Improve Physical and Psychological Symptoms and Quality of Life in People Living with HIV with Mind-Body Practices

Improve Physical and Psychological Symptoms and Quality of Life in People Living with HIV with Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“Our bodies and minds are intimately connected. Living with HIV can be stressful and can challenge our emotional well-being. Similarly, stress and anxiety can affect our bodies. So maintaining “a healthy mind in a healthy body” is key.” – CATIE

 

More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development a 20-year-old infected with HIV can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people. People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include chronic pain, muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, and the challenge to come to terms with a new identity as someone living with HIV.

 

Mindfulness training has been found to be effective in treating chronic pain conditions. In addition, mindfulness training has been shown to improve psychological well-being, lower depression and strengthen the immune system of patients with HIV infection. The research and evidence is accumulating. Hence it makes sense to stop and summarize the research on the ability of mind-body practices to help relieve the symptoms of patients living with HIV.

 

In today’s Research News article “Mind-body practices for people living with HIV: a systematic scoping review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560810/ ), Ramirez-Garcia and colleagues review and summarize the published research studies of the effectiveness of mind-body practices for the treatment of the symptoms of HIV infection. “Mind-body practices include Tai Chi, Qigong, yoga, meditation, and all types of relaxation” training. They identified 84 published research studies.

 

They report that these studies found that for patients with HIV, Mindfulness-Based Stress Reduction (MBSR) decrease the physical symptoms and the side effects of the drug treatment, and improves the patient’s psychological state. They also report that Cognitive Behavioral Therapy and the combining at least three relaxation techniques decreases the patient’s physical and psychological symptoms, and increase quality of life and health. Yoga practice was also found to lower the patient’s blood pressure. Tai Chi, Qigong, and relaxation techniques were found to improve the patient’s physical and psychological condition.

 

Hence the accumulated research suggests that mind-body therapies in addition to antiretroviral treatment are safe and effective treatments to improve the health, well-being, and quality of life of patients living with HIV. This is important as these patients will be living for many years with the symptoms of HIV and the side effects of its treatment. The addition of mind-body practices can help make living with HIV more tolerable and improve the patients’ lives.

 

So, improve physical and psychological symptoms and quality of life in people living with HIV with Mindbody practices.

 

“Living a healthy lifestyle can help you better control HIV and prevent the progression to AIDS. Eating a healthy diet and maintaining a healthy body weight, exercising regularly, practicing safe sex, and following your medicine regimen are all important steps in managing HIV.” – Johns Hopkins Health

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Ramirez-Garcia, M. P., Gagnon, M. P., Colson, S., Côté, J., Flores-Aranda, J., & Dupont, M. (2019). Mind-body practices for people living with HIV: a systematic scoping review. BMC complementary and alternative medicine, 19(1), 125. doi:10.1186/s12906-019-2502-z

 

Abstract

Background

Mind-body practices are frequently used by people living with HIV to reduce symptoms and improve wellbeing. These include Tai Chi, Qigong, yoga, meditation, and all types of relaxation. Although there is substantial research on the efficacy of mind-body practices in people living with HIV, there is no summary of the available evidence on these practices. The aim of this scoping review is to map available evidence of mind-body practices in people living with HIV.

Methods

The Arksey and O’Malley (Int J Soc Res Methodol 8:19-32, 2005) methodological framework was used. A search of 16 peer-review and grey literature databases, websites, and relevant journals (1983–2015) was conducted. To identify relevant studies, two reviewers independently applied the inclusion criteria to all abstracts or full articles. Inclusion criteria were: participants were people living with HIV; the intervention was any mind-body practice; and the study design was any research study evaluating one or several of these practices. Data extraction and risk of bias assessment were performed by one reviewer and checked by a second, as needed, using the criteria that Cochrane Collaboration recommends for systematic reviews of interventions (Higgins and Green, Cochrane handbook for systematic reviews of intervention. 2011). A tabular and narrative synthesis was carried out for each mind-body practice.

Results

One hundred thirty-six documents drawing on 84 studies met the inclusion criteria. The most widely studied mind-body practice was a combination of least three relaxation techniques (n = 20), followed in declining order by meditation (n = 17), progressive muscle relaxation (n = 10), yoga (n = 9) and hypnosis (n = 8). Slightly over half (47/84) of studies used a RCT design. The interventions were mainly (46/84) conducted in groups and most (51/84) included daily individual home practice. All but two studies were unblinded to participants.

Conclusion

The amount of available research on mind-body practices varies by practice. Almost half of the studies in this review were at high risk of bias. However, mindfulness, a combination of least three relaxation techniques and cognitive behavioral strategies, and yoga show encouraging results in decreasing physical and psychological symptoms and improving quality of life and health in people living with HIV. More rigorous studies are necessary to confirm the results of Tai Chi, Qigong, and some relaxation techniques.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560810/

 

Improve Caregiver Psychological Health by Changing the Brain Response with Mindfulness

Improve Caregiver Psychological Health by Changing the Brain Response with Mindfulness

 

By John M. de Castro, Ph.D.

 

“We are set up for short-term stress, but caregiving is long-term stress. Mindfulness is basically coming back into the present moment, so it works to inhibit the stress response. Most of us run around listening to our thoughts, and this is particularly true of caregivers, who are driven by the to-do list. They are never at rest.” – Joan Griffiths Vega

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Caregiving for dementia patients is a daunting intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. This places tremendous psychological and financial stress on the caregiver. Hence, there is a need to both care for the dementia patients and also for the caregivers. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In addition, mindfulness training has been found to help protect aging individuals from physical and cognitive declines.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity.  Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread area. and have found that meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

In today’s Research News article “Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530345/), Jain and colleagues recruited dementia caregivers (91% female) and provided for them either 4 weeks of mindfulness training or 4 weeks of relaxation training. Training occurred in a once a week meeting along with home practice. The participants were measured before and after training for grief, depression, and mindfulness. They then had brain scans performed with functional Magnetic Resonance Imaging (fMRI) while they viewed pictures of their loved one with dementia or a stranger with the pictures labelled with either grief related words, e.g. disease, dementia, and sick or with neutral words e.g. village, planter and curve.

 

They found that at baseline grief and depression levels were high and strongly related. They also found that the higher the levels of mindfulness the lower the levels of grief and depression. After mindfulness training there were reductions in grief and depression and increases in mindfulness. These findings are similar to previous research of improvements in the mental health of caregivers after mindfulness training.

 

Interestingly, in comparison to pictures of strangers, when showed pictures of their loved ones with dementia the caregivers showed increases in brain activation in the dorsal anterior cingulate gyrus and precuneus. Viewing grief related words results in increased activity in the medial prefrontal cortex. The greater the decreases in grief following training the greater the activation of the medial prefrontal cortex and precuneus.

 

The structures showing activation to the caregiver’s loved one all are components of what is called the default mode network which is involved in self-referential thinking and thinking about others. It would appear that the mindfulness training resulted in greater thinking about the dementia patient and the self when viewing a picture of the patient. This may be reflective of heightened compassion for the self and the patient. This in turn, may produce improvements in the caregivers mental health.

 

So, improve caregiver psychological health by changing the brain response with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

“By focusing on the fact that families and communities are producers of health and health care, not just clients or consumers, it empowers families and communities to co-create health interventions,” – Alicia Bazzano

 

Study Summary

 

Jain, F. A., Connolly, C. G., Moore, L. C., Leuchter, A. F., Abrams, M., Ben-Yelles, R. W., … Iacoboni, M. (2019). Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers. Frontiers in human neuroscience, 13, 155. doi:10.3389/fnhum.2019.00155

 

Abstract

Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement.

Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable.

Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = −0.70, p = 0.0002; r = −0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus.

Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530345/

Relaxation and Mindfulness Training Have Differing Psychological and Neural Effects

Relaxation and Mindfulness Training Have Differing Psychological and Neural Effects

 

By John M. de Castro, Ph.D.

 

“this practice of nonjudgmental self-awareness is one of the most effective ways to improve mood and anxiety.” – Neda Gould

 

Mindfulness training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. As a result, mindfulness training has been called the third wave of therapies. One problem with understanding mindfulness training effects is that there are, a wide variety of mindfulness techniques and it is not known which work best for improving different conditions.

 

There are a number of different types of meditation. Many can be characterized on a continuum with the degree and type of attentional focus. In focused attention meditation, the individual practices paying attention to a single meditation object, learns to filter out distracting stimuli, including thoughts, and learns to stay focused on the present moment, filtering out thoughts centered around the past or future. In open monitoring meditation, the individual opens up awareness to everything that’s being experienced regardless of its origin. These include bodily sensations, external stimuli, and even thoughts.

 

These techniques have common properties of restful attention on the present moment, but there are large differences. These differences are likely to produce different effects on the practitioner. One way to distinguish between the effects of these different meditation techniques is to observe the effects of each technique on the brain.  In today’s Research News article “Common and Dissociable Neural Activity After Mindfulness-Based Stress Reduction and Relaxation Response Programs.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976535/ ), Sevinc and colleagues recruited adults and randomly assigned them to receive 8 weekly 2-hour group sessions with 20 minutes of daily home practice with guided recordings of either a Relaxation Response program or a Mindfulness-Based Stress Reduction (MBSR) program.

 

In the Relaxation Response program, the participants practiced a body scan with emphasis on relaxation and focused meditation on the breath in a 20-minute session. In the MBSR program the participants practiced body scan with focus on awareness of the sensations from the body for 2 weeks, yoga for 2 weeks, and open monitoring meditation for 2 weeks. The last 2 weeks the participants could chose whichever of the practices they wanted to perform. They were measured before and after training for perceived stress, mindfulness, self-compassion, rumination, and life stressors. They also underwent Magnetic Resonance Imaging (MRI) while they listened to a guided recording for the body scan from their home practices.

 

They found that both practices equivalently reduced perceived stress and increased mindfulness. But the Mindfulness-Based Stress Reduction (MBSR) program also significantly increased self-compassion and decreased rumination. Interestingly, although both practices produced increases functional connectivity between the prefrontal cortex and motor cortex, the two practices also produced different connectivities. When the body scan was practiced with emphasis on relaxation there was increased functional connectivity was with the right inferior frontal gyrus. This is an area that’s involved in behavioral inhibition. On the other hand, when the body scan was practiced with emphasis on awareness of sensations there was increased functional connectivity between the Insula and Cingulate Cortex, areas associated with sensory awareness.

 

Hence, although both practices were beneficial, the MBSR program appears to create better psychological well-being. In addition, the body scan technique used in the MBSR program, emphasizing sensory awareness, appears to increase the connectivity between brain areas that are involved in sensory awareness. On the other hand, a relaxation instruction with the body scan appears to produce increased brain systems devoted to restraining responses. Different mindfulness techniques produced different psychological and neural outcomes. Both appear to improve stress responding and mindfulness, but the MBSR program also produces better compassion for the self and less repetitive negative thinking, rumination.

 

So, there may be a place for the relaxation response program, but with these otherwise healthy adults, the Mindfulness-Based Stress Reduction (MBSR) program appears to produce superior results.

 

 “If you have unproductive worries,” you can train yourself to experience those thoughts completely differently. “You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self,’” – Elizabeth Hoge

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Sevinc, G., Hölzel, B. K., Hashmi, J., Greenberg, J., McCallister, A., Treadway, M., … Lazar, S. W. (2018). Common and Dissociable Neural Activity After Mindfulness-Based Stress Reduction and Relaxation Response Programs. Psychosomatic Medicine, 80(5), 439–451. http://doi.org/10.1097/PSY.0000000000000590

 

ABSTRACT

Objective

We investigated common and dissociable neural and psychological correlates of two widely used meditation-based stress reduction programs.

Methods

Participants were randomized to the Relaxation Response (RR; n = 18; 56% female) or the Mindfulness-Based Stress Reduction (MBSR; n = 16; 56% female) programs. Both programs use a “bodyscan” meditation; however, the RR program explicitly emphasizes physical relaxation during this practice, whereas the MBSR program emphasizes mindful awareness with no explicit relaxation instructions. After the programs, neural activity during the respective meditation was investigated using functional magnetic resonance imaging.

Results

Both programs were associated with reduced stress (for RR, from 14.1 ± 6.6 to 11.3 ± 5.5 [Cohen’s d = 0.50; for MBSR, from 17.7 ± 5.7 to 11.9 ± 5.0 [Cohen’s d = 1.02]). Conjunction analyses revealed functional coupling between ventromedial prefrontal regions and supplementary motor areas (p < .001). The disjunction analysis indicated that the RR bodyscan was associated with stronger functional connectivity of the right inferior frontal gyrus—an important hub of intentional inhibition and control—with supplementary motor areas (p < .001, family-wise error [FWE] rate corrected). The MBSR program was uniquely associated with improvements in self-compassion and rumination, and the within-group analysis of MBSR bodyscan revealed significant functional connectivity of the right anterior insula—an important hub of sensory awareness and salience—with pregenual anterior cingulate during bodyscan meditation compared with rest (p = .03, FWE corrected).

Conclusions

The bodyscan exercises in each program were associated with both overlapping and differential functional coupling patterns, which were consistent with each program’s theoretical foundation. These results may have implications for the differential effects of these programs for the treatment of diverse conditions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976535/