Improve Eating Behavior in Obese Cancer Survivors with Mindfulness

Improve Eating Behavior in Obese Cancer Survivors with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindful eating helps you distinguish between emotional and physical hunger. It also increases your awareness of food-related triggers and gives you the freedom to choose your response to them.” – Adda Bjarnadottir

 

Eating is produced by two categories of signals. Homeostatic signals emerge from the body’s need for nutrients, is associated with feelings of hunger, and usually work to balance intake with expenditure. Non-homeostatic eating, on the other hand, is not tied to nutrient needs or hunger but rather to the environment, to emotional states, and or to the pleasurable and rewarding qualities of food. These cues can be powerful signals to eat even when there is no physical need for food. External eating is non-homeostatic eating in response to the environmental stimuli that surround us, including the sight and smell of food or the sight of food related cause such as the time of day or a fast food restaurant ad or sign.

 

Mindful eating involves paying attention to eating while it is occurring, including attention to the sight, smell, flavors, and textures of food, to the process of chewing and may help reduce intake. Indeed, high levels of mindfulness are associated with lower levels of obesity and mindfulness training has been shown to reduce binge eating, emotional eating, and external eating.

 

A mindfulness training technique that was developed to treat addictions called Mindfulness-Oriented Recovery Enhancement (MORE) involves 10 weekly sessions of 2 hours and includes mindful breathing and body scan meditations, cognitive reappraisal to decrease negative emotions and craving, and savoring to augment natural reward processing and positive emotion. Participants are also encouraged to practice at home for 15 minutes per day. It is not known if MORE is effective in changing eating behavior in obese women cancer survivors.

 

In today’s Research News article “Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552347/), Thomas and colleagues recruited obese (BMI >30) women who had a cancer diagnosis either current or in remission. They were randomly assigned to receive a 10-week, 1.5-hour session, once per week, of either a standard exercise and nutrition program or the Mindfulness-Oriented Recovery Enhancement (MORE) program. The participants were measured before and after the program for body composition, eating behaviors, interoceptive awareness, savoring the moment, and attention bias toward food. In addition, they were measured for muscular electrical responses to food and non-food pictures to assess responsiveness to cues.

They found that in comparison to baseline and the exercise and nutrition program Mindfulness-Oriented Recovery Enhancement (MORE) produced significantly greater increases in smiling to natural reward cues, and interoceptive awareness including increases in noticing body sensations, attention regulation, self-regulation, and body listening, and significant decreases in attentional responsiveness to food cues and external eating. Using a path analysis, they found that MORE had its effects on attentional responsiveness to food cues directly and also indirectly by its positive effects on attention bias toward natural reward cues that, in turn, negatively affected their responsiveness to food cues. Finally, these decreases in attentional responsiveness to food cues were related to decreases in the participants’ waist to hip ratio.

 

These results are interesting and suggest that Mindfulness-Oriented Recovery Enhancement (MORE) may reduce inappropriate responsiveness to food in obese women with cancer by increasing their awareness of their internal state (interoceptive awareness) and their responsiveness to natural reward cues. Hence, the training makes the women more sensitive to their actual internal state which makes them more responsive to real hunger and satiety and less responsive to non-homeostatic eating signals. In addition, it appears to allow them to receive more reward from non-food related natural stimuli and thereby reduce their need to receive reward through eating. Thus, MORE appears to improve obese women’s ability to better regulate their eating behavior.

 

So, improve eating behavior in obese cancer survivors with mindfulness.

 

“Mindfulness practice helps individuals develop skills for self-regulation by improving awareness of emotional and sensory cues, which are also important in altering one’s relationship with food.” –  Sunil Daniel

 

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

 

Thomas, E. A., Mijangos, J. L., Hansen, P. A., White, S., Walker, D., Reimers, C., … Garland, E. L. (2019). Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial. Integrative cancer therapies, 18, 1534735419855138. doi:10.1177/1534735419855138

 

Abstract

Introduction: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial. Methods: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: (a) exercise and nutrition counseling or (b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms. Results: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias—the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards. Conclusions and Implications: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6552347/

 

Strengthen the Brain’s Interoceptive Networks with Mindfulness

Strengthen the Brain’s Interoceptive Networks with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness strengthens interoception, operationalized here as the mean insula connection strength within the overall connectome.” – Strong et al.

 

Most of us spend the majority of our lives lost in thought. Even when we become aware of our surroundings it is principally of the sights and sounds surrounding us. It is usually only when something is very wrong that we become aware of our bodies, what is called interoceptive awareness. We are generally unaware of the signals from our bodies such as the breath, movements in the GI tract, heart beats accompanied with surges in blood pressure, the sensations from our muscles and joints, even the sensations from our skin. Adding to the lack of awareness of our bodies we are also unaware of our implicit beliefs and attitudes about our bodies and the emotions that accompany these attitudes.

 

To exemplify this, just for a moment start paying attention to the sensations coming from the contact of your clothing with your skin. You were in all probability totally unaware of these sensations until your attention was directed toward them. Now notice the feelings from your facial muscles. Are they tense, relaxed, or something in-between. You probably were not aware of their state yet they can be good indicators of stress and your emotional state. This can be a real problem as interoceptive awareness is extremely important for our awareness of our emotional state which is in turn needed to regulate and respond appropriately to the emotions. Being aware of the state of our bodies is also important for maintaining health, both for recognizing our physical state and also for making appropriate decisions about health-related behaviors. Interoceptive awareness is even fundamental to our sense of self and world view.

 

Most contemplative practices focus attention on our internal state and thus improve our body awareness. But, in fact there is little empirical evidence on how this is accomplished. The insula cortex is a large piece of cerebral cortex has been covered and is buried deep inside at the juncture of the parietal, temporal, and frontal lobes. The insula is highly interconnected with a wide variety of other cortical and subcortical areas of the brain and it has been implicated in interoceptive awareness. So, changes in the insula may well reflect changes in interoceptive awareness. This suggests that mindfulness training would produce changes in the insula cortex.

 

In today’s Research News article “Mindfulness training induces structural connectome changes in insula networks.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962606/ ), Sharp and colleagues examined the Magnetic Resonance Images (MRIs) from two groups of participants in a larger study. Both groups had received cognitive training plus physical fitness training, while one group received an additional mindfulness training. Training consisted of 3 70-minute training sessions per week for 16 weeks. Functional Magnetic Resonance Images (f-MRIs) were obtained before and after training as well as a subjective interoceptive awareness measure.

 

They found that only after the training that included mindfulness training was there a significant increase in the strength of the connections between the insula cortex on the right side of the brain and the rest of the brain. These results suggest that mindfulness training alters the connectivity of the brain region that underlies interoceptive awareness. This may explain how mindfulness training improves body awareness and in turn the ability to sense and regulate emotions. Because emotion regulation is so fundamental to psychological health, these findings could explain how mindfulness training improves mental health and relieves mental illness.

 

So, strengthen the brain’s interoceptive networks with mindfulness.

 

“”Mindfulness” is a capacity for heightened present-moment awareness that we all possess to a greater or lesser extent. Training this capacity seems to have a quieting effect on brain areas associated with our subjective appraisal of our self. By considering thoughts and feelings as transitory mental events that occur, but are separate from the self, people are able to lessen their hold on their worries and positive mental health outcomes follow.” – Sian Bellock

 

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

 

Paul B. Sharp, Bradley P. Sutton, Erick J. Paul, Nikolai Sherepa, Charles H. Hillman, Neal J. Cohen, Arthur F. Kramer, Ruchika Shaurya Prakash, Wendy Heller, Eva H. Telzer, Aron K. Barbey. Mindfulness training induces structural connectome changes in insula networks. Sci Rep. 2018; 8: 7929. Published online 2018 May 21. doi: 10.1038/s41598-018-26268-w

 

Abstract

Although mindfulness meditation is known to provide a wealth of psychological benefits, the neural mechanisms involved in these effects remain to be well characterized. A central question is whether the observed benefits of mindfulness training derive from specific changes in the structural brain connectome that do not result from alternative forms of experimental intervention. Measures of whole-brain and node-level structural connectome changes induced by mindfulness training were compared with those induced by cognitive and physical fitness training within a large, multi-group intervention protocol (n = 86). Whole-brain analyses examined global graph-theoretical changes in structural network topology. A hypothesis-driven approach was taken to investigate connectivity changes within the insula, which was predicted here to mediate interoceptive awareness skills that have been shown to improve through mindfulness training. No global changes were observed in whole-brain network topology. However, node-level results confirmed a priori hypotheses, demonstrating significant increases in mean connection strength in right insula across all of its connections. Present findings suggest that mindfulness strengthens interoception, operationalized here as the mean insula connection strength within the overall connectome. This finding further elucidates the neural mechanisms of mindfulness meditation and motivates new perspectives about the unique benefits of mindfulness training compared to contemporary cognitive and physical fitness interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962606/

 

Feeling Feelings: Getting in Touch with the Body

Most of us spend the majority of our lives lost in thought. Even when we become aware of our surroundings it is principally of the sights and sounds surrounding us. It is usually only when something is very wrong that we become aware of our bodies, what is called interoceptive awareness. We are generally unaware of the signals from our bodies such as the breath, movements in the GI tract, heart beats accompanied with surges in blood pressure, the sensations from our muscles and joints, even the sensations from our skin. Adding to the lack of awareness of our bodies we are also unaware of our implicit beliefs and attitudes about our bodies and the emotions that accompany these attitudes.

To exemplify this, just for a moment start paying attention to the sensations coming from the contact of your clothing with your skin. You were in all probability totally unaware of these sensations until your attention was directed toward them. Now notice the feelings from your facial muscles. Are they tense, relaxed, or something in-between. You probably were not aware of their state yet they can be good indicators of stress and your emotional state.

This can be a real problem as interoceptive awareness is extremely important for our awareness of our emotional state which is in turn needed to regulate and respond appropriately to the emotions. Being aware of the state of our bodies is also important for maintaining health, both for recognizing our physical state and also for making appropriate decisions about health related behaviors. Interoceptive awareness is even fundamental to our sense of self and world view.

Obviously it is important that we find ways to improve our poor body awareness. Most contemplative practices focus attention on our internal state and thus should improve our body awareness. But, in fact there is little empirical evidence on the issue. In today’s Research News article “Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1063072420383350/?type=1&theater

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4284997/

Bornemann and colleagues examine the effect of a 3-month training employing focused meditation and body scan meditation on interoceptive awareness. They found significant increases in five of the eight scales of interoceptive awareness compared to a control group.

It was found that meditation and body scan practice improved the regulatory aspects of interoceptive awareness. These include Self-Regulation which is the ability to control distress by paying attention to sensations from the body, Attention Regulation which is the ability to focus in a sustained way on the sensations from the body, and Body Listening which is the ability to gain insight into the physical and emotional state by listening to the signals from the body. These are important skills involved in being able to not only be aware of body sensations but to use these sensations to better understand and control their internal state and physical wellbeing.

Contemplative practice also improved Emotional Awareness, which is the ability to be aware of and understand the connection between body sensations and emotions, and Body Trusting, which is experiencing one’s own body as a safe place. These are also important abilities as they allow us to trust in the usefulness of the information from the body to better understand and control our emotions.

It is interesting that the contemplative practice did not increase Noticing of body sensations such as heart beat and breathing. Rather it appears to markedly improve our ability to use the information from our bodies to understand and regulate our emotional or motivational state. This is very important to our wellbeing both mental and physical. It puts us better in control by providing the signals we need to be better able to regulate our state.

These improvements in interoceptive awareness could also explain to some extent how mindfulness practices produce their well-documented significant improvements in physical and psychological health and wellbeing. It simply makes us better able to respond to and control our bodies and our emotions.

So engage in contemplative practice and learn how to feel your feelings and benefit your body’s signals.

CMCS – Center for Mindfulness and Contemplative Studies