It’s Eliminating the Causes of Suffering, Stupid

August 21, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“The Buddha taught that beyond suffering lies great bliss. As we take steps towards removing the causes of suffering, we experience progressive levels of happiness. The path is a long one. But staying on it leads to a tremendous sense of liberation. There are other benefits from adhering to this philosophy – one can live in happiness, untroubled by any kind of negativity. At the end of this path, when desire and ignorance would have completely fallen away, one may experience the same transcendental joy that the Buddha did.” – Buddha Groove

In a previous essay the first Noble Truth was discussed, reflecting the patently obvious fact that there is suffering, a.k.a. unsatisfactoriness. In the next essay the second Noble Truth was discussed also stating the obvious that there are causes to the suffering. But, not so obviously we saw how, all encompassing, unsatisfactoriness is in our lives and how subtle are its causes. We saw that most of the unsatisfactoriness emanated from our inability to accept things as they are and instead, go to war against reality.

As we look carefully and deeply at this unsatisfactoriness, we find that it is much more encompassing than we initially thought, affecting every aspect of our lives and experience, day in and day out. In fact, unsatisfactoriness is the rule and not the exception. It is the biggest single impediment to being truly happy, making progress on a spiritual path, and experiencing liberation. The Buddha recognized this and held out hope in the third Noble Truth, that suffering can be eliminated, that there can be a cessation of unsatisfactoriness.

At first glance the idea of eliminating suffering would seem simple, just eliminate the cause of suffering. Since, the cause of suffering, desiring things to be different than they are, is also simple, it should be an easy task to eliminate the desiring and thereby the suffering. But, it’s not simple at all. It took arguably the greatest, most mentally disciplined, mindfulness practitioner of all time, the Buddha, six years of struggle to accomplish it. For most of us, it would seem to be an almost impossible task. To get an idea of the difficulty just realize that wanting to eliminate the desire for things to be different, is itself a desire for things to be different!

The complexity of the cessation of desires is also underscored by the fact that many desires are healthy and in fact necessary for life, e.g. hunger, thirst, breathing, etc. Obviously these desires should not be eliminated. In addition, many are for pleasant things that make life enjoyable, such as companionship, love, art, music, good food and wine, etc. It would certainly be a bland life without them. Others are unpleasant things that need to be avoided or tempered, such as pain, illness, fear, loneliness. It would seem problematic to remove these desires. In fact, the third Noble Truth does not call for the elimination of desires. Rather, it suggests that we should eliminate clinging to, grasping onto, these desires.

The difference between desires and clinging to desires is a subtle but very important distinction. There is nothing wrong with desires themselves. It is human nature to have them and if not clung to, they are normally healthy. But to be invested in the outcome of the desires is where the problem arises. It is perfectly fine to desire going to a concert, but it causes suffering when the outcome makes a difference. If the concert is cancelled or sold out or your car breaks down so you can’t get there would you be OK with it, or would you be upset? If it’s the latter then you’re attached, you’re grasping, you’re clinging. If it’s the former you’re displaying the equanimity that the Buddha taught is the way to the cessation of suffering. Similarly, if you desire to get rid of a headache and take analgesics and rest, this is fine. But, if the headache continues and you’re angry and upset to have to deal with the continuing pain, then that’s clinging, grasping, and attaching to the desire. You can only alleviate the suffering by accepting that the headache is still there. Indeed, research has shown that the headache pain lessens just as soon as you cease to fight it and let go of resistance. As Ajahn Chah said, “If you let go a little, you’ll have a little happiness. If you let go a lot, you’ll have a lot of happiness. If you let go completely . . . you’ll be completely happy.”

Once again, though, this sounds simple, but in practice is devilishly difficult to do. The mind is programmed to control. It automatically tries to produce good feelings and hold onto them and eliminate bad feelings and prevent them from returning. So, even though we may wish to cease clinging to desires, our own mind works against us. We might try to force our will on the mind and battle its tendencies. But, as Adyashanti likes to say “If you go to war with your mind you’ll be at war forever.” The Buddha found this to be absolutely true as his attempts to control his mind with asceticism were a nearly mortal failure. He finally found a better way, “The Middle Way” where one works to restrain the mind, but doesn’t get upset when failure occurs, simply returns to the effort with expectations of slowly moving more and more toward equanimity. This is a patient practice in the middle between striving and giving up. It works to tame the mind, but not dominate it.

The practice begins with an intention to explore everyday experiences, looking at each and asking the question, do I feel unsatisfactoriness and when you do exploring why, what is the cause of the unsatisfactoriness. Sometimes it’s simple. You’re caught at a red light and detect unsatisfactoriness and realize that you want to get somewhere (you want things to be different) rather than appreciating the drive. With this realization, you can often spontaneously let go and stop clinging to the desire to be somewhere else and simply enjoy a relaxing interlude to the stress of driving. At times, though, it may be difficult to release the clinging. You may feel that you’re underpaid at work and thus feel unsatisfactoriness with you job rather than enjoying the moment to moment experience of the work. This feeling of unfairness may not simply diminish upon realization. This will take more work. One important lesson here, is that the key to ending suffering and becoming happy is not in a monastery or a pilgrimage, but right here in everyday life. This is where the practice is. This is where equanimity can be developed. It’s right here, right now, in the present moment, in the midst of your life.

The practice from here becomes subtle. It involves first working with everyday experiences and noticing when unsatisfactoriness arises and secondly noting the underlying cause, the desire, the wanting, the craving. Then, thirdly, noting and observing that both the unsatisfactoriness and the desire go through a phase of arising, increasing in magnitude and fourthly noting that they both go through a phase of decline, falling away. Obviously, this requires patience and mindful observing. But, it reveals that unsatisfactoriness and its cause, desire, just like everything else, are impermanent. They come and they go. Note that you have just observed the cessation of unsatisfactoriness and desire, the exact state that you want to achieve. Note also that you didn’t do anything. It all happened spontaneously, on its own.

For example, you may want to go out for dinner at a restaurant for a nice meal but realize that your budget won’t allow it. This will likely be followed by feelings of frustration, the unsatisfactoriness. Observe the feelings arising. Then, look deeply for the underlying cause, perhaps the desire to have more money, greed. Observe, also how this desire for money arises and strengthens. Then if you patiently stay with these feelings, you’ll note that they begin to decrease and fall away. The unsatisfactoriness and the greed slowly dissipate and eventually completely cease. You are left not caring that you can’t go out for the meal, that you don’t have the money. You have achieved a brief equanimity. As I’m sure, you’ll recognize, this liberation will not last long, the feelings will arise again either immediately or at a later time. You haven’t extinguished them, only experienced a brief cessation.

Once, the falling away of unsatisfactoriness and the underlying desire, is experienced. There is nothing else for you to do. Do not attempt to control this experience in any way. Do not attempt to maintain or lengthen the experience. This is a form of desiring things to be different than they are; the exact cause of unsatisfactoriness in the first place. It’s very hard not to try to control it. Remember your mind is programmed to do this. Don’t get upset if the mind jumps in and tries to do so. It’s just what minds do. Simply watch it and see how this itself creates unsatisfactoriness that arises and falls away.

This is where the subtlety comes in. The equanimity, the decrease of unsatisfactoriness, and the cessation of desire can’t be controlled. They must simply be allowed to come and go. As the practice continues the number of times this equanimity occurs and the duration of the cessation will start to increase on their own. The realization begins to dawn that you really don’t have to do anything. All you need to do is accept things as they are. This acceptance produces a pleasant state that reinforces the process, making it occur more frequently and for longer duration in the future. You come to not only understand, but directly experience that unsatisfactoriness and desire can be ended simply by patiently waiting for them to spontaneously diminish and cease. When you do a pleasant feeling will spontaneously arise. This in turn leads to an upward spiral leading slowly to enduring equanimity.

It is important to understand that attempting to actually do anything to produce, hold onto, or lengthen the state is counterproductive. Patience and persistence is required here. Trust that it will all happen on its own if you just let it. Don’t meddle. But, don’t stop observing. This is the method revealed in the Third Noble Truth. It is the way to true happiness, true liberation, true enlightenment.

The Buddha provides a path that makes it more likely that this will occur. It is the fourth Noble Truth, also called the Noble Eightfold Path which is the subject of other essays.

“After suffering, the Buddha taught, there is supreme happiness. Every step of the way to removing the causes of unhappiness brings more joy. On the path to the end of suffering, which is a path that Buddhists may spend their whole lifetimes practicing, there are levels of happiness and freedom from craving and ignorance that can be achieved.” – Buddhist Studies

CMCS – Center for Mindfulness and Contemplative Studies

Improve Anxiety and Depression in Primary Care with Mindfulness

August 20, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Group mindfulness treatment should be considered as an alternative to individual psychotherapy, especially at primary health care centers that can’t offer everyone individual therapy,” – Jan Sundquist

“Primary care is at the front line of the health delivery system” (Craner et al., 2016). Most patients enter the health system either though primary care physicians who are responsible for wellness and for the diagnosis and treatment of mental and physical diseases. If the disease is common or simple, they’ll treat it themselves or if it’s more complex or dangerous they’ll refer it to specialists. Either way, they’re the first step in treatment.

Mood and anxiety disorders, including depression are the most common mental illnesses and affect almost 30% of the US population. Depression is the most common mental disorders seen in primary care patients, constituting nearly a third of all patients. People with an anxiety disorder are 3 to 5 times more likely than those without to visit their doctor and constitute around 6% of primary care patients. Hence these mood disorders are an important challenge for primary care. Yet, primary care physicians have little training in psychological therapy techniques and generally treat these disorders by prescribing drugs.

In recent years, it has become apparent that mindfulness training is a powerful treatment option for depression and anxiety disorders either alone or in combination with other therapies. It is rare, however, for mindfulness training to be implemented in the course of primary care. In today’s Research News article “Outcomes of a 6-Week Cognitive– Behavioral and Mindfulness Group Intervention in Primary Care.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1300205500003373/?type=3&theater

or see summary below.

Craner and colleagues recruited patients who came into primary care with a diagnosis of either depression or anxiety disorders. They were provided 6-weeks of therapy that was a combination of mindfulness training and Cognitive Behavioral Therapy (CBT). Instruction was provided in weekly 1-hour group sessions and patients were encouraged to practice at home. They were measured for depression and anxiety disorder intensity before and after the conclusion of treatment.

They found that after the therapy the patients had a large and significant reduction in both their depression and anxiety. This was particularly significant in that these impressive results were obtained from a relatively brief group treatment delivered in the primary care facility itself. To our knowledge this is the first demonstration of successful mindfulness-based treatment for mood disorders conducted in a primary care facility. This is an ideal point for delivery of services to treat a major mental health problem in a safe and effective way without expensive specialist involvement and without employing drugs. Because the services were delivered at the point of entry into the health care system, it allows the delivery of services quickly, immediately upon diagnosis, maximizing effectiveness.

But, the results must be interpreted cautiously as there was no comparison or control condition. A randomized controlled clinical trial is needed to insure that the positive results were due the mindfulness-based therapy and not due to a placebo effect, experimenter bias, spontaneous remissions, or some other confounding factor. But, these are exciting preliminary findings which clearly support conducting further research.

CMCS – Center for Mindfulness and Contemplative Studies

“Once I stopped battling anxiety, it lost its power over me. The negative thoughts do still pop up, but what has changed is how I react to them now that they no longer frighten me. On the few occasions that I have had panic attacks since practicing mindfulness, I have consciously switched to mindful breathing and the panic has subsided. The vicious circle has gone, and has been replaced with positive thoughts about everything I have achieved and may yet achieve. I will always have anxious thoughts, I’m only human, but I know they are just that, just thoughts.” – Amy Straker

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Craner, J. R., Sawchuk, C. N., & Smyth, K. T. (2016, July 14). Outcomes of a 6-Week Cognitive– Behavioral and Mindfulness Group Intervention in Primary Care. Families, Systems, & Health. Advance online publication. http://dx.doi.org/10.1037/fsh0000202

Abstract:

Introduction: Cognitive–behavioral and mindfulness-based interventions are established treatments for depressive and anxiety disorders; however, there is a lack of research for these interventions in primary care settings. The current study evaluates an evidence-based group intervention provided to primary care patients with a variety of mood and anxiety concerns. Method: Participants included 54 adult primary care patients who attended at least four sessions of a six-session cognitive–behavioral and mindfulness group. A total of nine separate groups were conducted, all of which were colocated within the primary care setting. Major depressive disorder and generalized anxiety disorder were the most common psychiatric conditions, with approximately 56% of the sample having one or more chronic medical conditions. Self-report measures of depression (Patient Health Questionnaire–9) and anxiety (Generalized Anxiety Disorder Questionnaire–7) were completed at each session. Results: Significant improvements were noted on self-reported measures of depression and anxiety when comparing pre- and posttreatment assessment measures with large effect sizes. Discussion: A brief, principle-based cognitive–behavioral and mindfulness group intervention delivered in primary care was associated with improved symptoms across a range of patient presentations. Evidence-based group interventions in primary care settings have the benefits of increased access and cost-effectiveness.

Alter the Brain for Better Pain Management with Meditation

August 19, 2016September 5, 2020 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“For some people with chronic pain, mindful meditation is an appealing pain management option because it has an unusual benefit; it is something that you personally control. Unlike pain medications or medical procedures, meditation is not done to you, it is something you can do for yourself.” – Stephanie Burke

Pain can be difficult to deal with, particularly if it’s persistent. But, even short-term pain, acute pain, is unpleasant. Pain, however, is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. Nevertheless, it would be useful to find ways to lower the intensity of perceived pain and improve recovery from painful stimuli.

Pain signals are processed in the brain and the state of the brain can alter the perception of pain. Indeed, pain is affected by the mind. The perception of pain can be amplified by the emotional reactions to it and also by attempts to fight or counteract it. On the other hand, pain perception can also be reduced by mental states. Indeed, contemplative practices have been shown to reduce both chronic and acute pain. These changes are reflected in the underlying processing of the pain signals in the nervous system. This suggests that mindfulness training produces long-lasting alterations of the neural circuits underlying pain processing.

In today’s Research News article “Altered Neural Activity Associated with Mindfulness during Nociception: A Systematic Review of Functional MRI.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1299302553427001/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931491/

Bilevicius and colleagues review the published research literature on the neural circuits involved in mindfulness’ alterations of perceived pain. In these studies, it was routinely reported that mindfulness produced a reduction in the anticipation of pain and pain unpleasantness. There were mixed findings in regard to whether the intensity of pain was reduced or not. Regardless, mindfulness appears to reduce unpleasantness without blocking the actual perception of pain.

They then looked at the reported effects of mindfulness training on brain activity as measured with functional Magnetic Resonance Imagery (fMRI). The published studies reported consistently that mindfulness training increased the activity of two key areas in pain processing, the Insula and the Anterior Cingulate Cortex in response to pain signals. On the other hand, mindfulness training produced decreased activity in response to pain in the Lateral Prefrontal Cortex. The ACC and the Insula are involved in processing stimuli originating in the present moment and their increased activity suggests that the mindfulness training altered the neural circuits involved in present moment awareness of pain signals. The Lateral Prefrontal Cortex, on the other hand, is associated with the awareness, cognitive processing, of pain. This suggests that mindfulness training produces a reduction in the thinking about pain.

These results suggest that mindfulness training produces lasting changes to the nervous system, sometimes called neuroplasticity. These changes altered the usual processing of pain signals. Although, the pain signals occurring in the present moment are heightened, they have less of an impact upon awareness and cognitive appreciation of pain. Mindfulness training, then appears to produce long-lasting changes in the brain that allow pain signals to be processed but reduce the psychological responses to pain, making it less unpleasant. The individual then can respond adaptively to the pain but not suffer as much.

So, alter the brain for better pain management with meditation.

“Imaging studies show that mindfulness soothes the brain patterns underlying pain and, over time, these changes take root and alter the structure of the brain itself, so that patients no longer feel pain with the same intensity. Many say that they barely notice it at all.” – Danny Penman

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Bilevicius, E., Kolesar, T. A., & Kornelsen, J. (2016). Altered Neural Activity Associated with Mindfulness during Nociception: A Systematic Review of Functional MRI. Brain Sciences, 6(2), 14. http://doi.org/10.3390/brainsci6020014

Abstract

Objective: To assess the neural activity associated with mindfulness-based alterations of pain perception. Methods: The Cochrane Central, EMBASE, Ovid Medline, PsycINFO, Scopus, and Web of Science databases were searched on 2 February 2016. Titles, abstracts, and full-text articles were independently screened by two reviewers. Data were independently extracted from records that included topics of functional neuroimaging, pain, and mindfulness interventions. Results: The literature search produced 946 total records, of which five met the inclusion criteria. Records reported pain in terms of anticipation (n = 2), unpleasantness (n = 5), and intensity (n = 5), and how mindfulness conditions altered the neural activity during noxious stimulation accordingly. Conclusions: Although the studies were inconsistent in relating pain components to neural activity, in general, mindfulness was able to reduce pain anticipation and unpleasantness ratings, as well as alter the corresponding neural activity. The major neural underpinnings of mindfulness-based pain reduction consisted of altered activity in the anterior cingulate cortex, insula, and dorsolateral prefrontal cortex.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4931491/

Improve Arthritis with Tai Chi

August 18, 2016 psyjdc 2 Comments

By John M. de Castro, Ph.D.

“With its integrative approach that strengthens the body while focusing the mind, tai chi addresses a range of physical and mental health issues—including bone strength, joint stability, cardiovascular health, immunity, and emotional well-being.” – Stephanie Watson

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. Arthritis can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities Arthritis reduces the individual’s ability to function at work and may require modifications of work activities which can lead to financial difficulties. It even affects the individual’s physical appearance. In addition, due to complications associated with rheumatoid arthritis, particularly cardiovascular disease, the lifespan for people with rheumatoid arthritis may be shortened by 10 years.

It is obvious that there is a need for a safe and effective treatment to help rheumatoid arthritis sufferers cope with the disease and its consequences. Increasing exercise has been shown to increase flexibility and mobility but many form of exercise are difficult for the arthritis sufferer to engage in and many drop out. But all that may be needed is gentle movements of the joints. Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It has been shown to have many physical and psychological benefits, especially for the elderly. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for an elderly population. So, it would seem that tai chi practice would be well suited to treat arthritis in seniors.

In today’s Research News article “The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis.” See

summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Shin and colleagues examine the effectiveness of tai chi practice to help alleviate some of the cardiovascular symptoms of rheumatoid arthritis. They recruited elderly (over 50 years of age) women with rheumatoid arthritis and assigned them to two groups, a tai chi and an exercise information group. The tai chi participants engaged in a group tai chi exercise once a week for 60 min for 3 months at the hospital gymnasium. Measurements were taken before and after the 3-month practice period of rheumatoid arthritis symptoms and cardiovascular function. They found that the tai chi group had a significant decrease in plasma cholesterol and measures of atherosclerosis including significant decreases in arterial stiffness and flow mediated dilatation. Both of these measures are associated with the beginnings of cardiovascular disease.

These findings suggest that tai chi practice is beneficial in reducing cardiovascular risk factors associated with rheumatoid arthritis. These risk factors are likely due to the sedentary lifestyle of most rheumatoid arthritis sufferers and the gentle exercise of tai chi appears to be sufficient to begin to reverse some of these risk factors. This is very significant as cardiovascular disease associated with rheumatoid arthritis is serious and can lead to premature death. Since tai chi is safe and appropriate for seniors, it would appear to be an excellent treatment to reduce the cardiovascular disease risks associated with rheumatoid arthritis in the elderly.

So, improve arthritis with tai chi.

“Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.” – Harvard Women’s Health Watch

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Shin, J.-H., Lee, Y., Kim, S. G., Choi, B. Y., Lee, H.-S., & Bang, S.-Y. (2015). The beneficial effects of Tai Chi exercise on endothelial function and arterial stiffness in elderly women with rheumatoid arthritis. Arthritis Research & Therapy, 17, 380. http://doi.org/10.1186/s13075-015-0893-x

Background: Rheumatoid arthritis (RA) has been known to be associated with increased risk of cardiovascular disease (CVD). The aim of this study was to investigate the effects of Tai Chi exercise on CVD risk in elderly women with RA.

Method: In total, 56 female patients with RA were assigned to either a Tai Chi exercise group (29 patients) receiving a 3-month exercise intervention once a week or a control group (27 patients) receiving general information about the benefits of exercise. All participants were assessed at baseline and at 3 months for RA disease activity (Disease Activity Score 28 and Routine Assessment of Patient Index Data 3), functional disability (Health Assessment Questionnaire), CVD risk factors (blood pressure, lipids profile, body composition, and smoking), and three atherosclerotic measurements: carotid intima-media thickness, flow-mediated dilatation (FMD), and brachial-ankle pulse wave velocity (baPWV).

Results: FMD, representative of endothelial function, significantly increased in the Tai Chi exercise group (initial 5.85 ± 2.05 versus 3 months 7.75 ± 2.53 %) compared with the control group (initial 6.31 ± 2.12 versus 3 months 5.78 ± 2.13 %) (P = 1.76 × 10−3). Moreover, baPWV, representative of arterial stiffness, significantly decreased in the Tai Chi exercise group (initial 1693.7 ± 348.3 versus 3 months 1600.1 ± 291.0 cm/s) compared with the control group (initial 1740.3 ± 185.3 versus 3 months 1792.8 ± 326.1 cm/s) (P = 1.57 × 10−2). In addition, total cholesterol decreased significantly in the Tai Chi exercise group compared with the control group (−7.8 ± 15.5 versus 2.9 ± 12.2 mg/dl, P = 2.72 × 10−2); other changes in RA-related characteristics were not significantly different between the two groups. Tai Chi exercise remained significantly associated with improved endothelial function (FMD; P = 4.32 × 10−3) and arterial stiffness (baPWV; P = 2.22 × 10−2) after adjustment for improvement in total cholesterol level.

Conclusion: Tai Chi exercise improved endothelial dysfunction and arterial stiffness in elderly women with RA, suggesting that it can be a useful behavioral strategy for CVD prevention in patients with RA.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4718020/

Improve Self-efficacy and Movements in Teens with Yoga

August 17, 2016July 19, 2020 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Although teens frontal lobe activity is still developing well into their twenties, they do have frontal lobes. Mindfulness practices can help teens engage their frontal lobes, and slow down and weigh the outcome of their actions.” – Donna Torney

Adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. An important characteristic that develops during this time is self-efficacy, the belief in one’s ability to succeed in specific situations or accomplish a task. This characteristic is an important foundation for success in many other areas of development. So, methods that could help to improve the development of self-efficacy could be very helpful for the child in navigating the difficult adolescent years.

Yoga practice has been shown to have a large number of beneficial effects on the psychological, emotional, and physical health of the individual and is helpful in the treatment of mental and physical illness. The acceptance of yoga practice has spread from the home and yoga studios to its application with children in schools. Studies of these school programs have found that yoga practice produces a wide variety of positive psychosocial and physical benefits. These include improved mood state, self-control, social abilities, self-regulation, emotion regulation, self-esteem, and ability to focus. In addition, yoga practice produces improvements in student grades and academic performance. They have also shown that the yoga practice produces lower levels of anxiety, depression, general distress, rumination, and intrusive thoughts.

So, yoga practice may be helpful to adolescents in the development of their self-efficacy. In today’s Research News article “Influence of Yoga-Based Personality Development Program on Psychomotor Performance and Self-efficacy in School Children.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1297633423593914/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908105/

Das and colleagues examine the effects of a 10-week intensive yoga camp on adolescents’ self-efficacy and cognitive task performance. The camp involved 10-hours per day of yoga postures, meditation, breathing exercises, relaxation techniques, and yoga games. They were measured before and after the camp for self-efficacy and the Trail Marking Test which measures fine motor coordination, visual–motor integration, visual perception, and cognitive planning ability. The results were compared with a matched group of adolescents who spent the 10-weeks in a traditional school setting.

They found that the yoga training produced a marked, significant, increase in self-efficacy including the academic, social, and emotional domains. Whereas, the control group showed no change in self-efficacy. The yoga group also showed large, significant improvements on the trail Making Test while the control group did not. These results suggest that the intensive yoga practice was very beneficial for the adolescents. The improvements in the teens beliefs regarding their ability to succeed academically, socially and emotionally has important implications for their successful navigation of the difficult teen years. In addition, their improvements in motor ability, planning, and cognitive performance suggest improved physical and intellectual development and success in school.

It is important, though, to recognize that the yoga training was very intensive. It is unclear whether a less intensive yoga program like that typically used in schools would have similarly impressive effects. In addition, the comparison, control, condition was not equivalent in that they didn’t experience a similar intensive training and social contact situation. So, it is not possible to know if it was the yoga training itself or the intensive camp context that produced the effects. It remains for future research to clarify these issues.

Regardless, the results are suggestive that yoga practice may have profound effects on teen’s development of self-efficacy, motor, and cognitive development.

“Yoga has proven very helpful for teenagers. The deep breathing, focusing, and stretching of Yoga help calm the mind and soothe the body and spirit. Restorative Yoga especially helps to balance the nervous system, and ease teens out of the flight-or-fight response. And luckily Yoga is now considered “cool” by most teenagers, so your kids can practice without worrying about being ostracized.” – Jane Heyman

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Das M, Deepeshwar S, Subramanya P and Manjunath NK (2016) Influence of Yoga-Based Personality Development Program on Psychomotor Performance and Self-efficacy in School Children. Front. Pediatr. 4:62. doi: 10.3389/fped.2016.00062

Abstract

Selective attention and efficacy are important components of scholastic performance in school children. While attempts are being made to introduce new methods to improve academic performance either as part of curricular or extracurricular activities in schools, the success rates are minimal. Hence, this study assessed the effect of yoga-based intervention on psychomotor performance and self-efficacy in school children. Two hundred ten school children with ages ranging from 11 to 16 years (mean age ± SD; 13.7 ± 0.8 years) satisfying the inclusion and exclusion criteria were recruited for the 10-day yogä program. An equal number of age-matched participants (n = 210; mean ± SD; 13.1 ± 0.8 years) were selected for the control group. Participants were assessed for attention and performance at the beginning and end of 10 days using trail making task (TMT) A and B, and self-efficacy questionnaire. The yoga group showed higher self-efficacy and improved performance after 10 days of yoga intervention. The performance in TMT-A and -B of the yoga group showed a significantly higher number of attempts with a reduction in time taken to complete the task and a number of wrong attempts compared with control group. Results suggest that yoga practice enhances self-efficacy and processing speed with fine motor coordination, visual–motor integration, visual perception, planning ability, and cognitive performance.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908105/

Reduce Chronic Pain with Mindfulness

August 16, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“If you move into pure awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment. It is impossible for it not to change because the gesture of holding it, even if not sustained for long, even for a second or two, already reveals its larger dimensionality.” – Jon Kabat-Zinn

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity. At least 100 million adult Americans have common chronic pain conditions. It affects more Americans than diabetes, heart disease and cancer combined. Chronic pain accompanies a number of conditions. The most common form is low back pain affecting between 6% to 15% of the population. Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65. Fibromyalgia is a mysterious disorder whose causes are unknown. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. It is very common affecting over 5 million people in the U.S., about 2% of the population.

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and Yoga have been shown to specifically improve back pain and mind-body practices in general have been shown to reduce the gene expressions that underlie the inflammatory response which contribute to arthritis. So, it would seem reasonable to look further into the effectiveness of alternative and complementary practices in treating chronic pain.

In today’s Research News article “Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1296780620345861/?type=3&theater

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1296780620345861/?type=3&theateror see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439829/

Bawa and colleagues review the published research literature on the use of mindfulness training to treat chronic pain. Most of the studies reviewed used either Mindfulness-based Stress Reduction (MBSR) or Mindfulness-based Cognitive Therapy (MBCT) programs. They found that the published literature reported that mindfulness practices in general produced a small but significant reduction in pain, depression, and anxiety and an increase in sleep quality. They also found moderate significant improvements in physical functioning, physical and psychological quality of life. Large significant effects of mindfulness training were reported for pain acceptance and perceived pain. Hence, the published literature reports many beneficial effects of mindfulness training for chronic pain. The largest effects were for the psychological aspects of pain, but, also for the physical aspects of pain, albeit smaller effects.

There are a number of effects of mindfulness training that might underlie these improvements in chronic pain. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable that mindfulness practices would be helpful in pain management. In addition, pain is accompanied by, and frequently caused by, inflammation and mindfulness training has been shown to reduce the inflammatory response. This may account for the mindfulness’ effects on the physical aspects of chronic pain.

These are exciting findings that non-drug treatments can be effective for chronic pain. They are effective and importantly, safe. So, reduce chronic pain with mindfulness.

“a regular meditation practice is the best ongoing foundation for working with pain. Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” – Christiane Wolf

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. The British Journal of General Practice, 65(635), e387–e400. http://doi.org/10.3399/bjgp15X685297

Abstract

Background: Chronic pain and its associated distress and disability are common reasons for seeking medical help. Patients with chronic pain use primary healthcare services five times more than the rest of the population. Mindfulness has become an increasingly popular self-management technique.

Aim: To assess the effectiveness of mindfulness-based interventions for patients with chronic pain.

Design and setting: Systematic review and meta-analysis including randomised controlled trials of mindfulness-based interventions for chronic pain. There was no restriction to study site or setting.

Method: The databases MEDLINE®, Embase, AMED, CINAHL, PsycINFO, and Index to Theses were searched. Titles, abstracts, and full texts were screened iteratively against inclusion criteria of: randomised controlled trials of mindfulness-based intervention; patients with non-malignant chronic pain; and economic, clinical, or humanistic outcome reported. Included studies were assessed with the Yates Quality Rating Scale. Meta-analysis was conducted.

Results: Eleven studies were included. Chronic pain conditions included: fibromyalgia, rheumatoid arthritis, chronic musculoskeletal pain, failed back surgery syndrome, and mixed aetiology. Papers were of mixed methodological quality. Main outcomes reported were pain intensity, depression, physical functioning, quality of life, pain acceptance, and mindfulness. Economic outcomes were rarely reported. Meta-analysis effect sizes for clinical outcomes ranged from 0.12 (95% confidence interval [CI] = −0.05 to 0.30) (depression) to 1.32 (95% CI = −1.19 to 3.82) (sleep quality), and for humanistic outcomes 0.03 (95% CI = −0.66 to 0.72) (mindfulness) to 1.58 (95% CI = −0.57 to 3.74) (pain acceptance). Studies with active, compared with inactive, control groups showed smaller effects.

Conclusion: There is limited evidence for effectiveness of mindfulness-based interventions for patients with chronic pain. Better-quality studies are required.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439829/

Unstick a Wandering Mind for Task Performance

August 15, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“people are substantially less happy when their minds are wandering than when they’re not, which is unfortunate considering we do it so often. Moreover, the size of this effect is large—how often a person’s mind wanders, and what they think about when it does, is far more predictive of happiness than how much money they make, for example.” – Matt Killingsworth

We spend a tremendous amount of time with our minds wandering and not on the task or the environment at hand. We daydream, plan for the future, review the past, ruminate on our failures, exalt in our successes. In fact, we spend almost half of our waking hours off task with our mind wandering. Mindfulness is the antithesis of mind wandering. When we’re mindful, we’re paying attention to what is occurring in the present moment. In fact, the more mindful we are the less the mind wanders and mindfulness training reduces mind wandering.

You’d think that if we spend so much time with the mind wandering it must be enjoyable. But, in fact research has shown that when our mind is wandering we are actually unhappier than when we are paying attention to what is at hand. There are times when mind wandering may be useful, especially in regard to planning and creative thinking. But, for the most part, it interferes with our concentration on the task at hand. People differ in the amount of time their mind wanders and, when the mind wanders, the difficulty they have disengaging from the off-task thoughts and returning to present moment attention. This is referred to as the stickiness of mind-wandering.

In today’s Research News article “Self-Reported Stickiness of Mind-Wandering Affects Task Performance.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1295900037100586/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870246/

Van Vugt and Broers investigate the relationship of this stickiness of mind-wandering to how well individuals do in performing a task that requires attention, a go, no-go decision task. On some of the trials the subjects, prior to task onset, were reminded of one of the things that were currently on their mind, as a means of evoking mind wandering. On other trials, no such reminders were present. Participants were asked what their mental state was during the trial and how difficult it was to disengage from the wandering thoughts and return to attention to the task, stickiness.

They found that establishing a current concern prior to the trial did not increase mind wandering, but decreased the accuracy of performance. But, as expected, when the mind was wandering, it interfered with performance of the attention demanding task. They also found that the more difficulty that the participant had in disengaging from wandering thoughts, stickiness, the more mind wandering occurred and the lower the accuracy of response in the task. So, not only the amount of mind wandering, but also the stickiness of the mind wandering was detrimental to performance on a task that demands attention.

These results are interesting and show that mind wandering and stickiness can be studied in the laboratory under controlled conditions. It remains to be seen if mindfulness training can improve this kind of task performance and reduce mind wandering and stickiness. It has been demonstrated that mindfulness improves attention and cognitive task performance. But, it is not known whether it can change stickiness. Regardless, it is clear that we must unstick a wandering mind for task performance.

“In mindfulness what gets stronger are the brain’s circuits for noticing when your mind has wandered, letting go, and returning to your chosen focus. And that’s just what we need to stay with during that one important task we’re working on.” – Daniel Goleman

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Van Vugt, M. K., & Broers, N. (2016). Self-Reported Stickiness of Mind-Wandering Affects Task Performance. Frontiers in Psychology, 7, 732. http://doi.org/10.3389/fpsyg.2016.00732

Abstract

When asked to perform a certain task, we typically spend a decent amount of time thinking thoughts unrelated to that task–a phenomenon referred to as “mind-wandering.” It is thought that this mind-wandering is driven at least in part by our unfinished goals and concerns. Previous studies have shown that just after presenting a participant with their own concerns, their reports of task-unrelated thinking increased somewhat. However, effects of these concerns on task performance were somewhat inconsistent. In this study we take the opposite approach, and examine whether task performance depends on the self-reported thought content. Specifically, a particularly intriguing aspect of mind-wandering that has hitherto received little attention is the difficulty of disengaging from it, in other words, the “stickiness” of the thoughts. While presenting participants with their own concerns was not associated with clear effects on task performance, we showed that the reports of off-task thinking and variability of response times increased with the amount of self-reported stickiness of thoughts. This suggests that the stickiness of mind-wandering is a relevant variable, and participants are able to meaningfully report on it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870246/

It’s the Causes of Suffering, Stupid

August 14, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Basically, life is suffering. And we create our suffering by thirsting or craving for what we cannot have. But are these really all the causes of suffering? Do we really create all of our suffering? I would argue that there is more to suffering than what we cause with our craving. Fighting with reality surely adds to our suffering – if I do not accept that I am sick, for example, and moan the whole time that I shouldn’t be sick, I will suffer more.” – Rachel Buddeberg

In a previous essay http://contemplative-studies.org/wp/index.php/2016/08/07/its-the-suffering-stupid/

the first Noble Truth was discussed, reflecting the patently obvious fact that there is suffering, a.k.a. unsatisfactoriness. Although I previously overlooked and ignored this important truth, an investigation of my daily life revealed that it was chock full of unsatisfactoriness. It became clear that this unsatisfactoriness must be witnessed completely to see the Buddha’s wisdom. Life is so full of unsatisfactoriness that it’s impossible to move forward on a spiritual path until it is addressed. Unsatisfactoriness is at the very core of existence and a major impediment in attaining true happiness let alone enlightenment. It became evident to me that it was the suffering, stupid.

But, once this is clearly realized and a complete inventory is taken of unsatisfactoriness, what’s the next step. This is presented in the Second Noble Truth that there are causes to suffering. My initial naive thoughts were that the causes of suffering were obvious. If I stepped on a nail and experienced pain or contracted the flu and experienced malaise, the causes were obvious. But, once I realized that unsatisfactoriness was rampant in my life, I realized that I wasn’t always sure what caused it. Why should I care if someone thinks highly of me? Why should I try to avoid boredom? Why should I be unhappy when certain forms of music are played? Why should I be afraid of heights even when I know it’s safe? The causes here are subtler and more difficult to identify. But, it’s important to do so, as unsatisfactoriness can only be eliminated if we first know what’s producing it.

To put it simply, unsatisfactoriness arises whenever we want things to be different than they are. Struggling against what is, is the primary source of unsatisfactoriness. This is a simple and absolutely true statement. But as with everything there’s more to it. There are a number of sources that are either built into us or inculcated by our society that produce a desire for things to be different. But, keep in mind that no matter what the source, ultimately it’s the refusal to accept what is that’s the source of unsatisfactoriness.

Our attraction and aversion to sensory experiences is a big driver of wanting things to be different. We want pleasurable experiences, be they beautiful sights, music, the flavors of a good wine, perfumes, sexual orgasm, ocean waves hitting our skin, etc. There is nothing wrong with these desires. Many are programmed into us by evolution. The problem arises when we are attached to these sensations and are never satisfied unless they’re present. Hence, in order to obtain them we strive to change the ways things are. When we don’t accept their absence, we suffer. There’s nothing wrong with liking pleasant sensations. We can enjoy them when they’re present. After all that’s accepting the present as it is. In fact, we can even seek them out. Problems arise when we’re not OK when we can’t get them or when we strive to hold onto these experiences even though they will inevitably fade. Not accepting that this is the nature of these experiences causes us to grasp onto them and then suffer when they dissipate. These are seemingly subtle distinctions, but they’re crucial. Grasping is the key. If we don’t grasp, then there’s no unsatisfactoriness.

We are not only wired to seek out pleasant sensation we’re also wired to avoid or eliminate unpleasant sensations, be they ugly or disgusting sights, grating sounds (the noise from lawn tools is one of my aversions), the taste of spoiled wine, the odor of rotten eggs, feeling of being chilled or overheated, pain, etc. There is nothing wrong with not liking these sensations, avoiding them, or attempting to stop them. Again evolution has programmed many of them to help protect us. The problem arises when we do not accept that these sensations arise as they inevitably will, or when we grasp at their avoidance not accepting what is. So, rather than accepting that we’re experiencing a headache, we fight against it, which amplifies the pain. Sure, lie down, close your eyes, rest, take an analgesic, but also accept that pain is present. There’s no sense in denying it or fighting it. That’s what causes the unsatisfactoriness. Just accept it, and relax knowing that like all sensations it will eventually go away. Additionally, we suffer when we become fearful of the possibility that they might occur. So we worry about the next headache or ruminate about the last one. This is a waste of time and makes us miserable. There is no headache present. Enjoy your non-headache. Aversion to certain kinds of sensory stimuli can be a major source of unsatisfactoriness, but only when we don’t accept what is.

Another major source of unsatisfactoriness is the unwillingness to accept ourselves as we are, to desire to be different than what we are. We want to be more successful, more attractive, more knowledgeable, more liked, happier, healthier, more assertive, younger, older, slimmer, stronger, less fearful, a better parent, less fidgety, etc. Just look in the self-help section of a bookstore as evidence of its pervasiveness. This is especially true in western society, where most people simply don’t like themselves. They want to be different. Once again, this is not accepting what is, rather wanting things to be different, producing intense unsatisfactoriness. This lack of acceptance of the self can generate unhealthy jealousy of others who seeming have what we wish we had. It can also cause us to judge others, making us feel better about ourselves by denigrating others. Hence, this desire to be different than we are can be a major source of unsatisfactoriness.

This is not to say that we shouldn’t want to improve ourselves. There’s no problem with working hard to advance one’s career, to lose weight, to exercise, to change hair color, to save toward purchasing a house, etc. This is normal and healthy. The problem arises when we can’t accept what we are in the present moment, when we can’t see that we’re just fine as we are even though we’re working to improve ourselves. There is much about us that we can’t change. No matter how hard I try, I won’t be able to make myself taller, smarter, or unemotional. This is what I am. To be happy, I need to accept myself as I am in the present moment. Fighting it is a waste of time and energy and a major source of unsatisfactoriness.

It is easy to say “got it”, I see the causes of suffering, so let’s move on to how I get enlightened. But, it is important to thoroughly investigate the causes of unsatisfactoriness. It drives home how we go about making ourselves unhappy. Every time you wish that things were different than they are right now, ask the question, why? What’s wrong or missing from the present moment? This doesn’t have to be done for major agonizing suffering. It’s best to look at something simple, like we’re bored. Ask why? Why are we unsatisfied with what’s going on right now? Is it that we crave more sensory stimulation? Then take a careful look at the sensations you’re currently experiencing and ask why they’re not sufficient. It can be an amazing revelation to see how we’re bored because we’re used to and are ignoring the incredible wonder of what is right around us. We’re not happy with the same old experiences, we crave something new. Why?

Don’t try to move on too quickly. Take the time to explore this thoroughly. This morning I was out for a speed walk workout in the heat and humidity, wishing it were cooler. If it was, I thought, then I’d enjoy the walk. But, I explored this a bit more deeply and realized that I was missing the extraordinary feelings of my body being hot, the sweat on my brow, the sun on my face. Then I started to appreciate the present moment and started to enjoy the situation that I was in at the time. The exploration of unsatisfactoriness can lead to greater happiness and simple enjoyment of what is. So, explore the reasons for your unsatisfactoriness and begin to understand your mind and to learn to appreciate what you have right now.

“If we can recognize when incorrect comprehension has affected our mind states, we can then make more sound judgments. We can tell when we are seeing things correctly, because we can notice peacefulness inside of us. Only when incorrect comprehension is in action do we feel tension and agitation.” – Lisa Mitchell

CMCS – Center for Mindfulness and Contemplative Studies

Use Mindfulness for Major Depression Rather than Drugs

August 13, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Many participants said that as time went on, the benefits of MBCT permeated their whole life. ‘Through relating mindfully to their own experiences and to others, they were feeling more confident and were engaging with an increased range of social activity and involvement’.” – Emily Nauman

Depression is epidemic. Major depressive disorder affects approximately 14.8 million American adults, or about 7% of the U.S. population age 18 and older. Depression is more prevalent in women than in men. It also affects children with one in 33 children and one in eight adolescents having clinical depression. It is so serious that it can be fatal as about 2/3 of suicides are associated with depression. It makes lives miserable, not only the patients but also associates and loved ones, interferes with the conduct of normal everyday activities, and can come back repeatedly. Even after complete remission, 42% have a reoccurrence.

The first line treatment is antidepressant drugs. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission and even after repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attain remission. This leaves a third of all patients treated still in deep depression. Being depressed and not responding to treatment is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail.

Mindfulness meditation is a safe alternative that has been shown to be effective for major depressive disorder even in individuals who do not respond to drug treatment. Mindfulness Based Cognitive Therapy (MBCT) was developed specifically to treat depression and has been shown to be very effective in treating existing depression and preventing relapse when depression is in remission. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate depression.

In today’s Research News article “A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1294008510623072/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465797/

Eisendrath and colleagues tested the efficacy of 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) alone vs. 8-weeks of an antidepressant drug (sertraline) alone for matched patients with Major Depressive Disorder. Patients were measured before and after treatment for depression, depressive symptoms, mindfulness, self-compassion, rumination, and decentering. They found that both MBCT and antidepressant drug treatments produced significant decreases in depressive symptoms. But the MBCT group showed significantly greater improvement. They also found that for the MBCT group, the greater the increase in mindfulness and decentering, the greater the improvement in depression.

These are excellent and important results. Mindfulness Based Cognitive Therapy (MBCT) as the sole treatment was more effective than an antidepressant drug in decreasing depressive symptoms in patients suffering from major depressive disorder. In addition, this greater improvement appeared to be due to increases in mindfulness. It is significant that MBCT is actually more effective than drugs. It remains to be seen if its effects continue, preventing relapse after the cessation of active treatment.

It is not known exactly how mindfulness relieves depression. It can be speculated that mindful meditation by shifting attention away from the past or future to the present moment interrupts the kinds of thinking that are characteristic of and support depression. These include rumination about past events, worry about future events, and catastrophizing about potential future events. Mindfulness meditation has been shown to interrupt rumination, worry, and catastrophizing and focus the individual on what is transpiring in the present. By interrupting these forms of thinking that support depression, shifting attention to the present moment where situations are actually manageable, mindful meditation may disrupt depression.

Regardless of the speculations, it is clear that MBCT is a safe and effective treatment for major depressive disorder. So, use mindfulness for major depression rather than drugs.

“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Eisendrath, S. J., Gillung, E., Delucchi, K., Mathalon, D. H., Yang, T. T., Satre, D. D., … Wolkowitz, O. M. (2015). A Preliminary Study: Efficacy of Mindfulness-Based Cognitive Therapy versus Sertraline as First-line Treatments for Major Depressive Disorder. Mindfulness, 6(3), 475–482. http://doi.org/10.1007/s12671-014-0280-8

Abstract

Major depressive disorder (MDD) is the leading cause of disability in the developed world, yet broadly effective treatments remain elusive. The primary aim of this pilot study was to investigate the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) monotherapy, compared to sertraline monotherapy, for patients with acute MDD. This open-label, nonrandomized controlled trial examined a MBCT cohort (N=23) recruited to match the gender, age, and depression severity of a depressed control group (N=20) that completed 8 weeks of monotherapy with the antidepressant sertraline. The 17-item clinician-rated Hamilton Depression Severity Rating Scale (HAMD-17) was the primary outcome measure of depression to assess overall change after 8 weeks and rates of response and remission. The 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16) was the secondary outcome measure to further assess depression severity. Both cohorts were demographically similar and showed significant improvement in depression ratings. No difference was found in the degree of change in HAMD-17 scores (t(34) = 1.42, p = .165) between groups. Secondary analysis showed statistically significant differences in mean scores of the QIDS-SR16 (t (32) = 4.39, p < 0.0001), with the MCBT group showing greater mean improvement. This study was limited by the small sample size and non-randomized, non-blinded design. Preliminary findings suggest that an 8-week course of MBCT monotherapy may be effective in treating MDD and a viable alternative to antidepressant medication. Greater changes in the self-rated QIDS-SR16 for the MBCT cohort raise the possibility that patients derive additional subjective benefit from enhanced self-efficacy skills.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465797/

Reduce Self-harm with Mindfulness-based Dialectical Behavior Therapy

August 12, 2016 psyjdc 1 Comment

By John M. de Castro, Ph.D.

“People who self-injure have often found themselves either the victims of abuse or otherwise powerless and helpless in the midst of terrible circumstances. Self-abuse often provides an escape from overwhelming feelings of isolation, fear, humiliation or fury. Some who self-injure explain that it gives a sense of control in a world where they feel helpless. It can also be a physical sign of emotional pain.” – CHRISTY MATTA

Self-injury is a disturbing phenomenon occurring worldwide, especially in developed countries, such as the U.S. and those in western Europe. Approximately two million cases are reported annually in the U.S. Each year, 1 in 5 females and 1 in 7 males engage in self-injury usually starting in the teen years. Frequently, untreated depression and other mental health challenges create an environment of despair that leads people to cope with these challenges in unhealthy ways. Nearly 50 percent of those who engage in self-injury have been sexually abused. Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. About ¾ of BPD patients engage in self-injurious behaviors.

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DPT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. DBT reduces self-injurious behaviors in BPD patients. But, not all respond. In order to improve treatment for self-injurious behaviors in BPD is important to identify the factors associated with patients who respond to treatment vs. those who don’t.

In today’s Research News article “Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1293102947380295/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870399/

Ruocco and colleagues studied the neural responses of Borderline Personality Disorder (BPD) patients who decrease self-injurious behaviors in response to Dialectical Behavior Therapy (DBT) vs. those who don’t respond. Patients had their brains scanned before and after 7-months of DBT. They found that a wide variety of self-harming behaviors were significantly reduced after the DBT. They also found that those patients who responded well and had large reductions in self-harming demonstrated less activation of the Dorsolateral Prefrontal Cortex before treatment than patients who didn’t respond well to treatment. After treatment the patients who responded to therapy showed greater activation of the Dorsolateral Prefrontal Cortex. These relationships were present even after controlling for depression and mania.

These are interesting and potentially important results. The Dorsolateral Prefrontal Cortex is known to be involved in behavioral regulations. It appears that patients low in this activation, in other words, low in behavioral regulation, benefit the most from treatment which increases this activity and increases self-control. Hence, these results suggest that BPD patients who respond best to treatment are those whose self-injurious behaviors are exacerbated by lack of ability to regulate behaviors. DBT appears to reduce self-harm by improving the patient’s ability to regulate their self-injurious behaviors. These findings also suggest that the best candidates for DBT are those who lack behavioral regulation ability.

So, reduce self-harm with mindfulness-based dialectical behavior therapy.

“Mindfulness teaches these teens to experience emotion without acting on it, thus building in a delay to self-harming behavior.” – Pat Harvey

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Ruocco, A. C., Rodrigo, A. H., McMain, S. F., Page-Gould, E., Ayaz, H., & Links, P. S. (2016). Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study. Frontiers in Human Neuroscience, 10, 220. http://doi.org/10.3389/fnhum.2016.00220

Abstract

Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870399/