Month: March 2017

Improve Type II Diabetes with Yoga

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Improve Type II Diabetes with Yoga

 

By John M. de Castro, Ph.D.

 

“a number of studies have revealed that yoga can reduce contributing factors and help patients cope with diabetic symptoms. Although regular exercise can help, yoga for diabetes provides unique benefits that can effectively restore the body to a state of natural health and proper function.” – Yoga U

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. Although this has been called adult-onset diabetes it is increasingly being diagnosed in children. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world.

 

Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia.

 

A leading cause of this tissue resistance to insulin is overweight and obesity and a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes.

A mindfulness practice that combines mindfulness with exercise is yoga and it has been shown to be helpful in the treatment of Type II Diabetes. In order for any treatment, including yoga practice, to be effective beyond the guided treatment, the regimen of practice must be continued and adhered to.

 

In today’s Research News article “Adherence to yoga and its resultant effects on blood glucose in Type 2 diabetes: A community-based follow-up study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225741/

Angadi and colleagues studied the effect of varying levels of adherence to yoga practice after treatment to treat the symptoms of Type II Diabetes. They recruited adult (40 years of age and older) patients who had been diagnosed with Type II Diabetes. As part of a previous study these patients had been practicing yoga for 3 months. To measure adherence, their attendance at continuing yoga practices was simply recorded over a 6-month period. Blood sugar levels, fasting and after a meal, and glycosylated hemoglobin (HbA1c), a marker of blood sugar level control, were measured at baseline and again at 1, 3, and 6 months.

 

They found that at the end of 6 months, the greater the attendance at yoga classes, the lower the fasting blood sugar levels. This suggests, not surprisingly, that adherence to attendance at yoga classes is important for the continuing effectiveness of yoga in reducing blood sugar levels in patients with Type II Diabetes. It should be noted that all of the participants in this study had been practicing yoga for 3 months prior and there was not a control comparison condition that did not practice yoga. As such, the primary effectiveness of yoga practice was already present. The current study simply looked at the consequences of varying levels of continuing yoga practice for the subsequent 6-month period. Hence, continuing a program of yoga practice appear to be helpful in maintaining the effectiveness of yoga practice as an adjunctive activity for the treatment of Type II Diabetes.

 

So, improve Type II Diabetes with yoga.

 

“Regular yoga practice can help reduce the level of sugar in the blood, along with lowering blood pressure, keeping your weight in check, reducing the severity of the symptoms  and slowing the rate of progression of the disease.” – TheHealthSite.com

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Angadi, P., Jagannathan, A., Thulasi, A., Kumar, V., Umamaheshwar, K., & Raghuram, N. (2017). Adherence to yoga and its resultant effects on blood glucose in Type 2 diabetes: A community-based follow-up study. International Journal of Yoga, 10(1), 29–36. http://doi.org/10.4103/0973-6131.186159

 

Abstract

Aim:

To study the adherence to yoga and its effects on blood glucose parameters in patients with Type 2 Diabetes Mellitus.

Methods:

A single group longitudinal study over 6 months was conducted at VASK yoga centre, Bangalore. Fasting Blood Sugar, Post Prandial Blood Sugar Levels and Glycosylated Hemoglobin and qualitative in-depth interview of the participants and therapist was conducted at baseline, end of 3rd month and end of 6 months; intermediate observations was conducted at the end of every month.

Results:

Adherence to yoga in the community in Bangalore is around 50% over 6 months. Participants who completed the yoga programme had significantly lower HbA1c (end of 3rd month). At the end of 6 months yoga adherence was significantly negatively correlated with FBS and stress. Further there was a trend towards those who dropped out having higher FBS, controlling for medication intake, stress levels and diet pattern (OR = 1.027, P = 0.07). Qualitative data revealed that most of the participants joined and completed the yoga programme to help cure their diabetes. Participants who dropped out from the yoga programme gave reasons of travel, ill-health and increased work-load at office.

Conclusions:

Adherence to yoga has an effect on the blood glucose parameters in diabetes. Hence, strategies to motivate participants to undergo ‘lifestyle modification practices’ including maximizing adherence to yoga should be the focus to experience any beneficial effects of yoga.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225741/

 

Improve Drug Resistant Major Depressive Disorder with Yoga Breathing Exercises

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Improve Drug Resistant Major Depressive Disorder with Yoga Breathing Exercises

 

By John M. de Castro, Ph.D.

 

“Yoga breathing can help you manage the symptoms of both anxiety and depression. After years of meditating, and learning to observe my anxiety-based depression, I actually recovered from a condition that literally almost killed me. I regained and continue to maintain my optimum mental health with a yoga breathing practice.” – Amy Weintraub

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with antidepressant drugs only about a third attained remission of the depression. After repeated and varied treatments including antidepressant drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, antidepressant drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

Being depressed and not responding to treatment or relapsing 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 training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. Aerobic exercise has also been found to relieve depression.

 

Yoga practice in many ways is ideal as it is both a mindfulness practice and an exercise and it can be practiced in groups or individually at home. It has also been shown to reduce depression. Yoga practice, though, is a combination of practices including postures, meditation, and breathing exercises. Hence, it is not clear which, or which combination of these components is effective for depression. In today’s Research News article “A Breathing-based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272872/

Sharma and colleagues perform a controlled pilot test of yogic breathing exercises alone for the treatment of antidepressant drug resistant major depressive disorder.

 

They recruited patients diagnosed with a major depressive disorder who after at least 8 weeks of antidepressant drug treatment did not show a decrease or remission in their depression. The participants were then randomly assigned to either a wait-list control condition or to receive 8 weeks of yogic breathing exercise practice meeting in groups, once a week for 90 minutes and practiced daily at home for 20 to 30 minutes. The intervention consisted of a series of sequential, rhythm-specific breathing exercises that bring practitioners into a restful, meditative state. They were measured prior to and after the intervention and mid-course at 4-weeks into practice for anxiety, depression, suicidal ideation and behavior, medication compliance, and adverse effects.

 

They found that the yogic breathing group had high completion rates and no adverse effects. The intervention group, in comparison to the wait-list control group, had a highly significant, 44% decrease in clinician rated depression, and in self-rated anxiety and depression. Hence, yogic breathing exercises appeared to produce dramatic, clinically significant reductions in depression in patients who were unresponsive to antidepressant drug treatment.

 

These are interesting and exciting findings that simple breathing exercises with no side effects can produce clinically significant relief of antidepressant drug resistant major depressive disorder. It is remarkable that such a simple intervention can have such huge effects on a disorder that is exceedingly difficult to treat. It should be mentioned that the control condition did not receive and additional treatment. So, it is important that this pilot study be followed by a randomized controlled clinical trial that also includes other forms of active treatments such as relaxation or meditation training. This could help reduce confounding and to sort out which components of the yogic breathing exercise were effective.

 

So, improve drug resistant major depressive disorder with yoga breathing exercises.

 

“A powerful tool for preventing the onset of depressed moods in the first place, breath awareness restores energy during acute phases of depression, lightens your emotional load, and creates needed distance from gloomy thoughts. And it complements other healing strategies by providing an underpinning of relaxation and emotional stability.” – Rolf Sovic

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Sharma, A., Barrett, M. S., Cucchiara, A. J., Gooneratne, N. S., & Thase, M. E. (2017). A Breathing-based Meditation Intervention for Patients with Major Depressive Disorder Following Inadequate Response to Antidepressants: A Randomized Pilot Study. The Journal of Clinical Psychiatry, 78(1), e59–e63. http://doi.org/10.4088/JCP.16m10819

 

Abstract

Objective

To evaluate feasibility, efficacy and tolerability of Sudarshan Kriya yoga (SKY) as an adjunctive intervention in patients with major depressive disorder (MDD) with inadequate response to antidepressant treatment.

Method

Patients with MDD (defined by DSM-IV-TR) depressed despite ≥8 weeks of antidepressant treatment were randomized to SKY or a waitlist control (delayed yoga) arm for 8 weeks. The primary efficacy end point was change in 17-item Hamilton Depression Rating Scale (HDRS-17) total score from baseline to 2 months. The key secondary efficacy end points were change in Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) total scores. Analyses of the intent-to-treat (ITT) and completer sample were performed. The study was conducted at the University of Pennsylvania between October 2014 and December 2015.

Results

In the ITT sample (n=25), the SKY arm (n=13) showed a greater improvement in HDRS-17 total score compared to waitlist control (n=12)(−9.77 vs. 0.50, P =.0032). SKY also showed greater reduction in BDI total score versus waitlist control (−17.23 vs. −1.75, P = .0101). Mean changes in Beck Anxiety Inventory (BAI) total score from baseline were significantly greater for SKY than waitlist (ITT mean difference: −5.19; 95% CI −0.93 to −9.34; P = .0097; completer mean difference: −6.23; 95% CI −1.39 to −11.07; P = .0005). No adverse events were reported.

Conclusion

Results of this randomized, waitlist-controlled pilot study suggest the feasibility and promise of an adjunctive SKY-based intervention for patients with MDD who have not responded to antidepressants.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5272872/

Improve Attitudes and Mental Health at Work with Mindfulness

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Improve Attitudes and Mental Health at Work with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness is, above all, about being aware and awake rather than operating unconsciously. When you’re consciously present at work, you’re aware of two aspects of your moment-to-moment experience—what’s going on around you and what’s going on within you. To be mindful at work means to be consciously present in what you’re doing, while you’re doing it, as well as managing your mental and emotional state.” –  Shamash Alidina

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. It frequently results from emotional exhaustion. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. Sleep disruption is an important consequence of the stress.  This exhaustion produces a loss of enthusiasm, empathy, and compassion. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the workplace. From a business standpoint, it reduces employee efficiency and productivity and increases costs. From the worker perspective, it makes the workplace a stressful, unhappy place, promoting physical and psychological problems. Hence, preventing burnout in the workplace is important. One technique that is gaining increasing attention is mindfulness training. It has been demonstrated to be helpful in treating and preventing burnout in a number of work environments.

 

In today’s Research News article “Mindful2Work: Effects of Combined Physical Exercise, Yoga, and Mindfulness Meditations for Stress Relieve in Employees. A Proof of Concept Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241323/

de Bruin and colleagues performed a pilot study of the effectiveness of a program of exercise, meditation, and yoga for the relief of work related stress symptoms. They recruited

workers who were referred by physicians who diagnosed them with work related stress issues. The workers received training in six weekly 2-hour sessions and a follow-up session, consisting of 20 minutes of aerobic exercise, 20 minutes of Hatha restorative yoga, and 80 minutes of mindfulness meditation including psycho-education. The participants were encouraged to practice at home. They were measured before and after the intervention, 6 weeks and 6 months after the completion of the program for workability, perceived stress, anxiety, depression, emotions, and sleep.

 

They found that the participants liked the program rating it at 8.1 on a 10-point scale. Following the intervention work-related fatigue and exhaustion (burnout) was markedly and significantly reduced while motivation, activation, focus and concentration, and energy were significantly increased. The employees became significantly less likely to leave their job, worked a significantly greater proportion of their contract hours, and found the work environment to be significantly better. Hence, the employees showed markedly improved attitudes and behavior toward their jobs. The employees’ psychological health was also greatly improved, with significant reductions in anxiety, depression, perceived stress, and increases in sleep quality and positive emotions. These effects all had very large effect sizes and were still strong and present 6 months after the conclusion of training. Hence, work-related psychological issues were improved in a lasting way with the intervention.

 

These results of this pilot study were impressive. But, the lack of a control group or condition markedly limits the conclusions that can be reached. Also, since the intervention contained meditation, yoga, and aerobic exercise, it cannot be determined which, or which combination of components are necessary for the benefits. But, the results certainly suggest that a large randomized controlled clinical trial should be conducted. With the intense stresses of the modern work environment, a program that reduced stress and improved attitudes and emotions, would be extremely valuable both to the employer and the employees.

 

So, improve attitudes and mental health at work with mindfulness.

 

“Many corporations and employees are realizing that the benefits of mindfulness practices can be dramatic. In addition to supporting overall health and well-being, mindfulness has been linked to improved cognitive functioning and lower stress levels.” – Carolyn Gregoire

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

De Bruin, E. I., Formsma, A. R., Frijstein, G., & Bögels, S. M. (2017). Mindful2Work: Effects of Combined Physical Exercise, Yoga, and Mindfulness Meditations for Stress Relieve in Employees. A Proof of Concept Study. Mindfulness, 8(1), 204–217. http://doi.org/10.1007/s12671-016-0593-x

 

Abstract

Work-related stress and associated illness and burnout is rising in western society, with now as much as almost a quarter of European and half of USA’s employees estimated to be at the point of burnout. Mindfulness meditation, yoga, and physical exercise have all shown beneficial effects for work-related stress and illness. This proof of concept study assessed the feasibility, acceptability, and preliminary effects of the newly developed Mindful2Work training, a combination of physical exercise, restorative yoga, and mindfulness meditations, delivered in six weekly group sessions plus a follow-up session. Participants (n = 26, four males), referred by company doctors with (work-related) stress and burnout complaints, completed measurements pre and post the intervention, as well as at 6-week (FU1) and 6-month (FU2) follow-up. Results showed very high feasibility and acceptability of the Mindful2Work training. The training and trainers were rated with an 8.1 and 8.4 on a 1–10 scale, respectively, and training dropout rate was zero. Significant improvements with (very) large effect sizes were demonstrated for the primary outcome measures of physical and mental workability, and for anxiety, depression, stress, sleep quality, positive and negative affect, which remained (very) large and mostly increased further over time. Risk for long-term dropout from work (checklist individual strength [CIS]) was 92 % at pre-test, reduced to 67 % at post-test, to 44 % at FU1, and 35 % at FU2, whereas employees worked (RTWI) 65 % of their contract hours per week at pre-test, which increased to 73 % at post-test, 81 % at FU1 and 93 % at FU2. Intensity of home practice or number of attended sessions were not related to training effects. To conclude, the newly developed Mindful2Work training seems very feasible, and acceptable, and although no control group was included, the large effects of Mindful2Work are highly promising.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241323/

 

Improve the Aging Brain’s Cognition with Mindfulness

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Improve the Aging Brain’s Cognition with Mindfulness

 

By John M. de Castro, Ph.D.

 

“there is a small but growing body of evidence that regular meditation really can slow ageing – at least at the cellular level.” – James Kingsland

 

Human life is one of constant change. We revel in our increases in physical and mental capacities during development, but regret their decreases during aging. The aging process involves a systematic progressive decline in every system in the body, the brain included. This includes our mental abilities which decline with age including impairments in memory, attention, problem solving ability, and emotion regulation. It is inevitable and cannot be avoided. There is some hope for these age-related declines, however, as there is evidence that they can be slowed. There are some indications that physical and mental exercise can reduce the rate of cognitive decline and lower the chances of dementia. For example, contemplative practices such as meditation, yoga, and tai chi or qigong have all been shown to be beneficial in slowing or delaying physical and mental decline with aging.

 

Using modern neuroimaging techniques, scientists have been able to view the changes that occur in the nervous system with aging. In addition, they have been able to investigate various techniques that might slow the process of neurodegeneration that accompanies normal aging. They’ve found that mindfulness practices reduce the deterioration of the brain that occurs with aging restraining the loss of neural tissue. Indeed, the brains of mindfulness practitioners have been found to degenerate less with aging than non-practitioners.

 

Since the global population of the elderly is increasing at unprecedented rates, it is imperative to investigate methods to slow physical and mental aging and mitigate its effects. In today’s Research News article “Mindful Aging: The Effects of Regular Brief Mindfulness Practice on Electrophysiological Markers of Cognitive and Affective Processing in Older Adults.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241348/

Malinowski and colleagues recruited individuals between the ages of 55 and 75 years and randomly assigned them to either receive mindfulness training or to an active brain training. Mindfulness training consisted of breath following meditation practice. The brain training condition involved performing mental arithmetic problems that required effortful cognitive processing. Both mindfulness and braining training groups practiced for 10 minutes, 5 days per week, for eight weeks. Before and after training participants were measured for mindfulness, self-efficacy, and mental well-being and were assessed for cognitive and emotion regulation abilities by performance of an eStroop task while their brains’ electrical responses, Electroencephalogram (EEG), were recorded. In the eStroop task the participants viewed a computer screen where one to four words were presented simultaneously. The participants were asked to simply press one of four keys to indicate the number of words presented. There were four conditions; emotionally positive words (love), emotionally negative words (sad), emotionally neutral words (box), and incongruent words. In the incongruent condition the words, one, two, three, or four were presented, with the number of words different from the meaning of the words, e.g. the word three presented two times.

 

They found that from pre-test to post-test the mindfulness training, but not the brain training group increased in mindfulness and increased their response speed (reaction time) in the eStroop task under all conditions. So, the breath meditation increased mindfulness and made for quicker reactions in the cognitive task. The N2 negative going neural response occurring 0.27 to 0.34 seconds after the presentation of the words, was significantly stronger in the mindfulness than the brain training group. The electrical response was measured over the frontal central cortex, components of the network regulating attention. This result suggests that mindfulness training improves the brains ability to regulate attention.

 

This study is particularly strong because the control condition was active and required similar commitment of time and energy and belief that the treatment would produce improvements. As a result, the conclusions from the study are very clear. The results suggest that mindfulness training produces improved attentional ability resulting from improved neural responses. These effects were produced in an older group of participants. This suggests that mindfulness training may reduce the cognitive-attentional decline that normally occurs with aging.

 

This is an exciting proposition, that mindfulness training may improve our ability to cognitively age healthily. As the population continues to live longer and the number of older and elderly individuals increases, the problem of cognitive decline will place an increasing burden on caregivers and stress the healthcare system. So, being able to delay and reduce this decline could have profound effects on individuals and society. Hence, promoting mindfulness training for the elderly could reap substantial benefits for the elderly and the system that supports them in their declining years..

 

So, improve the aging brain’s cognition with mindfulness.

 

“Our modern assumptions, ideas, beliefs, and cultural narratives about growing old are too small for us to inhabit. Our thinking about aging is often hijacked by fear, negativity, and ageism. The authentic experience of aging is a source wonder, curiosity, and fascination. Mindful aging is a skillful means to embrace the process of growing older in order to cultivate a deeper understanding and appreciation of the natural flow of all life.” – Brian Alger

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Malinowski, P., Moore, A. W., Mead, B. R., & Gruber, T. (2017). Mindful Aging: The Effects of Regular Brief Mindfulness Practice on Electrophysiological Markers of Cognitive and Affective Processing in Older Adults. Mindfulness, 8(1), 78–94. http://doi.org/10.1007/s12671-015-0482-8

 

Abstract

There is growing interest in the potential benefits of mindfulness meditation practices in terms of counteracting some of the cognitive effects associated with aging. Pursuing this question, the aim of the present study was to investigate the influence of mindfulness training on executive control and emotion regulation in older adults, by means of studying behavioral and electrophysiological changes. Participants, 55 to 75 years of age, were randomly allocated to an 8-week mindful breath awareness training group or an active control group engaging in brain training exercises. Before and after the training period, participants completed an emotional-counting Stroop task, designed to measure attentional control and emotion regulation processes. Concurrently, their brain activity was measured by means of 64-channel electroencephalography. The results show that engaging in just over 10 min of mindfulness practice five times per week resulted in significant improvements in behavioral (response latency) and electrophysiological (N2 event-related potential) measures related to general task performance. Analyses of the underlying cortical sources (Variable Resolution Electromagnetic Tomography, VARETA) indicate that this N2-related effect is primarily associated with changes in the right angular gyrus and other areas of the dorsal attention network. However, the study did not find the expected specific improvements in executive control and emotion regulation, which may be due to the training instructions or the relative brevity of the intervention. Overall, the results indicate that engaging in mindfulness meditation training improves the maintenance of goal-directed visuospatial attention and may be a useful strategy for counteracting cognitive decline associated with aging.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241348/

 

 

Improve Obesity with Yoga

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Improve Obesity with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is a powerful activity that connects mind, body and a sense of self to achieve endless health benefits, including maintaining weight-loss. The philosophy of yoga fosters a healing practice that brings peace and acceptance to the self no matter where you are in your life.” – Laurel Dierking

 

Obesity has become an epidemic in the industrialized world. In the U.S. the incidence of obesity, defined as a Body Mass Index (BMI) of 30 or above has more than doubled over the last 35 years to currently around 35% of the population, while two thirds of the population is considered overweight or obese (BMI > 25). Although the incidence rates have appeared to stabilize, the fact that over a third of the population is considered obese is very troubling. This is because of the health consequences of obesity. Obesity has been found to shorten life expectancy by eight years and extreme obesity by 14 years. This occurs because obesity is associated with cardiovascular problems such as coronary heart disease and hypertension, stroke, metabolic syndrome, diabetes, cancer, arthritis, and others.

 

Obviously, there is a need for effective treatments to prevent or treat obesity. But, despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective treatment. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. This suggests that mindfulness training may be an effective treatment for overeating and obesity alone or in combination with other therapies. Yoga practice has been shown to have a myriad of physical and psychological benefits. These include significant loss in weight and body mass index (BMI), resting metabolism, and body fat in obese women with Type 2 diabetes and improve health in the obese. Hence it would seem reasonable to investigate the benefits of yoga therapy on the weight and body composition of the obese.

 

In today’s Research News article “Yoga Practice for Reducing the Male Obesity and Weight Related Psychological Difficulties-A Randomized Controlled Trial.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198375/

Rshikesan and colleagues recruited overweight and obese (BMI > 25) male participants. They were randomly assigned to either receive Integrated Yoga Therapy or a no-treatment control condition. The yoga therapy instruction was conducted for 90 minutes per day, 5 days per week, for 14 weeks, consisting of lecture, stretching, yoga sun salutations, postures, breathing exercises and meditation This was followed by 3 months of home yoga practice. The participants were measured prior to training, after 14 weeks of training and after the 3-month home practice, for body weight, Body Mass Index (BMI), waist and hip circumference, body shape index, skinfold thickness, % body fat, perceived stress, and acceptance of weight related problems.

 

They found that compared to the no-treatment control condition that showed non-significant improvements, the yoga therapy group had significant decreases in weight, arm circumference, % body fat, Body Mass Index (BMI), and skinfold thickness and a decrease in perceived stress. Hence, Integrated Yoga Therapy produced a significant improvement in the physical and psychological manifestations of obesity.

 

These are encouraging results but the conclusions from the study need to be tempered as the improvements were relatively small, with a 3%, ~ 2 kg, reduction in weight after over a half a year of practice. In addition, the control condition did not include any programmed exercise or dietary activity. So, the results could have been produced by any increase in exercise induced caloric expenditure, or potentially by a placebo, experimenter bias, or attentional effect. Also, it has long been known that upon initiating an exercise program there is a small decrease in weight initially, but no further reductions occur with continued practice. So, it cannot be concluded that the yoga practice would continue to reduce weight and improve body shape. Regardless, the program did improve the physical and psychological manifestations of obesity.

 

So, improve obesity with yoga.

 

“What matters is having other fat people around, supporting each other and improving together. Fat people spend their whole lives trying to fit into a world that neither fits nor accepts them. Having a separate space to explore one’s physical self — and one’s spirituality — with others who have the same goals, is tremendously healing.” – Kay Erdwinn

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Rshikesan, P. B., Subramanya, P., & Nidhi, R. (2016). Yoga Practice for Reducing the Male Obesity and Weight Related Psychological Difficulties-A Randomized Controlled Trial. Journal of Clinical and Diagnostic Research : JCDR, 10(11), OC22–OC28. http://doi.org/10.7860/JCDR/2016/22720.8940

 

Abstract

Introduction

Obesity is a health disorder and increasing all over the world. It is also a cause for many non-communicable diseases. Yoga practice reduces the stress level which may improve the eating habits and help in weight reduction.

Aim

To assess the final outcome of the effects after 3 months of the 14 weeks yoga training on obesity of adult male in an urban setting.

Materials and Methods

This was a randomized controlled trial with parallel groups (Yoga and Control groups) on male obese. Total 80 subjects with Body Mass Index (BMI) between 25 to 35 kg/cm2 were enrolled and randomized into two equal groups in which 72 subjects (yoga n = 37 and control n=35) completed the trial. Yoga group mean age ± SD was 40.03±8.74 and Control group mean age±SD was 42.20±12.06. A 14 weeks special IAYT (Integrated Approach of Yoga Therapy) yoga training was given to the Yoga group and no specific activity was given to Control group. The interim results of this study at 14 weeks were covered in another article which is under process. After the 14 weeks of yoga training the Yoga group was asked to continue the yoga practice for the next 3 months and the Control group was not given any physical activity. The final outcome is covered in this paper.

The assessments were anthropometric parameters of body weight (Wt), BMI (Body Mass Index), MAC (Mid-upper Arm Circumferences of left and right arm), WC (Waist Circumference), HC (Hip Circumference), WHR (Waist Hip Ratio), SKF (Skin Fold Thickness) of biceps, triceps, sub scapular, suprailiac and cumulative skin fold thickness value), Percentage body fat based on SKF and Psychological questionnaires of PSS (Perceived Stress Scale) and AAQW (Acceptance and Action Questionnaire for Weight related difficulty). Assessments were taken after 3 months of yoga training, for both Yoga and Control groups. Within group, between group and correlation analyses were carried out using SPSS 21.

Results

Improvement in anthropometric and psychological parameters such as Wt, Percentage body fat, PSS were observed in the final outcome. Also, some of the improvements such as AAQW score were lost in the final outcome, compared to interim results.

Conclusion

The yoga practice is effective for obesity control for adult male in an urban setting.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198375/

 

What’s Wrong with Meditation II – Improper Instruction

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Image result for upset with meditation

What’s Wrong with Meditation II – Improper Instruction

 

By John M. de Castro, Ph.D.

 

“The next biggest danger is that no one thinks there are or can be any dangers to meditation, so there is almost no discussion and information-gathering on the subject. Everyone is just going blah blah about the benefits. As a consequence, meditators are constantly being blindsided and derailed by things that should be trivial hazards, easily dismissed or bypassed. If we compare meditation to a day at the beach, it is as if people are saying, “Oh, don’t worry, you can never get enough direct sunlight. Just soak it up. You don’t even need a hat. And swim out in the ocean as far as you want. It’s a lake. With dolphins that will love you.”” – Lorin Roche

 

As was discussed in the prior essay on What’s Wrong with Meditation I – Expectations there are three essential problems with the way meditation has been presented in the west that have produced problems, misconceptions, and misunderstandings. First, meditation has been presented in a way that has evoked beliefs, ideas, and images that are overly idealized and not reflective of the typical experiences of meditation practice. Secondly, is the focus of the present essay, that immediately jumping into meditation practice has been encouraged, without the provision for proper background information, study, or instruction. Lastly, the jargon used to describe the process, experiences, obstacles, and results is extreme, evoking images and expectations that far exceed normal experience.

 

The Dalai Lama was brought on a tour of a major new meditation center in the United States. At the end of the tour, he simply asked “where’s the library?” He was astonished when he was told that there wasn’t one. He commented that before any of his new monks were allowed to meditate that had to spend at least a couple of years studying before they were allowed to meditate. He stressed that it is imperative that the practitioner have a proper background to understand the practical and theoretical basis for meditation before starting. This story exemplifies the difference between ancient Tibetan practice and meditation as it’s taught in the west where practitioners are launched into meditation practice with only minimal instruction. Hence people dive in without knowledge of obstacles and dangers hidden beneath the surface.

 

This western practice would be fine if meditation was straightforward and there weren’t any difficulties and traps that could ensnare the meditator. But, meditation practice is not simple and straightforward and without instruction in what to expect and how to recognize true progress, the practitioner is left to grope and stumble their way through the process. Beginners are generally not instructed, except in very general terms, as to what is the goal and how to recognize it if they attain it. They are frequently told to just follow and/or count the breath but receive no instruction as to what to do when their mind inevitably wanders. They are told simply return to following the breath. This was exactly how I was instructed when I began meditation practice.

 

As a result of this lack of instruction, beginners deride themselves for mind wandering making the process unpleasant. They are not told that this is effectively punishing themselves for recognizing that their mind has wandered. This makes it less likely that the individual will recognize and return from mental discursions. With a little instruction, they can learn that minds do what minds do, and that’s OK. They’re going to wander. Get used to it! But, they also need to be instructed to celebrate their recognizing it and returning to the meditative focus. This instruction produces reward for recognizing that the mind has wandered making it more likely that it will be recognized again and sooner. If beginners were simply given this much simple instruction their meditation practice will be much more enjoyable and productive and they’ll be much less likely to give up the practice.

 

Beginning meditators are frequently told that they should quiet the mind but are never instructed as to exactly what that means. They often confuse a quiet mind with a total blank, believing that a quiet mind is one without content. If they are simply instructed that they are to quiet the internal chatter, not everything. There’ll still be sounds, sights, odors, touches, etc. But when the mind is quiet there is no verbal commentary accompanying them. They are simply observing these stimuli as they are without categorization, judgment, labelling, reflection on past stimuli, or projections as to the future course of the stimuli. That’s a quiet mind. But few beginners are taught this. A completely blank mind can and will happen later in practice, but only after the mind has been quieted, not stopped. If beginning meditators were simply provided instruction about what is their goal and what a quiet mind is actually like their meditation practice will be much more enjoyable and productive.

 

A very important instruction for beginners is to warn them about the troubling kinds of thoughts and memories that often spontaneously arise during meditation. People come with the misconception that meditation will help them escape from their problems. Nothing could be further from the truth. In fact, meditation does the exact opposite, forcing the meditator to confront their issues. The strength here is that meditation is a wonderful occasion to begin to deal with these issues. But, often the thoughts or memories are overwhelming. Proper instruction is needed on how to work with issues gradually, avoiding delving too deeply too soon. At retreats, there are always boxes and boxes of tissues available for the inevitable copious tears shed by some of the participants as they are dealing with deeply troubling issues. Yes, in meditation you try to quiet the mind. But, in that relaxed quiet state, powerful, highly emotionally charged thoughts and memories are likely to emerge. The practitioner needs proper instruction beforehand of the likelihood of this happening and how to deal effectively with it. Knowing that this is normal, healthy, and part of the process, helps immeasurably to lessen the impact of these thoughts and memories on the individual and increases the likelihood that they can be effectively resolved. At times, professional therapeutic intervention may be needed. Once again, if this is understood ahead of time, the individual is more likely to seek assistance.

 

Meditation practice can also produce some troubling experiences beyond unmasking deep psychological issues. These are rarely presented or discussed with people before engaging in meditation. Not the least of these experiences are awakening experiences themselves. These can occur at any time and even to beginners. If they are not properly understood, they can lead to sometimes devastating consequences. These experiences are so powerful and unusual that they can be misinterpreted. Awakening experiences have been misdiagnosed as psychotic breaks and the individual placed on powerful drugs and/or institutionalized. There are no systematic studies of the extent of this problem, but a number of psychiatrists who meditate and understand awakening experiences have said that it is quiet extensive. At the very least, the individual may believe that they are losing their sanity or as one has said, “I just got used to the idea that occasionally I would have just one of those days.” This is one of the reasons why the Dalai Lama insists that beginners study first, so they can recognize what is happening to them if and when these experiences arise.

 

Meditation practice can sometimes produce energetic states that can vary in intensity, location, and duration. If and when these occur, they are usually quite surprising and unexpected. Many practitioners never experience these states or only experience very mild energy states. But, for those that do, if they have no prior instruction they can readily misinterpret them. They are sometimes called Kundalini energy states and involve energy focused in specific parts of the body or overall. They can feel like nervousness, tension, or almost like electrical currents flowing through the body and can produce spontaneous and undirected movements. These can be minor or overwhelmingly intense and can last from a few days to years. With these states sleep can be quite difficult and the individual may go days at a time without any sleep whatsoever. These energy states are usually found to be aversive and difficult to cope with. If the practitioner hasn’t been instructed about these states, they may seek out medical help. Unfortunately, the medical professions are not trained to recognize these states and often prescribe powerful anxiolytic drugs that can stupefy the individual but not affect the energies. Monasteries and major retreat centers are often equipped to recognize and treat these energies states. But, the vast majority of meditators and meditation instructions are completely devoid of an understanding of Kundalini energies. A little prior study and instruction can go a long way toward preventing misinterpretations and getting assistance from experienced teachers.

 

Another state that can be produced by awakening experiences has been termed as the “dark night of the soul.” After awakening there is, almost inevitably, a honeymoon period of happiness and bliss. But this is frequently followed by an aversive state that has been described as a spiritual desert. These have been reported by awakened individuals throughout the centuries, including the Christian and Sufi mystics and saints, Buddhist masters, and everyday practitioners. In these states the individual loses interest in life and seemingly has no motivation to do virtually anything. They feel emotionally dry and lament the loss of what they call the juice of life. Everything is flat and the individual often becomes deeply depressed. This dark night can last for months or years. To deal with dark nights the individual needs sophisticated instruction from accomplished teachers. No preparatory instruction will help to stop or prevent this from occurring. But, with proper instruction the individual can be better prepared to understand what is happening to them and what to expect in the future. This again can prevent misinterpretation and consequent maladaptive responses and harmful consequences.

 

At this point it should be clear why the Dalai Lama is so insistent upon extensive study and instruction prior to engaging in meditation. It can prevent potential negative reactions and consequences to some of the unexpected consequences of meditation. It has been my experience that the less instruction a person has prior to engaging in meditation the greater the likelihood that problems occur and the greater the likelihood of them being misinterpreted and counterproductive and even damaging responses occurring. So, study about meditation, work with an experienced teacher, and prepare yourself ahead of time before getting deeply involved in meditation practice. If you do, the rewards can be maximized and the pitfalls minimized, making practice productive and potentially profoundly altering.

 

The issues discussed above can seem off putting. You may be asking yourself if it makes any sense at all to engage in a meditation practice with all these potential problems. The answer is a resounding yes. The amazing benefits of meditation practice on your psychological, emotional, physical, and spiritual health make it well worth the effort. In fact, it has the potential to change you in profound ways for all of existence. The above caveats should be taken as indicators that study and guidance should be undertaken and that meditation should be practiced with understanding of what to expect both good and bad ahead of time. These warnings are important but should not be taken a stop signs, only caution signs. Know what you’re getting into, be prepared, and then reap the extraordinary benefits.

 

“It’s a kind of re-birth.  The dark night of the soul is a kind of death that you die.  What dies is the egoic sense of self.  Of course, death is always painful, but nothing real has actually died there – only an illusory identity.  Now it is probably the case that some people who’ve gone through this transformation realized that they had to go through that, in order to bring about a spiritual awakening.  Often it is part of the awakening process, the death of the old self and the birth of the true self.” – Eckhart Tolle
CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Improve the Psychological Well-Being of Patients with Multiple Chronic Diseases with Yoga

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Improve the Psychological Well-Being of Patients with Multiple Chronic Diseases with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga can be beneficial for individuals with disabilities or chronic health conditions through both the physical postures and breathwork. Each pose can be modified or adapted to meet the needs of the student. Yoga asanas can be performed while seated in a chair or wheelchair.” – National Center on Health, Physical Activity and Disability (NCHPAD)

 

The prevalence of chronic diseases has increased with population ageing with around 18% of the elderly having debilitating chronic diseases. “The most common diagnoses are diabetes, stroke, hypertension, cancer, arthritis, asthma, fractures, the presence of an artificial knee or hip, fatigue, multiple sclerosis, demyelinating diseases of the central nervous system, gonarthrosis, ataxia, COPD, dependence on renal dialysis, malignant neoplasm of breast/prostate, depressive episodes, and pure hypercholesterolemia” (Curtis et al., 2016) and dementia.

 

The situation, however, is much more complex as over half have an additional chronic disease (multimorbidity). This situation has been termed Complex Chronic Disease and Disability (CCDD). Although there are a myriad of combinations, the disease pairs that were significantly associated with the highest likelihood of disability contained dementia (dementia–hip fracture, dementia–cardiovascular disease, and dementia–depression). These individuals are very frail, often confined to bed or wheelchairs. They provide a difficult challenge for caregiving and treatments to help relieve their suffering are badly needed.

 

Yoga practice has been found to be effective for the prevention and treatment of a large array of chronic psychological and physical problems, even for the elderly in hospice, with cancer, COPD, Kidney Disease, anxiety and depression, and dementia. Hence, it would seem reasonable to hypothesize that yoga may be effective for patients with Complex Chronic Disease and Disability (CCDD). In today’s Research News article “Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223015/

Curtis and colleagues performed a pilot study of the effectiveness of yoga practice for male and female elderly (average age 63 years) in an institution with Complex Chronic Disease and Disability (CCDD). Most were in wheelchairs or had severe mobility issues.

 

The patients were provided with a Hatha Yoga program modified for practice in a sitting position, once a week for 8 weeks and were provided with recordings to guide personal daily practice. The practice included relaxation, body scan, and yoga postures. They were measured prior to, midway through, and after the practice for pain, pain catastrophizing, including rumination, magnification, and helplessness, perceived stress, anxiety and depression, perceived injustice, mindfulness, self-compassion, and spiritual well-being, including peace and meaning. They found that the yoga practice benefited the patients increasingly as the practice continued over the 8 weeks producing significant reduction in anxiety and pain magnification, and increases in self-compassion.

 

These are interesting results and suggest that yoga practice may be beneficial for chronically disabled patients with multiple diseases, improving their psychological well-being. This is a very difficult group to care for and treat and as such, the fact that yoga practice may be helpful, is exciting. It should be mentioned that this was a pilot study, without a control condition, and thus no firm conclusions can be reached. But, the results provide evidence and a rationale for conducting a large randomized controlled clinical trial in the future. A program that can help ease the suffering of these afflicted individuals would certainly be warmly welcomed both by the patients and the caregivers.

 

“Yoga therapy is very much about the whole person. It is complementary to physical therapy, but we take into account that back pain may be related to an emotional element, or it may be from lifestyle, some pattern that is not serving them, physical movement patterns or other patterns.” – Janice Gate

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Curtis, K., Kuluski, K., Bechsgaard, G., Ridgway, J., & Katz, J. (2016). Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study. Evidence-Based Complementary and Alternative Medicine : eCAM, 2016, 6267879. http://doi.org/10.1155/2016/6267879

 

Abstract

Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N = 10) admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position) once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing), psychological variables (depression, anxiety, and experiences with injustice), mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1) anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18) = 4.74, p < .05, and ηp2 = .35, (2) Self-Compassion Scale-Short Form, F(2,18) = 3.71, p < .05, and ηp2 = .29, and (3) Magnification subscale of the Pain Catastrophizing Scale, F(2,18) = 3. 66, p < .05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223015/

Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

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Improve Type 2 Diabetes Management with Acceptance and Commitment Therapy

 

By John M. de Castro, Ph.D.

 

Acceptance and Commitment Therapy (ACT) – “Be more present to the “here-and-now.” This focus helps to decrease being caught up in what happened in the past. It also frees individuals from worrying too much about the future. Being present helps you to more fully connect to and enjoy the moment. Observe thoughts and feelings in such a way that they no longer keep you stuck in life. Learning to observe through openness and acceptance can help you find freedom from negative thoughts and feelings. Clarify your values and then take action. Finding what is most meaningful to you and choosing to act on these values are important parts of the therapy. This will be part of the process of building a rich and full life.” – VA Mental Health Services

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. Although this has been called adult-onset diabetes it is increasingly being diagnosed in children. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. A leading cause of this tissue resistance to insulin is overweight and obesity and a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control.

 

Recently, mindfulness practices have been shown to be helpful in managing diabetes. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. It has been shown to be affective for a number of physical and psychological issues. The effectiveness of ACT to enhance management of Type II Diabetes is not known.

 

In today’s Research News article “A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

Shayeghian and colleagues recruited adult (40-60 years of age) patients with Type II Diabetes and randomly assigned them to either receive a one day diabetes health education training or health education plus 10 weeks, once a week two hour session, of group Acceptance and Commitment Therapy (ACT). The participants were measured prior to, after, and 3 months after the intervention for Glycated hemoglobin (HbA1C), diabetes self-care activities, acceptance of diabetes-related thoughts and feelings, and coping styles.

 

They found that ACT, in comparison to education only, resulted in significantly lower glycated hemoglobin, higher self-care activities and higher acceptance scores. This suggests that ACT promotes self-care and acceptance of their disease which translates into better plasma glucose management. Importantly, these benefits were still significant three months after treatment, suggesting that the effects are enduring. They also found that patients with effective coping styles had a greater impact of ACT on their self-care, suggesting that ACT works better for people who use effective strategies to cope with their disease.

 

These are exciting results, as Type II diabetes is so prevalent and effective self-care so important to the health of the patient. They suggest that ACT  improves the self-care that is so important for successful disease management. But the conclusions must be tempered with the fact that the control condition did not have an additional active intervention, e.g. exercise. So, the results could have been due to placebo effects, experimenter bias, attentional effects, etc. These results, though provide support for implementing a larger randomized controlled clinical trial with an active control condition or comparison to other active treatments.

 

So, improve Type 2 Diabetes management with Acceptance and Commitment Therapy.

 

“Results show that participants walked significantly further following the programme, and had lower levels of anxiety, depression and diabetes-related distress. Average blood glucose levels (HbA1c) were shown to have reduced by 0.6%. Qualitative interviews showed that participants found ACT Now! to be engaging, acceptable, attractive and helpful.” – NHS Grampian

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

Study Summary

Shayeghian, Z., Hassanabadi, H., Aguilar-Vafaie, M. E., Amiri, P., & Besharat, M. A. (2016). A Randomized Controlled Trial of Acceptance and Commitment Therapy for Type 2 Diabetes Management: The Moderating Role of Coping Styles. PLoS ONE, 11(12), e0166599. http://doi.org/10.1371/journal.pone.0166599

 

Abstract

Background and Aim

Evidence of the efficacy of existing psychological interventions for self-management in diabetes is limited. The current study aimed at assessing the effects of group-based ACT on self-management of patients with T2DM, considering the moderating role of coping styles.

Methods

One hundred and six patients with type 2 diabetes were randomly assigned either to the education alone (n = 53) or to a combination of education and group-based acceptance and commitment therapy (n = 53) over a period of 10 sessions. In each group, 50 participants completed a 3 month follow-up assessment.

Results

After 3 months, compared to patients who received education alone, those in the group-based acceptance and commitment therapy condition were more likely to use effective coping strategies, reported better diabetes self-care, and optimum glycated hemoglobin (HbA1C) levels in the target range.

Conclusions

Consideration of the role of coping style for a more accurate evaluation of the effects of acceptance and commitment therapy may be a useful addition to services provided for patients with type 2 diabetes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132195/

Improve Treatment Resistant Depression with Mindfulness

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Improve Treatment Resistant Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

“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

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

Being depressed and not responding to treatment (Treatment Resistant Depression) or relapsing 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 training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. In order to identify the best possible treatment, it is particularly important to investigate MBCT’s efficacy for Treatment Resistant Depression relative to other treatments that place equivalent demands upon the patients.

 

In today’s Research News article “A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756643/

Eisendrath and colleagues compared the relative efficacy of MBCT to a structurally equivalent active comparison condition, a Health-Enhancement Program. They recruited adults who were diagnosed with Major Depressive Disorder who were taking antidepressant medication. They were encouraged to continue their antidepressant medication while participating in the study. They were randomly assigned, stratified by gender, to receive 8-weeks of either standard Mindfulness Based Cognitive Therapy (MBCT) treatment or the Health-Enhancement Program. Both groups met once a week for 2 ¼ hours and were assigned 45 minutes of homework 6 days per week. The MBCT program included training in skills to identify cognitive distortions and to disengage from depression-focused ruminative thinking patterns, body scans, sitting meditations, three-minute breathing spaces, and mindful movement. The Health-Enhancement Program included aerobic exercise, functional movement, music therapy, and dietary education. The participants were evaluated for depression levels, and expectancies of treatment effects before and after treatment and mid-treatment (4-weeks).

 

They found that MBCT, in comparison to the Health-Enhancement Program produced a significantly greater reduction in depression (36.6% vs. 25.3%). In addition, MBCT treatment had a significantly greater proportion of patients respond to treatment. MBCT also produced higher, albeit not significantly different, rates of depression remission (22.4%). The two groups did not differ in their expectations that treatment would be successful, suggesting equivalent placebo effects. Hence, MBCT, was found to be superior to a structurally equivalent Health-Enhancement Program treatment in reducing depression in patients with Treatment Resistant Depression (TRD).

 

These are exciting results and strengthen the case that Mindfulness Based Cognitive Therapy (MBCT) is an effective treatment for the very difficult to treat Treatment Resistant Depression. MBCT uses mindfulness training and cognitive training to allow the patients to reprogram their thought patterns and how they interpret experiences, recognizing that their thoughts are only, just that, thoughts and not reflective of their selves. They learn to experience their emotions but adaptively react to them, seeing them as simply experiences that come and go. This helps them release rumination about past and future problems and focus on the present. This appears to go to the core of the psychological aspects of the disorder and greatly enhance the patient’s ability to cope with their depression.

 

So, improve treatment resistant depression with mindfulness.

 

“MBCT enables people to relate mindfully to the self and with others. The key, it seems, lies in the way MBCT enhances relationships: Less stress about relationships in turn helps prevent future episodes of depression.” – Emily Nauman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Eisendrath, S. J., Gillung, E., Delucchi, K. L., Segal, Z. V., Nelson, J. C., McInnes, L. A., … Feldman, M. D. (2016). A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy for Treatment-Resistant Depression. Psychotherapy and Psychosomatics, 85(2), 99–110. http://doi.org/10.1159/000442260

 

Abstract

Background

Due to the clinical challenges of treatment-resistant depression (TRD), we evaluated the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) relative to a structurally equivalent active comparison condition as adjuncts to treatment-as-usual (TAU) pharmacotherapy in TRD.

Methods

This single site, randomized controlled trial compared 8-week courses of MBCT and the Health-Enhancement Program (HEP), comprising physical fitness, music therapy and nutritional education, as adjuncts to TAU pharmacotherapy for outpatient adults with TRD.

The primary outcome was change in depression severity, measured by percent reduction in total score on the 17-item Hamilton Depression Rating Scale (HAM-D17), with secondary depression indicators of treatment response and remission.

Results

We enrolled 173 adults, mean length of current depressive episode was 6.8 years (sd = 8.9). At the end of 8-week treatment, a multivariate analysis showed that relative to the HEP condition, the MBCT condition was associated with a significantly greater mean percent reduction on the HAM-D17 (36.6% versus 25.3%; p=.01) and a significantly higher rate of treatment responders (30.3% versus 15.3%; p=.03). Although numerically superior for MBCT than for HEP, the rates of remission did not significantly differ between treatments (22.4% versus 13.9%; p=.15). In these models, state anxiety, perceived stress, and the presence of personality disorder had adverse effects on outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756643/

Reduce Medical Student’s Stress Response with Yoga

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Reduce Medical Student’s Stress Response with Yoga

 

By John M. de Castro, Ph.D.

 

“By reducing perceived stress and anxiety, yoga appears to modulate stress response systems. This, in turn, decreases physiological arousal — for example, reducing the heart rate, lowering blood pressure, and easing respiration.” – Harvard Mental Health Letter

 

Medical School is challenging both intellectually and psychologically. Stress levels are high and burnout is common. It’s been estimated that 63% of medical students experience negative consequences from stress while symptoms of severe stress were present in 25% of students. The prevalence of stress is higher among females than among males. High stress levels lead to lower performance in medical school and higher levels of physical and mental health problems, especially anxiety and depression. Indeed 50% of medical students report burnout and 11% have considered suicide in the last year.

 

Obviously, there is a need to either lower stress levels in medical education or find methods to assist medical students in dealing with the stress. One promising possibility is mindfulness training. It has been shown to reduce both the psychological and physiological responses to stress. It has also been shown to reduce stress in students, to help with the negative consequences of stress, and to reduce burnout in medical professionals. So, it would seem reasonable to suspect that mindfulness would be helpful in assisting medical students cope with the stress of their training.

 

Yoga practice is a mindfulness technique that has been found to have extensive physical and psychological benefits and has the additional benefit of being also a physical exercise. This may be particularly beneficial for stressed medical students. In today’s Research News article “Medical Students’ Stress Levels and Sense of Well Being after Six Weeks of Yoga and Meditation.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174168/

Prasad and colleagues recruited male and female medical students who did not practice yoga. The participants attended a one hour Hatha yoga class, twice a week, for six weeks. They were measured before and after training for perceived stress, happiness, peace, focus, endurance, positivity, personal satisfaction, self-confidence, patience, and fatigue.

 

They found that after the yoga practice there was a significant reduction in perceived stress and significant increases in peace, focus, and endurance. In addition, there were no adverse effects and the students were very positive about participation. Hence, they found that after yoga practice there was significant improvement in the medical students’ stress levels and psychological state.

 

This study is a pilot, proof of concept study, that did not include a control condition. So, conclusions need to be tempered. Without an active control condition a large number of confounding factors, including placebo effects, attention effects, experimenter bias, maturation effects, etc., are potential explanations for the significant improvements. The study, though is encouraging and provides evidence supporting conducting a large randomized controlled clinical trial of the effectiveness of yoga for the treatment of stress in medical students.

 

“The science is now in: practice in mindfulness meditation decreases stress and can help you avoid the negative outcomes of burnout and loss of empathy. Mindfulness practice can also help you study more efficiently and retain more information from class lectures. It can increase your quality of life and, in some people, it protects against depression. And of all of these effects are founded upon changes in basic brain structures and function. “ – Brown University School of Medicine

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Prasad, L., Varrey, A., & Sisti, G. (2016). Medical Students’ Stress Levels and Sense of Well Being after Six Weeks of Yoga and Meditation. Evidence-Based Complementary and Alternative Medicine : eCAM, 2016, 9251849. http://doi.org/10.1155/2016/9251849

 

Abstract

Objective. To determine the effect of six weeks of yoga and meditation on medical students’ levels of perceived stress and sense of wellbeing prior to taking their exams. Methods. We conducted a prospective case-control study of first-through-third-year medical students at our academic institution, measuring levels of perceived stress and sense of wellbeing before and after a six-week yoga and meditation intervention. Questionnaires used for evaluation included the perceived stress scale (PSS) and self-assessment surveys (SAS). The postintervention surveys were completed on the day of the students’ written exams. Results. A total of thirteen women and fourteen men participated. Median age was 28 (24 yrs–32 yrs). 48.1% were Caucasian, 7.4% Black, 11.1% Hispanic, 11.1% Asian, and 22.2% other. Paired t-tests showed a statistically significant reduction in perceived stress (18.44 versus 14.52; p = 0.004) after the six-week yoga and meditation program. After the yoga intervention, self-assessment survey results showed a significant improvement in feelings of peace, focus, and endurance. Improvements in happiness, positivity, personal satisfaction, and self-confidence were also seen. An improvement in unsubstantiated parameters such as patience and fatigue was observed. Conclusion. Yoga and meditation may be effective in reducing stress levels and improving aspects of personal wellbeing in medical students.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174168/