Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Eric L. Garland; Adam W. Hanley; Michael R. Riquino; Sarah E. Reese; Anne K. Baker; Karen Salas; Brooke P. Yack; Carter E. Bedford; Myranda A. Bryan; Rachel Atchley; Yoshio Nakamura; Brett Froeliger; Matthew O. Howard

doi:10.1037/ccp0000390

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Eric L. Garland
, Adam W. Hanley
, Michael R. Riquino
, Sarah E. Reese
, Anne K. Baker
, Karen Salas
, Brooke P. Yack
, Carter E. Bedford
, Myranda A. Bryan
, Rachel Atchley
, Yoshio Nakamura
, Brett Froeliger
, Matthew O. Howard

School of Social Work

Research output: Contribution to journal › Article › peer-review

141 Scopus citations

Abstract

Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p <.001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p =.048), which in turn predicted decreases in opioid misuse risk by follow-up (p =.02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.

Original language	English
Pages (from-to)	927-940
Number of pages	14
Journal	Journal of Consulting and Clinical Psychology
Volume	87
Issue number	10
DOIs	https://doi.org/10.1037/ccp0000390
State	Published - Oct 2019

Funding

Matthew O. Howard passed away in December 2018. This work was supported by a grant from the Fahs Beck Fund for Research and Experimentation (principal investigator [PI]: Eric L. Garland) and a gift from Stephanie Loker Harpst. Eric L. Garland was also supported by National Institute on Drug Abuse Grant R01DA042033 (PI: Eric L. Garland) and National Center for Complementary and Integrative Health Grant R61AT009296 (PI: Eric L. Garland) during the preparation of this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Matthew O. Howard passed away in December 2018. This work was supported by a grant from the Fahs Beck Fund for Research and Experimentation (principal investigator [PI]: Eric L. Garland) and a gift from Stephanie Loker Harpst. Eric L. Garland was also supported by National Institute on Drug Abuse Grant R01DA042033 (PI: Eric L. Garland) and National Center for Complementary and Integrative Health Grant R61AT009296 (PI: Eric L.

Funder number
R01DA042033
R61AT009296

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Mindfulness
Nondual awareness
Opioid
Pain
Positive emotion

Access to Document

10.1037/ccp0000390

Cite this

Garland, 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., Nakamura, Y., Froeliger, B., & Howard, M. O. (2019). Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(10), 927-940. https://doi.org/10.1037/ccp0000390

@article{290830e4ddf0451ab7a808de21ed27a0,

title = "Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial",

abstract = "Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66\% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p <.001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p =.048), which in turn predicted decreases in opioid misuse risk by follow-up (p =.02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.",

keywords = "Mindfulness, Nondual awareness, Opioid, Pain, Positive emotion",

author = "Garland, \{Eric L.\} and Hanley, \{Adam W.\} and Riquino, \{Michael R.\} and Reese, \{Sarah E.\} and Baker, \{Anne K.\} and Karen Salas and Yack, \{Brooke P.\} and Bedford, \{Carter E.\} and Bryan, \{Myranda A.\} and Rachel Atchley and Yoshio Nakamura and Brett Froeliger and Howard, \{Matthew O.\}",

note = "Publisher Copyright: {\textcopyright} 2019 American Psychological Association.",

year = "2019",

month = oct,

doi = "10.1037/ccp0000390",

language = "English",

volume = "87",

pages = "927--940",

journal = "Journal of Consulting and Clinical Psychology",

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publisher = "American Psychological Association",

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Garland, EL, Hanley, AW, Riquino, MR, Reese, SE, Baker, AK, Salas, K, Yack, BP, Bedford, CE, Bryan, MA, Atchley, R, Nakamura, Y, Froeliger, B & Howard, MO 2019, 'Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial', Journal of Consulting and Clinical Psychology, vol. 87, no. 10, pp. 927-940. https://doi.org/10.1037/ccp0000390

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. / Garland, Eric L.; Hanley, Adam W.; Riquino, Michael R. et al.
In: Journal of Consulting and Clinical Psychology, Vol. 87, No. 10, 10.2019, p. 927-940.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms

T2 - A randomized controlled trial

AU - Garland, Eric L.

AU - Hanley, Adam W.

AU - Riquino, Michael R.

AU - Reese, Sarah E.

AU - Baker, Anne K.

AU - Salas, Karen

AU - Yack, Brooke P.

AU - Bedford, Carter E.

AU - Bryan, Myranda A.

AU - Atchley, Rachel

AU - Nakamura, Yoshio

AU - Froeliger, Brett

AU - Howard, Matthew O.

PY - 2019/10

Y1 - 2019/10

N2 - Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p <.001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p =.048), which in turn predicted decreases in opioid misuse risk by follow-up (p =.02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.

AB - Objective: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. Method: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. Results: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p <.001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p =.048), which in turn predicted decreases in opioid misuse risk by follow-up (p =.02). Conclusions: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy.

KW - Mindfulness

KW - Nondual awareness

KW - Opioid

KW - Pain

KW - Positive emotion

UR - https://www.scopus.com/pages/publications/85072847785

U2 - 10.1037/ccp0000390

DO - 10.1037/ccp0000390

M3 - Article

C2 - 31556669

AN - SCOPUS:85072847785

SN - 0022-006X

VL - 87

SP - 927

EP - 940

JO - Journal of Consulting and Clinical Psychology

JF - Journal of Consulting and Clinical Psychology

IS - 10

ER -

Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial

Abstract

Funding

UN SDGs

Keywords

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