Increase Wellness and Decrease Burnout in Medical Students with Mindfulness

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Increase Wellness and Decrease Burnout in Medical Students with Mindfulness

 

By John M. de Castro, Ph.D.

 

“training in mindfulness – focusing controlled attention on physical sensations, thoughts, and emotions in the present moment – helps students to acknowledge and process the stresses and strains of their work.” – Cathy Kerr

 

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. Currently, over a third of healthcare workers report that they are looking for a new job. 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 as it 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. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. It would be best to provide techniques to combat burnout early in a medical career. Medical School is extremely stressful and many students show distress and express burnout symptoms. Medical school may be an ideal time to intervene.

 

In today’s Research News article “A Targeted Mindfulness Curriculum for Medical Students During Their Emergency Medicine Clerkship Experience.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040904/ ), Chung and colleagues in an uncontrolled pilot study delivered a mindfulness curriculum to students during their training in emergency medicine. The training was delivered in 4-weekly 60 minute sessions that included meditation practice, readings, journaling, discussion, and developing a personal wellness plan. They completed questionnaires before and after the 4 weeks of training and 6 months later regarding the impact of the training on their behavior and attitudes.

 

They found that in comparison to baseline, after training there were significant improvements in self-reported behaviors and attitudes. The students reported increased confidence in their ability to meditate and be mindful, explain these skills to others, and recommend these practices to others. They also reported that they practiced meditation and mindfulness more often and talked to others about these practices. In addition, they reported that wellness was important to medical students and that they were using their own wellness plan. Importantly, these improvements were still present 6 months after the completion of the training.

 

These are very preliminary results from an uncontrolled pilot study and need to be verified in a randomized controlled trial with objective measures of wellness and resistance to stress. Previous controlled studies, however, have shown that mindfulness training is effective in treating and preventing burnout and reducing the psychological and physiological responses to stress. So, these present results are suggestive that this simple brief curriculum may produce similar benefits.

 

It is important to use a brief training and this one only involved 4 hours of formal instruction. Medical students have a vast amount of important information to learn and master in a limited amount of time. They do not have the luxury of unused time for extensive instruction. So, a brief training that produces positive results that persist could be very valuable to their health and well-being during this stressful time and during a stressful career.

 

So, increase wellness and decrease burnout in medical students with mindfulness.

 

“I have taken my own advice. I am still at it: sitting on the deck, focusing on my breath, watching my thoughts, clearing my mind amid the shrill end-of-summer calls of the cicadas. I think I have noticed an effect — I feel a deeper sense of acceptance in my life, without losing a passion or resolve to change things for the better.” – Manoj Jain

 

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

 

Chung, A. S., Felber, R., Han, E., Mathew, T., Rebillot, K., & Likourezos, A. (2018). A Targeted Mindfulness Curriculum for Medical Students During Their Emergency Medicine Clerkship Experience. The western journal of emergency medicine, 19(4), 762-766.

 

Abstract

Introduction

Despite high rates of burnout in senior medical students, many schools provide the majority of their wellness training during the first and second preclinical years. Students planning a career in emergency medicine (EM) may be at particularly high risk of burnout, given that EM has one of the highest burnout rates of all the specialties in the United States We developed an innovative, mindfulness-based curriculum designed to be integrated into a standard EM clerkship for senior medical students to help students manage stress and reduce their risk of burnout.

Methods

The curriculum included these components: (1) four, once-weekly, 60-minute classroom sessions; (2) prerequisite reading assignments; (3) individual daily meditation practice and journaling; and (4) the development of a personalized wellness plan with the help of a mentor. The design was based on self-directed learning theory and focused on building relatedness, competence, and autonomy to help cultivate mindfulness.

Results

Thirty students participated in the curriculum; 20 were included in the final analysis. Each student completed surveys prior to, immediately after, and six months after participation in the curriculum. We found significant changes in the self-reported behaviors and attitudes of the students immediately following participation in the curriculum, which were sustained up to six months later.

Conclusion

Although this was a pilot study, our pilot curriculum had a significantly sustained self-reported behavioral impact on our students. In the future, this intervention could easily be adapted for any four-week rotation during medical school to reduce burnout and increase physician wellness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040904/

Improve Mental Health and Well-Being with Smartphone APP Mindfulness Training

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Improve Mental Health and Well-Being with Smartphone APP Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“The seemingly simple act of mindfulness may help reduce the impact of stress, anxiety, depression, and chronic pain. Mindfulness is the act of paying attention to moments of experience with an accepting and friendly attitude so as to observe with all the senses what is happening in each moment. The practice of mindfulness is an effective means of enhancing and maintaining optimal mental health and overall well-being.” – APA

 

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. The vast majority of the mindfulness training techniques, however, require a certified trained therapist. This results in costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules and at locations that may not be convenient. As an alternative, Mindfulness training programs over the internet and with smartphone apps have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. These online and smartphone app trainings have been shown to be effective. But the question arises as to the relative effectiveness of various online and mobile trainings in inducing mindfulness and improving psychological health.

 

In today’s Research News article “Efficacy and Moderation of Mobile App-Based Programs for Mindfulness-Based Training, Self-Compassion Training, and Cognitive Behavioral Psychoeducation on Mental Health: Randomized Controlled Noninferiority Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231823/ ), Mak and colleagues compared the efficacy of 3 smartphone aps that trained for either mindfulness, self-compassion, or cognitive behavioral psychoeducation, to improve mental health and well-being in adults.

 

They recruited adults online and randomly assigned each to one of the three trainings. The participants downloaded the apps for their smartphones. The trainings were delivered in 28 daily sessions. The mindfulness exercises, included body scan, mindful breathing, mindful eating, and mindful walking. Self-Compassion training consisted compassionate body scan, affectionate breathing, loving-kindness meditation for beginners, compassionate walking, soften-allow-soothe, self-compassion break, and self-compassion journaling. Cognitive behavioral psychoeducation included relaxation skills, coping strategies for stress, problem-solving skills, emotional management skills, and cognitive strategies for negative thoughts.

 

The participants completed online measures of mental well-being, psychological distress, mindfulness, self-compassion, discomfort with emotions, ambiguity tolerance, program satisfaction, and utilization before and after training and 3 months later. There were, unfortunately relatively low participation rates with 28% of the recruited participants who downloaded the apps never activated them. Of those that did only 24% completed their program and only 17% completed the follow-up measures. Most of the attrition occurred in the first week.

 

They found that all three trainings produced significant enhancements of mental well-being and mindfulness and significant reductions in psychological distress that persisted at the 3-month follow-up. Self-compassion, and cognitive behavioral psychoeducation trainings, but not mindfulness, resulted in higher self-compassion at the end of training but this was no longer significant at follow-up.

 

This study did not have a control condition for comparison, so the conclusions have to be tempered with the understanding that contaminants such as placebo effects, and time and practice-based contaminants might be responsible for the results. In addition, the high attrition rates may be responsible for the results as those who were not helped by the apps terminated participation leaving only those who were improving left in the sample.

 

On the other hand, other controlled studies have demonstrated the efficacy of mindfulness and self-compassion trainings and cognitive behavioral psychoeducation in improving psychological health and well-being. So, the results from the present study are likely due to the trainings and not contaminants. Hence, these findings are suggestive that the three smartphone apps are able to improve the mental health and well-being of otherwise normal adults. This is important as being able to deliver these trainings over smartphones allows for the distribution of these mental health improving programs economically to widespread audiences.

 

So, improve mental health and well-being with smartphone app mindfulness training.

 

“Fine-tuning which type of mindfulness or meditation someone uses as a prescriptive to treat a specific need will most likely be the next big advance in the public health revolution of mindfulness and meditation. Stay tuned!” – Christopher Bergland

 

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

 

Mak, W. W., Tong, A. C., Yip, S. Y., Lui, W. W., Chio, F. H., Chan, A. T., & Wong, C. C. (2018). Efficacy and Moderation of Mobile App-Based Programs for Mindfulness-Based Training, Self-Compassion Training, and Cognitive Behavioral Psychoeducation on Mental Health: Randomized Controlled Noninferiority Trial. JMIR mental health, 5(4), e60. doi:10.2196/mental.8597

 

Abstract

Background

Mindfulness-based interventions, self-compassion training, and cognitive behavioral therapy have garnered much evidence in its salutary effects on mental health. With increasing application of smartphone and mobile technology on health promotion, this study investigated the efficacy and possible moderators of mindfulness, self-compassion, and cognitive behavioral psychoeducation training mobile apps in the improvement of mental health.

Objective

The aim of this study was to examine the efficacy of 3 mobile app–based programs: mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation program in improving mental well-being and reducing psychological distress. Changes in mindful awareness and self-compassion were also assessed. To further delineate the suitability of each program for different types of individuals, individual difference variables (ie, discomfort with emotions and tolerance for ambiguity) were explored for potential moderation.

Methods

This study was a 3-arm, randomized, controlled, noninferiority trial examining the efficacy of mindfulness-based program, self-compassion program, and cognitive behavioral psychoeducation. Participants were randomized into either 1 of the 3 conditions. Throughout the 4-week, 28-session program, participants spent 10-15 min daily reviewing the course content and practicing various related exercises. At preprogram, postprogram, and 3-month follow-up, participants also completed Web-based measures of mental well-being, psychological distress, mindful-awareness, and self-compassion as well as the proposed moderators.

Results

Among the 2161 study participants, 508 and 349 completed the post- and 3-month follow-up assessment, respectively. All 3 conditions (mindfulness-based program: N=703; cognitive behavioral psychoeducation: N=753; self-compassion program: N=705) were found to be efficacious in improving mental well-being and reducing psychological distress. All conditions enhanced mindful awareness at postprogram. Significant interaction effect was found on self-compassion; cognitive behavioral psychoeducation and self-compassion program, but not mindfulness-based program, significantly enhanced self-compassion at postprogram. No significant differences regarding usage and users’ satisfaction were found among the 3 conditions. None of the proposed moderators were found to be significant.

Conclusions

Mindfulness-based, self-compassion, and cognitive behavioral psychoeducation mobile apps were efficacious in improving mental well-being and reducing psychological distress among adults at postprogram and 3-month follow-up. Future app-based psychological training programs should consider gamification and personalization of content or feedback to enhance engagement and mitigate the high attrition rates that are common in app-based health promotion programs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231823/

 

Compulsive Sexual Behavior is Related to Shame and Low Mindfulness

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Compulsive Sexual Behavior is Related to Shame and Low Mindfulness

 

By John M. de Castro, Ph.D.

 

“In addition to helping bring about a reduction in dysfunctional sex-related actions, fantasies and thoughts, mindfulness training may help affected individuals gain improved emotional control, an increased ability to handle stressful situations and improved resistance to any potentially damaging sex-related urges that arise.” – The Ranch

 

Sexual behavior is a very important aspect of human behavior, especially for reproduction. In fact, Sigmund Freud made it a centerpiece of his psychodynamic theory. At its best, it is the glue that holds families and relationships together. But it is a common source of dysfunction and psychosocial problems. Compulsive sexual behavior “encompasses problems with preoccupation with thoughts surrounding sexual behavior, loss of control over sexual behavior, disturbances in relationships due to sexual behavior, and disturbances in affect (e.g., shame) due to sexual behavior.” It is also called sex addiction and hypersexuality. It is chronic and remarkably common affecting 3% to 17% of the population. In addition, it is associated with substance abuse in around half of people with compulsive sexual behavior.

 

Compulsive sexual behavior is frequently treated with psychotherapy, Cognitive Behavioral, Therapy, or drugs with mixed success. Since, it is also looked at as an addiction and mindfulness treatment has been found to be effective for both sexual dysfunction and for addictions, mindfulness may be affective for individuals with both substance abuse and compulsive sexual behavior. Indeed, mindfulness has been shown to be related to compulsive sexual behavior in men undergoing treatment for substance abuse. This suggests that further study of the relationship between mindfulness and compulsive sexual behavior should be investigated.

 

In today’s Research News article “Dispositional Mindfulness, Shame, and Compulsive Sexual Behaviors among Men in Residential Treatment for Substance Use Disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764544/ ), Brem and colleagues examined the medical records of men in residential treatment for substance abuse looking at measures of mindfulness, compulsive sexual behavior, shame, alcohol use and associated problems, and drug use and associated problems. They examined the relationships between the variables with hierarchical multiple regressions.

 

They found that for these men in residential treatment for substance abuse, the higher the levels of mindfulness the lower the levels of compulsive sexual behavior, shame, alcohol use and associated problems, and drug use and associated problems. Hence mindfulness appears to be associated with lower levels of problems associated with substance abuse. In addition, they found that the higher the levels of compulsive sexual behavior, the higher the levels of shame and alcohol use and associated problems. Significantly, men who engaged in compulsive sexual behavior were more likely to experience shame when mindfulness was low. With average and high levels of mindfulness, compulsive sexual behavior was not related to shame.

 

Hence it appears that mindfulness not only is associated with lower shame but that it also appears to inoculate men who demonstrate compulsive sexual behavior from feelings of shame. Shame appears to interfere with successful treatment for substance abuse. Being ashamed increases negative feelings about the self and success in treatment is aided by positive feelings about the self.  So, these results suggest that being mindful may be an asset encouraging successful treatment for substance abuse in part by reducing the feelings of shame that interfere with success.

 

So, reduce compulsive sexual behavior by reducing shame with mindfulness.

 

“The greatest aid has been, and is, the knowledge and application of mind body awareness (or mindfulness, consciousness). It was the realisation about the nature of the relationship between me (the observer) and my mind which gave me the greatest insight and a powerful tool to overcome the negative behaviour patterns that sexual addiction creates. And I am still learning everyday!” – Sex Addict

 

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

 

Brem, M. J., Shorey, R. C., Anderson, S., & Stuart, G. L. (2017). Dispositional Mindfulness, Shame, and Compulsive Sexual Behaviors among Men in Residential Treatment for Substance Use Disorders. Mindfulness, 8(6), 1552-1558.

 

Abstract

Approximately 31% of men in treatment for a substance use disorders (SUD) engage in compulsive sexual behavior (CSB). Shame, a well-documented consequence of CSB, increases the likelihood of relapse following treatment for SUDs. Despite the risk of relapse, prior research has not investigated factors that may attenuate the relation between CSB and shame. Dispositional mindfulness is one such factor known to mitigate shame. However, researchers have yet to examine dispositional mindfulness as a moderator of the relationship between CSB and shame among a sample of men in treatment for SUDs. In an effort to inform intervention efforts, the present study aimed to investigate the hypothesis that CSB would not relate to shame among men with high, as opposed to low, levels of dispositional mindfulness. The present study reviewed medical records of 184 men in residential treatment for SUDs who completed cross-sectional measures of shame, CSB, dispositional mindfulness, and substance use problems. Results demonstrated a significant interaction between CSB and dispositional mindfulness such that CSB positively related to shame at low, but not mean or high, levels of dispositional mindfulness. These results support and extend previous mindfulness and CSB treatment research. Findings suggested that intervention efforts for CSB may benefit from increasing dispositional mindfulness in an effort to reduce shame-related cognitions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764544/

 

Mindfulness Improves Depression by Affecting Trait Anxiety

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Mindfulness Improves Depression by Affecting Trait Anxiety

 

By John M. de Castro, Ph.D.

 

“When you become aware of the present moment, you gain access to resources you may not have had before. You may not be able to change a situation, but you can mindfully change your response to it. You can choose a more constructive and productive way of dealing with stress rather than a counterproductive or even destructive way of dealing with it.” – Mindful

 

A characterizing feature of anxiety disorders is recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Indeed, Mindfulness practices have been shown to be quite effective in relieving anxiety. Anxiety often co-occurs with depression. Mindfulness training is also effective for treating depression. Anxiety disorders and depression have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders and for depression either alone or in combination with other therapies. The fact that anxiety and depression occur together so often suggests that they may be linked and mindfulness training may affect that linkage.

 

In today’s Research News article “The Factorial Structure of Trait Anxiety and Its Mediating Effect Between Mindfulness and Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212471/ ), Wang and colleagues recruited college students with depression and measured before and after training for trait anxiety, depression and mindfulness. A second set of students were provided with an 8-week program of Mindfulness-Based Cognitive Therapy (MBCT). It met once a week for 2.5 hours.  MBCT was developed specifically to treat depression. It involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. These students were measured before and after training for trait anxiety, depression and mindfulness.

 

They then performed a factor analysis of the trait anxiety scale from the untreated group of students and identified two distinct factors; Trait Anxiety Present and Trait Anxiety Absent. They found that the higher the level of mindfulness the lower the levels of depression and both of the trait anxiety factors. In addition, the higher the levels of both of the trait anxiety factors, the higher the levels of depression. So, trait anxiety and depression covaried and mindfulness was associated with lower levels of these psychological issues. In a mediation analysis they discovered that the association of mindfulness with lower depression was mediated by the two trait anxiety factors. In other words, mindfulness was associated with lower trait anxiety and this was in turn associated with lower levels of depression.

 

In the second group of students they found that MBCT training resulted in significantly lower levels of depression and both trait anxiety factors. Importantly, after MBCT training the mediational relationship of mindfulness to trait anxiety to depression was still present. So, the training lowered levels of anxiety and depression but did not change their relationships with mindfulness, with trait anxiety changes associated with the changes in depression.

 

These results are interesting and suggest a high degree of relationship between trait anxiety and depression. This could represent a conceptual overlap in that both involve rumination regarding past events. On the other hand, it could indicate that anxiety and depression are separate but linked. Perhaps, feeling chronic anxiety may lead to depression. This would explain the mediation analysis wherein high mindfulness is associate with low anxiety and this tends to relieve depression.

 

So, mindfulness improves depression by affecting trait anxiety.

 

“mindfulness-based practices have proved to be helpful in promoting mental well-being, especially by reducing the symptoms of depression and anxiety in various populations. For people with medicine noncompliance issues or people unwilling to start formal psychotherapy, mindfulness-based therapies could be a beneficial alternative to consider.” Han Ding

 

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

 

Wang, T., Li, M., Xu, S., Jiang, C., Gao, D., Wu, T., Lu, F., Liu, B., … Wang, J. (2018). The Factorial Structure of Trait Anxiety and Its Mediating Effect Between Mindfulness and Depression. Frontiers in psychiatry, 9, 514. doi:10.3389/fpsyt.2018.00514

 

Abstract

Background: Increasing studies have found that high trait anxiety is a key susceptibility phenotype that causes depression. Mindfulness-based interventions can target on dealing with depressogenic vulnerability effectively. Evidence indicates that trait anxiety could affect the trajectory of anti-depressive psychotherapy, and play an important role in the relationship between mindfulness and depression. Furthermore, related studies have found that trait anxiety could involve factors beyond anxiety and be a two-factor construct instead of one-dimensional concept. This viewpoint provides a new prospective for exploring the pathways of the two factors of trait anxiety in the complex relationship and further understand the potential mechanism of vulnerable personality mediated the link of mindfulness and depression.

Methods: A cross-sectional survey and a preliminary intervention study were conducted. Thousand two hundred and sixty-two subjects completed a set of self-reported questionnaires that evaluated trait anxiety, mindfulness, and depressive symptoms. Twenty-Three eligible participants with depression were recruited to attend mindfulness-based cognitive training for eight weeks. The same questionnaires were completed 1 week before the training and 6 months after the training. Factor analysis was performed on the 1262-subject sample to explore and confirm the factorial structure of trait anxiety. In addition, mediating effect analysis was conducted in the two studies to test whether two factors of trait anxiety were mediators of the relationship between mindfulness and depression.

Results: The exploratory factor analysis extracted two dimensions of trait anxiety, namely, trait anxiety-present factor (TA-P) and trait anxiety-absent factor (TA-A). And confirmatory factor analysis showed that the fit of the two-factor model was acceptable. Both TA-P and TA-A were significantly negatively correlated with mindfulness and positively correlated with depression, and they played a mediating role between mindfulness and depression. The two factors of trait anxiety had multiple mediating effects on the relationship between mindfulness and depression, and the mediating effect of the TA-P factor was stronger than that of the TA-A factor.

Conclusion: Our results demonstrated a two-factor model of trait anxiety in the Chinese population. TA-P and TA-A played a multiple mediating role in the relationship between mindfulness and depression. The findings provide new perspectives for psychological interventions to treat depression for people with susceptible personalities. Aiming to reduce negative emotional tendencies (TA-P factor) and enhance positive cognition (TA-A factor) may achieve the early prevention and efficient treatment of depression.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212471/

 

Improve Bipolar Disorders in Low and Middle Income Countries with Mindfulness

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Improve Bipolar Disorders in Low and Middle Income Countries with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness-based cognitive therapy appears to have lasting benefits for people with bipolar disorder, , , incorporating mindfulness practices and mindful breathing into daily life on a regular basis was associated with better prevention of depressive relapse.” – Mahesh Agrawal

 

Bipolar Disorder, also known as Manic Depressive Disorder, is a mood disorder characterized by alternating states of extreme depression, relative normalcy, and extreme euphoria (mania). The symptoms of depression and mania are so severe that the individual is debilitated and unable to conduct their normal daily lives. The depression is so severe that suicide occurs in about 1% of cases of Bipolar Disorder. There are great individual differences in Bipolar Disorder. The extreme mood swings can last for a few days to months and can occur only once or reoccur frequently.

 

Bipolar Disorder affects about 1% of the population throughout the world at any time. But about 3% to 10% of the population may experience it sometime during their lives. It is usually treated with drugs. But these medications are not always effective and can have difficult side effects. Hence, there is a great need for alternative treatments. Mindfulness practices and treatments have been shown to be effective for major mental disorders, including depression and anxiety disorders and to improve the regulation of emotions. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed for the treatment of depression and has been shown to be very effective.

 

There are a number of alternative treatments including mindfulness that have been shown to be effective for bipolar disorder in developed affluent countries. But bipolar disorder knows no borders. Countries with less affluent citizens are just as likely to suffer from bipolar disorder but may react differently to these treatments. Hence, there is a need to assesses the effectiveness of these alternative treatments on bipolar disorder in middle and low income countries.

 

In today’s Research News article “Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127962/ ), Demissie and colleagues review and summarize the published research literature on the effectiveness of alternative treatments for bipolar disorder in countries with middle to low general income levels. They examined randomized controlled research studies that employed “any psychological intervention delivered either face to face (individual or group format) or online.” These included psychoeducation, family therapy, Cognitive Behavioral Therapy (CBT), or Mindfulness-Based Cognitive Therapy (MBCT).

 

They identified 18 studies 15 of which included psychoeducation, 2 CBT and 1 MBCT. They report that psychoeducation was effective in preventing relapse and improving treatment adherence while CBT was effective in prolonging the period of remission. All three intervention types were effective in reducing psychiatric symptoms and MBCT was also effective in promoting emotion regulation and mindfulness.

 

These studies suggest that alternative treatments are effective in treating bipolar disorder in middle and low income countries as they are in affluent countries. Psychoeducation appears well studied and effective. There were, however, only 2 studies with CBT and only 1 with MBCT. They suggest efficacy. But much more research is needed particularly comparing the different adjunctive treatments to determine which produce the greatest improvements alone or in combination with drugs.

 

So, improve bipolar disorders in low and middle income countries with psychoeducation, cognitive therapy, or mindfulness.

 

“Even though it’s not a cure for bipolar disorder, meditation can help you relax and reduce stress. It can also help you disengage from stressful or anxious thoughts, and better control your mood.” – Anthony Watt

 

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

 

Demissie, M., Hanlon, C., Birhane, R., Ng, L., Medhin, G., & Fekadu, A. (2018). Psychological interventions for bipolar disorder in low- and middle-income countries: systematic review. BJPsych open, 4(5), 375-384. doi:10.1192/bjo.2018.46

 

Abstract

Background

Adjunctive psychological interventions for bipolar disorder have demonstrated better efficacy in preventing or delaying relapse and improving outcomes compared with pharmacotherapy alone.

Aims

To evaluate the efficacy of psychological interventions for bipolar disorder in low- and middle-income countries.

Method

A systematic review was conducted using PubMed, PsycINFO, Medline, EMBASE, Cochrane database for systematic review, Cochrane central register of controlled trials, Latin America and Caribbean Center on Health Science Literature and African Journals Online databases with no restriction of language or year of publication. Methodological heterogeneity of studies precluded meta-analysis.

Results

A total of 18 adjunctive studies were identified: psychoeducation (n = 14), family intervention (n = 1), group cognitive–behavioural therapy (CBT) (n = 2) and group mindfulness-based cognitive therapy (MBCT) (n = 1). In total, 16 of the 18 studies were from upper-middle-income countries and none from low-income countries. All used mental health specialists or experienced therapists to deliver the intervention. Most of the studies have moderately high risk of bias. Psychoeducation improved treatment adherence, knowledge of and attitudes towards bipolar disorder and quality of life, and led to decreased relapse rates and hospital admissions. Family psychoeducation prevented relapse, decreased hospital admissions and improved medication adherence. CBT reduced both depressive and manic symptoms. MBCT reduced emotional dysregulation.

Conclusions

Adjunctive psychological interventions alongside pharmacotherapy appear to improve the clinical outcome and quality of life of people with bipolar disorder in middle-income countries. Further studies are required to investigate contextual adaptation and the role of non-specialists in the provision of psychological interventions to ensure scalability and the efficacy of these interventions in low-income country settings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127962/

 

Improve Balance in Stroke Victims with Tai Chi Practice

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Improve Balance in Stroke Victims with Tai Chi Practice

 

By John M. de Castro, Ph.D.

 

“Stroke can impair balance, heightening the risk of a debilitating fall. But  . . .  stroke survivors can improve their balance by practicing the Chinese martial art of tai chi.” – ScienceDaily

 

Every year, more than 795,000 people in the United States have a stroke and it is the third leading cause of death, killing around 140,000 Americans each year. A stroke results from an interruption of the blood supply to the brain, depriving it of needed oxygen and nutrients. This can result in the death of brain cells and depending on the extent of the damage produce profound loss of function. Even after recovery from stroke patients can experience residual symptoms. Problems with balance and falling are very common.

 

There are a number of risk factors for stroke that are unchangeable, such as family history, age, and genes. But there are a very large number of factors that are under our control including high blood pressure, smoking, high cholesterol, poor diet, sedentariness, and obesity. Given this list it is clear that basic physical fitness and exercise would be excellent for stroke prevention. Yoga practice is an exercise that can be adapted to the needs and limitations of stroke victims. The ancient mindful movement technique Tai Chi and Qigong are very safe forms of gentle exercise that appears to be beneficial for stroke victims including improving balance. It is difficult to get stroke survivors to engage in exercise. Perhaps the practice of Tai Chi , since it is adaptable, very gentle, and fun, might be acceptable and effective in the treatment of stroke survivors.

 

In today’s Research News article “Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289026/ ), Wu and colleagues review summarize and perform a meta-analysis of the published research literature on the effectiveness of Tai Chi in improving balance and preventing falls in stroke survivors. They identified 6 randomized controlled trials for inclusion in the analysis.

 

They found that the published research reported that after Tai Chi practice the stroke victims demonstrated significantly better balance and walking ability and fewer falls than stroke victims who performed physical therapy or other exercises. Hence, the published research supports the conclusion that Tai Chi practice is a safe and effective exercise for stroke victims to improve balance and decrease the likelihood of falls.

 

Tai Chi is a gentle and safe exercise that is appropriate for all ages including the elderly and for individuals with illnesses that limit their activities or range of motion, such as stroke recovery. 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 improve motor ability and balance and reduce falls in stroke victims.

 

So, improve balance in strike victims with tai chi practice.

 

“Stroke survivors are particularly at risk from falls, with evidence suggesting they suffer up to seven times as many falls per year than healthy adults. Tai Chi, an ancient Chinese martial art, could help prevent falls by improving people’s balance, muscle strength and endurance as well as providing psychological benefits.“ – Ruth Taylor-Piliae

 

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

 

Wu, S., Chen, J., Wang, S., Jiang, M., Wang, X., & Wen, Y. (2018). Effect of Tai Chi Exercise on Balance Function of Stroke Patients: A Meta-Analysis. Medical science monitor basic research, 24, 210-215. doi:10.12659/MSMBR.911951

 

Abstract

Background

Tai Chi is an ancient form of physical activity that has been shown to improve cardiovascular function, but to date there had been no comprehensive systematic review on the effect of Tai Chi exercise on balance function of patients with stroke. This study evaluated the effect of Tai Chi exercise on balance function in stroke patients.

Material/Methods

PubMed, Cochrane library, and China National Knowledge Information databases and the Wan Fang medical network were searched to collect the articles. The random-effects model was used to assess the effect of Tai Chi exercise on balance function of stroke patients.

Results

Six studies were chosen to perform the meta-analysis according to the inclusion and exclusion criteria. There were significant improvements of balance on Berg Balance Scale score (MD=4.823, 95% CI: 2.138–7.508), the standing balance with fall rates (RR=0.300, 95%CI: 0.120–0.770), functional reach test and dynamic gait index in Tai Chi intervention group compared to the control intervention group. However, the short physical performance battery for balance (SPBB) showed Tai Chi did not significantly improve the ability of balance for stroke patients (MD=0.293, 95%CI: −0.099~0.685).

Conclusions

Tai Chi exercise might have a significant impact in improving balance efficiency by increasing BBS score and reducing fall rate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6289026/

 

Improve Cognitive Function in Breast Cancer Survivors with Mindfulness

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Improve Cognitive Function in Breast Cancer Survivors with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Participation in a mindfulness-based stress reduction program yields robust and sustained improvement in cancer-related cognitive impairment, a prevalent and potentially debilitating condition that affects attention, memory and executive function in survivors.” – ScienceDaily

 

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. Cognitive impairments are a frequent side effect of cancer treatment. This has been dubbed “chemo brain.” Patients often refer to it as a mental cloudiness.

 

The patients report problems including forgetting things, trouble concentrating, trouble remembering details like names and dates, trouble multi-tasking, like answering the phone while cooking, taking longer to finish things, disorganized and slower thinking, and trouble remembering common words. These cognitive impairments generally produce problems with work and even social relationships such that patients tend to isolate themselves. They can also produce treatment problems as the patients often forget to take their medications.

 

These problems result from the fact that chemotherapy, radiation therapy and many cancer drugs directly affect the nervous system. At present, there are no known treatments for these cognitive impairment side effects of chemotherapy. Contemplative practices have been shown to affect memory and have positive effects on cancer treatment and recovery.  There is some evidence that contemplative practices may be useful for the alleviation of “chemo brain” symptoms. So, it makes sense to step back and review what is known regarding the ability of mindfulness training to improve the cancer patient’s cognitive abilities.

 

In today’s Research News article “Mindfulness-based interventions and cognitive function among breast cancer survivors: a systematic review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260900/ ), Cifu and colleagues review and summarize the published research studies on the effectiveness of mindfulness training for the cognitive deficits present after recovery from breast cancer. They identified 6 studies; 5 of which were randomized controlled studies and 4 of which used the Mindfulness-Based Stress Reduction (MBSR) program.

 

They found mixed results from the studies but the majority found that mindfulness training produced significant improvements in the cognitive abilities of the patients. The 2 studies that reported follow-up data demonstrated that the improvements were sustained 2 and 6 months after the end of the program. These mixed findings suggest that mindfulness training may be useful in treating the problems with thinking, memory, and attention that result from treatment for breast cancer, but more research is needed to reach firm conclusions.

 

It is not known what the mechanism might be by which mindfulness training relieves these cognitive impairments. But it has been previously demonstrated that mindfulness training improves cognition in healthy and aging populations by changing the brain, particularly the frontal cortical regions. It is possible that this is the same phenomenon only with breast cancer survivors.

 

So, improve cognitive function in breast cancer survivors with mindfulness.

 

“Mindfulness-based stress reduction (MBSR) may improve cognitive function in breast and colorectal cancer survivors.” Neurology Advisor

 

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

 

Cifu, G., Power, M. C., Shomstein, S., & Arem, H. (2018). Mindfulness-based interventions and cognitive function among breast cancer survivors: a systematic review. BMC cancer, 18(1), 1163. doi:10.1186/s12885-018-5065-3

 

Abstract

Background

Breast cancer survivors have an elevated risk of cognitive impairment compared to age-matched women without cancer. Causes of this impairment are complex, including both treatment and psychological factors. Mindfulness-based interventions, which have been shown to improve cognitive function in the general population, may be one approach to mitigate cognitive impairment in this survivor population. Our objective was to conduct a systematic literature review of studies on the effect of mindfulness-based interventions on cognition among breast cancer survivors.

Methods

We conducted searches of three electronic databases (Scopus, PubMed and Cochrane Database of Systematic Reviews) in September 2017 for studies pertaining mindfulness and cognitive function among breast cancer survivors. Abstracts were manually searched by two reviewers and additional articles were identified through reference lists.

Results

A total of 226 articles were identified through our systematic search and six met inclusion criteria for this review. The reviewed studies lacked consistency in terms of the cognition domains studied (e.g. executive function, recent memory, etc) and in the measures used to assess cognition. Of the included studies, two found no association between mindfulness interventions and cognitive function, two found improvement that was not sustained at the follow-up, and another two found sustained improvement at 2- or 6-months.

Conclusions

Mindfulness-based interventions have shown some evidence for improving cognition among breast cancer survivors, but further research using validated and comprehensive cognitive assessments is needed. More research is also needed related to the timing, duration and content of mindfulness interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6260900/

 

Develop Transformational Leadership with Mindfulness

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Develop Transformational Leadership with Mindfulness

 

By John M. de Castro, Ph.D.

 

“there is a definite impact on leadership skills by practicing mindfulness, such as increase in productivity, decision-making, listening,, and reduction in stress levels. But for leaders, the biggest benefit of mindfulness is its direct impact on the development of emotional intelligence.” – Monica Thakrar

 

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 not only to productivity in the workplace but also to our psychological and physical health. Mindfulness practices have been implemented in the workplace and they have been shown to markedly reduce the physiological and psychological responses to stress. This, in turn, improves productivity and the well-being of the employees. As a result, many businesses have incorporated mindfulness practices into the workday.

 

Mindfulness may also help to promote leadership in the workplace. It can potentially do so by enhancing emotion regulation, making the individual better able to recognize, experience, and adaptively respond to their emotions, and making the leader better able to listen to and to understand the needs and emotion of the workers they lead. There has been, however, little research attention to the effects of mindfulness on leadership.

 

In today’s Research News article “When Mindfulness Interacts With Neuroticism to Enhance Transformational Leadership: The Role of Psychological Need Satisfaction.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02588/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_862317_69_Psycho_20190101_arts_A ), Decuypere and colleagues recruited nurses who were in leadership positions (head nurses) in nursing care facilities. They completed measures of mindfulness, transformational leadership, need satisfaction, emotional stability (neuroticism), autonomy, competence, and relatedness.

 

They found that the higher the levels of mindfulness, the higher the levels of transformational leadership, autonomy, competence, and relatedness and the lower the levels of neuroticism. Conversely, the higher the levels of neuroticism the lower the levels of mindfulness, transformational leadership, autonomy, competence, and relatedness. They then examined whether the association of mindfulness with transformational leadership was mediated by mindfulness’ association with the other variables. They found that the association of mindfulness with transformational leadership was completely mediated by its associations with need satisfaction and competence, and partially mediated by its association with autonomy and relatedness. They further demonstrated that neuroticism affected these relationships such that when neuroticism was higher there was a stronger relationship between mindfulness and need satisfaction and competence than when neuroticism was low.

 

These are interesting results that suggest that mindfulness affects the ability of head nurses to be transformational leaders and that this is amplified when there are low levels of emotional stability. Furthermore, these results suggest that mindfulness is associated with the nurses’ ability to regulate their emotions and this is what makes them better leaders. Hence, when they lack emotional stability, mindfulness has even great impacts.

 

This all suggests that the ability to lead others emanates from one’s ability to deal with one’s own emotions and this is strongly influenced by mindfulness. It has been well established that mindfulness produces a greater ability to experience and adaptively respond to emotions, emotion regulation. What is new here is that this is related to leadership.

 

So, develop transformational leadership with mindfulness.

 

“The key to effective leadership is the ability to integrate your head (IQ) with your heart (EQ). . . Our hearts are where essential leadership qualities like passion, compassion and courage reside. By practicing mindfulness, mindful leaders exhibit high levels of self-awareness and intentionality in their actions.” – Bill George

 

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

 

Decuypere A, Audenaert M and Decramer A (2018) When Mindfulness Interacts With Neuroticism to Enhance Transformational Leadership: The Role of Psychological Need Satisfaction. Front. Psychol. 9:2588. doi: 10.3389/fpsyg.2018.02588

 

Transformational leadership is a popular and well-researched leadership style. Although much is understood about its positive consequences, less research has focused on antecedents of transformational leadership. In this research we draw upon self-determination theory and incorporate a self-regulatory approach to investigate if and how leader mindfulness influences transformational leadership. The analyses show that autonomy, competence and relatedness need satisfaction mediate between mindfulness and transformational leadership, indicating that mindfulness is associated with psychological need satisfaction. Furthermore, the data show that neuroticism moderates the relationship between mindfulness and relatedness need satisfaction. Generally speaking, the association between mindfulness and relatedness need satisfaction is positive. When neuroticism is also high, mindfulness has the largest impact. Or conversely, when emotional stability is high, mindfulness has the smallest association with relatedness need satisfaction. This is in line with evidence suggesting that mindfulness may primarily exert its influence through emotional self-regulation. Furthermore, the moderated mediation model for relatedness need satisfaction is significant, indicating that neuroticism is a boundary condition for the indirect effect of mindfulness on transformational leadership through relatedness need satisfaction.

https://www.frontiersin.org/articles/10.3389/fpsyg.2018.02588/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_862317_69_Psycho_20190101_arts_A

 

Mindfulness Measured by Paper and Pencil Test does Not Predicts Real World Behavior

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Mindfulness Measured by Paper and Pencil Test does Not Predicts Real World Behavior

 

By John M. de Castro, Ph.D.

 

“I’m recognizing as I write this that even this moment will come and pass, and as I feel that, I notice some relief in my chest and my shoulders widening and releasing to let my heart relax. I’m being mindful that my day is winding down, and the thought is hitting me: “the work before me will get done.”- Elizabeth Ann Rue

 

A prerequisite in science is that in order to study something you have to be able to reliably and validly measure it. With many concepts such as mindfulness, depression, and anxiety that reflect subjective states, there are currently no objective means to measure them. Measurement then falls to some kind of after the fact test or to a self-report. Traditionally, mindfulness has been measured with paper and pencil psychometric tests, such as the Five Facets of Mindfulness Questionnaire. They ask the participant to answer the question in regard to their overall, general state of mindfulness.  It is unclear whether these subjective questionnaire reports are reliable, accurate, and honest and whether they relate to actual behavior of people in their natural, everyday environments. Hence it is important to investigate whether the results of these self-report tests actually predict what the people will do in their everyday life.

 

In today’s Research News article “Dispositional mindfulness in daily life: A naturalistic observation study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261408/ ), Kaplan and colleagues performed two studies to determine first what people expect the behavior of mindful people to look like and second whether actual behavior conforms to these expectations. In a first study they recruited adults online and had them complete measures of their perceptions of the behavior of mindful people. They found that “laypersons assume that mindfulness relates to (1) attention to sensory perceptions, (2) emotional positivity, (3) quality social interactions, and (4) a prosocial orientation in daily life.”

 

In a second study, they recruited adults and randomly assigned them to either a control condition or to receive 8 weeks of meditation training they were measured before and after training for mindfulness and personality characteristics and wore a recording device over a weekend that recorded 50 seconds of sounds every 9 minutes. The sound samples were transcribed and analyzed for amount of time talking to others, positive and negative words, perception words (e.g., hear, see, feel, soft, loud), substantive, meaningful, conversations, and prosocial orientation (gratitude, affection, gossip, complaining).

 

They found that the level of mindfulness of the participant was positively related to the perceptual orientation, use of words indicating sensations, but was not reliably associated with positivity, negativity, social interactions, prosocial, or antisocial interactions. Hence, the actual observations of the participants behavior were not in line with the expectations people have about the behavior of mindful people.

 

The results suggest that mindful people are more tuned into their perceptual worlds, which is an expectation about the present moment awareness of mindful people. But, in other ways, people high in trait mindfulness were not especially socially, emotionally, or prosocially oriented. This may indicate that mindfulness measured with paper and pencil tests is not a valid indicator of actual mindful behavior. On the other hand, they may indicate that peoples expectations about the observable behavior of mindful people are incorrect.

 

This study is important in that it investigated actual, objectively defined behaviors by people that are expressed in their natural, everyday environments. This kind of analysis may prove to be a better actual measure of mindfulness than questionnaires and tests. It remains for future research to investigate this more thoroughly. But this study opens up a new and potentially important realm for the investigation of mindfulness.

 

“How often have you rushed out the door and into your day without even thinking about how you’d like things to go? Before you know it, something or someone has rubbed you the wrong way, and you’ve reacted automatically with frustration, impatience, or rage—in other words, you’ve found yourself acting in a way you never intended. You don’t have to be stuck in these patterns. Pausing to practice mindfulness for just a few minutes at different times during the day can help your days be better, more in line with how you’d like them to be.” – Parneet Pal

 

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

 

Kaplan, D. M., Raison, C. L., Milek, A., Tackman, A. M., Pace, T., & Mehl, M. R. (2018). Dispositional mindfulness in daily life: A naturalistic observation study. PloS one, 13(11), e0206029. doi:10.1371/journal.pone.0206029

 

Abstract

Mindfulness has seen an extraordinary rise as a scientific construct, yet surprisingly little is known about how it manifests behaviorally in daily life. The present study identifies assumptions regarding how mindfulness relates to behavior and contrasts them against actual behavioral manifestations of trait mindfulness in daily life. Study 1 (N = 427) shows that mindfulness is assumed to relate to emotional positivity, quality social interactions, prosocial orientation and attention to sensory perceptions. In Study 2, 185 participants completed a gold-standard, self-reported mindfulness measure (the FFMQ) and underwent naturalistic observation sampling to assess their daily behaviors. Trait mindfulness was robustly related to a heightened perceptual focus in conversations. However, it was not related to behavioral and speech markers of emotional positivity, quality social interactions, or prosocial orientation. These findings suggest that the subjective and self-reported experience of being mindful in daily life is expressed primarily through sharpened perceptual attention, rather than through other behavioral or social differences. This highlights the need for ecological models of how dispositional mindfulness “works” in daily life, and raises questions about the measurement of mindfulness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261408/

 

Improve Treatment Resistant Major Depression with Yoga

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Improve Treatment Resistant Major Depression with Yoga

 

By John M. de Castro, Ph.D.

 

“Some people who haven’t responded to traditional treatments might do well with yoga, because unlike antidepressant drugs, yoga and deep breathing target the autonomic nervous system.” – Amanda MacMillan

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs fail.  Yoga practice is a mindfulness training and has the added benefit of being an exercise which has been also found to be effective for depression.

 

Recently, it has been discovered that there are genetic differences between patients with major depression who respond to antidepressant drugs and those who don’t. In particular non-responders appear to have a 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms. The serotonin system in the brain is a target of antidepressant drugs and these genetic variants may underlie non-responsiveness to the drugs. Since, yoga practice appears to be effective for depression in patients who do not respond to antidepressant drugs, it is likely that yoga practice works in spite of these genetic variants.

 

In today’s Research News article “5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278208/ ), Tolahunase and colleagues recruited patients with major depressive disorder and randomly assigned them to receive either a 12-week yoga program or to receive antidepressant drugs (SSRIs). Yoga was practiced for 2 hours per day, 5 days per week, for 12 weeks and consisted of postures, breathing exercises, and meditation. They were measured before and after treatment for depression, other psychiatric conditions, and childhood trauma. Blood was drawn for DNA genotyping.

 

They found that both groups had significant reductions in depression over the treatment period, but, the yoga group had significantly greater reductions in depression and higher remission rates (59% compared to 33%) than the antidepressant drug group. The participants with 5-HTTLPR and MTHFR 677C>T polymorphisms had significantly lower reductions in depression and remission rates in the antidepressant drug group but not in the yoga group. The participants in the yoga group with the polymorphisms benefited with reductions in depression and increases in remission rates to the same extent as those without the polymorphisms.

 

These are remarkable results. Yoga practice produced greater relief of depression than antidepressant drugs and, in addition, yoga practice produced this relief irrespective of the genetic polymorphisms that affect responses to antidepressant drugs. This suggests that yoga practice my work to relieve depression through a different mechanism than antidepressant drugs. Hence, yoga practice appears to be an almost ideal treatment for major depressive disorder, producing high remission rates and great reductions in depression, safely, without major side effects, and irrespective of the genetic polymorphisms that reduce responsiveness to antidepressant drugs. This suggests that yoga practice should be the first line treatment for major depressive disorder.

 

So, improve treatment resistant major depression with yoga

 

“many patients dealing with depression, anxiety, or stress, yoga may be a very appealing way to better manage symptoms. Indeed, the scientific study of yoga demonstrates that mental and physical health are not just closely allied, but are essentially equivalent. The evidence is growing that yoga practice is a relatively low-risk, high-yield approach to improving overall health.” – Harvard Mental Health Newsletter

 

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

 

Tolahunase, M. R., Sagar, R., & Dada, R. (2018). 5-HTTLPR and MTHFR 677C>T polymorphisms and response to yoga-based lifestyle intervention in major depressive disorder: A randomized active-controlled trial. Indian journal of psychiatry, 60(4), 410-426.

 

Abstract

Background:

There is growing evidence suggesting that both genetic and environmental factors modulate treatment outcome in, a highly heterogeneous, major depressive disorder (MDD). 5-HTTLPR variant of the serotonin transporter gene (SLC6A4) and MTHFR 677C>T polymorphisms have been linked to the pathogenesis of MDD, and antidepressant treatment response. The evidence is lacking on the clinical utility of yoga in patients with MDD who have 5-HTTLPR and MTHFR 677C>T polymorphisms and less likely to respond to medications (SSRIs).

Aims:

We aimed to examine the impact of YBLI in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are less likely to drug therapy with SSRIs.

Settings and Design:

In a 12 week randomized active-controlled trial, MDD patients (n = 178) were randomized to receive YBLI or drug therapy.

Methods:

Genotyping was conducted using PCR-based methods. The clinical remission was defined as BDI-II score ≤ 9.

Statistical Analysis Used:

An intent-to-treat analysis was performed, and the association of genotype with treatment remission consisted of the logistic regression model. A P value of <0.05 was considered statistically significant.

Results:

Multivariate logistic regression models for remission including either 5-HTTLPR or MTHFR 677C>T genotypes showed statistically significant odds of remission in YOGA arm vs. DRUG arm. Neither 5-HTTLPR nor MTHFR 677C>T genotype showed any influence on remission to YBLI (P = 0.73 and P = 0.64, respectively). Further analysis showed childhood adversity interact with 5-HTTLPR and MTHFR 677C>T polymorphisms to decrease treatment response in DRUG treatment arm, but not in YOGA arm.

Conclusions:

YBLI provides MDD remission in those who have susceptible 5-HTTLPR and MTHFR 677C>T polymorphisms and are resistant to SSRIs treatment. YBLI may be therapeutic for MDD independent of heterogeneity in its etiopathogenesis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278208/