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Improve Psychological Health with Mindfulness Smartphone Aps

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Improve Psychological Health with Mindfulness Smartphone Aps

 

By John M. de Castro, Ph.D.

 

“With apps reaching more people than face-to-face teaching can, he says, “nothing will influence how mindfulness is perceived and practised in our culture more in the next 20 years”. – Amy Fleming

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, Apps for smartphones have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But, the question arises as to the effectiveness of these Apps in inducing mindfulness and improving psychological health.

 

In today’s Research News article “Efficacy of a Mindfulness-Based Mobile Application: a Randomized Waiting-List Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770479/ ), van Emmerik and colleagues recruited adults who had an interest in mindfulness and spirituality through social media and randomly assigned them to either a mindfulness App group or a wait-list control group.

 

The mindfulness App participants were directed to download from the App Store of Google Play Store the VGZ Mindfulness Coach App and complete the 5-week program consisting of 25 exercises including “breathing exercises, attention exercises, body scan exercises, guided meditation exercises, visualization exercises, mantra exercises, and yoga exercises.” The participants were measured before the program and 8 and 20 weeks later for mindfulness, including the observing, describing, non-reacting, non-judging, and acting with awareness facets, quality of life, including physical health, psychological health, social relationships and environment, psychiatric symptomology, self-actualization, and satisfaction with the App.

 

They found that the App produced large significant increases in mindfulness including all five facets, psychological health, social relationships and environment, and decreases in psychiatric symptomology. In addition, the participants reported a high degree of satisfaction and engagement with the App. Hence, the mindfulness App group evidenced marked improvement in mindfulness and psychological health.

 

The results need to be interpreted with caution as the study did not contain an active control condition. This leaves open the possibility that the results were affected by biases such as placebo effects, demand characteristics, experimenter bias, etc. Nevertheless, with these caveats in mind, the results suggest that mindfulness can be increased with a smartphone app which may, in turn, improve psychological health in otherwise healthy individuals. This is exciting as the low cost, convenience, and ease of use, of such Apps allows for widespread applicability. This may provide a low-cost means of improving the mindfulness and psychological health of large swaths of the general population.

 

So, improve psychological health with mindfulness smartphone Aps.

 

“Every app uses varying voices, work flow styles, and types of guided meditation. . . At the end of the day, the most important thing is that you feel drawn to practice everyday.” – Marylyn Wei

 

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

 

Arnold A. P. van Emmerik, Fieke Berings, Jaap Lancee. Efficacy of a Mindfulness-Based Mobile Application: a Randomized Waiting-List Controlled Trial. Mindfulness (N Y) 2018; 9(1): 187–198. Published online 2017 Jun 21. doi: 10.1007/s12671-017-0761-7

 

Abstract

Although several hundreds of apps are available that (cl)aim to promote mindfulness, only a few methodologically sound studies have evaluated the efficacy of these apps. This randomized waiting-list controlled trial therefore tested the hypothesis that one such app (the VGZ Mindfulness Coach) can achieve immediate and long-term improvements of mindfulness, quality of life, general psychiatric symptoms, and self-actualization. One hundred ninety-one experimental participants received the VGZ Mindfulness Coach, which offers 40 mindfulness exercises and background information about mindfulness without any form of therapeutic guidance. Compared to 186 control participants, they reported large (Cohen’s d = 0.77) and statistically significant increases of mindfulness after 8 weeks and small-to-medium increases of the Observing, Describing, Acting with awareness, Nonjudging, and Nonreactivity mindfulness facets as measured with the Five Facet Mindfulness Questionnaire (Cohen’s d = 0.66, 0.26, 0.49, 0.34, and 0.43, respectively). Also, there were large decreases of general psychiatric symptoms (GHQ-12; Cohen’s d = −0.68) and moderate increases of psychological, social, and environmental quality of life (WHOQOL-BREF; Cohen’s d = 0.38, 0.38, and 0.36, respectively). Except for social quality of life, these gains were maintained for at least 3 months. We conclude that it is possible to achieve durable positive effects on mindfulness, general psychiatric symptoms, and several aspects of quality of life at low costs with smartphone apps for mindfulness such as the VGZ Mindfulness Coach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770479/

Treat Physical Health Conditions with Mindfulness

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Treat Physical Health Conditions with Mindfulness

 

By John M. de Castro, Ph.D.

 

“A growing body of research now links the Eastern practice to improved conditions for serious ailments, from diabetes to heart disease to cancer. How? By “treating the whole person… so they can live in greater health and joy.” – Shauna Shapiro

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness Training, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, on-line mindfulness training programs have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But, the question arises as to the effectiveness of these programs.

 

In today’s Research News article “Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599726/, Toivonen and colleagues review and summarize the published research literature on the effectiveness on on-line mindfulness training programs on the psychological and physical symptoms of chronic diseases. They report on 16 published studies.

 

They found that studies of on-line mindfulness training for the treatment of chronic pain conditions, including fibromyalgia, demonstrated significant effectiveness for pain coping and the psychological symptoms produced by chronic pain. But, the evidence was inconclusive regarding alterations of experienced pain. Studies of heart disease treatment with on-line mindfulness trainings demonstrated small improvements relative to usual care in exercise tolerance, heart rate, systolic blood pressure, and stress. Studies of Irritable Bowel Syndrome (IBS) demonstrated significant effectiveness of on-line mindfulness trainings for the symptoms, quality of life, and psychological distress produced by IBS. Studies of epilepsy demonstrated significant effectiveness of on-line mindfulness trainings for the depression accompanying epilepsy. Studies of Tinnitus demonstrated significant effectiveness of on-line mindfulness trainings for Tinnitus severity, depression, anxiety and perceived stress accompanying Tinnitus. Studies of acquired brain injury demonstrated significant effectiveness of on-line mindfulness trainings for the mental fatigue accompanying acquired brain injury. Studies of cancer survivors demonstrated significant effectiveness of on-line mindfulness trainings for the fatigue, depressed mood, and psychological distress accompanying cancer survival.

 

The published studies found that it did not make a significant difference if the on-line mindfulness training occurred through immediate interaction or with continuously available resources or whether there was an active facilitator or not. Hence, on-line training did not require active participation by a therapist. Effectiveness was present regardless. The materials and not the format or the therapist was important.

 

These are important and exciting results that demonstrate the effectiveness of on-line mindfulness training for the treatment of chronic diseases. Thus, mindfulness trainings can be implemented with high cost-effectiveness, to large numbers of people, without the necessity of a therapist’s involvement, and without the requirement for attendance at particular locations. The results suggest that mindfulness practices can be provided widely and inexpensively to relieve at least some of the suffering produced by a wide variety of chronic diseases.

 

“Other research has looked broadly at use of mindfulness-based group therapy compared to individual cognitive-behavioral therapy for patients with various conditions including depression, anxiety and stress and adjustment disorders. They found that the mindfulness group therapy as effective as the individual therapy.” – American Psychiatric Association

 

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

 

Toivonen, K. I., Zernicke, K., & Carlson, L. E. (2017). Web-Based Mindfulness Interventions for People With Physical Health Conditions: Systematic Review. Journal of Medical Internet Research, 19(8), e303. http://doi.org/10.2196/jmir.7487

 

Abstract

Background

Mindfulness-based interventions (MBIs) are becoming increasingly popular for helping people with physical health conditions. Expanding from traditional face-to-face program delivery, there is growing interest in Web-based application of MBIs, though Web-based MBIs for people with physical health conditions specifically have not been thoroughly reviewed to date.

Objective

The objective of this paper was to review Web-based MBIs for people with physical health conditions and to examine all outcomes reported (eg, efficacy or effectiveness for physical changes or psychological changes; feasibility).

Methods

Databases PubMed, PsycINFO, Science Direct, CINAHL Plus, and Web of Science were searched. Full-text English papers that described any Web-based MBI, examining any outcome, for people with chronic physical health conditions were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included intervention characteristics, population characteristics, outcomes, and quality indicators. Intervention characteristics (eg, synchronicity and guidance) were examined as potential factors related to study outcomes.

Results

Of 435 publications screened, 19 published papers describing 16 studies were included. They examined Web-based MBIs for people with cancer, chronic pain or fibromyalgia, irritable bowel syndrome (IBS), epilepsy, heart disease, tinnitus, and acquired brain injury. Overall, most studies reported positive effects of Web-based MBIs compared with usual care on a variety of outcomes including pain acceptance, coping measures, and depressive symptoms. There were mixed results regarding the effectiveness of Web-based MBIs compared with active control treatment conditions such as cognitive behavioral therapy. Condition-specific symptoms (eg, cancer-related fatigue and IBS symptoms) targeted by treatment had the largest effect size improvements following MBIs. Results are inconclusive regarding physical variables.

Conclusions

Preliminary evidence suggests that Web-based MBIs may be helpful in alleviating symptom burden that those with physical health conditions can experience, particularly when interventions are tailored for specific symptoms. There was no evidence of differences between synchronous versus asynchronous or facilitated versus self-directed Web-based MBIs. Future investigations of Web-based MBIs should evaluate the effects of program adherence, effects on mindfulness levels, and whether synchronous or asynchronous, or facilitated or self-directed interventions elicit greater improvements.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5599726/

Reduce General Practitioner Burnout with On-Line Mindfulness

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Reduce General Practitioner Burnout with On-Line Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness practice — the cultivation of a focused awareness on the present moment — can improve physicians’ performance by not only preventing burnout, but also by helping them better connect with their patients.” – Carolyn Gregoire

 

“General Practitioners confront stress on a daily basis. Even moderate levels of stress when prolonged, all too frequently results in a professional burnout. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout. Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning out has to be a priority.

 

Mindfulness has been demonstrated to be helpful in coping with stress and in treating and preventing burnout. But, General Practitioners (GPs) are pressed for time and it is difficult for them to commit the time to mindfulness training on a schedule at a therapist’s location. Mindfulness training over the internet is an alternative training for people who find face-to-face training difficult and inconvenient. Online mindfulness training has shown great promise with effectiveness equivalent to face-to-face training.

 

In today’s Research News article “Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study.” (See summary below). Montero-Marin and colleagues recruited General Practitioners and provided them with on-line mindfulness training with both audio and video instruction in 45-minute sessions occurring twice a week for 4 weeks. Before and after training the GPs were measured for mindfulness, positive and negative emotions, resilience, and burnout.

 

They separated the GPs according to their participation rates into completers who completed two or more practices per week and non-completers who completed on average less than one practice per week. They found that the completers in contrast to the non-completers had significant increases in mindfulness and positive emotions. They also found that the amount of practice had a direct effect on positive emotions and also and indirect effect by increasing mindfulness which in turn increases positive emotions.

 

Hence, on-line mindfulness training appeared to enhance mindfulness and positive feelings in those GPs who completed the provided practices. To some extent the results were disappointing as there were a large proportion of the GPs who did not complete the program’s practice requirements (approximately 80% of those recruited). This could be due to the busy schedules of the GPs or that the program was not sufficiently engaging to motivate participation. In addition, there were no significant effects of the practice on negative emotions, resilience, or burnout. This may be due to the relatively small amount of practice. Perhaps a longer duration program might have more positive effects. Indeed, previous research has shown significant reductions in GP burnout with 8 weeks of in-person mindfulness training. Hence, it is possible that the program in the present study needs to be longer. It is also possible that on-line presentation is not effective for GP burnout.

 

The program, when completed, did produce greater mindfulness and positive emotions. So, there is reason to believe that it may be effective. This suggests that a modified more engaging and longer program should be developed and tested in a randomized controlled trial as an effective treatment for GPO burnout is sorely needed.

 

“When I talk or listen to peers and colleagues, I am amazed at how many healthcare professionals are already integrating mindfulness, meditation or relaxation techniques into their lives on a regular basis in order to ground themselves and find headspace and calm.” – Jon Kabat-Zin

 

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

 

Montero-Marin, J., Gaete, J., Araya, R. et al. Impact of a Blended Web-Based Mindfulness Programme for General Practitioners: a Pilot Study. Mindfulness (2017). doi:10.1007/s12671-017-0752-8

 

Abstract

General practitioners (GPs) report high levels of distress. This study examined whether a brief blended web-based mindfulness intervention could be effective at enhancing well-being for GPs and assessed the possible mediating role of awareness. An open uncontrolled trial, with pre-post measurements, was conducted. The programme comprised one face-to-face meeting (4 h) and eight online practice sessions with no support (two weekly sessions over 4 weeks). The primary outcome was positive affect (PANAS-positive). The secondary outcomes were as follows: negative affect (PANAS-negative), awareness (MAAS), resilience (CDRISC), and the burnout subtypes (BCSQ-12). Mixed-effects analysis for repeated measures and mediation analysis by regression models were performed. Two hundred ninety Spanish GPs took part in the study, attending the face-to-face meeting. Nearly one out 10 participants (n = 28) completed ‘one weekly practice’, and 10.4% (n = 30) accomplished ‘two or more weekly practices’. There were benefits for those with ‘two or more weekly practices’ in PANAS-positive (B = 2.97; p = 0.007), and MAAS (B = 4.65; p = 0.023). We found no benefits for those with ‘one weekly practice’ in any of the outcomes. There were mediating effects of MAAS in PANAS-positive (explaining a 60.8% of total effects). A brief blended mindfulness intervention, with minimum face-to-face contact and web-based practice sessions, seems to confer improvements in the well-being of Spanish GPs. The benefits may be mediated by awareness. The implementation of this kind of programme might enhance the well-being among GPs, but there is a need to improve adherence to practice. Further research using randomized controlled designs will be needed to support the evidence found in our study.

Reduce Stress with Preventative On-line Mindfulness Training

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Reduce Stress with Preventative On-line Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“Mindfulness not only reduces stress but also gently builds an inner strength so that future stressors have less impact on our happiness and physical well-being.” – Shamash Alidina

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness Training, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts.

 

In today’s Research News article “Effects of preventive online mindfulness interventions on stress and mindfulness: A 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/PMC5199155/, Jayawardene and colleagues reviewed and conducted a meta-analysis of the published research literature on the effectiveness of preventative mindfulness training on-line with normal, non-clinical, individuals for the relief of stress effects. They found 8 published randomized controlled trials. Most used modifications of the Mindfulness-Based Stress Reduction (MBSR) program and lasted from 2 to 12 weeks. MBSR includes body scan, meditation, and yoga practices.

 

They found that the published studies report significant reductions in perceived stress of moderate effect sizes and increases of mindfulness of small effect sizes following mindfulness training in comparison to baseline and control conditions. These effects persisted up to several months after the end of training. They also found that the older the participant the larger the reduction in perceived stress produced by mindfulness training.

 

These results are significant but not unexpected as Mindfulness-Based Stress Reduction (MBSR) was developed specifically to target perceived stress. What is significant is that this effectiveness occurs even when the training occurs strictly over the internet and with normal, non-clinical, populations. This is important as it suggests that inexpensive mindfulness training can be offered to widespread audiences. In addition, online training is convenient for the participants, as they do not have to go to a practitioners site on a particular schedule. This, in turn, allows for the application of mindfulness training for the prevention and treatment of psychological and physical disorders with busy people, low income people, and even people in remote locations, thus greatly expanding the numbers of people who can benefit.

 

Mindfulness training has been shown to have a myriad of physical and psychological benefits. The present findings are exciting in that they suggest that mindfulness training can occur inexpensively to disparate populations. The on-line mindfulness training may then, by reducing stress effects in normal people, act to prevent the many physical and psychological problems that result from chronic stress, improving their health and well-being.

 

So, reduce stress with preventative on-line mindfulness training.

 

“These are difficult times right now for a lot of people. Learning to become more “present,” frees us to be more flexible and creative – and ultimately, more resilient, enjoying better health and well-being.’”– Elisha Goldstein

 

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

 

Jayawardene, W. P., Lohrmann, D. K., Erbe, R. G., & Torabi, M. R. (2017). Effects of preventive online mindfulness interventions on stress and mindfulness: A meta-analysis of randomized controlled trials. Preventive Medicine Reports, 5, 150–159. http://doi.org/10.1016/j.pmedr.2016.11.013

 

Abstract

Empirical evidence suggested that mind-body interventions can be effectively delivered online. This study aimed to examine whether preventive online mindfulness interventions (POMI) for non-clinical populations improve short- and long-term outcomes for perceived-stress (primary) and mindfulness (secondary). Systematic search of four electronic databases, manuscript reference lists, and journal content lists was conducted in 2016, using 21 search-terms. Eight randomized controlled trials (RCTs) evaluating effects of POMI in non-clinical populations with adequately reported perceived-stress and mindfulness measures pre- and post-intervention were included. Random-effects models utilized for all effect-size estimations with meta-regression performed for mean age and %females. Participants were volunteers (adults; predominantly female) from academic, workplace, or community settings. Most interventions utilized simplified Mindfulness-Based Stress Reduction protocols over 2–12 week periods. Post-intervention, significant medium effect found for perceived-stress (g = 0.432), with moderate heterogeneity and significant, but small, effect size for mindfulness (g = 0.275) with low heterogeneity; highest effects were for middle-aged individuals. At follow-up, significant large effect found for perceived-stress (g = 0.699) with low heterogeneity and significant medium effect (g = 0.466) for mindfulness with high heterogeneity. No publication bias was found for perceived-stress; publication bias found for mindfulness outcomes led to underestimation of effects, not

studies. POMI had substantial stress reduction effects and some mindfulness improvement effects. POMI can be a more convenient and cost-effective strategy, compared to traditional face-to-face interventions, especially in the context of busy, hard-to-reach, but digitally-accessible populations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5199155/

Improve Exercise Capacity in Heart Disease with Mindfulness

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Improve Exercise Capacity in Heart Disease with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Why bother to do a mindfulness practice in addition to regular workouts?” You know that exercise can clear your head and turn around a bad mood. But when you add mindfulness in to the mix, you add rocket fuel to these already valuable benefits.” – Belief net
Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” – Centers for Disease Control. A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. But, these treatments can be costly, invasive, have major side effects, and often don’t address the root causes of the disease. On the other hand, the safest effective treatments for heart disease are lifestyle changes.

 

It has been demonstrated that lifestyle is a major contributor to the development of heart disease. quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses have shown to be effective in treating heart disease. Contemplative practices such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health have also been shown to be safe and effective treatments. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction.

 

One problem with the employment of mindfulness treatment programs to treat disease is that they require patients to meet frequently with professional therapists in either individual or group settings. This can be inconvenient, costly, and time consuming and for many people who live in remote areas, unavailable. So, to overcome these problems, mindfulness based techniques have been successfully developed and delivered over the internet. In a study by Younge et al. it was demonstrated that a 12-week mindfulness intervention significantly improved exercise capacity and decreased heart rate and blood pressure. The study, however, did not include a long-term follow-up. So, it is unknown how long-lasting the effects of the mindfulness treatment may be. In today’s Research News article “Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423609/, Gotink and colleagues perform a 12-month follow-up of the patients included in the study by Younge et al.

 

They recruited adult patients with existing, diagnosed heart disease and randomly assigned to a 12-week on-line mindfulness training or a usual medical care condition. The mindfulness training program included different meditations, self-reflection, yoga, and practical assignments and suggestions for using mindfulness in day-to-day life. After completion of the program the participants continued to receive biweekly reminders to continue practice. The patients were measured before and after training and 9-months later for exercise capacity measured with the 6-minute walk test, blood pressure, heart rate, respiratory rate, and cortisol levels, mental and physical functioning, anxiety and depression, perceived stress, and social support.

 

They found that similar to the benefits of mindfulness training documented at the end of training, 9-months later there were still small but significant improvements in the mindfulness group in exercise capacity, systolic blood pressure, mental functioning, and depression. These results are important in that they demonstrate that on-line mindfulness training can have lasting benefits for patients with heart disease. On-line training is inexpensive, convenient, and available to everyone with internet connections. It is effective for producing long-term improvements in exercise capacity in patients with heart disease allowing the patients to safely engage in beneficial exercise programs to strengthen the cardiovascular system. In addition, mindfulness training has been shown to help with producing other lifestyle changes that are beneficial for heart disease, Hence, it would be reasonable to suggest that on-line mindfulness training should be incorporated into standard  heart disease treatment programs.

 

So, improve exercise capacity in heart disease with mindfulness.

 

“There are well documented studies that show meditation reverses the physiologic manifestations of stress such as elevated blood pressure and heart rate.” – Joon Lee

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are

Improve Exercise Capacity in Heart Disease with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Why bother to do a mindfulness practice in addition to regular workouts?” You know that exercise can clear your head and turn around a bad mood. But when you add mindfulness in to the mix, you add rocket fuel to these already valuable benefits.” – Belief net
Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” – Centers for Disease Control. A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. But, these treatments can be costly, invasive, have major side effects, and often don’t address the root causes of the disease. On the other hand, the safest effective treatments for heart disease are lifestyle changes.

 

It has been demonstrated that lifestyle is a major contributor to the development of heart disease. quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses have shown to be effective in treating heart disease. Contemplative practices such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health have also been shown to be safe and effective treatments. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction.

 

One problem with the employment of mindfulness treatment programs to treat disease is that they require patients to meet frequently with professional therapists in either individual or group settings. This can be inconvenient, costly, and time consuming and for many people who live in remote areas, unavailable. So, to overcome these problems, mindfulness based techniques have been successfully developed and delivered over the internet. In a study by Younge et al. it was demonstrated that a 12-week mindfulness intervention significantly improved exercise capacity and decreased heart rate and blood pressure. The study, however, did not include a long-term follow-up. So, it is unknown how long-lasting the effects of the mindfulness treatment may be. In today’s Research News article “Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423609/, Gotink and colleagues perform a 12-month follow-up of the patients included in the study by Younge et al.

 

They recruited adult patients with existing, diagnosed heart disease and randomly assigned to a 12-week on-line mindfulness training or a usual medical care condition. The mindfulness training program included different meditations, self-reflection, yoga, and practical assignments and suggestions for using mindfulness in day-to-day life. After completion of the program the participants continued to receive biweekly reminders to continue practice. The patients were measured before and after training and 9-months later for exercise capacity measured with the 6-minute walk test, blood pressure, heart rate, respiratory rate, and cortisol levels, mental and physical functioning, anxiety and depression, perceived stress, and social support.

 

They found that similar to the benefits of mindfulness training documented at the end of training, 9-months later there were still small but significant improvements in the mindfulness group in exercise capacity, systolic blood pressure, mental functioning, and depression. These results are important in that they demonstrate that on-line mindfulness training can have lasting benefits for patients with heart disease. On-line training is inexpensive, convenient, and available to everyone with internet connections. It is effective for producing long-term improvements in exercise capacity in patients with heart disease allowing the patients to safely engage in beneficial exercise programs to strengthen the cardiovascular system. In addition, mindfulness training has been shown to help with producing other lifestyle changes that are beneficial for heart disease, Hence, it would be reasonable to suggest that on-line mindfulness training should be incorporated into standard  heart disease treatment programs.

 

So, improve exercise capacity in heart disease with mindfulness.

 

“There are well documented studies that show meditation reverses the physiologic manifestations of stress such as elevated blood pressure and heart rate.” – Joon Lee

 

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

 

Gotink, R. A., Younge, J. O., Wery, M. F., Utens, E. M. W. J., Michels, M., Rizopoulos, D., … Hunink, M. M. G. (2017). Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS ONE, 12(5), e0175923. http://doi.org/10.1371/journal.pone.0175923

 

Abstract

There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen’s D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05–0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423609/

also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Gotink, R. A., Younge, J. O., Wery, M. F., Utens, E. M. W. J., Michels, M., Rizopoulos, D., … Hunink, M. M. G. (2017). Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS ONE, 12(5), e0175923. http://doi.org/10.1371/journal.pone.0175923

 

Abstract

There is increasing evidence that mindfulness can reduce stress, and thereby affect other psychological and physiological outcomes as well. Earlier, we reported the direct 3-month results of an online modified mindfulness-based stress reduction training in patients with heart disease, and now we evaluate the effect at 12-month follow-up. 324 patients (mean age 43.2 years, 53.7% male) were randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. The primary outcome was exercise capacity measured with the 6 minute walk test (6MWT). Secondary outcomes were blood pressure, heart rate, respiratory rate, NT-proBNP, cortisol levels (scalp hair sample), mental and physical functioning (SF-36), anxiety and depression (HADS), perceived stress (PSS), and social support (PSSS12). Differences between groups on the repeated outcome measures were analyzed with linear mixed models. At 12-months follow-up, participants showed a trend significant improvement exercise capacity (6MWT: 17.9 meters, p = 0.055) compared to UC. Cohen’s D showed significant but small improvement on exercise capacity (d = 0.22; 95%CI 0.05 to 0.39), systolic blood pressure (d = 0.19; 95%CI 0.03 to 0.36), mental functioning (d = 0.22; 95%CI 0.05 to 0.38) and depressive symptomatology (d = 0.18; 95%CI 0.02 to 0.35). All other outcome measures did not change statistically significantly. In the as-treated analysis, systolic blood pressure decreased significantly with 5.5 mmHg (p = 0.045; d = 0.23 (95%CI 0.05–0.41)). Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423609/

Improve Caregiving for Family Members with Mental Illness with On-Line Mindfulness Training

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Improve Caregiving for Family Members with Mental Illness with On-Line Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“When specifically used with family caregivers, MBSR improves overall mental health, reduces stress and decreases depression. “ – Jane Hamilton

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is mentally or physically ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. This caregiving comes at a cost to the caregiver. It exacts a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality.

 

Providing care for a relative with mental illness can be particularly challenging. Mental illnesses can make it difficult to relate to the individual and receive the kind of positive feelings that can support caregiving. The challenges of caring for a relative with mental illness require that the individual be able to deal with stress, to regulate their own emotions, and to be sensitive and attentive. These skills are exactly those that are developed in mindfulness training. It improves the psychological and physiological responses to stress. It improves emotion regulation. And it improves the ability to maintain attention and focus in the face of high levels of distraction. So, it is not surprising that mindfulness improves caregiving and assists the caregiver in coping with the stress.

 

The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. This is particularly true for caregivers where the demands on the individual are substantial. As a result, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts.

 

In today’s Research News article “Effectiveness and Usability of a Web-Based Mindfulness Intervention for Families Living with Mental Illness.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408047/, Stjernswärd and Hansson recruited adult participants who have a family member with a diagnosed mental illness. They were randomized into a mindfulness training and a wait-list control group. Mindfulness training occurred on-line and consisted of audio/video files, descriptive text files, and instructions for daily mindfulness exercises, and self-compassion exercises. It was recommended that participants engage in the training twice a day for 10 minutes, six days per week for 8 weeks. recommended training was set to 2 × 10 min/day, 6 days/week for 8 consecutive weeks.

 

Participants were measured before and after training and 3-months later for mindfulness, caregiver quality of life, self-compassion, and perceived stress. They found that mindfulness training produced significant increases in mindfulness, self-compassion, and caregiver quality of life, including relational problems, mental health, and problems with daily activities and significant reductions in perceived stress.

 

These are interesting results but must be tempered with the knowledge that the control condition was a no-treatment, wait-list control. So, the results could be due to confounding factors such as placebo effects, experimenter bias, attention effects, etc. But, they suggest that mindfulness training for caregivers with family members with mental illnesses can be successfully delivered on-line. If the results are supported by better controlled trials, they could be important in that improvements in the mental health and quality of life can be offered to caregivers in a convenient and inexpensive format. This could be very helpful in relieving a difficult situation for the caregivers and result in improved caregiving.

 

So, improve caregiving for family members with mental illness with on-line mindfulness training.

 

“5 Steps to Avoid Caregiver Burnout

  1. Develop a mindfulness practice, whether it’s yoga, meditation, or Qigong.
  2. Incorporate mini-mindfulness moments. Set aside time several times a day to ground yourself and to be in the present moment.
  3. Learn to accept your emotions, both pleasant and unpleasant, rather than wishing them away.
  4. Recognize the need for self-care in caregiving. Taking time for yourself may be an old piece of advice but it’s essential.
  5. Find a support network that can help you build a mindfulness practice, whether it is your friend, the YMCA, or a meditation group.” – 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

Stjernswärd, S., & Hansson, L. (2017). Effectiveness and Usability of a Web-Based Mindfulness Intervention for Families Living with Mental Illness. Mindfulness, 8(3), 751–764. http://doi.org/10.1007/s12671-016-0653-2

 

Abstract

Families living with mental illness express needs of support and experiences of burden that may affect their own health detrimentally and hence also their ability to support the patient. Mindfulness-based interventions have shown beneficial health effects in both clinical and healthy populations. The aim of the current study was to explore the effectiveness and usability of a web-based mindfulness program for families living with mental illness, which was first tested in a feasibility study. The study was designed as a randomized controlled trial with an experiment group and a wait-list control group with assessments on primary and secondary outcomes at baseline, post-intervention, and at a 3-month follow-up. Significant positive improvements in mindfulness and self-compassion, and significant decreases in perceived stress and in certain dimensions of caregiver burden were found, with good program usability. Easily accessible mindfulness-based interventions may be useful in addressing caregivers’ needs of support and in preventing further ill health in caregivers. Further studies are needed, among others, to further customize interventions and to investigate the cost-effectiveness of such programs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5408047/

Mindfulness Training is Effective when Learned over the Internet.

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Mindfulness Training is Effective when Learned over the Internet.

 

By John M. de Castro, Ph.D.

 

“online mindfulness/stress management programs can be as effective as real-world programs, delivered at a fraction of the cost. . . . online programs could make mindfulness more accessible to underserved populations—as long as they have a computer and an Internet connection.” – Hooria Jazaieri

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness Training, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist in on-line programs may greatly reduce their effectiveness.

 

In today’s Research News article “Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes?” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

Fish and colleagues review and summarize the published research literature on the effectiveness of mindfulness therapies delivered online. They identified 9 randomized controlled trials of web-based mindfulness training. “All interventions introduced participants to some form of mindfulness practice including body scans, mindfulness of breathing, mindful movement and loving kindness” meditation.

 

They found that the studies reported that mindfulness training resulted in large improvements in mindfulness, reductions in stress, and clinically significant reductions in depression and anxiety. A large proportion of participants, 83%, continued practice after training ceased and the beneficial effects of the practice were still significant as much as 6-months later. These are impressive results which are comparable to the effects reported for therapist guided mindfulness training for stress, anxiety, and depression.  The studies, however, generally used weak control conditions and there is a need to continue the research with stronger research designs.

 

These are important findings in that mindfulness therapies were successfully implemented on-line. Web-based therapy allows for widespread, inexpensive, and convenient distribution of the treatment programs thereby opening up treatment to individuals who live in remote areas, cannot afford traditional therapist led treatment, or do not have the time to come repeatedly to a clinic during the workday. Hence, mindfulness training can be provided at low cost to widespread communities and individuals at their convenience. This greatly magnifies the potential societal benefits of mindfulness training; improving health and well-being.

 

So, mindfulness training is effective when learned over the internet.

 

“One of the benefits of living in a digital age is that we can pretty much access whatever we want. That is certainly true of meditation. Every major meditation center or university has an online component, offering you virtual courses, guided meditations, information on retreats and workshops. “ – Mindful

 

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

Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes? Mindfulness, 7(5), 1011–1023. http://doi.org/10.1007/s12671-016-0548-2

 

Abstract

New cost-effective psychological interventions are needed to contribute to treatment options for psychiatric and physical health conditions. This systematic review aims to investigate the current literature on one potentially cost-effective form of mindfulness-based therapy, those delivered through technological platforms without any mindfulness facilitator input beyond the initial design of the programme. Three electronic databases (Ovid Medline, PsychINFO and Embase) were searched for relevant keywords, titles, medical subject headings (MeSH) and abstracts using search terms derived from a combination of two subjects: ‘mindfulness’ and ‘technology’. Overall, ten studies were identified. The majority of studies were web-based and similar in structure and content to face-to-face mindfulness-based stress reduction courses. Clinical outcomes of stress (n = 5), depression (n = 6) and anxiety (n = 4) were reported along with mindfulness (n = 4), the supposed mediator of effects. All eight studies that measured significance found at least some significant effects (p < .05). The highest reported effect sizes were large (stress d = 1.57, depression d = .95, both ps > .005). However, methodological issues (e.g. selection bias, lack of control group and follow-up) which reflect the early nature of the work mean these largest effects are likely to be representative of maximal rather than average effects. Whilst there are important differences in the construction, length and delivery of interventions, it is difficult to draw firm conclusions about the most effective models. Suggestions of key characteristics are made though, needing further investigation preferably in standardised interventions. Given the existing research and the speed at which technology is making new platforms and tools available, it seems important that further research explores two parallel lines: first, refinement and thorough evaluation of already established technology-based mindfulness programmes and second, exploration of novel approaches to mindfulness training that combine the latest technological advances with the knowledge and skills of experienced meditation teachers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

 

Learn Mindfulness On-Line to Reduce Stress Effects

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Learn Mindfulness On-Line to Reduce Stress Effects

 

By John M. de Castro, Ph.D.

 

“Mindfulness not only reduces stress but also gently builds an inner strength so that future stressors have less impact on our happiness and physical well-being.” –  Shamash Alidina

 

Mindfulness training has been shown through extensive research to be effective in improving the physical and psychological condition of otherwise healthy people and also treating the physical and psychological issues of people with illnesses and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be particularly effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, adopted so far, however, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a result, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist in on-line programs may greatly reduce their effectiveness.

 

In today’s Research News article “Effects of preventive online mindfulness interventions on stress and mindfulness: A 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/PMC5199155/

Jayewardene and colleagues review and perform a meta-analysis of the published research literature investigating the effectiveness of preventive mindfulness interventions delivered exclusively online for reducing stress responses in normal adults. They identified 8 randomized controlled trials with 75% having waitlist control groups and interventions lasting from 2 to 12 weeks. All but one study employed interventions that were modifications of the Mindfulness Based Stress Reduction (MBSR) program for completely online implementation. MBSR is composed of meditation, body scan and yoga training.

 

They found that overall the published literature reported significant improvements in mindfulness of small effect size and significant reductions in perceived stress of moderate size. They reported that there was no evidence suggesting publication bias as being responsible for the reported effects. So, the literature supports the assertion that mindfulness training online is effective in reducing perceived stress and increasing mindfulness.

 

These are exciting findings. It is well established that mindfulness training is effective for reducing the physical and psychological reactions to stress and that Mindfulness Based Stress Reduction (MBSR) programs are effective. What is new in this review is establishing that these benefits can be produced with training occurring exclusively online. This is important as it suggests that inexpensive mindfulness training can be offered to widespread audiences. In addition, online training is convenient for the participants, as they do not have to go to a practitioners site on a particular schedule. This, in turn, allows for the application of mindfulness training for the prevention and treatment of psychological and physical disorders with busy people, low income people, and even people in remote locations, thus greatly expanding the numbers of people who can benefit.

 

So, learn mindfulness on-line to reduce stress effects.

 

“A live, in-person Mindfulness-Based Stress Reduction (MBSR) class is still the best way to learn mindfulness, because it is more likely that you will complete the course, due to the live interaction and group support. But doing an in-person course is not always possible, for financial and logistical reasons. The online course uses precisely the same course curriculum and resources that are used in the local in-person course, and if you follow the suggestions and practices for each of the eight weeks of the course, the learning can be just as deep and profound.” – Dave Potter

 

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 Twitter @MindfulResearch

 

Study Summary

Jayewardene, W. P., Lohrmann, D. K., Erbe, R. G., & Torabi, M. R. (2017). Effects of preventive online mindfulness interventions on stress and mindfulness: A meta-analysis of randomized controlled trials. Preventive Medicine Reports, 5, 150–159. http://doi.org/10.1016/j.pmedr.2016.11.013

 

Abstract

Empirical evidence suggested that mind-body interventions can be effectively delivered online. This study aimed to examine whether preventive online mindfulness interventions (POMI) for non-clinical populations improve short- and long-term outcomes for perceived-stress (primary) and mindfulness (secondary). Systematic search of four electronic databases, manuscript reference lists, and journal content lists was conducted in 2016, using 21 search-terms. Eight randomized controlled trials (RCTs) evaluating effects of POMI in non-clinical populations with adequately reported perceived-stress and mindfulness measures pre- and post-intervention were included. Random-effects models utilized for all effect-size estimations with meta-regression performed for mean age and %females. Participants were volunteers (adults; predominantly female) from academic, workplace, or community settings. Most interventions utilized simplified Mindfulness-Based Stress Reduction protocols over 2–12 week periods. Post-intervention, significant medium effect found for perceived-stress (g = 0.432), with moderate heterogeneity and significant, but small, effect size for mindfulness (g = 0.275) with low heterogeneity; highest effects were for middle-aged individuals. At follow-up, significant large effect found for perceived-stress (g = 0.699) with low heterogeneity and significant medium effect (g = 0.466) for mindfulness with high heterogeneity. No publication bias was found for perceived-stress; publication bias found for mindfulness outcomes led to underestimation of effects, not overestimation. Number of eligible RCTs was low with inadequate data reporting in some studies. POMI had substantial stress reduction effects and some mindfulness improvement effects. POMI can be a more convenient and cost-effective strategy, compared to traditional face-to-face interventions, especially in the context of busy, hard-to-reach, but digitally-accessible populations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5199155/

ACT On-line to Reduce Chronic Pain

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By John M. de Castro, Ph.D.

 

“What kind of therapy is beneficial?  What are the specific components of therapy most applicable to people with chronic pain?  I can tell you that mindfulness, CBT, and ACT based interventions are definitely part of the equation, i.e., they are always helpful.  In fact, mindfulness practice is often a necessary component of healing.” – Howard Schubiner, MD

 

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity.  At least 100 million adult Americans have common chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.

 

An impediment to widespread adoption of various psychotherapy techniques, including ACT, is that they require a trained professional therapist and attendance at scheduled therapy sessions. This can make the treatments expensive and inconvenient. The internet holds great promise to deliver therapy inexpensively and conveniently to large numbers of people spread across wide geographic areas. Mindfulness training has been successfully conducted over the internet with positive benefit. ACT has been successfully has been delivered on-line reducing depression. So, on-line ACT training appears to be a viable method for treatment.

 

In today’s Research News article “Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1369590659731523/?type=3&theater

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

Trompetter and colleagues investigate the effectiveness of ACT, delivered on-line, to treat chronic pain and what variable might predict the kinds of patients who are most likely to have positive responses to ACT. They recruited patients suffering from chronic pain and randomly assigned them to either receive 12-weeks of on-line ACT treatment or Expressive Writing Treatment or to a waitlist control group. They measured pain and pain interference in daily life before and after treatment and 3 months after the conclusion of treatment. Before treatment they also measured demographic variables, pain intensity, pain disability, psychological distress, and mental health.

 

They found that ACT produced a significant reduction in pain interference in daily life and that this effect was moderated by the psychological well-being of the participants. That is, that participants with high levels of psychological well-being had much greater benefit from ACT than those at lower levels. There were no other significant predictors of benefit. These results suggest that ACT conducted on-line can be effective in reducing the interference from pain in the conduct of the daily lives of chronic pain patients. This is important as on-line presentation can greatly increase the scalability, affordability, and convenience of treatment for the huge numbers of chronic pain patients. The results further indicate that on-line ACT should be used primarily for patients who have moderate to high levels of psychological well-being at the beginning.

 

So, ACT on-line to reduce chronic pain.

 

“Overall, it appears that the cognitive-behavioral approach has a positive effect when combined with active treatments such as medications, physical therapy, and medical treatments for chronic pain clients in treating pain, thoughts about pain, and pain behavior problems.” –  Carrie L. Winterowd

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Trompetter, H. R., Bohlmeijer, E. T., Lamers, S. M. A., & Schreurs, K. M. G. (2016). Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective. Frontiers in Psychology, 7, 353. http://doi.org/10.3389/fpsyg.2016.00353

 

Abstract

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

 

Get Mindful On-Line and Get Feeling Better

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By John M. de Castro, Ph.D.

 

“mindfulness exercises delivered in face-to-face settings or remotely via the Internet seem to yield similar changes in symptoms. The remote delivery does not seem to lessen the efficacy of mindfulness interventions.”– Johanna Boettcher

 

Mindfulness training has been shown through extensive research to be effective in improving the physical and psychological condition of otherwise healthy people and also treating the physical and psychological issues of people with illnesses. Techniques such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be particularly effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, adopted so far, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a results, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist in on-line programs may greatly reduce their effectiveness.

 

In today’s Research News article “Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1362554723768450/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

Fish and colleagues review the published research literature on the effectiveness of technology-based mindfulness training programs that did not include an active facilitator’s participation. They found 10 studies published, 9 of which were web-based programs. They found that, in general, the mindfulness programs produced increases in mindfulness and reductions in perceived stress, depression, anxiety, and rumination and these effects were maintained at follow-ups occurring as much as 6-months later. Unfortunately, compliance was relatively low and drop-out rates were relatively high.

 

These are encouraging findings and suggest that mindfulness can be effectively trained with web-based materials and that this can produce psychologically beneficial results. But, there were no direct comparisons to traditional programs. So, it cannot be determined if the web-based programs are as effective as traditional programs. In addition, there methods need to be developed to help maintain compliance and decrease dropping out of web-based programs. Regardless, the benefits are substantial and the results are sufficiently positive to encourage further research.

 

So, get mindful on-line and get feeling better.

 

“Internet delivery of mindfulness training may be a viable alternative if an evidence base can be established. It can be self-paced, less costly, and more accessible while additionally allowing for participant anonymity. “ – David Messer

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes? Mindfulness, 7(5), 1011–1023. http://doi.org/10.1007/s12671-016-0548-2

 

Abstract

New cost-effective psychological interventions are needed to contribute to treatment options for psychiatric and physical health conditions. This systematic review aims to investigate the current literature on one potentially cost-effective form of mindfulness-based therapy, those delivered through technological platforms without any mindfulness facilitator input beyond the initial design of the programme. Three electronic databases (Ovid Medline, PsychINFO and Embase) were searched for relevant keywords, titles, medical subject headings (MeSH) and abstracts using search terms derived from a combination of two subjects: ‘mindfulness’ and ‘technology’. Overall, ten studies were identified. The majority of studies were web-based and similar in structure and content to face-to-face mindfulness-based stress reduction courses. Clinical outcomes of stress (n = 5), depression (n = 6) and anxiety (n = 4) were reported along with mindfulness (n = 4), the supposed mediator of effects. All eight studies that measured significance found at least some significant effects (p < .05). The highest reported effect sizes were large (stress d = 1.57, depression d = .95, both ps > .005). However, methodological issues (e.g. selection bias, lack of control group and follow-up) which reflect the early nature of the work mean these largest effects are likely to be representative of maximal rather than average effects. Whilst there are important differences in the construction, length and delivery of interventions, it is difficult to draw firm conclusions about the most effective models. Suggestions of key characteristics are made though, needing further investigation preferably in standardised interventions. Given the existing research and the speed at which technology is making new platforms and tools available, it seems important that further research explores two parallel lines: first, refinement and thorough evaluation of already established technology-based mindfulness programmes and second, exploration of novel approaches to mindfulness training that combine the latest technological advances with the knowledge and skills of experienced meditation teachers.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/