Improve Obsessive-Compulsive Disorder With Mindfulness

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Improve Obsessive-Compulsive Disorder With Mindfulness

 

By John M. de Castro, Ph.D.

 

“To be able to focus on what is really happening in any given moment, as opposed to dwelling on the past or anticipating the future, takes away the power of OCD.” – Janet Singer

 

Obsessive-Compulsive Disorder (OCD) sufferer have repetitive anxiety producing intrusive thoughts (obsessions) that result in repetitive behaviors to reduce the anxiety (compulsions). In a typical example of OCD, the individual is concerned about germs and is unable to control the anxiety that these thoughts produce. Their solution is to engage in ritualized behaviors, such as repetitive cleaning or hand washing that for a short time relieves the anxiety. The obsessions and compulsions can become so frequent that they become a dominant theme in their lives. Hence OCD drastically reduces the quality of life and happiness of the sufferer and those around them. About 2% of the population, 3.3 million people in the U.S., are affected at some time in their life.

 

Fortunately, OCD can be treated and Mindfulness training has been shown to be effective in treating OCD. In addition, changing the maladaptive thought processes occurring in OCD through Cognitive Restructuring (CR) has also been shown to be effective. In today’s Research News article “A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426247/), Rupp and colleagues compare the effectiveness of mindfulness training and cognitive restructuring in treating Obsessive-Compulsive Disorder (OCD).

 

They recruited patients with Obsessive-Compulsive Disorder (OCD) and randomly assigned them to receive either cognitive restructuring or detached mindfulness training or to a wait-list control condition. The treatments were delivered in 100-minute sessions, twice a week for two weeks and contained homework assignments. Cognitive restructuring targets distorted thinking that underlies OCD and teaches the patient to observe the thoughts and question the appraisals produced by the thoughts. Detached mindfulness training also targets the distorted thinking that underlies OCD but teaches the patient to observe the thoughts and detach from them, see them as separate from themselves. They were measured before and after training and 4 weeks later for intelligence, depression, psychological disorders, and Obsessive-Compulsive Disorder (OCD) symptoms.

 

They found that compared to baseline and the wait-list control group both treatments resulted in significant reductions in OCD symptoms that were clinically significant and maintained at the 4-week follow-up. There were also small deceases in depression levels in the patients after both treatments. Hence, both treatments improved the symptoms of patients suffering from Obsessive-Compulsive Disorder (OCD). Hence brief training in cognitive restructuring or detached mindfulness are effective in treating OCD symptoms.

 

It has previously been demonstrated that Mindfulness training is effective in treating OCD. The current study suggests that an unusual mindfulness technique, detached mindfulness, may also be effective. It appears that very different types of treatments, cognitive restructuring and detached mindfulness are effective in treating the symptoms of Obsessive-Compulsive Disorder (OCD). The control condition, however, received no treatment. So, it is possible that the improvements observed may have been due to subject expectancy effects (placebo effects) and not to the treatments. Future research should include placebo control conditions.

 

So, improve obsessive-compulsive disorder with mindfulness.

 

“a person trapped by an endless cycle of washing, checking, or cleaning is experiencing exactly the same struggle with accepting thoughts, feelings, and sensations as people with intrusive thoughts.  So, mindfulness is really for anyone who wants to stop feeling like what is going on inside their mind is a burden.  It’s hard to imagine anyone with OCD who would wish to continue feeling that way.” – John Hershfield

 

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

 

Rupp, C., Jürgens, C., Doebler, P., Andor, F., & Buhlmann, U. (2019). A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder. PloS one, 14(3), e0213895. doi:10.1371/journal.pone.0213895

 

Abstract

Objective

Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions.

Design

We conducted a randomized waitlist-controlled trial. n = 43 participants were randomly assigned to either DM or CR. Out of those participants, n = 21 participants had been previously assigned to a two-week waitlist condition.

Materials and methods

In both conditions, treatment comprised four double sessions within two weeks. Assessment took place at baseline (Pre1), after treatment (Post) and four weeks after the end of treatment (FU). There was a second baseline assessment (Pre2) in the waitlist group. Independent evaluators were blinded concerning the active condition. Adherence and competence ratings for the two therapists were obtained from an independent rater.

Results

40 patients completed the treatment. Two patients dropped out because of exacerbated depression. There were no further adverse events. Both CR and DM were shown to be superior to waitlist and equally effective at reducing OCD symptoms from pre to post assessment as measured with the Y-BOCS (CR: d = 1.67, DM: d = 1.55). In each of the two treatment conditions, eight patients (40%) exhibited a clinical significant change at post assessment.

Conclusions

The results of this clinical trial suggest the potential efficacy of DM as a stand-alone intervention for OCD, however, our findings need to be interpreted with caution. Results indicate that both CR and DM should be considered as possible alternative treatments for OCD, whereas the working mechanisms of DM have yet to be elucidated.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426247/

 

Reduce Eating Disorders with Effective Coping and Mindfulness

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Reduce Eating Disorders with Effective Coping and Mindfulness

 

By John M. de Castro, Ph.D.

 

“For individuals suffering from an eating disorder, becoming mindful, or aware of the present moment, can help save individuals from the critical voices inside of their heads.”

 

Around 30 million people in the United States of all ages and genders suffer from an eating disorder; either anorexia nervosa, bulimia, or binge eating disorder. 95% of those who have eating disorders are between the ages of 12 and 26. Eating disorders are not just troubling psychological problems, they can be deadly, having the highest mortality rate of any mental illness. Eating disorders can be difficult to treat because eating is necessary and cannot be simply stopped as in smoking cessation or abstaining from drugs or alcohol. One must learn to eat appropriately not stop. So, it is important to find methods that can help prevent and treat eating disorders. Contemplative practices, mindfulness, and mindful eating have shown promise for treating eating disorders.

 

In today’s Research News article Mindfulness, rumination, and coping skills in young women with Eating Disorders: A comparative study with healthy controls.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420013/), Hernando and colleagues explored the relationship between eating disorders and mindfulness. They recruited female patients diagnosed with an eating disorder and a matched healthy female control group. The participants completed measures of mindfulness, rumination, effective coping, and coping styles.

 

They found that in comparison to the matched healthy controls, the women with eating disorders had significantly lower levels of mindfulness and effective coping and higher levels of rumination. They also found that the higher the levels of mindfulness or the higher the levels of effective coping, the lower the likelihood of an eating disorder. In addition, they found that the higher the levels of rumination, the greater the likelihood of an eating disorder.

 

It should be kept in mind that the study was cross-sectional in nature and thus caution must be exercised in reaching conclusions especially regarding causation. Nevertheless, the results suggest that mindfulness is associated with less likelihood of an eating disorder and the higher the levels of rumination the greater the likelihood of and eating disorder. This makes sense as being able to be focused in the present moment is the antithesis of rumination which is being focused in the past (worry) or the future (anxiety). The results also suggest that being able to effectively cope with negative feeling is also associated with less likelihood of and eating disorder. This suggests that disordered eating may be a means that the patient uses to cope with negative feelings. If the patient has other more effective means of coping, disordered eating is less likely.

 

Reduce eating disorders with effective coping and mindfulness.

 

“It is common for individuals with eating disorders to numb emotions through restricting, binging or choosing foods that are not pleasurable while eating. Mindful eating can help a person reconnect to the joy and experience of eating by creating an awareness of thoughts, emotions, feeling, and behaviors associated with the eating experience.” – Julia Cassidy

 

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

 

Hernando, A., Pallás, R., Cebolla, A., García-Campayo, J., Hoogendoorn, C. J., & Roy, J. F. (2019). Mindfulness, rumination, and coping skills in young women with Eating Disorders: A comparative study with healthy controls. PloS one, 14(3), e0213985. doi:10.1371/journal.pone.0213985

 

Abstract

Eating Disorders (ED) have been associated with dysfunctional coping strategies, such as rumination. Promoting alternative ways of experiencing mental events, based on a mindfulness approach, might be the clue for learning more effective coping and regulatory strategies among young women with ED. This study examined the comparison between patients with ED diagnosis and healthy subjects in mindfulness, rumination and effective coping. In addition, we analyzed the independent association of those with the presence of ED. The study sample was formed by two groups of young women ranged 13–21 years: Twenty-five with an ED diagnosis and 25 healthy subjects. They were assessed by using the Freiburg Mindfulness Inventory (FMI) and the Responses Styles Questionnaire (RSQ). Our findings show that ED patients have significantly lesser average scores in mindfulness and effective coping than the healthy sample (p < .05). Also, our data concludes that mindfulness and effective coping independently predict the presence or absence of ED in young women. The study results suggest that training mindfulness abilities may contribute to making effective coping strategies more likely to occur in ED patients, which is incompatible with some eating-related symptoms. Further studies are needed, trough prospective and experimental designs, to evaluate clinical outcomes of mindfulness training among young women with ED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420013/

 

Improve Attention and Hyperactivity in Kindergarten Children with Yoga

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Improve Attention and Hyperactivity in Kindergarten Children with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga is a systematic workout regimen that has rejuvenating and calming effects on our body and mind. Young kids go through conflicting emotions, and yoga helps calm them down. They are also extremely flexible and therefore, a practice like yoga will help them contort their bodies in different ways.” – Shirin Mehdi

 

Yoga practice has been shown to have a large number of beneficial effects on the psychological, emotional, and physical health of the individual and is helpful in the treatment of mental and physical illness. The acceptance of yoga practice has spread from the home and yoga studios to its application with children in schools. Studies of these school programs have found that yoga practice produces a wide variety of positive psychosocial and physical benefits.

 

Teachers also note improvements in their students following yoga practice. These include improved classroom behavior and social–emotional skills, concentration, mood, ability to function under pressure, social skills, and attention and lower levels of hyperactivity. In addition, school records, academic tests have shown that yoga practice produces improvements in student grades and academic performance. This, in turn, improves the classroom experience for the teachers. Hence there are very good reasons to further study the effects of yoga practice early in children’s schooling; kindergarten.

 

In today’s Research News article “12 Weeks of Kindergarten-Based Yoga Practice Increases Visual Attention, Visual-Motor Precision and Decreases Behavior of Inattention and Hyperactivity in 5-Year-Old Children.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00796/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_963174_69_Psycho_20190416_arts_A), Jarraya and colleagues recruited kindergarten students and randomly assigned them to either practice yoga, normal physical education, or no treatment control. Yoga and Physical Education occurred twice per week for 30 minutes for 12 weeks. The Hatha yoga practice included postures and breathing exercises. The children were measured by their kindergarten teacher before and after the treatments for visual attention, visuomotor precision, inattention, and hyperactivity/impulsivity.

 

They found that in comparison to PE and control children, the children who practiced yoga had significantly improved visual attention and visuomotor precision, and significantly lower inattention, and hyperactivity/impulsivity. Visuomotor precision is a measure of cognitive function and includes measures of language, memory and learning, sensorimotor, social perception, and visuospatial processing. Hence, yoga practice improved attention, behavioral control, and higher-level thinking in the kindergarten children.

 

These are exciting results that are similar to those observed with older children. The abilities observed to have improved in the kindergarten children who practiced yoga are abilities that are essential for school performance. Attention is a key ability and that along with an additional reduction in hyperactivity sets the stage for learning. Then improved cognitive ability further heightens learning ability. This suggests that yoga practice has large benefits and should be recommended for young children to promote their ability to learn and perform in school.

 

So, improve attention and hyperactivity in kindergarten children with yoga.

 

“It sounds kind of goofy to people who don’t work with little kids, but kids that have a weak core have a hard time sitting still, and that can look like they’re not paying attention. Those are the kinds of mind-body connections you don’t think about until you start looking into it.” – Chas Zelinsky

 

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

 

Jarraya S, Wagner M, Jarraya M and Engel FA (2019) 12 Weeks of Kindergarten-Based Yoga Practice Increases Visual Attention, Visual-Motor Precision and Decreases Behavior of Inattention and Hyperactivity in 5-Year-Old Children. Front. Psychol. 10:796. doi: 10.3389/fpsyg.2019.00796

 

The present study assesses the impact of Kindergarten-based yoga on cognitive performance, visual-motor coordination, and behavior of inattention and hyperactivity in 5-year-old children. In this randomized controlled trial, 45 children (28 female; 17 male; 5.2 ± 0.4 years) participated. Over 12 weeks, 15 children performed Hatha-yoga twice a week for 30 min, another 15 children performed generic physical education (PE) twice a week for 30 min, and 15 children performed no kind of physical activities, serving as control group (CG). Prior to (T0) and after 12 weeks (T1), all participants completed Visual Attention and Visuomotor Precision subtests of Neuropsychological Evaluation Battery and teachers evaluated children’s behavior of inattention and hyperactivity with the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV. At T0, no significant differences between groups appeared. Repeated measures analysis of variance revealed that following Bonferroni–Holm corrections yoga, in comparison to PE and CG, had a significant positive impact on the development on behavior of inattention and hyperactivity. Further, yoga has a significant positive impact on completion times in two visumotor precision tasks in comparison to PE. Finally, results indicate a significant positive effect of yoga on visual attention scores in comparison to CG. 12 weeks of Kindergarten-based yoga improves selected visual attention and visual-motor precision parameters and decreases behavior of inattention and hyperactivity in 5-year-old children. Consequently, yoga represents a sufficient and cost-benefit effective exercise which could enhance cognitive and behavioral factors relevant for learning and academic achievement among young children.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00796/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_963174_69_Psycho_20190416_arts_A

 

Affect the Brain with Religious Chanting

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Affect the Brain with Religious Chanting

 

By John M. de Castro, Ph.D.

 

“According to a recent medical report, chanting Om has been associated with reducing stress. One of the biggest health benefits of Om chanting is that it brings down stress levels. It provides relief from anxiety and tension. Regular chanting ensures that you feel peaceful from within and are less distracted while doing any form of work.” – Pavankumar elkoochi

 

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

 

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 area. and have found that meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits. What changes in the brain that may occur with chanting are not known.

 

In today’s Research News article “The neurophysiological correlates of religious chanting.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414545/), Gao and colleagues recruited participants who practiced Buddhist chanting for at least one year for 15 minutes per day. The participants were measured for brain electrical activity with the electroencephalogram (EEG) and for cardiac activity with an electrocardiogram (ECG) under 3 conditions, rest, silent Buddhist chanting (religious chanting), and silent chanting Santa Claus (non-religious chanting). One Buddhist monk who had spent years chanting underwent a function Magnetic Resonance Imaging (fMRI) brain scan under similar conditions.

 

They found that the fMRI revealed altered activity in the posterior cingulate cortex during religious vs. non-religious chanting. In the experienced chanters the EEG activity was found to have significantly higher power in the Delta low frequency region (1-4 Hertz) from the posterior cingulate cortex region during religious, but not non-religious chanting. In addition, the ECG had significantly lower power during religious, but not non-religious chanting.

 

These findings are very interesting and suggest that religious chanting has specific effects upon the brain and peripheral nervous system that might explain some of the benefits of this chanting. The lowered cardiac power suggests relaxation and a predominance of the parasympathetic division of the autonomic nervous system. This could in part be responsible for anti-stress effects of meditation practice.

 

The posterior cingulate cortex has been shown through multiple lines of evidence to be involved in self-referential thinking. Delta frequency waves are associated with reduced actual activity as they are increased during light sleep. Hence the results suggest that religious chanting suppresses thinking about the self. This is exactly what most meditation practices attempt to do. The results, then suggest that religious chanting is an effective contemplative practice in altering the brain activity to reduce self-referential thinking and peripheral nervous system activity to increase relaxation.

 

So, affect the brain with religious chanting.

 

“Mantras give the wandering mind a focal point. They produce a beat and a flow that is easy for the mind and body’s energy system to grasp a hold of. When the mind wants to wander out of the meditative state, the mantra helps bring it back.” – EOC

 

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

 

Gao, J., Leung, H. K., Wu, B., Skouras, S., & Sik, H. H. (2019). The neurophysiological correlates of religious chanting. Scientific reports, 9(1), 4262. doi:10.1038/s41598-019-40200-w

 

Abstract

Despite extensive research on various types of meditation, research on the neural correlates of religious chanting is in a nascent stage. Using multi-modal electrophysiological and neuroimaging methods, we illustrate that during religious chanting, the posterior cingulate cortex shows the largest decrease in eigenvector centrality, potentially due to regional endogenous generation of delta oscillations. Our data show that these functional effects are not due to peripheral cardiac or respiratory activity, nor due to implicit language processing. Finally, we suggest that the neurophysiological correlates of religious chanting are likely different from those of meditation and prayer, and would possibly induce distinctive psychotherapeutic effects.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6414545/

 

Become More Sensitive to Others with Meditation

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Become More Sensitive to Others with Meditation

 

By John M. de Castro, Ph.D.

 

“as we pay attention to our breath, our body, our lives, in this simple and gentle way, a natural consequence is the opening of the heart.” – Matthew Brensilver

 

Humans are social animals. This is a great asset for the species as the effort of the individual is amplified by cooperation. In primitive times, this cooperation was essential for survival. But in modern times it is also essential, not for survival but rather for making a living and for the happiness of the individual. This ability to cooperate is so essential to human flourishing that it is built deep into our DNA and is reflected in the structure of the human nervous system. This deep need for positive social interactions heightens the pain of social rejection.

 

Mindfulness has been found to increase prosocial behaviors such as altruism, compassion and empathy and reduce antisocial behaviors such as violence and aggression. In today’s Research News article “Exploring the Role of Meditation and Dispositional Mindfulness on Social Cognition Domains: A Controlled Study.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00809/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_963174_69_Psycho_20190416_arts_A), Campos and colleagues examine the relationship of mindfulness to social cognition, “the mental operations that underlie social interactions, including perceiving, interpreting, and generating responses to the intentions, dispositions, and behaviors of others”.

 

They recruited a group of healthy adult meditation practitioners and a group of non-meditators and had them complete measures of mindfulness, empathy, emotion recognition, theory of mind, attribution style, depression, anxiety, and cognitive impairment. Comparing the two groups they found that the meditators had significantly higher levels of mindfulness, interpersonal reactivity (empathy), emotion recognition, and theory of mind and significantly lower levels of cognitive impairment and lower levels of attribution style, including hostility bias intentionality bias, blame, anger bias, and aggressivity bias. They also found that the higher the levels of mindfulness, particularly the non-reactivity facet of mindfulness, the higher the levels of empathy.

 

This study is cross-sectional and has to be interpreted with caution. The results, however suggest that meditators have higher levels of social cognition. That is, that meditators are much more sensitive to others. This, in turn, improves their ability to understand and interact with others. They also suggest that meditators have a better ability to be non-reactive to what is transpiring in the present moment. This would make them better at responding empathetically to others. Hence, the study suggests that meditation practice may improve the individual’s sensitivity to others.

 

So, become more sensitive to others with meditation.

 

“Learning to communicate with empathy can go a long way toward building more positivity in your relationships and reducing your stress. If we all focused more on listening and understanding each other, the world would be a lot less stressful—and a lot happier—place to live.” – Arthur Ciamamicoli

 

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

 

Campos D, Modrego-Alarcón M, López-del-Hoyo Y, González-Panzano M, Van Gordon W, Shonin E, Navarro-Gil M and García-Campayo J (2019) Exploring the Role of Meditation and Dispositional Mindfulness on Social Cognition Domains: A Controlled Study. Front. Psychol. 10:809. doi: 10.3389/fpsyg.2019.00809

 

Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.

https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00809/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_963174_69_Psycho_20190416_arts_A

 

Relieve Low Back Pain with Yoga

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Relieve Low Back Pain with Yoga

 

By John M. de Castro, Ph.D.

 

“reductions in disability and pain intensity were found despite the reductions in opioid use and other medical and self-help pain treatments at six months. The trial confirms the findings of two prior randomized controlled trials with non-veterans showing that yoga is safe and can reduce pain and disability among adults with chronic low back pain.” – National Pain

 

Low Back Pain is the leading cause of disability worldwide and affects between 6% to 15% of the population. It is estimated, however, that 80% of the population will experience back pain sometime during their lives. But active military and veterans have a higher rate than the general population. There are varied treatments for low back pain including chiropractic care, acupuncture, biofeedback, physical therapy, cognitive behavioral therapy, massage, surgery, opiate pain killing drugs, steroid injections, and muscle relaxant drugs. These therapies are sometimes effective particularly for acute back pain. But, for chronic conditions the treatments are less effective and often require continuing treatment for years and opiate pain killers are dangerous and can lead to abuse, addiction, and fatal overdoses. Obviously, there is a need for safe and effective treatments for low back pain that are low cost and don’t have troublesome side effects.

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga practice has also been shown to be effective for the relief of chronic low-back pain.  Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals. So, it makes sense to further explore the effectiveness of yoga practice for chronic low back pain in military veterans.

 

In today’s Research News article “Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399016/), Groessl and colleagues recruited military veterans with chronic low back pain and randomly assigned them to receive either 12 weeks, twice a week, 60-minutes of hatha yoga practice or to a wait-list control condition. Yoga practice consisted of postures, breathing practice, and focused meditation. They were measured for back-specific functional limitations, pain intensity, and medication use before and after treatment and 3 months later.

 

They found that the veterans who practiced yoga had decreases in functional limitations due to back pain and pain intensity that were significant 3 months after the end of formal yoga practice. Opiate use declined over the trial period, but this was true for both yoga and control groups. Hence, yoga practice was found to be a safe, effective, and lasting treatment for back pain and disability in military veterans who have high rates of chronic low back pain. These results are similar to those seen in other groups of patients suffering from chronic low-back pain. It would be interesting in future research to compare yoga practice to other forms of exercise in relieving back-related disability and pain in a similar group.

 

So, relieve low back pain with yoga.

 

“By demonstrating that yoga is an evidence-based treatment for cLBP in military veterans, complementary and integrative health researchers and [Veterans Affairs] administrators are in a position to begin implementing yoga programs more formally,” – Erik Groessl

 

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

 

Groessl, E. J., Liu, L., Chang, D. G., Wetherell, J. L., Bormann, J. E., Atkinson, J. H., … Schmalzl, L. (2017). Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial. American journal of preventive medicine, 53(5), 599–608. doi:10.1016/j.amepre.2017.05.019

 

Abstract

Introduction:

Chronic low back pain (cLBP) is prevalent, especially among military veterans. Many cLBP treatment options have limited benefits and are accompanied by side effects. Major efforts to reduce opioid use and embrace nonpharmacological pain treatments have resulted. Research with community cLBP patients indicates that yoga can improve health outcomes and has few side effects. The benefits of yoga among military veterans were examined.

Design:

Participants were randomized to either yoga or delayed yoga treatment in 2013–2015. Outcomes were assessed at baseline, 6 weeks, 12 weeks, and 6 months. Intention-to-treat analyses occurred in 2016.

Setting/Participants:

One hundred and fifty military veterans with cLBP were recruited from a major Veterans Affairs Medical Center in California.

Intervention:

Yoga classes (with home practice) were led by a certified instructor twice weekly for 12 weeks, and consisted primarily of physical postures, movement, and breathing techniques.

Main outcome measures:

The primary outcome was Roland–Morris Disability Questionnaire scores after 12 weeks. Pain intensity was identified as an important secondary outcome.

Results:

Participant characteristics were mean age 53 years, 26% were female, 35% were unemployed or disabled, and mean back pain duration was 15 years. Improvements in Roland–Morris Disability Questionnaire scores did not differ between the two groups at 12 weeks, but yoga participants had greater reductions in Roland–Morris Disability Questionnaire scores than delayed treatment participants at 6 months −2.48 (95% CI= −4.08, −0.87). Yoga participants improved more on pain intensity at 12 weeks and at 6 months. Opioid medication use declined among all participants, but group differences were not found.

Conclusions:

Yoga improved health outcomes among veterans despite evidence they had fewer resources, worse health, and more challenges attending yoga sessions than community samples studied previously. The magnitude of pain intensity decline was small, but occurred in the context of reduced opioid use. The findings support wider implementation of yoga programs for veterans.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399016/

 

 

 

Improve Pain, Mental Health and Quality of Life in Cancer Patients with Mindfulness

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Improve Pain, Mental Health and Quality of Life in Cancer Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Results show promise for mindfulness-based interventions to treat common psychological problems such as anxiety, stress, and depression in cancer survivors and to improve overall quality of life.” – Linda E. Carlson

 

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. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. But, surviving cancer carries with it a number of problems. Pain, anxiety, depression, fatigue and insomnia and reduced quality of life are common symptoms in the aftermath of surviving cancer.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, and anxiety and depression. The research is accumulating. So, it is useful to take a step back and look at what has been learned.

 

In today’s Research News article “A Systematic Review: Mindfulness Intervention for Cancer-Related Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371675/), Ngamkham and colleagues review and summarize the high quality published research literature on the application of mindfulness training for the treatment of cancer related pain. They found 6 randomized controlled clinical trials (RCTs). These studies used Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), Breathing Meditation, or Mindful Awareness Practice (MAP) programs as treatments.

 

They found that the published research reports that mindfulness training produces a significant reduction in cancer related pain that was still present 6-months after the training. The research also found significant reductions in anxiety and depression and significant increases in the patient’s quality of life. Hence, mindfulness training was found to be a safe and effective treatment for patients suffering with cancer related pain.

 

It is not known exactly how mindfulness training produces these benefits. It has been shown, however, that in healthy individuals, mindfulness training also produces reductions in pain, anxiety, and depression. It is thought that one way mindfulness training reduces is by reducing worry and rumination which is thought to amplify pain. Mindfulness training has also been shown to improve emotion regulation and reduce response to stress that may also contribute to pain reduction. Regardless mindfulness training should be recommended for cancer patients to reduce pain and improve their well-being.

 

So, improve pain, mental health and quality of life in cancer patients with mindfulness.

 

“Fear. Uncertainty about the future. Some of the most difficult elements of the cancer experience are well-suited for mindfulness.” – Lu Hanessian

 

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

 

Ngamkham, S., Holden, J. E., & Smith, E. L. (2019). A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia-Pacific journal of oncology nursing, 6(2), 161–169. doi:10.4103/apjon.apjon_67_18

 

Abstract

Moderate-to-severe pain is a common problem experienced by patients with cancer. Although analgesic drugs are effective, adverse side effects are common and some analgesic drugs are addictive. Nonpharmacological treatment may be a way to treat cancer pain without causing negative side effects. Mindfulness is used as an effective nonpharmacological treatment to improve quality of life (QoL) and to address psychological problems including distress, anxiety, stress, and depression. However, the effect of mindfulness on pain severity has not been sufficiently investigated. Therefore, a systematic review was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. The search was conducted in PubMed, Ovid MEDLINE, and CINAHL and included only empirical studies published from 2008 to 2017. Search terms included mindfulness, mindfulness-based intervention, meditation, cancer, pain, and cancer-related pain. Six studies met the search criteria. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL. However, most studies reviewed were conducted in the United States and Denmark. Further research is needed to test culturally appropriate mindfulness interventions to reduce pain.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371675/

 

Improve Feedback Learning with Focused Meditation

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Improve Feedback Learning with Focused Meditation

 

By John M. de Castro, Ph.D.

 

“Meditation is a powerful tool for the body and the mind; it can reduce stress and improve immune function. But can it also help us train our minds to learn faster from feedback or information acquired through past experiences?” – Jasmine Collier

 

Learning is fundamental to humans’ ability to survive and adapt in our environments. It is particularly essential in modern environments. Indeed, modern humans need to spend decades learning the knowledge and skills that are needed to be productive. Essential to the learning process is reacting to feedback from the consequences of actions. This is known as the “Law of Effect. Mindfulness is known to improve learning. So, it would seem reasonable to investigate how mindfulness training may improve the ability to respond to the feedback and learn.

 

In today’s Research News article “Meditation experience predicts negative reinforcement learning and is associated with attenuated FRN amplitude.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420441/), Knytl and Opitz recruited healthy adults and separated them into groups who were non-meditators, novice meditators, and experienced meditators. The meditators were practitioners of focused meditation. They performed a probablistic selection task while the electroencephalogram (EEG) was recorded. Event related potentials (ERPs) were recorded in response to the presentation of the symbols.

 

In the probablistic selection task the participants were asked to select between two symbols presented randomly on a computer screen. One symbol, if selected, would produce positive feedback (10 points). Whether that symbol produced the feedback did not occur on every occasion. There were different probabilities of feedback, 20%, 30%, 40%, 60%, 70%, 80%. In the 60% case feedback would occur 6 out of every 10 times the symbol was presented. The participants were not told which symbols would produce positive feedback. They had to discover it themselves.

 

They found that non-meditators were significantly more negatively biased while focused meditators were significantly more positively biased. The non-meditators were better at not responding on trials where there was no positive feedback symbol present while the focused meditators were better at responding on trials where there was a positive feedback symbol present. In addition, they found that the more years of focused meditation experience the larger the difference.

 

In the EEG, the focused meditators had the smallest feedback related negativity (FRN) which involves a greater negative going electrical response of the frontal lobes in the event related potential (ERP) that occurred about a quarter of a second after the stimulus on positive trials than on negative trials. This response is thought to signal reinforcement occurring in the brain systems. In addition, they found that the more years of meditation experience the larger the reduction in the FRN.

 

The study is complicated and the results difficult to interpret, but they suggest that focused meditation experience makes and individual more sensitive to positive reinforcement and less sensitive to negative reinforcement. This bias is reflected in both the behavioral and event related potential data. This suggests that the demonstrated ability of focused meditation training to improve attention ability improves the ability of the meditator to detect stimuli that produce positive reinforcement. This makes meditators better at learning the feedback signals provided by the environment.

 

So, improve feedback learning with focused meditation.

 

“Humans have been meditating for over 2000 years, but the neural mechanisms of this practice are still relatively unknown. These findings demonstrate that, on a deep level, meditators respond to feedback in a more even-handed way than non-meditators, which may help to explain some of the psychological benefits they experience from the practice.” – Paul Knytl

 

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

 

Knytl, P., & Opitz, B. (2018). Meditation experience predicts negative reinforcement learning and is associated with attenuated FRN amplitude. Cognitive, affective & behavioral neuroscience, 19(2), 268–282. doi:10.3758/s13415-018-00665-0

 

Abstract

Focused attention meditation (FAM) practices are cognitive control exercises where meditators learn to maintain focus and attention in the face of distracting stimuli. Previous studies have shown that FAM is both activating and causing plastic changes to the mesolimbic dopamine system and some of its target structures, particularly the anterior cingulate cortex (ACC) and striatum. Feedback-based learning also depends on these systems and is known to be modulated by tonic dopamine levels. Capitalizing on previous findings that FAM practices seem to cause dopamine release, the present study shows that FAM experience predicts learning from negative feedback on a probabilistic selection task. Furthermore, meditators exhibited attenuated feedback-related negativity (FRN) as compared with nonmeditators and this effect scales with meditation experience. Given that reinforcement learning and FRN are modulated by dopamine levels, a possible explanation for our findings is that FAM practice causes persistent increases in tonic dopamine levels which scale with amount of practice, thus altering feedback processing.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420441/

 

Improve Glucose Control in Type 2 Diabetes with Tai Chi Practice

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Improve Glucose Control in Type 2 Diabetes with Tai Chi Practice

 

By John M. de Castro, Ph.D.

 

“Gentle exercise has been shown by studies to prevent diabetes in 60 percent of cases. Therefore, since tai chi is a gentle exercise, we can assume that it’s effective in preventing and improving the control of diabetes.” – Paul Lam

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States have diabetes and the numbers are growing. Type 2 Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is the 7th leading cause of death in the United States. In addition, diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. Qigong and Tai Chi have been practiced for thousands of years with benefits for health and longevity. Qigong and Tai Chi trainings are designed to enhance function and regulate the activities of the body through controlled breathing, mindful concentration, and gentle movements. Diet and exercise are prescribed to treat Type 2 Diabetes.

 

Qigong and Tai Chi are gentle exercises that are potentially useful in treating Type 2 Diabetes. There are many forms of mindful movement and practice can occur with different frequencies and durations. It would be useful to know what types and durations of Tai Chi practice were best for the treatment of Type 2 Diabetes. In today’s Research News article “Different training durations and styles of tai chi for glucose control in patients with type 2 diabetes: a systematic review and meta-analysis of controlled trials.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419417/), Xia and colleagues review, summarize, and perform a meta-analysis of the published controlled research literature on the effectiveness of different types and durations of Tai Chi practice for the treatment of Type 2 Diabetes.

 

They identified 17 research studies that included a comparison, control, group. They report that the research finds that in general Tai Chi practice produces significant improvements in the metabolic profile of Type 2 Diabetes patients including a significant reduction in fasting blood glucose levels, plasma HbA1c, total cholesterol, triglycerides, and body mass index (BMI). For fasting blood glucose levels, plasma HbA1c these reductions were greatest when Tai Chi had been practiced for at least 3 months. These differences were not significant for Yang style movements of Tai Chi, but were significant for other Tai Chi styles.

 

These results suggest that only certain styles of Tai Chi practiced for at least 3 months are effective in treating Type 2 diabetes. These are useful findings that further clarify what are the most effective parameters for Tai Chi practice for treating Type 2 diabetes. It is important to recognize that Tai Chi is a gentle and safe exercise that is appropriate for all ages including the elderly and for individuals with illnesses. Also, Tai Chi is inexpensive to administer, can be performed in groups or alone, at home or in a facility, and can be quickly learned. In addition, it can be practiced in social groups. This can make it fun, improving the likelihood of long-term engagement in the practice. So, Tai Chi practice would appear to be an almost ideal gentle exercise to treat Type 2 Diabetes.

 

So, improve glucose control in Type 2 Diabetes with Tai Chi practice.

 

“According to two small studies, Tai Chi exercises can improve blood glucose levels and improve the control of type 2 diabetes and immune system response.” – Anna Sophia McKenney

 

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

 

Xia, T. W., Yang, Y., Li, W. H., Tang, Z. H., Li, Z. R., & Qiao, L. J. (2019). Different training durations and styles of tai chi for glucose control in patients with type 2 diabetes: a systematic review and meta-analysis of controlled trials. BMC complementary and alternative medicine, 19(1), 63. doi:10.1186/s12906-019-2475-y

 

Abstract

Background

Physical activity is an important part of the diabetes management plan. However, the effects caused by different training durations and styles of Tai Chi have not been evaluated. We conducted an updated systematic review of the effects of Tai Chi on patients with type 2 diabetes based on different training durations and styles.

Methods

We performed a search for Chinese and English studies in 8 databases. Two reviewers independently selected the eligible trials and conducted a critical appraisal of the methodological quality.

Results

Seventeen trials were included. Tai Chi was found to have reduced fasting blood glucose (FBG) [SMD = − 0.54, 95% CI (− 0.91, − 0.16), P = 0.005] and HbA1c [SMD = − 0.68, 95% CI (− 1.17, − 0.19), P = 0.006] overall, compared with a control group. Considering the subgroup analysis, the pooled results showed that 24 movements or Yang-style Tai Chi did not significantly reduce FBG after a duration of ≤3 months [SMD = − 0.46, 95% CI (− 1.42, 0.50), P = 0.35] or > 3 months [SMD = − 0.50, 95% CI (− 1.49, 0.49), P = 0.32], nor did it reduce HbA1c [SMD = − 1.22, 95% CI (− 2.90, 0.47), P = 0.16] after a duration > 3 months in all studies. However, other styles of Tai Chi significantly reduced FBG [SMD = − 0.90, 95% CI (− 1.28, − 0.52), P < 0.00001] and HbA1c [SMD = − 0.90, 95% CI (− 1.28, − 0.52), P < 0.00001] after a duration > 3 months, while no significant reduction in FBG [SMD = − 0.34, 95% CI (− 0.76, 0.08), P = 0.12] or HbA1c [SMD = − 0.34, 95% CI (− 0.76, 0.08), P = 0.12] was found after a duration ≤3 months.

Conclusions

Tai Chi seems to be effective in treating type 2 diabetes. Different training durations and styles result in variable effectiveness. The evidence was insufficient to support whether long-term Tai Chi training was more effective.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419417/

 

Lower Body Weight and Improve Heart Health with Yoga

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Lower Body Weight and Improve Heart Health with Yoga

 

By John M. de Castro, Ph.D.

 

“A large number of studies show that yoga benefits many aspects of cardiovascular health. There’s been a major shift in the last five years or so in the number of cardiologists and other professionals recognizing that these benefits are real.” – Hugh Calkins

 

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” (Centers for Disease Control). A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Cardiac rehabilitation programs for patients recovering from a heart failure, emphasize these lifestyle changes. Unfortunately, for a variety of reasons, 60% of heart failure patients decline participation, making these patients at high risk for another attack.

 

Safe and effective alternative treatments for cardiovascular disease are contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. These practices have also been shown to be helpful for producing the kinds of lifestyle changes needed to prevent heart disease such as smoking cessation, weight reduction, and stress reduction. Indeed, yoga practice is both a mindfulness training technique and a physical exercise. As such, it would seem particularly interesting to explore as a treatment to reduce the risk of cardiovascular disease.

 

In today’s Research News article “A Comparison of Blood Viscosity and Hematocrit Levels between Yoga Practitioners and Sedentary Adults. International journal of exercise science.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413846/), Shadiow and colleagues recruited adults who had practiced Hatha Yoga for at least 3 years and sedentary individuals who had not exercised in at least the last 6 months. After a 12 hour fast and 24 hours without exercise the participants were measured for body size, blood pressure, and blood was drawn for assays of blood viscosity and hematocrit.

 

They found, not surprisingly, that the yoga practitioners had significantly lower body weights and Body Mass Indices (BMIs). Importantly, the yoga practitioners had significantly lower blood viscosity values than the sedentary individuals. Low blood viscosity is associated with cardiac health. So, the results suggest that consistent long-term yoga practice in healthy individuals reduces body size and improves indicators of heart health. These conclusions need to be tempered with the understanding that this was a cross-sectional study that is open to alternative explanations. But, the results support conducting a randomized controlled clinical trial to definitively ascertain the effects of yoga practice on weight and heart health.

 

So, lower body weight and improve heart health with yoga.

 

“people who took yoga classes saw improvements in a number of factors that affect heart disease risk. They lost an average of five pounds, shaved five points off their blood pressure, and lowered their levels of harmful LDL cholesterol by 12 points.” – Julie Corliss

 

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

 

Shadiow, J., Tarumi, T., Dhindsa, M., & Hunter, S. D. (2019). A Comparison of Blood Viscosity and Hematocrit Levels between Yoga Practitioners and Sedentary Adults. International journal of exercise science, 12(2), 425–432.

 

Abstract

Elevations in whole blood viscosity (WBV) and hematocrit (Hct), have been linked with increased risk of cardiovascular disease (CVD). Endurance training has been demonstrated to lower WBV and Hct; however, evidence supporting the efficacy of yoga on these measures is sparse. A cross-sectional study was conducted examining WBV and Hct levels between yoga practitioners with a minimum of 3 years of consistent practice and sedentary, healthy adults. Blood samples were collected from a total of 42 participants: 23 sedentary adults and 19 regular yoga practitioners. Brachial arterial blood pressure (BP) was measured and the averages of 3 measures were reported. The yoga practitioner group had significantly lower WBV at 45 s−1 (p < 0.01), 90 s−1 (p < 0.01), 220 s−1 (p < 0.05), and 450 s−1 (p < 0.05) than sedentary participants. No significant group differences in Hct (p =0.38) were found. A tendency toward lower systolic BP (p=0.06) was observed in the yoga practitioner group; however, no significant group differences in BP were exhibited. A consistent yoga practice was associated with lower WBV, a health indicator related to CVD risk. These findings support a regular yoga practice as a valid form of exercise for improving rheological indicators of cardiovascular health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413846/