequate, with means as follows on a 0–3 scale: on intervention items, 2.5 (SD = 0.4); on process items, 2.7 (SD = 0.4).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The psychometrics of the trauma history measure used in the present study have not been evaluated.

    “Also, the psychometrics of the trauma history measure used in the present study have not been evaluated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    The affective benefits of MORE may stem from its integration of mindfulness and reappraisal, as well as from its emphasis on mindful savoring.

    “The affective benefits of MORE may stem from its integration of mindfulness and reappraisal, as well as from its emphasis on mindful savoring, the process of attending to and appreciating pleasant events and the positive emotions that flow from them (Bryant & Veroff, 2007).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bryant & Veroff, 2007

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    More frequent use of cognitive reappraisal predicts attenuated PTSD symptoms.

    “more frequent use of cognitive reappraisal predicts attenuated PTSD symptoms (Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Boden, Bonn-Miller, Kashdan, Alvarez, & Gross, 2012

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    MORE uses mindfulness training to facilitate cognitive reappraisal, and this mindful reappraisal approach may have led to the observed reduction in post-traumatic stress.

    “In this sense, MORE uses mindfulness training to facilitate cognitive reappraisal; this potentially synergistic “mindful reappraisal” approach may have led to the observed reduction in post-traumatic stress.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The meta-analysis did not take patient complexity into account, and when doing so, findings are highly divergent with regard to what treatments work best.

    “However, this meta-analysis did not take patient complexity into account, and when doing so, findings are highly divergent with regard to what treatments work best (Gerger, Munder, & Barth, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gerger, Munder, & Barth, 2014

      Not checked in the free run.

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  • The paper relies on this without support.

    Few integrated, empirically-supported treatment options for co-occurring disorders are available, and even fewer have been tested in randomized controlled trials with homeless individuals.

    “Despite the prevalence and consequences of COD, few integrated, empirically-supported treatment options are available, and even fewer have been tested as interventions for homeless individuals in randomized controlled trials (RCTs).”

  • The paper relies on this without support.

    This pragmatic trial is the first head-to-head comparison of MORE against CBT for co-occurring psychiatric and substance use disorders.

    “This pragmatic trial represents the first head-to-head comparison of MORE against CBT for co-occurring psychiatric and substance use disorders.”
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  • A cited randomized trial is described as quasi-experimental

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    The text groups Kearney et al. among quasi-experimental studies, but the cited reference identifies it as a randomized controlled pilot study.

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Authors
Garland, E. L., Roberts-Lewis, A., Tronnier, C. D., Graves, R., & Kelley, K.
Affiliations
  • University of Utah (US)
  • University of North Carolina at Chapel Hill (US)
  • Smith College (US)
  • Triangle (US)
Corresponding author
Garland, Eric L.
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2016-02
Volume
77
Pages
7-16
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2015.11.012
PMC
PMC4752876
OpenAlex
W2174697612
Cited by
173
References
61
Citations by year
2026: 5 · 2025: 15 · 2024: 13 · 2023: 18 · 2022: 18 · 2021: 20 · 2020: 15 · 2019: 27 · 2018: 17 · 2017: 19 · 2016: 4 · 2015: 1
FWCI
16.95
Type
journal article
Language
en
Update notices
erratum (2018-01-01)
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • Substance Abuse and Mental Health Services Administration (SAMHSA) (TI 020489, R34DA037005)
  • National Institute on Drug Abuse (NIDA)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
Mindfulness-Oriented Recovery Enhancement, cognitive behavioral therapy, co-occurring substance use disorders, mental illness, traumatic stress, post-traumatic stress, drug craving, trait mindfulness, homeless men, therapeutic communities, group therapy, self-regulation, negative affect, positive affect
MeSH terms
Adult, Awareness, Humans, Male, Middle Aged, Psychotherapy, Group, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Substance-Related Disorders, Stress Disorders, Traumatic, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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