Improve the Physiology and Quality of Life with Cancer with Qigong

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Improve the Physiology and Quality of Life with Cancer with Qigong

 

By John M. de Castro, Ph.D.

 

“Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival.” – Qigong Institute

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. It is estimated that 15 million adults and children with a history of cancer are alive in the United States today. But, surviving cancer carries with it a number of problems. “Physical, emotional, and financial hardships often persist for years after diagnosis and treatment. Cancer survivors are also at greater risk for developing second cancers and other health conditions.” National Cancer Survivors Day.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including stress,  sleep disturbance, and anxiety and depression.. Tai Chi or Qigong practice has been shown to improve quality of life, reduce fatigue, and lower blood pressure and cortisol levels.  In today’s Research News article “Qigong in Cancer Care: Theory, Evidence-Base, and Practice.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597070/, Klein reviews and summarized the published research literature on the application of Qigong practice for the treatment of patients with cancer. She defined Qigong practice as “Qigong refers to all skills of mind-body exercises that integrate breathing adjustment, body adjustment and mind adjustment into one.”

 

She reports that Qigong practice appears to strengthen the immune system and decrease the inflammatory responses; processes that tend to exacerbate the progression of cancer. In addition, Qigong practice appears to affect the DNA itself, preserving the telomeres, which are associated with cellular health. Qigong practice by cancer patients appears to improve the patients’ quality of life, reduce the fatigue that often accompanies cancer treatment, strengthen immune function, reduce cortisol levels, a stress marker, and reduce the cognitive impairments that frequently accompany cancer treatment. These benefits are present regardless of the variant of Qigong that is practiced. Finally, she reports that the research literature reports that Qigong practice is safe, with no known negative side effects.

 

The research suggests that Qigong practice is a safe and effective treatment for cancer patients. It appears to produce physiological changes that promote the individual’s ability to fight the cancer, mitigate the negative effects of cancer treatments, and overall improve the individual’s ability to carry on with their lives. Also, Qigong is a gentle practice, completely safe, can be used by anyone, including the elderly and sickly, is inexpensive to administer, is convenient as it can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice.

 

So, improve the physiology and quality of life with cancer with Qigong.

 

“Qigong is clearly not for those who would like to take a pill and wait for the next instruction from the oncologist. But for anyone who has found their diagnosis has led them to a deeper enquiry into the subtler energetic levels of health and healing, this practice has a proven track record and can provide excellent results for those with the discipline for daily practice.” – Ginny Fraser

 

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

 

Klein, P. (2017). Qigong in Cancer Care: Theory, Evidence-Base, and Practice. Medicines, 4(1), 2. http://doi.org/10.3390/medicines4010002

 

Abstract

Background: The purpose of this discussion is to explore the theory, evidence base, and practice of Qigong for individuals with cancer. Questions addressed are: What is qigong? How does it work? What evidence exists supporting its practice in integrative oncology? What barriers to wide-spread programming access exist? Methods: Sources for this discussion include a review of scholarly texts, the Internet, PubMed, field observations, and expert opinion. Results: Qigong is a gentle, mind/body exercise integral within Chinese medicine. Theoretical foundations include Chinese medicine energy theory, psychoneuroimmunology, the relaxation response, the meditation effect, and epigenetics. Research supports positive effects on quality of life (QOL), fatigue, immune function and cortisol levels, and cognition for individuals with cancer. There is indirect, scientific evidence suggesting that qigong practice may positively influence cancer prevention and survival. No one Qigong exercise regimen has been established as superior. Effective protocols do have common elements: slow mindful exercise, easy to learn, breath regulation, meditation, emphasis on relaxation, and energy cultivation including mental intent and self-massage. Conclusions: Regular practice of Qigong exercise therapy has the potential to improve cancer-related QOL and is indirectly linked to cancer prevention and survival. Wide-spread access to quality Qigong in cancer care programming may be challenged by the availability of existing programming and work force capacity.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597070/

Improve Attention Deficit Hyperactivity Disorder (ADHD) with Mindfulness

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Improve Attention Deficit Hyperactivity Disorder (ADHD) with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Unlike many tools for ADHD, mindfulness develops the individual’s inner skills. It improves your ability to control your attention by helping to strengthen your ability to self-observe, to train attention, and to develop different relationships to experiences that are stressful. In other words, it teaches you to pay attention to paying attention, and can also make people more aware of their emotional state, so they won’t react impulsively. That’s often a real problem for people with ADHD.” – Carl Sherman

 

Attention Deficit Hyperactivity Disorder (ADHD) is most commonly found in children, but for about half it persists into adulthood. It’s estimated that about 5% of the adult population has ADHD. Hence, this is a very large problem that can produce inattention, impulsivity, hyperactivity, and emotional issues, and reduce quality of life. The most common treatment is drugs, like methylphenidate, Ritalin, which helps reducing symptoms in about 30% of the people with ADHD. Unfortunately, the effectiveness of the drugs appears to be markedly reduced after the first year. In addition, the drugs often have troublesome side effects, including nervousness agitation, anxiety, irritability, sleep and appetite problems, head and stomach aches, nausea, dizziness, and heart palpitations. If that’s not enough they can be addictive and can readily be abused. So, drugs, at present, do not appear to be a good solution, only affecting some, only for a short time, and with unwanted side effects.

 

There are indications that mindfulness training may be an effective treatment for ADHD. It makes sense that it should be, as the skills and abilities strengthened by mindfulness training are identical to those that are defective in ADHD,  attention, impulse control, executive function, emotion control, and mood improvement. In addition, unlike drugs, it is a relatively safe intervention that has minimal troublesome side effects. Since mindfulness is so promising as a treatment, it is important to further investigate the role of mindfulness in ADHD and its treatment.

 

In today’s Research News article “Mindfulness-Based Cognitive Behavioral Therapy as an Adjunct Treatment of Attention Deficit Hyperactivity Disorder in Young Adults.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526699/, Aadil and colleagues review and summarize the published research literature of the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults. MBCT involves both mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms.

 

They identified 16 published trials and every one of them reported small but significant reductions in symptoms of ADHD. The improvements included significant reductions in ADHD severity, depression and emotional symptoms and increases in mindfulness, attentional ability, and quality of life. These improvements occurred even in patients who did not respond to drug treatment. Hence, MBCT is a safe and effective treatment for Attention Deficit Hyperactivity Disorder (ADHD). These are important and very impressive results. Mindfulness training is clearly a safe and effective treatment that may be used either as a supplement or instead of drug treatment and can help to alleviate the symptoms.

 

So, Improve Attention Deficit Hyperactivity Disorder (ADHD) with Mindfulness.

 

“78% of participants who practiced mindful awareness reported reduction in their ADHD symptoms.” – Lidia Zylowska

 

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

 

Aadil, M., Cosme, R. M., & Chernaik, J. (2017). Mindfulness-Based Cognitive Behavioral Therapy as an Adjunct Treatment of Attention Deficit Hyperactivity Disorder in Young Adults: A Literature Review. Cureus, 9(5), e1269. http://doi.org/10.7759/cureus.1269

 

Abstract

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurological disorder that often continues into adult age. Stimulants medication are the mainstay of treatment, however, in the recent years, there has been a lot of studies conducted to understand the effectiveness and feasibility of mindfulness-based cognitive behavioral therapy for treatment of attention deficit hyperactivity disorder in children and adults. In this article, we have reviewed 17 articles to look for the beneficial effects of such therapy in adults. Overall, we found that there is a clear beneficial effect of such therapies, especially when used in adjunct with stimulant medication and may increase overall compliance. For better understanding, we suggest that large, well-designed studies should be conducted with robust strategies, allowing more comparison studies with the better analytical outcome.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526699/

No Escape

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No Escape

 

By John M. de Castro, Ph.D.

 

Contemplative practice is, for the most part, a wonderful, relaxing, and peaceful endeavor. Engaging in it makes us feel refreshed and rested. This is wonderful, but can be a trap. We can use it as another in our arsenal of tactics to escape from a reality. This is a mistake and a lost opportunity.

 

Our lives are generally full of problems, from work, to family, to relationships, to health, to the challenges of getting it all done in a 24-hour day. In addition, we bring baggage from the past in the form of unresolved issues from childhood, or traumatic experiences, or deep emotional hurts. We also are confronted with fears and anxieties about an uncertain future. The totality of all of these problems can be overwhelming.

 

A frequent response is to try to escape them through various distractions such as the media, the internet, sports, alcohol and drugs, etc. It is useful to give ourselves a break once in a while and relieve some of the stress. But, if this is all we do, then it prevents us from addressing the problems and these distractions become an additional problem.

 

Our contemplative practice should not be added to the list of escape tactics. Indeed, contemplative practice is not an escape. Many people believe that spiritual awakening, aka enlightenment, will be an escape from their human problems. That is simply not the case. After awakening, all our problems are still there.

 

Contemplative practice should be employed to quiet the mind and allow for space for the emotions to be fully and honestly experienced. This sets the stage for being able to confront our problems, contemplate resolutions, and work through unresolved issues with a calm clarity. With the mind’s incessant chatter at least slightly muted and the emotions reduced to manageable intensity, we have to opportunity to honestly address our problems.

 

Contemplative practice is not the time to try to address the problems. It is the time to set the stage for addressing the problems. So, do not enter contemplative practice with the intent of thinking about the issues. Enter it as a time to allow the mind and physiology to settle and to enter into a present moment mindset. Regardless, the mind will inevitably wander and our deepest issues will emerge.

 

This can be seen in the amplified context of a silent meditation retreat. Here we cannot escape from our problems. They frequently emerge with full force and we are forced to confront them. Retreat can be an emotionally wrenching experience. Most can deal with it and benefit greatly by bringing them into the light of day and confronting them. But others can be overwhelmed. Retreat must be entered into with caution and with the presence of an understanding and experienced staff, to help us when the emotions become too strong to handle.

 

Hence, contemplative practice is not another escape but a means to get us prepared to fully address our deepest issues.

 

So, engage in contemplative practice and engage in dealing with the problems of life. The two endeavors complement each other.

 

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

Reduce Burnout in Palliative Care Teams with Mindfulness

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Reduce Burnout in Palliative Care Teams with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The fullness of life, tuned-in “being” and focused work that result from mindfulness have significant health and well-being consequences for hospice and palliative care professionals.” – Ellen Langer

 

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. It is estimated that over 45% of healthcare workers experience burnout. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion, sometimes called compassion-fatigue. This can be particularly problematic in a palliative care setting where empathy and compassion are critical.

 

Regardless of the reasons for burnout or its immediate presenting consequences, 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. Hence, preventing existing healthcare workers from burning out has to be a priority. Mindfulness has been demonstrated to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. Another factor that could affect healthcare workers’ responses to stress is self-compassion. By treating oneself with kindness and understanding the effects of stress can be mitigated. So, it makes sense to investigate the relationship of mindfulness and self-compassion to compassion-fatigue and burnout in palliative care workers.

 

In today’s Research News article “Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501358/, Orellana-Rios and colleagues recruited staff members of a palliative care facility and provided for them a 10-week program of mindfulness training that was incorporated into their daily job duties. The training included discussions, loving kindness meditation, walking meditation and tong-len meditation. They were also encouraged and provided materials (CDs) for home practice. Participants were measured before and after treatment for burnout, anxiety, depression, somatization, emotion regulation, work satisfaction and enjoyment, and goal attainment. They also provided saliva samples for measurement of cortisol levels. After completion of the study, the participants were interviewed concerning the effectiveness of the program.

 

They found that following the training there was a significant decrease in burnout, perceived stress, and anxiety and a significant increase in emotional awareness, resilience, joy, goal attainment, and enjoyment of work. In the interviews, the participants generally reported improvements in feeling empowered to take care of themselves, including mindful pauses throughout their day, and lower levels of worry and rumination.

 

These are interesting and potentially significant preliminary results. This should be considered as a pilot study as there was no control or comparison condition included. The participants’ measurements before training were simply compared to those after training and there were no long-term follow-up measurements. But, the results are sufficiently interesting to justify the conduct of a large-scale randomized controlled clinical trial including an active control and long-term follow-up.

 

Taken together with previous research that has demonstrated that mindfulness training decreases burnout, anxiety, depression, and increases emotion regulation and resilience, the results suggest that mindfulness training is highly beneficial for the improvement of the emotional well-being of staff involved in palliative care. Although not measured, this suggests that staff turnover and importantly, the care for the patients was also improved.

 

So, reduce burnout in palliative care teams with mindfulness.

 

“in the end, talking to patients about palliative care can make a huge difference in their lives. It can restore their dignity and empower them to live the remainder of their lives on their own terms. And that’s why palliative care, which promotes quality of life through mindfulness, creativity, and compassion, is gaining widespread acceptance.” – Anne Bruce

 

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

 

Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y. U., Anton, A., Sinclair, S., & Schmidt, S. (2018). Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an “on the job“ program. BMC Palliative Care, 17, 3. http://doi.org/10.1186/s12904-017-0219-7

 

Abstract

Background

Maintaining a sense of self-care while providing patient centered care, can be difficult for practitioners in palliative medicine. We aimed to pilot an “on the job” mindfulness and compassion-oriented meditation training for interdisciplinary teams designed to reduce distress, foster resilience and strengthen a prosocial motivation in the clinical encounter.

Methods

Our objective was to explore the feasibility and effectiveness of this newly developed training. The study design was an observational, mixed-method pilot evaluation, with qualitative data, self-report data, as well as objective data (cortisol) measured before and after the program.

Twenty-eight staff members of an interdisciplinary palliative care team participated in the 10-week training conducted at their workplace.

Measures were the Perceived Stress Questionnaire, the Maslach Burnout Inventory, the somatic complaints subscale of the SCL-90-R, the Emotion Regulation Skills Questionnaire, the Hospital Anxiety and Depression Scale, and a Goal Attainment Scale that assessed two individual goals. Semi-structured interviews were employed to gain insight into the perceived outcomes and potential mechanisms of action of the training. T-tests for dependent samples were employed to test for differences between baseline and post-intervention.

Results

Significant improvements were found in two of three burnout components (emotional exhaustion and personal accomplishment), anxiety, stress, two emotional regulation competences and joy at work. Furthermore, 85% of the individual goals were attained. Compliance and acceptance rates were high and qualitative data revealed a perceived enhancement of self-care, the integration of mindful pauses in work routines, a reduction in rumination and distress generated in the patient contact as well as an enhancement of interpersonal connection skills. An improvement of team communication could also be identified.

Conclusions

Our findings suggest that the training may be a feasible, effective and practical way of reducing caregiver-distress and enhancing the resources of palliative care teams.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5501358/

Improve Psychological Health in Pregnancy with Mindfulness

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Improve Psychological Health in Pregnancy with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Not only does cultivating moment-to-moment awareness of thoughts and surroundings seem to help pregnant women keep their stress down and their spirits up—benefits that are well-documented among other groups of people—it may also lead to healthier newborns with fewer developmental problems down the line.” – Kira Newman

 

The perinatal period, from the onset of pregnancy to the end of the infants first year, is a time of intense physiological and psychological change in both the mother and the infant. Anxiety, depression, and fear are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. A debilitating childbirth fear has been estimated to affect about 6% or pregnant women and 13% are sufficiently afraid to postpone pregnancy. It is difficult to deal with these emotions under the best of conditions but in combinations with the stresses of pregnancy can turn what could be a joyous experience of creating a human life into a horrible worrisome, torment.

 

The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Childbirth fear is associated with “low childbirth self-efficacy, greater use of pain medication during labor, more unwanted obstetric interventions in labor, as well as increased risk of postpartum depression.” Hence, it is clear that there is a need for methods to treat childbirth fear, depression, and anxiety during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy. So, it would make sense to further study the effects of mindfulness training during the perinatal period.

 

In today’s Research News article “A Comparative Study of Mindfulness Efficiency Based on Islamic-Spiritual Schemes and Group Cognitive Behavioral Therapy on Reduction of Anxiety and Depression in Pregnant Women.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385237/, Aslami and colleagues recruited Islamic women in their 16th to 32nd week of pregnancy and based upon pretesting of anxiety and depression selected two groups; a high anxiety and a high depression group. The groups were then randomly divided into a no-treatment control condition, a 12-week Cognitive Behavioral Therapy (CBT) condition or an 8-week Mindfulness-Based Stress Reduction (MBSR) condition. Traditional MBSR consists of training and practice in meditation, yoga, and body scan. The researchers modified the training protocol to include Islamic spiritual teachings. The CBT and MBSR conditions were assigned home practice for 45 minutes per day for 6 days per week. The participants were measured for anxiety and depression before and after treatment.

 

They found that both the Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR) conditions produced significant decreases in both anxiety and depression while the no-treatment control group did not. In addition, the MBSR condition produced significantly greater reductions than the CBT condition. In fact, MBSR produced a very large reduction, on average, of 79% in anxiety and 81% in depression while CBT produced, on average, only a 45% reduction in anxiety and a 43% reduction in depression. Hence, although CBT was effective, MBSR produced far greater improvements in the pregnant women’s psychological states.

 

These are excellent results. It has been well established that mindfulness training produces significant reductions in anxiety and depression in a wide variety of people with a variety of conditions. But, this trial compared its effectiveness to another known effective treatment, Cognitive Behavioral Therapy (CBT) and found MBSR to be far superior. I am not aware of any other direct comparisons of the two forms of therapy. It is not known, however, if the inclusion of Islamic spiritual teachings added to MBSR’s effectiveness in this group of Islamic women. Regardless, it is clear the MBSR training is highly effective in reducing anxiety and depression in pregnant women. This should be of great assistance in making for a smooth remainder of the pregnancy and delivery and may well produce better outcomes with the infant.

 

So, improve psychological health in pregnancy with mindfulness.

 

“There could not be a better time to learn mindfulness than during pregnancy and early motherhood. For one thing, this is a time when most people have a strong motivation to become the best person they can be in a relatively short period of time. When you realize the full enormity of the responsibility you have taken on by becoming a mom, the primary source of care for another whole human being, not to mention one that you love more than you thought you could ever love, there is a really high level of motivation to try your best to get yourself into the best mental and emotional shape possible.” – Cassandra Vieten

 

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

 

Aslami, E., Alipour, A., Najib, F. S., & Aghayosefi, A. (2017). A Comparative Study of Mindfulness Efficiency Based on Islamic-Spiritual Schemes and Group Cognitive Behavioral Therapy on Reduction of Anxiety and Depression in Pregnant Women . International Journal of Community Based Nursing and Midwifery, 5(2), 144–152.

 

Abstract

Background:

Anxiety and depression during the pregnancy period are among the factors affecting the pregnancy undesirable outcomes and delivery. One way of controlling anxiety and depression is mindfulness and cognitive behavioral therapy. The purpose of this study was to compare the efficiency of mindfulness based on the Islamic-spiritual schemas and group cognitive behavioral therapy on reduction of anxiety and depression in pregnant women.

Methods:

The research design was semi-experimental in the form of pretest-posttest using a control group. Among the pregnant women in the 16th to 32nd weeks of pregnancy who referred to the health center, 30 pregnant women with high anxiety level and 30 pregnant women with high depression participated in the research. Randomly 15 participants with high depression and 15 participants with high anxiety were considered in the intervention group under the treatment of mindfulness based on Islamic-spiritual schemes. In addition, 15 participants with high scores regarding depression and 15 with high scores in anxiety were considered in the other group. The control group consisted of 15 pregnant women with high anxiety and depression. Beck anxiety-depression questionnaire was used in two steps of pre-test and post-test. Data were analyzed using SPSS, version 20, and P≤0.05 was considered as significant.

Results:

The results of multivariate analysis of variance test and tracking Tukey test showed that there was a significant difference between the mean scores of anxiety and depression in the two groups of mindfulness based on spiritual- Islamic scheme (P<0.001) and the group of cognitive behavioral therapy with each other (P<0.001) and with the control group(P<0.001). The mean of anxiety and depression scores decreased in the intervention group, but it increased in the control group.

Conclusion:

Both therapy methods were effective in reduction of anxiety and depression of pregnant women, but the effect of mindfulness based on spiritual- Islamic schemes was more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385237/

Improve Caregiver and Cirrhosis Patient Psychological Health with Mindfulness

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Improve Caregiver and Cirrhosis Patient Psychological Health with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness practices also help people observe their thoughts and behaviors with less reactivity and judgment, which could enable caregivers to better respond to the emotional and physical difficulties they encounter.” – Emily Nauman

 

There is a tremendous demand for caregiving in the US. It is estimated that over 65 million (29% of the adult population) provides care to someone who is mentally or physically ill, disabled or aged, averaging 20 hours per week spent caring for their loved ones. This caregiving comes at a cost to the caregiver. It exacts a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality.

 

Liver disease affects about 3.9 million people and Cirrhosis kills nearly 40,000 people each year. Providing care for an individual with end stage liver disease has not been seriously studied. The challenges of caring for an individual with cirrhosis require that the individual be able to deal with stress, to regulate their own emotions, and to be sensitive and attentive. These skills are exactly those that are developed in mindfulness training. It improves the psychological and physiological responses to stress. It improves emotion regulation. And it improves the ability to maintain attention and focus in the face of high levels of distraction. So, it is not surprising that mindfulness improves caregiving and assists the caregiver in coping with the stress.

 

In today’s Research News article “Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539344/, Bajaj and colleagues recruited patients with cirrhosis and their caregivers. The majority of the caregivers were women and spouses. They measured the patients before and after treatment for depression, anxiety, sleep quality, sleepiness, health related quality of life, and sickness impact. Caregivers were also measured for depression, anxiety, sleep quality, caregiving burden and perceived caregiver burden. Both patients and their caregivers received a 4-week program of modified structured Mindfulness-Based Stress Reduction (MBSR) along with discussions of barriers and strategies to deal with stress. The program included training in Qigong (gentle movements), body scan, progressive relaxation, and loving kindness meditation. Patients and caregivers were encouraged to practice these skills at home.

 

They found that following treatment the patients showed significant improvements in depression, sleep quality, and health related quality of life. In addition, they found that after treatment the caregivers had significant improvements in depression, sleep quality, caregiving burden and perceived caregiver burden. Mindfulness training has been shown to reduce depression, improve sleep and health related quality of life, and caregiving in a wide variety of healthy and ill individuals. So, it is not surprising that the modified MBSR program produced similar significant benefits for both the cirrhosis patients and their caregivers. It is encouraging that a relatively brief (4 week) program can have such positive benefits.

 

The study did not have a control condition. So, unequivocal conclusions cannot be reached. But, the results are sufficiently encouraging to justify the implementation of a large scale randomized controlled clinical trial including an active control condition of the effectiveness of MBSR training for cirrhosis patients and their caregivers.

 

So, improve caregiver and cirrhosis patient psychological health with mindfulness.

 

“When it comes to embracing mindfulness as a caregiver, start with asking yourself questions. How can you look at ways to reduce stress so you don’t take on the entire thing as your job and you have to do everything? When you’re more intentional, you can look at what is truly needed in this picture to help the care recipient and ask who might be supportive besides yourself and how can you involve other resources?” – Nancy Kriseman

 

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

 

Bajaj, J. S., Ellwood, M., Ainger, T., Burroughs, T., Fagan, A., Gavis, E. A., … Wade, J. B. (2017). Mindfulness-Based Stress Reduction Therapy Improves Patient and Caregiver-Reported Outcomes in Cirrhosis. Clinical and Translational Gastroenterology, 8(7), e108–. http://doi.org/10.1038/ctg.2017.38

 

Abstract

Objectives:

Patient-reported outcomes such as health-related quality of life (HRQOL) are impaired in cirrhosis due to under-treated mood and sleep disorders, which can adversely impact their caregivers. Mindfulness-based stress reduction (MBSR) can improve patient-reported outcomes (PRO) in non-cirrhotic patients but their impact in cirrhosis is unclear. To evaluate the effect of MBSR and supportive group therapy on mood, sleep and HRQOL in cirrhotic patients and their caregivers.

Methods:

Cirrhotic outpatients with mild depression (Beck Depression Inventory (BDI)>14) on screening with an adult caregiver were enrolled. At baseline, BDI, sleep (Pittsburgh sleep quality index PSQI, Epworth Sleepiness Scale, ESS), anxiety (Beck Anxiety inventory) and HRQOL (Sickness Impact Profile, SIP) for both patients/caregivers and caregiver burden (Zarit Burden Interview Short-form, ZBI-SF and perceived caregiver burden, PCB) and patient covert HE(CHE) status were measured. Patients who had BDI>14 at baseline, along with their caregivers then underwent a structured MBSR program with four weekly hour-long group sessions interspersed with home practice using CDs. After the last group, all questionnaires were repeated.

Results:

20 patient/caregiver dyads were included. All patients were men (60±8 years MELD 12.9±5.7, 14 prior hepatic encephalopathy (HE)) while most caregivers (n=15) were women (55±12 years, 23±14 years of relationship, 65% spouses). There was no change in patient BDI between screening and baseline (20.1±11.2 vs. 19.0±10.6, P=0.81). All dyads were able to complete the four MBSR+supportive group therapy sessions. There was a significant improvement in BDI (19.0±10.6 vs.15.6±8.2 P=0.01), PSQI (7.2±3.7 vs. 5.5±3.7, P<0.001) and overall HRQOL (25.0±13.2 vs. 17.7±14.0,P=0.01) but not in anxiety or CHE rates in patients. Similarly caregiver burden (ZBI-SF13.0±9.0 vs. 9.8±6.9,P=0.04, Perceived burden 72.1±29.9 vs. 63.0±14.5,P=0.05) and depression reduced (BDI 9.1±7.8 vs. 5.9±6.0,P=0.03) while caregiver sleep quality (7.2±3.7 vs. 5.5±3.7,P<0.001) improved. Prior HE did not affect PRO change after MBSR+supportive groups but the ZBI-SF of caregivers taking care of HE patients improved to a greater extent (delta −1.1±6.5 vs. 7.4±5.3 HE, P=0.04).

Conclusion:

A short program of mindfulness and supportive group therapy significantly improves PRO and caregiver burden in cirrhotic patients with depression. This non-pharmacological method could be a promising approach to alleviate psychosocial stress in patients with end-stage liver disease and their caregivers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539344/

Mindfulness Impairs the Formation of Automatic Habits

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Mindfulness Impairs the Formation of Automatic Habits

 

By John M. de Castro, Ph.D.

 

“The very fact of paying too much attention or being too aware of stimuli coming up in these tests might actually inhibit implicit learning. That suggests that mindfulness may help prevent formation of automatic habits — which is done through implicit learning — because a mindful person is aware of what they are doing.” – Chelsea Stillman

 

When people think of learning they’re usually visualizing learning information like historical facts, people’s names, mathematical formulas, etc. This is called explicit memory. But, there’s another very important form of learning, called implicit learning, which is learning how to perform automatic tasks rapidly and efficiently. Things like riding a bike, playing a musical instrument, serving a tennis ball and tying your shoelaces all require implicit learning and memory.

 

Implicit learning requires the person to actually perform and practice a task to master it. Many athletic skills fall into this category. The skills are mastered with repetition so that they can be performed instinctively and mindlessly when needed. Implicit learning also involves most mundane tasks that we perform constantly throughout our day. Walking, producing speech, even typing this sentence on a keyboard all involve implicitly learned skills. So, implicit learning is important and helps to reduce the cognitive load on our nervous system for everyday behaviors. We don’t have the think about them so we can devote our brain capacity to higher level thoughts and ideas.

 

It has been demonstrated that mindfulness helps with explicit learning, such as academic material. For example, mindfulness training can improve college entrance exam scores in students. But, mindfulness appears to disrupt implicit learning. In today’s Research News article “Task-Related Functional Connectivity of the Caudate Mediates the Association Between Trait Mindfulness and Implicit Learning in Older Adults.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955759/, Stillman and colleagues examine this disruptive effect of mindfulness and the neural systems responsible.

 

They recruited a group of healthy young adults (aged 18-37 years) and a group of healthy older adults (aged 60-90 years). They were measured for mindfulness and they completed an established implicit learning task. The task, Triplets Learning Task, involves a presentation of three stimuli with, unbeknownst to the participant, some triplets occurring more frequently than others. In general, people learn to respond to the more frequent triplets faster without awareness that there’s any difference between sets. In other words, they learn implicitly. While they were performing this task, their brains were scanned with functional Magnetic Resonance Imaging (f-MRI).

 

The researchers found that for the younger group, there was no significant relationship between mindfulness and implicit learning. On the other hand, the older group had a significant relationship between mindfulness and implicit learning with the higher the mindfulness score, the lower the score on the Triplets Learning Task. Hence, mindfulness disrupted implicit learning in older but not younger participants.

 

Investigating the brain scans of this older group, they found that the degree of relationship between mindfulness and implicit learning was related to the level of connectivity between the Caudate Nucleus and the Medial Temporal Lobe, a system previously shown to be associated with implicit learning. In particular, the greater the connectivity the better the implicit learning, but the greater the mindfulness, the lower the connectivity. A further mediational analysis indicated that the negative influence of mindfulness on implicit learning was mediated by its negative effect on the connectivity. In other words, mindfulness changed the brain which resulted in disruption of implicit learning.

 

These are complicated findings. But, they are particularly interesting as they suggest that mindfulness effects the brain and this produces the behavioral effects. The results suggest that the disruptive influence of mindfulness on implicit learning occurs primarily in older adults and that it is mediated by mindfulness’ negative influence on the functional connectivity of the Caudate Nucleus with the Medial Temporal Lobe. It is known that there is deterioration in the Caudate Nucleus and the Medial Temporal Lobe with aging. It is possible, then, that mindfulness can only exert its disruptive effects when there is an already weakened Caudate Nucleus – Medial Temporal Lobe system present.

 

It is interesting that mindfulness did not disrupt implicit learning in the younger participants. This might explain why mindfulness training improves athletic performance. Athletes are generally young and the lack of disruption of implicit learning by mindfulness allows mindfulness to produce psychological enhancements that improve performance. This might not be true for older athletes.

 

Regardless, it is clear that mindfulness disrupts the establishment of automatic unconscious habits in older adults as a result of its negative effects on the interaction of two brain areas, Caudate Nucleus and the Medial Temporal Lobe.

 

“people reporting low on the mindfulness scale tended to learn more—their reaction times were quicker in targeting events that occurred more often within a context of preceding events than those that occurred less often.” – Georgetown University Medical Center

 

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

 

Stillman, C. M., You, X., Seaman, K. L., Vaidya, C. J., Howard, J. H., & Howard, D. V. (2016). Task-Related Functional Connectivity of the Caudate Mediates the Association Between Trait Mindfulness and Implicit Learning In Older Adults. Cognitive, Affective & Behavioral Neuroscience, 16(4), 736–753. http://doi.org/10.3758/s13415-016-0427-2

 

Abstract

Accumulating evidence shows a positive relationship between mindfulness and explicit cognitive functioning, i.e., that which occurs with conscious intent and awareness. However, recent evidence suggests that there may be a negative relationship between mindfulness and implicit types of learning, or those that occur without conscious awareness or intent. Here we examined the neural mechanisms underlying the recently reported negative relationship between dispositional mindfulness and implicit probabilistic sequence learning in both younger and older adults. We tested the hypothesis that the relationship is mediated by communication, or functional connectivity, of brain regions once traditionally considered to be central to dissociable learning systems: the caudate, medial temporal lobe (MTL), and prefrontal cortex (PFC). We first replicated the negative relationship between mindfulness and implicit learning in a sample of healthy older adults (60–90 years old) who completed three event-related runs of an implicit sequence learning task. Then, using a seed-based connectivity approach, we identified task-related connectivity associated with individual differences in both learning and mindfulness. The main finding was that caudate-MTL connectivity (bilaterally) was positively correlated with learning and negatively correlated with mindfulness. Further, the strength of task-related connectivity between these regions mediated the negative relationship between mindfulness and learning. This pattern of results was limited to the older adults. Thus, at least in healthy older adults, the functional communication between two interactive learning-relevant systems can account for the relationship between mindfulness and implicit probabilistic sequence learning.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955759/

Reduce Pain with Mindfulness

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Reduce Pain with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness is an effective practice for approaching chronic pain. It teaches individuals to observe their pain, and be curious about it. And, while counterintuitive, it’s this very act of paying attention that can help your pain.” –  Margarita Tartakovsky

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans and 1.5 billion people worldwide, have common chronic pain conditions. It is important to remember that pain is an important signal that there is something wrong or that damage is occurring. This signals that some form of action is needed to mitigate the damage. This is an important signal that is ignored at the individual’s peril. So, in dealing with pain, it’s pain signals should not be completely blocked or prevented. They need to be perceived. But, methods are needed to mitigate the pain and the psychological distress produced.

 

The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and prescription opioid overdoses kill more than 14,000 people annually. The situation in the U.S. with opioid overdoses has become so severe that it’s taken on epidemic proportions. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the patient’s ability to cope with the pain. 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 perceived stress and the emotional reactions to pain may be helpful in pain management. Indeed, mindfulness practices have been shown to reduce the physiological and psychological responses to stress and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. As a result, mindfulness practices have been shown to be effective in treating pain.

 

In today’s Research News article “Mindfulness meditation–based pain relief: a mechanistic account.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941786/, Zeidan and Vago review the published research literature on the effectiveness of mindfulness practices in the treatment of pain. They report that the scientific research finds that mindfulness practices are safe and effective in treating perceived pain from a wide variety of conditions, including fibromyalgia, migraine, chronic pelvic pain, irritable bowel syndrome, and chronic low back pain.

 

Further, they report that the reduction in perceived pain appears to result from alterations of the nervous system. In particular, long-term meditators have significant increased activation of sensory processing–related brain regions (thalamus, insula) and reduced activation in brain areas that process the evaluation of pain (Medial Prefrontal Cortex), Orbital Frontal Cortex). There was also a significant relationship between meditative experience, lower perceived pain, and greater deactivation of the Medial Prefrontal Cortex / Orbital Frontal Cortex. Even after only brief meditation practice changes can be detected in brain areas that process pain stimuli (insula and anterior cingulate cortex) and the psychological appreciation of pain (Orbital Frontal Cortex).

 

These findings strongly suggest that in response to mindfulness practices multiple areas of the brain change, resulting in reduced subjective pain. These benefits can be obtained by short-term mindfulness practice but are further improved with long-term practice. Hence, mindfulness practices appear to be safe and effective alternative treatments to drugs and thereby may be useful in addressing the opioid epidemic.

 

So, reduce pain with mindfulness.

 

“When it comes to chronic pain, the key is learning to live with it rather than vainly trying to avoid or eradicate it . . .  Mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I can choose how I relate to it”).” -Christiane Wolf

 

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

 

Zeidan, F., & Vago, D. (2016). Mindfulness meditation–based pain relief: a mechanistic account. Annals of the New York Academy of Sciences, 1373(1), 114–127. http://doi.org/10.1111/nyas.13153

 

Abstract

Pain is a multidimensional experience that involves sensory, cognitive, and affective factors. The constellation of interactions between these factors renders the treatment of chronic pain challenging and financially burdensome. Further, the widespread use of opioids to treat chronic pain has led to an opioid epidemic characterized by exponential growth in opioid misuse and addiction. The staggering statistics related to opioid use highlight the importance of developing, testing, and validating fast-acting nonpharmacological approaches to treat pain. Mindfulness meditation is a technique that has been found to significantly reduce pain in experimental and clinical settings. The present review delineates findings from recent studies demonstrating that mindfulness meditation significantly attenuates pain through multiple, unique mechanisms—an important consideration for the millions of chronic pain patients seeking narcotic-free, self-facilitated pain therapy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941786/

Reduce Mild Aging Cognitive Decline with Yogic Meditation

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Reduce Mild Aging Cognitive Decline with Yogic Meditation

 

By John M. de Castro, Ph.D.

 

“The healthier and more active one’s lifestyle, the more likely he or she will maintain cognitive performance over time. And meditation may be a key ingredient for ensuring brain health and maintaining good mental performance.” – Grace Bullock

 

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. But, there is some hope for age related cognitive decline, as there is evidence that it can be slowed. There are some indications that physical and mental exercise can reduce the rate of cognitive decline and lower the chances of dementia. For example, contemplative practices such as meditation, yoga, and Tai Chi and Qigong have all been shown to be beneficial in slowing or delaying physical and mental decline with aging. Mindfulness practices have been shown to improve cognitive processes.

 

Yoga is a mindfulness practice that is safe and applicable to the elderly. So, it could potentially be an ideal practice for the slowing of age related cognitive decline. In today’s Research News article “A randomized controlled trial of Kundalini yoga in mild cognitive impairment.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540331/, Eyre and colleagues recruited elderly (older than 55 years of age, average 68) with a mild degree of cognitive impairment and randomly assigned them to a 12 week, 60 minutes once a week, standard memory enhancement treatment or to yogic meditation practice, Kundalini Yoga. Daily homework was assigned. Kundalini Yoga includes meditation, breathing exercises, and mantra practice. The participants were measured before and after training and 12 weeks later for memory ability, executive function, resilience, physical and cognitive symptoms, neuropsychiatric symptoms, illness, apathy, and mood including depression.

 

They found that following training both the yoga and memory enhancement groups had significant improvements in memory and apathy and these improvements were still present 12 weeks after the end of training. In contrast, only the Kundalini Yoga group had significant improvements in depression, resilience, and executive function, including cognitive flexibility, response inhibition, and semantic fluency. Hence, both groups improved in memory and apathy, but only the Kundalini Yoga group also improved in mood, resilience, and higher-level thinking (cognitive function).

 

These are exciting findings suggesting the Kundalini Yoga is a safe and effective treatment that for age related declines in cognitive function, depression, apathy, and memory and improves stress resilience. It has been demonstrated that mindfulness training produces a wide variety of benefits for the elderly including mood, memory and cognitive improvements. So, Kundalini Yoga can be added to the list of effective mindfulness trainings for the elderly.

 

This was an excellent study as the comparison condition was the current “gold standard” of treatment for mild cognitive impairment in the elderly, memory enhancement training. Yet, Kundalini Yoga was significantly more beneficial. The improvement in stress resilience is important and may underlie some of the other benefits of the Kundalini Yoga training. Aging can produce considerable economic, physical, psychological, and social stresses. Improvement in the ability to withstand the effects of these stresses should be highly beneficial by decreasing the impact of these stresses on other aspects of physical and psychological functioning in the elderly.

 

So, reduce mild aging cognitive decline with yoga.

 

“Meditation could be a promising intervention in contrasting the negative effects of aging. Indeed, it has been shown to enhance cognitive efficiency in several domains, such as attention and executive functions.” Marco Sperduti

 

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

 

Eyre, H. A., Siddarth, P., Acevedo, B., Van Dyk, K., Paholpak, P., Ercoli, L., … Lavretsky, H. (2017). A randomized controlled trial of Kundalini yoga in mild cognitive impairment. International Psychogeriatrics, 29(4), 557–567. http://doi.org/10.1017/S1041610216002155

 

Abstract

Background

Global population aging will result in increasing rates of cognitive decline and dementia. Thus, effective, low-cost, and low side-effect interventions for the treatment and prevention of cognitive decline are urgently needed. Our study is the first to investigate the effects of Kundalini yoga (KY) training on mild cognitive impairment (MCI).

Methods

Older participants (≥55 years of age) with MCI were randomized to either a 12-week KY intervention or memory enhancement training (MET; gold-standard, active control). Cognitive (i.e. memory and executive functioning) and mood (i.e. depression, apathy, and resilience) assessments were administered at baseline, 12 weeks and 24 weeks.

Results

At baseline, 81 participants had no significant baseline group differences in clinical or demographic characteristics. At 12 weeks and 24 weeks, both KY and MET groups showed significant improvement in memory; however, only KY showed significant improvement in executive functioning. Only the KY group showed significant improvement in depressive symptoms and resilience at week 12.

Conclusion

KY group showed short- and long-term improvements in executive functioning as compared to MET, and broader effects on depressed mood and resilience. This observation should be confirmed in future clinical trials of yoga intervention for treatment and prevention of cognitive decline

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540331/

What is Mindfulness

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What is Mindfulness

 

By John M. de Castro, Ph.D.

 

 “Mindfulness is the aware, balanced acceptance of the present experience. It isn’t more complicated than that. It is opening to or receiving the present moment, pleasant or unpleasant, just as it is, without either clinging to it or rejecting it.” ~Sylvia Boorstein

 

Mindfulness has become a buzzword that is used in many contexts with many different meanings. There is no single definition that is agreed upon by the research and practitioner communities.  In fact, there are many different definitions. Arguably the most commonly used definition and the one that I prefer, is the definition proposed by Jon Kabat-Zinn. “Mindfulness means paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally.”

 

This definition contains a number of important components that help to better understand exactly what mindfulness is. Firstly, mindfulness is “paying attention.” But, not just letting the mind settle somewhere passively, but “on purpose.” That makes it an active process; a willful choice. With mindfulness, the mind is not aimlessly wandering. Rather it is focused.

 

The problem comes up, though, that our minds are unruly. In fact, the mind is often referred to as a “monkey mind,” implying that it jumps around in an untamed and unruly fashion. This is without a doubt true. Matt Killingsworth sampled people’s thinking at unpredictable times during the day and discovered that 47% of the time people’s minds were off-topic, that is, they were thinking about something else other than what was going on at the moment. They were not mindful almost half the time.

 

It is often a shock for people to discover that a large amount of the time they are not controlling their minds. Rather, the mind appears to be some extent controlling what they are experiencing. Most people suffer from the illusion that they are in control. So, it is eye opening to discover that frequently they are not. To get control of the mind and keep it paying attention to what is going on in the moment requires a degree of effort. But, even then the mind tends to wander off, thinking about past events, planning for the future, or simply day dreaming. Fortunately, mind wandering can be reduced with practice. But, even highly trained mindfulness practitioners have frequent lapses where the mind goes off by itself into topics far removed from the present. So, no one should expect to be able to completely control the mind, just hope to control it better.

 

A second important aspect of the definition is that, in mindfulness, attention is directed to what is occurring in the “present moment.” That seems straightforward until one tries to define exactly what portion in time is the present moment. Our first inclination is to think of the present moment as instantaneous, exactly this particular moment only. But with a little reflection it becomes obvious that what we experience as the present moment actually extends back in time a short ways and also forward slightly into the future. If it didn’t extend back in time we could never see motion, as we wouldn’t be aware of a change from a previously seen position. For that matter, we wouldn’t be able to hear a full word, only the immediate sound. Obviously this is not the case, because the present moment actually contains a little bit of the past. Demonstrating that the present actually extends a little into the future is more difficult and subtle to detect. But, if we interrupt speech in the middle of a sentence, you will find that you seemingly “hear” the next syllable or word that the mind is expecting to appear or if we interrupt a movie you seemingly “see” the next frame.

 

The total amount of time constituted by the present moment is difficult to precisely define. Marc Wittmann asserts that before we can answer that question of how long is now we must first define exactly what we mean by the present moment. He identifies three different ideas of the present moment; functional moment, experienced moment, and mental presence. The most pertinent for our discussion of mindfulness is the experienced moment, the subjective present. It is an experienced now within an ongoing stream of events. For example, while listening to music a note does not stand alone in consciousness but is joined by the prior note and the expected future note. In speech, each word is perceived in reference to past and expected words, as in the phrase “how are you”. When we hear “are” we process it recognizing that it’s in reference to a question, “How” and due to our learning we also experience the “are” with the expectation of a following word “you”. It’s been estimated that the experienced moment lasts somewhere up to 3 seconds. So, when we refer to present moment awareness we are referring not to an instant but to the approximately 3 seconds that we experience as the present.

 

A third important aspect of the definition is that, in mindfulness there is no judgment of experience. This indicates that when we are mindful we are simply experiencing things as they are without evaluation. It is important to note that it is value judgments that are absent. Making judgments about the likely course of events and what actions are needed is actually a part of mindfulness. If we’re driving mindfully we are constantly judging whether we need to slow down or turn to avoid hitting another car, whether we can safely make it through a traffic light that is about to change, whether a car may pull out in front of us. If we are driving mindfully we’re making these judgments but totally aware the whole time of what is happening.

 

The non-judgmental aspect of mindfulness involves value judgments about what we’re experiencing. Things are not good or bad, pleasant or unpleasant, liked or disliked, happy or sad, worthwhile or worthless, etc. They simply are. Although seemingly simple, this is actually devilishly difficult to do. The mind has been trained pretty much since birth to judge everything. This is actually quite good and adaptive, allowing us to decide if we should approach and acquire things we need or to avoid things that could do us harm. But, the judgment goes on even when it has little consequence toward survival. So, we see another person and classify them as attractive, or smart, or boring, or obnoxious, or rich, or a fool, or friendly, or a rival, etc. We hear a loud sound and we immediately think it’s threatening, or unnecessary noise, or enjoyable, or someone being inconsiderate, etc. We taste a food and immediately think that it’s delicious, or sour, or nauseating, or healthful, etc. We are constantly judging.

 

Being non-judgmental requires quieting the mind. If left to itself, the mind will always judge. So, to be mindful we need to shut off the evaluating chatter. Just experiencing everything as it is, as a pure and simple experience. It’s actually quite amazing what happens when judgment is turned off. Suddenly, we begin to appreciate even the simplest of things which begin to shine and stand out in their own unique way. Another person is simply seen as another human being with needs and desires, and a consciousness, just like us, a reflection of our own humanness. An odor can be experienced as a unique sensation that will never be repeated exactly the same again. Just breathing can be experienced fully as a series of movements and sensations that arise and fall away and the repeat over and over again, automatically, without direction or thought, each time revitalizing and nourishing our physical being, leading to a recognition of physiology at work. These are just some of the fruits of mindfulness.

 

It is very difficult to stop the judging even for brief periods of time. But, again practice comes to the rescue. Over time, if the effort is expended, judging slowly decreases and stops for longer and longer periods of time. Don’t expect to ever be able to stop judging completely. This would be a battle with you mind that can’t be won. Just expect that you can become better at looking at things as they are without value judgments and be able to maintain it for a longer period of time.

 

The final aspect of the definition that needs amplification and discussion is the notion that mindfulness involves paying attention in “a particular way.” Unfortunately, this is a rather ambiguous phrase that actually refers to a very important component of mindfulness. The “particular way” refers to attention primarily to immediate sensory experience. It could be focused on a particular component, aspect, or thing, or it could be broadly on all that is immediately present. The key is that it is a total appreciation of what is without any attempt to hold onto it, letting it arise, and fall away without grasping at it or attempting to change it. The experiences can include feelings, bodily sensations, and the surrounding environment and even thoughts. But observing the thoughts as just another thing arising, and falling away, with no attempt to hold onto them, elaborate on them, judge them, or associate them with any other thoughts just letting them flow through awareness and fall away like a cloud passing over the horizon. In other words, thinking can be mindful if we are completely aware of what we are doing and not getting carried away and lost in the thoughts.

 

This is a rather idealized conception of mindfulness. In practice, one can be very mindful without coming even close to this description. This discourse should be looked on as describing the model, the ideal, with it understood that reality will in fact be a diluted or compromised version of this ideal. One can be very mindful and still judge the experience, as long as there’s a recognition that that is what is happening. One can be very mindful and still bring in memories from the past or plans for the future, as long as there’s an awareness that these are not an essential part of the experience but the minds embellishments. One can be very mindful and still

Try to maintain a feeling or keep an enjoyable experience going, as long as one recognizes that what you are doing is simply another part of present moment experience. It is even possible, albeit difficult, to daydream mindfully as long as you are completely aware that this is what you’re engaging in completely under willful control. In other words, mindfulness need not be perfect, it only experiencing things as they are, in the present moment, without judgment.

 

One problem with the definition is that it specifies the processes involved in mindfulness but neglects to specify exactly what entity is being mindful. It doesn’t specify who or what is attending, who or what is producing the purpose, who or what is not judging, who or what is having the immediate experience. When these questions arise, it’s a sign that the issue has moved from mindfulness to the spiritual side of mindfulness, who or what is aware. This is not the place for a discussion of these aspects of mindfulness. But, it is important to recognize that this definition and description of mindfulness only scratches the surface. There are deeper levels to mindfulness to be explored.

 

“Mindfulness is the process of actively noticing new things. When you do that, it puts you in the present. It makes you more sensitive to context and perspective. It’s the essence of engagement.” – 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