The Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM): Development and Validation of a New Tool to Assess Therapist Adherence and Competence

ABSTRACT

Objective

Mindfulness-Oriented Recovery Enhancement (MORE) is a mind-body therapy that unites complementary aspects of mindfulness training, third-wave cognitive behavioral therapy (CBT), and principles from positive psychology into an integrative treatment for addiction and its comorbidities. As interest in MORE has grown among researchers and clinicians, there is an increasing need to provide quality assurance measures to ensure treatment integrity during implementation of MORE. Here, we describe the development and validation of the Mindfulness-Oriented Recovery Enhancement Fidelity Measure (MORE-FM).

Method

We developed a 17-item scale assessing therapist competence and adherence to the MORE treatment manual, which was then used for fidelity monitoring of 40 MORE treatment sessions across two Stage 2 and two Stage 1 RCT for addictive behaviors (e.g., opioid misuse, obesity) involving a total N = 295.

Results

Internal consistency for the Adherence (α =.89) and Competence subscales (α =.92) was high, and interrater reliability was adequate (Adherence subscale ICC =.77; Competence subscale ICC =.51), with therapists exhibiting good-to-excellent levels of fidelity across all trials. Importantly, linear mixed modeling indicated that higher levels of overall fidelity were associated with greater reductions in opioid misuse across two Stage 2 RCTs (F_1,48.00 = 7.38, p=.009), indicating that the MORE-FM is a valid measure of treatment fidelity that can predict clinical outcomes.

Conclusions

Findings from this study yielded insights for future iterations of the MORE-FM. In sum, the MORE-FM is a valuable tool for assessing and enhancing the integrity of MORE in future research trials and clinical applications.

KEYWORDS:

• adherence
• addiction
• competence
• mindfulness-based interventions
• opioid

Additional information

Funding

This work was supported by grants R34DA037005, R03DA032517, and R01DA042033 from the National Institute on Drug Abuse (PI: Garland). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.