Adding Mindful Awareness in Body-Oriented Therapy (MABT) to Medication Treatment Benefits People With Opioid Use Disorder

Adding a mindfulness-based intervention to a standard treatment for opioid use disorder does not appear to alter substance use but does lead to positive changes in other areas that can help improve the standard treatment, according to a new study published in Mindfulness. The study was conducted by researchers at the University of Washington and partially funded by the National Center for Complementary and Integrative Health through the NIH Helping to End Addiction Long-term® Initiative (NIH HEAL Initiative®). 

The most effective treatment for reducing drug use in people with opioid use disorder, and for lowering the morbidity and mortality associated with the disorder, is to take certain medications, an approach called medication for opioid use disorder, or MOUD. The typical medications taken in MOUD are buprenorphine or methadone and sometimes naltrexone. Among people with opioid use disorder, there is a high prevalence of other substance use, psychiatric disorders, and chronic pain; these conditions are associated with poor treatment outcomes, suggesting the need for additional supportive interventions.

The study involved 303 adults from six community clinics in the Northwestern United States who were diagnosed with opioid use disorder and stabilized on MOUD, averaging over a year in MOUD treatment. Participants were randomly assigned to receive either MOUD only or MOUD plus mindful awareness in body-oriented therapy (MABT). MABT is a program that teaches interoceptive awareness skills through psychoeducation, mindfulness, and touch-based coaching to promote self-care and emotion regulation. Interoceptive awareness involves sensing, processing, and appraising the internal state of the body, and past research indicates that training in interoception may improve patient well-being and support MOUD.

MABT was delivered individually to participants in 75-minute sessions that occurred once a week for 8 weeks. Participants were taught sensory awareness and mindfulness skills to build their interoceptive capacity. The touch-based coaching, provided by licensed massage therapists trained in the MABT protocol, involved using manual touch to guide a participant’s attention to specific regions of the body. Participants also had weekly take-home assignments to practice and incorporate MABT skills into their daily lives.

At the start of the study, participants already had high rates of abstinence from opioids and overall substance use. At the 3-month assessment, these high abstinence rates were maintained and likely contributed to their being no difference between the MOUD-only group and the MOUD plus MABT group. Changes between the two groups were seen in other areas, however.

The study participants in general were experiencing high rates of co-occurring chronic pain and mental health symptoms, including post-traumatic stress disorder (PTSD), depression, and anxiety. After 3 months, participants in the MOUD plus MABT group had significantly better improvements in PTSD symptoms, pain severity, pain interference in activities, and physical symptoms. Depression and anxiety symptoms, however, did not differ significantly between the two groups after 3 months. 

Overall interoceptive awareness increased significantly more in the MOUD plus MABT group than in the MOUD-only group. And although not significantly different, those receiving MOUD plus MABT tended to experience a greater reduction in emotion regulation difficulties.

According to the researchers, whereas this study evaluated patients after they had become stabilized on MOUD, future research on MABT’s effect in people initiating early MOUD treatment when they are at highest risk of dropping out, would help to understand the full potential benefits of MABT on substance use. The researchers also noted that a future publication will present results beyond the 3-month period assessed in this study.