PLoS One
December 6, 2017
Eric L Garland, Adam W. Hanley, Phillipe R. Goldin et al.
161 citations
A reanalysis of longitudinal data provides evidence for the mindfulness-to-meaning theory, which proposes that mindfulness promotes positive emotion regulation by increasing the ability to notice and savor positive experiences. The findings suggest that mindfulness training enhances positive emotions through this mechanism, supporting the theory's predictions about how mindfulness fosters well-being.
Psychological Assessment
December 1, 2018
Adam W. Hanley, Yoshio Nakamura, Eric L Garland
125 citations
Two new questionnaires, the Nondual Awareness Dimensional Assessment-Trait (NADA-T) and the Nondual Awareness Dimensional Assessment-State (NADA-S), were developed to measure nondual awareness—a sense of oneness or absence of self-other boundaries. Principal component analysis with 528 participants identified two dimensions of the NADA-T: self-transcendence and bliss. Further analyses in three independent samples (totaling 725 participants) showed both dimensions reflect a single overarching nondual awareness construct. The NADA-T correlated with interdependent self-construals and dispositional mindfulness.
Mindfulness
May 1, 2020
Adam W. Hanley, Michael Dambrun, Eric L Garland
66 citations
Five sessions of mindfulness training, compared with an active listening control, led healthy young adults to report a decreased sense of body boundary dissolution and a more allocentric (less self-centered) spatial frame of reference. The effect on spatial frame of reference was mediated by the reduction in perceived body boundaries. The findings suggest that even brief mindfulness practice can shift the experience of self, relaxing the boundary between self and environment and extending the spatial frame of reference beyond the physical body.
Psychological Medicine
April 1, 2023
Eric L Garland, Spencer T Fix, Justin Hudak et al.
51 citations
Long-term opioid therapy for chronic pain can lead to anhedonia, or reduced ability to experience pleasure from natural rewards. A behavioral intervention called Mindfulness-Oriented Recovery Enhancement (MORE) was tested in 63 veterans on long-term opioid therapy for chronic pain, who were randomly assigned to eight weeks of MORE or a supportive group therapy. MORE increased brain and physiological responses to natural reward cues and reduced subjective anhedonia more than the control. The reduction in anhedonia was linked to increased brain activity during savoring of rewards. MORE may be an effective treatment for anhedonia in chronic opioid users and those at risk for opioid use disorder.
Neuropsychopharmacology
September 12, 2020
Justin Hudak, Adam W. Hanley, William R. Marchand et al.
46 citations
Among people receiving Mindfulness-Oriented Recovery Enhancement for opioid misuse, those who showed higher levels of endogenous theta brainwave activity during meditation subsequently required lower doses of opioids. Theta oscillations, which are linked to relaxation and focused attention, may serve as a neural marker predicting treatment response.
JAMA Psychiatry
April 1, 2024
Nina A Cooperman, Shou-En Lu, Adam W. Hanley et al.
39 citations
Adding a telehealth mindfulness-based program called Mindfulness-Oriented Recovery Enhancement (MORE) to standard methadone treatment reduced the risk of returning to drug use by 42% and the risk of dropping out of methadone treatment by 59% over 16 weeks among people with opioid use disorder and chronic pain. Participants receiving MORE also had fewer days of drug use, better methadone adherence, and greater reductions in pain and depression than those receiving standard care alone. Anxiety did not differ significantly between groups. The findings suggest that telehealth MORE is a feasible and effective supplement to methadone treatment.
Science Advances
October 14, 2022
Eric L Garland, Adam W. Hanley, Justin Hudak et al.
39 citations
Theta oscillations (4 to 8 Hz) in frontal midline brain regions, which support self-regulation, are inversely linked to default mode network activity involved in self-referential processing. Addiction involves impaired self-regulation and default mode network dysfunction. In a mechanistic study of 165 long-term opioid users, Mindfulness-Oriented Recovery Enhancement increased frontal midline theta during meditation compared to supportive psychotherapy. Theta during meditation was associated with self-transcendent experiences such as ego dissolution and bliss. Increased theta mediated the treatment's effect on reducing opioid misuse, suggesting mindfulness-induced theta stimulation may reset default mode network dysfunction to inhibit addictive behavior.
Psychotherapy
April 30, 2020
Simon B. Goldberg, Adam W. Hanley, Scott A. Baldwin et al.
22 citations
Mindfulness practice time and psychological outcomes are linked on the same day, but practicing more on one day does not predict better outcomes the next day. Instead, feeling better or more mindful on a given day predicts more practice the following day. Over 12 weeks, 25 participants in a standardized mindfulness program completed daily diaries. Same-day relationships showed expected patterns: more practice was associated with higher positive affect and mindfulness and lower negative affect. However, lagged analyses found no evidence that practice time drives next-day outcomes. Post hoc analysis indicated that practice time moderated the connection between day-to-day affect, strengthening the positive affect link and weakening the negative affect link. The findings suggest that the causal direction may flow from outcome to practice time, not the reverse.
Mindfulness
January 1, 2023
Eric L Garland, R Lynae Roberts, Adam W. Hanley et al.
14 citations
A new measure, the Mindful Reappraisal of Pain Sensations Scale (MRPS), was developed and validated across multiple studies. The scale captures how mindfulness helps people shift from catastrophic pain appraisals to viewing pain as a harmless sensory signal. In samples of opioid-treated chronic pain patients, the MRPS showed a single-factor structure and good convergent and divergent validity. Mindfulness training via Mindfulness-Oriented Recovery Enhancement (MORE) increased MRPS scores more than supportive psychotherapy. Changes in MRPS scores statistically mediated the effect of MORE on reducing chronic pain severity through 9-month follow-up, indicating the MRPS measures a key analgesic mechanism involving attentional disengagement and interoceptive exposure.
Journal of Integrative and Complementary Medicine
September 1, 2024
Adam W. Hanley, Ayaka Lingard, Eric L Garland
7 citations
A 2-hour single-session version of Mindfulness-Oriented Recovery Enhancement (One MORE) improved chronic pain patients' pain catastrophizing, pain intensity, pain interference, physical function, sleep, anxiety, and depression through a 3-month follow-up. The intervention also increased mindfulness, positive reappraisal, savoring, and self-transcendence. These results from a waitlist-controlled randomized trial with 40 participants suggest that a brief, scalable, low-cost nonpharmacologic treatment may help address the logistical barriers of longer 8-week mindfulness-based interventions for chronic pain.
International Journal of Wellbeing
October 1, 2024
Michael Dambrun, Adam W. Hanley, Eric L Garland et al.
5 citations
Practicing brief attentional mindfulness meditations—either a body scan or breath-focused meditation—can boost positive emotions such as gratitude, elevation, and pride, and in turn improve well-being and inner peace. Two online experiments showed that a 21-minute session increased these emotions, an effect explained by self-transcendence. A shorter 11-minute session replicated the emotional boost, and two self-transcendent emotions (elevation and gratitude) specifically mediated improvements in well-being and inner peace, while pride did not.
Journal of Pain and Symptom Management
January 3, 2026
Karolina L Bryl, Adam W. Hanley, Raymond E Baser et al.
1 citation
Chronic pain is common among cancer survivors but often goes untreated. Existing treatments carry risks or offer limited relief, and non-drug options have shown only modest benefits. Mindfulness-Oriented Recovery Enhancement (MORE), an intervention that targets the neurocognitive mechanisms of chronic pain, has helped people without cancer but had not been tested in cancer survivors. This pilot trial enrolled 60 cancer survivors with moderate-to-severe pain (average age 60; 75% female) and randomly assigned them to one of three MORE formats (16, 8, or 2 hours) or a waitlist. MORE proved feasible, with high enrollment (71%) and assessment completion (91%), and acceptable, with high adherence and satisfaction.
Psychological services
July 21, 2025
Tracy Herrmann, Joanna Ellen Bettmann, Adam W. Hanley et al.
1 citation
Veterans often avoid or drop out of mental health treatment, so new approaches are needed. A nature-based mindfulness intervention was tested against an indoor version for veterans with mental illness. Forty-one veterans from a Veterans Affairs health care center were randomly assigned to either a six-session outdoor or indoor group mindfulness program. More veterans completed the outdoor program than the indoor one, though average attendance did not differ. The outdoor group also showed greater reductions in posttraumatic stress disorder symptoms over time. Nature-based interventions may help reduce stigma and improve treatment completion rates for veterans.
Cureus
March 1, 2025
Sean D Young, Josh Kim, Adam W. Hanley
1 citation
Mindfully listening to music, including improvisational jazz, can reduce chronic pain and anxiety more effectively than listening without mindfulness training. In a pilot study of 120 adults with chronic musculoskeletal pain, participants were randomly assigned to mindful listening or music education groups, each with either preferred music or jazz. Those in the mindful listening groups reported significantly greater reductions in pain intensity and anxiety. A clinically meaningful (20%) decrease in pain occurred more often in the mindful jazz (50%) and mindful music (41%) groups than in the jazz education (29%) and music education (26%) groups. The findings suggest that combining mindfulness with music listening enhances pain relief.
International Journal of Behavioral Medicine
June 12, 2026
Carter Minnick, Adam W. Hanley, Eric L Garland
A brief, Spanish-language adaptation of Mindfulness-Oriented Recovery Enhancement (Spanish B-MORE) was tested in a pilot randomized controlled trial with 20 Spanish-speaking adults experiencing chronic pain. Participants rated the intervention as highly acceptable, averaging 9.4 out of 10, and would recommend it to others. Immediately after sessions, pain intensity, pain unpleasantness, and anxiety all decreased with large effect sizes. At six weeks, those who received B-MORE showed greater improvements across all clinical outcomes compared to a waitlist control group. The intervention appears to be a brief, scalable, and culturally responsive option for chronic pain in Spanish-speaking populations, warranting further study in larger trials.
Psychology of Consciousness Theory Research and Practice
May 11, 2026
Kush V. Bhatt, Adam W. Hanley, Chantal Martin-Soelch et al.
Mindfulness-based interventions reduce chronic pain, and a secondary analysis of two randomized controlled trials (480 patients on long-term opioid therapy) suggests that nondual awareness—a state of attenuated self-other distinction—partly explains this effect. Participants in an 8-week mindfulness program (MORE) showed significantly lower pain severity and interference than a supportive therapy control group, along with greater increases in nondual awareness. Path analyses indicated that gains in nondual awareness mediated the reductions in pain severity and interference, and nondual awareness was a stronger mediator than the mindfulness facet of nonreactivity. The findings link mindfulness-induced nondual awareness to chronic pain relief, and future work should explore neurobiological mechanisms and other interventions that foster nondual awareness.
JMIR Research Protocols
April 23, 2026
Kennedi Childs, Carter Minnick, Geraldine Martorella et al.
Chronic musculoskeletal pain often becomes entangled with a person's sense of self, making treatment difficult. Mindfulness-based interventions may help by promoting self-transcendence, a potential mechanism for lasting pain relief. This protocol describes a three-arm randomized controlled trial with 173 adults who have chronic musculoskeletal pain. Participants will receive either traditional mindful breathing instruction, mindful breathing plus direct pointing instruction, or be placed on a waitlist. Self-transcendence will be measured using self-reports, EEG theta activity, and fNIRS default mode network activity. Pain intensity and functional interference will be tracked from baseline through a three-month follow-up. Data collection runs from October 2024 to May 2027; no results are yet available.
Journal of Integrative and Complementary Medicine
May 1, 2026
Steven D. Pratscher, Lloyd Lalande, Allison Davis et al.
A single session of Guided Respiration Mindfulness Therapy (GRMT), an integrative breathwork intervention involving one hour of conscious connected breathing with somatically focused mindfulness and relaxation, was highly acceptable and satisfying to adults with chronic pain. Among 11 enrolled participants, 10 completed the session; all recommended the intervention to others. Large, clinically meaningful improvements in pain intensity and pain interference occurred from baseline to 2-week and 6-week follow-ups, with mean differences of -2.9 and -3.5 respectively. The findings demonstrate proof of concept and warrant further research.
Complementary Therapies in Medicine
December 1, 2025
Adam W. Hanley, Yoshio Nakamura, Robert R Edwards et al.
Both Reiki and mindfulness meditation significantly reduced knee osteoarthritis symptoms compared to doing nothing, with over half of participants in those groups reporting a clinically meaningful reduction of more than 30% in symptoms after just four weekly 30-minute sessions. The improvements from mindfulness were significantly better than those from a sham Reiki procedure, while Reiki's effects were comparable to mindfulness. The study involved 164 adults with physician-confirmed knee osteoarthritis and had high retention and successful blinding, supporting the reliability of the results. These findings suggest that both therapies may be effective, well-tolerated, and time-efficient options for managing knee osteoarthritis pain.
European Journal of Investigation in Health, Psychology and Education
November 25, 2025
Sean D Young, Adam W. Hanley
Mindfully listening to jazz for 20 minutes daily over four weeks reduces pain intensity, unpleasantness, and anxiety in people with chronic musculoskeletal pain more than simply listening to jazz without a mindful approach. A pilot randomized controlled trial compared daily mindful jazz listening (27 participants) with regular jazz listening (30 participants). The results suggest that the mindful listening group experienced greater reductions in pain and anxiety both immediately after the session and at a four-week follow-up. This brief, music-based intervention may offer a more accessible option for chronic pain management than traditional mindfulness-based programs.
Mindfulness
May 24, 2023
E. Garland, Bhanuteja Gullapalli, Kort C. Prince et al.
A randomized controlled pilot trial compared Zoom-based Mindfulness-Oriented Recovery Enhancement plus Just-in-Time Adaptive Intervention prompts triggered by wearable sensors (MORE+JITAI) to a Zoom-based supportive group psychotherapy control among 63 opioid-treated chronic pain patients. Ecological momentary assessments over 90 days showed that MORE+JITAI produced significantly greater reductions in craving, pain, and stress, and greater increases in positive affect over time than the control. JITAI-initiated mindfulness practice was associated with improvements in these outcomes and increases in heart rate variability. Machine learning predicted the effectiveness of JITAI-initiated mindfulness practice with reasonable accuracy. The intervention shows preliminary efficacy for reducing factors implicated in opioid misuse.
JAMA Internal Medicine
February 28, 2022
E. Garland, Adam W. Hanley, Y. Nakamura et al.
A mindfulness-based program called Mindfulness-Oriented Recovery Enhancement (MORE) reduced opioid misuse and improved chronic pain more than supportive group psychotherapy in adults with both conditions. After 9 months, 45.0% of participants receiving MORE had stopped misusing opioids, compared with 24.4% receiving supportive therapy. MORE also led to significant improvements in chronic pain symptoms. The program appears to be an effective treatment for opioid misuse among people with chronic pain in primary care.
Behaviour Research and Therapy
February 28, 2022
Anna Parisi, Adam W. Hanley, E. Garland
Mindfulness-Oriented Recovery Enhancement (MORE) reduces acute opioid craving, pain, and negative affect more than supportive group psychotherapy for chronic pain patients on long-term opioid therapy. In a trial with 50 participants receiving MORE and 45 receiving supportive group therapy, medium-to-large effects favored MORE for session-level improvements in craving, pain, and negative affect. Higher curiosity predicted craving reductions; greater decentering and daily mindfulness practice predicted reduced negative affect. Momentary measures showed significant group-by-time interactions for craving and pain. The findings suggest MORE provides immediate symptom relief on therapeutic targets in daily life.
Journal of Substance Abuse Treatment
May 8, 2021
Nina A. Cooperman, Adam W. Hanley, A. Kline et al.
Mindfulness-Oriented Recovery Enhancement (MORE) added to methadone maintenance treatment (MMT) reduced illicit drug use, craving, pain, physical and emotional limitations, depression, and anxiety, while increasing well-being, vitality, and social functioning through 16-week follow-up compared to MMT alone. In this randomized trial of 30 individuals in MMT, those receiving eight weekly two-hour MORE groups plus treatment as usual showed significantly better outcomes than those receiving only treatment as usual. The authors conclude that MORE could be an effective adjunct to MMT and that larger trials are warranted.
Psychology of Consciousness
November 19, 2020
Adam W. Hanley, D. Dorjee, E. Garland
Mindfulness training increased both decentering and self-transcendence in novice practitioners compared with an active listening condition. Greater decentering midway through five training sessions predicted greater self-transcendence at the end, suggesting that becoming better able to non-reactively observe thoughts, feelings, and physical sensations during meditation facilitates self-transcendent experiences. This provides initial empirical evidence that mindfulness can cultivate self-transcendence through decentering.