Restructuring reward processing with Mindfulness‐Oriented Recovery Enhancement: novel therapeutic mechanisms to remediate hedonic dysregulation in addiction, stress, and pain
Open accessAbstract
Though valuation processes are fundamental to survival of the human species, hedonic dysregulation is at the root of an array of maladies, including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders. To address this crucial problem, novel interventions are needed to restore hedonic regulatory processes gone awry in persons exhibiting addictive behaviors. This article describes a theoretical rationale and empirical evidence for the effects of one such new intervention, Mindfulness‐Oriented Recovery Enhancement (MORE), on top‐down and bottom‐up mechanisms implicated in cognitive control and hedonic regulation. MORE is innovative and distinct from extant mindfulness‐based interventions in that it unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction—a mechanistic target that no other behavioral intervention has been designed to address. Though additional studies are needed, clinical and biobehavioral data from several completed and ongoing trials suggest that MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.
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Claims the paper makes
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- Findingown data
In a pragmatic RCT of participants with co-occurring substance dependence, traumatic stress, and psychiatric disorders, MORE outperformed CBT in reducing drug craving.
“In a third pragmatic RCT (n = 180), participants with co-occurring substance dependence, traumatic stress, and psychiatric disorders were randomly assigned to participate in MORE (n = 64), CBT (n = 64), or treatment-as-usual in a therapeutic community (n = 52). MORE outperformed the CBT intervention with regard to reductions in drug craving, posttraumatic stress, and negative affect, and produced”
Quote in the paperSubstantial claim - Findingcitation
In alcohol-dependent adults in long-term residential treatment, MORE was associated with greater reductions in perceived stress and thought suppression than a support-group control at post-treatment.
“In the first trial, MORE was tested as a treatment for alcohol-dependent adults (n = 53) in long-term residential treatment. The results indicated that, compared to a support-group control condition (n = 26), MORE (n = 27) was associated with greater reductions in perceived stress and thought suppression, as well as enhanced recovery of parasympathetically mediated heart rate variability (HRV)”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39] Garland EL Gaylord SA Boettiger CA Howard MO Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial J Psychoactive Drugs 2010 42 2 177 192 20648913 PMC2921532 source
Not checked in the free run.
- Findingown data
In a pragmatic RCT of participants with co-occurring substance dependence, traumatic stress, and psychiatric disorders, MORE outperformed CBT in reducing posttraumatic stress.
“MORE outperformed the CBT intervention with regard to reductions in drug craving, posttraumatic stress, and negative affect, and produced”
Quote in the paperSubstantial claim - Findingown data
In a pragmatic RCT of participants with co-occurring substance dependence, traumatic stress, and psychiatric disorders, MORE outperformed CBT in reducing negative affect.
“MORE outperformed the CBT intervention with regard to reductions in drug craving, posttraumatic stress, and negative affect, and produced”
Quote in the paperSubstantial claim - Findingnone given
MORE has been tested in three completed randomized controlled trials.
“Thus far, MORE has been tested in three completed randomized controlled trials (RCTs).”
Quote in the paperSubstantial claim
- Findingcitation
In alcohol-dependent adults in long-term residential treatment, MORE was associated with enhanced recovery of parasympathetically mediated HRV from stress and alcohol cue exposure at post-treatment compared with a support-group control.
“as well as enhanced recovery of parasympathetically mediated heart rate variability (HRV) from stress and alcohol cue exposure at post-treatment.39”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39] Garland EL Gaylord SA Boettiger CA Howard MO Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial J Psychoactive Drugs 2010 42 2 177 192 20648913 PMC2921532 source
Not checked in the free run.
- Findingcitation
In chronic pain patients with prescription opioid misuse on long-term opioids, MORE participants were more likely to no longer meet criteria for opioid use disorder at post-treatment than support-group control.
“and were more likely to no longer meet criteria for opioid use disorder at post-treatment.40”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Garland EL Manusov EG Froeliger B Kelly A Williams JM Howard MO Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial J Consult Clin Psychol 2014 82 3 448 24491075 PMC4076008 source
Not checked in the free run.
- Interpretationcitation
Sustained training in selective attention to natural rewards over drug rewards may provide the learning signal needed to reverse addiction and restore default reward-processing parameters toward valuation of intrinsically proregulatory objects and behaviors.
“If neural reward circuits provide a basic logic for goal selection,26 sustained training in selective attention to natural rewards over drug rewards may provide the learning signal needed to reverse addiction and restore default reward-processing parameters back toward valuation of intrinsically proregulatory objects and behaviors.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Shizgal P Hyman SE Motivational and addictive states Principles of Neural Science 5 New York McGraw Hill
Not checked in the free run.
- Interpretationcitation
Restructuring reward processing may arise from restoration of the feedback loop between frontoparietal structures for metacognition and attention and limbic-striatal circuitry for learning and motivation.
“This restructuring of reward processing may arise from restoration of the feedback loop between frontoparietal structures essential to metacognition and attention and limbic–striatal circuitry crucial to learning and motivation (Fig. 3).28”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [28] Garland E Froeliger B Howard M Mindfulness training targets neurocognitive mechanisms of addiction at the attention-appraisal-emotion interface Name Front Psychiatry 2013 4 173 PMC3887509 24454293 source
Not checked in the free run.
- Premisecitation
Impairments in frontal-executive function prevent effective inhibitory control of overlearned automatic drug use action schemas.
“Impairments in frontal-executive function prevent effective inhibitory control of overlearned, highly stereotyped, cognitive and behavioral repertoires for drug seeking and consumption, also known as automatic drug use action schemas, 15,16”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [15] Pierce RC Vanderschuren L Kicking the habit: The neural basis of ingrained behaviors in cocaine addiction Neurosci Biobehav Rev 2010 35 212 219 20097224 PMC2903634 source
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- cites [16] Tiffany ST A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes Psychol Rev 1990 97 147 168 2186423 source
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- Interpretationreasoning
Addiction, involving dysfunction in controlled and automatic self-regulation and hedonic experience, may be treatable by mental training programs targeting both top-down and bottom-up mechanisms in the stress-addiction risk chain.
“Insofar as addiction involves dysfunction in controlled and automatic processes implicated in self-regulation and hedonic experience, it may be tractable to mental training programs that simultaneously target top-down and bottom-up mechanisms in the risk chain linking stress to addiction (Fig. 1).”
Quote in the paperSubstantial claim - Premisecitation
Psychoactive substances can usurp natural reward processing by acting on the mesolimbic dopamine system to drive addictive behavior.
“the processing of natural rewards may be usurped by psychoactive substances that capitalize on the mesolimbic dopamine system to drive addictive behavior.11”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [11] Volkow ND Fowler JS Wang G-J The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies Neuropharmacology 2004 47 3 13 15464121 source
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- Premisecitation
Individuals with substance use disorders may become increasingly insensitive to natural reward from healthful and socially affiliative stimuli.
“such that individuals with substance use disorders may become increasingly insensitive to natural reward from healthful and socially affiliative stimuli, while becoming increasingly sensitized to stress and dependent on drugs to preserve a dwindling sense of well-being.14”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Koob GF Le Moal M Addiction and the brain antireward system Annu Rev Psychol 2008 59 29 53 18154498 source
Not checked in the free run.
- Premisecitation
Mindfulness techniques may reduce evaluative processing in the brain.
“Studies suggest that mindfulness techniques may reduce evaluative processing in the brain.1–3”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [1] Farb NA Segal ZV Mayberg H Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference Soc Cogn Affect Neurosci 2007 2 4 313 322 18985137 PMC2566754 source
Not checked in the free run.
- cites [2] Taylor V Grant J Daneault V Impact of mindfulness on the neural responses to emotional pictures in experienced and beginner meditators NeuroImage 2011 21679770 source
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- cites [3] Vago DR Silbersweig DA Self-awareness, self-regulation, and self-transcendence (S-ART): a framework for understanding the neurobiological mechanisms of mindfulness Front Hum Neurosci 2012 6 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480633/ Accessed September 7, 2015 23112770 PMC3480633 source
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- Interpretationcitation
MORE directly aims to restructure drug cue reactivity by enhancing natural reward responsiveness, using mindfulness to facilitate top-down intentional governance of first- and second-order valuation processes.
“In contrast, MORE directly aims to restructure drug cue reactivity by enhancing natural reward responsiveness, using mindfulness to facilitate top-down, intentional governance of first- and second-order valuation processes.29”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [29] Gross JJ Emotion regulation: Current status and future prospects Psychol Inq 2015 26 1 1 26 source
Not checked in the free run.
- Interpretationreasoning
MORE unites mindfulness training, third-wave CBT, and positive psychology into an integrative dual-process intervention designed to target the multivariate risk chain linking stress to addiction.
“MORE unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative, dual-process intervention designed to target this multivariate risk chain.”
Quote in the paperSubstantial claim - Premisecitation
Pleasure and pain operate through overlapping neural systems and neurochemical processes that create a common currency of emotion in the brain.
“preclinical and clinical studies suggest that these two opposing phenomena operate via an overlapping set of neural systems and neurochemical processes5 that instantiate a “common currency” of emotion in the brain.6”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [5] Leknes S Tracey I A common neurobiology for pain and pleasure Nat Rev Neurosci 2008 9 4 314 320 18354400 source
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- cites [6] Cabanac M The dialectics of pleasure Pleas Brain 2010 113 124
Not checked in the free run.
- Interpretationreasoning
For addiction, restructuring reward learning through reevaluation (second-order valuation) may be essential.
“For addiction, which is primarily a disorder of salience dysregulation and learning processes gone awry, restructuring reward learning through reevaluation (second-order valuation) may be essential.”
Quote in the paperNot a substantial claim - Interpretationreasoning
MORE is innovative and distinct from extant MBIs because it unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward.
“MORE is innovative and distinct from extant mindfulness-based interventions in that in unites traditional mindfulness meditation with reappraisal and savoring strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction, which no other behavioral intervention has been designed”
- Also stated in: § Introduction · hedged
“MORE may be innovative and unique in that in unites traditional mindfulness meditation with strategies designed to reverse the downward shift in salience of natural reward relative to drug reward, representing a crucial tipping point to disrupt the progression of addiction, which no other behavioral intervention has been designed to do.”
Quote in the paperNot a substantial claim- Rests on an assumption: No other behavioral intervention has been designed to reverse the downward shift in salience of natural reward relative to drug reward.
- Rests on an assumption: Extant MBIs use mindfulness to disrupt elaborative processing rather than to guide and potentiate it.
- Rests on an assumption: Many existing MBIs eschew an explicit focus on promoting evaluative processing and therefore do not directly or intentionally engage in restructuring of learned responses.
- Also stated in: § Introduction · hedged
- Interpretationcitation
Mindfulness can enhance interoceptive awareness of the salience of courses of action and experiences, optimizing prediction error signaling to increase fit between behavior and goals.
“Insofar as mindfulness allows access to an expanded set of information from which semantic and conditioned associations may be restructured,32 it can be used to enhance interoceptive awareness of the salience of various courses of action and experiences, thereby optimizing prediction error signaling in the brain to increase goodness-of-fit between behavior and goal states.33”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [32] Garland EL Farb NA Goldin PR Fredrickson BL The Mindfulness-to-Meaning Theory: Extensions, Applications, and Challenges at the Attention–Appraisal–Emotion Interface Psychol Inq 2015 26 4 377 387 PMC4826727 27087765 source
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- cites [33] Barrett LF Simmons WK Interoceptive predictions in the brain Nat Rev Neurosci 2015 16 7 419 429 10.1038/nrn3950 26016744 PMC4731102 source
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- Premisecitation
Mindfulness meditation is well-suited to facilitate reevaluation of addiction-related conditioned stimuli and responses.
“New theory suggests that mindfulness meditation is well-suited to facilitate this reevaluation process. According to the mindfulness-to-meaning theory,30”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Garland EL Farb NAR Goldin P Fredrickson BL Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation Psychol Inq 2015 26 4 293 314 27087765 PMC4826727 source
Not checked in the free run.
- Interpretationreasoning
The allostatic process fuels the downward shift in hedonic set point that undergirds addiction.
“Ultimately, this allostatic process fuels the downward shift in the hedonic set point that undergirds addiction.”
Quote in the paperSubstantial claim - Premisecitation
Only humans have the desire to evaluate their own desires.
“some philosophers propose that only humans have the desire to evaluate their own desires,9 and a parsimonious read of the data suggests that this is indeed the case.10”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [9] Frankfurt H Freedom of the will and the concept of a person J Philos 1971 67 5 20 source
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- cites [10] Steklis HD Lane RD The Unique Human Capacity for Emotional Awareness: Psychological, Neuroanatomical, Comparative and Evolutionary Perspectives Watanabe S Kuczaj S Emotions of Animals and Humans. The Science of the Mind Springer Japan 2012 165 205 http://link.springer.com/chapter/10.1007/978-4-431-54123-3_8 Accessed August 21, 2015 source
Not checked in the free run.
- Premisecitation
Drug-induced restructuring of reward learning results from neuroplastic modifications to brain circuits subserving stress and reward.
“Drug-induced restructuring of reward learning is thought to result from neuroplastic modifications to brain circuits subserving stress (e.g., extended amygdala) and reward (e.g., ventral striatum), such that individuals with substance use disorders may become increasingly insensitive to natural reward from healthful and socially affiliative stimuli, while becoming increasingly sensitized to stress”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Koob GF Le Moal M Addiction and the brain antireward system Annu Rev Psychol 2008 59 29 53 18154498 source
Not checked in the free run.
- Premisecitation
Drug-related cues bias attention due to dopamine-driven incentive salience from prior drug use.
“These schemas are elicited by drug-related interoceptive and exteroceptive cues, for which attention may become biased due to dopamine-driven incentive salience conferred by prior drug use episodes.19”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [19] Berridge KC The debate over dopamine’s role in reward: the case for incentive salience Psychopharmacol Berl 2007 191 391 431 17072591 source
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- Premisecitation
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”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [46] Garland EL Froeliger B Howard MO Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity Psychopharmacology (Berl) 2014 231 16 3229 3238 10.1007/s00213-014-3504-7 24595503 PMC4111972 source
Not checked in the free run.
- cites [47] Garland EL Froeliger B Howard MO 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 J Behav Med 2014 38 2 327 336 10.1007/s10865-014-9607-0 25385024 PMC4355224 source
Not checked in the free run.
- Premisecitation
Greater relative responsiveness to natural versus drug-related reward significantly predicted less substance misuse at follow-up.
“such increases in relative responsiveness of natural to drug-related reward significantly predict decreased substance misuse at follow-up.48”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Garland EL Mindfulness-Oriented Recovery Enhancement modulates neurocognitive mechanisms and reward system function in addiction, stress, and pain Sloan Kettering Memorial Hospital New York, NY 2015
Not checked in the free run.
- Premisecitation
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”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [47] Garland EL Froeliger B Howard MO 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 J Behav Med 2014 38 2 327 336 10.1007/s10865-014-9607-0 25385024 PMC4355224 source
Not checked in the free run.
- Premiseown data
Greater striatal and rACC savoring responses significantly predicted more positive affect and fewer cigarettes smoked over the 8-week study.
“increases in striatal and rACC savoring responses significantly predicted increases in positive affect and decreases in the number of cigarettes smoked over the 8-week study period.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
- Interpretationown data
The combined mindfulness, reappraisal, and savoring training in MORE may correct dysfunction in prefrontal-striatal circuits that are central to reward processing and addiction.
“Preliminary neuroimaging evidence suggests that the synergy of mindfulness, reappraisal, and savoring skills training in MORE may treat dysfunction in prefrontal–striatal circuits integral to reward processing and addiction.”
Quote in the paperSubstantial claim - Premisecitation
MORE yielded larger gains in positive affect than usual care.
“produced greater increases in positive affect than treatment as usual.41”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [41] Garland EL Roberts-Lewis A Tronnier CD Graves R Kelly K Mindfulness-Oriented Recovery Enhancement as a transdiagnostic treatment for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial Manuscr Submitt Publ 2015 PMC4752876 26701171 source
Not checked in the free run.
- Interpretationreasoning
MORE uses mindfulness as a cognitive amplifier to enhance a domain-general cognitive resource for restructuring reward-learning processes, including flexibility of attention allocation to re-evaluate and align behavior and goals.
“In these ways, MORE uses mindfulness as a cognitive amplifier to enhance a domain-general cognitive resource for restructuring reward-learning processes, including boosting the flexibility of attention allocation to re-evaluate and align one’s behavior and goals.”
Quote in the paperNot a substantial claim - Interpretationreasoning
Evidence is accumulating that MORE, as a mindfulness-based intervention, targets mechanisms of hedonic dysregulation in addiction treatment.
“Across these completed and ongoing studies, evidence is amassing that suggests that MORE, as an MBI, targets mechanisms of hedonic dysregulation in the treatment of addiction.”
Quote in the paperSubstantial claim - Interpretationreasoning
MORE may reorganize reward processing.
“suggesting that MORE may restructure reward processing.”
Quote in the paperSubstantial claim - Interpretationown data
Clinical and biobehavioral data from completed and ongoing trials suggest MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.
“Though additional studies are needed, clinical and biobehavioral data from several completed and ongoing trials suggest that MORE may exert salutary effects on addictive behaviors and the neurobiological processes that underpin them.”
Quote in the paperSubstantial claim - Premisecitation
Taking part in MORE was linked to better parasympathetically mediated heart rate variability while attending to emotional information.
“improved parasympathetically mediated HRV during attention to emotional information,46”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46] Garland EL Froeliger B Howard MO Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity Psychopharmacology (Berl) 2014 231 16 3229 3238 10.1007/s00213-014-3504-7 24595503 PMC4111972 source
Not checked in the free run.
- Premisecitation
MORE seemed to lower reactivity to drug cues.
“reducing drug cue reactivity,46”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46] Garland EL Froeliger B Howard MO Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity Psychopharmacology (Berl) 2014 231 16 3229 3238 10.1007/s00213-014-3504-7 24595503 PMC4111972 source
Not checked in the free run.
- Premisecitation
MORE seemed to alter attentional bias toward addiction-related stimuli.
“modulating attentional bias for addiction-related stimuli.39,48”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [39] Garland EL Gaylord SA Boettiger CA Howard MO Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial J Psychoactive Drugs 2010 42 2 177 192 20648913 PMC2921532 source
Not checked in the free run.
- cites [48] Garland EL Mindfulness-Oriented Recovery Enhancement modulates neurocognitive mechanisms and reward system function in addiction, stress, and pain Sloan Kettering Memorial Hospital New York, NY 2015
Not checked in the free run.
- Premisecitation
Among nicotine-dependent people, taking part in MORE was linked to meaningful decreases in cigarette smoking.
“a recent pilot study indicated that participation in MORE is associated with significant reductions in cigarette smoking among nicotine-dependent individuals.42,43”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
- Premisecitation
Taking part in MORE was linked to less attentional bias toward emotionally threatening cues.
“participation in MORE was associated with reduced attentional bias for emotionally threatening cues,45”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [45] Garland EL Howard MO Mindfulness-oriented recovery enhancement reduces pain attentional bias in chronic pain patients Psychother Psychosom 2013 82 5 311 318 23942276 source
Not checked in the free run.
- Study design and conductcitation
MORE has only recently begun to be compared with more robust, empirically supported therapies such as CBT.
“only recently has MORE begun to be compared to more robust, empirically supported therapies (e.g., CBT; see Ref. 49).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] Garland EL Roberts-Lewis A Tronnier CD Graves R Kelley K Mindfulness-Oriented Recovery Enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial Behav Res Ther 2016 77 7 16 26701171 PMC4752876 source
Not checked in the free run.
- Premisecitation
MORE raises autonomic responsiveness to natural reward cues more than to drug cues.
“MORE increases autonomic responsiveness to natural reward cues relative to drug cues”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [48] Garland EL Mindfulness-Oriented Recovery Enhancement modulates neurocognitive mechanisms and reward system function in addiction, stress, and pain Sloan Kettering Memorial Hospital New York, NY 2015
Not checked in the free run.
- Premisecitation
In smokers, MORE produced greater decreases over time in striatal and rACC responses to cigarette cues than the no-treatment control condition.
“participants in the MORE intervention exhibited significant decreases in striatal and rACC responses to cigarette cues over time relative to those in the no-treatment control condition.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
- Premisecitation
Taking part in MORE was linked to stronger cardiac markers of natural reward processing.
“enhanced cardiac46 and electrocortical indices of natural reward processing”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [46] Garland EL Froeliger B Howard MO Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity Psychopharmacology (Berl) 2014 231 16 3229 3238 10.1007/s00213-014-3504-7 24595503 PMC4111972 source
Not checked in the free run.
- Premisecitation
MORE seemed to weaken the link between drug craving and addictive behavior.
“decreasing the correlation strength between drug craving and addictive behavior,40”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Garland EL Manusov EG Froeliger B Kelly A Williams JM Howard MO Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial J Consult Clin Psychol 2014 82 3 448 24491075 PMC4076008 source
Not checked in the free run.
- Interpretationreasoning
MORE's effects on transdiagnostic mechanisms and addiction-specific targets indicate that it may hold promise for treating addictive disorders and other comorbid conditions.
“Taken together, MORE’s therapeutic effects on transdiagnostic mechanisms and addiction-specific targets suggest its potential promise as an intervention for addictive disorders and other comorbid conditions.”
Quote in the paperSubstantial claim - Premisecitation
The mindfulness-to-meaning theory proposes that mindfulness provides a means of restructuring reward learning.
“In this way, the mindfulness-to-meaning theory proposes that mindfulness provides a means of restructuring reward learning.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Garland EL Farb NAR Goldin P Fredrickson BL Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation Psychol Inq 2015 26 4 293 314 27087765 PMC4826727 source
Not checked in the free run.
- Premisecitation
Compared with no-treatment control, MORE was linked to greater striatal and rACC responses during savoring.
“compared to the no-treatment control group, participation in MORE was associated with increased striatal and rACC responses during savoring.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
- Study design and conductcitation
Earlier randomized controlled trials of MORE used active control conditions intended to control for nonspecific therapeutic factors that could otherwise confound efficacy evaluations.
“prior RCTs of MORE have employed active control conditions39,40 in an attempt to control for nonspecific therapeutic factors (e.g., social support, attention by a caring professional, expectation of benefit) that might otherwise confound evaluations of intervention efficacy”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [39] Garland EL Gaylord SA Boettiger CA Howard MO Mindfulness training modifies cognitive, affective, and physiological mechanisms implicated in alcohol dependence: Results of a randomized controlled pilot trial J Psychoactive Drugs 2010 42 2 177 192 20648913 PMC2921532 source
Not checked in the free run.
- cites [40] Garland EL Manusov EG Froeliger B Kelly A Williams JM Howard MO Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial J Consult Clin Psychol 2014 82 3 448 24491075 PMC4076008 source
Not checked in the free run.
- Interpretationown data
MORE participation is linked to restructuring of frontostriatal circuitry functions involved in hedonic regulation and addictive behavior.
“Study findings, while preliminary, suggest that participation in MORE is associated with a restructuring of frontostriatal circuitry functions implicated in hedonic regulation and addictive behavior.”
Quote in the paperSubstantial claim - Premisecitation
Smokers in MORE showed significantly larger increases in resting-state functional connectivity between the rACC and orbitofrontal cortex.
“smokers participating in MORE evidenced significantly greater increases in rsFC between the rACC and the orbitofrontal cortex”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
- May combine two claims. 9
- Classified as probably not a substantial claim. 6
May combine two claims.
FindingcitationIn chronic pain patients with prescription opioid misuse on long-term opioids, MORE produced greater reductions in pain, stress arousal, and opioid craving than a support-group control.
“In a second trial, a modified version of MORE was tested as a treatment for prescription opioid misuse among chronic pain patients prescribed long-term opioid analgesics (n = 115). Compared with a support-group control condition (n = 58), participants in MORE (n = 57) evidenced greater reductions in pain, stress arousal, and opioid craving, and were more likely to no longer meet criteria for”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] Garland EL Manusov EG Froeliger B Kelly A Williams JM Howard MO Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial J Consult Clin Psychol 2014 82 3 448 24491075 PMC4076008 source
Not checked in the free run.
May combine two claims.
InterpretationcitationMindfulness may interrupt drug-use action schema, which can then be reconfigured in working memory to support adaptive goal pursuit such as abstinence.
“Applying this theory to addiction,31 mindfulness may be used to interrupt drug-use action schema, which can then be consciously reconfigured in working memory to subserve adaptive goal pursuit (i.e., abstinence).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [31] McConnell P Froeliger BE Mindfulness, mechanisms and meaning: Perspectives from the cognitive neuroscience of addiction Psychol Inq in press PMC4766863 26924915 source
Not checked in the free run.
May combine two claims.
PremisecitationIndividuals with substance use disorders may become increasingly sensitized to stress and dependent on drugs to preserve a dwindling sense of well-being.
“while becoming increasingly sensitized to stress and dependent on drugs to preserve a dwindling sense of well-being.14”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [14] Koob GF Le Moal M Addiction and the brain antireward system Annu Rev Psychol 2008 59 29 53 18154498 source
Not checked in the free run.
May combine two claims.
PremisecitationStress, negative affect, and pain provide interoceptive input that elicits drug use schemas and further dysregulates prefrontal control over automaticity, amplifying addictive behavior.
“Stress, negative affect, and pain provide additional interoceptive input to elicit drug use schemas and further dysregulate prefrontal control over automaticity,20–23 amplifying addictive behavior.24”
Quote in the paperSubstantial claim0 of 5 sources checked- cites [20] Arnsten AFT Stress signalling pathways that impair prefrontal cortex structure and function Nat Rev Neurosci 2009 10 6 410 422 19455173 PMC2907136 source
Not checked in the free run.
- cites [21] Dias-Ferreira E Sousa JC Melo I Chronic stress causes frontostriatal reorganization and affects decision-making Science 2009 325 621 625 19644122 source
Not checked in the free run.
- cites [22] Shackman AJ Salomons TV Slagter HA Fox AS Winter JJ Davidson RJ The integration of negative affect, pain and cognitive control in the cingulate cortex Nat Rev Neurosci 2011 12 3 154 167 21331082 PMC3044650 source
Not checked in the free run.
- cites [23] Tiffany ST Drug craving and affect Substance Abuse and Emotion Washington, DC US: American Psychological Association 2010 83 108 source
Not checked in the free run.
- cites [24] Sinha R Chronic stress, drug use, and vulnerability to addiction Ann N Y Acad Sci 2008 1141 1 105 130 18991954 PMC2732004 source
Not checked in the free run.
May combine two claims.
PremisecitationHedonic dysregulation underlies addiction, stress, and chronic pain, as shown by a shift in the relative salience of natural reward to drug reward in people with severe substance use disorders.
“Though valuation processes are fundamental to survival of the human species, hedonic dysregulation is at the root of an array of clinical disorders, including addiction, stress, and chronic pain, as evidenced by the allostatic shift in the relative salience of natural reward to drug reward observed among persons with severe substance use disorders.”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [11] Volkow ND Fowler JS Wang G-J The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies Neuropharmacology 2004 47 3 13 15464121 source
Not checked in the free run.
- cites [12] Alcaro A Panksepp J The SEEKING mind: Primal neuro-affective substrates for appetitive incentive states and their pathological dynamics in addictions and depression Neurosci Biobehav Rev 2011 21396397 source
Not checked in the free run.
- cites [13] Koob GF Le Moal M Drug addiction, dysregulation of reward, and allostasis Neuropsychopharmacology 2001 24 97 129 11120394 source
Not checked in the free run.
- cites [14] Koob GF Le Moal M Addiction and the brain antireward system Annu Rev Psychol 2008 59 29 53 18154498 source
Not checked in the free run.
May combine two claims.
PremisecitationMindfulness can be used to disengage from automatic schema into a metacognitive state where attention expands and new cognitive structures can be constructed through memory reconsolidation.
“According to the mindfulness-to-meaning theory,30 mindfulness meditation can be used to disengage from automatic schema into a metacognitive state of awareness in which attention expands to encompass previously unattended data from which new cognitive structures can be constructed through a process of memory reconsolidation.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [30] Garland EL Farb NAR Goldin P Fredrickson BL Mindfulness broadens awareness and builds eudaimonic meaning: A process model of mindful positive emotion regulation Psychol Inq 2015 26 4 293 314 27087765 PMC4826727 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningAn imbalance between hedonic and aversive states and dysregulation in cortico-limbic-striatal networks produces an overall reward-processing deficit that may propel escalation toward compulsive drug seeking.
“The relative imbalance of hedonic and aversive states and dysregulation in the cortico–limbic–striatal networks that instantiate them results in an overall reward-processing deficit that may propel the downward spiral of behavioral escalation toward compulsive drug seeking.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationAddiction results from dysregulation of bottom-up reward-salience circuitry and impaired top-down frontal-executive cognitive-control circuitry.
“dual-process models posit that addiction results from dysregulation of bottom-up neural circuitry that codes for the salience of reward-related stimuli as well as impaired top-down frontal-executive brain circuitry that subserves cognitive-control processes, including proactive regulation of attention and emotion.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S4 (based).
Interpretationnone givenOnce adaptive cognitive and behavioral sequences have been constructed and practiced, they may be evoked with less effort and top-down cognitive control.
“Once adaptive cognitive and behavioral sequences have been constructed and practiced, they may be evoked with less effort and top-down cognitive control.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductreasoningIt remains unknown whether MORE affects universal and/or unique mechanistic targets.
“it is not yet known whether MORE modulates universal and/or unique mechanistic targets, because the range of treatment conditions to which this intervention has been compared has been limited to date.”
Quote in the paperSubstantial claim- Rests on an assumption: The range of treatment conditions against which MORE has been tested has been limited so far.
Classified as probably not a substantial claim.
Interpretationnone givenMindful reappraisal and savoring techniques represent complex sequences of emotion regulatory strategies involving attentional orienting, appraisal, valuation, acceptance, cognitive broadening, and reappraisal.
“These mindful reappraisal and mindful savoring techniques represent complex sequences of emotion regulatory strategies, involving iterative admixtures of attentional orienting, appraisal, valuation, acceptance, cognitive broadening, and reappraisal.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
Study design and conductreasoningThe separate efficacy of MORE's mindfulness, reappraisal, and savoring components is unknown.
“the differential efficacy of these intervention components is unknown.”
Quote in the paperSubstantial claim- Rests on an assumption: MORE combines mindfulness training with reappraisal and savoring techniques in one multimodal treatment.
Probably not a substantial claim: may not pass S2 (checkable).
InterpretationreasoningMORE may represent a significant advance in the application of contemplative science to clinical intervention.
“In this respect, MORE may represent a significant advance in the application of contemplative science to clinical intervention.”
Quote in the paperNot a substantial claimMay combine two claims.
Premiseown dataThose connectivity increases were correlated with less smoking, better positive affect, and stronger ventral striatal activation during savoring.
“which were also correlated with reduced smoking, improved positive affect, and enhanced ventral striatal activation during savoring.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [42] Eichberg C Mathew A Baddeley J Mindfulness-Oriented Recovery Enhancement (MORE): A novel smoking-cessation treatment focused on cognitive reappraisal and the savoring of naturalistic rewards Poster Present Front Neurosci Charlest SC 2015
Not checked in the free run.
- cites [43] Froeliger B Mathew A Eichberg C Restructuring reward mechanisms in nicotine addiction: a pilot fMRI study of Mindfulness Oriented Recover Enhancement in cigarette smokers under review PMC5360937 28373890
Not checked in the free run.
The paper relies on this without support.
No other behavioral intervention has been designed to reverse the downward shift in salience of natural reward relative to drug reward.
“representing a crucial tipping point to disrupt the progression of addiction, which no other behavioral intervention has been designed to do.”
The paper relies on this without support.
Extant MBIs use mindfulness to disrupt elaborative processing rather than to guide and potentiate it.
“extant MBIs ostensibly use mindfulness to disrupt elaborative processing rather than to guide and potentiate it.b”
The paper relies on this without support.
Many existing MBIs eschew an explicit focus on promoting evaluative processing and therefore do not directly or intentionally engage in restructuring of learned responses.
“While many existing MBIs use mindfulness to disrupt patterns of maladaptive associative learning, they eschew an explicit focus on promoting evaluative processing and therefore do not directly or intentionally engage in restructuring of learned responses.”
The paper relies on this without support.
Few of the mechanistic targets examined in the MORE research program have been studied in other behavioral addiction treatments.
“few of the mechanistic targets (e.g., reward responsiveness, addiction attentional bias) studied in the MORE research program have been explored in studies of other behavioral treatments for addiction (e.g., CBT, motivational interviewing).”
The paper relies on this without support.
The range of treatment conditions against which MORE has been tested has been limited so far.
“the range of treatment conditions to which this intervention has been compared has been limited to date.”
The paper relies on this without support.
MORE combines mindfulness training with reappraisal and savoring techniques in one multimodal treatment.
“MORE is a multimodal intervention that combines mindfulness training with reappraisal and savoring techniques”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A parallel can be found in the use of somatically-informed approaches to support patients in recovery from addiction or in the long term management of chronic pain.
“A parallel can be found in the use of somatically-informed approaches to support patients in recovery from addiction or in the long term management of chronic pain (Garland, 2016) and therapies delivered during depression remission, such as MBCT and WB-CT, encourage the regulation of negative affect via exposure to its somatic and cognitive features.”
From Static and treatment-responsive brain biomarkers of depression relapse vulnerability following prophylactic psychotherapy: Evidence from a randomized control trial (2022) · cites this paper as Garland, 2016
The restructuring reward hypothesis states that mindfulness may reduce addictive behavior by shifting the relative salience of drug and natural rewards from valuation of drug-related reward back to valuation of natural rewards that were salient before the development of addiction.
“The restructuring reward hypothesis states that mindfulness may reduce addictive behavior by shifting the relative salience of drug and natural rewards from valuation of drug-related reward back to valuation of natural rewards that were salient before the development of addiction.”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [23]
Though various conceptual models have been advanced, few tests of these specific neural hypotheses have been conducted.
“Though various conceptual models have been advanced [22, 23, 73], few tests of these specific neural hypotheses have been conducted.”
From Mindfulness-based treatment of addiction: current state of the field and envisioning the next wave of research (2018) · cites this paper as [23]
Cognitive remediation, including working memory training and mindfulness, can enhance reward processing in non-clinical individuals with high trait social anhedonia and in prescription opioid abusers.
“there are data showing that cognitive remediation, including working memory training and mindfulness, can enhance reward processing in non-clinical populations with high trait social anhedonia (Li et al., 2016) and in prescription opioid abusers (Garland, 2016).”
From The effects of early life stress on reward processing (2018) · cites this paper as Garland, 2016
No interventions yet target subclinical anhedonia or reinforcement-learning deficits in at-risk groups, but evidence suggests they could work.
“To our knowledge, interventions meant to target subclinical anhedonia or impairments in reinforcement learning in at risk populations have yet to be tested, however there is evidence for potential efficacy.”
From The effects of early life stress on reward processing (2018) · cites this paper as Garland, 2016
Cites
(1978) · Medical Entomology and Zoology · Cited by 53,488 · see citing works
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
Koob, G. F., & Volkow, N. D. (2010) · Neuropsychopharmacology · doi:10.1038/npp.2009.110 · Cited by 5,340 · see citing works
Emotion regulation: current status and future prospects
Gross, J. J. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2014.940781 · Cited by 5,229 · see citing works
Handbook of Affective Sciences
(2002) · doi:10.1093/oso/9780195126013.001.0001 · Cited by 5,104 · see citing works
Freedom of the Will and the Concept of a Person
Frankfurt, H. G. (1971) · The Journal of Philosophy · doi:10.2307/2024717 · Cited by 4,663 · see citing works
Henry, M. A. (1995) · The Journal of the American Dental Association · doi:10.14219/jada.archive.1995.0108 · Cited by 3,454 · see citing works
Stress signalling pathways that impair prefrontal cortex structure and function
Arnsten, A. F. T. (2009) · Nature Reviews Neuroscience · doi:10.1038/nrn2648 · Cited by 3,299 · see citing works
Drug Addiction, Dysregulation of Reward, and Allostasis
Koob, G. (2001) · Neuropsychopharmacology · doi:10.1016/s0893-133x(00)00195-0 · Cited by 2,953 · see citing works
Attention regulation and monitoring in meditation
Lutz, A., Slagter, H. A., Dunne, J. D., & Davidson, R. J. (2008) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2008.01.005 · Cited by 2,659 · see citing works
The role of the basal ganglia in habit formation
Yin, H. H., & Knowlton, B. J. (2006) · Nature Reviews Neuroscience · doi:10.1038/nrn1919 · Cited by 2,402 · see citing works
The debate over dopamine’s role in reward: the case for incentive salience
Berridge, K. C. (2007) · Psychopharmacology · doi:10.1007/s00213-006-0578-x · Cited by 2,347 · see citing works
Addiction motivation reformulated: an affective processing model of negative reinforcement
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004) · Psychological Review · doi:10.1037/0033-295x.111.1.33 · Cited by 2,162 · see citing works
The integration of negative affect, pain and cognitive control in the cingulate cortex
Shackman, A. J., Salomons, T. V., Slagter, H. A., Fox, A. S., Winter, J. J., & Davidson, R. J. (2011) · Nature Reviews Neuroscience · doi:10.1038/nrn2994 · Cited by 2,082 · see citing works
Chronic stress, drug use, and vulnerability to addiction
Sinha, R. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1441.030 · Cited by 1,904 · see citing works
Allostasis and Allostatic Load Implications for Neuropsychopharmacology
McEwen, B. (2000) · Neuropsychopharmacology · doi:10.1016/s0893-133x(99)00129-3 · Cited by 1,833 · see citing works
Interoceptive predictions in the brain
Barrett, L. F., & Simmons, W. K. (2015) · Nature Reviews Neuroscience · doi:10.1038/nrn3950 · Cited by 1,766 · see citing works
A cognitive model of drug urges and drug-use behavior: role of automatic and nonautomatic processes
Tiffany, S. T. (1990) · Psychological Review · doi:10.1037/0033-295x.97.2.147 · Cited by 1,554 · see citing works
The Tree of Knowledge: The Biological Roots of Human Understanding
Laberge, Y. (2007) · Complicity An International Journal of Complexity and Education · doi:10.29173/cmplct8773 · Cited by 1,464 · see citing works
Addiction and the brain antireward system
Koob, G. F., & Le Moal, M. (2008) · Annual Review of Psychology · doi:10.1146/annurev.psych.59.103006.093548 · Cited by 1,457 · see citing works
Vago, D. R., & Silbersweig, D. A. (2012) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2012.00296 · Cited by 1,310 · see citing works
Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference
Farb, N. A. S., Segal, Z. V., Mayberg, H., Bean, J., McKeon, D., Fatima, Z., & Anderson, A. K. (2007) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsm030 · Cited by 1,307 · cited 2× · see citing works
“The central tenet of this model28 posits that MORE and other mindfulness-based interventions may remediate the dysregulated habit behaviors, craving, and negative affect undergirding addiction by way of strengthening functional connectivity (1) within a metacognitive attentional control network (lPFC, dACC, parietal c…”
BackgroundChronic Stress Causes Frontostriatal Reorganization and Affects Decision-Making
Dias-Ferreira, E., Sousa, J. C., Melo, I., Morgado, P., Mesquita, A. R., Cerqueira, J. J., Costa, R. M., & Sousa, N. (2009) · Science · doi:10.1126/science.1171203 · Cited by 858 · see citing works
Garland, E. L., Farb, N. A., R. Goldin, P., & Fredrickson, B. L. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2015.1064294 · Cited by 810 · see citing works
Self-citationReconstructing and deconstructing the self: cognitive mechanisms in meditation practice
Dahl, C. J., Lutz, A., & Davidson, R. J. (2015) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2015.07.001 · Cited by 809 · see citing works
A common neurobiology for pain and pleasure
Leknes, S., & Tracey, I. (2008) · Nature Reviews Neuroscience · doi:10.1038/nrn2333 · Cited by 784 · cited 1× · see citing works
“A number of hypotheses have been generated from the new perspective emerging from the MORE research program, including the following testable predictions to be pursued in future research: (1) mindfulness strengthens top-down cognitive control; (2) enhancing attentional stability, setshifting capacity, and metacognitiv…”
BackgroundVolkow, N. D., Fowler, J. S., & Wang, G.-J. (2004) · Neuropharmacology · doi:10.1016/j.neuropharm.2004.07.019 · Cited by 616 · see citing works
A strategy for optimizing and evaluating behavioral interventions
Collins, L. M., Murphy, S. A., Nair, V. N., & Strecher, V. J. (2005) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3001_8 · Cited by 492 · see citing works
Cabanac, M. (1979) · The Quarterly Review of Biology · doi:10.1086/410981 · Cited by 441 · see citing works
Garland, E. L., Manusov, E. G., Froeliger, B., Kelly, A., Williams, J. M., & Howard, M. O. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0035798 · Cited by 431 · see citing works
Self-citationDreyfus, G. (2011) · Contemporary Buddhism · doi:10.1080/14639947.2011.564815 · Cited by 424 · see citing works
Taylor, V. A., Grant, J., Daneault, V., Scavone, G., Breton, E., Roffe-Vidal, S., Courtemanche, J., Lavarenne, A. S., & Beauregard, M. (2011) · NeuroImage · doi:10.1016/j.neuroimage.2011.06.001 · Cited by 362 · cited 2× · see citing works
“The central tenet of this model28 posits that MORE and other mindfulness-based interventions may remediate the dysregulated habit behaviors, craving, and negative affect undergirding addiction by way of strengthening functional connectivity (1) within a metacognitive attentional control network (lPFC, dACC, parietal c…”
BackgroundGarland, E. L., Gaylord, S. A., Boettiger, C. A., & Howard, M. O. (2010) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2010.10400690 · Cited by 319 · see citing works
Self-citationGarland, E. L., Froeliger, B., & Howard, M. O. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00173 · Cited by 268 · see citing works
Self-citationThe behavioural final common path
McFarland, D. J., & Sibly, R. M. (1975) · Philosophical transactions of the Royal Society of London. Series B, Biological sciences · doi:10.1098/rstb.1975.0009 · Cited by 248 · cited 1× · see citing works
“A number of hypotheses have been generated from the new perspective emerging from the MORE research program, including the following testable predictions to be pursued in future research: (1) mindfulness strengthens top-down cognitive control; (2) enhancing attentional stability, setshifting capacity, and metacognitiv…”
BackgroundEmotion Refinement: A Theory Inspired by Chinese Poetics
Frijda, N. H., & Sundararajan, L. (2007) · Perspectives on Psychological Science · doi:10.1111/j.1745-6916.2007.00042.x · Cited by 242 · see citing works
Alcaro, A., & Panksepp, J. (2011) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2011.03.002 · Cited by 240 · see citing works
Garland, E. L., Farb, N. A., Goldin, P. R., & Fredrickson, B. L. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2015.1092493 · Cited by 233 · see citing works
Self-citationGarland, E. L., Froeliger, B., & Howard, M. O. (2014) · Psychopharmacology · doi:10.1007/s00213-014-3504-7 · Cited by 216 · see citing works
Self-citationBryant, F. B., Chadwick, E. D., & Kluwe, K. (2011) · International Journal of Wellbeing · doi:10.5502/ijw.v1i1.18 · Cited by 206 · see citing works
Garland, E. L., Geschwind, N., Peeters, F., & Wichers, M. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00015 · Cited by 199 · see citing works
Self-citationBrosschot, J. F., Verkuil, B., & Thayer, J. F. (2010) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2010.02.002 · Cited by 176 · see citing works
Garland, E. L., Roberts-Lewis, A., Tronnier, C. D., Graves, R., & Kelley, K. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.11.012 · Cited by 173 · see citing works
Self-citationMindfulness-Oriented Recovery Enhancement Reduces Pain Attentional Bias in Chronic Pain Patients
Garland, E. L., & Howard, M. O. (2013) · Psychotherapy and Psychosomatics · doi:10.1159/000348868 · Cited by 141 · see citing works
Self-citationGarland, E. L., Froeliger, B., & Howard, M. O. (2015) · Journal of Behavioral Medicine · doi:10.1007/s10865-014-9607-0 · Cited by 136 · see citing works
Self-citationInvestigating the biology of consciousness
The American Association for Research into Nervous and Mental Diseases, & Damasio, A. R. (1998) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.1998.0339 · Cited by 128 · see citing works
The Meaning of Mindfulness: A Second-Order Cybernetics of Stress, Metacognition, and Coping
Garland, E. L. (2007) · Complementary health practice review · doi:10.1177/1533210107301740 · Cited by 118 · see citing works
Self-citationKicking the habit: The neural basis of ingrained behaviors in cocaine addiction
Pierce, R. C., & Vanderschuren, L. J. M. J. (2010) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2010.01.007 · Cited by 115 · see citing works
Froeliger, B., Mathew, A. R., McConnell, P. A., Eichberg, C., Saladin, M. E., Carpenter, M. J., & Garland, E. L. (2017) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2017/7018014 · Cited by 83 · see citing works
Self-citationTiffany, S. T. (2010) · Substance abuse and emotion. · doi:10.1037/12067-004 · Cited by 39 · see citing works
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
Moss, A. C., Erskine, J. A. K., Albery, I. P., Allen, J. R., & Georgiou, G. J. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.01.029 · Cited by 32 · see citing works
Toward a Reflexive Positive Psychology
Sundararajan, L. (2008) · Theory & Psychology · doi:10.1177/0959354308093400 · Cited by 27 · see citing works
Steklis, H. D., & Lane, R. D. (2012) · The Science of the Mind · doi:10.1007/978-4-431-54123-3_8 · Cited by 12 · see citing works
Healing with Form, Energy, and Light: The Five Elements in Tibetan Shamanism, Tantra, and Dzogchen
Wangyal, T. (2002) · Cited by 12 · see citing works
Garland, E. L. (2014) · Evidence Based Mental Health · doi:10.1136/eb-2014-101856 · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
1 of the 57 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
- Garland E.L., 2013, Mindfulness‐Oriented Recovery Enhancement for Addiction, Stress, and Pain
- Cabanac M., 2010, Pleasures of the Brain, 113
- Garland E.L. A.Beck P.Hansen et al.2015.Integrated Mindfulness‐oriented recovery enhancement and physical health intervention for obese cancer survivors: preliminary results from a pilot randomized controlled trial. Poster presentation. 12th International Conference of the Society for Integrative Oncology. November 15 2015. Boston MA.
Cited by
Sorted by citations
Mindfulness and Behavior Change
Schuman-Olivier, Z., Trombka, M., Lovas, D. A., Brewer, J. A., Vago, D. R., Gawande, R., Dunne, J. P., Lazar, S. W., Loucks, E. B., & Fulwiler, C. (2020) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000277 · Cited by 435 · see citing works
Garland, E. L., & Howard, M. O. (2018) · Addiction Science & Clinical Practice · doi:10.1186/s13722-018-0115-3 · Cited by 300 · see citing works
“Though various conceptual models have been advanced [22, 23, 73], few tests of these specific neural hypotheses have been conducted.”
BackgroundSelf-citationThe effects of early life stress on reward processing
Novick, A. M., Levandowski, M. L., Laumann, L. E., Philip, N. S., Price, L. H., & Tyrka, A. R. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2018.02.002 · Cited by 192 · see citing works
“Another example is specialized mindfulness training for addiction, which has been hypothesized to restructure associative learning and valuation of natural rewards via alterations to anterior cingulate and ventral striatal activity (Garland, 2016).”
BackgroundLi, W., Garland, E. L., McGovern, P., O’Brien, J. E., Tronnier, C. D., & Howard, M. O. (2017) · Psychology of Addictive Behaviors · doi:10.1037/adb0000269 · Cited by 188 · see citing works
“…Garland et al., 2014) conducted three RCTs that demonstrated therapeutic effects of MORE on addiction-related outcomes including substance misuse, craving, emotional distress, attentional bias, and hedonic regulation (see Garland, 2016 for a review of postulated therapeutic mechanisms of MORE).”
BackgroundSelf-citationGarland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., Yack, B. P., Bedford, C. E., Bryan, M. A., Atchley, R., et al. (2019) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000390 · Cited by 167 · see citing works
“According to the reward restructuring hypothesis (Garland, 2016), the effects of mindfulness training on reducing substance misuse may be mediated by increased positive affectivity and enhanced responsiveness to natural rewards.”
BackgroundMethodInfluentialSelf-citationGarland, E. L., Hanley, A. W., Goldin, P. R., & Gross, J. J. (2017) · PLoS ONE · doi:10.1371/journal.pone.0187727 · Cited by 163 · see citing works
Self-citationEtiology and Treatment of Pain and Psychosocial Issues in Patients With Inflammatory Bowel Diseases
Regueiro, M., Greer, J. B., & Szigethy, E. (2017) · Gastroenterology · doi:10.1053/j.gastro.2016.10.036 · Cited by 142 · see citing works
Garland, E. L., & Fredrickson, B. L. (2019) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2019.01.004 · Cited by 134 · see citing works
Self-citationArpacı, İ., Балоглу, М., Kozan, H. İ. Ö., & Kesici, Ş. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8847 · Cited by 129 · see citing works
“Similar suggestions were made by Wahbeh and Oken [36], Garland et al [82], Black [83], Peltz and Black [84], and Garland [85].”
ResultLi, W., Garland, E. L., & Howard, M. O. (2018) · Journal of Addictive Diseases · doi:10.1080/10550887.2018.1442617 · Cited by 107 · see citing works
“formal mindfulness training with third-wave cognitive-behavioral therapy and principles from positive psychology (20,21).”
BackgroundSelf-citationGarland, E. L., Hanley, A. W., Kline, A., & Cooperman, N. A. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.07.007 · Cited by 105 · see citing works
“Consistent with the restructuring reward hypothesis (Garland, 2016), participants in MORE may have utilized savoring to magnify the craving reducing effects of positive emotions, thereby reducing the intensity of their cravings.”
BackgroundSelf-citationPriddy, S. E., Howard, M. O., Hanley, A. W., Riquino, M. R., Friberg-Felsted, K., & Garland, E. L. (2018) · Substance Abuse and Rehabilitation · doi:10.2147/sar.s145201 · Cited by 101 · see citing works
“Improved communication in this frontostriatal circuit may provide the means by which MBIs can restructure reward processes hijacked during the addictive process.(73) In this way, MBIs may strengthen a domain-general neurocognitive resource that can be used to modulate the automaticity, hedonic dysregulation, and stres…”
BackgroundSelf-citationGarland, 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-citationEgan, H. H., O’Hara, M., Cook, A., & Mantzios, M. (2021) · Journal of Further and Higher Education · doi:10.1080/0309877x.2021.1912306 · Cited by 141 · see citing works
“However, it has been found that mindfulness is not in fact associated with a hedonic association (Garland 2016) that increases impulsive and unhealthy decision-making, but rather that mindfulness reiterates the notion that actions taken in the present moment have an impact on the future.”
BackgroundPrice, C. J., Thompson, E. A., Crowell, S. E., Pike, K., Cheng, S. C., Parent, S., & Hooven, C. (2019) · Substance Abuse · doi:10.1080/08897077.2018.1488335 · Cited by 94 · see citing works
Froeliger, B., Mathew, A. R., McConnell, P. A., Eichberg, C., Saladin, M. E., Carpenter, M. J., & Garland, E. L. (2017) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2017/7018014 · Cited by 83 · see citing works
“In contrast to other MBIs, MORE integrates mindfulness training with reappraisal and savoring skills designed to decrease valuation of drug reward and amplify natural reward processing, thereby disrupting the cycle of craving, maladaptive affect, and cognition underpinning addictive behavior [15, 23].”
Self-citationGarland, 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
“Indeed, interventions that restructure reward processes by enhancing positive emotion regulation (e.g., Mindfulness-Oriented Recovery Enhancement, see Garland 2016) may effectively remediate affective deficits among opioid-misusing patients and possibly attenuate addictive tendencies toward opioids.”
Self-citationGarland, E. L. (2021) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2021.03.019 · Cited by 78 · see citing works
Self-citationGarland, 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
“In light of such proposed hedonic (dys)regulatory mechanisms, interventions that promote positive emotions by enhancing natural reward processing may be especially efficacious for concurrent treatment of pain and opioid misuse (Garland, 2016; Finan and Garland, 2015; Navratilova et al., 2016).”
BackgroundSelf-citationParisi, A. B., Roberts, R. L., Hanley, A. W., & Garland, E. L. (2022) · Mindfulness · doi:10.1007/s12671-022-01964-x · Cited by 62 · see citing works
“At the same time, MORE applies these techniques in an effort to reduce physical pain and psychiatric symptoms while enhancing well-being (Garland, 2016).”
BackgroundInfluentialSelf-citationArpacı, İ. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00186-y · Cited by 66 · see citing works
“Individuals with a high score on abandonment schema experience insecure attachment relationships, particularly avoidant attachment to parents (Haaland et al. 2011).”
BackgroundA multi-group analysis of the effects of individual differences in mindfulness on nomophobia
Arpaci, I., Baloglu, & Kesici, Ş. (2019) · Information Development · doi:10.1177/0266666917745350 · Cited by 60 · see citing works
“These findings are in line with the contemporary literature on mindfulness and addiction (e.g., Garland, 2016; Peltz and Black, 2014; Black, 2014; Garland et al., 2013; Witkiewitz et al., 2014).”
ResultVerdejo‐García, A., Rezapour, T., Giddens, E., Zonoozi, A. K., Rafei, P., Berry, J., Caracuel, A., Copersino, M. L., Field, M., Garland, E. L., et al. (2022) · Addiction · doi:10.1111/add.16109 · Cited by 73 · see citing works
Self-citationCooperman, 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-citationHanley, 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-citationMindfulness 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
“Taken together, these data provide support for the hypothesis of restructuring reward processing, which asserts that MBIs shift valuation from drug-related rewards back to natural rewards, and in so doing, reduce craving and addictive behavior [62].”
BackgroundSelf-citationZamboni, L., Centoni, F., Fusina, F., Mantovani, E., Rubino, F., Lugoboni, F., & Federico, A. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001381 · Cited by 54 · see citing works
Garland, E. L., Howard, M. O., Zubieta, J.-K., & Froeliger, B. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000453400 · Cited by 50 · see citing works
Self-citationChildhood adversity and impaired reward processing: A meta-analysis
Oltean, L.-E., Șoflău, R., Miu, A. C., & Szentágotai-Tătar, A. (2022) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2022.105596 · Cited by 50 · see citing works
Shomaker, L. B., Berman, Z., Burke, M., Annameier, S. K., Pivarunas, B., Sánchez, N., Smith, A. D., Hendrich, S. G., Riggs, N. R., Legget, K. T., et al. (2019) · Appetite · doi:10.1016/j.appet.2019.05.022 · Cited by 51 · see citing works
“…with the notion that restructuring of reward processing may be one neurobiological mechanism that underlies mindfulness-based interventions, such that reward sensitivity to palatable junk food becomes relatively less salient than alternative, healthier rewards (Garland, 2016; Volkow, et al., 2013).”
BackgroundResultInfluentialGarland, 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
“MORE is a multimodal intervention that unites complementary aspects of mindfulness training, “third wave” cognitive-behavioral therapy, and principles of positive psychology into an integrative, transdiagnostic therapy for addiction, stress, and pain (Garland, 2013, 2016).”
BackgroundSelf-citationEconomic Evaluations of Mindfulness-Based Interventions: a Systematic Review
Zhang, L., Lopes, S. S., Lavelle, T. A., Jones, K. O., Chen, L., Jindal, M., Zinzow, H. M., & Shi, L. (2022) · Mindfulness · doi:10.1007/s12671-022-01960-1 · Cited by 45 · see citing works
“…opioid addiction and other substance misuse disorders (Haight et al., 2018), MBIs for those in recovery for substance misuse disorders, such as MBRP, have been developed and standardized to become a notable option to control addictive behaviors (Garland, 2016; Grant et al., 2017; Li et al., 2017).”
Hudak, J., Hanley, A. W., Marchand, W. R., Nakamura, Y., Yabko, B. A., & Garland, E. L. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-00831-4 · Cited by 47 · see citing works
“In turn, enhancing natural reward via mindfulness practice is theorized to restructure reward processing by shifting valuation of drug-related rewards back to valuation of natural rewards, and thereby reducing addictive behavior [53]—a contention supported by recent neurophysiological data in chronic opioid users [31].”
ResultSelf-citationCognitive mechanisms and therapeutic targets of addiction
Copersino, M. L. (2016) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2016.11.005 · Cited by 45 · see citing works
Beerse, M. E., Van Lith, T., Pickett, S. M., & Stanwood, G. D. (2020) · Experimental Biology and Medicine · doi:10.1177/1535370219883634 · Cited by 45 · see citing works
Li, W., Garland, E. L., O’Brien, J. E., Tronnier, C. D., McGovern, P., Anthony, B., & Howard, M. O. (2017) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-017-9765-8 · Cited by 43 · see citing works
“, the positive feedback loops between automatic addictive behavior, attentional bias toward addictive behavior-related stimuli, cue reactivity and craving, and thought suppression) (Brand et al. 2016; Garland et al. 2011, Garland et al. 2014b; Garland 2016; Goyal et al. 2014; Hofmann et al. 2010; Jha et al. 2007).”
BackgroundInfluentialSelf-citationGarland, E. L. (2020) · Pain · doi:10.1097/j.pain.0000000000001988 · Cited by 36 · see citing works
“Given hedonic dysregulation of the reward system in opioid misuse, I previously proposed the reward restructuring hypothesis that posits that psychosocial interventions may increase responsiveness to natural rewards by shifting reward processing from valuing drug-related rewards back towards much greater valuing of na…”
BackgroundSelf-citationMindfulness-based interventions for addictions among diverse and underserved populations
Spears, C. A. (2018) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2018.12.012 · Cited by 34 · see citing works
Garland, E. L., Hanley, A. W., Bedford, C. E., Zubieta, J., Howard, M. O., Nakamura, Y., Donaldson, G. W., & Froeliger, B. (2018) · Journal of Addictive Diseases · doi:10.1080/10550887.2018.1459148 · Cited by 36 · see citing works
Self-citationThomas, 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
“the allostatic shift in reward salience, which may in turn exert salutary effects on addictive behaviors and the neurobiological processes that drive them.(22) MORE has demonstrated therapeutic effects in disorders of appetitive dysregulation such as alcohol dependence,(31) illicit drug dependence,(32) opioid misuse,(…”
BackgroundSelf-citationAlizadehgoradel, J., Imani, S., Vahid, N., Vanderhasselt, M., Molaei, B., Salehinejad, M. A., Ahmadi, S., & Taherifard, M. (2021) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2021.19.4.653 · Cited by 27 · see citing works
“esses snatched during the addictive process [70].”
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
“According to the restructuring reward hypothesis [74], savoring may counter hedonic hyporeactivity underlying opioid misuse by shifting valuation of drug-related rewards back to valuation of natural rewards.”
BackgroundSelf-citationMcConnell, P. A., Garland, E. L., Zubieta, J., Newman‐Norlund, R., Powers, S. E., & Froeliger, B. (2019) · Addiction Biology · doi:10.1111/adb.12743 · Cited by 30 · see citing works
Self-citationCan a meditation app help my sleep? A cross-sectional survey of Calm users
Huberty, J., Puzia, M., Larkey, L., Vranceanu, A., & Irwin, M. R. (2021) · PLoS ONE · doi:10.1371/journal.pone.0257518 · Cited by 24 · see citing works
“Prior research, including systematic reviews, shows that mindfulness meditation programs are efficacious for reducing sleep disturbance [4, 8, 14, 15].”
BackgroundSchuman‐Olivier, Z., Goodman, H., Rosansky, J. A., Fredericksen, A. K., Barria, J., Parry, G. J., Sokol, R. G., Gardiner, P. M., Cook, B. L., & Weiss, R. D. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.54950 · Cited by 24 · see citing works
Short-term mindfulness practice attenuates reward prediction errors signals in the brain
Kirk, U., Pagnoni, G., Hétu, S., & Montague, R. (2019) · Scientific Reports · doi:10.1038/s41598-019-43474-2 · Cited by 23 · see citing works
Reward-related neural correlates of early life stress in school-aged children
Morelli, N. M., Liuzzi, M. T., Duong, J. B., Kryza‐Lacombe, M., Chad‐Friedman, E., Villodas, M. T., Dougherty, L. R., & Wiggins, J. L. (2021) · Developmental Cognitive Neuroscience · doi:10.1016/j.dcn.2021.100963 · Cited by 22 · see citing works
“…(i. e., subclinical anhedonia) or impairments in reinforcement learning through cognitive remediation techniques may be effective in reducing or even preventing adolescent psychopathology, presenting a potentially fruitful research direction based on this work (Garland, 2016; X. Li et al., 2016).”
BackgroundHsiao, Y.-Y., Tofighi, D., Kruger, E. S., Lee Van Horn, M., MacKinnon, D. P., & Witkiewitz, K. (2019) · Mindfulness · doi:10.1007/s12671-018-1023-z · Cited by 23 · see citing works
“…been proposed, including attentional control, emotion- and self-regulation, trait and state mindfulness, mindfulness practice, changes in brain function and structure, negative affect, and acceptance, among others (Garland, 2016; Hölzel et al., 2011; Hunter-Reel et al., 2009; Tang and Leve, 2016).”
BackgroundGarland, 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
“Together, results from the current study and earlier research demonstrating that MORE-induced increases in autonomic and electrocortical responses to natural rewards are associated with decreased opioid craving suggest that enhancing natural reward responsiveness through mindfulness may be a means of restoring adaptiv…”
BackgroundResultInfluentialSelf-citationLorenzetti, V., Gaillard, A., Beyer, E., Kowalczyk, M. A., Kamboj, S. K., Manning, V., & Gleeson, J. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04789-7 · Cited by 20 · see citing works
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-citationStruggling with Happiness: A Pathway Leading Depression to Gambling Disorder
Rogier, G., Picci, G., & Velotti, P. (2019) · Journal of Gambling Studies · doi:10.1007/s10899-018-09825-w · Cited by 20 · see citing works
“In accordance with this, a recent mindfulness-inspired treatment for addiction has the central objective of restoring hedonic function through training the savouring capacities (Garland 2016).”
BackgroundMethodSalivary measurement and mindfulness-based modulation of prescription opioid cue-reactivity
Hanley, A. W., & Garland, E. L. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108351 · Cited by 19 · see citing works
Self-citationAn exploratory study of the role played by hedonic dysregulation in gambling disorder
Velotti, P., & Rogier, G. (2020) · International Gambling Studies · doi:10.1080/14459795.2020.1784977 · Cited by 18 · see citing works
“Also, we highlighted that several failures in regulation processes of positive emotions should be addressed in treatment for individuals suffering from GD. Specifically, Garland (2016) recommended training in savoring capacities for individuals suffering from substance use disorder.”
BackgroundInfluentialHanley, 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-citationParisi, A. B., Hanley, A. W., & Garland, E. L. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104066 · Cited by 18 · see citing works
Self-citationA Pilot Randomized Trial of a Mindfulness-Informed Intervention for Child Welfare-Involved Families
Brown, S. M., Bender, K. A., Bellamy, J. L., Garland, E., Dmitrieva, J., & Jenson, J. (2018) · Mindfulness · doi:10.1007/s12671-018-1001-5 · Cited by 1 · see citing works
Self-citationFarb, N. A. S., Desormeau, P., Anderson, A. K., & Segal, Z. V. (2022) · NeuroImage: Clinical · doi:10.1016/j.nicl.2022.102969 · Cited by 16 · see citing works
“…found in the use of somatically-informed approaches to support patients in recovery from addiction or in the long term management of chronic pain (Garland, 2016) and therapies delivered during depression remission, such as MBCT and WB-CT, encourage the regulation of negative affect via exposure…”
Garland, E. L. (2024) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.16147 · Cited by 17 · see citing works
“25 MORE is guided by the restructuring reward hypothesis , 26 – 28 which proposes that increasing sensitivity to natural rewards will decrease the pull of drug-related rewards to reduce addictive behaviour (e.g., opioid misuse or addiction).”
Self-citationCarlton, C. N., Antezana, L., Garcia, K. M., Sullivan‐Toole, H., & Richey, J. A. (2021) · Affective Science · doi:10.1007/s42761-021-00085-3 · Cited by 15 · see citing works
“Garland (2016) provided a theoretical model through which the effect of mindfulness-oriented recovery enhancement (MORE) on addiction, stress, and pain can potentially be understood as an aftereffect of restructuring reward processing.”
BackgroundBoness, C. L., Hasler, B. P., Sheehan, H., & Pedersen, S. L. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107348 · Cited by 17 · see citing works
Hanley, A. W., & Garland, E. L. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000725 · Cited by 17 · see citing works
“Second, both chronic pain and opioid exposure can lead to a persistent deficit in hedonic capacity, characterized by increased sensitivity to aversive states and insensitivity to natural rewards (27,28).”
BackgroundSelf-citationGarland, E. L., & Howard, M. O. (2021) · Psychopharmacology · doi:10.1007/s00213-020-05729-z · Cited by 15 · see citing works
“2014) which by virtue of their neurocognitive mechanisms (Garland et al. 2013; Garland 2016) are likely to enhance inhibitory control.”
BackgroundSelf-citationChai, J., Xiao, X., An, N., Liu, F., Liu, S., Hu, N., Yang, Y., Cui, Y., & Li, Y. (2022) · Mindfulness · doi:10.1007/s12671-022-01942-3 · Cited by 16 · see citing works
“Mindfulness has been suggested to stimulate the reward system (Garland, 2016), which is dysfunctional in patients with negative symptoms, and improve anhedonia (Kirk & Montague, 2015).”
BackgroundMallik, D., Kaplan, J., Somohano, V. C., Bergman, A. L., & Bowen, S. W. (2021) · Substance Use & Misuse · doi:10.1080/10826084.2021.1899220 · Cited by 15 · see citing works
“MBIs for SUD increase awareness of internal cues that trigger craving and relapse (Garland, 2016).”
BackgroundThe Mediation of Family Context and Youth Depressive Symptoms by Adolescent Emotion Regulation
LaMontagne, L. G., Diehl, D. C., Doty, J. L., & Smith, S. (2022) · Youth & Society · doi:10.1177/0044118x211067266 · Cited by 14 · see citing works
“Similarly, Garland (2016) posed that hedonic dysregulation underlies addictions as well as depression and both can be treated with mindfulness-based interventions.”
BackgroundShankland, R., Kotsou, I., Cuny, C., Strub, L., & Brown, N. J. L. (2017) · Happiness Studies Book Series · doi:10.1007/978-3-319-61810-4_6 · Cited by 14 · see citing works
Bernstein, R. M., Sánchez, N., Clark, E. L. M., Conte, I., Gulley, L. D., Legget, K. T., Cornier, M., Melby, C. L., Johnson, S. A., Lucas‐Thompson, R. G., et al. (2021) · Eating Behaviors · doi:10.1016/j.eatbeh.2021.101580 · Cited by 13 · see citing works
Garland, E. L., Recasens, M., Taple, B. J., Donaldson, G. W., & Weisberg, R. B. (2024) · Annals of Medicine · doi:10.1080/07853890.2024.2392870 · Cited by 13 · see citing works
Self-citationChronic non‐medical prescription opioid use and empathy for pain: Does pain make the difference?
Kroll, S. L., Thayer, J. F., Williams, D. P., Pfabigan, D. M., Baumgartner, M. R., Lamm, C., & Quednow, B. B. (2021) · Psychophysiology · doi:10.1111/psyp.13776 · Cited by 12 · see citing works
Barrows, P. D., & Gordon, W. V. (2021) · Religions · doi:10.3390/rel12080586 · Cited by 12 · see citing works
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-citationChung, Y. I., White, R., Geier, C. F., Johnston, S. J., Smyth, J. M., Delgado, M. R., McKee, S. A., & Wilson, S. J. (2023) · Cognitive Affective & Behavioral Neuroscience · doi:10.3758/s13415-023-01070-y · Cited by 11 · see citing works
“…Recovery Enhancement (MORE) that incorporates mental imagery have shown that it is effective for increasing both reward-related activation of the ventral striatum (i.e., ventral portions of the caudate nucleus and putamen) and positive affect (Froeliger et al., 2017; Garland, 2016).”
BackgroundThe 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 10 · see citing works
Self-citationCorman, 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
Petrie, D. J., Knapp, K. S., Freet, C. S., Deneke, E., Brick, T. R., Cleveland, H. H., & Bunce, S. C. (2022) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2022.09.012 · Cited by 10 · see citing works
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
“…生。研究发现，对过量进食的超重者进行 5.5 个月正念辅助进食控制训练后，相对于普通 干预组，自我报告更低的受奖赏驱动进食，并可依此预测其在干预一年后的体重下降趋势 (Mason et al., 2016)。此外，对 40 名女性分组进行正念注意引导和食物享乐属性引导的一 次干预后发现，正念组参与者报告饥饿感保持稳定但满足感提升，在干预后仅进食较少的…”
InfluentialBehavioral 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
Shi, Z., Li, X., Todaro, D. R., Cao, W., Lynch, K. G., Detre, J. A., Loughead, J., Langleben, D. D., & Wiers, C. E. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03061-0 · Cited by 9 · see citing works
McCallion, E. A., Robinson, C. S. H., Clark, V. P., & Witkiewitz, K. A. (2020) · Mindfulness · doi:10.1007/s12671-020-01323-8 · Cited by 9 · see citing works
Price, C. J., Pike, K. C., Treadway, A., Palmer, J. K., & Merrill, J. O. (2024) · Mindfulness · doi:10.1007/s12671-024-02463-x · Cited by 10 · see citing works
Chen, X., & Reed, P. (2022) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2022.101821 · Cited by 8 · see citing works
Parisi, A. B., Hudak, J., Froeliger, B., & Garland, E. L. (2023) · Nature Mental Health · doi:10.1038/s44220-023-00084-2 · Cited by 8 · see citing works
Self-citationBuddhism in Addiction Recovery
Wang, V., & Stone, B. M. (2022) · Encyclopedia · doi:10.3390/encyclopedia2010035 · Cited by 8 · see citing works
“Furthermore, the model of MBIs has influenced the treatment of addiction and substance use disorders, including the establishment of Mindfulness-Based Relapse Prevention (MBRP) [7], Mindfulness-Oriented Recovery Enhancement (MORE) [8], and other MBIs [9].”
BackgroundInfluentialThe Sleep-Reward-Pain Pathway Model: an Integrative Review
Reid, M. J., Climent‐Sanz, C., & Finan, P. H. (2022) · Current Sleep Medicine Reports · doi:10.1007/s40675-022-00232-7 · Cited by 7 · see citing works
The acute effect of mindfulness-based regulation on neural indices of cue-induced craving in smokers
Zheng, M., Hong, T., Zhou, H., Garland, E. L., & Hu, Y. (2024) · Addictive Behaviors · doi:10.1016/j.addbeh.2024.108134 · Cited by 6 · see citing works
Self-citationTreating Motivational and Consummatory Aspects of Anhedonia
Treadway, M. T. (2023) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20230008 · Cited by 8 · see citing works
Price, C. J., Pike, K. C., & Merrill, J. O. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112813 · Cited by 7 · see citing works
Hosseini, P. S., Saadi, Z. E., & Fard, R. J. (2023) · Journal of Health Reports and Technology · doi:10.5812/jhrt-136888 · Cited by 7 · see citing works
Wexler, R. S., Fox, D. J., ZuZero, D., Bollen, M., Parikshak, A., Edmond, H., Lemau, J., Montenegro, D., Ramirez, J., Kwin, S., et al. (2024) · PAIN Reports · doi:10.1097/pr9.0000000000001132 · Cited by 5 · see citing works
“29 Through external processing of meditation experiences through group discussion, participants are encouraged to engage socially, therefore increasing their engagement in mindfulness practice—a process that may augment both quantitative and qualitative outcomes.”
BackgroundVerdejo‐García, A., Rezapour, T., Giddens, E., et al. (2022) · medRxiv · doi:10.1101/2022.07.28.22278144 · Cited by 6 · see citing works
“The experts endorsed only four (of the initial 10) intervention regulation training, as previously proposed [55].”
BackgroundSelf-citationBecker, S., & Diers, M. (2016) · Der Schmerz · doi:10.1007/s00482-016-0149-y · Cited by 9 · see citing works
Behavior and Substance Addictions in Children
Belisle, J., & Dixon, M. R. (2020) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2020.02.013 · Cited by 5 · see citing works
Dundas, I., Ravnanger, K., Binder, P.-E., & Stige, S. H. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.493349 · Cited by 5 · see citing works
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
Chmiel, J., Malinowska, A., Rybakowski, F., & Leszek, J. (2024) · Brain Sciences · doi:10.3390/brainsci14040320 · Cited by 8 · see citing works
“Garland’s concept of the restructuring reward hypothesis lays the groundwork for understanding how MBIs may counteract the allostatic effects of addiction on reward neurocircuitry [124].”
BackgroundNeurocircuitry of Mindfulness-Based Interventions for Substance Use Prevention and Recovery
Kirlić, N., Cohen, Z. P., & Stewart, J. L. (2021) · Current Addiction Reports · doi:10.1007/s40429-021-00396-2 · Cited by 5 · see citing works
Taylor, V. A., Smith, R. S., & Brewer, J. A. (2022) · Sensors · doi:10.3390/s22145131 · Cited by 4 · see citing works
“This result is also consistent with the notion that the underlying mechanisms for which mindfulness influences behavior is by targeting reinforcement learning processes [8,17,19].”
ResultFritz, J. M., Rhon, D. I., Garland, E. L., Hanley, A. W., Greenlee, T. A., Fino, N. F., Martin, B. I., Highland, K. B., & Greene, T. (2022) · Pain Medicine · doi:10.1093/pm/pnac138 · Cited by 3 · see citing works
Self-citationWang, V., Stone, B. M., Vest, N. A., & LaBelle, O. P. (2023) · Addiction Research & Theory · doi:10.1080/16066359.2023.2282531 · Cited by 3 · see citing works
- Authors
- Garland, E. L.
- Affiliations
- University of Utah (US)
- Corresponding author
- Garland, Eric L.
- ORCID
- Garland, Eric L.
- Venue
- Annals of the New York Academy of Sciences
- Publisher
- Wiley
- Published
- 2016-04
- Volume
- 1373
- Issue
- 1
- Pages
- 25-37
- ISSN
- 0077-8923 (ISSN-L)
- 1749-6632
- PMC
- PMC4940274
- OpenAlex
- W2314235134
- Semantic Scholar
- 3b563b826364d2a41471b02fa784420a0eb696c3
- Cited by
- 137
- References
- 57
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 14 · 2023: 15 · 2022: 18 · 2021: 18 · 2020: 13 · 2019: 14 · 2018: 12 · 2017: 11 · 2016: 5
- FWCI
- 2.07
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Annals of the New York Academy of Sciences (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (NIH) (R34DA037005)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- Mindfulness-Oriented Recovery Enhancement, reward processing, addiction, substance use disorders, cognitive control, cognitive reappraisal, savoring, natural reward, drug reward, stress, chronic pain, mindfulness meditation
- MeSH terms
- Humans, Reward, Stress, Psychological, Behavior, Addictive, Treatment Outcome, Meditation, Chronic Pain, Mindfulness
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