Improve Thinking in Adolescents with Yoga Practice

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Improve Thinking in Adolescents with Yoga Practice

 

By John M. de Castro, Ph.D.

 

“Yoga is like music. The rhythm of the body, the melody of the mind, and the harmony of the soul creates the symphony of life.” B.K.S. Iyengar

 

Yoga practice has been shown to have a large number of beneficial effects on the psychological, emotional, and physical health of the individual and is helpful in the treatment of mental and physical illness. The acceptance of yoga practice has spread from the home and yoga studios to its application with children in schools. Studies of these school programs have found that yoga practice produces a wide variety of positive emotional, psychosocial, and physical benefits.

Teachers also note improvements in their students following yoga practice. These include improved classroom behavior, social–emotional, and cognitive skills. In addition, school records, academic tests, and physiological measures have shown that yoga practice produces improvements in student grades and academic performance.

 

To better understand the effects of yoga practice on adolescents it is important to take into consideration that yoga is a not only a mindfulness practice, but it is also a physical exercise. It is important to compare yoga practice in schools to other forms of physical exercise to determine if yoga produces its benefits because of improved mindfulness or because of the physical exercise provided.

 

In today’s Research News article “.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521753/), Vhavle and colleagues recruited adolescents and randomly assigned them to participate in school in 1-hour daily practice for 2 months of either yoga or physical exercise. They were measured before and after training for executive function, cognition, attention, visual scanning, and memory with a numerical and an alphabetical trail making test.

 

All participants had fast times in completing the trail making tests indicating high levels of ability. The researchers found that both groups took significantly longer after training than before for the numerical trail making test. Only the yoga group took a significantly shorter time to complete the alphabetical trail making test after training than before and this was significantly different from the exercise group.

 

The numerical trail making test emphasizes visual scanning and cognitive function. The scores were very fast and so all of the students were very adept at this test. Hence, there may have been a ceiling effects making it impossible to detect further improvements. On the other hand, the alphabetical trail making test measures executive function, attention, and working memory and yoga practice produced significant improvement s in performance. These results then, suggests that school-based yoga practice may enhance adolescents’ thinking skills better than physical exercise. This suggests that the mindfulness component and not the exercise component of yoga practice is the most important aspect of the practice for the improvement of thinking ability in the youths.

 

So, improve thinking in adolescents with yoga practice.

 

“Studies also show that exercise facilitates children’s executive function (i.e., processes required to select, organize, and properly initiate goal-directed actions) by increasing activation in the prefrontal cortex and serotonergic system. By integrating physical movement with breathing exercises and mindful awareness, yoga serves as a promising form of physical and cognitive training to enhance learning-related outcomes.” – Yoga4Classrooms

 

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

 

Vhavle, S. P., Rao, R. M., & Manjunath, N. K. (2019). Comparison of Yoga versus Physical Exercise on Executive Function, Attention, and Working Memory in Adolescent Schoolchildren: A Randomized Controlled Trial. International journal of yoga, 12(2), 172–173. doi:10.4103/ijoy.IJOY_61_18

 

Abstract

Purpose:

Executive function, attention, and memory are an important indicator of cognitive health in children. In this study, we analyze the effect of yoga and physical exercise on executive functioning, attention, and memory.

Methods:

In this prospective two-armed randomized controlled trial, around 802 students from ten schools across four districts were randomized to receive daily 1 h yoga training (n = 411) or physical exercise (n = 391) for 2 months. Executive function, attention, and memory were studied using Trail Making Test (TMT). Yoga (n = 377) and physical exercise (n = 371) students contributed data to the analyses. The data were analyzed using intention-to-treat approach using Student’s t-test.

Results:

There was a significant increase in numerical TMT (TMTN) values within yoga (t = −2.17; P < 0.03) and physical activity (PA) (t = −3.37; P < 0.001) groups following interventional period. However, there was no significant change in TMTN between yoga and PA groups (t = 0.44; P = 0.66). There was a significant increase in alphabetical TMT (TMTA) values within yoga (t = 6.21; P < 0.00) and PA groups (t = 1.19; P < 0.234) following interventional period. However, there was no significant change in TMTA between yoga and PA groups (t = 3.46; P = 0.001).

Conclusion:

The results suggest that yoga improves executive function, attention, and working memory as effectively as physical exercise intervention in adolescent schoolchildren.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521753/

 

Reduce Negative Emotions with Brief Mindfulness Training

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Reduce Negative Emotions with Brief Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“meditation is very helpful when it comes to engaging with negative emotions. These emotions are a natural part of our human experience: Waves of sadness, pain, jealousy, and anger are there to remind us that we are alive, and that we still have unresolved questions to address. At that point, meditation becomes a valuable tool to engage with these emotions.” – Itai Ivtzan

 

Emotions are important to our well-being. They provide the spice of life, the joy, the love, the happiness. But they can be negative and troubling producing anger, sadness, hurt and fear. They can also be harmful such as the consequences of out of control anger or suicidal depression. We need emotions, but we must find ways to keep them under control. Emotion regulation is the term used to describe the ability to control emotions. It is not eliminating or suppressing them. Far from it, emotion regulation allows for the emotion to be fully felt and experienced. But it maintains the intensity of the emotion at a manageable level and also produces the ability to respond to the emotion appropriately and constructively. Clearly, emotion regulation is a key to a happier life.

 

Mindfulness practices have been shown to improve emption regulation and reduce negative emotions. There has accumulated considerable research evidence on this. So, it is reasonable to pause and summarize what has been found. In today’s Research News article “Brief mindfulness training for negative affectivity: A systematic review and meta-analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441958/), Schumer and colleagues review, summarize, and performed a meta-analysis of the published research studies investigating the effectiveness of brief mindfulness training (2 weeks or less) for the reduction of negative emotions. These emotions included anger, anxiety, depression, distress, irritability, sadness, shame, stress. They identified 63 published randomized controlled trials.

 

They found that brief mindfulness training with meditation naïve participants produced a significant decrease in negative emotions. The effect was larger for community samples compared to student samples. This makes sense as students are frequently required to participate due to college curriculum requirements, making them far less motivated. They also found that mindfulness trainings containing multiple mindfulness exercises produced better results than focused meditation or body scan alone. Training a variety of mindfulness exercises may make it more likely that the most effective technique for the individual participant is included.

 

There is considerable research that mindfulness training reduces negative emotions such as anger, anxiety, depression, distress, irritability, sadness, shame, and stress. The importance of this meta-analysis is that it demonstrated that even when mindfulness training is brief it still produces a reduction in negative emotions. There are numerous situations in the busy modern environment, such as in high stress jobs, where time is limited and only brief trainings are practicable. Demonstrating that even these brief trainings can be beneficial suggests that squeezing in mindfulness training when the situation allows is still helpful to the psychological health of the practitioner. The findings also suggest that the mindfulness training itself should be heterogenous, containing multiple mindfulness exercises to be maximally effective.

 

So, reduce negative emotions with brief mindfulness training.

 

“The first step in dealing with feelings is to recognize each feeling as it arises. The agent that does this is mindfulness. In the case of fear, for example, you bring out your mindfulness, look at your fear, and recognize it as fear. You know that fear springs from yourself and that mindfulness also springs from yourself. They are both in you, not fighting, but one taking care of the other.” — Thich Nhat Hanh

 

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

 

Schumer, M. C., Lindsay, E. K., & Creswell, J. D. (2018). Brief mindfulness training for negative affectivity: A systematic review and meta-analysis. Journal of consulting and clinical psychology, 86(7), 569–583. doi:10.1037/ccp0000324

 

Abstract

Objective:

Over the last ten years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multi-session interventions lasting up to two weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity.

Method:

PubMed, PsycINFO, and the Mindfulness Research Monthly Newsletter were systematically searched for brief mindfulness intervention RCTs assessing negative affectivity outcomes (e.g., depression, rumination, anxiety, stress). 65 RCTs, including 5,489 participants predominantly without experience in meditation (64.64% female, mean age = 24.62), qualified for the meta-analytic review.

Results:

The meta-analysis revealed a small but significant effect of brief mindfulness training on reducing negative affectivity compared to control programs (g=.21, p<.001). The overall effect size was significantly moderated by participant characteristics: community samples (g=.41, p<.001) produced larger training effects compared to student samples (g=.14, p=.001) (Qbetween p=.03). No significant effect size differences were found between clinical and non-clinical samples. However, when accounting for publication bias, the overall effect size of brief mindfulness training programs on negative affectivity was significantly reduced (g=.04).

Conclusions:

Brief mindfulness training programs are increasingly popular approaches for reducing negative affectivity. This meta-analysis indicates that brief mindfulness training modestly reduces negative affectivity. Quantitative analyses indicated the presence of publication bias (i.e., unpublished null effect studies), highlighting the need to continue rigorous evaluation of brief mindfulness interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441958/

 

Reduce Psychological Distress Produced by Critical Thinking with Mindfulness

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Reduce Psychological Distress Produced by Critical Thinking with Mindfulness

 

By John M. de Castro, Ph.D.

 

“The most active form of developing critical thinking is through meditation. Meditation makes you exercise control of mind over matter. Your mind becomes an active place for several activities such as: cleansing of mind from rubbish which may lead to wrong actions and decisions; accepting healthy thoughts into the cleansed mind; and letting the good ideas come to work and change the way you think.” – Operation Meditation

 

We tend to believe that the ability to think critically is a major positive characteristic that should be trained. For intellectual tasks this is probably true. But in the emotional realm, critical thinking might actually be negative and lead to greater emotional distress. Disordered, self-critical, thinking is associated with a variety of mental illnesses. This form of thinking can produce cognitive distortions that consist of dysfunctional reasoning including arbitrary inference, false dichotomy, selective abstraction, and overgeneralization. Mindfulness has been shown to improve thought processes and also the individual’s ability to regulate their emotions. So, mindfulness may counteract the negative emotional consequences of critical thinking.

 

In today’s Research News article “The Moderating Effect of Mindfulness on the Mediated Relation Between Critical Thinking and Psychological Distress via Cognitive Distortions Among Adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606771/), Su and Shum recruited high school seniors and had them complete measures of anxiety, depression, cognitive distortions, mindfulness, and critical thinking. They then subjected these measures to regression analysis.

 

They found that the higher the levels of cognitive distortions the higher the levels of stress, anxiety, and depression, and lower levels of mindfulness. In other words, psychological distress (anxiety, depression, and stress) were associated with faulty thinking. They then performed linear structural modelling and found that critical thinking was associated with psychological distress directly and indirectly by being associated with cognitive distortions which is, in turn, is associated with psychological distress. They found that mindfulness moderates the relationship between critical thinking and psychological distress. It does so by being related to lower cognitive distortions and by being related to lower psychological distress.

 

These results are interesting and suggest that having high critical thinking can lead to distorted thinking that can, in turn, lead to greater anxiety, depression, and stress. This faulty thinking may be related to thinking about the self, being overly critical of the self and thereby producing psychological problems. The results also suggest that mindfulness can to some extent blunt this process by making it less likely that distorted thinking will develop and also by directly reducing anxiety, depression, and stress. Hence, mindfulness may allow for critical thinking without producing psychological distress.

 

So, reduce psychological distress produced by critical thinking with mindfulness.

 

“The capacity to be mindful is associated with higher well-being in daily life.” – David Creswell

 

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

 

Michael Ronald Su, Kathy Kar-man Shum. The Moderating Effect of Mindfulness on the Mediated Relation Between Critical Thinking and Psychological Distress via Cognitive Distortions Among Adolescents. Front Psychol. 2019; 10: 1455. Published online 2019 Jun 26. doi: 10.3389/fpsyg.2019.01455

 

Abstract

Critical thinking has been widely regarded as an indispensable cognitive skill in the 21st century. However, its associations with the affective aspects of psychological functioning are not well understood. This study explored the interrelations between trait mindfulness, critical thinking, cognitive distortions, and psychological distress using a moderated mediation model. The sample comprised 287 senior secondary school students (57% male and 43% female) aged 14–19 from a local secondary school in Hong Kong. The results revealed that high critical thinking was significantly associated with high levels of psychological distress when mindful awareness was low among adolescents. Trait mindfulness was found to moderate the indirect effects of critical thinking on psychological distress via cognitive distortions as the mediator. Specifically, in low trait mindfulness conditions, critical thinking was found to associate positively with cognitive distortions and psychological distress. Such associations were not observed in high trait mindfulness conditions. The findings reveal that though critical thinking has positive associations with cognitive functioning, its associations with affective well-being might be negative. The results also suggest that mindfulness might play an important role in preventing the possible psychological distress associated with critical thinking. Educational implications relating to the fostering of critical thinking and mindful awareness are discussed.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606771/

Spirituality Improves Health Behaviors Particularly When Coupled with Religion

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Spirituality Improves Health Behaviors Particularly When Coupled with Religion

 

By John M. de Castro, Ph.D.

 

“Spirituality is a universal phenomenon and an inherent aspect of human nature that unfolds during adolescence as the individual searches for transcendence, meaning, and purpose in life.” – Sangwon Kim

 

We tend to think that illness is produced by physical causes, disease, injury, viruses, bacteria, etc. But many health problems are behavioral problems or have their origins in maladaptive behavior. This is evident in car accident injuries that are frequently due to behaviors, such as texting while driving, driving too fast or aggressively, or driving drunk. Other problematic behaviors are cigarette smoking, alcoholism, drug use, or unprotected sex. It is well established that if patterns and habits of healthy behaviors can be established early in life, long-term health can be promoted and ill health can be prevented. Adolescence is a time when these behavioral causes of health problems usually develop.

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health. Religiosity is also known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the influence of spirituality and religiosity on the ability of adolescents to develop positive health behaviors.

 

In today’s Research News article “”I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/), Malinakova and colleagues obtained data from a Czechoslovakian survey of a representative sample of adolescents aged 11, 13, and 15 years. Among other measures the youths completed measures of religious attendance, spirituality, tobacco, alcohol, and cannabis use, drug use experience, and sexual intercourse.

 

They found that either religious attendance or high spirituality was associated with a lower risk of smoking while only high spirituality was associated with lower alcohol use and only religious attendance appeared to be associated with lower early sexual intercourse. But when the combination of religious attendance and high spirituality was looked at, there were large significantly lower levels of tobacco, alcohol, and cannabis use and lifetime drug use.

 

These results are interesting but correlational. So, caution must be exercised in making conclusions about causality. They suggest, though, that individually religious attendance and spirituality only have limited associations with lower levels of health risk behaviors in adolescents. But in combination they have a strong association with lower levels of these behaviors. This suggests that just attending religious services doesn’t impact health risk behaviors unless it is combined with spirituality. It would appear that when youths are religious and also spiritual, they are much less likely to engage in behaviors that may damage their health.

 

So, spirituality improves health behaviors particularly when coupled with religion.

 

“The results also showed a consistent relationship between high levels of spiritual health and positive overall self-rated health. Overall, while the perceived importance of spiritual health declined by age, for adolescents who maintain a strong sense of the importance of self-perceived spiritual health, the possible benefits are striking.” – HBSC News

 

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

 

Malinakova, K., Kopcakova, J., Madarasova Geckova, A., van Dijk, J. P., Furstova, J., Kalman, M., … Reijneveld, S. A. (2019). “I am spiritual, but not religious”: Does one without the other protect against adolescent health-risk behaviour?. International journal of public health, 64(1), 115–124. doi:10.1007/s00038-018-1116-4

 

Abstract

Objectives

Spirituality and religious attendance (RA) have been suggested to protect against adolescent health-risk behaviour (HRB). The aim of this study was to explore the interrelatedness of these two concepts in a secular environment.

Methods

A nationally representative sample (n = 4566, 14.4 ± 1.1 years, 48.8% boys) of adolescents participated in the 2014 Health Behaviour in School-aged Children cross-sectional study. RA, spirituality (modified version of the Spiritual Well-Being Scale), tobacco, alcohol, cannabis and drug use and the prevalence of sexual intercourse were measured.

Results

RA and spirituality were associated with a lower chance of weekly smoking, with odds ratios (OR) 0.57 [95% confidence interval (CI) 0.36–0.88] for RA and 0.88 (0.80–0.97) for spirituality. Higher spirituality was also associated with a lower risk of weekly drinking [OR (95% CI) 0.91 (0.83–0.995)]. The multiplicative interaction of RA and spirituality was associated with less risky behaviour for four of five explored HRB. RA was not a significant mediator for the association of spirituality with HRB.

Conclusions

Our findings suggest that high spirituality only protects adolescents from HRB if combined with RA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353810/

 

Improve Workplace Wellness with Mindful Meditation

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Improve Workplace Wellness with Mindful Meditation

 

By John M. de Castro, Ph.D.

 

“If your workforce deals with stress, emotional health issues, or low morale, you’ll likely benefit from implementing a meditation program. Meditation programs have a lot of amazing health and wellness benefits that will have a positive impact on your employees.” – Robyn Whalen

 

Work is very important for our health and well-being. We spend approximately 25% of our adult lives at work. How we spend that time is immensely important for our psychological and physical health. Indeed, the work environment has even become an important part of our social lives, with friendships and leisure time activities often attached to the people we work with. But, more than half of employees in the U.S. and nearly 2/3 worldwide are unhappy at work. This is partially due to work-related stress which is epidemic in the western workplace. Almost two thirds of workers reporting high levels of stress at work. This stress can result in impaired health and can result in burnout; producing fatigue, cynicism, and professional inefficacy.

 

To help overcome unhappiness, stress, and burnout, mindfulness practices have been implemented in the workplace. Indeed, mindfulness practices have been shown to markedly reduce the physiological and psychological responses to stress. As a result, it has become very trendy for business to incorporate meditation into the workday to help improve employee well-being, health, and productivity. These programs attempt to increase the employees’ mindfulness at work and thereby reduce stress and burnout. The research has been accumulating. So, it is important to step back and summarize what has been learned.

 

In today’s Research News article “Mindfulness meditation for workplace wellness: An evidence map.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598008/), Hilton and colleagues reviewed and summarized published systematic reviews of the research on mindfulness training in the workplace and its effects on employee health and well-being. They identified 175 reviews that focused on health care workers, caregivers, educators, and general workplace workers.

 

They report that the reviews demonstrated that mindfulness-based interventions were effective in treating chronic conditions producing relief of psychological distress, anxiety, and depression symptoms. Mindfulness was found to produce small decreases in chronic pain but significant improvements in pain-related quality of life. Mindfulness training was found to reduce substance abuse and help prevent relapse, reduce negative emotions, anxiety, depression, somatization, irritable bowel syndrome, and stress effects. Mindfulness training also was effective in cancer care, including reducing stress, anxiety, depression, and fatigue, and improving sleep and quality of life. for support of caregivers.

 

These findings are remarkable. The wide range of positive benefits on physical and mental health are breathtaking. To this authors knowledge there is no other treatment that has such broad application and effectiveness. This suggests that workplace mindfulness training is safe and highly effective and should be implemented throughout the workplace.

 

So, improve workplace wellness with mindful meditation.

 

“The ancient art of meditation has many benefits, especially in the workplace. Studies have shown that meditation practiced in the workplace has a direct impact on increased productivity, creativity, focus, and the overall happiness of employees.” – The Lotus

 

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

 

Hilton, L. G., Marshall, N. J., Motala, A., Taylor, S. L., Miake-Lye, I. M., Baxi, S., … Hempel, S. (2019). Mindfulness meditation for workplace wellness: An evidence map. Work (Reading, Mass.), 63(2), 205–218. doi:10.3233/WOR-192922

 

Abstract

BACKGROUND:

Mindfulness interventions aim to foster greater attention and awareness of present moment experiences. Uptake of mindfulness programs in the workplace has grown as organizations look to support employee health, wellbeing, and performance.

OBJECTIVE:

In support of evidence-based decision making in workplace contexts, we created an evidence map summarizing physical and mental health, cognitive, affective, and interpersonal outcomes from systematic reviews of randomized controlled trials (RCTs) of mindfulness interventions.

METHODS:

We searched nine electronic databases to July 2017, dually-screened all reviews, and consulted topic experts to identify systematic reviews on mindfulness interventions. The distribution of evidence is presented as an evidence map in a bubble plot.

RESULTS:

In total, 175 systematic reviews met inclusion criteria. Reviews included a variety of mindfulness-based interventions. The largest review included 109 randomized controlled trials. The majority of these addressed general health, psychological conditions, chronic illness, pain, and substance use. Twenty-six systematic reviews assessed studies conducted in workplace settings and with healthcare professionals, educators, and caregivers. The evidence map shows the prevalence of research by the primary area of focus. An outline of promising applications of mindfulness interventions is included.

CONCLUSIONS:

The evidence map provides an overview of existing mindfulness research. It shows the body of available evidence to inform policy and organizational decision-making supporting employee wellbeing in work contexts.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598008/

 

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

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Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

 

By John M. de Castro, Ph.D.

 

“[Mindfulness] is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders.” – Sanjib Saha

 

There has developed a large volume of research findings supporting the effectiveness of mindfulness training for the treatment of mental illnesses. Effectiveness has been documented for a wide variety of psychological disorders including anxiety, depression, stress responses, obsessive-compulsive disorder, eating disorders, addictions, and major mental illnesses. But there is little understanding of the cost-effectiveness of these mindfulness trainings. So, it is important take a serious look at the costs of implementing these therapies in comparison to the healthcare savings produced and/or the costs of other treatments of similar effectiveness.

 

In today’s Research News article “Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/), Duarte and colleagues review and summarize the published studies of the cost-effectiveness of acceptance and mindfulness-based interventions. The following acceptance and mindfulness-based interventions were identified:  Mindfulness Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR) , Dialectical Behavior Therapy (DBT),  Acceptance and Commitment Therapy (ACT), mindfulness‐based relapse prevention (MBRP), and other mindfulness meditation and mindfulness training. They identified 10 published studies.

 

They reported that the published studies found mixed results depending on the type of economic analysis and the comparator condition. In general, they report that acceptance and mindfulness-based interventions are mildly cost-effective for the treatment of depression, emotional unstable personality disorder, and general mental health conditions. It is clear, however, that this issue needs to be further studied.

 

In an age of high healthcare costs, it is important to perform economic analyses of treatments. Before widespread implementation of a treatment it is important to know that the costs of implementing the treatments are less than the healthcare savings produced. Various acceptance and mindfulness-based interventions can be expensive to implement and the savings produced hard to evaluate. So, the analysis has produced ambiguous results. One way to improve the cost-effectiveness of acceptance and mindfulness-based interventions is to implement the therapies online or with smartphone technologies. This markedly reduces the costs while maintaining effectiveness.

 

So, mindfulness therapies may be cost-effective for the treatment of mental illness.

 

“MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants’ quality-adjusted life years.” – Patricia Herman

 

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

 

Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R. (2019). Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review. The British journal of clinical psychology, 58(2), 187–210. doi:10.1111/bjc.12208

 

Abstract

Objectives

Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.

Methods

Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database’s inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.

Results

Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.

Conclusion

This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Practitioner points

The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.

Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.

Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.

The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/

 

Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

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Mindfulness’ Reduction of Depression is not Related to Patient Engagement, Therapist Adherence or Interpersonal Skills

 

By John M. de Castro, Ph.D.

 

“Mindfulness training helps improve a patient’s engagement with their health, particularly in patients with chronic pain. It fosters a sense of bodily engagement and improves an individual’s ability to promote their health and well-being outside of the clinical setting.” – Caroline Meade

 

Psychotherapy is an interpersonal transaction. Its effectiveness in treating the ills of the client is to some extent dependent upon the chemistry between the therapist and the client, termed the therapeutic alliance. Research has demonstrated that there is a positive relationship with moderate effect sizes between treatment outcomes and the depth of the therapeutic alliance. The personality and characteristics of the therapist are essential ingredients in forming a therapeutic alliance. Research has shown that effective therapists are able to express themselves well. They are astute at sensing what other people are thinking and feeling. In relating to their clients, they show warmth and acceptance, empathy, and a focus on others, not themselves.

 

There are also other factors that may be important for successful therapy. The client’s engagement in the process may be as important as the therapists. In addition, the therapist’s adherence to the therapeutic program or interpersonal skills may also be important ingredients in producing successful therapeutic outcomes. There is little known, however, of the role of these characteristics in the effectiveness of treatment for mental health issues such as depression.

 

In today’s Research News article “Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/), Snippe and colleagues recruited adults with diabetes and comorbid depression and randomly assigned them to receive either Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Behavioral Therapy, or to a wait-list. Treatments occurred in 8 weekly 45-60-minute sessions.  MBCT was specifically developed to treat depression and involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms, particularly depression.

 

The patients were measured before and after treatment for depression. “Therapists received a structured treatment manual including specific instructions on exercises, inquiry, and homework assignments per session.” All treatment sessions were video recorded. The recordings were viewed and coded by 2 blinded evaluators who rated the sessions according to the therapists’ adherence to the manual, therapists’ interpersonal skills, and client engagement in the sessions.

 

They found that although depression levels were significantly reduced by both treatments, the degree of improvement was not related to either the therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. They found that the clients’ engagement in the sessions was positively associated with the therapists’ adherence to the manual. They also found that non-adherence to the manual occurred with verbose clients, when no symptoms were present, and with the clients’ life events during the week.

 

The results are interesting and reveal, as has previously been reported, that Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT) are both effective in reducing depression. It is interesting that the degree of effectiveness was not related to therapists’ adherence to the manual, therapists’ interpersonal skills, or to the clients’ engagement in the sessions. It remains for future research to identify the factors responsible for differing therapeutic outcomes.

 

So, mindfulness’ reduction of depression is not related to patient engagement, therapist adherence or interpersonal skills.

 

“When you are looking at primary care, this is the single most important thing. Can your intervention help enhance people’s capacity for self-management and health behavior change, especially among those who struggle most with self-regulation? Because at the heart of accountable care and patient-centered care is people being able to self-manage their own illness.” – Zev Schuman-Olivier

 

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

 

Snippe, E., Schroevers, M. J., Tovote, K. A., Sanderman, R., Emmelkamp, P., & Fleer, J. (2019). Explaining variability in therapist adherence and patient depressive symptom improvement: The role of therapist interpersonal skills and patient engagement. Clinical psychology & psychotherapy, 26(1), 84–93. doi:10.1002/cpp.2332

 

Abstract

Understanding why therapists deviate from a treatment manual is crucial to interpret the mixed findings on the adherence–outcome association. The current study aims to examine whether therapists’ interpersonal behaviours and patients’ active engagement predict treatment outcome and therapist adherence in cognitive behaviour therapy (CBT) and mindfulness‐based cognitive therapy (MBCT) for depressive symptoms. In addition, the study explores rater’s explanations for therapist nonadherence at sessions in which therapist adherence was low. Study participants were 61 patients with diabetes and depressive symptoms who were randomized to either CBT or MBCT. Depressive symptoms were assessed by the Beck Depression Inventory‐II. Therapist adherence, therapist interpersonal skills (i.e., empathy, warmth, and involvement), patients’ active engagement, and reasons for nonadherence were assessed by two independent raters (based on digital video recordings). Therapist adherence, therapists’ interpersonal skills, and patients’ active engagement did not predict posttreatment depressive symptom reduction. Patients’ active engagement was positively associated with therapist adherence in CBT and in MBCT. This indicates that adherence may be hampered when patients are not actively engaged in treatment. Observed reasons for nonadherence mostly covered responses to patient’s in‐session behaviour. The variety of reasons for therapist nonadherence might explain why therapist adherence was not associated with outcomes of CBT and MBCT.

Key Practitioner Message

  • Therapist adherence was not associated with posttreatment depressive symptom improvement after CBT and MBCT
  • Patient engagement was positively associated with therapist adherence to CBT and MBCT
  • A broad variety of patient‐related reasons for therapist nonadherence were observed, of which some may not result in poorer treatment outcomes and may rather reflect therapist flexibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585745/

 

Improve Quality of Life in Women with Ovarian Removal with Mindfulness

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Improve Quality of Life in Women with Ovarian Removal with Mindfulness

 

By John M. de Castro, Ph.D.

 

“midlife women with higher mindfulness scores experienced fewer menopausal symptoms. These findings suggest that mindfulness may be a promising tool to help women reduce menopausal symptoms and overall stress.” – Richa Sood

 

Women who carry genetic markers, BRCA1 or BRCA2 mutation, have a very high risk of developing ovarian cancer. Often as a preventative measure, women opt to have their ovaries and fallopian tubes surgically removed (salpingo-oophorectomy). A consequence of this procedure is to produce the onset of menopausal symptoms. These include hot flashes, (n + Add New Category ight) sweats, vaginal dryness, loss of sexual desire, and pain during intercourse. Hormone treatments may reduce the symptom intensity but do not eliminate them.

 

Hence, there is a need to find alternative treatment to help relieve these troubling symptoms following ovary removal. Mindfulness training has been shown to help reduce the symptoms of natural meonpause. But it is not known whether mindfulness training might also help alleviate these symptoms in women after surgical removal of the ovaries.

 

In today’s Research News article “Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587763/), van Driel and colleagues recruited women who carried the BRCA1 or BRCA2 mutation and had undergone surgical removal of their ovaries and fallopian tubes before the age of 52 years. They continued care as usual and were randomly assigned to receive an 8-week program of Mindfulness-Based Stress Reduction (MBSR) or no additional treatment. The MBSR program met for 2.5 hours once a week along with 30-45 minutes of daily home practice and consisted of discussion, meditation, yoga, and body scan practices. The women were measured before and after MBSR and 3 and 9 months later for menopausal-specific quality of life, sexual function, and sexual distress.

 

They found that in comparison to baseline and the usual care control group, the group that received MBSR training had significantly improved menopausal-specific quality of life, including improved vasomotor (i.e. burden caused by hot flushes, night sweats, and sweating in general) and physical symptoms (e.g. burden caused by stamina reduction, aches, and urination frequency) quality of life. These improvements were found immediately after MBSR training and 9 months later. No significant improvements were found for sexual function or distress.

In women

The study results suggest that MBSR training is a safe and effective treatment to produce long-term improvements in the menopausal quality of life in women who carry the BRCA1 or BRCA2 mutation and had undergone surgical removal of their ovaries and fallopian tubes. MBSR consists of a package of practices. It will remain for future research to determine which of these practices or which combination of practices are necessary and sufficient to produce the benefits.

 

So, improve quality of life in women with ovarian removal with mindfulness.

 

“Mindfulness cannot entirely remove the symptoms of menopause, but it can help you deal with them in a calmer and more compassionate way – and self compassion boosts mental health. Learning these simple techniques to focus our awareness, relax the body, and ride out the storm, (whether the storm is physical or emotional) can pay great dividends’” – Karita Cullen

 

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

 

van Driel, C., de Bock, G. H., Schroevers, M. J., & Mourits, M. J. (2019). Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial. BJOG : an international journal of obstetrics and gynaecology, 126(3), 402–411. doi:10.1111/1471-0528.15471

 

Abstract

Objective

To assess the short‐ and long‐term effects of mindfulness‐based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk‐reducing salpingo‐oophorectomy (RRSO).

Design

Randomised controlled trial.

Setting

A specialised family cancer clinic of the university medical center Groningen.

Population

Sixty‐six women carriers of the BRCA1/2 mutation who developed at least two moderate‐to‐severe menopausal symptoms after RRSO.

Methods

Women were randomised to an 8‐week MBSR training programme or to care as usual (CAU).

Main outcome measures

Change in the Menopause‐Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time.

Results

At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0–3.9) and 3.8 (95% CI 3.3–4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1–4.0) and 3.9 (95% CI 3.5–4.4). No significant differences were found between the MBSR and CAU groups in the other scores.

Conclusion

Mindfulness‐based stress reduction was effective at improving quality of life in the short‐ and long‐term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress.

Tweetable abstract

Mindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587763/

Spirituality is associated with Character Strength, Well-Being, and Prosociality in Adolescents

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Spirituality is associated with Character Strength, Well-Being, and Prosociality in Adolescents

 

By John M. de Castro, Ph.D.

 

“Given that adolescents are at the crossroads of life and face many issues and challenges that are unique, uncertain and value-conflict, they need to critically reflect on practical interests and examine broad issues on religiously tethered and untethered spirituality in their lives.” – Charlene Tan

 

Spirituality is defined as “one’s personal affirmation of and relationship to a higher power or to the sacred.” Spirituality has been promulgated as a solution to the challenges of life both in a transcendent sense and in a practical sense. The transcendent claims are untestable with the scientific method. But the practical claims are amenable to scientific analysis. There have been a number of studies of the influence of spirituality on the physical and psychological well-being of practitioners mostly showing positive benefits, with spirituality encouraging personal growth and mental health.

 

Adolescence is a time of mental, physical, social, and emotional growth. It is during this time that higher levels of thinking, sometimes called executive function, develops. But adolescence can be a difficult time, fraught with challenges. During this time the child transitions to young adulthood; including the development of intellectual, psychological, physical, and social abilities and characteristics. There are so many changes occurring during this time that the child can feel overwhelmed and unable to cope with all that is required. Indeed, up to a quarter of adolescents suffer from depression or anxiety disorders, and an even larger proportion struggle with subclinical symptoms. It makes sense, then, to investigate the influence of spirituality on the ability of youths to navigate this difficult time and develop positive qualities and better mental health.

 

In today’s Research News article “A Longitudinal Study of Spirituality, Character Strengths, Subjective Well-Being, and Prosociality in Middle School Adolescents.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400865/), Kor and colleagues recruited adolescents (aged 13 to 17 years) from middle schools in Israel. They were measured at three points over 14 months for optimism, prosociality, spirituality, religious practices, personal devotion, spiritual transcendence, positive and negative emotions, satisfaction with life, and 24 character strengths consisting of curiosity, love of learning, judgment, creativity, perspective, bravery, perseverance, honesty, zest, love, kindness, social intelligence, teamwork, fairness, leadership, forgiveness, humility, prudence, self-regulation, appreciation of beauty, gratitude, hope, humor, and spirituality.

 

They found that spirituality was relatively stable over time and was moderately associated with interpersonal character strengths. High levels of spirituality were significantly associated with high levels of life satisfaction, positive emotions, and prosociality at all three measurement times. Hence, spirituality was associated with the character strength and well-being of the adolescents.

 

These results are correlational and as such caution must be exercised in reaching causal conclusions. But the study suggests that being spiritual is associated with positive characters in the adolescents and greater well-being and attentiveness to the needs of others (prosociality). This further suggests that being spiritual may help adolescents navigate the complex and difficult terrain of adolescence. It remains to be seen if promoting spirituality may produce improvements in adolescent character and well-being.

 

So, spirituality is associated with character strength, well-being, and prosociality in adolescents.

 

“Adolescent well-being has received extensive attention, with ample evidence of the positive role of religion and spirituality in youth development.” – Chris Boyatzis

 

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

 

Kor, A., Pirutinsky, S., Mikulincer, M., Shoshani, A., & Miller, L. (2019). A Longitudinal Study of Spirituality, Character Strengths, Subjective Well-Being, and Prosociality in Middle School Adolescents. Frontiers in psychology, 10, 377. doi:10.3389/fpsyg.2019.00377

 

Abstract

Using data from 1,352 middle-school Israeli adolescents, the current study examines the interface of spirituality and character strengths and its longitudinal contribution to subjective well-being and prosociality. Participants were approached three times over a 14-months period and completed measures of character strengths, spirituality, subjective well-being (positive emotions, life satisfaction), and prosociality. Findings revealed a fourth-factor structure of character strengths that included the typical tripartite classification of intrapersonal, interpersonal, and intellectual strengths together with spirituality emerging as a statistically autonomous factor. Spirituality was stable over time and contributed to higher subjective well-being and prosociality both cross-sectionally and longitudinally. Discussion focuses on spirituality as a fundamental character strength and an important aspect of positive development.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6400865/

 

Improve the Symptoms of HIV Infection in Children with Yoga

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Improve the Symptoms of HIV Infection in Children with Yoga

 

By John M. de Castro, Ph.D.

 

“It’s about going deep under the waves—the hurricane that’s HIV—and finding a stillness. As debilitating and emotional as HIV is, yoga helps me transcend it so that I can rediscover myself. Then I remember I am not HIV; I am not the face of AIDS. I am me.” – River Huston

 

More than 35 million people worldwide and 1.2 million people in the United States are living with HIV infection. These include a significant number of children and adolescents. In 1996, the advent of the protease inhibitor and the so-called cocktail changed the prognosis for HIV. Since this development a 20-year-old infected with HIV can now expect to live on average to age 69. Hence, living with HIV is a long-term reality for a very large group of people. People living with HIV infection experience a wide array of physical and psychological symptoms which decrease their perceived quality of life. The symptoms include chronic pain, muscle aches, anxiety, depression, weakness, fear/worries, difficulty with concentration, concerns regarding the need to interact with a complex healthcare system, stigma, and the challenge to come to terms with a new identity as someone living with HIV.

 

Mindfulness training has been shown to improve psychological well-being, lower depression and strengthen the immune system of patients with HIV infection. Yoga practice has also been found to be effective in treating HIV. Most studies, however, focus on adult patients with HIV. There are, however, a large number of children and adolescents who are infected with HIV. Hence it makes sense to examine the ability of yoga training to treat HIV infection in children and adolescents.

 

In today’s Research News article “Effect of Yoga on Immune Parameters, Cognitive Functions, and Quality of Life among HIV-Positive Children/Adolescents: A Pilot Study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521755/), Chandra and colleagues recruited children and adolescents (aged 8 to 18 years) who had HIV infection from a HIV/AIDS rehabilitation center. Treatment as usual was continued while they were provided with daily 1-hour yoga practice sessions for 6 months. They were measured before and after training for immune system function, health-related quality of life, fatigue-related quality of life, depression, and cognitive function.

 

They found that in comparison to baseline, yoga practice produced a significant decrease in in HIV viral load and a significant increase in plasma CD4 counts. There was also a significant increase in health-related quality of life, including the health and general activities, feelings, getting along with others, and about school subscales, and fatigue-related quality of life, including general fatigue (b) sleep fatigue, and (c) cognitive fatigue. After yoga practice the children and adolescents had significant improvements in cognitive function and increases in depression.

 

The observed effectiveness of yoga practice for the treatment of HIV infected children and adolescents, parallels that observed in prior studies with adults. These include reducing the presence of the virus in the blood, improvement of immune system function, quality of life, and mental abilities. This was a pilot study and did not have a control condition, so conclusions need to be tempered. The results, though are encouraging and should motivate conducting a large randomized controlled trial. Regardless, the results are very encouraging and suggest that yoga practice is beneficial for the health and well-being of youths infected with HIV.

 

So, improve the symptoms of HIV infection in children with yoga.

 

“Yoga is an ideal exercise for people with HIV. It not only helps build muscle and energy, but also reduces stress. . .  stress greatly increases the risk that HIV will progress to AIDS.” – Matt McMillen

 

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

 

Hari Chandra, B. P., Ramesh, M. N., & Nagendra, H. R. (2019). Effect of Yoga on Immune Parameters, Cognitive Functions, and Quality of Life among HIV-Positive Children/Adolescents: A Pilot Study. International journal of yoga, 12(2), 132–138. doi:10.4103/ijoy.IJOY_51_18

 

Abstract

Context:

HIV/AIDS individuals have problems relating to immune system, quality of life (QOL), and cognitive functions (CFs). Yoga is found to be useful in similar conditions. Hardly, any work is reported on yoga for HIV-positive adults/adolescents. Hence, this study is important.

Aim:

The aim of the study is to determine the effect of yoga on immune parameters, CFs, and QOL of HIV-positive children/adolescents.

Settings and Design:

Single-group, pre–post study with 4-month yoga intervention.

Methods:

The study had 18 children from an HIV/AIDS rehabilitation center for children/adolescents. CD4, CD8, CD4/CD8 ratio, and viral loads were studied. CF tests included six letter cancellation test, symbol digit modalities test, digit-span forward backward test, and Stroop tests. QOL was assessed using PedsQL-QOL and fatigue questionnaire. Depression was assessed using CDI2-SR.

Statistical Analysis Used:

t-test and Wilcoxon signed-rank tests, as applicable.

Results:

The study included 18 children/adolescents. There was improvement in general health of the participants. There was statistically significant increase in CD4 cells counts (p = 0.039) and significant decrease in viral load (p = 0.041). CD4/CD8 ratio moved to normal range. QOL significantly improved. CFs had mixed results with improved psychomotor performance (PP) and reduced executive functions.

Conclusions:

There was improvement in general health and immune parameters. While depression increased, QOL improved. CFs showed mixed results with improved PP and reduced executive functions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521755/