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Objective The opioid crisis in the USA remains severe during the COVID-19 pandemic, which has reduced access to evidence-based interventions. This Stage 1 randomized controlled trial (RCT) assessed the preliminary efficacy of Zoom-based Mindfulness-Oriented Recovery Enhancement (MORE) plus Just-in-Time Adaptive Intervention (JITAI) prompts to practice mindfulness triggered by wearable sensors (MORE + JITAI). Method Opioid-treated chronic pain patients ( n = 63) were randomized to MORE + JITAI or a Zoom-based supportive group (SG) psychotherapy control. Participants completed ecological momentary assessments (EMA) of craving and pain (co-primary outcomes), as well as positive affect, and stress at one random probe per day for 90 days. EMA probes were also triggered when a wearable sensor detected the presence of physiological stress, as indicated by changes in heart rate variability (HRV), at which time participants in MORE + JITAI were prompted by an app to engage in audio-guided mindfulness practice. Results EMA showed significantly greater reductions in craving, pain, and stress, and increased positive affect over time for participants in MORE + JITAI than for participants in SG. JITAI-initiated mindfulness practice was associated with significant improvements in these variables, as well as increases in HRV. Machine learning predicted JITAI-initiated mindfulness practice effectiveness with reasonable sensitivity and specificity. Conclusions In this pilot trial, MORE + JITAI demonstrated preliminary efficacy for reducing opioid craving and pain, two factors implicated in opioid misuse. MORE + JITAI is a promising intervention that warrants investigation in a fully powered RCT. Preregistration This study is registered on ClinicalTrials.gov (NCT04567043).

The tendency to decenter from internal experiences, such as thoughts, emotions, and sensations, can alter the sense of self. In some instances, decentering can occasion self-transcendent experiences, during which a profound sense of oneness with others and the natural world is realized. Thus, a theoretical thread links decentering, self-transcendence (ST), and a sense of nature connectedness (NC), but whether ST mediates the relationship between decentering and NC has not been empirically examined. The present study investigated the relationships between these three constructs in two separate samples, totaling 657 participants. Results indicated significant, positive relationships between decentering, ST, and NC. Furthermore, in separate path analyses, ST either partially or fully mediated the relationship between decentering and NC. This study provides the first empirical evidence that decentering from internal experiences can alter the sense of self to a degree that a sense of connection with nature emerges. Future experimental research is needed to investigate the dynamic unfolding of decentering, ST, and NC over time and whether the regular cultivation of these transient mental states, potentially through mindfulness practice, has measurable effects on environmental behavior.

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