R Lynae Roberts1, Katharina Ledermann2, Eric L Garland3. 1. Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 S. 1500 East, Salt Lake City, UT 84108, USA; College of Social Work, University of Utah, Goodwill Humanitarian Building, 395 S.1500 East, Salt Lake City, UT 84108, USA. 2. Department of Psychiatry and Psychotherapy, University Hospital Zurich, Culmannstrasse 8, Zurich 8091, Switzerland; Department of Clinical and Health Psychology, University of Fribourg, Rue P-A Faucigny 2, Fribourg 1700, Switzerland. 3. Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, 395 S. 1500 East, Salt Lake City, UT 84108, USA; College of Social Work, University of Utah, Goodwill Humanitarian Building, 395 S.1500 East, Salt Lake City, UT 84108, USA; Veterans Health Care Administration VISN 19 Whole Health Flagship, VA Salt Lake City Health Care System, USA. Electronic address: eric.garland@socwk.utah.edu.
Abstract
OBJECTIVE: Long-term opioid therapy presents health risks for people with chronic pain. Some chronic pain patients escalate their opioid dose to regulate negative emotions. Therefore, emotion regulatory strategies like reappraisal are key treatment targets for this population. Mindfulness has been shown to enhance reappraisal, but the mechanisms of action are unknown. This study was a secondary analysis of data from a randomized, controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE) to test a specific postulate of the Mindfulness-to-Meaning Theory: that mindfulness-based interventions promote reappraisal, via interoceptive self-regulation, as a means of decreasing emotional distress. METHODS: Ninety-five patients with opioid-treated chronic pain (age = 56.8 ± 11.7, 66% female) were randomized to 8 weeks of MORE or Support Group (SG) psychotherapy. An interoceptive awareness latent variable was constructed from the Multidimensional Assessment of Interoceptive Awareness (MAIA). Next, interoceptive self-regulation was assessed as a mediator of the effect of MORE on post-treatment reappraisal, and then reappraisal was examined as a mediator of change in distress through 3-month follow-up. RESULTS: MORE participants had greater improvements in interoceptive awareness than the SG as measured by the interoceptive awareness latent variable (β = 0.310, p = 0.008) and by the self-regulation MAIA subscale (β = 0.335, p = 0.001). The effect of MORE on treatment-induced increases in reappraisal was mediated by increased interoceptive self-regulation (indirect effect: β = 0.110, p = 0.030). In turn, decreases in distress through 3-month follow-up were mediated by increases in reappraisal (indirect: β = -0.136, p = 0.031). CONCLUSION: MORE facilitated reappraisal of distress by enhancing interoceptive self-regulation, supporting a central mechanistic causal pathway specified by the Mindfulness-to-Meaning Theory.
OBJECTIVE: Long-term opioid therapy presents health risks for people with chronic pain. Some chronic pain patients escalate their opioid dose to regulate negative emotions. Therefore, emotion regulatory strategies like reappraisal are key treatment targets for this population. Mindfulness has been shown to enhance reappraisal, but the mechanisms of action are unknown. This study was a secondary analysis of data from a randomized, controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE) to test a specific postulate of the Mindfulness-to-Meaning Theory: that mindfulness-based interventions promote reappraisal, via interoceptive self-regulation, as a means of decreasing emotional distress. METHODS: Ninety-five patients with opioid-treated chronic pain (age = 56.8 ± 11.7, 66% female) were randomized to 8 weeks of MORE or Support Group (SG) psychotherapy. An interoceptive awareness latent variable was constructed from the Multidimensional Assessment of Interoceptive Awareness (MAIA). Next, interoceptive self-regulation was assessed as a mediator of the effect of MORE on post-treatment reappraisal, and then reappraisal was examined as a mediator of change in distress through 3-month follow-up. RESULTS: MORE participants had greater improvements in interoceptive awareness than the SG as measured by the interoceptive awareness latent variable (β = 0.310, p = 0.008) and by the self-regulation MAIA subscale (β = 0.335, p = 0.001). The effect of MORE on treatment-induced increases in reappraisal was mediated by increased interoceptive self-regulation (indirect effect: β = 0.110, p = 0.030). In turn, decreases in distress through 3-month follow-up were mediated by increases in reappraisal (indirect: β = -0.136, p = 0.031). CONCLUSION: MORE facilitated reappraisal of distress by enhancing interoceptive self-regulation, supporting a central mechanistic causal pathway specified by the Mindfulness-to-Meaning Theory.