Effects of Mindfulness-Oriented Recovery Enhancement on reward responsiveness and opioid cue-reactivity

Abstract

Rationale Dysregulated reward processing is a hallmark feature of drug addiction; however scant research has evaluated restructuring reward processing in the context of addiction treatment. Objectives We examined effects of Mindfulness-Oriented Recovery Enhancement (MORE) on reward responsiveness (RR) and opioid cue-reactivity in a sample of chronic pain patients with opioid use problems. We previously reported that MORE decreased pain, opioid misuse and craving relative to a social support control group (SG). Here we examined whether these outcomes were linked to changes in RR in a subset of participants. Methods Participants were chronic pain patients (71% women, age = 46.6±13.9) who received MORE (n=20) or SG (n=29). RR was measured before and after 8 weeks of treatment via heart rate (HR) and heart rate variability (HRV) responses during a dot-probe task that included opioid-, pain-related and natural reward stimuli, as well as craving ratings. Results The MORE group, who reported decreased opioid misuse and opioid craving during treatment, evidenced less subjective opioid cue-reactivity, greater HR decelerations, and greater increases in HRV to all cues after treatment compared to the SG; HR and HRV effects were most pronounced for natural reward cues. Within the MORE group, HR deceleration to natural reward cues was correlated with increased subjective arousal to the cues, whereas HR deceleration to opioid cues was correlated with decreased subjective arousal. Effects of MORE on craving were mediated by enhanced RR. Conclusions Results suggest that during treatment with MORE, cardiac-autonomic responsiveness to non-drug reward increases, while reactivity to opioid reward decreases. Studies are needed to discern whether changes in RR were a result or a determinant of reductions in opioid misuse and craving. RR may play a role in addiction treatment.

Smoking cue reactivity in current smokers, former smokers and never smokers

“…However, to our knowledge, successful quitting has never been linked to heart rate decelerations in response to smoking cues and studies that have examined the relationship between pre-treatment smoking cue reactivity and smoking cessation outcomes have yielded inconsistent findings (Abrams, Monti, Carey, Pinto, & Jacobus, 1988;Perkins, 2011;Shadel et al, 1998). In a recent study of opioid addicted individuals, the completion of a mindfulness-based intervention was associated with decreased opioid craving as well as with significant heart rate decelerations in response to opioid related stimuli (Garland, Froeliger, & Howard, 2014). Although it is unknown to what extent such findings extend to smokers, the similarity of these findings with those from the former smokers in the present study is noteworthy.…”

Mindfulness-Oriented Recovery Enhancement Ameliorates the Impact of Pain on Self-Reported Psychological and Physical Function Among Opioid-Using Chronic Pain Patients

“…Lastly, by providing instruction in mindful savoring of positive events and pleasant experiences, MORE may enhance enjoyment of life and attenuate the emotional toll of chronic pain. To wit, recent evidence suggests that MORE enhances sensitivity to naturally rewarding experiences, thereby reducing the perceived need for opioids (17). In these ways, MORE may modulate the impact of chronic pain, leading to improvements in functional ability and quality of life.…”

“…Reframing the meaning of stressful events through cognitive reappraisal has been shown to significantly reduce negative emotions (14) and the urge to use addictive substances (15). Finally, positive emotion regulatory strategies such as savoring pleasant events may enhance positive affect and foster psychological resilience (16) while reducing anhedonia (17). MORE combines the complementary aspects of these three therapeutic elements into a broad spectrum treatment for chronic pain.…”

Mindfulness and Cognitive Functions: Toward a Unifying Neurocognitive Framework

“…Finally, the adaptive workspace framework suggests that mindfulness meditation leads to the flexibility to shift or reset the focus of attention and thought, in particular when such focus is dysfunctional, such as in the unwholesome mentation associated with rumination in depression (e.g., Ietsugu et al 2015), obsessive thinking in obsessive-compulsive disorder (e.g., Singh et al 2004), and to craving-related thoughts in addictions (e.g., Garland et al 2014). Indeed, theories of consciousness and attention (Dehaene et al 2006;Raffone et al 2014;Simione et al 2012) highlight the interdependence or co-determination of attentional focus and conscious (cognitive) access, which can give rise to closed or repetitive loops in thinking, such as in mind wandering (Smallwood and Schooler 2015), and inattentional blindness in perceptual processing (Mack and Rock 1998).…”