Fear

Mindfulness Reduces the Ability of Anxiety to Affect Student Performance

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Mindfulness Reduces the Ability of Anxiety to Affect Student Performance

 

By John M. de Castro, Ph.D.

 

“Let the fears arise, but also let them go. After you make the catalog, look at each fear, each anxious moment, and then let it go on its way.” – Carolyn Gimian

 

The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. It also affects students’ performance in school. So, there is a need to find ways to improve psychological well-being during the pandemic. Mindfulness is known to decrease the psychological and physical responses to stress. So, mindfulness may be helpful in developing students’ capacities to cope with the mental and physical challenges resulting from the COVID-19 pandemic.

 

In today’s Research News article “Impact of fear of COVID-19 on students’ performance, moderating role of mindfulness: HSK students’ perception-based view.” (See summary below or view the full text of the study at:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677726/ ) Meiyi and colleagues recruited college students and had them complete measures of mindfulness, fear of Covid-19, anxiety, and student performance.

 

They found that mindfulness was associated with lower fear of Covid-19 and anxiety, and higher levels of student performance. In addition, with students high in mindfulness anxiety had a smaller effect on student performance. Hence, mindfulness improves student performance directly and also by lowering fear of Covid-19 and anxiety which interfere with student performance. Mindfulness also appears to moderate the impact of anxiety on student performance.

 

So, mindfulness improves college student performance both directly and indirectly by its associations with lower fear of Covid-19 and anxiety.

 

“The only way to ease our fear and be truly happy is to acknowledge our fear and look deeply at its source. Instead of trying to escape from our fear, we can invite it up to our awareness and look at it clearly and deeply.” ― Thích Nhất Hạnh

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Twitter @MindfulResearch

 

Study Summary

 

Meiyi Z, Liu Y. Impact of fear of COVID-19 on students’ performance, moderating role of mindfulness: HSK students’ perception-based view. Front Public Health. 2022 Nov 7;10:967125. doi: 10.3389/fpubh.2022.967125. PMID: 36420013; PMCID: PMC9677726.

 

Abstract

COVID-19 created difficulties and problems in almost everyone’s daily life routine. Educational institutions too had to reschedule their academic activities. This shift caused attitudinal and behavioral changes in students’ learning patterns. Using stress theory, the present study tries to determine the association of fear of COVID-19 with students’ performance. In addition, the present study also attempts to check the impact of fear of COVID-19 on anxiety. Further, this study tries to find the association of anxiety with students’ performance. This study also attempts to determine the mediating role of anxiety and the moderating role of mindfulness. For empirical investigation, the current study collected data from 320 HSK students from different colleges and universities in China. The present study applied partial least square structural equation modeling for the empirical investigation of hypotheses by using Smart-PLS software. The present study’s findings confirmed that fear of COVID-19 negatively affects students’ performance, and it positively correlates with anxiety. The study’s outcomes revealed that anxiety negatively affects students’ performance. The outcomes also confirmed that anxiety negatively mediates the relationship between fear of COVID-19 and students’ performance. The present study’s findings acknowledged that mindfulness does not moderate the relationship between fear of COVID-19 and student performance and has a positive moderation between anxiety and student performance. The present study offers important practical, theoretical, and managerial implications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9677726/

 

Reduce Pregnancy-Related Anxiety with Mindfulness

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Reduce Pregnancy-Related Anxiety with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness practice provides an opportunity for the discovery of previously unrecognized inner resources of strength and resilience. By the time the workshop is over, women’s confidence levels increase and their fears begin to dissipate. They realize that even if giving birth is hard, it’s something that they can manage, moment by moment.” Nancy Bardacke

 

The period of pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. These feelings during pregnancy can weigh on the mother’s mind when she contemplates another pregnancy. Hence, there is a need for methods to treat pregnancy-related anxiety in the postnatal period. Mindfulness training has been shown to improve anxiety normally and to relieve maternal anxiety and depression during pregnancy. So, mindfulness training may be helpful for the psychological health of women after having a child to make it more likely to contemplate another pregnancy.

 

In today’s Research News article “A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346737/ ) and colleagues recruited women who have had one child but did not intend to have another due to pregnancy-related anxiety. They were randomly assigned to either a no-treatment control condition or to receive 2.5 hours, once a week for 8 weeks of Mindfulness-Based Stress Reduction (MBSR). MBSR includes training and practice in meditation, body scan, and yoga and includes group discussion along with home practice. Before and after training they completed measures of pregnancy-related anxiety, including subscales measuring fear of childbirth, fear of giving birth to disabled children, fear of changing in marital relationships, fear of changing in mood and its impact on the child, and self-centered fears.

 

They found that in comparison to pre-training and the no-treatment control group, the women who received Mindfulness-Based Stress Reduction (MBSR) training had significantly lower levels of pregnancy-related anxiety, including all subscales; fear of childbirth, fear of giving birth to disabled children, fear of changing in marital relationships, fear of changing in mood and its impact on the child, and self-centered fears.

 

The present study did not include an active control condition or follow up. So, it is not known whether the training had lasting effects and whether the benefits may have been due to confounding factors such as attentional effects, placebo effects, or experimenter bias. Prior controlled research, however, has routinely demonstrated that mindfulness training reduces anxiety. So, it is likely that the mindfulness training in the present study produced the reductions in anxiety. The reductions in pregnancy-related anxiety produced by Mindfulness-Based Stress Reduction (MBSR) training would tend to make it more likely that the women would be open to another pregnancy. But unfortunately, this was not measured. Future research should include an active comparison condition such as exercise, follow up with the women several weeks later, and measures of the likelihood of a future pregnance.

 

So, reduce pregnancy-related anxiety with mindfulness.

 

“Jen . . . who recently had her first child, was put on bed rest and couldn’t even exercise to keep her stress down. “I had so much anxiety,” she recalls. “Meditation really helped me stay calm and sane.” – Kira Newman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Malekpoorafshar, M., Salehinejad, P., Pouya, F., Khezri Moghadam, N., & Shahesmaeili, A. (2021). A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial. Journal of family & reproductive health, 15(1), 19–27. https://doi.org/10.18502/jfrh.v15i1.6070

 

Abstract

Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulness-based stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery.

Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups.

Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories.

Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancy-related anxiety is recommended to increase the birth rate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8346737/

 

Yoga Practitioners Cope Better with the Stress and Psychological Distress During Covid-19 Pandemic

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Yoga Practitioners Cope Better with the Stress and Psychological Distress During Covid-19 Pandemic

 

By John M. de Castro, Ph.D.

 

“As the lockdown cannot last forever and workplaces will have to be functional soon, there is an increased possibility of recurrent infection. Therefore, Yoga can provide the necessary tool for risk reduction, amelioration of stress and anxiety and strengthening of the immune function.” – Kanupriya Sharma 

 

Mindfulness training and yoga practices have been shown to improve health and well-being in healthy individuals. They have also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress and yoga practice also produces similar improvements. So, yoga practice may be helpful in coping with the mental and physical challenges resulting from the lockdown during the COVID-19 pandemic.

 

In today’s Research News article “Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257944/ ) Nagarathna and colleagues recruited adult (>18 years of age) participants in India online during the Covid-19 lockdown and had them complete a questionnaire measuring demographics, Covid-19 exposure, physical health, mental health, coping strategies, lifestyle, and physical activities.

 

They defined a yoga group as those participants who practiced yoga before and during the Covid-19 lockdown and the non-yoga group as those who did not. They report that the yoga group had a significantly greater proportion of females and students, were younger, were less likely to use alcohol, tobacco, or other substances and eat junk food, more likely to be vegetarian, were disciplined in their diet, and had greater sleep quality, physical strength and endurance, and energy, have lower levels of anxiety and fear, but did not differ in Covid-19 exposure. In addition, the yoga group indicated more adaptive coping strategies.

 

This study was a comparison between groups defined by whether they were yoga practitioners or not. Any observed differences could well be due to the types of people attracted to yoga practice versus those who are not. It cannot be concluded that the practice of yoga was responsible for the differences. But prior research has demonstrated in controlled trials that the practice of yoga produces many physical and psychological benefits. So, the differences observed here may well be due to causal effects of yoga practice. Regardless of causation, the results clearly show that during the Covid-19 lockdown, yoga practitioners have greater physical and mental well-being and have healthier lifestyles.

 

So, yoga practitioners cope better with the stress and psychological distress during Covid-19 pandemic.

 

“Yoga can be a powerful tool to deal with the lockdown’s uncertainty and isolation, as well as to maintain physical well-being.” – United Nations

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Nagarathna, R., Anand, A., Rain, M., Srivastava, V., Sivapuram, M. S., Kulkarni, R., Ilavarasu, J., Sharma, M., Singh, A., & Nagendra, H. R. (2021). Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic. Frontiers in psychiatry, 12, 613762. https://doi.org/10.3389/fpsyt.2021.613762

 

Abstract

Uncertainty about Coronavirus disease 2019 (COVID-19) and resulting lockdown caused widespread panic, stress, and anxiety. Yoga is a known practice that reduces stress and anxiety and may enhance immunity. This study aimed to (1) investigate that including Yoga in daily routine is beneficial for physical and mental health, and (2) to evaluate lifestyle of Yoga practitioners that may be instrumental in coping with stress associated with lockdown. This is a pan-India cross-sectional survey study, which was conducted during the lockdown. A self-rated scale, COVID Health Assessment Scale (CHAS), was designed by 11 experts in 3 Delphi rounds (Content valid ratio = 0.85) to evaluate the physical health, mental health, lifestyle, and coping skills of the individuals. The survey was made available digitally using Google forms and collected 23,760 CHAS responses. There were 23,290 valid responses (98%). After the study’s inclusion and exclusion criteria of yogic practices, the respondents were categorized into the Yoga (n = 9,840) and Non-Yoga (n = 3,377) groups, who actively practiced Yoga during the lockdown in India. The statistical analyses were performed running logistic and multinomial regression and calculating odds ratio estimation using R software version 4.0.0. The non-Yoga group was more likely to use substances and unhealthy food and less likely to have good quality sleep. Yoga practitioners reported good physical ability and endurance. Yoga group also showed less anxiety, stress, fear, and having better coping strategies than the non-Yoga group. The Yoga group displayed striking and superior ability to cope with stress and anxiety associated with lockdown and COVID-19. In the Yoga group, participants performing meditation reportedly had relatively better mental health. Yoga may lead to risk reduction of COVID-19 by decreasing stress and improving immunity if specific yoga protocols are implemented through a global public health initiative.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257944/

 

Improve Treatment Resistant Obsessive-Compulsive Disorder with Compassion-Focused Therapy

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Improve Treatment Resistant Obsessive-Compulsive Disorder with Compassion-Focused Therapy

 

By John M. de Castro, Ph.D.

 

“A big part of learning to live with OCD is to incorporate self-compassion. Instead of avoiding your anxiety, self-compassion invites you to look at it with understanding and gentle curiosity. This approach allows you to see your pain exactly how it is without self-judgment or self-criticism.” – Nancy Larsen

 

Obsessive-Compulsive Disorder (OCD) sufferers have repetitive anxiety producing intrusive thoughts (obsessions) that result in repetitive behaviors to reduce the anxiety (compulsions). In a typical example of OCD, the individual is concerned about germs and is unable to control the anxiety that these thoughts produce. Their solution is to engage in ritualized behaviors, such as repetitive cleaning or hand washing that for a short time relieves the anxiety. The obsessions and compulsions can become so frequent that they become a dominant theme in their lives. Hence OCD drastically reduces the quality of life and happiness of the sufferer and those around them. About 2% of the population, 3.3 million people in the U.S., are affected at some time in their life.

 

Fortunately, Obsessive-Compulsive Disorder (OCD) can be treated and many respond to Cognitive Behavioral Therapy (CBT). But some do not. Mindfulness training has been shown to be effective in treating OCD. One understudied meditation technique is Compassion -Focused Therapy. It is designed to develop kindness and compassion to oneself and others. On the face of it learning self-compassion would seem to be useful in dealing with OCD. But there is little empirical evidence.

 

In today’s Research News article “Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835278/ ) Petrocchi and colleagues recruited patients with Obsessive-Compulsive Disorder (OCD) who had received 6-months of Cognitive Behavioral Therapy (CBT) and still have significant residual OCD symptoms. They received 8 weekly 2-hour sessions of Compassion-Focused Therapy after varying periods of baseline (Multiple Baseline Research Design). The treatment consisted of training in meditation and visualization practices during sessions and at home. It is designed to replace self-criticism with self-compassion. Before and after training and 1 month later they were measured for OCD symptom severity, OCD symptom presence and distress, depression, fear of guilt, self-criticizing, self-attacking, self-reassuring, and self-compassion.

 

They found that the patients all had large improvements in Obsessive-Compulsive Disorder (OCD) symptoms that were maintained at the 1-month follow-up. They also found significant improvements in fear of guilt, self-criticism, and self-reassurance. In additions, there were less reliable improvements in depression and common humanity. Hence, Compassion-Focused Therapy improved the symptom of OCD in patients who didn’t respond to Cognitive Behavioral Therapy (CBT).

 

These are important preliminary findings that must be followed up with a large randomized controlled trial. But these results suggest that Compassion-Focused Therapy may be effective in treating Obsessive-Compulsive Disorder (OCD) symptoms in patients who do not respond to the gold standard treatment of Cognitive Behavioral Therapy (CBT). The results may suggest that CBT should incorporate Compassion-Focused training when being employed to treat OCD. This should be explored in future studies.

 

So, improve treatment resistant obsessive-compulsive disorder with compassion-focused therapy.

 

“people with OCD may feel better if they remind themselves that it is normal to worry, and that it is not their fault if their OCD symptoms get worse.” –  Jessica Caporuscio

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Petrocchi, N., Cosentino, T., Pellegrini, V., Femia, G., D’Innocenzo, A., & Mancini, F. (2021). Compassion-Focused Group Therapy for Treatment-Resistant OCD: Initial Evaluation Using a Multiple Baseline Design. Frontiers in psychology, 11, 594277. https://doi.org/10.3389/fpsyg.2020.594277

 

Abstract

Obsessive–compulsive disorder (OCD) is a debilitating mental health disorder that can easily become a treatment-resistant condition. Although effective therapies exist, only about half of the patients seem to benefit from them when we consider treatment refusal, dropout rates, and residual symptoms. Thus, providing effective augmentation to standard therapies could improve existing treatments. Group compassion-focused interventions have shown promise for reducing depression, anxiety, and avoidance related to various clinical problems, but this approach has never been evaluated for OCD individuals. However, cultivating compassion for self and others seems crucial for OCD patients, given the accumulating research suggesting that fear of guilt, along with isolation and self-criticism, can strongly contribute to the development and maintenance of OCD. The primary aim of this pilot study was to evaluate the acceptability, tolerability, and effectiveness of an 8-week group compassion-focused intervention for reducing OCD symptoms, depression, fear of guilt and self-criticism, and increasing common humanity and compassionate self-reassuring skills in treatment-resistant OCD patients. Using a multiple baseline experimental design, the intervention was evaluated in a sample of OCD patients (N = 8) who had completed at least 6 months of CBT treatment for OCD, but who continued to suffer from significant symptoms. Participants were randomized to different baseline assessment lengths; they then received 8 weekly, 120-min group sessions of compassion-focused therapy for OCD (CFT-OCD), and then were tested again at post-treatment and at 1 month follow up. Despite the adverse external circumstances (post-treatment and follow-up data collection were carried out, respectively, at the beginning and in the middle of the Italian lockdown due to the COVID-19 pandemic), by the end of treatment, all participants demonstrated reliable decreases in OCD symptoms, and these improvements were maintained at 4-week follow-up for seven of eight participants. The intervention was also associated with improvements in fear of guilt, self-criticism, and self-reassurance, but less consistent improvements in depression and common humanity. Participants reported high levels of acceptability of and satisfaction with the intervention. Results suggest that the intervention may be beneficial as either a stand-alone treatment or as an augmentation to other treatments.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835278/

 

Movement-Based Therapies are Affective for Rehabilitation from Disease

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Movement-Based Therapies are Affective for Rehabilitation from Disease

 

By John M. de Castro, Ph.D.

 

“Tai chi is often described as “meditation in motion,” but it might well be called “medication in motion.” There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems.” – Havard Health

 

Mindful movement practices such as yoga and Tai Chi and Qigong have been used for centuries to improve the physical and mental health and well-being of practitioners. But only recently has the effects of these practices come under scientific scrutiny. This research has been accumulating. So, it makes sense to pause and examine what has been learned about the effectiveness of these practice for rehabilitation from disease.

 

In today’s Research News article “Movement-Based Therapies in Rehabilitation.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476461/ ) Phuphanich and colleagues review and summarize the published research studies of the effects of mindful movement practices on rehabilitation from disease.

 

They report that published research has found that yoga practice reduces fatigue, sleep disturbances, depression, and anxiety and improves the immune system in cancer patients. Yoga has been found to be an effective treatment for mental health issues such as anxiety, depression, and post-traumatic stress disorder (PTSD). Yoga has been found to reduce pain levels, fear avoidance, stress, and sleep disturbance and increases self-efficacy and quality of life in chronic pain patients. Yoga has been found to improve the symptoms of traumatic brain injury, stroke, spinal cord injury, Parkinson disease, dementia, multiple sclerosis, epilepsy, and neuropathies. In addition, yoga has been found to improve systolic and diastolic blood pressures, heart rate, respiratory rate, waist circumference, waist/hip ratio, cholesterol, triglycerides, hemoglobin A1c, and insulin resistance in cardiopulmonary diseases.

 

They report that the published research has found that Tai Chi and Qigong practices reduce falls in the elderly. Tai Chi and Qigong has been found to reduce pain levels and increase quality of life in chronic pain patients. In addition, there is evidence that Tai Chi and Qigong practices improves depression, anxiety, posttraumatic stress disorder, sleep disturbance, schizophrenia, rheumatoid arthritis, spinal cord injury, traumatic brain injury, and immune disorders.

 

These are remarkable findings. The range of disorders that are positively affected by yoga, Tai Chi, and Qigong practices is breathtaking. These practices are also safe and can be widely implemented at relatively low cost and can be performed alone or in groups and at home or in a therapeutic setting. This suggests that these practices should be routinely implemented for rehabilitation from disease.

 

So,  movement-based therapies are affective for rehabilitation from disease.

 

“Being mindful through any physical activity can not only improve performance in the activity such as yoga, tennis, swimming, etc, but it can also increase flexibility, confidence in movement and generate a sense of body and mind connection that has the potential for improving your overall sense of well-being.“- Anupama Kommu

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Phuphanich, M. E., Droessler, J., Altman, L., & Eapen, B. C. (2020). Movement-Based Therapies in Rehabilitation. Physical medicine and rehabilitation clinics of North America, 31(4), 577–591. https://doi.org/10.1016/j.pmr.2020.07.002

 

Abstract

Movement therapy refers to a broad range of Eastern and Western mindful movement-based practices used to treat the mind, body, and spirit concurrently. Forms of movement practice are universal across human culture and exist in ancient history. Research demonstrates forms of movement therapy, such as dance, existed in the common ancestor shared by humans and chimpanzees, approximately 6 million years ago. Movement-based therapies innately promote health and wellness by encouraging proactive participation in one’s own health, creating community support and accountability, and so building a foundation for successful, permanent, positive change.

Key Points – Movement-based therapies

  • Decrease fear avoidance and empower individuals to take a proactive role in their own health and wellness.
  • Can benefit patients of any ability; practices are customizable to the individual’s needs and health.
  • Are safe, cost-effective, and potent adjunct treatments used to supplement (not replace) standard care.
  • Deliver patient-centered, integrative care that accounts for the physical, psychological, social, and spiritual aspects of health and illness.
  • Have diverse, evidence-based benefits, including reduction in pain, stress, and debility, and improvements in range of motion, strength, balance, coordination, cardiovascular health, physical fitness, mood, and cognition.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7476461/

 

Reduce Fear of Cancer Return with Mind-Body Practices

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Reduce Fear of Cancer Return with Mind-Body Practices

 

By John M. de Castro, Ph.D.

 

“the mind and body are really one entity, not two separate parts. Stated simply, there is no separation or division between the mind, body, spirit, and emotions. The best stress management program is one that moves you from fear toward peace, however you understand that concept.” – Health Encyclopedia

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. Coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis. But over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. Cancer survivors are also at greater risk for developing second cancers and other health conditions and as a result fear of cancer recurrence is a major problem that can interfere with recovery. Hence there is a need to identify safe and effective treatments to reduce fear of cancer return.

 

Mindfulness training has been shown to help with cancer recovery and help to relieve chronic pain. It can also help treat the residual physical and psychological symptoms, including stress,  sleep disturbance, fear, and anxiety and depression. There has been considerable research conducted on the effectiveness of mind-body practices in treating fear of cancer return. So it makes sense to step back and summarize what has been learned.

 

In today’s Research News article “Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488231/), Hall and colleagues reviewed, summarized, and performed a meta-analysis of the published randomized controlled trials (RCTs) of the effects of mind-body practices on the fear of cancer recurrence. They included studies employing meditation, yoga, Tai Chi and Qigong, cognitive-behavioral skills, spirituality, relaxation, and various art therapies. They uncovered 18 published RCTs that included 2806 total participants.

 

They found that mind-body practices produced significant reduction in fear of cancer recurrence regardless of whether the comparison condition was an active control condition, whether the treatment occurred in group or individual format, whether the treatment contained cognitive behavioral skills or not, or whether the treatment contained meditation practice or not. These reductions were still present, albeit at reduced magnitude, up to 2 years after treatment.

 

Fear of cancer recurrence can produce behaviors that interfere with cancer recovery including increased stress, worry, rumination, etc. So, reducing this fear not only improves the psychological health of the patients but also improves their prognosis. These results suggest that mind-body are safe and effective, and have lasting effects reducing fear of cancer recurrence and thus should be incorporated in the treatments for patients recovering from cancer.

 

So, reduce fear of cancer return with mind-body practices.

 

“It is not usually possible for doctors to say for certain that your cancer has been cured. They can’t definitely say that it will never come back. Living with this uncertainty is one of the most difficult things about having cancer.” – Cancer Research UK

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Hall, D. L., Luberto, C. M., Philpotts, L. L., Song, R., Park, E. R., & Yeh, G. Y. (2018). Mind-body interventions for fear of cancer recurrence: A systematic review and meta-analysis. Psycho-oncology, 27(11), 2546–2558. doi:10.1002/pon.4757

 

Abstract

Objective

Fear of cancer recurrence (FCR) is a common existential concern and source of distress among adults with a cancer history. Multiple randomized controlled trials (RCTs) have examined mind-body approaches to mitigating FCR. We summarized characteristics of these trials and calculated their pooled effects on decreasing FCR.

Methods

Six electronic databases were systematically searched from inception to May 2017, using a strategy that included multiple terms for RCTs, cancer, mind-body medicine, and FCR. Data extraction and reporting followed Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled effect sizes on self-report measures of FCR were computed by using random-effects models.

Results

Nineteen RCTs (pooled N = 2806) were included. Most studies (53%) were published since 2015 and targeted a single cancer type (84%; mostly breast). Intervention sessions (median = 6, mode = 4) tended to last 120 minutes and occur across 1.5 months. Delivery was predominantly in-person (63%) to either groups (42%) or individuals (42%). Most interventions incorporated multiple mind-body components (53%), commonly cognitive-behavioral skills (58%), or meditative practices (53%). Small-to-medium pooled effect sizes were observed post-intervention (Hedges’ g = −0.36, 95% CI = −0.49, −0.23, P < .001) and at follow-up assessments (median = 8 months, P < .001). Potential modifiers (control group design, group/individual delivery, use of cognitive-behavioral or mindfulness skills, number of mind-body components, cancer treatment status, and number of sessions) did not reach statistical significance.

Conclusions

Mind-body interventions are efficacious for reducing FCR, with small-to-medium effect sizes that persist after intervention delivery ends. Recommendations include testing effects among survivors of various cancers and exploring the optimal integration of mind-body practices for managing fundamental uncertainties and fears during cancer survivorship.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488231/

 

Improve the Physical and Psychological Health of Cancer Patients with Mindfulness

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Improve the Physical and Psychological Health of Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“It turns out that some of the most difficult elements of the cancer experience are very well-suited to a mindfulness practice.” – Linda Carlson

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, fear, and anxiety and depression. The evidence is accumulating. So, it is timely to review and summarize what has been learned.

 

In today’s Research News article “Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916350/), Cillessen and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials (RCTs) on the effectiveness of mindfulness training in treating the symptoms of cancer and its treatment. They found 29 RCTs that included a total of 3224 participants.

 

The summary of the published research reflected that mindfulness training produced significant reductions in psychological distress in the cancer patients including reductions in anxiety, depression, fatigue, and fear of cancer reoccurrence with small to moderate effects sizes. These improvements were found both immediately after treatment and also at follow-up from 3 to 24 months later. Further they found that mindfulness trainings that adhered to the protocols for Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT) had the greatest effect sizes.

 

It has been repeatedly demonstrated that mindfulness training is effective in reducing psychological distress including reductions in anxiety, depression, fatigue, and fear in a wide variety of individuals with and without disease states. The present meta-analysis demonstrates the effectiveness of mindfulness training for the relief of psychological and physical suffering of cancer patients. It does not affect the disease process. Rather, it reduces the patients psychological suffering and does so for a prolonged period of time.

 

So, improve the physical and psychological health of cancer patients with mindfulness.

 

“patients who practice mindfulness begin to feel better despite their medical problems. Physical symptoms don’t necessarily go away, but that’s not the aim of mindfulness. Rather, the goal is to help you find a different perspective and a new way of coping with your illness.” – Eric Tidline

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Cillessen, L., Johannsen, M., Speckens, A., & Zachariae, R. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: A systematic review and meta-analysis of randomized controlled trials. Psycho-oncology, 28(12), 2257–2269. doi:10.1002/pon.5214

 

Abstract

Objective

Mindfulness‐based interventions (MBIs) are increasingly used within psycho‐oncology. Since the publication of the most recent comprehensive meta‐analysis on MBIs in cancer in 2012, the number of published trials has more than doubled. We therefore conducted a systematic review and meta‐analysis of randomized controlled trials (RCTs), testing the efficacy of MBIs on measures of psychological distress (primary outcome) and other health outcomes in cancer patients and survivors.

Methods

Two authors conducted independent literature searches in electronic databases from first available date to 10 October 2018, selected eligible studies, extracted data for meta‐analysis, and evaluated risk of bias.

Results

Twenty‐nine independent RCTs (reported in 38 papers) with 3274 participants were included. Small and statistically significant pooled effects of MBIs on combined measures of psychological distress were found at post‐intervention (Hedges’s g = 0.32; 95%CI: 0.22‐0.41; P < .001) and follow‐up (g = 0.19; 95%CI: 0.07‐0.30; P < .002). Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain (g: 0.20 to 0.51; p: <.001 to.047). Larger effects of MBIs on psychological distress were found in studies (a) adhering to the original MBI manuals, (b) with younger patients, (c) with passive control conditions, and (d) shorter time to follow‐up. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.

Conclusions

MBIs appear efficacious in reducing psychological distress and other symptoms in cancer patients and survivors. However, many of the effects were of small magnitude, suggesting a need for intervention optimization research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916350/

 

Improve Mental Health with Yoga Nidra and Meditation

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Improve Mental Health with Yoga Nidra and Meditation

 

By John M. de Castro, Ph.D.

 

“Yoga nidra promotes deep rest and relaxation that isn’t found in your average meditation practice. The stages of body scan and breath awareness alone can be practiced to calm the nervous system, leading to less stress and better health.” – Allison Ray Jeraci

 

“Meditation leads to concentration, concentration leads to understanding, and understanding leads to happiness” – This wonderful quote from the modern-day sage Thich Nhat Hahn is a beautiful pithy description of the benefits of meditation practice. Meditation allows us to view our experience and not put labels on it, not make assumptions about it, not relate it to past experiences, and not project it into the future. Rather meditation lets us experience everything around and within us exactly as it is arising and falling away from moment to moment.

 

Meditation training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. Meditation techniques have common properties of restful attention on the present moment, but there are large differences. These differences are likely to produce different effects on the practitioner. Yoga Nidra is a deep relaxation technique where the practitioner lies on the back in a “corpse pose” and is guided through body scan and imagery into a deeply relaxed state. Meditation involves a more active and concentrated process on the part of the practitioner but also leads to relaxation. It is not known if these two different contemplative techniques have different effects on psychological health.

 

In today’s Research News article “The Impact of Yoga Nidra and Seated Meditation on the Mental Health of College Professors.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134749/ ), Ferreira-Vorkapic and colleagues recruited healthy adults and randomly assigned them to either practice Yoga Nidra of meditation for 3 months, once a week for 45 minutes, or to a wait-list control. They were measured before and after training for anxiety, depression, fear, and perceived stress.

 

They found that in comparison to baseline and the wait-list control group, the participants who practiced either Yoga Nidra or meditation had significant reductions in anxiety, depression, fear, and perceived stress. There were no significant differences between the contemplative techniques on any of the measure of psychological health. Hence, the techniques would appear to be equally effective in improving the psychological state of the participants.

 

It should be mentioned that since the control condition did not receive any treatment and both treated groups had significant effects, that a subject expectancy (placebo effect), attention, of experimenter bias effects may account for the improvements. It is also possible that the techniques may produce different effects on variable that were not measured, as only negative mood states were measured and a variety of contemplative techniques have been shown to reduce anxiety, depression, fear, and perceived stress. Regardless, the present study demonstrates that the contemplative techniques of Yoga Nidra and meditation are effective in improving the psychological states of the practitioners.

 

So, improve mental health with Yoga Nidra and meditation.

 

“As you can imagine, feeling well rested is life changing, but yoga nidra also improves your overall health. A 2013 study showed that practicing yoga nidra improved anxiety, depression, and overall well-being.” – Karen Brody

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Ferreira-Vorkapic, C., Borba-Pinheiro, C. J., Marchioro, M., & Santana, D. (2018). The Impact of Yoga Nidra and Seated Meditation on the Mental Health of College Professors. International journal of yoga, 11(3), 215-223.

 

Abstract

Background:

World statistics for the prevalence of anxiety and mood disorders shows that a great number of individuals will experience some type of anxiety or mood disorder at some point in their lifetime. Mind–body interventions such as Hatha Yoga and seated meditation have been used as a form of self-help therapy and it is especially useful for challenging occupations such as teachers and professors.

Aims:

In this investigation, we aimed at observing the impact of Yoga Nidra and seated meditation on the anxiety and depression levels of college professors.

Materials and Methods:

Sixty college professors, men and women, aged between 30 and 55 years were randomly allocated in one of the three experimental groups: Yoga Nidra, seated meditation, and control group. Professors were evaluated two times throughout the 3-month study period. Psychological variables included anxiety, stress, and depression.

Results:

Data analysis showed that the relaxation group presented better intragroup results in the anxiety levels. Meditation group presented better intragroup results only in the anxiety variable (physical component). Intergroup analysis showed that, except for the depression levels, both intervention groups presented better results than the control group in all other variables.

Conclusions:

Prepost results indicate that both interventions represent an effective therapeutic approach in reducing anxiety and stress levels. However, there was a tendency toward a greater effectiveness of the Yoga Nidraintervention regarding anxiety, which might represent an effective tool in reducing both cognitive and physiological symptoms of anxiety.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134749/

 

Reduce Fear of Falling in the Elderly with Yoga

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Reduce Fear of Falling in the Elderly with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga makes you have a strong core, so when moving around in your daily life, you are not just flapping around. You are stable, in control.” – Anne Bachner

 

The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly.

 

Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults, fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. It is obviously important to discover methods to improve balance and decrease the number of falls in the elderly. Yoga practice helps to develop strength, flexibility, and balance. It would seem likely, then, that practicing yoga would reduce the likelihood of falling by the elderly.

 

In today’s Research News article “A mixed methods evaluation of yoga as a fall prevention strategy for older people in India.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/ ), Keay and colleagues recruited elderly participants (> 60 years of age) and provided them with 2 1-hour yoga classes per week for 3 months. The program emphasized standing poses that develop balance. The participants were measured before and after training for overall health, body size, fear of falling, history of falls, physical performance, and blood pressure. At the end of training the participants also attended focus groups with discussion focused on “perceptions of the yoga program, perceived benefits of yoga and understanding fall injury/reporting falls.”

 

They found that there were no adverse events and no falls reported during the program. After the 3-month yoga program the elderly participants were significantly faster in the sit-stand test, had increased stride length while walking, and significantly lower body weight and fear of falling. Hence, participation in a yoga program improved the physical abilities of the elderly. It should be noted that there wasn’t a control or comparison condition so conclusions should be reached cautiously.

 

The results suggest that practicing yoga is beneficial for elderly men and women. These results are sufficiently encouraging to support conducting a large randomized controlled trial. The participants in the present study were quite healthy at the beginning of the trail, so ceiling effects may have prevented the detection of further benefits. Indeed, the participants all successfully passed the most difficult balance test during the baseline test, leaving no room for improvement, In a future trial, it would be good to include participants whose health and physical abilities weren’t quite as good. Regardless, the results suggest that yoga practice is beneficial for the elderly.

 

So, reduce fear of falling in the elderly with yoga.

 

“the number of falls in older adults declined 48 percent in the six months after they began attending yoga classes compared to the six months prior.” – Breann Schossow

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Keay, L., Praveen, D., Salam, A., Rajasekhar, K. V., Tiedemann, A., Thomas, V., … Ivers, R. Q. (2018). A mixed methods evaluation of yoga as a fall prevention strategy for older people in India. Pilot and Feasibility Studies, 4, 74. http://doi.org/10.1186/s40814-018-0264-x

 

Abstract

Background

Falls are an emerging public health issue in India, with the impact set to rise as the population ages. We sought to evaluate the acceptability, feasibility and likely impact of a yoga-based program aimed at improving balance and mobility for older residents in urban India.

Methods

Fifty local residents aged 60 years and older were recruited from urban Hyderabad, Andhra Pradesh. They were invited to attend a 1-h yoga class, twice weekly for 3 months. Mixed methods were used to evaluate the acceptability and feasibility (qualitative) and likely impact (quantitative). Two focus groups and eight interviews with participants were conducted to evaluate the acceptability and feasibility of a yoga program. Thematic analysis was conducted in context of perceptions, barriers and benefits of yoga participation and fall ascertainment. Physical performance using the Short Physical Performance Battery, fear of falling, blood pressure and weight loss were measured before and after the program.

Results

The interviews and focus groups provided insights into the preferred format for classes, including session times, level of supervision and location. Improvements were seen in the Short Falls Efficacy Scale-International (Short FES-I (15.9 ± 4.0 vs 13.8 ± 2.1 s, p = 0.002)), the number of steps taken in the timed 4-m walk (T4MW (9.0 ± 1.8 vs 8.6 ± 1.8, p = 0.04)), Short FES-I scores (9.4 ± 2.9 vs 8.6 ± 2.9, p = 0.02) and weight (63.8 ± 12.4 vs 62.1 ± 11.6, p = 0.004) were lower. No changes were seen in standing balance, blood pressure or T4MW time.

Conclusion

Yoga was well accepted and resulted in improved ability to rise from a chair, weight loss, increased step length and reduced fear of falling. These results provide impetus for further research evaluating yoga as a fall prevention strategy in India.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928579/

 

Reduce Fear of Pain at Work and Musculoskeletal Pain with Mindfulness

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Reduce Fear of Pain at Work and Musculoskeletal Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“a regular meditation practice is the best ongoing foundation for working with pain. Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”). – Mindful

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have common chronic pain conditions. It has to be kept in mind that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s important that pain signals not be blocked or prevented. They need to be perceived. But, methods are needed to mitigate the psychological distress produced by chronic pain.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the patient’s ability to cope with the pain. Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain.

 

In today’s Research News article “Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400305/, Jay and colleagues examine a fear avoidance model of pain where a vicious circle develops creating more pain. The individual when they start to move and feel pain, interpret the pain as potentially damaging and so alter their movements. This is counterproductive and can create more pain, producing more pain avoidance behaviors, producing even more pain, etc. To examine this idea, they recruited female laboratory assistants who were suffering from chronic musculoskeletal pain and randomly assigned them to receive either physical-cognitive-mindfulness training or to follow treatment-as-usual. Therapy consisted of 10 weeks of exercise, cognitive behavioral therapy, and mindfulness training. They were measured before and after training for pain intensity, pain frequency, and leisure time and work related pain fear avoidance.

 

They found that before training, as predicted, there were significant positive relationships between work pain fear avoidance and pain, particularly in the neck and shoulders, such that the greater the pain fear avoidance the greater the pain. They also found that in comparison to the treatment-as-usual control group that the physical-cognitive-mindfulness training group had significant improvements after training of over 50% in pain and in work related pain fear avoidance. Leisure time pain fear avoidance was not related to pain and not affected by the treatment.

 

The results suggest that work related pain fear avoidance is related to musculoskeletal pain intensity and that physical-cognitive-mindfulness training improves both. These relationships, however, are situation specific as leisure time pain fear avoidance  was unrelated. It is unclear if the relationships between pain and pain fear avoidance are causal because of the correlative nature of the relationships. It is also unclear which, or which combinations, of the three components of the treatment was effective in reducing pain and pain fear avoidance. The results, however, are interesting and should be followed up with further research.

 

So, reduce fear of pain at work and musculoskeletal pain with mindfulness.

 

“Chronic pain is frustrating and debilitating. The last thing we want to do is pay more attention to our pain. But that’s the premise behind mindfulness, a highly effective practice for chronic pain (among other concerns).” – Margarita Tartakovsky

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Jay, K., Brandt, M., Jakobsen, M. D., Sundstrup, E., Berthelsen, K. G., schraefel, mc, … Andersen, L. L. (2016). Ten weeks of physical-cognitive-mindfulness training reduces fear-avoidance beliefs about work-related activity: Randomized controlled trial. Medicine, 95(34), e3945. http://doi.org/10.1097/MD.0000000000003945

 

Abstract

People with chronic musculoskeletal pain often experience pain-related fear of movement and avoidance behavior. The Fear-Avoidance model proposes a possible mechanism at least partly explaining the development and maintenance of chronic pain. People who interpret pain during movement as being potentially harmful to the organism may initiate a vicious behavioral cycle by generating pain-related fear of movement accompanied by avoidance behavior and hyper-vigilance.

This study investigates whether an individually adapted multifactorial approach comprised of biopsychosocial elements, with a focus on physical exercise, mindfulness, and education on pain and behavior, can decrease work-related fear-avoidance beliefs.

As part of a large scale 10-week worksite randomized controlled intervention trial focusing on company initiatives to combat work-related musculoskeletal pain and stress, we evaluated fear-avoidance behavior in 112 female laboratory technicians with chronic neck, shoulder, upper back, lower back, elbow, and hand/wrist pain using the Fear-Avoidance Beliefs Questionnaire at baseline, before group allocation, and again at the post intervention follow-up 10 weeks later.

A significant group by time interaction was observed (P < 0.05) for work-related fear-avoidance beliefs. The between-group difference at follow-up was –2.2 (–4.0 to –0.5), corresponding to a small to medium effect size (Cohen’s d = 0.30).

Our study shows that work-related, but not leisure time activity-related, fear-avoidance beliefs, as assessed by the Fear-avoidance Beliefs Questionnaire, can be significantly reduced by 10 weeks of physical-cognitive-mindfulness training in female laboratory technicians with chronic pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5400305/