Mindfulness-Oriented Recovery Enhancement remediates anhedonia in chronic opioid use by enhancing neurophysiological responses during savoring of natural rewards.
Eric L Garland, Spencer T Fix, Justin Hudak, Edward M Bernat, Yoshio Nakamura, Adam W. Hanley, Gary W Donaldson, William R. Marchand, Brett Froeliger
Psychological Medicine April 1, 2023 DOI: 10.1017/S0033291721003834 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 63 |
| Population | Veterans receiving long-term opioid therapy for chronic pain |
| Intervention | Mindfulness-Oriented Recovery Enhancement |
| Duration | 8-week intervention, 4-month follow-up |
| Topics | Addiction Meditation |
| Keywords | Analgesia Hedonic dysregulation Reward processing Savoring |
| Citations | 51 |
| Key findings | Mindfulness-Oriented Recovery Enhancement increased neural and physiological responses to natural reward cues and reduced anhedonia more than supportive group therapy in chronic pain patients on long-term opioid therapy. |
Abstract
Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT. Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up. Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring. MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.
Comparable studies
Other randomized controlled trials on meditation, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Alterations in Brain and Immune Function Produced by Mindfulness Meditation Healthy employees in a work environment | 2003 | Randomized controlled trial | n = 41 |
| Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Recovered recurrently depressed patients | 2000 | Randomized controlled trial | n = 145 |
| Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Working adults | 2008 | Randomized controlled trial | n = 139 |
| Short-term meditation training improves attention and self-regulation Undergraduate Chinese students | 2007 | Randomized controlled trial | n = 40 |
| Mindfulness-Based Cognitive Therapy for Depression: Replication and Exploration of Differential Relapse Prevention Effects. Recovered recurrently depressed patients | 2004 | Randomized controlled trial | n = 73 |
Citations in the library
Cited by 17
- Effects of Savoring Meditation on Positive Emotions and Pain-Related Brain Function: A Mechanistic Randomized Controlled Trial in People With Rheumatoid Arthritis. Journal of Pain July 1, 2024
- Anhedonia: Current and future treatments Psychiatry and Clinical Neurosciences Reports March 1, 2025
- Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions Neuroscience & Biobehavioral Reviews September 25, 2023
- Development and Initial Validation of Mindfulness-Based Pain Reduction (MBPR) in Patients With Chronic Low Back Pain. Journal of Pain Research 2025
- Mindfulness-induced self-transcendence promotes universal love with consequent effects on opioid misuse. Behaviour Research and Therapy April 1, 2024
and 12 more in the library
Cites 10
- Restructuring Reward Mechanisms in Nicotine Addiction: A Pilot fMRI Study of Mindfulness‐Oriented Recovery Enhancement for Cigarette Smokers Evidence-based Complementary and Alternative Medicine 2017
- Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients Drug and Alcohol Dependence March 29, 2017
- Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care JAMA Internal Medicine February 28, 2022
- A Pilot Randomized Clinical Trial of Mindfulness-Oriented Recovery Enhancement as an Adjunct to Methadone Treatment for People with Opioid Use Disorder and Chronic Pain: Impact on Illicit Drug Use, Health, and Well-Being Journal of Substance Abuse Treatment May 8, 2021
- Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology October 1, 2019
and 5 more in the library