New research shows that a specific type of mindfulness therapy, Mindfulness-Oriented Recovery Enhancement (MORE), effectively reduced chronic pain and opioid use among current and former military personnel, while simultaneously improving psychological health and mental well-being across a number of measures.

The findings, published Wednesday in the American Journal of Psychiatry, came from a six-year randomized clinical trial involving 230 veterans and active-duty military personnel with chronic pain conditions, who were being treated with long-term opioid therapy.

Study participants were randomized into two groups: the MORE group received eight weekly group therapy sessions, and were instructed to complete short audio-guided mindfulness practices each day; the control group received eight weekly supportive psychotherapy group sessions, and were instructed to engage in a journaling practice each day. Group sessions were conducted in-person and then, after the onset of the COVID-19 pandemic, virtually by Zoom.

Baseline data were collected before treatment, then outcomes were measured after treatment and at two-month intervals for a total of eight months. Through the study period, participants in the MORE group reduced their opioid dose by an average of 20.7%, compared to a 3.9% reduction in the supportive psychotherapy group. MORE also outperformed supportive psychotherapy in reducing pain severity and pain interference. Although both groups experienced a reduction in depression and posttraumatic stress disorder (PTSD) symptoms, patients in MORE showed greater improvements in positive emotions and other indicators of well-being.

“These results show that MORE can help veterans and active-duty military personnel who are interested in reducing their opioid use to safely do so without worsening their pain or their mental health,” said Eric Garland, lead author of the study and distinguished professor of social work at the University of Utah. “This work represents an important way we can give back to people who have served this country and those who have been injured in the line of duty.”

This study, which was funded by the U.S. Department of Defense, is one of several large-scale clinical trials of MORE. Previously published research with a civilian population showed MORE effectively reduced opioid misuse by 45%, more than doubling the effect of supportive psychotherapy in that study.

Garland added that the low implementation costs associated with MORE make it a highly-accessible treatment option that has been shown to simultaneously address chronic pain, opioid use and psychological health. “My hope,” said Garland, “is that this evidence-based treatment method will be widely utilized throughout our healthcare system and help restore the high quality of life our veterans and military personnel have earned through their service.”

About Mindfulness-Oriented Recovery Enhancement (MORE)

MORE is an innovative therapy that combines meditation, cognitive-behavioral therapy and principles from positive psychology into sequenced training in mindfulness, savoring and reappraisal skills.

Participants are taught to break down the experience of pain or opioid craving into their sensory components, “zooming in” on what they are feeling and breaking it down into different sensations like heat, tightness or tingling. They are trained to notice how those experiences change over time, and to adopt the perspective of an observer. They are also taught to savor pleasant, healthful and life-affirming experiences, amplifying the sense of joy, reward and meaning that can come from positive, everyday events. Finally, participants are taught to reframe stressful events to find a sense of meaning in the face of adversity, to recognize what can be learned from difficult events and how dealing with those experiences might make a person stronger.

• Jennifer Nozawa marketing & communications manager, University of Utah College of Social Work
  801-585-9303 jennifer.nozawa@socwk.utah.edu
• Eric Garland distinguished professor, associate dean for research/director of the Center on Mindfulness and Integrative Health Intervention Development, University of Utah College of Social Work
  801-581-3826 eric.garland@socwk.utah.edu