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.

“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

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/

Reduce Pain by Accepting it Mindfully

May 14, 2016 psyjdc Leave a comment

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

May 10, 2016 psyjdc Leave a comment

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

April 20, 2016 psyjdc Leave a comment

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1213461405344450/?type=3&theater

Or see below, or for full text see

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

April 1, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1200545726636018/?type=3&theater or see below:

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.