Month: January 2019

Improve Schizophrenia Symptoms with Yoga

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Improve Schizophrenia Symptoms with Yoga

 

By John M. de Castro, Ph.D.

 

“Using a combination of asanas (poses and stretches) and pranayama (systematic breathing practices), yoga can help you achieve a state of focus and relaxation that makes it easier to shine a lens on the nature of your thoughts. Understanding this nature and how it affects and distorts your reality is a key part of treating schizophrenia and helping you realize just how much it’s affecting your life and the relationships that you have with others.” – Tyler Dabel

 

Schizophrenia is the most common form of psychosis. Its effects about 1% of the population worldwide. It appears to be highly heritable and involves changes in the brain. It is characterized by both positive and negative symptoms. Positive symptoms include hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. Negative symptoms include a reduced ability to function normally, neglect of personal hygiene, lack of emotion, blank facial expressions, speaking in a monotone, loss of interest in everyday activities, social withdrawal, an inability to experience pleasure, and a lack of insight into their symptoms. The symptoms of schizophrenia usually do not appear until late adolescence or early adulthood.

 

Schizophrenia is very difficult to treat with psychotherapy and is usually treated with antipsychotic drugs. These drugs, however, are not always effective, sometimes lose effectiveness, and can have some difficult side effects. Mindfulness training has been shown to be beneficial for a variety of mental health problems, including psychosis. Mindfulness has also been shown to associated with lower symptom severity of schizophrenia. Yoga is a mindfulness practice that has been shown to improve the symptoms of schizophrenia. Hence it is important to further investigate the effectiveness of yoga practice for the treatment of schizophrenia.

 

In today’s Research News article “Add-on Yoga Therapy for Social Cognition in Schizophrenia: A Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134743/ ), Govindaraj and colleagues performed an uncontrolled pilot study of yoga practice for the treatment of schizophrenia. They recruited schizophrenia patients who were stabilized on antipsychotic medications and provided for them 20, 1-hour, yoga sessions over 6 weeks. The practice consisted of poses, breathing practices, and chanting. They were measured before and after treatment for positive and negative symptoms of schizophrenia, social disability, and social cognition.

 

They found that after the 6 weeks of yoga practice there were significant reductions in both positive and negative symptoms of schizophrenia and in social disability, and significant increases in social cognition. This was an uncontrolled pilot study, so conclusions must be tempered, But the results are encouraging and support the potential application of yoga practice for the treatment of the symptoms of schizophrenia. They provide the support needed to launch a large randomized controlled trial to firmly establish whether yoga practice may be a beneficial add-on treatment for schizophrenia.

 

So, improve schizophrenia symptoms with yoga.

 

“yoga has significant benefits to those diagnosed with schizophrenia. The effects of yoga therapy are multifaceted, including reduction of psychotic symptoms and depression, improving cognition, increasing quality of life, and producing neurobiological changes, such as increased oxytocin levels.” – Namita Nayyar

 

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

Govindaraj, R., Naik, S., Manjunath, N. K., Mehta, U. M., Gangadhar, B. N., & Varambally, S. (2018). Add-on Yoga Therapy for Social Cognition in Schizophrenia: A Pilot Study. International journal of yoga, 11(3), 242-244.

 

Abstract

Background:

Yoga as a mind–body therapy is useful in lifestyle-related disorders including neuropsychiatric disorders. In schizophrenia patients, yoga has been shown to significantly improve negative symptoms, functioning, and plasma oxytocin level.

Aim:

The aim of the study was to study the effect of add-on yoga therapy on social cognition in schizophrenia patients.

Materials and Methods:

In a single pre-post, study design, 15 schizophrenia patients stabilized on antipsychotic medication for 6 weeks were assessed for social cognition (theory of mind, facial emotion recognition, and social perception [SP]) and clinical symptoms (negative and positive symptoms and social disability) before and after twenty sessions of add-on yoga therapy.

Results:

There was a significant improvement in the social cognition composite score after 20 sessions of yoga (t[13] = −5.37, P ≤ 0.001). Clinical symptoms also reduced significantly after twenty sessions of yoga.

Conclusion:

Results are promising to integrate yoga in clinical practice, if proven in well-controlled clinical trials.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134743/

 

Improve Irritable Bowel Syndrome (IBS) with Mindfulness

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Improve Irritable Bowel Syndrome (IBS) with Mindfulness

 

By John M. de Castro, Ph.D.

 

“IBS causes a huge public health and economic burden in the U.S. The standard of care currently has been diet changes along with medications. A mind-based . . . has the potential to minimize both the public health and economic burden of this debilitating disease,” – Saurabh Sethi

 

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal (GI) disorder with worldwide prevalence rates ranging from 9–23%. In the U.S. the rates generally in the area of 10–15% affecting between 25 and 45 million people. IBS is not life threatening but it is very uncomfortable producing changes in bowel movement patterns, bloating and excess gas, and pain in the lower belly. It is also a major source of absenteeism both at work and in school. IBS is also associated with a marked reduction in the individual’s health quality of life, with disruption of the physical, psychological and social routines of the individuals. At present, there are no known cures for IBS and treatments involve symptomatic relief, often with fairly radical dietary changes.

 

The cause(s) of IBS are not known. But emotion dysregulation is suspected to be involved. It is clear that psychological stress exacerbates the illnesses and anxiety amplifies the symptoms. This suggests that mindfulness or the lack thereof may be involved as mindfulness is known to be helpful in reducing the psychological and physical responses to stress and mindfulness is known to improve emotion regulation. In addition, It has been shown that meditation and yoga can help relieve IBS symptoms.  So, it would make sense to further investigate the effectiveness of mindfulness training and emotion regulation for Irritable Bowel Syndrome (IBS).

 

In today’s Research News article “Comparing the Efficacy of Mindfulness-Based Stress Reduction Therapy with Emotion Regulation Treatment on Quality of Life and Symptoms of Irritable Bowel Syndrome.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178327/ ), Ghandi and colleagues recruited patients with Irritable Bowel Syndrome (IBS) and randomly assigned them to receive either an 8-week, once a week for 90 minutes program of Mindfulness Based Stress Reduction (MBSR), Emotion Regulation group training, or a wait-list. The MBSR treatment consisted of body scan, meditation, and yoga practices and group discussion with homework. Emotion Regulation training consisted in training on “emotional awareness” and “acceptance”. The patients were measured before and after training and 2 months later for IBS severity and quality of life with IBS.

 

They found that both Mindfulness Based Stress Reduction (MBSR) and Emotion Regulation training produced significant improvements in IBS severity and the quality of life with IBS and that this effectiveness was maintained 2 months later. There were no significant differences in the effectiveness of MBSR and emotion regulation training. Hence, both MBSR and emotion regulation training produce large and lasting improvements in the symptoms of IBS and the quality of life of the patients.

 

Since MBSR training is known to improve emotion regulation, the fact that MBSR and emotion regulation training produced equivalent benefits suggests that MBSR may be effective for IBS because of its ability to improve emotion regulation, particularly improving the emotional responses to stress. It will require further research to examine this possibility.

 

So, improve Irritable Bowel Syndrome (IBS) with mindfulness.

 

“For a person who has IBS, mindfulness-based therapies are thought to help to reduce anxiety related to digestive symptoms. Due to our body’s natural stress response, such anxiety can actually exacerbate the very digestive symptoms that a person with IBS is most concerned about. The theory behind mindfulness-based therapies for IBS is that when you experience less reactivity to physical sensations related to your digestive system, you will experience less unwanted symptoms.” – Barbara Bolen

 

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

Abstract

 

Ghandi, F., Sadeghi, A., Bakhtyari, M., Imani, S., Abdi, S., & Banihashem, S. S. (2018). Comparing the Efficacy of Mindfulness-Based Stress Reduction Therapy with Emotion Regulation Treatment on Quality of Life and Symptoms of Irritable Bowel Syndrome. Iranian journal of psychiatry, 13(3), 175-183.

 

Objective: Irritable bowel syndrome is a common gastrointestinal disorder. The perception of stress and GI-specific anxiety play a key role in irritable bowel syndrome (IBS). The present study aims at comparing the efficacy of mindfulness-based stress reduction therapy with emotion regulation on the quality of life and severity in patients IBS.

Method : This randomized clinical trial was conducted in 3 phases: pretest, posttest, and follow-up. Follow-up was performed 2 months after the last intervention. The study population consisted of 24 IBS patients who were randomly selected according to Rome-IV Criteria and were then divided into 3 eight-member groups: (1) mindfulness-based stress reduction, (2) emotion regulation, and (3) control group. IBS-QOL34 and IBS-SSS were administered as assessment tools to all the 3 groups. The experimental groups were subjected to MBSR and ER psychotherapy, while the control group received no psychological intervention. After the 2-month follow-up, the 3 groups were evaluated again.

Results: The results revealed that MBSR improved the quality of life of IBS patients and dicreased severity of their condition. The findings of between and within subjects design revealed that the difference between MBSR and control groups was significant in IBS at follow-up (p = 0.01).

Conclusion: MBSR could be considered as a new, effective, and stable method in psychotherapy, in irritable bowel syndrome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178327/

 

Mindfulness Improves the Symptoms of Post-Traumatic Stress Disorder (PTSD) by Altering Gene Expression

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Mindfulness Improves the Symptoms of Post-Traumatic Stress Disorder (PTSD) by Altering Gene Expression

 

By John M. de Castro, Ph.D.

 

“Mindfulness has been shown to be an effective stress reduction practices in general, but there may be other ways it works for people with PTSD as well. Recent research suggests that mindfulness may help to mitigate the relationship between maladaptive thinking and posttraumatic distress.” – Matthew Tull

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

 

Obviously, these are troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective. Mindfulness Based Stress Reduction (MBSR) has been found to improve PTSD symptoms. It has been shown that mindfulness practices can alter the brain structures and connectivity and this may underlie the beneficial effects of mindfulness on PTSD. These alterations probably involve changes in the chemistry of the brain particularly with systems associated with stress and depression.

 

In today’s Research News article “Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153325/ ), Bishop and colleagues examine the activation of genes associated with stress and depression in patients with PTSD who responded and did not respond to treatment with Mindfulness Based Stress Reduction (MBSR), They examined patients from a previous study of the effectiveness of MBSR for the treatment of PTSD who showed a significant reduction in PTSD symptoms and those that did not. The MBSR treatment consisted of body scan, meditation, and yoga practices and group discussion and occurred in 9 weekly, 2.5 hour sessions. with homework. Blood samples were drawn before and after treatment. They measured the degree of methylation of genes in the he promoter region of SLC6A4 previously associated with depression risk and symptoms and genes in the FKBP5 Intron 7 region identified as a functional regulator of glucocorticoid signaling.

 

They found that after Mindfulness Based Stress Reduction (MBSR) treatment there was a significant reduction in methylation of genes in the FKBP5 Intron 7 region in responders but an increase in non-responders. These genes are associated with stress related responding. Methylation tends to suppress gene expression, So, decreased methylation indicates an increased level of activity in stress related hormonal pathways.

 

These findings are interesting but not surprising as MBSR was developed specifically to improve stress responses. It is interesting that only patients who responded to treatment had this change to the genes underlying stress responding. So, it appears that MBSR is effective for PTSD symptoms but only if it changes stress related gene expression. It will be interesting to examine in the future the factors that result in non-responders being resistant to treatment with MBSR.

 

So, improve the symptoms of post-traumatic stress disorder (PTSD) by altering gene expression with mindfulness.

 

“Many people cope with trauma by distancing themselves from the sensations in their bodies and minds (the most extreme example of this is dissociation). Therefore, bringing one’s attention deliberately back to the body can unzip trauma symptoms they may not be prepared to address. However, mindfulness meditation can be helpful to those with PTSD and a history of trauma when practiced under the guidance of a mental healthcare provider and modified to be better suited for trauma survivors.” – Julia Ozog

 

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

Bishop, J. R., Lee, A. M., Mills, L. J., Thuras, P. D., Eum, S., Clancy, D., Erbes, C. R., Polusny, M. A., Lamberty, G. J., … Lim, K. O. (2018). Methylation of FKBP5 and SLC6A4 in Relation to Treatment Response to Mindfulness Based Stress Reduction for Posttraumatic Stress Disorder. Frontiers in psychiatry, 9, 418. doi:10.3389/fpsyt.2018.00418

 

Abstract

Mindfulness Based Stress Reduction (MBSR) is an effective non-pharmacologic treatment for veterans with PTSD. Extensive work has identified epigenetic factors related to PTSD disease risk and pathophysiology, but how these factors influence treatment response is unclear. Serotonin signaling and hypothalamic-pituitary-adrenal (HPA) axis functioning may be perturbed in PTSD and are molecular pathways targeted by PTSD treatments. To identify potential biomarkers for treatment response, we utilized genomic DNA isolated from peripheral blood samples from veterans with PTSD who were responders (n = 11) or non-responders (n = 11) to MBSR as part of a clinical trial. We assessed methylation levels at CpG sites in regions of the serotonin transporter (SLC6A4) previously associated with expression and depression outcomes, as well as the Intron 7 region of the FK506 binding protein 5 (FKBP5) containing known glucocorticoid response elements suggested to regulate this gene. Selected subjects were matched across MBSR responder status by baseline symptoms, age, sex, current smoking status, and current antidepressant use. Percent methylation was compared between responders and non-responders at baseline (pre-MBSR treatment). Additionally, percent change in methylation from baseline to post-treatment was compared between responders and non-responders. There was a significant time x responder group interaction for methylation in FKBP5 intron 7 bin 2 [F(1, 19) = 7.492, p = 0.013] whereby responders had a decrease in methylation and non-responders had an increase in methylation from before to after treatment in this region. Analyses of the three CpG sites within bin 2 revealed a significant time x responder group interaction for CpG_35558513 [F(1, 19) = 5.551, p = 0.029] which resides in a known glucocorticoid response element (GRE). Decreases in FKBP5 methylation after treatment in responders as compared to increases in non-responders suggest that effective meditation intervention may be associated with stress-related pathways at the molecular level. These preliminary findings suggest that DNA methylation signatures within FKBP5 are potential indicators of response to meditation treatment in PTSD and require validation in larger cohorts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153325/

 

Improve Social Anxiety Disorder with Mindfulness

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Improve Social Anxiety Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Using mindfulness, we can begin to notice what happens in the body when anxiety is present and develop strategies to empower clients to “signal safety” to their nervous system. Over time, clients feel empowered to slow down their response to triggers, manage their body’s fear response (fight-or-flight) and increase their ability to tolerate discomfort. The client experiences this as feeling like they have a choice about how they will respond to a trigger.” -Jeena Cho

 

It is a common human phenomenon that being in a social situation can be stressful and anxiety producing. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well and the anxiety is overwhelming, causing the individual to withdraw. Social Anxiety Disorder (SAD) is characterized by a persistent, intense, and chronic fear of being watched and judged by others and feeling embarrassed or humiliated by their actions. This fear may be so severe that it interferes with work, school, and other activities and may negatively affect the person’s ability to form relationships.

 

Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders including Social Anxiety Disorder (SAD). Mindfulness-Based Stress Reduction (MBSR) and also Cognitive Behavioral Therapy (CBT) have been shown to be effective in treating Social Anxiety Disorder (SAD). It is not known, however, if they operate through similar or different mechanisms.

 

In today’s Research News article “Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600696/ ), Goldin and colleagues recruited patients with diagnosed Social Anxiety Disorder (SAD) and randomly assigned them to receive 12 weekly 2..5 hour sessions with daily homework of either Mindfulness-Based Stress Reduction (MBSR) or Cognitive Behavioral Therapy (CBT). MBSR consists of a combination of meditation, body scanning, and yoga practices. Cognitive Behavioral Therapy (CBT) is designed to alter how the patient relates to the thought processes that often underlie and exacerbate mood disorders. They were measured before treatment, once a week during treatment, and every 3 months for the following year for social anxiety, mindfulness, and cognitive reappraisal.

 

They found that both MBSR and CBT produced a progressive significant reduction in social anxiety and significant increases in mindful attitude and reappraisal, changing thinking about social anxiety, over the course of treatment that was maintained for the year following. They also found that the cognitive reappraisal strategy of disputing, challenging anxious thoughts and feelings and reappraisal success significantly increased over the course of treatment and were maintained for the year following but CBT produce a significantly greater increases than MBSR. In addition, they found that MBSR but not CBT produced significant increases in acceptance and acceptance success of anxiety over the course of treatment that were maintained for the year following. In examining the relationships between the variables they found that reappraisal and reappraisal success were significantly associated with the reduction of social anxiety for CBT but not MBSR. On the other hand, reappraisal disputing was significantly associated with reduction of social anxiety for MBSR but not CBT.

 

These are complex but interesting results that suggest that while both MBSR and CBT produce significant reductions in social anxiety and share many similar mechanisms, they also do so in different ways. CBT appears to reduce social anxiety by increasing the cognitive reappraisal strategy of disputing, challenging anxious thoughts and feelings, and its success in reducing anxiety. MBSR, on the other hand, appears to reduce social anxiety by increasing mindful acceptance of anxiety and its success.

 

So, improve social anxiety disorder with mindfulness.

 

“The power of a mindfulness practice, however, may come in the realization that one can live a meaningful life even with social anxiety. Schjerning says that he still feels nervous in social situations but now feels compassion — not judgment — for himself, and sees that “I can be more the person I want to be.” – Jason Drwal

 

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

 

Goldin, P. R., Morrison, A. S., Jazaieri, H., Heimberg, R. G., & Gross, J. J. (2017). Trajectories of social anxiety, cognitive reappraisal, and mindfulness during an RCT of CBGT versus MBSR for social anxiety disorder. Behaviour research and therapy, 97, 1-13.

 

Highlights

CBGT and MBSR produced similar decreases in social anxiety

CBGT (vs. MBSR): greater disputing anxiety and reappraisal success

CBGT: weekly reappraisal and reappraisal success predict social anxiety

MBSR (vs. CBGT): greater acceptance of anxiety and acceptance success

MBSR: weekly mindful attitude and disputing anxiety predict social anxiety

Abstract

Cognitive-Behavioral Group Therapy (CBGT) and Mindfulness-Based Stress Reduction (MBSR) are efficacious in treating social anxiety disorder (SAD). It is not yet clear, however, whether they share similar trajectories of change and underlying mechanisms in the context of SAD. This randomized controlled study of 108 unmedicated adults with generalized SAD investigated the impact of CBGT vs. MBSR on trajectories of social anxiety, cognitive reappraisal, and mindfulness during 12 weeks of treatment. CBGT and MBSR produced similar trajectories showing decreases in social anxiety and increases in reappraisal (changing the way of thinking) and mindfulness (mindful attitude). Compared to MBSR, CBGT produced greater increases in disputing anxious thoughts/feelings and reappraisal success. Compared to CBGT, MBSR produced greater acceptance of anxiety and acceptance success. Granger Causality analyses revealed that increases in weekly reappraisal and reappraisal success predicted subsequent decreases in weekly social anxiety during CBGT (but not MBSR), and that increases in weekly mindful attitude and disputing anxious thoughts/feelings predicted subsequent decreases in weekly social anxiety during MBSR (but not CBGT). This examination of temporal dynamics identified shared and distinct changes during CBGT and MBSR that both support and challenge current conceptualizations of these clinical interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600696/

 

Improve the Psychological State of Patients with Rheumatoid Arthritis with Mindfulness

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Improve the Psychological State of Patients with Rheumatoid Arthritis with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Drugs are effective for rheumatoid arthritis, but they don’t affect the stress pathways that are so fundamental to the condition. Stress symptoms activate inflammation and even heighten the perception of pain. “A mindfulness-based intervention, which targets the multiple components of the body’s stress response, can decrease overall pain severity and increase quality of life.” – Michael Irwin

 

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. Due to complications associated with rheumatoid arthritis (RA), the lifespan for people with RA may be shortened by 10 years. This is due to a higher incidence of cardiovascular disease in rheumatoid arthritis (RA) patients, with the risk more than double that of non-RA individuals.

 

Obviously, there is a need to explore alternative treatments for rheumatoid arthritis. One possibility is contemplative practice. A variety of which have been shown to have major mental and physical benefits including a reduction in the inflammatory response and have been shown to improve arthritis. In today’s Research News article “Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233984/ ), DiRenzo and colleagues review and summarize the published randomized clinical trials of mindfulness-based interventions for patients with rheumatoid arthritis.

 

They found only 5 published studies which produced inconclusive results regarding the effectiveness of mindfulness-based interventions on the physical symptoms of rheumatoid arthritis such as pain and inflammation. On the other hand, the research suggests that mindfulness-based interventions improve the psychological states of patients with rheumatoid arthritis including depression, anxiety, and psychological distress. The results, although inconclusive are sufficiently suggestive of positive outcomes that further research is warranted. It is clear that larger better controlled studies are needed before unambiguous conclusions can be reached.

 

So, improve the psychological state of patients with rheumatoid arthritis with mindfulness.

 

“The other thing I think is important to note about our study is that mindfulness meditation can be combined with any rheumatological therapy. It is truly complementary medicine in that sense, done in addition to pharmacological or other intervention. So, for physicians and patients who wonder what they can do to improve well-being, beyond taking medications, this study offers evidence for a beneficial approach to dealing with the psychological distress of RA.” – Elizabeth Pradhan

 

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

DiRenzo, D., Crespo-Bosque, M., Gould, N., Finan, P., Nanavati, J., & Bingham, C. O. (2018). Systematic Review and Meta-analysis: Mindfulness-Based Interventions for Rheumatoid Arthritis. Current rheumatology reports, 20(12), 75. doi:10.1007/s11926-018-0787-4

 

Abstract

Purpose of Review

To determine the efficacy of mindfulness-based interventions (MBIs) on clinical and patient-reported outcomes in rheumatoid arthritis (RA).

Recent Findings

We identified randomized clinical trials from inception through April 2018 from MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, the Cochrane Library, and hand searches. After screening 338 references, we included five trials with one post-hoc analysis that evaluated MBIs and collectively included 399 participants. Outcome instruments were heterogeneous across studies. Three studies evaluated RA clinical outcomes by a rheumatologist; one study found improvements in disease activity. A limited meta-analysis found no statistically significant difference in the levels of DAS28-CRP in the two studies that evaluated this metric (− 0.44 (− 0.99, 0.12); I2 0%). Four studies evaluated heterogeneous psychological outcomes, and all found improvements including depressive symptoms, psychological distress, and self-efficacy. A meta-analysis of pain Visual Analog Scale (VAS) levels post intervention from three included studies was not significantly different between MBI participants and control group (− 0.58 (− 1.26, 0.10); I2 0%) although other studies not included in meta-analysis found improvement.

Summary

There are few trials evaluating the effect of MBIs on outcomes in patients with RA. Preliminary findings suggest that MBIs may be a useful strategy to improve psychological distress in those with RA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233984/

Reduce Pain with Mindfulness

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Reduce Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Meditation (which is the ‘formal’ practice of mindfulness) actually changes the way the mind perceives pain (2) so that it’s more bearable. It is a natural and effective way to ease physical pain.” – Melli O’Brien

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

Pain involves both physical and psychological issues. 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. There is an accumulating volume of research findings to demonstrate that mind-body therapies have highly beneficial effects on the health and well-being of humans. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain in adults.

 

Hospital inpatients frequently are in pain and the management of that pain is important to the patients and to the amount of hospitalization time. It is not known whether mindfulness training is effective for the relief of acute pain in hospitalized patients. In today’s Research News article “Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602767/ ), Garland and colleagues examined the effectiveness of mindfulness training in comparison to hypnotic suggestion and psychoeducation for the relief of inpatient acute pain.

 

They recruited hospital inpatients who reported intolerable pain that was not adequately managed. They were randomly assigned to receive either mindfulness training in a “single, scripted 15-min training session in focused attention on breathing and body sensations, with concomitant metacognitive monitoring and acceptance of discursive thoughts, negative emotions, and pain”, or a hypnotic suggestion in a “single, scripted 15-min self-hypnosis session which invited patients to roll their eyes upward, close their eyes, and breathe deeply, focus on sensations of floating, and imagine the visual, auditory, olfactory, and tactile details of a pleasant scene of their choosing”, or a psychoeducation session of a “single 15-min session in which a social worker provided empathic responses to the patient and then attempted to increase perception of pain control by reviewing common behavioral pain coping strategies (e.g., stretching, using hot and cold compresses).” They were measured before and after the training for pain intensity, pain unpleasantness, anxiety, relaxation, pleasant body sensations, and desire for opioids.

 

They found that both the mindfulness and the hypnotic suggestion groups but not the psychoeducation group had significant decreases in pain intensity and pain unpleasantness. The mindfulness group also reported significantly higher relaxation and pleasant body sensations after training than the psychoeducation group while the hypnotic suggestion group reported significantly lower desire for opioids after training than the psychoeducation group. All three groups showed a reduction in anxiety.

 

Hence, a brief mindfulness training or hypnotic suggestion in hospital patients significantly improved their pain and psychological state. These are interesting results that suggest that these trainings may be useful for the relief of acute pain in hospital patients. But this trial was very brief. It remains for future research to establish the duration of effectiveness and the ability of continued training to potentiate the effectiveness and its duration.

 

So, reduce pain with mindfulness.

 

“When we’re in pain, we want it to go away. Immediately. And that’s understandable. Chronic pain is frustrating and debilitating. . . The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain.” –  Margarita Tartakovsky

 

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

Garland, E. L., Baker, A. K., Larsen, P., Riquino, M. R., Priddy, S. E., Thomas, E., Hanley, A. W., Galbraith, P., Wanner, N., … Nakamura, Y. (2017). Randomized Controlled Trial of Brief Mindfulness Training and Hypnotic Suggestion for Acute Pain Relief in the Hospital Setting. Journal of general internal medicine, 32(10), 1106-1113.

 

Abstract

Background

Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions.

Objective

We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantly reduce acute pain intensity and unpleasantness compared to a psychoeducation pain coping control. We also hypothesized that mindfulness and suggestion would produce significant improvements in secondary outcomes including relaxation, pleasant body sensations, anxiety, and desire for opioids, compared to the control condition.

Methods

This three-arm, parallel-group randomized controlled trial conducted at a university-based hospital examined the acute effects of 15-min psychosocial interventions (mindfulness, hypnotic suggestion, psychoeducation) on adult inpatients reporting “intolerable pain” or “inadequate pain control.” Participants (N = 244) were assigned to one of three intervention conditions: mindfulness (n = 86), suggestion (n = 73), or psychoeducation (n = 85).

Key Results

Participants in the mind-body interventions reported significantly lower baseline-adjusted pain intensity post-intervention than those assigned to psychoeducation (p < 0.001, percentage pain reduction: mindfulness = 23%, suggestion = 29%, education = 9%), and lower baseline-adjusted pain unpleasantness (p < 0.001). Intervention conditions differed significantly with regard to relaxation (p < 0.001), pleasurable body sensations (p = 0.001), and desire for opioids (p = 0.015), but all three interventions were associated with a significant reduction in anxiety (p < 0.001).

Conclusions

Brief, single-session mind-body interventions delivered by hospital social workers led to clinically significant improvements in pain and related outcomes, suggesting that such interventions may be useful adjuncts to medical pain management.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602767/

 

Happy New Year with Mindfulness

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Happy New Year with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The object of a new year is not that we should have a new year. It is that we should have a new soul.”  ~G.K. Chesterton

 

At the stroke of midnight on December 31st all over the world revelers ring in the new calendar year with a hearty celebration. It’s a celebration of a relatively arbitrary day that has been designated as the first day of a new calendar year. The celebration of the solstice, 10 days before, at least has astrological meaning as the shortest day of the year. But, January 1 has no such physical meaning. January 1 was designated as the start of the year by Julius Caesar in 45 BC. That date was chosen to honor the Roman God Janus, the god of beginnings, whose two faces allowed him to look back into the past and forward into the future. That symbolism has stuck as the new year’s celebration involves a reflection about the year past and hope for the year to come.

 

Don’t Look Back

 

To some extent this looking back into the past and forward into the future is the antithesis of mindfulness which emphasizes the present moment. Our recollection of the past is, in fact, an illusion. When we look at the past we view it with the distorted lens of memory and the delusions that we have about the self. The memories of what happened during the last year bare only a fleeting resemblance to what actually happened. Recollections tend to be dominated by hazy and distorted memories of emotionally charged events and neglects everyday times of calm and contentment. When we look back we primarily remember the highs and the lows and believe that if we could simply keep repeating the highs and eliminate the lows then we’d be truly happy. This is the trap sometimes known as the hedonic treadmill. We keep seeking the highs and are unhappy when we can’t reproduce them or if we are successful are unhappy to find that we can’t maintain them. Unfortunately, our New Year’s celebration and our resolutions reinforce and amplify these ideas propelling us to even greater unhappiness in the new year.

 

Our view of the past is additionally distorted by the beliefs that we have about ourselves. These self-concepts are mainly incorrect and terribly distorted. Western culture, by its adoration of extraordinary and unrealistic models of perfection, produces and reinforces rampant self-dislike. We can never really attain the societal norm of perfection and this makes us feel horribly deficient. As a result, most westerners don’t like what they are and want to be different. As a consequence, people look back on the events of the year and interpret them through the lens of self-dislike.

 

We remember primarily those events that conform to our beliefs about what we should be, but cannot achieve. This creates a vicious cycle where the low self-esteem and self-worth causes us to remember events that exemplify this self-concept, creating even greater self-dislike. Those rare events that reveal us to be adequate are quickly forgotten. The events of the past year, then, are perceived as evidence to support our harsh view of ourselves. Rather than accurately remembering what actually happened during the year, our recollections are dominated by this distorted reality. So, don’t look back at the past year, rather look carefully and mindfully at yourself. You need to develop self-acceptance, before you can ever hope to have an honest idea of what the past contained.

 

Don’t Look to the Future

 

These distortions also color our thoughts about the upcoming year. We resolve to change ourselves to better conform to our unrealistic beliefs about what we should be. The New year’s resolutions that are such a common part of our new year’s celebration are a direct outgrowth of our self-dislike. The problem with these new year’s resolutions is that they are a declaration that we’re not happy with ourselves or the way things are. We want to be different. That’s not bad unto itself. Striving to better oneself is a good thing. The problem is that what we desire for ourselves is usually totally unrealistic as it’s based on a distorted reality. But, we strongly believe that this is what we need to be happy. It’s all a delusion that’s doomed to failure. In fact, research has suggested that only 8% of these resolutions are ever achieved.

 

Better New Year’s Resolutions

 

We need to craft a new set of resolutions, based upon self-acceptance, and a realistic view about what needs to be and can be achieved. The resolutions should be to better see things, including ourselves as they really are. To look at the world and ourselves mindfully without judgment, just as we are. These are the kinds of resolutions that can really work towards, not making us happy, but letting us be happy in the coming year; to simply experience the happiness that has been within us all along.

 

There are some rules of thumb about these resolutions. Don’t be too grandiose. Don’t set goals of perfection. Small steps with a recognition that you won’t always be successful are recommended. Make a resolution to practice mindfulness. Pick a practice that you not only can do, but that you can comfortably sustain. The only one perfect right practice is the one that you’ll do and keep doing. It may be meditation, yoga, body scan, tai chi or qigong, contemplative prayer, or another of the many available practices or some combination of practices. The only thing that matters is that you’re drawn to it, comfortable doing it, and you’ll stick with it. Once you start, don’t try too hard. Remember the Buddha recommended the middle way, with right effort, not too much and not too little. Practice nonjudgmentally. Don’t judge whether you’re doing it right or wrong, whether the particular practice was good or bad, or whether you’re making progress or not. Just practice. Just relax and let the practice do you. You don’t need to do it.

 

Focus on Now

 

All of these various practices promote nonjudgmental attention to what is occurring in the present moment, the now. Slowly you come to realize that the now is the only time available where you can be satisfied and happy. The past are only nows that are gone and the future are only nows that have yet to happen. So, focus on the present moment. It’s where life happens. If you can learn to be happy right now, then you’ll be able to happy in the future when it becomes now. As you look calmly, nonjudgmentally, and deeply at what is happening right now you begin to see the beauty and wonder that is there all of the time. You just need to stop ruminating about the past and worrying about the future. Learn to enjoy the moment.

 

Focusing on the present moment the impermanence of all things becomes evident. In the present we can observe things rising up and then falling away. Change is constant. If things are bad at the moment, you can be sure that it’ll change. So, be patient. On the other hand, if things are good, know also that this will change too. Don’t try to hang onto what is present. Learn to enjoy the moment as it is. These observations reveal that every moment is new. It has never happened before and it will never happen again. Every moment is a new opportunity. Don’t worry about it passing. The next moment will again provide a new opportunity. Make the most of it. If you can learn to do this, you’ll enjoy life to its fullest, as the dynamically changing perpetual now.

 

Renewal

 

In the new year, we need to not think about a “happy new year.” Rather think about a “happy new day.” In fact, it’s best to think about each “happy new moment.” Focus on the present moment and wish yourself and everyone else a “happy new moment.” Every moment is a unique opportunity to experience life as it is, appreciate its wonder, and enjoy it while it’s here, in the present moment. Each moment is an opportunity for renewal. If we’re not happy in the moment, we can be in the next. We have a new opportunity every new moment. If we pay attention to them, we can use the opportunity to create happiness.

 

So, have a “happy new moment” with mindfulness.

 

“Empty your glass and feel your way through this New Year. If it feeds your soul, do it. If it makes you want to get out of bed in the morning with a smile, carry on. Be present and let your energy synchronise with the earth and give you the clarity to move forward and be comfortable and contented with who you are. Let your intuition guide you through a wonderful year and attract an abundance of positive opportunity.” – Alfred James

 

“Many of us are thinking about new year’s resolutions and taking stock at this time, but how many of those typical resolutions are just ‘self’ improvement projects (which means we’re trying to get more, be more or have more) rather than ways to actually embrace the life we already have right here and now?” – Mrs. Mindfulness

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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