ACT On-line to Reduce Chronic Pain

 

By John M. de Castro, Ph.D.

 

“What kind of therapy is beneficial?  What are the specific components of therapy most applicable to people with chronic pain?  I can tell you that mindfulness, CBT, and ACT based interventions are definitely part of the equation, i.e., they are always helpful.  In fact, mindfulness practice is often a necessary component of healing.” – Howard Schubiner, MD

 

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. For many, however, pain is a constant in their lives. Chronic pain affects a wide swath of humanity.  At least 100 million adult Americans have common chronic pain conditions. 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. Fortunately, there are alternative treatments. Mindfulness and yoga practices have been shown to improve pain. A therapeutic technique that includes mindfulness training called Acceptance and Commitment Therapy (ACT) has been shown to be effective in treating a number of physical and psychological disorders and has been shown to successfully improve acceptance of chronic pain, pain intensity, satisfaction with life, and physical functioning in patients with chronic pain.

 

Acceptance and Commitment Therapy (ACT) is a mindfulness based psychotherapy technique that focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. Additionally, it teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. At its core, ACT is targeted at increasing psychological flexibility, which is an ability to modify behavior based upon conscious and open contact with thoughts, feelings, and sensory experiences, and in a manner that reflects the individual’s values and goals.

 

An impediment to widespread adoption of various psychotherapy techniques, including ACT, is that they require a trained professional therapist and attendance at scheduled therapy sessions. This can make the treatments expensive and inconvenient. The internet holds great promise to deliver therapy inexpensively and conveniently to large numbers of people spread across wide geographic areas. Mindfulness training has been successfully conducted over the internet with positive benefit. ACT has been successfully has been delivered on-line reducing depression. So, on-line ACT training appears to be a viable method for treatment.

 

In today’s Research News article “Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1369590659731523/?type=3&theater

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

Trompetter and colleagues investigate the effectiveness of ACT, delivered on-line, to treat chronic pain and what variable might predict the kinds of patients who are most likely to have positive responses to ACT. They recruited patients suffering from chronic pain and randomly assigned them to either receive 12-weeks of on-line ACT treatment or Expressive Writing Treatment or to a waitlist control group. They measured pain and pain interference in daily life before and after treatment and 3 months after the conclusion of treatment. Before treatment they also measured demographic variables, pain intensity, pain disability, psychological distress, and mental health.

 

They found that ACT produced a significant reduction in pain interference in daily life and that this effect was moderated by the psychological well-being of the participants. That is, that participants with high levels of psychological well-being had much greater benefit from ACT than those at lower levels. There were no other significant predictors of benefit. These results suggest that ACT conducted on-line can be effective in reducing the interference from pain in the conduct of the daily lives of chronic pain patients. This is important as on-line presentation can greatly increase the scalability, affordability, and convenience of treatment for the huge numbers of chronic pain patients. The results further indicate that on-line ACT should be used primarily for patients who have moderate to high levels of psychological well-being at the beginning.

 

So, ACT on-line to reduce chronic pain.

 

“Overall, it appears that the cognitive-behavioral approach has a positive effect when combined with active treatments such as medications, physical therapy, and medical treatments for chronic pain clients in treating pain, thoughts about pain, and pain behavior problems.” –  Carrie L. Winterowd

 

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

Trompetter, H. R., Bohlmeijer, E. T., Lamers, S. M. A., & Schreurs, K. M. G. (2016). Positive Psychological Wellbeing Is Required for Online Self-Help Acceptance and Commitment Therapy for Chronic Pain to be Effective. Frontiers in Psychology, 7, 353. http://doi.org/10.3389/fpsyg.2016.00353

 

Abstract

The web-based delivery of psychosocial interventions is a promising treatment modality for people suffering from chronic pain, and other forms of physical and mental illness. Despite the promising findings of first studies, patients may vary in the benefits they draw from self-managing a full-blown web-based psychosocial treatment. We lack knowledge on moderators and predictors of change during web-based interventions that explain for whom web-based interventions are especially (in)effective. In this study, we primarily explored for which chronic pain patients web-based Acceptance and Commitment Therapy (ACT) was (in)effective during a large three-armed randomized controlled trial. Besides standard demographic, physical and psychosocial factors we focused on positive mental health. Data from 238 heterogeneously diagnosed chronic pain sufferers from the general Dutch population following either web-based ACT (n = 82), or one of two control conditions [web-based Expressive Writing (EW; n = 79) and Waiting List (WL; n = 77)] were analysed. ACT and EW both consisted of nine modules and lasted nine to 12 weeks. Exploratory linear regression analyses were performed using the PROCESS macro in SPSS. Pain interference at 3-month follow-up was predicted from baseline moderator (characteristics that influence the outcome of specific treatments in comparison to other treatments) and predictor (characteristics that influence outcome regardless of treatment) variables. The results showed that none of the demographic or physical characteristics moderated ACT treatment changes compared to both control conditions. The only significant moderator of change compared to both EW and WL was baseline psychological wellbeing, and pain intensity was a moderator of change compared to EW. Furthermore, higher pain interference, depression and anxiety, and also lower levels of emotional well-being predicted higher pain interference in daily life 6 months later. These results suggest that web-based self-help ACT may not be allocated to chronic pain sufferers experiencing low levels of mental resilience resources such as self-acceptance, goals in life, and environmental mastery. Other subgroups are identified that potentially need specific tailoring of (web-based) ACT. Emotional and psychological wellbeing should receive much more attention in subsequent studies on chronic pain and illness.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786566/

 

Lessen a Pain in the Neck with Yoga

 

By John M. de Castro, Ph.D.

 

“Many people suffer from neck pain on a regular basis. Stress, poor posture, accidents, and long-stored physiological tension can contribute to a mild stiff neck or even a full-blown muscle spasm of the neck, shoulders, and upper back. When confronted with neck pain, we tend turn to medication or a heating pad for relief. However, there are several yoga poses that have therapeutic effects on the neck as well. The next time you have a twinge of pain, turn yoga poses for relief from neck pain and tension.”Adam Brady

 

We all have to deal with pain. It’s inevitable, but hopefully mild and short lived. But, for many, pain is a constant in their lives. The most common forms of chronic pain are back and neck pain. Indeed, back pain is the number one cause of disability worldwide. In addition, neck pain is the number three cause of chronic pain; affecting more than a quarter of Americans. People who experience chronic back and neck pain are limited in their daily activities and may compensate in order to walk, run, sit, etc. and the compensatory postures can produce further sometimes different problems.

 

There are a myriad of causes for chronic back and neck pain, including something as simple as improper positioning while sleeping, or even sitting or standing with bad posture. It can also occur due to injuries, accidents, heavy lifting or other spinal issues. These types of pain are not only a problem for the individual but are also costly for society as they constitute the largest category of medical insurance claims.

 

Just as there are many different causes there are also a plethora of treatments for back and neck pain. The most common is the use of drugs, including over –the-counter pain relievers and at times opiates. These are helpful but have limited effectiveness and opiates can lead to addiction and even death. Sometimes the pain can lead to surgical interventions that can be costly and are not always effective. So, alternative treatments such as acupuncture have also been used with some success. We’ve seen in previous posts that mindfulness practices, in general, are effective in treating pain and specific practices such as yoga can be effective for the relief of chronic low-back pain.  Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals.

 

In today’s Research News article “Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1368694369821152/?type=3&theater

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971133/

Kim summarized the published research literature on the effectiveness of yoga practices for the treatment of neck pain. They could only identify three controlled trials. These trials reported that, in comparison to control conditions, yoga practice significantly reduced neck pain intensity and the functional disabilities resulting from chronic neck pain.

 

Hence, the limited research available suggests that yoga practice is effective in treating chronic neck pain. It should be noted that none of the trials included a placebo control group or an active control. So, it is difficult to make firm conclusions. But, what evidence is available suggests that this ancient practice can be helpful in reducing neck pain and its consequent disabilities. Great care, however, should be taken with yoga practice and proper instruction by a certified yoga teacher should be obtained to prevent further injury.

 

So, lessen of a pain in the neck with yoga.

 

“Hatha is the sanctuary for those suffering every type of pain. It is the foundation for those practicing every type of Yoga.” ~Svatmarama

 

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

Kim, S.-D. (2016). Effects of yoga on chronic neck pain: a systematic review of randomized controlled trials. Journal of Physical Therapy Science, 28(7), 2171–2174. http://doi.org/10.1589/jpts.28.2171

 

Abstract

[Purpose] The aim of this study was to investigate the effectiveness of yoga in the management of chronic neck pain. [Subjects and Methods] Five electronic databases were searched to identify randomized controlled trials (RCTs) of yoga intervention on chronic neck pain. The trials were published in the English language between January 1966 and December 2015. The Cochrane Risk of Bias Tool was used to assess the quality of the trials. [Results] Three trials were identified and included in this review. A critical appraisal was performed on the trials, and the result indicated a high risk of bias. A narrative description was processed because of the small number of RCTs. Neck pain intensity and functional disability were significantly lower in the yoga groups than in the control groups. [Conclusion] Evidence from the 3 randomly controlled trials shows that yoga may be beneficial for chronic neck pain. The low-quality result of the critical appraisal and the small number of trials suggest that high-quality RCTs are required to examine further the effects of yoga intervention on chronic neck pain relief.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971133/

 

Settle Down Out-of-Control Teens with Mindfulness

 

By John M. de Castro, Ph.D.

 

“In the last few years, mindfulness has emerged as a way of treating children and adolescents with conditions ranging from ADHD to anxiety, autism spectrum disorders, depression and stress. And the benefits are proving to be tremendous.” – Juliann Garey

 

The last component of the nervous system to develop is the higher cortical areas that underlying behavioral inhibition; the ability to hold back responses. As a result, the adolescent brain is fully developed to produce behavior and react to the environment, but is defective in the ability to withhold or restrain behaviors when inappropriate. So, adolescents are often impulsive, take unnecessary risks, and can be inappropriately aggressive, leading to disciplinary problems.

 

This late development of higher level control of behavior is responsible for some troubling statistics. Young people ages 15-24 represent only 14% of the U.S. population, but they account for 30% of the total costs of motor vehicle injuries among males. Regarding youth violence and aggression, 46% of males, and 26% of females reported they had been in physical fights, one million U.S. students took guns to school and six thousand were kicked out of school for packing weapons, the annual death toll from school shootings has more than doubled, the youth homicide rate increased by 168 percent, and juvenile arrest for possession of weapons, aggravated assault, robbery, and murder have risen more than 50 percent.

 

It is important for society to control violent and aggressive behavior and late adolescence and young adulthood are periods when the likelihood is high. Mindfulness has been shown to reduce violence and aggression in adults. So, it would seem reasonable to investigate whether mindfulness training may be effective in helping to control the aggressive tendencies of youth. In today’s Research News article “Effect of a Mindfulness Training Program on the Impulsivity and Aggression Levels of Adolescents with Behavioral Problems in the Classroom.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1367699476587308/?type=3&theater

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

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.01385/full?utm_source=newsletter&utm_medium=email&utm_campaign=Psychology-w40-2016

Franco and colleagues recruited 12-19 year old youths who had multiple incidents of misbehavior in school. The students were randomly assigned to either receive 20-weeks of 15 minutes per day, 5 days per week, of open monitoring meditation, or to a wait list control condition. Before and after training the youths were measured for aggression and impulsivity with self-report psychometric scales.

 

They found that the meditation group, but not the control group, had significant reductions in overall impulsivity (14%), including significant reductions in cognitive (19%), motor (13%), and non-planned (10%) impulsivity and also significant reductions in physical (14%) and verbal (24%) aggression, and hostility (19%) and anger (16%). All of these effects had large significant effect sizes. Hence, meditation training produced marked reduction in impulsivity and aggression in these troubled adolescents.

 

These are impressive results and suggest that meditation may be very effective in helping adolescents control their impulsivity and aggression. Gaining control over their behavior may allow them to engage in their education without distraction. Meditation may have this impact as a result of its ability to improve emotion regulation, providing the youths with the ability to cope with emotions in a more positive and adaptive way. It may also act by decreasing rumination and worry and thereby reduce the effects of past issues and worries about the future to intrude on present behavior. Regardless of the explanation, the results are exciting and suggest that meditation practice should be tried for troubled youth in other settings.

 

So, settle down out-of-control teens with mindfulness.

 

“It is suggested here that there is a difference between knowing about emotions and knowing your own emotions as they are experienced. In addition to learning about emotions, there is a distinct advantage in learning how to notice what’s happening in the present moment. Attending to and identifying emotions can mitigate the emotional reaction and increase emotional balance and clarity.” –  Tina Barseghian

 

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

Franco C, Amutio A, López-González L, Oriol X and Martínez-Taboada C (2016) Effect of a Mindfulness Training Program on the Impulsivity and Aggression Levels of Adolescents with Behavioral Problems in the Classroom. Front. Psychol. 7:1385. doi: 10.3389/fpsyg.2016.01385

 

Objective: The aim of the present study was to analyze the effects of a mindfulness training psycho-educative program on impulsivity and aggression levels in a sample of high school students.

Methods: A randomized controlled trial with pre-test–post-test measurements was applied to an experimental group and a control group (waiting list). The Barratt Impulsivity Scale (BIS-11) Patton et al. (1995) and the Aggression Questionnaire (Buss and Perry, 1992) were used.

Results: Statistical analyses showed a significant decrease in the levels of impulsivity and aggressiveness in the experimental group compared with the control group. These results have important implications for improving the level of academic engagement and self-efficacy of students and for reducing school failure.

Conclusion: This is one of the first studies showing the effectiveness of mindfulness training at reducing impulsive and aggressive behaviors in the classroom. The efficacy of mindfulness-based programs is emphasized.

http://journal.frontiersin.org/article/10.3389/fpsyg.2016.01385/full?utm_source=newsletter&utm_medium=email&utm_campaign=Psychology-w40-2016

 

A Mindful Halloween and Day of the Dead

 

By John M. de Castro, Ph.D.

 

For death,
Now I know, is that first breath
Which our souls draw when we enter
Life, which is of all life center.

~Edwin Arnold

 

The beginning of the month of November is marked by a variety of celebrations throughout the world including the Day of the Dead and Halloween, the night before All Souls Day. Halloween was actually a pagan holiday called Samhain that was coopted by the Christians. But, they are all celebrations of those who have passed away, a celebration of our ancestors, a celebration of the dead. This might seem a bit macabre to be celebrating death. And, indeed, the macabre is an integral part of the celebration.

 

It does seem to be strange, however, that death is celebrated when it is in fact the second most frequent fear. So why do we celebrate? Perhaps Mark Twain put his finger on it “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time. The celebration is not really about death. It’s actually a celebration of life. Death reminds us that our lives are limited. We celebrate to help us experience life while we still have it. As pointed out by Angelina JolieThere’s something about death that is comforting. The thought that you could die tomorrow frees you to appreciate your life now.

 

These ideas are well stated in the Zen Evening Gatha that is recited every evening in Buddhist monasteries.

Let me respectfully remind you,
life and death are of supreme importance.
Time swiftly passes by and opportunity is lost.
Each of us should strive to awaken.
Awaken.  Take heed.
Do not squander your life.

 

Rather than not squandering our lives, many of us live in a state of unaware numbness, going through the motions of life, but not really living. Focusing on an anticipated happiness in the future or ruminating about past issues. We seem to not comprehend that the essence of life is the present moment. That is all life is, a long-lasting present moment. It is the only time that we can actually live. So, if we do not relish what is in the present moment, we might as well already be dead. This is where contemplative practice and mindfulness comes in. These practices help us to learn to live fully in the present, experiencing what life has to offer.

 

Somehow, in our everyday lives we see the present as unsatisfactory or boring. But, nothing could be further from the truth. If we truly do focus on the present we are often surprised by its richness. Even focusing on something simple like our breathing, really paying attention to it in all its exquisite detail, we can see that this simple experience is replete with beauty and nuance. We can feel the delicious sensations of our body in action. We can see how remarkable this simple process really is. We can see how essential it is to our very existence, yet we take it for granted. And that is only breathing. There is so much in the present moment that when we carefully look at it we’re amazed as to how we could ever have missed it. Life is a miracle. Life is special. Only by being mindful can we deeply immerse in the wonder of life.

 

Halloween and the Day of the Dead is also an opportunity to recognize our ancestors without whom we would not exist. It’s a time to view how interconnected we are to all of humanity. All one has to do is follow the family tree back a few generations to see how widespread our connections are throughout time, culture, religion, race, etc. If we go very far back, we can see that everyone is connected to everyone else somewhere in our ancestry. Also, by looking at our ancestors and understanding what they have contributed to our existence, we can see how important it is for us to commit to future generations to promote understanding, peace, and prosperity for the future.

 

But what about death itself, should we be as afraid of it as we are? It is helpful to remember that life is bounded by birth and death. Do we fear the state we were in prior to birth? In fact, many psychologists think of birth, the entry into life, as a traumatic event. It involves leaving a very peaceful state for the chaos of life, what William James called the “blooming, buzzing confusion”. So, maybe we should fear birth and not fear death which may simply return us to the peaceful prenatal state. Perhaps we should look forward to it.

 

The important thing and the message of Halloween and the Day of the Dead is to experience this precious time of life that we’ve been given. Indeed, many have suggested that the entire purpose of life is simply to experience it. So celebrate life and don’t worry about death. Enjoy Halloween and the Day of the Dead in the present moment. Stay in the present moment and be truly alive, celebrate every experience, and when death comes welcome it having experienced life to its fullest.

 

 “On no subject are our ideas more warped and pitiable than on death. Instead of the sympathy, the friendly union, of life and death so apparent in Nature, we are taught that death is an accident, a deplorable punishment for the oldest sin, the arch-enemy of life, etc…. But let children walk with Nature, let them see the beautiful blendings and communions of death and life, their joyous inseparable unity, as taught in woods and meadows, plains and mountains and streams of our blessed star, and they will learn that death is stingless indeed, and as beautiful as life, and that the grave has no victory for, for it never fights. All is divine harmony.” ~John Muir

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

Self is a verb

 

By John M. de Castro, Ph.D.

 

“The falling away of self is the most significant, bewildering, and liberating spiritual event in one’s entire life, and perhaps the least understood.” – Adyashanti

 

 “What is fascinating is that in the western psychological view, the “self” or the “executive function” is actually a process and not really a thing. It waxes and wanes all the time, goes into the foreground and background of awareness depending on how much we need it, disappears when we sleep, is not the same as it was when we were little, much less the same as it was last year, and is even subtly different than it was last week.” – Ron Crouch

 

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

 

A simple self-exploration can verify this. Spend some time looking within to find the self, to find anything that comprises the self. You will discover that you can’t find it. That’s because it’s a concept not a thing. Now quiet the mind for a brief time, even if for only a few seconds, and you’ll note that when you’ve eliminated thinking, the self disappears. In other words, self only appears when you’re thinking about it. This is clear evidence that self is a concept and is created by thought. In other words, there’s a process involving thought that creates a self. This is a verb. We are not a self, we are producing a self, we are selfing!

 

As another exercise, write down a set of responses to “I am ______.” You may have answered, a man, an engineer, an academic, a father, a cyclist, a Buddhist, etc. In other words, you would list of a set of labels that you believe are essential to your idea of yourself. These labels come from our minds summarization and categorization of a variety of experiences and memories. Thinking now goes to work using these labels in its construction of the self. Note these are not the self itself, but rather the remembered characteristics of the individual. These are now employed in producing the self, in selfing.

 

Webster’s dictionary defines self as:

“1a :  the entire person of an individual

b :  the realization or embodiment of an abstraction

2a (1) :  an individual’s typical character or behavior

(2) :  an individual’s temporary behavior or character

  b :  a person in prime condition

3:  the union of elements (as body, emotions, thoughts, and sensations) that constitute the individuality and identity of a person”

This definition suggests that the “self” consists of a set of components including physiology, behaviors, personality, emotions, thoughts, beliefs, memories, etc. It is not a single thing rather it’s a set of things that in their entirety are considered a self. The self itself is thought to define one’s individuality. But, note that the definition indicates that self is an embodiment of an abstraction. In other words, the dictionary defines self as a concept, not a thing.

 

Each of these components of a self are themselves processes. To create a self, we recall memories, stories about us, that exemplify our nature. The active process of memory retrieval and review is part of selfing. We incorporate beliefs about ourselves in the self. These include ideas such as outgoing, intelligent, unlovable, overweight, etc. But these beliefs are produced by thoughts that are fueled by memories and prior learning. They are an active construction, a part of selfing. We include our emotions as components of our constructed selves. These include happy, afraid, loving, etc. But emotions are changeable moment to moment. We only include what we consider stable patterns of emotions. But this requires memory and thought, reflecting on our past emotional states, and is thus an active construction, part of selfing.

 

We also include what we consider our personalities in our constructed self. Personality is itself a constructed concept. There is no single entity that comprises a personality. Personality is thought to be composed of a set of relatively permanent and stable characteristics that mark our individuality, such as the so-called “Big Five” personality traits, openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. But, once again these are not things, but concepts. They are actually constructed from consistencies of the answers to a set of standardized questions such as I am interested in people, I think a lot before I speak or act, I get stressed out easily, I pay attention to details, I have a vivid imagination. These all refer to the “I” (self) and refer to how you act or feel. But, note that these questions cannot be answered without reference to our memories of how we’ve acted or felt in the past. So, we address each question by constructing an answer based upon a review of memories, an active process. Hence, our personality is also constructed. It also is a process. If self is in part composed of personality then it also is constructed, part of selfing.

 

We think of the body as our self, with the skin physically separating us from the outside world and others. But is this actually true? The body is constantly changing. Every cell in the body is different than it was a few years ago. The body actually changes from moment to moment. It is constantly incorporating things from the outside, air, food, and water and contributing to things outside through breathing, sweating, and elimination. Hence, the body is not constant and it is not something separate from the environment. So, how can something so fluid and impermanent be a self? It is only our ideas and perceptions and beliefs about our bodies that are actually what we think of as a self. It’s a construction produced by thought. It is just one more component of selfing.

 

Buddhism teaches that there is no self. This is an unfortunate term as it implies no existence. A good example of what is really meant is contained in this story. A student came to his Zen teacher stating that he had a breakthrough. That he experienced no self. The teacher raised up his stick and hit him on the back of the head, then asked “now tell me who felt that?” The story emphasizes that no self does not mean that there isn’t an experiencing entity. Rather, that there is no enduring thing that is the self. The Buddha refused to answer whether a self-existed or not. He taught that we should not dwell on thoughts like these but rather to view everything as impermanent, arising and passing away. He taught that we should then look at the self in this way and investigate where this perception of self originates. So, the Buddha taught that what is important is to not think about a self but rather investigate the process of selfing.

 

The great Zen master Dogen wrote “To study the Buddha Way is to study the self. To study the self is to forget the self. To forget the self is to be enlightened by the 10,000 things.” This well states the view that we need to investigate the process of selfing, study the self, but then realize that it’s just a lived experience and not a permanent thing; forget it, and stop looking at the world through a lens of self. There is indeed a lived experience. It would be a mistake to deny it. But, what the idea of no self points to is that it is only an impermanent experience, nothing more, nothing less.

 

So, self is simply a natural process of the mind. It is constructed. A solid self is an illusion. The idea of self may be useful in helping us navigate everyday existence, particularly during development, but has no true existence. We can’t really eliminate the idea of self as it is a lived experience. But, we can recognize it for what it is, a process and not an entity, and no longer make it central to our existence. Getting it out of the center is helpful as it destroys many delusions. That is the key to the teaching. Let self be experienced, see it for what it is, a process, and give it no dominant place in our lives. Let what is experienced in the present moment define what we are.

 

“Everything we think has self-nature, actually doesn’t. Buddha called it anatta or no-self where nothing has self-nature. That means, you and I and all of us are not really this thing called a self, or me. This is strange because it’s almost impossible for the Western mind or the human mind to think of itself in any terms other than self. The mind doesn’t even know where to begin how to do this. But, with deep insight this orientation toward self, collapses. We see that—wow—none of this has self-nature in it!” – Adyashanti

 

“Suffering exists, but no sufferer can be found.

Actions exist, but no doer of actions is there.

Nirvana exists, but no one who enters it.

The Path exists, but no traveler can be seen.” – Visuddimagga, 513
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 Knee Osteoarthritis with Tai Chi

 

By John M. de Castro, Ph.D.

 

“adults with knee osteoarthritis-—the most common joint disease in midlife—saw up to three times greater improvement in both pain and joint function from biweekly hour-long tai chi sessions, compared with those who attended stretching and wellness classes. The flowing, meditative movements tone the muscles surrounding joints, enhance body awareness to reduce risk of injury, and improve alignment.” – Natalie Gingerich

 

Osteoarthritis is a chronic degenerative joint disease that is the most common form of arthritis. It produces pain, swelling, and stiffness of the joints. It is the leading cause of disability in the U.S., with about 43% of arthritis sufferers limited in mobility and about a third having limitations that affect their ability to perform their work. In the U.S., osteoarthritis affects 14% of adults over 25 years of age and 34% of those over 65.

 

Knee osteoarthritis is not localized to the cartilage alone but involves the whole joint, including articular cartilage, meniscus, ligament, and peri-articular muscle. It is painful and disabling. While age is a major risk factor for osteoarthritis of the knee, young people are not immune. It effects 5% of adults over 25 years of age and 12% of those over 65. Its causes are varied including, hereditary, injury including sports injuries, repetitive stress injuries, infection, or from being overweight.  There are no cures for knee osteoarthritis. Treatments are primarily symptomatic, including weight loss, exercise, braces, pain relievers and anti-inflammatory drugs, corticosteroids, arthroscopic knee surgery, or even knee replacement.

 

Gentle movements of the joints with exercise appears to be helpful in the treatment of knee osteoarthritis. This suggests that alternative and complementary practices that involve gentle knee movements may be useful in for treatment. Indeed, yoga practice has been shown to be effective in treating arthritis and mind-body practices in general have been shown to reduce the gene expressions that underlie the inflammatory response which contribute to arthritis. So, it would seem reasonable to look further into the effectiveness of alternative and complementary practices, such as Tai Chi, in treating knee osteoarthritis.

 

In today’s Research News article “The Effects of Tai Chi Chuan on Improving Mind-Body Health for Knee Osteoarthritis Patients: A Systematic Review and Meta-Analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1364546776902578/?type=3&theater

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011213/?report=classic

Chang and colleagues review the published research literature (11 articles) on the effects of Tai Chi training on the physical and mental issues that accompany knee osteoarthritis. They found that Tai Chi practice significantly improved the physical symptoms of knee osteoarthritis including reduced perceived pain and stiffness, and lessened fear of falling, increased quadriceps muscle strength, enhanced lower extremity strength, improved walking, stair climbing, sitting to standing, and faster getting up and moving.

 

The mechanism of action for Tai Chi’s effects are not known. But, it could be the gentle slow movements of the knee or the anti-inflammatory effects of Tai Chi that may be responsible. The findings of this meta-analysis suggest that Tai Chi is an effective treatment for the physical effects of knee osteoarthritis. Since Tai Chi is safe, with few, if any, adverse effects, a gentle exercise appropriate for aging individuals, and inexpensive as it can easily be performed at home, and can be readily scaled for large groups without the necessary presence of a therapist, it is almost an ideal treatment.

 

So, improve knee osteoarthritis with tai chi.

 

“Tai Chi may be an especially applicable treatment for older adults…The physical component provides exercise consistent with current recommendations…range of motion, flexibility, muscle conditioning and aerobic cardiovascular exercise…the mental component could address the chronic pain state through effects on psychological well-being, life satisfaction, and perceptions of health.” – Mayo Clinic

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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Study Summary

Wen-Dien Chang, Shuya Chen, Chia-Lun Lee, Hung-Yu Lin, Ping-Tung Lai. The Effects of Tai Chi Chuan on Improving Mind-Body Health for Knee Osteoarthritis Patients: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016; 2016: 1813979. Published online 2016 Aug 21.

 

Abstract

Purpose. To conduct a meta-analysis and systematic review examining whether Tai Chi Chuan could have mental and physical benefits for patients with knee osteoarthritis. Methods. MEDLINE, PUBMED, EMBASE, and CINAHL databases were searched for relevant studies. Data of the studies were collected, and outcomes were classified using the International Classification of Functioning, Disability, and Health model. Effect sizes of the mental and physical components were determined, along with the recommendation grades of Philadelphia Panel Classification System for Tai Chi Chuan on knee osteoarthritis. Results. Eleven studies were selected and retrieved from the databases. The results of meta-analysis revealed that the effects of Tai Chi Chuan were observed for physical components in the body functions and structures domain. The effects favoring Tai Chi Chuan were observed in the physical component in the activities and participation domain. Insufficient data was included in the meta-analysis of the mental component.Conclusions. The review revealed that Tai Chi Chuan had beneficial outcomes for patients with knee osteoarthritis. The evidence-based results represented that it had small-to-moderate effects on body functions and structures, activities, and participation of physical component. However, there was insufficient evidence to support that Tai Chi Chuan had beneficial mental effect.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011213/?report=classic

 

Improve Premenstrual Syndrome with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga boosts circulation, which can relieve fluid buildup that causes bloating. The paced, deep breathing also increases oxygen flow to tissues, decreasing discomfort induced by cramps.” – Suzanne Trupin

 

PMS or Premenstrual Syndrome is an extremely common problem among women and almost 85% of women, between 20 years old and 40 years old, suffer from PMS. It is associated with a collection of emotional and physical symptoms that is experienced during the time of ovulation or Luteal phase of the Menstruation cycle.  PMS produces physical symptoms such as Joint or muscle pain, headache, fatigue, weight gain related to fluid retention, abdominal bloating, breast tenderness, acne flare-ups, and constipation or diarrhea. These symptoms are accompanied by a constellation of psychological symptoms such as tension or anxiety, depressed mood, crying spells, mood swings and irritability or anger, appetite changes and food cravings, trouble falling asleep (insomnia), social withdrawal, and poor concentration. Around 5% of women are disabled by extremely severe symptoms. PMS is often accompanied with depression and called Premenstrual Dysphoric Disorder (PMDD) and can be dangerous as the suicide rate for patients with depression is much higher in the second half of the menstrual cycle.  Rather than improve with age, PMS can get worse as patients age and approach menopause.

 

For most women PMS is left untreated, with the women simply putting up with the misery. But for some drugs are prescribed such as antidepressants, NSAIDs, diuretics, and hormones. These are all accompanied by significant side effects. There is, therefore, a need to find safe and effective treatment for the torment of PMS. Mindfulness training has been shown to improve the physical and psychological state of women and men and women with high levels of mindfulness experience milder PMS symptoms. It would seem reasonable to examine whether training in a mindfulness technique, specifically yoga training, might be helpful relieving the symptoms of PMS.

 

In today’s Research News article “Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1363573563666566/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962262/

Tsai recruited female employees of a large manufacturing company and provided them with a 12-week yoga program with twice a week sessions of 50 minutes. The yoga included breathing, posture, and meditation exercises. Before and after training the women completed measurements of premenstrual and menstrual symptoms, stress, sleep, alcohol intake, exercise and general health.

 

They found that after yoga training the women’s menstrual pain, use of analgesics, and body pain was lower. Also, the women reported less premenstrual abdominal swelling, breast tenderness, abdominal cramps, and cold sweats. In addition, the decreased menstrual pain was associated with increases in physical function, bodily pain, general health perception, vitality/energy, social function, and mental health. So the yoga practice appeared to reduce both premenstrual and menstrual physical symptoms.

 

The study results are very encouraging and suggest that yoga practice can be beneficial in relieving women’s symptoms surrounding menstruation. The study, however did not have a control group for comparison and so conclusions must be tempered. It is possible that participation in any program to improve their health and well-being would produce similar effects. Nevertheless, the results justify and encourage more extensive controlled research studies on the application of yoga practice to the relief of troublesome symptoms related to women’s menstrual cycle.

 

So, improve premenstrual syndrome with yoga.

 

“The benefits of yoga in relieving the symptoms of PMS are countless and difficult to list. Yoga is like a magical wand that touches our lives to bless us with a fit, flexible and healthy body,flawless, glowing skin, peaceful mind and great overall health. The benefits of yoga are not only limited to the physical level, it transcends the body to bring harmony between the body and the soul and fill the mind with happiness.”Deblina Biswas

 

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

Tsai, S.-Y. (2016). Effect of Yoga Exercise on Premenstrual Symptoms among Female Employees in Taiwan. International Journal of Environmental Research and Public Health, 13(7), 721. http://doi.org/10.3390/ijerph13070721

 

Abstract

Yoga classes designed for women with premenstrual syndrome are available, but their efficacy is unclear. We investigated the effects of 12 weeks’ yoga exercise (yoga intervention) on premenstrual symptoms in menstruating females in Taiwan. Sixty-four subjects completed the yoga intervention, and before and after the intervention filled out a structured self-report questionnaire about their demographics, personal lifestyle, menstrual status, baseline menstrual pain scores, premenstrual symptoms, and health-related quality of life. Of 64 subjects, 90.6% reported experiencing menstrual pain during menstruation. After the yoga intervention, subjects reported decreased use of analgesics during menstruation (p = 0.0290) and decreased moderate or severe effects of menstrual pain on work (p = 0.0011). The yoga exercise intervention was associated with the improvement of the scale of physical function (p = 0.0340) and bodily pain (p = 0.0087) of the SF-36, and significantly decreased abdominal swelling (p = 0.0011), breast tenderness (p = 0.0348), abdominal cramps (p = 0.0016), and cold sweats (p = 0.0143). Menstrual pain mitigation after yoga exercise correlated with improvement in six scales of the SF-36 (physical function, bodily pain, general health perception, vitality/energy, social function, mental health). Employers can educate female employees about the benefits of regular exercise such as yoga, which may decrease premenstrual distress and improve female employee health.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962262/

 

 

Get Mindful On-Line and Get Feeling Better

 

By John M. de Castro, Ph.D.

 

“mindfulness exercises delivered in face-to-face settings or remotely via the Internet seem to yield similar changes in symptoms. The remote delivery does not seem to lessen the efficacy of mindfulness interventions.”– Johanna Boettcher

 

Mindfulness training has been shown through extensive research to be effective in improving the physical and psychological condition of otherwise healthy people and also treating the physical and psychological issues of people with illnesses. Techniques such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as well as Yoga practice and Tai Chi or Qigong practice have been demonstrated to be particularly effective. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

The vast majority of the mindfulness training techniques, adopted so far, require a certified trained therapist. This produces costs that many clients can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with their busy schedules. As a results, there has been attempts to develop on-line mindfulness training programs. These have tremendous advantages in decreasing costs and making training schedules much more flexible. But, the question arises as to whether these programs are as effective as their traditional counterparts. Many believe that the presence of a therapist is a crucial component to the success of the programs and the lack of an active therapist in on-line programs may greatly reduce their effectiveness.

 

In today’s Research News article “Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1362554723768450/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

Fish and colleagues review the published research literature on the effectiveness of technology-based mindfulness training programs that did not include an active facilitator’s participation. They found 10 studies published, 9 of which were web-based programs. They found that, in general, the mindfulness programs produced increases in mindfulness and reductions in perceived stress, depression, anxiety, and rumination and these effects were maintained at follow-ups occurring as much as 6-months later. Unfortunately, compliance was relatively low and drop-out rates were relatively high.

 

These are encouraging findings and suggest that mindfulness can be effectively trained with web-based materials and that this can produce psychologically beneficial results. But, there were no direct comparisons to traditional programs. So, it cannot be determined if the web-based programs are as effective as traditional programs. In addition, there methods need to be developed to help maintain compliance and decrease dropping out of web-based programs. Regardless, the benefits are substantial and the results are sufficiently positive to encourage further research.

 

So, get mindful on-line and get feeling better.

 

“Internet delivery of mindfulness training may be a viable alternative if an evidence base can be established. It can be self-paced, less costly, and more accessible while additionally allowing for participant anonymity. “ – David Messer

 

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

Fish, J., Brimson, J., & Lynch, S. (2016). Mindfulness Interventions Delivered by Technology Without Facilitator Involvement: What Research Exists and What Are the Clinical Outcomes? Mindfulness, 7(5), 1011–1023. http://doi.org/10.1007/s12671-016-0548-2

 

Abstract

New cost-effective psychological interventions are needed to contribute to treatment options for psychiatric and physical health conditions. This systematic review aims to investigate the current literature on one potentially cost-effective form of mindfulness-based therapy, those delivered through technological platforms without any mindfulness facilitator input beyond the initial design of the programme. Three electronic databases (Ovid Medline, PsychINFO and Embase) were searched for relevant keywords, titles, medical subject headings (MeSH) and abstracts using search terms derived from a combination of two subjects: ‘mindfulness’ and ‘technology’. Overall, ten studies were identified. The majority of studies were web-based and similar in structure and content to face-to-face mindfulness-based stress reduction courses. Clinical outcomes of stress (n = 5), depression (n = 6) and anxiety (n = 4) were reported along with mindfulness (n = 4), the supposed mediator of effects. All eight studies that measured significance found at least some significant effects (p < .05). The highest reported effect sizes were large (stress d = 1.57, depression d = .95, both ps > .005). However, methodological issues (e.g. selection bias, lack of control group and follow-up) which reflect the early nature of the work mean these largest effects are likely to be representative of maximal rather than average effects. Whilst there are important differences in the construction, length and delivery of interventions, it is difficult to draw firm conclusions about the most effective models. Suggestions of key characteristics are made though, needing further investigation preferably in standardised interventions. Given the existing research and the speed at which technology is making new platforms and tools available, it seems important that further research explores two parallel lines: first, refinement and thorough evaluation of already established technology-based mindfulness programmes and second, exploration of novel approaches to mindfulness training that combine the latest technological advances with the knowledge and skills of experienced meditation teachers.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5010616/

 

Reduce Pain with Meditation Rather Than Drugs

 

By John M. de Castro, Ph.D.

 

“For some people with chronic pain, mindful meditation is an appealing pain management option because it has an unusual benefit; it is something that you personally control. Unlike pain medications or medical procedures, meditation is not done to you, it is something you can do for yourself.” – Stephanie Burke

 

Pain can be difficult to deal with, particularly if it’s persistent. But, even short-term pain, acute pain, is unpleasant. Pain, however, 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 important that pain signals not be blocked or prevented. They need to be perceived. Nevertheless, it would be useful to find ways to lower the intensity of perceived pain and improve recovery from painful stimuli. Pain signals are processed in the brain and the state of the brain can alter the perception of pain. Indeed, opioid drugs are very effective pain killers and they work by affecting opioid receptors in the brain that are important in the perception of pain.

 

Pain is affected by the mind. The perception of pain can be amplified by the emotional reactions to it and also by attempts to fight or counteract it. Pain perception can be reduced by aerobic exercise and mental states, including placebo effects, attention, and conditioning. Additionally, contemplative practices have been shown to reduce both chronic and acute pain. It has been shown that exercise and mental states affect pain perception via opioid receptors. Their effects on pain can be prevented by the injection of a drug, naloxone, that blocks opioid receptors. Hence, mental states appear to alter pain perception through effects on the opioid system in the brain. But, it is not known if contemplative practices act in the same way.

 

In today’s Research News article “Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1361495810541008/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792946/

Zeidan and colleagues examine the involvement of opioid receptors in the pain reduction produced by meditation practice. They recruited participants who had no experience with meditation and randomly assigned them to four groups. Two groups engaged in meditation for 20 minutes per day for four days, while two groups listened to an audiobook for 20 minutes per day for four days. One meditation group and one no-meditation group received a naloxone injection while the other two groups received injections of a non-active saline solution. Both participants and experimenters were blind as to whether they were receiving naloxone or saline. Before and after injection, participants were tested while meditating or resting for sensitivity to pain induced by heat to the skin. Participants rated their perceived pain to different levels of heat.

 

They found that mindfulness meditation reduced pain perception by 21% and pain unpleasantness by 36% relative to resting controls. This occurred for the meditation groups regardless of whether naloxone or saline was injected. So, the opioid receptor blocking drug naloxone had no effect on the reductions in pain produced by meditation. Hence, meditation, unlike other mental states, appears to reduce pain independent of the opioid pain system in the brain.

 

There are a number of effects of meditation that might underlie the reduction in pain perception. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Meditation practices have been shown to reduce stress responses and anxiety, and to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. So, it would seem reasonable that mindfulness practices would be helpful in pain management. In addition, pain is accompanied by, and frequently caused by, inflammation and meditation has been shown to reduce the inflammatory response. This may account for the mindfulness’ effects on the physical aspects of chronic pain.

 

So, reduce pain with meditation rather than drugs.

 

“Meditation teaches patients how to react to the pain. People are less inclined to have the ‘Ouch’ reaction, and are able to control their emotional reaction to pain.” – BRIAN STEINER

 

 

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

Fadel Zeidan, Adrienne L. Adler-Neal, Rebecca E. Wells, Emily Stagnaro, Lisa M. May, James C. Eisenach, John G. McHaffie, Robert C. Coghill. Mindfulness-Meditation-Based Pain Relief Is Not Mediated by Endogenous Opioids. J Neurosci. 2016 Mar 16; 36(11): 3391–3397. doi: 10.1523/JNEUROSCI.4328-15.2016

 

Abstract

Mindfulness meditation, a cognitive practice premised on sustaining nonjudgmental awareness of arising sensory events, reliably attenuates pain. Mindfulness meditation activates multiple brain regions that contain a high expression of opioid receptors. However, it is unknown whether mindfulness-meditation-based analgesia is mediated by endogenous opioids. The present double-blind, randomized study examined behavioral pain responses in healthy human volunteers during mindfulness meditation and a nonmanipulation control condition in response to noxious heat and intravenous administration of the opioid antagonist naloxone (0.15 mg/kg bolus + 0.1 mg/kg/h infusion) or saline placebo. Meditation during saline infusion significantly reduced pain intensity and unpleasantness ratings when compared to the control + saline group. However, naloxone infusion failed to reverse meditation-induced analgesia. There were no significant differences in pain intensity or pain unpleasantness reductions between the meditation + naloxone and the meditation + saline groups. Furthermore, mindfulness meditation during naloxone produced significantly greater reductions in pain intensity and unpleasantness than the control groups. These findings demonstrate that mindfulness meditation does not rely on endogenous opioidergic mechanisms to reduce pain.

SIGNIFICANCE STATEMENT Endogenous opioids have been repeatedly shown to be involved in the cognitive inhibition of pain. Mindfulness meditation, a practice premised on directing nonjudgmental attention to arising sensory events, reduces pain by engaging mechanisms supporting the cognitive control of pain. However, it remains unknown if mindfulness-meditation-based analgesia is mediated by opioids, an important consideration for using meditation to treat chronic pain. To address this question, the present study examined pain reports during meditation in response to noxious heat and administration of the opioid antagonist naloxone and placebo saline. The results demonstrate that meditation-based pain relief does not require endogenous opioids. Therefore, the treatment of chronic pain may be more effective with meditation due to a lack of cross-tolerance with opiate-based medications.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792946/

Does Perinatal Mindfulness Training Help?

 

By John M. de Castro, Ph.D.

 

“Since mindfulness has a lot to do with being in touch with the sensations in your body, and being aware, new moms are in a prime state to learn it! In fact, pregnancy and early motherhood, nursing and sleep disturbance, weight gain and weight loss-these all in some way force you to be in your body. For those of us who live most of our lives above our necks, this can actually be a great blessing.”Cassandra Vieten 

 

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 and depression are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. Depression is characterized by a low or sad mood, loss of interest in fun activities, changes in eating, sleep, and energy, problems in thinking, concentrating, and making decisions, feelings of worthlessness, shame, or guilt, and thoughts that life is not worth living. It is 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.

 

Depression occurring after delivery of a baby is well known, documented and discussed. Less well known but equally likely is depression during pregnancy. The American Congress of Obstetricians and Gynecologists suggest that between 14 and 23 percent of women suffer from some form of depression during pregnancy. 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 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.

 

The psychological health of pregnant women has consequences for fetal development, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. It is also associated with higher levels of stress hormone in the mother and in the newborns, which can make them more stress reactive, temperamentally difficult, and more challenging to care for and soothe. Long-term there’s some evidence that the children have more social and emotional problems, including aggression and conduct problems and possibly child IQ and language.

 

It is clear that there is a need for methods to treat 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. Moderate exercise including yoga practice is also beneficial during pregnancy. Mindfulness training has also been shown to improve anxiety and depression normally and to relieve maternal anxiety and depression during pregnancy. So, it would make sense to study the effects of mindfulness training during the perinatal period.

 

In today’s Research News article “The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1360546443969278/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868288/

Lever Taylor and colleagues review 17 research studies on the effectiveness of mindfulness training on the women’s psychological health during the perinatal period. They found that compared to before, after mindfulness training the women demonstrated significantly reduced levels of depression, anxiety, and stress, and increased mindfulness, all with moderate effect sizes. The effects appeared to be greater for women who had the greatest levels of distress prior to training. Unfortunately, when a control condition was included (7 studies), either usual care or a wait-list control, these women improved comparable amounts to the mindfulness trained women and there were no significant differences between the groups.

 

Hence, clear conclusions cannot be drawn regarding the effectiveness of mindfulness training for the psychological health of women during the perinatal period. The reviewed studies in general investigated the effectiveness of a variety of different mindfulness training practices. So, the lack of effectiveness in comparison to control conditions may well have been due to the employment of sub-optimal trainings. In addition, the majority of studies looked at healthy normal women and mindfulness training may only be effective in women with psychological distress. Needless to say, more research is needed to determine whether, under what conditions, and with what kind of training program that mindfulness training may be helpful for the psychological health of women during the perinatal period.

 

But your job in this holding environment is to, well, hold what is happening. To tolerate his distressing moments, to recognize and reflect his feelings and their expressions in his body and on his face, even to be the target of and survive his anger, frustration, and aggression. You can do a kind of aikido with your baby. Mindful awareness can help you in this dance of attunement, synchrony, and consciously participating in co-creating the space through which both of you move through your days” – 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

Lever Taylor, B., Cavanagh, K., & Strauss, C. (2016). The Effectiveness of Mindfulness-Based Interventions in the Perinatal Period: A Systematic Review and Meta-Analysis. PLoS ONE, 11(5), e0155720. http://doi.org/10.1371/journal.pone.0155720

 

Abstract

Perinatal mental health difficulties are associated with adverse consequences for parents and infants. However, the potential risks associated with the use of psychotropic medication for pregnant and breastfeeding women and the preferences expressed by women for non-pharmacological interventions mean it is important to ensure that effective psychological interventions are available. It has been argued that mindfulness-based interventions may offer a novel approach to treating perinatal mental health difficulties, but relatively little is known about their effectiveness with perinatal populations. This paper therefore presents a systematic review and meta-analysis of the effectiveness of mindfulness-based interventions for reducing depression, anxiety and stress and improving mindfulness skills in the perinatal period. A systematic review identified seventeen studies of mindfulness-based interventions in the perinatal period, including both controlled trials (n = 9) and pre-post uncontrolled studies (n = 8). Eight of these studies also included qualitative data. Hedge’s g was used to assess uncontrolled and controlled effect sizes in separate meta-analyses, and a narrative synthesis of qualitative data was produced. Pre- to post-analyses showed significant reductions in depression, anxiety and stress and significant increases in mindfulness skills post intervention, each with small to medium effect sizes. Completion of the mindfulness-based interventions was reasonable with around three quarters of participants meeting study-defined criteria for engagement or completion where this was recorded. Qualitative data suggested that participants viewed mindfulness interventions positively. However, between-group analyses failed to find any significant post-intervention benefits for depression, anxiety or stress of mindfulness-based interventions in comparison to control conditions: effect sizes were negligible and it was conspicuous that intervention group participants did not appear to improve significantly more than controls in their mindfulness skills. The interventions offered often deviated from traditional mindfulness-based cognitive therapy or mindfulness-based stress reduction programmes, and there was also a tendency for studies to focus on healthy rather than clinical populations, and on antenatal rather than postnatal populations. It is argued that these and other limitations with the included studies and their interventions may have been partly responsible for the lack of significant between-group effects. The implications of the findings and recommendations for future research are discussed.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868288/