Anxiety

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”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1184314174925840/?type=3&theater

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 Psychological and Physical Effects of HIV with Yoga

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By John M. de Castro, Ph.D.

 

“Yoga is not just about the physical side, it’s also about the mind-body connection. I think having that awareness and accepting their condition can help them when they go out into the world, and lift up their self-esteem. Life is fast – yoga can help them be calm and still.” – Surang Sengsamran

 

HIV is a virus that gradually attacks the immune system. It destroys a type of white blood cell called a T-helper cell (CD4 Cell). This isn’t a problem unto itself, but the immune system is our body’s natural defense against illness. Hence, HIV infection makes it harder to combat other infections and diseases. If HIV is untreated, these secondary infections produce chronic illness and eventually death. It is important, then, in treating HIV infection to strengthen the immune system and increase the levels of CD4 in the blood to fight off disease.

 

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 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. Hence, patients with HIV infection, even when controlled with drugs, have a reduction in their quality of life.  There is thus a need to find methods to improve the quality of life in people who are living with HIV infection.

 

Mindfulness has been shown to strengthen the immune system. It also improve psychological and physical well-being in people suffering from a wide range of disorders including depression and anxiety. It has also been shown that mindfulness is associated with psychological well-being and lower depression in patients with HIV infection. Integrated Yoga is a contemplative practice that includes postures, breathing practices, relaxation techniques, and meditation. It has been shown to increase mindfulness, and reduce anxiety and depression. So, it would stand to reason that Integrated Yoga would be beneficial for people who are living with HIV infection.

 

In today’s Research News article “Effect of Integrated Yoga (IY) on psychological states and CD4 counts of HIV-1 infected patients: A randomized controlled pilot study”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1183625434994714/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728960/

Naoroibam and colleagues randomly assigned patients with HIV infection to either a one-hour per day, six-days per week Integrated Yoga practice for one-month or to a treatment as usual condition. Compared to before treatment and the control group, they found that the Integrated Yoga practice produced a significant reduction in anxiety and depression levels and an increase in T-helper cell (CD4 Cell) counts in the blood. It should be kept in mind that there was not an active control condition. So, it is unclear if the effectiveness of Integrated Yoga practice was due to exercise effects or perhaps to expectancy effects, researcher bias effects, etc. It will remain for future research to sort out exactly what is responsible to the improvement in the HIV patients.

 

Regardless, these are exciting and potentially important results suggesting that Integrated Yoga practice may not only improve the psychological well-being of HIV infected patients but also strengthen the immune system. This would make them better able to combat other infections and diseases.

 

So, improve psychological and physical effects of HIV with yoga.

 

“As you become more adept at yoga, you learn which poses can help you, depending on how you are feeling physically. There are certain poses that assist in relieving fatigue, diarrhea, anxiety, depression. You do learn about the nature of self, but you also learn that so much is beyond your control. It helps you realize, somehow, to trust in a higher being.” – Steve McCeney

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

 

Improve Psychological Health of Veterans with a Mantra

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Improve Psychological Health of Veterans with a Mantra

 

By John M. de Castro, Ph.D.

 

“Asking for clarity provides a way to begin to see a path out of the pain of personal issues. With spiritual support the pain begins to be released, the path becomes clearer and the next step to create the rest of life begins to emerge.” – The Merritt Center

 

Alternative and Complementary techniques have been growing in acceptance and use over the last couple of decades. With good reason. They have been found to be beneficial for physical and mental health. Contemplative practices have been shown to improve health and well-being. These include mindfulness practices, meditation, yoga, mindful movement practices such as tai chi and qigong, and spiritual practices such as contemplative prayer. One ancient practice that is again receiving acceptance and use is mantra practice.

 

In today’s Research News article “Multi-site evaluation of a complementary, spiritually-based intervention for Veterans: The Mantram Repetition Program”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1182903115066946/?type=3&theater

Butner and colleagues investigate the effectiveness of a form of mantra practice, Mantram Repetition Practice (MRP) on the mindfulness, mental health, and spirituality of veterans. The MRP involves the repetition of a sacred word or phrase over and over again to slow the individual down and produce one-pointed attention. It is effectively a mindfulness meditation practice, except that there are no formal practice periods. The participant is trained to engage in MRP during their daily activities, periodically and as needed, particularly during times of confusion and stress. The individual selects a sacred word or phrase for use in MRP from a list that have particular meaning to them and within their preferred religious practice. Typical Christian words and phrases are “My God and My All”, “Jesus, Jesus”, “Son of God”, “Hail Mary”, “Mother of Jesus”, “Lord Jesus Christ”, “Son of God, have mercy on me.”

 

Butner and colleagues recruited veterans and measured mindfulness, physical and mental health, and spirituality before and after an 8-week Mantram Repetition Program (MRP) training. The veterans attended weekly training sessions, were encouraged to do homework and to use the MRP during their daily lives. Typical times were while waiting, doing mechanical tasks such as doing dishes, exercising, when encountering annoying situations, while eating, before bed, and to manage unwanted emotions. They found that after 8-weeks of MRP training and practice the veterans demonstrated significantly higher mindfulness and spirituality including greater peace, more meaning in life, and greater faith. After training the veterans also had significant reductions in psychological distress, including reduced somatization, depression and anxiety.

 

It should be noted that there was not an active control group. Improvement was documented by comparing before to after training scores. Because of the lack of active control, there are many confounding, alternative, explanations for the findings. These include participant expectancy effects, experimenter bias effects, simple improvement over time, occurrences between the beginning and end of the treatment period, etc. The results clearly demonstrate that the veterans improved substantially over the 8-weeks. It will remain for future research to verify that it was the Mantram Repetition Practice (MRP) and not a confounding variable that was responsible for the changes.

 

These caveats notwithstanding, the finding for MRP are compatible with those produced by other mindfulness programs with the exception of increased spirituality. It is possible that MRP produces its beneficial effects due to its development of mindfulness. Alternatively, spirituality, by itself, has been shown to be related to better physical and psychological health. So, MRP may be effective due to its improvement of spirituality in the veterans. It may also be that the combination of increased mindfulness and increased spirituality improves effectiveness or that the two have additive effects.

 

So, improve psychological health of veterans with a mantra.

 

“The veterans experiences with spirituality were real and unique, significantly contributing to growth. They needed the inclusion of Christian spirituality as part of their process in posttraumatic growth, and it was the key element in them moving forward.” – Sharon Flowers

 

CMCS – Center for Mindfulness and Contemplative Studies

Promote Physical and Mental Well-Being with Tai Chi

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By John M. de Castro, Ph.D.

 

“Tai Chi exercise had positive effects on the self-assessed physical and mental health of college students. Scores on the mental health dimension appeared to be particularly sensitive to change. Colleges/universities might consider offering Tai Chi as a component of their ongoing physical activity programs available to students.” – Y. T. Wang

 

Many people have fond memories of their college years. It is likely, however, that they forgot about the stress and angst of those years. The truth is that college is generally very stressful for most students, from the uncertainty of freshman year, to the social stresses of emerging adulthood, to the anxiety of launching into a career after senior year. Evidence for the difficulties of these years can be found in college counseling centers which are swamped with troubled students. In fact, it’s been estimated that half of all college students report significant levels of anxiety and depression.

 

Being able to perform at an optimum level is important in college. It would be very helpful if a

safe and effective way could be found to reduce stress, depression and anxiety in college students. Mindfulness training has been shown to reduce anxiety, stress, and depression . So, mindfulness training would appear to be well suited to deal with the problems of college students. The ancient eastern practice of mindful movement Tai Chi has been shown to reduce stress, depression, and anxiety. Hence, it would make sense to investigate whether Tai Chi practice might be effective for improving college student angst.

 

In today’s Research News article “A systematic review of the health benefits of Tai Chi for students in higher education”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1180406471983277/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733099/

Webster and colleagues review the published literature on the effectiveness of Tai Chi practice in improving college student physical and psychological states. They found that that the preponderance of evidence in the literature reported that Tai Chi practice significantly improved muscular flexibility. But the most interesting effects were in the psychological domain with Tai Chi practice significantly reducing depression, anxiety, symptoms of compulsion, somatization symptoms, hostility, and symptoms of phobia, and improved interpersonal sensitivity.

 

Hence, the published scientific literature suggests that Tai Chi practice can be of significant benefit for college students, improving them physically and improving their psychological well-being. Tai Chi practice is a gentle mindful movement practice. It is safe, having few if any adverse consequences, and effective with college students. This suggests that the engagement in Tai Chi practice should be encouraged in college promoting the physical and mental well-being of the students.

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“Of all the exercises, I should say that T’ai Chi is the best. It can ward off disease, banish worry and tension, bring improved physical health and prolong life. It is a good hobby for your whole life, the older you are, the better. It is suitable for everyone – the weak, the sick, the aged, children, the disabled and blind. It is also an economical exercise. As long as one has three square feet of space, one can take a trip to paradise and stay there to enjoy life for thirty minutes without spending a single cent.” ~T.T. Liang

 

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

 

Improve Gastrointestinal Disorders with Mindfulness

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By John M. de Castro, Ph.D.

 

 “The functional gastrointestinal disorders (FGIDs) are a group of more than 20 chronic and hard to treat medical conditions of the gastrointestinal tract that constitute a large proportion of the presenting problems seen in clinical gastroenterology.” – Jennifer Wolkin

 

Functional Gastrointestinal Disorders are the most common disorders of the gastrointestinal tract in the general population. The most common disorder in this group is Irritable Bowel Syndrome (IBS). Functional Gastrointestinal Disorders can involve the esophagus, stomach and/or intestines and are disorders of function (how these structures work), not structural or biochemical abnormalities. Estimates vary, but about 25% of people in the United States have one of these disorders. The conditions account for about 40% of GI problems seen by doctors and therapists.

 

The cause(s) of Functional Gastrointestinal Disorders are not known. But, emotion dysregulation is suspected to be involved. It is clear that psychological stress exacerbates the illnesses and anxiety amplifies the symptoms. This suggests that mindfulness or the lack thereof may be involved as mindfulness is known to be helpful in reducing the psychological and physical responses to stress and mindfulness is known to improve emotion regulation. In addition, contemplative practice has been shown to improve the symptoms of Irritable Bowel Syndrome. So, it would make sense to further investigate the relationship of mindfulness to emotion regulation, stress, and Functional Gastrointestinal Disorders.

 

In today’s Research News article “Difficulties in Emotion Regulation and Mindfulness in Psychological and Somatic Symptoms of Functional Gastrointestinal Disorders”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1178359818854609/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733315/

Mazaheri investigated the relationships between gastrointestinal symptoms, emotions, emotion regulation, and mindfulness in patients diagnosed with Functional Gastrointestinal Disorders. They found that the higher the levels of either depression, anxiety, or stress the greater the GI symptoms and that the lower the levels of emotion regulation the greater the symptoms. Significantly, they found that high levels of mindfulness were associated with lower levels of GI symptoms, depression, anxiety, and stress and with higher levels of emotion regulation.

 

The results support the contention that an inability to regulate emotions and stress are an important factor in Functional Gastrointestinal Disorders. In addition, they suggest that mindfulness is not only associated with lower levels of emotion and psychological stress but also with a greater ability to regulate these emotions. It should be noted that the results of this study are strictly observational and correlational and as such no conclusion about causation can be reached. But, the results give strong support to the need to perform a randomized controlled trial where mindfulness is trained and its effects on emotion regulation and Functional Gastrointestinal Disorders are measured.

 

With the caveat that causation hasn’t been established, it can be speculated that mindfulness training may be a safe and effective method for both the prevention and treatment of Functional Gastrointestinal Disorders. Mindfulness’ ability to improve emotion regulation may help the individual to be able to better experience emotions but respond to them in an effective and adaptive manner, lessening their impact. It remains for future research to investigate this exciting possibility.

 

So, improve gastrointestinal disorders with mindfulness.

 

“patients with heightened GI-specific anxiety may benefit from participation in a mindfulness programme as an adjunct to their usual clinical care.” – D. J. Kearney

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Calm Anxiety with Yoga

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“Yoga helps our entire system slow down. Our bodies are programmed to heal naturally, and what stops that healing are all the stressors of daily life. Yoga dissolves those stressors for the time during practice and usually the effects last for hours after.” – Elena Brower

 

Yoga practice is multifaceted. It is a physical exercise that strengthens the body. It is also a spiritual practice which can bring insights and understanding. But, it also a mind practice which can bring profound psychological changes. (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/yoga-contemplative-practice/). These psychological changes can be positive enhancing the current state. But they can also be beneficial for the treatment of negative states, mental illness.

 

Everyone experiences occasional anxiety and that is normal. But, frequent or very high levels of anxiety can be quite debilitating. These are termed anxiety disorders and they are the most common psychological problem. In the U.S., they affect over 40 million adults, 18% of the population, with women accounting for 60% of sufferers One out of every three absences from work are caused by high levels of anxiety and it is the most common reason for chronic school absenteeism. In addition, people with an anxiety disorder are three-to-five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than non-sufferers, making it a major burden on the healthcare system.

 

Anxiety disorders typically include feelings of panic, fear, and uneasiness, problems sleeping, cold or sweaty hands and/or feet, shortness of breath, heart palpitations, an inability to be still and calm, dry mouth, and numbness or tingling in the hands or feet. They have generally been treated with drugs. It has been estimated that 11% of women in the U.S. are taking anti-anxiety medications. But, there are considerable side effects and these drugs are often abused. Although, psychological therapy can be effective it is costly and not available to large numbers of sufferers. So, there is a need to investigate alternative treatments.

 

Contemplative practices appear to be a viable alternative (see http://contemplative-studies.org/wp/index.php/category/research-news/anxiety/). Indeed, yoga practice has been shown to be a safe and effective method to reduce anxiety (see http://contemplative-studies.org/wp/?s=yoga+anxiety). There are many variations of yoga practice. In order to understand which types of practice and which components are most affective against anxiety, there is a need to compare the effectiveness of different types of yoga practice for the treatment of anxiety disorders.

 

In today’s Research News article “Effect of Integrated Yoga Module on Selected Psychological Variables among Women with Anxiety Problem”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1176415959048995/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655636/

Parthasarathy and colleagues compared 8-weeks, 45 minutes per day, of Yoga practice, Integrated Yoga practice, and no treatment for the treatment of patients with anxiety disorders. The Yoga practice consisted of training in breath control, yoga postures, and relaxation. The Integrated Yoga practice consisted of training in loosening exercises, breath control, yoga postures, and guided meditation (Yoga Nidra). They found that both types of yoga practice reduced anxiety, but the Integrated Yoga practice produced the greatest reduction in anxiety levels. Interesting the reverse was found when measuring reactions to frustration with both yoga practices reducing reactions to frustration but with the Yoga practice superior to the Integrated Yoga practice.

 

These findings support the prior findings that yoga practice is a safe and effective method to treat anxiety disorders. In addition, they extend previous findings by showing that yoga practice can also improve the individual’s reaction to frustration. Since frustration often leads to emotionality, this yoga produced reduction in reactivity to frustration may be one of the mechanisms by which yoga is effective for emotional issues including anxiety.

 

It appears from the results that the addition of guided meditation (Yoga Nidra) practice to the yoga practice may add additional anxiety reduction to that produced by the yoga practice alone. It has been shown previously that yoga practice reduces anxiety. It has also been shown that meditation reduces anxiety levels (see http://contemplative-studies.org/wp/?s=meditation+anxiety). The current results suggest that the effects of yoga and meditation may be additive. By combining the two a significantly better treatment for anxiety is produced.

 

So, calm anxiety with yoga.

 

“Continual focus and obsession with thoughts of fear and worry will only create additional levels of anxiety. Yoga and meditation allow us to have control over our thoughts through mental detachment and the ability to focus the mind on the present experience.” – Timothy Burgin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

ACT for Mental Health

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“ACT work is based more on the psychology of the normal. I think we have every reason to believe that most of the things that people struggle with are based on the failure to bring out normal psychological processes.” – Stephen Hayes

 

Acceptance and Commitment Therapy (ACT) is a psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT). It 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. Additionally, ACT helps people strengthen aspects of cognition such as in committing to valued living. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Mindfulness practices have in general been shown to be effective in treating depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/) and anxiety disorders (see http://contemplative-studies.org/wp/index.php/category/research-news/anxiety/) Since Acceptance and Commitment Therapy (ACT) employs mindfulness training it is not surprising that it is also effective for a variety of mental health issues including depression (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/act/).

 

ACT contains a number of modules that allow the client to work on particular thoughts and actions that are relevant to the individual’s problems. This allows for component analysis research, where certain ACT modules are used or dropped out and the change in ACT effectiveness measured, thus allowing the assessment of the effectiveness of each component module. In today’s Research News article “Acceptance and Commitment Therapy modules: Differential impact on treatment processes and outcomes”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1163205643703360/?type=3&theater

Villatte and colleagues examined “two ACT component modules; one targeting openness to thoughts, feelings, and sensations and the other emphasizing engagement in meaningful actions.” Participants who were suffering from depression and/or anxiety disorders were randomly assigned to receive ACT therapy emphasizing one of the two modules.  In the ACT OPEN module, the client explores the thoughts and ideas about the depression or anxiety and are then encouraged to let go of these thoughts, to let them diffuse, “(e.g. thoughts are observed as if they are leaves floating on a stream).” In the ACT ENGAGED module the client’s own values are explored as guides to orient actions and as sources of satisfaction. They then explore their experiences with an eye toward allowing their values to guide them through the obstacles that occur in everyday life.

 

Villatte and colleagues found that both modules produced significant improvements in acting with awareness and nonreactivity to thoughts, feelings, sensations. They both also produced significant reductions in anxiety and depression symptom severity, but the ACT OPEN module was significantly more effective than the ACT ENGAGED module. The ACT OPEN module only produced significant improvements in cognitive diffusion and experiential acceptance. Both modules also produced clinically significant improvements in quality of life and values based action, but the ACT ENGAGED module was significantly more effective than the ACT OPEN module.

 

Hence they found that the module emphasizing letting go of thoughts and ideas about their problems, ACT OPEN, was more effective in reducing the symptoms of anxiety and depression than the module emphasizing applications of the individual’s own values to guide actions, ACT ENGAGED. This finding reinforces the importance of the emphasis of mindfulness practice on letting go of thoughts and focusing on present experience. It suggests that this may be a critical component in mindfulness applications to mental health issues. The fact that the module emphasizing applications of the individual’s own values to guide actions, ACT ENGAGED produced greater improvements in quality of life suggests that the emphasis in mindfulness practice on acting with awareness may be crucial to satisfying engagement in life.

 

It is possible that letting go is needed as a prerequisite before values based actions are effective. So, values based actions may not be as effective when practiced before practicing letting go. Future research should investigate presenting these modules in different orders. Regardless it is clear that Acceptance and Commitment Therapy (ACT) modules are effective in the treatment of anxiety and depression.

 

So, ACT for mental health.

 

“People don’t go into therapy when life is moving forward at a reasonable clip; they go in when life is stuck or going backwards. And it’s not that they get cured or fixed, because humans are not broken, they don’t need to be fixed. They need to be supported in a way that allows them to grow and do a better job over time with the things that they really care about—their kids, their work, their intimate relationships, their sense of participation and connection with the world around them.” – Stephen Hayes
CMCS – Center for Mindfulness and Contemplative Studies

Better Music with Mindfulness

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“The way yoga brings you to yourself can’t but help an artist tap into that deeper well. Yoga and art are actually very similar: The challenge of stretching beyond your comfort zone, of learning to breathe and surrender into places that are painful or tight, is sometimes also what allows a profound artistic opening.” – Diane Anderson

 

Effective musician craft is described as entering a state of “flow.” This refers to a state of complete immersion in an activity such that it becomes totally absorptive leaving no attention left for any distractions. The musician literally becomes totally lost in their music. Musicians report that when they are in “flow” they are at their best and the music is precise and nuanced. “Flow” and the quality of performance is disrupted by anxiety, which is common prior to and during performance, and confusion and uncertainty about the piece that they are playing. So, reductions in anxiety and confusion would be expected to improve “flow” and the resulting performance.

 

Contemplative practices are also geared to producing a state similar to “flow” where the practitioner becomes totally immersed in the present moment and distractions are minimized. The contemplative practice that are most similar to music performance are those that involve movement, yoga, tai chi, and qigong. Yoga practice has been shown to reduce anxiety (see http://contemplative-studies.org/wp/index.php/2015/11/11/yoga-improves-stress-responses-and-mood/ and http://contemplative-studies.org/wp/index.php/2015/09/03/keep-up-yoga-practice-for-anxiety-and-depression/) and improve movement (see http://contemplative-studies.org/wp/index.php/2015/08/11/improve-physical-health-with-yoga/).  So, it is reasonable to hypothesize that yoga practice might improve musical performance.

 

In today’s Research News article “Yoga Enhances Positive Psychological States in Young Adult Musicians”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1162081867149071/?type=3&theater

Butzer and colleagues trained a group of young professional classical musicians in yoga for 8-weeks and compared their ability to enter “flow”, mindfulness, and levels of confusion, and performance anxiety to a no-treatment control group. They found that the yoga group improved significantly in mindfulness and their ability to achieve “flow”, and a significant decrease in confusion. In addition, they found that higher levels of “flow” and mindfulness were associated with a decrease in performance anxiety. So, yoga practice appeared to improve mindfulness and “flow” and reduce confusion which in turn reduced performance anxiety in the musicians.

 

This is the first study that I am aware of that demonstrated that yoga practice could improve musician characteristics that are associated with superior musical performance. There are a number of ways that yoga practice might act to do this. Yoga practice improved mindfulness in the musicians. Hence, it improved the ability of the musicians to attend to the present moment which is a necessity to enter “flow.” Also, by reducing the ability of other stimuli and thoughts to intrude and distract attention, yoga should reduce confusion. Mindfulness is also known to improve emotion regulation and decrease anxiety levels. This would in turn allow the musician to reduce performance anxiety and be better able to respond constructively to it.

 

Regardless of the explanation, it is clear that yoga practice is beneficial for musicians producing the conditions for better performances. So, produce better music with mindfulness.

 

“When people get nervous, they think about what other people are thinking, rather than concentrating on the music. Yoga helps you to be more in the moment. When you are stressed you hold your breath, and the nervous energy makes you feel tight, and everything feels ‘up in the air.’ If you take a deep breath with a long exhale you can actually bring that energy back down and ground it.” – Mia Olson
CMCS – Center for Mindfulness and Contemplative Studies

 

Log-on for Less Anxiety with Mindfulness

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“Needless anxiety and stress cannot burden us if the thoughts don’t enter our mind. And fortunately, we are only capable of focusing on one thing at a time. When you’re aware of only what you’re working on and the sensations of your body, conscious worry is not possible.” – Jordan Bates

 

Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. (Source: National Institute of Mental Health). Generalized Anxiety Disorder (GAD) affects about 3.1% of the U.S. population. GAD involves excessive worry about everyday problems. People with GAD may excessively worry about and anticipate problems with their finances, health, employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their anxiety is more intense than the situation warrants. Physically, GAD sufferers will often show excessive fatigue, irritability, muscle tension or muscle aches, trembling, feeling twitchy, being easily startled, trouble sleeping, sweating, nausea, diarrhea or irritable bowel syndrome, and headaches.

 

Anxiety disorders are not only a torment for the victims but they also place tremendous pressure on the health care system. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders. Anxiety disorders are treatable but only about a third of the sufferers get treatment. The most common treatment for GAD is drugs. Anxiolytic drugs are some of the most prescribed drugs in the U.S. Psychotherapy is another common form of treatment with Cognitive Behavioral Therapy particularly effective. Mindfulness practices are known to reduce anxiety (see http://contemplative-studies.org/wp/index.php/2015/11/02/be-open-or-focused-in-meditation-to-reduce-anxiety/,  http://contemplative-studies.org/wp/index.php/2015/07/17/the-mindfulness-cure-for-social-anxiety/, http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/), and appear to do so by altering brain activity (see http://contemplative-studies.org/wp/index.php/2015/08/13/get-the-brain-to-reduce-anxiety-with-meditation/).

 

The problems with these treatments is that drugs can have very troublesome side effects and psychotherapy can be expensive and time consuming. Therapy also demands that there be a qualified professional in the immediate area and the patient has the time and transportation available to attend therapy sessions. So, there is a need for cost-effective, convenient, and safe alternative treatments.

 

One way to lower costs and make therapy available for patients over wide geographical areas is to deliver therapy over the internet. In today’s Research News article “Internet-delivered acceptance-based behaviour therapy for generalized anxiety disorder: A randomized controlled trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1159827387374519/?type=3&theater

Dahlin and colleagues developed a form of mindfulness based Acceptance and Commitment Therapy (ACT) for delivery by a therapist over the internet. They recruited participants with GAD over the internet and assigned them randomly to either receive therapy for 9-weeks or to a waiting list control condition. They found significant improvement in Generalized Anxiety Disorder (GAD) and depression for the therapy group with large to moderate effect sizes. These improvements were still present 34-weeks later.

 

These are exciting results. Anxiety disorders are so prevalent and so infrequently treated that it’s important to demonstrate that a safe and effective therapy can be inexpensively delivered over the internet. This opens the door to widespread access to safe, convenient, effective, and inexpensive treatment. Future trials should employ a more active control condition and open up treatment to a wider array of GAD sufferers.

 

Mindfulness practices have a number of effects that appear to be helpful with anxiety disorders. They have been shown to improve emotion regulation. This allows the individual to experience the anxiety but react to it in a constructive way and thereby preventing an upward spiraling of anxiety as the patient becomes more anxious of becoming more anxious. Mindfulness practices also appear to blunt physiological and psychological reactions to stress. Since, high levels of anxiety are stressful, mindfulness practices may reduce the reactions to this stress, making the anxiety more bearable. Finally, anxiety involves worries about the future. By focusing the individual on the present, mindfulness practices interrupt worries about the future.

 

Regardless of the explanation, it is clear that mindfulness based Acceptance and Commitment Therapy (ACT) is effective for Generalized Anxiety Disorder (GAD) even when delivered over the internet.

 

So log-on for less anxiety with mindfulness.

 

“I confessed to him that I saw breathing exercises as an attempt to distract. He said, “Yes. It’s a tool. Mindfulness is all in the subtleties.” Then he paused and told me, “Instead, when thoughts and feelings come, you simply say to them ‘Hello. I see you. Welcome.’”” – Lucy Roleff


CMCS – Center for Mindfulness and Contemplative Studies