Mindfulness Training Restores Reward System Function, Reduces Cravings, in OUD
A mindfulness-based training intervention called Mindfulness-Oriented Recovery Enhancement (MORE) improved positive emotion regulation, and subsequently reduced opioid craving, in patients with opioid use disorder (OUD), according to study results published in JAMA Psychiatry.
“Opioid addiction decreases the brain’s ability to experience natural healthy pleasure, driving increased cravings for the drug,” said study lead and corresponding author Eric L. Garland, PhD, of the department of psychiatry and Sanford Institute for Empathy and Compassion at the University of California, San Diego, La Jolla, California. “Our research shows that MORE helps restore this capacity, reducing cravings and potentially preventing opioid misuse.”
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The findings stemmed from a mechanistic substudy of a randomized clinical trial that included 160 patients with chronic noncancer pain who had taken opioid analgesics for at least 90 days. Among them, 98 patients met criteria for OUD.
Participants completed a positive emotion regulation task while electroencephalogram (EEG) was recorded. After the baseline pretreatment assessment, 62 participants at risk for opioid misuse, indicated by a Current Opioid Misuse Measure score of 9 or higher, were randomized 1:1 to either 8 weeks of MORE or supportive group therapy. At post-treatment, the EEG positive emotion regulation task was repeated.
The primary mechanistic outcome was parietal late positive potential and P300 amplitude, EEG markers that reflect the processing of motivationally salient stimuli, during the positive emotion regulation task.
According to the study, patients with chronic pain and OUD had difficulty experiencing positive emotions. Amid attempts to savor images often considered naturally rewarding, such as smiling babies, puppies, or sunsets, they demonstrated blunted brain responses. Moreover, this numbing of positive emotions was directly associated with greater opioid cravings.
Participants randomized to MORE, however, showed increased brain responses to positive stimuli after 8 weeks of the intervention. Their improved ability to savor was linked with a 50% lower opioid craving compared with supportive group therapy, the research team reported.
“[T]his study provides neurophysiological evidence of diminished positive emotion regulation capacity among patients with OUD and its potential normalization by MORE,” study authors concluded. “Restructuring reward system function with mindfulness-based interventions and other integrative cognitive-affective training approaches may generate the learning signal required to restore adaptive hedonic regulation and thereby treat the pathophysiology undergirding opioid misuse and addiction.”
