Improve Quality of Life with Migraine Headaches with Mindfulness

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Improve Quality of Life with Migraine Headaches with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Be mindful of your breathing. If you notice that your respirations are fast and shallow, concentrate on taking slower, deeper and longer breaths. As your breathing slows, your body will begin to relax. Tensions and stress slowly will ebb from your body, allowing you to release the some of the pain and discomfort associated with your headaches.” – National Headache Institute

 

Migraine headaches are a torment far beyond the suffering of a common headache. It is an intense throbbing pain usually unilateral, focused on only one side of the head and lasts from 4 hours to 3 days. They are actually a collection of neurological symptoms. Migraines often include: visual disturbances, nausea, vomiting, dizziness, extreme sensitivity to sound, light, touch and smell, and tingling or numbness in the extremities or face. Migraines are the 8th most disabling illness in the world. While most sufferers experience attacks once or twice a month, about 4% have chronic daily headaches. Migraines are very disruptive to the sufferer’s personal and work lives as most people are unable to work or function normally when experiencing a migraine.

 

There is no known cure for migraine headaches. Treatments are targeted at managing the symptoms. Prescription and over-the-counter pain relievers are frequently used. There are a number of drug and drug combinations that appear to reduce the frequency of migraine attacks. These vary in effectiveness but unfortunately can have troubling side effects and some are addictive. Behaviorally, relaxation and sleep appear to help lower the frequency of migraines. Mindfulness practices have been shown to reduce stress and improve relaxation. So, they may be useful in preventing migraines. Indeed, it has been shown that mindfulness practice can reduce headache pain.

 

In today’s Research News article “Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036307/ ), Tavallaei and colleagues recruited women suffering with migraine headaches and randomly assigned them to receive either an on-line mindfulness training based upon the Mindfulness-Based Stress Reduction (MBSR) program or medical treatment as usual. The mindfulness training program was presented over the internet in 8 weekly sessions and included meditation, body scan, and didactic presentation. The participants were measured before and after treatment for mindfulness, migraine disability, pain, and distress including depression, anxiety, and stress.

 

They found that in comparison to the baseline and the treatment-as-usual control group that the group who received mindfulness training had significantly lower levels of migraine disability, distress, and pain and significantly higher levels of mindfulness. They found that the reductions in pain were due to changes in the emotional reactions to pain and not the sensory experiences of pain. So, the pain was perceived normally but the women did not react to the sensations emotionally and this resulted in a lower impact of the headache pain.

 

The results suggest that mindfulness training increases the quality of life and reduces the psychological distress of women with migraine headaches. Similar findings have been reported in other prior research studies. The importance of the present study resides in the presentation of the program over the internet. Presentation over the internet is important as in-person programs are inconvenient and expensive. Presentation over the internet allows for widespread, convenient, and inexpensive distribution of the therapy to affected populations. This makes mindfulness training more readily available to migraine sufferers.

 

So, improve quality of life with migraine headaches with mindfulness.

 

“mindfulness has been examined as a treatment for chronic pain and pain-related conditions, finding positive results such as reduction in medication usage, improved physical functioning, and physical-health-related quality of life.” – Monika Tomova

 

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

 

Tavallaei, V., Rezapour-Mirsaleh, Y., Rezaiemaram, P., & Saadat, S. H. (2018). Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy. European Journal of Translational Myology, 28(2), 7380. http://doi.org/10.4081/ejtm.2018.7380

 

Abstract

Our aim was to investigate effectiveness of mindfulness by bibliotherapy on disability, distress, perceived pain and mindfulness in women with tension headaches and migraines. Primary headaches have been of great interest to mental health researchers because of the high prevalence, as well as significant disability and distress in the affected people. Despite the promising results of in-person treatment and some limitations that such interventions may cause, patients may be encountered with problems when using health care services. The present study is a quasi-experimental randomized design with pre-test, post-test, and control group. The study population consisted of 1396 women with migraine headache referring to headache clinic of Baqiyatallah Hospital in Tehran. Of these, 30 patients (including tboh experimental and control group) were selected by objective sampling method and were randomly assigned to the two groups. The experimental group, in addition to medical treatment as usual, was treated for a period of 8 sessions by Mindfulness-based Stress Reduction Internet-based Bibliotherapy, but the control group used only the medical treatment. The sample had no attritions. Data were collected by the four scales of (DASS-21), Migraine Disability Assessment Test (MIDAS), McGill’s Short Form Questionnaire (MPQ-SF), and Mindfulness Inventory (MAAS). We used covariance analysis to analyze the findings in the measured scales. MBSR-IBB treatment had no significant effect on pain sensory dimension (P <0.44), despite improvement of mindfulness (P <0.0001). In contrast, the greatest effect was on the level of disability (P <0.0001). We observed also a significant improvement in distress (P <0.0001). In conclusion, in spite of the presence of headaches, the mindfulness improved the quality of life and reduced the level of mental distress. In addition, using the Internet-based bibliotherapy method, these services can be used with easier access, lower cost, and more flexibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036307/

 

Improve Connectivity of Brain Areas Underlying Executive Cognitive Function with Mindfulness

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Improve Connectivity of Brain Areas Underlying Executive Cognitive Function with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Think of mindfulness practices as short routines or “gym” sessions that exercise your executive functions. Performed consistently, mindfulness practices strengthen your executive function muscles and help you to be more mindful when you need to be. “ – Casey Dixon

 

There has accumulated a large amount of research demonstrating that mindfulness has significant benefits for psychological, physical, and spiritual wellbeing. It even improves high level thinking known as executive function. Its positive effects are so widespread that it is difficult to find any other treatment of any kind with such broad beneficial effects on everything from thinking to mood and happiness to severe mental and physical illnesses. This raises the question of how mindfulness training could produce such widespread and varied benefits. One possibility is that mindfulness practice results in beneficial changes in the nervous system.

 

The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, mindfulness practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

In today’s Research News article “Mindfulness Meditation Training and Executive Control Network Resting State Functional Connectivity: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489372/ ), Taren and colleagues examine the effects of mindfulness training on the underlying brain systems responsible for high level thinking, executive function. They recruited “stressed unemployed job-seeking community adults” and randomly assigned them to participate in a 3-day residential retreat either of intensive mindfulness meditation training or of relaxation training. The meditation retreat was a condensed version of the Mindfulness-Based Stress Reduction (MBSR) program that contains discussion, meditation, yoga, and body scan practices. The relaxation retreat called Health Enhancement through Relaxation (HER) included walking, stretching, and didactics performed in a relaxed manner. Before and after training the participants were measured for mindfulness and underwent brain scanning with Magnetic Resonance Imaging (MRI), while engaged in either meditation or relaxation respectively.

 

They found that following the retreat, in comparison to baseline and the relaxation group, the mindfulness group had increased functional connectivity between the dorsolateral prefrontal cortex and dorsal network consisting of the superior parietal lobule and supplementary eye field, and also increased functional connectivity with the ventral network consisting of the inferior frontal gyrus and the angular gyrus. These interconnected structures have been demonstrated to be important in high level, executive function, thinking. It’s quite striking that these changes in the brain can be produced by a relatively short-term, 3-day, mindfulness retreat.

 

Hence, mindfulness training appears to strengthen the connections between the brain structures that underly the highest levels of human thinking. These results suggest that intensive mindfulness training even over a relatively short period of time can produce neuroplastic changes in the brain that improve the sharing of information between these structures and these changes, in turn, produce improved thinking. This suggests the underlying neural mechanism by which mindfulness training improves thought processes.

 

So, improve connectivity of brain areas underlying executive cognitive function with mindfulness.

 

“The impact that mindfulness exerts on our brain is borne from routine: a slow, steady, and consistent reckoning of our realities, and the ability to take a step back, become more aware, more accepting, less judgmental, and less reactive. Just as playing the piano over and over again over time strengthens and supports brain networks involved with playing music, mindfulness over time can make the brain, and thus, us, more efficient regulators, with a penchant for pausing to respond to our worlds instead of mindlessly reacting.” – Jennifer Wolkin

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Taren, A. A., Gianaros, P. J., Greco, C. M., Lindsay, E. K., Fairgrieve, A., Brown, K. W., … Creswell, J. D. (2017). Mindfulness Meditation Training and Executive Control Network Resting State Functional Connectivity: A Randomized Controlled Trial. Psychosomatic Medicine, 79(6), 674–683. http://doi.org/10.1097/PSY.0000000000000466

 

Abstract

Objective

Mindfulness meditation training has been previously shown to enhance behavioral measures of executive control (e.g. attention, working memory, cognitive control), but the neural mechanisms underlying these improvements are largely unknown. Here, we test whether mindfulness training interventions foster executive control by strengthening functional connections between dorsolateral prefrontal cortex (dlPFC) – a hub of the executive control network – and frontoparietal regions that coordinate executive function.

Methods

Thirty-five adults with elevated levels of psychological distress participated in a 3 day RCT of intensive mindfulness meditation or relaxation training. Participants completed a resting state fMRI scan before and after the intervention. We tested whether mindfulness meditation training increased resting state functional connectivity (rsFC) between dlPFC and frontoparietal control network regions.

Results

Left dlPFC showed increased connectivity to the right inferior frontal gyrus (T = 3.74), right middle frontal gyrus (T = 3.98), right supplementary eye field (T = 4.29), right parietal cortex (T = 4.44), and left middle temporal gyrus (T = 3.97; all p<0.05) following mindfulness training relative to the relaxation control. Right dlPFC showed increased connectivity to right middle frontal gyrus (T = 4.97, p < 0.05).

Conclusions

We report that mindfulness training increases rsFC between dlPFC and dorsal network (superior parietal lobule, supplementary eye field, MFG) and ventral network (right IFG, middle temporal/angular gyrus) regions. These findings extend previous work showing increased functional connectivity amongst brain regions associated with executive function during active meditation by identifying specific neural circuits in which rsFC is enhanced by a mindfulness intervention in individuals with high levels of psychological distress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489372/

 

Reduce Physician Burnout with Mindfulness

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Reduce Physician Burnout with Mindfulness

 

By John M. de Castro, Ph.D.

 

“For me, the program has been worth everything. It has enabled me to emerge from my depression, change my toxic work situation, improve my home and family life, and allow myself to be happy and realize that I deserve to be happy.” ~ Anonymous MD

 

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 residency is an extremely stressful period and many express burnout symptoms. This would seem to be an ideal time to intervene.

 

In today’s Research News article “Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954313/ ), Romcevich and colleagues conducted a small pilot study of the effectiveness of a Mind-Body Skills Training (MBST) program to reduce burnout in hospital residents. They recruited 2nd through 4th year residents and had them complete 4 weekly 90-minute training sessions and 12 on-line modules including relaxation, breath following meditation, and loving kindness meditation. They were measured before and after training and 6 months later for burnout, perceived stress, resilience, mindfulness, self-compassion, and burnout subscales of emotional exhaustion, depersonalization, and personal achievement.

 

They found that after training there were significant improvements in personal achievement, perceived stress, resilience, and mindfulness and an unexpected decrease in self-compassion. At the 6-month follow-up there were significant improvements in self-compassion, depersonalization and mindfulness. Hence, the pilot results suggest that Mind-Body Skills Training (MBST) may be effective in improving well-being and decreasing symptoms of burnout in medical residents.

 

It will be necessary to replicate these results in a larger controlled randomized trial. But the pilot results are encouraging. They suggest that this form of mindfulness training may be a safe and effective method to improve well-being and intervene early in the career to prevent future burnout in medical professionals.

 

So, reduce physician burnout with mindfulness.

 

“these tools can help us be the best we can be in our “inner space” while we struggle to eliminate the challenges and burdens that occupy the “outer space” of our practice of medicine. After all, if we can’t take care of ourselves, we won’t have anything left to care for others.” – Lynne Lillie

 

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

 

Romcevich, L. E., Reed, S., Flowers, S. R., Kemper, K. J., & Mahan, J. D. (2018). Mind-Body Skills Training for Resident Wellness: A Pilot Study of a Brief Mindfulness Intervention. Journal of Medical Education and Curricular Development, 5, 2382120518773061. http://doi.org/10.1177/2382120518773061

 

Abstract

Background:

Interventions to address burnout include mind-body skills training (MBST), but few studies have evaluated the feasibility of MBST for busy pediatric residents.

Objective:

In this pilot study, we tested the feasibility of a brief MBST intervention, using in-person peer-led training supported by online modules, to decrease stress and burnout in pediatric resident physicians.

Methods:

Of 99 (10%) residents, 10 residents at Nationwide Children’s Hospital in Ohio participated in up to four 90-minute MBST sessions more than 1 month, led by a co-resident with 5 years of informal training in mind-body skills. Participants were offered 8 assigned online modules through OSU Center for Integrative Health and Wellness. Measures including Maslach Burnout Inventory (MBI), Cohen’s Perceived Stress, Smith’s Brief Resilience, Cognitive and Affective Mindfulness Scale-Revised, and Neff’s Self-Compassion Scale (NSS) were administered before (T1) and after (T2) the course. Participants were offered optional monthly “maintenance” sessions for 6 months and completed a third set of measures at this follow-up (T3).

Results:

The residents completed an average of 4.3/8 online modules and attended an average of 2.8/4 in-person sessions. There was significant improvement in positive attitude, perceived stress, and resilience post intervention (T2). Follow-up evaluation (T3) also demonstrated significant improvement in burnout (depersonalization) and mindfulness. More than 75% of participants found the course worthwhile.

Conclusions:

A short mixed-method mindfulness-based skills course may be a practical way to offer resilience and stress management training to busy resident physicians.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954313/

 

Improve the Psychological and Physical Health of Dialysis Patients with Mindfulness

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Improve the Psychological and Physical Health of Dialysis Patients with Mindfulness

 

By John M. de Castro, Ph.D.

 

“We found that by engaging in mindfulness meditation, our patients have significantly decreased their anxiety, especially at the beginning of a treatment as they are connected to the dialysis machine,” – Thang Trey Ng

 

End-stage renal disease (ESRD) is a serious and all too common medical problem that results from a total and permanent failure of the kidneys. As a result, the body retains fluid and harmful wastes build up. Treatment, usually dialysis, is required to replace the work of the failed kidneys. Kidney dialysis uses a machine to filter harmful wastes, salt, and excess fluid from your blood. This restores the blood to a normal, healthy balance. Without dialysis or a kidney transplant the ESRD patient cannot survive It is estimated that ESRD occurs in more than 650,000 patients per year in the United States and is increasing by 5% per year. Those who live with ESRD are 1% of the U.S. Medicare population but account for 7% of the Medicare budget. Worldwide there are an estimated 2 million ESRD patients.

 

End-stage renal disease (ESRD) is frequently accompanied by a number of other serious diseases, such as cardiovascular disease and diabetes. Making matters worse is the fact that ESRD patients often experience psychological distress including depression. It is possible that mindfulness training may be helpful as it has been found be helpful for patients with kidney disease, to help relieve depression and improve the patients ability to effectively deal with stress.

 

In today’s Research News article “The effect of mindfulness program on general health of patients undergoing hemodialysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009148/ ), Nejad and colleagues recruited patients with End-stage renal disease (ESRD) on dialysis and randomly assigned them to receive 8 1.5 hour weekly sessions of either a mindfulness training program or an End-stage renal disease (ESRD) education program. They were measured before and after training and 1 month later for physical health, anxiety, depression, sleep disturbance, and social problems.

 

They found that in comparison to baseline and to the education control group the patients who received mindfulness training had significant improvements in all measured variables including significantly lower levels of anxiety, depression, sleep disturbance, and social problems and significantly higher levels of physical health. Importantly, these improvements were still present 1 month after the completion of training. This suggests that the benefits are enduring. A strength of this study is that the control condition was an active control which eliminates many sources of bias and contamination.

 

The study thus indicates that mindfulness training produces substantial physical and psychological benefits for patients with End-stage renal disease (ESRD) who are on dialysis. It remains for future research to clarify exactly how mindfulness training may be helping the patients. It is possible that the improved emotion regulation or ability to cope with the physical and psychological effects of stress produced by mindfulness training were responsible for the benefits for these patients. Regardless, training in mindfulness helps relieve at least some of the burden on these patients.

 

So, improve the psychological and physical health of dialysis patients with mindfulness.

 

“Meditation could be a valuable, low-cost, nonpharmacologic intervention for reducing blood pressure and adrenaline levels in patients with chronic kidney disease” – Kurtis Pivert

 

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

 

Moosavi Nejad, M., Shahgholian, N., & Samouei, R. (2018). The effect of mindfulness program on general health of patients undergoing hemodialysis. Journal of Education and Health Promotion, 7, 74. http://doi.org/10.4103/jehp.jehp_132_17

 

Abstract

INTRODUCTION:

Patients undergoing hemodialysis have a low level of health and mindfulness technique in mind-body medicine is used to help patients with chronic illness. Therefore, this clinical trial was conducted to determine the effect of the mindfulness program on the general health of patients undergoing treatment with hemodialysis.

METHODS:

Sixty hemodialysis patients were selected through the convenient method and randomly divided into experimental and control groups. Both groups completed demographic information questionnaire and general health questionnaire. Then, the experimental group received 8 sessions of mindfulness training and the control group received 8 sessions of education in relation to end-stage renal disease and hemodialysis. Educational sessions were performed for both groups in the second 30 min after hemodialysis for 1 h in six individual sessions and two 1.5 h group sessions. Immediately after and 1 month after the intervention, the General Health Questionnaire was completed by both groups.

RESULTS:

Analysis of the findings showed no significant differences between the mean score of general health disorder and its subscales before the intervention in to two groups (P > 0.05). Nevertheless, after intervention in the experimental group, the mean of general health disorder score decreased from 44.17 ± 12.32 to 21.9 ± 6.4 and 1 month after the intervention, the mean score of this score was 23.6 ± 6.2. The mean score of physical symptoms, anxiety and sleep disorder, social functioning deficiency, and depression were also significantly lower in the experimental group immediately after intervention and 1 month after the intervention; however, there were no significant differences between the mean of this score immediately and 1 month after the intervention. In addition, the mean score of general health disorder changes immediately and 1 month after the intervention in the experimental group was significantly more than the control group. In the control group, there was no significant difference between the mean score of general health disorder and its subscales before, immediately, and 1 month after the intervention (P > 0.05).

CONCLUSIONS:

The results of this research showed that mindfulness has been effective in reducing physical and anxiety symptoms, sleep disorder, social dysfunction, and depression symptoms. Therefore, the use of mindfulness as a complementary treatment can improve the general health level in these patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009148/

 

Mindful Labor Day

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Image result for labor day pictures

Mindful Labor Day

 

By John M. de Castro, Ph.D.

 

 “Sometimes it’s important to work for that pot of gold.  But other times it’s essential to take time off and to make sure that your most important decision in the day simply consists of choosing which color to slide down on the rainbow.”  ~ Douglas Pagels

 

Labor Day is a National Holiday in the United States. It was designed to celebrate the accomplishments of the American worker, particularly organized labor. It is important to celebrate this holiday mindfully. Work is a major component of our lives, it dictates our income, contributes to our social lives, and for many people is an essential part of their self-concept and their self-worth. But rather than using the holiday to reflect on this important part of their lives, most people treat Labor Day mindlessly, as a time to vacation and party. Perhaps, though, it’s important to take at least a little time on this holiday to mindfully reflect on work.

 

To understand the importance of work we need only look at the Buddha’s Noble Eightfold Path. Two of the eight components are Right Actions and Right Livelihood. But, Right Livelihood is itself an action and it would seem that Right Livelihood should be contained in Right Actions and not a separate component. But, the Buddha included Right Livelihood as a separate component to underscore its importance for spiritual development. It’s his way of emphasizing that what one does for a living is an extremely important action. The Buddha taught that it was essential for spiritual development to only engage in work that produces greater happiness, wisdom, and well-being, and relieves suffering in ourselves and others and avoid jobs that produce harm.

 

We should take a mindful look at our occupations on Labor Day and ask whether they promote greater happiness, wisdom, and well-being, and relieves suffering or produces harm. In some case, the fact that it is Right Livelihood is obvious as with professions such as physician, social worker, peace negotiator, relief worker, therapist, etc. On the other hand, professions such as drug dealer, arms merchant, professional criminal, etc. are clearly not. But for most occupations it is much more difficult to discern whether or not they constitute Right Livelihood. This is a point for deep, mindful, exploration for Labor Day.

 

Working on an oil rig in the Gulf of Mexico produces a product, energy, that is needed for the well-being of virtually everyone. Without affordable energy, every aspect of the economy would collapse. So, working on the oil rig could be seen as promoting well-being and relieving suffering. On the other hand, there is potential for great environmental harm, including oil spills that directly pollute sensitive environments, or contributing to carbon dioxide emissions that can indirectly create great harm by contributing to global warming. So should someone on the eightfold path accept or reject a job working on an oil rig? The answer cannot be given by anyone other than the individual themselves. It is imperative that this be looked at deeply and objectively to determine for themselves if they are doing more harm than good. The primary spiritual impact of Right Livelihood is on the individual engaging in the occupation. So, the decision has to be theirs. That is not to say that experts or friends can’t or shouldn’t be consulted, but that ultimately the individual must decide for themselves and be willing to accept the potential consequences. Needless to say, this should be a focus for deep mindful reflection on Labor Day.

 

The labor movement itself has important consequences for ourselves and others and should also be explored mindfully on Labor Day. It grew out of great labor abuses that existed where unscrupulous employers took advantage of workers, demanding much and paying little. This is an example how great harm can be produced when the wealthy and powerful, as a result of greed, do not practice Right Livelihood. The Buddha taught that there was nothing wrong with being successful and accumulating wealth provided that this was done ethically and honestly, and it promoted the overall well-being of the community. But, for a time, this was not the case. This underscores how the notion of Right Livelihood doesn’t only apply to workers, but also to employers, financiers, Wall Street executives, politicians, etc.

 

The labor movement arose to counteract the rampant abuses of workers. By organizing the workers obtained strength in numbers. This allowed them to stand up to employers and demand better pay and working conditions. It truly exemplifies our interdependence. We are not alone, but rather, are intricately connected to everyone else. This is true for work in general. It is a productive point for mindful contemplation of how our work and in fact, our entire lives are connected to the work of others. If we’re a truck driver we’re totally dependent upon the people who make the trucks, produce the fuel, build the roads, insures, maintains, and repairs the vehicles, makes and enforces the laws governing the roadways, etc. But, we are also dependent upon the work or those who produce our food, make our clothes, build our houses, educate our children, defend and protect us, etc. Our work is interdependent with the work of everyone else. This is an important point for reflection on Labor Day.

 

I recently received an award for my work career. It was a wonderful boost for my ego and made me feel very good about myself. But, with a little mindful reflection, I realized that this was not my award solely. It could never have been achieved without the involvement of a vast array of people, colleagues, students, friends, family superiors, workers, direct reports, police, government, etc. and all of the people who they are dependent upon, and so forth. It couldn’t have been achieved without virtually everyone. It was really an award for a cooperative effort. This kind of thinking made me humble. It made me know that it was not about “I.” Rather, it’s about “we.” Mindful reflection about our work can help us to see the interconnectedness we have with every other living thing.

 

A major issue for Labor Day reflection is what happens in the course of our daily work. We can learn much about ourselves by mindfully examining what transpires at work. What happens can bring us great joy or great suffering, but most of the time, it just provides momentary satisfaction or dissatisfaction. It is the smaller moments that compose the majority of our work lives but they are crucial to our happiness or unhappiness at work. Applying mindfulness and reflection to how we react and our thoughts regarding the events at work, we can gain great insight into the workings of our minds and how they can produce unsatisfactoriness and unhappiness.

 

The fact that your boss failed to mention that your performance was very good that day may make you feel unappreciated at work. But, it is likely that your boss was preoccupied with her own problems. But, looking carefully at your thought process you can begin to see how your response was based on the needs of your own ego. Many people’s feelings of self-worth, or self-hatred for that matter, are built around their work. Not being recognized by a superior may threaten a fragile self-image and produce discomfort and resentment. Work is actually a wonderful opportunity to learn about yourself.

 

You may observe a coworker engaged in petty theft and not report it. Looking deeply at this event you may be able to see that you have a strong need to be liked and you feel that reporting the unethical behavior may cause others to dislike you or see you as a threat. In this case your need for social acceptance causes you to compromise your integrity. The fact that social approval was more important to you than ethics can be a revelation regarding your inner psychological landscape. Once again, work can teach you a lot.

 

There are actually many many events that happen at work every day, small and large, that reveal the workings of your mind and emotions. Applying mindfulness, noticing and being aware of your reactions and actions at work can change your ideas about yourself and change your actions at work and these can lead to greater understanding and acceptance. This, in turn, can lead to greater satisfaction and happiness. Mindfulness is a key. If you are not in the present moment, if you are not paying attention but rather reacting without thinking or noticing, if your mind is wandering and off task, then this splendid opportunity will be lost. So, vow to be mindful at work and become better and happier with the way you make your living.

 

So, on this Labor Day, vow to be mindful and take advantage of the opportunities provided at work to learn about yourself. Grow as a person and grow spiritually by making every work day a mindful work day.

 

“When people say, “This is the way to do it,” that’s not true. There are always many ways, and the way you choose should depend on the current context. You can’t solve today’s problems with yesterday’s solutions. So when someone says, “Learn this so it’s second nature,” let a bell go off in your head, because that means mindlessness. The rules you were given were the rules that worked for the person who created them, and the more different you are from that person, the worse they’re going to work for you. When you’re mindful, rules, routines, and goals guide you; they don’t govern you.” – Ellen Langer

 

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

Improve Brain Metabolism and Muscle Energetics in Older Adults with Tai Chi

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Improve Brain Metabolism and Muscle Energetics in Older Adults with Tai Chi

 

By John M. de Castro, Ph.D.

 

”A comparison of the effects of regular sessions of tai chi, walking, and social discussion, has found tai chi was associated with the biggest gains in brain volume and improved cognition.”  – Fiona McPherson

 

The aging process involves a systematic progressive decline in every system in the body, the brain included. This includes our mental abilities which decline with age including impairments in memory, attention, and problem solving ability. It is inevitable and cannot be avoided. Using modern neuroimaging techniques, scientists have been able to view the changes that occur in the nervous system with aging. In addition, they have been able to investigate various techniques that might slow the process of neurodegeneration that accompanies normal aging. They’ve found that mindfulness practices reduce the deterioration of the brain that occurs with aging restraining the loss of neural tissue. Indeed, the brains of practitioners of meditation and yoga have been found to degenerate less with aging than non-practitioners.

 

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. Because it is not strenuous, involving slow gentle movements, and is safe, having no appreciable side effects, it is appropriate for an elderly population. Indeed, Tai Chi and Qigong have been shown to be beneficial in slowing or delaying physical and mental decline with aging and to increase brain matter in the elderly.

 

In today’s Research News article “Tai Chi Improves Brain Metabolism and Muscle Energetics in Older Adults.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055800/ ), Zhou and colleagues recruited healthy older people (>55 years of age) and trained them in Tai Chi practice with a one hour, twice a week, for 12 weeks instruction. They were measured before and after training for leg strength while having their brains scanned for metabolites with Magnetic Resonance Imaging (MRI). N‐acetylaspartate (NAA) is a neuronal marker of neuronal health. They also measured the rate of recovery of phosphocreatine (PCr) in the leg following exercise, a marker of muscular fitness.

 

They found that after training there was a significant increase in N‐acetylaspartate (NAA). NAA is a marker of the number of neurons present in the brain. Hence it’s increase in this study suggests that Tai Chi training increases the number of brain cells in the elderly. This further suggests that Tai Chi training is neuroprotective and may reduce the degeneration of the brain that occurs in normal aging.

 

They also found that after training there was a significant decrease in the rate of recovery of phosphocreatine (PCr) in the leg following exercise. A PCr decrease indicates that the capacity of muscles to use oxygen has increased. This, then, is a measure of muscular fitness. Hence it’s decrease in this study suggests that Tai Chi training improves exercise fitness in older adults helping to counter the age related decline in strength.

 

These results suggest the biochemical mechanisms that may underlie the ability of Tai Chi training to slow or delay physical and mental decline and to increase brain matter. These results not only further support the benefits of Tai Chi training for aging adults but also indicate how this training may change the chemistry of the brain and muscles to counter the effects of aging.

 

So, improve brain metabolism and muscle energetics in older adults with Tai Chi.

 

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

 

“Studies have shown that the incorporation of Tai Chi to an elders’ exercise program can be beneficial. Tai Chi practice was “beneficial to improve the balance control ability and flexibility of older adults, which may be the reason of preventing falls.” – Eric Edelman

 

In today’s Research News article “Tai Chi Improves Brain Metabolism and Muscle Energetics in

Study Summary

 

Zhou, M., Liao, H., Sreepada, L. P., Ladner, J. R., Balschi, J. A., & Lin, A. P. (2018). Tai Chi Improves Brain Metabolism and Muscle Energetics in Older Adults. Journal of Neuroimaging, 28(4), 359–364. http://doi.org/10.1111/jon.12515

 

ABSTRACT

BACKGROUND AND PURPOSE

Tai Chi is a mind‐body exercise that has been shown to improve both mental and physical health. As a result, recent literature suggests the use of Tai Chi to treat both physical and psychological disorders. However, the underlying physiological changes have not been characterized. The aim of this pilot study is to assess the changes in brain metabolites and muscle energetics after Tai Chi training in an aging population using a combined brain‐muscle magnetic resonance spectroscopy (MRS) examination.

METHODS

Six healthy older adults were prospectively recruited and enrolled into a 12‐week Tai Chi program. A brain 1H MRS and a muscle 31P MRS were scanned before and after the training, and postprocessed to measure N‐acetylaspartate to creatine (NAA/Cr) ratios and phosphocreatine (PCr) recovery time. Wilcoxon‐signed rank tests were utilized to assess the differences between pre‐ and post‐Tai Chi training.

RESULTS

A significant within‐subject increase in both the NAA/Cr ratios (P = .046) and the PCr recovery time (P =.046) was observed between the baseline and the posttraining scans. The median percentage changes were 5.38% and 16.51% for NAA/Cr and PCr recovery time, respectively.

CONCLUSIONS

Our pilot study demonstrates significant increase of NAA/Cr ratios in posterior cingulate gyrus and significantly improved PCr recovery time in leg muscles in older adults following short‐term Tai Chi training, and thus provides insight into the beneficial mechanisms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055800/

 

Improve Psychological Health with Mindfulness Training at Work

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Improve Psychological Health with Mindfulness Training at Work

 

By John M. de Castro, Ph.D.

 

“As an executive coach and physician, I often sing the praises of mindfulness approaches and recommend them to clients to manage stress, avoid burnout, enhance leadership capacity, and steady their minds when in the midst of making important business decisions, career transitions, and personal life changes.” – David Brendel

 

Work is very important for our health and well-being. We spend approximately 25% of our adult lives at work. How we spend that time is immensely important for our psychological and physical health. Indeed, the work environment has even become an important part of our social lives, with friendships and leisure time activities often attached to the people we work with. But, more than half of employees in the U.S. and nearly 2/3 worldwide are unhappy at work. This is partially due to work-related stress which is epidemic in the western workplace. Almost two thirds of workers reporting high levels of stress at work. This stress can result in impaired health and can result in burnout; producing fatigue, cynicism, and professional inefficacy.

 

To help overcome unhappiness, stress, and burnout, mindfulness practices have been implemented in the workplace. Indeed, mindfulness practices have been shown to markedly reduce the physiological and psychological responses to stress. As a result, many businesses have incorporated mindfulness practices into the workday to help improve employee well-being, health, and productivity and reduce burnout and turnover.

 

In today’s Research News article “A Stress Reduction Program Adapted for the Work Environment: A Randomized Controlled Trial With a Follow-Up.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954607/ ), Lacerda and colleagues recruited employees at two business locations who complained of stress and randomly assigned them to an 8-week mindfulness training or wait-list condition. At the end of the 8-weeks the wait-list group received the mindfulness training. Training occurred once a week for 60 minutes and consisted of self-awareness, empathy, stress reduction, meditation and body scan practices. The participants were measured before and after training and 8 weeks later for psychiatric symptoms, stress symptoms, depression, anxiety, processing speed, and mindfulness.

 

They found that compared to baseline and the wait-list control group, the employees who received the mindfulness training had significant reductions in non-severe psychiatric symptoms, anxiety, depression, and stress, and increases in processing speed/attention and mindfulness. These improvements were still present 8 weeks later. Hence, mindfulness training produced significant improvements in the mental health of these stressed employees.

 

It is well established that mindfulness training results in reductions in anxiety, depression, perceived stress and burnout, and improvements in cognition. The importance of this study stems from the fact that the mindfulness program only required a 1-hour commitment at work once a week to produce these improvements. This is a tolerable commitment of time for most managers and may not only improve the employees’ mental health but also lead to improvements in productivity, and reductions in turnover and health care costs. Thus, this form of training would appear to be well worth the investment.

 

So, improve psychological health with mindfulness training at work.

 

“when someone says, “Learn this so it’s second nature,” let a bell go off in your head, because that means mindlessness. The rules you were given were the rules that worked for the person who created them, and the more different you are from that person, the worse they’re going to work for you. When you’re mindful, rules, routines, and goals guide you; they don’t govern you.” – Harvard Business Review

 

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

 

Lacerda, S. S., Little, S. W., & Kozasa, E. H. (2018). A Stress Reduction Program Adapted for the Work Environment: A Randomized Controlled Trial With a Follow-Up. Frontiers in Psychology, 9, 668. http://doi.org/10.3389/fpsyg.2018.00668

 

Abstract

Objective: The aim of this study was to evaluate an in situ stress reduction program, named PROGRESS, developed to meet the specific needs of workers in a business context and to research its impact upon non-severe psychiatric symptoms, stress, anxiety, depression, processing speed/attention and mindfulness.

Methods: Participants with stress complaints were randomized into two groups: the main intervention group: group 1-G1, (n = 22); and the control group: group 2-G2, (n = 22). The protocol was divided into three distinct phases for the purpose of the study. Both groups were evaluated at time 1 (T1), before the first 8-week intervention, which only G1 received. The second evaluation was made on both groups at time 2 (T2), immediately after this first program; in order to test the program’s replicability and investigate possible follow-up effects, an identical second 8-week program was offered to G2 during time 3 (T3), while G1 was simply instructed to maintain the practice they had learned without further instruction between T2 and T3. A Confirmatory factor analysis (CFA) was conducted to investigate the construct validity of PROGRESS.

Results: Repeated measures MANOVA test, comparing G1 and G2, showed the effect of the intervention from T1 to T2 (p = 0.021) and from T2 to T3 (p = 0.031). Univariate analysis showed that participants from G1 improved levels of non-severe psychiatric symptoms, anxiety, depression, stress, processing speed/attention and mindfulness when compared with G2, from T1 to T2 (p < 0.05). After the participants in G2 received the intervention (T2 to T3), this group also showed improvement in the same variables (p < 0.05). At the end of their follow-up period (T2-T3) – during which they received no further support or instruction – G1 maintained the improvements gained during T1-T2. The two main components were stress (stress in the last 24-h, in the last week and last month) and mental health (non-severe psychiatric symptoms, depression, anxiety and mindfulness).

Conclusion: PROGRESS, an in situ mindfulness program adapted to fit within the reality of business time constraints, was effective at replicating in more than one group the reduction of stress, depression, anxiety, non-severe psychiatric symptoms, processing speed and also the improvement of attention skills, showing sustained improvement even after 8-weeks follow-up.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954607/

 

Improve Athletic Performance with Mindfulness-Acceptance-Commitment Therapy

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Improve Athletic Performance with Mindfulness-Acceptance-Commitment Therapy

 

By John M. de Castro, Ph.D.

 

“The crowd gets quiet, and the moment starts to become the moment for me . . . that’s part of that Zen Buddhism stuff. Once you get into the moment, you know when you are there. Things start to move slowly, you start to see the court very well. You start reading what the defense is trying to do.” – Michael Jordan

 

Athletic performance requires the harmony of mind and body. Excellence is in part physical and in part psychological. That is why an entire profession of Sports Psychology has developed. “In sport psychology, competitive athletes are taught psychological strategies to better cope with a number of demanding challenges related to psychological functioning.” They use a number of techniques to enhance performance including mindfulness training. It has been shown to improve attention and concentration and emotion regulation and reduces anxiety and worry and rumination, and the physiological and psychological responses to stress. As a result, mindfulness training has been employed by athletes and even by entire teams to enhance their performance.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. It would seem that ACT would be an excellent practice to improve athletic performance

 

In today’s Research News article “Effectiveness of the mindfulness-acceptance-commitment-based approach on athletic performance and sports competition anxiety: a randomized clinical trial. Electronic Physician.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033134/ ), Dehghani and colleagues examine the ability of a mindfulness-acceptance-commitment-based program to improve the performance of women basketball players. They recruited college female basketball players between the ages of 18 to 30 years and randomly assigned them to receive either 8, 1.5-hour sessions of a mindfulness-acceptance-commitment-based program or a waitlist control condition. The women were measured before and after treatment for self-evaluated sports performance, acceptance or avoidance of internal experiences, and sports competition anxiety.

 

They found that in comparison to the baseline and the control group the women who received the mindfulness-acceptance-commitment-based program had significantly higher scores for sports performance (57% higher), and lower scores for experiential avoidance and sports anxiety (29% and 47% lower respectively). Hence the treated participants were markedly improved in the psychological readiness to compete and their sports performance.

 

It should be noted that the women in the control condition did not receive any treatment. In addition, there were no objective measures of athletic performance. Future research should compare the effectiveness of the mindfulness-acceptance-commitment-based program to another active intervention, perhaps yoga practice or cognitive behavioral therapy. This would better control for potential research contamination. It should also provide objective measures of performance in athletic competition.

 

Mindfulness practices are well documented to lower anxiety levels and physiological and psychological responses to stress. In addition, learning to accept experiences and not attempt to avoid them would better prepare an athlete to consciously confront the sports situations that they are engaged in. Both of these components of the mindfulness-acceptance-commitment-based program then would be expected to improve an athletes mental and physical performance.

 

So, improve athletic performance with mindfulness-acceptance-commitment therapy.

 

“I approached it with mindfulness. As much as we pump iron and we run to build our strength up, we need to build our mental strength up… so we can focus… so we can be in concert with one another.” – Phil Jackson

 

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

 

Dehghani, M., Saf, A. D., Vosoughi, A., Tebbenouri, G., & Zarnagh, H. G. (2018). Effectiveness of the mindfulness-acceptance-commitment-based approach on athletic performance and sports competition anxiety: a randomized clinical trial. Electronic Physician, 10(5), 6749–6755. http://doi.org/10.19082/6749

 

Abstract

Background

Improving sports performance and reducing anxiety is one of the most important goals of athletes. Recurrence of symptoms and treatment cessation are common problems with common interventions. Approaches based on mindfulness-acceptance-commitment (MAC) can be a response to these limitations

Objective

The main purpose of the present study was to determine effectiveness of the mindfulness-acceptance-commitment-based approach to athletic performance enhancement and sports competition anxiety in students who have had athletic experience for 3 to 5 years.

Methods

This randomized clinical trial was conducted at the Faculty of Educational Sciences of Iran University of Medical Sciences in Tehran, Iran, from May 1, 2017 to September 15, 2017. A total of 31 students were randomly assigned to experimental (n=15) and control groups (n=16). The experimental group received the protocol Mindfulness-Acceptance-Commitment (MAC) for 8 sessions. Subjects completed the Charbonneau Sports Performance Questionnaire, Action and Acceptance Questionnaire (AAQ) and Sports Competition Anxiety Test (SCAT) Questionnaire. Data analysis was conducted by using multivariate covariance analysis (MANCOVA) by SPSS-22.

Results

The results of the study indicated that the MAC approach increases significantly the performance of basketball playing athletes (p<0.05). Furthermore, the MAC approach decreases significantly experiential avoidance and sports anxiety in athletes (p<0.05). The size of the difference between the groups is moderate (Eta squared).

Conclusions

This study revealed that the mindfulness-acceptance-commitment-based approach is an effective intervention to increasing athletic performance and reducing experiential avoidance and sports anxiety in athletes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033134/

Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

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Improve Borderline Personality Disorder with Dialectical Behavior Therapy Mindfulness

 

By John M. de Castro, Ph.D.

 

“People with borderline personality disorder can be challenging to treat, because of the nature of the disorder. They are difficult to keep in therapy, frequently fail to respond to our therapeutic efforts and make considerable demands on the emotional resources of the therapist, particular when suicidal behaviors are prominent. Dialectical Behavior Therapy is an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way which is optimistic and which preserves the morale of the therapist.” – Psych Central

 

Borderline Personality Disorder (BPD) is a very serious mental illness that is estimated to affect 1.6% of the U.S. population. It involves unstable moods, behavior, and relationships, problems with regulating emotions and thoughts, impulsive and reckless behavior, and unstable relationships. BPD is associated with high rates of co-occurring depression, anxiety disorders, substance abuse, eating disorders, self-harm, suicidal behaviors, and completed suicides. Needless to say, it is widespread and debilitating.

 

One of the few treatments that appears to be effective for Borderline Personality Disorder (BPD) is Dialectical Behavior Therapy (DBT). It is targeted at changing the problem behaviors characteristic of BPD including self-injury. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Although the effectiveness of DBT for BPR is well established the most effective and cost effective means of delivering DBT has not been established.

 

In today’s Research News article “Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/ ), Sinnaeve and colleagues examine the effectiveness of DBT provided either as a Step-down DBT program or delivered on an out-patient basis. The Step-down DBT program consisted of 3 months of therapy as an inpatient and then 6 months as an outpatient. Outpatient DBT was delivered for 12 months completely on an outpatient basis. They recruited adult (18–45 years of age) patients with severe Borderline Personality Disorder (BPD) and randomly assigned them to either the step-down or outpatient program of Dialectical Behavior Therapy (DBT). They were measured at baseline and at 3, 6, 9, and 12 months of treatment for psychiatric symptoms, borderline personality disorder, suicidal thoughts, quality of life, and costs of therapy delivery.

 

They found that both programs were effective and produced significant decreases in the severity of Borderline Personality Disorder (BPD). But, the step-down program was far more effective in retaining participants with 95% of the participants who started the program completing it as opposed to only 45% of the out-patient participants completing the program. In addition, the step-down program patients had significant reductions in suicidal intentions and improvements in quality of life while the out-patient participants did not. Hence the step-down delivery of DBT was found to be significantly more effective than the outpatient DBT,

 

On the other hand, the step-down program was far more expensive to deliver; €19,899 per patient versus €12,472. To further investigate this the costs per Quality Adjusted Life Year (QALY) for both programs were calculated. QALY measures how much benefit (increase in quality of life) is produced per unit of cost. This analysis suggested that the step-down program was not as cost effective as the outpatient program. So, it would appear that although a step-down program is more effective it may not be as cost effective as a more traditional outpatient program. Regardless, Dialectical Behavior Therapy (DBT) was an effective treatment for severe Borderline Personality Disorder (BPD) regardless of delivery method.

 

So, improve borderline personality disorder with dialectical behavior therapy produced mindfulness.

 

“DBT was the first psychotherapy shown to be effective in treating BPD in controlled clinical trials, the most rigorous type of clinical research.“ – Kristalyn Salters

 

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

 

Sinnaeve, R., van den Bosch, L. M. C., Hakkaart-van Roijen, L., & Vansteelandt, K. (2018). Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial. Borderline Personality Disorder and Emotion Dysregulation, 5, 12. http://doi.org/10.1186/s40479-018-0089-5

 

Abstract

Background

Step-down dialectical behaviour therapy (DBT) is a treatment consisting of 3 months of residential DBT plus 6 months of outpatient DBT. The program was specifically developed for people suffering from severe borderline personality disorder (BPD). The present study examines the effectiveness and cost-effectiveness of step-down DBT compared to 12 months of regular, outpatient DBT.

Methods

Eighty-four participants reporting high levels of BPD-symptoms (mean age 26 years, 95% female) were randomly assigned to step-down versus standard DBT. Measurements were conducted at baseline and after 3, 6, 9 and 12 months. The Lifetime Parasuicide Count and BPD Severity Index (BPDSI) were used to assess suicidal behaviour, non-suicidal self-injury (NSSI) and borderline severity. Costs per Quality Adjusted Life Year (QALY) were calculated using data from the EQ-5D-3L and the Treatment Inventory Cost in Psychiatric Patients (TIC-P).

Results

In step-down DBT, 95% of patients started the program, compared to 45% of patients in outpatient DBT. The probability of suicidal behaviour did not change significantly over 12 months. The probability of NSSI decreased significantly in step-down DBT, but not in outpatient DBT. BPDSI decreased significantly in both groups, with the improvement leveling off at the end of treatment. While step-down DBT was more effective in increasing quality of life, it also cost significantly more. The extra costs per gained QALY exceeded the €80,000 threshold that is considered acceptable for severely ill patients in the Netherlands.

Conclusions

A pragmatic randomized controlled trial in the Netherlands showed that 9 months of step-down DBT is an effective treatment for people suffering from severe levels of BPD. However, step-down DBT is not more effective than 12 months of outpatient DBT, nor is it more cost-effective. These findings should be considered tentative because of high noncompliance with the treatment assignment in outpatient DBT. Furthermore, the long-term effectiveness of step-down DBT, and moderators of treatment response, remain to be evaluated.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040072/

 

Improve Weight Loss in the Overweight with Mindfulness

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Improve Weight Loss in the Overweight with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In our complex, fast-paced world, mindfulness meditation and similar techniques have been recommended to reduce stress, enhance immunity, boost learning, increase productivity and more. New research suggests an important addition to the list: At least three recent studies have suggested that mindful eating can improve weight-loss efforts and combat obesity.” – Amby Burfoot

 

Obesity has become an epidemic in the industrialized world. In the U.S. the incidence of obesity, has more than doubled over the last 35 years to currently around 35% of the population, while two thirds of the population are considered overweight or obese (Body Mass Index; BMI > 25). Although the incidence rates have appeared to stabilize, the fact that over a third of the population is considered obese is very troubling. This is because of the health consequences of obesity. Obesity has been found to shorten life expectancy by eight years and extreme obesity by 14 years. This occurs because obesity is associated with cardiovascular problems such as coronary heart disease and hypertension, stroke, metabolic syndrome, diabetes, cancer, arthritis, and others.

 

Obviously, there is a need for effective treatments to prevent or treat obesity. But, despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective treatment. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. This suggests that mindfulness training may be an effective treatment for overeating, overweight, and obesity alone or in combination with other therapies.

 

In today’s Research News article “The Effectiveness of Cognitive Behavioral Therapy With Mindfulness and an Internet Intervention for Obesity: A Case Series.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fnut.2018.00056/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_715866_87_Nutrit_20180724_arts_A ), Ogata and colleagues recruited 3 overweight adult women who had previously tried and failed to lose weight. They were provided a program of mindfulness training in combination with Cognitive Behavior Therapy (CBT) and daily recording of food intake. Treatment occurred in 60-minute weekly meetings for 9 weeks. It was aimed at developing mindfulness and “to increase distress tolerance, improve healthy coping strategies, and reduce maladaptive coping strategies (e.g., avoidant and impulsive coping styles that involve emotional eating); and relearning adaptive eating habits.” The women were measured weekly for body size, eating behaviors, anxiety, and mindfulness and at a follow-up assessment occurring 18 months later.

 

The three participants over the 9-week program lost 6.9%, 5.3%, and 8.9% of their body weight respectively and all had continued to lose weight over the subsequent 18 months; 14.0%, 7.9%, and 11% respectively. The participants also showed significant decreases in emotional and external eating and increases in mindfulness and restrained eating. Hence the mindfulness and CBT program was successful in producing significant and prolonged weigh reductions and altered eating behaviors toward a more restrained eating.

 

There was no control condition so a placebo effect or experimenter bias effect may be present. But, the participants did not lose weight when involved in other dietary programs where comparable placebo and experimenter bias effects would be expected to have been in effect. So, these sources of confounding are unlikely to account for the weight losses.

 

Mindfulness training with CBT has been previously been shown to increase mindful eating and that eating food mindfully can results in lower overall intake and weight loss. The program has also been shown to reduce the psychological and physical responses to stress and stress is known to promote eating. So, it is reasonable to conclude that it produces its effects on the body weight of overweight individuals by increasing mindful eating and reducing stress.

 

So, improve weight loss in the overweight with mindfulness.

 

“Although average weight loss was modest at post-treatment, continued decreases in weight at follow-up is encouraging and highlights the potential of using mindfulness training to support weight loss and its maintenance.” – Regina Schaffer

 

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

 

Ogata K, Koyama KI, Amitani M, Amitani H, Asakawa A and Inui A (2018) The Effectiveness of Cognitive Behavioral Therapy With Mindfulness and an Internet Intervention for Obesity: A Case Series. Front. Nutr. 5:56. doi: 10.3389/fnut.2018.00056

 

It is difficult for obese (body mass index of more than 30) and overweight (body mass index of 25–30) people to reduce and maintain their weight. The aim of this case series was to examine the effectiveness of a new cognitive behavioral therapy (CBT) program that combines mindfulness exercises (e.g., the raisin exercise and breathing exercises) and an online intervention to prevent dropout and subsequent weight gain in overweight participants. This case series included three participants, for whom previous weight reduction programs had been unsuccessful. All participants completed the program (60-min, group sessions provided weekly for 9 weeks) and an 18-month follow-up assessment. Results showed that all participants succeeded in losing weight (loss ranged from 5.30 to 8.88% of their total body weight). Although rebound weight gain is commonly observed in the first year following initial weight loss, the follow-up assessment showed that participants achieved further weight loss during the 18-month follow-up period. These results suggest that a CBT program that comprises mindfulness and an online intervention may be an effective method for weight loss and maintenance, and may prevent dropout in obese and overweight individuals.

https://www.frontiersin.org/articles/10.3389/fnut.2018.00056/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_715866_87_Nutrit_20180724_arts_A