Mindfulness-Oriented Recovery Enhancement

Domain II · Behavioural & cognitive · Eric Garland · 2013

What it is

Mindfulness-Oriented Recovery Enhancement (MORE) is a manualised group (or individual) treatment developed by Eric Garland (social work; now University of Utah C-MIIND). It combines mindfulness training, "third-wave" CBT and positive psychology for addiction, chronic pain, opioid misuse and stress.

Format

• Formats
• Group: 8 weekly sessions of 2 hours. Trials used closed groups of about 4–9 members, in clinic or by video or phone.

Who practises it, and how they are trained or regulated

• Mindfulness-Oriented Recovery Enhancement (MORE) is a manualised group (or individual) treatment developed by Eric Garland (social work; now University of Utah C-MIIND). It combines mindfulness training, "third-wave" CBT and positive psychology for addiction, chronic pain, opioid misuse and stress.
• Theory of change: addiction and chronic pain are seen as a downward spiral. Attention gets captured by drug cues, stress and pain, negative appraisals feed distress, and natural pleasures lose their pull ("hedonic dysregulation"), so the drug becomes the main source of reward and relief. MORE works on three linked processes. Mindfulness builds metacognitive control, so the client notices automatic fixation and turns…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• See non-adherence in section 5.
• Choosing only big events. Coach towards small, frequent ones. Working: clients spontaneously report savoring moments.
• Vague plans. Push for specific times and situations. Working: the client can describe concrete skill use for each trigger.
• Acceptance being heard as resignation, or as giving up on pain relief. Working: clients report less struggle with symptoms.
• Clients hearing "it's all in your head". Validate that the pain is real. Working: clients can place a recent episode on the spiral.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.