Relieve Depression by Decentering

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By John M. de Castro, Ph.D.

 

“By practicing with others, people realize that the way their minds generate depressive and ruminative thoughts is really no different from others, like that builder over there, or my neighbor. These are just thoughts — not facts in my life,” – Willem Kuyken

 

Mindfulness Based Cognitive Therapy (MBCT) was developed specifically to treat depression and has been shown to be very effective in treating existing depression and preventing relapse when depression is in remission. MBCT involves mindfulness training, containing sitting and walking meditation and body scan, and cognitive therapy to alter how the patient relates to the thought processes that often underlie and exacerbate depression. MBCT attempts to decenter depressive thought processes; that is to learn to observe these thoughts and feelings as objective events in the mind rather than personally identifying with the thoughts or feelings.

 

Decentering changes the nature of experience by having the individual step outside of experiences and observe them from a distanced perspective. This allows the individual to see their thoughts as a constructed reality produced by their self and not as absolute truth. This, in turn, results in an ability to see depressive thoughts as not true, but simply a construct of the minds operation. This, then, allows the individual to begin to change how they interpret experience. Hence the depressive thought that how another treated them demonstrates that “I am worthless” can be reinterpreted to “this person acts this way out of their personal needs.”

 

It is not known whether the decentering produced by MBCT is actually necessary for the treatment of depression. This issue was explored in today’s Research News article “Exploring the relationship of decentering to health related concepts and cognitive and metacognitive processes in a student sample.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1419777434712845/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784351/

Kessel and colleagues recruited university students and measured them for depressive symptoms, decentering, self-focused attention, attentional filtering, and metacognition (ability to judge one’s own performance). They found that the higher the student’s level of decentering, including the decentering components of accepting self-perceptions and distancing, the lower the levels of depression. The relationships discovered were relatively strong. Conversely, the higher the levels of dysfunctional self-focused attention the lower the levels of decentering and the higher the levels of depression.

 

The results are clear and interesting. They suggest that decentering is clearly and relatively strongly inversely related to depression. They also suggest that this relationship may be mediated by decentering, with the lowering of dysfunctional self-focused attention, resulting in lower depression levels. It should be kept in mind that this study was correlational. So, no conclusions can be drawn regarding causation. But, the results suggest that MBCT’s effectiveness against depression is at least in part due to its promotion of decentering. They also suggest that decentering training by itself might be an effective treatment for depression.

 

So, relieve depression by decentering.

 

“Mindfulness practices of MBCT allowed people to be more intentionally aware of the present moment, which gave them space to pause before reacting automatically to others. Instead of becoming distressed about rejection or criticism, they stepped back to understand their own automatic reactions—and to become more attuned to others’ needs and emotions. Awareness gave them more choice in how to respond, instead of becoming swept up in escalating negative emotion.” – Emily Nauman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Kessel, R., Gecht, J., Forkmann, T., Drueke, B., Gauggel, S., & Mainz, V. (2016). Exploring the relationship of decentering to health related concepts and cognitive and metacognitive processes in a student sample. BMC Psychology, 4, 11. http://doi.org/10.1186/s40359-016-0115-6

 

Abstract

Background: Decentering, a central change strategy of Mindfulness-Based Cognitive Therapy, is a process of stepping outside of one’s own mental events leading to an objective and non-judging stance towards the self. The study aimed at investigating associated mechanisms of decentering.

Method: The present study investigated the relation of decentering, operationalized by means of the German Version of the Experiences Questionnaire, to severity of depressive symptoms, assessed by the adaptive Rasch-based depression screening, and self-focussed attention, assessed by the Questionnaire of Dysfunctional and Functional Self-Consciousness. Furthermore, the relationship between decentering and a) the ability to shift and allocate attention by means of the Stroop test, and b) metacognitive monitoring, i.e. the absolute difference between judged and real task performance, was investigated. These relationships were examined in 55 healthy students using Pearson’s correlations.

Results: In line with our assumptions, higher decentering scores were significantly associated with lower scores on severity of depressive symptoms, with higher functional- and lower dysfunctional self-focussed attention. Contrary to our expectations, results neither indicated a relationship between decentering and attention ability, nor between decentering and metacognitive monitoring.

Conclusions: The present results suggest that decentering is associated with concepts of mental health (i.e. less severity of depressive symptoms and higher functional self-focussed attention). Overall, the concept decentering seems to be mainly composed of self-focussed aspects when investigated in a healthy sample without intervention. Further investigations of associated concepts of decentering should consider aspects of self-relevance and emotional valence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784351/

Increase Mindfulness to Improve Mental Health

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By John M. de Castro, Ph.D.

 

“Meditation gives you the wherewithal to pause, observe how easily the mind can exaggerate the severity of a setback, and resist getting drawn back into the abyss.”— Richie Davidson

 

Mindfulness practice has been shown to produce improved emotion regulation. Practitioners demonstrate the ability to fully sense and experience emotions, but respond to them in more appropriate and adaptive ways. In other words, mindful people are better able to experience yet control emotions. This is a very important consequence of mindfulness. Humans are very emotional creatures and these emotions can be very pleasant, providing the spice of life. But, when they get extreme they can produce misery and even mental illness. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health and the treatment of mental illness especially depression and anxiety disorders.

 

It has been shown that repeated writing about upsetting experiences (narrative disclosure) can be beneficial for the individual’s physical and mental health. This narrative disclosure is thought to produce benefits by interrupting experiential avoidance. That is, the process of writing about difficult experiences forces the individual to face them and stop avoiding dealing with the experiences and the emotions evoked by them. Hence, it is reasonable to further explore the roles of mindfulness and experiential avoidance in the effects of narrative disclosure on mental health.

 

In today’s Research News article “Mindfulness and Experiential Avoidance as Predictors and Outcomes of the Narrative Emotional Disclosure Task.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1418454504845138/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821161/

Moore and colleagues recruited college students and randomly assigned them to receive 3 daily 20-minute sessions of either writing about traumatic or upsetting events (narrative disclosure) or a neutral control condition of witting about their day. Before writing and 3 months afterwards both groups completed self-report scales of mindfulness, experiential avoidance, depression, psychological distress, and self-acceptance.

 

Contrary to expectations, they did not find any difference in mental health, mindfulness, or experiential avoidance as a result of narrative disclosure in comparison to control writing. But, they found that for both conditions, decreases in experiential avoidance were associated with decreases in both depression and psychological distress and increases in self-acceptance. On the other hand, for the narrative disclosure but not control condition, increases in mindfulness were associated with significant decreases in depression and psychological distress, and increases in self-acceptance. Hence, regardless of condition reduced experiential avoidance was associated with improved mental health. But, only within the narrative disclosure condition was increased mindfulness associated with improved mental health.

 

These are interesting results that defy simple interpretation. It is clear that regardless of writing condition low experiential avoidance contributes to mental health. So, facing up to and not avoiding troubling experiences contributes to mental health. In the case with mindfulness, however, the case is more complex. The results suggest that those individuals for whom narrative disclosure produces changes in mindfulness, there is a resultant improvement in mental health. It is interesting to note that within the control condition, high mindfulness at baseline was associated with improved mental health. So, it would appear, as has previously been demonstrated that mindfulness is associated with better mental health and that further increases in mindfulness produced by narrative disclosure results in further improvements in psychological well-being. So, being more mindful contributes to mental health and increasing mindfulness will further improve mental health.

 

So, increase mindfulness to improve mental health.

 

“Working with emotions during our meditation sessions sharpens our ability to recognize a feeling just as it begins, not 15 consequential actions later. We can then go on to develop a more balanced relationship with it—neither letting it overwhelm us so we lash out rashly nor ignoring it because we’re afraid or ashamed of it.” – Sharon Salzberg

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Moore, S. D., Brody, L. R., & Dierberger, A. E. (2009). Mindfulness and Experiential Avoidance as Predictors and Outcomes of the Narrative Emotional Disclosure Task. Journal of Clinical Psychology, 65(9), 971–988. http://doi.org/10.1002/jclp.20600

 

Abstract

This randomized study examined whether narrative emotional disclosure improves mindfulness, experiential avoidance, and mental health, and how baseline levels of and changes in mindfulness and experiential avoidance relate to mental health. Participants (N = 233) wrote repeated traumatic (experimental condition) or unemotional daily events narratives (control condition). Regression analyses showed neither condition nor gender effects on mental health or experiential avoidance at a 1-month follow-up, although the control condition significantly increased in one component of mindfulness. Decreased experiential avoidance (across conditions) and increased mindfulness (in the experimental condition) significantly predicted improved mental health. Narrative disclosure thus did not improve outcomes measured here. However, increasing mindfulness when writing narratives with traumatic content, and decreasing experiential avoidance regardless of writing content, was associated with improved mental health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4821161/

 

Reduce Anxiety and Depression in Pregnancy with Mindfulness

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By John M. de Castro, Ph.D.

 

“research is beginning to show how mindfulness decreases depression and anxiety during pregnancy and boosts positive emotions.” – Mindful

 

Depression occurring after delivery of a baby is well known, documented and discussed. Less well known but equally likely is intense depression and anxiety during pregnancy. But, between 14% and 23% of women suffer from some form of depression and between 5% to 16% of women experience an anxiety disorder during pregnancy. Intense anxiety and depression are difficult to deal with 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 torment.

 

Without treatment, prenatal depression can pose a serious threat to a mother-to-be, who may stop taking care of herself or, in extreme cases, become suicidal. This can even cause a woman to want to terminate her pregnancy. There are no statistics on the matter but it has been speculated that prenatal depression can lead to abortion. Anxiety during depression is also a serious threat being associated with more health problems during pregnancy, postpartum depression and anxiety, and premature birth.

 

Prenatal depression and anxiety are often not recognized or diagnosed. When it is, the typical treatment is drugs. But these drugs are often ineffective and frequently have troublesome side effects and may not be safe during pregnancy. So, alternative treatments are needed. Mindfulness training may be an answer. Meditation and yoga practices have been shown to help improve mental and physical health during pregnancy. This is encouraging as mindfulness training has many benefits and is completely safe, even during pregnancy. Hence, it is important to further research the potential beneficial effects of mindfulness training during pregnancy.

 

In today’s Research News article “The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1417100888313833/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045953/

Yazdanimehr and colleagues investigate the effectiveness of mindfulness training for anxiety and depression during pregnancy. They recruited women who were 1 to 6 months pregnant and randomly assigned them to receive treatment as usual (control) or Mindfulness-Based Cognitive Therapy (MBCT). Treatment was delivered over 8 weeks with 1.5 hour sessions occurring once a week. Depression and anxiety were measured before and after treatment and followed up 1 month later.

 

They found that the women receiving MBCT had significant improvements in both depression (46%) and anxiety (45%) at the end of treatment and at one month follow-up while there were no significant change for the control participants. Mindfulness-Based Cognitive Therapy (MBCT) was developed specifically to treat depression. So, its effectiveness with the women is not surprising. It develops mindfulness and works to alter thought patterns to interpret experiences objectively without reference to negative or self-deprecating beliefs. This training is very effective for the relief of depression and also anxiety.

 

The fact that MBCT had such large effects with this vulnerable population is particularly encouraging. By relieving anxiety and depression in these pregnant women it should be helping to insure a better pregnancy, more full term births, and less problems postnatally. This suggests that MBCT could be a very valuable treatment and perhaps a recommended practice for pregnant women.

 

So, reduce anxiety and depression in pregnancy with mindfulness.

 

“Pregnancy and childbirth are great crash-courses for motherhood. For nine months, you are increasingly required to be in your body. Labor and childbirth may be the time when you are most in touch with your body-the most embodied any of us will ever be-though not necessarily in a very comfortable way. This doesn’t end when the baby is born. Learning how to be present and grounded in your body even in the face of discomfort is a great skill to cultivate now and for the rest of your life as a mother.” – 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

 

Study Summary

Yazdanimehr, R., Omidi, A., Sadat, Z., & Akbari, H. (2016). The Effect of Mindfulness-integrated Cognitive Behavior Therapy on Depression and Anxiety among Pregnant Women: a Randomized Clinical Trial. Journal of Caring Sciences, 5(3), 195–204. http://doi.org/10.15171/jcs.2016.021

 

Abstract

Introduction: Pregnancy can be associated with different psychological problems such as depression and anxiety. These problems are often neglected and left untreated. This study aimed to examine the effect of mindfulness-integrated cognitive behavior therapy on depression and anxiety among pregnant women.

Methods: A convenient sample of 80 pregnant women were selected. Participants were randomly allocated to either the experimental or the control groups. Participants in the experimental group received mindfulness-integrated cognitive behavior therapy while women in the control group only received routine prenatal care services. A demographic questionnaire, the Edinburgh Postnatal Depression Scale, and the Beck Anxiety Inventory were used for data collection. Descriptive statistics measures such as frequency, mean, and standard deviation as well as the repeated-measures analysis of variance test were used for data analysis.

Results: After the study intervention, the mean scores of anxiety and depression in the experimental group were significantly lower than the control group.

Conclusion: Mindfulness-integrated cognitive behavior therapy can significantly alleviate pregnant women’s depression and anxiety. So implementation of this method alongside with other prenatal care services is recommended.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045953/

 

Help Headaches in Adolescents with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness meditation is proving to be of significant help in not only reducing migraines or chronic pain, but improvements in mood, outlook on life and illness, increased coping skills, enhanced sense of well-being, changes in perception of pain, higher tolerance of pain, enhanced immune function, less fatigue and stress and better sleep.” – Cynthia Perkins

 

Headaches are the most common disorders of the nervous system. It has been estimated that 47% of the adult population have a headache at least once during the last year. There are a wide variety of drugs that are prescribed for chronic headache pain with varying success. Headaches are treated with pain relievers, ergotamine, blood pressure drugs such as propranolol, verapamil, antidepressants, antiseizure drugs, and muscle relaxants. Drugs, however, can have some problematic side effects particularly when used regularly and are ineffective for many sufferers. So, almost all practitioners consider lifestyle changes that help control stress and promote regular exercise to be an important part of headache treatment and prevention. Avoiding situations that trigger headaches is also vital.

 

Mindfulness training has been shown to be an effective treatment for headache pain in adults. It is not known whether it is also effective for adolescents. Yet, 60% of children and adolescents report headaches, with 20% having frequent or severe headaches. In today’s Research News article “Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1415631915127397/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700163/

Hesse and colleagues study the effectiveness of mindfulness training for recurrent headaches in adolescents. They recruited adolescent females with recurrent headaches. The teens received group mindfulness training once a week for 1 to 1.5 hours for 12 weeks. Before and after training the adolescents recorded their mindfulness practices and headaches, and completed scales measuring headache-related disability, anxiety, depression, and quality of life, while their parents also completed a report of the teens’ quality of life.

 

They found that mindfulness training did not produce any changes in the frequency or severity of headaches, headache-related disability, or anxiety, but a significant reduction in depression and an improvement in acceptance of headache pain. The parents reported that the adolescents had improved physical quality of life. Hence, mindfulness training improved the teen’s depression, quality of life, and acceptance of pain but not the headaches themselves. These are encouraging results that need to be followed up with a large randomized controlled clinical trial. But, they suggest that mindfulness training may be a useful treatment for headache pain in adolescents.

 

Mindfulness practices may be helpful with headache pain by focusing attention on the present moment. This has been shown to reduce worry and catastrophizing which, in turn, reduces depression. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, reducing worry and catastrophizing can reduce headache pain. Mindfulness teaches the individual to view pain as a present moment experience that can be experienced just as it is and accept it. As a result, the individual accepts the pain and stops fighting against it, which can amplify the pain.

 

So, help headaches in adolescents with mindfulness.

 

“Years of research and clinical experience demonstrate that behavioral medicine methods can have a powerful effect on pain, especially when used in conjunction with medical treatment. Behavioral medicine examines and trains an individual to become aware of the power of the mind and emotions on physical health. One potent method for recovering health is meditation.” – Michigan Headache & Neurological Institute

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Hesse, T., Holmes, L. G., Kennedy-Overfelt, V., Kerr, L. M., & Giles, L. L. (2015). Mindfulness-Based Intervention for Adolescents with Recurrent Headaches: A Pilot Feasibility Study. Evidence-Based Complementary and Alternative Medicine : eCAM, 2015, 508958. http://doi.org/10.1155/2015/508958

 

Abstract

Recurrent headaches cause significant burden for adolescents and their families. Mindfulness-based interventions (MBIs) have been shown to reduce stress and alter the experience of pain, reduce pain burden, and improve quality of life. Research indicates that MBIs can benefit adults with chronic pain conditions including headaches. A pilot nonrandomized clinical trial was conducted with 20 adolescent females with recurrent headaches. Median class attendance was 7 of 8 total sessions; average class attendance was 6.10 ± 2.6. Adherence to home practice was good, with participants reporting an average of 4.69 (SD = 1.84) of 6 practices per week. Five participants dropped out for reasons not inherent to the group (e.g., extracurricular scheduling); no adverse events were reported. Parents reported improved quality of life and physical functioning for their child. Adolescent participants reported improved depression symptoms and improved ability to accept their pain rather than trying to control it. MBIs appear safe and feasible for adolescents with recurrent headaches. Although participants did not report decreased frequency or severity of headache following treatment, the treatment had a beneficial effect for depression, quality of life, and acceptance of pain and represents a promising adjunct treatment for adolescents with recurrent headaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700163/

 

What is Mindfulness

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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

Improve Chronic Obstructive Pulmonary Diseases (COPD) with Yoga

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By John M. de Castro, Ph.D.

 

 “practicing yoga is one of the best things you can do for the health of your lungs. Yoga will strengthen the muscles of your chest, increase your lung capacity and boost oxygen intake.” – Tania Tarafdar

 

Chronic obstructive pulmonary diseases (COPD) are progressive lung diseases that obstruct airflow. The two main types of COPD are chronic bronchitis and emphysema. COPD is very serious being the third leading cause of death in the United States, over 140,000 deaths per year and the number of people dying from COPD is growing. More than 11 million people have been diagnosed with COPD, but an estimated 24 million may have the disease without even knowing it. COPD causes serious long-term disability and early death. Symptoms develop slowly. Over time, COPD can interfere with the performance of routine tasks and is thus a major cause of disability in the United States. The most common cause of COPD is smoking. But, COPD also occurs with miners and is called black lung disease. COPD is not contagious. Most of the time, treatment can ease symptoms and slow progression.

 

There is no cure for COPD. COPD treatments include lifestyle changes, medicine, bronchodilators, steroids, pulmonary rehabilitation, oxygen therapy, and surgery. They all attempt to relieve symptoms, slow the progress of the disease, improve exercise tolerance, prevent and treat complications, and improve overall health. Yoga practice would seem to be a useful lifestyle change that could improve COPD symptoms as it has been shown to improve exercise tolerance and overall health and includes breathing exercises. Indeed, it has been shown that yoga practice improves the mental and physical health of patients with COPD.

 

In today’s Research News article “Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1413254018698520/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052394/

Ranjita and colleagues studied the effectiveness of yoga practice on Chronic obstructive pulmonary diseases (COPD) by recruiting non-smoking male coal miners with COPD and randomly assigned them to a treatment as usual group or a yoga practice group. Yoga was practiced in 90-minute session, 6 days per week for 12 weeks. Before and after training the participants were measured for exercise tolerance with a walking test, breathing difficulty, blood oxygen levels, pulse rate, and fatigue.

 

They found that the miners who participated in the yoga practice had a significant (24.4%) improvement in breathing, a 25.9% decrease in fatigue, a 19.9% increase in the walking test distance covered, a 1.3% increase in blood oxygen levels, and a 4.3% decrease in resting pulse rate. Hence, yoga practice significantly improved the miners’ lung function, energy level, and physical fitness.

 

These are excellent results and suggest that yoga practice may be a very useful additional treatment for Chronic obstructive pulmonary diseases (COPD). Previous research has shown that yoga practice improved overall health, depression, anxiety in COPD sufferers. Since, yoga practice is a gentle exercise that includes breathing exercises, it seems reasonable that it would have these beneficial effects for COPD sufferers. It would be useful if future research compared yoga practice to other forms of exercise as treatments for COPD. The yoga practice used in this study was exceptionally intensive. Many patients would not be willing to engage in such an intense practice. Future research should also look at whether less intensive yoga practice might be beneficial.

 

So, improve chronic obstructive pulmonary diseases (COPD) with yoga.

 

“A comprehensive yoga program can have a salutary effect on general health and respiratory health and thereby help increase a person’s ability to perform activities of daily living. COPD is known to increase the level of stress, emotional vulnerability, inactivity and muscle wasting. Yoga techniques are particularly suited for promoting relaxation, psycho-emotional stability and exercise tolerance.” – Vijai Sharma

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

Ranjita, R., Hankey, A., Nagendra, H. R., & Mohanty, S. (2016). Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial. Journal of Ayurveda and Integrative Medicine, 7(3), 158–166. http://doi.org/10.1016/j.jaim.2015.12.001

 

Abstract

Background: Coal mine dust exposure causes chronic airflow limitation in coal miners resulting in dyspnea, fatigue, and eventually chronic obstructive pulmonary disease (COPD). Yoga can alleviate dyspnea in COPD by improving ventilatory mechanics, reducing central neural drive, and partially restoring neuromechanical coupling of the respiratory system.

Objectives: To evaluate the effectiveness of Integrated Approach of Yoga Therapy (IAYT) in the management of dyspnea and fatigue in coal miners with COPD.

Materials and methods: Randomized, waitlist controlled, single-blind clinical trial. Eighty-one coal miners (36–60 years) with stable Stages II and III COPD were recruited. The yoga group received an IAYT module for COPD that included asanas, loosening exercises, breathing practices, pranayama, cyclic meditation, yogic counseling and lectures 90 min/day, 6 days/week for 12 weeks. Measurements of dyspnea and fatigue on the Borg scale, exercise capacity by the 6 min walk test, peripheral capillary oxygen saturation (SpO2%), and pulse rate (PR) using pulse oximetry were made before and after the intervention.

Results: Statistically significant within group reductions in dyspnea (P < 0.001), fatigue (P < 0.001) scores, PR (P < 0.001), and significant improvements in SpO2% (P < 0.001) and 6 min walk distance (P < 0.001) were observed in the yoga group; all except the last were significant compared to controls (P < 0.001).

Conclusions: Findings indicate that IAYT benefits coal miners with COPD, reducing dyspnea; fatigue and PR, and improving functional performance and peripheral capillary SpO2%. Yoga can now be included as an adjunct to conventional therapy for pulmonary rehabilitation programs for COPD patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052394/

 

Improve Health and Lower Costs with Workplace Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness is, above all, about being aware and awake rather than operating unconsciously. When you’re consciously present at work, you’re aware of two aspects of your moment-to-moment experience—what’s going on around you and what’s going on within you.” –  Shamash Alidina

 

A healthcare system is only as good as the propensity of people to utilize it. For a number of reasons including procrastination, denial, fear, etc. people often do not go to the doctor even when needed. This can have negative health consequences. On the other hand, using the health care system in a timely manner promotes health by preventing disease or increasing early diagnosis which can reduce the duration and severity of disease. So, counterintuitively, using the healthcare system can actually reduce costs. Hence finding methods to promote the timely and appropriate use of the healthcare system is in everyone’s interest.

 

In the U.S., the majority of health insurance is provided by employers who are responsible for the costs. So, it is in the best interest of employers to promote the health of their employees to reduce costs and improve their bottom line. This is a win-win situation where health promotion in the workplace is good both for the employer and the employee. There have been a number of programs implemented in the workplace that have been tried to improve employee health. A common program is one that promotes a healthy diet and exercise. Less common, but growing in popularity are programs that employ mindfulness training. But, to date there has not been a direct comparison of the two.

 

In today’s Research News article “A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1412011575489431/?type=3&theater

or see summary: Klatt and colleagues recruited faculty and staff who participated in the university’s health care plan which also tracked costs. They were randomly assigned to receive either a diet and exercise education program or a mindfulness training program, or to a no-treatment matched control group. They measured health care costs for the nine months prior to the trainings and for five years after. The mindfulness training was a group based training in mindfulness meditation while the diet and exercise education program worked to improve awareness of health behaviors.

 

They found that both training groups, in comparison to controls, had increased use of the healthcare system as evidenced by an increase in prescription medications but a decreased use of primary care, fewer hospital admissions, and overall lower healthcare costs. The overall savings averaged $4,000 per employee per year. Hence, both mindfulness and diet and exercise training programs resulted in substantially lower healthcare costs that were maintained over a 5-year period. To have such a long-term follow-up is extremely rare but very valuable as it demonstrates that the training programs have enduring consequences.

 

The authors “hypothesize that the results of this study reflect that both of the original interventions raised health awareness, so that participants were more proactive and involved in their health.” It is likely that they did so in different ways. Diet and exercise education did so directly by stressing engaging in health behaviors while mindfulness training did so by raising the individual’s awareness of their body and physical state. If this is true it suggests that combining the two interventions may have an even greater impact on health and healthcare costs.

 

So, improve health and lower costs with workplace mindfulness.

 

“Once you learn mindfulness skills, you can practice them at almost any moment of the day—sitting at your computer, stuck in traffic, even eating. In fact, there has been a . . . growing interest in using the practice of mindfulness in the workplace to provide a buffer against stress.” – Jason Marsh

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Klatt MD, Sieck C, Gascon G, Malarkey W, Huerta T. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention. Complement Ther Med. 2016 Aug;27:139-44. doi: 10.1016/j.ctim.2016.05.008.

 

Abstract

Objective: To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group.

Design and setting: We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n = 84) and the diet/exercise intervention (n = 86) to a retrospectively matched control group (n = 258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study.

Main outcome measures: Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention.

Results: Significantly fewer primary care visits (p < .001) for both intervention groups as compared to controls, with a non-significant trend towards lower overall HC utilization (4,300.00 actual dollar differences) and hospital admissions for the intervention groups after five years. Pharmacy costs and number of prescriptions were significantly higher for the two intervention groups compared to controls over the five years (p < 0.05), yet still resulted in less HC utilization costs, potentially indicating greater self-management of care.

Conclusion: This study provides valuable information as to the cost savings and value of providing workplace lifestyle interventions that focus on awareness of one’s body and health. Health economic studies validate the scale of personal and organization health cost savings that such programs can generate.

Lower Stress and Improve Mood with Cancer with Mindfulness

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By John M. de Castro, Ph.D.

 

“Through Mindfulness, you can embrace that staying positive in the face of cancer includes recognizing and validating all the feelings you are experiencing, negative ones included.” – Richard Dicken

 

Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly improving. 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. Unfortunately, most of these residual problems go untreated. Psychologically, cancer survivors frequently suffer from anxiety, depression, mood disturbance, Post-Traumatic Stress Disorder (PTSD), sleep disturbance, fatigue, sexual dysfunction, loss of personal control, impaired quality of life, and psychiatric symptoms which have been found to persist even ten years after remission.

 

So, coping with the emotions and stress of cancer is a challenge and there are no simple treatments for these psychological sequelae of surviving cancer. Mindfulness training, however, may be helpful. It has been shown to improve recovery from cancer and to reduce anxiety and depression in people with a wide variety of conditions. One form of mindfulness training, Mindfulness-Based Stress Reduction (MBSR) was specifically designed to help people cope with stress and emotions. In today’s Research News article “Mindfulness-Based Stress Reduction as a Stress Management Intervention for Cancer Care: A Systematic Review.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1410585555632033/?type=3&theater

or see summary below: Rush and Sharma reviewed the published research literature on the effectiveness of MBSR for the treatment of stress and negative mood in cancer patients (13 articles). They found that the majority of studies indicate that Mindfulness-Based Stress Reduction (MBSR) is significantly effective in improving mood and reducing stress in cancer patients.

 

Hence, the published research literature indicates that MBSR is a safe and effective treatment for the psychological issues consequent upon cancer diagnosis and treatment. MBSR contains a number of components including meditation, yoga, and body scan. The literature does not isolate which components or which combination of components are necessary for MBSR’s effectiveness. The literature also does not identify what changes produced by this practice underlie its reduction in stress responses and improves mood. But, it can be speculated that the focus on the present moment is crucial. Ruminations about the past and worries about the future can by themselves impair mood and increase stress in cancer patients. So, it is possible that the focus on present moment awareness in MBSR is the crucial process, allowing the patients to focus on their present problems without amplifying them through worry and rumination. These are important questions for future research.

 

MBSR reduces both the physiological and psychological responses to stress. Since stress can exacerbate all of the symptoms of cancer treatment and can reduce the body’s ability to cope with the disease, improvement in the stress response is extremely important to enduring and recovering from cancer and its treatment. In addition, a positive mood can help the individual relax and cope with the difficulties of cancer treatment. So, the reduction in stress and the improvement in mood produced by MBSR likely improves the prognosis for cancer patients and may lead to a greater likelihood of remission and even survival.

 

So, lower stress and improve mood with cancer with mindfulness.

 

“meditation can help to relieve particular symptoms and improve quality of life for people with cancer. Research has shown that it can improve your mood, improve your ability to concentrate, reduce severe depression and anxiety, and boost the immune system.” – Cancer Research UK
CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

Rush SE, Sharma M. Mindfulness-Based Stress Reduction as a Stress Management Intervention for Cancer Care: A Systematic Review. J Evid Based Complementary Altern Med. 2016 Aug 3. pii: 2156587216661467. [Epub ahead of print]

 

Abstract

Cancer is acknowledged as a source of stress for many individuals, often leading to suffering, which can be long-lasting. Mindfulness-based stress reduction offers an effective way of reducing stress among cancer patients by combining mindfulness meditation and yoga in an 8-week training program. The purpose of this study was to inspect studies from October 2009 to November 2015 and examine whether mindfulness-based stress reduction can be utilized as a viable method for managing stress among cancer patients. A systematic search from Medline, CINAHL, and Alt HealthWatch databases was conducted for quantitative articles involving mindfulness-based stress reduction interventions targeting cancer patients. A total of 13 articles met the inclusion criteria. Of these 13 studies, 9 demonstrated positive changes in either psychological or physiological outcomes related to anxiety and/or stress, with 4 describing mixed results. Despite the limitations, mindfulness-based stress reduction appears to be promising for stress management among cancer patients.

 

Cost Effectively Treat Recurrent Depression with Mindfulness

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By John M. de Castro, Ph.D.

 

“Depression is not only the most common mental illness, it’s also one of the most tenacious. Up to 80 percent of people who experience a major depressive episode may relapse. Drugs may lose their effectiveness over time, if they work at all. But a growing body of research is pointing to an intervention that appears to help prevent relapse by altering thought patterns without side effects: mindfulness-based cognitive therapy, or MBCT”. – Stacy Lu

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. Hence, MBCT is a promising alternative treatment. As such, it is important to further investigate its effectiveness. But, costs are also important, so determining the cost-effective of MBCT is also very important.

 

In today’s Research News article “Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1408935652463690/?type=3&theater

or see summary below, Shawyer and colleagues recruited adults who were in remission from verified Major Depressive Disorder and engaged them in a continuous self-monitoring of depression. They were then randomly assigned them to either receive no-treatment or 8 weeks of 2 hour, once a week, Mindfulness-Based Cognitive Therapy (MBCT) with once a month optional booster sessions for 3 months. They measured days depressed, patient quality of life, and the economic costs of disability and treatment, before and after treatment and 14 and 24 months later.

 

They found that over the two years of the study that the patients receiving MBCT had significantly fewer days (44%) with depression than control patients regardless of whether treatment was performed in primary or secondary care facilities. This resulted in major cost savings, with the yearly costs for mental health treatment for the MBCT treated patients 32% lower and overall health care costs 24% lower than control patients. Hence, Mindfulness-Based Cognitive Therapy (MBCT) was found to be not only an effective treatment for reoccurrence of major depression, but also a cost-effective treatment.

 

MBCT uses mindfulness training and cognitive training to allow the patients to reprogram their thought patterns and how they interpret experiences, recognizing that their thoughts are only, just that, thoughts and not reflective of their selves. They learn to experience their emotions but adaptively react to them, seeing them as simply experiences that come and go. The results of today’s Research News study demonstrates, as have a number of other studies, that this approach is effective for the treatment of recurrent depression. But, in today’s cost conscious medical environment, the study, importantly, demonstrated that MBCT also reduces health care costs. Hence, MBCT improves major depression cost-effectively.

 

So, cost effectively treat recurrent depression with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

“Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.” – William Marchand

 

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

 

Study Summary

Frances Shawyer, Joanne C Enticott, Mehmet Özmen, Brett Inder,and Graham N Meadows Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care? Aust N Z J Psychiatry, October 2016; vol. 50, 10: pp. 1001-1013., first published on April 19, 2016

 

Abstract

Objective: While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up.

Method: Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost–utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost–utility acceptability curves.

Results: Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care.

Conclusion: Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.

http://anp.sagepub.com.ezproxy.shsu.edu/content/50/10/1001.full

Improve the Brain’s Regulation of Emotions in PTSD with Mindfulness

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By John M. de Castro, Ph.D.

 

“Mindfulness can help people train themselves to get unstuck from a vicious cycle of negative thinking, often a cornerstone of trauma.” – Jennifer Wolkin

 

Experiencing trauma is quite common. It has been estimated that 60% of men and 50% of women will experience a significant traumatic event during their lifetime. But, only a fraction will develop Post-Traumatic Stress Disorder (PTSD). But this still results in a frightening number of people with 7%-8% of the population developing PTSD at some point in their life. For military personnel, it’s much more likely for PTSD to develop with about 11%-20% of those who have served in a war zone developing PTSD.

 

PTSD involves a number of troubling symptoms including reliving the event with the same fear and horror in nightmares or with a flashback. PTSD sufferers avoid situations that remind them of the event this may include crowds, driving, movies, etc. and may avoid seeking help because it keeps them from having to think or talk about the event. They often experience emotional numbing including difficulty experiencing positive or loving feelings toward other people, avoiding relationships, memory difficulties, or see the world as dangerous and no one can be trusted. Sufferers may feel hyperarousal, feeling keyed up and jittery, or always alert and on the lookout for danger. They may experience sudden anger or irritability, may have a hard time sleeping or concentrating, may be startled by a loud noise or surprise. Obviously, these are troubling symptoms that need to be addressed.

 

It is clear that a key problem with PTSD sufferers is a difficulty with regulating emotions. So, a technique, like mindfulness training, that improves emotion regulation may be beneficial. Indeed, mindfulness training has been found to be particularly effective for PTSD. Hence, it is important to further investigate mindfulness relationships to emotion regulation in PTSD sufferers in order to optimize treatment. In today’s Research News article “A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social–Emotional Processing.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1407398169284105/?type=3&theater

or see summary below or view the full text of the study at:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028840/

King and colleagues recruited combat veterans with PTSD and examined the effects of mindfulness training on the brain’s processing of emotional stimuli in veterans with PTSD. The veterans were randomly assigned to receive either 16-weeks of, 2-hour sessions, once a week, of group psychotherapy or Mindfulness-Based Exposure Therapy (MBET). MBET involved mindfulness training, self-compassion training, psycho-education, and mindfulness prolonged exposure therapy. Their brains were scanned with functional Magnetic Imaging (f-MRI) 2-weeks before and 2-weeks after training while they were presented with faces expressing either neutral, angry, or fearful emotions.

 

They found that Mindfulness-Based Exposure Therapy (MBET) produced a marked significant reduction in PTSD symptom severity that was greater than that produced by group therapy. They found that regardless of therapy type that relief of PTSD symptoms was associated with increased activation of the dorsal prefrontal cortex which is usually under active in PTSD sufferers. They also found increased activation in brain areas associated with emotion regulation, the medial prefrontal cortex and the rostral anterior cingulate cortex. In addition, the MBET trained veterans showed greater increases in amygdala and fusiform gyrus responses to angry faces, as well as increased response in medial prefrontal cortex to fearful faces. These responses suggest that the mindfulness training resulted in the veterans’ brains being more engaged in processing threatening stimuli.

 

These findings suggest that mindfulness training improves PTSD symptoms by improving the brain’s ability to process emotional stimuli. By paying greater attention to these stimuli they become better at regulating their emotional responses to them. Since, PTSD involves problems with emotions, the improved emotion regulation would be particularly beneficial to the veterans allowing them to better cope with the emotions produced in response to their memories or environmental stimuli.

 

So, improve the brain’s regulation of emotions in PTSD with mindfulness.

 

“Mindfulness can help people cope with and manage their trauma memories, explore their patterns of avoidance when confronting reminders of their trauma, and better understand their reactions to their symptoms. It helps them feel more grounded, and to notice that even very painful memories have a beginning, a middle and an end — that they can become manageable and feel safer. It’s hard work, but it can pay off.” – Anthony King

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

King, A. P., Block, S. R., Sripada, R. K., Rauch, S. A. M., Porter, K. E., Favorite, T. K., … Liberzon, I. (2016). A Pilot Study of Mindfulness-Based Exposure Therapy in OEF/OIF Combat Veterans with PTSD: Altered Medial Frontal Cortex and Amygdala Responses in Social–Emotional Processing. Frontiers in Psychiatry, 7, 154. http://doi.org/10.3389/fpsyt.2016.00154

 

Abstract

Combat-related posttraumatic stress disorder (PTSD) is common among returning veterans, and is a serious and debilitating disorder. While highly effective treatments involving trauma exposure exist, difficulties with engagement and early drop may lead to sub-optimal outcomes. Mindfulness training may provide a method for increasing emotional regulation skills that may improve engagement in trauma-focused therapy. Here, we examine potential neural correlates of mindfulness training and in vivo exposure (non-trauma focused) using a novel group therapy [mindfulness-based exposure therapy (MBET)] in Afghanistan (OEF) or Iraq (OIF) combat veterans with PTSD. OEF/OIF combat veterans with PTSD (N = 23) were treated with MBET (N = 14) or a comparison group therapy [Present-centered group therapy (PCGT), N = 9]. PTSD symptoms were assessed at pre- and post-therapy with Clinician Administered PTSD scale. Functional neuroimaging (3-T fMRI) before and after therapy examined responses to emotional faces (angry, fearful, and neutral faces). Patients treated with MBET had reduced PTSD symptoms (effect size d = 0.92) but effect was not significantly different from PCGT (d = 0.43). Improvement in PTSD symptoms from pre- to post-treatment in both treatment groups was correlated with increased activity in rostral anterior cingulate cortex, dorsal medial prefrontal cortex (mPFC), and left amygdala. The MBET group showed greater increases in amygdala and fusiform gyrus responses to Angry faces, as well as increased response in left mPFC to Fearful faces. These preliminary findings provide intriguing evidence that MBET group therapy for PTSD may lead to changes in neural processing of social–emotional threat related to symptom reduction.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028840/