Improve Diabetes Psychological Well-Being with Mindfulness

November 7, 2015 psyjdc Leave a comment

“I am a type-2 diabetic, and they took me off medication simply because I ate right and exercised. Diabetes is not like a cancer, where you go in for chemo and radiation. You can change a lot through a basic changing of habits.” – Sherri Shepherd

It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

Depression affects people with diabetes more often than people without it — up to 15 percent compared with 6.7 percent in the general population. When depression occurs along with a chronic illness like diabetes, the symptoms tend to be more severe. Compounding the problem further, the symptoms can become worse as depression can lead to missing medication doses, overeating, or skipping exercise. This may mean poorer blood glucose control, which, in turn, means more long-term health complications.

So, in treating diabetes it is important to treat not only the physical problem but also the psychological problems such as depression. Mindfulness training, especially Mindfulness-Based Cognitive Therapy Mindfulness-Based Cognitive Therapy (MBCT) has been demonstrated to be effective in treating depression (see http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/ and http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/).

In today’s Research News article “Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1113222965368295/?type=3&theater

Schroevers and colleagues examined whether an individualized version of MBCT might be effective for depression in people with diabetes. In comparison to diabetic patients on a waiting list, MBCT resulted in clinically significant reductions in depressive symptoms and diabetes related psychological distress and increases in the levels of acting with awareness and attention regulation. These improvements were still present three months after completing the program.

These are impressive results and suggest that MBCT is an effective treatment for the psychological issues that frequently accompany diabetes. MBCT may be effective due to its emphasis on the present moment in mindfulness. Depression is often rooted in the past and the individual ruminates about the misery of the past. By shifting focus to the present moment, mindfulness can move the individual from being preoccupied with a troubling past to being focused on addressing the manageable problems in the present. Indeed, Schroevers and colleagues demonstrated that MBCT produces an increase in acting with awareness. The individual then is more aware of what they’re doing. For the depressed diabetic individual this can help in the recognition of how he/she is acting in response to the depression or the diabetes. This allows them to reprogram their responses to be more appropriate to the circumstances of the present rather than responding to the depression itself.

Mindfulness also stresses non-judgmental awareness of the present. There is a decreased tendency to be constantly judging what is happening and instead just accept it as what is. This reduces worrying. Indeed, mindfulness practice has been shown to reduce worry (see http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/). Since worry involves concerns about future occurrences to some extent based upon past experiences, the more one can focus on the present the less opportunity there is for worries to arise. Mindfulness training also trains the individual to accept the worry, experience it, and then move on. This reduces the impact of the worry and prevents the development of worrying about worrying.

Another possibility is mindfulness’ ability to increase emotion regulation. That is mindfulness assists the individual in recognizing emotions as they arise and not over respond to them. It doesn’t prevent emotions. It simply allows the individual to better deal with them when they do arise. So when depression occurs the individual can recognize it, accept it, and then let it go and not respond to it. This liberates the individual to find new ways of responding to the environment and other people.

So, be mindful and improve psychological well-being with diabetes.

“Life is not over because you have diabetes. Make the most of what you have, be grateful.” – Dale Evans

CMCS – Center for Mindfulness and Contemplative Studies

Take Command and Control of Your Emotions

September 10, 2015 psyjdc 6 Comments

“If your emotional abilities aren’t in hand, if you don’t have self-awareness, if you are not able to manage your distressing emotions, if you can’t have empathy and have effective relationships, then no matter how smart you are, you are not going to get very far.” – Daniel Goleman

Emotions are powerful forces that have profound effects upon the course of our lives. We strive to obtain and maintain positive emotions. We are driven by negative emotions. And we are bored when we lack emotions. To some extent we can become a slave to our emotions unless we discover means to effectively deal with them.

Mindfulness appears to help to deal with our emotions. It has been shown to improve emotion regulation http://contemplative-studies.org/wp/index.php/2015/07/17/mindfully-get-a-grip/ and http://contemplative-studies.org/wp/index.php/2015/07/17/control-emotions-the-right-way-with-mindfulness/. It doesn’t block or prevent emotions from rising up. Rather it appears to allow us to recognize and feel the emotions but be able to control our responses to the emotions. So mindfulness appears to put us in control so we are no longer slaves to our surging emotions.

Mindfulness appears to act to improve emotion regulation by improving cognitive reappraisal

http://contemplative-studies.org/wp/index.php/2015/07/17/rethink-your-emotions/. It simply allows us to think more clearly about our emotions and interpret their source and meaning appropriately. So, rather than taking everything personally and interpreting our emotions as due to our own failings, we can see that they may be caused by the actions of others who are simply acting out their own issues that have nothing to say about us.

All of this indicates that mindfulness produces an overall improvement in our emotional intelligence http://contemplative-studies.org/wp/index.php/2015/07/17/be-smart-about-emotions/. It improves our ability to recognize our own and other people’s emotions, to discriminate between different feelings and label them appropriately, to use this information about the emotions to guide our thinking about them and the situations that evoked them, and to control our responses to them. It truly makes us smart about emotions and in control.

A number of mindfulness trainings have been shown to be effective in improving emotion regulation. Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to help the individual cope effectively with emotions particularly depression. But, it can also create a positive emotional upward trajectory http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/ where good feeling build on good feelings.

The cognitive component of MBCT is specifically designed to develop cognitive reappraisal of emotions, to help the individual better identify, label, and think about their emotions. This leaves open the question as to whether MBCT is effective because of the mindfulness component or the cognitive component or perhaps both.

In today’s Research News article “History of Mindfulness-Based Cognitive Therapy is Associated with Increased Cognitive Reappraisal Ability”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1085514061472519/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441334/

Troy and colleagues compared MBCT to Cognitive Behavior Therapy (CBT), without the mindfulness component, and to no-treatment controls. They found that the mindfulness component was crucial. Only the MBCT group showed increased cognitive reappraisal.

‘

This is quite surprising that Cognitive Behavior Therapy alone did not change cognitive reappraisal, but only did so when combined with mindfulness. This suggests that the focus on awareness of present moment experience viewed without judgment may be a potent practice to induce effective cognitive reappraisal. It suggests that being able to look at experience without judging it may be the necessary groundwork that allows the individual to look at the experience anew and appraise it optimally. By removing an initial inappropriate judgement about the situation, MBCT may make it easier to see the experience for what it is rather than have to overcome a wrong interpretation in order to rethink it. In other words it allows thinking to start from scratch rather than from error.

Regardless, it is clear that mindfulness gives you command and control of your emotions.

“To balance and control your emotions is one of the most important things in life. Positive emotions enhance your life. Negative emotions sabotage your life.” – Dr T.P.Chia

CMCS – Center for Mindfulness and Contemplative Studies

Spiraling Up with Mindfulness!

August 15, 2015 psyjdc 4 Comments

Mindfulness Based Cognitive Therapy (MBCT) was designed to treat depression. It has been so effective that the British Medical Service considers it a treatment of choice for depression. In a prior post http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/ the effectiveness of MBCT for depression was discussed. The relief of depression was evident even with depressed individuals who did not respond to antidepressant drugs.

Depression is characterized by negative mood states. But, depression is also supported by thought processes which tend to emphasize the negative. In addition the depressed individual tends to particularly pay attention to negative stimuli. They even contribute to their negativity by interpreting ambiguous situations as negative and even tend to see their own thoughts in a negative light. This creates a negative downward spiral where a depressed mood is interpreted negatively, for instance as indicative of low self-worth, which increases the depression, where they pick out the negative to focus on from all that is available in daily life, increasing depression, where even neutral events are seen as negative, increasing depression. So, depression leads to more depression which leads to more depression etc., a negative spiral into the depths of depression.

MBCT combines cognitive therapy for depression, which aims to alter the thought processes that reinforce the depression, and mindful meditation practice, which enhances focus on the present moment. Since depression is often characterized by rumination which is repetitive thoughts about negative past or future events, mindfulness training by its emphasis on staying in the present moment tends to markedly reduce ruminative thinking. (http://contemplative-studies.org/wp/index.php/category/research-news/depression/ ). Hence, there are clear reasons for MBCT’s effectiveness as it combines two components, CBT and meditation, each of which individually are effective for relief of depression and prevention of relapse.

It is obvious that depression emphasizes the negative. In fact, depressed individuals are not only characterized by increased negativity they also have very little if any positive feelings or thoughts. One way that MBCT is thought to ameliorate depression is by increasing positive thoughts as well as decreasing negative thoughts. In today’s Research News article “Mindfulness training promotes upward spirals of positive affect and cognition: multilevel and autoregressive latent trajectory modeling analyses”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1068976086459650/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313604/

Garland and colleagues investigated how MBCT works on a day to day basis in improving positive mood and thoughts in depressed individuals in remission and find that it creates a positive upward spiral of thoughts and feelings, the exact opposite of untreated depression.

They found as others have that MBCT tended to increase positive thoughts and feelings. But, in looking day to day after the end of the active treatment phase they observed that each day the positive feelings tended to increase the positive thoughts and feelings on the next day which in turn increased the positive thoughts and feelings on the next day etc. leading to an upward spiral where positivity led to greater positivity which led to even greater positivity. Hence the combination of CBT with mindfulness training creates an emotionally driven upward spiral by stimulating positive thoughts and feelings among people with deficits in positive feelings.

Hence MBCT relieves the negative thoughts and feelings and in addition produces a cascade in the opposite direction of positive thoughts and feelings. No wonder it’s so effective.

So, practice mindfulness and spiral up!

CMCS

Age Healthily – Treating Insomnia and Inflammation

August 6, 2015 psyjdc 1 Comment

Disturbance of sleep is common in the elderly. It directly produces impairments in daily activities. But, it also increases the risk for chronic disease and mortality in older adults. In particular insomnia appears to increase inflammation. Heightened markers of inflammations are associated with cardiovascular disease and diabetes and autoimmune diseases such as arthritis. In fact, inflammation is either directly or indirectly involved in nearly all diseases.

Chronic inflammation is the real problem. On the short term inflammation can be helpful in fighting off initial infection. But, if it continues over a prolonged period of time it can produce or exacerbate many health conditions. Since sleep disturbance in the elderly tends to be chronic and it increases inflammation it can be very detrimental to the individual’s health and thereby can increase mortality.

Obviously, it is important to the elderly to routinely get a good night’s sleep. In a previous post we discussed how insomnia affects older adults and contributes to decline in aging http://contemplative-studies.org/wp/index.php/2015/07/17/aging-healthily-sleeping-better-with-mindful-movement-practice/

In this post we reported that mindful movement practices such as Tai Chi was effective for the treatment of insomnia in the elderly. This study, however, did not compare mindful movements to other potential treatments and did not measure inflammation.

In today’s Research News article “Cognitive Behavioral Therapy vs. Tai Chi for Late Life Insomnia and Inflammatory Risk: A Randomized Controlled Comparative Efficacy Trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1063704673653458/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153053/

Irwin and colleagues demonstrated that indeed Tai Chi was effective for insomnia in older adults but that Cognitive Behavioral Therapy (CBT) was far superior, producing remission from insomnia in over half the participants treated with CBT compared to 30% for Tai Chi.

Importantly, Irwin and colleagues demonstrated that a marker of inflammation, C-reactive protein (CRP), was markedly reduced. CBT cut in half the proportion of participants with high inflammatory responses. In addition, the participants who had remission of insomnia had CRP levels that were nearly 50% lower. This is remarkable and indicates that CBT is highly effective in reducing not only insomnia but also the inflammatory response that frequently accompanies it. tai chi was also effective, but not to the same extent.

Although tai chi was not as effective as CBT it has marked advantages. CBT requires a formal treatment program with a trained therapist. This can be costly and inconvenient. Tai chi on the other hand can be engaged in without a therapist, at the convenience of the individual, and at virtually no cost. So, although CBT is superior in effectiveness, tai chi might be a better, more practical, alternative for many elderly.

So, it is important to treat insomnia in the elderly for their health and wellbeing. If practical choose Cognitive Behavioral Therapy but if that isn’t practical engage in tai chi practice.

CMCS – Center for Mindfulness and Contemplative Studies

Mindfully Improve Psychological Wellbeing

July 17, 2015July 17, 2015 psyjdc 2 Comments

Meditation, focusing, and CBT all have been shown to be effective treatments for a number of psychological problems. In previous research Sugiura and colleagues identified five factors in common to meditation, focusing, and Cognitive Behavioral Therapy (CBT), refraining from catastrophic thinking, self-observation, logical objectivity, detached coping, and acceptance. This raises the questions as to whether these common factors may be responsible for the common clinical outcomes, and which of these common factors is most important for each of a variety of disorders.

In today’s Research News article “Common Factors of Meditation, Focusing, and Cognitive Behavioral Therapy: Longitudinal Relation of Self-Report Measures to Worry, Depressive, and Obsessive-Compulsive Symptoms Among Nonclinical Students.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1052052538152005/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4432024/

Sugiura and colleagues pursue these questions with a sample of undergraduate students.

They found that the greater the detached coping the lower the levels of obsessive-compulsive (OCD) symptoms. Detached coping emphasizes detachment and distancing from external conditions. This is exactly what mindfulness training is supposed to do, to allow us to see things objectively as they are. This suggests that mindfulness training is effective against obsessive-compulsive symptoms through its development of the skill of detached coping. Similarly, it was found that the greater the detached coping the lower the levels of depressive symptoms. This suggests that mindfulness training is effective against depression by allowing the individual to look at their situation more objectively, with detachment, and as a result not respond to it as something to feel bad about.

Worrying is also effectively reduced by mindfulness. The mechanism appears to be more complicated than that for OCD or depressive symptoms. It was found that the greater the level of refraining from catastrophic thinking the lower the levels of worrying, while the greater the level of self-observation the stronger the levels of worrying. Refraining from catastrophic thinking reflects the skills necessary to detach from and to suspend negative thinking, which frequently involves a fear of a future negative outcome, a worry. Mindfulness, by focusing on the present rather than the future interferes with worrying about the future and thus can be an effective antidote to worry.

Finally, Self-observation constitutes engagement in self-focus with curiosity and openness. Surprisingly it was associated with increased worrying. It appears that self-observation activates negatives beliefs about worrying. This suggests that it produces a worrying about worrying that increases worry.

So, it appears that the factors in common to meditation, focusing, and CBT of refraining from catastrophic thinking, self-observation, and detached coping are also associated with the symptoms common to psychological problems. But, that different factors are involved with different issues. This suggests that the three treatments may be effective by invoking common intermediaries for various disorders.

So, practice mindfulness and improve your psychological wellbeing.

CMCS

Dealing With Major Depression when Drugs Fail

July 17, 2015 psyjdc 52 Comments

Mindfulness training has been repeatedly demonstrated to be an effective treatment for depression. It is so effective that the in the UK it is considered the treatment of choice for depression. But Major Depression is another level entirely. Very few treatments other than drugs have been effective.

Major 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. Once under control with drugs, other therapies are helpful in assisting the individual to adjust to the new normal and to remedy the sequellae of years of depression.

But what can be done when drugs do not work which happens quite frequently. It is suggested in today’s Research News article, “Mindfulness-based cognitive therapy vs. psycho-education for patients with major depression who did not achieve remission following antidepressant treatment”

http://www.sciencedirect.com.ezproxy.shsu.edu/science/article/pii/S0165178115000736#

that Mindfulness Based Cognitive Therapy (MBCT) may be a solution. Patients with Major Depression who have not responded to drugs did significantly improve with MBCT treatment and the improvement was superior to an active control group designed to simulate many of the conditions of MBCT.

This is remarkable. A mindfulness based treatment is effective on a major mental illness, which is principally a physiologically based disease, even when drugs fail. How is this possible that MBCT can be effective when other therapies and even drugs don’t help?

One possibility is the emphasis on the present moment in mindfulness. Depression is often rooted in the past and the individual ruminates about the misery of the past. By shifting focus to the present moment, mindfulness can move the individual from being preoccupied with a troubling past to being focused on a safe and secure present. Mindfulness also stresses non-judgmental awareness of the present. There is a decreased tendency to be constantly judging what is happening and instead just accept it as what is, which is a difficulty in depression.

Still another possibility is that mindfulness produces a heightening of acting with awareness. The individual then is more aware of what they’re doing. For the depressed individual this can help in the recognition of how he/she is acting in response to the depression. This allows them to reprogram their responses to be more appropriate to the circumstances of the present rather than responding to the depression itself.

Finally, it is known that drugs are effective for depression by altering the brain. It is also known that mindfulness training produces alterations of the nervous system. Perhaps, they act on the brain in similar ways, producing similar changes that help to relieve depression.

Regardless, if you’re depressed, try mindfulness.

CMCS