Improve Learning and Well-Being in College Students with Mindfulness and Coaching

Improve Learning and Well-Being in College Students with Mindfulness and Coaching

 

By John M. de Castro, Ph.D.

 

academic benefits of mindfulness include improved memory and focus, as well as relief from stress and anxiety. (Better test scores, anyone?) Mindfulness can also be a remedy for procrastination, which, as it turns out, is an “emotion management problem.” – Priya Thomas

 

In the modern world education is a key for success. Where a high school education was sufficient in previous generations, a college degree is now required to succeed in the new knowledge-based economies. There is a lot of pressure on students to excel so that they can get the best jobs after graduation. This stress might in fact be counterproductive as the increased pressure can actually lead to stress and anxiety which can impede the student’s physical and mental health, well-being, and school performance. It is, for the most part, beyond the ability of the individual to change the environment to reduce stress, so it is important that methods be found to reduce the college students’ responses to stress; to make them more resilient when high levels of stress occur.

 

Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress and resilience in the face of stress. It has also been found to promote the well-being of college students. Academically, it has been shown to improve memory, focused attention, and school performance. Academic coaching has long been known to also assist college students in their studies. The combination of mindfulness and academic coaching, however, has not been well explored.

 

In today’s Research News article “Mindfulness and Coaching to Improve Learning Abilities in University Students: A Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142624/) Corti and Gelati compared meditation naïve college students who signed up for and completed a short 10-module intervention called Mindful Effective Learning to students who did not sign up. Each module lasted for 3.5 hours. Modules trained students for mindfulness meditation, effective self-awareness and attention regulation, self-regulated study, study planning and time management, study techniques and mnemonics. The participants were measured before and after training for study organization, elaboration, self-evaluation, use of strategies, and metacognition, self-regulation, emotion regulation, anxiety, resilience, and mindfulness. They also completed a survey 6 months later about their experiences and one year later reported their grades.

 

They found that in comparison to baseline and to the no-treatment control group, the group that received Mindful Effective Learning training had significantly greater improvements in all measured variables. In other words, they had better study skills, mindfulness, self-regulation, motivation, and well-being. In addition, a year later, the trained students had improved grades.

 

This study is interesting but must be interpreted cautiously as the control group was not active and did not receive and training of any kind. This opens the study up to alternative interpretations including attention effects, participant expectancy effects, experimenter bias etc. In addition, the students self-selected whether to participate in Mindful Effective Learning training or not. This suggests that there may have been systematic differences between the students in the two groups.

 

It would have been better if the control group was active, receiving some form of training such as coping with college training. It would have been more interesting if a control group was included that received all of the study skills training without mindfulness meditation. This would help to determine if mindfulness or study skills training was the important component. Regardless, the pilot study was successful and provides rationale for performing a more extensive better controlled study.

 

So, improve learning and well-being in college students with mindfulness and coaching.

 

“Mindfulness and meditation are both great ways for students to improve their health. And the benefits of these practices can also trickle into their academic lives.” – Kenya McCullum

 

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

 

Corti, L., & Gelati, C. (2020). Mindfulness and Coaching to Improve Learning Abilities in University Students: A Pilot Study. International journal of environmental research and public health, 17(6), 1935. https://doi.org/10.3390/ijerph17061935

 

Abstract

This pilot study investigated the effects of a short 10-module intervention called MEL (Mindful Effective Learning), which integrates mindfulness, coaching, and training on study strategies, to improve learning abilities among university students. Inspired by ample research on the learning topics that points out how effective learning and good academic results depend simultaneously on self-regulation while studying combined with emotional and motivational factors, the intervention aimed to train students simultaneously in these three aspects. The intervention group participants (N = 21) and the control group participants (N = 24) were surveyed pre- and post-intervention with the Italian questionnaire AMOS (Abilities and Motivation to Study) and the Italian version of the Mindful Attention Awareness Scale (MAAS). The results showed that, regarding self-regulation in study, trained students improved their self-awareness, self-evaluation ability, metacognition skills, and organizational and elaborative ability to manage study materials; regarding emotional aspects, they improved their anxiety control; regarding motivation they developed an incremental theory of Self and improved their confidence in their own intelligence. Moreover, two follow-up self-report surveys were conducted, and trained students reported positive assessments of the MEL intervention. Findings suggest that a short intervention based on mindfulness and coaching and training on study strategies may improve students’ effective learning.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142624/

 

Improve Resilience and Inner Peace to Reduce Negative Views of the Past with Mindfulness

Improve Resilience and Inner Peace to Reduce Negative Views of the Past with Mindfulness

 

By John M. de Castro, Ph.D.

 

mindfulness promotes a more balanced time perspective, with a reduced focus on negative aspects of the past and negative anticipations of the future.” – Michael Rönnlund

 

Mindfulness stresses present moment awareness, minimizing focus on past memories and

future planning. Depression is characterized by a focus on the past while anxiety is characterized by focus on the future. This is representative of a past-negative time perspective which is a pessimistic negative view of what transpired in the past. Although awareness of the past and future are important, focus on the present moment generally leads to greater psychological health and well-being. This is generally characterized by inner peach which is a mild positive state with calmness and harmony in the mind. Although these concepts are well known, their interrelationships and the effect of meditation practice on them, have not been well studied.

 

In today’s Research News article “Dispositional Mindfulness and Past-Negative Time Perspective: The Differential Mediation Effects of Resilience and Inner Peace in Meditators and Non-Meditators.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212969/), Ge and colleagues recruited adults over the internet who regularly meditated and those who did not. They completed questionnaires measuring their meditation experience, mindfulness, resilience, inner peace, and past-negative time perspective.

 

They found that mindfulness, resilience, and inner peace were all significantly and positively inter-related and negatively related to past-negative time perspective. They also found that the meditators had significantly higher levels of mindfulness and inner peace and lower levels of past-negative time perspective than the non-meditators. Structural equation modelling revealed that the negative relationship between mindfulness and past-negative time perspective was mediated by the relationships of mindfulness with resilience and inner peace. That is the higher the levels of mindfulness the higher the levels of resilience and inner peace which in turn were related to lower levels of past-negative time perspective. Non-meditators also had an additional direct negative relationship between mindfulness and past-negative time perspective.

 

It should be kept in mind that these results are correlational and causation cannot be determined. But they suggest that mindfulness is associated with greater ability to cope with difficulties, resilience, greater calmness and mental harmony, inner peace, and a less negative pessimistic perspective of past events. In addition, mindfulness’ relationship with less past-negative time perspective, in part, occurs due to mindfulness’ relationship with resilience and inner peace.

 

It can be postulated that mindfulness produces a positive state that is resistant to disruption by events and this produces a more positive assessment of what occurred in the past. This, in turn, prevents the emergence of negative emotional states such as anxiety and depression. This may represent a mechanism whereby mindfulness alters the individual’s psychological makeup resulting in greater psychological health and well-being.

 

So, improve resilience and inner peace to reduce negative views of the past with mindfulness.

 

Mindfulness is about being fully aware of each moment in your life. Each thought, feeling, sensation and experience are accepted for what it is. There’s no battle going on in your head and heart. You are open to it ALL.” – Bev Janisch

 

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

 

Ge, J., Yang, J., Song, J., Jiang, G., & Zheng, Y. (2020). Dispositional Mindfulness and Past-Negative Time Perspective: The Differential Mediation Effects of Resilience and Inner Peace in Meditators and Non-Meditators. Psychology research and behavior management, 13, 397–405. https://doi.org/10.2147/PRBM.S229705

 

Abstract

Purpose

Past-negative time perspective (PNTP) can affect our everyday lives and is associated with negative emotions, unhealthy behaviors, rumination, anxiety, depression, and post-traumatic stress disorder (PTSD). Dispositional mindfulness may be able to reduce the negative effects of PNTP; however, few studies have investigated their relationship. Thus, the purpose of this study was to explore the effect dispositional mindfulness has on PNTP, as well as the mediating role of resilience and inner peace in this regard.

Methods

This study investigated the cross-sectional relationship between self-reported mindfulness, resilience, inner peace, and PNTP. In order to further explore the relationship between mindfulness and PNTP, this study specially selected and analyzed the samples of 185 meditators and 181 non-meditators.

Results

Correlation analysis revealed that mindfulness is significantly positively correlated with resilience and inner peace. Conversely, PNTP is significantly negatively correlated with mindfulness, resilience, and inner peace. Structural equation model analysis revealed that resilience and inner peace partially mediated the relationship between mindfulness and PNTP. Furthermore, a multi-group analysis showed that the mediating effects are different between meditators and non-meditators. For meditators, the effect of mindfulness on PNTP was fully mediated by resilience and inner peace. For non-meditators, the effect of mindfulness on PNTP was only partially mediated by resilience and inner peace.

Conclusion

Based on the significant differences between the mediational models of meditators and non-meditators, we believe that dispositional mindfulness can negatively predict PNTP, and practicing meditation consistently improves dispositional mindfulness, resilience and inner peace and effectively reduces PNTP. Our findings indicate that a combination of mindfulness and PNTP could be used to design new psychological interventions to reduce the symptoms of mental health concerns such as negative bias, rumination, depression, anxiety, and PTSD.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212969/

 

Spirituality is Associated with Greater Resilience in College Students

Spirituality is Associated with Greater Resilience in College Students

 

By John M. de Castro, Ph.D.

 

for many people, religion, personal beliefs and spirituality are a source of comfort, wellbeing, security, meaning, sense of belonging, purpose and strength.” – World Health Organization

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health.

 

Stress is ubiquitous in people’s lives and it can interfere with the individual’s ability to achieve their goals and maintain psychological well-being.  When highly stressed, resilience is required to cope with the stress and prevent its negative impact on psychological well-being. It would seem likely that since both spirituality and resilience are related to psychological well-being that they would be related to each other.

 

In today’s Research News article “Relationship between aggression and individual resilience with the mediating role of spirituality in academic students – A path analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032025/), Sadeghifard and colleagues recruited university students and had them complete measures of spirituality, aggression, and resilience. They then analyzed the relationships between these variables with structural equation modelling.

 

They found that the higher the levels of spirituality the higher the levels of resilience. While the higher the levels of resilience the lower the levels of aggression. They also found that spirituality was related to resilience both directly and indirectly. Structural equation modelling revealed that spirituality was directly related to higher levels of resilience and also indirectly by being related to lower levels of aggression which was, in turn, was related to higher resilience.

 

The study was correlational. So, causation cannot be determined. Nevertheless, the ability to effectively cope with stress and life’s difficulties, resilience, is an important part of maintaining psychological well-being and resilience appears to be impaired by aggression. Spirituality is known to contribute to psychological well-being and it is related to both lower levels of aggression and higher levels of resilience. It can be speculated that the relationship of spirituality to mental health results from its negative relationship with aggression and its positive relationship with resilience.

 

So, spirituality may make college students more resilient and thereby improve their psychological well-being.

 

for many people, religion, personal beliefs and spirituality are a source of comfort, wellbeing, security, meaning, sense of belonging, purpose and strength.” – Olivia Goldhill

 

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

 

Sadeghifard, Y. Z., Veisani, Y., Mohamadian, F., Azizifar, A., Naghipour, S., & Aibod, S. (2020). Relationship between aggression and individual resilience with the mediating role of spirituality in academic students – A path analysis. Journal of education and health promotion, 9, 2. https://doi.org/10.4103/jehp.jehp_324_19

 

Abstract

BACKGROUND:

The importance of spirituality and spiritual growth in humans has been increasingly taken to attention by psychologists and mental health professionals. In this study, we aimed to investigate the relationship between the tendency to aggression and individual resilience also considering the role of mediator of spirituality in academic students by path analysis.

MATERIALS AND METHODS:

A cross-sectional study was conducted using structural equation method (SEM). The target population consisted all of undergraduate academic students in Ilam, Iran University of Applied Sciences, in 2018. Participants included 200 people whom were selected by stratified random sampling. Data collection tools were demographic, Buss and Perry aggression, spirituality assessment, and resiliency of Connor and Davidson questionnaire. In this study, bivariate analysis was used to determine the directionality correlation between the study variables.

RESULTS:

The results showed that there was a significant and positive correlation between spirituality and resilience (r = 154% r = 83%). Furthermore, there was a negative and nonsignificant relationship between aggression with resiliency (r = −122% P = 101). In addition, there was no significant correlation between the aggression and spirituality (r = 0.05%, P = 0.942). The results of SEM showed that spirituality and aggression can predict about 20% of the variations in the degree of resilience in academic students. Accordingly, the results of SEM spirituality in an indirect path reduce the aggression and thus increase the resilience (r = 0.102).

CONCLUSION:

The results of this study showed the effect of spirituality on increasing the level of resilience and also positive mediator role of spirituality between aggression and resiliency.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032025/

Mindfulness is Associated with Greater Resilience and Less Emotional and Behavioral Problems in Adolescents

Mindfulness is Associated with Greater Resilience and Less Emotional and Behavioral Problems in Adolescents

 

By John M. de Castro, Ph.D.

 

“mindfulness practice could be beneficial to teens, helping them cultivate empathy, as well as skills for concentration and impulse control. In short, mindfulness can help adolescents navigate the challenges of adolescence.” – Sarah Rundell Beach

 

Adolescence is a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops. But adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. This can lead to emotional and behavioral problems.

 

Indeed, up to a quarter of adolescents suffer from depression or anxiety disorders, and an even larger proportion struggle with subclinical symptoms. Mindfulness training in adults has been shown to reduce anxiety and depression levels and improve resilience and emotional regulation. In addition, in adolescents it has been shown to improve emotion regulation and to benefit the psychological and emotional health.

 

In today’s Research News article “Mindfulness, Life Skills, Resilience, and Emotional and Behavioral Problems for Gifted Low-Income Adolescents in China.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00594/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1293822_69_Psycho_20200407_arts_A), Huang and colleagues recruited low-income gifted high school students and measured them for emotional and behavioral problems, including both internalizing and externalizing behaviors, resilience, life skills, including  self-control, assertiveness, refusal and relaxation, and mindfulness.

 

They found that the higher the levels of mindfulness the higher the levels of resilience and life skills and the lower the levels of emotional and behavioral problems. They also found that the higher the levels of life skills the higher the levels of mindfulness and resilience and the lower the levels of emotional and behavioral problems. Structural modelling revealed that mindfulness and life skills were associated with reduced emotional and behavioral problems both directly and indirectly by being associated with higher levels of resilience that was in turn associated with lower levels of emotional and behavioral problems.

 

These results are interesting but correlational and as such causation cannot be determined. Nevertheless, they suggest that the emotional and behavioral problems of gifted adolescents from low-income families are to some extent reduced by having strong mindfulness, resilience, and life skills. Additionally, the findings suggest that mindfulness and life skills are not only directly related to less emotional and behavioral problems but also indirectly by being related to higher levels of resilience. It remains for future research to determine if these connections are causal by training adolescents in mindfulness and life skills and observing if there are increases in resilience and decreases in emotional and behavioral problems.

 

So, mindfulness is associated with greater resilience and less emotional and behavioral problems in adolescents.

 

“Mindfulness processes and practices can help young people develop emotional resilience, self-awareness and regulation skills that assist them in taking greater responsibility for their behaviors, decisions and relationships.” – Jennifer Frank

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Huang C-C, Chen Y, Jin H, Stringham M, Liu C and Oliver C (2020) Mindfulness, Life Skills, Resilience, and Emotional and Behavioral Problems for Gifted Low-Income Adolescents in China. Front. Psychol. 11:594. doi: 10.3389/fpsyg.2020.00594

 

In contrast to emotional and behavioral problems (EBPs), which can disrupt normal adolescent development, resilience can buffer the effects of stress and adverse childhood experiences and can help youth overcome adversity. While research has looked at the relationship between adolescent resilience and EBPs, current literature relatively lack a discussion of a strengths-based approach of resilience framework, nor discuss non-western sociocultural contexts. In this study, we utilized the resilience theory to examine the effects of individual mindfulness and life skills on resilience and consequently on EBPs in a group of low-income and gifted adolescents in China. A secondary data of 152 adolescents from a specialized school for low-income and gifted students in Guangzhou, China was used for the analysis. The findings from structural equation modeling indicated that mindfulness and life skills were associated with heightened resilience and reduced EBPs. In addition, resilience reduced EBPs for this group of adolescents. These findings underscore the promise of mindfulness and life skills training on increasing resilience and reducing EBPs in gifted adolescents.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00594/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1293822_69_Psycho_20200407_arts_A

 

Reduce Burnout in Medical Residents with Mindfulness

Reduce Burnout in Medical Residents with Mindfulness

 

By John M. de Castro, Ph.D.

 

while they appreciate the great meaning in their work, clinicians’ ability to disconnect and recharge may be even more critical than it is for others when it comes to how they view work environments and feel as employees.” – David Gregg

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, and improving sleep. Hence, mindfulness may be a means to reduce burnout and improve well-being in hospital residents.

 

In today’s Research News article “Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081870/), Parsons and colleagues review and summarize the published research regarding methods to reduce burnout in medical residents. From this research they formed conclusions  and recommendations.

 

They report that the published studies demonstrate that medical resident burnout is mitigated by interventions that emphasize mindfulness, stress management, and resilience training. The evidence is fairly strong from well conducted controlled trials. It should be noted that mindfulness training improves both stress management and resilience. So, mindfulness training may be the key to all of the effective training strategies. They also report that working conditions tend to produce fatigue and stress that contribute to burnout. Reduction in burnout can be accomplished by adjustments to the work environment including shift scheduling.

 

So, reduce burnout in medical residents with mindfulness.

 

Research exploring the effects of mindfulness training suggests it produces broad and significant improvements in attributes applicable to patient care and physician well-being.” – American Medical Association

 

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

 

Parsons, M., Bailitz, J., Chung, A. S., Mannix, A., Battaglioli, N., Clinton, M., & Gottlieb, M. (2020). Evidence-Based Interventions that Promote Resident Wellness from the Council of Emergency Residency Directors. The western journal of emergency medicine, 21(2), 412–422. https://doi.org/10.5811/westjem.2019.11.42961

 

Abstract

Initiatives for addressing resident wellness are a recent requirement of the Accreditation Council for Graduate Medical Education in response to high rates of resident burnout nationally. We review the literature on wellness and burnout in residency education with a focus on assessment, individual-level interventions, and systemic or organizational interventions.

Best Practice Recommendations for Individual Interventions

  • Mindfulness training should be incorporated into residency training to improve wellness and reduce burnout (Level 1b, Grade B).
  • Consider incorporating behavioral interventions, such as reframing, self-compassion, and empathy into residency training (Level 4, Grade C)
  • Encourage self-care with respect to physical, psychological, and emotional health. This should include an emphasis on sleep, healthy eating, regular exercise, development of social and professional support networks, PCP visits, resources for substance abuse, and counseling or mentoring programs (Level 4, Grade C)
  • Program faculty should meet privately with residents potentially suffering from burnout to identify the unique causes and appropriate interventions. Close follow-up meetings should assess improvement (Level 4, Grade C)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081870/

 

Improve a Biological Marker of Aging, Telomeres, with Meditation

Improve a Biological Marker of Aging, Telomeres, with Meditation

 

By John M. de Castro, Ph.D.

 

“While we might expect our bodies and brains to follow a shared trajectory of development and degeneration over time, by actively practicing strategies such as meditation, we might actually preserve and protect our physical body and brain structure to extend our golden years and shine even more brightly in old age.” – Sonima Wellness

 

One of the most exciting findings in molecular biology in recent years was the discovery of the telomere. This is a component of the DNA molecule that is attached to the ends of the strands. Recent genetic research has suggested that the telomere and its regulation is the biological mechanism that produces aging. As we age the tail of the DNA molecule called the telomere shortens. When it gets very short cells have a more and more difficult time reproducing and become more likely to produce defective cells. On a cellular basis, this is what produces aging. As we get older the new cells produced are more and more likely to be defective. The shortening of the telomere occurs each time the cell is replaced. So, slowly as we age it gets shorter and shorter.

 

Fortunately, there is a mechanism to protect the telomere. There is an enzyme in the body called telomerase that helps to prevent shortening of the telomere. It also promotes cell survival and enhances stress-resistance.  Research suggests that processes that increase telomerase activity tend to slow the aging process by protecting the telomere.  One activity that seems to increase telomerase activity and protect telomere length is mindfulness practice. Hence, engaging in mindfulness practices may protect the telomere and thereby slow the aging process.

 

In today’s Research News article “Telomere length correlates with subtelomeric DNA methylation in long-term mindfulness practitioners.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067861/), and Mendioroz colleagues recruited long-term meditators (greater than 10 years of experience) and non-meditators matched for gender, ethnic group, and age. They were measured for mindfulness, anxiety, depression, resilience, happiness, self-compassion, experiential avoidance, and quality of life. They also provided blood samples that were assayed for telomere length and DNA methylation.

 

They found that the long-term meditators were significantly higher in for mindfulness, resilience, happiness, self-compassion, and quality of life and significantly lower in for anxiety, depression, and experiential avoidance.

 

They also found that the meditators had significantly longer telomeres than the matched controls. Interestingly, while in the controls the greater the age of the participant the shorter the telomeres, in the long-term meditators, telomere length was the same regardless of age. In addition, they found that in the long-term meditators, telomere length was significantly associated with DNA methylation at specific regions but not for the matched controls.

 

This study found, as have others, that long-term meditation practice is associated with longer telomeres. The fact, that the telomere length was not associated with age in the meditators suggests that meditation practice may protect the individual from age-related erosion of telomeres. The results further suggest that meditation may do so through specific methylation of DNA. Stress has been shown to results in shortening the telomeres. Hence, a potential mechanism whereby meditation may protect telomeres may be by reducing the physiological and psychological responses to stress.

 

It is suspected, but not proven, that telomere length is related to health and well-being. The findings that the long-term meditators had significantly better mental health tends to support this notion. There is evidence that meditation practice increases longevity. It can be speculated that meditation practice may do so by affecting molecular genetic mechanisms that prevent the degradation of the telomeres with age.

 

So, improve a biological marker of aging, telomeres, with meditation.

 

Meditation also helps to protect our telomeres, the protective caps at the end of our chromosomes. Telomeres are longest when we’re young and naturally shorten as we age. Shorter telomeres are associated with stress and higher risk for many diseases including cancer, and depend on the telomerase enzyme to enable them to rebuild and repair.”- Paula Watkins

 

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

 

Mendioroz, M., Puebla-Guedea, M., Montero-Marín, J., Urdánoz-Casado, A., Blanco-Luquin, I., Roldán, M., Labarga, A., & García-Campayo, J. (2020). Telomere length correlates with subtelomeric DNA methylation in long-term mindfulness practitioners. Scientific reports, 10(1), 4564. https://doi.org/10.1038/s41598-020-61241-6

 

Abstract

Mindfulness and meditation techniques have proven successful for the reduction of stress and improvement in general health. In addition, meditation is linked to longevity and longer telomere length, a proposed biomarker of human aging. Interestingly, DNA methylation changes have been described at specific subtelomeric regions in long-term meditators compared to controls. However, the molecular basis underlying these beneficial effects of meditation on human health still remains unclear. Here we show that DNA methylation levels, measured by the Infinium HumanMethylation450 BeadChip (Illumina) array, at specific subtelomeric regions containing GPR31 and SERPINB9 genes were associated with telomere length in long-term meditators with a strong statistical trend when correcting for multiple testing. Notably, age showed no association with telomere length in the group of long-term meditators. These results may suggest that long-term meditation could be related to epigenetic mechanisms, in particular gene-specific DNA methylation changes at distinct subtelomeric regions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067861/

 

Improve Well-Being and Workplace Performance with Online Mindfulness Training

Improve Well-Being and Workplace Performance with Online Mindfulness Training

 

By John M. de Castro, Ph.D.

 

online mindfulness intervention seems to be both practical and effective in decreasing employee stress, while improving resiliency, vigor, and work engagement, thereby enhancing overall employee well-being.” – Kimberly Aikens

 

Work is very important for our health and well-being. We spend approximately 25% of our adult lives at work. How we spend that time is immensely important for our psychological, social, and physical health. But, nearly 2/3 of employees worldwide are unhappy at work. This is partially due to work-related stress which is epidemic in the western workplace. Almost two thirds of workers reporting high levels of stress at work. This stress can result in impaired health and can result in burnout; producing fatigue, cynicism, and professional inefficacy.

 

To help overcome unhappiness, stress, and burnoutmindfulness practices have been implemented in the workplace. Indeed, mindfulness practices have been shown to markedly reduce the physiological and psychological responses to stress. As a result, it has become very trendy for business to incorporate meditation into the workday to help improve employee well-being, health, and productivity. These programs attempt to increase the employees’ mindfulness at work and thereby reduce stress and burnoutOnline mindfulness training has the advantage of being convenient and easily integrated into a busy schedule. It is important, though, to verify its effectiveness for improving psychological health and workplace performance.

 

In today’s Research News article “Online Mindfulness Training Increases Well-Being, Trait Emotional Intelligence, and Workplace Competency Ratings: A Randomized Waitlist-Controlled Trial.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00255/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1254058_69_Psycho_20200225_arts_A), Nadler and colleagues recruited healthy adults in their workplace and randomly assigned them to either a wait-list control condition or to receive an 8-week online workplace-based mindfulness training. The training was based upon the Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) programs. Mindfulness training was practiced 6 or 7 days per week. The workers were measured before and after training for mindfulness, perceived stress, resilience, positive and negative emotions, emotional intelligence, and workplace competence.

 

They found that in comparison to baseline and the wait-list control condition, mindfulness training produced significant increases in mindfulness, resilience, and positive emotions and significant decreases in perceived stress and negative emotions. Also, there were significant increase in emotional intelligence, including recognition of emotion in self and recognition of emotion in others, regulation of emotion in self, and regulation of emotion in others. In addition, they found that the greater the change in mindfulness, particularly in the acting with awareness and non-reactivity to inner experience facets of mindfulness, in the intervention group, the greater the increases in resilience, positive emotions, and emotional intelligence and the greater the decreases in negative emotions and perceived stress.  Finally, mindfulness training produced an increase in job performance, including decisiveness, making tough calls, assuming responsibility, interpersonal relationships, and creativity.

 

The present study results suggest the online mindfulness training is effective in improving psychological health, emotional intelligence, and job performance. Mindfulness training has been previously shown to improve resilience, emotions and emotional intelligence, perceived stress, and job performance. It appears that mindfulness training improves the employees ability to act mindfully with awareness and not react to their inner feelings. This means that they pay better attention to their jobs and are less reactive to their emotions during work. This make them better employees and improves their well-being.

 

The contribution of the present work is to demonstrate that these benefits can be produce by online training. This improves the usefulness of mindfulness training for workers as it can be accomplished inexpensively and conveniently with minimal disruption of work. This can make them better at their jobs and mentally and emotionally healthier. It was not studied here but this would predice not only better performance but also less burnout and better employee retention.

 

So, improve well-being and workplace performance with online mindfulness training.

 

Mindfulness can encourage divergent thinking, enabling you to generate more innovative solutions to business problems.” – Mind Tools

 

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

 

Nadler R, Carswell JJ and Minda JP (2020) Online Mindfulness Training Increases Well-Being, Trait Emotional Intelligence, and Workplace Competency Ratings: A Randomized Waitlist-Controlled Trial. Front. Psychol. 11:255. doi: 10.3389/fpsyg.2020.00255

 

A randomized waitlist-controlled trial was conducted to assess the effectiveness of an online 8-week mindfulness-based training program in a sample of adults employed fulltime at a Fortune 100 company in the United States. Baseline measures were collected in both intervention and control groups. Following training, the intervention group (N = 37) showed statistically significant increases in resilience and positive mood, and significant decreases in stress and negative mood. There were no reported improvements in the wait-list control group (N = 65). Trait mindfulness and emotional intelligence (EI) were also assessed. Following the intervention mindfulness intervention participants reported increases in trait mindfulness and increases on all trait EI facets with the exception of empathy. The control group did not report any positive changes in these variables, and reported reductions in resilience and increases in negative mood. Finally, both self and colleague ratings of workplace competencies were collected in the intervention group only and provided preliminary evidence that mindfulness training enhanced performance on key leadership competencies including competencies related to decisiveness and creativity. The present study demonstrates the effectiveness of an online-based mindfulness training program for enhancing well-being, self-perceptions of emotional intelligence, and workplace performance.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00255/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1254058_69_Psycho_20200225_arts_A

 

Change the Brain to Improve Resilience with Meditation

Change the Brain to Improve Resilience with Meditation

 

By John M. de Castro, Ph.D.

 

“Mindful people … can better cope with difficult thoughts and emotions without becoming overwhelmed or shutting down (emotionally). Pausing and observing the mind may (help us) resist getting drawn into wallowing in a setback.” – Badri Bajaj

 

Psychological well-being is sometimes thought of as a lack of mental illness. But it is more than just a lack of something. It is a positive set of characteristics that lead to happy, well-adjusted life. These include the ability to be aware of and accept one’s strengths and weaknesses, to have goals that give meaning to life, to truly believe that your potential capabilities are going to be realized, to have close and valuable relations with others, the ability to effectively manage life issues especially daily issues, and the ability to follow personal principles even when opposed to society. But stress can interfere with the individual’s ability to achieve these goals.  When highly stressed, resilience is required to cope with the stress and continue on the path to psychological well-being.

 

One way that mindfulness practices such as meditation may improve resilience is by altering the brain. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, mindfulness practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits. The changes in the brain, however, that are responsible for increased resilience are unknown.

 

In today’s Research News article “The Immediate and Sustained Positive Effects of Meditation on Resilience Are Mediated by Changes in the Resting Brain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448020/), Kwak and colleagues recruited healthy adults to participate in a 4-day retreat. They were randomly assigned to a meditation retreat or a relaxation retreat. They were measured before and after the retreat and 3 months later for mindfulness, resilience, and religious preference. Also, before and after the retreat the participants underwent functional Magnetic Resonance Imaging (f-MRI) of their brains.

 

They found that in comparison to baseline and the relaxation retreat participants, the meditation retreat participants at the 3-month follow-up had significant increases in both mindfulness and resilience. They also found that the meditation group had significantly increased functional connectivity between the left rostral anterior cingulate cortex and the dorsomedial prefrontal cortex, precuneus, and angular gyrus. In addition, the greater the increase in the functional connectivity in the meditation retreat group the greater the increases in resilience and mindfulness. The increase in resilience was associated with the increase in mindfulness and this association was found to be partially mediated by the change in functional connectivity. In other words, increased mindfulness was associated with increased resilience directly and also indirectly by its association with the increased functional connectivity which was in turn associated with greater resilience.

 

The results are interesting and suggest that the effect of meditation on resilience is due to increases in mindfulness that change the brain to produce greater resilience. In particular, meditation appears to increase the functional connectivity between brain regions, the cingulate cortex and the prefrontal cortex and the precuneus, and angular gyrus, and thus is partially responsible for increased resilience.

 

Resilience is very important for the individual to be able to withstand the stress and negative events in life. Meditation appears to change the brain to help people better cope with the stresses of life. This may underlie, at least in part, the psychological and physical benefits of meditation practice.

 

So, change the brain to improve resilience with meditation.

 

The emotional soup that follows a stressful event can whip up negative stories about yourself or others that goes on and on, beyond being useful. Mindfulness reduces this rumination and, if practiced regularly, changes your brain so that you’re more resilient to future stressful events.” – Shamash Alidina

 

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

 

Kwak, S., Lee, T. Y., Jung, W. H., Hur, J. W., Bae, D., Hwang, W. J., … Kwon, J. S. (2019). The Immediate and Sustained Positive Effects of Meditation on Resilience Are Mediated by Changes in the Resting Brain. Frontiers in human neuroscience, 13, 101. doi:10.3389/fnhum.2019.00101

 

Abstract

While recent studies have explored the maintenance of the effect of meditation on stress resilience, the underlying neural mechanisms have not yet been investigated. The present study conducted a highly controlled residential study of a 4-day meditation intervention to investigate the brain functional changes and long-term effects of meditation on mindfulness and resilience. Thirty participants in meditation practice and 17 participants in a relaxation retreat (control group) underwent magnetic resonance imaging scans at baseline and post-intervention and completed the Cognitive and Affective Mindfulness Scale (CAMS) and Resilience Quotient Test (RQT) at baseline, post-intervention, and the 3-month follow-up. All participants showed increased CAMS and RQT scores post-intervention, but only the meditation group sustained the enhancement after 3 months. Resting-state functional connectivity (rsFC) between the left rostral anterior cingulate cortex (rACC) and the dorsomedial prefrontal cortex (dmPFC), precuneus, and angular gyrus was significantly increased post-intervention in the meditation group compared with the relaxation group. The changes in rACC-dmPFC rsFC mediated the relationship between the changes in the CAMS and RQT scores and correlated with the changes in the RQT score both immediately and at 3 months post-intervention. Our findings suggest that increased rACC-dmPFC rsFC via meditation causes an immediate enhancement in resilience that is sustained. Since resilience is known to be associated with the preventative effect of various psychiatric disorders, the improvement in stress-related neural mechanisms may be beneficial to individuals at high clinical risk.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448020/

 

Heighten Mental and Physical Well-Being with Mindfulness Training

Heighten Mental and Physical Well-Being with Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“By focusing on the here and now, many people who practice mindfulness find that they are less likely to get caught up in worries about the future or regrets over the past, are less preoccupied with concerns about success and self-esteem, and are better able to form deep connections with others. If greater well-being isn’t enough of an incentive, scientists have discovered that mindfulness techniques help improve physical health in a number of ways. Mindfulness can: help relieve stress, treat heart disease, lower blood pressure, reduce chronic pain, , improve sleep, and alleviate gastrointestinal difficulties.” – Harvard Health

 

Mindfulness training has been shown to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Techniques such as Mindfulness Training, Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

This research suggests that engaging in mindfulness practices can make you a better human being, with greater mental and physical well-being. In today’s Research News article “Mindfulness Training: Can It Create Superheroes?” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00613/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_951898_69_Psycho_20190404_arts_A), Jones and colleagues review and summarize the published research on the effects of mindfulness training on psychological and physical well-being.

 

They found that the published research presented substantial findings that mindfulness training enhanced physical functioning including improved health, decreased heart rate, blood pressure, blood cholesterol, and blood cortisol and resistance to disease, including improved stress responding, increased immune system response, and decreased inflammatory responses. They also report the mindfulness training produces tended to protect against the mental and physical effects of aging, including reduced cognitive decline and reduced brain deterioration. In addition, they report that mindfulness training produces improved cognitive processing, including improved heightened attentional ability, improved neural processing, and alterations of brain systems underlying consciousness. Mindfulness training also produced greater resilience and fearlessness, including improved emotion regulation, reduced responding to negative stimuli, lower pain responding, and lower fear conditioning. Mindfulness training also produced more self-less and pro-social behaviors, including increased altruism, increased kindness, and compassion. Finally, they report that mindfulness training can produce some control over autonomic responses.

 

This review suggests that people who engage in mindfulness training become superior in mental and physical health to non-practitioners and have superior cognitive abilities particularly in regard to attention and higher-level thinking. This doesn’t exactly make them “superheroes” but rather better versions of themselves.

 

So, heighten mental and physical well-being with mindfulness training.

 

Ultimately, engaging in mindfulness meditation cultivates our ability to both focus and broaden our attention, which is a practical way to elicit psychological well-being.” – Jennifer Wolkin

 

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

 

Jones P (2019) Mindfulness Training: Can It Create Superheroes? Front. Psychol. 10:613. doi: 10.3389/fpsyg.2019.00613

 

With the emergence of the science of heroism there now exists both theoretical and empirical literature on the characteristics of our everyday hero. We seek to expand this inquiry and ask what could be the causes and conditions of a superhero. To address this we investigate the origins of mindfulness, Buddhist psychology and the assertion that its practitioners who have attained expertise in mindfulness practices can develop supernormal capabilities. Examining first their foundational eight “jhana” states (levels of attention) and the six consequent “abhinnas” (siddhis or special abilities) that arise from such mental mastery, we then explore any evidence that mindfulness practices have unfolded the supernormal potential of its practitioners. We found a growing base of empirical literature suggesting some practitioners exhibit indicators of enhanced functioning including elevated physical health and resistance to disease, increased immunity to aging and improved cognitive processing, greater resilience and fearlessness, more self-less and pro-social behaviors, some control over normally autonomic responses, and possibly some paranormal functionality. These improvements in normal human functioning provide some evidence that there are practices that develop these abilities, and as such we might want to consider adopting them to develop this capability. There are however insufficient studies of expert meditators and more research of adepts is called for that explores the relationship between levels of attentional skill and increases in functionality. We propose in search of the superhero, that if conventional mindfulness training can already augment mental and physical capabilities, a more serious inquiry and translation of its advanced methods into mainstream psychological theory is warranted.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00613/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_951898_69_Psycho_20190404_arts_A

Improve Resilience in First-Responders with a Smartphone Mindfulness App

Improve Resilience in First-Responders with a Smartphone Mindfulness App

 

By John M. de Castro, Ph.D.

 

“The mindfulness practices work at both a preventative and remedial level by assisting them to maintain higher levels of resilience to deal with their emergency responder roles and helping to reduce and cease distressing reactions after difficult personal and traumatic incidents.” – Mark Molony

 

First responders such as firefighters and police experience a great deal of stress and frequent traumatic events and as a part of their jobs. The first-responders need to be resilient in the face of these difficult circumstances to cope with the stress. It is possible that mindfulness training might help. Mindfulness has been shown to increase resilience and reduce the psychological and physiological responses to stress. So, it is reasonable to infer that mindfulness training may help to develop resilience in first-responders and be of benefit to their mental health.

 

In today’s Research News article “Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399574/), Joyce and colleagues examine the ability of mindfulness training delivered with a smartphone app to increase the levels of resilience in first-responders. They recruited Primary Rescue and Hazmat firefighters and randomly assigned their stations to either receive 6, 20-25 minute, sessions  of mindfulness training or to an Healthy Living control condition. The mindfulness training was based upon Acceptance and Compassion Therapy (ACT) and emphasized mindfulness, self-acceptance, and compassion. Both programs were delivered through a smartphone app. The first-responders were measured before and after training and 6 months later for mindfulness, resilience, cognitive fusion, experiential avoidance and psychological inflexibility, self-compassion, optimism, coping orientation, and life purpose.

 

They found that in comparison to baseline and the control condition, participation in the mindfulness training resulted in a significant increase in adaptive resilience and mindfulness which continued to increase over the 6-month follow-up period. Significant differences in optimism, and the use of instrumental and emotional support were present at the end of training but were not sustained at follow-up. Interestingly, there were no significant differences in “bounce-back” resilience.

 

Adaptive resilience involves the ability to adapt to stressful life circumstances and events. It involves the “individual’s ability to tolerate experiences such as change, personal problems, illness, pressure, failure, and painful feelings.” On the other hand, “bounce-back” resilience involves the ability to recover from stressful events. Since mindfulness focuses the individual on the present moment, it would be expected that it would influence the experience and coping with stressful events as they’re occurring. This is the case with adaptive resilience. On the other hand, mindfulness moves attention away from past events and would thus not be expected to influence coping with past stressful events as is the case with “bounce-back” resilience. Hence, it makes sense that mindfulness training would affect adaptive resilience and not “bounce-back” resilience.

 

It is important for the well-being of first responders that they be able to cope with the, at times, intense stress and trauma involved in their jobs. Hence, mindfulness training may be very beneficial as the present results suggest. This may help to prevent illness, burnout, and post-traumatic stress disorder (PTSD). In addition, the fact that mindfulness was taught with a smartphone app is important as it makes the training convenient and adaptable to the individual’s schedule. It is also highly scalable allowing for inexpensive widespread availability of the training.

 

So, Improve Resilience in First-Responders with a Smartphone Mindfulness App.

 

“Because PTSD is an anxiety disorder, episodes of distress occur when a person begins to worry about the future based on previous painful, intense or stressful memories. Meditation can help bring that person’s attention back to the current moment, which reduces or eliminates anxiety.” – Erin Fletcher

 

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

 

Joyce, S., Shand, F., Lal, T. J., Mott, B., Bryant, R. A., & Harvey, S. B. (2019). Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders. Journal of medical Internet research, 21(2), e12894. doi:10.2196/12894

 

Abstract

Background

A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time.

Objective

This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers.

Methods

We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills.

Results

Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002).

Conclusions

The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399574/