Be Mindful with Parkinson’s Disease

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mindfulness-parkinsons2-advocat

 

By John M. de Castro, Ph.D.

 

“For the person with Parkinson’s, mindfulness might be considered as a method to help with issues of denial and acceptance, loss of independence, and the many frustrations that accompany a disease over which a person has no control and can help him or her feel more connected to body, mind, and spirit in ways that enhance self-understanding and personal insight.”

 

Parkinson’s Disease (PD) is an incurable progressive degenerative disease of the central nervous system. The condition is caused by the death of nerve cells in the brain that produce the neurotransmitter dopamine. Its physical symptoms include resting tremor, slow movements, muscle rigidity, problems with posture and balance, loss of automatic movements, and slurring of speech. PD itself is not fatal but is often associated with related complications can reduce life expectancy, such as falls, choking, and cardiovascular problems. There are also psychological effects, especially anxiety and depression. All of these symptoms result in a marked reduction in the quality of life. There are around seven million people worldwide and one million people in the U.S. living with PD and about 60,000 people are diagnosed with PD every year. PD is associated with aging as the vast majority of patients are diagnosed after age 50. In fact, it has been speculated that everyone would eventually develop PD if they lived long enough.

 

Mindfulness training has been found to improve the psychological symptoms and the quality of life with PD patients. In today’s Research News article “The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1354151734608749/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016929/

Advocat and colleagues investigate the effectiveness of mindfulness training on the symptoms of Parkinson’s Disease (PD). They randomly assigned Parkinson’s Disease patients to either receive a modified 6-week, 2-hour per week, mindfulness program or remain with treatment as usual on a wait list. Mindfulness training participants were also provided materials to practice at home. As part of the intervention, they also received education on PD management, stress managements, spirituality, exercise, nutrition, available support, and environmental issues. The participants were measured before and after treatment and 6 months later for PD symptoms, mindfulness, depression, anxiety, locus of control, exercise, and nutrition.

 

They found that the immediately after the intervention the mindfulness group in comparison to controls had a significant increase in mindfulness and perceived internal locus of control. At the 6-month follow up the mindfulness group had a significant increase in mindfulness, decrease in stress, and an improvement in their diet. On the average, but not significant, were improvements in in Parkinson’s Disease symptoms overall and with activities of daily living.

 

These results are disappointing and did not replicate previous findings of a positive effect of mindfulness training on PD. The study however, was small, with only 23 patients completing the intervention and thereby did not have sufficient statistical power to detect small differences. The mindfulness training also only lasted for 6-weeks and contained only 5-20 minutes per week of mindfulness training which may have been insufficient to be effective. In addition, follow up measures of adherence to the program were neutral suggesting that the participants were not particularly diligent in their practice. This suggests that future interventions should have a larger number of participants, contain more intensive mindfulness training, and include methods to insure compliance with the practice instructions.

 

Regardless of these disappointing findings, mindfulness training holds promise to help relieve the suffering of patients with Parkinson’s Disease. It is not a cure and it does not even delay the progression of the disease, but it can be helpful in improving the patient’s quality of life and ability to deal with PD. So, be mindful with parkinson’s disease.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

“Long-term mindfulness practitioners increase the working capacity of the brain and connections within the brain, and increase brain matter than non-practitioners. This suggests mindfulness may keep brains young and healthy.“ – Terry Gebhardt 

 

This and other Contemplative Studies posts are available at the Contemplative Studies Blog http://contemplative-studies.org/wp/

They are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Advocat, J., Enticott, J., Vandenberg, B., Hassed, C., Hester, J., & Russell, G. (2016). The effects of a mindfulness-based lifestyle program for adults with Parkinson’s disease: a mixed methods, wait list controlled randomised control study. BMC Neurology, 16(1), 166. http://doi.org/10.1186/s12883-016-0685-1

 

Abstract

Background: Parkinson’s disease (PD) is the second commonest neurodegenerative disease in developed countries. Current treatment for PD is pharmacologically focused and can have significant side-effects. There is increasing interest in holistic approaches including mindfulness to help manage the challenges associated with living with PD. We hypothesised that there would be an improvement in PD associated function and wellbeing in participants after participating in a 6-week mindfulness-based lifestyle program, and that these improvements would be sustainable at 6 months. Our primary objective was to determine changes in function and wellbeing associated with PD.

Methods: An exploratory prospective, mixed-method, randomised control trial incorporating a before and after design with a waitlist control, with an embedded qualitative component was conducted in 2012–2013. Participants included community living adults with disability congruent to H&Y Stage 2 PD, aged 18–75, fluent in spoken and written English and able to attend at least four of six sessions of the program. Participants were randomised to the intervention or wait-list control groups at two locations. All participants in the wait-list control group eventually received the intervention. Two randomisation codes were created for each location. Allocation to the intervention or wait-list control was by random number generation. The program facilitator and participants were blinded to participant data.

Results: Group 1 included 35 participants and group 2 (the waitlist control), 37. Data was analysed from 24 (group 1) and 33 (group 2) participants. The intervention group, compared to the waitlist control, showed a small improvement in function and wellbeing associated with PD immediately after the program (t-score = −0.59) and at 6-month post intervention (t-score = −1.42) as reported by the PDQ-39 SI. However this finding was not significant (p = 0.56 and 0.16 respectively). A small yet significant effect size (β = 0.23) in PDQ-39 ADL was reported in group 1 after 6-months post-intervention. This showed a positive improvement in the ADL as reported by group 1 after 6-months (t-score −1.8, p = 0.04). Four secondary measures are reported.

Conclusions: Our findings suggest mindfulness-based lifestyle programs have potential to assist participants in managing the ongoing difficulties associated with a neurological condition such as Parkinson’s disease. Importantly, our study shows promise for the long term benefits of such programs. Improvements to participant activities in daily living and mindfulness were retained at 6-months post intervention. A more definitive study should be conducted in a larger sample of PD patients to further explore these findings and their impact on reducing stress and anxiety in PD patients.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016929/

 

Improve Brain Processing of Emotions in the Elderly with Meditation

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By John M. de Castro, Ph.D.

 

“Yet until recently little was known about how a few hours of quiet reflection each week could lead to such an intriguing range of mental and physical effects. Now, as the popularity of mindfulness grows, brain imaging techniques are revealing that this ancient practice can profoundly change the way different regions of the brain communicate with each other – and therefore how we think – permanently.” –  Tom Ireland

 

Meditation training has been shown to alter the nervous system, increasing the size and connectivity of structures associated with present moment awareness, higher level thinking, and regulation of emotions, while decreasing the size and connectivity of structures associated with mind wandering and self-referential thinking, known as the Default Mode Network (DMN). The brain is capable of changing and adapting in a process called neuroplasticity. As a result, the neural changes produced by meditation training become relatively permanent.

 

Meditation training has also been shown to produce improvements in emotion regulation. Most of the research to date on the neural systems altered by meditation training has focused on higher level cortical centers. But, emotions involve lower centers such as those located in the Pons in primitive brain stem. In today’s Research News article “Pons to Posterior Cingulate Functional Projections Predict Affective Processing Changes in the Elderly Following Eight Weeks of Meditation Training.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1349231245100798/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006446/

Shao and colleagues investigate the changes in connectivity between the Pons sites involved in emotions and the Posterior Cingulate Cortex and the Precuneus area which are important in the Default Mode Network (DMN). They recruited elderly (>60 years of age) participants with no experience with meditation or relaxation training through newspaper ads. They were randomly assigned to receive 8-weeks of either meditation training or relaxation training. Training occurred with 1.5-hour training sessions occurring 3 time per week. All participants received functional Magnetic Resonance Imaging (fMRI) brain scans and were tested with an emotion processing task both before and after training.

 

They found that after meditation training the elderly participants had moderated emotional responses that converged toward the middle, such that positive emotions were not as positive and arousing while negative emotions were not as negative and arousing as prior to training. This effect did not occur in the relaxation trained participants. They also found increased functional connectivity between the Pons emotion centers and the Posterior Cingulate Cortex and the Precuneus area components of the Default Mode Network (DMN). The increased connectivity was primarily in the Pons to DMN direction. In addition, the greater the change in the connectivity the greater the reduction in negative emotional responses by the participants. Again, these effect did not occur in the relaxation trained participants.

 

These are interesting results that extend the previous findings on improved emotion regulation after meditation training as the training was found to moderate emotional reactivity, making both positive and negative emotions less extreme. They further showed that this moderation of emotions is associated with increased connectivity between the areas of primitive emotion in the Pontine brain stem and the higher level Default Mode Network (DMN) procession in the Cerebral Cortex. These effects were shown to be due to the meditation training as relaxation training did not produce them.

 

One of the ways that emotions can get out of hand is by ruminating about past emotional responses and worrying about future emotional responses. This can increase the magnitude of emotional responses. Rumination and worry is the role of the DMN. The present research suggests that the improve emotion regulation seen after meditation training may be due to the increased influence of lower emotion centers on reducing the activation of the brain areas responsible for rumination and worry. In that way emotions can be experienced and analyzed as real time experiences and not amplified beyond their actual magnitude. This is a tremendous benefit of meditation training, allowing for more realistic appraisal of emotions.

 

So, improve brain processing of emotions in the elderly with meditation.

 

“One way to do this is mindfulness meditation, in which you observe your thoughts and feelings with the objectivity of a disinterested, nonjudgmental witness. This form of mental training gives you “the wherewithal to pause, observe how easily the mind can exaggerate the severity of a setback, note that it as an interesting mental process, and resist getting drawn into the abyss,” – Richie Davidson

 

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

Robin Shao, Kati Keuper, Xiujuan Geng, Tatia M.C. Lee. Pons to Posterior Cingulate Functional Projections Predict Affective Processing Changes in the Elderly Following Eight Weeks of Meditation Training. EBioMedicine. 2016 Aug; 10: 236–248. Published online 2016 Jun 15. doi: 10.1016/j.ebiom.2016.06.018

 

Abstract

Evidence indicates meditation facilitates affective regulation and reduces negative affect. It also influences resting-state functional connectivity between affective networks and the posterior cingulate (PCC)/precuneus, regions critically implicated in self-referential processing. However, no longitudinal study employing active control group has examined the effect of meditation training on affective processing, PCC/precuneus connectivity, and their association. Here, we report that eight-week meditation, but not relaxation, training ‘neutralized’ affective processing of positive and negative stimuli in healthy elderly participants. Additionally, meditation versus relaxation training increased the positive connectivity between the PCC/precuneus and the pons, the direction of which was largely directed from the pons to the PCC/precuneus, as revealed by dynamic causal modeling. Further, changes in connectivity between the PCC/precuneus and pons predicted changes in affective processing after meditation training. These findings indicate meditation promotes self-referential affective regulation based on increased regulatory influence of the pons on PCC/precuneus, which new affective-processing strategy is employed across both resting state and when evaluating affective stimuli. Such insights have clinical implications on interventions on elderly individuals with affective disorders.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006446/

 

Improve Quality of Life during and after Radiotherapy with Yoga

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By John M. de Castro, Ph.D.

 

“When you say yoga, some people think of standing on their heads, but it’s the non-physical aspects of yoga, such as breathing, that are fundamental to healing.” – Jnani Chapman

 

About 12.5% of women in the U.S. develop invasive breast cancer over their lifetimes and every year about 40,000 women die. Indeed, more women in the U.S. die from breast cancer than from any other cancer, besides lung cancer. Breast cancer diagnosis, however, is not a death sentence. It is encouraging that the death rates have been decreasing for decades from improved detection and treatment of breast cancer. Five-year survival rates are now at around 95%.

 

But treatments for breast cancer can be difficult on the patient markedly reducing their mental and physical quality of life. Chemotherapy or radiotherapy can produce increased fatigue, pain, and bone loss, reduced fertility, difficulty with weight maintenance, damage to the lymphatic system, heightened fear of reoccurrence, and an alteration of their body image. With the loss of a breast or breasts, scars, hair shedding, complexion changes and weight gain or loss many young women feel ashamed or afraid that others will reject or feel sorry for them. As a result, breast 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.

 

Unfortunately, most of these residual problems often go untreated. So, safe and effective treatments for the effects of radiotherapy on breast cancer patients are needed. Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual psychological symptoms and improve cognitive function. Yoga has also been shown to be helpful with the residual symptoms. In today’s Research News article “Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1348160035207919/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972683/

Ratcliff and colleagues recruited women diagnosed with breast cancer and scheduled to undergo radiotherapy for 6-weeks. They were randomly assigned to receive either yoga practice, stretching, or to a wait list while receiving treatment as usual. The yoga group and the stretching group practiced 3 times per week for 60 minutes during the 6-weeks of radiotherapy. Measurements were taken before treatment during the last week of radiotherapy and 1, 3, and 6 months later of health related quality of life, depression, sleep disturbance, posttraumatic stress symptoms, benefits finding, and salivary cortisol levels.

 

They found that the greater the distress prior to treatment the greater the effect of yoga practice.

Women who were high in sleep disturbance and depression prior to treatment showed the greatest improvement in mental health related quality of life with the effect getting stronger 3 and 6 months following treatment. This suggests that yoga practice has the greatest impact when the women are particularly distressed before treatment and the effects are lasting. They also found that yoga practice led to increased benefits finding, that is to increased acceptance of life’s imperfections, change in priorities, and development of a sense of purpose in life as a result of having been diagnosed with cancer. This increased benefits finding at 3-months led to improvements in physical health related quality of life at 6-months.

 

These results are interesting and demonstrate that yoga practice can be of benefit to women with breast cancer undergoing radiotherapy, improving their mental and physical health related quality of life. Yoga practice appears to be most beneficial to women who have the most problems with sleep and depression before treatment and the benefits appear to be lasting. So yoga practice helps the most those who need it the most. Yoga practice appears to work, in part, by improving the patient’s ability to find benefits in being diagnosed with cancer.

 

So, improve quality of life during and after radiotherapy with yoga.

 

“Yoga is known as a great way to ease stress and boost the body’s immune system. But it can be another way to fight chemo-related nausea and vomiting. And that’s not all. The gentle stretching and movement of yoga might give you more energy and help you sleep better.” –  Amanda Gardner

 

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

Ratcliff, C. G., Milbury, K., Chandwani, K. D., Chaoul, A., Perkins, G., Nagarathna, R., … Cohen, L. (2016). Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy. Integrative Cancer Therapies, 15(3), 250–262. http://doi.org/10.1177/1534735415624141

 

Abstract

Hypothesis

This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.

Methods

Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment.

Results

Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL.

Conclusion

Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4972683/

 

Reduce Back Pain with Mindfulness

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Image result for back pain

 

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

 

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

 

Pain involves both physical and psychological issues. The stress, fear, and anxiety produced by pain tends to elicit responses that actually amplify the pain. So, reducing the emotional reactions to pain may be helpful in pain management. Mindfulness practices have been shown to improve emotion regulation producing more adaptive and less maladaptive responses to emotions. Indeed, mindfulness practices have been shown to be safe and  beneficial in pain management in general and yoga and mindfulness has been shown to specifically improve back pain. Mindfulness Based Stress Reductions (MBSR) programs contain both yoga and mindfulness practices. So, it would seem reasonable to project that MBSR practice would improve emotion regulation and thereby be beneficial for back pain.

 

In today’s Research News article “Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1347215058635750/?type=3&theater

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

http://jama.jamanetwork.com/article.aspx?articleid=2504811

Cherkin and colleagues recruited a large sample of adults suffering with low back pain. They were then randomly assigned to a treatment as usual group or to groups which received treatment as usual plus 2 hours per week for 8-weeks of either Mindfulness Based Stress Reduction (MBSR) treatment or Cognitive Behavioral Therapy (CBT). Participants were measured before, 4-weeks into, and after treatment at 8, 26, and 52 weeks for back pain, functional related limitations, bothersomeness, depression, anxiety, pain intensity, pain improvement, general physical health, and general mental health.

 

They found that at the primary endpoint of 26 weeks both the MBSR and CBT groups showed statistically significant better clinically meaningful improvements in pain bothersomeness and functional related limitations than the treatment as usual group and these improvements were still present at one-year follow-up. They also found that at 8 and 26 weeks both the MBSR and CBT groups showed statistically significant improvements in depression, anxiety, pain intensity, and global mental health than the treatment as usual group and the improvement in pain intensity was still present at one-year follow-up.

 

These results are excellent and conclusively demonstrate that both Mindfulness Based Stress Reduction (MBSR) treatment and Cognitive Behavioral Therapy (CBT) are far superior to the usual treatment in the improvement of low back pain physical and psychological symptoms. These improvements occurred without any significant adverse effects. The fact that many of the effects were still present a year later is particularly significant and indicate the treatments have lasting effects. Hence, both MBSR and CBT are safe and effective treatments for chronic low back pain.

 

So, reduce back pain with mindfulness.

 

“mindfulness-based stress reduction may be particularly helpful for people because even if their use lapses, they develop a skill they can draw on later when they need it. That suggests that training the mind has potential to change people on a more lasting basis than doing a manipulation of the spine or massage of the back, techniques that may be effective in the short term but lose effects over time. You can practice it by waiting at the bus stop and just breathing.” – Daniel Cherkin

 

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

Daniel C. Cherkin, Karen J. Sherman, Benjamin H. Balderson, Andrea J. Cook, Melissa L. Anderson, Rene J. Hawkes, Kelly E. Hansen, Judith A. Turner. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016;315(12):1240-1249. doi:10.1001/jama.2016.2323.

 

Abstract

Importance:  Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain.

Objective:  To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care.

Design, Setting, and Participants  Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113).

Interventions:  CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received.

Main Outcomes and Measures:  Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks.

Results:  There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes.

Conclusions and Relevance:  Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.

http://jama.jamanetwork.com/article.aspx?articleid=2504811

 

Improve Cognitive, Thought, Processes with Mindfulness

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By John M. de Castro, Ph.D.

 

“People with anxiety have a problem dealing with distracting thoughts that have too much power. They can’t distinguish between a problem-solving thought and a nagging worry that has no benefit. If you have unproductive worries you can train yourself to experience those thoughts completely differently. “You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self,’” – Elizabeth Hoge

 

Stress is universal. We are constantly under some form of stress. In fact, if we don’t have enough stress, we seek out more. Moderate stress can be a good thing promoting growth and flourishing. But, it must be moderate or what is called the optimum level of stress. Too little or too much stress can be damaging. Unfortunately for many of us living in a competitive, multitasking, modern environment stress is all too often higher than desirable. In addition, many of the normal mechanisms for dealing with stress have been eliminated. The business of modern life removes opportunities for rest, extra sleep, and leisure activities. Instead people are working extra hours and limiting or passing up entirely vacations to stay competitive. Persistently high levels of stress are damaging and can directly produce disease or debilitation increasing susceptibility to other diseases.

 

It is beyond the ability of the individual to change the environment to reduce stress, so it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices including meditation practice have been shown to reduce the psychological and physiological responses to stress. Because of their ability to relieve stress, mindfulness trainings are increasingly being practiced by individuals and are even being encouraged in some workplaces. But, some other treatments such as exercise or biofeedback may also be effective.

 

In today’s Research News article “Comparing Daily Mindfulness Meditations, Biofeedback Exercises, and Daily Physical Exercise on Attention Control, Executive Functioning, Mindful Awareness, Self-Compassion, and Worrying in Stressed Young Adults.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1346420245381898/?type=3&theater

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

http://link.springer.com/article/10.1007/s12671-016-0561-5

de Bruin and colleagues compare the efficacy of five weeks of daily mindfulness meditation, heart rate variability biofeedback, or physical exercise to reduce the psychological symptoms of stress in 18 to 40-years old adults who were highly stressed. The participants were randomly assigned to one of the three treatments and were tested prior to and after the 5-week treatment period for attention control, executive functioning, mindful awareness, self-compassion, and worrying.

 

They found that all three interventions produced statistically significant improvements in all of the outcome measures, attention control, executive functioning, mindful awareness, self-compassion, and worrying, and there were no significant differences between the treatments in their effectiveness. The exercise group practiced for 40% more hours than either the meditation or heart rate variability biofeedback groups. The fact that the groups did not differ is surprising. But, it is clear that all three therapies significantly reduce the cognitive and emotional effects of stress.

 

The advantage for the individual is that they can choose which form of therapy best suits them and their situation. Since these people are already stressed by their busy lives, it would seem that the added time commitment for exercise would be a disadvantage. Also biofeedback treatment requires greater professional attention than either meditation or exercise. So, for practical reasons, meditation would appear to be the preferable therapy for the relief of the cognitive and emotional effects of stress.

 

So, improve cognitive, thought, processes with mindfulness.

 

“Mindfulness also allows us to become more aware of the stream of thoughts and feelings that we experience and to see how we can become entangled in that stream in ways that are not helpful. This lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply ‘mental events’ that do not have to control us.” – Mark Williams

 

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

de Bruin, E.I., van der Zwan, J.E. & Bögels, S.M. A RCT Comparing Daily Mindfulness Meditations, Biofeedback Exercises, and Daily Physical Exercise on Attention Control, Executive Functioning, Mindful Awareness, Self-Compassion, and Worrying in Stressed Young Adults. Mindfulness (2016) 7: 1182. doi:10.1007/s12671-016-0561-5

 

Abstract

Our Western society is characterized by multitasking, competition, and constant time pressure. Negative effects of stress for the individual (anxiety, depression, somatic complaints) and for organizations and society (costs due to work absence) are very high. Thus, time-efficient self-help interventions to address these issues are necessary. This study assessed the effects of daily mindfulness meditations (MM) versus daily heart rate variability biofeedback (HRV-BF) and daily physical exercise (PE) on attention control, executive functioning, mindful awareness, self-compassion, and worrying. Young adults (n = 75, age range 18 to 40) with elevated stress levels were randomized to MM, HRV-BF, or PE, and measurements were taken at pre-test, post-test, and follow-up. Interventions in all three groups were self-guided and lasted for 5 weeks. Generalized estimating equation analyses showed that overall, all three interventions were effective and did not differ from each other. However, practice time differed between groups, with participants in the PE group practicing much more than participants in the other two groups. Therefore, additional analyses were carried out in two subsamples. The optimal dose sample included only those participants who practiced for at least 70 % of the total prescribed time. In the equal dose sample, home practice intensity was equal for all three groups. Again, the effects of the three interventions did not differ. In conclusion, MM, HRV-BF, and PE are all effective self-help methods to improve attention control, executive functioning, mindful awareness, self-compassion, and worrying, and mindfulness meditation was not found to be more effective than HRV-biofeedback or physical exercise for these cognitive processes.

http://link.springer.com/article/10.1007/s12671-016-0561-5

 

Reduce Food Cravings with Mindfulness

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By John M. de Castro, Ph.D.

 

 “When it comes to overcoming food addictions and cravings, if we learn to observe and view our craving-related thoughts and feelings as something separate from ourselves, they lose their power over us.  And we can begin to take back our rightful place in the driver’s seat.” – Traci Pedersen

 

Craving for certain foods is an almost universal phenomenon. There are specific foods, chocolate for many, the thought of which sets off an intense desire to consume them and often food seeking to obtain and ingest them. This is normal. But, in some, food cravings, also known as specific hungers, are the source of overeating and may be a source of overweight and obesity. So, being able to cope with or control food cravings may be of assistance in reducing intake and body weight.

 

Mindfulness has been demonstrated to be effective in reducing food intake. It attempts to reduce intake by engendering mindful eating, which involves paying attention to eating while it is occurring, including attention to the sight, smell, flavors, and textures of food, to the process of chewing and swallowing, and to the physiological feelings of hunger and fullness from the body. Another way mindfulness can help control intake is that it can promote decentering, where the individual learns to view thoughts as just thoughts and not personal. Taking a step back from the craving for a food the individual can see that “I have a thought about wanting chocolate” is different from “I must have chocolate.”

 

It is not known whether mindfulness may produce reduced food cravings by engendering decentering, by another mechanism, or by producing multiple routes to lower cravings. In today’s Research News article “Food-Specific Decentering Experiences Are Associated with Reduced Food Cravings in Meditators: A Preliminary Investigation.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1345624652128124/?type=3&theater

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

http://link.springer.com/article/10.1007/s12671-016-0554-4

Papies and colleagues investigate mindfulness’ and decentering’s associations with food cravings. They recruited practiced meditators and measured, meditation experience, decentering from food thoughts, awareness of food thoughts, and food cravings. They found that the greater the meditation experience the lower the food cravings. They also found that the greater the decentering from food thoughts the lower the food cravings and this association was stronger for women than for men. Finally, they demonstrated that meditation experience was only associated with lower food cravings when the meditators were low in decentering from food thoughts.

 

These results suggest that both meditation experience and decentering are associated with lower food cravings. Unfortunately, there were no measure of actual intake. So, it cannot be determined if the lower food cravings were associated with actually lower food intake. The fact that meditation experience was only associated with lower cravings when decentering was low may be accounted for by the fact that when decentering was high food cravings were low and there was no room for meditation experience to further lower cravings. In addition, because this study was correlational, cause and effect cannot be determined. For example, people who are low in cravings might be the types of people drawn to meditation and who are already highly decentered.

 

Regardless, it is clear that there are strong relationships between meditation experience and decentering of food thoughts with the levels of food craving in the individual. It will remain for future research to manipulate these variable, disentangle their respective influences, examine causal relationships, and determine if they’re associated with lower food intake. Nevertheless, the present results make it clear that this future research is justified and has the potential to lead to more effective strategies to reduce intake, overweight, and obesity.

 

“Mindful eating is a practice that allows us to tune in to the body’s needs and be thoughtful about how we nourish ourselves. By fully appreciating a food’s flavors and textures and being in the moment while eating, we open ourselves up to a deeper level of enjoyment, and it becomes easier to make better choices.” – Sonia Jones

 

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

Papies, E.K., van Winckel, M. & Keesman, M. Food-Specific Decentering Experiences Are Associated with Reduced Food Cravings in Meditators: A Preliminary Investigation. Mindfulness (2016) 7: 1123. doi:10.1007/s12671-016-0554-4

Abstract

This study examined the association of food-specific decentering experiences with food cravings in a sample of meditators. Decentering refers to viewing one’s thoughts as transient mental events and thus experiencing them as less subjectively real. This process has been suggested to be a key mechanism underlying the effects of mindfulness and many contemplative practices. Although most earlier studies have focused on the effects of decentering with regard to negative affect, some studies have shown that brief inductions of decentering among non-meditators reduce food cravings as well as unhealthy food choices. Here, we report a preliminary investigation of whether the food-specific decentering experiences that meditators have in daily life are associated with fewer food cravings. A small sample of meditators (N = 33, female = 15) answered a number of questions about decentering experiences with regard to thoughts about food, and they completed the short version of the Food Cravings Questionnaire–Trait and a measure of meditation experience. Results confirmed that both more meditation experience and more food-specific decentering experiences were associated with fewer food cravings in daily life. In addition, results suggested that when participants had stronger decentering experiences, they experienced fewer food cravings, regardless of their level of meditation experience. Exploratory analyses further revealed that decentering was more strongly associated with reduced cravings in women than in men. These preliminary findings suggest that food-specific decentering experiences indeed help meditators deal with food desires, and thus extend the evidence for decentering effects into the domain of reward. Future research might investigate this in larger samples, validate a food-specific measure of decentering, and consider the broader implications of decentering experiences in daily life.

http://link.springer.com/article/10.1007/s12671-016-0554-4

 

Red Means Relax

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By John M. de Castro, Ph.D.

 

 “City life is stressful. Everybody is running around like crazy, stuck in traffic jams trying to make meetings, trying to make ends meet, trying to meet deadlines, trying to get kids to and from activities. There aren’t enough hours in the day for all this business.” – Rebecca Pidgeon
Modern life is stressful and busy. We move through the day from task to task. A successful day is defined as one where the day’s to-do list has been virtually completed. This busyness usually occurs mindlessly. That’s not to say that the mind isn’t engaged. In fact, it’s fully engaged in thoughts and plans, and memories and ruminations. But often when engaged in one task the mind is occupied with thoughts of completing it so that we can move on to the next one. In the process we do not fully appreciate what we’re doing at the moment. This strategy is effective in accomplishing an agenda. But, it produces a very big problem, we’re so busy doing we neglect being.

 

Although much is accomplished, we never really enjoy the accomplishing, only the accomplishment. We have ignored the most important thing in life; awareness of the present moment. We can only fully experience life in the present moment. We can only revel in the wonder of our existence in the present moment. We can only be truly happy in the present moment. It’s impossible to negotiate the modern world without being lost in thought frequently. The problem is that we spend the entire day in that state.

 

Thus the modern world occupies us totally. Only occasionally do we have a quiet moment to reflect on what’s really happening. We’re moving from to-do list to to-do list and our lives are passing by without really living. That realization should be a jolt. We’ve somehow lost perspective and gotten so caught up in the minutia that we now see it as important instead of the trivialities that they are. To truly experience and enjoy our lives and be happy we must find ways to interrupt the mindless thinking and intersperse periods of mindfulness, where we are fully engaged in what is happening in the moment. There are so many signals in the environment to distract us and create endless thinking but there are none to signal mindfulness. In order to promote mindfulness, we need to identify signals in the environment that we can use as triggers for mindfulness.

 

While driving it is important for our safety to pay attention. But, there are occasional signals that are useful as signals for mindfulness. One I particularly like is the red traffic light. I used to encounter a red light and respond with frustration and sometimes anger that I was being delayed. My mind would be full of thoughts about what I might have done to avoid the light or about anger with the other drivers who kept me from making the light or searching for indications that the light was about to change and my torment would soon end. But, in fact there is nothing you can do. So the best strategy is to actually do nothing. I repeat to myself the simple phrase “red means relax.” Don’t do, just relax and do nothing.

 

The red light is in fact a wonderful opportunity to relax, take a deep breath, and allow the accumulated stress of driving to dissipate. It is also a wonderful time just to be mindful and appreciate the present moment. Look around and see the beautiful sky and appreciate the intense blueness and the ever changing landscape of clouds. See the other cars and drivers and marvel at the orderliness of movement produced by traffic control. Note how wonderful red lights actually are in keeping us safe and traffic moving. Look at the light itself and marvel at the color of red, how it registers in our eyes and is viewed in our awareness. Feel the sensations from our bodies, feel the energy, appreciate the health, and marvel at the miracle of life. There is so much waiting for us at red lights, it’s such a shame that we’ve been wasting it for so long.

 

A wonderful part of relaxing to red is that we return to driving with an entirely new attitude. I start viewing other drivers as fellow travelers, not annoyances or competitors. I start appreciating the sensations of driving, something that has been long ignored while we cruise along on “auto-pilot.” You’ll be amazed at the effect of this simple small rest, that cost you nothing, yet earned you so much.

 

The next task is to find other stimuli or events that can be used to trigger mindfulness within the stream of daily life. Meals can be helpful, provided you eat quietly, without media or reading, or looking at Facebook posts on our smartphones. I admit that I’m not very good with this one, but my wife is and it’s transformed her appreciation of food, eating, and the understanding of the interconnectedness of it all.

 

Look for times in your own daily activit1es when it really isn’t necessary that you be focused on a task. Turn off your phones, take a deep breath, relax, and be mindful. An evening walk could become a source of joy and happiness, a coffee break at work could refresh you much more deeply than effectively still working in your head, a shopping trip could be a sensory extravaganza, even an interaction with loved ones could be occasions for deeply listening and just being present for them, transforming your relationships. There are many possibilities. Find one and try it out. If you find that it produces greater joy and happiness in your life, keep doing it, and look for another to add. Keep it up, expanding your times of mindfulness and feel your reintegration into your life.

 

So, stop at red lights and remember “red means relax.”

 

“Your mind will answer most questions if you learn to relax and wait for the answer.” – William S. Burroughs
CMCS – Center for Mindfulness and Contemplative Studies

 

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

Think About It: Mindfulness May Improve Cognitive Functions

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By John M. de Castro, Ph.D.

 

“Mindfulness helps us focus: Studies suggest that mindfulness helps us tune out distractions and improves our memory and attention skills.” – Leah Weiss

 

Mindfulness is defined by Jon Kabat-Zinn as “the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment.” In its most basic form, mindfulness training is attention training. As a result, it’s been assumed that mindfulness training would improve attentional ability. It was also assumed that the ability to focus and attend without mind wandering would improve higher level thinking, cognition, sometimes known as executive function.

 

Although there have been a number of studies to investigate the relationship of mindfulness to attentional ability and executive function, they have varied widely in the form of mindfulness training and the methods to measure attention and executive function. In today’s Research News article “Cognitive effects of MBSR/MBCT: A systematic review of neuropsychological outcomes.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1343930858964170/?type=3&theater

or see summary below. Lao and colleagues review the published research literature on the effects of mindfulness training on attention and executive function. They restricted the reviewed studies to only those that studied adults, who were randomly assigned to either an 8 to 12-week mindfulness training or a control condition, that employed either Mindfulness Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) as the mindfulness training methods, and that measured attention and/or executive function with an objective measure. The literature search produced 18 articles that met all of the criteria. Eleven of the studies used healthy adults while the other 7 were either actively depressed or in remission patients.

 

They found that the studies that investigated attentional or executive attentional abilities only one had a statistically significant improvement in attention from mindfulness training, although all the rest showed mean attentional improvement that was not statistically significant. This contrasted to previous reviews that found significant effects of mindfulness training on attentional ability. But, many of the studies included in these other reviews were not randomized but compared long-term meditators to novices. This suggests that improvement in attentional ability may not result from short-term practice, but require long-term mindfulness training to develop.

 

Similarly, they found that there were mixed findings for higher level thinking, executive functions, with some studies finding significant results while others finding positive changes on the average, but that were not statistically significant. There were, however, significant effects on the awareness of awareness, meta awareness, and the ability to alter thinking, cognitive flexibility. These are significant as they suggest that even though short-term practice was involved, the highest levels of cognitive processing are improved with mindfulness training. Finally, they found that mindfulness training produced statistically significant improvements is memory function, particularly short-term, working, memory.

 

This literature summary, however, was not a meta-analysis where the results of multiple studies are summed and statistically evaluated. Rather Lao and colleagues simply reported on the statistical significance of individual studies. This process lacks the statistical power of a meta-analysis. Since many of the findings were in the direction of improvement, a meta-analysis may well have shown significant overall effects for mindfulness training where few or none were present in the individual studies. Hence, the literature summary was able to detect several significant cognitive and memory effects of mindfulness training, but the jury is still out on its ability to affect other executive function and attentional abilities.

 

So, think about it: mindfulness may improve cognitive functions.

 

“Cultivating mindfulness is not an easy task, but with persistence and practice we can make significant changes in the way we use our attention. We can improve concentration, our intimate relationships, our spiritual practice, and our overall mental health. What’s at stake is nothing less than our experience of life itself.” – ToDo 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

Lao SA, Kissane D, Meadows G. Cognitive effects of MBSR/MBCT: A systematic review of neuropsychological outcomes. Conscious Cogn. Volume 45, October 2016, Pages 109–123, http://dx.doi.org/10.1016/j.concog.2016.08.017

 

Highlights

  • Review of evidence for whether MBSR and MBCT improve cognitive performance.
  • Attention and executive functions were not improved through MBSR/MBCT.
  • Preliminary evidence for working memory, meta-awareness and cognitive flexibility improvements.

Abstract

Mindfulness is theorised to improve attention regulation and other cognitive processes. This systematic review examines whether 8-week standardised and manualised mindfulness training programs such as Mindfulness Based Cognitive Therapy (MBCT) and Mindfulness Based Stress Reduction (MBSR) enhances attention, memory and executive function abilities measured by objective neuropsychological tests. Seven databases were searched resulting in 18 studies meeting inclusion criteria for review. Overall studies did not support attention or executive function improvements. We found preliminary evidence for improvements in working memory and autobiographical memory as well as cognitive flexibility and meta-awareness. Short-term mindfulness meditation training did not enhance theorised attentional pathways. Results call into question the theoretical underpinnings of mindfulness, further highlighting the need for a comprehensive theoretical framework.

Reduce Hedonic Eating with Mindfulness

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By John M. de Castro, Ph.D.

 

“But whether or not you are predisposed to hedonic eating because of your genetics, everyone could benefit by becoming more mindful of what they eat, how much they eat, and when they eat.” – Tim Boyer

 

Obesity has become an epidemic in the industrialized world. In the U.S. the incidence of obesity, defined as a Body Mass Index (BMI) of 30 or above has more than doubled over the last 35 years. Currently more than 2 in 3 adults are considered to be overweight or obese and around 35% of the population meets the criteria for obesity. Overweight and obesity result from an imbalance between energy intake and expenditure. At some point in their lives people who are overweight have eaten a surplus of food energy relative to the amount they’re expending. This fact has led to investigations of the drivers of overeating in hope of discovering methods to treat or prevent obesity.

 

Eating is produced by two categories of signals. Homeostatic signals emerge from the body’s need for nutrients and usually work to balance intake with expenditure. Hedonic eating, on the other hand, is not tied to nutrient needs but rather to the pleasurable and rewarding qualities of food. This latter form of eating appears to be related to the activity of a neural system that produces pleasure and uses opioids as its neurotransmitter. Hedonic eating releases opioids in the brain eliciting pleasure. Indeed, blocking the ability of this system to produce pleasure with drugs that block this systems activity results in a reduction in hedonic eating.

 

Mindful eating involves paying attention to eating while it is occurring, including attention to the sight, smell, flavors, and textures of food, to the process of chewing and may help reduce intake. Indeed, high levels of mindfulness are associated with lower levels of obesity and mindfulness training has been shown to reduce binge eating, emotional eating, and external eating. It is suspected that mindful eating counters hedonic eating. So, how well mindfulness reduces intake may reflect how well it influences the opioid system in the brain. Hence, opioid blocking responses should predict the effectiveness of mindful eating interventions.

 

In today’s Research News article “Acute responses to opioidergic blockade as a biomarker of hedonic eating among obese women enrolled in a mindfulness-based weight loss intervention trial.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1343082565715666/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485926/

Mason and colleagues recruited obese women (BMI 30-46) and had them complete questionnaires on nausea, binge eating, food addictions, reward based eating, mindful eating, and emotional eating. They completed these measures after ingesting a placebo pill (no active ingredients) and after a pill containing naltrexone, an opioid blocker. The effectiveness of the blocker was verified by its ability to raise salivary cortisol levels. The participants then received a 5.5-month intervention of either mindfulness training or an active relaxation and cognitive therapy control condition.

 

They found that the greater the pretest reward based eating drive and food addictions and the lower the mindful eating, the greater the response to the opioid blocker naltrexone, suggesting that those who are most susceptible to hedonic eating are the most responsive to blocking the opioid system. Importantly, they also found that the greater the response of highly mindful participants to the opioid blocker the greater, 6-months later, the reduction in food addiction symptoms, binge eating, and reward based eating produced by the mindfulness training.

 

These results suggest that the cortisol response to naltrexone is an indicator of susceptibility to hedonic eating. They further suggest that this responsiveness is predictive of the effectiveness of mindfulness training in reducing hedonic eating. These results may be useful in the future in matching the most effective treatment to the characteristics of the obese individual, with those who are the most responsive to hedonic eating the best candidates for mindful eating treatment. In that way the effectiveness of treatment in reducing intake and body weight and be maximized.

 

So, reduce hedonic eating with mindfulness.

 

“This alternative approach has been dubbed “mindful eating.” Applied to eating, mindfulness includes noticing the colors, smells, flavors, and textures of your food; chewing slowly; getting rid of distractions like TV or reading; and learning to cope with guilt and anxiety about food.” – Harvard Health Letter

 

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

Mason, A. E., Lustig, R. H., Brown, R. R., Acree, M., Bacchetti, P., Moran, P. J., … Epel, E. S. (2015). Acute responses to opioidergic blockade as a biomarker of hedonic eating among obese women enrolled in a mindfulness-based weight loss intervention trial. Appetite, 91, 311–320. http://doi.org/10.1016/j.appet.2015.04.062

 

Highlights

  • We examined acute cortisol and nausea responses to naltrexone
  • Naltrexone responses were associated with measures of hedonic eating
  • Naltrexone responses may identify greater opioid-mediated hedonic eating drive
  • A mindfulness vs. standard weight loss program may improve food addiction

Abstract

There are currently no commonly used or easily accessible ‘biomarkers’ of hedonic eating. Physiologic responses to acute opioidergic blockade, indexed by cortisol changes and nausea, may represent indirect functional measures of opioid-mediated hedonic eating drive and predict weight loss following a mindfulness-based intervention for stress eating. In the current study, we tested whether cortisol and nausea responses induced by oral ingestion of an opioidergic antagonist (naltrexone) correlated with weight and self-report measures of hedonic eating and predicted changes in these measures following a mindfulness-based weight loss intervention. Obese women (N=88; age=46.7±13.2 years; BMI=35.8±3.8) elected to complete an optional sub-study prior to a 5.5-month weight loss intervention with or without mindfulness training. On two separate days, participants ingested naltrexone and placebo pills, collected saliva samples, and reported nausea levels. Supporting previous findings, naltrexone-induced cortisol increases were associated with greater hedonic eating (greater food addiction symptoms and reward-driven eating) and less mindful eating. Among participants with larger cortisol increases (+1 SD above mean), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b=−0.95, SE(b=0.40, 95% CI [−1.74, −0.15], p=.021. Naltrexone-induced nausea was marginally associated with reward-based eating. Among participants who endorsed naltrexone-induced nausea (n=38), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b=−1.00, 95% CI [−1.85, −0.77], p=.024, and trended toward reduced reward-based eating, binge eating, and weight, post-intervention. Single assessments of naltrexone-induced cortisol increases and nausea responses may be useful time- and cost-effective biological markers to identify obese individuals with greater opioid-mediated hedonic eating drive who may benefit from weight loss interventions with adjuvant mindfulness training that targets hedonic eating.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485926/

 

Lower Fibromyalgia Pain with Higher Mindfulness

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By John M. de Castro, Ph.D.

 

“Meditation, particular mindfulness techniques, can lead to improvements in pain intensity when compared to standard care for many chronic pain patients. It also may help improve pain-related disability, pain acceptance, feelings of control over the pain, depression, anxiety, and quality of life, immediately after treatment as well as at follow up later on.” – University Health News

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers.

 

Many studies have linked fibromyalgia with depression. In fact, people with fibromyalgia are up to three times more likely to be depressed at the time of their diagnosis than someone without fibromyalgia. In addition, the stress from pain and fatigue can cause anxiety and social isolation. As a result, many patients experience intense anger regarding their situation. The emotions are understandable, but can act to amplify the pain. Hence, controlling the emotions may reduce the perceived pain. Mindfulness practices have been shown to be effective in reducing pain from fibromyalgia. This may occur directly or indirectly by reducing emotions or both.

 

In today’s Research News article “Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1342272192463370/?type=3&theater

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552195/

Jones and colleagues obtained measures of mindfulness and fibromyalgia impact from a national sample of nearly 5000 fibromyalgia sufferers. They found that the approximately 20% of the sample who meditated had small but statistically lower fibromyalgia impact and symptoms scores than those who did not meditate. They also found that the higher the level of the mindfulness facets of Describing, Non-Reacting, Non-Judging, and Acting with Awareness the lower the fibromyalgia symptoms and the greater the mindfulness facet of Observing the greater the fibromyalgia symptom scores. These relationships still remained significant for all facets regardless of whether a univariate or a multiple regression were employed to document the relationships.

 

These findings confirm with a large national sample and a correlational study what has been previously found that mindfulness improves the symptoms of fibromyalgia. The one exception was with mindfully Observing which was positively correlated with fibromyalgia symptoms. This may have occurred due to a reverse causation such that individuals with more severe fibromyalgia symptoms become more observing of them in the present moment.

 

There are a number of potential explanations for the relationship between high mindfulness and low fibromyalgia symptoms. Mindfulness has been shown to improve emotion regulation which allows the individual to experience the emotions fully but to respond to them in a constructive, productive fashion, thus taking away the amplifying effect of the emotions on pain. Mindfulness training also improves the individual’s ability to focus on the present moment and this has been shown to reduce rumination and catastrophizing which can produce anxiety and depression also amplifying the symptoms. Regardless of the mechanism it is clear the mindfulness can be beneficial in controlling the emotional sequela of fibromyalgia pain.

 

So, lower fibromyalgia pain with higher mindfulness.

 

“People often increase the pain experience by adding to the physical sensations with a host of thoughts and feelings, like catastrophizing the pain or trying to suppress and ignore the pain. Mindfulness is a practice of attending to pain — or body sensations — and thoughts and feelings with that present-moment attention in an accepting and curious manner. With mindfulness practice you learn to relate to anxiety differently, with an open curiosity. Learning to do that leads to a reduction in the fear response itself,” – Susan Smalley

 

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

Jones, K. D., Mist, S. D., Casselberry, M. A., Ali, A., & Christopher, M. S. (2015). Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia. Explore (New York, N.Y.), 11(4), 304–309. http://doi.org/10.1016/j.explore.2015.04.006

 

Abstract

Context and Objective: A growing body of literature suggests that mindfulness techniques may be beneficial in fibromyalgia. A recent systematic review and meta-analysis of six trials indicated improvement in depressive symptoms and quality of life, calling for increased rigor and use of standardized measures in future trials. The purpose of the study was to examine the relationship between mindfulness [as measured by the Five Facet Mindfulness Questionnaire (FFMQ)] and fibromyalgia impact [as measured by the Revised Fibromyalgia Impact Questionnaire (FIQR)].

Design, Setting, and Participants: A cross-sectional survey was conducted with adults diagnosed with fibromyalgia from a national fibromyalgia advocacy foundation e-mail list.

Results: A total of 4986 respondents represented all 50 states in the United States and 30 countries. FIQR scores demonstrated moderate to severe fibromyalgia with the majority of subjects (59%) scoring ≤60. Scores on the FFMQ subscales ranged from 20.8 to 27.3, with highest scores for the observe subscale. All subscale correlations were small to moderate and indicated that more severe fibromyalgia impact was associated with less mindfulness except in the observe scale (r = .15, P > .000). No clinical or demographics explained as much variance in the FIQR total as any of the mindfulness subscales.

Conclusions: Fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions. Baseline values for the observe subscale of the FFMQ were unexpectedly high. Further research is needed to know if this may be due to non-mindful observations and should be noted when the FFMQ is used in fibromyalgia clinical trials.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552195/