Improve Arthritis Depression, Pain, and Disability with Mindfulness

July 23, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People in pain often react automatically to [what’s going on]. “You think I feel pain, and then the body tightens and you have a flurry of other thoughts like Pain is ruining my life. Mindfulness allows you to notice this distress as it happens and to intentionally step back, shifting awareness to the body and adjusting it in a way that can bring ease.” – Steven Rosenzweig

Arthritis is a chronic disease that most commonly affects the joints. Depending on the type of arthritis symptoms may include pain, stiffness, swelling, redness, and decreased range of motion. It affects an estimated 52.5 million adults in the United States. It is associated with aging as arthritis occurs in only 7% of adults ages 18–44, while 30% adults ages 45–64 are affected, and 50% of adults ages 65 or older. Due to complications associated with arthritis, the lifespan for people with RA may be shortened by 10 years.

The pain, stiffness, and lack of mobility associate with arthritis produce fatigue and markedly reduce the quality of life of the sufferers. It can have very negative psychological effects diminishing the individual’s self-image and may lead to depression, isolation, and withdrawal from friends and social activities. It even affects the individual’s physical appearance. As the quality of life deteriorates the individual can feel a loss of control and become anxious about the future. Stress can build and influence the individual’s attitude toward life and can lead to frustration, anger, and hopelessness. The physical disability produced by arthritis, reduces the individual’s ability to function at work and may require modifications of work activities. This can lead to financial difficulties. The normal chores at home may take much longer to accomplish and the individual may need the help of a relative or caregiver. Hence, it can produce stress on the entire family system.

There are no cures for arthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers, anti-inflammatory drugs, and corticosteroids. Recently, mindfulness practices have been found to be effective in coping with the symptoms of arthritis. In today’s Research News article “Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1277531588937431/?type=3&theater

or below, Costa and colleagues studied the relationship between mindfulness, acceptance, disability, and depression in adult rheumatoid arthritis sufferers. They measure them for mindfulness, pain, pain acceptance, health impact of arthritis, depression, anxiety, and stress.

They found, not surprisingly, that the greater the level of pain the greater the levels of disability and depression. Higher levels of both mindfulness, especially the non-reacting facet of mindfulness, and acceptance were found to be associated with lower levels of pain, disability and depression. Performing a mediational analysis, Costa and colleagues found that the effects of pain on depression were reduced by both acceptance and non-reacting while pain’s effects on disability was reduced by only acceptance.

The results show that being non-reactinge and accepting of experience were associated with lower levels of arthritis symptoms, with acceptance associated with lower levels of both depression and physical disability and mindful non-reacting to experience associated with lower levels of depression. Depression is amplified by rumination about past pain and worry about future pain. Mindfulness focuses the individual on the present moment and thereby reduces worry and rumination. This, to some extent explains, mindfulness’ association with lower depression. Accepting the situation is also important for pain management, as fighting against pain amplifies the pain. As a result, acceptance can reduce attempts to control the pain and thereby reduce the experience of pain and the resultant symptoms of depression and physical disability.

So, improve arthritis depression, pain, and disability with mindfulness and acceptance.

“mindfulness training, which teaches people to push away troublesome thoughts, helped improve well-being in people with rheumatoid arthritis and similar diseases. Patients . . . who received the training didn’t have less pain compared to those who didn’t, but they coped better, were less tired and showed less stress. “Yes, they still have pain, but they are able to manage their pain in more constructive ways,” – Randy Dotinga

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Joana Costa, José Pinto-Gouveia, and João Marôco. Chronic pain experience on depression and physical disability: The importance of acceptance and mindfulness-based processes in a sample with rheumatoid arthritis. J Health Psychol, 1359105316649785, first published on June 15, 2016

Abstract

The mediating effect of acceptance and mindfulness in the relationship between pain, depression, and physical disability was examined in 55 rheumatoid arthritis patients. Results showed that the relationship between pain and depression was mediated by both nonreact and acceptance. By contrast, the relationship between pain and physical disability was mediated by acceptance but not by nonreact. This study provides evidences that the influence of these processes is different on depression and on physical disability. These findings support models that take both general measures of mindfulness and content-specific measures of acceptance into account when conceptualizing rheumatoid arthritis. Theoretical and clinical implications are discussed.

Reduce Inflammation and Depression with Mindfulness

July 13, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness is a valuable practice for improving the cognitive symptoms of depression, such as distorted thinking and distractibility. It helps individuals recognize these more subtle symptoms, realize that thoughts are not facts and refocus their attention to the present.” – Margarita Tartakovsky

Major depression is one of the most common mental disorders. In 2014, an estimated 15.7 million adults aged 18 or older in the United States had at least one major depressive episode in the past year. This number represented 6.7% of all adults. In addition, major depression carries the heaviest burden of disability among mental and behavioral disorders. It is most frequently treated with anti-depressive drugs. But, these frequently do not work or lose effectiveness over time and have many troublesome side effects. So, there is a need for better treatment methods.

Depression has been linked to chronic inflammation. Patients with major depressive disorder exhibit all of the cardinal features of an inflammatory response, including increased expression of pro-inflammatory cytokines and their receptors. In addition, administration of inflammatory cytokines to otherwise non-depressed individuals cause symptoms of depression. This suggests that chronic inflammation may be a contributing factor to the development, promotion, or maintenance of depression.

Mindfulness practice has been shown to be effective in the treatment of chronic depression. It has also been shown to reduce inflammation and the inflammatory cytokines. So, it would make sense to study the relationship of mindfulness training to depression and the inflammatory response in depressed individuals. In today’s Research News article “Brief Mindfulness Training Reduces Salivary IL-6 and TNF-α in Young Women with Depressive Symptomatology.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1270480726309184/?type=3&theater

or below,

Walsh and colleagues do just that. They recruited female college students who had mild to moderate depression and assigned them to either a mindfulness training group or a contact control group. Mindfulness training was modelled after a Mindfulness Based Stress Reduction (MBSR) program and included meditation, body scan, and yoga, but the program was conducted over only 4 weeks rather than the customary 8 weeks. The contact control group met in a group on a similar schedule but simple filled out questionnaires. The participants were measured for salivary inflammatory cytokine levels, depression, and other mental issues both before and training and 3 months later.

They found that mindfulness training decreased the levels of the inflammatory cytokines IL-6 and TNF-α between 59% to 76% and this decrease was maintained at the 3 month follow up. There was also a significant decrease in depression but this was true for both the mindfulness and contact groups. The higher the levels of baseline depression the greater the effect of mindfulness training on reducing inflammatory cytokines. These results suggest that mindfulness training is effective in reducing the inflammatory response and that the more depressed the individual is the greater the benefit.

These are exciting findings. They suggest that mindfulness training reduces chronic inflammation in depressed women. The fact that the depression levels were low to start with may have produced a floor effect making it impossible to detect a benefit of mindfulness training on the levels of depression. This prohibits and analysis of the relationship of the reduction in the inflammatory cytokines to the reduction in depression. But, the results are suggestive of a potential effect in that the most depressed women showed the greatest reductions in the inflammatory response. It will require further work with women exhibiting higher levels of depression and perhaps with a longer treatment period to conclusively demonstrate whether there’s a causal connection between the two.

Mindfulness training has a number of known effects that may underlie its ability to reduce depression and inflammation. In particular mindfulness training has been shown to reduce the psychological and physiological responses to stress. This decreased stress response may be responsible for the reduction in inflammation. In addition, mindfulness training is known to improve focus on the present moment and thereby reduce rumination about the past or worry about the future, both of which are characteristic of depression. This may well underlie the ability of mindfulness training to reduce depression.

So, reduce inflammation and depression with mindfulness.

CMCS – Center for Mindfulness and Contemplative Studies

“Everyone can benefit from mindfulness meditation, but some can more than others. There are no negative side effects of mindfulness, and there are the positive benefits of stress reduction and relaxation. Reducing inflammation and boosting immune health can help fight a broad range of ailments, from a stubbed toe to chronic inflammatory conditions.” – Amanda Page

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

Study Summary

Walsh, E., Eisenlohr-Moul, T., & Baer, R. (2016). Brief Mindfulness Training Reduces Salivary IL-6 and TNF-α in Young Women with Depressive Symptomatology. Journal of Consulting and Clinical Psychology, doi:10.1037/ccp0000122

Abstract

OBJECTIVE: Pro-inflammatory cytokines have been implicated in the pathophysiology and maintenance of depression. This study investigated the effects of a brief mindfulness intervention on salivary pro-inflammatory correlates of depression (IL-6, TNF-α) and self-reported symptoms of depression in college women.

METHODS: Sixty-four females with a cut score of ≥16 on the Center for Epidemiological Studies for Depression Scale (CES-D) were assigned to a 4-week mindfulness-based intervention (MBI; N = 31) or a contact-control group (N = 33). For both groups, salivary cytokines and depressive symptoms were assessed at baseline and posttreatment. For the mindfulness group only, salivary cytokines were also assessed at a 3-month follow-up.

RESULTS: Both groups showed similar reductions in depression. However, MBI (vs. control) predicted greater reductions in IL-6 and TNF-α; changes in IL-6 were sustained at 3-month follow-up. Higher baseline depressive symptoms predicted greater reductions in inflammation in the mindfulness group.

CONCLUSION: MBIs may reduce inflammatory immune markers commonly implicated in depression. Individuals with greater depressive symptoms may benefit more from mindfulness training. Although reductions in salivary cytokines in the mindfulness condition were not attributable to changes in depressive symptoms, future work should examine the possibility that such reductions are protective against the development of future depressive episodes.

http://eds.a.ebscohost.com.ezproxy.shsu.edu/ehost/pdfviewer/pdfviewer?vid=5&sid=911f511a-9143-4771-8f7c-e876dcfe165f%40sessionmgr4005&hid=4208

Relieve Depression with Mindfulness and Spirituality

July 3, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

Depression is epidemic. Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year. Depression is more prevalent in women than in men. It also affects children with one in 33 children and one in eight adolescents having clinical depression. It is so serious that it can be fatal as about 2/3 of suicides are caused by depression. It makes lives miserable, not only the patients but also associates and loved ones, interferes with the conduct of normal everyday activities, and can come back repeatedly. Even after complete remission, 42% have a reoccurrence.

The first line treatment is antidepressant drugs. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission and even after repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attain remission. This leaves a third of all patients treated still in deep depression. These patients are deemed to have treatment-resistant depression. Being depressed and not responding to treatment is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail.

Mindfulness training has been shown to be effective for depression alone or in combination with drug therapy. Although there are a number of mindfulness treatments that are effective, Mindfulness-Based Stress Reduction (MBSR) has been found to be effective for a myriad of physical and psychological problems including depression. MBSR, like all mindfulness trainings has physical, psychological, emotional, and spiritual components and spirituality has been shown to be associated with reduced depression. But, MBSR is even more complex as it contains yoga and body scan in addition to meditation. Because of the complexity and the variety of effects of these practices it is difficult to know which components are effective in promoting well-being and which are not.

In today’s Research News article “Decreased Symptoms of Depression After Mindfulness-Based Stress Reduction: Potential Moderating Effects of Religiosity, Spirituality, Trait Mindfulness, Sex, and Age”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1263767500313840/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4365440/

Greeson and colleagues investigate the influences of the mindfulness and spiritual aspects of Mindfulness-Based Stress Reduction (MBSR) on depression in adults. Participants completed measurement scales of anxiety, depression, mindfulness, spirituality, and religious participation both before and after 8-weeks of MBSR training. They found, as has been previously demonstrated, that following MBSR training depression was significantly reduced. They also found that the higher the level of mindfulness after treatment the lower the level of depression. This was also true for the levels of spirituality, the higher they were the lower the depression. Finally, they employed a sophisticated statistical procedure, Hierarchical multiple regression analysis, to demonstrate that mindfulness and spirituality act independently to reduce depression.

These findings are interesting and suggest that the complex and multifaceted Mindfulness-Based Stress Reduction (MBSR) program reduces depression both by increasing mindfulness and by increasing spirituality. Since there is no training in spirituality or direct effort to influence spirituality in MBSR training, it would appear to be an indirect effect of MBSR. The results suggest that it is not the result of increased mindfulness, but arises nonetheless as an added bonus of the training. MBSR is an outgrowth of ancient practices of meditation, yoga, and body scan that were initially employed for spiritual purposes. So, I guess that it should come as no surprise that even when employed in a secular practice, that they still increase spirituality. It should also come as no surprise that spirituality would be associated with reduced depression as spirituality gives meaning and purpose to life which is incompatible with depression.

So, relieve depression with mindfulness and spirituality.

“Meditation has penetrated our culture in a way that would have been inconceivable 20 years ago when I started to investigate it [as a potential treatment] for mood disorders. It resonates with people’s desires to find a way of slowing down and returning to an inner psychological reality that is not as easily perturbed.” – Zindel Segal

CMCS – Center for Mindfulness and Contemplative Studies

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Eliminate Dysfunctional Attitudes with Mindfulness

July 1, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Mindfulness also allows us to become more aware of the stream of thoughts and feelings that we experience and to see how we can become entangled in that stream in ways that are not helpful. This lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply ‘mental events’ that do not have to control us.” – Mark Williams

The common everyday use of the word depression is incorrect. It is used to describe cases of sadness or grief. These have a clear cause, are emotional states, and tend to be transitory. Depression, on the other hand, does not have a proximal cause and doesn’t slowly fade away. It includes sadness, a dysphoric mood state, but it also includes a loss of emotionality not a heightening. In addition, depression has characteristic cognitive (thought) processes that tend to accentuate and maintain the depression. Indeed, many forms of therapy for depression target these thought processes for change.

A characteristic of depression is dysfunctional attitudes. These involve ideas about themselves and others which tend to perpetuate the depression. For example, people high in depression tend to be overly sensitive to the evaluations of others, with their happiness dependent upon others liking and approving of them. This dysfunctional attitude is termed “Dependency.” Another dysfunctional attitude involves having idealized and perfectionistic expectations about themselves and their competences, with appearance and perfect performance at work and in everything they attempt to do, essential to their self-worth. This dysfunctional attitude is termed “Perfectionism/Performance Evaluation.”

Mindfulness training has been shown to be highly effective for depression. It also appears to alter cognitive processes. Indeed, a very effective form of therapy for depression, Mindfulness Based Cognitive Therapy (MBCT), is specifically designed to increase mindfulness and interrupt the thought processes typical of depression. So, it makes sense to further study the links between mindfulness and dysfunctional attitudes in depressed people. In today’s Research News article “Effects of brief mindful acceptance induction on implicit dysfunctional attitudes and concordance between implicit and explicit dysfunctional attitudes.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1262454323778491/?type=3&theater

or below.

Keng and colleagues do just that. They recruited adults with mild to moderate depression. They completed a series of measures of mindfulness, depression, sad mood, and implicit and explicit dysfunctional attitudes. They then were given a task to induce a sad mood, recalling and writing for 10-minutes about three specific life incidents that made them feel lonely, sad, rejected, or hurt and again completed the measurements. The induction worked as the sadness ratings nearly doubled. Finally, they were randomly divided to receive a 15-min session of mindfulness induction (breath following meditation) or mind wandering. Subsequently they were again measured.

They found that neither the mindfulness induction nor the mind wandering resulted in a direct change in implicit and explicit dysfunctional attitudes. Rather, the effectiveness of these manipulations depended upon the overall level of mindfulness of the participant upon entering the experiment. For those participants who were high in mindfulness, the mindfulness induction reduced implicit dysfunctional attitudes, while for those participants who were low in mindfulness, the mindfulness induction increased implicit dysfunctional attitudes. In addition, they found that the mindfulness facets of describe and acting with awareness were the aspects of mindfulness that were most responsible for the effect. So, mindfulness induction decreased implicit dysfunctional attitudes in depressed people who were high in describing and acting with awareness but makes them worse in people low in these facets.

These results may be important for the clinical treatment of depression. Care must be taken in producing mindfulness with patients who are low in mindfulness to begin with as mindfulness induction may make them worse. On the other hand, inducing mindfulness in patients who are high in mindfulness may be a useful strategy to alter the implicit dysfunctional thinking in depression. It may suggest that mindfulness training be employed with patients who are low in mindfulness to raise mindfulness levels before treatment begins. Insuring high mindfulness may be important before treatment.

It should be kept in mind that the intervention in the present experiment was very short term, only 15 minutes of mindfulness. It may be that greater amounts of mindfulness training would result in benefits for both high and low mindful patients. Regardless, the results suggest that the dysfunctional attitudes in depression may be treated with mindfulness.

“As a remedy for depression and anxiety, mindfulness meditation may help patients let go of negative thoughts instead of obsessing over them. Training people to experience the present, rather than reviewing the past or contemplating the future, may help keep the mind out of a depressive or anxious loop.” – Hal Arkowitz

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Keng SL, Seah ST, Tong EM, Smoski M. Effects of brief mindful acceptance induction on implicit dysfunctional attitudes and concordance between implicit and explicit dysfunctional attitudes. Behav Res Ther. 2016 May 14;83:1-10. doi: 10.1016/j.brat.2016.05.004.

Highlights

Mindfulnesstraining lowers implicit dysfunctional attitudes for mindful individuals.
The training worsens implicit dysfunctional attitudes for less mindful individuals.
The training enhances concordance between implicit and explicit attitudes.

Abstract

Mindfulness-based interventions have been shown to be effective in alleviating depressive symptoms. While much work has examined the effects of mindfulness training on subjective symptoms and experiences, and less is known regarding whether mindfulness training may alter relatively uncontrollable cognitive processes associated with depressed mood, particularly implicit dysfunctional attitudes. The present study examined the effects of a brief mindful acceptance induction on implicit dysfunctional attitudes and degree of concordance between implicit and explicit dysfunctional attitudes in the context of sad mood. A total of 79 adult participants with elevated depressive symptoms underwent an autobiographical mood induction procedure before being randomly assigned to mindful acceptance or thought wandering inductions. Results showed that the effect of mindful acceptance on implicit dysfunctional attitude was significantly moderated by trait mindfulness. Participants high on trait mindfulness demonstrated significant improvements in implicit dysfunctional attitudes following the mindful acceptance induction. Those low on trait mindfulness demonstrated significantly worse implicit dysfunctional attitudes following the induction. Significantly greater levels of concordance between implicit and explicit dysfunctional attitudes were observed in the mindful acceptance condition versus the thought wandering condition. The findings highlight changes in implicit dysfunctional attitudes and improvements in self-concordance as two potential mechanisms underlying the effects of mindfulness-based interventions.

ACT for Psychological Flexibility, Mindfulness, and Depression

June 28, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

Mindfulness training in general has been shown to be effective for treating depression. Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that is based upon Cognitive Behavioral Therapy (CBT) and has also been shown to be effective for depression. 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. 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.

As impressive as the effectiveness of many mindfulness based therapies are for depression, they require the supervision of a trained therapist working either with a single individual or in small groups. With the magnitude of the problem of depression, these therapies can only touch a small fraction of depression suffers. Recently the internet has been used to provide therapy to a wide audience. It allows for therapies to be made available to a much larger number of patients over a much larger geographical area. Indeed, ACT provided over the internet has been shown to be effective for depression. It is not known, however, which psychological processes are affected by ACT that work to relieve depression and what participant characteristics are predictive of responsiveness to ACT for depression.

In today’s Research News article “How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1260365230654067/?type=3&theater

or below or view the full text of the study at:

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6

Pots and colleagues investigated potential mediators of ACT therapy for depression delivered over the internet. They randomly assigned patients diagnosed with mild to moderate depression to either receive Acceptance and Commitment Therapy (ACT), an expressive writing treatment, or a wait-list control condition. ACT was delivered over the internet in nine modules that could be completed by participants over nine to twelve weeks. The expressive writing condition was delivered similarly over the internet over the same time frame and involved the participants writing about their recent emotional experiences. The wait-list control participants received no treatments until 6-months later. Measures were taken of depression, mindfulness, psychological flexibility, anxiety, positive mental health and demographic variables prior to and after treatment and 6 and 12 months later.

They found, as previously reported, that ACT produced significant improvements in depressive symptoms that were maintained 6 and 12 months later. ACT produced a large improvement in psychological flexibility and the mindfulness facet of non-reactivity to internal events that were found to mediate the effect on depression. In other words, ACT reduced depression by improving non-reactivity and psychological flexibility.

Pots and colleagues state that “The central therapeutic mechanism in ACT is psychological flexibility, which is the ability to act in accordance with intrinsically motivating values or goals while being in contact with the present moment.” Hence, the results indicate that ACT was successful in producing its desired effect and this increase in the alignment of actions with values is a strong determinant of the reduction in depression. This is thought to be an important aspect of emotion regulation that is so important for allowing emotions to be experienced but not allowing them to produce maladaptive responses. This is also facilitated by not being particularly reactive to these emotions. Hence ACT appears to improve depression by improving the coherence and alignment of beliefs and values with the individual’s actions and emotions.

So, improve psychological flexibility, mindfulness, and depression with Acceptance and Commitment Therapy (ACT).

“It may be wise to not undertake the entire program while in the midst of an episode of clinical depression. Current evidence suggests that it may be prudent to wait until you have gotten the necessary help in climbing out of the depths and are able to approach this new work of working with your thoughts and feelings, with your mind and spirit unburdened by the crushing weight of acute depression.” – Jon Kabat-Zinn, Mark Williams, John Teasdale, and Zindel Segal

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Pots WT, Trompetter HR, Schreurs KM, Bohlmeijer ET. How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms. BMC Psychiatry. 2016 May 23;16:158. doi: 10.1186/s12888-016-0841-6.

Abstract

BACKGROUND: Acceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention.

METHODS: Data from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms.

RESULTS: The treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up.

CONCLUSIONS: The findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations.

http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0841-6

Improve Well-Being with Menstrual Disorder with Yoga Nidra

June 20, 2016 psyjdc 1 Comment

By John M. de Castro, Ph.D.

“The ancient practice of yoga nidra, also known as yogic sleep, is a meditative practice that results in conscious deep sleep. Current research suggests that yoga nidra can help relieve menstrual problems, diabetes symptoms and post-traumatic stress disorder (PTSD).” – Elaine Gavalas

Menstrual disorders are associated with disruptive physical and/or emotional symptoms just before and during menstruation, including heavy bleeding, missed periods and unmanageable mood swings. Symptoms can include abnormal uterine bleeding, which may be abnormally heavy or absent or occurs between periods, painful menstrual periods, premenstrual syndrome, or premenstrual dysphonic disorder (depression). These disorders are all very common and most women experience some of these symptoms sometime during their premenopausal years, while around 20% experience them throughout their fertile years.

Yoga has documented benefits for the individual’s psychological and physical health and well-being. It has also been shown to improve menstrual problems. Yoga, however, consists of a number of components including, poses, breathing exercises, yoga nidra (meditation), concentration, and philosophy/ethics. So, it is difficult to determine which facet or combination of facets of yoga are responsible for which benefit. Hence, it is important to begin to test each component in isolation to determine its effects.

In today’s Research News article “Psycho-Biological Changes with Add on Yoga Nidra in Patients with Menstrual Disorders: a Randomized Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1255064667850790/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794540/

Rani and colleagues randomly assigned women who displayed menstrual disorders for more than 6-months to either a yoga Nidra or treatment as usual group. Yoga nidra is generally practiced while lying on the back on a mat on the floor with the arms out at the sides and the palm facing up. This is the what’s known as the corpse pose in yoga. It is generally a deep guided meditation practice. It usually begins with a systematic body scan meditation and then moves into a deep meditative state. The most easily observable effect of the yoga nidra practice is the extremely deep relaxation of the nervous system and healing of the body by allowing it the rest and recharge it usually lacks in our all too busy lifestyles. Yoga nidra produces a state of deep relaxation and sedation without the individual actually going to sleep.

At baseline Rani and colleagues measured psychological general well-being, and a variety of hormone levels. The yoga nidra group then received 30-35-minute yoga nidra, 5 days per week for 3 months and practiced at home for the subsequent 3 months. Measurements were then repeated at the end of the 6-month program. Control participants received their normal medical treatments during the 6-month period. They found that the yoga Nidra group showed significant improvements in anxiety, depression, positive well-being, general health, and vitality while the control group did not. Similarly, they found that the yoga Nidra group had significant decreases in 4 hormone levels; thyroid-stimulating hormone, follicle-stimulating hormone, luteinizing hormone, and prolactin. Hence, yoga Nidra produced positive benefits for psychological well-being and also for endocrine (hormonal) function.

These are exciting findings. Yoga Nidra practice improved psychological well-being in women with menstrual disorder. Yoga practice and meditation practice have these same benefits for practitioners. But, it’s interesting that these psychological benefits can be produced by yoga nidra practice alone. The findings of decreased hormone levels are significant. Pituitary hormones, follicle stimulating hormone, luteinizing hormones, prolactin and thyroid hormones are very much involved in the menstrual cycle and are required for normal development of ova. Yoga Nidra practice may be helping with menstrual disorder by producing better regulation of these crucial hormones. Future research will be required to investigate this idea.

It is important to note that the control group did not receive any new active treatment. It is possible that the effects observed were not due to yoga Nidra, but to the expectations of the participants that the yoga nidra would improve their disorder. It will be important for future research to include and active or placebo control condition.

Regardless, the results suggest that well-being can be improved in women with menstrual disorder with yoga nidra.

“Yoga nidra for me is like a ‘super nap’ that recharges me in no time. It is a complete rejuvenation package – a must to relieve ourselves of daily stress in today’s busy world.” – Pritika Nair

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Rani, K., Tiwari, S. C., Kumar, S., Singh, U., Prakash, J., & Srivastava, N. (2016). Psycho-Biological Changes with Add on Yoga Nidra in Patients with Menstrual Disorders: a Randomized Clinical Trial. Journal of Caring Sciences,5(1), 1–9. http://doi.org/10.15171/jcs.2016.001

Abstract

Introduction: Menstrual disorders are common problems among women in the reproductive age group. Yuga interventions may decrease the physical and psychological problems related to menstrual disorders. The present study was aimed to assess the effect of Yoga Nidra on psychological problems in patients with menstrual disorders.

Methods: A total number of 100 women recruited from the department of obstetrics and gynecology and were then randomly allocated into two groups: a) intervention received yogic intervention and medication for 6 month, and b) control group received no yogic intervention and they only received prescribed medication). Psychological General Well-Being Index (PGWBI) and hormonal profile were assessed at the time of before and after six months on both groups.

Results: The mean score of anxiety, depression, positive well-being, general health, and vitality scores, as well as hormonal levels, in posttest were significantly different in intervention group as compared with pretest. But there was no significant difference in control group.

Conclusion: Yoga Nidra can be a successful therapy to overcome the psychiatric morbidity associated with menstrual irregularities. Therefore, Yogic relaxation training (Yoga Nidra) could be prescribed as an adjunct to conventional drug therapy for menstrual dysfunction.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794540/

Promote Adaptive Emotions with Mindful Non-Judgment

May 24, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“By cultivating such mindfulness of emotions, we can build our resiliency to handle all of the intense experiences associated with urban living. We can limit our ability to get hijacked by emotions, which can carry us away to undesired places (like getting on the wrong subway).” – Jonathan Kaplan

We are very emotional creatures. Without emotion, life is flat and uninteresting. Emotions provide the spice of life. We are constantly having or reacting to emotions. We often go to great lengths in an attempt to create or keep positive emotions and conversely to avoid, mitigate, or get rid of negative emotions. They are so important to us that they affect mostly everything that we do and say and can even be determinants of life or death. Anger, fear, and hate can lead to murderous consequences. Anxiety and depression can lead to suicide. At the same time love, joy, and happiness can make life worth living. Our emotions also affect us physically with positive emotions associated with health, well-being, and longevity and negative emotions associated with stress, disease, and shorter life spans.

The importance of emotions is only surpassed by our ignorance of them. Our rational side tries to downplay their significance and as a result research studies of emotions are fairly sparse and often ridiculed by politicians. So there is a great need for research on the nature of emotions, their effects, how they are regulated or not, and what factors affect them. One important factor is mindfulness, which has been shown to affect our ability to regulate emotions. Research has demonstrated that people either spontaneously high in mindfulness or trained in mindfulness are better able to be completely in touch with their emotions and feel them completely, while being able to respond to them more appropriately and adaptively. In other words, mindful people are better able to experience yet control emotions.

In today’s Research News article “Mindfulness and Emotional Outcomes: Identifying Subgroups of College Students using Latent Profile Analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1235541963136394/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269250/

Pearson and colleagues explore the components of mindfulness and how they relate to emotions in college students. They measured mindfulness with the Five Facet Mindfulness Questionnaire (FFMQ) which measures the mindfulness components of observing, describing, acting with awareness, non-judging, and non-reactivity. Using sophisticated statistical analysis they were able to identify 4 distinct classes of student responses; a high mindfulness group that were relatively high on every facet of mindfulness; a low mindfulness group that were relatively low on every facet of mindfulness; a judgmentally observing group that is high in observing but very low on non-judging of inner experience and acting with awareness; and a non-judgmentally aware group that were high on non-judging of inner experience and acting with awareness, but very low on the observing facet of mindfulness.

They found that the “high mindfulness” and “non-judgmentally aware” groups did not differ and had lower depressive symptoms, anxiety symptoms, affective lability, and distress intolerance. On the other hand, the “judgmentally observing” groups had higher depressive symptoms, anxiety symptoms, affective lability, and distress intolerance. Finally, they found that the “low mindfulness group” was in the middle significantly better than the “judgmentally observing” group, but significantly worse than the “non-judgmentally aware” and “high mindfulness groups” in adaptive emotionality. Hence, having high mindfulness and being aware without judging are associated with relatively positive emotional states while observing while judging experiences is associated with relatively negative emotional states. Simply being low in mindfulness is associated with an average emotional state.

These results suggest that mindfulness is associated with positive emotional states but judging experience is associated with poor emotional states. So, being overall mindful and particularly non-judging leads to the most adaptive emotional states. This reinforces the previous findings of mindfulness promotion emotional regulation. But, they extend this understanding to emphasize just how important judging experience is; if its judged it leads to poor emotional outcomes while if it’s not, it leads to positive emotional outcomes. Although correlational these observations suggest that emotional states can be elevated with mindful non-judgement.

So, promote adaptive emotions with mindful non-judgment.

“For many of us, instead of feeling our emotions, we criticize ourselves for having them. We call ourselves weak, dramatic, stupid, too sensitive. . . we get angry with ourselves for feeling scared or upset. We become disgusted when we’re jealous of others. We get frustrated when we’re still grieving a breakup or a fight. The key is to accept our emotions.” – Margarita Tartakovsky

CMCS – Center for Mindfulness and Contemplative Studies

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

Study Summary

Pearson, M. R., Lawless, A. K., Brown, D. B., & Bravo, A. J. (2015). Mindfulness and Emotional Outcomes: Identifying Subgroups of College Students using Latent Profile Analysis. Personality and Individual Differences,76, 33–38. http://doi.org/10.1016/j.paid.2014.11.009

Highlights

We used latent profile analysis to group college students based on mindfulness scores
A 4-class solution was selected, leading to four subgroups of college students
High mindfulness and non-judgmentally aware groups had adaptive outcomes
Low mindfulness and judgmentally observing groups had maladaptive outcomes
We discuss the implications of person-centered analyses for studying mindfulness

Abstract

In non-meditating samples, distinct facets of mindfulness are found to be negatively correlated, preventing the meaningful creation of a total mindfulness score. The present study used person-centered analyses to distinguish subgroups of college students based on their mindfulness scores, which allows the examination of individuals who are high (or low) on all facets of mindfulness. Using the Lo-Mendell-Rubin Adjusted LRT test, we settled on a 4-class solution that included a high mindfulness group (high on all 5 facets, N = 245), low mindfulness group (moderately low on all 5 facets, N = 563), judgmentally observing group (high on observing, but low on non-judging and acting with awareness, N =63), and non-judgmentally aware group (low on observing, but high on non-judging and acting with awareness, N =70). Consistent across all emotional outcomes including depressive symptoms, anxiety symptoms (i.e., worry), affective instability, and distress intolerance, we found that the judgmentally observing group had the most maladaptive emotional outcomes followed by the low mindfulness group. Both the high mindfulness group and the non-judgmentally aware group had the most adaptive emotional outcomes. We discuss the implications of person-centered analyses to exploring mindfulness as it relates to important psychological health outcomes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269250/

Relieve Uncertainty and Panic Disorder with Mindfulness

May 20, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“Panic gains momentum from the energy we put into fighting it, and the fact is, we don’t always need to fight it. Life happens to you and me as it happens to all people, whether we are ready for it or not, and all we really need to do is be open to experiencing it one moment at a time.” – Krista Lester

Anxiety and fear happen in everyone and under normal conditions are coped with adaptively and effectively and do not continue beyond the eliciting conditions. But, in a large number of people the anxiety is non-specific and overwhelming. Anxiety Disorders 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 They 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.

A subset of people with anxiety disorders are diagnosed with Panic Disorder. These are sudden attacks of fear and nervousness, as well as physical symptoms such as difficulty breathing, pounding heart or chest pain, intense feeling of dread, shortness of breath, sensation of choking or smothering, dizziness or feeling faint, trembling or shaking, sweating, nausea or stomachache, tingling or numbness in the fingers and toes, chills or hot flashes, and a fear that they are losing control or are about to die. A common additional symptom of panic disorder is the persistent fear of having future panic attacks. The fear of these attacks can cause the person to avoid places and situations where an attack has occurred or where they believe an attack may occur. Needless to say patients are miserable, their quality of life is low, and their ability to carry on a normal life disrupted.

There are a number of treatments for Panic Disorder including psychotherapy, relaxation training, and medication. Recently it’s been demonstrated that panic disorder can be treated with mindfulness practice. In particular, Mindfulness Based Cognitive Therapy (MBCT) has been shown to be particularly effective. It is not known, however, the exact mechanism of action of MBCT effects on Panic Disorder. In today’s Research News article “Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1232976826726241/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823195/

Kim and colleagues investigate whether an intolerance of uncertainty may be a key factor in Panic Disorder and the response to MBCT. Intolerance of uncertainty is defined as a “dispositional characteristic that results from a set of negative beliefs about uncertainty and its implications, and involves the tendency to react negatively on an emotional, cognitive, and behavioral level to uncertain situations and events.”

Kim and colleagues recruited patients suffering with Panic Disorder and treated them with an 8-week program of Mindfulness Based Cognitive Therapy (MBCT). They measured Panic Disorder intensity, depression, and intolerance of uncertainty both before and after treatment. They found that MBCT produced significant decreases in all measures, with patients having significantly lower levels of Panic Disorder intensity, depression, and intolerance of uncertainty after treatment. They also found that before treatment, the higher the level of intolerance of uncertainty, the greater the intensity of Panic Disorder and the higher the level of depression. In addition, the greater the reduction in intolerance of uncertainty produced by MBCT, the greater the reduction in Panic Disorder intensity. The significant association between intolerance of uncertainty and Panic Disorder intensity was present even after the pre-treatment level of Panic Disorder intensity and Depression were accounted for.

These results suggest that Mindfulness Based Cognitive Therapy (MBCT) is an effective treatment for Panic Disorder. They further suggest that the effectiveness of MBCT is at least in part due to it reducing the intolerance of uncertainty that is characteristic of Panic Disorder patients. Mindfulness training in general and MBCT in particular increase attention to what is transpiring in the present moment and decrease thinking about the future. Since intolerance of uncertainty is a worry about future events, it would seem reasonable that MBCT would reduce it. Since intolerance of uncertainty is clearly related to Panic Disorder, its reduction should reduce Panic Disorder.

It should be noted that the study did not contain a control (comparison) condition. So, it cannot be concluded that MBCT was responsible for the improvements. It is possible that a placebo effect or spontaneous remissions were responsible. Regardless, the results are suggestive that MBCT is a safe and effective intervention for the relief of Panic Disorder, depression, and intolerance of uncertainty. So, relieve uncertainty and panic disorder with mindfulness.

“mindfulness takes ‘thinker’ out of thought, and teaches us to step back and observe our minds and our thoughts. Mindfulness is learning to see exactly what is happening. It ‘disengages’ our ‘automatic pilot’ and gives us the necessary space to see cause and effect as it happens in ‘real’ time. Cause: thought. Effect: panic and/or anxiety.” – Bronwyn Fox

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Kim, M. K., Lee, K. S., Kim, B., Choi, T. K., & Lee, S.-H. (2016). Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder. Psychiatry Investigation, 13(2), 196–202. http://doi.org/10.4306/pi.2016.13.2.196

Abstract

Objective: Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods: We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results: There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion: IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823195/

Relieve Depression with Mindful Meditation

May 19, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People at risk for depression are dealing with a lot of negative thoughts, feelings and beliefs about themselves and this can easily slide into a depressive relapse. MBCT helps them to recognize that’s happening, engage with it in a different way and respond to it with equanimity and compassion.” – Willem Kuyken

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. It is generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression. Major depression can be quite debilitating. It is distinguishable from everyday sadness or grief by the depth, intensity, and range of symptoms. These can include feelings of sadness, tearfulness, emptiness or hopelessness, angry outbursts, irritability or frustration, even over small matters, loss of interest or pleasure in most or all normal activities, such as sex, hobbies or sports, sleep disturbances, including insomnia or sleeping too much, tiredness and lack of energy, so even small tasks take extra effort, changes in appetite — often reduced appetite and weight loss, but increased cravings for food and weight gain in some people, anxiety, agitation or restlessness, slowed thinking, speaking or body movements, feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that aren’t your responsibility, trouble thinking, concentrating, making decisions and remembering things, frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide, unexplained physical problems, such as back pain or headaches. Needless to say individuals with depression are miserable.

Depression appears to be the result of a change in the nervous system that can generally only be reached with drugs that alter the affected neurochemical systems. But, depression can be difficult to treat. Of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. In, addition, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. So, it is important to investigate alternative treatments for depression.

Mindful meditation training is a viable alternative treatment for depression. It has been shown to be an effective treatment for active depression and for the prevention of its recurrence. It can even be effective in cases where drugs fail. In today’s Research News article “Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1232267610130496/?type=3&theater

or below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383597/

Jain and colleagues investigated the state of knowledge regarding mindful meditation effectiveness for depression. They reviewed the published research literature on the application of mindful meditation training to the relief of depression and/or the prevention of relapse. Meditation occurred in a variety of different techniques, meditation, yoga, mindful movement (i.e. Tai Chi), and mantra meditation. The most frequent technique (57% of studies) was Mindfulness Based Cognitive Therapy (MBCT). This was not a surprise as MBCT was developed specifically to treat depression.

They reported that the research results made a clear case that meditation therapies are effective for depression. They were effective in relieving depression when the patient was experiencing an active episode and also when the patient had recovered from major depression but was experiencing residual depressive symptoms. Thus, the published research is clear that mindful meditation is an effective treatment for depression. They caution, however, that more research is needed to unequivocally demonstrate its effectiveness under more highly controlled conditions.

It is not known exactly how meditation relieves depression. It can be speculated that mindful meditation by shifting attention away from the past or future to the present moment interrupts the kinds of thinking that are characteristic of and support depression. These include rumination about past events, worry about future events, and catastrophizing about potential future events. Mindfulness meditation has been shown to interrupt rumination, worry, and catastrophizing and focus the individual on what is transpiring in the present. By interrupting these forms of thinking that support depression, shifting attention to the present moment where situations are actually manageable, mindful meditation may disrupt depression.

Regardless of the speculations, it is clear that mindfulness meditation is a safe and effective treatment for depression.

“It’s been more than two years since I started that experiment. I have not missed a single day. And I’m going to tell you right now, still in half-disbelief myself: meditation worked. I don’t mean I feel a little better. I mean the Depression is gone. Completely. I still have very hard days, yes. But when issues come up, real or imagined (or a combination of both), meditation provides an awareness that helps me sort through it all, stay steady on, and understand deeply what is going on. “ – Spike Gillespie

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Jain, F. A., Walsh, R. N., Eisendrath, S. J., Christensen, S., & Cahn, B. R. (2015). Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review. Psychosomatics, 56(2), 140–152. http://doi.org/10.1016/j.psym.2014.10.007

Abstract

Background: Recently, the application of meditative practices to the treatment of depressive disorders has met with increasing clinical and scientific interest, due to a lower side-effect burden, potential reduction of polypharmacy, as well as theoretical considerations that such interventions may target some of the cognitive roots of depression. We aimed to determine the state of the evidence supporting this application.

Methods Randomized, controlled trials of techniques meeting the Agency for Healthcare Research and Quality (AHRQ) definition of meditation, for participants suffering from clinically diagnosed depressive disorders, not currently in remission, were selected. Meditation therapies were separated into praxis (i.e. how they were applied) components, and trial outcomes were reviewed.

Results: Eighteen studies meeting inclusionary criteria were identified, encompassing seven distinct techniques and 1173 patients, with Mindfulness-Based Cognitive Therapy comprising the largest proportion. Studies including patients suffering from acute major depressive episodes (N = 10 studies), and those with residual subacute clinical symptoms despite initial treatment (N = 8), demonstrated moderate to large reductions in depression symptoms within group, and relative to control groups. There was significant heterogeneity of techniques and trial designs.

Conclusions: A substantial body of evidence indicates that meditation therapies may have salutary effects on patients suffering from clinical depressive disorders during the acute and subacute phases of treatment. Due to methodological deficiences and trial heterogeneity, large-scale, randomized controlled trials with well-described comparator interventions and measures of expectation are needed to clarify the role of meditation in the depression treatment armamentarium.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383597/

Cope with Violence Trauma with Mindfulness

May 12, 2016 psyjdc Leave a comment

By John M. de Castro, Ph.D.

“People with PTSD ruminate, and rumination is all about not being present. It’s all about focusing on something terrible that happened in the past or something frightening that will happen in the future, so these patients are stuck in a rut. My personal bias is that mindfulness-based therapy has a big effect on rumination, and decreasing rumination allows people to experience the present moment, which expands their awareness of different possibilities and increases their ability to pay attention to things they have avoided in the past,” – Anthony King

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. Many, but, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life.

PTSD can be produced by traumatic events occurring to anyone in a variety of different contexts. These include interpersonal violence (IPV). It is defined “as the intentional use of physical or sexual violence against another person within the context of a relationship. This includes physical or sexual violence committed by a family member, intimate partner, friend, or acquaintance.” A frequent form of IPV is intimate partner violence. Indeed, 27% of women and 11% of men have reported that they had been harmed by sexual or physical violence at some time during their lives.

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience negative changes in beliefs and feelings including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise.

Obviously, these are serious and troubling symptoms that need to be addressed. There are a number of therapies that have been developed to treat PTSD. One of which, mindfulness training has been found to be particularly effective. In today’s Research News article “Trauma-Informed Mindfulness-Based Stress Reduction for Female Survivors of Interpersonal Violence: Results from a Stage I RCT.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1227840437239880/?type=3&theater

or below

Kelly and Garland randomly assigned adult female survivors of interpersonal violence (IPV) to either an 8-week mindfulness training or wait-list control condition. The intervention was a form of Mindfulness Based Stress Reduction (MBSR) that was modified for treatment with trauma survivors.

They found that the treatment produced a clinically significant decrease in PTSD symptoms to the point where a significant number of participants could no longer be classified as PTSD sufferers. The more the participant practiced the mindfulness training the greater the reduction in PTSD symptoms. There were also significant decreases in the mindfulness group in depression and anxious attachment. Anxious attachment is a symptom of PTSD that involves “vacillating between attempts to draw in significant others with endearing attention-seeking behaviors and attempts to attract attention through emotional outbursts of crying or anger.” Reducing anxious attachment allows the sufferer to conduct much healthier interpersonal relationships.

These are very promising results that suggest that the modified form of Mindfulness Based Stress Reduction (MBSR) is a safe and effective treatment for PTSD caused by interpersonal violence (IPV). It is not known how mindfulness training could be so effective for PTSD. It can be speculated that the improvement in present moment awareness might have helped by focusing on the individual on the present rather than the past when the trauma occurred and by reducing rumination about the past. In addition, mindfulness training is known to improve emotion regulation and this may allow the PTSD sufferers to not avoid but fully experience the emotions and then respond to them in a constructive fashion. Finally, mindfulness training is known to reduce the physiological and psychological responses to stress. This lowered stress levels may reduce the intensity of their response to memories of the trauma, allowing the individual to be able to internally address the events directly.

Regardless of the mechanism, it is clear that mindfulness training is an effective treatment for PTSD symptoms caused by interpersonal violence (IPV). So, cope with violence trauma with mindfulness.

“Mindfulness-based stress reduction teaches individuals to attend to the present moment, to attend to what they are experiencing — their thoughts, their feelings — in a nonjudgmental, accepting manner. We think that teaching people these mindfulness skills helps them to have a different relationship with their PTSD symptoms — a willingness to let thoughts be there without trying to push them away,” -Melissa Polusny

CMCS – Center for Mindfulness and Contemplative Studies

Study Summary

Kelly, A. and Garland, E. L. (2016), Trauma-Informed Mindfulness-Based Stress Reduction for Female Survivors of Interpersonal Violence: Results From a Stage I RCT. J. Clin. Psychol., 72: 311–328. doi:10.1002/jclp.22273

Abstract

OBJECTIVE: This pilot randomized controlled trial evaluated a novel trauma-informed model of mindfulness-based stress reduction (TI-MBSR) as a phase I trauma intervention for female survivors of interpersonal violence (IPV).

METHOD: A community-based sample of women (mean age = 41.5, standard deviation = 14.6) with a history of IPV was randomly assigned to an 8-week TI-MBSR intervention (n = 23) or a waitlist control group (n = 22). Symptoms of posttraumatic stress disorder (PTSD) and depression as well as anxious and avoidant attachment were assessed pre- and postintervention.

RESULTS: Relative to the control group, participation in TI-MBSR was associated with statistically and clinically significant decreases in PTSD and depressive symptoms and significant reductions in anxious attachment. Retention in the intervention was high, with most participants completing at least 5 of the 8 sessions for the intervention. Minutes of mindfulness practice per week significantly predicted reductions in PTSD symptoms.

CONCLUSION: TI-MBSR appears to be a promising and feasible phase I intervention for female survivors of interpersonal trauma.