Improve Knee Osteoarthritis in Older Adults with Yoga

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Improve Knee Osteoarthritis in Older Adults with Yoga 

By John M. de Castro, Ph.D.

 

“Osteoarthritis is a chronic, long-term disease that affects millions of elderly adults. There is currently no known cure for it and treatment options are limited. New research, however, suggests that chair yoga is effective in relieving osteoarthritis pain.” Ana Sandoiu

 

Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. It is the leading cause of disability in the U.S., with about 43% of arthritis sufferers limited in mobility and about a third having limitations that affect their ability to perform their work. Knee osteoarthritis effects 5% of adults over 25 years of age and 12% of those over 65. It is painful and disabling. Its causes are varied including, hereditary, injury including sports injuries, repetitive stress injuries, infection, or from being overweight.

 

There are no cures for knee osteoarthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers and anti-inflammatory drugs, corticosteroids, arthroscopic knee surgery, or even knee replacement. Gentle movements of the joints with exercise and physical therapy appear to be helpful in the treatment of knee osteoarthritis. This suggests that alternative and complementary practices that involve gentle knee movements may be useful for treatment.

 

Various forms of traditional Chinese exercises, such as Tai Chi, Qigong, and Baduanjin involve slow gentle movements of the limbs and mindfulness and have been shown to reduce the physical symptoms of knee osteoarthritis. Another mindfulness practice, yoga, has been shown to be a safe and effective treatment for a wide variety of physical and psychological conditions, including arthritis. So, it would seem reasonable to look further into the effectiveness of yoga practice in treating knee osteoarthritis.

 

In today’s Research News article “Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569242/, Cheung and colleagues recruited elderly (>60 years of age) participants with knee osteoarthritis and randomly assigned them to one of three conditions; Hatha Yoga, Strengthening Exercise, or Education Control. The yoga and exercise training occurred in 8 weekly 45-minute sessions supplemented with 4 30-minute sessions per week at home. The Education Control consisted of the distribution of pamphlets on knee osteoarthritis. Participants were measured before, the midpoint (4 weeks), and after training for knee osteoarthritis pain, stiffness, and physical function, lower extremity function, anxiety, depression, fear of falling, spiritual health, quality of life, program satisfaction, and adherence to the program.

 

They found that compared to the education condition, the Hatha Yoga and strengthening exercise practices produced significantly greater improvements in overall knee osteoarthritis symptoms, including pain, physical function, chair stands, walking, anxiety, and fear of falling. But, the Hatha Yoga practice compared to the strengthening exercise produced significantly superior improvements in overall knee osteoarthritis symptoms, including pain, physical function, anxiety, and fear of falling. Hence, although both exercises produced significant improvements in the symptoms of knee osteoarthritis, Hatha Yoga was significantly better. Importantly, no adverse events were produced by the Hatha Yoga practice.

 

These are important results as, although yoga has been previously shown to improve knee osteoarthritis symptoms, it has not been shown to be superior to other exercise programs. This superiority suggests that the mindfulness components of yoga have benefits for knee osteoarthritis in addition to the gentle exercise components. This may be due to the ability of mindfulness training to reduce anxiety and stress responses which are known to amplify pain and fear. Regardless, the findings clearly indicate that Hath Yoga practice is safe and effective and should be recommended for elderly individuals with knee osteoarthritis.

 

So, improve knee osteoarthritis in older adults with yoga.

 

“For the millions of older adults who suffer from osteoarthritis in their lower extremities (hip, knee, ankle or foot), chair yoga is proving to be an effective way to reduce pain and improve quality of life while avoiding pharmacologic treatment or adverse events.” – Florida Atlantic University

 

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

 

Cheung, C., Wyman, J. F., Bronas, U., McCarthy, T., Rudser, K., & Mathiason, M. A. (2017). Managing knee osteoarthritis with yoga or aerobic/strengthening exercise programs in older adults: a pilot randomized controlled trial. Rheumatology International, 37(3), 389–398. http://doi.org/10.1007/s00296-016-3620-2

 

Abstract

Although exercise is often recommended for managing osteoarthritis (OA), limited evidence-based exercise options are available for older adults with OA. This study compared the effects of Hatha yoga (HY) and aerobic/strengthening exercises (ASE) on knee OA. Randomized controlled trial with three arms design was used: HY, ASE, and education control. Both HY and ASE groups involved 8 weekly 45-min group classes with 2–4 days/week home practice sessions. Control group received OA education brochures and weekly phone calls from study staff. Standardized instruments were used to measure OA symptoms, physical function, mood, spiritual health, fear of falling, and quality of life at baseline, 4 and 8 weeks. HY/ASE adherences were assessed weekly using class attendance records and home practice video recordings. Primary analysis of the difference in the change from baseline was based on intent-to-treat and adjusted for baseline values. Eight-three adults with symptomatic knee OA completed the study (84% female; mean age 71.6 ± 8.0 years; mean BMI 29.0 ± 7.0 kg/m2). Retention rate was 82%. Compared to the ASE group at 8 weeks, participants in the HY group had a significant improvement from baseline in perception of OA symptoms (−9.6 [95% CI −15.3, −4]; p = .001), anxiety (−1.4 [95% CI −2.7, −0]; p = .04), and fear of falling (−4.6 [−7.5, −1.7]; p = .002). There were no differences in class/home practice adherence between HY and ASE. Three non-serious adverse events were reported from the ASE group. Both HY and ASE improved symptoms and function but HY may have superior benefits for older adults with knee OA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569242/

Reduce Medical Resident Burnout with Mindfulness

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Reduce Medical Resident Burnout with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness meditation introduces a way of cultivating awareness of one’s relationship with the present moment. With practice, it may lead to healthier ways of working with stressful life experiences, including those inherent to residency training.” – Vincent Minichiello

 

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 it is a threat to the healthcare providers and their patients. 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 “Mindfulness, burnout, and effects on performance evaluations in internal medicine residents.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565254/, Braun and colleagues recruited medical residents and had them complete measures of mindfulness, burnout, depression, and stress. They were also rated by the staff for their level of professional development.

 

They found that 71% of the residents met the criterion for burnout and this was associated with poor performance in their residency. Importantly, dispositional mindfulness, particularly “acting with awareness,” was significantly, negatively associated with meeting the burnout criterion, such that low mindfulness predicted a high likelihood of burnout. Burned-out residents tended to be low in mindfulness while resilient residents tended to be high in mindfulness.

 

These are interesting results, but were correlational, so causal relationships cannot be determined. Nevertheless, previous studies have demonstrated that mindfulness training can reduce burnout. This combined with the present results suggest that being mindful and acting with awareness are helpful for preventing burnout.  It remains for future research to demonstrate if mindfulness training can prevent burnout in medical residents.

 

So, reduce medical resident burnout with mindfulness.

 

“Having a greater ability to recognize what’s going on inside allows you to set aside distractions and really attend to the moment. Paradoxically, what you learn in meditation is that turning toward the distress and becoming curious about it rather than being swept away by it is a way to detoxify it. The more we try to escape the stress, the worse it becomes.” – Ron Epstein

 

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

 

Braun, S. E., Auerbach, S. M., Rybarczyk, B., Lee, B., & Call, S. (2017). Mindfulness, burnout, and effects on performance evaluations in internal medicine residents. Advances in Medical Education and Practice, 8, 591–597. http://doi.org/10.2147/AMEP.S140554

 

Abstract

Purpose

Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents.

Methods

Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory.

Results

Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the “acting with awareness” facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the “system-based practices” and “professionalism” domains and negative effects on a milestone from the “patient care” domain.

Conclusion

Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565254/

Mindfulness is Associated with Reduced Inflexibility and Psychopathology in Adolescents

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Mindfulness is Associated with Reduced Inflexibility and Psychopathology in Adolescents

 

By John M. de Castro, Ph.D.

 

“As present-moment focused, mindfulness, acceptance, and defusion interventions alter the context, behavioral flexibility emerges and, with it, increased sensitivity to context, including that aspect of context we call consequences.” – Kelly Wilson

 

Adolescence should be a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops. These executive functions are an important foundation for success in the complex modern world. But, adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required.

 

Making these profound changes successfully requires a good deal or flexibility, adapting and changing with the physical, psychological, and social changes of adolescence. In today’s Research News article “Inflexible Youngsters: Psychological and Psychopathological Correlates of the Avoidance and Fusion Questionnaire for Youths in Nonclinical Dutch Adolescents.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605724/, Muris and colleagues examined the relationships between mindfulness, inflexibility and mental health in adolescents. They recruited youths aged 12 to 16 years and had them complete measures of mindfulness, psychological inflexibility, thought suppression self-compassion, self-worth, self-efficacy, somatization, psychopathological symptoms, anxiety, depression, and aggression.

 

They found that the higher the levels of mindfulness the lower the levels of inflexibility, thought suppression, somatization, anxiety, depression, emotional problems, aggression, oppositional conduct, and the higher the levels of self-worth and self-efficacy. They also found that psychological inflexibility was inversely related to the same variables, with higher levels of inflexibility associated with higher levels of thought suppression, somatization, anxiety, depression, emotional problems, aggression, oppositional conduct, and the lower the levels of self-worth and self-efficacy. In other words, mindfulness was associated with positive mental health while inflexibility was associated with negative mental health in these youths.

 

They further investigated the effectiveness of psychological inflexibility to affect the mental health of the adolescents while holding mindfulness mathematically constant. They found that each had independent contributions to the levels of anxiety and depression, with mindfulness associated with lower values and inflexibility associated with higher values. So, mindfulness and psychological inflexibility appear to be independently associated with emotional health in adolescents.

 

It is important to keep in mind that this study was correlational and did not manipulate the levels of any variables. So, causal connections cannot be determined between the variables. The associations though suggest that both mindfulness and psychological flexibility are important contributors to the psychological development of adolescents. It will be interesting to investigate in future research whether training in mindfulness and flexibility will help to promote healthy mental health in youths.

 

“While psychological inflexibility was most strongly associated with Neuroticism , as expected, mindfulness demonstrated the strongest association with consciousness, a trait reflecting impulse control abilities and attention to detail.” – Robert Latzman

 

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

 

Muris, P., Meesters, C., Herings, A., Jansen, M., Vossen, C., & Kersten, P. (2017). Inflexible Youngsters: Psychological and Psychopathological Correlates of the Avoidance and Fusion Questionnaire for Youths in Nonclinical Dutch Adolescents. Mindfulness, 8(5), 1381–1392. http://doi.org/10.1007/s12671-017-0714-1

 

Abstract

The present study examined psychological and psychopathological correlates of psychological inflexibility as measured by the Avoidance and Fusion Questionnaire for Youth (AFQ-Y) in two independent samples of nonclinical Dutch adolescents aged between 12 and 18 years (Ns being 184 and 157). Participants completed a survey containing the AFQ-Y and scales assessing mindfulness, thought suppression, self-compassion, self-worth, self-efficacy, and internalizing/externalizing symptoms. In both samples, the AFQ-Y was found to be a reliable measure of psychological inflexibility that correlated in a theoretically meaningful way with other psychological constructs. Most importantly, AFQ-Y scores correlated positively with internalizing and externalizing symptoms, and in most cases, these associations remained significant when controlling for other measures. These findings suggest that psychological inflexibility is an important factor in youth psychopathology that needs to be further investigated in future research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605724/

Improve Emotions of Ethnically Diverse At-Risk Students with Mindfulness

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Improve Emotions of Ethnically Diverse At-Risk Students with Mindfulness

 

By John M. de Castro, Ph.D.

 

“There is plenty of evidence available now that demonstrates the value of teaching mindfulness to young people, and many of the benefits of mindfulness are skills and dispositions that are especially helpful in the context of education. Mindfulness practices help children improve their ability to pay attention, by learning to focus on one thing (e.g., breath, sound) while filtering out other stimuli. Mindfulness also provides kids with skills for understanding their emotions and how to work with them.” – Sarah Beach

 

Adolescence should be a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops. These executive functions are an important foundation for success in the complex modern world. But, adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. These difficulties can be markedly amplified by negative life events during childhood.

 

At-risk youth confront unique pressures that have been linked to poor psychosocial outcomes, impaired academic performance, and maladaptive behaviors such as substance use and delinquency. These risk factors may include language barriers, low SES, parents’ own involvement in high risk or illegal behavior, restrictive or neglectful parenting, and home environments that expose children to alcohol and substance abuse. Mindfulness training has been found to be helpful for adolescents and also to improve performance in school. So, it is possible that mindfulness training would be helpful for at-risk adolescents.

 

In today’s Research News article “A School-Based Mindfulness Pilot Study for Ethnically Diverse At-Risk Adolescents.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809539/pdf/nihms652885.pdf, Bluth and colleagues recruited adolescents who were attending an alternative high school for troublesome and at-risk students. They were randomly assigned to receive either and 11-week class of mindfulness training or substance abuse training. The mindfulness training included body scan, sitting meditation, lovingkindness practice, walking meditation and mindful movement. The substance abuse training consisted of lectures designed to help adolescents address drug use and co-occurring life problems. The students were measured before and after the trainings for class attendance, retention, program acceptability, mindfulness, self-compassion, social connectedness, anxiety, depression, and perceived stress.

 

At the beginning of the mindfulness training there was considerable resistance and acting out. But, by the end of training the students responded that the class was helpful and wanted it to continue. They also found that the mindfulness training produced significant improvements in the students’ depression and anxiety levels. Mindfulness training has in the past been repeatedly shown to help relieve depression and anxiety. But, it is an important finding that it can do so in these difficult to treat at-risk adolescents. So, the study showed that mindfulness training was feasible and acceptable to these at-risk adolescents and produced improvements in their negative emotions.

 

The results are encouraging. These troubled youths are extremely difficult to work with and treat and that was reflected in the negative behaviors at the beginning of the class. But, by the end of the class the students found the mindfulness training useful and there were fairly large improvements in anxiety and depression. There were trends for other improvements and a larger future trial may be able to demonstrate other benefits of the mindfulness training. Although it was clear that mindfulness training is not a panacea for troubled youths, it can be helpful and provide space for them to destress and explore their inner lives.

 

So, improve emotions of ethnically diverse at-risk students with mindfulness.

 

“But a growing body of evidence suggests that mindfulness practice could be beneficial to teens, helping them cultivate empathy, as well as skills for concentration and impulse control. In short, mindfulness can help adolescents navigate the challenges of adolescence.” Sarah Beach

 

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

 

Bluth, K., Campo, R. A., Pruteanu-Malinici, S., Reams, A., Mullarkey, M., & Broderick, P. C. (2016). A School-Based Mindfulness Pilot Study for Ethnically Diverse At-Risk Adolescents. Mindfulness, 7(1), 90–104. http://doi.org/10.1007/s12671-014-0376-1

 

Adolescence is a transitional period marked by rapid physical, behavioral, emotional, and cognitive developmental changes. In addition to these normative development changes, adolescents also face a multitude of contextual stressors such as academic pressures at school, changing relationships with peers, and all too often, unstable family life characterized by divorce, frequent moves, income and occupational changes, and disruptions in family routines. Up to a quarter of adolescents suffer from depression or anxiety disorders, and an even larger proportion struggle with subclinical symptoms. Anxiety and depression during this stage can lead to impaired academic, social, and family functioning, and have long-term adverse outcomes.

Given the need to better understand both the implementation and potential benefit of mindfulness programs for at-risk youth, we conducted a randomized pilot study to investigate the feasibility and acceptability of such an intervention with ethnically diverse, primarily Hispanic youth enrolled in an alternative high school. We specifically examine intervention effects on psychosocial wellbeing and school performance relative to the control group, a class which focused on substance abuse prevention.

this study contributes to the literature by confirming the feasibility and acceptability of a mindfulness intervention with this population, and expands our knowledge on what works.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809539/pdf/nihms652885.pdf

Improve Multiple Sclerosis with Meditation and Yoga

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Improve Multiple Sclerosis with Meditation and Yoga

 

By John M. de Castro, Ph.D.

 

“Studies show that for some people with MS, chronic exposure to stress is associated with worsening neurological symptoms and increased brain lesions. Researchers believe that mindfulness may help people better respond to stress by fostering healthier coping strategies. Mindfulness practice appears to be a safe, drug-free approach to coping with stress and anxiety, which may in turn help reduce your MS symptoms.” – Amit Sood

 

Multiple Sclerosis (MS) is a progressive demyelinating disease which attacks the coating on the neural axons which send messages throughout the body and nervous system. It affects about 2 million people worldwide and about 400,000 in the U.S. It is most commonly diagnosed in people between the ages of 20 and 50 years.  Unfortunately, there is no cure for multiple sclerosis. There are a number of approved medications that are used to treat MS but are designed to lessen frequency of relapses and slow the progression of the disease, but they don’t address individual symptoms.

 

Although there is a progressive deterioration, MS is not fatal with MS patients having about the same life expectancy as the general population. Hence, most MS sufferers have to live with the disease for many years. So, quality of life becomes a major issue. Quality of life with MS is affected by fatigue, cognitive decrements, physical impairment, depression, and poor sleep quality. There is a thus a critical need for safe and effective methods to help relieve the symptoms of MS and improve quality of life.

 

Mindfulness practices have been previously shown to improve depression, sleep quality, cognitive impairments, emotion regulation, and fatigue. It has also been shown to improve the symptoms of multiple sclerosis.  Yoga is a mindfulness practice that has the added feature of exercising and stretching the muscles. It would seem likely that yoga practice might be an ideal treatment for improving the quality of life and lessening symptoms in patients with multiple sclerosis.

 

In today’s Research News article “Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649345/, Gilbertson and Klatt examined the combination of meditation and chair yoga practice which in the treatment of multiple sclerosis. They called this program “Mindfulness in Motion.” In a pilot feasibility study, they recruited patients with multiple sclerosis and provided them with 8 weeks of the “Mindfulness in Motion” program. The program met once a week for one hour and participants were expected to practice at home for 20 minutes every day. Participants were measured before and after the 8 weeks of practice for mindfulness, fatigue, anxiety, depression, behavior control, and positive affect, physical functioning, role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health.

 

They found that compared to baseline after completing the “Mindfulness in Motion” program the participants showed significant improvements in physical functioning, role-physical, vitality, mental health, anxiety, depression, and positive affect and cognitive and psychosocial fatigue and mindfulness including observing, acting with awareness, nonjudgment, and nonreactivity. Hence, after the 8-week “Mindfulness in Motion” program the participants showed marked and significant improvements in the psychological symptoms of multiple sclerosis.

 

It needs to be kept in mind that this study was a pilot feasibility study that did not have an active control condition, so conclusions must be made carefully. But, this is an extremely encouraging first step that suggests that the combination of two practices which individually produce symptom relief, meditation and chair yoga practice, is a particularly effective treatment for the psychological symptoms of multiple sclerosis.

 

So, improve multiple sclerosis with meditation and yoga.

 

“Studies in multiple sclerosis, these have shown that mindfulness can improve quality of life and help people cope better with their MS. The studies also found that it decreased stress, anxiety and depression.” – MS Trust

 

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

 

Rachel M. Gilbertson, Maryanna D. Klatt. Mindfulness in Motion for People with Multiple Sclerosis: A Feasibility Study. Int J MS Care. 2017 Sep-Oct; 19(5): 225–231. doi: 10.7224/1537-2073.2015-095

 

Abstract

Background:

Mindfulness in Motion is an 8-week mindfulness-based intervention that uses yoga movement, mindfulness meditation, and relaxing music. This study examined the feasibility of using Mindfulness in Motion in people with multiple sclerosis (MS) and the effect of this program on stress, anxiety, depression, fatigue, and quality of life in people with MS.

Methods:

Twenty-two people with MS completed the 8-week mindfulness program as well as assessments 1 week before and after the intervention.

Results:

Pre/post comparison of four self-reported questionnaires—the Mental Health Inventory, 36-item Short Form Health Status Survey, Modified Fatigue Impact Scale, and Five Facet Mindfulness Questionnaire—showed significant improvement in physical functioning, vitality, and mental health. Specifically, improvements were seen in anxiety, depression, and positive affect; cognitive, psychosocial, and overall functioning regarding fatigue; and mindfulness in the areas of observing, acting with awareness, nonjudgment, and nonreactivity.

Conclusions:

Due to the uncertainty in disease progression associated with MS, and the multiplicity of mental and physical symptoms associated with it, programming that addresses anxiety, depression, and fatigue is a key area of future research in MS disease management. Mindfulness in Motion proved to be a feasible program yielding positive results, supporting the need for research to determine the extent to which the program can improve quality-of-life outcomes for people with MS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649345/

Slightly Improve Substance Use Disorder with Mindfulness

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Slightly Improve Substance Use Disorder with Mindfulness

 

By John M. de Castro, Ph.D.

 

“though it may seem paradoxical, by increasing your ability to accept and tolerate the present moment, you become more able to make needed changes in your life. . . Also, practicing balanced emotional responses can reduce your stress level, and anxiety and stress are often triggers for substance abuse and addictive behavior. In addition, when you choose a neutral rather than a judgmental response to your thoughts and feelings, you can increase your sense of self-compassion rather than beating yourself up, which is often associated with addictive behaviors.” – Adi Jaffe

 

Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. In the U.S. about 17 million people abuse alcohol. Drunk driving fatalities accounted for over 10,000 deaths annually. Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse. Hence, it is important to find an effective method to prevent these relapses.

 

Mindfulness practices have been shown to improve recovery from various addictions. Mindfulness-based Relapse Prevention (MBRP) has been developed to specifically assist in relapse prevention and has been shown to be effective. “MBRP integrates mindfulness practices with cognitive-behavioral Relapse Prevention therapy and aims to help participants increase awareness and acceptance of difficult thoughts, feelings, and sensations to create changes in patterns of reactive behavior that commonly lead to relapse. Mindfulness training in MBRP provides clients with a new way of processing situational cues and monitoring internal reactions to contingencies, and this awareness supports proactive behavioral choices in the face of high-risk relapse situation.” – Grow et al. 2015

 

In today’s Research News article “Mindfulness-based Relapse Prevention for Substance Use Disorders: A Systematic Review and Meta-analysis.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636047/, Grant and colleagues review and perform a meta-analysis of the published research literature on the effectiveness of Mindfulness-based Relapse Prevention (MBRP) in treating substance use disorder. They identified 9 randomized controlled trials and examined the effects of MBRP on relapse, frequency and quantity of substance use, withdrawal/craving symptoms, treatment dropout, depressive and anxiety symptoms, negative consequences from substance use, and health-related quality of life and also its safety

 

They found that the summarized published research literature reported few and small positive effects. On most of the outcome measures there were no significant improvements produced by MBRP. Small significant improvements were found for withdrawal effects and cravings and the negative effects of substance use. They found that there were no adverse effects of MBRP. These are disappointing results that suggest that Mindfulness-based Relapse Prevention (MBRP) is safe but only slightly effective in treating substance use disorder.

 

These are surprising results as individual trials have reported significant effects. But, it appears that the different trials reported significant effects on different variables with some finding effects on a measure while others finding no effects on the same measure but reporting effects on different measures. When summarized, the reported effects appear to average away. Substance use disorder is such an important social and health issue where there are few viable treatment options, that further research on Mindfulness-based Relapse Prevention (MBRP) is warranted to investigate what components are effective and which not and how to optimize effectiveness.

 

So, slightly improve substance use disorder with mindfulness.

 

“Modeled after mindfulness-based cognitive therapy for depression and mindfulness-based stress reduction, MBRP tackles the very roots of addictive behavior by targeting two of the main predictors of relapse: negative emotions and cravings.” – Carolyn Gregoire

 

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

 

Sean Grant, Benjamin Colaiaco, Aneesa Motala, Roberta Shanman, Marika Booth, Melony Sorbero, Susanne Hempel. Mindfulness-based Relapse Prevention for Substance Use Disorders: A Systematic Review and Meta-analysis. J Addict Med. 2017 Sep; 11(5): 386–396. Published online 2017 Jul 19. doi: 10.1097/ADM.0000000000000338

 

Abstract

Objectives:

Substance use disorder (SUD) is a prevalent health issue with serious personal and societal consequences. This review aims to estimate the effects and safety of Mindfulness-based Relapse Prevention (MBRP) for SUDs.

Methods:

We searched electronic databases for randomized controlled trials evaluating MBRP for adult patients diagnosed with SUDs. Two reviewers independently assessed citations, extracted trial data, and assessed risks of bias. We conducted random-effects meta-analyses and assessed quality of the body of evidence (QoE) using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results:

We identified 9 randomized controlled trials comprising 901 participants. We did not detect statistically significant differences between MBRP and comparators on relapse (odds ratio [OR] 0.72, 95% confidence interval [CI] 0.46–1.13, low QoE), frequency of use (standardized mean difference [SMD] 0.02, 95% CI −0.40 to 0.44, low QoE), treatment dropout (OR 0.81, 95% CI 0.40 to 1.62, very low QoE), depressive symptoms (SMD −0.09, 95% CI −0.39 to 0.21, low QoE), anxiety symptoms (SMD −0.32, 95% CI −1.16 to 0.52, very low QoE), and mindfulness (SMD −0.28, 95% CI −0.72 to 0.16, very low QoE). We identified significant differences in favor of MBRP on withdrawal/craving symptoms (SMD −0.13, 95% CI −0.19 to −0.08, I2 = 0%, low QoE) and negative consequences of substance use (SMD −0.23, 95% CI −0.39 to −0.07, I2 = 0%, low QoE). We found negligible evidence of adverse events.

Conclusions:

We have limited confidence in estimates suggesting MBRP yields small effects on withdrawal/craving and negative consequences versus comparator interventions. We did not detect differences for any other outcome. Future trials should aim to minimize participant attrition to improve confidence in effect estimates.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636047/

It’s Eliminating the Causes of Suffering, Stupid

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It’s Eliminating the Causes of Suffering, Stupid

By John M. de Castro, Ph.D.

“The Buddha taught that beyond suffering lies great bliss. As we take steps towards removing the causes of suffering, we experience progressive levels of happiness. The path is a long one. But staying on it leads to a tremendous sense of liberation. There are other benefits from adhering to this philosophy – one can live in happiness, untroubled by any kind of negativity. At the end of this path, when desire and ignorance would have completely fallen away, one may experience the same transcendental joy that the Buddha did.” – Buddha Groove

In a previous essay the first Noble Truth was discussed, reflecting the patently obvious fact that there is suffering, a.k.a. unsatisfactoriness. In the next essay the second Noble Truth was discussed also stating the obvious that there are causes to the suffering. But, not so obviously we saw how, all encompassing, unsatisfactoriness is in our lives and how subtle are its causes. We saw that most of the unsatisfactoriness emanated from our inability to accept things as they are and instead, go to war against reality.

As we look carefully and deeply at this unsatisfactoriness, we find that it is much more encompassing than we initially thought, affecting every aspect of our lives and experience, day in and day out. In fact, unsatisfactoriness is the rule and not the exception. It is the biggest single impediment to being truly happy, making progress on a spiritual path, and experiencing liberation. The Buddha recognized this and held out hope in the third Noble Truth, that suffering can be eliminated, that there can be a cessation of unsatisfactoriness.

At first glance the idea of eliminating suffering would seem simple, just eliminate the cause of suffering. Since, the cause of suffering, desiring things to be different than they are, is also simple, it should be an easy task to eliminate the desiring and thereby the suffering. But, it’s not simple at all. It took arguably the greatest, most mentally disciplined, mindfulness practitioner of all time, the Buddha, six years of struggle to accomplish it. For most of us, it would seem to be an almost impossible task. To get an idea of the difficulty just realize that wanting to eliminate the desire for things to be different, is itself a desire for things to be different!

The complexity of the cessation of desires is also underscored by the fact that many desires are healthy and in fact necessary for life, e.g. hunger, thirst, breathing, etc. Obviously these desires should not be eliminated. In addition, many are for pleasant things that make life enjoyable, such as companionship, love, art, music, good food and wine, etc. It would certainly be a bland life without them. Others are unpleasant things that need to be avoided or tempered, such as pain, illness, fear, loneliness. It would seem problematic to remove these desires. In fact, the third Noble Truth does not call for the elimination of desires. Rather, it suggests that we should eliminate clinging to, grasping onto, these desires.

The difference between desires and clinging to desires is a subtle but very important distinction. There is nothing wrong with desires themselves. It is human nature to have them and if not clung to, they are normally healthy. But to be invested in the outcome of the desires is where the problem arises. It is perfectly fine to desire going to a concert, but it causes suffering when the outcome makes a difference. If the concert is cancelled or sold out or your car breaks down so you can’t get there would you be OK with it, or would you be upset? If it’s the latter then you’re attached, you’re grasping, you’re clinging. If it’s the former you’re displaying the equanimity that the Buddha taught is the way to the cessation of suffering. Similarly, if you desire to get rid of a headache and take analgesics and rest, this is fine. But, if the headache continues and you’re angry and upset to have to deal with the continuing pain, then that’s clinging, grasping, and attaching to the desire. You can only alleviate the suffering by accepting that the headache is still there. Indeed, research has shown that the headache pain lessens just as soon as you cease to fight it and let go of resistance. As Ajahn Chah said, “If you let go a little, you’ll have a little happiness. If you let go a lot, you’ll have a lot of happiness. If you let go completely . . . you’ll be completely happy.”

Once again, though, this sounds simple, but in practice is devilishly difficult to do. The mind is programmed to control. It automatically tries to produce good feelings and hold onto them and eliminate bad feelings and prevent them from returning. So, even though we may wish to cease clinging to desires, our own mind works against us. We might try to force our will on the mind and battle its tendencies. But, as Adyashanti likes to say “If you go to war with your mind you’ll be at war forever.” The Buddha found this to be absolutely true as his attempts to control his mind with asceticism were a nearly mortal failure. He finally found a better way, “The Middle Way” where one works to restrain the mind, but doesn’t get upset when failure occurs, simply returns to the effort with expectations of slowly moving more and more toward equanimity. This is a patient practice in the middle between striving and giving up. It works to tame the mind, but not dominate it.

The practice begins with an intention to explore everyday experiences, looking at each and asking the question, do I feel unsatisfactoriness and when you do exploring why, what is the cause of the unsatisfactoriness. Sometimes it’s simple. You’re caught at a red light and detect unsatisfactoriness and realize that you want to get somewhere (you want things to be different) rather than appreciating the drive. With this realization, you can often spontaneously let go and stop clinging to the desire to be somewhere else and simply enjoy a relaxing interlude to the stress of driving. At times, though, it may be difficult to release the clinging. You may feel that you’re underpaid at work and thus feel unsatisfactoriness with you job rather than enjoying the moment to moment experience of the work. This feeling of unfairness may not simply diminish upon realization. This will take more work. One important lesson here, is that the key to ending suffering and becoming happy is not in a monastery or a pilgrimage, but right here in everyday life. This is where the practice is. This is where equanimity can be developed. It’s right here, right now, in the present moment, in the midst of your life.

The practice from here becomes subtle. It involves first working with everyday experiences and noticing when unsatisfactoriness arises and secondly noting the underlying cause, the desire, the wanting, the craving. Then, thirdly, noting and observing that both the unsatisfactoriness and the desire go through a phase of arising, increasing in magnitude and fourthly noting that they both go through a phase of decline, falling away. Obviously, this requires patience and mindful observing. But, it reveals that unsatisfactoriness and its cause, desire, just like everything else, are impermanent. They come and they go. Note that you have just observed the cessation of unsatisfactoriness and desire, the exact state that you want to achieve. Note also that you didn’t do anything. It all happened spontaneously, on its own.

For example, you may want to go out for dinner at a restaurant for a nice meal but realize that your budget won’t allow it. This will likely be followed by feelings of frustration, the unsatisfactoriness. Observe the feelings arising. Then, look deeply for the underlying cause, perhaps the desire to have more money, greed. Observe, also how this desire for money arises and strengthens. Then if you patiently stay with these feelings, you’ll note that they begin to decrease and fall away. The unsatisfactoriness and the greed slowly dissipate and eventually completely cease. You are left not caring that you can’t go out for the meal, that you don’t have the money. You have achieved a brief equanimity. As I’m sure, you’ll recognize, this liberation will not last long, the feelings will arise again either immediately or at a later time. You haven’t extinguished them, only experienced a brief cessation.

Once, the falling away of unsatisfactoriness and the underlying desire, is experienced. There is nothing else for you to do. Do not attempt to control this experience in any way. Do not attempt to maintain or lengthen the experience. This is a form of desiring things to be different than they are; the exact cause of unsatisfactoriness in the first place. It’s very hard not to try to control it. Remember your mind is programmed to do this. Don’t get upset if the mind jumps in and tries to do so. It’s just what minds do. Simply watch it and see how this itself creates unsatisfactoriness that arises and falls away.

This is where the subtlety comes in. The equanimity, the decrease of unsatisfactoriness, and the cessation of desire can’t be controlled. They must simply be allowed to come and go. As the practice continues the number of times this equanimity occurs and the duration of the cessation will start to increase on their own. The realization begins to dawn that you really don’t have to do anything. All you need to do is accept things as they are. This acceptance produces a pleasant state that reinforces the process, making it occur more frequently and for longer duration in the future. You come to not only understand, but directly experience that unsatisfactoriness and desire can be ended simply by patiently waiting for them to spontaneously diminish and cease. When you do a pleasant feeling will spontaneously arise. This in turn leads to an upward spiral leading slowly to enduring equanimity.

It is important to understand that attempting to actually do anything to produce, hold onto, or lengthen the state is counterproductive. Patience and persistence is required here. Trust that it will all happen on its own if you just let it. Don’t meddle. But, don’t stop observing. This is the method revealed in the Third Noble Truth. It is the way to true happiness, true liberation, true enlightenment.

The Buddha provides a path that makes it more likely that this will occur. It is the fourth Noble Truth, also called the Noble Eightfold Path which is the subject of other essays.

“After suffering, the Buddha taught, there is supreme happiness. Every step of the way to removing the causes of unhappiness brings more joy. On the path to the end of suffering, which is a path that Buddhists may spend their whole lifetimes practicing, there are levels of happiness and freedom from craving and ignorance that can be achieved.” – Buddhist Studies

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

Protect the Aging Brain with Yoga

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Protect the Aging Brain with Yoga

 

By John M. de Castro, Ph.D.

 

“We’ve all known yogis who seemed to defy the hands of time. The current study is just one of a long list of studies indicating that yoga may promote healthy aging. Whether it be more growth hormone or less stress, a well-balanced yoga practice is good for you.” – Grace Bullock

 

Human life is one of constant change. We revel in our increases in physical and mental capacities during development, but regret their decreases during aging. The aging process involves a systematic progressive decline in every system in the body, the brain included. Starting in the 20s there is a progressive decrease in the volume of the brain as we age. But, the nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity.

 

Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread area. and have found that meditation practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits. 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.

 

In today’s Research News article “Greater Cortical Thickness in Elderly Female Yoga Practitioners—A Cross-Sectional Study.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476728/, Afonso and colleagues recruited women over 60 years of age with at least 8 years of Hatha yoga practice and a group of women, matched for age, education and physical activity, who had never practiced yoga, meditation, or other mind-body practices. They were measured for their ability to perform daily tasks of living, depression, and cognitive function. All participants underwent brain scanning with Magnetic Resonance Imaging (MRI).

 

They found that the yoga practitioners had significantly greater cortical thickness in the frontal lobes than the control group while there were no areas where the yoga practitioners had significantly less cortical thickness. Hence, the practice of yoga appears to protect the prefrontal cortical areas from age related degeneration. This replicates previous findings that mindfulness practices, in general, increase the size of the prefrontal cortex. The prefrontal areas are important for high level thinking, including attention, behavioral inhibition, and executive functions. Hence, their preservation is important for the maintenance of cognitive ability with aging. So, the practice of yoga should be viewed as an important means to preserve the brain and mental ability and thereby age successfully.

 

So, protect the aging brain with yoga.

 

“scientifically and medically, most of the claims made for yoga practice stand up. The benefits on both body and mind are legion. The anti-ageing impact is profound. Doing yoga reduces back pain, improves balance and muscle strength and reverses muscle loss. It improves symptoms of rheumatoid arthritis, menopausal symptoms, even the control of type 2 diabetes. It decreases anxiety and depression. It hugely enhances flexibility. There are endless sound academic sources to back up these statements as well as the testimony of countless practitioners.” – Carla McKay

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

 

Afonso, R. F., Balardin, J. B., Lazar, S., Sato, J. R., Igarashi, N., Santaella, D. F., … Kozasa, E. H. (2017). Greater Cortical Thickness in Elderly Female Yoga Practitioners—A Cross-Sectional Study. Frontiers in Aging Neuroscience, 9, 201. http://doi.org/10.3389/fnagi.2017.00201

 

Abstract

Yoga, a mind-body activity that requires attentional engagement, has been associated with positive changes in brain structure and function, especially in areas related to awareness, attention, executive functions and memory. Normal aging, on the other hand, has also been associated with structural and functional brain changes, but these generally involve decreased cognitive functions. The aim of this cross-sectional study was to compare brain cortical thickness (CT) in elderly yoga practitioners and a group of age-matched healthy non-practitioners. We tested 21 older women who had practiced hatha yoga for at least 8 years and 21 women naive to yoga, meditation or any mind-body interventions who were matched to the first group in age, years of formal education and physical activity level. A T1-weighted MPRAGE sequence was acquired for each participant. Yoga practitioners showed significantly greater CT in a left prefrontal lobe cluster, which included portions of the lateral middle frontal gyrus, anterior superior frontal gyrus and dorsal superior frontal gyrus. We found greater CT in the left prefrontal cortex of healthy elderly women who trained yoga for a minimum of 8 years compared with women in the control group.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476728/

Reduce Opioid Treated Low Back Pain with Meditation

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Reduce Opioid Treated Low Back Pain with Meditation

 

By John M. de Castro, Ph.D.

 

“When your focus is on the pain, obviously that increases the pain. For people who meditate, their muscle tension and heart rate drops, their respiration slows and breaths gets deeper. All those things have impact on the pain.” – Jane Ehrman

 

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

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. These include reducing pain catastrophizing. Indeed, mindfulness practices have been shown to be safe and  beneficial in pain management in general and yoga and mindfulness has been shown to specifically improve back pain. Since opiates are frequently used to treat chronic low back pain, there is a need to study the combination of long-term opiate treatment and meditation practice.

 

In today’s Research News article “Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/, Zgierska and colleagues recruited adult patients with chronic low back pain who had been treated for at least 3 months with relatively high doses (at least 30 mg/day) of opiates for pain. The patients were randomly assigned to receive meditation practice in combination with Cognitive Behavioral Therapy or to a wait-list control condition. The treatment consisted of 2-hour sessions once a week for 8 weeks of Cognitive Behavioral Therapy (CBT) for identifying and modifying unhealthy thought patterns concerning their pain (e.g. catastrophizing) and additionally mindfulness practices including breath meditation, loving-kindness meditation, body scan and mindful movement practices. Patients were also prescribed to practice meditation at home for at least 30 minutes, 6 days per week. Opiate medications were continued throughout testing. Patients were measured before and after treatment a half a year later for mindfulness, pain intensity, pain acceptance and coping, pain sensitivity to thermal stimuli, disability, opiate dose, and inflammatory biomarkers.

 

They found that the meditation group had a sustained decrease in unpleasantness and pain sensitivity to thermal stimuli (experimentally induced pain) and an 8% reduction in everyday pain intensity while the wait-list control group had an 8% increase in pain. The decrease in pain was greater for patients who consistently meditated at home compared to inconsistent meditators. In addition, the greater the increase in mindfulness in the meditation group, the greater the decrease in disability. No patients withdrew from the study suggesting that the treatment was acceptable and valued.

 

The intervention employed a combination of meditation with Cognitive Behavioral Therapy (CBT). So, it cannot be determined whether meditation, CBT, or their combination produced the benefits for the patients. Nevertheless, the results clearly demonstrated that the treatment was very effective in reducing pain and sensitivity to pain in patients with chronic low back pain who are under treatment with relatively high doses of opiates. It is quite striking that the effects were so large given the high doses of opiates in use and underscores the efficacy of the treatment. This suggests that perhaps the opioids had lost a degree of effectiveness with these patients and meditation training could replace the lost pain relief. So, meditation and CBT can effectively reduce pain even in patients taking opiates.

 

So, reduce opioid treated low back pain with meditation.

 

“Mindful mediation is an appealing option for treating your pain because it has an unusual benefit; it places you in a position of control. Unlike pain medications or surgical procedures, meditation is not done to you—but rather it is something you do for yourself.” – Stephanie Burke

 

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

 

Zgierska, A. E., Burzinski, C. A., Cox, J., Kloke, J., Stegner, A., Cook, D. B., … Bačkonja, M. (2016). Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain Medicine: The Official Journal of the American Academy of Pain Medicine, 17(10), 1865–1881. http://doi.org/10.1093/pm/pnw006

 

Abstract

Objective. To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP).

Design. 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone).

Setting. Outpatient.

Subjects. Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months.

Methods. The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein).

Results. Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen’s d = 0.86), and decreased pain sensitivity to thermal stimuli (P< 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits.

Conclusions. Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063022/

Improve the Self-Concept with the Mindful Self

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Improve the Self-Concept with the Mindful Self

 

By John M. de Castro, Ph.D.

 

“Mindfulness is about living with intention and awareness which creates the mind body connection towards a whole self. When we feel disconnected or fragmented from ourselves, others and what was once important to us we become open to a multitude of problems in life.” – Naila Narsi

 

Most people strongly believe that they have a self, an ego. Reflecting this, our language is replete with concepts that contain self; oneself, myself, himself, herself, ourselves, self-concept, self-esteem, self-love, self-regard, selfless, selfish, selfhood, selfie, etc. But, particularly note the term self-concept. It directly states that self is a concept. It is not a thing. It is an idea.  This is important, as most of us think that there is a thing that is the self, when, in fact, there is not. A concept is a way to summarize a set of phenomena that appear to have common properties, such as fruit, or more abstractly, attention. But, note there is not a single entity that is fruit. It is a set of things that are grouped together by common biological factors. The idea of attention is not a thing. Rather it refers to a set of processes. This is also true of the concept of self.

 

The self is a concept and is created by thought. In other words, there’s a process involving thinking that creates the concept of a self. This is a verb. We are not a self, we are producing a self, we are selfing! This suggests that the self can change and grow with circumstances. One that appears to have profound effects on the idea of self is mindfulness training. In today’s Research News article “The Mindful Self: A Mindfulness-Enlightened Self-view.” See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01752/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_433120_69_Psycho_20171024_arts_A, Xiao and colleagues explore the literature and theorization regarding the effects of mindfulness practice on the self-view.

 

They posit that mindfulness training “is a way of looking deeply into oneself in a spirit of self-inquiry and self-understanding.” This can alter the way the individual thinks of the self, a form of re-perceiving the self. The published research indicates that mindfulness training can produce improvements in self-compassion, self-acceptance, self-perspective change, self-consciousness, self-concept, self-deconstruction and reconstruction, and self-referential processing. So, with mindfulness training the individual becomes more compassionate and accepting toward self and others and less self-focused; able to step outside and observe experience from a distance. In other words, mindfulness changes the components that make up the self-concept and in essence change the individual’s idea of their self.

 

Xiao and colleagues label this new perspective and idea of the self, created by mindfulness training, as the “Mindful Self.” This is viewed as a more authentic and true self and is similar to the highest level of psychological development, as visualized by Abraham Maslow, called self-actualization. The “Mindful Self” Is a balanced self-identity with a detached awareness, an understanding of interdependence, greater compassion and acceptance of self and others, empathy, and a desire for the cultivation of happiness; and growth, including a consideration of the development of the self and others.

 

The published literature supports the idea that mindfulness training produces a marked improvement in how the individual conceptualizes the self. It moves the concept of self toward a more authentic and integrated whole that is more connected to others and the environment. This “Mindful Self” is constructed by altering less mature ideas of the self with focused and relaxed attention on what is actually happening both inside and outside the individual. This is a great step in maturation, leading to a more accurate and integrated notion of the self. This, in turn, leads to improved interactions with others and greater overall happiness.

 

So, improve the self-concept with the “Mindful Self.”

 

“We all have a sense of self. Whether that sense of self is positive or negative is based upon our experiences in life and our perceptions and assessment of ourself. . . .However, the problem is that our perception of ourself is often distorted.” – Monica Frank

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Xiao Q, Yue C, He W and Yu J-y (2017) The Mindful Self: A Mindfulness-Enlightened Self-view. Front. Psychol. 8:1752. doi: 10.3389/fpsyg.2017.01752

 

Abstract

This paper analyzes studies of mindfulness and the self, with the aim of deepening our understanding of the potential benefits of mindfulness and meditation for mental health and well-being. Our review of empirical research reveals that positive changes in attitudes toward the self and others as a result of mindfulness-enabled practices can play an important role in modulating many mental and physical health problems. Accordingly, we introduce a new concept—the “mindful self”—and compare it with related psychological constructs to describe the positive changes in self-attitude associated with mindfulness meditation practices or interventions. The mindful self is conceptualized as a mindfulness-enlightened self-view and attitude developed by internalizing and integrating the essence of Buddhist psychology into one’s self-system. We further posit that the mindful self will be an important intermediary between mindfulness intervention and mental health problems, and an important moderator in promoting well-being. More generally, we suggest that the mindful self may also be an applicable concept with which to describe and predict the higher level of self-development of those who grow up in the culture of Buddhism or regularly engage in meditation over a long period of time.

https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01752/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_433120_69_Psycho_20171024_arts_A