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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)., Competing Interests: Conflict of InterestEric Garland, PhD, LCSW is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received payment for delivering lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland is a licensor to BehaVR, LLC. Mark Tuomenoksa is the Chief Technology Officer of Illumivu. No other authors have any related conflicts of interest to disclose., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: Mindfulness is theorized to decrease the affective amplification of chronic pain by facilitating a shift from emotionally-laden, catastrophic pain appraisals of nociceptive input to reappraising chronic pain as an innocuous sensory signal that does not signify harm. Understanding of these hypothetical psychological mechanisms of mindfulness-based analgesia has been limited by a lack of direct measures. We conducted a series of psychometric and experimental studies to develop and validate the Mindful Reappraisal of Pain Sensations Scale (MPRS)., Methods: After item generation, we conducted exploratory and confirmatory factor analyses of the MRPS in samples of opioid-treated chronic pain patients both before (n=450; n=90) and after (n=222) participating in Mindfulness-Oriented Recovery Enhancement (MORE). We then examined the convergent and divergent validity of the MRPS. Finally, in data from a randomized clinical trial (n=250), the MRPS was tested as a mediator of the effects of MORE on reducing chronic pain severity., Results: Exploratory and confirmatory factor analyses demonstrated the single-factor structure of the MRPS. The MRPS also evidenced convergent and divergent validity. Mindfulness training through MORE significantly increased MRPS scores relative to supportive psychotherapy ( F 4,425.03 = 16.15, p < .001). Changes in MRPS scores statistically mediated the effect of MORE on reducing chronic pain severity through 9-month follow-up., Conclusions: Taken together, these studies demonstrate that the MRPS is a psychometrically sound and valid measure of novel analgesic mechanisms of mindfulness including attentional disengagement from affective pain appraisals and interoceptive exposure to pain sensations., Competing Interests: ELG is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland has also been a consultant and licensor to BehaVR, LLC. No other authors have any related conflicts of interest to disclose.

Objectives: Mindfulness-Oriented Recovery Enhancement (MORE) is an integrative intervention designed to ameliorate addiction, chronic pain, and psychiatric symptoms. Although multiple randomized controlled trials (RCTs) have examined the clinical efficacy of MORE, no study has quantitatively synthesized this body of research. Thus, we conducted a meta-analysis of RCTs examining the effects of MORE on addictive behaviors, craving, opioid dose, pain, and psychiatric symptoms., Methods: Relevant manuscripts were identified through comprehensive searches of four bibliographic databases. Two- and three-level random-effects models were used to generate synthesized effect size estimates, and meta-regressions were performed to examine whether study and sample characteristics influenced the magnitude of aggregate effect sizes., Results: Our search identified 16 manuscripts reporting data from eight RCTs ( N  = 816). Moderate to small effects in favor of MORE were observed for addictive behaviors (SMC =  - .54, p  = .007), craving (SMC =  - .42, p  = .010), opioid dose (MC =  - 17.95, p  < .001), chronic pain (SMC =  - .60, p  < .001), and psychiatric symptoms (SMC =  - .34, p  < .001). MORE's effects on psychiatric symptoms and craving were not moderated by participant race, gender, age, or income., Conclusions: Study findings provide empirical evidence of MORE's efficacy for a wide diversity of individuals, and as such, MORE should now be disseminated broadly throughout the healthcare system., Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01964-x., Competing Interests: Competing InterestsEric Garland, PhD, LCSW, is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in MORE and mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland also receives royalties from the sale of books related to MORE. Dr. Garland is also a consultant and licensor to BehaVR, LLC., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: Many US law schools are now offering elective courses in mindfulness training to alleviate disproportionately high levels of anxiety, depression, stress, and disordered alcohol use among law students. To date, empirical evidence on the effectiveness of these courses has been lacking. The aim of this pilot study was to explore the feasibility and impact of a 13-week mindfulness course, "Mindful Lawyering," specifically tailored to law students. The primary hypothesis was that mindfulness training would be significantly correlated with improvements in well-being and mindfulness., Methods: The design was a non-randomized, quasi-experimental study involving 64 law students. The mindfulness group was 31 students taking Mindful Lawyering; the comparison group was 33 students taking other law school courses. Outcome measures were the Depression, Anxiety, and Stress Scale; the Positive and Negative Affect Scale; the Alcohol Use Disorders Identification Test; and the Five Facet Mindfulness Questionnaire., Results: Results provide promising evidence to support the hypothesis. The mindfulness group showed significantly greater improvement on measures of stress ( p  < .001, d  = 1.15), anxiety ( p  < .001, d  = . 90), depression ( p  = .012, d  = .66), negative affect ( p  = .002, d  = .81), disordered alcohol use ( p  = .011, d  = .67), and mindfulness ( p  < .001, d  = 1.32) from pre to post relative to the comparison group. The course was well accepted and feasible for law students., Conclusions: Findings from the current study suggest that mindfulness training may occasion improvements in the well-being of law students. More research is needed to replicate these findings in larger, randomized samples of law students., Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-01965-w., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2022.)

Objectives: Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: 1) perceived body boundary dissolution, and 2) more allocentric spatial frames of reference., Methods: A sample of healthy, young adults (n=45) were randomized to five sessions of mindfulness training or an active listening control condition., Results: Results indicated mindfulness training decreased perceived body boundaries ( F 4,172 =6.010, p <.001, η 2 =.12) and encouraged more allocentric frames of reference ( F 4,168 =-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries ( p =.039, η 2 =.06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference (( β =-.58, p=.001)), and path analysis revealed the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries ( β =.24, se =.17, CI : 0.11 to 0.78)., Conclusions: Taken together, study results suggest that mindfulness training alters practitioners' experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences., Competing Interests: Conflict of Interest Statement Adam Hanley, Michael Dambrun, and Eric Garland declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Relationships between dispositional mindfulness and the personality metatraits, stability and plasticity, remain unexplored despite continued efforts to more accurately characterize associations between dispositional mindfulness and personality. The metatraits are theorized to constitute basic requirements for biological survival and their expression is believed to be a strong determinant of well-being. As such, this study used path analysis to explore associations between dispositional mindfulness, the metatraits and psychological well-being in a sample of 403 American adults. Results indicate that dispositional mindfulness is principally associated with stability, or the capacity to sustain currently operative schemas and goals. Results further suggest a positive relationship between dispositional mindfulness and plasticity, or the tendency to flexibly adapt to changing circumstances. A more granular investigation of these associations demonstrated that the facets of dispositional mindfulness are differentially related with the metatraits. Ultimately, the metatraits were found to fully mediate the relationship between dispositional mindfulness and psychological well-being., Competing Interests: Declaration of Conflicting Interests Adam Hanley, Anne Baker and Eric Garland declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Dispositional mindfulness (DM), or the tendency to attend to present moment experience, may have important implications for the structure of human personality. However, relationships between DM and the Big Five Model of Personality (BF) have not been definitively established. Therefore, the purpose of this meta-analysis was to extend previous investigations of the relationship between DM and the BF, utilizing a larger sample of studies, attending to relational inconsistencies potentially associated with alternative methods of operationalizing DM, conducting the first meta-analysis of the DM subdomains in relation to the BF, and situating the results in a cybernetic model. Results indicate that neuroticism evidenced the strongest, negative relationship with DM and conscientiousness evidenced the strongest, positive relationship with DM, suggesting the mindful personality may be characterized principally by emotional stability and conscientious self-regulation - potentially reflective of an inclination towards the personality metatrait stability. Measurement differences were also observed, with the mindful personality arrived at through the FFMQ differing to some extent from the mindful personality emerging from the MAAS. Broadly, the mindful personality associated with the FFMQ appears to reflect greater personality complexity, with the FFMQ evidencing associations with all five personality factors while the MAAS appears primarily linked with only three personality factors (Neuroticism, Conscientiousness and Agreeableness). Examination of the relationships between the BF and DM at the facet level also suggest unique patterns of association between the DM facets and each of the personality factors., Competing Interests: Declaration of Conflicting Interests Adam Hanley and Eric Garland declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Putatively, mindfulness meditation involves generation of a state of "nonappraisal", yet, little is known about how mindfulness may influence appraisal processes. We investigated whether the state and practice of mindfulness could enhance cognitive reappraisal. Participants (N = 44; M age = 24.44, SD = 4.00, range 19 - 38, 82.2% female) were randomized to either 1) mindfulness, 2) suppression, or 3) mind-wandering induction training conditions. Cognitive reappraisal was assessed with the Emotion Regulation Questionnaire (ERQ) prior to experimental induction, and state mindfulness was assessed immediately following induction using the Toronto Mindfulness Scale (TMS). Participants practiced their assigned strategy for one week and then were reassessed with the ERQ reappraisal subscale. Participants receiving mindfulness training reported significantly higher levels of state mindfulness than participants in the thought suppression and mind wandering conditions. Although brief mindfulness training did not lead to significantly greater increases in reappraisal than the other two conditions, state mindfulness during mindfulness meditation was prospectively associated with increases in reappraisal. Path analysis revealed that the indirect effect between mindfulness training and reappraisal was significant through state mindfulness. Degree of state mindfulness achieved during the act of mindfulness meditation significantly predicted increases in reappraisal over time, suggesting that mindfulness may promote emotion regulation by enhancing cognitive reappraisal.