Improve Adolescent Emotion Regulation and Mental Health with Mindfulness

August 13, 2019 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“But a growing body of evidence suggests that mindfulness practice could be beneficial to teens, helping them cultivate empathy, as well as skills for concentration and impulse control. In short, mindfulness can help adolescents navigate the challenges of adolescence.” – Sarah Rudell Beach

Adolescence is a time of mental, physical, social, and emotional growth. But adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. Indeed, up to a quarter of adolescents suffer from depression or anxiety disorders, and an even larger proportion struggle with subclinical symptoms.

Mindfulness training in adults has been shown to reduce anxiety, depression, and perceived stress levels and improve emotional regulation. In addition, in adolescents it has been shown to improve emotion regulation and to benefit the psychological and emotional health. There is a need to explore the relationship between these effects of mindfulness training in adolescents.

In today’s Research News article “Adolescents’ Mindfulness and Psychological Distress: The Mediating Role of Emotion Regulation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567674/), Ma and Fang recruited middle school students between the ages of 12-18 years and had them complete scales measuring mindfulness, anxiety, depression, perceived stress, difficulties with emotion regulation, and emotion regulation.

They found that the higher the levels of mindfulness, the lower the levels of anxiety, depression, perceived stress, and difficulties with emotion regulation, including all subscales; “lack of emotional clarity (Clarity), difficulty in engaging in goal-directed behavior under negative emotions (Goals), loss of control under negative emotions (Impulse), limited strategies for emotion regulation (Strategies), and non-acceptance of emotional responses (Non-acceptance).” Using a mediation model, they found that high levels of mindfulness were related to lower levels of anxiety, depression, and perceived stress directly and indirectly as a results of mindfulness’ negative relationship with difficulties with emotion regulation. In other words, mindfulness was directly related to lower levels of psychological distress and also indirectly by its relationship with lower levels of difficulties with emotion regulation which were in turn related to less psychological distress.

The study is correlational and as such causation cannot be concluded. But prior research has demonstrated that mindfulness causes reductions in anxiety, depression, perceived stress, and difficulties with emotional regulation. Hence, it would be reasonable to conclude that the present findings were also due to the effects of mindfulness on psychological health.

Adolescence is a time of strong emotions that the adolescents have not yet learned how to effectively regulate. This makes this period of life very difficult with high levels of emotional distress. The finding though indicate that mindfulness may be a way to mitigate the emotional upheavals of adolescence of improve the psychological health of the teens by improving their ability to deal with their emotions.

So, improve adolescent emotion regulation and mental health with mindfulness.

“Mindfulness teaches teenagers to recognize the downward spiral of thoughts before it gets out of hand, perhaps learning to label it as simply “worrying.” They can acknowledge the anxiety without getting caught up in it, without it leading to the rumination that ultimately ruins their mood.” – Sarah Rudell Beach

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

Ma, Y., & Fang, S. (2019). Adolescents’ Mindfulness and Psychological Distress: The Mediating Role of Emotion Regulation. Frontiers in psychology, 10, 1358. doi:10.3389/fpsyg.2019.01358

Abstract

Mindfulness has been widely linked with psychological well-being in general population. There are emerging studies supporting the relationship between adolescents’ mindfulness and their mental health. However, the mechanisms through which mindfulness may influence adolescents’ psychological distress have only recently been explored, and more related research is still needed. This study investigated the relationship between adolescents’ dispositional mindfulness and psychological symptoms of depression, anxiety and stress. The mediating variables were also explored in perspective of two common emotion regulation theories, which were measured through Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ). DERS has been used as a comprehensive assessment of emotion regulation difficulties. ERQ is also widely accepted to measure the emotion regulation process including dimensions of cognitive reappraisal and expressive suppression. Measures assessing mindfulness, emotion regulation, and psychological distress were administered to 1067 adolescents in mainland China. The results confirmed that adolescents’ dispositional mindfulness was negatively associated with depression, anxiety, and stress. DERS, especially the sub-dimensions of Acceptance and Strategies, significantly mediated the relationship between mindfulness and symptoms of depression, anxiety and stress. Whereas, ERQ including subscales of cognitive reappraisal and expressive suppression exerted limited mediating effect. These findings provided insights for the potential underlying mechanism between adolescents’ mindfulness and psychological distress, demonstrating that DERS might be more pervasive than ERQ. Further research was suggested to explore other mediating variables underlying mindfulness and psychological distress among adolescents and develop mindfulness-based programs to improve adolescents’ mindfulness and emotion regulation ability.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567674/

Improve Children and Adolescents Mental Health with Mindfulness

August 9, 2019 psyjdc Leave a comment

Improve Children and Adolescents Mental Health with Mindfulness

By John M. de Castro, Ph.D.

“In the last few years mindfulness has emerged as a way of treating children and adolescents with conditions ranging from ADHD to anxiety, autism spectrum disorders, depression and stress. And the benefits are proving to be tremendous.” – Julianne Garey

Childhood is a miraculous period during which the child is dynamically absorbing information from every aspect of its environment. This occurs almost without any intervention from the adults as the child appears to be programmed to learn. It is here that behaviors, knowledge, skills, and attitudes are developed that shape the individual.

Adolescence is a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops. But adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required.

Mindfulness training for children and adolescents has been shown to have very positive effects. These include academic, cognitive, psychological, and social domains. Mindfulness training has been shown to improve emotion regulation and to benefit the psychological and emotional health of adolescents. Importantly, mindfulness training with children and adolescents appears to improve the self-concept, improves attentional ability and reduces stress. The research findings and evidence are accumulating. So, it makes sense to step back and review and summarize what has been learned regarding the effectiveness of mindfulness training for the cognitive growth and mental health and well-being of children and adolescents.

In today’s Research News article “Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents – a meta-analysis of randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546608/), Dunning and colleagues review, summarize and perform a meta-analysis of randomized controlled trials of the effects of mindfulness training on the cognitive ability, psychological health, and well-being of children and adolescents. They identified 33 published randomized controlled trials, 17 of which had active control conditions.

They found that over all published studies, mindfulness training resulted in improved cognition and executive function, with larger effects for older children and adolescents. Mindfulness training also produced significantly increased mindfulness and decreased negative behaviors, stress, anxiety and depression. increased mindfulness and decreased stress, anxiety and depression were still significant. But when mindfulness practices were compared to active control conditions cognitive improvements were no longer significant but there were still significant increases in mindfulness and decreases in stress, anxiety and depression.

These results are interesting and suggest that mindfulness training produces significant improvements in the mental health of children and adolescents. The results, however, suggest that reported improvements in cognition and behavior may be due to placebo or experimenter bias effects as these same improvements occurred with active control conditions. The improvements in cognitive ability appears to be maximized in adolescents when high level executive functions are developing. The lack of significant effects in studies with active control conditions may have been due to the small number of studies, 7, that had active controls and studied cognition.

Regardless, the accumulated research suggests that training children and adolescents in mindfulness may help them navigate the difficult emotional challenges confronting them during development.

So, improve children and adolescents’ mental health with mindfulness.

“For children, mindfulness can offer relief from whatever difficulties they might be encountering in life. It also gives them the beauty of being in the present moment.” – Annaka Harris

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

Dunning, D. L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J., & Dalgleish, T. (2019). Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents – a meta-analysis of randomized controlled trials. Journal of child psychology and psychiatry, and allied disciplines, 60(3), 244–258. doi:10.1111/jcpp.12980

Abstract

Background

Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design.

Methods

A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition.

Results

Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen’s d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only.

Conclusions

This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

Key points

Mindfulness based interventions (MBIs) are a popular way of attempting to improve the mental and physical health outcomes of children and adolescents.
This is the first meta-analysis of MBIs with youth composed exclusively of randomized controlled trials (RCTs) including RCTs with active control groups – the gold standard in intervention studies.
When using the gold standard research design results showed that MBIs are useful in improving Depression and Anxiety outcomes, but not behavioural or cognitive outcomes,
The meta-analysis advocates the use of MBIs for improving mental health in young people.
Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546608/

Increase Positive Emotions and Decrease Emotional Disturbance in Adolescents with Meditation

August 5, 2019 psyjdc Leave a comment

Increase Positive Emotions and Decrease Emotional Disturbance in Adolescents with Meditation

By John M. de Castro, Ph.D.

“Adolescence is a time of change and growth. It is the period of life reserved for rebellion and self-discovery, but as the demands in life increase for teens, this time is often fraught with confusion, anxiety or depression. For many teens these challenges lead to disconnection and isolation.” – Making Friends with Yourself

Mindfulness training has been shown in adolescents to improve emotion regulation and to benefit the psychological and emotional health. Since adolescent girls are more likely to have emotional issues than boys, it would seem reasonable to hypothesize that mindfulness would have greater psychological benefits for adolescent girls than for boys.

In today’s Research News article “Gender differences in response to a school-based mindfulness training intervention for early adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174072/), Kang and colleagues recruited male and female 6^th grade students and randomly assigned them to receive a school-based, 6-week program, 4-5 times per week for, on average, 5 minutes per day of either guided meditations or brief lessons on African history. Before and after training the students were measured for global emotional disturbance, positive emotions, mindfulness, and self-compassion.

They found that in comparison to baseline and the active controls, the adolescents who meditated had significantly higher positive emotions and significantly lower global emotional disturbance. For males there were significant increases in positive emotions for both groups while for females there were significant increases in positive emotions only for the meditation group. A similar trend was present for global emotional disturbance. In addition, they found that for females the higher the levels of self-compassion the higher the levels of positive emotions and the lower the levels of global emotional disturbance. This was not true for males.

The results appear to show that meditation training is particularly effective in improving emotions in female but not male adolescents. But the difference was not in the meditation condition but rather in the control condition. Whereas the female controls did not show any improvement in emotions while the meditation group improved. For the males, both groups improved. So, both males and female adolescents had improved emotions following 6-weeks of meditation practice. Adolescents is a turbulent time with strong emotions. The present results suggest that providing meditation training in school may be helpful in controlling and leveling these emotions.

So, increase positive emotions and decrease emotional disturbance in adolescents with meditation.

“Adolescence is a developmental moment of peak stress, and a teen’s heightened self-consciousness (“Do I look weird? Did I just sound stupid in class?”) cranks up the volume of the inner critic. Self-compassion encourages mindfulness, or noticing your feelings without judgment; self-kindness, or talking to yourself in a soothing way; and common humanity, or thinking about how others might be suffering similarly.” – Rachel Simmons

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

Kang, Y., Rahrig, H., Eichel, K., Niles, H. F., Rocha, T., Lepp, N. E., … Britton, W. B. (2018). Gender differences in response to a school-based mindfulness training intervention for early adolescents. Journal of school psychology, 68, 163–176. doi:10.1016/j.jsp.2018.03.004

Abstract

Mindfulness training has been used to improve emotional wellbeing in early adolescents. However, little is known about treatment outcome moderators, or individual differences that may differentially impact responses to treatment. The current study focused on gender as a potential moderator for affective outcomes in response to school-based mindfulness training. Sixth grade students (N = 100) were randomly assigned to either the six weeks of mindfulness meditation or the active control group as part of a history class curriculum. Participants in the mindfulness meditation group completed short mindfulness meditation sessions four to five times per week, in addition to didactic instruction (Asian history). The control group received matched experiential activity in addition to didactic instruction (African history) from the same teacher with no meditation component. Self-reported measures of emotional wellbeing/affect, mindfulness, and self-compassion were obtained at pre and post intervention. Meditators reported greater improvement in emotional wellbeing compared to those in the control group. Importantly, gender differences were detected, such that female meditators reported greater increases in positive affect compared to females in the control group, whereas male meditators and control males displayed equivalent gains. Uniquely among females but not males, increases in self-reported self-compassion were associated with improvements in affect. These findings support the efficacy of school-based mindfulness interventions, and interventions tailored to accommodate distinct developmental needs of female and male adolescents.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6174072/

Produce Long-Term Improvements in Depression and Insulin Resistance in Adolescents with Mindfulness

June 26, 2019 psyjdc Leave a comment

Produce Long-Term Improvements in Depression and Insulin Resistance in Adolescents with Mindfulness

By John M. de Castro, Ph.D.

“So like with so many topics related to type 2 diabetes, insulin resistance can be avoided, and reversed, through living healthfully and mindfully.” – Defeat Diabetes Foundation

Diabetes is a major health issue. It is estimated that 30 million people in the United States and nearly 600 million people worldwide have diabetes and the numbers are growing. Type II Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. 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.

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. This suggests that mindfulness training may be able to reduce insulin resistance in adolescents at risk for Type II diabetes.

In today’s Research News article “One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01040/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_990182_69_Psycho_20190516_arts_A), Shomaker and colleagues recruited overweight and obese adolescent girls (12-17 years of age) with a family history of Type II Diabetes. They were randomly assigned to receive a 6-week program of either a mindfulness-based intervention (MBI) or a cognitive behavioral therapy (CBT) depression prevention. They were measured before and after the interventions and 1-year later for mindfulness, insulin resistance, depression, body size, and body fat.

They found that 1 year after the interventions only the mindfulness group had significant improvement in insulin resistance. Although both groups had significant decreases in depression, the mindfulness group had significantly greater decreases than the CBT group. These findings are consistent with prior findings by this research group. But these results demonstrate that the effectiveness of mindfulness training is lasting. This suggests that mindfulness training should be recommended for adolescent girls who are overweight and obese and with a family history of Type II Diabetes. This may prevent the onset of type II diabetes in this at-risk group.

So, produce long-term improvements in depression and insulin resistance in adolescents with mindfulness.

“Research shows that meditation actually helps the body regulate blood sugar by using insulin more efficiently. The stress hormone cortisol is a major contributor to insulin resistance, and meditation leads to lower cortisol levels, which in turn allows insulin to do its job properly.” – Avi Craimer

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

Shomaker LB, Pivarunas B, Annameier SK, Gulley L, Quaglia J, Brown KW, Broderick P and Bell C (2019) One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance. Front. Psychol. 10:1040. doi: 10.3389/fpsyg.2019.01040

Introduction: To explore if a brief mindfulness-based intervention (MBI) leads to sustained, improved clinical outcomes in adolescents at-risk for type 2 diabetes (T2D).

Methods: Participants were 12–17y girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioral therapy (CBT) group. At baseline and 1-year, mindfulness, depression, insulin resistance (IR), and body composition were assessed with validated instruments.

Results: One-year retention was 71% (n = 12) in MBI; 81% (n = 13) in CBT. At 1-year, depression decreased (Cohen’s d = 0.68) and IR decreased (d = 0.73) in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI.

Discussion: One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and IR in at-risk adolescents. Replication and exploration of mechanisms within the context of a larger clinical trial are necessary.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01040/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_990182_69_Psycho_20190516_arts_A

Reduce Stress and Enhance Academic Buoyancy in Adolescents with Online Acceptance and Commitment Therapy

May 11, 2019 psyjdc Leave a comment

Reduce Stress and Enhance Academic Buoyancy in Adolescents with Online Acceptance and Commitment Therapy

By John M. de Castro, Ph.D.

Mindfulness training in adults has been shown in adolescents to improve emotion regulation and to benefit the psychological and emotional health. A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

The original form of Acceptance and Commitment Therapy (ACT), however, required a certified trained therapist. This resulted in costs that many clients couldn’t afford. In addition, the participants had to be available to attend multiple sessions at particular scheduled times that were not always compatible with busy schedules and at locations that were not always convenient. As an alternative, mindfulness-based treatments delivered over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the effectiveness of ACT for adolescents when delivered over the internet.

In today’s Research News article “Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394525/ ), Puolakanaho and colleagues recruited adolescents in the 9^th grade and randomly assigned them to receive a 5-week online program of Acceptance and Commitment Therapy (ACT) or to a no-treatment control condition. They were measured before and after the program for academic skills, reading fluency, math skills, stress, school stress, and academic buoyancy. Academic buoyancy “refers to a student’s capacity to overcome everyday academic life setbacks and challenges successfully.”

They found that 76% of the participants completed the Acceptance and Commitment Therapy (ACT) program. They found that in comparison to baseline and the no-treatment controls that ACT produced a significant reduction in overall stress levels and a significant increase in academic buoyancy. These findings suggest that ACT can be taught online to adolescents and successfully promote their ability to withstand the stress of adolescence and to promote their ability to overcome the challenges of school.

So, reduce stress and enhance academic buoyancy in adolescents with online acceptance and commitment therapy.

“mindfulness is uniquely able to help adolescents navigate this time of growing autonomy, more complicated life challenges and heightened reactivity to stressors in their lives.” – Karen Pace

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

Puolakanaho, A., Lappalainen, R., Lappalainen, P., Muotka, J. S., Hirvonen, R., Eklund, K. M., Ahonen, T., … Kiuru, N. (2018). Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial. Journal of youth and adolescence, 48(2), 287-305.

Abstract

Acceptance and commitment therapy programs have rarely been used as preventive tools for alleviating stress and enhancing coping skills among adolescents. This randomized controlled trial examined the efficacy of a novel Finnish web- and mobile-delivered five-week intervention program called Youth COMPASS among a general sample of ninth-grade adolescents (n= 249, 49% females). The intervention group showed a small but significant decrease in overall stress (between-group Cohen’s d = 0.22) and an increase in academic buoyancy (d= 0.27). Academic skills did not influence the intervention gains, but the intervention gains were largest among high-stressed participants. The results suggest that the acceptance and commitment based Youth COMPASS program may be well suited for promoting adolescents’ well-being in the school context.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394525/

Promote Well-Being in Adolescents with Spirituality

May 2, 2019February 21, 2021 psyjdc Leave a comment

Promote Well-Being in Adolescents with Spirituality

By John M. de Castro, Ph.D.

“Call it faith. Call it spirituality. Call it zealotry. Our consciousness creates the reality that reflects it. If we feel apart, other, afraid, and deadened, we will live in a world that reflects and perpetuates these energies.” – Kelly Brogan

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. ”Spirituality has been promulgated as a solution to the challenges of life both in a transcendent sense and in a practical sense. The transcendent claims are untestable with the scientific method. But the practical claims are amenable to scientific analysis. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health.

It makes sense, then, to investigate the influence of spirituality on the ability of youths to navigate this difficult time and develop positive qualities and better mental health. In today’s Research News article “A Longitudinal Study of Spirituality, Character Strengths, Subjective Well-Being, and Prosociality in Middle School Adolescents.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00377/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_925884_69_Psycho_20190305_arts_A ), Kor and colleagues recruited adolescents aged 13 to 17 years and had them complete scales at baseline and 3 and 14 months later measuring character strength, optimism, spirituality, religiosity, transcendence, devotion, positive and negative emotions, life satisfaction, and prosociality.

They found that spirituality in adolescents was composed of spirituality, religiosity, transcendence, and devotion and was relatively stable over the 14-month measurement period. They found that the higher the levels of spirituality, the greater the levels of character strength, life satisfaction, positive emotions, and prosocial behaviors over all three measurement time points.

These findings are interesting but correlational. So, conclusions regarding causation cannot be reached. But the findings suggest that, surprisingly, spirituality does not fluctuate greatly over time in adolescents. They also suggest that spirituality is associated with a relatively satisfying and happy life that is engaged positively with other people. Hence, spirituality would appear to be a positive factor that is helpful to youths in maintaining well-being over the turbulent time of adolescence.

So, promote well-being in adolescents with spirituality.

“Both religion and spirituality can have a positive impact on mental health. In some ways, they provide the same impact. For example: Both religion and spirituality can help a person tolerate stress by generating peace, purpose and forgiveness.” – Laura Greenstein

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

Kor A, Pirutinsky S, Mikulincer M, Shoshani A and Miller L (2019) A Longitudinal Study of Spirituality, Character Strengths, Subjective Well-Being, and Prosociality in Middle School Adolescents. Front. Psychol. 10:377. doi: 10.3389/fpsyg.2019.00377

Using data from 1,352 middle-school Israeli adolescents, the current study examines the interface of spirituality and character strengths and its longitudinal contribution to subjective well-being and prosociality. Participants were approached three times over a 14-months period and completed measures of character strengths, spirituality, subjective well-being (positive emotions, life satisfaction), and prosociality. Findings revealed a fourth-factor structure of character strengths that included the typical tripartite classification of intrapersonal, interpersonal, and intellectual strengths together with spirituality emerging as a statistically autonomous factor. Spirituality was stable over time and contributed to higher subjective well-being and prosociality both cross-sectionally and longitudinally. Discussion focuses on spirituality as a fundamental character strength and an important aspect of positive development.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00377/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_925884_69_Psycho_20190305_arts_A

Mindfulness is Associated with Changing Neural Connectivity in Children and Adolescents

March 21, 2019 psyjdc Leave a comment

Mindfulness is Associated with Changing Neural Connectivity in Children and Adolescents

By John M. de Castro, Ph.D.

“mindfulness meditation training increases resting state connectivity between top-down executive control regions, highlighting an important mechanism through which it reduces stress levels.” Daniel Reed

There has accumulated a large amount of research demonstrating that mindfulness has significant benefits for psychological, physical, and spiritual wellbeing. It even improves high level thinking known as executive function. Its positive effects are so widespread that it is difficult to find any other treatment of any kind with such broad beneficial effects on everything from thinking to mood and happiness to severe mental and physical illnesses. This raises the question of how mindfulness training could produce such widespread and varied benefits. One possibility is that mindfulness practice results in beneficial changes in the nervous system.

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 areas. In other words, mindfulness practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

The brains of children and adolescents are different from fully mature adult brains. They are dynamically growing and changing. It is unclear how mindfulness affects their maturing brains. In today’s Research News article “Mindfulness and dynamic functional neural connectivity in children and adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610942/ ), Marusak and colleagues examined the relationship of mindfulness with brain activity in the maturing brain. They recruited children and adolescents aged 7 to 17 years and measured them for mindfulness, anxiety, and depression.

The children and adolescents then had their brains scanned with functional Magnetic Imaging (fMRI). The scans were evaluated for static connectivity, the relatively permanent connections between brain areas, and dynamic connectivity, the changing connections between areas. They looked specifically at 3 systems in the brain, the central executive network, associated with higher level thinking and attention, the salience and emotion network, associate with the importance of stimuli, and the default mode network, associated with mind wandering and self-referential thinking.

They found that mindfulness was associated with better mental health of the children and adolescents with high levels of mindfulness significantly associated with low levels of depression and anxiety. Mindfulness was also significantly associated with the amount of present-moment oriented thinking occurring during the brain scan session. Mindfulness was not associated with static connectivity within the children’s and adolescents’ brains.

With dynamic connectivity on the other hand, they found that mindfulness was associated with greater numbers of transitions between connectivity states. That is, the higher the levels of mindfulness the greater the number of times the connectivity pattern in the brain changed from one set of connections to another. Finally, they also found that the numbers of transitions between connectivity states mediated the association of mindfulness with lower anxiety, such that mindfulness was associated with lower anxiety both with a direct association of mindfulness with lower anxiety and indirectly by higher mindfulness being associated with greater dynamic connectivity which was in turn associated with lower anxiety.

The results suggest that mindfulness is associated with greater brain flexibility in transitioning from different states and this may allow for less anxiety. This suggests that mindfulness allows for greater ability to see things and evaluate what is occurring in different ways and this helps the youths to better appreciate what is happening and thereby lower anxiety. These are incredibly interesting findings that begin to reveal the neural dynamics occurring in children and adolescents that underlie the ability of mindfulness to improve mental health. Mindfulness isn’t associated with different brain connectivity structures in the brains but rather with different abilities to switch around in real time between systems and this improves mental health.

“Just 11 hours of learning a meditation technique induce positive structural changes in brain connectivity by boosting efficiency in a part of the brain that helps a person regulate behavior in accordance with their goals.” – University of Oregon

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

Marusak, H. A., Elrahal, F., Peters, C. A., Kundu, P., Lombardo, M. V., Calhoun, V. D., Goldberg, E. K., Cohen, C., Taub, J. W., … Rabinak, C. A. (2017). Mindfulness and dynamic functional neural connectivity in children and adolescents. Behavioural brain research, 336, 211-218.

Abstract

Background

Interventions that promote mindfulness consistently show salutary effects on cognition and emotional wellbeing in adults, and more recently, in children and adolescents. However, we lack understanding of the neurobiological mechanisms underlying mindfulness in youth that should allow for more judicious application of these interventions in clinical and educational settings.

Methods

Using multi-echo multi-band fMRI, we examined dynamic (i.e., time-varying) and conventional static resting-state connectivity between core neurocognitive networks (i.e., salience/emotion, default mode, central executive) in 42 children and adolescents (ages 6–17).

Results

We found that trait mindfulness in youth relates to dynamic but not static resting-state connectivity. Specifically, more mindful youth transitioned more between brain states over the course of the scan, spent overall less time in a certain connectivity state, and showed a state-specific reduction in connectivity between salience/emotion and central executive networks. The number of state transitions mediated the link between higher mindfulness and lower anxiety, providing new insights into potential neural mechanisms underlying benefits of mindfulness on psychological health in youth.

Conclusions

Our results provide new evidence that mindfulness in youth relates to functional neural dynamics and interactions between neurocognitive networks, over time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5610942/

Restrain Body Fatness Growth During Adolescence with Yoga

January 31, 2019 psyjdc 1 Comment

Restrain Body Fatness Growth During Adolescence with Yoga

By John M. de Castro, Ph.D.

“Practicing yoga changes your mind: It changes the way you approach life, your body, and eating. Yoga shows you how to appreciate your body for all of the amazing things that it can do for you and points you in the direction of wanting to fill your body with the best possible fuel rather than processed junk food. And changing your mind about your body and the foods you feed it will be a much more effective weight-loss tool than burning a bunch of calories in an aggressive kick-boxing class and then mindlessly plowing through equal or more calories later that day.” – Heidi Kristoffer

Obesity has become an epidemic in the industrialized world. In the U.S. the incidence of obesity, has more than doubled over the last 35 years to currently around 35% of the population, while two thirds of the population are considered overweight or obese (Body Mass Index; BMI > 25). Obesity has been found to shorten life expectancy by eight years and extreme obesity by 14 years. This occurs because obesity is associated with cardiovascular problems such as coronary heart disease and hypertension, stroke, metabolic syndrome, diabetes, cancer, arthritis, and others.

Obviously, there is a need for effective treatments to prevent or treat overweight and obesity. But, despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective treatment. It would be important to intervene early during growth to restrain the growth of body fatness. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. Yoga practice has been shown to have a myriad of physical and psychological benefits. These include significant loss in weight and body mass index (BMI), resting metabolism, and body fat in obese women with Type 2 diabetes and improves health in the obese. In addition, it has the added benefit of being a gentle exercise. Hence it would seem reasonable to further investigate the benefits of yoga practice on the weight and body composition during adolescence.

In today’s Research News article “How Is the Practice of Yoga Related to Weight Status? Population-Based Findings From Project EAT-IV.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865393/ ), Neumark-Sztainer and colleagues utilized a longitudinal data set from Project EAT of adolescent Middle and High School students. They were measured for yoga practice, body size and demographic characteristics initially and after 5 years.

They found that 56.4% of females and 29.1% of males did some yoga while 20.5% of females and 6.1% of males practiced regularly in the past year. The frequency of yoga practice did not differ over weight status, but overweight adolescents were more likely to keep the yoga practice at a gentle level and less likely to engage in hot yoga or engage in a yoga class. Importantly, over the 5-year period the adolescents who practiced yoga had non-significant reductions in Body Mass Index (BMI), an index of body fatness while those that did not practice yoga had a significant increase in BMI. The adolescents who practiced yoga had significantly less body fatness gain over the 5-year period.

This study is important as it is a rare longitudinal look at body mass changes in adolescents over a 5-year period. But these results are correlational, so causation cannot be concluded. Nevertheless, the results are suggestive that adolescents benefit from yoga practice. They suggest that prolonged yoga practice works to restrain gain in body fatness during maturation. This could be very important during adolescence when body size is so important for the developing self-image and for social and romantic relationships, and is very important for their health and well-being later in life.

So, restrain body fatness growth during adolescence with yoga.

“Today urban society is stigmatized with chronic diseases. Unhealthy lifestyle is the main reason for the occurrence of chronic illness. BMI, is a reliable indicator of physical well-being of an individual, as there is urgent attention in the alarming rise of such diseases. Yoga works wonderful in stabilizing BMI and in restoring health.” – Minakshi Welukar

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

Neumark-Sztainer, D., MacLehose, R. F., Watts, A. W., Eisenberg, M. E., Laska, M. N., & Larson, N. (2017). How Is the Practice of Yoga Related to Weight Status? Population-Based Findings From Project EAT-IV. Journal of physical activity & health, 14(12), 905-912.

Abstract

Background

Yoga may provide a strategy for healthy weight management in young adults. This study examined prevalence and characteristics of young adults’ yoga practice and associations with changes in body mass index (BMI).

Methods

Surveys were completed by 1830 young adults (31.1±1.6 years) participating in Project EAT-IV. Cross-sectional and five-year longitudinal analyses were conducted stratified by initial weight status.

Results

Two-thirds (66.5%) of non-overweight women and 48.9% of overweight women reported ever doing yoga, while 27.2% of non-overweight women and 16.4% of overweight women practiced regularly (≥30 minutes/week). Fewer men practiced yoga. Among young adults practicing regularly (n=294), differences were identified in intensity, type, and location of yoga practice across weight status. Young adults who were overweight and practiced yoga regularly showed a non-significant five-year decrease in their BMI (−0.60 kg/m2; p=0.49), while those not practicing regularly had significant increases in their BMI (+1.37 kg/m2; p<0.01). Frequency of yoga was inversely associated with weight gain among both overweight and non-overweight young adults practicing yoga regularly.

Conclusions

Young adults of different body sizes practice yoga. Yoga was associated with less weight gain over time, particularly in overweight young adults. Practicing yoga on a regular basis may help with weight gain prevention.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865393/

Mindfulness is Associated with Lower Anxiety and Depression in Adolescents Partly by Higher Emotional Intelligence

January 30, 2019 psyjdc 1 Comment

Mindfulness is Associated with Lower Anxiety and Depression in Adolescents Partly by Higher Emotional Intelligence

By John M. de Castro, Ph.D.

“It is well-documented that mindfulness helps to relieve depression and anxiety in adults. A small but growing body of research shows that it may also improve adolescent resilience to stress through improved cognitive performance and emotional regulation. This is encouraging news for anyone concerned about the increasing rates of depressive symptoms and suicide rates among adolescents in the United States” – Malka Main

Mindfulness training in adults has been shown to reduce anxiety and depression levels and improve emotional regulation. In addition, in adolescents it has been shown to improve emotion regulation and to benefit the psychological and emotional health. In today’s Research News article “Does Emotional Intelligence Mediate the Relation Between Mindfulness and Anxiety and Depression in Adolescents?” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02463/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_856297_69_Psycho_20181220_arts_A ), Foster and colleagues recruited 8^th Grade students and had them complete an online questionnaire measuring mindfulness, anxiety, depression, and emotional intelligence, including subscales for emotional recognition and expression, understanding emotions, motions direct cognition, and emotional management and control. The data were then subjected to regression analysis.

They found that the higher the levels of mindfulness the higher the levels of emotional intelligence, overall and all subscales, and the lower the levels of anxiety and depression. They also found that the higher the levels of emotional intelligence, overall and all subscales, the higher the levels of mindfulness and the lower the levels of anxiety and depression. Performing a mediation analysis, they found that mindfulness was associated with lower levels of anxiety and depression directly and also indirectly by its association with emotional intelligence which in turn was associated with lower levels of anxiety and depression.

The study was correlational. So, no conclusions about causation can be reached. The results, however, suggest that adolescents are similar to adults in having clear relationships between mindfulness, emotional intelligence, and psychological health. Like adults, the adolescents’ levels of mindfulness and emotional intelligence are associated with lower levels of anxiety and depression. The results, though, also suggest that mindfulness’ association with anxiety and depression is partly by a direct association and partly indirectly through an association with emotional intelligence. This further highlights the fact that mindfulness is an important contributor to the development of an understanding of and ability to regulate emotions. It can’t be overemphasized how important this is for the adolescent in navigating the turbulent years of adolescence.

So, mindfulness is associated with lower anxiety and depression in adolescents partly by higher emotional intelligence.

“Anything that increases awareness helps with the struggle with depression, anxiety, and substance use. In terms of adolescents increasing awareness actually increases maturation—particularly if the practice is done in an environment leading to increased connection with others who understand your challenges.” – Michel Mennesson

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

Foster B, Lomas J, Downey L and Stough C (2018) Does Emotional Intelligence Mediate the Relation Between Mindfulness and Anxiety and Depression in Adolescents? Front. Psychol. 9:2463. doi: 10.3389/fpsyg.2018.02463

High anxiety and depression are often observed in the Australian adolescent population, and if left untreated, can have long-term negative consequences impacting educational attainment and a range of important life outcomes. The utilization of mindfulness techniques has been associated with decreased anxiety and depression, but the underlying mechanisms for this is only beginning to be understood. Previous research with adult samples has suggested that the development of emotional intelligence (EI) may be one mechanism by which mindfulness confers its benefits on wellbeing. This study is the first to examine the relation between mindfulness, EI, anxiety, and depression in an adolescent population. It was hypothesized that EI would mediate the relationships between mindfulness and anxiety, as well as mindfulness and depression. The sample consisted of 108 adolescents from a public secondary school, aged between 13 and 15 years (Mage = 13.68, SDage = 0.56, 51 males and 57 females). Participants completed an online self-report questionnaire which measured dispositional mindfulness, EI, anxiety, and depression. The results indicated that one subscale of EI – Emotional Recognition and Expression (ERE) mediated the relation between mindfulness and anxiety, while two subscales of EI – ERE and Emotional Management and Control (EMC) mediated the relation between mindfulness and depression. Future research utilizing a mindfulness intervention should be conducted to examine whether the use of mindfulness increases EI and decreases anxiety and depression in adolescents.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02463/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_856297_69_Psycho_20181220_arts_A

Mindfulness is Associated with Higher Emotional Intelligence

December 29, 2018 psyjdc 1 Comment

Mindfulness is Associated with Higher Emotional Intelligence

By John M. de Castro, Ph.D.

“Mindful emotion regulation represents the capacity to remain mindfully aware at all times, irrespective of the apparent valence or magnitude of any emotion that is experienced. It does not entail suppression of the emotional experience, nor any specific attempts to reappraise or alter it in any way. Instead, MM involves a systematic retraining of awareness and nonreactivity, leading to defusion from whatever is experienced, and allowing the individual to more consciously choose those thoughts, emotions and sensations they will identify with, rather than habitually reacting to them. In this way, it erodes the automatic process of appraisal that gives rise to disturbing emotions in the first place” – Richard Chambers

Mindfulness practice has been shown to improve emotion regulation. Practitioners demonstrate the ability to fully sense and experience emotions, but respond to them in more appropriate and adaptive ways. In other words, mindful people are better able to experience yet control their responses to emotions. This is a very important consequence of mindfulness. Humans are very emotional creatures and these emotions can be very pleasant, providing the spice of life. But when they get extreme, they can produce misery and even mental illness. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health and the treatment of mental illness especially depression and anxiety disorders.

Adolescence should be a time of mental, physical, social, and emotional growth. But adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, emotional, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. Making these profound changes successfully requires a good deal or flexibility, adapting and changing with the physical, psychological, and social changes of adolescence and particularly to regulating the extreme fluctuations of emotions occurring during this time.

Hence, developing mindfulness and emotional regulation is important especially during adolescence. In today’s Research News article “Emotional Intelligence and Mindfulness: Relation and Enhancement in the Classroom With Adolescents.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02162/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_830687_69_Psycho_20181120_arts_A ), Rodríguez-Ledo and colleagues examine the relationship between emotional intelligence and mindfulness in adolescent school students, aged 11 to 14 years. They were randomly assigned to receive either 9 months of once a week for 55 minutes mindfulness, attention, and emotional intelligence training or no training. The students were measured before and after training for emotional intelligence, emotional development, socialization, empathy, and mindfulness. The mindfulness measure included scales of kinesthetic, internal, and external mindfulness. Kinesthetic mindfulness was paying attention to movements, internal mindfulness was paying attention to mental and emotional states, while external mindfulness was paying attention to stimuli outside of the individual.

Examining the pretest measures they found that the higher the levels of mindfulness the higher the levels of emotional development, emotional intelligence, empathy, and self-control in social situations. The relationships with emotional development and emotional intelligence were especially strong for kinesthetic and internal mindfulness suggesting that the ability to attend to internal states is particularly important for understand and regulating their own emotions. The relationships with empathy was especially strong for external and internal mindfulness suggesting that the ability to attend to the environment and the internal state are particularly important for understanding others emotions. Finally, they found that the mindfulness training significantly increased kinesthetic and internal mindfulness.

These results are interesting and suggests that mindfulness training is effective in making school children more sensitive to their internal states and not to the external environment. Attention to these internal states appears to be related to emotional intelligence. So, adolescents can be trained in mindfulness of their internal milieu and this is related to their emotional intelligence. This makes sense as emotions are changes in internal states and the first step in regulating them is to become aware of them.

Since adolescence is a time of emotional upheaval, these skills may be particularly important for the navigation of this difficult time of development. It remains for future research to determine if mindfulness training of adolescents can have long lasting effects on their ability to regulate their emotions and successfully transition to adulthood.

“The appearance of things change according to the emotions and thus we see magic and beauty in them, while the magic and beauty are really in ourselves.” – Kahlil Gibran

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

Rodríguez-Ledo C, Orejudo S, Cardoso MJ, Balaguer Á and Zarza-Alzugaray J (2018) Emotional Intelligence and Mindfulness: Relation and Enhancement in the Classroom With Adolescents. Front. Psychol. 9:2162. doi: 10.3389/fpsyg.2018.02162

Emotional intelligence (EI) and mindfulness are two constructs that have been separately studied, and the relation between them still remains unclear. Research in this area has not attempted to go further into how enhancing EI and mindfulness together can achieve better improvements in this ability to attend mindfully. To bridge this knowledge gap, our research goal was to study the relationship between EI and the mindfulness competence in our study sample and to assess the impact of implementing EI and a mindfulness competence developmental program (SEA) about participants’ mindfulness competence. The sample consisted of 156 students aged 11–14 years old from a Spanish public high school. One hundred and eight participants were randomly assigned to the experimental condition, and the remaining 48 were to the control condition. The instruments used to evaluate EI were the CDE-SEC, EQi-Youth Version and the General Empathy Scale. Mindfulness on the School Scope Scale was used to assess mindfulness competences. Social adaptation was evaluated by using the social abilities and adjustment questionnaire BAS3. All the instruments where answered by the participants and have been adapted to a sample of youths with such age specifications. The results showed that EI and mindfulness were related to many of the variables measured by the instruments. Showing a good mindfulness competence was particularly related to having a good general level of the EI trait, and to many of the assessed social and emotional variables. The data indicated a significant relation between the mindfulness competence and having better general empathy skills or being better socially adjusted to the school context. The data also indicated a significant effect on participants’ interior and kinesthetic mindfulness competence after implementing the SEA Program. These findings corroborate the relationship between EI and mindfulness, and the possibility of enhancing mindfulness by applying a direct intervention program in the classroom.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02162/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_830687_69_Psycho_20181120_arts_A