Relieve Fatigue Accompanying Neurologic Disease with Mindfulness

September 19, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness meditation — or mentally focusing on being in the present moment — has also proven an effective tool to help people with cognitive and behavioral issues after TBI. With meditation of all kinds — from chanting to visual imagery — people can make peace with their new self and not get swept up in the constant maelstrom of mental obsessions.” – Victoria Tilney McDonough

Brain damage is more or less permanent. The neurons and neural structures that are destroyed when the brain is damaged for the most part do not regrow. Brain Injury is caused by a number of different events from a violent blow to the head (Traumatic Brain Injury, TBI), to interruption of the blood supply to the brain (strokes), and to demyelinating diseases such as Multiple Sclerosis (MS). These neurological diseases are common and disabling. In the United States it is estimated that annually 1.7 million people sustain Traumatic Brain Injury, while 400,000 people are diagnosed with Multiple Sclerosis, and about 800,000 people have strokes.

Regardless of the cause, the brain is damaged, and the tissues that are destroyed are permanently lost. But, we know that people can recover to some extent from brain injury. How is it possible that recovery can occur when there is no replacement of the damaged tissue? There appears to be a number of strategies that are employed by the brain to assist in recovery. Other areas of the brain can take over some of the function, other behavioral strategies can be employed to accomplish the task, and non-injured areas of the brain can adapt and change to compensate for the lost function. Rehabilitation usually involves strategies to promote these recovery mechanisms.

Each of these neurologic diseases are accompanied by a profound fatigue. This disrupts rehabilitation as it makes it difficult for the patients to engage in the needed activities. In fact, the depth of fatigue is associated with lower levels of quality of life, everyday functioning, and life expectancy. So, it is important to find methods to reduce fatigue in patients with neurologic diseases. Mindfulness training has been found to be helpful in recover from Traumatic Brain Injury, Multiple Sclerosis, and stroke. It would seem likely then that mindfulness training reduces fatigue.

In today’s Research News article “Clinical Utility of Mindfulness Training in the Treatment of Fatigue After Stroke, Traumatic Brain Injury and Multiple Sclerosis: A Systematic Literature Review and Meta-analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1327481707275752/?type=3&theater

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

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00912/full

Ulrichsen and colleagues review the published research literature on the effects on fatigue of mindfulness training on adult patients with neurologic diseases. In all of the studies 8-weeks of either Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) were employed as therapy. They found that mindfulness training significantly reduced fatigue with moderate effect size.

These are encouraging results as fatigue plays such a crucial role in the disease and its reduction is needed for other rehabilitation activities to be effective. It isn’t clear exactly how mindfulness training reduces fatigue. It is possible that by improving present moment awareness, especially of the patient’s physical state, that worry and rumination that contribute to the feelings of fatigue may be lowered or that the improved attentional mechanisms allows the patients to perform well in spite of fatigue.

Regardless, relieve fatigue accompanying neurologic disease with mindfulness.

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

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Ulrichsen KM, Kaufmann T, Dørum ES, Kolskår KK, Richard G, Alnæs D, Arneberg TJ, Westlye LT and Nordvik JE (2016) Clinical Utility of Mindfulness Training in the Treatment of Fatigue After Stroke, Traumatic Brain Injury and Multiple Sclerosis: A Systematic Literature Review and Meta-analysis. Front. Psychol. 7:912. doi: 10.3389/fpsyg.2016.00912

Abstract

BACKGROUND: Fatigue is a common symptom following neurological illnesses and injuries, and is rated as one of the most debilitating sequela in conditions such as stroke, traumatic brain injury (TBI), and multiple sclerosis (MS). Yet effective treatments are lacking, suggesting a pressing need for a better understanding of its etiology and mechanisms that may alleviate the symptoms. Recently mindfulness-based interventions have demonstrated promising results for fatigue symptom relief.

OBJECTIVE: Investigate the efficacy of mindfulness-based interventions for fatigue across neurological conditions and acquired brain injuries.

MATERIALS AND METHODS: Systematic literature searches were conducted in PubMed, Medline, Web of Science, and PsycINFO. We included randomized controlled trials applying mindfulness-based interventions in patients with neurological conditions or acquired brain injuries. Four studies (N = 257) were retained for meta-analysis. The studies included patients diagnosed with MS, TBI, and stroke.

RESULTS: The estimated effect size for the total sample was -0.37 (95% CI: -0.58, -0.17).

CONCLUSION: The results indicate that mindfulness-based interventions may relieve fatigue in neurological conditions such as stroke, TBI, and MS. However, the effect size is moderate, and further research is needed in order to determine the effect and improve our understanding of how mindfulness-based interventions affect fatigue symptom perception in patients with neurological conditions.

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00912/full

Mindfulness Training Equals Drugs in Effectiveness for Depression

September 8, 2016 psyjdc Leave a comment

Mindfulness Training Equals Drugs in Effectiveness for Depression

By John M. de Castro, Ph.D.

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

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is distinguishable from everyday sadness or grief by the depth, intensity, and range of symptoms. These can include feelings of sadness, tearfulness, emptiness or hopelessness, worthlessness , angry outbursts, irritability or frustration, even over small matters, loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports, sleep disturbances, tiredness and lack of energy, so even small tasks take extra effort, changes in appetite, anxiety, agitation or restlessness, slowed thinking, suicidal thoughts, and suicide attempts or suicide. Needless to say individuals with depression are miserable.

Depression is generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Depression appears to be the result of a change in the nervous system that is primarily treated with drugs that alter the affected neurochemical systems. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Being depressed and not responding to treatment is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail.

Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. The combination of drugs along with MBCT has been shown to be quite effective in treating depression and preventing relapse. Since, drugs have troubling side effects and can lose effectiveness over time, it is important to determine if after remission, MBCT can continue to prevent relapse if the drugs are removed. In other words, after MBCT can the drugs be withdrawn.

In today’s Research News article “The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study).” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1317432901613966/?type=3&theater

or see summary below or view the full text of the study at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781448/ Kuyken and colleagues randomly assigned patients with major depression who are taking antidepressant medications to either continue their medication or taper off the drugs and receive Mindfulness Based Cognitive Therapy (MBCT). Patients were followed for two years. They found that MBCT was as effective as continuing drugs in preventing reoccurrence of the depression, and reducing the number of depression free days, symptoms of depression, quality of life, and other psychological problems. Hence, MBCT was found to be a safe and effective alternative to continued drug treatment.

These results are striking. Mindfulness Based Cognitive Therapy (MBCT) can be used to replace drugs. It is not superior, but it appears to be equal to drug treatments in relieving depression and preventing its reoccurrence. The fact that its benefits were still present two years later indicates that MBCT produces lasting effects. Since MBCT does not have the troubling side effects that typically accompany the drugs, it may be a superior treatment. So, MBCT should be strongly considered to replace antidepressant drugs in the treatment of recurrent major depression

“Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.” –

Margarita Tartakovsky

CMCS – Center for Mindfulness and Contemplative Studies

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts

Study Summary

Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., … Byford, S. (2015). The effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse/recurrence: results of a randomised controlled trial (the PREVENT study). Health Technology Assessment (Winchester, England), 19(73), 1–124. http://doi.org/10.3310/hta19730

Abstract

BACKGROUND: Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.

OBJECTIVES: To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT’s acceptability and mechanism of action.

DESIGN: Single-blind, parallel, individual randomised controlled trial.

SETTING: UK general practices.

PARTICIPANTS: Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.

INTERVENTIONS: Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT’s acceptability and mechanism of action.

MAIN OUTCOMES MEASURES: The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.

RESULTS: In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.

CONCLUSIONS: There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781448/

Improve Body Awareness and Reduce Depression Due to Pain with Mindfulness

August 29, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

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

Pain involves both physical and psychological issues. Indeed, people with chronic pain are much more likely to become depressed and people with depression are much more likely to develop chronic pain. Mindfulness practices have been shown to be safe and beneficial in pain management and to reduce depression. But, how mindfulness training may reduce the depression accompanying chronic pain is not known. Mindfulness is known to improve the awareness of the sensations from the body. It is possible then that the reduction of depression about pain is produced by making the patient more aware of their bodies and thus better able to respond to any aversive states in the body.

In today’s Research News article “Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1308036735886916/?type=3&theater

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

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full

de Jong and colleagues recruited chronic pain patients with depression and randomly assigned them to receive either an 8-week Mindfulness-Based Cognitive Therapy (MBCT) plus the normal treatment provided to these patients or to receive only treatment as usual. They were measured for body awareness, pain catastrophizing, and depression before, during, and after the 8 weeks of treatment.

They found that the MBCT group had reduced depression and increased body awareness, especially in self-distracting and self-regulation. “Not-Distracting refers to not ignoring or distracting oneself from uncomfortable body sensations such as pain. Self-Regulation refers to the ability to control psychological distress by consciously attending to body sensations.” Hence MBCT significantly improved the chronic pain patient’s ability to control their pain by paying attention to it. Using a sophisticated statistical technique of mediation analysis, they were able to determine that the effects of mindfulness on depression were completely mediated by its effect on body awareness.

These results are interesting and important. It is well established that mindfulness training and MBCT in particular are very effective in reducing depression. The present findings, though, demonstrate that its ability to reduce the depression produced by chronic pain is due to improved body awareness. This may seem counterintuitive that increasing the awareness of body pain would improve the depression produced by the pain. But, denying pain by ignoring it or by distracting oneself from it doesn’t work and actually increases its pain’s impact by increasing worry and rumination. Directly addressing the pain and seeing it as it is, makes it easier to cope with it.

So, improve body awareness and reduce depression due to pain with mindfulness.

“MBCT helps participants learn how to recognize their sense of being and see themselves as separate from their thoughts and moods. This disconnect can allow people to become liberated from thought patterns in which the same negative messages may be replayed over and over. . . . In general, MBCT attempts to give participants the necessary tools to combat depressive symptoms as they arise. People who learn these skills may then be able to revert to these methods in times of distress or when faced with potentially overwhelming situations.” – Goodtherapy.org

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

de Jong M, Lazar SW, Hug K, Mehling WE, Hölzel BK, Sack AT, Peeters F, Ashih H, Mischoulon D and Gard T (2016) Effects of Mindfulness-Based Cognitive Therapy on Body Awareness in Patients with Chronic Pain and Comorbid Depression. Front. Psychol. 7:967. doi: 10.3389/fpsyg.2016.00967

Abstract

Body awareness has been proposed as one of the major mechanisms of mindfulness interventions, and it has been shown that chronic pain and depression are associated with decreased levels of body awareness. We investigated the effect of Mindfulness-Based Cognitive Therapy (MBCT) on body awareness in patients with chronic pain and comorbid active depression compared to treatment as usual (TAU; N = 31). Body awareness was measured by a subset of the Multidimensional Assessment of Interoceptive Awareness (MAIA) scales deemed most relevant for the population. These included: Noticing, Not-Distracting, Attention Regulation, Emotional Awareness, and Self-Regulation. In addition, pain catastrophizing was measured by the Pain Catastrophizing Scale (PCS). These scales had adequate to high internal consistency in the current sample. Depression severity was measured by the Quick Inventory of Depressive Symptomatology-Clinician rated (QIDS-C16). Increases in the MBCT group were significantly greater than in the TAU group on the “Self-Regulation” and “Not Distracting” scales. Furthermore, the positive effect of MBCT on depression severity was mediated by “Not Distracting.” These findings provide preliminary evidence that a mindfulness-based intervention may increase facets of body awareness as assessed with the MAIA in a population of pain patients with depression. Furthermore, they are consistent with a long hypothesized mechanism for mindfulness and emphasize the clinical relevance of body awareness.

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.00967/full

Improve Anxiety and Depression in Primary Care with Mindfulness

August 20, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

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

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

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

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

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

or see summary below.

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

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

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

CMCS – Center for Mindfulness and Contemplative Studies

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

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

Study Summary

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

Abstract:

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

Reduce Chronic Pain with Mindfulness

August 16, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

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

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

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

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

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

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

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

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

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

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

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

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

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

Abstract

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

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

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

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

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

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

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

Use Mindfulness for Major Depression Rather than Drugs

August 13, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

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

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

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

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

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

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

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

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

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

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

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

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

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

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

Abstract

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

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

Improve Marital Satisfaction with Mindfulness

June 18, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“We are vulnerable creatures, we humans. In the act of exposing our heart and hopes, we also expose our fears and fragility. But we need not be slaves to the past, or to the external love object, be it bear or spouse. We can deliberately develop a more secure sense of attachment, training our mind to become a place of security, safety, and warm fuzzy reassurance simply by paying attention to now, not then.” – Cheryl Fraser

Infertility, the inability to become pregnant, is primarily a medical condition and due to physiological problems, most frequently, hormonal inadequacy. The diagnosis of infertility involves documenting a failure to become pregnant despite having carefully timed, unprotected sex for at least one year. Sadly, infertility is quite common. It is estimated that in the U.S. 6.7 million women, about 10% of the population of women 15-44, have an impaired ability to get pregnant or carry a baby to term and about 6% are infertile.

Infertility can be more than just a medical issue. It can be an emotional crisis for many couples, especially for the women. Couples attending a fertility clinic reported that infertility was the most upsetting experience of their lives. Women with infertility reported feeling as anxious or depressed as those diagnosed with cancer, hypertension, or recovering from a heart attack. Men’s reactions are more complicated. If the reason for the infertility is due to an issue with the woman, then men aren’t as distressed as the women. But if they are the ones who are infertile, they experience the same levels of low self-esteem, stigma, and depression as infertile women do. In addition, infertility can markedly impact the couple’s relationship, straining their emotional connection and interactions and the prescribed treatments can take the spontaneity and joy from lovemaking making it strained and mechanical.

The stress of infertility and engaging in infertility treatments may exacerbate the problem. These issues conspire to stress the marital relationship and interfere with the emotional health of the individuals. In today’s Research News article “The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman with Infertility.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1253726174651306/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803966/

Shargh and colleagues randomly assigned women diagnosed with infertility to a group receiving Mindfulness Based Cognitive Therapy (MBCT) or a control group. They measured the marital satisfaction and emotional health of the women prior to and after an 8-week MBCT program presented in a group format or care as usual. They found that the MBCT program produced a significant increase in marital satisfaction, including communications, conflict resolution and ideal deviation, and a significant increase in emotional health including lower bodily complaints, anxiety, depression and social malfunction.

These results are potentially important as infertility places intense stress on marital relationships. The results seem reasonable, though, given the documented effectiveness of mindfulness training to relieve stress, anxiety, and depression, and improve social function and romantic relationships. It is important, however, to demonstrate that mindfulness training is similarly effective with women with infertility issues. This can have other positive consequences as there are indications that the relief produced by mindfulness training may improve the likelihood of these women successfully conceiving. It is also encouraging that these results can be obtained when MBCT is delivered in a group format. This makes it more efficient and cost effective.

So, improve marital satisfaction in couples struggling with infertility with mindfulness.

CMCS – Center for Mindfulness and Contemplative Studies

“Each of us has a different set of sexual experiences and needs. When we feel disconnected from pleasure, simply bringing non-judgmental awareness to our bodies can help us clear away the baggage of cultural narratives. And in doing so, we can uncover our own unique sexual story and gain compassion for ourselves, wherever we are at in our sexual journey.” – Pam Costa

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

Study Summary

Shargh, N. A., Bakhshani, N. M., Mohebbi, M. D., Mahmudian, K., Ahovan, M., Mokhtari, M., & Gangali, A. (2016). The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman with Infertility. Global Journal of Health Science, 8(3), 230–235. http://doi.org/10.5539/gjhs.v8n3p230

Abstract

Infertility affects around 80 million people around the world and it has been estimated that psychological problems in infertile couples is within the range of 25-60%. The purpose of this study was to determine the effectiveness of Mindfulness-based cognitive group therapy on consciousness regarding marital satisfaction and general health in woman with infertility. Recent work is a clinical trial with a pre/posttest plan for control group. Covering 60 women who were selected by in access method and arranged randomly in interference (30) and control (30) groups. Before and after implementation of independent variable, all subjects were measured in both groups using Enrich questionnaire and marital satisfaction questionnaire. Results of covariance analysis of posttest, after controlling the scores of pretest illustrated the meaningful difference of marital satisfaction and mental health scores in interference and control groups after treatment and the fact that MBCT treatment in infertile women revealed that this method has an appropriate contribution to improvement of marital satisfaction and mental health. Necessary trainings for infertile people through consultation services can improve their mental health and marital satisfaction and significantly help reducing infertile couples’ problems.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803966/

Improve Neuroticism with Mindfulness

June 6, 2016 psyjdc 1 Comment

By John M. de Castro, Ph.D.

“Self-deprecating comedians and complainers wear their neuroticism as a badge of honor. In truth, the negatively biased are more prone to depression, anxiety, self-consciousness and hypochondria, to name just a few behavioral tripwires. Neuroticism is no fun for anyone.” – Psychology Today

We often speak of people being neurotic. But, do we really know what we’re talking about? Do we really know what it is? Neurosis is actually an outdated diagnosis that is no longer used medically. The disorders that were once classified as a neurosis are now more accurately categorized as post-traumatic stress disorder, somatization disorders, anxiety disorder, panic disorder, phobias, dissociation disorder, obsessive compulsive disorder and adjustment disorder.

Neuroticism, however, is considered a personality trait that is a lasting characteristic of the individual. It is characterized by negative feelings, repetitive thinking about the past (rumination), and worry about the future, moodiness and loneliness. It appears to be linked to vulnerability to stress. People who have this characteristic are not happy with life and have a low subjective sense of well-being and recognize that this state is unacceptable. There is some hope for people with high neuroticism as this relatively stable characteristic appears to be lessened by mindfulness training. This is potentially important and deserves further investigation.

In today’s Research News article “Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1245647922125798/?type=3&theater

or below

Armstrong and Rimes examined the ability of Mindfulness Based Cognitive Therapy (MBCT) to treat individuals high in neuroticism. They randomly assigned participants with high neuroticism to either an 8-week, once a week for 2-hours, MBCT treatment group or and on-line self-help treatment control group. Measures were taken before and 4-weeks after treatment of mindfulness, neuroticism, impairment in everyday functioning, anxiety, depressive symptoms, self-compassion, beliefs about emotions, rumination, and decentering.

They found that after treatment in comparisons to the control group the MBCT group had significantly lower neuroticism scores, and rumination, and a trend toward lower functional impairment due to stress. In addition, the MBCT group had significantly higher self-compassion and decentering and trends toward lessened unhelpful beliefs and emotions and higher mindfulness. Surprisingly, since MBCT was developed specifically to treat depression, there were no significant differences in anxiety or depression.

These results are interesting and potentially important. This, however, was a pilot study that had relatively small group sizes (17). The fact that significant differences were detected nonetheless indicates that the effects were fairly strong. The results clearly indicate that a larger randomized controlled trial is called for.

Mindfulness may affect neuroticism in a number of ways. By focusing the individual on the present moment, mindfulness should lessen the neuroticism characteristics of rumination about the past and worry about the future. Mindfulness is also known to reduce the psychological and physiological responses to stress and stress is known to contribute to neuroticism. Finally, mindfulness has been shown to produce heightened emotion regulation. So, the mindful individual feels and appreciates their emotions but responds appropriately and adaptively. This should lessen the moodiness, negative feelings, and loneliness characteristic of neuroticism. So, it is not surprising the mindfulness based treatments would be effective in lowering neuroticism. This is a hopeful development, as people high in neuroticism are very unhappy people. Mindfulness may provide some relief and help them toward a happier life.

So, improve neuroticism with mindfulness.

“Being in the moment with those thoughts and recognizing them for what they are has really helped me to kind of shove them aside, or to kind of diffuse them,” she says. “I think it’s really helped me become a more aware person of what other people might be feeling.” – JoSelle Vanderhooft

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Armstrong L, Rimes KA. Mindfulness-Based Cognitive Therapy for Neuroticism (Stress Vulnerability): A Pilot Randomized Study. Behav Ther. 2016 May;47(3):287-98. doi: 10.1016/j.beth.2015.12.005. Epub 2016 Jan 5. PMID: 27157024. doi:10.1016/j.beth.2015.12.005

Highlights

A new MBCT intervention for neuroticism versus online general self-help is examined
Compared with self-help, MBCT results in significantly lower levels of neuroticism
Rumination and self-compassion improved more in the MBCT group than the control group
MBCT is an acceptable and feasible intervention for neuroticism
Neuroticism may be amenable to change through psychological intervention

Abstract

Objective: Neuroticism, a characteristic associated with increased stress vulnerability and the tendency to experience distress, is strongly linked to risk of different forms of psychopathology. However, there are few evidence-based interventions to target neuroticism. This pilot study investigated the efficacy and acceptability of mindfulness-based cognitive therapy (MBCT) compared with an online self-help intervention for individuals with high levels of neuroticism. The MBCT was modified to address psychological processes that are characteristic of neuroticism. Method: Participants with high levels of neuroticism were randomized to MBCT (n = 17) or an online self-help intervention (n = 17). Self-report questionnaires were administered preintervention and again at 4 weeks postintervention. Results: Intention-to-treat analyses found that MBCT participants had significantly lower levels of neuroticism postintervention than the control group. Compared with the control group, the MBCT group also experienced significant reductions in rumination and increases in self-compassion and decentering, of which the latter two were correlated with reductions in neuroticism within the MBCT group. Low drop-out rates, high levels of adherence to home practice, and positive feedback from MBCT participants provide indications that this intervention may be an acceptable form of treatment for individuals who are vulnerable to becoming easily stressed. Conclusions: MBCT specifically modified to target neuroticism-related processes is a promising intervention for reducing neuroticism. Results support evidence suggesting neuroticism is malleable and amenable to psychological intervention. MBCT for neuroticism warrants further investigation in a larger study.

Relieve Uncertainty and Panic Disorder with Mindfulness

May 20, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Panic gains momentum from the energy we put into fighting it, and the fact is, we don’t always need to fight it. Life happens to you and me as it happens to all people, whether we are ready for it or not, and all we really need to do is be open to experiencing it one moment at a time.” – Krista Lester

Anxiety and fear happen in everyone and under normal conditions are coped with adaptively and effectively and do not continue beyond the eliciting conditions. But, in a large number of people the anxiety is non-specific and overwhelming. Anxiety Disorders are the most common psychological problem. In the U.S., they affect over 40 million adults, 18% of the population, with women accounting for 60% of sufferers They typically include feelings of panic, fear, and uneasiness, problems sleeping, cold or sweaty hands and/or feet, shortness of breath, heart palpitations, an inability to be still and calm, dry mouth, and numbness or tingling in the hands or feet.

A subset of people with anxiety disorders are diagnosed with Panic Disorder. These are sudden attacks of fear and nervousness, as well as physical symptoms such as difficulty breathing, pounding heart or chest pain, intense feeling of dread, shortness of breath, sensation of choking or smothering, dizziness or feeling faint, trembling or shaking, sweating, nausea or stomachache, tingling or numbness in the fingers and toes, chills or hot flashes, and a fear that they are losing control or are about to die. A common additional symptom of panic disorder is the persistent fear of having future panic attacks. The fear of these attacks can cause the person to avoid places and situations where an attack has occurred or where they believe an attack may occur. Needless to say patients are miserable, their quality of life is low, and their ability to carry on a normal life disrupted.

There are a number of treatments for Panic Disorder including psychotherapy, relaxation training, and medication. Recently it’s been demonstrated that panic disorder can be treated with mindfulness practice. In particular, Mindfulness Based Cognitive Therapy (MBCT) has been shown to be particularly effective. It is not known, however, the exact mechanism of action of MBCT effects on Panic Disorder. In today’s Research News article “Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1232976826726241/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823195/

Kim and colleagues investigate whether an intolerance of uncertainty may be a key factor in Panic Disorder and the response to MBCT. Intolerance of uncertainty is defined as a “dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications, and involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.”

Kim and colleagues recruited patients suffering with Panic Disorder and treated them with an 8-week program of Mindfulness Based Cognitive Therapy (MBCT). They measured Panic Disorder intensity, depression, and intolerance of uncertainty both before and after treatment. They found that MBCT produced significant decreases in all measures, with patients having significantly lower levels of Panic Disorder intensity, depression, and intolerance of uncertainty after treatment. They also found that before treatment, the higher the level of intolerance of uncertainty, the greater the intensity of Panic Disorder and the higher the level of depression. In addition, the greater the reduction in intolerance of uncertainty produced by MBCT, the greater the reduction in Panic Disorder intensity. The significant association between intolerance of uncertainty and Panic Disorder intensity was present even after the pre-treatment level of Panic Disorder intensity and Depression were accounted for.

These results suggest that Mindfulness Based Cognitive Therapy (MBCT) is an effective treatment for Panic Disorder. They further suggest that the effectiveness of MBCT is at least in part due to it reducing the intolerance of uncertainty that is characteristic of Panic Disorder patients. Mindfulness training in general and MBCT in particular increase attention to what is transpiring in the present moment and decrease thinking about the future. Since intolerance of uncertainty is a worry about future events, it would seem reasonable that MBCT would reduce it. Since intolerance of uncertainty is clearly related to Panic Disorder, its reduction should reduce Panic Disorder.

It should be noted that the study did not contain a control (comparison) condition. So, it cannot be concluded that MBCT was responsible for the improvements. It is possible that a placebo effect or spontaneous remissions were responsible. Regardless, the results are suggestive that MBCT is a safe and effective intervention for the relief of Panic Disorder, depression, and intolerance of uncertainty. So, relieve uncertainty and panic disorder with mindfulness.

“mindfulness takes ‘thinker’ out of thought, and teaches us to step back and observe our minds and our thoughts. Mindfulness is learning to see exactly what is happening. It ‘disengages’ our ‘automatic pilot’ and gives us the necessary space to see cause and effect as it happens in ‘real’ time. Cause: thought. Effect: panic and/or anxiety.” – Bronwyn Fox

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S.-H. (2016). Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder. Psychiatry Investigation, 13(2), 196–202. http://doi.org/10.4306/pi.2016.13.2.196

Abstract

Objective: Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods: We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results: There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion: IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823195/

Relieve Depression with Mindful Meditation

May 19, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. It is generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Major depression can be quite debilitating. It is distinguishable from everyday sadness or grief by the depth, intensity, and range of symptoms. These can include feelings of sadness, tearfulness, emptiness or hopelessness, angry outbursts, irritability or frustration, even over small matters, loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports, sleep disturbances, including insomnia or sleeping too much, tiredness and lack of energy, so even small tasks take extra effort, changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people, anxiety, agitation or restlessness, slowed thinking, speaking or body movements, feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility, trouble thinking, concentrating, making decisions and remembering things, frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide, unexplained physical problems, such as back pain or headaches. Needless to say individuals with depression are miserable.

Depression appears to be the result of a change in the nervous system that can generally only be reached with drugs that alter the affected neurochemical systems. But, depression can be difficult to treat. 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. In, addition, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. So, it is important to investigate alternative treatments for depression.

Mindful meditation training is a viable alternative treatment for depression. It has been shown to be an effective treatment for active depression and for the prevention of its recurrence. It can even be effective in cases where drugs fail. In today’s Research News article “Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1232267610130496/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383597/

Jain and colleagues investigated the state of knowledge regarding mindful meditation effectiveness for depression. They reviewed the published research literature on the application of mindful meditation training to the relief of depression and/or the prevention of relapse. Meditation occurred in a variety of different techniques, meditation, yoga, mindful movement (i.e. Tai Chi), and mantra meditation. The most frequent technique (57% of studies) was Mindfulness Based Cognitive Therapy (MBCT). This was not a surprise as MBCT was developed specifically to treat depression.

They reported that the research results made a clear case that meditation therapies are effective for depression. They were effective in relieving depression when the patient was experiencing an active episode and also when the patient had recovered from major depression but was experiencing residual depressive symptoms. Thus, the published research is clear that mindful meditation is an effective treatment for depression. They caution, however, that more research is needed to unequivocally demonstrate its effectiveness under more highly controlled conditions.

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

Regardless of the speculations, it is clear that mindfulness meditation is a safe and effective treatment for depression.

“It’s been more than two years since I started that experiment. I have not missed a single day. And I’m going to tell you right now, still in half-disbelief myself: meditation worked. I don’t mean I feel a little better. I mean the Depression is gone. Completely. I still have very hard days, yes. But when issues come up, real or imagined (or a combination of both), meditation provides an awareness that helps me sort through it all, stay steady on, and understand deeply what is going on. “ – Spike Gillespie

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Jain, F. A., Walsh, R. N., Eisendrath, S. J., Christensen, S., & Cahn, B. R. (2015). Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review. Psychosomatics, 56(2), 140–152. http://doi.org/10.1016/j.psym.2014.10.007

Abstract

Background: Recently, the application of meditative practices to the treatment of depressive disorders has met with increasing clinical and scientific interest, due to a lower side-effect burden, potential reduction of polypharmacy, as well as theoretical considerations that such interventions may target some of the cognitive roots of depression. We aimed to determine the state of the evidence supporting this application.

Methods Randomized, controlled trials of techniques meeting the Agency for Healthcare Research and Quality (AHRQ) definition of meditation, for participants suffering from clinically diagnosed depressive disorders, not currently in remission, were selected. Meditation therapies were separated into praxis (i.e. how they were applied) components, and trial outcomes were reviewed.

Results: Eighteen studies meeting inclusionary criteria were identified, encompassing seven distinct techniques and 1173 patients, with Mindfulness-Based Cognitive Therapy comprising the largest proportion. Studies including patients suffering from acute major depressive episodes (N = 10 studies), and those with residual subacute clinical symptoms despite initial treatment (N = 8), demonstrated moderate to large reductions in depression symptoms within group, and relative to control groups. There was significant heterogeneity of techniques and trial designs.

Conclusions: A substantial body of evidence indicates that meditation therapies may have salutary effects on patients suffering from clinical depressive disorders during the acute and subacute phases of treatment. Due to methodological deficiences and trial heterogeneity, large-scale, randomized controlled trials with well-described comparator interventions and measures of expectation are needed to clarify the role of meditation in the depression treatment armamentarium.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383597/