Stress

Medical School Mindfulness  

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“It has been suggested that inadequate self-care and ineffective coping styles are often established during medical training; they may persist after training and be self-destructive in the long-run. Therefore, introducing students to self-regulation skills along with other self-care approaches during medical school may improve their personal health and professional satisfaction not only during residency but also beyond.”  – William McCann

 

Medical School is challenging both intellectually and psychologically. Stress levels are high and burnout is common. It’s been estimated that 63% of medical students experience negative consequences from stress while symptoms of severe stress was present in 25% of students. The prevalence of stress is higher among females than among males. High stress levels lead to lower performance in medical school and higher levels of physical and mental health problems, especially anxiety and depression. Indeed 50% of medical students report burnout and 11% have considered suicide in the last year.

 

Obviously there is a need to either lower stress levels in medical education or find methods to assist medical students in dealing with the stress. One promising possibility is mindfulness training. It has been shown to reduce stress in students (See http://contemplative-studies.org/wp/index.php/2015/08/10/burnout-burnout-with-mindfulness/), to help with the negative consequences of stress (see http://contemplative-studies.org/wp/index.php/2015/07/17/destress-with-mindfulness/) and to reduce burnout in medical professionals (see http://contemplative-studies.org/wp/index.php/2015/08/10/burnout-burnout-with-mindfulness/). So, it would seem reasonable to suspect that mindfulness would be helpful in assisting medical students cope with the stress of their training.

 

In today’s Research News article “The relationships among self-care, dispositional mindfulness, and psychological distress in medical students”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4481049/

Slonim and colleagues demonstrate that the higher the level of mindfulness in medical students the lower their distress levels including levels of depression, anxiety, and stress. They also found that higher levels of self-care, in particular spiritual growth, were associated with lower levels of distress.  Finally, they showed that high levels of mindfulness strengthened the relationship between self-care and lower distress levels.  That is, the higher the mindfulness level the greater the impact of self-care on lowering distress. So, mindfulness not only directly lowers depression, anxiety, and stress in medical students but also magnifies the positive effects of self-care on these symptoms of distress.

 

Mindfulness may assist medical students by increasing present moment awareness. This reduces patterns of automatic, mindless, and judgmental thinking which can mitigate the impact of the situation on the individual. So, the student can attribute how they’re feeling and acting to the situation rather than to some personal failing.

 

Mindfulness is known to increase emotion regulation allowing the student to more accurately interpret what they’re feeling and respond to it appropriately. This also reduces the impact of strong negative emotional responses to thoughts and emotions their levels of depression and anxiety. So, mindful students experience their emotional reactions, recognize their causes, and adjust to them in an adaptive way.

 

Finally, mindfulness has been demonstrated to directly reduce symptoms of stress and the individual’s responses to stress. This occurs both by altering the physical and hormonal responses to stress and by reducing the negative spiral of stress, where the fact of stress induces more stress. This dramatically improves the students’ ability to cope with the stressful demands of medical education, perform at a higher level and make burnout less likely.

 

So, be mindful and be better equipped to deal with stressful educational experiences.

 

CMCS – Center for Mindfulness and Contemplative Studies

Yoga Practice Improves Prisoner Mood and Stress

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“You may think that only you are a prisoner, but other people are also prisoners. You are in a small prison, but others are in the big prison outside. When will they be released? Think that you are a yogi and that you are pursuing your sadhana in this particular place and at this particular moment. Immediately you will experience great joy. If you change your understanding, you will be free in a minute.”- Baba Muktananda

 

Around 2 ¼ million people are incarcerated in the United States. Even though these are euphemistically labelled correctional facilities very little correction actually occurs. This is supported by the rates of recidivism. About three quarters of prisoners who are released commit crimes and are sent back to prison within 5-years. Hence there is a great need for better prison programs that can not only help the prisoner adjust to prison life but also to life after release.

 

Contemplative practices have recently been employed in prisons and have been found to improve prisoner well-being and behavior. LINK to Auty Yoga and Meditation Improves Well-Being in Prisoners. Yoga is a multifaceted practice containing physical, mindfulness, and spiritual components. As such, yoga would seem to be ideal for the needs of an incarcerated population. Indeed, it has been shown to be beneficial for prisoners. Unfortunately, all that can be said is that engaging in a yoga program produces better results than not. But there is little understanding of how yoga practice might work and the amount of yoga needed to produce the benefits.

 

In today’s Research News article “Preliminary Evidence That Yoga Practice Progressively Improves Mood and Decreases Stress in a Sample of UK Prisoners”

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Bilderbeck and colleagues investigated the factors associated with the beneficial effects of yoga practice for prisoners. They found that the more yoga classes attended and the greater the amount of self-practice outside of classes the greater the improvement in the prisoners’ level of perceived stress and negative emotions. In other words, sustained, regular practice of yoga produced greater improvements in the prisoners.

 

Of course it is impossible to tell if the prisoners who obtained the greatest benefit were then the ones who would engage more reliably in the practice or that great amounts of practice produce greater benefit. It is also impossible to know if some other factor such as the impact of the social context or simply relief of the incredible boredom of prison life might have been responsible both for greater adherence and also to improvements in well-being. There is a need for research that controls and manipulates these factors to determine the actual causal connections.

 

There is also a need to follow up on prisoners who have practiced yoga in prison to determine the long-term impact on adjustment to life outside of prison and recidivism. Finally, there is a need to determine what facets of yoga practice are crucial for each benefit and which are unimportant.

 

Regardless, it is clear that practicing yoga is beneficial to the well-being of prisoners.

 

“Right, if you’re not careful, you could despair, but there is a support system, definitely in this prison, and it’s awesome just to be able to be part of a community where people do yoga and meditate – and I have the Siddha Yoga correspondence course. I use these things to take me out of my mind and more into the heart space.” – Gino Sevacos, prisoner at San Quentin State Prison,

 

CMCS – Center for Mindfulness and Contemplative Studies

 

Age Healthily with Qigong – Soothing Stress Responses

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“Those who think they have no time for bodily exercise will sooner or later have to find time for illness.” – Edward Stanley

 

Stress takes a toll on the physiology. This is particularly so in aging. Stress accelerates cellular aging, amplifying the breakdown of cells that occurs with age. It can accelerate sensory losses with aging, including vision and hearing loss. Stress weakens the immune system, making the elderly more susceptible to infections and disease. It even contributes the development of Alzheimer’s Disease. In addition, people under stress tend to try to deal with it in unhealthy ways, including drugs and alcohol, poor diet, and lack of exercise. The sum of all of these negative consequences of chronic stress shows up in a reduction of longevity. So, stress can make the aging age faster, reduce quality of life, and make the golden years not so golden.

 

It is known that exercise can help relieve stress and its effects. But, the aging body cannot generally tolerate vigorous exercise. But, the gentle mindful movement exercise practices of Tai Chi or Qigong are well tolerated by the elderly and appear to be very beneficial for health (see http://contemplative-studies.org/wp/index.php/2015/07/17/aging-healthily-sleeping-better-with-mindful-movement-practice/ and http://contemplative-studies.org/wp/index.php/2015/08/06/age-healthily-treating-insomnia-and-inflammation/). In addition,  Tai Chi or Qigong develop mindfulness and mindfulness practices are known to improve health and well-being in aging (see http://contemplative-studies.org/wp/index.php/2015/07/17/age-healthily-mindfulness/) and reduce stress (see http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/ and http://contemplative-studies.org/wp/index.php/2015/07/17/destress-with-mindfulness/).

 

So, it would seem likely that mindful movement practice such as Qigong would serve both as an exercise and a mindfulness practice and improve the aging process. In today’s Research News article “Qi-gong training reduces basal and stress-elicited cortisol secretion in healthy older adults.”

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Ponzio and colleagues test this idea. They engaged older adults in generally poor health in a 12-week Qigong training. They measured activity of the stress hormone, cortisol and found that cortisol levels were lower at rest suggesting that they were less stressed after training. In addition, they found that when the participants were put under stress they had lower cortisol responses to the stress, suggesting that they responded to stress better. Finally, those who responded to the stress showed lower perceived stress than they expressed before the training.

 

These results suggest that Qigong can reduce stress and reactivity to stress in aging individuals. This is important as Qigong is gentle and well tolerated by the elderly. This ancient Chinese discipline appears to be an antidote to stress in aging and should produce health benefits as a consequence.

 

So, practice Qigong and soothe stress responses and age healthily.

 

“He who is of a calm and happy nature will hardly feel the pressure of age, but to him who is of an opposite disposition, youth and age are equally a burden.” – Plato 

 

CMCS – Center for Mindfulness and Contemplative Studies

Go to College with Mindfulness

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Many people have fond memories of their college years. It is likely, however, that they forgot about the stress and angst of those years. The truth is that college is generally very stressful for most students, from the uncertainty of freshman year, to the social stresses of emerging adulthood, to the anxiety of launching into a career after senior year. Evidence for the difficulties of these years can be found in college counseling centers which are swamped with troubled students. In fact, it’s been estimated that half of all college students report significant levels of anxiety and depression.

To make matters worse, many college students do not get sufficient sleep. In one study only 11% of college students reported getting sufficient sleep while 73% reported sleep problems. In another study it was found that about 27% of college students have overt sleep disorders such as narcolepsy or insomnia. These sleep problems are associated with lower grades. Many students attempt to combat this problem with heavy use of legal and illegal stimulants which further disrupt sleep and produce other problematic side effects..

So, it is important to find a safe and effective way to reduce stress, depression and anxiety and promote sleep in college students. Mindfulness training has been shown to reduce anxiety and stress http://contemplative-studies.org/wp/index.php/2015/07/29/get-your-calm-on/ and to reduce depression http://contemplative-studies.org/wp/index.php/2015/08/04/get-out-of-the-dumps-with-loving-kindness-meditation/. In addition, it has been shown to improve sleep quality http://contemplative-studies.org/wp/index.php/2015/07/17/mindfulness-is-a-snooze/. So, mindfulness training would appear to be well suited to deal with the problems of college students.

In today’s Research News article “A Randomized Controlled Trial of Koru: A Mindfulness Program for College Students and Other Emerging Adults”

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016159/

Greeson and colleagues test the effectiveness of a mindful meditation program with college students. The found that the student who participated in four 75-min meditation training sessions reported lower perceived stress and fewer sleep problems while having higher levels of mindfulness and self-compassion. When the wait-list control group was later provided with the meditation training, they evidenced the same improvements.

The improved sleep quality was positively associated with increased levels of mindfulness and self-compassion. In turn, the improved self-compassion after meditation training involved increased kindness toward both themselves and humanity in general, and decreased self-judgment, social isolation, and a lower tendency to over-identify with their problems. All of these changes after meditation training had moderate to large effect sizes which suggests that the training effects are of sufficient magnitude to be clinically useful.

These are exciting findings. A simple, relatively brief training is shown to be a safe and effective method to address the stress, mood problems, and sleep disturbance occurring in college students. This, if implemented widely, could greatly improve both the college experience and academic performance.

So, go to college with mindfulness. It will produce even fonder memories of the college years.

CMCS – Center for Mindfulness and Contemplative Studies

 

Get your Calm on!

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Mindfulness Based Stress Reduction (MBSR) is one of the first secular based mindfulness training programs in the west. In fact, it could be argued that the development of MBSR was what launched the mindfulness movement in the west. The movement took off probably because MBSR was shown to be so very effective in the treatment of a wide range of physical, psychological, and emotional issues that plague western culture.

Stress is rampant in competitive western culture producing physical and psychological damage. MBSR’s effectiveness at calming the reactions to stress and reducing anxiety has made it a very popular.

MBSR is not a single practice. Rather it is a combination of practices including meditation, yoga, and body scan meditation. Whether all of these components are necessary for effectiveness or if some components are more effective for some conditions while others are superior for others has yet to be established with empirical evidence. This is an important issue for the understanding of the exact mechanisms by which MBSR has its effects.

It is also not known how much MBSR or how much of each component is needed to have a maximum impact. In more scientific words, a dose response study is needed. This is important to produce optimum effectiveness.

In today’s Research News Article “Effectiveness of Brief Mindfulness Techniques in Reducing Symptoms of Anxiety and Stress’

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David Call and colleagues tested whether very brief, three weekly 45-min sessions of hatha yoga or body scan would be effective in reducing stress and anxiety in undergraduate students. Both practices reduced both anxiety and stress levels.

Interestingly, neither group showed a significant increase in mindfulness, possibly due to the lack of meditation practice and perhaps suggesting that yoga and body scan practices might act directly on stress and anxiety rather than by raising mindfulness that then reduced the symptoms. This contradicts the notion that mindfulness based increases in present moment awareness are the cause of the reduction in anxiety which is future oriented. It remains possible that the physiological effects of yoga and body scan on reducing the hormonal and neural responses to stress may be responsible.

The magnitude of the effects on stress and anxiety were quite large and clinically significant. It is amazing that such a brief treatment of 3 sessions of 45 minutes could have this large of an impact. It remains to be seen if the impact is lasting. Regardless, the fact that a brief simple intervention can markedly reduce stress and anxiety is exciting as it is highly scalable; rolling it out to large numbers of individuals.

So, practice yoga and/or body scan and get your calm on.

CMCS

Destress with Mindfulness

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Stress is a reaction to a stimulus that disturbs our physical or mental equilibrium. Given this definition, it seems that in the modern world most components of our life are stressors. Some stress (acute stress) is positive and actually strengthens the body, it can be exciting, and it keeps us on our toes. But stress that persists for a long period of time (chronic stress) it wears our resources down and can become detrimental to our health.

Chronic stress can produce a condition called distress which can lead to headaches, upset stomach, elevated blood pressure, chest pain, and problems sleeping and can make other diseases worse. Stress is epidemic in that United States. It has been found that over two thirds of Americans experienced symptoms of stress such as fatigue, irritability or anger, or changes in sleeping habits. Forty-three percent of all adults suffer adverse health effects from stress. 75% to 90% of all doctor’s office visits are for stress-related ailments and complaints.

Clearly, stress is a major problem. Stress is not always under our control as it originates most often from external sources. Since in modern American life stress appears to be unavoidable, it is important to identify treatments to mitigate or prevent the symptoms of stress.

In today’s Research News article “Physical Activity, Mindfulness Meditation, or Heart Rate Variability Biofeedback for Stress Reduction: A Randomized Controlled Trial.”

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van der Zwan and associates demonstrate that meditation, physical exercise, and biofeedback are equally effective in reducing stress, anxiety, and depression, and improve sleep quality and psychological well-being.

These findings are noteworthy as it is important to be able to have a variety of treatment options. The patient then can choose a treatment that seems best suited to themselves and their life style and life conditions. It is significant, though, that van der Zwan and colleagues found that most participants preferred mindfulness meditation (52 %, compared to 24 % for both physical exercise, and biofeedback). Hence mindfulness meditation is the option preferred by most patients.

A good reason for the popularity of meditation may be that meditation is restful, relaxing, and pleasant and does not require specific equipment or visit to a specialist’s clinic or a gym. It also is known to improve happiness, creativity, relationship quality, and even help ward off infection. It reduces the physiological changes induced by stress by reducing sympathetic activation and the levels of stress hormones. Furthermore, it helps us to better understand ourselves and others and improves our ability to control our lives. It would seem to be an ideal for stress management.

So, practice mindful meditation and destress.

CMCS

Be Smart about Emotions

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Emotions are powerful forces in our lives. They supply the richness and texture to life experiences, producing joy, surprise, love, happiness, elation, and satisfaction. But, they can also be troubling, associated with fear, hate, stress, anxiety, and anger. We are highly motivated by these emotions and in general seek the experience of positive emotions and try to avoid the experiencing the negative ones.

We should not view emotions as a problem and that our lives would be better without them. To the contrary, eliminating or blunting emotions is itself a problem. This is termed by psychologists as flat affect. People who experience this often comment that they have lost the “juice” in life and desire to return to the emotional ups and downs that seem to supply life’s richness. So, the emotions appear to be essential for humans to lead a rich full life.

On the other hand, when emotions become too strong they can overwhelm the individual and lead to maladaptive behavior. For example thrill seeking can lead to dangerous activities. Also, many mental illnesses are characterized by extremes of emotions. These include phobias, panic disorders, anxiety disorders, bipolar disorders, etc. In addition, strong negative emotions can lead to violence and aggression.

We need to be emotional, but not too much so. We need to be able to have emotions, but not in the extremes and we need to not overreact or overly seek emotions. In other words we need to be able to be smart with our emotions and develop the ability to regulate our emotional lives. This is termed by psychologists as emotional regulation and the ability to do so is termed as emotional intelligence.

Mindfulness has been shown to increase positive emotional states and decrease negative ones. This is one of the reasons that many people practice techniques to develop mindfulness. It seems to make their live better by assisting them in dealing with emotions. It appears to increase emotional regulation and thus mindful people can be said to have higher emotional intelligence.

How this might work to improve an individual’s ability to cope with life is explored in today’s Research News article “Dispositional mindfulness and perceived stress: The role of emotional intelligence.”

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In this article Bao, Xue, & Kong explore how mindfulness might reduce perceived stress in life. They document that mindfulness is associated with lower levels of perceived stress and can do so directly. It appears to improve the individual’s ability to cope with life and be less stressed by the events in life. It is also demonstrated that mindfulness may reduce perceived stress by improving emotional intelligence, improving the individual’s ability to regulate and use emotions to their benefit and thereby reduce perceived stress.

Hence, the well documented ability of mindfulness to lower the individual’s feelings of stress in response to life appears, at least in part, to result from its ability to improve how well the individual can regulate their emotions. In other words, it appears to make people emotionally intelligent.

So, practice mindfulness and be smarter with your emotions; letting them enhance the experience of life while blunting their destructive side.

CMCS