Zoom-Based Mindfulness-Oriented Recovery Enhancement Plus Just-in-Time Mindfulness Practice Triggered by Wearable Sensors for Opioid Craving and Chronic Pain

Abstract

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).

Immediate Effects of Mindful Awareness in Body-oriented Therapy as an Adjunct to Medication for Opioid Use Disorder

“…The results of this study are both similar and distinct from other studies to date examining the bene ts of mindfulness-based approaches as an adjunct to MOUD, and for those using or misusing prescribed opioids (Cooperman et al, 2023;Garland, et al, 2022;Garland, et al, 2023;Garland et al, 2024). The MORE and MABT interventions have overlapping components and are both focused on developing mindfulness to promote reappraisal processes that support health and well-being.…”

“…Prior randomized controlled trials of MBI approaches for MOUD with published outcomes involve Mindfulness-Oriented Recovery Enhancement (MORE). MORE studies have demonstrated improvements in pain, opioid use, and other outcomes in chronic pain patients receiving methadone maintenance treatment, primary care patients with opioid misuse, and people with chronic pain on prescribed opioids (Cooperman et al, 2023;Garland et al, 2022;Garland et al, 2023;Garland et al, 2024).…”

Using Digital Technology to Increase Integration of Meditation into Daily Life: The Case for Meditation-Based Ecological Momentary Interventions

“…This could include wearable sensors, along with various digital inputs captured through smartphones and other devices, such as audio and visual data, text from email and other messaging platforms. Garland et al (2023) exemplified this approach by leveraging heart rate variability measured via wearable sensors to tailor the delivery of mindfulness practices. Additional potential examples include prompting individuals to engage in mindful walking when walking is detected through the Global Positioning System (GPS) or encouraging intentional feelings of loving-kindness and compassion when their use of social media to interact with others is identified.…”

“…In a recent RCT,Garland et al (2023) explored the efficacy of combining Zoom-based Mindfulness-Oriented Recovery Enhancement (MORE) with EMI prompts triggered by wearable sensors in opioid-treated chronic pain patients. The study randomized participants (n = 63) into either MORE + EMI or a Zoom-based supportive group psychotherapy control.…”