Improve Caregiver Psychological Health by Changing the Brain Response with Mindfulness

Improve Caregiver Psychological Health by Changing the Brain Response with Mindfulness

 

By John M. de Castro, Ph.D.

 

“We are set up for short-term stress, but caregiving is long-term stress. Mindfulness is basically coming back into the present moment, so it works to inhibit the stress response. Most of us run around listening to our thoughts, and this is particularly true of caregivers, who are driven by the to-do list. They are never at rest.” – Joan Griffiths Vega

 

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. Caregiving for dementia patients is a daunting intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. This places tremendous psychological and financial stress on the caregiver. Hence, there is a need to both care for the dementia patients and also for the caregivers. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving. In addition, mindfulness training has been found to help protect aging individuals from physical and cognitive declines.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity.  Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread area. and have found that meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

In today’s Research News article “Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530345/), Jain and colleagues recruited dementia caregivers (91% female) and provided for them either 4 weeks of mindfulness training or 4 weeks of relaxation training. Training occurred in a once a week meeting along with home practice. The participants were measured before and after training for grief, depression, and mindfulness. They then had brain scans performed with functional Magnetic Resonance Imaging (fMRI) while they viewed pictures of their loved one with dementia or a stranger with the pictures labelled with either grief related words, e.g. disease, dementia, and sick or with neutral words e.g. village, planter and curve.

 

They found that at baseline grief and depression levels were high and strongly related. They also found that the higher the levels of mindfulness the lower the levels of grief and depression. After mindfulness training there were reductions in grief and depression and increases in mindfulness. These findings are similar to previous research of improvements in the mental health of caregivers after mindfulness training.

 

Interestingly, in comparison to pictures of strangers, when showed pictures of their loved ones with dementia the caregivers showed increases in brain activation in the dorsal anterior cingulate gyrus and precuneus. Viewing grief related words results in increased activity in the medial prefrontal cortex. The greater the decreases in grief following training the greater the activation of the medial prefrontal cortex and precuneus.

 

The structures showing activation to the caregiver’s loved one all are components of what is called the default mode network which is involved in self-referential thinking and thinking about others. It would appear that the mindfulness training resulted in greater thinking about the dementia patient and the self when viewing a picture of the patient. This may be reflective of heightened compassion for the self and the patient. This in turn, may produce improvements in the caregivers mental health.

 

So, improve caregiver psychological health by changing the brain response with mindfulness.

 

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

 

“By focusing on the fact that families and communities are producers of health and health care, not just clients or consumers, it empowers families and communities to co-create health interventions,” – Alicia Bazzano

 

Study Summary

 

Jain, F. A., Connolly, C. G., Moore, L. C., Leuchter, A. F., Abrams, M., Ben-Yelles, R. W., … Iacoboni, M. (2019). Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers. Frontiers in human neuroscience, 13, 155. doi:10.3389/fnhum.2019.00155

 

Abstract

Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement.

Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable.

Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = −0.70, p = 0.0002; r = −0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus.

Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530345/

Improve Executive and Emotional Control of Grief with Mindfulness

Improve Executive and Emotional Control of Grief with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness for grief is not about whitewashing your pain, or “getting over” your loss. It is about learning how to stay present, cultivate compassion, and make wise choices that will help you cope with this new normal known as life after loss.” – Heather Stang

 

Grief is a normal, albeit complex, process that follows a loss of a significant person or situation in one’s life. This can involve the death of a loved one, a traumatic experience, termination of a relationship, loss of employment etc. Exactly what transpires depends upon the individual and the nature of the loss. It involves physical, emotional, psychological and cognitive processes. Not everyone grieves in the same way but there have been identified four general stages of grief, shock and denial, intense concern, despair and depression, and recovery. These are normal and healthy. But, in about 15% of people grief can be overly intense or long and therapeutic intervention may become necessary.

 

Mindfulness practices have been found to help with coping with loss and its consequent grief.  Mindfulness-Based Cognitive Therapy (MBCT)  was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy That is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. This would seem to be an ideal treatment protocol to treat intense grief.

 

In today’s Research News article “Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360180/ ), Huang and colleagues recruited participants who had lost a significant relative within the last 4 years and self-reported intense unresolved grief. They completed an 8-week, once a week for 2.5 hours Mindfulness-Based Cognitive Therapy (MBCT) treatment including daily, 30-40 minute, home practice. The participants were measured before and after treatment for grief, anxiety, depression, and emotion regulation.

 

The participants also underwent 3 brain scanning sessions with functional Magnetic Resonance Imaging (fMRI). During 2 of the sessions they performed a numerical Stroop task in which they were to report which of 2 numerals was larger. In one session they were to ignore the physical size of the numeral and only report on the numerically larger numeral. In the second session they were to ignore the numerical magnitude of the numeral and only report on the physically larger numeral. This task measures cognitive interference and executive control.

 

They found that after MBCT treatment there were large and highly significant increases in mindfulness and emotion regulation and decreases in grief, anxiety, and depression. They also found that after treatment the higher the level of mindfulness the lower the levels of grief, anxiety, and depression. In addition, the participants after treatment were significantly better at ignoring irrelevant stimuli and respond faster in the Stroop task. This suggests reduced negative emotionality and improved cognitive control.

 

The researchers observed that after treatment during the cognitive task there was a decrease in activity in the cingulate cortex. These areas are involved in what is termed the Default Mode Network which becomes active during mind wandering and self-referential thinking. In other words, the brain areas associated with a lack of attention to the task at hand became less active. This suggests that there was greater attention to the present moment after MBCT training.

 

Long-term intense grief can be very harmful to the psychological and physical well-being of the individual. The present findings suggest that MBCT practice may be an effective treatment. It appears to reduce the negative emotions and improve the ability to regulate them in grieving individuals. It appears to do so, by altering the brain systems associated with mind wandering. It is during mind wandering where rumination occurs that tends to exacerbate anxiety and depression. So, the brain changes produced by MBCT treatment tend to keep the individual focused on the present lowering the impact of the past on their emotional state.

 

So, improve executive and emotional control of grief with mindfulness.

 

Mindfulness reminds us that pain and sorrow, like all else, are impermanent.  Does this mean grief goes away completely?  Of course not.   But it does mean that it will change shape and form, it will ebb and flow, some days it will hurt like hell and some days you will start to smile.  It means that our grief, like everything else, is impermanent and ever-changing.  Once we accept this, even if only on a rational level, some of the need to avoid our grief starts to diminish.  We can stop believing it is permanent and will never change, even when we feel it will last forever.  We can start noticing and accepting our grief for what it really is and the small changes every day in our experiences.’ – WYG

 

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

 

Huang, F. Y., Hsu, A. L., Hsu, L. M., Tsai, J. S., Huang, C. M., Chao, Y. P., Hwang, T. J., … Wu, C. W. (2019). Mindfulness Improves Emotion Regulation and Executive Control on Bereaved Individuals: An fMRI Study. Frontiers in human neuroscience, 12, 541. doi:10.3389/fnhum.2018.00541

 

Abstract

The grief of bereavement is recognized as a severe psychosocial stressor that can trigger a variety of mental and physical disorders, and the long-lasting unresolved grief has a detrimental effect on brain functionality. Literature has documented mindfulness-based cognitive therapy (MBCT) as an efficient treatment for improving well-being, specifically related to the mood and cognition, in a variety of populations. However, little attention has been devoted to neural mechanisms with regard to bereaved individuals’ cognition after MBCT intervention. In this study, we recruited 23 bereaved participants who lost a significant relative within 6 months to 4 years to attend 8-week MBCT course. We used self-reporting questionnaires to measure emotion regulation and functional magnetic resonance imaging (fMRI) with the numerical Stroop task to evaluate the MBCT effect on executive control among the bereaved participants. The self-reported questionnaires showed improvements on mindfulness and reductions in grief, difficulties in emotion regulation, anxiety, and depression after the MBCT intervention. The fMRI analysis demonstrated two scenarios: (1) the activity of the fronto-parietal network slightly declined accompanied with significant improvements in the reaction time of incongruent trials; (2) the activities in the posterior cingulate cortex and thalamus were positively associated with the Texas Revised Inventory of Grief, implying emotional interferences on cognitive functions. Results indicated that MBCT facilitated the executive control function by alleviating the emotional interferences over the cognitive functions and suggested that the 8-week MBCT intervention significantly improved both executive control and emotion regulation in bereaved individuals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360180/

 

Reduce Grief with Mindfulness

Reduce Grief with Mindfulness

 

By John M. de Castro, Ph.D.

 

Releasing the grief we carry is a long, tear-filled process. Yet it follows the natural intelligence of the body and heart. Trust it, trust the unfolding. Along with meditation, some of your grief will want to be written, to be cried out, to be sung, to be danced. Let the timeless wisdom within you carry you through grief to an open heart.” – Jack Kornfield

 

Grief is a normal, albeit complex, process that follows a loss of a significant person or situation in one’s life. This can involve the death of a loved one, a traumatic experience, termination of a relationship, loss of employment etc. Exactly what transpires depends upon the individual and the nature of the loss. It involves physical, emotional, psychological and cognitive processes. Not everyone grieves in the same way but there have been identified four general stages of grief, shock and denial, intense concern, despair and depression, and recovery. These are normal and healthy. But, in about 15% of people grief can be overly intense or long and therapeutic intervention may become necessary.

 

A stillbirth can be a devastating loss as the joyous anticipation of a new baby is replaced by a death. This can produce intense mental challenges. Mindfulness training is known to help with coping with emotions and stress, and is very effective for depression. Hence, mindfulness training may be helpful in coping with the grief following a stillbirth. In today’s Research News article “Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367631/

Roberts and Montgomery recruited women, aged 18 to 35 years, in rural India who had a history of stillbirth. They provided them with a one session per week for 5-weeks of mindfulness training based upon Mindfulness-Based Stress Reduction (MBSR). This included meditation, body scanning, and yoga practices and had additional education materials on risk factors for stillbirth and prevention strategies. The women were measured before and after the intervention and 6-weeks later for grief, anxiety and depression symptoms, satisfaction with life, religious coping, social support, and mindfulness. During the 6-week follow up period the women practiced daily at home.

 

They found, not surprisingly, that at baseline the women had clinically significant levels of anxiety, depression, and grief. After the mindfulness training, there were significant improvements in grief, anxiety and depression, religious coping, and the mindfulness facets of describe and acting with awareness. Hence the mindfulness training appeared to increase mindfulness and help relieve some of the psychological consequences of having a stillbirth. This could be important as the grief and depression after stillbirth can be severe. Relieving these consequences may be very helpful to the women learning to cope with and move past their tragic loss.

 

These are encouraging results, but must be viewed as preliminary pilot data. There was no control condition so, there are a large number of possible other explanations for the results including placebo effects, attentional effects, experimenter bias, etc. The data do support, however, conducting a larger randomize controlled clinical trial. Such research could lead to mindfulness training being used to assist in coping with loss and grief.

 

So, reduce grief with mindfulness.

 

“Mindful grieving informs us to allow ourselves to feel what is there, without judgment. For me, there was sadness there and I needed to nonjudgmentally acknowledge it, feel it, and let it be. It was important in that moment that I didn’t resist it or strive to make it any different, but just feel it as it was. Ronald Pies, M.D. wrote to us, “Having problems means being alive”, and I’d add “Being alive, means grieving loved ones who pass.” Grief is a natural part of the human experience.” – Elisha Goldstein

 

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

Roberts, L., & Montgomery, S. (2016). Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study. Interdisciplinary Journal of Best Practices in Global Development, 2(1), 1.

 

Abstract

Introduction

Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth.

Methods

We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention.

Results

29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as significant reduction in overall perinatal grief and on each of the three subscales.

Discussion

The shortened, culturally adapted, mindfulness-based intervention pilot study was well received and had very low attrition. We also found significant reductions of perinatal grief and mental health symptoms over time, as well as a high degree of practice of mindfulness skills by participants. This study not only sheds light on the tremendous mental health needs among rural women of various castes who have experienced stillbirth in Chhattisgarh, it also points to a promising effective intervention with potential to be taken to scale for wider delivery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367631/