Improve Chronic Low Back Pain in Low Income Patients with Yoga

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Improve Chronic Low Back Pain in Low Income Patients with Yoga

 

By John M. de Castro, Ph.D.

 

“Yoga’s focus on balance and steadiness encourages your body to develop defenses against the causes of back pain, which include weak abdominal and pelvic muscles, as well lack of flexibility in the hips. When you strengthen these muscles, you improve your posture, which reduces the load on your back, and thus reduces the aches you feel. In addition, stretching can increase flexibility by increasing blood flow to tight muscles.” – Annie Hauser

 

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. Mindfulness practices are effective in treating pain and have been shown to be safe and effective in the management of low back pain. Yoga practice has been shown to have a myriad of health benefits. These include relief of chronic pain. Yoga practice has also been shown to be effective for the relief of chronic low-back pain.  Many forms of yoga focus on the proper alignment of the spine, which could directly address the source of back and neck pain for many individuals. The majority of the research, though, has focused on relatively affluent populations. There is a need to study the effectiveness of yoga practice for low back pain in low-income populations.

 

In today’s Research News article “Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746048/), Colgrove and colleagues recruited adult low-income minority group members who had chronic low back pain and assigned them to a wait-list control condition or to receive yoga training twice a week for 60 minutes for 12 weeks. They were measured before and after training for pain, disability, muscle strength, and flexibility. Blood was drawn and the inflammatory marker TNF-α was measured. Finally, they underwent Magnetic Resonance Imaging (MRI) of their brains.

 

They found that in comparison to baseline and the wait-list control group, the yoga group had significantly lower levels of pain, improved abdominal strength, and improved spinal and hip flexibility. Although trends were present there were too few participants to detect significant changes in TNF-α levels or in the brain scans.

 

This was a pilot study assessing feasibility and as such enrolled only a small number of patients. Nevertheless, the results showed that yoga practice improves the pain levels, core strength, and flexibility of low-income minority patients with chronic low back pain. These results are similar to those seen with affluent non-minority populations. These encouraging results support conducting a large randomized controlled clinical study.

 

So, improve chronic low back pain in low income patients with yoga.

 

“Yoga is one of the more effective tools for helping soothe low back pain. The practice helps to stretch and strengthen muscles that support the back and spine, such as the paraspinal muscles that help you bend your spine, the multifidus muscles that stabilize your vertebrae, and the transverse abdominis in the abdomen, which also helps stabilize your spine.” – Matthew Sloan

 

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

 

Colgrove, Y. M., Gravino-Dunn, N. S., Dinyer, S. C., Sis, E. A., Heier, A. C., & Sharma, N. K. (2019). Physical and Physiological Effects of Yoga for an Underserved Population with Chronic Low Back Pain. International Journal of Yoga, 12(3), 252–264. doi:10.4103/ijoy.IJOY_78_18

 

Abstract

Background:

Yoga has been shown useful in reducing chronic low back pain (CLBP) through largely unknown mechanisms. The aim of this pilot study is to investigate the feasibility of providing yoga intervention to a predominantly underserved population and explore the potential mechanisms underlying yoga intervention in improving CLBP pain.

Methods:

The quasi-experimental within-subject wait-listed crossover design targeted the recruitment of low-income participants who received twice-weekly group yoga for 12 weeks, following 6–12 weeks of no intervention. Outcome measures were taken at baseline, preintervention (6–12 weeks following baseline), and then postintervention. Outcome measures included pain, disability, core strength, flexibility, and plasma tumor necrosis factor (TNF)-α protein levels. Outcomes measures were analyzed by one-way ANOVA and paired one-tailed t-tests.

Results:

Eight patients completed the intervention. Significant improvements in pain scores measured over time were supported by the significant improvement in pre- and post-yoga session pain scores. Significant improvements were also seen in the Oswestry Disability Questionnaire scores, spinal and hip flexor flexibility, and strength of core muscles following yoga. Six participants saw a 28.6%–100% reduction of TNF-α plasma protein levels after yoga, while one showed an 82.4% increase. Two participants had no detectable levels to begin with. Brain imaging analysis shows interesting increases in N-acetylaspartate in the dorsolateral prefrontal cortex and thalamus.

Conclusion:

Yoga appears effective in reducing pain and disability in a low-income CLBP population and in part works by increasing flexibility and core strength. Changes in TNF-α protein levels should be further investigated for its influence on pain pathways.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6746048/

 

Improve Attention Deficit Hyperactivity Disorder (ADHD) with Mindfulness

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Improve Attention Deficit Hyperactivity Disorder (ADHD) with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness meditation for people with ADHD? It may seem like a stretch, since difficulty with mindfulness is the very challenge for those with attention deficit hyperactivity disorder. And yet recent research shows that mindfulness training can be adapted for this condition and that it can improve concentration.” – Lynda McCollough

 

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

 

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

 

In today’s Research News article “A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571280/), Xue and colleagues review, summarize, and perform a meta-analysis of the published research studies of the effectiveness of mindfulness training for the symptoms of Attention Deficit Hyperactivity Disorder (ADHD). They included 11 controlled published research studies.

 

They report that the published research found that mindfulness training produced significant improvements in mindfulness and in the Attention Deficit Hyperactivity Disorder (ADHD) symptoms of  inattention and hyperactivity/impulsivity with large effect sizes. The effect sizes were smaller, albeit still significant, when mindfulness training was compared to wait-list control groups as opposed to active control conditions.

 

These results are exciting and important as they suggest that mindfulness training is safe and effective for treating Attention Deficit Hyperactivity Disorder (ADHD) symptoms in both children and adults. It has been well established that mindfulness training improves attention and relaxation and reduces impulsivity in a variety of non-ADHD populations. This meta-analysis suggests that these same improvements occur in patients with ADHD. Training in paying attention non-judgmentally to the present moment appears to calm and improve the ability of ADHD patients to focus just as it does with people without ADHD.

 

So, improve Attention Deficit Hyperactivity Disorder (ADHD) with mindfulness

 

“They discovered 78% of the study participants who practiced ADHD mindfulness reported reductions in ADHD symptoms, and 30% of the participants reported “clinically” reduced symptoms, which means they had a 30% or more reduction. They also found participants who did the mindfulness training did significantly better for “measures of attentional conflict” (when two or more things compete for your attention). And, as a bonus, participants also made improvements on measures of depression and anxiety.” – Casey Dixon

 

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

 

Xue, J., Zhang, Y., & Huang, Y. (2019). A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Medicine, 98(23), e15957. doi:10.1097/MD.0000000000015957

 

Abstract

Background:

Mindfulness-based interventions (MBIs) have been reported to be efficacious in treating attention deficit hyperactivity disorder (ADHD). However, the value of the control effect of MBIs on ADHD core symptoms remains controversial. To clarify the literature on the control effect of MBIs on the symptoms of ADHD and guide future researches, an effect-size analysis was conducted.

Methods:

A systematic search in PubMed, Embase, Web of Science, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wangfang Data databases was performed up to January 11, 2019. The overall effect size of MBIs on ADHD core symptoms (ie, inattention and hyperactivity/impulsivity) was recorded by the metric of Hedges’ g with 95% confidence interval, Z-value, and P-value.

Results:

Eleven eligible studies featuring 682 participants were included in the meta-analysis. The overall results indicated that MBIs had large effects on inattention (Hedges’ g = −0.825) and hyperactivity/impulsivity (Hedges’ g = −0.676) relative to the control group. Results from subgroup analyses between self- and observer rating on ADHD symptoms revealed that the effect of MBIs both remained in a large range and self-rated ADHD core symptom had a greater impact on heterogeneity across the studies. Meta-regression found that the overall effect might be moderated by participant age group and control condition.

Conclusion:

The present meta-analysis suggested that MBIs had large effects in reducing ADHD core symptoms in comparison with the control group. Future researches are needed to assess follow-up effects of MBIs on ADHD core symptoms and explore the correlation between the individual level of mindfulness and reduction of ADHD symptoms.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571280/

 

Improve Emotion Regulation in Teacher Trainees with Mindfulness

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Improve Emotion Regulation in Teacher Trainees with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindful emotion regulation represents the capacity to remain mindfully aware at all times, irrespective of the apparent valence or magnitude of any emotion that is experienced. It does not entail suppression of the emotional experience, nor any specific attempts to reappraise or alter it in any way. Instead, MM involves a systematic retraining of awareness and nonreactivity, leading to defusion from whatever is experienced, and allowing the individual to more consciously choose those thoughts, emotions and sensations they will identify with, rather than habitually reacting to them.” – Richard Chambers

 

Mindfulness practice has been shown to improve emotions and their regulation. Practitioners demonstrate more positive and less negative emotions and the ability to fully sense and experience emotions, while responding to them in appropriate and adaptive ways. In other words, mindful people are better able to experience yet control their responses to emotions. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health and the treatment of mental illness especially depression and anxiety disorders.

 

Teachers experience burnout at high rates. Roughly a half a million teachers out of a workforce of three million, leave the profession each year and the rate is almost double in poor schools compared to affluent schools. Indeed, nearly half of new teachers leave in their first five years. Burnout frequently results from emotional exhaustion. Hence, methods of improving teacher emotion regulation need to be studied. Intervening during teacher training may be a useful strategy as improving emotion regulation very early before the teaching career begins may prepare the teachers to better deal with the difficulties of their profession.

 

In today’s Research News article “Improving emotion regulation and mood in teacher trainees: Effectiveness of two mindfulness trainings.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749600/), Wimmer and colleagues recruited college students who intended to become school teachers and assigned them to one of four conditions, mindfulness training with yoga, mindfulness training without yoga, awareness training, or no-treatment. The mindfulness training was based upon Mindfulness-Based Stress Reduction (MBSR). The modified MBSR program consisted of 7 weekly 1.5-hour group sessions involving meditation, yoga, body scan, and discussion. The teachers are also encouraged to perform 20 minutes of daily practice. Awareness training occurred on a similar schedule and emphasized reflections on consciousness and awareness. They were measured before and after training for emotion regulation, response style, and positive and negative emotions.

 

They found that in comparison to the no-treatment control and baseline both mindfulness groups had significant increases in reappraisal and decreases in symptom‐focused rumination, distraction, and depressive mood. These effects of mindfulness training were found to be, in part, mediated by the distraction strategy of emotion regulation. There were no significant differences in the effects of mindfulness training with and without yoga on emotion regulation or mood.

 

These results suggest that mindfulness training regardless of whether yoga is included is effective in increasing emotion regulation in college students aspiring to become teachers. It is interesting that distraction was to some extent a mediator of the effects of mindfulness training. This strategy involves dealing with strong emotions by shifting attention to more pleasant aspects of the situation. Mindfulness training, by improving attentional control, may facilitate the ability to shift attention to other distracting areas.

 

It is not known whether these effects of mindfulness training are lasting and may influence the students’ abilities to deal with the stresses of teaching in the future. It would be hoped that mindfulness training may help to prepare prospective teachers to effectively work with the emotions that arise from their profession. This would then improve their resistance to professional burnout. It remains for future research to investigate the longevity of the emotion regulation improvements.

 

So, improve emotion regulation in teacher trainees with mindfulness.

 

“our emotions don’t have to take over your life or interfere with your important relationships when you learn how to understand, manage, and respond to your emotions more effectively. Become mindful of your own personal tendencies and emotional triggers. Notice what situations tend to prompt emotional responses in you. When you increase self-knowledge in this way, you are better prepared to competently and confidently employ emotion regulation coping skills no matter what the situation.” – Laura Chang

 

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

 

Wimmer, L., von Stockhausen, L., & Bellingrath, S. (2019). Improving emotion regulation and mood in teacher trainees: Effectiveness of two mindfulness trainings. Brain and behavior, 9(9), e01390. doi:10.1002/brb3.1390

 

Abstract

Background/Objective

The present research investigated potential effects of mindfulness training on emotion regulation and mood of future schoolteachers in a nonrandomized pre–post design, and whether these are influenced by the yoga component of mindfulness‐based stress reduction (MBSR) and/or by homework practice.

Method

N = 169 university students received either mindfulness training (experimental groups), awareness activities (active control group), or no training (passive control group), in the context of university seminars. Allocation to groups was bound by the seminar chosen by participants, and in that sense was self‐selected. Mindfulness was trained in two adapted MBSR courses, one of which including yoga, and the other excluding yoga.

Results

Specific benefits of both mindfulness training groups were observed for emotion regulation in terms of an increase in cognitive reappraisal and a reduction in symptom‐focused rumination as well as depressive mood. No benefits of mindfulness training were observed for reductions in expressive suppression, self‐focused rumination, anxious, and negative mood or an increase in distraction and positive mood respectively. Mindfulness training with and without yoga was mostly equally effective. Outcomes were largely not moderated by practice quantity or quality, but reductions in depressive mood were mediated by gains in reappraisal and distraction.

Conclusions

Mindfulness training can be implemented in the context of university seminars to foster advantageous emotion regulation strategies and lower depressive mood in future schoolteachers. Discontinuing yoga within mindfulness interventions does not seem to reduce training benefits.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749600/

 

Improve Episodic Memory and Alter Brain Activity during Memory Retrieval with Mindfulness

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Improve Episodic Memory and Alter Brain Activity during Memory Retrieval with Mindfulness

 

By John M. de Castro, Ph.D.

 

“A critical part of attention (and working memory capacity) is being able to ignore distraction. There has been growing evidence that meditation training (in particular mindfulness meditation) helps develop attentional control, and that this can start to happen very quickly.” – About Memory

 

There has accumulated a large amount of research demonstrating that mindfulness has significant benefits for psychological, physical, and spiritual wellbeing. One way that mindfulness practices may produce these benefits is by altering the brain. The nervous system is a dynamic entity, constantly changing and adapting to the environment. It will change size, activity, and connectivity in response to experience. These changes in the brain are called neuroplasticity. Over the last decade neuroscience has been studying the effects of contemplative practices on the brain and has identified neuroplastic changes in widespread areas. In other words, mindfulness practice appears to mold and change the brain, producing psychological, physical, and spiritual benefits.

 

One way to observe the effects of meditation techniques is to measure the effects of each technique on the brain’s activity. This can be done by recording the electroencephalogram (EEG). The brain produces rhythmic electrical activity that can be recorded from the scalp. It is usually separated into frequency bands. Delta activity consists of oscillations in the 0.5-3 cycles per second band. Theta activity in the EEG consists of oscillations in the 4-8 cycles per second band. Alpha activity consists of oscillations in the 8-12 cycles per second band. Beta activity consists of oscillations in the 13-30 cycles per second band while Gamma activity occurs in the 30-100 cycles per second band.

 

In today’s Research News article “Increases in Theta Oscillatory Activity During Episodic Memory Retrieval Following Mindfulness Meditation Training.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738165/), Nyhus and colleagues recruited adult participants and randomly assigned them to a wait-list control condition or to receive 4-weeks of once a week for 1 hour of mindfulness meditation training along with 20 minutes of daily home practice. They were measured for episodic memory and mindfulness before and after training. They learned words either by imagining a place associated with them or rating their pleasantness. The electroencephalogram (EEG) was measured from the scalp as the participants were engaged in an episodic memory task.

 

They found that meditation training produced a significant increase in mindfulness, especially the observe, describe, and act with awareness facets. The meditation group were also significantly better at identifying the source (place or pleasantness) of the word in the episodic memory task. With the EEG they found that the meditation group after training had significant increases in power in the Theta frequency band (4-7.5 hz.) in the frontal and parietal cortical areas of the brain. The increase in theta power were correlated with the level of the describe facet of mindfulness.

 

Theta power has been previously found to increase during tasks that test episodic memory. That was true here also. But in the present study the increases in theta power were greater after mindfulness meditation training. This suggests that the training altered the nervous system making it more responsive to episodic memories. The fact that mindfulness has been found to improve memory and that source memory was improved in the present study would appear to support this assertion. Hence, it would appear that mindfulness meditation improves episodic memory by enhancing brain processing of memories.

 

So, improve episodic memory and alter brain activity during memory retrieval with mindfulness.

 

“The meditation-and-the-brain research has been rolling in steadily for a number of years now, . . . . The practice appears to have an amazing variety of neurological benefits – from changes in grey matter volume to reduced activity in the “me” centers of the brain to enhanced connectivity between brain regions.” – Alice Walton

 

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

 

Nyhus, E., Engel, W. A., Pitfield, T. D., & Vakkur, I. (2019). Increases in Theta Oscillatory Activity During Episodic Memory Retrieval Following Mindfulness Meditation Training. Frontiers in human neuroscience, 13, 311. doi:10.3389/fnhum.2019.00311

 

Abstract

Mindfulness meditation has been shown to improve episodic memory and increase theta oscillations which are known to play a role in episodic memory retrieval. The present study examined the effect of mindfulness meditation on episodic memory retrieval and theta oscillations. Using a longitudinal design, subjects in the mindfulness meditation experimental group who underwent 4 weeks of mindfulness meditation training and practice were compared to a waitlist control group. During the pre-training and post-training experimental sessions, subjects completed the Five Facet Mindfulness Questionnaire (FFMQ) and studied adjectives and either imagined a scene (Place Task) or judged its pleasantness (Pleasant Task). During the recognition test, subjects decided which task was performed with each word (“Old Place Task” or “Old Pleasant Task”) or “New.” FFMQ scores and source discrimination were greater post-training than pre-training in the mindfulness meditation experimental group. Electroencephalography (EEG) results revealed that for the mindfulness meditation experimental group theta power was greater post-training than pre-training in right frontal and left parietal channels and changes in FFMQ scores correlated with changes in theta oscillations in right frontal channels (n = 20). The present results suggest that mindfulness meditation increases source memory retrieval and theta oscillations in a fronto-parietal network.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738165/

 

Improve Psychiatric Problems among Veterans with Mindfulness

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Improve Psychiatric Problems among Veterans with Mindfulness

 

By John M. de Castro, Ph.D.

 

“mindfulness-based interventions show promise in helping soldiers reduce symptoms of PTS and depression as well as experience improvements in various psychosocial domains.” – Adam Clark

 

There are vast numbers of people worldwide who suffer with mental or physical illnesses. Mindfulness practices have been found to be helpful with coping with these illnesses and in many cases reducing the symptoms of the diseases. Mindfulness-Based Cognitive Therapy (MBCT) involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that attempts to teach patients to distinguish between thoughts, emotions, physical sensations, and behaviors, and to recognize irrational thinking styles and how they affect behavior. MBCT has been found to be effective in treating a wide range of psychological issues. Military veterans are highly susceptible to psychiatric illnesses. So, it would make sense to investigate the effectiveness of MBCT for treating the psychiatric problems of military veterans

 

In today’s Research News article “Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748402/), Marchand and colleagues examined the medical records of veterans who had undergone Mindfulness-Based Cognitive Therapy (MBCT) therapy for psychiatric illnesses. MBCT was provided in 8 weeks of once a week 2-hour sessions. Their conditions included psychiatric disorders such as anxiety and depression, substance abuse, and ADHD, and medical disorders such as diabetes, hypertension, and chronic pain.

 

They found that only 67% of the veterans completed the Mindfulness-Based Cognitive Therapy (MBCT)  program. The greater the number of emergency room visits and psychiatric admission prior to the study significantly predicted the likelihood of completion of the MBCT program. This suggests that veterans who have a history of seeking treatment are more likely to complete therapy. Importantly, they found that following the MBCT program there was a significant decrease in psychiatric admission with large effect size.

 

These are interesting findings that suggest that the Mindfulness-Based Cognitive Therapy (MBCT)  program is effective in treating a variety of psychiatric conditions in military veterans. There appears to be a problem, however, with veterans who don’t have a history of seeking treatment completing the therapeutic program. This may signal the need for further study of what can be done to improve participation in this group. It is also possible that prior care with these particular veterans has not been effective and their dropping out of therapy may reflect the lack of success for them with the MBCT program. It is clear nonetheless that when the veterans complete the program it is highly effective in treating their conditions.

 

So, improve psychiatric problems among veterans with mindfulness.

 

“We now have a lot of evidence that mindfulness meditation is helpful for a range of different conditions, including depression, anxiety, substance problems and chronic pain.” – Joseph Wielgosz

 

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

 

Marchand, W. R., Yabko, B., Herrmann, T., Curtis, H., & Lackner, R. (2019). Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders. Journal of alternative and complementary medicine (New York, N.Y.), 25(9), 902–909. doi:10.1089/acm.2018.0511

 

Abstract

Objectives: The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders.

Design: Retrospective chart review.

Settings: Veterans Administration Medical Center (VAMC).

Subjects: Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%).

Intervention: Eight-week MBCT class.

Outcome measures: Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations.

Results: The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits (p = 0.004) and psychiatric admissions (p = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention (N = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post (p = 0.002). There was no significant change in ED visits (p = 0.535).

Conclusions: MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6748402/

 

Improve Personal Growth in Cancer Survivors with Mindfulness and Spirituality

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Improve Personal Growth in Cancer Survivors with Mindfulness and Spirituality

 

By John M. de Castro, Ph.D.

 

“religion and spirituality can help cancer patients find meaning in their illness and provide comfort in the face of fear.” – American Cancer Society

 

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

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, and anxiety and depression. In addition, religion and spirituality become much more important to people when they’re diagnosed with cancer or when living with cancer. It is thought that people take comfort in the spiritual when facing mortality. Hence, spirituality and mindfulness may be useful tools for the survivors of cancer to cope with their illness. Thus, there is a need to study the relationships of spirituality and mindfulness on the ability of cancer survivors to positively adjust to their situation.

 

In today’s Research News article “Spiritual coping, perceived growth, and the moderating role of spiritual mindfulness in cancer survivors.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340393/), Rudaz and colleagues recruited cancer survivors and had them complete questionnaires measuring spiritual coping (using spirituality as a comfort during difficulties), spiritual mindfulness, personal growth, and positive reinterpretation (interpreting stressful events in a positive way).

 

They found that for the cancer survivors, the greater the levels of mindfulness, the greater the levels of personal growth and the greater the levels of positive reinterpretation. Hence mindfulness was associated with positive adjustments to their illness. Further they found that higher levels of spiritual coping were associated with higher levels of personal growth and higher levels of positive reinterpretation only when mindfulness was high. No relationship was present when mindfulness was low. Younger participants and those with higher levels of education had significantly higher levels of personal growth.

 

It has to be kept in mind that the study was correlational and as such no conclusions about causation can be reached. But the results suggest that spiritual mindfulness is associated with two positive characteristics in cancer survivors, personal growth and positive reinterpretation. In other words, being mindful was associated with an ability to interpret the illness in a positive way and use it as a springboard for greater personal growth. Being able to take solace in spirituality (spiritual coping) was only an effective strategy when the cancer survivors had high levels of mindfulness. Hence, mindfulness is an important characteristic on its own but also one that allows for spirituality to be associated with growth. They appear to have to work together.

 

So, improve personal growth in cancer survivors with mindfulness and spirituality.

 

“Results show promise for mindfulness-based interventions to treat common psychological problems such as anxiety, stress, and depression in cancer survivors and to improve overall quality of life.” — Linda E. Carlson

 

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

 

Rudaz, M., Ledermann, T., & Grzywacz, J. G. (2018). Spiritual coping, perceived growth, and the moderating role of spiritual mindfulness in cancer survivors. Journal of psychosocial oncology, 36(5), 609–623. doi:10.1080/07347332.2018.1464091

 

Abstract

Purpose.

This study examined the moderating role of spiritual mindfulness on the association between spiritual coping and perceived growth in individuals with and without current treatment for cancer.

Design/Sample.

Adults with a cancer history (N = 534) from the Midlife in the United States study completed a telephone interview and self-administered questionnaires.

Methods/Findings.

Moderated regression analyses, controlled for age and educational attainment, showed that mindfulness moderated the effect of spiritual coping on personal growth and on positive reinterpretation. High mindfulness amplified the effect of spiritual coping on both personal growth and positive reinterpretation. Further, this moderating effect was significantly different for adults with versus without current treatment for cancer for positive reinterpretation but not for personal growth.

Conclusions/Implications.

These findings highlight the potential amplifying effect of spiritual mindfulness on the effect of spiritual coping on perceived growth in cancer survivors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340393/

 

Improve Emotion Regulation with Exercise and Mindfulness

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Improve Emotion Regulation with Exercise and Mindfulness

 

By John M. de Castro, Ph.D.

 

“When we engage in mindful practices, we can bring greater awareness, clarity, and equanimity to our day to day experiences. This leads to greater balance and less of the intense swings in mood that can throw us off kilter for days at a time.” – Sean Fargo

 

Mindfulness practice has been shown to improve emotions and their regulation. Practitioners demonstrate more positive and less negative emotions and the ability to fully sense and experience emotions, while responding to them in appropriate and adaptive ways. In other words, mindful people are better able to experience yet control their responses to emotions. The ability of mindfulness training to improve emotion regulation is thought to be the basis for a wide variety of benefits that mindfulness provides to mental health and the treatment of mental illness especially depression and anxiety disorders. Aerobic exercise can also improve emotions and their regulation. So, it makes sense to study the relationship between exercise and mindfulness in effecting emotion regulation.

 

In today’s Research News article “How Does Exercise Improve Implicit Emotion Regulation Ability: Preliminary Evidence of Mind-Body Exercise Intervention Combined With Aerobic Jogging and Mindfulness-Based Yoga.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718717/), Zhang and colleagues recruited healthy female postgraduate students who did not have meditation experience and who did not engage in exercise. They were randomly assigned to a wait-list control condition or to engage in exercise 3 times per week over 8 weeks. The exercise alternated between jogging for 40 minutes and yoga practice for 60 minutes. The yoga practice consisted of postures, breathing exercises, and meditation. They were measured before and after the intervention for emotion regulation, negative emotions, aerobic fitness, and mindfulness.

 

They found that in comparison to baseline and the wait-list control group, the aerobic exercise and yoga group had significant increases in emotion regulation, aerobic fitness, and mindfulness and decreases in negative emotions. They also found that increases in aerobic fitness were associated with increases in emotion regulation. But this association was only significant with participants who had high or moderate increases in their levels of mindfulness. At low levels of improvements in mindfulness there was no significant relationship between aerobic fitness and emotion regulation.

 

These findings are interesting and suggest that aerobic exercise and yoga improves the individual’s ability to regulate their emotions. But mindfulness is required for aerobic exercise to be effective. The increases in mindfulness would be expected as the exercise intervention contained yoga and meditation components. Aerobic exercise is known to improve mood. It is new to show that it also improves emotion regulation. Perhaps that’s the reason for the improvements in mood. But in order for the emotion regulation to be improved by exercise, it must be accompanied by improvements in mindfulness. This suggests that the ability to pay attention in the present moment nonjudgmentally to one’s emotions is required for the exercise to affect the ability to regulate the emotions. Here mindfulness plays a permissive role allowing the exercise to have its effect on the participants ability to regulate their emotions.

 

So, Improve Emotion Regulation with Exercise and Mindfulness.

 

“By acting mindfully, people are not only aware of their own feelings but become able to distance from it, avoiding feeling overpowered and acting out.” – Joan Swart

 

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

 

Zhang, Y., Fu, R., Sun, L., Gong, Y., & Tang, D. (2019). How Does Exercise Improve Implicit Emotion Regulation Ability: Preliminary Evidence of Mind-Body Exercise Intervention Combined With Aerobic Jogging and Mindfulness-Based Yoga. Frontiers in psychology, 10, 1888. doi:10.3389/fpsyg.2019.01888

 

Abstract

Purpose: The primary aim of the present study is to examine the effect of 8-week mind-body exercise intervention combining aerobic jogging and mindfulness-based yoga on implicit emotion regulation ability. The secondary aim is to explore the specific potential pathways by which the mind-body exercise intervention fosters implicit emotion regulation. This may help us to understand how the key components of exercise intervention contribute to emotional benefits.

Methods: Sixty participants were randomly allocated to one of two parallel groups: (1) the intervention group (n = 29) and (2) the waitlist control group (n = 31). Participants were asked to fill out scales measuring mindfulness and instructed to complete an emotion regulation task to assess implicit emotion regulation ability as well as the PWC 170 Test to evaluate aerobic fitness before and after the intervention.

Results: The results of the two-way repeated ANOVA revealed that 8 weeks of intervention improved implicit emotion regulation, mindfulness, and aerobic fitness levels. Path analysis showed that only improved aerobic fitness mediated the intervention effect on implicit emotion regulation ability, controlling for change in negative affect. Notably, the relationship between the effects on implicit emotion regulation ability and aerobic fitness was moderated by improved mindfulness.

Conclusion: Eight weeks of mind-body exercise intervention improves implicit emotion regulation ability. The aerobic fitness may be an essential pathway which mediates the efficacy on implicit emotion regulation ability. Furthermore, different components, such as aerobic fitness and mindfulness, may interactively contribute to such emotional benefits.

Keywords: mind-body exercise, aerobic jogging, mindfulness-based yoga, implicit emotion regulation ability, aerobic fitness, mindfulness, potential pathway

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718717/

 

Improve Fibromyalgia Symptoms with Mindfulness

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Improve Fibromyalgia Symptoms with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness training is a low-cost, side-effect-free addition to fibromyalgia treatment that almost anyone can try — research suggests it helps you improve negative emotions surrounding fibromyalgia pain and, over time, change the way you respond to and think about your fibromyalgia symptoms.” – Madeline Vann

 

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.

 

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. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. The studies are accumulating, so, it would make sense to pause and summarize what has been learned.

 

In today’s Research News article “Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719827/), Haugmark and colleagues review, summarize, and perform a meta-analysis of the published randomized controlled trials exploring the effectiveness of mindfulness- and acceptance-based interventions in the treatment of fibromyalgia. They found 9 published randomized controlled trials employing Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), or Acceptance and Commitment Therapy (ACT).

 

They found that the published research studies report that the mindfulness- and acceptance-based interventions produced small to moderate but significant improvements in the fibromyalgia patients’ levels of pain, depression, anxiety, sleep quality, health-related quality of life, and mindfulness. These benefits were sustained at follow-up but were diminished in magnitude. Hence, these interventions were safe and effective treatments for the suffering and psychological well-being of patients with fibromyalgia.

 

Mindfulness-Based Stress Reduction (MBSR), Mindfulness-Based Cognitive Therapy (MBCT), and Acceptance and Commitment Therapy (ACT) are quite different therapies with some vastly different therapeutic techniques. But they all have in common, mindfulness training. So, it would appear that mindfulness training was the critical component responsible for the benefits. This should not be surprising as mindfulness has been shown in many studies of various healthy and distressed groups to improve pain, depression, anxiety, sleep quality, and health-related quality of life. But fibromyalgia has no cure and causes great suffering in its victims. It is very comforting to see that mindfulness training can, at least, mitigate the suffering.

 

So, improve fibromyalgia symptoms with mindfulness.

 

“people with fibromyalgia may have what’s called an “attentional bias” toward negative information that appeared to be linked to pain severity. Researchers suggested that mindfulness training may help manage this trait and therefore reduce pain.” – Adrienne Dellwo

 

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

 

Haugmark, T., Hagen, K. B., Smedslund, G., & Zangi, H. A. (2019). Mindfulness- and acceptance-based interventions for patients with fibromyalgia – A systematic review and meta-analyses. PloS one, 14(9), e0221897. doi:10.1371/journal.pone.0221897

 

Abstract

Objectives

To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions.

Methods

We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence.

Results

The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision.

Conclusion

Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6719827/

 

Improve the Psychological Health of Cancer Patients with Psilocybin

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Improve the Psychological Health of Cancer Patients with Psilocybin

 

By John M. de Castro, Ph.D.

 

“Our research has shown that, in a medically controlled setting with expert screening and preparation, psilocybin can relieve the symptoms of anxiety and depression often found in patients with a cancer diagnosis.” – Heffter Research Institute

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. Psychedelics produce effects that are similar to those that are reported in spiritual awakenings. They report a loss of the personal self. They experience what they used to refer to as the self as just a part of an integrated whole. They report feeling interconnected with everything else in a sense of oneness with all things. They experience a feeling of timelessness where time seems to stop and everything is taking place in a single present moment. They experience ineffability, being unable to express in words what they are experiencing and as a result sometimes producing paradoxical statements. And they experience a positive mood, with renewed energy and enthusiasm.

 

It is easy to see why people find these experiences so pleasant and eye opening. They often report that the experiences changed them forever. Even though the effects of psychedelic substances have been experienced and reported on for centuries, only very recently have these effects come under rigorous scientific scrutiny.

 

Psilocybin is a psychedelic substance that is found naturally in a number of varieties of mushrooms. It has been used for centuries particularly by Native Americans for their spiritual practices. When studied in the laboratory under double blind conditions, Psilocybin has been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).”

 

In today’s Research News article “Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/), Griffiths and colleagues recruited patients with a potentially life threatening cancer diagnosis and high levels of anxiety and/or a mood disorder. They were randomly assigned to receive psilocybin in the lab in a living room type highly supportive environment with either a low dose in the first session and the high dose in the second 5 weeks later or in reverse order with the high dose first followed by low dose. Doses were administered double blind.

 

They were measured during the session for heart rate and respiration and ratings by attending monitors. After the drug effects subsided (7 hours after administration) they were measured for hallucinogen ratings, altered states of consciousness, mystical experiences, states of consciousness, and mysticism. They were also measured at baseline and five weeks after each session and 6 months later for anxiety, depression, mood, psychiatric symptoms, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, life coherence, and persisting effects of psilocybin. Family friends, and co-workers were also asked to rate the participant’s behavior and attitudes.

 

After the sessions no continuing adverse events were detected. During the sessions there were significant dose dependent increases in heart rate, blood pressure, joy and happiness, and visual experiences, and all ratings by the session monitors of behavior and mood. These effects all dissipated by the end of the session.

 

In comparison to baseline at all time points after psilocybin administration there were clinically significant decreases in anxiety, depression, psychiatric symptoms and significant increases in mood, quality of life, optimism, spirituality, death acceptance, death transcendence, purpose in life, and life coherence. Family friends, and co-workers also reported significant improvements in mood and behavior in the cancer patients. They also found that the greater the mystical experiences that the cancer patients had during the sessions the greater the levels of meaningfulness, spiritual significance, increased life satisfaction, meaningful existence, death acceptance, death transcendence, purpose in life, and coherence and the lower the levels of anxiety and depression.

 

The results suggest that psilocybin administration to patients with life threatening cancer diagnoses who also had high levels of anxiety and/or mood disturbance produced large and clinically significant improvements in their psychological and spiritual well-being. These benefits were observed by clinicians, session monitors, family, friend, and co-workers, and the patients themselves. These results are remarkable particularly due to the magnitude of the effects, the breadth of the benefits, their obviousness to all concerned, and the persistence of the effects, generally still large and significant 6 months after the session. This suggests that psilocybin treatment may be greatly beneficial to relieve the psychological suffering and the spiritual difficulties precipitated by cancer diagnosis.

 

So, improve the psychological health of cancer patients with psilocybin.

 

“a substantial majority of people suffering cancer-related anxiety or depression found considerable relief for up to six months from a single large dose of psilocybin — the active compound in hallucinogenic “magic mushrooms.” – Vanessa McMains

 

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

 

Griffiths, R. R., Johnson, M. W., Carducci, M. A., Umbricht, A., Richards, W. A., Richards, B. D., … Klinedinst, M. A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of psychopharmacology (Oxford, England), 30(12), 1181–1197. doi:10.1177/0269881116675513

 

Abstract

Cancer patients often develop chronic, clinically significant symptoms of depression and anxiety. Previous studies suggest that psilocybin may decrease depression and anxiety in cancer patients. The effects of psilocybin were studied in 51 cancer patients with life-threatening diagnoses and symptoms of depression and/or anxiety. This randomized, double-blind, cross-over trial investigated the effects of a very low (placebo-like) dose (1 or 3 mg/70 kg) vs. a high dose (22 or 30 mg/70 kg) of psilocybin administered in counterbalanced sequence with 5 weeks between sessions and a 6-month follow-up. Instructions to participants and staff minimized expectancy effects. Participants, staff, and community observers rated participant moods, attitudes, and behaviors throughout the study. High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety. Participants attributed improvements in attitudes about life/self, mood, relationships, and spirituality to the high-dose experience, with >80% endorsing moderately or greater increased well-being/life satisfaction. Community observer ratings showed corresponding changes. Mystical-type psilocybin experience on session day mediated the effect of psilocybin dose on therapeutic outcomes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367557/

 

Reduce Suicide with Mindfulness

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Reduce Suicide with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The pain of depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain.” – William Styron

 

After cancer and heart disease, suicide accounts for more years of life lost than any other cause. Around 43,000 people take their own lives each year in the US. Someone dies from suicide every 12.3 minutes. Worldwide over 800,000 people die by suicide every year. (Suicide Awareness Voices of Education). It is much more prevalent with males who account for 79% of suicides. The problem is far worse than these statistics suggest as it has been estimated that for every completed suicide there were 12 unsuccessful attempts. In other words, about a half a million people in the U.S. attempt suicide each year. Yet compared with other life-threatening conditions there has been scant research on how to identify potential suicide attempters, intervene, and reduce suicidality.

 

Mindfulness training has been shown to reduce suicidality. Dialectical Behavior Therapy (DBT) is a mindfulness-based therapy targeted at changing the problem behaviors including self-injury and suicide. Behavior change is accomplished through focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness. Hence it makes sense to further study the ability of DBT to reduce suicides in adolescents.

 

In today’s Research News article “Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/), McCauley and colleagues recruited adolescents (12-18 years of age) with at least one suicide attempt, elevated suicide ideation, a history of self-harm, and symptoms of Borderline Personality Disorder (BPD). They were randomly assigned to receive 6 months of individualized group therapy either of Dialectical Behavior Therapy (DBT) or individual and group non-directive supportive therapy. They were measured before, midway and after treatment and 3 and 6 months later for suicides, suicide ideation, self-harm, mood, anxiety, psychosis, eating disorders, Borderline Personality Disorder (BPD), substance abuse, and externalizing symptoms.

 

They found that in comparison to individual and group non-directive supportive therapy, the participants in Dialectical Behavior Therapy (DBT) attended more sessions, remained in treatment longer, and had higher completing rates. Importantly, after treatment, the group receiving Dialectical Behavior Therapy (DBT) had significantly fewer suicide attempts, less self-harm, and significantly higher rates of clinical change.

 

These are important results that suggests that Dialectical Behavior Therapy (DBT) is an effective treatment for adolescents with a history of suicide attempts and self-harm. Since compliance and completion rates were high, it suggests that the treatment was acceptable to the youths. The fact that DBT was compared to another therapy is important as it demonstrates that participant expectancy effects or placebo effects cannot account for the findings. They are also important as they suggest that DBT may help save adolescent lives in a very vulnerable population or at the very least help to relieve their suffering.

 

So, reduce suicide with mindfulness.

 

“In general, the practice of mindfulness involves observing your thoughts without buying into them. You label your thoughts as just that – thoughts. Not necessarily truth. Not necessarily a call to action. If you have the thought, “I should kill myself,” you can then observe, “I just had the thought that I should kill myself.” – Stephanie Freedenthal

 

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

 

McCauley, E., Berk, M. S., Asarnow, J. R., Adrian, M., Cohen, J., Korslund, K., … Linehan, M. M. (2018). Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA psychiatry, 75(8), 777–785. doi:10.1001/jamapsychiatry.2018.1109

 

Key Points

Question

Is dialectical behavior therapy more effective than individual and group supportive therapy in reducing suicide attempts and nonsuicidal self-injury in suicidal adolescents?

Findings

This multisite randomized clinical trial of 173 adolescents indicated a significant advantage for dialectical behavior therapy compared with individual and group supportive therapy for reducing repeat suicide attempts, nonsuicidal self-injury, and total self-harm after treatment. Although the dialectical behavior therapy advantage weakened over time, secondary analyses indicated that youths receiving dialectical behavior therapy were more likely to respond to treatment, indexed by the absence of any self-harm, after treatment and at 12-month follow-up.

Meaning

Dialectical behavior therapy is effective for reducing repeat suicide attempts among highly suicidal adolescents, underscoring the value of dialectical behavior therapy in suicide prevention initiatives.

Abstract

Importance

Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited.

Objective

To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths.

Design, Setting, and Participants

This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year.

Interventions

Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed.

Main Outcomes and Measures

A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview.

Results

A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes.

Conclusions and Relevance

The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584278/Importance