Discussion
anhedonia, OUD, chronic pain, decreased anhedonia, depression
CHRONIC PAIN, BRADLEY, SKIN
Here we obtained neurophysiological evidence in support of the hypothesis that MORE increases motivated attention to natural reward cues in chronic pain patients on LTOT – effects that were associated with decreased anhedonia. Relative to an active SG psychotherapy control condition, participants in the MORE group exhibited heightened LPP and SCL responses to natural reward stimuli. In individual difference analyses, increases in LPP activity during savoring predicted reductions in anhedonia symptoms through a 4-month follow-up.Findings suggest that training in attention allocation to the positive exteroceptive and interoceptive features of a stimulus context (i.e. savoring) through MORE can amplify LPP markers of motivated attention to natural reward stimuli. MORE's effects were similar on View and Regulate trials; though MORE provides training in proactive up-regulation of reward via savoring, it seems to enhance motivated attention to natural reward cues in a bottom-up fashion even when no conscious attempts to savor are made. Hypothetically, repeated practice of savoring may restructure the reward value of non-drug rewards, such that over time, no proactive efforts to up-regulate reward are needed; indeed, automatic (implicit) emotion regulation has been observed and indexed by the LPP (Zhang & Zhou, SCL during attention to natural reward cues also increased following 8 weeks of treatment with MORE, with no difference between the View and Regulate conditions. In contrast, SCL and the LPP decreased among participants in the SG – likely a function of habituation. Skin conductance habituation has been reliably demonstrated during viewing of positive affective images (Codispoti, Ferrari, & Bradley, Further, based on a recent systematic review (Kiluk et al., The current study had several other important limitations. First, because that the present analysis did not examine MORE's effects during attention to negative emotional stimuli, it is possible that MORE might increase attentional responses to emotionally salient stimuli of any valence. Yet, prior studies have indicated that MORE decreases attention to both negatively valenced stimuli (Garland et al., In summary, following 8 weeks of treatment with MORE, patients receiving LTOT for chronic pain exhibited increased electrocortical and sympathetic nervous system responses during attention to natural reward cues that predicted decreases in anhedonia 4 months after treatment ended. In light of neurophysiological evidence of clinical target engagement, adequately powered, full-scale clinical trials are now needed to test the efficacy of MORE as a means of treating anhedonia and reward deficits among chronic opioid users, people with chronic pain, and those at risk for OUD. Given that anhedonia is the hallmark of depression, and depression may exacerbate the risk for opioid misuse and OUD among chronic pain patients (Emery & Akil, 