Welcome back to the Healing Pain Podcast with Eric Garland, PhD, LCSW

As always, it’s an honor and a pleasure to be spending this time with you. If you’re using any type of psychologically informed care, whether you’re a physical therapist, an occupational therapist, a coach, a nurse, a physician, or a mental health provider, you’ll notice that many people observe that pain impacts their thoughts and brings about emotional states that affect their body, aggravates pain and for some, increases their desire for drugs such as opioids. More and more patients are seeking integrative and comprehensive pain therapies that care for both their body as well as their mind. Some realize that pain medications alone are not enough to address the root cause of their problem.

In this episode, we speak with Professor Eric Garland, who teaches at the University of Utah, a licensed clinical social worker and a researcher who uses mindfulness to treat many chronic conditions. His research has been shown to be effective and support the recovery from alcohol dependence, opioid misuse, nicotine addiction, relieve pain as well as symptoms of post-traumatic stress disorder, reduces video game addiction and unhealthy eating behaviors. We’ll take a deep dive into the theory, research and practical components of delivering mindfulness-based interventions.

Specifically, this episode centers around three concepts that I want to define before we begin this episode. The first is simply mindfulness, which is a state achieved by focusing one’s awareness on the present moment while accepting thoughts, feelings, and bodily sensations. The second is reappraisal, which entails helping people shift their thinking and developing new, more helpful perspectives, beliefs, and actions to deal with stressful events. The third is the skill of savoring, which is a positive sense of reward needed to drive and sustain behavior change. This is an excellent episode for those living with chronic pain, stress and related conditions, as well as the practitioners who treat them. I enjoyed speaking with Eric and I know you will as well. Let’s begin. Let’s meet Professor Eric Garland.

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Using Savoring And Mindfulness To Treat Chronic Pain And Addiction With Eric Garland

Eric, welcome to the show. It’s great to have you here.

Thanks for having me here, Joe.

I’m excited to talk about some of your work, both your clinical work and your research, which I know are intimately related and discussing some of the mechanisms around mindfulness. We’ve discussed a lot of different types of psychological interventions on the show over the years. We haven’t gone deep into mindfulness and some of the research you have starts to go deep into the mechanisms and the moderators, which is interesting. Before we get into all that technical stuff, tell us how you first became interested in mindfulness.

My interest in mindfulness began with a deep a g personal practice of mindfulness meditation. I started that when I was eighteen years old as a way to help me navigate life, gain deep insights into what life was all about. I married that personal interest in mindfulness practice with a scholarly interest in the philosophies that wrapped around mindfulness meditation as the centerpiece. I was studying various branches of Buddhism, Hinduism and Daoism in college. There was a time when I thought I would become a scholar of contemplative religious studies, but I want a different path in life and became a clinician instead.

I took this personal interest in mindfulness. That was a path to personal spiritual growth and I developed it into a tool to help people who are suffering from chronic pain, addiction and mental health problems. After doing clinical work in the field for a while, mostly in integrative medicine settings, then I began my career as a scientist, where I focused on mindfulness in earnest to understand its mechanisms and show with rigorous science how it can help people.

Eighteen is relatively young to start mindfulness and fall into it. I’m sure lots of people would like to see their kids practice more mindfulness and meditation. I know it’s used in lots of schools and different types of programs. You became a licensed clinical social worker. Did you start implementing mindfulness in right away? Sometimes clinicians can have a hard time weaving mindfulness in with patients, or they’re not sure how to explain mindfulness or how to explain what they’re doing and practice. How did that start to evolve for you before you got to the research part?

I got into this integration of mindfulness into psychotherapy before it was a thing. Before, the world had heard a lot about Jon Kabat-Zinn and mindfulness-based stress reduction. This was in the early years. There was certainly a psychotherapist practicing mindfulness, but it was more on the underground. The thing that I could find that was closest to the mindfulness traditions that I had been studying from a philosophical standpoint, the technique that was closest to the Western medical arena was clinical hypnosis. I started early in my career getting certified in clinical hypnosis. I was doing that to find a Western legitimacy to this meditative pursuit of altered states of consciousness.

As time went on, it came to be that because of all the good science around mindfulness conducted by my colleagues and I hope I myself have contributed to that, mindfulness became something that was more accepted in Western medicine. We started to be able to talk about it. From the early days of my clinical practice, I was weaving in mindfulness meditation into sessions with patients along with hypnosis and cognitive behavioral therapy. It was a potent combination.

How would you differentiate mindfulness from let’s say traditional cognitive behavioral therapy?

The first starting point of bifurcation is that in traditional cognitive behavioral therapy, we aim to change negative thoughts, to transform negative thoughts into more helpful ways of thinking about life stressors. Whereas in traditional mindfulness meditation practice, we aim to disengage from thought entirely and shift into a different mode of experience where we’re witnessing thoughts and emotions without trying to actively alter their content. Although I gave you that explanation, that’s an oversimplification.

It was more than a decade ago where I proposed that mindfulness would facilitate the transformation of thoughts so that mindfulness should enhance the ability to do cognitive therapy because mindfulness helps us to have a more psychologically flexible perspective on our life situation. There’s been a fair amount of data gathered to support that hypothesis over the past several years. I don’t think the distinction is that clear-cut as one might think. The main difference is mindfulness teaches us a different way of being in the world as opposed to cognitive therapy, which focuses more on changing our behaviors.

When you mentioned that mindfulness could help facilitate traditional CBT, which is changing thoughts, that shows up in a lot of different types of psychotherapies. Even something that’s called pain education has aspects of that. I know the answer to this but I’m going to ask you that anyway. Would the mindfulness come before you try to reappraise or help restructure thoughts, would it come after, or is it like a through-line in essence throughout the entire aspect of it?

As a trained cognitive-behavioral therapist, but also someone who was immersed in the mindfulness field, early on, I wanted to integrate these two things into one approach to practice. That was one of the major impetuses for me developing mindfulness-oriented recovery enhancement or more, which integrates mindfulness training with cognitive behavioral therapy and also principles from positive psychology, namely the most important one being savoring. That notion spurred me on to do this.

To answer your question directly in more, we teach mindfulness as a foundation upon which we scaffold these other skills. First, we teach mindfulness as the platform and the foundation in order to help patients to develop greater stability of mind, better attentional control, better clarity, and also in openness. This psychological flexibility that then they can use to reappraise negative thoughts about their lives and to shift into focusing on positive life experience and savoring the good out of it.

I’ve always thought if we’re in a controlled environment in the clinic and I’m prompting someone by asking them what type of thoughts or emotions you’re having around the problem you have, we’re prompting them to notice or observe their thoughts. When they’re out on their own if they don’t have the skill of observing, then they may not be able to engage themselves in that process of restructuring or reappraisal. Would that sound correct?

They might find themselves freaking out and not even knowing why. “I’m in a bad mood.” Why are you in a bad mood? “I don’t know. It’s a crappy day.” Not necessarily having the insight to catch the moment by moment arising of the negative thought patterns that then promote those destructive emotions.

You have a paper which I recommend everyone should read. It’s in the Current Opinion in Psychology of 2019. It’s called Positive Psychological States in the Arc from Mindfulness to Self-Transcendence: Extensions of the Mindfulness-to-Meaning Theory and Applications to Addiction and Chronic Pain Treatment. It’s a long paper with some interesting theories. One, you mentioned savoring. I want to touch on that first. What does savoring mean to you? How does that impact on states of chronic pain?

That paper that you referenced is probably one of the wildest pieces I’ve published so far. I commend you for reading it because I went out on a limb in some of the theories that I pushed in that paper. In that paper, savoring is a key piece of it, but there’s almost a journey that begins with mundane forms of savoring leading all the way to self-transcendent forms of savoring. To put it simply, savoring is the process of focusing attention on unpleasant everyday events, and not only appreciating the pleasure that can be derived from the sensory features of that event. How it looks, how it smells, how it sounds, its touch, texture, but also becoming aware of how encountering this pleasant experience is affecting you.

How is it affecting your emotions? How is it affecting the bodily states of pleasure that can arise when you’re having a good experience? That second part of savoring is crucially important. It involves this process of mindfulness. When we’re savoring something, a beautiful sunset or nice weather, a breeze on a warm summer day, you can appreciate the experience, but at a certain point, it starts to affect you. You start to notice those positive emotions of contentment, relaxation or maybe joy or appreciation.

Those emotions also have this impact on the body. We start to notice pleasurable sensations in the body. As this occurs on a neurophysiological level, there’s an activation in reward circuitry in the brain that is in part mediated by the endogenous opioid system. That happens to be involved in the body’s own natural painkilling process. You’ve asked, what’s the connection to chronic pain treatment? Part of the connection is there that when we’re deeply and mindfully immersed in a pleasant everyday experience, that experience becomes so rewarding that it can relieve pain. The neurocircuitry of pain and pleasure are intimately intertwined.

You have a nice example of your first day on the beach after a long, cold winter and the feeling of sunshine on your skin and that warmth. That’s pretty easy for us to connect to savoring type of experience.

From a physical therapy standpoint, I’ll give a different example. Let’s say you’re doing a stretch or some physical therapy exercise with a skilled therapist. You get right to that point where it’s pushing you, but it’s not pushing you too far. In that moment of your body getting activated again, there may be some pleasure at that moment. If you have a bunch of beliefs that have accrued around that like, “I hate exercise. I can’t do this. This is going to hurt me.” You may not notice that. Therefore, you may need techniques like mindfulness and reappraisal to overcome those negative thought patterns. When you then focus in on the experience, you feel the warmth in your muscles and you recognize that this activity is good for you and it’s helping to heal you, there can be a source of pleasure there.

I love that for a physical therapist. When I started to look at some studies on traditional exercise versus more mindful moving practices like yoga or Tai chi, where it’s purposely having an awareness component to it, or a focus component to it. It offers an opportunity that we can teach people to savor movement when beforehand they were averse to it. In this paper, you also talk about a transcendent upward spiral, which is important to maybe talk about what an upward spiral means in that. You talk about aspects of decentering, attentional broadening, reappraisal and then savoring was the first part of that. It also sounds a little bit like these are mechanisms of how mindfulness is in essence working. Is that what you’re saying in this paper?

Yes. All these various mechanisms that you named, they interact with one another to create what I and my colleague and mentor, Barbara Fredrickson, have termed an upward spiral. We observed and researched more than about a decade ago that positive thoughts and emotions can magnify each other. There are a lot of downward spirals in life. A lot of vicious circles we get into. Negative thinking makes us feel bad. When we feel bad, we don’t feel like being active or doing things that are good for us. That makes us feel worse. We start to think negatively about ourselves. That gets us trapped further in this downward spiral. In the same way that there are downward spirals in life, there can also be upward spirals in life.

We can interrupt and reverse this downward spiral process by inducing an upward spiral of positive cognition and positive affect. We posited several years ago that mindfulness would be a linchpin in reversing the downward spiral into an upward spiral. Mindfulness is not the only process that’s important here. It’s a key process because it helps us to become aware of when we’re falling into the negative mental pattern and then gives us some freedom from it. Mindfulness, the theory goes, can synergize more elaborate cognitive and emotional processes like reappraisal and savoring. When we’re mindful, we have the capacity to reframe the difficult parts of our life as meaningful, as teaching us something important. It’s helping us to grow. When we do that, we feel better. We feel happier.

When we savor those positive feelings, that further accelerates the upward spiral. When we’re in a positive mental state, and this is Barb’s work, that tunes our attention to notice other pleasant and good parts of our lives. It broadens the field of cognition. It makes us more open-minded and starts to notice parts of our life that we didn’t notice and helps us to come up with creative solutions to our life problems and motivates us to take meaningful action to improve our lives. That whole arc that I described, I called that the Mindfulness-To-Meaning Theory. It is the basis for this paper that you’re referencing.

The new piece that the paper adds is the self-transcendence aspect. As the upward spiral goes and we start to have these more meaningful experiences of getting engaged in life, connected with other people, doing things that we care about. We may also progress to experiences of self-transcendence, where you get beyond yourself and start to connect with something greater than yourself. It’s a healing experience. It can be very liberating.

From an analgesia standpoint, my colleagues and I like to joke, “No self, no pain.” If you think about it, if you don’t have a self, you’re not going to be in pain. In those moments when you transcend yourself, you get beyond your limited perspective and beyond your fixation on the condition of your own individual body, that can be relieving. This may be starting to sound like a bunch of metaphysical gobbledygook, but I’ve got data to back this up.

We published data from a randomized controlled trial in 2019 in the Journal of Consulting and Clinical Psychology that showed that the mindfulness therapy that I developed, Mindfulness-Oriented Recovery Enhancement, which integrates training in mindfulness, reappraisal and savoring decreased chronic pain, severity and decreased opioid misuse. Germane to what we’re talking about right here, what we found interesting was that this therapy was reducing pain in part by increasing self-transcended experiences. Self-transcendent experiences statistically mediated the effect of mindfulness-oriented recovery enhancement on relieving pain. These kinds of lofty metaphysical experiences have real clinical value. When we discovered that, that was exciting to us. We were pretty thrilled because this is probably the first time this has been shown in the scientific literature.

If you talk to people who are long time meditators who have gone on long meditation retreats, they’ll mention this transcendent sense of self. As you probably well know, it’s hard to describe. Although sometimes it’s not hard to describe because it’s clear when you’re in the moment. Anyone who has had the experience, it’s easy to talk to them about it. If you haven’t had the experience, people have a hard time identifying with it. How do you put in words developing that transcendent sense of self that comes from a consistent or a deep mindfulness practice?

Since we’re talking about savoring, I’m going to bring it up in the context of savoring. Recognizing this connection, I only connected these dots which is one reason why I wrote this paper that you’re referencing. At that moment, for example, you’ve been stuck inside due to COVID and you’ve been missing the ocean. You finally get out to the ocean after a long time. You stand at the edge of the water. You’re hearing the sound of the waves. You’re feeling the warmth of the sun.

When you’re in that moment, savoring that experience, you can under the right conditions, experience a sense of oneness with the world around you. What is that like? That could be like the quieting of your mind so that your thoughts slow or even completely cease. There’s no more focus on your body as this isolated unit, but rather you may feel the sense of there’s almost like a physical continuum between yourself and the world. There’s no sharp boundary between yourself and the world.

The envelope of the skin in which we all find ourselves, that boundary starts to become more permeable. It starts to dissolve and even fade away. Sometimes in that experience, there can be a feeling of a blissful warmth that extends outward into space. Other people describe it as a form of love, communion, connection or peace. It’s a sense of there being no separation between you, the observer and the world that you’re observing. It’s all one picture.

Is there a sense of stepping outside yourself and being able to observe yourself observing the experience?

That gets back to your first question about the mindful form of self-transcendence. What I was describing to you is more of this relational form of self-transcendence. My colleagues and I developed a quantitative instrument to assess self-reports of self-transcendence called The Nondual Awareness Dimensional Assessment. We published that a couple of years ago in the Journal of Psychological Assessment. There, we found two domains of this self-transcendent experience. One was more relational like I’m describing. The other is one that you’re hinting at, which is you stepped back and you’re observing yourself and observing your experience.

There’s a certain moment at which the observing capacity turns back upon itself. You’re no longer focusing your awareness on the objects of your experience. You’re no longer focusing on your thoughts, your feelings or your perceptions, but awareness is focusing on itself. It’s focusing on its own capacity to be aware. Do you ever stand between two mirrors and you’re looking at yourself in one mirror and you’re seeing a reflection that goes back to infinity? There’s a sense of that at that moment. That’s a different attitude of self-transcendence than the relational one. They’re both things that advanced meditators and practitioners have discussed for thousands of years. We’re only beginning to understand these states and their clinical value with modern science.

I know you’ve done some work and research in this area, any idea how many hours it takes someone to be able to dip into that sense of transcendent self via training?

I can give you a clinical anecdote from the trials that I’ve conducted. Over the past several years, I’ve probably enrolled more than 1,000 patients in randomized controlled trials of Mindfulness-Oriented Recovery Enhancement. What I can tell you is that in the very first session, there are some patients who drop into that immediately, which is shocking. If you ask people, when has this happened? People say, “Only to the most advanced meditators,” but that’s not what we found.

When we do this research with people who are in a bad way, a lot of the people in our studies have multiple medical and psychiatric comorbidities. They’re suffering from chronic pain. They’re suffering from a major depressive disorder. They’re suffering from PTSD. They might be addicted to opioids or other drugs. They don’t necessarily have a high level of education or high SES. Many of them are unemployed. This group of people who have been through some tough stuff in life, out of a group of ten people, there will be 1 or 2 people who tap into that state almost immediately.

There will be other people in that group who would take 5 to 8 weeks of training, a practice to taste that state. There are others who maybe they never achieve it in the eight-week intervention that we have been studying, but we’ve been surprised at how patients will tiptoe into this state. They’re not swimming in it. They’re not totally immersed, at least touching it. It’s not too uncommon. Let’s put it that way. The key is asking people about whether they’ve experienced it. If they do start to experience a taste of it, giving them some positive reinforcement for being open to an experience like that.

I was a meditator. I’ve studied ACT pretty extensively. In ACT, they talk about this transcendent sense of self. I’ve meditated for years. I never experienced it in one day. You dip into this and it’s like, “This different room you walk into.” At the end of the meditation, I went up to the instructor. This is at a very traditional contemporary Buddhist-type of meditation center. I said, “I had this experience.” She said, “If it comes up, that’s fine. Just allow it to be there, but we don’t encourage people to detach from the experience.” I had read enough research at this point. I was like, “No, I was fully present. I wasn’t detached.” I completely knew where I was, what was happening. I knew the context I was in the room, etc. At that point, my scientific jargon and her explanation weren’t able to connect at that point, but it’s not detaching from yourself though at all.

That response is precisely what I’m alluding to when I say, “If you encourage people to talk about it and give them some reinforcement, you may be surprised at how readily people experience this.” It’s funny because talking about this stuff has been considered a no-no in many spiritual traditions. Therefore, in the modern mindfulness-based therapies that have emerged from them. Quite frankly, that’s a pity because there’s a lot of therapeutic potential in those states. If you look at the traditional Buddhist philosophy, for example, around this issue, those types of tastes of experiences, people are worried that somehow people are going to become attached to them.

They’re going to become an impediment to enlightenment, but I’m not in the business of enlightenment. I’m a psychotherapist. My job is to help people feel better. The traditions could be right. The attachments to these states could be an impediment to enlightenment. As a social worker, I may only have 6 to 8, 10 sessions to help somebody who’s suffering from a wide range of issues. If I can help them to achieve a healing state of consciousness that helps to significantly alleviate their pain and their craving for drugs or need to take opioids, then that’s a win as far as I’m concerned.

What you’re saying is that this particular aspect is probably not trained enough in either traditional mindfulness or when mindfulness is used in a clinical setting.

Yet these states can be therapeutic. I finished the biggest and most important study of my career. This was a five-year clinical trial funded by the National Institute on Drug Abuse. This was a study of Mindfulness-Oriented Recovery Enhancement for opioid misuse and chronic pain patients. The study had 250 patients in it. It was a big clinical trial. We found the same pattern that people did achieve these transcendent states and that the effect of Mindfulness-Oriented Recovery Enhancement on reducing pain was statistically mediated by this self-transcendent experience. We’ve got two separate randomized controlled trials replicating this effect. To me, that means these states are important. If they’re associated with clinical benefit, we need to pay attention to them as healthcare providers and scientists.

Can you tell us a little bit about your MORE protocol?

MORE is a manualized treatment. The treatment is published as a book. It is an integration of the three great traditions of mindfulness, cognitive behavioral therapy and positive psychology. It begins with a platform of mindfulness. We teach mindfulness at the beginning of the treatment. We teach mindfulness meditation at the beginning of every therapy session. MORE is an eight-session protocol. As the treatments even goes on, we start introducing other techniques. Next, we introduced reappraisal. Helping people to challenge and change negative thoughts to help them define meaning in the face of adversity. We introduced the skill of savoring. Teaching people how to mindfully focus their attention on what is pleasant, meaningful and good as a way to extract a healthier sense of pleasure and joy. Also, to remediate deficits in the brain reward systems that we know are integral to chronic pain, addiction and mood disorders. That’s this treatment sequence, mindfulness, reappraisal then savoring. As you say, mindfulness is woven throughout. It’s the thread that connects. That continues for all eight sessions of the therapy. We’re trying to teach patients how to not only alleviate physical pain and emotional pain but also to gain self-control over craving and over their automatic behavior.

The craving is important with regard to opioid addiction.

I’ve studied MORE for several years as a treatment for a variety of addictive behaviors, alcohol use disorders, substance use disorders, smoking cessation. We’ve studied it as a treatment for obesity, video game addiction. The bulk of the work has been on people with chronic pain who are taking prescription opioids and who may be at risk for progressing to misuse opioids or have already gone all the way to an opioid use disorder. There’s a lot of data at this point on MORE. The data across all of these trials, if you look at it as a whole, it shows this is an effective therapy. Not only do we have clinical outcome data, but we also have a whole bunch of neuroscience data to show how MORE is changing the brain and the body.

There are a lot of interesting effects there. One of the interesting ones is that it seems to be restructuring the way that the reward system in the brain works by helping people to become less reactive or less sensitive to drug-related cues and to become more sensitive, more responsive to natural, healthy rewards. Not only do we teach people savoring and they tell us, “After you taught me that technique, now I can enjoy life more,” but their brains become more responsive to natural pleasure. We can measure it with EEG.

You can see neuro-plasticity happening from the intervention. How many minutes do you require the participants to work on mindfulness or meditation throughout the protocol?

In the sessions themselves, the eight sessions, we gradually titrate the length of the mindfulness meditation. In the first session, it’s about seven-ish minutes long. By the eighth session, the patients are sitting for about a 40-minute long mindfulness meditation exercise. For homework, we only prescribe fifteen minutes a day. That’s a lot less than some of the other mindfulness therapies that are out there, but it’s hard for people to sit and practice for a long period of time. Even if we prescribed fifteen minutes a day, that seems to be enough to produce these benefits.

There’s some good research around smaller brief interventions with regard to mindfulness and supporting some type of change. It’s also approachable and it’s doable for people.

We tell people, “Even if you can’t do 15 minutes, do 3 minutes five times a day. Do whatever it takes. Try to practice some.” Our data is showing that the duration of mindfulness practice is correlated with the clinical outcomes. The people who practice longer are getting more benefits. There may be patients who never practice outside of the session. That’s why teaching mindfulness in the moment in these sessions is important. Giving people the therapeutic experience with mindfulness during the session, that maybe their opportunity to have this healing experience.

I liked some of the processes that you talk about in the paper with regard to mindfulness. It starts to make you think about what psychological process is at work when you’re teaching mindfulness or mindfulness is taking root in someone. There are some people who have a critique on mindfulness who claim that it lacks the behavior change part of it. The cognitive part is there, but yet the behavior change part is not there. Do you have a response to that or some words you would add to that conversation?

That’s a legitimate concern. I see that point, which is why there’s a lot of gain to be had by integrating mindfulness with other forms of therapy like cognitive behavioral therapy. I agree. You can change the mind, but where the rubber hits the road is how people change their life and get engaged with life. In my private practice, I’ve done psychotherapy for a while with lots of different conditions. I remember a case that’ll never leave my mind. I’ve treated major depressive disorder with purely behavioral techniques. I didn’t do anything cognitive at all and it worked wonders. I see their point, this critique to mindfulness but I do think that it doesn’t have to be an either/or approach. At least that was my standpoint. That’s why I developed Mindfulness-Oriented Recovery Enhancement. I think that mindfulness would facilitate the positive behavior change that patients need.

Eric, it’s been a pleasure talking to you. I enjoy reading your research. It’s needed with regard to how mindfulness impacts all different types of processes and different types of both mental and physical health conditions. Can you tell people how they can learn more about you and how they can follow your work?

I have a website so people could come to check out the work there. That’s www.DrEricGarland.com. I also provide training in Mindfulness-Oriented Recovery Enhancement to clinicians. I train social workers, psychologists, nurses, physicians, physical therapists. I train healthcare providers in this technique. I hold a couple of trainings every year. These are two-day workshops, intensive, combined didactic with experiential learning and mock client-therapist interactions. Since COVID, I’ve been holding these online, so doing it over Zoom. That seems to be a good format for people to learn no matter where they are. If you’re interested, come to my website.

I want to thank Eric for being on the show. Make sure you check out his work with regard to the MORE method. You can find it at DrEricGarland.com. Stay tuned and I’ll see you next time.

Thanks, Joe.

Important Links:

• Professor Eric Garland
• Jon Kabat-Zinn
• Positive Psychological States in the Arc from Mindfulness to Self-Transcendence: Extensions of the Mindfulness-to-Meaning Theory and Applications to Addiction and Chronic Pain Treatment – Article
• Mindfulness-Oriented Recovery Enhancement
• The Nondual Awareness Dimensional Assessment – Article

About Eric Garland, PhD, LCSW

Dr. Eric Garland, PhD, LCSW is Distinguished Endowed Chair in Research, Professor, and Associate Dean for Research  in the University of Utah College of Social Work, Director of the Center on Mindfulness and Integrative Health Intervention Development (C-MIIND) and, Associate Director of Integrative Medicine in Supportive Oncology and Survivorship at the Huntsman Cancer Institute. Dr. Garland is the developer of an innovative mindfulness-based intervention founded on insights derived from cognitive, affective, and neurobiological science, called Mindfulness-Oriented Recovery Enhancement (MORE). As Principal Investigator or Co-Investigator, he has received nearly $50 million in research grants from a variety of prestigious entities including the National Institutes of Health (NIH), the Department of Defense (DOD), and the Patient Centered Outcomes Research Institute (PCORI) to conduct translational research on biopsychosocial mechanisms implicated in stress and health, including randomized controlled trials of MORE as a treatment for prescription opioid misuse and chronic pain conditions. In recognition of his expertise in mindfulness research, in 2012 Dr. Garland was named Fellow of the Mind and Life Institute, the world’s premier, multidisciplinary organization for the scientific study of contemplative practices, and in 2019 was inducted as a Fellow into the American Academy of Social Work and Social Welfare. Dr. Garland served as Chair of the Research Working Group of the National Academic Consortium for Integrative Medicine and Health, and in 2019 was appointed by NIH Director Dr. Francis Collins to the NIH HEAL Multi-Disciplinary Working Group comprised of national experts on pain and addiction research to help guide the HEAL initiative. Dr. Garland has had over 150 scientific articles and book chapters published in respected, peer-reviewed outlets, and he currently serves as Associate Editor for the journal Mindfulness. To complement his expertise in clinical research, Dr. Garland is a licensed psychotherapist (LCSW) with more than a decade of clinical experience working with persons suffering from addictive behaviors, mood disorders, traumatic stress, chronic pain, and psychosomatic conditions. He has provided mindfulness-based therapy, cognitive-behavioral therapy, and clinical hypnosis for these patients across a wide range of integrative medicine and mental health settings. In recognition of his expertise as a psychotherapist, in 2015 Dr. Garland was elected Distinguished Fellow of the National Academies of Practice.