How To Rewire the Brain’s Response to Pain and Reward | Eric Garland

Key Takeaway

Mindfulness Oriented Recovery Enhancement (MORE) simultaneously addresses addiction, emotional distress, and chronic pain through three core components: mindfulness, reappraisal, and savoring. The most immediately actionable practice is STOP: before engaging in an addictive habit, Stop what you're doing, Take mindful breaths for 30-60 seconds, Observe your thoughts and cravings without judgment, and Proceed with intention. This simple interruption of automatic behavior can weaken cravings over time and help you regain conscious control over habits.

Episode Overview

Dr. Eric Garland shares the origin and science behind MORE (Mindfulness Oriented Recovery Enhancement), an evidence-based therapy backed by $90 million in federal research and 16 clinical trials. MORE integrates mindfulness meditation, cognitive reappraisal, and savoring practices to treat addiction, chronic pain, and emotional distress. The episode explores how mindfulness cultivates meta-awareness—the ability to observe automatic habits and cravings—and how self-transcendent experiences can provide natural sources of reward that reduce dependency on external substances or behaviors. Dr. Garland explains practical techniques like STOP for interrupting addictive habits and zooming in/out for pain management.

Full Transcript

Transcript of How To Rewire the Brain’s Response to Pain and Reward | Eric Garland from 10% Happier. Auto-generated from episode audio; may contain minor errors.

You have one integrated therapy that can simultaneously address addictive behavior, emotional distress, and chronic pain. MORE is a breakthrough evidence-based mindbody therapy rooted in ancient wisdom and modern neuroscience. Backed by $90 million in federal research in 16 clinical trials, Moore has been proven to be three times as effective as standard therapy. Eric Garland, welcome to the show. Thanks for having me so much, Dan. Excited to be here with you. I'm excited to have you here. All right, let let's just start with a little background. I'd love to hear about the origin story for more or M o r e mindfulness oriented recovery enhancement if memory serves.

Part of the origin story is you being able to avoid surgery through mindfulness. Yeah, if you want to start there. I was going to tell you the story of how I got into this whole thing to begin with. So, I don't know. You know, I I think I always gravitated to meditative states of consciousness. I can remember being a little kid and swimming in my parents' pool and I'd hold my breath and sink down to the bottom of the pool and then I'd look up at the sunlight on the top of the water and I would just get lost in the in the ripples of light and and just totally my mind would become quiet and spacious and then I'd run out of breath.

I have to scramble, swim back up to the surface, take another breath and then sink back down and I'd kind of do it over and over again. So I think I was kind of an unusual kid and then when I got to college I a friend taught me how to practice mindfulness meditation for the very first time and I just immediately gravitated to it. I mean, I just I just felt like one of the most important things in my entire life. And I subsequently discovered that mindfulness meditation was not only a key to accessing I think it seemed to have this great healing power.

And at the time I I was studying psychology and at that time psychology was all rats and brains and I really I I did not find much in in psychology at that time around consciousness. So I really had to turn my focus into studying the contemplative wisdom traditions. For example, Bajriana Buddhism, Adva Adant Hinduism, Dowoism, mystical branches of the Abrahamic religions. And in these contemplative paths, I I saw there was this really sophisticated model for understanding human consciousness. So I I wanted to get my HD in comparative religion and philosophy.

And I got rejected from every single one of those programs. And thank God for that because I would have lived a life of abject poverty. other. So I went into the mental health field. I was getting my masters in social work when I encountered clinical hypnosis and that was like the closest thing I could find in modern health care that was related to meditation. So then I went to get my PhD from UNC Chapel Hill to to do clinical research on hypnosis. And I'll never forget this.

I I moved my wife and my my newborn son into a newly purchased house in North Carolina. And the first night I was in the new house, my new mentor called me and he said, "Eric, I'm sorry. I can't work with you anymore. My grants have run out and I I got to do fundraising. I can't take on a student." And I just I cried all night long. I remember that. But then in the morning, I woke up and he said, "You know, I can't work with you, but I'm just curious.

Would you per chance be interested in studying mindfulness?" And I said, "Mindfulness? People study mindfulness?" And and my whole my whole career, you know, 20-year research program unfolded from that point. So I really I think my whole story has been woven with synchronicity and serendipity. So from that point I I started pursuing the study of mindfulness for pain and addiction and at the time I was working in I was working as a psychotherapist in an integrative medicine center alongside physicians and nurses and I was the headshrinker guy.

So they would send me you know their hardest cases the most complex patients that had these really chronic overlapping conditions. So mental health problems, substance use disorders, chronic pain and psychossematic conditions. So the people they just really didn't know how to help. And so I started working with these patients and trying to integrate mindfulness into the practice of psychotherapy. And and at this time mindfulness was not what it is today. You know, it wasn't wasn't everywhere like on magazines at the checkout stand in the supermarket.

Far less known. So there really weren't models that I knew of of how to integrate mindfulness into psychotherapy. There actually were at the time. that was Cabbis Zen's mindfulness-based stress reduction, but I wasn't even aware of it at the moment when I was creating more. And so I just started winging it and integrating mindfulness meditation into my cognitive behavioral therapy practice and pulling in threads of positive psychology. And that was really became the living living laboratory, my clinical practice with these patients where I where the genesis of of this new therapeutic approach came.

So then at the same time I was studying neuroscience and the cognitive science of addiction and stress and trying to use that to inform the development of this new therapy. And then I was really fortunate I I received a grant from the mind and life institute which was established by his holiness the Daly Lama who I know you've met and I had the great fortune of receiving this this grant to do the first study of more and and it was really sweet man. The the the the award letter was signed by his holiness the Dalai Lama.

So it was just was it was a beautiful moment in my life and and and I conducted the first study of Moore in people with alcohol use problems and that gave us a clear signal that this might really be an effective treatment. So then when I went to into my first academic position at Florida State University, I was a young professor trying to figure out, you know, what am I going to do with my career and I bumped into a physician and he said, "Wait a second.

You've been doing clinical work on mindfulness for pain, but your research is on mindfulness for addiction. Well, you're in Florida, man. This is the pain pill mill capital of the USA, and we have this big problem with opioids here. I have all these patients in my clinic, and we just don't know how to help these folks. They've been on on pain pills for more than a decade, and many of them are have a problem with opioids, and we just don't know how to help them. Maybe you could help them.

From that moment, that was the springboard to to two decades of of research and clinical practice in this area. this area. this area. Do you want to talk about the surgery or the non-surgery? the non-surgery? the non-surgery? You want me to talk about that? So, I developed this way way before that. That was one of life's greatest ironies. So I developed this this treatment I adapted more as a treatment for chronic pain and opioid misuse in 2010 and started landing grants from the National Institutes of Health and the Department of Defense to study this therapy.

And then 7 years later I had a severe herniated disc L4 L5 large extrusion of disc material into the canal pressing on my spinal nerve and that hurt pretty bad man. pretty severe sciatica. You know, it was it was so severe that I couldn't sleep. I had to actually wrap an ice pack around my leg for about 6 months in order to sleep. I never got surgery because mindfulness got me through it. And the principles of more at large got me through it. Unfortunately, I have some firstirhand experience needing to use these skills, but more existed before that.

But I will say that going through that experience has has certainly given certainly increased my my empathy and my understanding for what people suffer with. We'll go into great detail on what exactly more is and again mindfulness oriented recovery enhancement. But just on a high level, what's the elevator pitch for more? Yeah, the elevator pitch is more is a breakthrough evidence-based mindbody therapy rooted in ancient wisdom and modern neuroscience that is designed to simultaneously address addictive habits, emotional distress, and physical pain. We talked about this a little bit before we started rolling here and I know you've talked about it at great length with the producer of this episode, Eleanor Vasili, but just to make it abundantly clear to the listener, you developed this to treat a very specific set of populations who are dealing with, you know, full-blown addiction, but the basic of the protocol and the practices within it can be applied to everyday addictions, everyday emotional distress, everyday physical pain.

Yeah. I mean, I think we all or maybe not we all, but I think many of us struggle with addictive habits. It may not be a full-blown drug addiction. It It could be addiction to unhealthy food. It could be addiction to shopping. It could be internet addiction. It could be addiction to doom scrolling on your phone. Falling into addictive habits is is a basic property of the human mind. And certainly pain is ubiquitous. I think 50 million Americans experience high impact chronic pain each year. So that 50 million American adults.

So that's about one in six. And then emotional pain is just part of being a human being. As you know, there are three parts of more. Mindfulness, reappraisal, and savoring. With your permission, I'd like to go deep on each of these. Absolutely. Absolutely. Absolutely. Let's start with mindfulness. Many of the listeners to the show know what this means, but what do you mean by it specifically in this context? So mindfulness is the practice of cultivating awareness and acceptance of your present moment thoughts, emotions and body sensations and observing those experiences as if you were a witness, as if you were an objective observer.

And in more we we cultivate mindfulness through the practice of mindfulness meditation. There are a number of different meditation practices in Moore, but the but they're all oriented around generating what I what is considered in the field to be meta awareness. the awareness of awareness which I think is really the the therapeutic heart of what mindfulness is all about. John Cabbid Zen, a pioneer in the space, often points out that we our name as a species is homo sapiens sapiens, the one who knows and knows he or she knows.

And that second sapiens has atrophied over time because nobody bothers to point out to us that we have this kind of bonus level in the brain and mind that allows us to step out of the contents of consciousness and to view it all with some non-judgmental remove. And it's it's a massively good news when it when it is pointed out. I want to talk about the how of it like how we generate it and a little bit more about the mindfulness meditation practices that you in this protocol but just stepping back a little bit why is mindfulness helpful when dealing with things like everyday addictions to scrolling or gambling or eating or whatnot.

Great question and actually answering that question led to the development of more it actually was really getting my mind around a revolutionary theory in my in sorry a revolutionary theory in in addiction the cognitive processing model of addiction which essentially states that addiction is an automatic habit and that we learn to become addicted in the same way we learn anything. When you you do a behavior and then that behavior is rewarded, behavior becomes reinforced. So it it makes it easier to do that behavior which then increases the reward and reinforcement which then strengthens the behavior and the behavior happens again and again and again easier and easier and eventually with enough repetitions it becomes this automatic habit where the behavior can occur outside of the conscious intention to engage in the behavior and outside of even conscious awareness that the behavior is happening.

it becomes full autopilot. And I mean, I I don't know if you've had this experience. I certainly have. You know, walking around, all of a sudden, I find myself looking at my phone. I wasn't even intending to pull my phone out. And then I say to myself, man, I've been on my phone too much. You know, I'm I got too much time on my phone. Just stop doing this. And I put it in my pocket. And then I I walk another 10 ft. And then the next thing I know, I'm looking at my phone again.

And I did I certainly didn't intend to do it. It was just an automatic habit. So if addictive behavior can become automatized, fully automatic, then it stands to reason that a practice, a skill set that is designed to increase awareness of automatic behavior would be really useful to to regulate it. And in fact, that's what mindfulness is all about. Mindfulness, you could think of mindfulness as a form of automatization, making the unconscious conscious. When you when you think about the basic practice of mindfulness, that's really what we're doing.

So for example, take mindful breathing, which is a practice that shows up in all sorts of different meditative traditions and therapies. When we practice mindfulness on the breath, we focus our attention on the sensation of the breath moving into the nostrils as we breathe in. And you're noticing the the temperature of that air, you know, the warmth and the coolness of the air moving in and out of the nostrils. And then what happens, you know, most people, if you're like any any any normal human being, after 10 20 seconds, your mind starts to wander.

It wanders off automatically to thoughts or feelings or memories. You're not choosing to make your mind wander. It just does it on its own. It's automatic. And so what do we do when we're practicing mindfulness? The first step is to become aware that the mind has wandered. And so that that moment of awareness of the automaticity of the mind wandering is a key moment of meta awareness. So when we notice that the mind wanders off, we don't get mad at ourselves. We don't beat ourselves up.

We just notice where the mind has wandered off to. We acknowledge and accept that thought or feeling. Then we let it go and we bring our attention right back to the point of focus. Right back to the breath. So this basic practice and then it's rinse and repeat. Right? The mind wanders again. You notice that it wanders off. You acknowledge and accept. You let it go. You come back to the breath. So when you're doing this this loop of mindfulness as we call it and more, what you're really practicing is you're practicing the awareness of automaticity.

becoming aware of when the mind is wandering off into autopilot and then grabbing a hold of it and bringing it back under conscious control. And so I think that basic skill, it's just one example, but that even that basic core skill of mindfulness has a lot of applicability to gaining awareness of unhealthy automatic habits that we all fall into and then gaining some control over them. over them. over them. Yeah. So you can hypothetically catch your zombie arm reaching into your pocket for your phone and not do it.

What's interesting though is you as a longtime meditator are telling stories about how even to this day you find yourself on your phone and don't remember reaching for the phone. So this is not some sort of silver bullet. It just gives you a leg up. True. And yeah, I've got over 30 years of meditation practice experience under my belt, but I'm still pretty darn far from being the Buddha. Unfortunately, maybe I need to quit my day job and spend more time on the cushion. That thought has occurred to me, not about you, but about me.

Logical question then is you know how how do you develop mindfulness? You just described the core tenants of practice. Focus on one thing usually or often the breath. Every time you get distracted, start again and then as you said, rinse and repeat. But there are other forms of mindfulness meditation that I believe you use in more which again many of our listeners will be familiar with. But body scans where you start from the top of the head and just feel the sensations systematically moving down from the tippy top of your head to your forehead and jaw etc etc.

Oh yes, absolutely. And and those are sort of the the core basic techniques. Although I would add that in more there's always something a little more. So for example, even with the body scan for which which we're many of us are familiar with moving the attention through the body, sensing the sensations in each part of the body, we actually end that practice by pointing the person to become aware of the space around the body, the space enveloping the body and then to extend the focus of awareness successively further and further away from the body, further and further out into space and then as far out into space as they can conceive, even out and towards the center of the universe.

and then we encourage the patient to rest awareness in that space. So that's that's one of the ways which we do things a little bit differently. Similarly, even in basic mindful breathing, our mindful breathing practice always ends towards pointing towards non-dual or self-trcendent states of awareness in which awareness and space are are one. And and then lastly, another little twist there is we we we because Moore is really oriented around savoring. So appreciating and relishing and basking in positive emotional experience. We guide our patients to to finish the practice by turning their attention towards any positive mental states that have arisen during practice and really to to take a moment to to immerse themselves in it and appreciate it and enjoy it.

And that's really important with regard to helping to retrain the brain's reward system to help rewire the reward system and heal itself from the effects of addiction and pain. As I stated a while ago, the three parts of more are mindfulness, reappraisal, and savoring. You just mentioned savoring and we we will get to that because there's there's a lot to say there. But you said something else that I want to explore which is something about at the end of both a body scan and a mindful breathing you do recommend that people kind of broaden their awareness out in a way that leads to non-dual awareness and self-trcendence.

Can you define those terms and then I think on top of that say a little bit about how it it's helpful? helpful? helpful? Yes, absolutely. So this has been a real focus of my entire pathway I would say leading me into this work and more recently in the past I would say seven years in in a more intense focus of my scientific work. Non-dual awareness is a term that is used in in a number of contemplative traditions and it's contrasted with dual awareness and dual awareness refers to our normative experience of being a subject observing an object.

So there's myself and myself is encountering paying attention to objects in the world. And so that that's the duality of subject and object. And we typically go through life like this. We we feel like an isolated subject or self that's encapsulated by our skin and identified with our bodies and we're seeking out the objects of the world that we desire. But there can be moments when this norm normal subject object duality begins to fade and we feel this sense of closeness or interconnectedness or oneness with the world around us and in that moment the the separation between the subject and the object disappears and there is this non-dual awareness that arises and in the psychological literature this term the term for this is self-trcendence so going beyond the normal sense of self and I think an easy way for the listener to understand this is just the experience of connecting with something greater than the self.

And there there many nuances to this, but I think that's that's an easy way to to understand it. And and you know, I think this experience is not as far away as many of us think it might be. So, have you ever, for example, have you ever been at the concert of one of your favorite bands and you just become so absorbed in the lights and the music and that you just lose yourself in it and you just feel filled with the thrilling bliss of the musical notes?

Or maybe it's some people experience this in nature watching the let's let's say the beautiful sunset at the beach which I I live here. I'm fortunate enough to live here in California, Southern California. So gorgeous sunsets abound standing at the edge of the water looking out at the horizon feeling the expansiveness of space. The mind becomes extremely quiet and there's this sense of connectedness to all things. These experiences can happen on psychedelics like psilocybin and LSD and they certainly happen during meditation. And in fact, the original purpose, the original to to use a an egghehead word here, the original sotiological purpose of mindfulness in in traditions like Buddhism and Hinduism was not to regulate stress and it wasn't to strengthen your your attention.

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That's meetfabric.com/happier. That's meetfabric.com/happier. Mefab.com/happhappier. Policies issued by Western Southern Life Insurance Company, not available in certain states, prices subject to underwriting and health questions. I think most people can understand standing in nature looking at the Grand Canyon or whatever and feeling connected to something that's bigger than yourself. You could describe that as self-trcendence and also interconnection. Where I find people get confused and where even sometimes I get confused is the notion that the self itself is fundamentally an illusion. It's a tricky subject for sure. I don't know how you want me to respond to that but well I don't know concretely just experientially for example and we do this in more when you close this we do this in more when you close your eyes and you bring your attention to the sensation of your body resting in the chair and you become aware of the feeling of contact between your back and your legs and the cushion of the chair.

It's curious to notice where does the feeling of the body end and the feeling of the world begin. Yeah. Because I mean can you really feel a difference? And then another practice and this is an ancient one. This isn't mine. I don't can't claim this one. Starting to tune attention towards is is the space inside the body and the space outside of the body one space or two spaces. And don't use your mind to answer that question, right? Don't try to just intellectually answer the question.

Use the facts of your experience. What does it feel like? But I agree with you that that whole question of is the self an illusion? That's that's a thorny philosophical conversation. I don't know if we want to get into that. Let me steer it back to the very practical and concrete, which is how does self-trcendence, interdependence, non-dual awareness, all this stuff we've been talking about, yeah, yeah, yeah, managing my everyday addiction to my phone. phone. phone. Great question. That's a really good question. So, let me let me uh just frame this for you in the in more of the clinically severe case first and then bridge it into everyday experience if that's okay with you.

So when you think about chronic pain, which again I said is as I said is really prevalent. There's more chronic pain than there is diabetes, heart disease, and cancer combined. So it's just a terribly prevalent condition among adults in this country. If you if you say to yourself in your head, I'm in pain enough times over and over again. That little preposition in gets dropped and I am in pain becomes I am pain. As your identity becomes fused with pain, it becomes the central part of who you are.

You you you just become consumed by it. And the same kind of process happens in addiction. Repeated rumination on addiction related thoughts and cravings entrenched in the sense of self. Your identity becomes fused with addiction. The drug becomes the central point of meaning in life at the expense of the people, the activities, the values that you once cared about. And we know, we also know from neuroscience that both chronic pain and addiction involve disregulation in what's called the brain's default mode network. And the default mode network is is a circuitry of brain regions that's involved in creating the sense of self and in getting lost in thoughts about yourself and ruminating away from the present moment.

So if we can achieve these self-trcendent experiences where the normal sense of self becomes quieter, then this may actually interrupt activity in the brain's default mode network and help help our our sense of who we are to not be so stuck in or fused with or identified with these forms of suffering and that gives us a window of opportunity to free oursel from the trap of pain and addiction. So that's that's the concept. Concretely, how does it affect our our everyday sorts of addictions? when we have tastes of self-trcendence.

And I'm not claiming that we're going to have some, you know, knock you over the head, you know, bolt of lightning, the clouds open up and an angel comes down and, you know, bathes you in in in the golden light of enlightenment. But we might just have a little taste of this experience where we feel a little bit more connected to the world around us and we feel a little more expansive. And when we have when the mind touches these more self-trcendent places, they carry this inherent reward value.

They have this tone of positivity, of peacefulness, of love, maybe even bliss. They these are moments in which we we really tap into our own inner wellspring of well-being. And so in these moments, we actually can make ourselves feel good naturally on our own. And if we can make ourselves feel good naturally on our own, then maybe we don't need to seek positive feelings outside of ourselves by engaging in in addictive behavior. My friend Jud Brewer, who's done a lot of work in the same area that you work in, I think he refers to this as the BBO, the bigger better offer.

That if you can teach your brain that that it feels good to be aware or to be in a state of transcending the self, that maybe that's what you turn to in moments of distress rather than chocolate cake or strolling or rather than chocolate cake or scrolling. And I'm not saying that either of those are inherently evil, but it may be that the BBO is a better call. often. often. often. Yeah. And we have data that directly supports that. We have strong data that supports that.

supports that. supports that. So under under mindfulness and again I'll just reset for people that we're talking about the mindfulness oriented recovery enhancement protocol that that Eric devised and it's got three parts. Mindfulness, reappraisal, and savoring. We're still talking about the mindfulness piece. Under the mindfulness piece, you have a kind of free range practice that we can do off the cushion, you know, in our everyday lives called stop. stop. stop. Yeah, absolutely. So stop is is a really simple practice. The first step is is to stop to stop right before you engage in the addictive habit.

And instead of doing the thing that you felt compelled to do, second step is to just take a few mindful breaths. Doesn't have to be a long time. It could be 30 seconds. It could be a minute. It could be 3 minutes. Just enough time to focus on the sensation of the breath moving into the body to calm down the mind to calm down one's physiology. And then the next step is oh to observe your thoughts, your feelings, your body sensations in this moment in in the presence of of the the thing that you're craving.

And what you'll begin to observe is that your attention keeps getting drawn to this behavior or this thing that you that you really want that you're craving that it's actually difficult to shift your attention away from it. And that helps you to gain insight into the fact that you are craving that you are slipping into this addictive habit. But another thing that you'll begin to observe as as you do this practice is that cravings don't last forever that they actually are impermanent that they change over time.

And if at any point you get too overwhelmed in in the pro in the process, you can always return the focus of your attention back to the breath as a way to recenter the mind and to to get some relief from the distress in the body. And then the last step of of this stop process is to proceed with intention. So of course ultimately it's your choice whether or not you're going to engage in this in this behavior. You're going to consume the substance or or do the thing that you feel compelled to do.

But if you choose to do it, then do it mindfully with full attention, giving the activity the respect and the awareness that it deserves. You know, maybe there are some negative consequences for engaging in this behavior. and if so, consciously contemplate those negative consequences. But what a lot of people discover is that by stopping and interrupting this automatic addictive habit and practicing a few moments of mindfulness instead, that that the desire to do it is starting to fade away. It's getting weaker over time. And and this this practice, this very simple practice is the jumping off point for lots of people in changing addictive behavior is more elaborate and intensive.

That takes some some time to build into it. But this this this practice we teach people immediately in the more program. Well, if we have time, we'll come back to the full mindfulness of craving technique. But technique. But technique. But and you and hopefully we'll talk about mindfulness for pain, too. And that cuz that's a unique technique in more. Yeah. So, let's talk about mindfulness specifically for pain cuz you you've got a technique that is called zooming in and zooming out. Great. Do do you want me to give some context, you know, talking about Great.

So, you know, so what is pain? I mean, pain is really your body's alarm system. So when you're injured, there are special nerve cells called noiceptors and they relay the signal of damage from the injury up the nerves up the spine and into a structure in the center of the brain called the phalamus. And the phalamus acts like a relay station and it sends that signal of damage out to the higher order thinking parts of the brain like the prefrontal cortex as well as the feeling parts of the brain like the amydala and the insula.

And it's here in the thinking and feeling parts of the brain that the signal of damage is actually decoded into the conscious experience of pain. And so and and this is kind of crazy because these same higher order brain regions, they can actually act like a volume knob on your pain. So if you're feeling stressed or you're afraid or you're frustrated, that can crank the volume of your pain right up and make it hurt worse. That can actually turn the volume of the pain down. Given this neuroscientific model of pain, it's it's a truism that all pain is processed in the brain.

It doesn't matter whether the pain is coming from arthritis in your knee or from a herniated disc or from irritable bowel syndrome or even a headache. Now that that doesn't mean that all pain is in your head because the brain is a part of your body. So if you can change the way your mind functions, you can change the way your brain functions and that'll change your experience of pain. And that's that's the heart of the more approach. So the way we do this is through mindfulness and and a specific mindfulness of pain technique.

So the technique it it begins by mindful breathing as a way to calm down the mind to center our our focus and then we actually guide the patient to focus their attention on the sensations of pain themselves. So turn attention right into the heart of the sensation and to break down the experience of pain into into the subcomponent sensations that that make up pain. So rather than focusing on some terrible awful anguish, patients use mindfulness to zoom into the experience and to break it down into sensations of heat or tightness or tingling as well as to notice the spaces in between those sensations where there's either no sensation at all or potentially even pleasant sensations right next to the painful ones, which I know sounds pretty crazy, but a lot of times people start to notice that that when they really turn their attention towards the pain and break it down, they discover that it's not completely solid and in fact that the the experience of pain is is is more spacious than they thought it was.

So they're focusing attention intensely on the sensation. They're zooming into it and breaking it down. And if at any point they become too overwhelmed with the sensation, then then we guide the person to turn their attention back to the sensation of their breath to calm down the mind, calm down the body, and then to imagine as if they could send the breath into that sensation of pain to soften it. And the metaphor we use is is like water seeping into the soil. So there's the zooming into pain, there's zooming out from pain, and toggling back and forth, the the person begins to notice that these sensations change over time.

They're they're not permanent. And noticing that they're changing can can bring hope and and relief. And and this practice of using mindfulness to cultivate interosceptive awareness, the the awareness of the physiological condition of the body can get people out of their heads about their pain. And since a lot a lot of what's driving chronic pain is emotional anguish, turning up that volume knob of the pain, that by teaching people to actually get back out of their heads and into their bodies into the actual sensation, they discover that it's not as awful as they thought it was and maybe that they can cope with it successfully.

And in fact, that's what we find in in we've conducted more than 16 randomized control trials of more funded by more than $90 million in federal research funding. So we have done a lot of research on this therapy and we we see very clearly that more cuts pain significantly. So it drops chronic pain by about 25% and that effect lasts 9 months after the end of this 8week program. But the acute practice of this mindful zooming in and zooming out meditation that can alleviate pain in the moment by about 30% on average.

And that's about as much pain relief as you would expect from 5 milligs of oxycontton. And some people get a lot more pain relief than that. Some people can drop their pain to zero during the practice. Okay. So, let let's move to some of the other aspects of the Moore protocol. As I keep reminding listeners, there the three parts of mindfulness, reappraisal, and savoring. Let's talk about reappraisal. I'll start with an obvious question. What does that actually mean? Reappraisal. Reappraisal is the practice of challenging and changing negative thought patterns to reduce negative emotions and decrease self-destructive behavior.

So reappraisal is is the cornerstone of cognitive behavioral therapy. It's also an ancient idea that was reflected even in the in the stoic philosophers of ancient Rome who said cool things like we are disturbed not by events but by the views which we take of those events. So it's this idea that if we can change the way we think about the the challenges in our life that this will have a powerful effect on how we respond to those challenges. And so when we experience some sort of a we so when we experience some sort of a stressor, our mind automatically and rapidly goes into this stress appraisal where we we we see this thing that's happening to us as a threat and we often times feel really overwhelmed by it, like we can't handle it.

And these these computations happen super fast in the brain, you know, within the span of a couple seconds. And then the body starts getting stressed out. Then that's the whole fight orflight response that we're all we're all too familiar with. heart starts beating fast, muscles get tight, start sweating, stomach discomfort, your cortisol is is rising, and and you feel awful. And and if you have chronic pain, that actually magnifies the pain, makes the pain hurt worse. If you have if you've fallen into the habit of some sort of addictive behavior to relieve pain, and you're stressed out, that makes it more likely that that addictive behavior is going to come out.

So that's the stress process. But so reappraisal is the the practice of becoming aware that this is happening and then using a few moments of mindfulness to to stop this this process to disrupt it and then to consciously challenge and change those negative thoughts into a more helpful way of viewing the situation. So for example asking yourself what's a more helpful way to see this situation? What's the proof that my thoughts about this situation are true? What's the proof that they're not true? Is there an alternative explanation to what's going on here?

Is is is it all bad? What are the positive sides to the matter? And crucially asking asking yourself, how is facing this difficult life situation teaching me something or helping me to grow as a person? How is facing this adversity bringing a sense of meaning to my life? So, we guide the patient to actually consciously contemplate this alternative perspective to to reframe the challenge as an opportunity for personal growth. And that decreases negative emotions and cuts off the stress response. So there's evidence that beyond the anecdotal there's is there you know physiological evidence to show that reappraisal can help at the level of the brain or other parts of the body big time.

So reappraisal broadly speaking reappraisal is one of the most extensively studied emotional regulatory processes in in all of neuroscience. So in general what we see is this increase in prefrontal cortical activity and as the prefrontal cortex becomes more active that dampens activity in in the emotional parts of the brain like the amydala. In my own research studying more we've shown that reappraisal training people in reappraisal through more that people can actually drop their skin conductance responses. So that's that's what people measure when they do the lie detector test.

You're basically measuring sweat at the fingertip, which is a a very pure expression of sympathetic nervous system activity. That's the fight-or-flight response. So through reappraisal, patients are able to drop their stress arousal as measured by skin conductance responses. And reappraisal not only decreases their negative emotions, but actually can help with things like trauma, PTSD. So, in a moment of, you know, reliving a past trauma or experiencing a shame spiral over the fact that I did that thing again, I overeat or I had a little too much to drink or I spent, you know, 6 hours on the phone or in a moment of, oh, I'm starting to notice I've got a headache again and I'm catastrophizing about it.

Reappraisal can be really helpful. That's when I'm hearing from you and that I just want to make sure if I'm restating that all correctly. How do we remember to do it and what the right questions are to ask ourselves in order to reappraise effectively? Great question and and yes, you you articulated really well in those moments when if we do slip into some sort of unhealthy habit or addictive behavior and we are we are feeling shame about it or like you said, we we experience some sort of pain and we start to get really upset about it.

maybe start catastrophizing about it, thinking that that life is terrible because of this pain and that there's no way I can handle it. Reappraisal is really useful in those moments to stop yourself and to and to recognize your own inner coping resources and to reframe the negative thoughts to remind yourself that actually you do have the inner strength to deal with these challenges and that and that facing them is actually helping you to grow as a person. So, so how do you do it in those moments?

Well, the first step is actually to first step the first step is actually to become mindfully aware that you are getting stressed out. So stress is actually the signal. Stress is the reminder. So when you're when you're starting to get worked up, you remember it's time to practice reappraisal. And then the next moment is the next step is to become aware of what are the negative thoughts that I'm having that are that are leading to me feeling stressed out. And then once you're aware of those negative thoughts, you can become aware of what what is the impact of those thoughts on your emotional state?

How is it affecting my body? And then you stop and you practice a minute or two of mindfulness. Just enough to calm down the mind. Just enough to calm down the body. And then you moved to dispute or to challenge those negative thoughts by asking yourself questions like, "What's a more helpful way of viewing this situation? Is there an alternative explanation? If I had a friend in this situation, what would I want them to believe about it?" If I had a trusted teacher or or spiritual guide, what would what would they want me to to think about this situation?

Is there a blessing in disguise here? Maybe there's something good about the situation that I'm overlooking. And how is facing the situation helping me to grow as a person? How is it teaching me something important? How is facing this adversity bringing a sense of meaning to my life? So that's that's the that's the the practice. And we have an acronym for it. That's ABC. It's not our acronym. It's it's a it's a classic acronym used in cognitive behavioral therapy. So A stands for the activating event.

So that's the event that happened that led to you feeling stressed out. And then B. B is your beliefs or negative thoughts about the event that led you to feel stressed out. C are the emotional and behavioral consequences of those negative thoughts. D is dispute or challenge the negative thoughts. So reframe them. Think about the situation from a more helpful helpful perspective. And then the last step in the process is E, which is to evaluate what is the effect now of this reappraisal. Now that I'm thinking about this situation from a more helpful perspective, how is it impacting my emotions and and how can it help me to respond in terms of take take taking more constructive action?

I love this. The problem isn't the problem, it's your view of the problem and we can shift our view. That's just enormously empowering. is is a classic approach in cognitive therapy. But in more, we inject a little bit of mindfulness into this into this process because as as one of my good friends and colleagues, Philipe Guldan said, mindfulness is the WD40 of the mind. It just helps to lube things up. It increases psychological flexibility and perspective taking. And so injecting a little mindfulness into this process can help us to to reframe our negative views of the situation and and take a broader perspective.

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pain. It could be physical pain. It could be an emotional pain like stress or or anxiety or or sadness. But when the person engages in the addictive behavior like taking a drug for example, then the brain learns that shortcut really fast. And so over time the reward system gets rewired. The brain becomes hyper sensitive to stress and pain and drugrelated cues. But the brain also becomes less sensitive to the simple health healthy pleasures in everyday life. So the person starts to feel empty inside. And how do they fill that emptiness?

How do they fill the hole? They just take higher and higher doses of the drug to feel normal. They do more and more of the addictive behavior to feel normal. But that just digs the hole even deeper, right? That's that's the vicious cycle and and the downward spiral of addictive behavior. But what we see in more is that the cycle can be reversed. that by teaching people how to use mindfulness to savor natural healthy pleasure, then we help the brain regain its sensitivity to these to these natural healthy rewards.

And as this capacity to feel healthy pleasure comes back online, that then weakens the pull of the drug and reduces craving and addictive behavior. And we've shown this many times over in in multiple rigorous studies. So savoring is really the key to this whole process of helping people to reclaim this basic inherent sense of joy and healthy pleasure and meaning in life. And the way it works is savoring is really the practice of focusing mindful attention on a pleasant or positive everyday event. So turning attention towards the pleasant sensory features of that object or event.

So the beautiful colors, the pleasant sounds, the enjoyable sense and and the pleasure you get from the sense of touch touching the object of your body moving through space. All of these kind of sensory portals can can provide pleasant and enjoyable and good about the experience. But then the key part of savoring and this is the real subtle part is that when you start to savor something enjoyable, positive emotions arise in your mind and pleasurable sensations arise in your body. And when those positive feelings come up, we guide the person to turn their attention inward and to savor the positive inner feeling like water seeping into the soil.

So just turning attention into the positive inner experience and focusing mindfulness on that positive feeling and becoming deeply immersed in it. Sort of soaking and bathing in that positive inner feeling and allowing it to pervade the entire space of their mind and their body. and and that practice is is I think really important when it comes to people who are struggling with addictive habits with with chronic physical pain and also suffering from emotional pain like depression or PTSD because in all of those conditions what happens in the brain is that the brain becomes less sensitive to natural healthy pleasure and so what we're really doing I think is through savoring it's it's retraining the brain's capacity to reexperience natural healthy pleasure and joy it's it's sort of like weightlifting for your brain's reward board system.

You said a little bit of this, but I think it's worth re-emphasizing. How can we integrate this practice into our our day wherever we're at, whether we've got, you know, significant chronic pain or just everyday aches and pains or significant addiction or just everyday addiction. I think this is useful for everybody, myself included. So, can you just help us think about where and when and how to fit it into our day? Absolutely. You know, fortunately, savoring is like this little secret that you can keep in your pocket and and whip it at it anytime anytime that there is the opportunity.

So, for example, you you know, you've been inside working all day and you it's your first moment to step outside and maybe not if you're in the middle of this winter storm in the Northeast. But if you're if it's a nice day outside, you step outside and you and you open up the door, you feel the warmth of the sun on your face and you feel the or you feel the coolness of the breeze and you just stop in that moment and instead of rushing to your car or instead of picking up your phone and and doom scrolling, you take a moment to actually focus on the sensation of the warmth of the sun on your skin or the coolness of the breeze.

And when you notice that that sensation, you you become aware of the pleasure seeping into seeping into your mind, seeping into your body. And you take a moment to bask in it and focusing attention deeply on the pleasurable feelings and and imagine as if you could breathe them breathe those positive feelings into the center of your being. So just take it in. It doesn't have to be long. It could be it could be 20 seconds. It could be a minute. And then you you move on to the next thing.

So that that's that's one example. Maybe it's maybe you're watching your kid play in the backyard and play with their friends and and you you see the smile on your child's face and the sparkle in their eyes and instead of just rushing rushing around to do the do the next chore on your list or getting lost in your social media feed, you stop and you actually focus your attention on your kid's smile and you notice the sparkling in their eyes and you listen to their laughter.

And when you do that, maybe you'll notice a slight feeling of of your own joy and happiness. And then you turn your attention inward and you savor that positive inner feeling and just breathe it into the center of your being and allow it to linger and expand. So, I think there's there's just tons of moments like this all throughout life that we we often times miss cuz we're just we're just rushing around on our to-do list, you know, do this, do this, and do this, do this, and that.

And when do we actually stop to smell the roses? But I have really good hard clinical data and neuroscience data showing that if you actually stop and smell the roses, it has healing power. It it relieves addictive cravings and it can reduce physical pain. I can imagine you could do this while eating. You could do it while in conversation while eating or just in any kind of conversation where anything nice or pleasing or pleasant happens. Exactly. Exactly. Yeah. I mean, the Buddha observed that life is suffering.

There's there's suffering inherent in life, but there's also beauty and joy inherent in life and they they arise. They they exist together. And why do we give the stress and the suffering and the pain all the air, all the attention? And I can answer that question for you because that that that's a biological imperative. Our brains have evolved over millennia to detect threat because our ancestors had to get good at detecting threat and focusing on pain in order to keep themselves safe to avoid destruction. So detecting threat is a really good survival adaptation.

But if all you pay attention to in life is stress and pain, what kind of quality of life do you have? Your life is feels pretty bad. But we can use mindful savoring to expand the scope of our awareness and to start to notice some of the other parts of our life that are not painful, that are neutral or maybe even good in spite of pain or maybe even because of the pain in life. And when we turn our attention towards those parts of life and we our scope of attention is broader so that we're actually getting a more balanced view not only noticing the stressors and the pain but also appreciating the beauty and the goodness then the painful parts of life become smaller by comparison.

Or as the Buddhists say sadu this has been a great conversation we've been able to cover a lot of ground very efficiently and economically. I'm curious though, is there anything you were hoping that we would get to that we haven't managed to get to? get to? get to? Yeah, I'd like to just give Yeah, I'd like to just give you some of the statistics around the MOO program if that's okay. So, more is a breakthrough evidence-based mindbody therapy rooted in ancient wisdom and modern neuroscience that's designed to simultaneously address addictive habits, emotional distress, and physical pain.

and backed by $90 million in federal research in 16 clinical trials, more has been proven to be three times as effective as standard therapy. So we've we've shown that more reduces opioid misuse by 45% 9 months after the 8we treatment. We've also shown that more reduces drug relapse by 42% and more cuts craving by 50%. But more also has these these effects on chronic pain as I said. So more reduces chronic pain by 25% with on average and some patients achieve even more significant pain relief than that.

And at the same time more has powerful anti-depressant effects and can result in clinically significant reductions in PTSD. So what makes more especially useful I think at this time in society is that you don't need a separate type of therapy for each one of these problems but actually you have one integrated therapy that can simultaneously address addictive behavior emotional distress and chronic pain and that's really important when thinking of solutions to the opioid crisis which is which is a severe crisis that's threatening our society and I think more is so effective because it it unites these innovative mindfulness reappraisal and savoring techniques into a powerful and sequenced mindbody treatment approach.

So just rattling rattling off some more statistics, you can decide to use them or not. Have some new data showing that more is highly cost effective. So for every $1 spent on more, there are over $700 in cost savings. And if you accumulate that over the lifetime of the patient, the estimated cost savings are over $300,000 per person. So that's a big deal, especially in these times where healthcare funding is is is so troubled. And so we're trying to get the word out on this. So in in March of 2024, I went to brief Congress.

I went to Capitol Hill and and brief the Addiction Treatment and Recovery Caucus of the US Congress on more because I'm really trying to disseminate this work. And now that I've spent 20 years trying to study this therapy and show that it works, I want to get it into the communities where people are suffering from addiction and emotional [clears throat] distress and chronic pain to help alleviate the opioid crisis. So a lot now is focused on disseminating more to teaching therapists and clinicians all around the country and all around the world.

And we have an active training program online training program at more theapy.com. theapy.com. theapy.com. Okay. So that's that's what I was going to ask you where where if people want to learn more either to get involved as a trainer or to get the therapy themselves, it's it sounds like they should go to mortraining.com. more therapy.com. I published a book on more that walks through the entire therapeutic process. And that that book was published by Guilford Press in 2024. And we're going to be coming out with an app very soon that that contains these practices and and the education around more and that can also be found at more theapy.com.

theapy.com. theapy.com. Eric, thanks for the work you're doing in the world. Thank you for coming on here and teaching us so much. Great job and on both and appreciate you. Thanks. Thank you so much for having me, Dan. It's great conversation.