Reduce Opioid-Treated Pain and Opioid Dosage with Mindfulness

Reduce Opioid-Treated Pain and Opioid Dosage with Mindfulness

 

By John M. de Castro, Ph.D.

 

Mind-body therapies — including meditation, cognitive behavioral therapy and hypnosis — were associated with improvements in pain and reduced opioid doses.” – Erin Michael

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. What is not known is the most effective mind-body treatments for chronic pain. There are a large variety of mind-body therapies including meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and Cognitive Behavioral Therapy (CBT). It is not known which are the most effective for reducing pain and opioid use in patients with chronic pain who are being treated with opioids.

 

In today’s Research News article “Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/ ) Garland and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials of the effectiveness of mind-body techniques for opioid-treated pain. They identified 60 published trials.

 

They report that the published research found that the studies that used Mind-Body Therapies produced significant reductions in pain outcomes and opioid use. This was true for studies that employed meditation, hypnosis, or Cognitive Behavioral Therapy (CBT), with the largest effect sizes found for meditation. Suggestion, imagery, and relaxation were all found to be less effective.

 

Hence, the published randomized controlled trials support the use of Mind-Body Therapies for the treatment of patients with chronic pain who are being treated with opioids. Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) are particularly effective in both treating pain and reducing opioid use. This is compatible with other results that mindfulness meditation has been repeatedly shown to reduce pain and improve recovery from opioid addiction.

 

Meditation, hypnosis, or Cognitive Behavioral Therapy (CBT) have a common property of changing the patient’s thought patterns associated with their pain and thereby alter their relationship with the pain. These thought patterns such as worry, rumination, and catastrophizing tend to amplify the physical pain. Reducing these tendencies can eliminate the amplification and thereby reduce the experienced pain. With less pain, less opioids are needed to control it.

 

So, reduce opioid-treated pain and opioid dosage with mindfulness.

 

Using mindfulness, meditation, hypnosis, therapeutic suggestion, and cognitive behavior therapy, in addition to opioid treatment of acute or chronic pain, provides an additional benefit to patients by reducing pain scores. Some of these interventions will decrease the duration or amount of opioid needed.” – Sumi Sexton

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Garland, E. L., Brintz, C. E., Hanley, A. W., Roseen, E. J., Atchley, R. M., Gaylord, S. A., Faurot, K. R., Yaffe, J., Fiander, M., & Keefe, F. J. (2019). Mind-Body Therapies for Opioid-Treated Pain: A Systematic Review and Meta-analysis. JAMA internal medicine, 180(1), 91–105. Advance online publication. https://doi.org/10.1001/jamainternmed.2019.4917

 

Key Points

Question

Are mind-body therapies (ie, meditation, hypnosis, relaxation, guided imagery, therapeutic suggestion, and cognitive behavioral therapy) associated with pain reduction and opioid-related outcome improvement among adults using opioids for pain?

Findings

In this systematic review and meta-analysis of 60 randomized clinical trials with 6404 participants, mind-body therapies were associated with improved pain (Cohen d = −0.51; 95% CI, −0.76 to −0.27) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08).

Meaning

Practitioners should be aware that mind-body therapies may be associated with moderate improvements in pain and small reductions in opioid dose.

Abstract

Importance

Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

Objective

To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain.

Data Sources

For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched.

Study Selection

Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain.

Data Extraction and Synthesis

Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs.

Main Outcomes and Measures

The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function.

Results

Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d = −0.51; 95% CI, −0.76 to −0.26) and reduced opioid dose (Cohen d = −0.26; 95% CI, −0.44 to −0.08). Studies tested meditation (n = 5), hypnosis (n = 25), relaxation (n = 14), guided imagery (n = 7), therapeutic suggestion (n = 6), and cognitive behavioral therapy (n = 7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d = −0.70), hypnosis (Cohen d = −0.54), suggestion (Cohen d = −0.68), and cognitive behavioral therapy (Cohen d = −0.43) but not for other MBTs. Although most meditation (n = 4 [80%]), cognitive-behavioral therapy (n = 4 [57%]), and hypnosis (n = 12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias.

Conclusions and Relevance

The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830441/Importance

Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients.

Acceptance and Commitment Therapy is Effective in Treating Substance Use Disorders

Acceptance and Commitment Therapy is Effective in Treating Substance Use Disorders

 

By John M. de Castro, Ph.D.

 

“Mindfulness reminds us that in stillness we find the wisdom to become a human being instead of a human doing. . .  Recovery is a journey, not a destination. Stillness opens our hearts and minds to the vast potential within us as we move through treatment.” – Beverly Conyers

 

Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse.

 

Hence, it is important to find an effective method to treat substance abuse and prevent relapse but an effective treatment has been elusive. Most programs and therapies to treat addictions have poor success rates. Recently, mindfulness training has been found to be effective in treating addictionsAcceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

The evidence has been accumulating on the effectiveness of Acceptance and Commitment Therapy (ACT) for the treatment of substance use disorders. So, it makes sense to step back and summarize what has been learned in the most recent studies. In today’s Research News article “The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524566/ ) Osaji and colleagues review and summarize the published research on the effectiveness of ACT in treating patients with substance use disorders.

 

They identified 22 published research studies and report that the published research found that  Acceptance and Commitment Therapy (ACT) was effective for the treatment of substance use disorders. They report that the research demonstrates that ACT is effective when used alone or in combination with other therapies. ACT successfully reduced substance use or produced discontinuation. It has been shown that various forms of mindfulness training are effective in treating addictions. The present findings simply extends this to ACT.

 

So, Acceptance and Commitment Therapy is effective in treating substance use disorders.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

“mindfulness can play a very important role in substance abuse recovery: patients learn how to rethink the nature of stressful situations and stimuli that may otherwise trigger a harmful train of thought that leads to drinking or using. Prior to a mindfulness intervention, patients may have been oblivious to the various factors that start the chain reaction of negative thought and unhealthy behavior. Mindfulness treatment gives them the chance to examine those factors on a level playing field, in a calm, supportive and safe environment. In time, the triggers become less daunting and more manageable.” – Foundations Recovery Network

 

Study Summary

 

Osaji, J., Ojimba, C., & Ahmed, S. (2020). The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. Journal of Clinical Medicine Research, 12(10), 629–633. https://doi.org/10.14740/jocmr4311

 

Abstract

Background

Acceptance and commitment therapy (ACT) is a form of behavioral therapy that teaches people to learn to accept rather than avoid challenging situations in their lives. ACT has shown to be an intervention with great success in the reduction of various mental disorders and substance use disorders (SUDs). The core of ACT when used in SUD treatment is guiding people to accept the urges and symptoms associated with substance misuse (acceptance) and use psychological flexibility and value-based interventions to reduce those urges and the symptoms (commitment). The purpose of this study is to review the existing literature to examine the evidence on the use of ACT in the management of SUD.

Methods

A thorough search of four databases (CINAHL, PubMed.gov, PsycINFO and PsycNET) from 2011 to 2020 was conducted using search terms like ACT, ACT and SUD, ACT, and substance misuse. The articles retrieved were critically appraised using the Critically Appraised Topic (CAT) Checklist.

Results

Most of the studies showed that ACT was effective in the management of SUD showing significant evidence of a reduction in substance use or total discontinuation with subsequent abstinence.

Conclusions

The literature review concluded that success has been achieved using ACT either as monotherapy or in combination with other therapy in the treatment of individuals with SUD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524566/

 

Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

Reduce Opioid Use after Surgery for Orthopedic Trauma with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.” – Pain Week

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids. An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates.

 

An encouraging alternative is mindfulness training. It has been found to be effective in treating addictions. One way that mindfulness may produce these benefits is by reducing cravings for opioids. The vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many patients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, mindfulness training over the internet has been developed. This has the tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. Hence it would make sense to study ACT delivered over the internet to reduce opioid use with pain patients.

 

In today’s Research News article “Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/ ) Anthony and colleagues recruited hospital patients who had a bone fracture requiring surgery and randomly assigned them to a treatment as usual control condition or to receive automated text based messages communicating a Acceptance and Commitment Therapy (ACT) message twice a day for the two weeks following surgery.

A day 1 example message was:

Maintaining focus on what you value most in life is sometimes difficult after surgery. Do not let the momentary discomforts due to surgery take away from what you want most in life. Pick 3 things that matter most to you in life. Remind yourself of these 3 things you value most during your recovery process.”

They were measured before and after the 2-week messaging period for opioid use, pain intensity, pain interference, and anxiety.

 

They found that although both groups were prescribed the same amount of opioids after surgery, the Acceptance and Commitment Therapy (ACT) message group consumed significantly fewer, 37% less, opioid pills during the 2 weeks following surgery than the control group. In addition, the ACT group reported significantly lower pain intensity and pain interference than the control group two weeks after surgery.

 

The ability of Acceptance and Commitment Therapy (ACT) to reduce perceived pain and to reduce opioid use have been previously documented. The important contribution of the present study is that it demonstrated that these benefits can be attained with ACT taught through automated text messages. This suggests that the benefits of the therapy can be provided routinely, inexpensively and conveniently to large numbers of patients. Although there was no long term follow up, it would be hoped that this treatment would result in lower likelihood of opioid addiction resulting from post-surgical use in these patients.

 

So, reduce opioid use after surgery for orthopedic trauma with mindfulness.

 

People suffering from opioid addiction and chronic pain may have fewer cravings and less pain if they use both mindfulness techniques and medication for opioid dependence.” – Science Daily

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Anthony, C. A., Rojas, E. O., Keffala, V., Glass, N. A., Shah, A. S., Miller, B. J., Hogue, M., Willey, M. C., Karam, M., & Marsh, J. L. (2020). Acceptance and Commitment Therapy Delivered via a Mobile Phone Messaging Robot to Decrease Postoperative Opioid Use in Patients With Orthopedic Trauma: Randomized Controlled Trial. Journal of medical Internet research, 22(7), e17750. https://doi.org/10.2196/17750

 

Abstract

Background

Acceptance and commitment therapy (ACT) is a pragmatic approach to help individuals decrease avoidable pain.

Objective

This study aims to evaluate the effects of ACT delivered via an automated mobile messaging robot on postoperative opioid use and patient-reported outcomes (PROs) in patients with orthopedic trauma who underwent operative intervention for their injuries.

Methods

Adult patients presenting to a level 1 trauma center who underwent operative fixation of a traumatic upper or lower extremity fracture and who used mobile phone text messaging were eligible for the study. Patients were randomized in a 1:1 ratio to either the intervention group, who received twice-daily mobile phone messages communicating an ACT-based intervention for the first 2 weeks after surgery, or the control group, who received no messages. Baseline PROs were completed. Two weeks after the operative intervention, follow-up was performed in the form of an opioid medication pill count and postoperative administration of PROs. The mean number of opioid tablets used by patients was calculated and compared between groups. The mean PRO scores were also compared between the groups.

Results

A total of 82 subjects were enrolled in the study. Of the 82 participants, 76 (38 ACT and 38 controls) completed the study. No differences between groups in demographic factors were identified. The intervention group used an average of 26.1 (SD 21.4) opioid tablets, whereas the control group used 41.1 (SD 22.0) tablets, resulting in 36.5% ([41.1-26.1]/41.1) less tablets used by subjects receiving the mobile phone–based ACT intervention (P=.004). The intervention group subjects reported a lower postoperative Patient-Reported Outcome Measure Information System Pain Intensity score (mean 45.9, SD 7.2) than control group subjects (mean 49.7, SD 8.8; P=.04).

Conclusions

In this study, the delivery of an ACT-based intervention via an automated mobile messaging robot in the acute postoperative period decreased opioid use in selected patients with orthopedic trauma. Participants receiving the ACT-based intervention also reported lower pain intensity after 2 weeks, although this may not represent a clinically important difference.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458063/

 

Mindfulness is Negatively Related to Compulsive Sexual Behavior in Adults Undergoing Substance Abuse Treatment

Mindfulness is Negatively Related to Compulsive Sexual Behavior in Adults Undergoing Substance Abuse Treatment

 

By John M. de Castro, Ph.D.

 

Stress contributes to many sex problems. Mindfulness helps by reducing stress.” – Michael Castleman

 

Sexual behavior is a very important aspect of human behavior, especially for reproduction. In fact, Sigmund Freud made it a centerpiece of his psychodynamic theory. At its best, it is the glue that holds families and relationships together. But it is a common source of dysfunction and psychosocial problems. Compulsive sexual behavior “encompasses problems with preoccupation with thoughts surrounding sexual behavior, loss of control over sexual behavior, disturbances in relationships due to sexual behavior, and disturbances in affect (e.g., shame) due to sexual behavior.” It is also called sex addiction and hypersexuality. It is chronic and remarkably common affecting 3% to 17% of the population. In addition, it is associated with substance abuse in around half of people with compulsive sexual behavior.

 

Compulsive sexual behavior is frequently treated with psychotherapy, cognitive behavioral, therapy, or drugs with mixed success. Since, it is also looked at as an addiction and mindfulness treatment has been found to be effective for both sexual dysfunction and for addictions, mindfulness may be affective for individuals with both substance abuse and compulsive sexual behavior. Indeed, mindfulness has been shown to be related to compulsive sexual behavior in men undergoing treatment for substance abuse. This suggests that further study of the relationship between mindfulness and compulsive sexual behavior with men and women should be investigated.

 

In today’s Research News article “Exploring Gender Differences in the Relationship between Dispositional Mindfulness and Compulsive Sexual Behavior among Adults in Residential Substance Use Treatment.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884324/) Brem and colleagues examined the records for patients admitted into residential substance abuse treatment facilities. The completed measures of alcohol use and problems, drug use and problems, and psychiatric symptomology. Mindfulness was measured over 5 domains: acting with awareness, observation of experience, describing with words, non-judging of inner experience, and non-reactivity to inner experience). Compulsive sexual behavior was measured over five domains: preoccupation, loss of control, affect disturbance, relationship disturbance, and internet problems.

 

They found that high levels of mindfulness facets were associated with low levels of compulsive sexual behavior. But the relationships differed between men and women. In particular, for men, the mindfulness facets of acting with awareness, nonjudging of inner experience, describing with words, and non-reactivity to inner experience were significantly negatively related to compulsive sexual behavior, while for women for men, the mindfulness facets of acting with awareness, nonjudging of inner experience were significantly negatively related to compulsive sexual behavior. For both men and women alcohol use and problems, drug use and problems, and depression were positively related to compulsive sexual behavior.

 

These results are interesting but correlational, so caution must be exercised in reaching conclusions regarding causation. But they do suggest that for men describing with words, and non-reactivity to inner experience are more important than for women in being related to compulsive sexual behavior.

 

This further suggests that compulsive sexual behavior occurs predominantly without real time awareness and hence mindfulness may be an important antidote to compulsive sexual behavior. But what facets of mindfulness are most important differs between the genders. So, in developing therapeutic programs for the treatment of substance abuse disorders, mindfulness training programs might be tailored differently for men and women.

 

So, mindfulness is negatively related to compulsive sexual behavior in adults undergoing substance abuse treatment.

 

findings tentatively support the usefulness of mindfulness in the effective treatment of sex addiction. In addition to helping bring about a reduction in dysfunctional sex-related actions, fantasies and thoughts, mindfulness training may help affected individuals gain improved emotional control, an increased ability to handle stressful situations and improved resistance to any potentially damaging sex-related urges that arise.” – The Ranch

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

               

Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2019). Exploring Gender Differences in the Relationship between Dispositional Mindfulness and Compulsive Sexual Behavior among Adults in Residential Substance Use Treatment. Mindfulness, 10(8), 1592–1602. https://doi.org/10.1007/s12671-019-01117-7

 

Abstract

Objectives:

Compulsive sexual behavior (CSB) is overrepresented among adults with substance use disorders (SUD), yet there is no empirically supported CSB treatment for this population. Cross-sectional and single case designs supported dispositional mindfulness as a potential CSB intervention target. However, the relations between CSB and each of the five dispositional mindfulness facets remain unknown.

Methods:

Extending prior research to inform intervention efforts, we reviewed medical records for 1993 adults (77.6% male) in residential treatment for SUD to examine gender differences in the relations between dispositional mindfulness facets (acting with awareness, observation of experience, describing with words, non-judging of inner experience, and non-reactivity to inner experience) and five CSB indicators (loss of control, relationship disturbance, preoccupation, affect disturbance, and internet problems).

Results:

For men, path analyses revealed that acting with awareness, nonjudging of inner experience, describing with words, non-reactivity to inner experience, alcohol/drug use and problems, and depression and anxiety symptoms related to CSB (p range: .00-.04). For women, acting with awareness, non-judging of inner experience, alcohol/drug use and problems, and depression symptoms related to several CSB indicators (p range: .00-.04).

Conclusions:

Mindfulness-based CSB interventions should evaluate the benefit of increasing intentional responses towards present-moment experiences among adults with SUD. Targeting alcohol/drug misuse, negative affect, and judgement towards thoughts and emotions may be beneficial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884324/

 

Lower Opioid Cravings are Associated with Lower Depression, Higher Self-Regulation, and Higher Mindfulness

Lower Opioid Cravings are Associated with Lower Depression, Higher Self-Regulation, and Higher Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain.” – Science Daily

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids, and another 13,000 deaths from heroin overdose. These statistics, although startling are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can render the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not.

 

An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates. Recent research is indicating that mindfulness has been found to be effective in treating addictions. One way that mindfulness may produce these benefits is by reducing cravings for opioids. It may also do so by affecting the ability of the addict to regulate their emotions. Indeed, mindfulness has been shown to improve emotional regulation.

 

In today’s Research News article “Autonomic and affective mediators of the relationship between mindfulness and opioid craving among chronic pain patients. Experimental and clinical psychopharmacology.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355352/), Baker and Garland recruited non-cancer chronic pain patients who were taking opioid analgesics and had them complete self-report measures of mindfulness, opioid craving, and depression. They also measured their heart rates with an electrocardiogram (ECG) while looking at either neutral pictures or “opioid-related image (e.g., pills, pill bottles).” These data were analyzed to determine heart rate variability as a measure of the activity of the peripheral autonomic nervous system.

 

They found that the higher the levels of mindfulness the higher the levels of heart rate variability while looking at opioid-related pictures. And the lower the levels of depression and opioid cravings. Also, the higher the levels of depression, the higher the levels of opioid cravings. Employing a multivariate path analysis, they found that mindfulness was not associated with lower opioid cravings directly, but indirectly via mindfulness’ associations with heart rate variability and depression. That is, they found that mindfulness was associated with higher heart rate variability which was in turn associated with lower opioid cravings and also with lower depression which was in turn associated with lower opioid cravings.

 

Heart rate variability is thought to measure the nervous systems adjustments to the physiology involved in regulating its physical responses to stimuli. In other words, it’s a measure of self-regulation. The present results suggest that mindfulness is associated with greater self-regulation and this is associated with lower cravings for opioids. The results also suggest that depression is associated with higher cravings for opioids and that mindfulness interrupts this by being associated with lower depression.

 

These results are correlative and as such causation cannot be determined. Nevertheless, prior research has demonstrated causal links between mindfulness and lower cravings and depression. So, the present results likely result from causal connections. The findings also suggest the mechanism whereby mindfulness may lower cravings by contributing to the ability to regulate physical responses to opioid-related stimuli and by reducing depression. These results provide more support for the use of mindfulness training as a treatment for addictions.

 

So, lower opioid cravings are associated with lower depression, higher self-regulation, and higher mindfulness.

 

people suffering from opioid addiction and chronic pain may have fewer cravings and less pain when adding mindfulness to the traditional methadone treatment.” – Grace Bullock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Baker, A. K., & Garland, E. L. (2019). Autonomic and affective mediators of the relationship between mindfulness and opioid craving among chronic pain patients. Experimental and clinical psychopharmacology, 27(1), 55–63. https://doi.org/10.1037/pha0000225

 

Abstract

Prescription opioid misuse among chronic pain patients is associated with self-regulatory deficits, affective distress and opioid cue reactivity. Dispositional mindfulness has been associated with enhanced self-regulation, lower distress, and adaptive autonomic responses following drug cue exposure. We hypothesized that dispositional mindfulness might serve as a protective factor among opioid-treated chronic pain patients. We examined heart rate variability (HRV) during exposure to opioid cues and depressed mood as mediators of the association between dispositional mindfulness and opioid craving. Data were obtained from a sample of chronic pain patients (N=115) receiving long-term opioid pharmacotherapy. Participants self-reported opioid craving and depression, and HRV was measured during an opioid-cue dot probe task. Dispositional mindfulness was significantly positively correlated with HRV, and HRV was significantly inversely associated with opioid craving. Dispositional mindfulness was significantly negatively correlated with depression, and depression was significantly positively correlated with opioid craving. Path analysis revealed significant indirect effects of dispositional mindfulness on craving through both HRV and depression. Dispositional mindfulness may buffer against opioid craving among chronic pain patients prescribed opioids; this buffering effect may be a function of improved autonomic and affective responses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355352/

 

Improve Emotional Response Inhibition in Patients with Chronic Pain and Opioid Use with Mindfulness

Improve Emotional Response Inhibition in Patients with Chronic Pain and Opioid Use with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation could represent a viable alternative to opioid-based therapy for chronic pain, and may be useful in helping patients taper their use of high doses of opioid-acting agents.” – Hymie Anisman

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. In today’s Research News article “Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735955/), Garland and colleagues examine the mechanisms by which mindfulness reduces perceived pain.

 

They recruited adult patients with non-cancer related chronic pain who were taking daily opioids. They were randomly assigned to receive 8-weeks of a Mindfulness-Oriented Recovery Enhancement (MORE) program or to an 8-week support groups meeting. Mindfulness-Oriented Recovery Enhancement (MORE) involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. The patients were measured before and after treatment and 3 months later for pain severity and the mindfulness facet of nonreactivity. The patients also performed a go – no-go task. They viewed either neutral or pain related images in which was embedded either the letter “M” or “W”. They were asked to press a key a quickly as possible when the letter “M” was present.

 

They found that in comparison to baseline and the support group, after the mindfulness treatment there was a significant reduction in pain severity and increase in nonreactivity and improvement in go – no-go task accuracy. These changes were maintained 3 months after the completion of th treatment. In addition, they found that the higher the levels of nonreactivity and the greater the amount of meditation practice, the fewer errors occurred in the go – no-go task with pain-related images. In other words, the greater the improvement in response inhibition to emotional stimuli. Finally, they found that the greater the reductions in go – no-go task errors with pain related images, the greater the reduction in pain severity.

 

The results are complicated and so are the conclusions. Nevertheless, the results suggest that mindfulness training reduces pain severity and increases the mindfulness facet of nonreactivity. This suggests that the mindfulness training improves the patient’s ability to not react to pain stimuli and thereby reduce the perceived severity of the pain. This increase in nonreactivity would also explain why the patients didn’t react to pain related distractors in the go – no-go task and thereby improve their accuracy.

 

These results suggest that Mindfulness-Oriented Recovery Enhancement (MORE) enhances the chronic pain patient’s ability to inhibit emotional responses in the presence of pain related stimuli. This ability in turn reduces perceived pain. It remains to be seen if these improvements make it easier for the patients to wean off of opiates.

 

So, improve emotional response inhibition in patients with chronic pain and opioid use with mindfulness.

 

Meditation teaches patients how to react to the pain. People are less inclined to have the ‘Ouch’ reaction, then they are able to control the emotional reaction to pain.” – Fadel Zeidan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Garland, E. L., Bryan, M. A., Priddy, S. E., Riquino, M. R., Froeliger, B., & Howard, M. O. (2019). Effects of Mindfulness-Oriented Recovery Enhancement Versus Social Support on Negative Affective Interference During Inhibitory Control Among Opioid-Treated Chronic Pain Patients: A Pilot Mechanistic Study. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 53(10), 865–876. doi:10.1093/abm/kay096

 

Abstract

Background

Among opioid-treated chronic pain patients, deficient response inhibition in the context of emotional distress may contribute to maladaptive pain coping and prescription opioid misuse. Interventions that aim to bolster cognitive control and reduce emotional reactivity (e.g., mindfulness) may remediate response inhibition deficits, with consequent clinical benefits.

Purpose

To test the hypothesis that a mindfulness-based intervention, Mindfulness-Oriented Recovery Enhancement (MORE), can reduce the impact of clinically relevant, negative affective interference on response inhibition function in an opioid-treated chronic pain sample.

Methods

We examined data from a controlled trial comparing adults with chronic pain and long-term prescription opioid use randomized to either MORE (n = 27) treatment or to an active support group comparison condition (n = 30). Participants completed an Emotional Go/NoGo Task at pre- and post-treatment, which measured response inhibition in neutral and clinically relevant, negative affective contexts (i.e., exposure to pain-related visual stimuli).

Results

Repeated-measures analysis of variance indicated that compared with the support group, participants in MORE evidenced significantly greater reductions from pre- to post-treatment in errors of commission on trials with pain-related distractors relative to trials with neutral distractors, group × time × condition F(1,55) = 4.14, p = .047, η2partial = .07. Mindfulness practice minutes and increased nonreactivity significantly predicted greater emotional response inhibition. A significant inverse association was observed between improvements in emotional response inhibition and treatment-related reductions in pain severity by 3-month follow-up.

Conclusions

Study results provide preliminary evidence that MORE enhances inhibitory control function in the context of negative emotional interference.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735955/

 

Spirituality Interferes with Successful Treatment of Cannabis Abuse in Adolescents

Spirituality Interferes with Successful Treatment of Cannabis Abuse in Adolescents

 

By John M. de Castro, Ph.D.

 

“there are three main reasons that cannabis is seen as a spiritual tool. First, “It is a light intoxicant and can therefore be used fairly frequently and without the kinds of impairment associated with major hallucinogens.” Second, cannabis is conducive to group social use and fosters conversation about philosophical and theological matters. Finally, cannabis weakens our ability for sustained attention. . . . it’s great for aiding in shifts of perspective and giving experiences a more pluralistic character.” – Robert Fuller

 

Drug and alcohol addictions are very difficult to kick and if successful about half the time the individual will relapse. So, there have been developed a number of programs to help the addict recover and prevent relapse. The 12 step programs of Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous, etc. have been as successful as any programs in treating addictions. These programs insist that spirituality is essential to recovery.

 

Marijuana use can lead to the development of problem use, known as a marijuana use disorder, which takes the form of addiction in severe cases. Recent data suggest that 30 percent of those who use marijuana may have some degree of marijuana use disorder. People who begin using marijuana before the age of 18 are four to seven times more likely to develop a marijuana use disorder than adults.” National Institute of Drug Abuse.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. Spirituality has been shown to assist in addiction recovery. So, it would make sense to investigate the relationship of spirituality with the ability of adolescents to recover from cannabis abuse.

 

In today’s Research News article “”God put weed here for us to smoke”: A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430642/), Yeterian and colleagues recruited adolescents, aged 14 to 21 years, who were undergoing a 12-step program for the treatment of cannabis abuse. The adolescents were measured before treatment and at 3 and 6-month follow-ups for religiosity, spirituality, and substance abuse. They also underwent interviews about their substance use and the program.

 

They found at follow-up that the higher the levels of spirituality the greater the increase in the use of cannabis by the adolescents, while the higher the levels of spirituality at baseline, the lower the levels of alcohol consumption. The results of the interviews suggested that the relationship of spirituality with increased cannabis use was due to the adolescents believing that cannabis deepened the sense of their spirituality.

 

Twelve-step programs emphasize spirituality and the current results suggest that this may be useful in treating alcohol abuse. But it may be counterproductive in treating cannabis abuse, contributing to greater use. The adolescents appear to see cannabis use as enhancing their spirituality and thus spiritual youths are susceptible to continued and increased cannabis use. This suggests that treatment programs for cannabis abuse should not include spirituality as part of the treatment.

 

So, spirituality interferes with successful treatment of cannabis abuse in adolescents.

 

“It is important for clinicians to be aware of the dynamics of spirituality and religion in the cause, maintenance, and treatment of substance misuse problems.” – John Allen

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Yeterian, J. D., Bursik, K., & Kelly, J. F. (2018). “God put weed here for us to smoke”: A mixed-methods study of religion and spirituality among adolescents with cannabis use disorders. Substance abuse, 39(4), 484–492. doi:10.1080/08897077.2018.1449168

 

Abstract

Background:

A growing literature on adults with substance use disorders (SUD) suggests that religious and spiritual processes can support recovery, such that higher levels of religiosity and/or spirituality predict better substance use outcomes. However, studies of the role of religion and spirituality in adolescent SUD treatment response have produced mixed findings, and religiosity and spirituality have rarely been examined separately.

Methods:

The present study examined religiosity and spirituality as predictors of outcomes in an outpatient treatment adolescent sample (N = 101) in which cannabis was the predominant drug of choice. Qualitative data were used to contextualize the quantitative findings.

Results:

Results showed that higher levels of spirituality at post-treatment predicted increased cannabis use at 6-month follow-up (β = .237, p = .043), whereas higher levels of baseline spirituality predicted a lower likelihood of heavy drinking at post-treatment (OR = .316, p = .040). Religiosity did not predict substance use outcomes at later timepoints. When asked to describe the relation between their religious/spiritual views and their substance use, adolescents described believing that they had a choice about their substance use and were in control of it, feeling more spiritual when under the influence of cannabis, and being helped by substance use.

Conclusions:

Together, findings suggest that for adolescents with SUD, religion and spirituality may not counteract the use of cannabis, which may be explained by adolescents’ views of their substance use as being consistent with their spirituality and under their control.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430642/

 

Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Trying to harness the mind in meditation is a bit like holding a water wiggly—those tubular, slippery, jelly-filled toys that leap out of your hand whenever you try to hold onto them. With the addition of a psychedelic state of mind, it could be like grasping with a greased hand.” – Paul Austin

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).” Since the effects of meditation and psilocybin appear similar, it’s important to look at the effects of the combination of meditation with psilocybin.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/ ), Smigielski and colleagues recruited experienced adult meditators participating in a 5-day meditation retreat and randomly assigned them to receive either a high dose of psilocybin or a placebo. The participants were matched for age, gender, mindfulness level, and meditation experience. They were administered psilocybin or placebo on the fourth day of the retreat. Before and after and on each day of the retreat they were measured for mindfulness and meditation depth. Six hours after psilocybin or placebo administration they were measured for altered states of consciousness and mystical experiences. Four months after the retreat they were evaluated for changes in behavior by self-report and that of a significant other. They did not observe any adverse events associated with psilocybin administration.

 

They found that on the day of administration the psilocybin group had significantly greater depth of meditation and after the retreat significantly higher mindfulness. While the drugs were in effect the psilocybin group had large significant increases in altered states of consciousness, including unity, spiritual experience, blissfulness, insightfulness, and disembodiment and large significant increases in mystical experiences, including complex imagery, elementary imagery, audiovisual synesthesia, and changed meaning of percepts. Four months after the retreat the participants who were administered psilocybin had significant changes in behavior documented by themselves and a significant other including significantly greater appreciation for life, self-acceptance, quest for meaning/sense of purpose, and appreciation of death.

 

Meditation retreats have been shown to increase meditation depth, mindfulness, mystical experiences, and to produce changes in consciousness. The present results suggest that psilocybin administration produces large and significant amplifications of these effects. In fact, the participants who received psilocybin reported that the experience was equivalent to the greatest mystical experiences that they have ever had. Remarkably, the effects of the single administration were enduring, altering and deepening their acceptance of themselves as they are, their appreciation of life and death, and their sense of meaning and purpose. These results suggest that the combination of meditation with psilocybin may be a safe and effective means to improve psychological and spiritual health and well-being.

 

So, augment mystical experiences in meditation and long-term well-being with psilocybin.

 

“After the retreat, mushroom-assisted meditators reported less self-consciousness and more illusions and hallucinations than the control group. What’s more, their brains showed alterations in the functioning of the default mode network—a group of interacting brain regions linked to self-awareness and rumination—during open awareness meditation. . . . What is even more remarkable is that experienced meditators in the psilocybin group reported better social functioning four months later.” – Grace Bullock

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Smigielski, L., Kometer, M., Scheidegger, M., Krähenmann, R., Huber, T., & Vollenweider, F. X. (2019). Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat. Scientific reports, 9(1), 14914. doi:10.1038/s41598-019-50612-3

 

Abstract

Meditation and psychedelics have played key roles in humankind’s search for self-transcendence and personal change. However, neither their possible synergistic effects, nor related state and trait predictors have been experimentally studied. To elucidate these issues, we administered double-blind the model psychedelic drug psilocybin (315 μg/kg PO) or placebo to meditators (n = 39) during a 5-day mindfulness group retreat. Psilocybin increased meditation depth and incidence of positively experienced self-dissolution along the perception-hallucination continuum, without concomitant anxiety. Openness, optimism, and emotional reappraisal were predictors of the acute response. Compared with placebo, psilocybin enhanced post-intervention mindfulness and produced larger positive changes in psychosocial functioning at a 4-month follow-up, which were corroborated by external ratings, and associated with magnitude of acute self-dissolution experience. Meditation seems to enhance psilocybin’s positive effects while counteracting possible dysphoric responses. These findings highlight the interactions between non-pharmacological and pharmacological factors, and the role of emotion/attention regulation in shaping the experiential quality of psychedelic states, as well as the experience of selflessness as a modulator of behavior and attitudes. A better comprehension of mechanisms underlying most beneficial psychedelic experiences may guide therapeutic interventions across numerous mental conditions in the form of psychedelic-assisted applications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/

 

Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

 

By John M. de Castro, Ph.D.

 

“mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain. Individuals with an opioid addiction could also be taught to change their negative thoughts and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment.” – Science News

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids, and another 13,000 deaths from heroin overdose. These statistics, although startling are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can render the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not.

 

An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates. Recent research is indicating that mindfulness has been found to be effective in treating addictionsMindfulness-Oriented Recovery Enhancement (MORE) was specifically developed to employ mindfulness training along with other proven methods to assist addicts in remaining off of drugs. MORE involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion.

 

One method to observe reward processing in the brain is to measure the changes in the electrical activity that occur in response to specific reward related stimuli. These are called event-related potentials or ERPs. The signal following a stimulus changes over time. The fluctuations of the signal after specific periods of time are thought to measure different aspects of the nervous system’s processing of the stimulus. The Late Positive Potential (LPP) response in the evoked potential (ERP) is a positive going electrical response occurring between a 4 to 8 tenths of a second following the target stimulus presentation. The LPP is thought to reflect attention to the emotional features of a stimulus.

 

In today’s Research News article “Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/), Garland and colleagues recruited chronic pain patients who were opioid users. They were randomly assigned to receive 8 weeks of either Mindfulness-Oriented Recovery Enhancement (MORE) or a therapist led support group. They were measured for brain activity with an electroencephalogram (EEG) before and after treatment and opioid use at 3-month follow-up. In one experiment they measure the EEG response (Late Positive Potential (LPP)) while being presented with opioid cues (pictures of pills and pill bottles) or a neutral picture either normally or while attempting to not react or judge the stimuli. In a separate experiment with a similar procedure except that the participants were presented with natural reward pictures (e.g., social affiliation, natural beauty, and athletic victories) or neutral pictures.

 

They found that before treatment opioid and natural reward stimuli reliably produced significantly larger Late Positive Potentials (LPP) indicating that the LPP reflected emotional responses to rewards. After treatment the group that received Mindfulness-Oriented Recovery Enhancement (MORE) had significantly smaller LPP responses to opioid related cues than the support group. When the participants were asked to not react or judge the stimuli the MORE group had significantly greater reductions in the LPP. Importantly, the participants in the MORE group had a significantly larger LPPs to natural reward stimuli and when the participants were asked to not react or judge the natural reward stimuli the MORE group had a significantly larger increases in the LPP.

 

They also investigated the subjective emotional responses of the participants to the opioid and natural reward stimuli and found that after Mindfulness-Oriented Recovery Enhancement (MORE) the participants had larger increases in response to natural reward stimuli and smaller responses to opioid related stimuli. At the 3 month follow-up they found that MORE reduced the use of opioids to a greater extent than the support group and that it did so directly and also indirectly by increasing natural reward responses which, in turn, reduced opioid use.

 

These results suggest that responses to the rewarding aspects of stimuli is important in opioid addiction and that Mindfulness-Oriented Recovery Enhancement (MORE) reduces opioid use in addicted individuals they demonstrate that MORE reduces emotional responses to opioid cues while amplifying responses to natural rewards. This suggests that mindfulness treatment reduces opioid use by altering the addict’s responses to stimuli related to the addiction and naturally rewarding stimuli; amplifying natural reward while suppressing opioid rewards. This makes opioids less rewarding and natural stimuli more rewarding.

 

So, mindfulness reduces addiction by altering pleasure appreciation in opioid users.

 

Mindfulness-Oriented Recovery Enhancement (MORE), increases the brain’s response to natural, healthy rewards while also decreasing the brain’s response to opioid-related cues.” – University of Utah

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Garland, E. L., Atchley, R. M., Hanley, A. W., Zubieta, J. K., & Froeliger, B. (2019). Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement. Science advances, 5(10), eaax1569. doi:10.1126/sciadv.aax1569

 

Abstract

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE’s therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/

 

Help Withdraw from Antidepressant Drugs with Mindfulness

Help Withdraw from Antidepressant Drugs with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness can help you deal with emotional symptoms of SSRI withdrawal. Techniques such as meditation and deep breathing can help you reduce levels of irritability by reminding you to slow down and step back from a situation before you react.” – Sarah Fader

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time.

 

It seems reasonable to use antidepressant drugs initially in the treatment of depression but then withdraw the drugs. But withdrawal effects can occur. Symptoms of antidepressant withdrawal are anxiety, insomnia or vivid dreams, headaches, dizziness, tiredness, irritability, flu-like symptoms, including achy muscles and chills, nausea, electric shock sensations, return of depression symptoms. Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. And can help with antidepressant withdrawal.

 

Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Hence, there is a need to study the application of MBCT to assist in the withdrawal of antidepressant medication.

 

In today’s Research News article “Managing Antidepressant Discontinuation: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/), Maund and colleagues review and summarize the published research studies of the effectiveness of various therapies including Mindfulness-Based Cognitive Therapy (MBCT) to assist in the withdrawal of patients from antidepressants. They found 15 published randomized controlled trials with 3 employing MBCT.

 

They report that the randomized controlled trials found that tapering off antidepressant drugs was far more successful than abrupt withdrawal and that psychological therapies significantly assisted in the success of the process, with successful cessation rates of 40% to 95% compared to 6% to 7% when the physician sent a letter recommending withdrawal. Mindfulness-Based Cognitive Therapy (MBCT) was found to have successful cessation rates of 55% to 75%. MBCT also did not increase relapse/recurrence rates with 44% to 48% relapse.

 

There were only three randomized controlled trials that employed Mindfulness-Based Cognitive Therapy (MBCT) to aid in antidepressant withdrawal and there were no studies that included discontinuation symptoms. So, conclusions must be tempered and measured. But the published research suggests that MBCT is is safe and effective in improving the likelihood of successful withdrawal from antidepressants without increasing the likelihood of relapse.

 

So, help withdraw from antidepressant drugs with mindfulness.

 

Psychiatric medication is designed to alleviate suffering. Mindfulness can function in this way too. However, psychiatric medication is not generally designed to promote flourishing. . . . Mindfulness can alleviate distress, but it can also lead us states of flourishing and a sense of the deep completeness of the moment.” – Matthew Brensilver

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A., Dawson, S., & Kendrick, T. (2019). Managing Antidepressant Discontinuation: A Systematic Review. Annals of family medicine, 17(1), 52–60. doi:10.1370/afm.2336

 

Abstract

PURPOSE

We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS

We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS

Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18–0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS

Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/