Yoga Practice Improves Glycemic Control in Type 2 Diabetes

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Yoga Practice Improves Glycemic Control in Type 2 Diabetes

 

By John M. de Castro, Ph.D.

 

“Yoga can do more than just relax your body in mind — especially if you’re living with diabetes. Certain poses may help lower blood pressure and blood sugar levels while also improving circulation, leading many experts to recommend yoga for diabetes management.” – Healthline

 

Diabetes is a major health issue. It is estimated that 30 million people in the United States and nearly 600 million people worldwide have diabetes and the numbers are growing. Type II Diabetes results from a resistance of tissues, especially fat tissues, to the ability of insulin to promote the uptake of glucose from the blood. As a result, blood sugar levels rise producing hyperglycemia. Diabetes is heavily associated with other diseases such as cardiovascular disease, heart attacks, stroke, blindness, kidney disease, and circulatory problems leading to amputations. As a result, diabetes doubles the risk of death of any cause compared to individuals of the same age without diabetes.

 

Type 2 diabetes is a common and increasingly prevalent illness that is largely preventable. One of the reasons for the increasing incidence of Type 2 Diabetes is its association with overweight and obesity which is becoming epidemic in the industrialized world. A leading cause of this is a sedentary life style. Unlike Type I Diabetes, Type II does not require insulin injections. Instead, the treatment and prevention of Type 2 Diabetes focuses on diet, exercise, and weight control. Recently, mindfulness practices have been shown to be helpful in managing diabetes. A mindfulness practice that combines mindfulness with exercise is yoga and it has been shown to be helpful in the treatment of Type II Diabetes.

 

In today’s Research News article “Effectiveness of Yoga-based Exercise Program Compared to Usual Care, in Improving HbA1c in Individuals with Type 2 Diabetes: A Randomized Control Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735507/ ) Gupta and colleagues recruited  patients over 30 years of age with Type 2 Diabetes. They were randomly assigned to receive either a 4-month program of diet and walking exercise or a Yoga-based Exercise Program. The yoga program consisted of meditation, breathing exercises, postures, and stretching. The participants had blood drawn before and after training and assayed for HbA1c, blood fats, and blood glucose.

 

They found that in comparison to baseline and the diet and walking group, the yoga group had a significantly greater reduction in HbA1c. Glycated hemoglobin, HbA1c, is a measure that reflect the control of blood glucose levels over a long period of time. Low HbA1c levels is a sign of good blood glucose control which is essential to the control of the effects of Type 2 Diabetes on the body. So, the results signal that yoga practice results in better glucose control in these patients than a diet and walking program. This suggests that yoga would promote better health in patients with Type 2 Diabetes.

 

So, yoga practice improves glycemic control in Type 2 Diabetes.

 

“Stress elevates blood sugar, which can lead to more diabetes complications. Yoga helps us center ourselves, and centering calms us and can help keep blood sugar levels balanced.” – Janet Zappe

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Gupta, U., Gupta, Y., Jose, D., Mani, K., Jyotsna, V. P., Sharma, G., & Tandon, N. (2020). Effectiveness of Yoga-based Exercise Program Compared to Usual Care, in Improving HbA1c in Individuals with Type 2 Diabetes: A Randomized Control Trial. International journal of yoga, 13(3), 233–238. https://doi.org/10.4103/ijoy.IJOY_33_20

 

Abstract

Background:

This study was designed to evaluate the effectiveness of a yoga-based exercise program (YBEP) in improving glycemic control in people with type 2 diabetes mellitus.

Materials and Methods:

Patients on stable oral glucose-lowering agents for at least 3 months and HbA1c 7.5%–10% were randomized in 1:1 ratio. The primary outcome measure was the difference of change in mean HbA1c between groups.

Results:

The participants (n = 81) had mean (±standard deviation) age of 50.6 (±8.5) years and HbA1c of 8.5 ± 0.7% (68.97 ± 7.42 mmol/mol). The follow-up data were available in 96% (78/81) of participants. Of 40 participants, 25 (62.5%) attended ≥75% (≥10 out of 13) of the sessions in YBEP. On the intention to treat analysis, a favorable reduction (0.21% 95% confidence interval [−0.34, 0.75], P = 0.454) in HbA1c was seen in YBEP group as compared to usual care. The reduction in HbA1c by ≥0.5% was observed in 44.7% of participants in YBEP as compared to 37.5% in usual care arm, respectively. Those who attended ≥75% of the sessions had better HbA1c reduction of 0.3% in comparison to 0.1% reduction seen in those who attended <75% of the sessions.

Conclusions:

YBEP demonstrated a clinically relevant HbA1c reduction compared to usual care in participants who had attended at least 75% of the yoga sessions. The reduction in HbA1c by >0.5% in 44.7% in the yoga group, suggests, that it can be prescribed as an exercise to individuals who are unable to walk either due to limited joint mobility, adverse weather conditions, lack of space for walking, cultural or religious prohibitions for women for outdoor physical activity, and so on.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735507/

 

Improve Obese Individuals’ Ability to Respond Adaptively to Stressors with Mindfulness

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Improve Obese Individuals’ Ability to Respond Adaptively to Stressors with Mindfulness

 

By John M. de Castro, Ph.D.

 

“patients with obesity do better at reducing stress with mindfulness exercises.” – Sharon Basaraba

 

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 to currently around 35% of the population, while two thirds of the population are considered overweight or obese (BMI > 25). Obesity has been found to shorten life expectancy by eight years and extreme obesity by 14 years. This occurs because obesity is associated with cardiovascular problems such as coronary heart disease and hypertension, stroke, metabolic syndrome, diabetes, cancer, arthritis, and others.

 

Obviously, there is a need for effective treatments to obese individuals. But, despite copious research and a myriad of dietary and exercise programs, there still is no safe and effective treatment. Mindfulness is known to be associated with lower risk for obesity, alter eating behavior and improve health in obesity. Stress responses are blunted and variable in obese individuals. Mindfulness training has been shown to improve the individuals physiological and psychological responses to stress. One of the ways that mindfulness may be effective for obese individuals is by improving their adaptive responses to stress.

 

In today’s Research News article “A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138245/ ) Daubenmeir and colleagues recruited adults with abdominal obesity (BMI>30) and provided them with a 12-week program of diet and exercise. Half were randomly assigned to also receive mindfulness training similar to the Mindfulness-Based Stress Reduction (MBSR) program. In previously reported results, the mindfulness training produced greater improvements in metabolism but non-significant improvements in body weight.

 

In the present study they report the results of studies of the obese participants stress responsivity. They were measured before and after the 12-week diet and exercise training with a social stress test that involved giving a speech and verbally doing math problems while being evaluated by strangers. In addition, cardiovascular factors were measured including the electrocardiogram (EKG), blood pressure and cardiac impedance.

 

They found that in comparison to baseline and the control condition, the mindfulness trained participants reported that the social stress tasks was a significantly greater positive challenge and produced significantly less anxiety. They also found that the mindfulness group had significantly greater cardiac output and significantly lower total peripheral resistance while the control group had a significant increase in total peripheral resistance.

 

These results suggest that mindfulness training increases the obese individual’s ability to adapt psychologically and physiologically to stress. That mindfulness reduces anxiety and improves adaptation to stress has been previously reported using different evaluation techniques and different participant populations. The present study extends these findings by demonstrating that mindfulness has similar benefits for the obese. Since stress reactivity can be a particular problem for the obese, the improved adaptive responses to stress after mindfulness training may be especially helpful for these individuals.

 

So, improve obese individuals’ ability to respond adaptively to stressors with mindfulness.

 

“restricted diets may in fact increase anxiety in obese children. However, practicing mindfulness, as well dieting, may counteract this and promote more efficient weight loss,” – Mardia López-Alarcón

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Daubenmier, J., Epel, E. S., Moran, P. J., Thompson, J., Mason, A. E., Acree, M., Goldman, V., Kristeller, J., Hecht, F. M., & Mendes, W. B. (2019). A Randomized Controlled Trial of a Mindfulness-Based Weight Loss Intervention on Cardiovascular Reactivity to Social-Evaluative Threat Among Adults with Obesity. Mindfulness, 10(12), 2583–2595. https://doi.org/10.1007/s12671-019-01232-5

 

Objective:

Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the “challenge and threat” framework, which defines adaptive and maladaptive patterns of psychophysiological stress reactivity. We hypothesized that mindfulness training would facilitate increased challenge-related appraisals, emotions, and cardiovascular reactivity, including sympathetic nervous system activation paired with increased cardiac output (CO) and reduced total peripheral resistance (TPR) compared to a control group, which would exhibit an increased threat pattern of psychophysiological reactivity to repeated stressors.

Methods:

Adults (N=194) with obesity were randomized to a 5.5-month mindfulness-based weight loss intervention or an active control condition with identical diet-exercise guidelines. Participants were assessed at baseline and 4.5 months later using the Trier Social Stress Task. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during the speech and verbal arithmetic tasks to assess pre-ejection period (PEP), CO, and TPR reactivity.

Results:

Mindfulness participants showed significantly greater maintenance of challenge-related emotions and cardiovascular reactivity patterns (higher CO and lower TPR) from pre to post-intervention compared to control participants, but groups did not differ in PEP. Findings were independent of changes in body mass index.

Conclusions:

Mindfulness training may increase the ability to maintain a positive outlook and mount adaptive cardiovascular responses to repeated stressors among persons with obesity though findings need to be replicated in other populations and using other forms of mindfulness interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138245/

 

Improve Romantic Relationship Well-Being with Brief Mindfulness or Relaxation Training

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Improve Romantic Relationship Well-Being with Brief Mindfulness or Relaxation Training.

 

By John M. de Castro, Ph.D.

 

“When you are mindful of the love in your life you open yourself up to the opportunity for love to grow. And not just romantic love, but self-love, and loving friendships as well.” – Mindful

 

Relationships can be difficult as two individuals can and do frequently disagree or misunderstand one another. These conflicts can produce strong emotions and it is important to be able to regulate these emotions in order to keep them from interfering with rational solutions to the conflict. Mindfulness may be helpful in romantic relationships, as it has been shown to improve the emotion regulation and decrease anger and anxiety. It may be a prerequisite for deep listening and consequently to resolving conflict. Indeed, mindfulness has been shown to improve relationships. So, mindfulness may be a key to successful relationships.

 

One of the effects of mindfulness training is an increase in the ability to relax. It is possible that it is relaxation that is responsible for improvements in romantic relationships. In today’s Research News article “Comparing the effects of a mindfulness versus relaxation intervention on romantic relationship wellbeing.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730385/ ) Karremans and colleagues recruited adult couples involved in a romantic relationship of at least 1 year in duration and living together. One member of each couple was randomly assigned to a 2-week program of either breath focused mindfulness training or progressive muscle relaxation training. The programs consisted of daily 10-minute audio guided practices. Before and after the interventions and one month later the participant and their partner completed measures of relationship satisfaction, relationship distress, perceived connectedness, partner acceptance, relationship excitement, and adherence to the training programs.

 

They found that after mindfulness training for both the participant and their partner there were significant increases in relationship satisfaction, perceived connectedness, and partner acceptance and decreases in relationship distress. These effects were still present at the 1-month follow-up. These findings did not significantly differ between the mindfulness and relaxation groups.

 

Because both groups had significant improvements in their relationship well-being it is possible that the results were produced by participant expectancy (placebo) effects rather than the interventions. But if this potential contaminant is disregarded, the results tend to suggest that both mindfulness and relaxation trainings improve romantic relationships. Previous research has also shown that mindfulness training improves relationships.

 

Relationships can be difficult but are fundamental to the well-being of the individuals. So, improving the relationships may have widespread implications for the individuals’ psychological health and well-being. The training procedures in the present study suggests that these benefits can be produced by a brief audio-guided mindfulness training program. This is important as it allows for more widespread and economical distribution of the treatment; improving relationships.

 

So, improve romantic relationship well-being with brief mindfulness or relaxation training.

 

“if you want to build more secure attachment or be more successful in love, try learning mindfulness along with your partner! “ – Melanie Greenberg

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Karremans, J. C., Kappen, G., Schellekens, M., & Schoebi, D. (2020). Comparing the effects of a mindfulness versus relaxation intervention on romantic relationship wellbeing. Scientific reports, 10(1), 21696. https://doi.org/10.1038/s41598-020-78919-6

 

Abstract

There is increasing scientific interest in the potential association between mindfulness and romantic relationship wellbeing. To date, however, experimental studies using active control groups and testing dyadic effects (i.e. examining both actor and partner effects) are lacking. In the current study, romantically involved individuals engaged for 2 weeks daily in either guided mindfulness exercises, or guided relaxation exercises. Participants, and their partners, completed measures of relationship wellbeing at pre- and post-intervention, and at 1-month follow up. The mindfulness intervention significantly promoted relationship wellbeing, for both participants (i.e. actor effects) and their partners (i.e. partner effects). However, these findings did not significantly differ from changes in relationship wellbeing in the relaxation condition. Theoretical implications of these findings for understanding the association between mindfulness and romantic relationship wellbeing are discussed. Moreover, the findings are discussed in light of recent debates about the relative lack of proper control groups in mindfulness research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730385/

 

Cancer Patients’ Quality of Life is Associated with Mindfulness

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Cancer Patients’ Quality of Life is Associated with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness-based intervention . . . may help to decrease the stress of cancer-related cognitive impairment and can therefore indirectly improve quality of life in this patient population.” – Hannah Slater

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. But cancer diagnosis is not necessarily a death sentence. Over half of the people diagnosed with cancer are still alive 10 years later and this number is rapidly increasing. But, surviving cancer carries with it a number of problems. Anxiety, depression, fatigue and insomnia are common symptoms in the aftermath of surviving breast cancer. These symptoms markedly reduce the quality of life of the patients. Mindfulness training has been shown to help with cancer recovery and help to relieve chronic pain. It can also help treat the residual physical and psychological symptoms, including stress, sleep disturbance, fear, and anxiety and depression.

 

In today’s Research News article “Stress and Quality of Life of Patients with Cancer: The Mediating Role of Mindfulness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748895/ ) Dehghan and colleagues recruited adult patients diagnosed with cancer and had them complete measures of mindfulness, perceived stress, and quality-of-life; including overall, functioning, and symptoms. They performed regression and path analysis on these data.

 

They found that the higher the level of mindfulness, the higher the level of quality-of-life functioning and the lower the level of perceived stress and quality of life symptoms. Also, the higher the level of perceived stress the higher the level of quality-of-life symptoms and the lower the level of overall and functioning quality of life. They reported from the path analysis that perceived stress was associated with poorer quality of life directly and indirectly by being associated with lower levels of mindfulness which were in turn associated with greater quality of life. In other words, perceived stress was associated with reduced quality of life in part by being associated with reduced mindfulness.

 

These results are correlative and causation cannot be determined. But prior manipulative research has demonstrated that mindfulness produces lower perceived stress and greater quality of life, So, the associations reported here are likely due to causal connections between the variables. Hence, the findings suggest that the quality of life of cancer patients is lowered by stress and this is in part due to stress lowering mindfulness.

 

So, cancer patients’ quality of life is associated with mindfulness.

 

“Mindfulness based interventions hold a great deal of promise for helping people with cancer cope across a broad range of symptoms and issues, both during and after the completion of active treatment.” – Jessica Pieczynski

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Dehghan, M., Jazinizade, M., Malakoutikhah, A., Madadimahani, A., Iranmanesh, M. H., Oghabian, S., Mohammadshahi, F., Janfaza, F., & Zakeri, M. A. (2020). Stress and Quality of Life of Patients with Cancer: The Mediating Role of Mindfulness. Journal of Oncology, 2020, 3289521. https://doi.org/10.1155/2020/3289521

 

Abstract

Background

Cancer is one of the major health problems worldwide, which in addition to physical disorders, causes stress and anxiety in patients and affects the quality of life of cancer patients. Mindfulness can affect stress and improve the quality of life. This research explained the correlation between stress, quality of life, and mindfulness.

Materials and Methods

Two hundred five cancer patients participated in this cross-sectional study. Patients completed the EORTC Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Mindfulness Attention and Awareness Scale (MAAS), and Perceived Stress Scale (PSS).

Results

Perceived stress and mindfulness predict nearly 39% of the changes of QOL in cancer patients. In addition, perceived stress was negatively associated with mindfulness and quality of life (P < 0.05). Mindfulness was positively correlated with quality of life (P < 0.05). Mindfulness played a mediating role in the relationship between perceived stress and quality of life (standardized β = −0.13; SE = 0.07, 95% confidence interval = −0.28 to −0.01; P value = 0.04).

Conclusion

In the present study, the variables of mindfulness and perceived stress affected the quality of life of cancer patients. Mindfulness can affect the quality of life of cancer patients directly and indirectly. These results emphasize the importance of mindfulness in the lives of cancer patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748895/

 

Reduce High School Students’ Anxiety Levels with Mindfulness

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Reduce High School Students’ Anxiety Levels with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Anxiety has become a large mental health concern in students, and schools should implement mindfulness to teach students to understand and regulate their anxiety.” – Gina Bradshaw

 

There is a lot of pressure on high school students to excel so that they can get the best jobs or admission into the best universities after graduation. This stress might in fact be counterproductive as the increased pressure can actually lead to stress and anxiety which can impede the student’s physical and mental health, well-being, and school performance. Mindfulness training has been shown through extensive research to be effective in improving physical and psychological health. Indeed, these practices have been found to improve psychological health in high school students. It is important to ascertain whether mindfulness can be integrated into the high school curriculum and produce improvements in student mental health.

 

In today’s Research News article “Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755132/ ) Johnstone and colleagues recruited students taking mandatory health education classes at a private high school. The students in 3 classrooms received 8 weeks of mindfulness training, in 2 classrooms received 8 weeks of wellness training, and in 8 classrooms received the usual health education curriculum. Along with the regular curriculum students in the mindfulness classes received training in meditation, body scan, and yoga while those in the wellness classes received training in time management and conflict resolution strategies. The students were instructed to practice at home for 10 minutes each day. The students completed measures of their expectancies, interventions acceptability, attendance, and their satisfaction with the intervention. Before and after the interventions they completed measures of mindfulness, perceived stress, depression, and anxiety.

 

They found that the students in the mindfulness training classrooms had significant reductions in anxiety after training compared to baseline and the students in the usual health education classes. But they did not significantly differ from the students in the wellness training classes. There were no significant differences between the groups in depression or perceived stress.

 

The students in the study did not have clinical levels of anxiety or depression prior to the study. So, improvements in mental health would be hard to detect given the low baseline. Nevertheless, significant reductions in anxiety were detected. Mindfulness training has been routinely found in prior research to reduce anxiety in both clinical and non-clinical participants. So, the reduced anxiety in the present study was not surprising.

 

Anxiety in high school students is generally high as the students are under pressure to perform in addition to the difficult adjustments ongoing during adolescence. High anxiety tends to interfere with school performance and social adjustments. Reducing these anxiety levels should be quite helpful to these students. Academic performance was not measured in the present study. But it would be predicted that reductions in anxiety in the students would result in better academic performance.

 

So, reduce high school students’ anxiety levels with mindfulness.

,

“With 15 minutes of daily meditation for at least three weeks, the brain becomes more responsive and less reactive — which can be especially helpful to teens prone to anxiety or erratic behavior,” – Jane Ehrman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Johnstone, J. M., Ribbers, A., Jenkins, D., Atchley, R., Gustafsson, H., Nigg, J. T., Wahbeh, H., & Oken, B. (2020). Classroom-Based Mindfulness Training Reduces Anxiety in Adolescents: Acceptability and Effectiveness of a Cluster-Randomized Pilot Study. Journal of restorative medicine, 10(1), 10.14200/jrm.2020.0101. https://doi.org/10.14200/jrm.2020.0101

 

Abstract

Objective:

Many high school students experience a high degree of anxiety and perceived stress. This study examined whether a classroom-based mindfulness program or a wellness program were acceptable and effective as anxiety and stress reduction interventions based on students’ self-reports.

Design, setting, and participants:

Thirteen health education classes (n=285 students, aged 14–16 years) were randomized by classroom to one of three conditions: mindfulness, wellness, or usual health class only (passive control/ waitlist), for 8 weeks.

Outcomes:

Pre- and post-intervention scores compared self-reported measures of depression, anxiety and stress.

Results:

Complete data were available from nine classes (n=202 students). Post-intervention anxiety scores were reduced in students who received the mindfulness intervention compared to those who received only their usual health class (β=−0.07, SE=0.03, P≤0.001; 95% CI=−0.12, −0.02). No significant between group differences were found for depression or stress (P>0.4). Students’ satisfaction with the mindfulness intervention they received withstood baseline credibility and expectancy effects: r=0.21, n=67, P=0.17 for credibility; r=−0.001, n=67, P=0.99 for expectancy. However, students’ satisfaction with the wellness intervention they received was positively correlated with their pre-intervention expectations, r=0.42, n=47, P>0.001. Fifty-two percent of the 68 students assigned to mindfulness (n=35) used the iPad app for mindfulness home practice at least once; of those, 10% used it 10 or more times.

Conclusion:

Eight weeks of classroom-based mindfulness, with limited home practice, reduced self-reported anxiety compared to usual health class, and withstood baseline expectancy effects in this group of high school students, a majority who come from high income families.

Clinical implications:

School- or community-based mindfulness may be an appropriate recommendation for adolescents who experience anxiety.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755132/

 

Mindfulness is Associated with Better Mental Health in Young Adults

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Mindfulness is Associated with Better Mental Health in Young Adults

 

By John M. de Castro, Ph.D.

 

“Mindfulness is recommended as a treatment for people with mental ill-health as well as those who want to improve their mental health and wellbeing.” – Mental Health Foundation

 

Mindfulness stresses present moment awareness, minimizing focus on past memories and future planning. Depression is characterized by a focus on the past while anxiety is characterized by focus on the future. Although awareness of the past and future are important, focus on the present moment generally leads to greater psychological health and well-being. Mindfulness appears to improve the individual’s ability to regulate emotions. It is reasonable to assume that this improvement in emotion regulation may be responsible for the beneficial effects of mindfulness on mental health. There is a need to better understand how mindfulness and emotion regulation produce these benefits.

 

In today’s Research News article “Dispositional mindfulness and mental health in Chinese emerging adults: A multilevel model with emotion dysregulation as a mediator.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676716/ ) Cheung and colleagues recruited from a university healthy young adults aged 18 to 29 years. They completed measures at baseline and 3 and 6 months later of mindfulness, emotion regulation, depression, anxiety, and well-being. These data were then subjected to regression analysis and multilevel mediation analysis.

 

They found that at all time points the higher the levels of mindfulness the lower the levels of depression, and anxiety, and the higher the levels of emotion regulation, and subjective well-being. They also found that the higher the levels of emotion regulation the lower the levels of depression, and anxiety, and the higher the levels of subjective well-being.

 

The mediation analysis suggested that mindfulness was associated with improved anxiety, depression, and well-being directly and also indirectly through emotion regulation, such that high mindfulness was associated with high emotion regulation which was, in turn, associated with lower anxiety and depression and higher well-being. Over the 3 measurements mental health of the participants appeared to decrease with higher levels of anxiety and depression and lower levels of well-being, perhaps as the stress of the academic year increased. But the relationships of these variables with mindfulness and emotion regulation remained intact over the 3 time periods.

 

These results are correlational and as such conclusions regarding causation cannot be made. But previous research has shown causal connections between mindfulness and emotion regulation, depression, anxiety, and well-being. So, the present results likely also reflect causal influences of mindfulness. The results suggest that mindfulness has direct beneficial effects on mental health and also indirect effects by improving the regulation of emotions. Emotion regulation involves the ability to fully experience emotions but also being able to control response to the emotions. This appears to be strengthened by mindfulness and is an important route by which mindfulness produces better mental health.

 

So, mindfulness is associated with better mental health in young adults.

 

“Young adulthood is an incredibly important time marked by major changes, big life decisions and new pressures. Without proper support and the right skills in place, many young adults can suffer from depression and feelings of anxiety that can manifest as avoidance, substance use and self-harm. Mindfulness techniques help clients attend to their thoughts and feelings non-judgmentally and moment-to-moment. This helps them connect with their inner selves, engage more fully in their present life activities and develop better coping mechanisms for life’s stressors.” – The Dorm

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Cheung, R., Ke, Z., & Ng, M. (2020). Dispositional mindfulness and mental health in Chinese emerging adults: A multilevel model with emotion dysregulation as a mediator. PloS one, 15(11), e0239575. https://doi.org/10.1371/journal.pone.0239575

 

Abstract

Using a multilevel model, this study examined emotion dysregulation as a mediator between dispositional mindfulness and mental health among Chinese emerging adults. Participants were 191 Chinese emerging adults (female = 172) between 18 and 27 years old (M = 21.06 years, SD = 2.01 years), who completed a questionnaire that assessed their dispositional mindfulness, emotion dysregulation, and mental health outcomes for three times over 12 months, with a three-month lag between each time point. Within-person analysis revealed that emotion dysregulation mediated between dispositional mindfulness and mental health outcomes, including subjective well-being and symptoms of depression and anxiety. Time was positively associated with emotion dysregulation and negatively associated with symptoms of depression and anxiety. Between-person analysis revealed that emotion dysregulation negatively mediated between dispositional mindfulness and symptoms of depression and anxiety, but not subjective well-being. These findings call attention to within-person versus between-person effects of emotion dysregulation as a mediator between dispositional mindfulness and psychological outcomes, particularly of symptoms of depression and anxiety. Attesting to the relations established in western societies, the relations are also applicable to emerging adults in the Chinese context. Evidence was thus advanced to inform translational research efforts that promote mindfulness and emotion regulation as assets of mental health.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7676716/

Change the Brain to Improve Fibromyalgia with Tai Chi

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Change the Brain to Improve Fibromyalgia with Tai Chi

 

By John M. de Castro, Ph.D.

 

“tai chi appears to be as effective or better for managing fibromyalgia . . .  and patients are more likely to attend tai chi classes than aerobic exercise sessions.” – NCCIH

 

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. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Tai Chi is an ancient Chinese practice involving mindfulness and gentle movements. They are easy to learn, safe, and gentle. So, it may be appropriate for patients with fibromyalgia where exercise can produce painful flares.

 

In general, mindfulness practices both produce psychological and physical benefits and also change the structure and connectivity of the brain. Indeed, Tai Chi practice has been shown to improve the symptoms of fibromyalgia. So, Tai Chi may be beneficial for fibromyalgia by altering the brain systems involved in the disorder.

 

In today’s Research News article “Altered resting state functional connectivity of the cognitive control network in fibromyalgia and the modulation effect of mind-body intervention.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214794/ ) Kong and colleagues recruited adult patients with fibromyalgia and a group of age, gender, and body size matched controls. The fibromyalgia patients received Tai Chi practice twice a week for 1-hour for 12 weeks. All participants underwent functional Magnetic Resonance Imaging (fMRI) of their brains before and after the 12-week period and also completed measures of depression, and fibromyalgia impact, including function, overall impact, and symptom severity.

 

They found that after Tai Chi training there was a significant improvement in the fibromyalgia patients’ depression, and fibromyalgia impact, including function, overall impact, and symptom severity. They examined a set of connected brain structures (frontal gyrus, parietal gyrus, and anterior cingulate cortex) called the cognitive control network. At baseline, the fibromyalgia patients had significantly greater levels of resting functional connectivity between the structures in this network. After 12 weeks of Tai Chi practice the functional connectivity between the structures in the cognitive control network were further significantly increased. In addition, they found that the greater the increase in functional connectivity the greater the improvement in overall fibromyalgia symptoms.

 

The ability of Tai Chi to improve the symptoms of fibromyalgia has been documented preciously. The contribution of the present study is to document the differences in the brains of fibromyalgia patients and healthy people and the changes in the brain of these patients that occur with Tai Chi practice. In particular the cognitive control network had increased functional connectivity in these patients and that connectivity increased significantly after Tai Chi practice. This may indicate the neural mechanism by which Tai Chi practice improves fibromyalgia symptoms. The fact that the amount of connectivity change was associated with the degree of improvement, supports this inference.

 

The baseline difference in connectivity may indicate that the way the patients’ brains adapted to help deal with the impact of fibromyalgia and Tai Chi practice further improved this adaptation. The cognitive control network is involved in high level thinking, attention, and executive control. Hence, these patients may be employing high level thought processes including the allocation of attention to help deal with the disease and Tai Chi practice further improves their ability to do this. It has been shown that attention to the pain in the present moment while not thinking about its past occurrences or worrying about the future reduces the severity of the pain. This may be what the brain is doing to help cope with fibromyalgia symptoms; using attention to mitigate the pain.

 

So, change the brain to improve fibromyalgia with Tai Chi

 

“subjects with fibromyalgia, reported benefits (compared with control groups or before/after comparisons) of Tai Chi in core symptom domains for this condition (pain, sleep, impact, physical function and mental function).” – Jana Sawynok

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Kong, J., Wolcott, E., Wang, Z., Jorgenson, K., Harvey, W. F., Tao, J., Rones, R., & Wang, C. (2019). Altered resting state functional connectivity of the cognitive control network in fibromyalgia and the modulation effect of mind-body intervention. Brain imaging and behavior, 13(2), 482–492. https://doi.org/10.1007/s11682-018-9875-3

 

Abstract

This study examines altered resting state functional connectivity (rsFC) of the cognitive control network (CCN) in fibromyalgia patients as compared to healthy controls, as well as how effective interventions, such as Tai Chi, can modulate the altered rsFC of the CCN. Patients with fibromyalgia and matched healthy subjects were recruited in this study. Fibromyalgia patients were scanned 12 weeks before and after intervention. The bilateral dorsolateral prefrontal cortex (DLPFC) was used as a seed to explore the rsFC of the CCN. Data analysis was conducted with 21 patients and 20 healthy subjects. Compared to healthy subjects, fibromyalgia patients exhibited increased rsFC between the DLPFC and the bilateral rostral anterior cingulate cortex (rACC) and medial prefrontal cortex (MPFC) at baseline. The rsFC between the CCN and rACC/MPFC further increased after Tai Chi intervention, and this increase was accompanied by clinical improvements. This rsFC change was also significantly associated with corresponding changes in the Overall Impact domain of the Revised Fibromyalgia Impact Questionnaire (FIQR). Further analysis showed that the rACC/MPFC rsFC with both the PAG and hippocampus significantly decreased following Tai Chi intervention. Our study suggests that fibromyalgia is associated with altered CCN rsFC and that effective treatment may elicit clinical improvements by further increasing this altered rsFC. Elucidating this mechanism of enhancing the allostasis process may deepen our understanding of the mechanisms underlying mind-body intervention non-pharmacological treatment of fibromyalgia and facilitate the development of new pain management methods.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214794/

 

Reduce Premature Ejaculation and Increase Sexual Satisfaction with Yoga

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Reduce Premature Ejaculation and Increase Sexual Satisfaction with Yoga

 

By John M. de Castro, Ph.D.

 

“Integrating yoga as a non-pharmacological treatment modality into contemporary sex therapy has the potential to offer beneficial effects for different facets of human sexuality.” – Anjali Mangesh Joshi

 

Sexual behavior is a very important aspect of human behavior. In fact, Sigmund Freud made it a centerpiece of his psychodynamic theory. At its best, it is the glue that holds families and relationships together. Problems with sex, though, are very common, but it is rarely discussed and there is little research. While research suggests that sexual dysfunction is common, it is a topic that many people are hesitant or embarrassed to discuss.

 

Premature ejaculation is a very common sexual dysfunction that affects around 30% of a males. Premature ejaculation can adversely affect the quality of life of the patients and their partners. Yet, it is under-reported and under treated. Three domains which define premature ejaculation include short ejaculatory latency, perceived lack of control of ejaculation, and negative personal consequences and interpersonal issues. Chronic stress can be a contributing factor to premature ejaculation in men.

 

Premature ejaculation is often treated with drugs such as Paroxetine, a selective serotonin reuptake inhibitor (SSRI). Mindfulness practices, such as yoga practice,,may be effective non-pharmacological treatments for Premature ejaculation. They have been shown to reduce stress and improve sexual function. It is likely, then, that yoga may be helpful in treating premature ejaculation.

 

In today’s Research News article “A Comparative Study of Yoga with Paroxetine for the Treatment of Premature Ejaculation: A Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735509/ ) Rohilla and colleagues recruited otherwise healthy adult men diagnosed with premature ejaculation. The participants selected whether they wished to participate in a 12-week program of yoga or to receive drug treatment (Paroxetine). Yoga postures and mudras were practiced 2 to 3 times per day. Before, during and after treatment the participants self-measured their intravaginal ejaculation latency times.

 

They found that over the 12 weeks of treatments both groups had significant and increasing intravaginal ejaculation latency times and self-reported sexual satisfaction. The effect size for the yoga group was significantly greater than for the Paroxetine group. Only 19% of the patients in the yoga group reported adverse effects and they were very mild. On the other hand, the patients receiving Paroxetine reported more significant adverse effects.

 

This is a pilot study and did not have randomized assignment of participants to groups or a placebo control group. So, self-selection of treatment and placebo effects may have been significant factors. But the results are clear with both groups significantly improving. Yoga appears to have slightly better outcomes and fewer adverse effects and may be the preferred treatment.

 

So, reduce premature ejaculation and increase sexual satisfaction with yoga.

 

“yoga has improved the time taken for ejaculation and satisfaction to female partner.” – Kshama Gupta

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Rohilla, J., Jilowa, C. S., Tak, P., Hasan, S., & Upadhyay, N. (2020). A Comparative Study of Yoga with Paroxetine for the Treatment of Premature Ejaculation: A Pilot Study. International journal of yoga, 13(3), 227–232. https://doi.org/10.4103/ijoy.IJOY_89_19

 

Abstract

Context:

Premature ejaculation (PME) is a common sexual disorder. Drugs used commonly used for its treatment have various side effects and disadvantages. Yoga is being increasingly studied in a variety of medical disorders with positive results. However, its evidence for patients with PME is very limited.

Aims:

The aims of this study were to investigate the effect of yoga on ejaculation time in patients with PME and to compare it with paroxetine.

Settings and Design:

This was a nonrandomized nonblinded comparative study in a tertiary care center.

Materials and Methods:

Among patients with PME, 40 selected paroxetine and 28 yoga. Intravaginal ejaculation latency time (IELT) was measured in seconds once before and three times after intervention.

Statistical Analysis Used:

Mean, standard deviation, paired and unpaired t-tests, and repeated measures ANOVA were used for statistical analysis.

Results:

IELT was significantly increased in both groups – paroxetine (from 29.85 ± 11.9 to 82.19 ± 32.9) and yoga (from 25.88 ± 16.1 to 88697 + 26.9). Although the effect of yoga was slightly delayed in onset, its effect size (η2 = 0.87, P < 0.05) was more than paroxetine (η2 = 0.73, P < 0.05). One-fifth of the patients in the paroxetine group (19.5%) and 8% in the yoga group continued to have the problem of PME at the end of the trial.

Conclusions:

Yoga caused improvement in both intravaginal ejaculation latency time and subjective sexual experience with minimal side effect. Therefore, yoga could be an easily accessible economical nonpharmacological treatment option for the patient with PME.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735509/

 

Reduce the Impact of Problematic Social Media Use on Depression During the Covid-19 Pandemic with Mindfulness

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Reduce the Impact of Problematic Social Media Use on Depression During the Covid-19 Pandemic with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Social media addiction is becoming an increasing problem. . . Mindfulness is a training that helps us become more present, self aware and better able to respond rather than react on autopilot in our everyday lives. It’s been shown to help with impulse control . . .and is a powerful tool for kicking addictions ranging from drugs, to social media.” – Elise Bialylew

 

Over the last few decades, the internet has gone from a rare curiosity to the dominant mode of electronic communications. In fact, it has become a dominant force in daily life, occupying large amounts of time and attention. As useful as the internet may be, it can also produce negative consequences. “Problematic Internet Use” is now considered a behavioral addiction, with almost half of participants in one study considered “Internet addicts”, developing greater levels of “tolerance” and experiencing “withdrawal” and distress when deprived. This phenomenon is so new that there is little understanding of its nature, causes, and consequences and how to treat it.

 

Mindfulness training has been shown to be helpful with each of the components of addictions, decreasing cravings, impulsiveness, and psychological and physiological responses to stress, and increasing emotion regulation.  It is no wonder then that mindfulness training has been found to be effective for the treatment of a variety of addictions. It also has been found to be helpful in overcoming internet and smartphone addictions.

 

Problematic use of the internet and social media has been amplified by the Covid-19 pandemic. It has produced social isolation and interacting over the internet is one of the few means available to communicate. It is not known the extent to which mindfulness may help to prevent social media use from becoming problematic promoting fear and depression.

 

In today’s Research News article “Relationship Between Problematic Social Media Usage and Employee Depression: A Moderated Mediation Model of Mindfulness and Fear of COVID-19.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.557987/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1514613_69_Psycho_20201224_arts_A ) Majeed and colleagues recruited adult Pakistanis who were employed during the Covid-19 lockdown. The participants completed online questionnaires measuring problematic social media usage, fear of Covid-19, depression, and mindfulness.

 

They found that the greater the problematic social media usage, the greater the fear of Covid-19, and depression and the lower the level of mindfulness. In addition, the greater the fear of Covid-19, the greater the level of depression and the lower the level of mindfulness. Finally, the greater the level of mindfulness the lower the level of depression. They performed a mediation analysis and found that the fear of Covid-19 mediated the positive relationship of problematic social media usage with depression such that problematic social media usage was associated with greater fear of Covid-19, which was, in turn, associated with greater depression. They further found that this mediation was moderated by mindfulness such that the higher the levels of mindfulness the weaker the mediation of fear of Covid-19.

 

These are correlative findings and as such must be interpreted with caution. But they show that higher problematic social media usage is associated with depression via fear of Covid-19 and this mediation is dampened by mindfulness. “Problematic social media usage is defined as; an excessive use of social media regularly, to the extent that it seems difficult to stay away from it.” It can be speculated that overuse of social media during the pandemic reinforces the fear of the disease and this fear in a lockdown context promotes depression.

 

Mindfulness appears to be somewhat of an antidote reducing the impact of the social media use on fear and depression. To some extent this is not surprising as mindfulness has been repeatedly shown to decrease depression and fear. Mindfulness also has been found to be helpful in overcoming internet and smartphone addictions. What is new here is the effect of mindfulness on the lowering the impact of social media use on fear and depression during a pandemic.

 

So, reduce the impact of problematic social media use on depression during the Covid-19 pandemic with mindfulness.

 

“compulsive mobile SNS use induces stress and that mindfulness has also lowering effects on stress derived from such compulsive behavior,” – Vanessa Apaolaza

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Majeed M, Irshad M, Fatima T, Khan J and Hassan MM (2020) Relationship Between Problematic Social Media Usage and Employee Depression: A Moderated Mediation Model of Mindfulness and Fear of COVID-19. Front. Psychol. 11:557987. doi: 10.3389/fpsyg.2020.557987

 

Social media plays a significant role in modern life, but excessive use of it during the COVID-19 pandemic has become a source of concern. Supported by the conservation of resources theory, the current study extends the literature on problematic social media usage during COVID-19 by investigating its association with emotional and mental health outcomes. In a moderated mediation model, this study proposes that problematic social media use by workers during COVID-19 is linked to fear of COVID-19, which is further associated with depression. The current study tested trait mindfulness as an important personal resource that may be associated with reduced fear of COVID-19 despite problematic social media use. The study collected temporally separate data to avoid common method bias. Pakistani employees (N = 267) working in different organizations completed a series of survey questionnaires. The results supported the moderated mediation model, showing that problematic social media use during the current pandemic is linked to fear of COVID-19 and depression among employees. Furthermore, trait mindfulness was found to be an important buffer, reducing the negative indirect association between problematic social media use and depression through fear of COVID-19. These results offer implications for practitioners. The limitations of this study and future research directions are also discussed.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.557987/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1514613_69_Psycho_20201224_arts_A

 

Improve the Mental Health of Chronic Pain Patients with Mindfulness Training Over the Internet.

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Improve the Mental Health of Chronic Pain Patients with Mindfulness Training Over the Internet.

 

 

By John M. de Castro, Ph.D.

 

“Daily mindfulness practice can be helpful for people living with chronic pain because sometimes there are negative or worrisome thoughts about the pain. These thoughts are normal, and can affect mood and increase pain. Being able to focus on relaxing the body, noticing the breath and body sensations as being there just as they are, can help manage pain, as well as reduce depression and anxiety symptoms.” – Amanda Necker

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have 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 highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

There is an accumulating volume of research findings that demonstrate that mindfulness practices, in general, are effective in treating pain. A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

Acceptance and Commitment Therapy (ACT) requires a scheduled program of sessions with a trained therapist. This results in 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 and at locations that may not be convenient. As an alternative, mindfulness training over the internet have been developed. These have tremendous advantages in decreasing costs, making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. In addition, research has indicated that mindfulness training online can be effective for improving the health and well-being of the participants.

 

In today’s Research News article “Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327284/ ) Rickardsson and colleagues recruited chronic pain patients and provided them with 10 weeks of 4 times per week 15 minute programmed Acceptance and Commitment Therapy (ACT) delivered via the internet. Therapists interacted with the individual participants via text once a week for 12 weeks. They were measured before and after training and at 3 and 12-month follow-ups for pain interference, psychological flexibility, value orientation, quality of life, pain intensity, insomnia, anxiety, and depression.

 

They found that following treatment there were significant improvements in pain interference, psychological inflexibility, value progress, value obstruction, QoL, depressive symptoms, pain intensity, anxiety and insomnia. These improvements were maintained at the 3 and 12-month follow-ups.

 

This was a pilot study without a comparison condition. As such, it must be interpreted with caution. But the results suggest that Acceptance and Commitment Therapy (ACT) can be effectively delivered via the internet with the suggestion that it produced lasting improvements in the psychological health of the chronic pain patients. The internet delivery is important as it allows for convenient, cost-effective, mass delivery of the program. This makes it a particularly desirable therapeutic method for the treatment of patients with chronic pain.

 

So, improve the mental health of chronic pain patients with mindfulness training over the internet.

 

“Mindfulness can help you . . . to reduce the suffering associated with pain without necessarily reducing the severity of the pain itself. It can also help you approach your pain with less fear and more acceptance, allowing you to live life fully, even though you have pain.” – Andrea Uptmor

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Rickardsson, J., Zetterqvist, V., Gentili, C., Andersson, E., Holmström, L., Lekander, M., Persson, M., Persson, J., Ljótsson, B., & Wicksell, R. K. (2020). Internet-delivered acceptance and commitment therapy (iACT) for chronic pain-feasibility and preliminary effects in clinical and self-referred patients. mHealth, 6, 27. https://doi.org/10.21037/mhealth.2020.02.02

 

Abstract

Background

Acceptance and commitment therapy (ACT) is an evidence-based treatment to improve functioning and quality of life (QoL) for chronic pain patients, but outreach of this treatment is unsatisfactory. Internet-delivery has been shown to increase treatment access but there is limited evidence regarding feasibility and effectiveness of web-based ACT for chronic pain. The aim of the study was to evaluate and iterate a novel internet-delivered ACT program, iACT, in a clinical and a self-referred sample of chronic pain patients. The intervention was developed in close collaboration with patients. To enhance learning, content was organized in short episodes to promote daily engagement in treatment. In both the clinical and self-referred samples, three critical domains were evaluated: (I) feasibility (acceptability, practicality and usage); (II) preliminary efficacy on pain interference, psychological inflexibility, value orientation, QoL, pain intensity, anxiety, insomnia and depressive symptoms; and (III) potential treatment mechanisms.

Methods

This was an open pilot study with two samples: 15 patients from a tertiary pain clinic and 24 self-referred chronic pain participants, recruited from October 2015 until January 2017. Data were collected via an online platform in free text and self-report measures, as well as through individual oral feedback. Group differences were analyzed with Chi square-, Mann-Whitney U- or t-test. Preliminary efficacy and treatment mechanism data were collected via self-report and analyzed with multilevel linear modeling for repeated measures.

Results

Feasibility: patient feedback guided modifications to refine the intervention and indicated that iACT was acceptable in both samples. User insights provided input for both immediate and future actions to improve feasibility. Comprehensiveness, workability and treatment credibility were adequate in both samples. Psychologists spent on average 13.5 minutes per week per clinical patient, and 8 minutes per self-referred patient (P=0.004). Recruitment rate was 24 times faster in the self-referred sample (24 patients in 1 month, compared to 15 patients in 15 months, P<0.001) and the median distance to the clinic was 40 km in the clinical sample, and 426 km in the self-referred sample (P<0.001). Preliminary effects: post-assessments were completed by 26 participants (67%). Significant effects of time were seen from pre- to post-treatment across all outcome variables. Within group effect sizes (Cohen’s d) at post-treatment ranged from small to large: pain interference (d=0.64, P<0.001), psychological inflexibility (d=1.43, P<0.001), value progress (d=0.72, P<0.001), value obstruction (d=0.42, P<0.001), physical QoL (d=0.41, P=0.005), mental QoL (d=0.67, P=0.005), insomnia (d=0.31, P<0.001), depressive symptoms (d=0.47, P<0.001), pain intensity (d=0.78, P=0.001) and anxiety (d=0.46, P<0.001). Improvements were sustained at 1-year follow-up. Psychological inflexibility and value progress were found to be potential treatment mechanisms.

Conclusions

The results from the present study suggests that iACT was feasible in both the clinical and the self-referred sample. Together with the positive preliminary results on all outcomes, the findings from this feasibility study pave the way for a subsequent large randomized efficacy trial.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7327284/