Month: December 2019

Reduce Pain and Falls and Improve Mobility in the Elderly with Tai Chi

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Reduce Pain and Falls and Improve Mobility in the Elderly with Tai Chi

 

By John M. de Castro, Ph.D.

 

“Solid research shows that tai chi can benefit people with osteoarthritis, rheumatoid arthritis, fibromyalgia, tension headache, and other ongoing, painful conditions.” – Harvard Health

 

The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. The elderly also frequently suffer from chronic pain.

 

Pain involves both physical and psychological issues. Physically, exercise can be helpful in strengthening the body to prevent or relieve pain. Psychologically, the stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Tai Chi, Qigong, and yoga  are all exercises and mindfulness practices that have been found to be effective for pain.

 

In today’s Research News article “Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126990/), You and colleagues examine the ability of Tai Chi practice to reduce chronic pain in the elderly. They recruited elderly (>65 years of age) with multisite (2 or more) musculoskeletal pain who either had 1 or more falls in the last year or used a cane or walker. They were randomly assigned to receive 12 weeks, 2 hours, twice a week of either Tai Chi or light physical exercise. They were measured before and after training for acceptability of the exercises, chronic health conditions, pain, attention, executive function, physical function, gait, falls, and fear of falling. 83% of the elderly completed the study.

 

They found that in comparison to baseline the elderly who engaged in Tai Chi had significantly lower pain and pain interference with activities, improvements in gait, including stride and swing time, and decreased gait asymmetry, and decreased fear of falling, and fewer falls over the subsequent 9 months, while the light exercise group did not.

 

These are encouraging pilot results that are similar to other findings with Tai Chi with other types of patients. Unfortunately, because this was a small pilot study there were no statistically significant differences between the Tai Chi group and the light exercise group even though the Tai Chi groups was significantly improved relative to baseline whereas the light exercise group was not. But these results provide justification for performing a future large scale randomized controlled trial.

 

It’s important to note that Tai Chi is a gentle and safe mindfulness practice. It is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice.

 

So, reduce pain and falls and improve mobility in the elderly with Tai Chi.

 

“Improved flexibility will reduce stiffness and help keep joints mobile. Stiffness causes pain; increase flexibility will relieve pain.  Tai Chi for Arthritis gently moves all joints, muscles and tendons throughout the body.” – Paul Lam

 

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

 

You, T., Ogawa, E. F., Thapa, S., Cai, Y., Zhang, H., Nagae, S., … Leveille, S. G. (2018). Tai Chi for older adults with chronic multisite pain: a randomized controlled pilot study. Aging clinical and experimental research, 30(11), 1335–1343. doi:10.1007/s40520-018-0922-0

 

Abstract

Background

Chronic pain is associated with poorer cognition and mobility, and fall risk in older adults.

Aims

To investigate the feasibility of a randomized trial of mind-body exercise (Tai Chi) versus light physical exercise in older adults with multisite pain.

Methods

Adults aged ≥ 65y with multisite pain who reported falling in the past year or current use of an assistive device were recruited from Boston area communities. Participants were randomized to either a Tai Chi or a light physical exercise program, offered twice weekly for 12 weeks. The primary outcomes were feasibility and acceptability. Secondary outcomes included pain characteristics, cognition, physical function, gait mobility, fear of falling, and fall frequency.

Results

Of 176 adults screened, 85 were eligible, and 54 consented and enrolled (average age 75±8y; 96.30% white; 75.93% female). The dropout rate was 18% for Tai Chi and 12% for light physical exercise. For those completing the study, exercise class attendance was 76% for Tai Chi and 82% for light physical exercise. There were no significant group differences in most secondary outcomes. Tai Chi significantly lowered pain severity (4.58±1.73 to 3.73±1.79, p<0.01) and pain interference (4.20±2.53 to 3.16±2.28, p<0.05), reduced fear of falling (90.82±9.59 to 96.84±10.67, p<0.05), and improved several single-task and dual-task gait variables, while light physical exercise did not change these measures

Discussion and Conclusions

This study demonstrated the feasibility and acceptability of conducting a larger randomized controlled trial in older adults with multisite pain. Study findings and challenges encountered will inform future research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126990/

 

Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

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Augment Mystical Experiences in Meditation and Long-Term Well-Being with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Trying to harness the mind in meditation is a bit like holding a water wiggly—those tubular, slippery, jelly-filled toys that leap out of your hand whenever you try to hold onto them. With the addition of a psychedelic state of mind, it could be like grasping with a greased hand.” – Paul Austin

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).” Since the effects of meditation and psilocybin appear similar, it’s important to look at the effects of the combination of meditation with psilocybin.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/ ), Smigielski and colleagues recruited experienced adult meditators participating in a 5-day meditation retreat and randomly assigned them to receive either a high dose of psilocybin or a placebo. The participants were matched for age, gender, mindfulness level, and meditation experience. They were administered psilocybin or placebo on the fourth day of the retreat. Before and after and on each day of the retreat they were measured for mindfulness and meditation depth. Six hours after psilocybin or placebo administration they were measured for altered states of consciousness and mystical experiences. Four months after the retreat they were evaluated for changes in behavior by self-report and that of a significant other. They did not observe any adverse events associated with psilocybin administration.

 

They found that on the day of administration the psilocybin group had significantly greater depth of meditation and after the retreat significantly higher mindfulness. While the drugs were in effect the psilocybin group had large significant increases in altered states of consciousness, including unity, spiritual experience, blissfulness, insightfulness, and disembodiment and large significant increases in mystical experiences, including complex imagery, elementary imagery, audiovisual synesthesia, and changed meaning of percepts. Four months after the retreat the participants who were administered psilocybin had significant changes in behavior documented by themselves and a significant other including significantly greater appreciation for life, self-acceptance, quest for meaning/sense of purpose, and appreciation of death.

 

Meditation retreats have been shown to increase meditation depth, mindfulness, mystical experiences, and to produce changes in consciousness. The present results suggest that psilocybin administration produces large and significant amplifications of these effects. In fact, the participants who received psilocybin reported that the experience was equivalent to the greatest mystical experiences that they have ever had. Remarkably, the effects of the single administration were enduring, altering and deepening their acceptance of themselves as they are, their appreciation of life and death, and their sense of meaning and purpose. These results suggest that the combination of meditation with psilocybin may be a safe and effective means to improve psychological and spiritual health and well-being.

 

So, augment mystical experiences in meditation and long-term well-being with psilocybin.

 

“After the retreat, mushroom-assisted meditators reported less self-consciousness and more illusions and hallucinations than the control group. What’s more, their brains showed alterations in the functioning of the default mode network—a group of interacting brain regions linked to self-awareness and rumination—during open awareness meditation. . . . What is even more remarkable is that experienced meditators in the psilocybin group reported better social functioning four months later.” – Grace Bullock

 

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

 

Smigielski, L., Kometer, M., Scheidegger, M., Krähenmann, R., Huber, T., & Vollenweider, F. X. (2019). Characterization and prediction of acute and sustained response to psychedelic psilocybin in a mindfulness group retreat. Scientific reports, 9(1), 14914. doi:10.1038/s41598-019-50612-3

 

Abstract

Meditation and psychedelics have played key roles in humankind’s search for self-transcendence and personal change. However, neither their possible synergistic effects, nor related state and trait predictors have been experimentally studied. To elucidate these issues, we administered double-blind the model psychedelic drug psilocybin (315 μg/kg PO) or placebo to meditators (n = 39) during a 5-day mindfulness group retreat. Psilocybin increased meditation depth and incidence of positively experienced self-dissolution along the perception-hallucination continuum, without concomitant anxiety. Openness, optimism, and emotional reappraisal were predictors of the acute response. Compared with placebo, psilocybin enhanced post-intervention mindfulness and produced larger positive changes in psychosocial functioning at a 4-month follow-up, which were corroborated by external ratings, and associated with magnitude of acute self-dissolution experience. Meditation seems to enhance psilocybin’s positive effects while counteracting possible dysphoric responses. These findings highlight the interactions between non-pharmacological and pharmacological factors, and the role of emotion/attention regulation in shaping the experiential quality of psychedelic states, as well as the experience of selflessness as a modulator of behavior and attitudes. A better comprehension of mechanisms underlying most beneficial psychedelic experiences may guide therapeutic interventions across numerous mental conditions in the form of psychedelic-assisted applications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813317/

 

Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

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Mindfulness Reduces Addiction by Improving Pleasure Appreciation in Opioid Users

 

By John M. de Castro, Ph.D.

 

“mindfulness-based interventions could help people dependent on opioids increase their self-awareness and self-control over cravings and be less reactive to emotional and physical pain. Individuals with an opioid addiction could also be taught to change their negative thoughts and savor pleasant events, which may help them to regulate their emotions and experience more enjoyment.” – Science News

 

Substance abuse and addiction is a terrible problem, especially opioid pain relievers. Opioid addiction has become epidemic and is rapidly increasing affecting more than 2 million Americans and an estimated 15 million people worldwide. In the U.S more than 20,000 deaths yearly were attributed to an overdose of prescription opioids, and another 13,000 deaths from heroin overdose. These statistics, although startling are only the tip of the iceberg. Drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. It can render the individual ineffective at work, it tears apart families, it makes the individual dangerous both driving and not.

 

An effective treatment for addiction has been elusive. Most programs and therapies to treat addictions have poor success rates. Recent research is indicating that mindfulness has been found to be effective in treating addictions. Mindfulness-Oriented Recovery Enhancement (MORE) was specifically developed to employ mindfulness training along with other proven methods to assist addicts in remaining off of drugs. MORE involves mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion.

 

One method to observe reward processing in the brain is to measure the changes in the electrical activity that occur in response to specific reward related stimuli. These are called event-related potentials or ERPs. The signal following a stimulus changes over time. The fluctuations of the signal after specific periods of time are thought to measure different aspects of the nervous system’s processing of the stimulus. The Late Positive Potential (LPP) response in the evoked potential (ERP) is a positive going electrical response occurring between a 4 to 8 tenths of a second following the target stimulus presentation. The LPP is thought to reflect attention to the emotional features of a stimulus.

 

In today’s Research News article “Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/), Garland and colleagues recruited chronic pain patients who were opioid users. They were randomly assigned to receive 8 weeks of either Mindfulness-Oriented Recovery Enhancement (MORE) or a therapist led support group. They were measured for brain activity with an electroencephalogram (EEG) before and after treatment and opioid use at 3-month follow-up. In one experiment they measure the EEG response (Late Positive Potential (LPP)) while being presented with opioid cues (pictures of pills and pill bottles) or a neutral picture either normally or while attempting to not react or judge the stimuli. In a separate experiment with a similar procedure except that the participants were presented with natural reward pictures (e.g., social affiliation, natural beauty, and athletic victories) or neutral pictures.

 

They found that before treatment opioid and natural reward stimuli reliably produced significantly larger Late Positive Potentials (LPP) indicating that the LPP reflected emotional responses to rewards. After treatment the group that received Mindfulness-Oriented Recovery Enhancement (MORE) had significantly smaller LPP responses to opioid related cues than the support group. When the participants were asked to not react or judge the stimuli the MORE group had significantly greater reductions in the LPP. Importantly, the participants in the MORE group had a significantly larger LPPs to natural reward stimuli and when the participants were asked to not react or judge the natural reward stimuli the MORE group had a significantly larger increases in the LPP.

 

They also investigated the subjective emotional responses of the participants to the opioid and natural reward stimuli and found that after Mindfulness-Oriented Recovery Enhancement (MORE) the participants had larger increases in response to natural reward stimuli and smaller responses to opioid related stimuli. At the 3 month follow-up they found that MORE reduced the use of opioids to a greater extent than the support group and that it did so directly and also indirectly by increasing natural reward responses which, in turn, reduced opioid use.

 

These results suggest that responses to the rewarding aspects of stimuli is important in opioid addiction and that Mindfulness-Oriented Recovery Enhancement (MORE) reduces opioid use in addicted individuals they demonstrate that MORE reduces emotional responses to opioid cues while amplifying responses to natural rewards. This suggests that mindfulness treatment reduces opioid use by altering the addict’s responses to stimuli related to the addiction and naturally rewarding stimuli; amplifying natural reward while suppressing opioid rewards. This makes opioids less rewarding and natural stimuli more rewarding.

 

So, mindfulness reduces addiction by altering pleasure appreciation in opioid users.

 

“Mindfulness-Oriented Recovery Enhancement (MORE), increases the brain’s response to natural, healthy rewards while also decreasing the brain’s response to opioid-related cues.” – University of Utah

 

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., Atchley, R. M., Hanley, A. W., Zubieta, J. K., & Froeliger, B. (2019). Mindfulness-Oriented Recovery Enhancement remediates hedonic dysregulation in opioid users: Neural and affective evidence of target engagement. Science advances, 5(10), eaax1569. doi:10.1126/sciadv.aax1569

 

Abstract

Addiction neuroscience models posit that recurrent drug use increases reactivity to drug-related cues and blunts responsiveness to natural rewards, propelling a cycle of hedonic dysregulation that drives addictive behavior. Here, we assessed whether a cognitive intervention for addiction, Mindfulness-Oriented Recovery Enhancement (MORE), could restructure reward responsiveness from valuation of drug-related reward back to valuation of natural reward. Before and after 8 weeks of MORE or a support group control, prescription opioid users (N = 135) viewed opioid and natural reward cues while an electroencephalogram biomarker of target engagement was assessed. MORE was associated with decreased opioid cue-reactivity and enhanced capacity to regulate responses to opioid and natural reward cues. Increased positive affective responses to natural reward cues were associated with decreased craving and mediated MORE’s therapeutic effects on opioid misuse. This series of randomized experiments provide the first neurophysiological evidence that an integrative behavioral treatment can remediate hedonic dysregulation among chronic opioid users.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795512/

 

Change the Brain to Reduce Chronic Pain with Mindfulness

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Change the Brain to Reduce Chronic Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“While many experts recommend mindfulness-based practices to manage pain, the goal of those practices is typically not to remove pain entirely, but to change your relationship with it so that you are able to experience relief and healing in the middle of uncomfortable physical sensations.” – Jon Kabat-Zinn

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. 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.

 

There is an accumulating volume of research findings to demonstrate that mindfulness practices, in general, are effective in treating pain. Pain experiences are processed in the nervous system. So, it’s likely that mindfulness practices somehow alter the brain’s processing of pain. In today’s Research News article “The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728003/), Zeidan and colleagues review and summarize the published research studies on the changes in the brain that accompany the relief of chronic pain by mindfulness-based treatments.

 

They report that mindfulness appears to reduce pain by increasing attention to the present moment. High levels of mindfulness are associated with lower pain experiences with chronic conditions and that these levels are associated with less activity in the, so called, default mode network in the brain (consisting of the medial prefrontal cortex, posterior cingulate cortex/precuneus, inferior, and lateral temporal cortices). The default mode network is thought to underlie self-referential thinking and mind wandering.

 

The research also reports that short-term meditation reduces chronic pain and increases communications between cortical areas and the thalamus suggesting top down control of pain sensitivity. On the other hand, long-term meditation practice reduces chronic pain by deactivating prefrontal cortical areas and activating somatosensory cortical regions. This suggests that long-term meditation reduces cognitive appraisals of arising sensory events. Finally, the research suggests that the neural mechanisms of mindfulness-based pain relief are different than opioid pain relief suggesting that there are different mechanisms involved.

 

Obviously, much more research is needed. But there is an evolving picture of the changes in the brain that occur with mindfulness practices that produce relief of chronic pain. It is different from that of opioid pain relievers and primarily involves high level, cortical, neural systems associated with attention to stimuli and the thought processes that arise evaluating those stimuli. In other words, mindfulness-based practices affect pain processing at the highest levels of attention and thinking.

 

So, change the brain to reduce chronic pain with mindfulness.

 

“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

 

Zeidan, F., Baumgartner, J. N., & Coghill, R. C. (2019). The neural mechanisms of mindfulness-based pain relief: a functional magnetic resonance imaging-based review and primer. Pain reports, 4(4), e759. doi:10.1097/PR9.0000000000000759

 

Abstract

The advent of neuroimaging methodologies, such as functional magnetic resonance imaging (fMRI), has significantly advanced our understanding of the neurophysiological processes supporting a wide spectrum of mind–body approaches to treat pain. A promising self-regulatory practice, mindfulness meditation, reliably alleviates experimentally induced and clinical pain. Yet, the neural mechanisms supporting mindfulness-based pain relief remain poorly characterized. The present review delineates evidence from a spectrum of fMRI studies showing that the neural mechanisms supporting mindfulness-induced pain attenuation differ across varying levels of meditative experience. After brief mindfulness-based mental training (ie, less than 10 hours of practice), mindfulness-based pain relief is associated with higher order (orbitofrontal cortex and rostral anterior cingulate cortex) regulation of low-level nociceptive neural targets (thalamus and primary somatosensory cortex), suggesting an engagement of unique, reappraisal mechanisms. By contrast, mindfulness-based pain relief after extensive training (greater than 1000 hours of practice) is associated with deactivation of prefrontal and greater activation of somatosensory cortical regions, demonstrating an ability to reduce appraisals of arising sensory events. We also describe recent findings showing that higher levels of dispositional mindfulness, in meditation-naïve individuals, are associated with lower pain and greater deactivation of the posterior cingulate cortex, a neural mechanism implicated in self-referential processes. A brief fMRI primer is presented describing appropriate steps and considerations to conduct studies combining mindfulness, pain, and fMRI. We postulate that the identification of the active analgesic neural substrates involved in mindfulness can be used to inform the development and optimization of behavioral therapies to specifically target pain, an important consideration for the ongoing opioid and chronic pain epidemic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728003/

 

Yoga Practice May Help Prevent the Development of Type II Diabetes

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Yoga Practice May Help Prevent the Development of Type II Diabetes

 

By John M. de Castro, Ph.D.

 

“Yoga can do more than just relax your body in mind — especially if you’re living with diabetes. Certain poses may help lower blood pressure and blood sugar levels while also improving circulation, leading many experts to recommend yoga for diabetes management.” – Healthline

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States and nearly 600 million people worldwide have diabetes and the numbers are growing. Type II 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. 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. 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. A leading cause of this is 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. Prevention is always better than treatments. So, it is important to investigate the ability of yoga practice to prevent Type II diabetes in at risk individuals.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795440/), Ramamoorthi and colleagues reviewed, summarized, and performed a meta-analysis of the published controlled research studies of the effectiveness of yoga practice in improving prediabetic symptoms. The found 14 published studies with a total of 834 participants.

 

They report that the published research found that yoga practice significantly improved prediabetic symptoms. They included a significant reduction in fasting blood glucose levels and systolic blood pressure, and improved blood lipid profiles including low density lipoproteins, cholesterol, and triglycerides.

 

This meta-analysis suggests that yoga practice is a safe and effective practice that improves the metabolic signs predictive of future Type II diabetes. It appears to improve glycemic control, blood lipid profiles, and blood pressure. These are very encouraging results. It will be important to follow-up over the long-term to see if these improvements are lasting and if they reduce the transition from then prediabetic state to Type II diabetes.

 

So, yoga practice may help prevent the development of Type II Diabetes.

 

“yoga for diabetes provides unique benefits that can effectively restore the body to a state of natural health and proper function.” – Yoga U

 

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

 

Ramamoorthi, R., Gahreman, D., Skinner, T., & Moss, S. (2019). The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: A systematic review and meta-analysis. PloS one, 14(10), e0221067. doi:10.1371/journal.pone.0221067

 

Abstract

A systematic review and meta-analysis was conducted to investigate the effects of yoga on glycemic control, lipid profiles, body composition and blood pressure in people in the pre-diabetic state. Studies on the effectiveness of yoga on population groups under high risk for diabetes, called prediabetic or suffering from metabolic syndromes were extracted from a thorough search of PubMed, Scopus, Cochrane Library, EBSCO and IndMED databases. Both Randomised Controlled Trial (RCT) and non-RCT studies were included in the systematic review and meta-analysis. Studies published between Jan 2002 and Dec 2018 were included. Studies were considered for evaluation if they investigated a yoga intervention to prevent T2DM, against a control group, while also reporting glycemic control and other health parameters of T2DM management. Summary effect sizes and 95% confidence intervals (CI) were calculated using the Comprehensive Meta-Analysis software in addition to publication bias. Of the 46,500 identified studies, 14 studies with 834 participants of whom were 50% women, were found to be eligible for inclusion in our systematic review. Our quantitative synthesis included 12 randomized control trials and 2 non-randomized control trials, with the follow-up period ranging from 4 to 52 weeks. Compared to controls, yoga intervention improved fasting blood glucose (FBG) [Standard Mean Difference (SMD -0.064 mg/dL (95% CI -0.201 to 0.074)]; low density lipoprotein (LDL) [SMD-0.090 mg/dL (95% CI -0.270 to 0.090)]; triglycerides [SMD -0.148 mg/dL (95% CI -0.285 to -0.012)]; total cholesterol [SMD -0.058 mg/dL (95% CI -0.220 to 0.104)] and systolic blood pressure [SMD -0.058 mm Hg (95% CI -0.168 to 0.053)]. This meta-analysis uncovered clinically improved effects of yoga intervention on glycemic control, lipid profiles and other parameters of T2DM management in prediabetic population. These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM. Further adequately powered, well designed RCTs are needed to support our findings and investigate the long-term effects of yoga in T2DM patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795440/

 

Improve Attention Deficit Hyperactivity Disorder (ADHD) Symptoms in Children with Yoga

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Improve Attention Deficit Hyperactivity Disorder (ADHD) Symptoms in Children with Yoga

 

By John M. de Castro, Ph.D.

 

“research reports that yoga may help relieve attention-deficit hyperactivity disorder (ADHD) in children.” – Elaine Gavalas

 

Attention Deficit Hyperactivity Disorder (ADHD) is most commonly found in children, but for about half it persists into adulthood. It’s estimated that about 5% of the adult population has ADHD. Hence, this is a very large problem that can produce inattention, impulsivity, hyperactivity, and emotional issues, and reduce quality of life. The most common treatment is drugs, like methylphenidate, Ritalin, which helps reducing symptoms in about 30% of the people with ADHD. Unfortunately, the effectiveness of the drugs appears to be markedly reduced after the first year. In addition, the drugs often have troublesome side effects, can be addictive, and can readily be abused. So, drugs, at present, do not appear to be a good solution, only affecting some, only for a short time, and with unwanted side effects.

 

There are indications that mindfulness training may be an effective treatment for ADHD. It makes sense that it should be, as the skills and abilities strengthened by mindfulness training are identical to those that are defective in ADHD,  attention, impulse control, executive function, emotion control, and mood improvement. In addition, unlike drugs, it is a relatively safe intervention that has minimal troublesome side effects. Yoga is both an exercise and a mindfulness practice. This could be particularly attractive for kids with ADHD.

 

In today’s Research News article “Effects of Yoga on Attention, Impulsivity, and Hyperactivity in Preschool-Aged Children with Attention-Deficit Hyperactivity Disorder Symptoms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871620/), Cohen and colleagues recruited preschool children (3-5 years of age) who had at least 4 symptoms of Attention Deficit Hyperactivity Disorder (ADHD). They were randomly assigned to either 6 weeks of Yoga practice or a wait-list control condition. Yoga practice consisted of breathing exercises and poses and occurred twice a week at school in a group setting for 30 minutes and on other days at home guided by a DVD. Before and after the intervention and 6 weeks and 3 months later the parents and teachers completed measures of the children’s ADHD symptoms, emotional symptoms, conduct problems, peer problems, hyperactivity/inattention and prosocial behaviors. The children were also directly measured for attention in a computer-based test and for heart rate variability.

 

They found that for children with high Attention Deficit Hyperactivity Disorder (ADHD) symptom scores, yoga practice produced significant reductions in inattention and hyperactivity/inattention ratings by the parents. On the attention task, after the yoga intervention the children had significantly improved attention but also significantly higher distractibility. These findings were maintained at follow-up.

 

The results suggest that yoga practice is particularly beneficial for children who are high in Attention Deficit Hyperactivity Disorder (ADHD) symptoms improving their attentional ability and hyperactivity. These findings require further investigation to look closer at students with lower ADHD scores. But, they suggest that yoga practice may be beneficial in treating ADHD  in preschool children. Intervening this early in development may help to prevent ADHD development and/or prevent its transition into adulthood.

 

So, improve attention deficit hyperactivity disorder (ADHD) symptoms in children with yoga.

 

“Pairing a hyperactive child with a quiet, slow form of exercise may sound counterintuitive and even disastrous, but it turns out yoga can be incredibly helpful for children with attention deficit hyperactivity disorder (ADHD).” – Dennis Thompson

 

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

 

Cohen, S., Harvey, D. J., Shields, R. H., Shields, G. S., Rashedi, R. N., Tancredi, D. J., … Schweitzer, J. B. (2018). Effects of Yoga on Attention, Impulsivity, and Hyperactivity in Preschool-Aged Children with Attention-Deficit Hyperactivity Disorder Symptoms. Journal of developmental and behavioral pediatrics : JDBP, 39(3), 200–209. doi:10.1097/DBP.0000000000000552

 

Abstract

Objective

Behavioral therapies are first line treatments for preschoolers with ADHD. Studies support yoga as an intervention for school age children with ADHD; this study evaluated the effects of yoga in preschoolers on parent and teacher rated attention/challenging behaviors; attentional control (KiTAP); and heart rate variability (HRV).

Methods

This randomized waitlist-controlled trial tested a 6-week yoga intervention in preschoolers with ≥ 4 ADHD symptoms on the ADHD Rating Scale-IV Preschool Version. Group 1 (n=12) practiced yoga first; Group 2 (n=11) practiced yoga second. We collected data at four time points: baseline, T1 (6 wk), T2 (12 wk), follow-up (3 mo after T2).

Results

At baseline, there were no significant differences between Group 1 and 2 on any measure. At T1, Group 1 had faster reaction times on the KiTAP Go/No go task (p=.01, 95% CI: −371.1, −59.1, d=−1.7), fewer Distractibility errors of omission (p=.009, 95% CI: −14.2, −2.3, d=−1.5), but more commission errors (p=.02, 95% CI:1.4, 14.8, d=1.3) than Group 2. Children in Group 1 with more severe symptoms at baseline showed improvement at T1 not seen in Group 2 on parent-rated Strengths and Difficulties Questionnaire hyperactivity-inattention (β=−2.1, p=.04, 95% CI: −4.0, −0.1) and inattention on the ADHD Rating Scale (β=−4.4, p=.02, 95% CI: −7.9, −0.9). HRV measures did not differ between groups.

Conclusions

Yoga was associated with modest improvements on an objective measure of attention (KiTAP) and selective improvements on parent ratings. Yoga may be a promising treatment for ADHD symptoms in preschoolers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871620/

 

Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

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Adolescent Characteristics that Predict Success of Mindfulness Therapy to Reduce Self-Harm and Suicidality

 

By John M. de Castro, Ph.D.

 

“The pain of depression is quite unimaginable to those who have not suffered it,  and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. It is important to identify the characteristics of adolescents who are most likely to benefit from DBT for the reduction of suicide.

 

In today’s Research News article “Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099), Adrian and colleagues recruited adolescents with previous lifetime suicide attempt, repetitive self‐harm in the past 12 weeks, borderline personality disorder (BPD) characteristics, and clinically significant suicidal ideation. They were randomly assigned to receive 6-months of either Dialectical Behavior Therapy (DBT) or individual/group supportive therapy. They were measured before and after treatment and at the midpoint of treatment for suicide attempts, non-suicidal self-injuries, self-harm, prior self-harm severity, externalizing symptoms, other psychiatric disorders, substance abuse, PTSD symptoms, borderline personality disorder (BPD) symptoms, adolescent-parent conflict, and emotional dysregulation. In addition, their parents were measured for emotional distress and adolescent-parent conflict.

 

They found that non-white adolescents had a greater response to treatment than white adolescents in the reduction in suicide ideation. The adolescent’s pre-treatment history also affected the response to treatment with adolescents with greater levels of family conflict, more extensive self‐harm histories, and more externalizing problems having a greater reduction in self-harm. They also found that Dialectical Behavior Therapy (DBT) was more effective for adolescents who were high in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation.

 

These results are interesting and suggest that certain adolescents are more responsive to treatment than others. Non-white (particularly Latino) youths, adolescents with greater levels of family conflict, more extensive self‐harm histories, more externalizing problems, higher in emotional dysregulation and whose parents had greater psychopathology and emotional dysregulation had more positive changes produced by therapy. These factors may be used to triage which youths would be most likely to benefit from different therapies and thus may potentiate therapeutic benefits.

 

Suicide is a major problem for adolescents and self-harm, self-injury, suicide ideation, and suicide attempts are all indicators of potential lethal outcomes. So, treatment is extremely important. Dialectical Behavior Therapy (DBT) appears to be effective but it is particularly effective for certain youths. Knowing this can help target and refine therapy to improve therapeutic effectiveness in reducing suicides in adolescents.

 

So, reduce suicidality in certain adolescents with mindfulness.

 

“Being curious about your suicidal thoughts is another part of mindful observation. If you have the thought, “I should kill myself,” how does it affect the thought’s meaning to then tell yourself, “Hmm, I wonder why I just had the thought that I should kill myself?” – Stacey Freedenthal

 

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

 

Molly Adrian, Elizabeth McCauley, Michele S. Berk, Joan R. Asarnow, Kathryn Korslund, Claudia Avina, Robert Gallop, Marsha M. Linehan. Predictors and moderators of recurring self‐harm in adolescents participating in a comparative treatment trial of psychological interventions. Journal of Child Psychology and Psychiatry, 30 July 2019, 60(10), 1123-1132, https://doi.org/10.1111/jcpp.13099

 

Key points

  • Adolescent prior self‐harm, externalizing problems, and reported family conflict were significant predictors of change in self‐harm, NSSI, and suicidal ideation, where adolescents with higher family conflict and less severe self‐harm history produced on average more reduction in SH from baseline to post‐treatment.
  • DBT produced better rate of improvement compared to IGST for adolescents who were emotionally dysregulation and whose parents had higher baseline emotion dysregulation and psychopathology.
  • Clinicians could consider either IGST or DBT for adolescents with self‐harm histories whose parents are well regulated and do not have impairing psychopathology. Adolescents with emotional dysregulation and parents with psychopathology and emotion dysregulation may benefit more from DBT than IGST.

Abstract

Background

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self‐harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

Methods

Adolescents (N = 173) were included in the intent‐to‐treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self‐injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self‐Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

Results

Adolescents with higher family conflict, more extensive self‐harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post‐treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post‐treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

Conclusions

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self‐harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13099

 

Meditation Alters the Perception of the Passage of Time

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Meditation Alters the Perception of the Passage of Time

 

By John M. de Castro, Ph.D.

 

“Experienced meditators typically report that they experience time slowing down in meditation practice as well as in everyday life. Conceptually this phenomenon may be understood through functional states of mindfulness.” – Marc Wittmann

 

There are times in life when time just seems to wiz by and others when it seems to creep. There are also times when it seems like a minute passing feels like 5 minutes and others when it feels like only a few seconds. In other words, our sense of the speed of time passing and the amount of time that has passed varies from occasion to occasion. One factor that effects the perception of time is the content of the interval and the frequency of events occurring. If the interval is relatively packed with events and stimuli, then the time period is overestimated, suggesting that time seemed to pass more slowly. If, on the other hand, there are few things occurring in the interval, then time is underestimated, suggesting that time seemed to pass more quickly.

 

Meditation involves paying close attention to the contents of the present moment; calming the mind and reducing thinking and discursive thought. Focusing on the present moment would tend to fill awareness. This suggests that meditating would increase the apparent amount of things occurring and would thus predict that the interval would appear longer than otherwise.

 

In today’s Research News article “Mindfulness meditation, time judgment and time experience: Importance of the time scale considered (seconds or minutes).” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799951/), Droit-Volet and colleagues recruited college students and randomly assigned them to receive either mindfulness meditation (body scan) or a control condition (listening to poems). In the first study, the mindfulness meditation participants listened to a guided body scan meditation while lying on their backs at home for 11 minutes daily for 7 days. The control condition was similar except they listened to recorded poems. They were then tested in the lab where they first meditated or listened to poems for 8 minutes and then were presented by tones separated either by short intervals (16-50 seconds) or long intervals (2-6 minutes) and were asked to estimated the duration of the intervals.

 

They found that the meditation group in comparison to the controls significantly underestimated the duration of the short intervals and significantly overestimated the duration of the longer intervals. During the session the meditation group but not the control group reported a significant reduction in anxiety and a significant increase in happiness and significantly faster passage of time.

 

In a second study a similar procedure was followed except that the same participants performed the meditation and also the control condition in counterbalanced order and only long intervals were used. In addition, they reported for each interval the passage of time, demands on their attention, task difficulty, present moment focus, and arousal levels.

 

Once again, they found that during the meditation session the participants overestimated the durations of the long intervals. They also indicated significantly longer passage of time, significantly greater demands on their attention, task difficulty, and present moment focus. They found that present moment awareness mediated the effect of meditation on duration estimates with the greater the focus on the present moment the greater the overestimation of the interval duration.

 

They suggest that the underestimation of the short intervals by the meditation group was due to the effects of attentional focus on the apparent passage of time with high degrees of attentional focus occupying the mind such that there is little resource left for assessing the passage of time. The results also suggest that the overestimation of long intervals was due to attention on the present moment. By focusing on the contents of awareness in the present moment there is a greater amount of stimuli in awareness, filling awareness. More happening signals a greater amount of time passing. Regardless of the explanation, the study demonstrates that meditation alters the estimation of time passage.

 

So, meditation alters the perception of the passage of time.

 

“My favorite pastime is to let time pass, to have time, to take my time, to live against time.” — Françoise Sagan

 

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

 

Droit-Volet, S., Chaulet, M., Dutheil, F., & Dambrun, M. (2019). Mindfulness meditation, time judgment and time experience: Importance of the time scale considered (seconds or minutes). PloS one, 14(10), e0223567. doi:10.1371/journal.pone.0223567

 

Abstract

This manuscript presents two studies on the effect of mindfulness meditation on duration judgment and its relationship to the subjective experience of time when the interval durations are on the second or the minute time scale. After the first 15 minutes of a 30-min meditation or control exercise, meditation-trained participants judged interval durations of 15 to 50 s or 2 to 6 min, during which they performed either a mindfulness meditation exercise or a control exercise. The participants’ scores on the self-reported scales indicated the effectiveness of the meditation exercise, as it increased the level of present-moment awareness and happiness and decreased that of anxiety. The results showed an underestimation of time for the short interval durations and an overestimation of time for the long intervals, although the participants always reported that time passed faster with meditation than with the control exercise. Further statistical analyses revealed that the focus on the present-moment significantly mediated the exercise effect on the time estimates for long durations. The inversion in time estimates between the two time scales is explained in terms of the different mechanisms underlying the judgment of short and long durations, i.e., the cognitive mechanisms of attention and memory, respectively.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6799951/

 

Help Withdraw from Antidepressant Drugs with Mindfulness

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Help Withdraw from Antidepressant Drugs with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness can help you deal with emotional symptoms of SSRI withdrawal. Techniques such as meditation and deep breathing can help you reduce levels of irritability by reminding you to slow down and step back from a situation before you react.” – Sarah Fader

 

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. It is usually treated with antidepressant 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.

 

It seems reasonable to use antidepressant drugs initially in the treatment of depression but then withdraw the drugs. But withdrawal effects can occur. Symptoms of antidepressant withdrawal are anxiety, insomnia or vivid dreams, headaches, dizziness, tiredness, irritability, flu-like symptoms, including achy muscles and chills, nausea, electric shock sensations, return of depression symptoms. Clearly, there is a need for treatment alternatives that can be effective alone or in combination with drugs. And can help with antidepressant withdrawal.

 

Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating depression. Hence, there is a need to study the application of MBCT to assist in the withdrawal of antidepressant medication.

 

In today’s Research News article “Managing Antidepressant Discontinuation: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/), Maund and colleagues review and summarize the published research studies of the effectiveness of various therapies including Mindfulness-Based Cognitive Therapy (MBCT) to assist in the withdrawal of patients from antidepressants. They found 15 published randomized controlled trials with 3 employing MBCT.

 

They report that the randomized controlled trials found that tapering off antidepressant drugs was far more successful than abrupt withdrawal and that psychological therapies significantly assisted in the success of the process, with successful cessation rates of 40% to 95% compared to 6% to 7% when the physician sent a letter recommending withdrawal. Mindfulness-Based Cognitive Therapy (MBCT) was found to have successful cessation rates of 55% to 75%. MBCT also did not increase relapse/recurrence rates with 44% to 48% relapse.

 

There were only three randomized controlled trials that employed Mindfulness-Based Cognitive Therapy (MBCT) to aid in antidepressant withdrawal and there were no studies that included discontinuation symptoms. So, conclusions must be tempered and measured. But the published research suggests that MBCT is is safe and effective in improving the likelihood of successful withdrawal from antidepressants without increasing the likelihood of relapse.

 

So, help withdraw from antidepressant drugs with mindfulness.

 

“Psychiatric medication is designed to alleviate suffering. Mindfulness can function in this way too. However, psychiatric medication is not generally designed to promote flourishing. . . . Mindfulness can alleviate distress, but it can also lead us states of flourishing and a sense of the deep completeness of the moment.” – Matthew Brensilver

 

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

 

Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A., Dawson, S., & Kendrick, T. (2019). Managing Antidepressant Discontinuation: A Systematic Review. Annals of family medicine, 17(1), 52–60. doi:10.1370/afm.2336

 

Abstract

PURPOSE

We aimed to determine the effectiveness of interventions to manage antidepressant discontinuation, and the outcomes for patients.

METHODS

We conducted a systematic review with narrative synthesis and meta-analysis of studies published to March 2017. Studies were eligible for inclusion if they were randomized controlled trials, quasi-experimental studies, or observational studies assessing interventions to facilitate discontinuation of antidepressants for depression in adults. Our primary outcomes were antidepressant discontinuation and discontinuation symptoms. Secondary outcomes were relapse/recurrence; quality of life; antidepressant reduction; and sexual, social, and occupational function.

RESULTS

Of 15 included studies, 12 studies (8 randomized controlled trials, 2 single-arm trials, 2 retrospective cohort studies) were included in the synthesis. None were rated as having high risk for selection or detection bias. Two studies prompting primary care clinician discontinuation with antidepressant tapering guidance found 6% and 7% of patients discontinued, vs 8% for usual care. Six studies of psychological or psychiatric treatment plus tapering reported cessation rates of 40% to 95%. Two studies reported a higher risk of discontinuation symptoms with abrupt termination. At 2 years, risk of relapse/recurrence was lower with cognitive behavioral therapy plus taper vs clinical management plus taper (15% to 25% vs 35% to 80%: risk ratio = 0.34; 95% CI, 0.18–0.67; 2 studies). Relapse/recurrence rates were similar for mindfulness-based cognitive therapy with tapering and maintenance antidepressants (44% to 48% vs 47% to 60%; 2 studies).

CONCLUSIONS

Cognitive behavioral therapy or mindfulness-based cognitive therapy can help patients discontinue antidepressants without increasing the risk of relapse/recurrence, but are resource intensive. More scalable interventions incorporating psychological support are needed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342590/

 

Improve Low Back Pain with Tai Chi Practice Alone or with Other Treatments

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Improve Low Back Pain with Tai Chi Practice Alone or with Other Treatments

 

By John M. de Castro, Ph.D.

 

“We would expect disability to improve because tai chi involves physical activity and exercise, and this would improve people’s ability to do physical tasks around the house, sports, work, etc.,” – Chris Maher

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses.

 

Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Tai Chi is a mindfulness practice that is safe and gentle and has been shown to improve spinal health and reduce pain. The evidence is accumulating, so, it would seem reasonable to summarize what has been learned regarding the ability of Tai Chi practice to treat chronic low back pain.

 

In today’s Research News article “Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750325/), Qin and colleagues review, summarize, and perform a met-analysis of the effectiveness of Tai Chi practice for the treatment of low back pain. They identified 10 randomized controlled trials employing a total of 959 participants.

 

They report that the studies found that Tai Chi practice either alone or in combination with other therapies significantly reduced low back pain level and the patient’s disability in comparison to control groups. Improvements in disability included pain intensity, personal care, lifting, walking, standing, sleeping, social life, and travelling. This summary makes it clear that Tai Chi practice is a safe and effective treatment for chronic low back pain.

 

Tai Chi is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion. It can also be practiced without professional supervision and in groups making it inexpensive to deliver and fun to engage in. This makes Tai Chi practice an excellent means to treat with chronic low back pain.

 

So, improve low back pain with Tai Chi practice alone or with other treatments.

 

“Tai chi helps with back pain in several ways. It strengthens the muscles in your abdomen and pelvic area that are crucial to supporting the lower back; it improves your balance and flexibility; and it makes you more aware of your posture when you sit, stand, and walk.” – Benjamin Kligler

 

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

 

Qin, J., Zhang, Y., Wu, L., He, Z., Huang, J., Tao, J., & Chen, L. (2019). Effect of Tai Chi alone or as additional therapy on low back pain: Systematic review and meta-analysis of randomized controlled trials. Medicine, 98(37), e17099. doi:10.1097/MD.0000000000017099

 

Abstract

Background:

This is the first systematic review evaluating and statistically synthesis the current studies regarding the effects of Tai Chi on pain and disability in patients with low back pain (LBP).

Methods:

Seven electronic databases including PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information from inception to early March 2019 were searched. The Physiotherapy Evidence Database (PEDro) Scale was used to assess quality of all included randomized controlled trials (RCTs). The pooled effect size (weight mean difference, WMD) and 95% confidence interval (CI) were calculated to determine the effect of Tai Chi on pain and disability among LBP patients based on random effects model.

Results:

The aggregated results of the meta-analysis suggested that Tai Chi significantly decreased pain (WMD = −1.27, 95%CI −1.50 to −1.04, P < .00001, I2 = 74%) and improve function disability, Oswestry disability index (ODI) subitems: pain intensity (WMD = −1.70, 95% CI −2.63 to −0.76, P = .0004, I2 = 89%); personal care (WMD = −1.93, 95% CI −2.86 to −1.00, P < .0001, I2 = 90%); lifting (WMD = −1.69, 95% CI −2.22 to −1.15, P < .0001, I2 = 66%); walking (WMD = −2.05, 95% CI −3.05 to −1.06, P < .0001, I2 = 88%); standing (WMD = −1.70, 95% CI −2.51 to −0.89, P < .0001, I2 = 84%); sleeping (WMD = −2.98, 95% CI −3.73 to −2.22, P < .00001, I2 = 80%); social life (WMD = −2.06, 95% CI −2.77 to −1.35, P < 0.00001, I2 = 80%) and traveling (WMD = −2.20, 95% CI −3.21 to −1.19, P < .0001, I2 = 90%), Japanese Orthopedic Association (JOA) score (WMD = 7.22, 95% CI 5.59–8.86, P < .00001, I2 = 0%), Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36) physical functioning (WMD = 3.30, 95% CI 1.92–4.68, P < .00001), and Roland-Morris Disability Questionnaire (RMDQ) (WMD = −2.19, 95% CI −2.56 to −1.82, P < .00001).

Conclusion:

We drew a cautious conclusion that Tai Chi alone or as additional therapy with routine physical therapy may decrease pain and improve function disability for patients with LBP. Further trials are needed to be conducted with our suggestions mentioned in the systematic review.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750325/