MBCT

Reduce Pain by Accepting it Mindfully

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By John M. de Castro, Ph.D.

 

“They were able to have a sense of personal control over their migraines. It really makes us wonder if an intervention like meditation can change the way people interpret their pain.” – Rebecca Erwin Wells

 

Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. The most common type of headache is the tension headache with 80 to 90 percent of the population suffering from tension headaches at least some time in their lives. The second most common type of headache is the migraine headache. Around 16 to 17 percent of the population complains of migraines. It is the 8th most disabling illness in the world with more than 90% of sufferers unable to work or function normally during their migraine. American employers lose more than $13 billion each year as a result of 113 million lost work days due to migraine.

 

There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Most tension headaches can be helped by taking pain relievers such as aspirin, naproxen, acetaminophen, or ibuprofen. A number of medications can help treat and prevent migraines and tension headaches, including ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.

 

Mindfulness training has been shown to be an effective treatment for headache pain. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing can reduce headache pain. In addition, mindfulness improves self-efficacy, the belief that the individual can adapt to and handle headache pain. In addition, mindfulness training also has been shown to alter not only what is thought, but also how thoughts are processed. Central to this cognitive change is mindfulness and acceptance. By mindfully viewing pain as a present moment experience it can be experienced just as it is and by accepting it, the individual stops fighting against the pain which can amplify the pain.

 

It is not known whether it is the changes in the what or how, or both, of thoughts that is responsible for mindfulness training’s efficacy in treating headache pain. In today’s Research News article “The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1229081490449108/?type=3&theater

or see below

Day and Thorn investigate this question. They randomly assigned headache patients to receive either 8-weeks of Mindfulness Based Cognitive Therapy (MBCT) or treatment as usual as a wait-list control condition. Before and again after treatment measurements were obtained of pain, pain acceptance, pain catastrophizing, and pain self-efficacy.

 

They found, as has previously been shown, that the MBCT training significantly reduced the level of pain and pain catastrophizing, and increased the levels of pain self-efficacy and pain acceptance. Day and Thorn then went on to use a sophisticated statistical technique to assess whether the change in pain produced by mindfulness training was due to the changes in the what or how about thinking. They found that only the how aspect of thought, pain acceptance, significantly mediated the effect. Neither of the what aspects of thought, pain catastrophizing nor pain self-efficacy, were significantly related to the mindfulness training effects on pain.

 

These results are very interesting and potentially important. They suggest that mindfulness training reduces headache pain by altering how pain is thought about, increasing acceptance of the pain. Acceptance is defined as the “conscious willingness to stay in direct contact with experience.” This may operate by reducing the individual’s attempts to counteract the pain. Since, fighting against the pain can actually increase the level of pain, accepting the pain interferes with this amplifying process, thus lowering the pain level experienced. It is interesting that neither the pain catastrophizing nor pain self-efficacy were significant mediators as they have long been thought to be important mechanisms of mindfulness’ effectiveness for pain management. But, it is clear that how pain is thought about, in particular, the acceptance of pain, is the key.

 

So, reduce pain by accepting it mindfully.

 

“Awareness transforms emotional pain just as it transforms the pain that we attribute more to the domain of body sensations. When we are immersed in emotional pain, if we pay close attention, we will notice that there is always an overlay of thoughts and a plethora of different feelings about the pain we are in, so here too the entire constellation of what we think of as emotional pain can be welcomed in and held in awareness.” – Jon Kabat-Zinn

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

 

Day MA, Thorn BE. The mediating role of pain acceptance during mindfulness-based cognitive therapy for headache. Complement Ther Med. 2016 Apr;25:51-4. doi: 10.1016/j.ctim.2016.01.002. Epub 2016 Jan 13.

 

Highlights

  • Pain acceptance was a significant mediator of the MBCT-pain interference relation.
  • Specifically, activity engagement emerged as the critical component of acceptance.
  • Pain catastrophizing and self-efficacy did not meet criteria for mediation.
  • This is the first study to show acceptance is a key mediator of MBCT for headache.

Abstract

Objectives: This study aimed to determine if mindfulness-based cognitive therapy (MBCT) engenders improvement in headache outcomes via the mechanisms specified by theory: (1) change in psychological process, (i.e., pain acceptance); and concurrently (2) change in cognitive content, (i.e., pain catastrophizing; headache management self-efficacy).

Design: A secondary analysis of a randomized controlled trial comparing MBCT to a medical treatment as usual, delayed treatment (DT) control was conducted. Participants were individuals with headache pain who completed MBCT or DT (N = 24) at the Kilgo Headache Clinic or psychology clinic. Standardized measures of the primary outcome (pain interference) and proposed mediators were administered at pre- and post-treatment; change scores were calculated. Bootstrap mediation models were conducted.

Results: Pain acceptance emerged as a significant mediator of the group-interference relation (p < .05). Mediation models examining acceptance subscales showed nuances in this effect, with activity engagement emerging as a significant mediator (p < .05), but pain willingness not meeting criteria for mediation due to a non-significant pathway from the mediator to outcome. Criteria for mediation was also not met for the catastrophizing or self-efficacy models as neither of these variables significantly predicted pain interference.

Conclusions: Pain acceptance, and specifically engagement in valued activities despite pain, may be a key mechanism underlying improvement in pain outcome during a MBCT for headache pain intervention. The theorized mediating role of cognitive content factors was not supported in this preliminary study. A large, definitive trial is warranted to replicate and extend the findings in order to streamline and optimize MBCT for headache.

 

Control Problem Gambling with CBT and Mindfulness

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By John M. de Castro, Ph.D.

 

“Whether you bet on sports, scratch cards, roulette, poker, or slots—in a casino, at the track, or online—problem gambling can strain relationships, interfere with work, and lead to financial catastrophe. You may even do things you never thought you would, like stealing money to gamble or pay debts.”

 

People love to gamble! They wager on everything from sports, to politics, to personal achievements, to even random outcomes, like slot machines of lotteries. It can be great fun, adding zest to otherwise mundane days or routine athletic competitions. It can be part of personal bonding with friends as in an ongoing poker game. A good bet can even be used to motivate someone to stop smoking, lose weight, or support a charity. In fact, over 80% of all Americans wager on at least a yearly basis and 15% gamble every week. In and of itself there is nothing wrong with gambling.

 

But, for 3% to 5% of people who gamble, it becomes a major problem. There are about 6 million Americans who are problem gamblers. They gamble money they can ill afford to lose and it becomes an obsession and an addiction. When this happens, it can wreak havoc with a person’s life, ruining careers, relationships, families, credit, and even physical and mental health. Indeed, on average about half of people with gambling addictions commit crimes to support their addiction and the majority of people in prison have a gambling problem.

 

There are a wide variety of treatments for problem gambling including psychotherapies, 12-step programs, medication, support groups, etc. Cognitive Behavioral Therapy (CBT) has been particularly effective. Recently, mindfulness has been added to produce Mindfulness Based Cognitive Therapy (MBCT). This has been found to be effective in treating a range of addictions.  Cognitive Behavioral Therapy attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. These skills are particularly pertinent to problem gambling as there’s no physical basis like in other addictions. Rather, it is entirely driven by inappropriate thought processes and emotions.

 

In today’s Research News article “Treating Problem Gambling Samples with Cognitive Behavioural Therapy and Mindfulness-Based Interventions: A Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1226586644031926/?type=3&theater

or see below

McIntosh and colleagues randomly assigned problem gamblers to receive a 4-week program of either treatment as usual (TAU) which provided an individualized Cognitive Behavioral Therapy (CBT), CBT using a standardized manual for gambling addiction, or Mindfulness Based Cognitive Therapy (MBCT). All groups, in addition, received an education package on problem gambling.

 

They found that all three treatments produced large and clinically significant improvements in problem gambling that persisted at 3 and 6 months after the end of treatment. They all improved patient quality of life and mindfulness, particularly the acting with awareness facet of mindfulness. They also found that the mindfulness group (MBCT) had additional improvements in rumination and thought suppression. Hence, Cognitive Behavioral Therapy, whether individualized, standardized, or included mindfulness were successful in treating problem gambling. But, mindfulness training in addition to CBT had the added benefits of decreasing rumination and thought suppression, which are thought to add to the patient’s psychological distress.

 

These are exciting results. More than half of the problem gamblers no longer met the clinical standard as problem gamblers 6 months after treatment. They support the growing research evidence of the efficacy of CBT for problem gambling. They also suggest that adding mindfulness training to the package produces additional benefits that can help the gambler stop repetitively thinking about gambling (rumination) and to stop trying to suppress this thinking, rather bringing it to consciousness where it can be addressed. These two extra benefits may be helpful for preventing relapse.

 

So, control problem gambling with CBT and mindfulness.

 

“mindfulness focuses on the present and acceptance of oneself. Such an approach allows the practitioner to identify and deal with the gambling urge when it comes. Mindfulness also enables the practitioner to appreciate each moment, leaving less opportunity to think about or desire hitting the casino or racetrack.”

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Study Summary

McIntosh CC, Crino RD, O’Neill K. Treating Problem Gambling Samples with Cognitive Behavioural Therapy and Mindfulness-Based Interventions: A Clinical Trial. J Gambl Stud. 2016 Apr 4. [Epub ahead of print], PMID: 27040973

 

Abstract

The problem gambling (PG) intervention literature is characterised by a variety of psychological treatments and approaches, with varying levels of evidence (PGRTC in Guideline for screening, assessment and treatment in problem and pathological gambling. Monash University, Melbourne, 2011). A recent PG systematic review (Maynard et al. in Res Soc Work Pract, 2015. doi:10.1177/1049731515606977) and the success of mindfulness-based interventions to effectively treat disorders commonly comorbid with PG suggested mindfulness-based interventions may be effective for treating PG. The current study tested the effectiveness of three interventions to treat PGs: 1. case formulation driven Cognitive Behaviour Therapy (CBT); 2. manualised CBT; and 3. mindfulness-based treatment. All three interventions tested returned large effect size improvements in PG behaviour after seven sessions (Cohen’s d range 1.46–2.01), at post-treatment and at 3 and 6-month follow-up. All of the interventions were rated as acceptable by participants at post-treatment. This study suggests that the mindfulness-based and TAU interventions used in the current study appear to be effective at reducing PG behavior and associated distress and they also appear to generalise to improvements in other measures such as quality of life-mental functioning and certain mindfulness facets more effectively than the manualised form of CBT utilised used here. Secondly, a brief mindfulness intervention delivered after psycho-education and a brief CBT intervention may be a useful supplement to traditional CBT treatments by addressing transdiagnostic processes such as rumination and thought suppression. Thirdly, CBT interventions continue to report effectiveness in reducing PG behaviour and associated distress consistent with the prevailing literature and clinical direction.

 

Mindful Cure for Insomnia

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Mindful Cure for Insomnia

 

By John M. de Castro, Ph.D.

 

“By taking this mindful attitude, sleep is facilitated by simply being aware of the moment-to-moment experience of relaxing into the bed, without judging or being critical of that experience, so that the mind can gently slip into sleep.” – John Cline

 

Modern society has become more around-the-clock and more complex producing considerable pressure and stress on the individual. The advent of the internet and smart phones has exacerbated the problem. The resultant stress can impair sleep. Indeed, it is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. Yet over 70 million Americans suffer from disorders of sleep and about half of these have a chronic disorder. These disorders include insomnia, sleep apnea, narcolepsy, and restless leg syndrome. It has been estimated that 30 to 35% of adults have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, and 10% have chronic insomnia

 

Sleep problems are more than just an irritant. Sleep deprivation is associated with decreased alertness and a consequent reduction in performance of even simple tasks, increased difficulties with memory and problem solving, decreased quality of life, increased likelihood of accidental injury including automobile accidents, and increased risk of dementia and Alzheimer’s disease. It also places stress on relationships, affecting the sleep of the older individuals sleep partner. Finally, insomnia can lead to anxiety about sleep itself. This is stressful and can produce even more anxiety about being able to sleep. This can become a vicious cycle, where not being able to sleep induces anxiety and stress about going to sleep which in turn makes it harder to go to sleep which reinforces the anxiety and on and on.

 

Obviously, people in modern society need to get more and better quality sleep. About 4% of Americans revert to sleeping pills. But, these do not always produce high quality sleep and can have problematic side effects. So, there is a need to find better methods to improve sleep even in the face of modern stressors. Contemplative practices have been reported to improve sleep amount and quality and help with insomnia. The importance of insomnia underscores the need to further investigate safe and effective alternatives to drugs.

 

In today’s Research News article “Mindfulness Meditation and CBT for Insomnia: A Naturalistic 12-Month Follow-up”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766838/

Ong and colleagues treated a group of adults with insomnia with combination of mindfulness training with Cognitive Behavioral Therapy for Insomnia (CBT-I) treatment. The mindfulness training consisted of body scan, sitting and walking meditation. CBT-I consisted of identifying and changing the thoughts and the behaviors that affect the ability to sleep or sleep well. The intervention was conducted in 2-hour weekly sessions over a 6-week period.

 

They found that after the treatment there were significant improvements in sleep quality, daytime tiredness pre-sleep arousal, effort to go to sleep, and insomnia severity. In addition, they found that the higher the level of mindfulness the lower the levels of daytime sleepiness and daytime tiredness. Importantly, these improvements were maintained 6 and 12-month after the end of treatment.

 

These findings are exciting and demonstrate that insomnia can be effectively treated without drugs and the treatment can have lasting effects. But, since there wasn’t a control group or condition, caution must be exercised in reaching firm conclusions. In addition, since there wasn’t a comparison with Cognitive Behavioral Therapy for Insomnia (CBT-I) alone without the added mindfulness training, it is impossible to reach a conclusion regarding the efficacy of either component by themselves. It is unclear whether it was the CBT-I or the mindfulness training, or both, or some form of confound such as a placebo effect or simply the passage of time that were responsible for the effects. Further more tightly controlled research is needed to clarify these important points.

 

Regardless, the study by Ong and colleagues reinforces the findings of previous research that mindfulness may be a safe and effective treatment for insomnia with long-term effectivenes.

 

“Exploring the practice of mindfulness requires no religious affiliation or philosophical belief. It’s a gentle, simple, practical method of paying attention — one that may deliver profound benefits for our waking and sleeping lives.” – Michael J. Breus

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

Ong, J. C., Shapiro, S. L., & Manber, R. (2009). Mindfulness Meditation and CBT for Insomnia: A Naturalistic 12-Month Follow-up. Explore (New York, N.Y.), 5(1), 30–36. http://doi.org/10.1016/j.explore.2008.10.004

 

Abstract

A unique intervention combining mindfulness meditation with cognitive behavioral therapy for insomnia (CBT-I) has been shown to have acute benefits at post-treatment in an open label study. The aim of the present study was to examine the long-term effects of this integrated intervention on measures of sleep and sleep-related distress in an attempt to characterize the natural course of insomnia following this treatment and to identify predictors of poor long-term outcome. Analyses were conducted on 21 participants who provided follow-up data at 6 and 12 months post treatment. At each time point, participants completed one week of sleep and meditation diaries and questionnaires related to mindfulness, sleep, and sleep-related distress, including the Pre-Sleep Arousal Scale (PSAS), Glasgow Sleep Effort Scale (GSES), Kentucky Inventory of Mindfulness Skills (KIMS), and the Insomnia Episode Questionnaire. Analyses examining the pattern of change across time (baseline, end-of-treatment, 6 month, and 12 month) revealed that several sleep-related benefits were maintained during the 12-month follow-up period. Participants who reported at least one insomnia episode (≥ 1 month) during the follow-up period had higher scores on the PSAS (p < .05) and GSES (p < .05) at end-of-treatment compared to those with no insomnia episodes. Correlations between mindfulness skills and insomnia symptoms revealed significant negative correlations (p < .05) between mindfulness skills and daytime sleepiness at each of the three time points but not with nocturnal symptoms of insomnia. These results suggest that most sleep-related benefits of an intervention combining CBT-I and mindfulness meditation were maintained during the 12-month follow-up period with indications that higher pre-sleep arousal and sleep effort at end-of-treatment constitute a risk for occurrence of insomnia during the 12 months following treatment.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766838/

 

Prevent Depression Relapse Better with Both Mindfulness and Drugs

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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

 

Major Depression is the most common mental illness, affecting over 6% of the population. It 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 not only treat the disease initially, but also to employ strategies to decrease or prevent relapse.

 

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 “Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial”

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Huijbers and colleagues recruited patients who had had three or more depressive episodes, were being treated with anti-depressive medications for at least six months, and were currently in remission. All patients then received an 8-week Mindfulness Based Cognitive Therapy (MBCT) program. MBCT included meditation, body scan, and mindful movement as well as exercises to bring present-moment awareness to everyday activities. Cognitive therapy included education, monitoring and scheduling of activities, identification of negative automatic thoughts and devising a relapse prevention plan. At the conclusion of treatment patients were randomly assigned to have the drugs withdrawn over five weeks or to continue receiving drugs.

 

Huijbers and colleagues found that at 15 months after MBCT treatment there was a 25% higher rate of relapse when the drugs were withdrawn compared to when they were maintained. In addition, the amount of time to relapse/recurrence was significantly shorter after discontinuation of the drugs. This suggests that withdrawing the drugs increases the risk of relapse/recurrence for patients in remission from major depression and suggests that the combination of MBCT along with a maintenance dose of drug is superior in preventing relapse.

 

So, prevent depression relapse better with both mindfulness and drugs.

 

“Because [mindfulness-based cognitive therapy] is a group treatment which reduces costs and the number of trained staff needed it may be feasible to offer MBCT as a choice to patients in general practice…We therefore have a promising relatively new treatment which is reasonably cost effective and applicable to the large group of patients with recurrent depression.” – Roger Mulder

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

 

Marloes J. Huijbers, Philip Spinhoven, Jan Spijker, Henricus G. Ruhé, Digna J. F. van Schaik, Patricia van Oppen, Willem A. Nolen,Johan Ormel, Willem Kuyken, Gert Jan van der Wilt, Marc B. J. Blom, Aart H. Schene, A. Rogier T. Donders, Anne E. M. Speckens. Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial. The British Journal of Psychiatry Feb 2016, DOI: 10.1192/bjp.bp.115.168971

Abstract

Background: Mindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied.

Aims: To investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.

Method: A multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.

Results: The difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.

Conclusions: Our findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

 

Change Major Depression Brain Chemistry with Mindfulness

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MBCT Major Depression2 Li

By John M. de Castro, Ph.D.

 

“Mindfulness-based cognitive therapy helps participants in the classes to see more clearly the patterns of the mind; and to learn how to recognize when their mood is beginning to go down. It helps break the link between negative mood and the negative thinking that it would normally have triggered. Participants develop the capacity to allow distressing mood, thoughts and sensations to come and go, without having to battle with them. They find that they can stay in touch with the present moment, without having to ruminate about the past, or worry about the future.” – Center for Suicide Research

 

Major Depressive Disorder (MDD) is a severe mood disorder that includes mood dysregulation and cognitive impairment. It is estimated that 16 million adults in the U.S. (6.9% of the population suffered from major depression in the past year and affects females (8.4%) to a great extent than males (5.2%). It’s the second-leading cause of disability in the world following heart disease. It has also been shown that depression is, to a large extent, inherited, but can also be affected by the environment. Since the genes basically encode when, where, and how chemicals are produced, it is likely that there are changes in brain chemistry produced by the genes responsible for Major Depressive Disorder.

 

The usual treatment of choice for MDD is drug treatment. This supports the altered brain chemistry notion for MDD since the most effective treatment for MDD, drug treatment, changes brain chemistry. In fact, it is estimated that 10% of the U.S. population is taking some form of antidepressant medication. But a substantial proportion of patients (~40%) do not respond to drug treatment. In addition, the drugs can have nasty side effects. So, there is need to explore other treatment options.

 

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. It makes sense that if altered brain chemistry underlies MDD and that MBCT is an effective treatment for MDD, then MBCT must in some way change brain chemistry. In today’s Research News article “Evaluating metabolites in patients with major depressive disorder who received mindfulness-based cognitive therapy and healthy controls using short echo MRSI at 7 Tesla”

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Li and colleagues explore brain chemistry changes in Major Depressive Disorder (MDD) and the effects of Mindfulness Based Cognitive Therapy (MBCT) on those brain chemistry changes.

 

They recruited patients who were diagnosed with MDD but who were not currently taking antidepressant drugs and who were not practicing meditation or yoga. The brains of these patients and healthy controls were scanned with a powerful imaging technique called Magnetic Resonance Spectroscopic Imaging (MRSI). It is capable of non-invasively detecting levels of particular chemicals in the brain. The patients then received an 8-week MBCT group therapy followed by rescanning of the brains for the same chemicals.

 

They found that the MDD patients compared to healthy controls had elevated levels of choline-containing compounds and decreased levels of N-acetyl aspartate, myo-inositol, and glutathione.

These chemicals are breakdown products of active brain chemicals (metabolites). These are all markers of brain function. The heightened levels of choline-containing compounds suggests that there is with increased cell density and/or membrane turnover in MDD. The decreased levels of N-acetyl aspartate suggest that there is a loss of neurons or neuronal function in MDD. The decreased levels of myo-inositol suggest that there is a loss of or dysfunction of glial cells in MDD. Finally, the decreased levels of glutathione suggest that there is a lower level of neuron excitation in the brain in MDD.

 

Importantly, Li and colleagues found that MBCT significantly reduced depression levels and at the same time normalized the levels of all of the metabolites that had abnormal levels in the patients. These are potentially important results. They demonstrate altered brain chemistry in MDD suggestive of dysfunction in the normal activities of the nervous system and point to potential causal factors in MDD. They also provide suggestions as to how MBCT changes the brain to effectively treat MDD.

 

It should be noted that the changes in metabolites in Major Depressive Disorder may be the result of the depression rather than its cause. The fact that the changes vanished after treatment reduced depression tends to support this contention. It is a complex disease effecting the most complex entity in the universe, the human brain. Hence, there is still a lot of work to do to determine the causal factors in MDD.

 

Regardless, change major depression brain chemistry with mindfulness.

 

 “Mindfulness is the only thing I know to do that can dig me out of despair and give me even a few seconds of time out from me,” – Ruby Wax

 

CMCS – Center for Mindfulness and Contemplative Studies

Change Brain Activity in Depression with Mindfulness

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By John M. de Castro, Ph.D.

 

“Skeptics, of course, may ask what good are a few brain changes if the psychological effects aren’t simultaneously being illustrated? Luckily, there’s good evidence for those as well, with studies reporting that meditation helps relieve our subjective levels of anxiety and depression, and improve attention, concentration, and overall psychological well-being.” – Alice Walton

 

In the last few decades, scientists have discovered that the brain is far more malleable than previously thought. Areas in the brain can change, either increase or decrease in size, connectivity, and activity in response to changes in our environment or the behaviors we engage in. This process is referred to as neuroplasticity. The nervous system is constantly changing and adapting to the environment. For example, the brain area that controls the right index finger has been found to be larger in blind subjects who use braille than in sighted individuals.  Similarly, cab drivers in London who navigate the twisting streets of the city, have a larger hippocampus, which is involved in spatial navigation, than predefined route bus drivers. Hence experience changes size, activity, and connectivity of the brain. These changes in the brain are called neuroplasticity.

 

Over the last decade neuroscience has studied the effects of contemplative practices on the brain and has demonstrated that these practices produce neuroplastic changes in widespread areas. Indeed, mindfulness practices have been shown to not only alter how we think and feel but also to alter the nervous system, producing changes in the size, activity, and connectivity of specific structures and systems in the nervous system. Depression has been shown to also involve changes to the nervous system and is significantly improved by mindfulness practices. As a result of mindfulness practices’ ability to alter the brain and relieve depression, these practices have been incorporated into various psychotherapies for depression.

 

Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression. It has been shown to be remarkably effective. Putting all these pieces together, it would seem likely that MBCT relieves depression by altering neural systems. In today’s Research News article “Multi-dimensional modulations of α and γ cortical dynamics following mindfulness-based cognitive therapy in Major Depressive Disorder”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1184978338192757/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454126/

Schoenberg and Speckens investigated changes in brain activity produced by MBCT using sophisticated techniques to explore the electrical activity that can be recorded from various regions of the scalp (Electroencephalogram, EEG). They compared patients with major depressive disorder who were randomly assigned to receive 8-weeks of group Mindfulness Based Cognitive Therapy (MBCT) or treatment as usual, waitlist control. They found that MBCT treatment produced clinically significant improvements in depressive symptoms, self-compassion, over identification with painful thoughts and feelings, and mindfulness. This is not surprising, and replicates the well-established finding that MBCT is highly effective in treating depression.

 

They recorded the EEG of both groups while they performed a Go/NoGo task. Performance on this task has been shown to be deficient in depressed patients and indicates deficient executive function. They found that MBCT significantly downregulated α and γ power in the electrical activity of the brain. This indicates that there was and increase the excitability of the cerebral cortex. This is generally associated with greater positive mood and decreased negative emotions. This suggests that MBCT may relive depression by its effects on the neural systems underlying the depressed mood.

 

They also found an enhancement of the α-desynchronisation occurring in response to the Go/NoGo task when negative material was presented, but decreased α-desynchronisation when positive material was presented. This suggests that MBCT activates the neural networks underlying positive emotion. These are the systems that are usually relatively inactive in depression. This again suggests that MBCT may relieve depression by enhancing the activity of neural systems responsible for positive mood, thus working in opposition to the negative mood so characteristic of depression.

 

Finally, they found that MBCT increased intra-hemispheric α-coherence of the fronto-parietal circuit. This coherence has been shown to be related to improved attention and reduced mind wandering. In depression, mind wandering is highly related to rumination which tends to reinforce and support the depressed state. This suggests that MBCT may relive depression by enhancing the coherence of neural systems responsible for attention, thus inhibiting the mind wandering and rumination so characteristic of depression.

 

Hence the present study found evidence for changed electrical dynamics in the cortex of depressed patients following Mindfulness Based Cognitive Therapy (MBCT). The changes that were observed reflect changed processing of emotional information and attention, such that positive mood was enhanced, negative mood was reduced, and mind wandering and rumination decreased. All of these processes tend to counteract depression and may at least in part be responsible for the effectiveness of MBCT in treating depression.

 

So, change brain activity in depression with mindfulness.

 

“Being in the present moment, accepting what is, without wanting to change or interpret it, will greatly enhance emotional well-being, leading to healthier thinking patterns that will touch and better every other aspects of your life.” – Jonathan Banks

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Disrupt Suicidal Thoughts with Mindfulness  

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“Did you really want to die?”
“No one commits suicide because they want to die.”
“Then why do they do it?”
“Because they want to stop the pain.”  ― Tiffanie DeBartolo

 

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

 

Depression and other mood disorders are the number-one risk factor for suicide. More than 90% of people who kill themselves have a mental disorder, whether depression, bipolar disorder or some other diagnosis, according to the National Alliance on Mental Illness (NAMI). So, the best way to prevent suicide may be to treat the underlying cause. For many this means treating depression. Mindfulness training has been shown to reduce suicidality in substance abusers (see http://contemplative-studies.org/wp/index.php/2015/11/30/decrease-suicidality-with-mindfulness/). Mindfulness training has also been shown to be effective for treating depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression and prevent relapse. So, it would seem reasonable to expect that MBCT would be effective in suicide prevention.

 

In today’s Research News article “Mindfulness-Based Cognitive Therapy (MBCT) Reduces the Association Between Depressive Symptoms and Suicidal Cognitions in Patients with a History of Suicidal Depression”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1158656587491599/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655869/

Barnhofer and colleagues treated patients with a history of suicidal depression with eight weeks of either MBCT, Cognitive Psychoeducation (CE), or Treatment as Usual (TAU). They found that at the end of treatment the participants treated with MBCT had a significant reduction in suicidal thoughts while the other groups did not. For the CE and TAU groups there were strong and significant correlations between depression and suicidal thoughts. That is, for these groups, the higher the level of depression the higher the levels of suicidal thought. In contrast for the MBCT group the correlations were significantly weaker That is, there was a much weaker relationship between depression and suicidal thoughts after Mindfulness-Based Cognitive Therapy (MBCT) than Cognitive Psychoeducation (CE), or Treatment as Usual (TAU).

 

These are interesting and potentially important findings that MBCT can reduce suicidal thoughts and that it weakens the link between depression and suicidal thoughts. This makes sense as MBCT is designed to reprogram depressive thought processes, helping the patient to see that their typical ways of thinking about and assessing their experiences are faulty and tend to heighten depression and that looking at and interpreting their experiences in a more rational way can reduce depression. This, in turn, appears to reduce suicidal thinking.

 

These results clearly suggest that Mindfulness-Based Cognitive Therapy (MBCT) may be an effective program to prevent suicide in people with high levels of suicidal thinking. Since mindfulness training has been shown to reduce suicidality in drug abusers, the second most likely group to commit suicide, it would appear that mindfulness training is potentially an important method to prevent suicide.

 

So, disrupt suicidal thoughts with mindfulness.

 

“The thought of suicide is a great consolation: by means of it one gets through many a dark night.” 
― Friedrich Nietzsche
CMCS – Center for Mindfulness and Contemplative Studies

 

Improve Inflammatory Bowel Disease with Mindfulness

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MBCT inflammatory bowel disease - Schoultz2

“I don’t think anybody would argue that fact that we know inflammation in the body, which comes from a lot of different sources, is the basis for a lot of chronic health problems, so by controlling that, we would expect to see increased life expectancy … but if we’re not changing those things and just taking ibuprofen, I don’t know if we’re really going to make any headway in that, I feel like there are probably a lot of factors that we could change without medicating with risk.” –  Josie Znidarsic

“Inflammatory Bowel Disease (IBD) is a broad term that describes conditions with chronic or recurring immune response and inflammation of the gastrointestinal tract. The two most common inflammatory bowel diseases are ulcerative colitis and Crohn’s disease. Inflammation affects the entire digestive tract in Crohn’s disease and only the large intestine in ulcerative colitis. Both illnesses are characterized by an abnormal response to the body’s immune system.” (Centers for Disease Control and Prevention).

 

Inflammatory Bowel Disease affects about 1 –1.3 million in the United States and its incidence appears to be increasing worldwide. IBD is a relapsing disorder with symptoms appearing, disappearing, and reoccurring repeatedly. It is characterized by diarrhea, fever and fatigue, abdominal pain and cramping, blood in the stool, reduced appetite, and unintended weight loss. IBD sufferers may lose weight and even become malnourished because they cannot properly digest and absorb food. The cause of IBD is unknown, and until we understand more, prevention or a cure will not be possible. It is most frequently treated with drugs, particularly anti-inflammatory drugs and immune system suppressors. These treatments, however, have considerable troubling side effects and patients frequently do not comply with the regimen.

 

There is a need for effective treatments for IBD that are safe and have few if any side effects. Since contemplative practices have been shown to reduce inflammatory responses (see http://contemplative-studies.org/wp/index.php/category/research-news/inflammatory-response/), and irritable bowel syndrome (see http://contemplative-studies.org/wp/index.php/category/research-news/ibs/) and have very few if any adverse side effects, they would seem to be appropriate potential treatments for IBD.  In today’s Research News article “Mindfulness-based cognitive therapy for inflammatory bowel disease patients: findings from an exploratory pilot randomised controlled trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1138739702816621/?type=3&theaterhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549082/

Schoultz and colleagues perform a pilot test of the effectiveness of an 8-week Mindfulness Based Cognitive Therapy (MBCT) program for Inflammatory Bowel Disease compared to a standard care control group. They found that MBCT produced significant reductions in depression and

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1138739702816621/?type=3&theatersizes studied there were trends toward improvements in Chron’s disease and ulcerative colitis activity. All of these effects were sustained at a 6-month follow-up.

 

This study was a pilot study that had only a small number of patients. This makes it difficult to detect statistically significant results. So, it is impressive that reductions in depression and anxiety were significant and attest to the robustness of these effects. This, however, should not be a surprise as MBCT was developed specifically with the treatment of depression and anxiety in mind and there is an impressive array of scientific studies verifying its effectiveness (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/mbct/).

 

The study is potentially very important in that there were large non-significant trends toward effectiveness in reducing IBD activity in the patients. These possible effects of mindfulness may be due to its ability to reduce inflammation and also to its ability to reduce the physiological and psychological effects of stress (see http://contemplative-studies.org/wp/index.php/category/research-news/stress/) since stress has been shown to be a trigger for flares in IBD symptoms. These results strongly suggest that a much larger controlled study is called for investigating this potentially useful treatment for IBD.

 

So, improve inflammatory bowel disease with mindfulness.

 

“All the suffering, stress, and addiction comes from not realizing you already are what you are looking for.” – Jon Kabat-Zinn

CMCS – Center for Mindfulness and Contemplative Studies

 

Reduce Depression with Cyber-Mindfulness  

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MBCT Depression Internet Beck2

 

“Our emotional reactions depend on the story we tell ourselves, the running commentary in the mind that interprets the data we receive through our senses.” ― Mark Williams,

 

Depression is widespread and debilitating. It is the most common mental illness affecting about 4% of the population worldwide. There are a number of treatments for depression the most common of which is antidepressant medication. But the drugs do not always work and can become ineffective over time. They can also have troublesome side effects. So, there is a need to discover safe and effective alternative treatments.

 

Mindfulness training has been shown to be an effective treatment for depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). Cognitive Behavioral Therapy (CBT) has been shown to be effective for depression by altering the ways people think about and process events that occur in their lives. Mindfulness Based Cognitive Behavioral Therapy (MBCT) adds mindfulness training to CBT. It was designed specifically to treat depression and has been shown to be effective even with people who do not respond to antidepressant medications (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/). MBCT has been so effective that the British Medical Service considers it a treatment of choice for depression.

 

MBCT can be delivered either individually or in groups. But, it requires that a highly trained therapist lead the process and it can be delivered to only a limited number of people at a time. Hence, it is relatively expensive to deliver. Also, it requires the patients to come to a practitioner’s facility on a regular basis over 8 to 12 weeks. This can be inconvenient for many and impossible for others. In addition, depressed individuals lack energy and motivation and many simply can’t find the strength to attend regular sessions. So, there is a need to develop better ways to deliver therapy. The internet provides a mechanism that could potentially overcome many of these drawbacks to face-to-face delivery of MBCT. It’s low cost and widely available and can be accessed when the patient feels up to it.

 

In today’s Research News article “PS2-43: Internet Delivered Mindfulness-based Cognitive Therapy for Reducing Residual Depressive Symptoms: An Open Trial and Quasi-experimental Comparison to Propensity Matched Controls”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1134263793264212/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4453426/

Beck and colleagues developed and tested an 8-session MBCT program delivered over the internet to recurrently depressed patients. Compared to treatment as usual for depression internet based MBCT produced a clinically significant decrease in depression with large effect size.

 

These are very exciting results. The cyber MBCT program is highly scalable and can be delivered to large numbers of depression sufferers at low cost. Because it’s delivered over the internet, it is convenient and available to patients who live in areas without access to clinics. The program needs to be compared to face-to-face MBCT. But, these results suggest that its effectiveness is comparable. Further research is definitely called for.

 

So, reduce depression with cyber-mindfulness.

 

“Unhappiness itself is not the problem—it is an inherent and unavoidable part of being alive. Rather, it’s the harshly negative views of ourselves that can be switched on by unhappy moods that entangle us. It is these views that transform passing sadness into persistent unhappiness and depression. Once these harsh, negative views of ourselves are activated, not only do they affect our mind, they also have profound effects on our body—and then the body in turn has profound effects on the mind and emotions.”  ― Mark Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

When Nothing Else Works for Depression Mindfulness Can!

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“When I see new patients with treatment-resistant depression, I tell them that if they want to borrow some of my optimism, they’re welcome to it. . .Despite how it feels, lots of people have been through this and lots of people get better.” – Ian Cook

 

Major Depression is the most common mental illness affecting over 6% of the population. 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 of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. This leaves a third of all patients treated without success. These patients are deemed to have treatment-resistant 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. In today’s Research News article “Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1130698403620751/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609854/

Pradhan and colleagues review the research literature on alternative treatments for treatment-resistant depression; ketamine, transcranial magnetic stimulation, and yoga and mindfulness interventions.

 

They report that infusion of the drug Ketamine, a glutamate receptor (NMDA) antagonist, has been shown to be effective quickly for treatment-resistant depression. Unfortunately its effects last only about a week and it has some troubling side effects. Another treatment, repetitive transcranial magnetic stimulation (rTMS) stimulates the human cortex through external magnetic stimulation and can be applied non-invasively. It appears to be effective for the relief of treatment-resistant depression in about half of the patients and it has very few and mild side effects. But treatments must be provided on a daily basis in a doctor’s office. So, it is very inconvenient and thereby often impossible for the patients.

 

Contemplative practices such as meditation and yoga are low cost and generally safe with few if any side effects. They have been shown to be effective for depression and to prevent relapse (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). A combination of cognitive behavioral therapy with mindfulness and meditation techniques, Mindfulness Based Cognitive Therapy (MBCT) has been demonstrated to be effective for depression even after drugs have failed to relieve the depression (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/).

Pradhan and colleagues perform a pilot study of a combination of MBCT and yoga they term Depression Specific Y-MBCT (DepS Y-MBCT) applied to treatment-resistant depression patients, one third of whom had suicidal tendencies. Of the 32 participants, 27 achieved remission from depression that was maintained for at least two months. These are exciting findings. A low cost and safe therapeutic technique combining mindfulness, yoga, and cognitive behavioral therapy produced and 85% remission rate for patients who did not respond to other treatments. Of course, these results need to be repeated in a randomized clinical trial. But, these results certainly justify the effort.

It is interesting that a disease like depression that is thought to be organically based in defective brain chemistry can be treated by a behavioral treatment. But, yoga and meditation have been found to alter the structure, connectivity, and chemistry of the brain. So, it may not be so mysterious how a behavioral treatment might be effective for a primarily physiological disorder. The mind and body are one. Treating the mind can also treat the body. This is one of the major messages of the alternative medical treatment movement.

 

So, apply mindfulness when nothing else works for depression.

 

“Start living right here, in each present moment. When we stop dwelling on the past or worrying about the future, we’re open to rich sources of information we’ve been missing out on—information that can keep us out of the downward spiral and poised for a richer life.” ― Mark Williams

 

CMCS – Center for Mindfulness and Contemplative Studies