Quality of Life

Improve Quality-of-life and Stress Responses in Caregivers for Patients with Dementia

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Improve Quality-of-life and Stress Responses in Caregivers for Patients with Dementia

 

By John M. de Castro, Ph.D.

 

“Mindfulness also happens to be a salvation for caregivers facing the ongoing stress from caring for a loved one with dementia. There is another reason mindfulness practice can be a game changer for dementia caregivers. Mindfulness can also help you provide care for your loved one with greater ease.” – Marguerite Manteau-Rao

 

Dementia is a progressive loss of mental function produced by degenerative diseases of the brain. Dementia patients require caregiving particularly in the later stages of the disease. Alzheimer’s disease is the most common type of dementia and accounts for 50 to 70 percent of dementia cases. Other types of dementia include vascular dementia, mixed dementia, dementia with Lewy bodies and frontotemporal dementia. For Alzheimer’s disease alone, there are an estimated 10 million caregivers providing 9 billion hours of care at a value of over $100 Billion dollars.

 

Caregiving for dementia patients is a daunting and all too frequent task. It is an intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. In the last year, 59% of the caregivers report that they are effectively on duty 24/7. Over time dementia will lead to loss of memory, loss of reasoning and judgment, personality and behavioral changes, physical decline, and death. The memory and personality changes in the patient may take away all those characteristics that make the loved one identifiable, unique, and endearing, producing psychological stress in the caregiver. The feelings of hopelessness can be overwhelming regarding the future of a patient with an irreversible terminal degenerative illness. In addition, caregivers often experience an anticipatory grief associated with a feeling of impending loss of their loved one. If this isn’t bad enough, a little appreciated consequence is that few insurance programs cover dementia care outside of the hospital. So, medical expenses can produce extra financial strain on top of the loss of income for the caregiver. It is sad that 72% of the caregivers reported relief when their loved one passes away.

 

Obviously, there is a need to both care for the dementia patients and also for the caregivers, for all types of caregiving but particularly for dementia. They play an essential and often irreplaceable role. So, finding ways to ease the burden is extremely important. Mindfulness practice for caregivers has been shown to help them cope with the physical and psychological demands of caregiving.  In today’s Research News article “Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers.” See summary below or view the full text of the study at:

http://onlinelibrary.wiley.com.ezproxy.shsu.edu/doi/10.1002/jclp.22470/full

Waelde and colleagues employ a mindfulness meditation with mantra practice to treat caregivers for dementia patients. They recruited female dementia caregivers and randomly assigned them to receive either an 9-week, once a week for 90 minutes, group-based, meditation with mantra practice with encouraged home practice, or a psychoeducation with telephone support condition. They were measured before and after training and one month later for satisfaction with life, depression, self-efficacy, subjective improvement, mental status, and diurnal salivary cortisol slope, a measure of stress.

 

They found that at the one-month follow up the mindfulness meditation with mantra practice group had significantly greater improvement than the psychoeducation group in life satisfaction and diurnal salivary cortisol slope. This suggests that the intervention reduced stress and improved the caregivers perceived quality of life. There were not significant improvements in depression or self-efficacy, but this may have been due to the amount of home practice. Indeed, the greater the amount of meditation practice occurring at home the greater the decrease in depression and the greater the increase in self-efficacy. This suggests that, in order for the mindfulness meditation with mantra practice to be effective for reducing depression and for improving the caregiver’s ability to cope with stress, it must be practiced regularly at home.

 

These results are potentially important. They suggest that meditation may be an effective means to improve the physical and psychological conditions of dementia caregivers. It should be mentioned that no one dropped out of the meditation condition, indicating that it is tolerable within the framework of the taxed time availability of the caregivers.

 

So, improve quality-of-life and stress responses in caregivers for patients with dementia.

 

“Mindfulness practice is especially relevant to the predicament of dementia caregiving. It can give caregivers the inner resources to sustain themselves emotionally and physically over the long haul and is a tool they can always fall back on moment to moment, regardless of the intensity of the care relationship.” – Marguerite Manteau-Rao

 

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

Waelde, L. C., Meyer, H., Thompson, J. M., Thompson, L. and Gallagher-Thompson, D. (2017), Randomized Controlled Trial of Inner Resources Meditation for Family Dementia Caregivers. J. Clin. Psychol.. doi:10.1002/jclp.22470

 

Abstract

Objective

This randomized controlled trial examined the comparative effectiveness of 2 interventions for improving diurnal cortisol slope and life satisfaction and reducing stress symptoms among older female dementia family caregivers.

Method

Thirty-one family dementia caregivers were randomized to 8 weeks of Inner Resources for Stress mindfulness meditation and mantra training (IR) or psychoeducation and telephone support (PTS).

Results

Intention-to-treat analyses revealed statistically significant pre-post improvements in diurnal cortisol slope and overall life satisfaction, but not depression or self-efficacy, in the IR relative to the PTS group. Adherence to between-session meditation practice was significantly associated with decreases in depression and self-reported improvements in ability to cope with stress. In addition, IR participants rated the overall benefits of the program more highly than the PTS group.

Conclusion

These results indicate that mindfulness meditation and mantra has promise as a feasible and effective caregiver intervention for quality of life and physiological responding to stress.

http://onlinelibrary.wiley.com.ezproxy.shsu.edu/doi/10.1002/jclp.22470/full

 

Improve Loneliness and Quality of Life with Women with HIV with Mindfulness

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Improve Loneliness and Quality of Life with Women with HIV with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness-Based Therapies had a long-term effect on stress and both a short- and long-term effect on depression in people living with an HIV infection.” – Yang Yang

 

More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development, a 20-year-old individual, infected with HIV, can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people.

 

People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, loneliness, and the challenge to come to terms with a new identity as someone living with HIV. Hence, patients with HIV infection, even when controlled with drugs, have a reduction in their quality of life.  There is thus a need to find methods to improve the quality of life in people who are living with HIV infection.

 

Mindfulness has been shown to improve psychological and physical well-being in people suffering from a wide range of disorders including depression and anxiety. It has also been shown that mindfulness is associated with psychological well-being and lower depression in patients with HIV infection. Integrated Yoga is a contemplative practice is a mindfulness practice that includes postures, breathing practices, relaxation techniques, and meditation. It has been shown to reduce anxiety and depression in in patients with HIV infection. So, it would stand to reason that other mindfulness practices would be beneficial for people who are living with HIV infection.

 

In today’s Research News article “The effectiveness of mindfulness-based cognitive therapy on quality of life and loneliness of women with HIV.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319288/

Samhkaniyan and colleagues recruited women infected with HIV and randomly assigned them to a no-treatment control or to receive 8 weeks of Mindfulness-Based Cognitive Therapy (MBCT), administered once weekly for 2 hours. They were measured before and after the 8-week intervention for loneliness and quality of life, including body health, emotional care, community relationships, and environmental health.

 

They found that the Mindfulness-Based Cognitive Therapy (MBCT) group had significant improvements in all measure in comparison to baseline and the control group, with significant improvements in loneliness, overall quality of life and each quality of life component, body health, emotional care, community relationships, and environmental health. Hence, MBCT appears to be an effective treatment for the psychological issues of loneliness and perceived quality of life in women diagnosed with HIV.

 

MBCT contains both mindfulness practice and also cognitive therapy that is designed to change faulty thought processes. Mindfulness training has been shown to relieve loneliness and lead to improvement in quality of life with a myriad of different conditions. Also, loneliness is an interpretation of the environmental conditions and the altered thinking produced by MBCT may well be responsible for the effect. A more mundane explanation is that the social contacts involved in receiving MBCT by themselves relieve loneliness and improve quality of life. A randomized controlled clinical trial with an active control group is needed to distinguish between these alternative explanations.

 

So, improve loneliness and quality of life with women with HIV with mindfulness.

 

“Given the stress-reduction benefits of mindfulness meditation training, there can be health protective effects not just in people with HIV but in folks who suffer from daily stress,” – David Creswell

 

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

Samhkaniyan, E., Mahdavi, A., Mohamadpour, S., & Rahmani, S. (2015). The effectiveness of mindfulness-based cognitive therapy on quality of life and loneliness of women with HIV . Journal of Medicine and Life, 8(Spec Iss 4), 107–113.

 

Abstract

Objective: The present study investigated the performance of Mindfulness according to the Cognitive approach on the Quality of Life and Loneliness of women with HIV.

Methods: This research is a semi-experimental with pretest-posttest and check team, which was conducted in winter, 2014. In this research, 24 positive HIV women in Tehran were selected by volunteers sampling method and were stochastically related to either the control team (n = 12) or the MBCT groups (n = 12) and, the World Health Organization quality of life survey and the University of California Los Angeles loneliness scale were administrated as pretest. The MBCT team got eight sessions of mindfulness according to the cognitive theory and the check team got no intervention. At the end, the post-test was administrated to two groups and, covariance method was used for data analysis by SPSS-20 software.

Findings: The results of the present study indicated that there were clear variations among the test groups check group and MBCT (p < 0.001). Therefore, Mindfulness-based Cognitive theory increased the mean quality of life and decreased loneliness.

Conclusion: The findings indicated that the Mindfulness-based Cognitive therapy increased the quality of life and decreased loneliness in positive HIV women. Therefore, in order to modify the quality of life and loneliness in these cases, attention to these variables during clinical trials with the goal of an appropriate intervention, will be beneficial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319288/

 

Improve the Quality of Life of Parents of Children with Chronic Diseases with Mindfulness

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Improve the Quality of Life of Parents of Children with Chronic Diseases with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness meditation is extremely good at relieving anxiety, stress, depression, exhaustion and irritability. Memory improves, reaction times become faster and mental and physical stamina increase. In short, regular meditators are happier and more contented than average, while being far less likely to suffer from psychological distress.” – Danny Penman

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. This caregiving comes at a cost to the caregiver. It exacts a toll on caregivers’ health and well-being and their quality of life. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical and mental health, compromised immune function, and increased mortality.

 

Providing care for a child with a chronic illness can be particularly challenging. About 27% of children in the U.S. has a chronic illness. Caring for the child requires that the parent be able to deal with stress, to regulate their own emotions, and to be sensitive and attentive to their child. These skills are exactly those that are developed in mindfulness training. It improves the psychological and physiological responses to stress. It improves emotion regulation. And it improves the ability to maintain attention and focus in the face of high levels of distraction. The application of mindfulness skills to the parents of children with a chronic illness is relatively new. So, it would seem reasonable to investigate this further.

 

In today’s Research News article “Cognitive Behavioural Therapy and Mindfulness for Health-Related Quality of Life: Comparing Treatments for Parents of Children with Chronic Conditions – A Pilot Feasibility Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301303/

Anclair and colleagues perform a pilot feasibility study of the application of Mindfulness training and Cognitive Behavioral Therapy to improve the health-related quality of life of parents with children with chronic diseases. They recruited parents of children with chronic diseases, obtained baseline measures and then randomly assigned them to receive either a group based, 8 week, once a week for 2 hours, Mindfulness training or Cognitive Behavioral Therapy. They were measured before and after treatment for satisfaction with life, including spare time, relation to child, relation to partner, relation to friends, and satisfaction with work, and health-related quality of life, including physical functioning, role functioning – physical causes, bodily pain, general health, vitality, social functioning, role functioning – emotional causes and mental health. These were summarized in two categories, physical component summary and mental component summary.

 

They found that both treatments produced significant improvements in the mental components but not the physical components of health-related quality of life. Significant improvements in the mental health components of vitality, social functioning, role functioning – emotional causes and mental health were apparent. In addition, both groups demonstrated significant improvements in life satisfaction, including spare time, relation to child, and relation to partner. There were no significant differences between the improvements produced by mindfulness training or Cognitive Behavioral Therapy. Hence both treatments appeared to be effective in improving the health-related quality of life and life satisfaction of parents with children with chronic diseases.

 

It should be noted that this was a pilot feasibility study and did not contain a no-treatment control. So, caution must be exercised in reaching conclusions. But the results suggest that both types of therapy improve life satisfaction and the mental and social components of health-related quality of life while not affecting the physical dimensions. The results are interesting and important enough to justify implementing a large-scale randomized clinical trial. Since the numbers of children with chronic diseases is huge, finding ways to help ease the burden on their parents may have major mental health consequences.

 

So, improve the quality of life of parents of children with chronic diseases with mindfulness.

 

“Overall, results from existing studies suggest that mindfulness interventions may be beneficial for reducing symptoms and associated problems through relaxation for many chronic illnesses, including epilepsy, fibromyalgia, headaches or migraines, cancer, and asthma.” – Cynthia Riccio

 

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

Anclair, M., Hjärthag, F., & Hiltunen, A. J. (2017). Cognitive Behavioural Therapy and Mindfulness for Health-Related Quality of Life: Comparing Treatments for Parents of Children with Chronic Conditions – A Pilot Feasibility Study. Clinical Practice and Epidemiology in Mental Health : CP & EMH, 13, 1–9. http://doi.org/10.2174/1745017901713010001

 

Abstract

Background:

Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders.

Objective:

The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions.

Method:

The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months.

Results:

The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner.

Conclusion:

The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5301303/

 

Improve Quality of Life and Performance with Multiple Sclerosis with Yoga

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Improve Quality of Life and Performance with Multiple Sclerosis with Yoga

 

By John M. de Castro, Ph.D.

 

“Studies in multiple sclerosis, these have shown that mindfulness can improve quality of life and help people cope better with their MS. The studies also found that it decreased stress, anxiety and depression.” – Multiple Sclerosis Trust

 

MS is a progressive demyelinating disease which attacks the coating on the neural axons which send messages throughout the body and nervous system. It affects about 2 million people worldwide and about 400,000 in the U.S. It is most commonly diagnosed in people between the ages of 20 and 50 years.  Unfortunately, there is no cure for multiple sclerosis. There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms.

 

Although there is a progressive deterioration, MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. So, quality of life becomes a major issue. Quality of life with MS is affected by fatigue, cognitive decrements, physical impairment, depression, and poor sleep quality. There is a thus a critical need for safe and effective methods to help relieve the symptoms of MS and improve quality of life. Mindfulness has been previously shown to improve depression, sleep quality, cognitive impairments, emotion regulation, and fatigue. Yoga is a mindfulness practice that has the added feature of exercising and stretching the muscles. It would seem likely that yoga practice might be an ideal treatment for improving the quality of life and lessening symptoms in patients with multiple sclerosis.

 

In today’s Research News article “Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis–Related Disability: A Pilot Study.” See summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315321/

Cohen and colleagues performed a pilot, single-group study, of the effectiveness of a specially designed yoga program for treating patients with multiple sclerosis. They recruited adult patients with multiple sclerosis with moderate disability and provided them with 8 weeks of twice weekly, 90-minute yoga sessions, including breathing practices, postures, meditation, and deep relaxation. The patients were encouraged to also practice at home. They assessed the feasibility of widespread implementation of such a program with budget utilization, recruitment rates, retention rates, attendance rates, and safety. They also assessed the patients’ quality of life, walking ability, extremity function, respiration, attention, and concentration, prior to and after the 8-week program and also 8-weeks later.

 

They found that the program was feasible, as it was implemented with acceptable costs, high participation rates and low drop-out rates, no unexpected adverse effects, and all participants reported home yoga practice. Importantly they found that after the intervention the patients were significantly improved on overall health status, quality of life issues, including bladder control, perceived deficits, and fatigue, standing, walking ability, motor control of both hands, hearing, and seeing. Many of these improvements continued to be significant at the 8-week follow-up.

 

Hence, this pilot study demonstrated the feasibility and potential benefits of yoga for patients with multiple sclerosis. This study did not contain a control condition, so any conclusions must be tempered and recognized as preliminary. Any exercise program might have produced similar benefits. A randomized controlled clinical trial is needed and warranted. But, the results were impressive and suggest that yoga for patients with multiple sclerosis can improve their quality of life and physical and mental ability and well-being. Since, multiple sclerosis produces a life-long disability, and yoga was shown to be both safe and effective, can be practiced at home, and substantially improves quality of life and motor ability, it would seem to be ideal to improve the lives of these patients.

 

So, improve quality of life and performance with multiple sclerosis with yoga.

 

“Mind-body therapies like yoga are also a practical therapeutic approach in MS because of their low risk of physical or emotional stress. The exercise of yoga also allows people with MS to engage in their treatment in a very active and engaged manner. there appears to be benefit in MS from participation in any regular physical activity like yoga. yoga may additionally improve cognitive ability by exercising one’s attention on focused breathing and positioning techniques and by generally improving mood and reducing stress.” – Edward Kim

 

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

Cohen, E. T., Kietrys, D., Fogerite, S. G., Silva, M., Logan, K., Barone, D. A., & Parrott, J. S. (2017). Feasibility and Impact of an 8-Week Integrative Yoga Program in People with Moderate Multiple Sclerosis–Related Disability: A Pilot Study. International Journal of MS Care, 19(1), 30–39. http://doi.org/10.7224/1537-2073.2015-046

 

Abstract

Background:

This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis (MS)–related disability. We explored the program’s effect on quality of life (QOL) and physical and mental performance.

Methods:

We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up. Feasibility was examined through cost, recruitment, retention, attendance, and safety. Outcomes included the Multiple Sclerosis Quality of Life Inventory (MSQLI), 12-item Multiple Sclerosis Walking Scale (MSWS-12), Timed 25-Foot Walk test (T25FW), 6-Minute Walk Test (6MWT), Nine-Hole Peg Test (NHPT), Five-Times Sit-to-Stand Test (FTSTS), Multidirectional Reach Test (MDRT), maximum expiratory pressure, and Paced Auditory Serial Addition Test-3″ (PASAT-3″).

Results:

Fourteen participants completed the study. The program was feasible. There were significant main effects on the 36-item Short Form Health Status Survey Mental Component Summary (SF-36 MCS), Modified Fatigue Impact Scale (MFIS), Bladder Control Scale (BLCS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), MSWS-12, T25FW, NHPT, PASAT-3″, 6MWT, FTSTS, and MDRT-Back. Improvements were found on the SF-36 MCS, MFIS, BLCS, PDQ, MHI, and MSWS-12 between baseline and postintervention. The effect on PDQ persisted at follow-up. Improvements were found on the T25FW, NHPT, 6MWT, FTSTS, and MDRT-Back between baseline and postintervention that persisted at follow-up. The PASAT-3″ did not change between baseline and postintervention but did between postintervention and follow-up.

Conclusions:

The yoga program was safe and feasible. Improvements in certain measures of QOL and performance were seen at postintervention and follow-up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315321/

 

Spiritual Concerns Decrease Quality of Life in Cancer Patients

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Spiritual Concerns Decrease Quality of Life in Cancer Patients

 

By John M. de Castro, Ph.D.

 

“For some, a cancer diagnosis has the opposite effect on their sense of spirituality. It makes them doubt their beliefs or religious values, challenges their faith, and can cause spiritual distress. Some people become angry with God for allowing them to get cancer or wonder if they are being punished. Spiritual distress can make it harder for patients to cope with cancer and its treatment.” –  National Comprehensive Cancer Network

 

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

 

Religion and spirituality become much more important to people when they’re diagnosed with cancer, when living with advanced cancer, and at end of life care. It is thought that people take comfort in the spiritual when facing their own mortality. There is very little information available, however, regarding the effectiveness of religion and spirituality in relieving the psychological burdens of cancer or on the quality of life of advance cancer patients. Additionally, the impact of spiritual concerns that the patient might have are not known. Concerns such as feelings of being abandoned by God or needing forgiveness for actions in their lives might lead to anxiety and worry rather than comfort.

 

In today’s Research News article “The Relationship of Spiritual Concerns to the Quality of Life of Advanced Cancer Patients: Preliminary Findings.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206727/

Winkelman and colleagues study the relationship of patients’ spiritual concern to their quality of life with advanced cancer. They recruited terminal cancer patients who were undergoing palliative radiation treatments. They completed measures of religiousness, spirituality, spiritual concerns including spiritual struggles and spiritual seeking, and quality of life including physical and existential quality of life. The patients died on average of 180 days after completing the measures.

 

The majority of the patients experienced one or more forms of spiritual struggle (58%), and most (82%) experienced spiritual seeking. Their struggles included “wondering why God has allowed this to happen” and “wondering whether God has abandoned me.” The most common spiritual seekings were “seeking a closer connection to God” and “thinking about what gives meaning to life.”  They found that the greater the spiritual concerns, spiritual struggles, or spiritual concerns, the lower the patient’s quality of life. Virtually all of the patients indicated that spiritual care was important in their treatment.

 

These results are somewhat surprising in that religiousness and spirituality were not associated with comfort but with poorer quality of life in these terminal cancer patients. In particular, it appears that concerns about the spiritual meaning of their situation were very common and greatly troubled the patients leading to poorer quality of life. Being at peace with God is a very important goal of these patients and their concerns interfered with attaining that peace. Hence, it appears that in hospice and palliative care there should be greater attention paid to the religiousness and spirituality of the patients, particularly to their spiritual concerns, struggles, and seeking. This is important as spiritual concerns trouble them deeply and decrease the quality of life of terminal cancer patients.

 

 “When we took a closer look, we found that patients with stronger spiritual well-being, more benign images of God (such as perceptions of a benevolent rather than an angry or distant God), or stronger beliefs (such as convictions that a personal God can be called upon for assistance) reported better social health. In contrast, those who struggled with their faith fared more poorly.” – Allen Sherman

 

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

Winkelman, W. D., Lauderdale, K., Balboni, M. J., Phelps, A. C., Peteet, J. R., Block, S. D., … Balboni, T. A. (2011). The Relationship of Spiritual Concerns to the Quality of Life of Advanced Cancer Patients: Preliminary Findings. Journal of Palliative Medicine, 14(9), 1022–1028. http://doi.org/10.1089/jpm.2010.0536

 

Abstract

Purpose

Religion and/or spirituality (R/S) have increasingly been recognized as key elements in patients’ experience of advanced illness. This study examines the relationship of spiritual concerns (SCs) to quality of life (QOL) in patients with advanced cancer.

Patients and Methods

Patients were recruited between March 3, 2006 and April 14, 2008 as part of a survey-based study of 69 cancer patients receiving palliative radiotherapy. Sixteen SCs were assessed, including 11 items assessing spiritual struggles (e.g., feeling abandoned by God) and 5 items assessing spiritual seeking (e.g., seeking forgiveness, thinking about what gives meaning in life). The relationship of SCs to patient QOL domains was examined using univariable and multivariable regression analysis.

Results

Most patients (86%) endorsed one or more SCs, with a median of 4 per patient. Younger age was associated with a greater burden of SCs (β = −0.01, p = 0.006). Total spiritual struggles, spiritual seeking, and SCs were each associated with worse psychological QOL (β = −1.11, p = 0.01; β = −1.67, p < 0.05; and β = −1.06, p < 0.001). One of the most common forms of spiritual seeking (endorsed by 54%)—thinking about what gives meaning to life—was associated with worse psychological and overall QOL (β = − 5.75, p = 0.02; β = −12.94, p = 0.02). Most patients (86%) believed it was important for health care professionals to consider patient SCs within the medical setting.

Conclusions

SCs are associated with poorer QOL among advanced cancer patients. Furthermore, most patients view attention to SCs as an important part of medical care. These findings underscore the important role of spiritual care in palliative cancer management.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206727/

Improve Quality of Life in Borderline Patients with Mindfulness

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By John M. de Castro, Ph.D.

 

“One problem that clients with borderline personality disorder face is that their behaviors are often ruled by emotions. This frequently leads to destructive behaviors such as drug use, risky sexual encounters, and self-injury. The goal of mindfulness as used in DBT is to get patients to recognize these patterns so they can act more thoughtfully.” – Christina Olenchek

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. In addition, 30 to 90 % of BPD cases are associated with high rates of early traumatic experiences including sexual, physical and emotional abuse. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. BPD is dangerous as it can propel the sufferer, on the spur of the moment, to overreact to anger, take drugs, harm themselves, and even terminate their lives.  Needless to say it is widespread, debilitating, and markedly reduces health and health related quality of life.

 

BPD has not responded well to a variety of therapies with the exception of Dialectical Behavior Therapy (DBT). It is significant that a difference between DBT and other therapies is that it emphasizes mindfulness. This suggests that mindfulness training may be essential in treating Borderline Personality Disorder and impulsivity. The effectiveness of DBT has been only demonstrated in adults. But Borderline Personality Disorder (BPD) also can occur in adolescents. But, it is not known if DBT may be effective for adolescents with BPD and can improve their health and quality of life.

 

In today’s Research News article “Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1370544862969436/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/

Swales and colleagues received and summarized data from 4 different programs that administered Dialectical Behavior Therapy (DBT) to adolescents with Borderline Personality Disorder (BPD). They obtained health status data including mobility, self-care, usual activities, pain or discomfort and anxiety and depression. They found that DBT produced a significant improvement in health status and health related quality of life with a clinically significant large effect size. Comparison of these results to those obtained in other studies with adults indicated that the results for the adolescents were comparable or better.

 

These are interesting findings but they suffer from the lack of a control comparison condition. It should be kept in mind, however, that Borderline Personality Disorder (BPD) rarely improves even with other forms of treatment. So, it is unlikely that these youths spontaneously got better or responded to a placebo effect. The results are important in that they demonstrate for the first time that DBT is effective for BPD in adolescents, improving their health and health related quality of life. Hence, mindfulness training appears to be an important of successful treatment of Borderline Personality Disorder (BPD) in adolescents.

 

So, improve quality of life in borderline patients with mindfulness.

 

“Many people with BPD have comorbid conditions, which often include mood disorders, anxiety disorders, or substance-use disorders. Studies show that mindfulness helps for many of these.” – Blaise Aguirre

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Swales, M., Hibbs, R. A. B., Bryning, L., & Hastings, R. P. (2016). Health related quality of life for young people receiving dialectical behaviour therapy (DBT): a routine outcome-monitoring pilot. SpringerPlus, 5(1), 1137. http://doi.org/10.1186/s40064-016-2826-9

 

Abstract

Purpose: Adults presenting with borderline personality disorder (BPD) score poorly on measures of health related quality of life (HRQoL). Little is known about HRQoL in adolescents with BPD type presentations and how treatment impacts quality of life. Our primary aim was to use routinely collected quality-of-life outcome measures pre and post-treatment in dialectical behaviour therapy (DBT) for adolescents to address this gap. Secondary aims were to benchmark these data against EuroQol 5 dimensions (EQ-5D™) outcomes for clients treated in clinical trials and to assess the potential of the EQ-5D™ as a benchmarking tool.

Method: Four adolescent DBT teams, routinely collecting outcome data using a pseudonymised secure web-based system, supplied data from consecutive discharges.

Results: Young people in the DBT programmes (n = 43) had severely impaired HRQoL scores that were lower at programme admission than those reported in published studies using the EQ-5D™ in adults with a BPD diagnosis and in one study of adolescents treated for depression. 40 % of adolescents treated achieved Reliable Clinical Change. HRQoL improved between admission and discharge with a large effect size. These results were not statistically significant when clustering in programme outcomes was accounted for.

Conclusion: Young people treated in NHS DBT programmes for BPD type presentations had poorer HRQoL than adults with a BPD diagnosis and adolescents with depression treated in published clinical trials. The EQ-5D™ detected reliable change in this group of adolescents. Programme outcome clustering suggests that both the measure and the web-based monitoring system provide a mechanism for benchmarking clinical programmes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954798/

 

Improve Quality of Life during and after Radiotherapy with Yoga

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By John M. de Castro, Ph.D.

 

“When you say yoga, some people think of standing on their heads, but it’s the non-physical aspects of yoga, such as breathing, that are fundamental to healing.” – Jnani Chapman

 

About 12.5% of women in the U.S. develop invasive breast cancer over their lifetimes and every year about 40,000 women die. Indeed, more women in the U.S. die from breast cancer than from any other cancer, besides lung cancer. Breast cancer diagnosis, however, is not a death sentence. It is encouraging that the death rates have been decreasing for decades from improved detection and treatment of breast cancer. Five-year survival rates are now at around 95%.

 

But treatments for breast cancer can be difficult on the patient markedly reducing their mental and physical quality of life. Chemotherapy or radiotherapy can produce increased fatigue, pain, and bone loss, reduced fertility, difficulty with weight maintenance, damage to the lymphatic system, heightened fear of reoccurrence, and an alteration of their body image. With the loss of a breast or breasts, scars, hair shedding, complexion changes and weight gain or loss many young women feel ashamed or afraid that others will reject or feel sorry for them. As a result, breast cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.

 

Unfortunately, most of these residual problems often go untreated. So, safe and effective treatments for the effects of radiotherapy on breast cancer patients are needed. Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual psychological symptoms and improve cognitive function. Yoga has also been shown to be helpful with the residual symptoms. In today’s Research News article “Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1348160035207919/?type=3&theater

or see summary below or view the full text of the study at:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972683/

Ratcliff and colleagues recruited women diagnosed with breast cancer and scheduled to undergo radiotherapy for 6-weeks. They were randomly assigned to receive either yoga practice, stretching, or to a wait list while receiving treatment as usual. The yoga group and the stretching group practiced 3 times per week for 60 minutes during the 6-weeks of radiotherapy. Measurements were taken before treatment during the last week of radiotherapy and 1, 3, and 6 months later of health related quality of life, depression, sleep disturbance, posttraumatic stress symptoms, benefits finding, and salivary cortisol levels.

 

They found that the greater the distress prior to treatment the greater the effect of yoga practice.

Women who were high in sleep disturbance and depression prior to treatment showed the greatest improvement in mental health related quality of life with the effect getting stronger 3 and 6 months following treatment. This suggests that yoga practice has the greatest impact when the women are particularly distressed before treatment and the effects are lasting. They also found that yoga practice led to increased benefits finding, that is to increased acceptance of life’s imperfections, change in priorities, and development of a sense of purpose in life as a result of having been diagnosed with cancer. This increased benefits finding at 3-months led to improvements in physical health related quality of life at 6-months.

 

These results are interesting and demonstrate that yoga practice can be of benefit to women with breast cancer undergoing radiotherapy, improving their mental and physical health related quality of life. Yoga practice appears to be most beneficial to women who have the most problems with sleep and depression before treatment and the benefits appear to be lasting. So yoga practice helps the most those who need it the most. Yoga practice appears to work, in part, by improving the patient’s ability to find benefits in being diagnosed with cancer.

 

So, improve quality of life during and after radiotherapy with yoga.

 

“Yoga is known as a great way to ease stress and boost the body’s immune system. But it can be another way to fight chemo-related nausea and vomiting. And that’s not all. The gentle stretching and movement of yoga might give you more energy and help you sleep better.” –  Amanda Gardner

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Ratcliff, C. G., Milbury, K., Chandwani, K. D., Chaoul, A., Perkins, G., Nagarathna, R., … Cohen, L. (2016). Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy. Integrative Cancer Therapies, 15(3), 250–262. http://doi.org/10.1177/1534735415624141

 

Abstract

Hypothesis

This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.

Methods

Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment.

Results

Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL.

Conclusion

Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972683/

 

Improve Caregiver Quality of Life with Yoga

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“Caring for someone with dementia is made up of an infinite number of small moments where we can go either way, adding more stress or bringing more ease. The problem when we are not mindful is our words come out and our actions unfold too quickly for us to have a chance to choose the wisest, most beneficial route. Mindfulness practice slows us down and takes some of the edge off our reactive tendencies.” – Marguerite Manteau-Rao

 

Caregiving for dementia patients is a daunting and all too frequent task. It is estimated that over 15 million Americans are dementia caregivers. It is an intense experience that can go on for four to eight years with increasing responsibilities as the loved one deteriorates. In the last year, 59% of the caregivers report that they are effectively on duty 24/7. It is sad that 72% report relief when their loved one passes away.

 

This long and difficult process can take a major toll on the caregiver. On a practical level they frequently experience financial problems from lost income and have their careers interrupted. But, the greatest problems occur due to the intense levels of stress experienced by the caregivers. Around 2/3rd of caregivers report high emotional stress and over 1/3rd report high physical stress. This stress, in turn can have emotional consequences with over 1/3rd of caregivers reporting depression and many report family problems. In addition, dementia caregivers are more likely to have physical issues such as high levels of stress hormones, reduced immune function, increased hypertension, and coronary heart disease. Needless to say caregivers need care for themselves.

 

Reducing stress is very important for dementia caregivers. Stress not only jeopardizes their own health but also the quality of care they provide for their loved ones. Since mindfulness training has been shown to be effective in reducing both the psychological and physical responses to stress (see http://contemplative-studies.org/wp/index.php/category/research-news/stress/), it would seem be potentially useful for the relief of caregiver stress. Indeed, mindfulness training has been shown to reduce stress and depression, improve the quality of caregiving, and improve the quality of life for the caregiver (see http://contemplative-studies.org/wp/index.php/category/research-news/caregiving/). Hence, it would seem reasonable to further explore mindfulness practices to care for the caregiver.

 

In today’s Research News article “Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer’s disease patients: A randomized controlled trial”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1170247206332537/?type=3&theater

Danucalov and colleagues applied an 8-week program of yoga and compassion meditation to a group of female Alzheimer’s caregivers and compared their response to those of a wait-list control group. At the end of yoga and compassion meditation training in comparison to before training and to the control group, the yoga group reported significant improvements in their quality of life including physical, psychological, environmental, and social domains. They showed increased mindfulness, improved vitality both immediately and in general, and increased self-compassion and self-kindness.

 

These findings are remarkable and potentially important. Yoga and compassion meditation training markedly improved the psychological and physical conditions for the caregivers producing a major improvement in quality of life. Training also increased their vitality which is critical given the intense fatigue that the caregiving can produce. How this practice might produce these benefits was not explored. But, the documented ability of yoga practice in reducing stress responses would seem a likely explanation. In addition, the compassion meditation may be a useful component as Loving Kindness Meditation has been shown to improve self-compassion and kindness toward others (see http://contemplative-studies.org/wp/index.php/category/contemplative-practice/loving-kindness/).

 

Regardless of the explanation, it appears clear that mindfulness training is effective in improving the physical and psychological problems experienced by dementia caregivers.

 

So, improve caregiver quality of life with yoga.

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Improve MS Quality of Life with Mindfulness

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“Multiple sclerosis (MS) can be an overwhelming challenge. One day you can feel strong and resilient, but the next day you can feel helpless and isolated. On these days, getting an extra push or boost from others just like you can make all the difference. ‘A positive attitude is the best medicine.’” – MS patient Lorri Lowe Peterson

“Multiple sclerosis (MS) is the most widespread disabling neurological condition of young adults around the world. more than 400,000 people in the United States and about 2.5 million people around the world have MS. About 200 new cases are diagnosed each week in the United States. The most common early symptoms of MS are: fatigue vision problems tingling and numbness vertigo and dizziness muscle weakness and spasms problems with balance and coordination.” – Healthline http://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic.

 

MS is most commonly diagnosed in people between the ages of 20 and 50 years with an average age between 30 and 35 years.  There is no cure for multiple sclerosis.  There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms. MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. So, quality of life becomes a major issue. There is a thus a critical need for safe and effective methods to help relieve the symptoms of MS and improve quality of life.

 

Quality of life with MS is affected by fatigue, cognitive decrements, physical impairment, depression, and poor sleep quality. But, depressive symptoms are the most problematic with clinically significant depression present in 50% of MS sufferers. Since mindfulness has been previously shown to improve depression (see http://contemplative-studies.org/wp/index.php/category/research-news/depression/) sleep quality (see http://contemplative-studies.org/wp/index.php/2015/07/17/mindfulness-is-a-snooze/), cognitive impairments (see http://contemplative-studies.org/wp/index.php/category/research-news/cognition/), and emotion regulation (see http://contemplative-studies.org/wp/index.php/category/research-news/emotions/, it would seem likely that mindfulness would affect the quality of life in MS patients.

 

In today’s Research News article “Examining trait mindfulness, emotion dysregulation, and quality of life in multiple sclerosis”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1148798548477403/?type=3&theater

Schirda and colleagues investigated the relationship of trait mindfulness with the quality of life and its associated symptoms in MS patients. They found that the higher the levels of trait mindfulness the lower the levels of depression and emotion dysregulation and the higher the quality of life in the patients. They also found that the reduction in emotion dysregulation was partially responsible for the positive relationship between mindfulness and quality of life. In addition, the higher the depression level the larger the impact of mindfulness’ association with emotion dysregulation on quality of life.

 

So, as predicted, mindfulness played an important role in mitigating the effects of MS on quality of life and its associated symptoms. These relationships in MS patients parallel the effects of mindfulness on healthy individuals and so would seem to be universal regardless of the disease state. That emotion regulation appears to be central is very interesting. Mindfulness is known to allow the individual to fully experience emotions but to respond to them in a positive and constructive way. The results of the study then suggest that this may be the critical effect of mindfulness for the patient to experience a high quality of life

 

It should be kept in mind that Schirda and colleagues’ study did not manipulate mindfulness, rather simply looking at existing levels of trait mindfulness and their relationships with quality of life. Hence, it can’t be concluded that mindfulness causes quality of life improvements in MS. For example, it could be that people who have a high quality of life with MS become more mindful. It will take future manipulative research to establish mindfulness’ effectiveness in treating MS patients.

 

But, we can tentatively recommend to improve MS quality of life with mindfulness.

 

“I want America to know that you can still have a full, exciting and productive life even if you or your loved one is battling a debilitating, chronic disease such as MS.” – Michaele Salahi

 

CMCS – Center for Mindfulness and Contemplative Studies