MABT Therapy Enhances Opioid Use Disorder Treatment Outcomes

Understanding Mindful Awareness in Body-Oriented Therapy for Opioid Use Disorder

Opioid use disorder (OUD) represents one of the most pressing public health challenges in the United States, affecting millions of individuals and their families. While medication for opioid use disorder (MOUD) has proven to be the most effective treatment for reducing drug use and lowering morbidity and mortality rates, researchers continue to explore complementary interventions that can enhance treatment outcomes and address the complex health needs of individuals in recovery.

A groundbreaking study conducted by researchers at the University of Washington, partially funded by the National Center for Complementary and Integrative Health (NCCIH) through the NIH HEAL Initiative, examined the effectiveness of adding mindful awareness in body-oriented therapy (MABT) to standard medication-based treatment. The research provides valuable insights into how complementary mind-body interventions can improve overall health outcomes beyond substance use reduction.

The Challenge of Co-Occurring Conditions in Opioid Use Disorder

Among individuals with opioid use disorder, there is a notably high prevalence of co-occurring conditions that complicate treatment and recovery. Many patients experience concurrent mental health disorders such as post-traumatic stress disorder (PTSD), depression, and anxiety alongside chronic pain conditions. These co-occurring health issues are significantly associated with poor treatment outcomes and increased risk of relapse, suggesting the critical need for additional supportive interventions beyond medication management alone.

Traditional MOUD approaches primarily focus on medication administration, typically using buprenorphine, methadone, or naltrexone. While these medications are highly effective at reducing opioid use and preventing withdrawal, they do not directly address the underlying trauma, pain, and emotional dysregulation that often accompany opioid addiction. This gap in comprehensive care creates an opportunity for integrated treatment approaches that combine pharmaceutical intervention with mind-body therapeutic techniques.

What is Mindful Awareness in Body-Oriented Therapy?

Program Overview and Core Components

MABT is an innovative therapeutic program designed to teach interoceptive awareness skills through a combination of psychoeducation, mindfulness practices, and touch-based coaching. Interoceptive awareness refers to the ability to recognize and interpret internal bodily sensations and signals, a capacity that is often diminished in individuals with substance use disorders and trauma histories.

The MABT intervention incorporates three primary therapeutic elements that work synergistically to promote self-care and enhance emotion regulation:

• Psychoeducation that helps participants understand the mind-body connection and the relationship between bodily sensations and emotional states
• Mindfulness practices designed to increase present-moment awareness and non-judgmental observation of internal experiences
• Touch-based coaching provided by licensed massage therapists specifically trained in the MABT protocol

Treatment Structure and Delivery

In the research study, MABT was delivered through individual sessions lasting 75 minutes each, occurring once weekly for eight weeks. During these sessions, participants learned specialized sensory awareness and mindfulness skills to build their interoceptive capacity—the ability to perceive and interpret internal bodily signals.

The touch-based coaching component represents a unique element of MABT. Licensed massage therapists used manual touch strategically to guide participants’ attention to specific regions of the body, helping them develop a more refined sense of bodily awareness. This tactile component appears to facilitate the internalization and embodied understanding of mindfulness principles, moving beyond purely cognitive or verbal interventions.

To reinforce learning and promote skill development, participants received weekly take-home assignments designed to help them practice MABT techniques independently and integrate these skills into their daily lives. This homework component aimed to extend the therapeutic benefits beyond the clinical sessions and support sustained behavior change.

Study Design and Participant Population

The research study involved 303 adults recruited from six community clinics located in the Northwestern United States. All participants had received a diagnosis of opioid use disorder and had been stabilized on MOUD treatment for an average of over one year, indicating they had achieved initial recovery stability.

Participants were randomly assigned to one of two conditions: MOUD only (control group) or MOUD plus mindful awareness in body-oriented therapy (intervention group). This randomized design allowed researchers to isolate the specific effects of adding MABT to standard medication treatment while controlling for other variables.

The study population represented a particularly important demographic for research—individuals who had already achieved initial stability on MOUD and were beyond the immediate acute withdrawal phase. This population selection allowed researchers to examine whether MABT could enhance outcomes and quality of life in individuals already benefiting from medication treatment.

Key Findings: Impact on Substance Use and Primary Outcomes

Substance Use Outcomes

One of the most significant findings from this research was that adding MABT to MOUD did not alter substance use outcomes compared to MOUD alone. At the start of the study, participants in both groups already maintained high rates of abstinence from opioids and other substances. At the three-month assessment point, these high abstinence rates were maintained in both groups with no statistically significant differences.

While this finding might initially appear to suggest MABT had no benefit, researchers noted an important contextual factor: the study population had achieved significant stability on MOUD over an extended period. The ceiling effect—already high abstinence rates leaving little room for improvement—likely contributed to the absence of differences between groups on the primary substance use outcome. This finding does not diminish the value of MABT but rather suggests that future research examining MABT’s effects on individuals initiating treatment at earlier stages might reveal different patterns of substance use improvement.

Secondary Health Outcomes: Where MABT Made a Significant Difference

Post-Traumatic Stress Disorder Symptoms

The most robust findings from this research emerged in secondary health outcomes. After three months of treatment, participants in the MOUD plus MABT group demonstrated significantly greater improvements in PTSD symptoms compared to the MOUD-only group. This finding is particularly significant given that PTSD is highly prevalent among individuals with opioid use disorder and significantly complicates recovery.

The mechanism by which MABT may reduce PTSD symptoms likely involves the development of enhanced interoceptive awareness and improved emotional regulation. Trauma often disrupts the normal relationship between internal bodily sensations and emotional responses. By teaching individuals to recognize and respond appropriately to bodily signals through mindfulness and touch-based coaching, MABT may help restore this disrupted connection and reduce hyperarousal symptoms characteristic of PTSD.

Chronic Pain Management

Chronic pain is among the most common co-occurring conditions in opioid use disorder, and it frequently drives relapse and treatment dropout. The MABT intervention demonstrated significant positive effects on multiple pain-related outcomes:

• Pain severity—the intensity of pain experienced by participants decreased significantly in the MABT group compared to controls
• Pain activity interference—the degree to which pain limited daily functioning and activities improved substantially in the intervention group
• Physical symptom frequency—the overall frequency of physical symptoms decreased more in the MABT group

These improvements in pain-related outcomes may result from multiple mechanisms. Enhanced interoceptive awareness allows individuals to recognize pain signals earlier and respond with appropriate self-care strategies. Improved emotion regulation reduces the emotional amplification of pain signals. Additionally, the mind-body integration fostered through MABT may normalize nervous system functioning, reducing pain sensitivity.

Mental Health Outcomes: Depression and Anxiety

While MABT produced significant improvements in PTSD symptoms, the intervention did not result in significantly different improvements in depression and anxiety symptoms between groups at the three-month assessment. Both groups experienced some improvement in these domains, but the differences between MOUD-only and MOUD plus MABT were not statistically significant. Researchers suggest that longer follow-up periods may reveal divergent trajectories in depression and anxiety symptomatology.

Interoceptive Awareness: A Key Mechanism of Change

Measuring Bodily Awareness

One of the central mechanisms through which MABT operates is the development of interoceptive awareness—the ability to perceive and interpret internal bodily signals. The research found that overall interoceptive awareness increased significantly more in the MOUD plus MABT group compared to the MOUD-only group. This finding directly supports the theoretical foundation of MABT and suggests that the intervention successfully achieved its primary mechanistic goal.

Emotion Regulation Improvements

Although not reaching statistical significance, participants receiving MOUD plus MABT tended to experience greater reductions in emotion regulation difficulties compared to the control group. Emotion regulation—the ability to manage emotional responses effectively—is crucial for individuals in recovery from opioid addiction, as emotional dysregulation often precipitates relapse.

The development of enhanced interoceptive awareness appears to support emotion regulation by creating a bridge between internal experience and adaptive responding. When individuals can accurately perceive their bodily and emotional states, they gain greater capacity to choose intentional responses rather than reactive patterns.

Clinical Implications and Treatment Recommendations

MABT as Complementary Care

The findings from this research suggest that MABT represents a valuable complementary intervention to standard MOUD treatment, particularly for individuals experiencing significant PTSD symptoms, chronic pain, or difficulties with emotional regulation. While MABT does not directly reduce substance use beyond what MOUD alone achieves in stabilized populations, it addresses critical health factors that significantly impact quality of life and long-term recovery success.

Best Practice Implementation

Clinicians considering incorporating MABT into treatment settings should recognize several important implementation factors. The intervention requires trained licensed massage therapists who have received specific MABT protocol training. The individual format with weekly sessions over eight weeks requires substantial clinical resources, and treatment engagement and homework completion are important factors supporting positive outcomes.

The integration of MABT into existing MOUD programs may be particularly beneficial in settings that already serve individuals with chronic pain or trauma histories. Community clinics and specialized addiction treatment centers represent appropriate venues for MABT implementation.

Future Research Directions

Timing of Intervention

The researchers emphasized an important limitation of the current study: it evaluated MABT in individuals who had already stabilized on MOUD over an extended period. They highlighted that future research examining MABT’s effects in individuals initiating early MOUD treatment—when they face the highest risk of dropping out—could reveal different patterns of benefit, particularly regarding substance use outcomes. Early intervention studies might demonstrate whether MABT enhances treatment engagement and retention during the critical early phase of recovery.

Extended Follow-Up Assessment

The current study assessed outcomes at the three-month mark, representing an important but relatively short-term timeframe. The researchers indicated that future publications will present results extending beyond this initial assessment period. Longer-term follow-up data could reveal sustained benefits, delayed effects, or patterns of benefit maintenance over extended recovery periods.

Research Expansion and Implementation Science

Additional research examining implementation outcomes and optimal delivery methods could advance understanding of how to integrate MABT effectively within diverse treatment settings. Questions about resource requirements, training needs, cost-effectiveness, and comparative effectiveness relative to other complementary interventions remain important areas for future investigation.

Frequently Asked Questions

Q: What makes MABT different from standard mindfulness interventions?

A: MABT uniquely combines mindfulness training with touch-based coaching from trained massage therapists and psychoeducation specifically designed to enhance interoceptive awareness. This multi-modal approach targets the mind-body connection in ways that pure mindfulness meditation may not achieve.

Q: Can MABT replace medication treatment for opioid use disorder?

A: No. MABT is designed as a complementary intervention to MOUD, not as a replacement. Medication remains the gold standard treatment for reducing substance use and preventing overdose mortality. MABT enhances medication treatment by addressing co-occurring health conditions.

Q: How long does MABT treatment last?

A: In the research study, MABT consisted of eight weekly individual sessions, each lasting 75 minutes, for a total of approximately two months of active treatment. Participants also received weekly homework assignments to extend practice beyond clinical sessions.

Q: Is MABT covered by insurance?

A: Insurance coverage varies by provider and plan. Since MABT involves specialized training and massage therapy components, coverage details should be discussed with individual insurance plans. Some integrative health clinics or addiction treatment programs may offer MABT as part of comprehensive treatment packages.

Q: Who should consider MABT as part of their treatment?

A: Individuals with opioid use disorder who are stabilized on MOUD and experiencing co-occurring PTSD, chronic pain, anxiety, or emotional regulation difficulties are particularly good candidates for MABT. Consultation with treatment providers can determine individual suitability.

Q: What training do MABT providers need?

A: MABT requires licensed massage therapists who have received specialized training in the MABT protocol. This ensures consistent, evidence-based delivery of the intervention with appropriate therapeutic boundaries and safety protocols.

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Author

medha deb

 

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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