Improve Physiological Relaxation in Breast Cancer Patients with Mindfulness

Improve Physiological Relaxation in Breast Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based meditation can help ease the stress, anxiety, fear, and depression that often come along with a breast cancer diagnosis and treatment.” –  Breastcancer.org

 

Mindfulness training has been shown to help with general cancer recovery. Mindfulness practices have been shown to improve the residual symptoms in cancer survivors. The Mindfulness-Based Stress Reduction (MBSR) program is a mindfulness training program that includes meditation practice, body scan, yoga, and discussion along with daily home practice. MBSR has been shown to be beneficial for cancer patients in general and also specifically for the symptoms of breast cancer survivors. So, it makes sense to further explore the mechanisms of the effectiveness of MBSR for the treatment of breast cancer survivors.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180838/ ) and colleagues recruited breast cancer survivors who had received a diagnosis and treatment at least 2 years ago. They either participated in a 6 week, 2 hour once a week session of Mindfulness-Based Stress Reduction (MBSR) or usual care. Before and after treatment they were measured for heart rate, heart rate variability with an electrocardiogram.

 

They found that in comparison to baseline and the usual care group after Mindfulness-Based Stress Reduction (MBSR) the survivors had significantly lower resting heart rate and higher heart rate variability. Increases in heart rate variability indicates a reduction in physiological activation, an increase in parasympathetic relaxation, providing a physiological indicator of physiological relaxation. This suggests that MBSR resulted in greater relaxation in the breast cancer survivors and this is an indicator of improved physical and psychological well-being in these cancer survivors.

 

So, mindfulness training increases physiological relaxation in breast cancer survivors.

 

practice mindfulness meditation to help you better handle the stressors that life is throwing your way. Being more mindful can also help you remain physically active and stick to a healthy diet – all key ingredients for successfully navigating cancer survivorship!” – Jessica Pieczynski

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Wang, S. J., Chang, Y. C., Hu, W. Y., Chang, Y. M., & Lo, C. (2022). The Comparative Effect of Reduced Mindfulness-Based Stress on Heart Rate Variability among Patients with Breast Cancer. International journal of environmental research and public health, 19(11), 6537. https://doi.org/10.3390/ijerph19116537

 

Abstract

Heart rate variability (HRV) is a powerful tool for observing interactions between the sympathetic and parasympathetic nervous systems. This study evaluated HRV during a mindfulness-based stress reduction (MBSR) program among women with breast cancer after receiving treatment. A quasi-experimental, nonrandomized design was used. Patients were allocated to usual care (n = 25) and MBSR (n = 25) groups. HRV was measured using recognized methods to assess the autonomic nervous system. Two-way ANOVA and t-tests were used to examine HRV changes between and within groups, respectively. A significant interaction effect of time with group was observed on heart rate (F (1, 96) = 4.92, p = 0.029, η2 = 0.049). A significant difference was also observed within the MBSR group preintervention and postintervention with regard to heart rate (t (24) = −3.80, p = 0.001), standard deviation of the RR interval (t (24) = 5.40, p < 0.001), root-mean-square difference in the RR interval (t (24) = 2.23, p = 0.035), and high-frequency power (t (24) = 7.73, p < 0.001). Large effect sizes for heart rate and SDNN of 0.94 and 0.85, respectively, were observed between the MBSR and usual care groups. This study provides preliminary evidence that an MBSR program may be clinically useful for facilitating parasympathetic activity associated with feelings of relaxation in treated breast cancer survivors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180838/

Promote Relaxation in Experienced Yoga Practitioners with OM Chanting

Promote Relaxation in Experienced Yoga Practitioners with OM Chanting

 

By John M. de Castro, Ph.D.

 

“Om is a great tool for manifesting positive things in your life. Chanting Om calms your mind and helps you bring in positive energy into your body.” – Times of India

Contemplative practices have been shown to improve health and well-being. One ancient practice that is again receiving acceptance and use is chanting. It is a very common component of many contemplative practices. Chanting is claimed to be helpful in contemplative practice and to help improve physical and mental well-being. OM chanting has been practiced for centuries. But there is very little empirical research on OM chanting or its effectiveness.

 

In today’s Research News article “Immediate Effects of OM Chanting on Heart Rate Variability Measures Compared Between Experienced and Inexperienced Yoga Practitioners.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015091/ ) Inbaraj and colleagues recruited healthy adult yoga practitioners and yoga naïve individuals and had them perform a loud OM chant for 5 minutes. They were assessed before and after the chanting with an electrocardiogram for assessment of heart rate variability.

 

They found that at baseline the yoga practitioners had significantly higher levels of high frequency heart rate variability than the yoga naïve group. Compared to baseline and the yoga naïve group after chanting the experienced yoga practitioners had a significant increase in high frequency heart rate variability. The greater the number of years of experience practicing yoga the greater the increase in high frequency heart rate variability.

 

Increases in heart rate variability indicates a reduction in physiological activation, an increase in parasympathetic relaxation, providing a physiological indicator of calm relaxation. So, the results suggest that practicing yoga increases the ability to relax both in general and after chanting.

 

Promote the ability to relax with yoga.

 

OM is present in everything that we speak. It is the sound of the Universe and everything that it contains. The primordial sound from which everything emerged.” – Meditative Mind

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Inbaraj, G., Rao, R. M., Ram, A., Bayari, S. K., Belur, S., Prathyusha, P. V., Sathyaprabha, T. N., & Udupa, K. (2022). Immediate Effects of OM Chanting on Heart Rate Variability Measures Compared Between Experienced and Inexperienced Yoga Practitioners. International journal of yoga, 15(1), 52–58. https://doi.org/10.4103/ijoy.ijoy_141_21

 

Abstract

Background:

Chanting “OM” is a form of meditation that has numerous health benefits. However, the neurophysiological mechanisms underpinning its effect are surprisingly scarce. The present study aimed to investigate the effect of OM chanting on autonomic modulation, using heart rate variability (HRV), on experienced yoga practitioners and yoga naïve persons.

Methods:

This prospective study included 19 yoga practitioners (9 females and 10 males; group mean age ± standard deviation [SD]; 25.9 ± 3.2 years) and 17 yoga naïve persons (8 females and 9 males; group mean age ± SD; 24.8 ± 3.6 years) of both sexes and similar age range. Both the groups were assessed for HRV indices (time and frequency domain measures) before and after loud OM chanting for 5 min.

Results:

Baseline comparison using Mann–Whitney U test between groups showed yoga practitioners had significantly increased high frequency (HF) power (P < 0.029) than nonyoga practitioners, signifying a state of tranquility before the chanting of OM. After 5 min of loud chanting of OM, a comparison between groups assessed using Wilcoxon Signed Ranks test revealed: HF Power, a component of the parasympathetic nervous system, was further amplified with a significantly increase (P < 0.001) in the yoga practitioners group compared to nonyoga practitioners. Furthermore, this increase in HF power was positively correlated with the years of experience in yoga.

Conclusion:

The present study showed that a brief chanting of OM (5 min) might enhance parasympathetic nervous system activity, promote relaxation, and provide calmness. Further, this experience may be achieved effectively in individuals experienced in yoga than nonyoga practitioners.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015091/

 

Increase Body Awareness and Emotional Regulation in College Women with Yoga

Increase Body Awareness and Emotional Regulation in College Women with Yoga

 

By John M. de Castro, Ph.D.

 

Among the suite of tools and strategies that so many of us lean on when it comes to living peacefully (or not) with our emotions, yoga is probably one of the most affecting and effective.” – Monisha Rudhran

 

Yoga 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. There are a wide variety of different yoga training techniques. Many varieties employ breath-focused and meditative-focused practices. Although the benefits of yoga practices in general are well studied there is little scientific research comparing breathing and meditative-focused yoga versus only yoga postures.

 

In today’s Research News article “Can Yoga Boost Access to the Bodily and Emotional Self? Changes in Heart Rate Variability and in Affective Evaluation Before, During and After a Single Session of Yoga Exercise With and Without Instructions of Controlled Breathing and Mindful Body Awareness in Young Healthy Women.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.731645/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1790561_a0P58000000G0YfEAK_Psycho_20211214_arts_A ) Herbert recruited female college students and had them perform 30 minutes of yoga exercises. One randomly assigned group was instructed to “exercise any movement with heightened body awareness and breathing control” while the other received no further instruction. They were measured before and after the 30 minutes of yoga for cardiac activity including heart rate variability with an electrocardiogram, positive and negative emotions, interoceptive awareness, self-referential processing, empathy, affective judgement, and heartbeat counting.

 

They found that cardiac activity was, not surprisingly, increased by yoga, but the two groups did not differ. Also, compared to pre-yoga, after yoga the heart rate was significantly lower during the affective task. In addition, after practicing yoga the participants were significantly faster and more accurate in their affective judgements to emotional stimuli and higher levels of body awareness (heartbeat counting). Hence, there were significant effects of yoga on cardiac activity, emotion regulation, and body awareness, but there was no significant effect of the instruction to be aware of the body and breathing during yoga.

 

The results suggest that a single 30-minute yoga session, like any other exercise, affects cardiac activity and it improves emotional processing and body awareness regardless of body awareness instruction. These findings are not new as it has been established in previous research by other researchers studying different groups that yoga practice improves body awareness and emotion regulation. That this happens after a single 30-minute practice is new and interesting.

 

The lack of a control group participating in another form of exercise, however, limits the conclusions regarding the effects of yoga per se. It is possible that any form of exercise would produce similar effects. In addition, a single 30-minute session may not be sufficient to observe effect of an intention to be aware of the body and breathing. More practice may be necessary. Alternatively, participating in yoga may heighten body and breathing awareness regardless of whether there was an explicit instruction. Nevertheless, short-term exercise appears to be healthful for the heart, body awareness, and the emotions.

 

So, increase body awareness and emotional regulation in college women with yoga.

 

Change your posture and you change the way you breathe. Change your breathing and you change your nervous system. This is one of the great lessons of yoga: Everything is connected.” – Timothy McCall

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Herbert C (2021) Can Yoga Boost Access to the Bodily and Emotional Self? Changes in Heart Rate Variability and in Affective Evaluation Before, During and After a Single Session of Yoga Exercise With and Without Instructions of Controlled Breathing and Mindful Body Awareness in Young Healthy Women. Front. Psychol. 12:731645. doi: 10.3389/fpsyg.2021.731645

 

Exercise is indispensable for a healthy lifestyle. Yoga exercise can have positive effects on well-being and on cardiac autonomic activity making it an ideal intervention for improving mind-body interactions and resilience to physical and mental stressors. Emotions trigger especially strong bodily and affective-cognitive responses because of their social relevance for the self and their biological relevance of mobilizing the organism for action. This study investigates whether changes in emotion processing related to self-other referential processing and changes in cardiac autonomic activity, reflected by heart rate variability (HRV), occur immediately after already a single session of yoga exercise when yoga postures are practiced with or without breathing- and mindful body awareness instructions. Women, all university students (N = 34, final sample: n = 30, n = 25 naïve to yoga practice) were randomly assigned to two experimental groups who performed the same yoga exercises with or without controlled breathing and mindfulness instructions. Emotional, self-other referential processing, awareness of bodily signals and HRV indicators were investigated before and after the exercise using standardized experimental tasks, standardized questionnaires, and mobile recording devices. Exercising for 30 minutes changed cardiac activity significantly. HRV measures showed adaptability of cardiac activity during the exercise as well as during the affective task post- to pre-exercise. Exercising with breathing instructions and mindful body awareness had no superior effects on cardiac, particularly parasympathetic activity, compared to practicing the same movements without such explicit instructions. Self-referential processing did not change; however, participants were faster and more accurate in their affective judgments of emotional stimuli [regardless of their reference (self/other)], and showed better awareness of bodily signals after compared to before the exercise session. The results support immediate, adaptive effects of yoga exercise on cardiac and affective-cognitive processing in an all-female healthy sample. Therefore, yoga exercise could be recommended as a physical activity for boosting cardiac and emotional resilience in this target group.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.731645/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1790561_a0P58000000G0YfEAK_Psycho_20211214_arts_A

 

Reduce Stress and Increase Well-Being in People with Schizophrenia with Mindfulness

Reduce Stress and Increase Well-Being in People with Schizophrenia with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In schizophrenic patients, mindfulness intervention leads to better psychosocial functioning, improved positive emotions, and reduced negative symptoms.” – Jia‐Ling Sheng

 

Schizophrenia is the most common form of psychosis. Its effects about 1% of the population worldwide. It appears to be highly heritable and involves changes in the brain. It is characterized by both positive and negative symptoms. Positive symptoms include hallucinations; seeing and, in some cases, feeling, smelling or tasting things that aren’t there, or delusions; unshakable beliefs that, when examined rationally, are obviously untrue. Negative symptoms include a reduced ability to function normally, neglect of personal hygiene, lack of emotion, blank facial expressions, speaking in a monotone, loss of interest in everyday activities, social withdrawal, an inability to experience pleasure, and a lack of insight into their symptoms. The symptoms of schizophrenia usually do not appear until late adolescence or early adulthood.

 

Schizophrenia is very difficult to treat with psychotherapy and is usually treated with antipsychotic drugs. These drugs, however, are not always effective, sometimes lose effectiveness, and can have some difficult side effects. Mindfulness training has been shown to be beneficial for a variety of mental health problems, including psychosis. Mindfulness has also been shown to associated with lower symptom severity of schizophrenia.

 

In today’s Research News article “Effects of Mindfulness-Based Stress Reduction (MBSR) on Stress, Heart Rate Variability, Affect, and Wellbeing among People with Schizophrenia.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8617870/ ) Kim and colleagues recruited patients who had been diagnosed with schizophrenia at two centers. The participants from one center constituted the no-treatment control condition while those from the other received 8-weekly 60 minute sessions of the Mindfulness-Based Stress Reduction (MBSR) program. The participants were measured before and after the treatment and 6 weeks later for perceived stress, positive and negative emotions, well-being, and heart rate variability.

 

They found that in comparison to baseline and the control group, the group that received Mindfulness-Based Stress Reduction (MBSR) had significantly lower perceived stress and negative emotions and significantly higher heart rate variability. Increases in heart rate variability indicates a reduction in physiological activation, an increase in parasympathetic relaxation, providing a physiological indicator of reduced stress. These changes remained significant at the 6 week follow up.

 

These findings demonstrate that mindfulness training with Mindfulness-Based Stress Reduction (MBSR) is effective in reducing stress and negative emotions in patients diagnosed with schizophrenia. Mindfulness training has been shown, in the past with a variety of groups to reduce stress, negative emotions, and heart rate variability. The present findings demonstrate that mindfulness training also improves the psychological well-being in patients with a major mental illness. This suggests that MBSR should be incorporated into the treatment program for patients who had been diagnosed with schizophrenia.

 

So, reduce stress and increase well-being in people with schizophrenia with mindfulness.

 

meditation is the best and successful treatment for Schizophrenia without any side-effects, caused by the very strong medications.” – Ruchi Singhal

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Kim, A. S., Jang, M. H., & Sun, M. J. (2021). Effects of Mindfulness-Based Stress Reduction (MBSR) on Stress, Heart Rate Variability, Affect, and Wellbeing among People with Schizophrenia. International journal of environmental research and public health, 18(22), 11871. https://doi.org/10.3390/ijerph182211871

 

Abstract

Mindfulness-based stress reduction programs have been found to be effective in reducing the stress response and improving the psychological wellbeing of various populations. We aimed to confirm the effects of a mindfulness-based stress reduction program on perceived stress, heart rate variability, positive and negative affect, and subjective wellbeing of community-dwelling people with schizophrenia. The participants in this study were 26 people with schizophrenia (experimental group: 14, control group: 12) enrolled in two community mental health centers located in Gyeonggi Province in South Korea. In the experimental group, the mindfulness-based stress reduction program was applied once a week for 60 min over 8 weeks. The experimental group showed a significantly greater decrease in perceived stress and negative affect, as well as significantly greater improvement in heart rate variability than the control group. The mindfulness-based stress reduction program was an effective nursing intervention to reduce stress and negative affect in people with schizophrenia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8617870/

 

Increase Physiological and Psychological Activation and Calmness with Qigong

Increase Physiological and Psychological Activation and Calmness with Qigong

 

By John M. de Castro, Ph.D.

 

regular [qigong] practice may help improve your balance, ease stress and anxiety, sharpen focus, and reduce your risk of chronic disease.” – Saundra Montijo

 

Qigong has been practiced for thousands of years with benefits for health and longevityQigong training is designed to enhance function and regulate the activities of the body through regulated breathing, mindful concentration, and gentle movements. Only recently though have the effects of these practices been scrutinized with empirical research. This research has found that they are effective for an array of physical and psychological issues.

 

In today’s Research News article “Relaxation or Regulation: The Acute Effect of Mind-Body Exercise on Heart Rate Variability and Subjective State in Experienced Qi Gong Practitioners.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208883/ ) Goldbeck and colleagues recruited experienced adult Qigong practitioners and measured their heat rate variability with the electrocardiogram (ECG) while at rest, during 2 10-minute sessions of qigong practice, and at rest again. Before and after the practices they completed measures of vitality, calmness, deep relaxation, meditative focus, and heightened body awareness.

 

They found that after the 10-minute qigong practices there were significant increases in vitality, calmness, pleasant body sensation, focused attention, body awareness, and perceived body activation. In addition, during the qigong sessions there was a significant decrease in heart rate variability. A decrease in heart rate variability is indicative of increased physiological activation (sympathetic nervous system activation).

 

The results are interesting and suggest that experienced qigong practitioners experience increases in both psychological and physiological activation in association with feelings of calmness during engagement in the practice. The physiological arousal is suggestive of the aerobic exercise component of qigong. It is interesting that calmness increased in synchrony with increased vitality and perceived body activation. This is suggestive of a state of “eutonic calmness” wherein activity is associated with pleasant calm feelings which has been postulated to be characteristic of mind-body exercises.

 

So, increase physiological and psychological activation and calmness with qigong.

 

a little bit of regular practice, Qigong can have a powerful effect on mind, body and spirit. Reported benefits have included increased general health and well being, reduced levels of stress, and a brighter and more balanced outlook on life’s possibilities.” – Mei Quan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Goldbeck, F., Xie, Y. L., Hautzinger, M., Fallgatter, A. J., Sudeck, G., & Ehlis, A. C. (2021). Relaxation or Regulation: The Acute Effect of Mind-Body Exercise on Heart Rate Variability and Subjective State in Experienced Qi Gong Practitioners. Evidence-based complementary and alternative medicine : eCAM, 2021, 6673190. https://doi.org/10.1155/2021/6673190

 

Abstract

Mind-body exercises such as Yoga or Qi Gong have demonstrated a wide range of health benefits and hold great promise for employment in clinical practice. However, the psychophysiological mechanism underlying these effects remains unclear. Theoretical frameworks highlight regulation as a characteristic and specific mechanism of mind-body exercise for which empirical evidence is scarce. To investigate the exact nature of this mechanism, we tracked acute changes in autonomic nervous system (ANS) activity and subjective state over a common form of mind-body exercise (Qi Gong). Heart rate variability (HRV) and subjective state were assessed in 42 Qi Gong practitioners from China and Germany during a standard moving Qi Gong exercise (Baduanjin). Relaxation in supine position prior and after the exercise served as a control condition to Qi Gong and to assess changes before and after the exercise. Following Qi Gong, all practitioners reported significantly increased subjective calmness and perceived body activation, attentional focus, and subjective vitality. On the physiological level, a significant decrease of parasympathetic modulation and increase in heart rate indicated a pattern of moderate general physiological activation during Qi Gong. A significant increase in overall RR-interval modulation and cardiac coherence during Qi Gong were indicative of a mechanism of active regulation. Examination of the RR-interval trajectories revealed a rhythmic pattern of ANS activation and deactivation in sync with activating and relaxing segments of the exercise. Significant changes in subjective state, not on the physiological level, before and after the exercise were observed. Significant associations between Qi-Gong-specific beliefs, age, cultural background, and experiential and physiological measures demonstrated the complexity of mind-body exercises as multicomponent interventions. Overall, this study highlights moderate general physiological activation, exercise-dependent rhythmic ANS modulation, and induction of a characteristic state of eutonic calmness as potential psychophysiological mechanisms underlying the health benefits of mind-body exercise.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208883/

 

Increase Relaxation with Focused Meditation while Increasing Activation with Open Monitoring Meditation

Increase Relaxation with Focused Meditation while Increasing Activation with Open Monitoring Meditation

 

By John M. de Castro, Ph.D.

 

Mindfulness meditation consists of focused attention meditation (FAM) and open monitoring meditation (OMM), both of which reduce activation of the default mode network (DMN) and mind-wandering.” – Masahiro Fujino

 

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. As a result, meditation training has been called the third wave of therapies. One problem with understanding meditation effects is that there are, a wide variety of meditation techniques and it is not known which work best for affecting different psychological areas.

 

There are a number of different types of meditation. Classically they’ve been characterized on a continuum with the degree and type of attentional focus. In focused attention meditation, the individual practices paying attention to a single meditation object, often the breath. In open monitoring meditation, the individual opens up awareness to everything that’s being experienced including thoughts regardless of its origin. Whether these different meditation types produce different effects has not been extensively studied.

 

In today’s Research News article “Differential Effects of Focused Attention and Open Monitoring Meditation on Autonomic Cardiac Modulation and Cortisol Secretion.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320390/ ) Ooishi and colleagues recruited healthy adult meditation novices and had them engage in 30 minutes of either focused attention meditation, focusing on the breath, or open monitoring meditation in randomized order separated by 2 hours. They were measured before and after each meditation for heart rate, heart rate variability, respiration rate, and salivary cortisol.

 

They found that focused attention meditation and open monitoring meditation both reduced respiration rates but produced different physiological responses. Analysis of the heart rate variability data revealed changes in the autonomic nervous system’s components of the sympathetic and parasympathetic nervous systems. These analyses suggested that focused attention meditation produced an increase in parasympathetic activation but not sympathetic activation while open monitoring meditation produced an increase in sympathetic activation but not parasympathetic activation and reduced salivary cortisol levels.

 

These findings suggest that focused attention meditation is associated with physiological relaxation while open monitoring meditation is associated with physiological activation. This fits with the findings that focused attention meditation produces greater reductions in anxiety compared to open monitoring meditation. But it needs to be kept in mind that the study employed brief, one-time meditations by meditation naïve participants. It is possible that focused attention meditation is simpler and produces less stress in naive participants while open monitoring meditation is more difficult to learn requiring greater effort and stress. It is clear that this work needs to be replicated with longer term meditation practice.

 

So, increase relaxation with focused meditation while increasing activation with open monitoring meditation.

 

Focused attention meditation improves focus.  . . an increased consciousness of bodily sensations. The open-monitoring meditation . .  increases our ability to resolve conflicts.  Open Monitoring meditation increases creativity by improving divergent and convergent thinking.” – Daily Meditation

 

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

 

Ooishi, Y., Fujino, M., Inoue, V., Nomura, M., & Kitagawa, N. (2021). Differential Effects of Focused Attention and Open Monitoring Meditation on Autonomic Cardiac Modulation and Cortisol Secretion. Frontiers in Physiology, 12, 675899. https://doi.org/10.3389/fphys.2021.675899

 

Abstract

Mindfulness-based interventions (MBIs) have been used widely as a useful tool for the alleviation of various stress-related symptoms. However, the effects of MBIs on stress-related physiological activity have not yet been ascertained. MBIs primarily consist of focused-attention (FA) and open-monitoring (OM) meditation. Since differing effects of FA and OM meditation on brain activities and cognitive tasks have been mentioned, we hypothesized that FA and OM meditation have also differing effects on stress-related physiological activity. In this study, we examined the effects of FA and OM meditation on autonomic cardiac modulation and cortisol secretion. Forty-one healthy adults (aged 20–46 years) who were meditation novices experienced 30-min FA and OM meditation tasks by listening to instructions. During resting- and meditation-states, electrocardiogram transducers were attached to participants to measure the R-R interval, which were used to evaluate heart rate (HR) and perform heart rate variability (HRV) analyses. Saliva samples were obtained from participants pre- and post-meditation to measure salivary cortisol levels. Results showed that FA meditation induced a decrease in HR and an increase in the root mean square of successive differences (rMSDD). In contrast, OM meditation induced an increase in the standard deviation of the normal-to-normal interval (SDNN) to rMSSD ratio (SDNN/rMSSD) and a decrease in salivary cortisol levels. These results suggest that FA meditation elevates physiological relaxation, whereas OM meditation elevates physiological arousal and reduces stress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320390/

 

Improve Prisoner’s Physical and Psychological Well-Being with Mindfulness

Improve Prisoner’s Physical and Psychological Well-Being with Mindfulness

 

By John M. de Castro, Ph.D.

 

“inmates participating in a 20-24 week meditation program showed a reduction in trouble sleeping, improved anger management capabilities, and lower levels of stress and anxiety.” – Mindfulness Strategies

 

Around 2 ¼ million people are incarcerated in the United States. Even though prisons are euphemistically labelled correctional facilities very little correction actually occurs. This is supported by the rates of recidivism. About three quarters of prisoners who are released commit crimes and are sent back to prison within 5-years. The lack of actual treatment for the prisoners leaves them ill equipped to engage positively in society either inside or outside of prison. Hence, there is a need for effective treatment programs that help the prisoners while in prison and prepares them for life outside the prison.

 

Contemplative practices are well suited to the prison environment. Mindfulness training teaches skills that may be very important for prisoners. In particular, it puts the practitioner in touch with their own bodies and feelings. It improves present moment awareness and helps to overcome rumination about the past and negative thinking about the future. It also relieves stress and improves overall health and well-being. Finally, mindfulness training has been shown to be effective in treating depressionanxiety, and anger and to help overcome trauma in male prisoners.

 

In today’s Research News article “A Pragmatic Study of the Impact of a Brief Mindfulness Intervention on Prisoners and Staff in a Category B Prison and Men Subject to Community-Based Probation Supervision.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780272/ )  Davies and colleagues in the first of 2 studies recruited prisoners and staff and provided them with 8 2-hours sessions of mindfulness training. They were measured before and after training for mindfulness, perceived stress, provocation of anger, burnout, anxiety, depression, impulse control, and heart rate variability. They also measured prisoners and staff who refused participation in the mindfulness training.

 

They found that staff had significantly lower stress levels and heart rate variability than prisoners. In comparison to baseline both the prisoners and the staff had significant increases in mindfulness and heart rate variability and decreases in perceived stress. In the second study they recruited individuals on probation and allocated them to receive either mindfulness training or no intervention. They were measured before and after training for mindfulness. They did not find any significant changes in mindfulness after the intervention.

 

The studies were designed based upon pragmatic conditions in the prison and with probation and as a result were not randomized. In addition, there were high attrition rates; 48% of the prison participants and 57% of the community participants did not complete the study. This raises the possibility that the observed effects of mindfulness training were due to the experimental contaminant of experimental mortality, where participants who did not respond to the treatment dropped out leaving only those who thought they were improving in the study.

 

But prior better controlled research has demonstrated that mindfulness training improves the well-being of prisoners. So, the improvements in mindfulness and stress levels observed in the present study were probably due to the training. The increase in heart rate variability observed after training is an indicator of physiological relaxation. So, the mindfulness training in the prison reduced subjective stress and a physiological indicator of stress.

 

So, improve prisoner’s physical and psychological well-being with mindfulness.

 

I’ve known inmates who have, as a result of their meditation practice, move from being violent streetfighters to gentle protectors of weaker prisoners. I’ve seen inmates develop an extraordinary amount of patience with exceedingly trying circumstances. I’ve seen seemingly macho men show a tender concern for others. In short, I’ve seen people who have committed some of the most serious crimes possible — people that some might describe as “animals” or “beyond hope” — becoming better people.” – Bodhipaksa

 

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

 

Davies, J., Ugwudike, P., Young, H., Hurrell, C., & Raynor, P. (2021). A Pragmatic Study of the Impact of a Brief Mindfulness Intervention on Prisoners and Staff in a Category B Prison and Men Subject to Community-Based Probation Supervision. International journal of offender therapy and comparative criminology, 65(1), 136–156. https://doi.org/10.1177/0306624X20944664

 

Abstract

Objectives:

This article presents two studies assessing the impact of mindfulness in prison (prisoners and staff) and non-custodial settings.

Method:

Study 1—prisoners (n = 17) and staff (n = 15) in a UK prison completed a mindfulness program; 16 individuals acted as a single time point comparison. Data were collected using self-report, computer based and physiological measurement. Study 2—men under community probation supervision were allocated to mindfulness (completed, n = 28) or TAU (n = 27). Data were collected using self-report mindfulness measures.

Results:

Study 1—statistically significant (increases in mindfulness skills (η2p = .234 to η2p = .388), cognitive control (η2p = .28), and heart rate variability (SDNN; η2p = .41) along with significant decreases in stress (η2p = .398) were found. In study 2, the mindfulness group showed non-significant improvements in mindfulness skills.

Conclusion:

The findings suggest brief mindfulness interventions could make an important contribution to offender rehabilitation and custodial staff wellbeing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780272/

 

Forest Walking and Forest Qigong Improve Cognitive Function in the Elderly

Forest Walking and Forest Qigong Improve Cognitive Function in the Elderly

 

By John M. de Castro, Ph.D.

 

“forest bathing has received increasing attention due to its health-promoting effects, including enhancing immune functions and decreasing blood pressure in hypertension patients, as well as stress relief effects.” – Genxiang Mao,

 

Modern living is stressful, perhaps, in part because it has divorced us from the natural world that our species was immersed in throughout its evolutionary history. Modern environments may be damaging to our health and well-being simply because the species did not evolve to cope with them. This suggests that returning to nature, at least occasionally, may be beneficial. Indeed, researchers are beginning to study nature walks or what the Japanese call “Forest Bathing” and their effects on our mental and physical health.

 

Mindfulness practices have been found routinely to reduce the psychological and physiological responses to stress and improve mood. People have long reported that walking in nature elevates their mood. It appears intuitively obvious that if mindfulness training occurred in a beautiful natural place, it would greatly improve the effectiveness of mindfulness practice. In fact, being in nature has been shown to improve psychological health.

 

Qigong has been practiced for thousands of years with benefits for health and longevity. Qigong training is designed to enhance function and regulate the activities of the body through regulated breathing, mindful concentration, and gentle movements. Qigong  practice has been found to be effective for an array of physical and psychological issues. Qigong has been shown to help the elderly improve attentionbalance, reducing fallsarthritiscognitive functionmemory, and reduce age related deterioration of the brain. So, it makes sense to further study the ability of Qigong training particularly when practiced in nature to improve well-being in the elderly.

 

In today’s Research News article “Psycho-Electrophysiological Benefits of Forest Therapies Focused on Qigong and Walking with Elderly Individuals.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999348/ ) Yi and colleagues recruited healthy elderly (65 years of age and older) participants and assigned them to one of 3 conditions; no-treatment control, forest walking, or forest Qigong. The forest programs were 2 hours per session twice per week for 6 weeks and included warm-up exercises, stretching, physio-cognitive play, and cool-down along with 50 minutes of either forest walking, or forest Qigong. They were measured before and after training for cognitive impairment, depression, and quality of life. They also had the electroencephalogram (EEG) and electrocardiogram (EKG) recorded. Bioimpedance was used to determine body composition and nutritional metabolism.

 

They found that in comparison to baseline and the no-treatment control condition, the forest qigong group had a significant decrease in depression while the forest walking group had a significant decrease in cognitive impairment and increase in quality of life. In the EEG, the forest walking group had significant increases in Alpha and Beta rhythm power and a significant decrease in low frequency heart rate variability after training while the control and forest qigong groups did not. In addition, the forest qigong group had a significant increase in the upper body bioimpedance phase angle while the forest walking group had a significant increase in the lower body bioimpedance phase angle.

 

Bioimpedance phase angle is an indicator of the metabolic nutrition of the muscles. So, the practice of qigong in the forest appears to increase the metabolic nutritional status of the upper body while walking in the forest appears to increase the metabolic nutritional status of the lower body. This is not surprising as qigong involves frequent arm movements while walking involves more leg movements. Low frequency heart rate variability is an indicator of sympathetic nervous system activity and its decrease in the forest walking group suggests that walking in the forest is physiologically relaxing, reducing activating sympathetic activity. Finally, EEG power is indicative of brain information processing and its increase with forest walking is indicative of an increase in information (cognitive) processing.

 

These findings are interesting and suggest that walking in the forest and qigong in the forest have different effects on elderly individuals. Where forest qigong appears to be superior for decreasing depression and upper body metabolism, forest walking appears to improve cognitive ability, lower body metabolism, and physiological relaxation. Hence qigong in the forest is superior for emotional health while walking in the forest is superior for cognitive health. This suggests that the combination of qigong and walking in the forest may produce better well-being for elderly individual.

 

So, forest walking and forest qigong improve cognitive function in the elderly.

 

Forest bathing, also known as forest therapy or shinrin-yoku in Japanese, is an evidence-based practice of connecting to nature as a way to heal.” – Credible Mind

 

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

 

Yi, J., Kim, S. G., Khil, T., Shin, M., You, J. H., Jeon, S., Park, G. H., Jeong, A. Y., Lim, Y., Kim, K., Kim, J., Kang, B., Lee, J., Park, J. H., Ku, B., Choi, J., Cha, W., Lee, H. J., Shin, C., Shin, W., … Kim, J. U. (2021). Psycho-Electrophysiological Benefits of Forest Therapies Focused on Qigong and Walking with Elderly Individuals. International journal of environmental research and public health, 18(6), 3004. https://doi.org/10.3390/ijerph18063004

 

Abstract

We developed two distinct forest therapy programs (FTPs) and compared their effects on dementia prevention and related health problems for older adults. One was focused on Qigong practice in the forest (QP) and the other involved active walking in the forest (WP). Both FTPs consisted of twelve 2-h sessions over six weeks and were conducted in an urban forest. We obtained data from 25, 18, and 26 participants aged 65 years or above for the QP, WP, and control groups, respectively. Neuropsychological scores via cognition (MoCA), geriatric depression (GDS) and quality of life (EQ-5D), and electrophysiological variables (electroencephalography, bioimpedance, and heart rate variability) were measured. We analyzed the intervention effects with a generalized linear model. Compared to the control group, the WP group showed benefits in terms of neurocognition (increases in the MoCA score, and alpha and beta band power values in the electroencephalogram), sympathetic nervous activity, and bioimpedance in the lower body. On the other hand, the QP group showed alleviated depression and an increased bioimpedance phase angle in the upper body. In conclusion, both active walking and Qigong in the forest were shown to have distinctive neuropsychological and electrophysiological benefits, and both had beneficial effects in terms of preventing dementia and relieving related health problems for elderly individuals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999348/

 

Mindfulness Training Reduces Posttraumatic Stress Among Survivors of Intimate Partner Violence

Mindfulness Training Reduces Posttraumatic Stress Among Survivors of Intimate Partner Violence

 

By John M. de Castro, Ph.D.

 

“People with PTSD may sometimes feel as though they have a hard time getting any distance from unpleasant thoughts and memories. . . Mindfulness may help people get back in touch with the present moment, as well as reduce the extent with which they feel controlled by unpleasant thoughts and memories.” – Matthew Tull

 

The human tendency to lash out with aggression when threatened was adaptive for the evolution of the species. It helped promote the survival of the individual, the family, and the tribe. In the modern world, however, this trait has become more of a problem than an asset. These violent and aggressive tendencies can lead to violence directed to intimate partners, including sexual and physical violence. In the U.S. there are over 5 million cases of domestic violence reported annually. Indeed, it has been estimated that 1 in 4 women and 1 in 7 men have experienced physical violence and 1 in 3 women and 1 in 6 men have experienced sexual violence from an intimate partner.

 

Intimate partner violence frequently produces Posttraumatic Stress Disorder (PTSD) symptoms in the survivors. Hence, there is a need to find ways to reduce the impact of intimate partner violence on the mental health of the survivors. Mindfulness training has been shown to reduce the symptoms of PTSD. Hence, mindfulness training may be effective in treating survivors of intimate partner violence.

 

In today’s Research News article “Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052636/ ) In a small pilot study, Gallegos and colleagues recruited, through family court, women who were survivors of intimate partner violence. They were randomly assigned to receive either an 8-week program of Mindfulness-Based Stress Reduction (MBSR) or wellness education. MBSR met once a week for 2 hours and consisted of meditation, body scan, and yoga practices along with discussion and home practice. For wellness education the participants were provided a manual that provided information on various aspects of health, including diet, physical activity, sleep, stress management, and communication. They received a weekly check-in phone calls regarding the use of the manual. The participants were measured before and after training and 4-weeks later for physical and sexual assault experiences, post-traumatic stress symptoms, emotion regulation, and attention. They also had their heart rate variability measured at rest and during exposure to positive, neutral, or negative (trauma related) pictures.

 

They found that in comparison to baseline, the women who received mindfulness training had significantly lower levels of post-traumatic stress symptoms and higher levels of emotion regulation, while the wellness education participants did not. This was true immediately after treatment and also 4 weeks later. There were also non-significant increases in heart rate variability while viewing trauma-related pictures in the mindfulness group and decreases in the wellness education group.

 

This is a pilot study of a small sample (29 women) and was not powered to detect significant differences between groups. The results, however were encouraging, suggesting that mindfulness training tends to relieve the symptoms of trauma, improve emotion regulation and produce relaxation of the autonomic nervous system in women who were survivors of intimate partner violence. In previous research it has been shown that mindfulness training reduces post-traumatic stress symptoms, improves emotion regulation, and relaxes the autonomic nervous system. The contribution of the present study is to suggest that mindfulness training might also be effective in the treatment of women who have survived intimate partner violence. The results, then, suggest that a large randomized controlled trial should be conducted,

 

So, reduce posttraumatic stress among survivors of intimate partner violence with mindfulness.

 

PTSD is really a different way of seeing the world, and is also seen at the level of physiology. But by going through a couple of months of making an effort to change thoughts and behaviors, that physiological syndrome can also change back again.” – Tony King

 

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

Gallegos, A. M., Heffner, K. L., Cerulli, C., Luck, P., McGuinness, S., & Pigeon, W. R. (2020). Effects of mindfulness training on posttraumatic stress symptoms from a community-based pilot clinical trial among survivors of intimate partner violence. Psychological trauma : theory, research, practice and policy, 12(8), 859–868. https://doi.org/10.1037/tra0000975

Abstract

Objective:

Exposure to intimate partner violence (IPV) is a significant public health issue associated with deleterious mental and medical health comorbidities, including posttraumatic stress disorder (PTSD). The hallmark symptoms of posttraumatic stress (PTS), even when not meeting the threshold for a diagnosis of PTSD, appear to be underpinned by poor self-regulation in multiple domains, including emotion, cognitive control, and physiological stress. Mindfulness-based stress reduction (MBSR) holds promise for treating PTS symptoms because evidence suggests it targets these domains. The current study was a pilot randomized clinical trial designed to examine changes in emotion regulation, attentional function, and physiological stress dysregulation among women IPV survivors with elevated PTS symptoms after participation in a group-based, 8-week MBSR program.

Method:

In total, 29 participants were randomized to receive MBSR (n = 19) or an active control (n = 10). Assessments were conducted at study entry, as well as 8 and 12 weeks later.

Results:

Between-group differences on primary outcomes were nonsignificant; however, when exploring within groups, statistically significant decreases in PTS symptoms, F(1.37, 16.53) = 5.19, p < .05, and emotion dysregulation, F(1.31, 14.46) = 9.36, p < .01, were observed after MBSR but not after the control intervention. Further, decreases in PTSD and emotion dysregulation were clinically significant for MBSR participants but not control participants.

Conclusions:

These preliminary data signal that MBSR may improve PTS symptoms and emotion regulation and suggest further study of the effectiveness of PTSD interventions guided by integrative models of MBSR mechanisms and psychophysiological models of stress regulation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052636/

 

Reduce Pain and Relax the Autonomic Nervous System with Mindfulness

Reduce Pain and Relax the Autonomic Nervous System with Mindfulness

 

By John M. de Castro, Ph.D.

 

“When we impose a litany of negativity upon our pain, it only becomes worse, and potentially elicits other difficulties including depression and anxiety. When we become more aware of what we are actually experiencing, without the overlay of our judgment, the overall perception of pain is reduced.” – Jennifer Wolkin

 

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 chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. 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 individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. Mindfulness appears to work by changing how the patient relates to pain rather than actually reducing or eliminating the pain. What is not known is the mechanism by which mindfulness affects chronic pain.

 

In today’s Research News article “The Role of Heart Rate Variability in Mindfulness-Based Pain Relief.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994350/ ) Adler-Neal and colleagues recruited healthy adult non-meditators and randomly assigned them to either a meditation or sham-meditation group. The group met for 4 25-minute sessions over 7 days and practiced focused breath meditation or sham-meditation. In the sham-meditation sessions the participants were told every 2 to 3 minutes to close their eyes and take a deep breath. They were measured before and after training for respiration and heart rate variability. In addition, the participants underwent noxious non-damaging thermal stimulation on the calf of the leg and rated their pain levels.

 

They found that after both meditation and sham-meditation training there was a significant reduction in pain intensity. pain unpleasantness, and respiration rate and increase in heart rate variability, with no group differences. They also found for the meditation group only that the greater the heart rate variability the lower the pain unpleasantness ratings.

 

Heart rate variability refers to the change in the time intervals between consecutive heart beats. Higher levels of HRV are indicative of flexibility in the Autonomic Nervous System and are associated with adaptability to varying environments and lower stress levels. Higher heart rate variability is an indicator of physiological relaxation. This relaxation may well underlie the reduced pain unpleasantness. Since contemplative practices such as meditation increases heart rate variability it makes sense that these practices would also lower the perception of pain.

 

It is interesting that sham-meditation had similar effects as real meditation on pain and heart rate variability. This suggests that mindfulness reduction in pain may be due to a placebo effect where the participants’ belief that the intervention would reduce pain produced reduced perception of pain. But it could also be that the sham-meditation was actually a mindfulness practice. By focusing the participant’s attention on the breath, it might have increased mindfulness. It remains for future research to investigate this possibility.

 

So, reduce pain and relax the autonomic nervous system with mindfulness.

 

The ancient Buddhist text called the Sullatta Sutta states that mindfulness practitioners have the ability to experience pain but then let go of it.” – Brain Tap

 

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

 

Adler-Neal, A. L., Waugh, C. E., Garland, E. L., Shaltout, H. A., Diz, D. I., & Zeidan, F. (2020). The Role of Heart Rate Variability in Mindfulness-Based Pain Relief. The journal of pain, 21(3-4), 306–323. https://doi.org/10.1016/j.jpain.2019.07.003

 

HIGHLIGHTS

  • Mindfulness and sham mindfulness meditation reduced pain during noxious heat
  • Mindfulness and sham mindfulness meditation increased heart rate variability (HRV)
  • Mindfulness-based pain relief was associated with higher HRV
  • Higher HRV during sham mindfulness meditation was associated with higher pain

Abstract

Mindfulness meditation is a self-regulatory practice premised on sustaining non-reactive awareness of arising sensory events that reliably reduces pain. Yet, the specific analgesic mechanisms supporting mindfulness have not been comprehensively disentangled from the potential non-specific factors supporting this technique. Increased parasympathetic nervous system (PNS) activity is associated with pain relief corresponding to a number of cognitive manipulations. However, the relationship between the PNS and mindfulness-based pain attenuation remains unknown. The primary objective of the present study was to determine the role of high frequency heart rate variability (HF HRV), a marker of PNS activity, during mindfulness-based pain relief as compared to a validated, sham-mindfulness meditation technique that served as a breathing-based control. Sixty-two healthy volunteers (31 females; 31 males) were randomized to a four-session (25 minutes/session) mindfulness or sham-mindfulness training regimen. Before and after each group’s respective training, participants were administered noxious (49°C) and innocuous (35°C) heat to the right calf. HF HRV and respiration rate were recorded during thermal stimulation and pain intensity and unpleasantness ratings were collected after each stimulation series. The primary analysis revealed that during mindfulness meditation, higher HF HRV was more strongly associated with lower pain unpleasantness ratings when compared to sham-mindfulness meditation (B = −0.82, p = 0.04). This finding is in line with the prediction that mindfulness-based meditation engages distinct mechanisms from sham-mindfulness meditation to reduce pain. However, the same prediction was not confirmed for pain intensity ratings (B = −0.41). Secondary analyses determined that mindfulness and sham-mindfulness meditation similarly reduced pain ratings, decreased respiration rate, and increased HF HRV (between group ps < 0.05). More mechanistic work is needed to reliably determine the role of parasympathetic activation in mindfulness-based pain relief as compared to other meditative techniques.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6994350/