Long-term opioid therapy for chronic pain can lead to anhedonia, or reduced ability to experience pleasure from natural rewards. A behavioral intervention called Mindfulness-Oriented Recovery Enhancement (MORE) was tested in 63 veterans on long-term opioid therapy for chronic pain, who were randomly assigned to eight weeks of MORE or a supportive group therapy. MORE increased brain and physiological responses to natural reward cues and reduced subjective anhedonia more than the control. The reduction in anhedonia was linked to increased brain activity during savoring of rewards. MORE may be an effective treatment for anhedonia in chronic opioid users and those at risk for opioid use disorder.
Theta oscillations (4 to 8 Hz) in frontal midline brain regions, which support self-regulation, are inversely linked to default mode network activity involved in self-referential processing. Addiction involves impaired self-regulation and default mode network dysfunction. In a mechanistic study of 165 long-term opioid users, Mindfulness-Oriented Recovery Enhancement increased frontal midline theta during meditation compared to supportive psychotherapy. Theta during meditation was associated with self-transcendent experiences such as ego dissolution and bliss. Increased theta mediated the treatment's effect on reducing opioid misuse, suggesting mindfulness-induced theta stimulation may reset default mode network dysfunction to inhibit addictive behavior.