Depression

Ease Caregiver Problems with Mindfulness

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“Many of us follow the commandment ‘Love One Another.’ When it relates to caregiving, we must love one another with boundaries. We must acknowledge that we are included in the ‘Love One Another.” ― Peggi Speers

 

Providing needed care for others, particularly loved ones can be very satisfying and rewarding. It may be an opportunity to provide care for someone who provided care for you. It may be an opportunity to express your love for another in a tangible way. It can be a joyful experience. But, particularly over time, caregiving can wear the caregiver out and the stress and sacrifices required begin to take their toll. As a result caregivers experience high levels of anxiety and depression, sleeplessness, physical exhaustion, weakening of the immune system can occur, opening the caregiver up to diseases, burnout, and feelings of hopelessness. All of which leads to an increase in the mortality rate of caregivers.

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. For Alzheimer’s disease alone, in 2008 there were an estimated 9.9 million caregivers providing 8.5 billion hours of care at a value of $94 Billion dollars.

 

Caring for an individual with dementia can be particularly challenging. Over time dementia will lead to loss of memory, loss of reasoning and judgment, personality and behavioral changes, physical decline, and death.  If this isn’t bad enough, a little appreciated consequence is that few insurance programs cover dementia care outside of the hospital. So, medical expenses can produce extra financial strain on top of the loss of income for the caregiver.

 

Dementia is particularly difficult for caregivers and can produce higher levels of stress than other forms of caregiving. The memory and personality changes in the patient may take away all those characteristics that make the loved one identifiable, unique, and endearing, producing psychological stress in the caregiver. The feelings of hopelessness can be overwhelming regarding the future of a patient with an irreversible terminal degenerative illness. In addition, caregivers often experience an anticipatory grief associated with a feeling of impending loss of their loved one.

 

Obviously, there is a need to care for caregivers, for all types of caregiving but particularly for dementia caregivers. They play an essential and often irreplaceable role. So, finding ways to ease the burden is extremely important. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving (see http://contemplative-studies.org/wp/index.php/category/research-news/caregiving/). In today’s Research News article “Feasibility of Central Meditation and Imagery Therapy for Dementia Caregivers”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1139767462713845/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106977/

Jain and colleagues provided an 8-week meditation and guided imagery mindfulness program to caregivers for family members with dementia. The practice resulted in significant reductions in the caregiver’s levels of anxiety and depression. It reduced levels of insomnia and increased mindfulness. These improvements were still evident three months later. On a more subtle level the caregivers reported qualitative shifts in their relationships with the dementia patients, including greater understanding and compassion, improved ability to manage their day-to-day caregiving, and reduced arguing.

 

Mindfulness practice focuses the individual on the present moment. This reduces worries about the future and ruminations about problems in the past. This is very helpful for dementia caregivers making them better able to attend to what is needed now and to spend less time catastrophizing, feeling remorse, or experiencing anticipatory grief. Mindfulness practice is also known to reduce the psychological and physical responses to stress. This would obviously be helpful for the caregiver. Finally, mindfulness practice is known to improve emotion regulation so that the caregiver can allow themselves to feel and experience their emotions but at the same time respond to them in a constructive and productive way. This has to be very helpful in dealing with the sometimes overwhelming emotions consequent upon dementia caregiving.

 

The Jain and colleagues study was a pilot program and as such had only a small group of participants and no control group. The results are exciting enough that it is certainly justified to launch a major randomized controlled trial of the effectiveness of mindfulness training to ameliorate the negative consequences of dementia caregiving.

 

So, ease caregiver problems with mindfulness.

 

“Many caregivers share that they often feel alone, isolated, and unappreciated. Mindfulness can offer renewed hope for finding support and value for your role as a caregiver…It is an approach that everyone can use. It can help slow you down some so you can make the best possible decisions for your care recipient. It also helps bring more balance and ease while navigating the caregiving journey.”  ― Nancy L. Kriseman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Stop Being Angry, Anxious, and Depressed over Fibromyalgia with Mindfulness

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Mindfulness fibromyalgia Amutio2

“Fibromyalgia is not a cookie-cutter illness. Each of us is different and unique. There is no cure or control over this, hence each day we must continuously adapt to our disease state.” – Dear Fibromyalgia

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

Many studies have linked fibromyalgia with depression. In fact, people with fibromyalgia are up to three times more likely to be depressed at the time of their diagnosis than someone without fibromyalgia. In addition, the stress from pain and fatigue can cause anxiety and social isolation. As a result, many patients experience intense anger regarding their situation. The emotions are understandable, but can act to amplify the pain. Hence, controlling the emotions may reduce the perceived pain.

 

Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia (see http://contemplative-studies.org/wp/index.php/2015/10/05/reduce-fibromyalgia-pain-with-mindfulness/). This may occur directly or indirectly by reducing emotions or both. Since mindfulness has been shown to improve emotion regulation, it would seem reasonable that this could be a route of effectiveness. In today’s Research News article “Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1135018156522109/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290530/

Amutio and colleagues investigate the effects of a 7-week, 2-hour per week mindfulness practice on the heightened emotions that accompany fibromyalgia. Results were compared to those obtained from a wait-list control group. It was found that the mindfulness training significantly reduced anger, anxiety, and depression at the end of training and these improvements were maintained three months later.

 

These are exciting results and suggest that mindfulness training is effective for the heightened emotions associated with fibromyalgia. It is unfortunate that Amutio and colleagues did not measure levels of pain. So, it is impossible to ascertain whether the emotional reductions also produced pain reductions. But, even if the mindfulness program only affects emotions, that by itself would be a significant contribution to the patients’ well-being.

 

Mindfulness has been shown to improve emotion regulation (see http://contemplative-studies.org/wp/index.php/category/research-news/emotions/) which allows the individual to experience the emotions fully but to respond to them in a constructive, productive fashion, thus taking away the amplifying effect of the emotions on pain. Mindfulness training also improves the individual’s ability to focus on the present moment and this has been shown to reduce rumination and catastrophizing (see http://contemplative-studies.org/wp/index.php/2015/08/07/pain-is-a-pain-relieve-it-with-meditation/) which can produce anxiety and depression. These would also amplify the pain. Regardless of the mechanism it is clear the mindfulness training can be beneficial in controlling the emotional sequela of fibromyalgia pain.

 

So, stop being angry, anxious, and depressed over fibromyalgia with mindfulness.

“Pain is inevitable. Suffering is optional. Say you’re running and you think, ‘Man, this hurts, I can’t take it anymore. The ‘hurt’ part is an unavoidable reality, but whether or not you can stand anymore is up to the runner himself.” ― Haruki Murakami

CMCS – Center for Mindfulness and Contemplative Studies

 

When Nothing Else Works for Depression Mindfulness Can!

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“When I see new patients with treatment-resistant depression, I tell them that if they want to borrow some of my optimism, they’re welcome to it. . .Despite how it feels, lots of people have been through this and lots of people get better.” – Ian Cook

 

Major Depression is the most common mental illness affecting over 6% of the population. 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 of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. This leaves a third of all patients treated without success. 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. In today’s Research News article “Transcranial Magnetic Stimulation, and Depression Specific Yoga and Mindfulness Based Cognitive Therapy in Management of Treatment Resistant Depression: Review and Some Data on Efficacy”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1130698403620751/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4609854/

Pradhan and colleagues review the research literature on alternative treatments for treatment-resistant depression; ketamine, transcranial magnetic stimulation, and yoga and mindfulness interventions.

 

They report that infusion of the drug Ketamine, a glutamate receptor (NMDA) antagonist, has been shown to be effective quickly for treatment-resistant depression. Unfortunately its effects last only about a week and it has some troubling side effects. Another treatment, repetitive transcranial magnetic stimulation (rTMS) stimulates the human cortex through external magnetic stimulation and can be applied non-invasively. It appears to be effective for the relief of treatment-resistant depression in about half of the patients and it has very few and mild side effects. But treatments must be provided on a daily basis in a doctor’s office. So, it is very inconvenient and thereby often impossible for the patients.

 

Contemplative practices such as meditation and yoga are low cost and generally safe with few if any side effects. They have been shown to be effective for depression and to prevent relapse (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). A combination of cognitive behavioral therapy with mindfulness and meditation techniques, Mindfulness Based Cognitive Therapy (MBCT) has been demonstrated to be effective for depression even after drugs have failed to relieve the depression (see http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/).

Pradhan and colleagues perform a pilot study of a combination of MBCT and yoga they term Depression Specific Y-MBCT (DepS Y-MBCT) applied to treatment-resistant depression patients, one third of whom had suicidal tendencies. Of the 32 participants, 27 achieved remission from depression that was maintained for at least two months. These are exciting findings. A low cost and safe therapeutic technique combining mindfulness, yoga, and cognitive behavioral therapy produced and 85% remission rate for patients who did not respond to other treatments. Of course, these results need to be repeated in a randomized clinical trial. But, these results certainly justify the effort.

It is interesting that a disease like depression that is thought to be organically based in defective brain chemistry can be treated by a behavioral treatment. But, yoga and meditation have been found to alter the structure, connectivity, and chemistry of the brain. So, it may not be so mysterious how a behavioral treatment might be effective for a primarily physiological disorder. The mind and body are one. Treating the mind can also treat the body. This is one of the major messages of the alternative medical treatment movement.

 

So, apply mindfulness when nothing else works for depression.

 

“Start living right here, in each present moment. When we stop dwelling on the past or worrying about the future, we’re open to rich sources of information we’ve been missing out on—information that can keep us out of the downward spiral and poised for a richer life.” ― Mark Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Stop Making Yourself Depressed with Mindfulness

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“Rumination . . . becomes the fast track to feeling helpless. Specifically, it paralyzes your problem-solving skills. You become so preoccupied with the problem that you’re unable to push past the cycle of negative thoughts.” – Margarita Tartakovsky

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, is more prevalent in women than in men, and as one in 33 children and one in eight adolescents have clinical depression. 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.

 

Depression can be a downward spiral where depressed people repeatedly think about their problems which, in turn, reinforces the depression making it worse and worse. This repetitive thinking is known as rumination. It is like a record that’s stuck and keeps repeating the same lyrics. It’s replaying a dispute with a loved one in the individual’s mind. It’s going over their past mistakes, again and again. Research has shown that rumination produces a variety of negative consequences, including depression, anxiety, post-traumatic stress disorder, binge-drinking and binge-eating.

 

One of the keys to dealing with depression may be addressing these repetitive thoughts. In fact, rumination may be a major contributing factor to recurrent depression. Mindfulness has been demonstrated to reduce worry and rumination (see http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/) and be effective for treating depression and preventing reoccurrence of depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/). So, it is possible that mindfulness’ beneficial effects upon depression may be mediated by its effects on worry and rumination.

 

In today’s Research News article “Memory Specificity and Mindfulness Jointly Moderate the Effect of Reflective Pondering on Depressive Symptoms in Individuals with a History of Recurrent Depression”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1122521014438490/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445381/

Brennan and colleagues studied adult patients with recurrent depression who had had at least three depressive episodes. They found that the more mindful the patients were the lower their depression and the lower their levels of brooding (rumination). They also found that high levels of using autobiographical memory along with low levels of mindfulness made depression worse in people who tended to think a lot. Hence high mindfulness may be protective against over thinking exacerbation of depression.

 

The results did not produce strong evidence that mindfulness is successful for depression by way of its effects on rumination. To a large extent each appeared to have independent effects on depression with mindfulness making it better and rumination making it worse. This may be the case for individuals with recurrent depression. More research is needed to see if it is also true for individuals with current depression or who are at-risk for depression.

 

Mindfulness can affect depression in a number of ways. It is known to improve emotion regulation, the ability to experience emotions and still react constructively to them. This can allow the individual to fully experience the feeling that they’re having but not overreact to them and let them dissipate. Mindfulness is also known to reduce physiological and psychological responses to stress and stress is known to be associated with depression. So, reducing it could lead to lower depression. Finally, mindfulness by focusing the individual on the present moment tends to decrease rumination about the past and worry about the future. So, there are many routes by which mindfulness may be effective for recurrent depression. But, it is clear that it is a safe and effective treatment for depression or to prevent reoccurrence of depression.

 

So, be mindful and stop making yourself depressed.

 

“Start living right here, in each present moment. When we stop dwelling on the past or worrying about the future, we’re open to rich sources of information we’ve been missing out on—information that can keep us out of the downward spiral and poised for a richer life.” ― Mark Williams

 

CMCS – Center for Mindfulness and Contemplative Studies

 

 

Women Behind Bars Benefit from Mindfulness Training

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“Prison is quite literally a ghetto in the most classic sense of the world, a place where the U.S. government now puts not only the dangerous but also the inconvenient—people who are mentally ill, people who are addicts, people who are poor and uneducated and unskilled.” — Piper Kerman

“Two hundred women, no phones, no washing machines, no hair dryers–it was like Lord of the Flies on estrogen.” — Piper Kerman

 

Prison is an extremely difficult environment for anyone, but especially for women. The prison population is by far majority male, but 18% are female. These women are different from their male counterparts in that they are much more likely to have experienced poverty, intimate partner violence, sexual abuse, and/or other forms of victimization often linked to their offending behavior. They are also much more likely to have co-occurring disorders—in particular, substance abuse problems interlinked with trauma and/or mental illness. In addition, they often struggle with depression, anxiety and post-traumatic stress.

 

So, incarcerated women need to be treated differently, including mental health services, to help them move toward rehabilitation and successful reintegration into society. Education, job training, psychotherapy, addiction treatment etc. can obviously be helpful. In addition, mindfulness training may also be very helpful. It has been found to be beneficial for the treatment of mental health problems in general (see http://contemplative-studies.org/wp/index.php/category/research-news/mental-health/) and for the treatment for substance abuse (see http://contemplative-studies.org/wp/index.php/category/research-news/addiction/). In addition contemplative practice has been found to be helpful for prisoners (see http://contemplative-studies.org/wp/index.php/category/research-news/prison/). So, it makes sense that mindfulness training may be beneficial especially for incarcerated women.

 

In today’s Research News article “The Impact of a Mindfulness Based Program on Perceived Stress, Anxiety, Depression and Sleep of Incarcerated Women”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1121590894531502/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586693/

Ferszt and colleagues had incarcerated women participate in a 12-week Mindfulness Based Program called Path to Freedom. They found that the intervention produced a decrease in perceived stress, anxiety, and depression. In addition, the women who participated were consistently positive about the program and many who did not participate, but heard of the program through word of mouth, asked to be included in future programs.

 

It is not surprising that mindfulness training reduced stress, anxiety, and depression. There are  extensive research findings demonstrating its effectiveness for these issues (see http://contemplative-studies.org/wp/index.php/category/research-news/stress/ regarding stress and http://contemplative-studies.org/wp/index.php/category/research-news/anxiety/ regarding anxiety and http://contemplative-studies.org/wp/index.php/category/research-news/depression/ regarding depression).

 

These are encouraging results. Stress, anxiety, and depression are difficult issues for incarcerated women. The presence of these issues can interfere with other programs designed to help in rehabilitation. In addition, they can be problematic for the women in adjusting to everyday life after release. So, relief of stress, anxiety, and depression may be very beneficial for their eventual success in prison and their reintegration into society.

 

So, mindfulness is beneficial for women behind bars as it is for women in all circumstances.

 

“The women I met in Danbury helped me to confront the things I had done wrong, as well as the wrong things I had done. It wasn’t just my choice of doing something bad and illegal that I had to own; it was also my lone-wolf style that had helped me make those mistakes and often made the aftermath of my actions worse for those I loved.”  — Piper Kerman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Treat Back Pain with Yoga

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 “Yoga teaches us to cure what need not be endured and endure what cannot be cured.” ~B.K.S. Iyengar

 

Low Back Pain affects a wide swath of humanity (6% to 15%) and is the leading cause of disability worldwide. It affects almost everyone with 80% of the population experiencing back pain sometime during their lives. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs.

 

The therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years. Obviously, there is a need for effective treatments for low back pain that are low cost and don’t have troublesome side effects. Since many yoga poses focus on stretching and strengthen in the back, it makes sense that yoga practice when done properly should be helpful for low-back pain. Indeed, Mindfulness Based Stress Reduction (MBSR) which includes yoga practice is effective for low back pain http://contemplative-studies.org/wp/index.php/2015/10/17/control-low-back-pain-with-mindfulness/.

 

In today’s Research News article “Evaluation of the Effectiveness and Efficacy of Iyengar Yoga Therapy on Chronic Low Back Pain”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1120568141300444/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393557/

Williams and colleagues examine the effectiveness of 24 weeks of Iyengar yoga practice on adults who have been suffering from low-back pain for longer than 3 months. They randomly assigned participants to either yoga practice or to receive standard medical care.

 

They found that the pain sufferers who participated in yoga had a 42% greater reduction in pain intensity than the group receiving standard medical care. This resulted in a trend toward a greater reduction in the use of pain medications in the yoga group. Importantly, the yoga participants showed a 24% greater improvement in their ability to carry on with normal activities, with a larger number of yoga participants having a clinically significant decrease in functional disability. In addition, the yoga participants showed a large, 47%, reduction in depression levels in comparison to the standard medical care participants. These effects were produced without any significant adverse effects and were still present 6-months after the conclusion of the active treatment.

 

These results confirm that yoga practice is a safe and effective treatment that produces long-term improvements in chronic low-back pain and in turn improves the patients’ abilities to carry on everyday activities and in turn reduces depression. This also appears to reduce the individuals use of drugs to treat their pain symptoms. Yoga has so many beneficial effects (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/yoga-contemplative-practice/) in addition to the assistance with pain that it would seem to be an almost ideal treatment.

 

So, practice yoga and improve low-back pain and disability.

 

“Hatha is the sanctuary for those suffering every type of pain. It is the foundation for those practicing every type of Yoga.” ~Svatmarama

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Yoga Improves Stress Responses and Mood

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“Yoga has a sly, clever way of short circuiting the mental patterns that cause anxiety.” – Baxter Bell

 

Depression and anxiety are great scourges on humankind. They affect millions of people worldwide decreasing productivity and increasing misery. The exact etiology of these disorders is unknown. But, modern research is slowly unraveling the mystery. One promising line of inquiry is investigating the linkage of depression and anxiety with the physiological responses to stress including stress hormone responses and the inflammatory response. Depression has been long known to be associated with increased stress hormone activity and increased inflammatory response. This raises the question as to what role the stress response plays in the development of depression.

 

The most common treatment for depression is antidepressant drugs. They are effective for some people and are also known to reduce the stress response and inflammation. But, they are not effective for everyone and they can have some unpleasant side effects. So, alternative treatment for depression and anxiety that are safe, effective and with few side effects are needed.

 

Yoga practice has been shown to reduce anxiety and depression (see http://contemplative-studies.org/wp/index.php/2015/09/03/keep-up-yoga-practice-for-anxiety-and-depression/) and to reduce stress and anxiety (see http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/). Yoga has also been shown to reduce inflammation (see http://contemplative-studies.org/wp/index.php/2015/09/11/reduce-inflammation-with-yoga/) and http://contemplative-studies.org/wp/index.php/2015/08/27/control-inflammation-with-mind-body-practices/) and immune system balance (see http://contemplative-studies.org/wp/index.php/2015/07/17/healthy-balance-through-yoga/). So, it would seem that the practice of yoga is potentially an alternative to antidepressant drug treatment for depression.

 

In today’s Research News article “A systematic review of randomised control trials on the effects of yoga on stress measures and mood”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1115024035188188/?type=3&theater

Pascoe and colleagues review 24 randomized controlled trials investigating the effectiveness of yoga practice for depression and anxiety and their linkages to the stress and inflammatory responses. They found that the published literature provided evidence that yoga practice reduces depression and anxiety and the stress and inflammatory responses.

 

In particular, Pascoe and colleagues report that the evidence suggests that yoga practice reduces anxiety and depression and at the same time reduces the nervous systems responses to stress as indicated by reductions in heart rate and blood pressure and by reductions in the levels of the stress hormone, cortisol. There was also reported to be a decrease in cytokine levels suggesting a decrease in the inflammatory response. Hence, yoga practice appears to be effective for anxiety and depression and reduces the associated stress and inflammatory responses.

 

Since, changes in depression and anxiety occurred at the same time as changes in stress and inflammatory responses, it strengthens the case of a causal link between the two. More research is need to further investigate this promising linkage.

 

So, yoga practice is a safe and effective treatment for anxiety and depression while reducing stress and inflammation.

 

“The yoga mat is a good place to turn when talk therapy and antidepressants aren’t enough.” – Amy Weintraub

 

CMCS – Center for Mindfulness and Contemplative Studies

Improve Diabetes Psychological Well-Being with Mindfulness

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“I am a type-2 diabetic, and they took me off medication simply because I ate right and exercised. Diabetes is not like a cancer, where you go in for chemo and radiation. You can change a lot through a basic changing of habits.” – Sherri Shepherd

 

It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Depression affects people with diabetes more often than people without it — up to 15 percent compared with 6.7 percent in the general population. When depression occurs along with a chronic illness like diabetes, the symptoms tend to be more severe. Compounding the problem further, the symptoms can become worse as depression can lead to missing medication doses, overeating, or skipping exercise. This may mean poorer blood glucose control, which, in turn, means more long-term health complications.

 

So, in treating diabetes it is important to treat not only the physical problem but also the psychological problems such as depression. Mindfulness training, especially Mindfulness-Based Cognitive Therapy Mindfulness-Based Cognitive Therapy (MBCT) has been demonstrated to be effective in treating depression (see http://contemplative-studies.org/wp/index.php/2015/08/15/spiraling-up-with-mindfulness/ and http://contemplative-studies.org/wp/index.php/2015/07/17/dealing-with-major-depression-when-drugs-fail/).

 

In today’s Research News article “Individual Mindfulness-Based Cognitive Therapy for People with Diabetes: a Pilot Randomized Controlled Trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1113222965368295/?type=3&theater

Schroevers and colleagues examined whether an individualized version of MBCT might be effective for depression in people with diabetes. In comparison to diabetic patients on a waiting list, MBCT resulted in clinically significant reductions in depressive symptoms and diabetes related psychological distress and increases in the levels of acting with awareness and attention regulation. These improvements were still present three months after completing the program.

 

These are impressive results and suggest that MBCT is an effective treatment for the psychological issues that frequently accompany diabetes. MBCT may be effective due to its emphasis on the present moment in mindfulness. Depression is often rooted in the past and the individual ruminates about the misery of the past. By shifting focus to the present moment, mindfulness can move the individual from being preoccupied with a troubling past to being focused  on addressing the manageable problems in the present. Indeed, Schroevers and colleagues demonstrated that MBCT produces an increase in acting with awareness. The individual then is more aware of what they’re doing. For the depressed diabetic individual this can help in the recognition of how he/she is acting in response to the depression or the diabetes. This allows them to reprogram their responses to be more appropriate to the circumstances of the present rather than responding to the depression itself.

 

Mindfulness also stresses non-judgmental awareness of the present. There is a decreased tendency to be constantly judging what is happening and instead just accept it as what is. This reduces worrying. Indeed, mindfulness practice has been shown to reduce worry (see http://contemplative-studies.org/wp/index.php/2015/07/17/stop-worrying/). Since worry involves concerns about future occurrences to some extent based upon past experiences, the more one can focus on the present the less opportunity there is for worries to arise. Mindfulness training also trains the individual to accept the worry, experience it, and then move on. This reduces the impact of the worry and prevents the development of worrying about worrying.

 

Another possibility is mindfulness’ ability to increase emotion regulation. That is mindfulness assists the individual in recognizing emotions as they arise and not over respond to them. It doesn’t prevent emotions. It simply allows the individual to better deal with them when they do arise. So when depression occurs the individual can recognize it, accept it, and then let it go and not respond to it. This liberates the individual to find new ways of responding to the environment and other people.

 

So, be mindful and improve psychological well-being with diabetes.

 

“Life is not over because you have diabetes. Make the most of what you have, be grateful.” – Dale Evans

 

CMCS – Center for Mindfulness and Contemplative Studies

 

ACT for Depression in Childhood Diabetes

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“Self-acceptance means you refuse to buy into your judgments your mind makes about you, whether they’re good judgments or bad ones. Instead of judging yourself, you recognize your strengths and your weaknesses, and you do what you can to be the person you want to be.” – Russ Harris

 

There is an image, a societal meme, of childhood being a time of great happiness, fancifulness, freedom, creativity, and play. But, the reality is frequently starkly different. It has been estimated that 2% to 4% of children are depressed. This is particularly true with children under intense stress from childhood illness, particularly chronic illness. Indeed, 2.4% of children suffer from childhood diabetes. The day to day struggle with diabetes and the feelings that they are burdens on the family frequently produces depression in these children.

 

Acceptance and Commitment Therapy (ACT) has been shown to be effective for depression in adults (see http://contemplative-studies.org/wp/index.php/2015/09/17/act-for-depression/). 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 living according to their values. It is not known, however, if ACT is effective for depression in diabetic children

 

In today’s Research News article “Effectiveness of Acceptance and Commitment Therapy for Depression, Psychological Well-Being and Feeling of Guilt in 7 – 15 Years Old Diabetic Children”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1111453218878603/?type=3&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4575800/

Moghanloo and colleagues provided ACT modified for children and adolescents in ten weekly sessions to a randomly assigned group of 7-15 year old diabetic children. The change from before to after was compared to a no intervention control group of children. They found that the children treated with ACT reported lower depression and feelings of guilt and had improved psychological well-being. The effects sizes were large and clinically meaningful. Hence, ACT appeared to be effective in children as it’s been shown to be in adults.

 

It should be noted that there was no follow-up to determine if the effects persisted after the end of active therapy. Also, since the control group did not receive psychological treatment of any kind, it is impossible to determine if ACT is particularly effective or any form of therapy would have worked as well.

 

Like most mindfulness techniques ACT is targeted to improving awareness and acceptance of experiences in the present moment. These include emotions. This may be particularly important in children. By making the children more aware of how they’re feeling and why, they may become better able to deal with and accept these sometimes overpowering emotions. In addition, ACT supplies tools to look at their own thoughts about their disease and psychological state and recognize, accept, and form a different relationship with them. This allows the individual to be more psychologically flexible and mindful. In this way ACT can assist the children in coping with not only their emotions but also their disease and thoughts about it in a more accepting and productive fashion.

 

So, ACT for depression in childhood diabetes.

 

“We have not passed that subtle line between childhood and adulthood until… we have stopped saying “It got lost,” and say “I lost it.” – Sydney J Harris

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Improve Well-being with HIV with Mindfulness

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“People wait in line to see me, saying there’s plenty of living to be done even if you have an HIV diagnosis. People say they are 10- or 15-year survivors and still moving forward.” – Greg Louganis

 

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, 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 there is a need to find methods to improve the quality of life in people who are living with HIV infection.

 

Mindfulness has been shown to improve psychological and physical well-being in people suffering from a wide range of disorders (see http://contemplative-studies.org/wp/index.php/2015/07/17/why-is-mindfulness-so-beneficial/ and http://contemplative-studies.org/wp/index.php/2015/07/17/how-do-mindfulness-based-interventions-improve-mental-health/). So, it would stand to reason that mindfulness would also be beneficial for people who are living with HIV infection.

 

In today’s Research News article “Dispositional mindfulness in people with HIV: Associations with psychological and physical health”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1107732272584031/?type=3&theater

Moskowitz and colleagues investigated the mindfulness, appraisal, positive and negative affect, coping, and indicators of psychological well-being and physical health of a group of primarily male HIV positive individuals. They found that mindfulness has significantly associated with a number of positive indicators of psychological well-being. HIV infected individuals who were high in mindfulness were found to have lower depression, lower perceived stress, fewer hassles, less negative affect, less escape-avoidance and self-blame forms of coping and more positive affect.

 

There are a number of potential explanations for the association of mindfulness with improved psychological well-being. The study demonstrated that the association between mindfulness and lower depression was mediated by lower perceived stress and negative emotions. This makes sense as mindfulness has been shown to reduce both the physical and psychological responses to stress (see http://contemplative-studies.org/wp/index.php/2015/07/17/destress-with-mindfulness/) and it is also known to improve emotion regulation (see http://contemplative-studies.org/wp/index.php/2015/09/10/take-command-and-control-of-your-emotions/) and stress reduction and emotion regulation are helpful in relieving depression. In addition, since mindful individuals are more attuned to the present moment they may be better able to deal with whatever symptoms are present and not worry and catastrophize about the future.

The results are impressive. They are, however, only associations and it cannot be concluded that there is a causal link between mindfulness and the improved psychological well-being. A trial where mindfulness training is actively manipulated is needed to resolve this issue. Nevertheless, these results are suggestive that mindfulness training may be a way to help the vast numbers of people living with HIV infection adapt and cope with the physical and psychological issues associated with living with infection.

 

So, be mindful of HIV

 

“I’m not cured, but the HIV is asleep deep in my body.”- Magic Johnson

 

CMCS – Center for Mindfulness and Contemplative Studies