The Neuroscience of Reducing Chronic Pain and Everyday Addictions | Eric Garland

This is the 10% Happier Podcast. I'm Dan Harris. Hello, everybody. How we doing? Today, we're going to talk about the neuroscience of reducing your everyday addictions like scrolling and shopping and gambling and drinking and eating. Plus, we're going to talk about how to work with chronic pain, how to reframe your problems, and we're going to talk about the clinical evidence for stopping and smelling the roses. This is a great interview. I really enjoyed this episode. My guest is a neuroscientist who's come up with a protocol called MORE, which stands for Mindfulness Oriented Recovery Enhancement. This protocol, in my opinion, quite brilliantly weaves in aspects of mindfulness with cognitive behavioral therapy and also has an emphasis on counter-programming against your evolutionarily wired negativity bias. This protocol, again, which is called MORE, was originally designed for people with full-blown addictions, but as you're about to hear, there are lots of extremely practical ways that everyone can weave aspects of this practice into daily life, and the evidence strongly suggests it will lead to an upgrade in the experience of being alive. My guest is Dr. Eric Garland, PhD. He's a professor in the Department of Psychiatry at the University of California in San Diego. As mentioned, he developed a mindfulness-oriented recovery enhancement. He's also published more than 260 scientific manuscripts and received more than $90 million in research grants. If you're interested in practicing mindfulness yourself, may I remind you that I've got a meditation app that you might want to check out. And over on the app, between March 23rd and March 27th, we're going to be running a five-day meditation challenge, which is inspired by a new Audible original, an audio book that I recently put out, which is called Even You Can Meditate. I co-wrote it and co-recorded it with the great meditation teacher and my close friend, Seben A. Selassie. If you want to check out the book, you can go to audible.com. And if you want to join me and Seb for the meditation challenge, just go to danharris.com to sign up for the new app, which is called 10% with Dan Harris. Again, the challenge runs from March 23rd through the 27th. Every day during the challenge, you'll get a guided meditation from Seben A. And then a couple of times, twice actually, during the course of the challenge, We'll do live sessions so you can join me and Seb for a live meditation and then ask us some questions. All right, enough out of me. We'll get started with Dr. Eric Garland right after this. 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And if you get a post-purchase survey, please be sure to mention you heard about Cozy Earth right here. Experience the craft behind the comfort and make every day feel intentional. Eric Garland, welcome to the show. Thank you so much for having me, Dan. Pleasure. Excited to be here with you. I'm excited to have you here. 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. 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 ripples of light. My mind would become quiet and spacious. And then I'd run out of breath, I'd 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 when I got to college, a friend taught me how to practice mindfulness meditation for the very first time. And I just immediately gravitated to it. And I subsequently discovered that mindfulness meditation was not only a key to accessing key spiritual insights about the nature of reality, but also it seemed to have this great healing power. At the time, I was studying psychology, and at that time, psychology was all rats and brains, and I really did not find much around consciousness. So I really had to turn my focus into studying the contemplative wisdom traditions. For example, Bajrayana Buddhism, Advaita Vedanta Hinduism, Taoism, mystical branches of the Abrahamic religions. I wanted to get my PhD 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. So I went into the mental health field, and I was getting my master's in social work when I encountered clinical hypnosis. And that was the closest thing I could find in modern healthcare that was related to meditation. So then I went to get my PhD from UNC Chapel Hill to do clinical research on hypnosis. And I'll never forget this. I moved my wife and 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 got to do fundraising. I can't take on a student. 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 perchance be interested in studying mindfulness? My whole career, you know, 20-year research program unfolded from that point. I started pursuing the study of mindfulness for pain and addiction. And at the time, I was working as a psychotherapist in an integrative Medicine Center alongside physicians and nurses. And I was the head shrinker guy. So they would send me their hardest cases, the most complex patients that had these chronic overlapping conditions. So mental health problems, substance use disorders, chronic pain, and psychosomatic 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 at this time, mindfulness was not what it is today. It wasn't everywhere, like on magazines at the checkout stand in the supermarket. It was 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. There was Kabat-Zinn'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 that we'll talk about later and that really became the living laboratory my clinical practice with these patients where the genesis of this new therapeutic approach came 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 received a grant from the Mind and Life Institute, which was established by His Holiness the Dalai Lama, who I know you've met. And I had the great fortune of receiving this grant to do the first study of more. And it was really sweet, man. The award letter was signed by His Holiness the Dalai Lama. So it was just, it was a beautiful moment in my life. And I conducted the first study of more in people with alcohol use problems. And that gave us a clear signal that this might really be an effective treatment. 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 mind-body therapy rooted in ancient wisdom and modern neuroscience that is designed to simultaneously address addictive habits, emotional distress, and physical pain. Backed by $90 million in federal research and 16 clinical trials, we've shown that MORE reduces opioid misuse by 45% nine months after the eight week treatment. We've also shown that MORE reduces drug relapse by 42% and MORE cuts craving by 50%, But Moore also has these effects on chronic pain, as I said. And at the same time, Moore has powerful antidepressant effects and can result in clinically significant reductions in PTSD. So what makes Moore 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 a severe crisis that's threatening our society. 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 Vasily, 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 full-blown addiction, but the basics of the protocol and the practices within it can be applied to everyday addictions, everyday emotional distress, everyday physical pain. That's right. I think many of us struggle with addictive habits. It may not be a full-blown drug addiction. 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 a basic property of the human mind. And certainly pain is ubiquitous. I think 50 million Americans experience high impact chronic pain each year. 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. Love to talk about it. 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 Moore, we cultivate mindfulness through the practice of mindfulness meditation. There are a number of different meditation practices in Moore, but they're all oriented around generating what is considered in the field to be meta-awareness, the awareness of awareness, which I think is really the therapeutic heart of what mindfulness is all about. John Kabat-Zinn, a pioneer in the space, often points out that 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 nonjudgmental remove. It's massively good news when it is pointed out. I want to talk about that, how of it, like how we generate it and a little bit more about the mindfulness meditation practices that you use 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 addiction, the cognitive processing model of addiction, which essentially states that addiction is an automatic habit, that we learn to become addicted in the same way we learn anything. When you do a behavior and then that behavior is rewarded, behavior becomes reinforced, so 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 I don know if you had this experience I certainly have walking around all of a sudden I find myself looking at my phone I wasn even intending to pull my phone out And then I say to myself man I been on my phone too much I got too much time on my phone. Stop doing this. And I put it in my pocket. I walk another 10 feet. And then the next thing I know, I'm looking at my phone again. 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 regulate it. And in fact, that's what mindfulness is all about. You could think of mindfulness as a form of de-automatization, of making the unconscious conscious. 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 temperature of that air, the warmth and the coolness of the air moving in and out of the nostrils. And then what happens? Most people, if you're like 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. 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. 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 loop of mindfulness, as we call it in MORE, what you 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 is just one example, but even that basic core skill of mindfulness has a lot of implicability to gaining awareness of unhealthy automatic habits that we all fall into and then gaining some control 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. All 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. So the logical question then is, you know, how do you develop mindfulness? You just described the core tenets 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, et cetera, et cetera. Yeah. And then are there other forms of meditation that you use or recommend? Oh, yes, absolutely. And those are the core basic techniques. Although I would add that in more, there's always something a little more, pun intended. So, for example, even with the body scan, 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. 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-transcendent states of awareness in which awareness and space are one. And then lastly, another little twist there is because more is really oriented around savoring, So appreciating and relishing and basking in positive emotional experience, we guide our patients to finish the practice by turning their attention towards any positive mental states that have arisen during practice and really to take a moment 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, rewire the reward system, and heal itself from the effects of addiction and pain. And we can talk more about that. Yeah, I fully intend to. As I stated a while ago, the three parts of more are mindfulness, reappraisal, and savoring. You just mentioned savoring, and we will get to that because there's a lot to say there. But you said something else that I want to explore, 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-transcendence. Can you define those terms? And then I think on top of that, say a little bit about how it's helpful. Yes, absolutely. So this has been a real focus of my entire pathway, I would say, leading into this work, and more recently in the past, I would say, seven years, a more intense focus of my scientific work. non-dual awareness is a term that is used 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 and paying attention to objects in the world that's the duality of subject and object and we typically go through life like this, 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 normal subject-object duality begins to fade, and we feel the sense of closeness or interconnectedness or oneness with the world around us. And in that moment, the separation between the subject and the object disappears, and there is this non-dual awareness that arises. And in the psychological literature, the term for this is self-transcendence, 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. There are many nuances to this, but I think that's an easy way to understand it. And I think this experience is not as far away as many of us think it might be. 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 that you just lose yourself in it and you just feel filled with the thrilling bliss of the musical notes? Some people experience this in nature. Let's say the beautiful sunset at the beach, which I live here, 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, let's use an egghead word here, the original soteriological purpose of mindfulness in traditions like Buddhism and Hinduism was not to regulate stress and it wasn't to strengthen your attention. The purpose was to gain insight into the fundamental nature of reality, which is this non-dual continuum. 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-transcendence 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. So I don't know how you want me to respond to that, but what I would say concretely, just experientially, for example, and 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? That's a very clever way to teach it. Yeah, because can you really feel a difference? And then another practice, and this is an ancient one, this isn't mine, I can't claim this one, starting to tune attention towards 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 whole question of is the self an illusion, that's a thorny philosophical conversation. I don't know if we want to get into that. Well, let me steer it back to the very practical and concrete, which is how does self-transcendence, interdependence, non-dual awareness, all this stuff we've been talking about, help managing my everyday addiction to my phone? Let me just frame this for you in the clinically severe case first, and then bridge it into everyday experience, if that's okay with you. When you think about chronic pain, which again, 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 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 just become consumed by it. And the same kind of process happens in addiction. Repeated rumination on addiction-related thoughts and cravings over and over again results in addiction becoming 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. We also know from neuroscience that both chronic pain and addiction involve dysregulation in what's called the brain's default mode network. And the default mode network 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-transcendent experiences where the normal sense of self becomes quieter, then this may actually interrupt activity in the brain's default mode network and help 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 ourself from the trap of pain and addiction. That's the concept. concretely? How does it affect our everyday sorts of addictions? Well, when we have tastes of self-transcendence, and I'm not claiming that we're going to have some knock you over the head, bolt of lightning, the clouds open up and an angel comes down and bathes you 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 when the mind touches these more self-transcendent places, they carry this inherent reward value. They have this tone of positivity, peacefulness, of love, maybe even bliss. These are moments in which 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 an addictive behavior. My friend Judd 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 it feels good to be aware or to be in a state of awe, to be transcending the self, that maybe that's what you turn to in moments of distress 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. Yeah, and we have data that directly supports that. We have strong data that supports that. Coming up, Dr. Eric Garland talks about some mindfulness techniques for dealing with pain, specifically zooming in and zooming out. I'll let him explain that. He talks about what pain actually is, some practical tools for reframing negative thought patterns, and for decreasing self-destructive behavior. Getting older is great in many ways. I find that the older I get, the happier I am, the calmer I am, the more content I am. The one drawback, of course, is that aging can be tough on the body. So I spent a lot of time personally thinking about how to take care of my body. knowing, of course, that everything is impermanent. Which leads me to one of our sponsors today, a company called Fatty15. This is a supplement built around something called C15, which is the first emerging essential fatty acid to be discovered in more than 90 years. It's an incredible scientific breakthrough, they say, to support your long-term health and wellness. 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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 in our everyday lives called STOP. That's right. Can you teach us how to do it? Yeah, absolutely. So STOP is a really simple practice. First step is to stop, to stop right before you engage in the addictive habit. Instead of doing the thing that you felt compelled to do, second step is to just take a few mindful breaths. It doesn't have to be a long time. It could be 30 seconds. It could be a minute. It could be three 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 O, to observe your thoughts, your feelings, your body sensations in this moment, in the presence of 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 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 you do this practice is that cravings don't last forever. They actually are impermanent, that they change over time. And if at any point you get too overwhelmed 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 get some relief from the distress in the body. And then the last step of this stop process is P, to proceed with intention. So, of course, ultimately, it's your choice whether or not you're going to engage in this behavior. You're going to consume the substance 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. 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 the desire to do it is starting to fade away. It's getting weaker over time. This practice, this very simple practice, is the jumping off point for lots of people and changing addictive behavior. I like it a lot. Great. It's a brief practice. The full mindfulness of craving technique is more elaborate and intensive. That takes some time to build into it. But 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. Hopefully we'll talk about mindfulness for pain too. And that, because that's a unique technique in MORE. Yeah. So let's talk about mindfulness specifically for pain because you've got a technique that is called zooming in and zooming out. That's right. I'd be curious to hear you describe that one as well. Great. Do you want me to give some context, talking about pain in the brain and all that stuff first? Please. Yeah, sure. Great. 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 nociceptors, 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 thalamus. And the thalamus 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 amygdala 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 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. But also when we're feeling calm or safe or we're feeling engaged in an activity that we love, that can actually turn the volume of the pain down. So given this neuroscientific model of pain, 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, 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. That's the heart of the Moore approach. So the way we do this is through mindfulness and a specific mindfulness of pain technique. It begins by mindful breathing as a way to calm down the mind, to center 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 the subcomponent sensations 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 experience of pain 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 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 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 person begins to notice that these sensations change over time. They're not permanent. and noticing that they're changing can bring hope and relief. And this practice of using mindfulness to cultivate interoceptive awareness, the awareness of the physiological condition of the body, can get people out of their heads about their pain. 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. We've conducted more than 16 randomized controlled trials of MORE, funded by more than $90 million in federal research funding. So we have done a lot of research on this therapy. We see very clearly that MORE cuts pain significantly. So it drops chronic pain by about 25%. And that effect lasts nine months after the end of this eight-week 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 five milligrams of OxyContin. And some people get a lot more pain relief than that. Some people can drop their pain to zero during the practice. But on average, it's cutting it by about a third. It's incredible. Okay, so let's move to some of the other aspects of the Moore protocol. As I keep reminding listeners, there are 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 the cornerstone of cognitive behavioral therapy. It's also an ancient idea that was reflected even 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 challenges in our life, that this will have a powerful effect on how we respond to those challenges. So when we experience some sort of a stressor, our mind automatically and rapidly goes into this stress appraisal where we see this thing that's happening to us as a threat. And we oftentimes feel really overwhelmed by it, like we can't handle it. And these computations happen super fast in the brain within the span of a couple seconds. And then the body starts getting stressed out. Then that's the whole fight or flight response that we're all too familiar with. heart starts beating fast, muscles get tight, start sweating, stomach discomfort, your cortisol is rising and you feel awful. And if you have chronic pain, that actually magnifies the pain, makes the pain hurt worse. 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 practice of becoming aware that this is happening and then using a few moments of mindfulness to stop this process, to disrupt it, and then to consciously challenge and change those negative thoughts into a more helpful way of viewing the situation. 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 it all bad? What are the positive sides to the matter? And crucially, 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 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, is there physiological evidence to show that reappraisal can help at the level of the brain or other parts of the body? big time. Broadly speaking, reappraisal is one of the most extensively studied emotional regulatory processes 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 the emotional parts of the brain, like the amygdala. In my own research studying more, we've shown that training people in reappraisal through more, that people can actually drop their skin conductance responses. That's what people measure when they do the lie detector test. You're basically measuring sweat at the fingertip, which is 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 reliving a past trauma or experiencing a shame spiral over the fact that I did that thing again, I overate or I had a little too much to drink or I spent six 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 what I'm hearing from you. And then 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? You articulated really well in those moments. If we do slip into some sort of unhealthy habit or addictive behavior and we are feeling shame about it Or like you said we experienced some sort of pain and we start to get really upset about it maybe start catastrophizing about it thinking that life is terrible because of this pain and that there no way I can handle it Reappraisal is really useful in those moments to stop yourself 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 facing them is actually helping you to grow as a person. So how do you do it in those moments? Well, the 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. When you're starting to get worked up, you remember it's time to practice reappraisal. And then the next step is to become aware of what are the negative thoughts that I'm having that are leading to me feeling stressed out. once you're aware of those negative thoughts, you can become aware of 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 move 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 spiritual guide, what would they want me 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? That's the practice and we have an acronym for it. That's A-B-C-D-E. It's not our acronym. 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. 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 perspective. And then the last step in the process is E, which is to evaluate what is the effect of this reappraisal. Now that I'm thinking about this situation from a more helpful perspective, how is it impacting my emotions and how can it help me to respond, 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. that's right and so like i said in more there's always something a little bit more so abcde is a classic approach in cognitive therapy but in more we inject a little bit of mindfulness into this process because as one of my good friends and colleagues philippe goldin said mindfulness is the wd-40 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 reframe our negative views of the situation and take a broader perspective. Coming up, Eric talks about some very practical ways to re-inject a sense of joy into your life. okay let's get to the third area of more and that is savoring you mentioned this a little bit earlier but i think at first blush it can seem a little counterintuitive we're talking about managing you know our quotidian pains and emotional distress and addictive behaviors how does savoring fit in? For many people, addictive behaviors, they start as an attempt to escape some kind of pain. It could be physical pain. It could be emotional pain like stress or anxiety 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 the reward system gets rewired. The brain becomes hypersensitive to stress and pain and drug-related cues, but the brain also becomes less sensitive to the simple 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. That's the vicious cycle and the downward spiral of addictive behavior. But what we see in Moore 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 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 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 the pleasure you get from the sense of touch, touching the object of your body moving through space. All of these kinds of sensory portals can provide the experience of pleasure. And so we guide the person to focus their attention on what is 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 that practice is, I think, really important when it comes to people who are struggling with addictive habits, 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 retraining the brain's capacity to re-experience natural, healthy pleasure and joy. It's sort of like weightlifting for your brain's reward system. I like that analogy. You said a little bit of this, but I think it's worth just re-emphasizing. How can we integrate this practice into our day, wherever we're at? whether we've got, you know, significant chronic pain or 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. Fortunately, savoring is like this little secret that you can keep in your pocket and whip it out at any time there's the opportunity. So for example, you know, you've been inside working all day and 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 it's a nice day outside, you step outside and you feel the warmth of the sun on your face, 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 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 sensation, you become aware of the pleasure 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 imagine as if you could 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 20 seconds. It could be a minute. And then you move on to the next thing. That's one example. Maybe it's you're watching your kid play in the backyard and play with their friends. And you see the smile on your child's face and the sparkle in their eyes. And instead of just rushing around to 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 your own joy. And then you turn your attention inward and you savor that positive inner feeling and just Breathe it into the center of your being. Allow it to linger and expand. There's just tons of moments like this all throughout life that we oftentimes miss because we're just rushing around on our to-do list. Do this, do this, do this, do this, do this, do this, and that. 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 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 that's right life is a we think of it as a shit show i think many of us do and it is in many ways i'm not trying to gaslight anybody and say everything's amazing but there are roses that you should stop and smell and life is a target-rich opportunity for savoring, and why would we pass that opportunity up? Exactly. The Buddha observed that life is suffering. There's suffering inherent in life, but there's also beauty and joy inherent in life, and they co-arise. 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'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 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, 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. Amen. Or as the Buddhists say, Sadhu. 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? So in March of 2024, I went to brief Congress. I went to Capitol Hill and briefed the addiction treatment and recovery caucus of the U.S. 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 distress and chronic pain to help alleviate the opioid crisis. So a lot of my work now is focused on disseminating more to teaching therapists and clinicians all around the country and are all around the world. And we have an active online training program at moretherapy.com. Okay. So that's what I was going to ask. If people want to learn more, either to get involved as a trainer or to get the therapy themselves, it sounds like they should go to moretherapy.com. Are there other resources that you've put out into the world that people should know about if they're interested in learning more about more? I published a book on more that walks through the entire therapeutic process. That book was published by Guilford press in 2024. And we're going to be coming out with an app very soon that contains these practices and the education around more. And that can also be found at more therapy.com. Excellent. 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 a great conversation. Great. Thanks again to Eric Garland. Great to meet him. Don't forget to come join us for the Meditation Challenge. We're launching over on the 10% with Dan Harris meditation app. It starts on March 23rd, runs for five days until the 27th. We're doing this in conjunction with a new Audible original, an audio book that I'm releasing with my co-author and great friend, Sabine Selassie. It's called Even You Can Meditate. So that's the name of the meditation challenge we're running, Even You Can Meditate. Head on over to danharris.com to download the app, or you can just get it wherever you get your apps. And finally, thank you so much to everybody who works so hard to make this show, and they really do work hard. Our producers are Tara Anderson and Eleanor Vasili. Our recording and engineering is handled by the great folks over at Pod People. Lauren Smith is our managing producer. Marissa Schneiderman is our senior producer. DJ Kashmir is our executive producer, and Nick Thorburn of the band Islands wrote our theme.