MBSR

Mindfully Control Back Pain

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By John M. de Castro, Ph.D.

 

“MBSR is a practice that can help you “turn the volume down” on the perception of back pain by teaching you to look into the pain, and being with the experience and not resisting it so much. Looking into our emotional reactivity to it. Focusing on the present, rather than being bitter about the past or worried about the future about your back pain, helps you take ownership of the situation (i.e., accept your pain), and ultimately, find creative solutions for pain relief. It trains you to be in control of your mind, not for your mind to control you.” – Mark Neenan
Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse and addiction. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

Pain involves both physical and psychological issues. 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 improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable to project that mindfulness practices would be helpful in pain management. Indeed, these practices have been shown to be safe and  beneficial in pain management in general and Yoga and mindfulness has been shown to specifically improve back pain. Mindfulness Based Stress Reductions (MBSR) programs contain both yoga and mindfulness practices. So, it would seem reasonable to project that MBSR practice would improve emotion regulation and thereby be beneficial for back pain.

 

In today’s Research News article “Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients”

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or see below.

Braden and colleagues investigate the effectiveness of a 4-week program of Mindfulness Based Stress Reductions (MBSR) for the treatment of low back pain. They randomly assigned patients with chronic low back pain to either an MBSR or reading control group. They found that only the MBSR group reported a significant decrease in low back pain and the somatic-affective aspects of depression following the MBSR training. In addition, they performed functional magnetic imaging of the brains of the patients, both before and after training, during a task designed to induce emotions. They found that after MBSR training there was increased activity in response to emotions in the subgenual Anterior Cingulate Cortex and the ventrolateral Prefrontal Cortex. Both of these areas have been associated with emotion regulation processing.

 

Hence the results suggest that a 4-week MBSR training program can be effective for the relief of low back pain and the improvement in emotions. The results suggest that the improvements may have been due to changes in brain processing of emotions produced by the MBSR training. Unfortunately, at a one year follow up the reductions in pain and depression were not maintained. This suggests that an abbreviated program of 4 weeks of MBSR (the standard program is 8-weeks) may be able to improve the patients but not sufficient to produce lasting effects. It remains to be shown if the standard 8-week program can produce more lasting effects. Regardless, the findings provide support for further research into the utility of MBSR training for the treatment of chronic low back pain.

 

So, mindfully control back pain.

 

“Mindfulness soothes the circuits that amplify secondary pain and you can see this process happening in a brain scanner. In effect, mindfulness teaches you how to turn down the volume control on your pain. And as you do so, any anxiety, stress and depression that you may be feeling begins to melt away too. Your body can then relax and begin to heal.” – Danny Penman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Study Summary

Braden BB, Pipe TB, Smith R, Glaspy TK, Deatherage BR, Baxter LC. Brain and behavior changes associated with an abbreviated 4-week mindfulness-based stress reduction course in back pain patients. Brain Behav. 2016 Feb 16:e00443. [Epub ahead of print]

 

Abstract

INTRODUCTION: Mindfulness-based stress reduction (MBSR) reduces depression, anxiety, and pain for people suffering from a variety of illnesses, and there is a growing need to understand the neurobiological networks implicated in self-reported psychological change as a result of training. Combining complementary and alternative treatments such as MBSR with other therapies is helpful; however, the time commitment of the traditional 8-week course may impede accessibility. This pilot study aimed to (1) determine if an abbreviated MBSR course improves symptoms in chronic back pain patients and (2) examine the neural and behavioral correlates of MBSR treatment.

METHODS: Participants were assigned to 4 weeks of weekly MBSR training (n = 12) or a control group (stress reduction reading; n = 11). Self-report ratings and task-based functional MRI were obtained prior to, and after, MBSR training, or at a yoked time point in the control group.

RESULTS: While both groups showed significant improvement in total depression symptoms, only the MBSR group significantly improved in back pain and somatic-affective depression symptoms. The MBSR group also uniquely showed significant increases in regional frontal lobe hemodynamic activity associated with gaining awareness to changes in one’s emotional state.

CONCLUSIONS: An abbreviated MBSR course may be an effective complementary intervention that specifically improves back pain symptoms and frontal lobe regulation of emotional awareness, while the traditional 8-week course may be necessary to detect unique improvements in total anxiety and cognitive aspects of depression.

 

Keep Health Care Professionals from Burning Out with Mindfulness

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By John M. de Castro, Ph.D.

 

“Through practicing mindfulness we become more aware of subtle changes in our mood and physical health, and can start to notice more quickly when we are struggling. Rather than waiting for a full meltdown before we take action, we can read the signals of our minds and bodies and start to take better care of ourselves.” – The Mindfulness Project

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations burnout is all too prevalent. This is the fatigue, cynicism, emotional exhaustion, and professional inefficacy that comes with work-related stress. Healthcare is a high stress occupation. It is estimated that over 45% of healthcare workers experience burnout with emergency medicine at the top of the list, over half experiencing burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity.

 

Burnout is not a unitary phenomenon. In fact, there appear to be a number of subtypes of burnout. The overload subtype is characterized by the perception of jeopardizing one’s health to pursue worthwhile results, and is highly associated with exhaustion. The lack of development subtype is characterized by the perception of a lack of personal growth, together with the desire for a more rewarding occupation that better corresponds to one’s abilities. The neglect subtype is characterized by an inattentive and careless response to responsibilities, and is closely associated with inefficacy. All of these types result from an emotional exhaustion. This exhaustion not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion.

 

Regardless of the reasons for burnout or its immediate presenting consequences, it is a threat to the healthcare providers and their patients. In fact, it is a threat to the entire healthcare system as it contributes to the shortage of doctors and nurses. Hence, preventing existing healthcare workers from burning has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout. One of the premiere techniques for developing mindfulness and dealing effectively with stress is Mindfulness Based Stress Reduction (MBSR) pioneered by Jon Kabat-Zinn. It is a diverse mindfulness training containing practice in meditation, body scan, and yoga. As a result, there have been a number of trials investigating the application of MBSR to the treatment and prevention of health care worker burnout.

 

In today’s Research News article “Outcomes of MBSR or MBSR-based interventions in health care providers: A systematic review with a focus on empathy and emotional competencies”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1197241983633059/?type=3&theater

http://www.complementarytherapiesinmedicine.com/article/S0965-2299(15)30014-5/fulltext

Lamothe and colleagues summarize the published literature on the effectiveness of Mindfulness Based Stress Reduction (MBSR) for healthcare worker burnout. They found that the preponderance of evidence from a variety of different trials indicated that MBSR treatment is effective for burnout. In particular, the research generally reports that MBSR treatment significantly improves mindfulness, empathy, and the mental health of healthcare workers. It was found to significantly relieve burnout, and reduce anxiety, depression, and perceived stress.

 

Hence, the published literature is highly supportive of the application of MBSR for the prevention and treatment of healthcare worker burnout. It appears to not only help the worker, but the improvement in the empathy of the worker projects positive consequences for the patients. In addition, the reduction in burnout suggests that MBSR treatment may help to reduce healthcare workers leaving the field, helping to relieve the systemic lack of providers. These are remarkable and potentially very important results.

 

Mindfulness training makes the individual more aware of their own immediate physical and emotional state. Since this occurs in real time, it provides the individual the opportunity to recognize what is happening and respond to it effectively before it contributes to an overall state of burnout. Indeed, mindfulness training has been shown to significantly improve emotion regulation. This produces clear experiencing of the emotion in combination with the ability to respond to the emotion adaptively and effectively. So, the healthcare worker can recognize their state, realize its origins, not let it affect their performance, and respond to it appropriately, perhaps by the recognition that rest is needed.

 

So, keep health care professionals from burning out with mindfulness.

 

“It helps people to undo some of the sense of the time pressure and urgency that makes it so hard to feel present for your patient, and it helps your patients feel like you’re really there, really listening and that you really care. What you learn is to undo the distractedness that comes with worrying about what happens next, and the concern with what’s already over and done with. It doesn’t take more time; it takes an intention and practice to do it successfully.” –  Dr. Michael Baime

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Improve Mind-Body Connection with Mindfulness

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MBSR EEG EKG 2 Gao

 

By John M. de Castro, Ph.D.

 

“It is fascinating to see the brain’s plasticity and that, by practicing meditation, we can play an active role in changing the brain and can increase our well-being and quality of life.” – Sarah Lazar

 

The mind and body are intrinsically intertwined. The old distinction between mind and body has been shown to be a false distinction. The brain, the organ of the mind, also controls the physiology, while the activity of the physiology affects the brain. So, mind and body are interconnected. Hence, mind practices should also affect the physiology just as physiological changes affect the mind.

 

Contemplative practices have been shown to influence both the mind, brain, and the physiology. Among the many physiological effects of contemplative practices are alterations of the cardiovascular system, producing reductions in heart rate, heart rate variability, and blood pressure. Contemplative practices have also been shown to alter the nervous system changing the size, activity, and connectivity of brain structures. These changes can be measured in many ways, but a convenient and inexpensive non-invasive method to document changes in brain activity is by recording the electrical activity of the nervous system from the scalp, known as the electroencephalograph or EEG. Indeed, the changes in brain activity produced by contemplative practices can be seen in the EEG.

 

Mindfulness Based Stress Reduction (MBSR) was one of the first contemplative practices to be applied to improving human well-being. It is an amalgam of practices, including meditation, yoga, and body scan. It has been shown to be beneficial for cardiovascular function and to change neural activity. One way to look at the integration of mind-body activity is to measure the relationship between brain activity and cardiovascular activity over time. In today’s Research News article “Entrainment of chaotic activities in brain and heart during MBSR meditation”

Harvard neuroscientist: Meditation not only reduces stress, here’s how it changes your brain

https://www.washingtonpost.com/news/inspired-life/wp/2015/05/26/harvard-neuroscientist-meditation-not-only-reduces-stress-it-literally-changes-your-brain/

Gao and colleagues investigated the effects of an 8-week Mindfulness Based Stress Reduction (MBSR) training program on the coordination of electrical activity from the nervous system (EEG) with the electrical activity from the heart (Electrocardiogram, ECG). The EEG and ECG were recorded during 10-minutes of mindful breathing both before and after MBSR training.

 

They measured the chaotic nature of the activity in both the EEG and ECG employing a measure of wavelet entropy. This measure documents the unpredictability and random nature of the signals. They found that after MBSR training there was a reduction in the entropy of both the brain waves, EEG, and the heart electrical activity, ECG. This demonstrates that MBSR training results in reduced variability and randomness of the electrical activities of both the heart and brain. Significantly, they found that the entropy of the EEG and EKG were highly correlated as a result of MBSR training. That is, the lower the entropy of the EEG, the lower the entropy of that ECG. In other words, as the brain activity became less chaotic, so did the activity of the heart. They were coordinated.

 

One way that Mindfulness Based Stress Reduction (MBSR) training might produce these effects on the level of entropy and its coordination of the heart and brain activities is by its effects on the autonomic nervous system. This system has two roughly opposing systems, the sympathetic and parasympathetic nervous systems. Sympathetic activation tends in activate the heart and brain while parasympathetic activity tends to reduce activation of both. If these two systems oppose one another instead of acting in a coordinated fashion, then greater variability of the EEG and ECG would be expected. MBSR has been shown to reduce the activity of the sympathetic nervous system both centrally and peripherally and increase parasympathetic activity. The current results, then, could well have occurred by MBSR producing better coordination of the balance of sympathetic and parasympathetic activity.

 

Mindfulness Based Stress Reduction (MBSR) appears to improve the coordination between the mind and body. This is emphasized in the body scan and yoga components of MBSR where attention to sensations from the body is emphasized. It is also emphasized during meditation as a result of learning to attend to the sensations associated with breathing. So, MBSR would seem well suited to increasing the coordination of mind and body. Today’s Research News results support this idea.

 

So, improve mind-body connection with mindfulness.

 

“We can intentionally shape the direction of plasticity changes in our brain. By focusing on wholesome thoughts, for example, and directing our intentions in those ways, we can potentially influence the plasticity of our brains and shape them in ways that can be beneficial.” – Richie Davidson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Better Measurement of Mindfulness, Anxiety, and Depression

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By John M. de Castro, Ph.D.

 

“Thus, differing assessments may support implicitly distinct theoretical positions with respect to operationalizing mind- fulness. . . . researchers must be well informed and intentional in their selection of assessment tools because the breadth of currently available assessments provides researchers with a variety of measures, each with specific strengths and weaknesses. Not surprisingly, the various measures resulting from the diverse operational definitions of mindfulness have, at times, been found to be uncorrelated or only modestly associated, providing further evidence of confusion within the mindfulness literature.” – Adam Hanley

 

A prerequisite in science is that in order to study something you have to be able to measure it. With many concepts such as mindfulness, depression, and anxiety that reflect subjective states, there are currently no objective means to measure them. Measurement then falls to some kind of after the fact test or to a self-report. Traditionally, these variables have been measured with paper and pencil psychometric tests, such as the Cognitive Affective Mindfulness Scale-Revised, the Beck Depression Inventory, or the Profile of Mood States. They ask the participant to answer the question in regard to how they generally feel. These forms are filled out before and again after an intervention to assess the effect of the intervention on these subjective states.

 

With the advent of smart phones, a different kind of assessment method has emerged and is gaining greater popularity. It is sometimes called ecological momentary assessment (EMA). Individuals receive messages on their smart phones periodically asking them to answer questions about their state at the present moment. This can be done on multiple, somewhat randomly selected, occasions over the day or longer. It provides a measure that doesn’t require the participant to estimate how they feel in general, but rather uses an average of measures provided by the participant at various times.

 

In today’s Research News article “Ecological momentary assessment versus standard assessment instruments for measuring mindfulness, depressed mood, and anxiety among older adults”

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Moore and colleagues recruited elderly (over 65 years of age) participants with clinically significant anxiety distress. They compared the results for participants’ levels of mindfulness, depression, and anxiety measured either by traditional paper and pencil measures of how they were in general to those measured with an ecological momentary assessment (EMA) using smart phones. To obtain the EMA measures participants were sampled 3 times per day for ten days. The participants were randomly assigned to receive Mindfulness Based Stress Reduction (MBSR) program or a health education program. They were compared both before and after the interventions with both the traditional and EMA measurements.

 

Mindfulness Based Stress Reduction (MBSR) involves training in meditation, body scan, and yoga. It has been shown previously to increase mindfulness, and to decrease depression and anxiety levels in normal individuals and those with anxiety disorders, including the elderly. Moore and colleagues found in their study that on average both measures showed an increase in mindfulness and decreases in depression and anxiety, but, the effects were only statistically significant for ecological momentary assessment (EMA) and not for the traditional paper and pencil measures. These results suggested that EMA measurement in more sensitive and less unstable than traditional measures. To further document this, they calculated the number of participants that would be needed to show a statistically significant effects for the two measurement types and found that EMA measures required nearly half as many participants as the traditional measures. Hence, they found that EMA measure are substantially more sensitive and is capable of detecting differences with fewer participants.

 

These results indicate that ecological momentary assessment (EMA) is a better way to assess the states of research participants. Obtaining measures at a variety of points in time appears to produce more accurate results than asking the participant to estimate their overall states. This makes sense that actual measures are superior to participant estimates. The EMA technique is more expensive, takes more time and effort, and is more intrusive into the daily lives of the participants, but may be worth it for the improved accuracy and sensitivity.

 

“If you’ve ever struggled with depression, take heart. Mindfulness, a simple yet powerful way of paying attention to your most difficult emotions and life experiences, can help you break the cycle of chronic unhappiness once and for all.” – Mark Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Improve Emotions in MS with Mindfulness

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By Dr. John M. de Castro

 

“Mindfulness practice appears to be a safe, drug-free approach to coping with stress and anxiety, which may in turn help reduce your MS symptoms.” – Amit Sood

 

“Multiple sclerosis (MS) is the most widespread disabling neurological condition of young adults around the world. more than 400,000 people in the United States and about 2.5 million people around the world have MS. About 200 new cases are diagnosed each week in the United States. The most common early symptoms of MS are: fatigue vision problems tingling and numbness vertigo and dizziness muscle weakness and spasms problems with balance and coordination.” – Healthline

 

MS is a progressive demyelinating disease which attacks the coating on the neural axons which send messages throughout the body and nervous system. It is most commonly diagnosed in people between the ages of 20 and 50 years.  Unfortunately, there is no cure for multiple sclerosis.  There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms. Although there is a progressive deterioration, MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. So, quality of life becomes a major issue. There is a thus a critical need for safe and effective methods to help relieve the symptoms of MS and improve quality of life.

 

Quality of life with MS is affected by fatigue, cognitive decrements, physical impairment, depression, and poor sleep quality. But, the emotional symptoms are the most problematic with clinically significant depression present in 50% of MS sufferers and anxiety in about a third of MS sufferers. Since mindfulness has been previously shown to improve depression, sleep quality, cognitive impairments, and emotion regulation, it would seem likely that mindfulness would affect the quality of life in MS patients.

 

In today’s Research News article “Effect of Mindfulness-Based Stress Reduction on Anxiety, Depression and Stress in Women with Multiple Sclerosis”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1179736912050233/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733502/

Kolahkaj and Zargar compared MS patients who were randomly assigned to receive either Mindfulness Based Stress Reduction (MBSR) or treatment as usual. They were compared prior to the intervention, after and two months later. They found that MBSR produced clinically significant reductions in depression, anxiety, and stress that were maintained two months after the end of active treatment.

 

The size and endurance of the effectiveness of MBSR is striking. But, it should be remembered that the control condition did not receive any active intervention, only receiving treatment as usual. Hence, the effectiveness of MBSR could be due to a number of contaminants including expectancy effects, experimenter bias effects, attention effects, etc. or social effects as MBSR is conducted in groups. It remains for future research to compare MBSR to other active interventions. In addition, Mindfulness Based Stress Reduction (MBSR) involves meditation, body scan, and Hatha yoga. It is a potent combination. But, it leaves the question open as to which of the components is effective against the various symptoms of MS. Once again, future research is needed to begin to separate out effective from ineffective components.

 

MBSR is known to reduce the psychological and physiological responses to stress. Since MS produces considerable stress in the sufferers, reducing the responses to stress may be a very important component of MBSR’s effectiveness for depression and anxiety. Also the yoga component of MBSR may be helpful in helping the MS sufferers to better deal with the effects of MS on motor movements and this may reduce stress, anxiety, and depression. Both meditation and yoga are known to improve emotion regulation, allowing the patient to better experience their emotions, yet respond to them adaptively and positively. This could markedly reduce anxiety, depression, and in turn, stress.

 

Regardless of the mechanism, it is clear that Mindfulness Based Stress Reduction (MBSR) produces marked improvement in the levels of anxiety, depression, and stress of MS patients. So, improve emotions in MS with mindfulness.

 

“I dissolved into a spiral of negative thinking. But since I started to practise mindfulness, I can control my negative thoughts and fears about the future. My stress levels are the lowest they’ve ever been and I’m back at work full-time.

I think mindfulness is even having a physical effect on the progression of the disease – my disability progression continues to be slow, even though I’ve been diagnosed for five years now.” – Gareth Walker

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Control Blood Pressure with Mindfulness

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“A chronic state of arousal isn’t healthy. It causes hypertension, and it has been implicated in diabetes, asthma, and various gastrointestinal disorders. Part of the arousal response is to turn off the immune system, so you are breaking down instead of healing yourself.” ~ Erika Friedmann

 

High Blood Pressure (Hypertension) is an insidious disease because there are no overt symptoms. The individual feels fine. But it can be deadly as more than 360,000 American deaths, roughly 1,000 deaths each day, had high blood pressure as a primary or contributing cause. In addition, hypertension markedly increases the risk heart attack, stroke, heart failure, and kidney disease.  Hypertension is present in about 70% of first heart attacks, about 80% of first strokes, and about 70% of chronic heart failures. It is also a very common disorder with about 70 million American adults (29%) having high blood pressure and only about half (52%) of people with high blood pressure have their condition under control. Additionally, nearly a third of American adults have prehypertension, with blood pressure higher than normal, but not yet considered hypertension.

 

High blood pressure, because it doesn’t have any primary symptoms is usually only diagnosed by direct measurement of blood pressure usually by a health care professional. When hypertension is chronically present over three quarters of patients are treated with antihypertensive drugs. But these medications often have adverse side effects. So, patients feel lousy when taking the drugs, but fine when they’re not. So, compliance is a major issue with many patients not taking the drugs regularly or stopping entirely.

 

Obviously there is a need for alternative to drug treatments for hypertension. Stress is known to be a contributing factor to hypertension. It acts in part by increasing activity in the sympathetic nervous system, the activating component of the peripheral nervous system and by increasing the release of stress hormones. So controlling stress would appear to be a reasonable non-drug approach to reducing high blood pressure.

 

Mindfulness Based Stress Reduction (MBSR) programs were designed specifically to reduce stress. They include meditation, body scan, and yoga practices. Meditation (see http://contemplative-studies.org/wp/index.php/2015/08/21/control-blood-pressure-with-meditation/), and yoga (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/yoga-contemplative-practice/), and body scan (see http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/)  have  been shown to be successful in reducing both the psychological and physiological responses to stress. So, it would seem appropriate to use these techniques as alternatives to drug treatment for hypertension.

 

In today’s Research News article “Effect of Group Mindfulness-Based Stress-Reduction Program and Conscious Yoga on Lifestyle, Coping Strategies, and Systolic and Diastolic Blood Pressures in Patients with Hypertension”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1154248347932423/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685370/

Nejati and colleagues compared hypertensive patients randomly assigned to receive an 8-week MBSR program or no treatment. They found significant positive improvements produced by MBSR treatment including improved lifestyle (nutrition, exercise, health responsibility, stress management, interpersonal support, and self-actualization), coping strategies (problem-focused and emotion-focused), and blood pressure (systolic and diastolic).

 

These results are impressive, but need to be tempered with the fact that the control condition was a no treatment condition. Without an active control many potentially confounding variables are present. But the results reinforce previous studies that make a compelling case that mindfulness practices such as MBSR are excellent alternatives to medication for the treatment of hypertension.

 

So, control blood pressure with mindfulness.

 

“Meditation can help us in many aspects of our lives, whether it be physically or mentally. It is a discipline that when practiced daily significantly decreases stress related diseases such as high blood pressure while increasing a deep relaxation response and the feel-good factor.” – Zenlama
CMCS – Center for Mindfulness and Contemplative Studies

 

Headaches are a Headache – Reduce them with Mindfulness 2

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“To diminish the suffering of pain, we need to make a crucial distinction between the pain of pain, and the pain we create by our thoughts about the pain. Fear, anger, guilt, loneliness and helplessness are all mental and emotional responses that can intensify pain.” ~Howard Cutler

 

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.

 

A Mindfulness Based Stress Reduction (MBSR) program has been shown to be an effective treatment for tension headache (see http://contemplative-studies.org/wp/index.php/2015/09/07/headaches-are-a-headache-reduce-them-with-mindfulness/). Unfortunately, migraine sufferers were not included in the study. In today’s Research News article “The Effectiveness of Mindfulness-Based Stress Reduction on Perceived Pain Intensity and Quality of Life in Patients with Chronic Headache”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1144418128915445/?type=3&theater

Bakhshani and colleagues examine the effectiveness of an 8-week Mindfulness Based Stress Reduction (MBSR) program compared to a treatment as usual (primarily drugs) control group for chronic headaches including tension and migraine headaches. They found that in comparison to the control group which primarily controlled pain with drugs the MBSR group had a clinically significant reduction in pain intensity with a moderate effect size. They also found that MBSR produced a significant improvement in quality of life including role limitation due to physical health, bodily pain, general health, energy and vitality, emotional health and physical and mental health. These results indicate that MBSR is a clinically meaningful effective treatment for both tension and migraine headaches, not only reducing pain but also improving the patients’ quality of life. Importantly, MBSR effects were superior to drug treatment.

 

MBSR is structured to reduce stress and has been empirically shown to significantly reduce both the physiological and psychological responses to stress (see http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/). Since tension headaches are primarily produced by stress and migraine headaches are frequently triggered by stress, it would seem reasonable to conclude that the stress reduction contributed to the effectiveness of MBSR for chronic headaches. Mindfulness training, by focusing attention on the present moment has also been shown to reduce worry and catastrophizing (see http://contemplative-studies.org/wp/index.php/category/research-news/worry/ and http://contemplative-studies.org/wp/index.php/2015/08/07/pain-is-a-pain-relieve-it-with-meditation/). Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing should reduce headache pain. In addition, negative emotions are associated with the onset of headaches. Mindfulness has been shown to increae positive emotions and decrease negative ones (see http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/). Finally, mindfulness has been shown to change how pain is processed in the brain reducing the intensity of pain signals in the nervous system.

 

Regardless of the mechanism, it is clear that MBSR is a safe and effective treatment that is more effective than drugs for chronic headaches. So, reduce headache pain and improve quality of life with mindfulness.

 

“The way to live in the present is to remember that ‘This too shall pass.’ When you experience joy, remembering that ‘This too shall pass’ helps you savor the here and now. When you experience pain and sorrow, remembering that ‘This too shall pass’ reminds you that grief, like joy, is only temporary.” ~Joey Green

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Mindfully Improve Memory

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“Mindfulness registers experiences, but it does not compare them. It does not label them or categorize them. It just observes everything as if it was occurring for the first time. It is not analysis which is based on reflection and memory.” – Bhante Gunaratana

 

Humans have both an amazing capacity to remember and a tremendously limited capacity depending upon which phase of the memory process that is looked at. Our long-term store of information is virtually unlimited. We can recall in great detail events that occurred years ago or a few minutes ago. It not only includes events but things that were memorized by rote, music, places and their relationship to other places, faces, emotions, facts, definitions, etc. It’s really quite amazing. On the other hand, or very short-term memory is extremely limited. This is called our working memory and it can contain only about 5 to 9 pieces of information at a time. This fact of a limited working memory store shapes a great deal about how we think, summarize, and categorize our world.

 

Memory is not always accurate. We forget a great deal of information or have great difficulty retrieving it. We sometimes vividly recall things that really never happened to us, called false memories. Problems with memory are exacerbated by interference within memory where similar things tend to produce problems in our ability to recalling them. The problems with memory are well known in the legal system where the unreliability of eyewitness testimony is legendary. So, methods to improve memory and recall could be quite helpful, particularly to students who are required to recall information regularly.

 

Mindfulness has a mixed record in regards to its effects on memory. It has been shown to increase the likelihood of false memories and to impair memory for emotionally negative words but not positive words in adults (see http://contemplative-studies.org/wp/index.php/category/research-news/memory/). But mindfulness has also been shown to improve working memory capacity and Graduate Record Exam (GRE) scores among college students (see http://www.ncbi.nlm.nih.gov/pubmed/23538911). So, mindfulness appears to be able to improve some forms of memory while impairing others. It is thus important to sort out what kinds of memories are affected by mindfulness, in what way, and with whom.

 

In today’s Research News article “A Randomized Controlled Trial Examining the Effect of Mindfulness Meditation on Working Memory Capacity in Adolescents.”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1143318002358791/?type=3&theater

http://ac.els-cdn.com/S1054139X15003808/1-s2.0-S1054139X15003808-main.pdf?_tid=79ab478a-9055-11e5-80cd-00000aab0f27&acdnat=1448113429_d94f3f38ebf8666c5d47d94b9f652dbb

Quach and colleagues investigated the effect of contemplative practices on working memory in 12 to 17 year-olds. They compared students receiving 4-weeks of the meditation component of a Mindfulness Based Stress Reduction (MBSR) program to students receiving 4-weeks of Hatha yoga training and to untreated students on a wait list. They found that over the 4 weeks the students receiving meditation training significantly improved their working memory capacity while neither the yoga training nor the wait list groups did.

 

Hence the results indicated that meditation training improved short-term memory in adolescents. This adds to the prior results that mindfulness improved working memory in college students and suggests that meditation practice may be an effective method to improve an important component of students’ memories, working memory. This should, in turn, improve cognitive abilities such as problem solving, mathematics, etc. and improve school performance in general. But, future research will be required to confirm this speculation.

 

Meditation training improves attentional ability and present moment awareness and reduces mind wandering. These effects of meditation may well account for the improved working memory. By simply being able to concentrate better on the material and stay on task more will be entered into memory and less lost. Also, meditation training has also been shown to increase the size of brain areas involved in memory. This structural change in the nervous system might also underlie the improved working memory. Regardless of the mechanism it appears clear that meditation practice can lead to improved working memory in high school and college students.

 

So, mindfully improve memory.

 

“Life is all memory, except for the one present moment that goes by you so quickly you hardly catch it going.” — Tennessee Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Mindfully Improve Thinking after Recovery from Cancer

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“You can be a victim of cancer, or a survivor of cancer. It’s a mindset.” – Dave Pelzer

 

Cancer diagnosis is not a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly improving. With breast cancer about 80% survive at least 5 years and the earlier the diagnosis the better the survival rate. With colorectal cancer about 50% survive at least 5 years and again the earlier the diagnosis the better the survival rate.  It is estimated that 14,483,830 adults and children with a history of cancer alive in the United States today. So, there are a vast number of cancer survivors.

 

Surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day. Unfortunately, most of these residual problems go untreated. Psychologically, cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.

 

Less well known is that cancer survivors frequently suffer from residual cognitive impairments that affect the majority of survivors and can last for many years. These include problems with attention, including divided attention and multitasking, memory, including short and long-term memory and retrieval, and executive function. These impairments in the ability to think and the extra energy needed for routine cognitive activities can increase fatigue over the day.

 

Mindfulness has been shown to help with cancer recovery and help to alleviate many of the residual psychological symptoms (see http://contemplative-studies.org/wp/index.php/category/research-news/cancer/) and it has been shown to improve cognitive function (see http://contemplative-studies.org/wp/index.php/category/research-news/cognition/).  So, it would seem reasonable to postulate that mindfulness might help in alleviating the cognitive impairments occurring in cancer survivors.

 

In today’s Research News article “Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1142698709087387/?type=3&theater

Johns and colleagues examined the effect of an 8-week Mindfulness-based stress reduction (MBSR) program on cognitive function in cancer survivors and compared it to an 8-week Education and Support (ES) program involving comparable amounts of time. They found that the MBSR group in comparison to the ES group showed greater improvements in overall attentional function, particularly with effective action and attentional lapses. The MBSR group also showed greater improvement in ability to cope with cognitive interference as measured by the classic Stroop test. These improvements were lasting as they were still present 6-months after the conclusion of treatment.

 

These are exciting results as they are in comparison to an active control condition and they suggest that MBSR is an effective treatment for the cognitive impairments in cancer recovery patients. There are a number of explanations for how MBSR might produce these improvements. MBSR targets stress and has been shown to effectively reduce psychological and physiological stress responses. This stress reduction could greatly help the survivors deal with their residual problems. MBSR also markedly improves attention, particularly present moment attention. This may fairly directly help improve cognitive function. MBSR also improves emotion regulation. This may make the survivors better able to cope with the emotional sequela of cancer recovery. Finally, MBSR has been shown to improve cognitive function in healthy individuals and may simply be improving overall cognitive function and not specifically treating the cognitive symptoms of cancer recovery.

 

Regardless of the explanation, it is clear that mindfulness training is effective in alleviating the cognitive problems following recovery from cancer.

 

So, improve thinking after recovery from cancer with mindfulness.

 

“Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” – Jim Valvano

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Reduce Symptoms in Breast Cancer Survivors with Mindfulness

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“Health is a state of complete harmony of the body, mind and spirit. When one is free from physical disabilities and mental distractions, the gates of the soul open.”  ~B.K.S. Iyengar

 

About 12.5% of women in the U.S. develop invasive breast cancer over their lifetimes and every year about 40,000 women die. Indeed, more women in the U.S. die from breast cancer than from any other cancer, besides lung cancer. It is encouraging, however, that the death rates have been decreasing for decades from improved detection and treatment of breast cancer. Five-year survival rates are now at around 95%.

 

The improved survival rates mean that more women are now living with cancer. This can be difficult as breast cancer survivors can have to deal with the consequences of chemotherapy, and often experience increased fatigue, pain, and bone loss, reduced fertility, difficulty with weight maintenance, damage to the lymphatic system, heightened fear of reoccurrence, and an alteration of their body image. With the loss of a breast or breasts, scars, hair shedding, complexion changes and weight gain or loss many young women feel ashamed or afraid that others will reject or feel sorry for them. As a result, survivors often develop psychological symptoms of stress, anxiety, depression, and impaired cognitive functioning. These consequences of breast cancer can be grouped into three categories, gastrointestinal, cognitive/psychological, and pain and fatigue.

 

Mindfulness practices have been shown to be beneficial in cancer recovery (see http://contemplative-studies.org/wp/index.php/category/research-news/cancer/) and particularly with recovery from breast cancer (see http://contemplative-studies.org/wp/index.php/2015/08/29/live-more-effectively-with-breast-cancer-with-mindfulness/ and http://contemplative-studies.org/wp/index.php/2015/09/09/beating-radiotherapy-for-cancer-with-mindfulness/). But, these practices can produce varying results depending upon the peculiarities of the patient. It would be helpful for potentiating the effectiveness of mindfulness practices applied to breast cancer survivors if markers could be found which could identify those who were likely to respond favorably to mindfulness training from those who would not. Markers in the immune system are likely candidates. Breast cancer treatment and the sequela produce considerable stress in the survivor. Stress produces a robust response in the immune system and mindfulness training has been shown to reduce stress and the immune system response. So, it would make sense that immune system markers of the stress response might be predictors of mindfulness training efficacy.

 

In today’s Research News article “Immune Biomarkers as Predictors of MBSR(BC) Treatment Success in Off-Treatment Breast Cancer Patients”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1132703630086895/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604564/

Reich and colleagues looked for immune system markers which identify mindfulness training responders among breast cancer survivors. They took blood samples for lymphocyte analysis and then trained half the women with a modified Mindfulness Based Stress Reduction program that was specifically designed to be appropriate for breast cancer (MBSR)[BC]. The second half of the women were used as a wait list control group. They found that the mindfulness training produced decreases in all three symptom clusters, gastrointestinal, cognitive/psychological, and pain and fatigue. They found that there were significant immune system markers. But, they were different for the three symptom clusters. B-lymphocytes and interferon-γ were the strongest predictors of gastrointestinal improvement, +CD4+CD8 were the strongest predictor of cognitive/psychological improvement, while lymphocytes and interleukin (IL)-4 were the strongest predictors of fatigue improvement.

 

These results are interesting and potentially important. They are further evidence that the stress reduction produced by mindfulness training is important in dealing with the symptoms of breast cancer survival. They also suggest that immune system markers may be significant predictors for response to mindfulness training. The fact that there were different markers for different symptom clusters, however, muddies the waters, making the markers useful for certain women who have heightened symptoms in particular areas. Regardless, it is clear that mindfulness training is an effective treatment for the symptoms present after successful treatment of breast cancer and potentially markers which can identify potential responders may be possible.

 

So, it is increasing clear that mindfulness is an effective treatment for residual symptoms in breast cancer survivors.

 

“The root of all health is in the brain. The trunk of it is in emotion. The branches and leaves are the body. The flower of health blooms when all parts work together.” ~Kurdish Saying

 

CMCS – Center for Mindfulness and Contemplative Studies