Increase Psychological Flexibility and Thereby Relieve Anxiety and Depression with Psychedelic Drugs

Increase Psychological Flexibility and Thereby Relieve Anxiety and Depression with Psychedelic Drugs

 

By John M. de Castro, Ph.D.

 

“psilocybin may be effective in the much wider population of patients who suffer from major depression than previously appreciated. The magnitude of the effect we saw was about four times larger than what clinical trials have shown for traditional antidepressants on the market,” – Alan Davis

 

Psychedelic substances have been used almost since the beginning of recorded history to alter consciousness and produce spiritually meaningful experiences. People find these experiences very pleasant and eye opening. They often report that the experiences changed them forever. But only very recently have these effects of psychedelic substances come under rigorous scientific scrutiny.

 

When studied in the laboratory under double blind conditions psychedelic substances have been shown to “reliably occasion deeply personally meaningful and often spiritually significant experiences (e.g. mystical-type experiences).” Psychedelic substances have also been shown to improve clinical depression. The case seems clear, but it’s important to look at the mechanism by which psychedelic substances improve depression.

 

In today’s Research News article “Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451132/ )  Davis and colleagues recruited adults who have had an experience with a single psychedelic drug. LSD was used by 42% of the respondents and psilocybin was used by 38%. The respondents completed a questionnaire measuring the drug used, when and how much; mystical experiences, acute insight, anxiety, depression, stress, and psychological flexibility.

 

They found that the greater the level of mystical experiences the greater the levels of acute insights and psychological flexibility. They also found that the greater the level of levels of acute insights and psychological flexibility the greater the decrease in anxiety and depression. A path analysis revealed that the effects of mystical experiences and acute insights on anxiety and depression were indirect by way of psychological flexibility. They increased psychological flexibility which reduced anxiety and depression.

 

These are interesting results but caution must be exercised in reaching conclusions as there was no control condition and the results are completely correlational and based upon subjective recall by the individuals. In addition, the participants volunteered by responding to recruitment materials and those who respond are likely those that benefited from the psychedelic experiences.

 

Regardless, the results replicate previous findings that psychedelic drugs increase mystical experiences and acute insights and these are associated with improved mental health. But the results suggest that these effects are completely mediated by increased psychological flexibility. In other words, mystical experiences and acute insights increase flexibility which improves anxiety and depression. “Psychological flexibility is described as an essential set of processes that help people manage stressors and engage in adaptive behaviors that promote values-driven action.”  Hence, this flexibility allows the individual to adaptively respond to events in the environment rather than internalizing them producing anxiety and depression. Psychedelic drugs appear to enhance this flexibility and thereby improve mental health.

 

So, increase psychological flexibility and thereby relieve anxiety and depression with psychedelic drugs.

 

The idea behind psychedelic therapy is that the receptive state that the drug confers opens the door to fresh ideas about how to think about the past and future, which the therapist can reinforce.” – Paul Tullis

 

 

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

 

Davis, A. K., Barrett, F. S., & Griffiths, R. R. (2020). Psychological flexibility mediates the relations between acute psychedelic effects and subjective decreases in depression and anxiety. Journal of contextual behavioral science, 15, 39–45. https://doi.org/10.1016/j.jcbs.2019.11.004

 

Abstract

Prior research has shown that acute subjective psychedelic effects are associated with both spontaneous and intended changes in depression and anxiety. Psychedelics are also theorized to produce increases in psychological flexibility, which could explain decreases in depression and anxiety following a psychedelic experience. Therefore, the present cross-sectional survey study sought to examine whether psychological flexibility mediated the relationship between acute psychedelic experiences and spontaneous or intended changes in depression and anxiety among a large international sample of people who reported having used a psychedelic (n=985; male=71.6%; Caucasian/white=84.1%; Mage=32.2, SD=12.6). A regression analysis showed that acute effects (i.e., mystical and insightful effects) were significantly associated with decreases in depression/anxiety following a psychedelic experience. A path analysis revealed that, while controlling for age and sex, increases in psychological flexibility fully mediated the effect of mystical and insightful experiences on decreases in depression and anxiety following a psychedelic experience. This suggests that psychological flexibility may be an important mediator of the therapeutic effects of psychedelic drugs. Future prospective experimental studies should examine the effect of psychedelic drug administration on psychological flexibility in order to gain a better understanding of the psychological processes that predict therapeutic effects of psychedelics.

Highlights

  • Acute psychedelic effects are related to changes in depression/anxiety
  • Changes in psychological flexibility fully mediate this relationship
  • Psychological flexibility should be examined in clinical trials with psychedelics

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451132/

 

Tai Chi Practice Improves the Symptoms of Multiple Diseases

Tai Chi Practice Improves the Symptoms of Multiple Diseases

 

By John M. de Castro, Ph.D.

 

“In addition to easing balance problems, and possibly other symptoms, tai chi can help ease stress and anxiety and strengthen all parts of the body, with few if any harmful side effects.” Peter Wayne

 

Tai Chi is an ancient mindfulness practice involving slow prescribed movements. It is gentle and completely safe, can be used with the elderly and sickly, is inexpensive to administer, can be performed in groups or alone, at home or in a facility or even public park, and can be quickly learned. In addition, it can also be practiced in social groups without professional supervision. This can make it fun, improving the likelihood of long-term engagement in the practice. Indeed, studies have shown that Tai Chi practice is effective in improving the symptoms of many different diseases. The evidence is accumulating. So, it makes sense to step back and summarize what has been learned about the effectiveness of different Tai Chi practices for different disease conditions.

 

In today’s Research News article “.Clinical Evidence of Tai Chi Exercise Prescriptions: A Systematic Review” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972853/ ) Huang and colleagues review and summarize the published randomized controlled trials on the effectiveness of different Tai Chi practices for different disease conditions. They identified 139 published randomized controlled trials utilizing a number of different Tai Chi styles and numbers of forms. Yang style was by far the most frequent style and 24 forms was the most frequent number of forms employed.

 

They report that the published research found that Tai Chi practice produced significant improvement in the symptoms of musculoskeletal system or connective tissue diseases such as osteoarthritis, fibromyalgia, and chronic low back pain.; on circulatory system diseases such as hypertension, stroke, coronary heart disease, and chronic heart failure; on mental and behavioral disorders such as depression, cognitive impairment, and intellectual disabilities; on nervous system diseases such as Parkinson’s disease, dementia, and sleep disorders; on chronic obstructive pulmonary disease (COPD); on endocrine, nutritional, or metabolic diseases such as type 2 diabetes and metabolic syndrome; on the physical and mental state of cancer patients, and on traumatic brain injury and urinary tract disorders; on balance control and flexibility and falls in older adults.

 

These are remarkable findings. Tai Chi practice appears to be a safe and effective treatment for the symptoms of a wide variety of diseases. It doesn’t cure the disease. Rather if alleviates the symptoms. It is not known the mechanisms by which Tai Chi has these benefits. Future research needs to further explore what facets or effects of Tai Chi practice are responsible for the disease symptom improvements.

 

So, Tai Chi practice improves the symptoms of multiple diseases.

 

Tai Chi and Qigong are evidence-based approaches to improve health-related quality of life, and they may be effective for a range of physical health conditions.” – Ryan Abbott

 

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

 

Huang, J., Wang, D., & Wang, J. (2021). Clinical Evidence of Tai Chi Exercise Prescriptions: A Systematic Review. Evidence-based Complementary and Alternative Medicine : eCAM, 2021, 5558805. https://doi.org/10.1155/2021/5558805

 

Abstract

Objectives

This systematic review aims to summarize the existing literature on Tai Chi randomized controlled trials (RCTs) and recommend Tai Chi exercise prescriptions for different diseases and populations.

Methods

A systematic search for Tai Chi RCTs was conducted in five electronic databases (PubMed, Cochrane Library, EMBASE, EBSCO, and Web of Science) from their inception to December 2019. SPSS 20.0 software and Microsoft Excel 2019 were used to analyze the data, and the risk of bias tool in the RevMan 5.3.5 software was used to evaluate the methodological quality of RCTs.

Results

A total of 139 articles were identified, including diseased populations (95, 68.3%) and healthy populations (44, 31.7%). The diseased populations included the following 10 disease types: musculoskeletal system or connective tissue diseases (34.7%), circulatory system diseases (23.2%), mental and behavioral disorders (12.6%), nervous system diseases (11.6%), respiratory system diseases (6.3%), endocrine, nutritional or metabolic diseases (5.3%), neoplasms (3.2%), injury, poisoning and certain other consequences of external causes (1.1%), genitourinary system diseases (1.1%), and diseases of the eye and adnexa (1.1%). Tai Chi exercise prescription was generally classified as moderate intensity. The most commonly applied Tai Chi style was Yang style (92, 66.2%), and the most frequently specified Tai Chi form was simplified 24-form Tai Chi (43, 30.9%). 12 weeks and 24 weeks, 2-3 times a week, and 60 min each time was the most commonly used cycle, frequency, and time of exercise in Tai Chi exercise prescriptions.

Conclusions

We recommend the more commonly used Tai Chi exercise prescriptions for different diseases and populations based on clinical evidence of Tai Chi. Further clinical research on Tai Chi should be combined with principles of exercise prescription to conduct large-sample epidemiological studies and long-term prospective follow-up studies to provide more substantive clinical evidence for Tai Chi exercise prescriptions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972853/

 

Improve Pain, Sleep, and the Mental Health of Chronic Pain Patients with Internet Mindfulness Training

Improve Pain, Sleep, and the Mental Health of Chronic Pain Patients with Internet Mindfulness Training

 

By John M. de Castro, Ph.D.

 

“In the context of chronic pain . . . meditation can help you to stop your mind wandering back to your pain when you are trying to focus on something else, therefore improving your ability to give your entire attention to the task at hand and in turn, improve your level of functioning. It gives you the power to take your mind off your pain and refocus it, therefore aiding you in replacing unhelpful, behaviours with healthy ones which can reduce your pain and allow you to take better care of your health.” – Ann-Marie D’arcy-Sharpe

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

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

 

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

 

In today’s Research News article “Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up.” (See summary below or view the full text of the study at: https://onlinelibrary.wiley.com/doi/10.1002/ejp.1723 ) Rickardsson and colleagues recruited adult chronic pain patients and randomly assigned them to either a wait-list control condition or to receive an 8-week program of Acceptance and Commitment Therapy (ACT) delivered over the internet. ACT was delivered in daily microlearning short learning interactions. There was a 74% completion rate of the modules. The participants were measured before and after training and at 3-, 6-, and 12-month follow-ups for psychiatric problems, pain interference, pain intensity, anxiety, depression, psychological inflexibility, values, and health-related quality of life.

 

They found that compared to baseline and the wait-list control group, the group that received internet-delivered Acceptance and Commitment Therapy (ACT) had significant decreases in pain interference, pain intensity, anxiety, depression, psychological inflexibility, value obstruction, and insomnia. These improvements were long-lasting as they were maintained at the 12-month follow-up.

 

These are impressive improvements in the pain and psychological health of these diverse chronic pain patients. These results correspond with the frequent prior observations that mindfulness training produces reductions in pain, anxiety, depression, psychological inflexibility, and insomnia in a wide range of patient types and normal individuals. These results are particularly impressive as Acceptance and Commitment Therapy (ACT) was delivered over the internet. in daily microlearning short learning interactions. This was very convenient for the patients and required only 12.4 minutes per week of therapist time per week and was thus very inexpensive to deliver. Yet ACT was highly effective and lasting in relieving the suffering of these chronic pain patients.

 

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

 

What we want to do as best as we can is to engage with the pain just as it is. It’s not about achieving a certain goal – like minimizing pain – but learning to relate to your pain differently.” – Elisha Goldstein

 

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

 

Jenny Rickardsson, Charlotte Gentili, Linda Holmström, Vendela Zetterqvist, Erik Andersson, Jan Persson, Mats Lekander, Brjánn Ljótsson, Rikard K. Wicksell. Internet‐delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1‐year follow‐up, European Journal of Pain, 2021;00:1–19, https://doi.org/10.1002/ejp.1723

 

Abstract

Background

Studies of Internet‐delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT – a novel format of Internet‐ACT using daily microlearning exercises – was examined for efficacy compared to a waitlist condition.

Methods

Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self‐referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post‐assessments were completed by 88% (n = 100) of participants. Twelve‐month follow‐up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention‐to‐treat‐approach.

Results

Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between‐group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between‐group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1‐year follow‐up.

Conclusions

Internet‐ACT as microlearning may improve a broad range of outcomes in chronic pain.

Significance

The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.

https://onlinelibrary.wiley.com/doi/10.1002/ejp.1723

 

jenny.rickardsson@ki.se

 

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

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

 

 

By John M. de Castro, Ph.D.

 

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

 

We all have to deal with pain. It’s inevitable, but hopefully it’s mild and short lived. For a wide swath of humanity, however, pain is a constant in their lives. At least 100 million adult Americans have chronic pain conditions. The most common treatment for chronic pain is drugs. These include over-the-counter analgesics and opioids. But opioids are dangerous and highly addictive. Prescription opioid overdoses kill more than 14,000 people annually. So, there is a great need to find safe and effective ways to lower the psychological distress and improve the individual’s ability to cope with the pain.

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

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

 

Abstract

Background

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

Methods

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

Results

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

Conclusions

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

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

 

Improve Refractory Depression with Mindfulness

Improve Refractory Depression with Mindfulness

 

By John M. de Castro, Ph.D.

 

Mindfulness and other meditations, particularly combined with cognitive therapy, work just as well for anxiety or depression as the medications do, but they don’t have those side effects,” – Daniel Goleman

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients do not respond to treatment. This is called refractory depression.

 

Mindfulness training has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failDialectical Behavior Therapy (DBT)  is a mindfulness-based therapeutic technique that produces behavior change by 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. DBT has been shown to be effective in treating depression. So, it makes sense, then, to study the effectiveness of Dialectical Behavior Therapy (DBT) for refractory depression.

 

In today’s Research News article “Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282863/ ) Lynch and colleagues recruited adults with refractory major depressive disorder and randomly assigned them to either treatment as usual or to receive 29 weekly 1 hour sessions of Dialectical Behavior Therapy (DBT). They were measured before and after treatment and 5 months and 11 months later for depressive symptoms, psychosocial functioning, suicidal ideation, psychological inflexibility, emotional coping, and social support.

 

They found that compared to baseline both groups continuously improved with reduced depressive symptoms, but the group that received Dialectical Behavior Therapy (DBT) demonstrated significantly greater reductions but they were only statistically significant immediately after treatment but not at the 5 and 11 month follow ups. Also remission rates were higher in the DBT group. In addition, the DBT group had significantly greater psychological flexibility, emotional coping after treatment and all follow-up measurements.

 

These are interesting results that suggest that Dialectical Behavior Therapy (DBT) is an effective treatment for refractory major depressive disorder. In other words, it helps the patients who are not helped by any other treatments; the most difficult to treat patients. The fact that the relief of depressive symptoms is not significantly different from the treatment as usual group at the 5 and 11-month follow ups suggests that booster session may be necessary. But it should be recognized that the patients were markedly improved relative to their baselines. It was just that the treatment as usual group improved as well. So, the DBT produced a large and sustained reduction in depression in these refractory patients.

 

So, improve refractory depression with mindfulness.

 

Meditation helped me realize that the misery I feel is temporary. It sucks, but if I can wade my way through it, I know I’ll probably have a better day tomorrow.” – Stacey Neglia

 

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

 

Lynch, T. R., Hempel, R. J., Whalley, B., Byford, S., Chamba, R., Clarke, P., Clarke, S., Kingdon, D. G., O’Mahen, H., Remington, B., Rushbrook, S. C., Shearer, J., Stanton, M., Swales, M., Watkins, A., & Russell, I. T. (2020). Refractory depression – mechanisms and efficacy of radically open dialectical behaviour therapy (RefraMED): findings of a randomised trial on benefits and harms. The British journal of psychiatry : the journal of mental science, 216(4), 204–212. https://doi.org/10.1192/bjp.2019.53

 

Abstract

Background

Individuals with depression often do not respond to medication or psychotherapy. Radically open dialectical behaviour therapy (RO DBT) is a new treatment targeting overcontrolled personality, common in refractory depression.

Aims

To compare RO DBT plus treatment as usual (TAU) for refractory depression with TAU alone (trial registration: ISRCTN 85784627).

Method

RO DBT comprised 29 therapy sessions and 27 skills classes over 6 months. Our completed randomised trial evaluated RO DBT for refractory depression over 18 months in three British secondary care centres. Of 250 adult participants, we randomised 162 (65%) to RO DBT. The primary outcome was the Hamilton Rating Scale for Depression (HRSD), assessed masked and analysed by treatment allocated.

Results

After 7 months, immediately following therapy, RO DBT had significantly reduced depressive symptoms by 5.40 points on the HRSD relative to TAU (95% CI 0.94–9.85). After 12 months (primary end-point), the difference of 2.15 points on the HRSD in favour of RO DBT was not significant (95% CI –2.28 to 6.59); nor was that of 1.69 points on the HRSD at 18 months (95% CI –2.84 to 6.22). Throughout RO DBT participants reported significantly better psychological flexibility and emotional coping than controls. However, they reported eight possible serious adverse reactions compared with none in the control group.

Conclusions

The RO DBT group reported significantly lower HRSD scores than the control group after 7 months, but not thereafter. The imbalance in serious adverse reactions was probably because of the controls’ limited opportunities to report these.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282863/

 

Mindfulness is Related to Improved Psychological Health During the Covid-19 Pandemic.

Mindfulness is Related to Improved Psychological Health During the Covid-19 Pandemic.

 

By John M. de Castro, Ph.D.

 

“During the current pandemic, there is so much uncertainty concerning the future, and many threats to our security (physical, social, emotional, and financial). It is totally natural and normal to feel anxious, fearful, and frustrated. . . Mindfulness can help us acknowledge this situation, without allowing us to be carried away with strong emotions; it can, in turn, help bring ourselves back to a centered calm. Only then can we see more clearly what it is we have control over and what it is that we do not.” – Michigan Medicine

 

Modern living is stressful under the best of conditions. But with the Covid-19 pandemic the levels of stress have been markedly increased. These conditions markedly increase anxiety. This is true for everyone but especially for healthcare workers and people caring for patients with COVID-19 and for people with pre-existing conditions that makes them particularly vulnerable. But it is also true for healthy individuals who worry about infection for themselves or loved ones.

 

The COVID-19 pandemic has also produced considerable economic stress, with loss of employment and steady income. For the poor this extends to high levels of food insecurity. This not only produces anxiety about the present but also for the future. It is important for people to engage in practices that can help them control their responses to the stress and their levels of anxiety. Mindfulness practices have been found routinely to reduce the psychological and physiological responses to stress, reduce anxiety levels, and improve mood. But there is a need to investigate the relationships of mindfulness to psychological health in relation to knowledge concerning Covid-19.

 

In today’s Research News article “Knowledge of COVID-19 and Its Influence on Mindfulness, Cognitive Emotion Regulation and Psychological Flexibility in the Indian Community.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.589365/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1490157_69_Psycho_20201124_arts_A ) Dubey and colleagues recruited adults in India during the Covid-19 lockdown. They were measured online for their knowledge and awareness of Covid-19, depression, anxiety, perceived stress, mindfulness, emotion regulation, and acceptance of private experiences or experiential avoidance.

 

They found that the greater the amount of knowledge of Covid-19 the lower the levels of perceived stress, anxiety, catastrophizing, and depression and the higher the levels of mindfulness and psychological flexibility. In addition, they found that the higher the levels of mindfulness, the higher the levels of knowledge of Covid-19 and psychological flexibility and the lower the levels of perceived stress, anxiety, catastrophizing, and depression.

 

These findings are correlational and thus caution must be exercised in concluding causation. But in previous research it has been shown that mindfulness produces better emotion regulation by increasing psychological flexibility and by lowering the levels of psychological distress by lowering the levels of perceived stress, anxiety, catastrophizing, and depression. So, the relationships seen here are likely caused by mindfulness.

 

It is interesting that knowledge and awareness of Covid-19 appears to be crucial in dealing with its psychological impact on the individual. Higher levels of knowledge appear to mitigate the negative emotional effects of the pandemic, perhaps by improving the ability to be cognitively flexible in coping with it. When it comes to the pandemic ignorance is not bliss, rather it evokes grater psychological distress.

 

The Covid-19 lockdown was obviously a time of great fear and anxiety, not only for the individual’s physical health but also for their economic stability. Being able to deal with the negative emotions produced is essential not only for the individual’ mental health but also for evoking constructive and adaptive responses. Mindfulness and knowledge of the pandemic appear to be important for doing just that.

 

So, mindfulness is related to improved psychological health during the Covid-19 Pandemic.

 

These are trying times, but incorporating mindful practices into your daily routine can help calm anxiety and build healthy coping skills.” – Rae Jacobson

 

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

 

Dubey N, Podder P and Pandey D (2020) Knowledge of COVID-19 and Its Influence on Mindfulness, Cognitive Emotion Regulation and Psychological Flexibility in the Indian Community. Front. Psychol. 11:589365. doi: 10.3389/fpsyg.2020.589365

 

ABSTRACT

The current global pandemic caused by COVID-19 has brought about an immense effect on the mental health of the general public. Considering the escalation in number of cases, mankind is facing a myriad of psychological problems, ranging from those related to taking precautions and maintaining safety to the ones caused by separation and bereavement. The current study aims to explore whether there is a significant difference between individuals with excellent, good, fair and vague knowledge of COVID-19 with respect to depression, anxiety, stress, level of mindfulness, specific cognitive emotion regulation strategies and psychological flexibility; to find out whether there is any significant relationship among these variables; and to determine whether knowledge of COVID-19, level of mindfulness, specific cognitive emotion regulation strategies and psychological flexibility are significant predictors of depression, anxiety and stress in the sample of the current study. The sample consisted of 402 individuals selected from the community following the research criteria. Data was collected using digital consent form, information schedule and questionnaires, from 3rd May to 13th May, 2020. The questionnaires consisted of a semi-structured interview schedule to assess knowledge of COVID-19, Depression, Anxiety and Stress Scale – 21, Five Facet Mindfulness Questionnaire-Short Form, Cognitive Emotion Regulation Questionnaire-Short version and Acceptance and Action Questionnaire-II. The data was statistically analyzed using analysis of variance test, correlational analysis and linear regression. The findings show that significant differences were present among individuals having varying degrees of knowledge of COVID-19 with respect to anxiety, level of mindfulness and psychological flexibility. Significant relationships were found to be present among the variables of the present study, having differing trends brought forward by the COVID-19 crisis. Certain socio-demographic characteristics and study variables were found to significantly predict the existing levels of depression, anxiety and stress in the current sample. The study suggests the necessity to formulate and implement appropriate mindfulness-based therapeutic interventions to address the mental health concerns arising as a result of the pandemic.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.589365/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1490157_69_Psycho_20201124_arts_A

 

Reduce Performance Anxiety in Student Vocalists with Mindfulness

Reduce Performance Anxiety in Student Vocalists with Mindfulness

 

By John M. de Castro, Ph.D.

 

“Mindfulness can really help you to stop worrying. While you can’t remove each and every stressor from your daily life, there are definitely steps you can try to feel more at ease with your performances.” – Petra Raspel

 

It is a common human phenomenon that being in a social situation can be stressful and anxiety producing. This includes the anxiety that occurs with artistic performance. Most people can deal with the anxiety and can become quite comfortable. But many do not cope well and the anxiety is overwhelming, interfering with the ability to perform. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.

 

A therapeutic technique that contains mindfulness training and Cognitive Behavioral Therapy (CBT) is Acceptance and Commitment Therapy (ACT). It focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes. It is not known whether ACT may be effective in reducing artistic performance anxiety.

 

In today’s Research News article “Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272702/ ) Clarke and colleagues recruited student vocalists who demonstrated performance anxiety and provided them with a six session group program of Acceptance and Commitment Therapy (ACT). Before and after ACT and 3 months later they were measured for music performance anxiety psychological flexibility, anxiety, depression, perceived stress, and well-being.

 

They found that after therapy there were significant reductions in music performance anxiety and psychological inflexibility and significant increases in psychological flexibility and well-being that were maintained 3 months later. Hence, Acceptance and Commitment Therapy (ACT) produced a significant improvement in the psychological well-being of student vocalists who suffered from music performance anxiety. Although not measured, these results would suggest that their vocal performances would improve.

 

This was a small pilot study without a control, comparison, condition. So, great caution must be exercised in interpreting the results. The study though makes a convincing case that a larger randomized control trial should be conducted. Mindfulness training has been shown in prior research to reduce anxiety in clinical and non-clinical populations. So, the reductions in music performance anxiety observed in the present study were not surprising and probably due to the mindfulness training delivered in ACT.

 

So, reduce performance anxiety in student vocalists with mindfulness.

 

Qualitative results showed benefits of daily mindfulness exercises on breathing, micro-muscular awareness, vocal tone, text communication and problem solving.”Petra Raspel

 

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

 

Clarke, L. K., Osborne, M. S., & Baranoff, J. A. (2020). Examining a Group Acceptance and Commitment Therapy Intervention for Music Performance Anxiety in Student Vocalists. Frontiers in psychology, 11, 1127. https://doi.org/10.3389/fpsyg.2020.01127

 

Abstract

Music performance anxiety (MPA) is a distressing and persistent anxious apprehension related to musical performance. The experience of MPA forces many musicians to give up performing or develop maladaptive coping mechanisms (e.g., avoidance or substance use), which can impact their career and wellbeing. High levels of MPA in students and vocalists are reported in the literature. Vocalists present a unique challenge for clinicians in that vocal and breathing mechanisms, required for performance, are negatively impacted when anxious. Acceptance and commitment therapy (ACT) has demonstrated efficacy for the treatment of a range of psychological problems including social anxiety disorder (of which MPA may be indicated as a subtype). This study sought to investigate whether group-based ACT may be a feasible and effective intervention for MPA in Australian student vocalists and aimed to design an intervention that could be adopted by music education providers. Potential participants (N = 31) completed an online survey including demographic questions and outcome measures. Six vocal students (four females; two males; aged M = 20.33 years) with elevated MPA scores participated in the ACT for MPA group program and 3-month follow-up. Group sessions were 2 h each week for six consecutive weeks. Participants were followed up 3 months post-intervention via online survey. There was a significant increase in psychological flexibility and significant decreases in MPA and psychological inflexibility. Gains were maintained at 3-month follow-up. The current study offers preliminary evidence for the feasibility and effectiveness of a group-based ACT protocol for musicians with performance anxiety which may be incorporated into tertiary performance training curricula.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272702/

 

Improve Cognitive Flexibility with Mindful Non-Reactivity

Improve Cognitive Flexibility with Mindful Non-Reactivity

 

By John M. de Castro, Ph.D.

 

Mindfulness meditation practice and self-reported mindfulness were correlated directly with cognitive flexibility and attentional functioning.” – Daphne Davis

 

Mindfulness training has been shown to be effective in improving physical and psychological health and particularly with the physical and psychological reactions to stress. Mindfulness also decreases the individual’s tendency to use tried and true solutions to problems and thereby improves cognitive flexibility. This has led to an increasing adoption of these mindfulness techniques for the health and well-being of both healthy and ill individuals.

 

Mindfulness, however, is complex and includes facets such as observing, describing, non-reacting, non-judging, and acting with awareness. It is not known which of these facets or which combinations of facets are responsible for the beneficial effects of mindfulness including improved cognitive flexibility. Hence there is a need to investigate the facets of mindfulness and their relationship to the psychological flexibility of the participants.

 

In today’s Research News article “The Mediating Role of Non-reactivity to Mindfulness Training and Cognitive Flexibility: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01053/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1365539_69_Psycho_20200630_arts_A), Zou and colleagues recruited online moderately stressed adults who did not have a mindfulness practice. They were matched and randomly assigned to a wait-list control condition or to receive a once a week for 2.5 hours for 8 weeks Mindfulness-Based Stress Reduction (MBSR) program. MBSR includes meditation, body scan, yoga practices, and discussion along with 45-minute daily home guided meditation practice. They were measured, before, twice during, and after training for mindfulness, including observing, describing, non-reacting, non-judging, and acting with awareness facets, cognitive flexibility, and perceived stress.

 

They found that in comparison to baseline and the wait-list control group, the group that received the Mindfulness-Based Stress Reduction (MBSR) program had significant increases in cognitive flexibility. A mediation analysis revealed that MBSR training solely indirectly by increasing the non-reactivity facet of mindfulness which in turn increased cognitive flexibility. Surprisingly, although perceived stress decreased over the 8-week period, there was no significant difference between groups.

 

Cognitive flexibility is ‘the ability to flexibly and adaptively respond to the environments, as opposed to the rigid or automatic thinking style, triggered by prior experience”.  Non-reactivity involves allowing experiences to come and go without reacting in an effort to change them. By not reacting in an autonomic way, it opens up the ability to react flexibly and adaptively to the situation. This ability makes the individual better able to address events in their life and thereby improve their well- being.

 

So, improve cognitive flexibility with mindful non-reactivity.

 

“mindfulness involves cultivation of a “beginner’s mind”, and demonstrate that mindfulness practice reduces cognitive rigidity via the tendency to overlook simple novel solutions to a situation due to rigid and repetitive thought patterns formed through experience.” – Jonathan Greenberg

 

CMCS – Center for Mindfulness and Contemplative Studies

 

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

 

Study Summary

 

Zou Y, Li P, Hofmann SG and Liu X (2020) The Mediating Role of Non-reactivity to Mindfulness Training and Cognitive Flexibility: A Randomized Controlled Trial. Front. Psychol. 11:1053. doi: 10.3389/fpsyg.2020.01053

 

Mindfulness training has been shown to have a beneficial effect on cognitive flexibility. However, little is known about the mediators that produce this effect. Cross-sectional studies show that there might be a link between Non-judgment, Non-reactivity and cognitive flexibility. Longitudinal studies examining whether Non-judgment or Non-reactivity mediate the effectiveness of mindfulness training on improving cognitive flexibility are lacking. The present study aims to test the effect of mindfulness training on increasing cognitive flexibility and to test whether this effect is mediated by Non-judgment or Non-reactivity. We conducted a single-blind randomized controlled trial in 54 nonclinical high-stress participants between October 2018 and January 2019. Participants were randomly assigned to a Mindfulness Based Stress Reduction (MBSR) group or a waitlist control group. The experimenters were blind to the group assignment of participants. The MBSR group received 8-weekly sessions (2.5-h per week) and a one-day retreat (6-h), and was required to accomplish a 45-min daily formal practice during the intervention. The waitlist control group did not receive any intervention during the waiting period and received a 2-day (6-h per day) mindfulness training after the post-intervention. The primary outcome was self-report cognitive flexibility and perceived stress administered before and after MBSR. The secondary outcome was self-report mindfulness skills (including Non-reactivity and Non-judgment) measured at pre-treatment, Week 3, Week 6, and post-intervention. For cognitive flexibility, mixed-model repeated-measure ANOVA results showed that there were significant main effects of Time, Group and a significant interaction of Time by Group. Follow-up ANOVA indicated that the MBSR group was associated with greater improvements in cognitive flexibility than the waitlist. Path analysis results showed that the effect of the treatment on cognitive flexibility at post-treatment was fully mediated by Non-reactivity at Week 6. The mediation effects of Non-reactivity at Week 3, and Non-judgment at Week 3 and Week 6 were not significant. Our findings support the efficacy of MBSR on improving cognitive flexibility. Non-reactivity is an important element of the effectiveness of MBSR training on cognitive flexibility.

https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01053/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1365539_69_Psycho_20200630_arts_A

 

Mindfulness Improves Flexibility Which Improves Residual Symptoms of Depression

Mindfulness Improves Flexibility Which Improves Residual Symptoms of Depression

 

By John M. de Castro, Ph.D.

 

Living resiliently represents a whole new way of being and doing. It isn’t just for the hard times — it’s for all times. Empowering us to live, love, and work adventurously in the face of change, it builds a well from which we can draw for the rest of our lives.” – Lynda Klau

 

Depression affects over 6% of the population. Depression can be difficult to treat. It is usually treated with antidepressant medication. But, of patients treated initially with drugs only about a third attained remission of the depression. Even after remission there are a number of symptoms that remain. These include lingering dysphoria, impaired psychosocial functioning, fatigue, and decreased ability to work. These residual symptoms can lead to relapse.

 

Mindfulness training is an alternative treatment for depression. It has been shown to be an effective treatment for depression and its recurrence and even in the cases where drugs failAcceptance and Commitment Therapy (ACT) is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT). ACT focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.

 

It is not known how Acceptance and Commitment Therapy (ACT) might affect the residual symptoms in individuals in remission from depression. In today’s Research News article “Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119364/), Østergaard and colleagues recruited patients in remission from major depressive disorder and provided them with 8 weekly sessions of group based Acceptance and Commitment Therapy (ACT). They were measured before and after ACT and 6 months and 1 year later for psychiatric symptoms, mental health depression, cognitive defusion, flexibility, values, engaged living and mindfulness.

 

They found that after treatment and for the year following there were significant reductions in depression and increases in positive mental health. Mediation analysis revealed that Acceptance and Commitment Therapy (ACT) decreased depression and increased positive mental health directly and indirectly by increasing psychological flexibility. That is ACT not only directly decreased depression and increased positive mental health but also increased psychological flexibility which in turn decreased depression and increased positive mental health. They also showed that ACT had these effects by changing acceptance, cognitive defusion, values, and committed action, all of which increased psychological flexibility.

 

Psychological flexibility is the ability to make changes in behavior in order to produce positive effects. It’s the individual’s ability to avoid rumination and brooding over negative emotions that contribute to depression. In this way psychological flexibility contributes to maintaining positive mental health. The study shows that ACT directly reduces residual symptoms and also increases psychological flexibility which in turn reduces residual symptoms in patients in remission from major depressive disorder. It is important to note that these benefits produced by ACT were enduring lasting over the year of testing. Hence, treatment with ACT  should reduce the likelihood of future depressive episodes.

 

So, mindfulness improves flexibility which improves residual symptoms of depression.

 

Mindfulness is a shallow description of a much larger process that makes us resilient when bad things happen.” – Michael Unger

 

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

 

Østergaard, T., Lundgren, T., Zettle, R. D., Landrø, N. I., & Haaland, V. Ø. (2020). Psychological Flexibility in Depression Relapse Prevention: Processes of Change and Positive Mental Health in Group-Based ACT for Residual Symptoms. Frontiers in psychology, 11, 528. https://doi.org/10.3389/fpsyg.2020.00528

 

Abstract

Relapse rates following a depressive episode are high, with limited treatments available aimed at reducing such risk. Acceptance and commitment therapy (ACT) is a cognitive-behavioral approach that has gained increased empirical support in treatment of depression, and thus represents an alternative in relapse prevention. Psychological flexibility (PF) plays an important role in mental health according to the model on which ACT is based. This study aimed to investigate the role of PF and its subprocesses in reducing residual symptoms of depression and in improving positive mental health following an 8-week group-based ACT treatment. Adult participants (75.7% female) with a history of depression, but currently exhibiting residual symptoms (N = 106) completed measures before and after intervention, and at 6 and 12-month follow-up. A growth curve model showed that positive mental health increased over 12-months. Multilevel mediation modeling revealed that PF significantly mediated these changes as well as the reduction of depressive symptoms, and that processes of acceptance, cognitive defusion, values and committed action, in turn, mediated increased PF.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119364/

 

Reduce the Psychological Burdens on Parkinson’s Disease Caregivers with Mindfulness

Reduce the Psychological Burdens on Parkinson’s Disease Caregivers with Mindfulness

 

By John M. de Castro, Ph.D.

 

Mindfulness-based interventions can improve mental health status, including reduction of stress and anxiety levels, in family caregivers of veterans with Parkinson’s disease.” Patricia Inacio

 

Parkinson’s Disease (PD) is an incurable progressive degenerative disease of the central nervous system. The condition is caused by the death of nerve cells in the brain that produce the neurotransmitter dopamine. There are around seven million people worldwide and one million people in the U.S. living with PD and about 60,000 people are diagnosed with PD every year. Its physical symptoms include resting tremor, slow movements, muscle rigidity, problems with posture and balance, loss of automatic movements, and slurring of speech. PD itself is not fatal but is often associated with related complications which can reduce life expectancy, such as falls, choking, and cardiovascular problems. Parkinson’s Disease (PD) also has psychological effects, especially cognitive decline, anxiety, and depression. All of these symptoms result in a marked reduction in the quality of life. There are no cures for Parkinson’s Disease or even treatments to slow its progression. There are only treatments that can produce symptomatic relief.

 

Caring for Parkinson’s Disease patients is very demanding and goes on for years. This exacts a tremendous toll on caregivers’ health and well-being. Caregiving has been associated with increased levels of depression and anxiety as well as higher use of psychoactive medications, poorer self-reported physical health, compromised immune function, and increased mortality. Mindfulness training has been shown to be beneficial for caregivers. So, mindfulness training may be helpful in decreasing the psychological difficulty of caring for a patient with Parkinson’s Disease.

 

In today’s Research News article “Mindfulness and Psychological Flexibility are Inversely Associated with Caregiver Burden in Parkinson’s Disease.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071391/), Klietz and colleagues recruited Parkinson’s Disease patients and their primary caregivers. The patients and the caregivers were asked to complete a questionnaire measuring depression, and health-related quality of life. The caregivers only completed measures of Parkinson’s disease caregiver burden, psychological flexibility, and mindfulness. The patients also completed a measure of Parkinson’s disease -related impairment.

 

They found that the higher the levels of Parkinson’s Disease symptoms, patient quality-of-life restrictions, caregiver quality-of-life restrictions, and depressive symptoms of the caregiver the higher the Parkinson’s Disease caregiver burden. But the higher the levels of mindfulness and psychological flexibility the lower the levels of Parkinson’s Disease caregiver burden.

 

These results are correlational and so causation cannot be determined. They show that the burden on the caregivers are related to the severity of Parkinson’s Disease symptoms and their impact on the patient’s and caregiver’s quality of life. But the results also suggest that if the caregiver’s have high levels of mindfulness and the ability to be flexible, they experience lower burden.

 

Psychological flexibility refers to the extent to which a person can cope with changing circumstances and think about problems and tasks in novel and creative ways.” This then suggests that the caregiver’s ability to think about their situation in different ways is important for reducing the burden they experience. “Mindfulness is defined as the tendency to purposely bring one’s attention to experiences occurring in the present moment without judgement.” This suggests that the caregiver’s ability to see their situation as it really is but not judge it contributes to lessening their burden. In the future it would be interesting to train caregivers in mindfulness and psychological flexibility and determine if this training produces a decrease in the burden the caregivers experience.

 

So, reduce the psychological burdens on Parkinson’s Disease caregivers with mindfulness.

 

Family caregivers fill a world of need, and in doing so are at risk of falling into the caregiver burnout abyss. . . Mindfulness is a necessary core competency that we all need to develop. Taking space for yourself will keep you grounded and peaceful while allowing you to be of service.” – Audrey Meinertzhagen

 

 

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

 

Klietz, M., Drexel, S. C., Schnur, T., Lange, F., Groh, A., Paracka, L., Greten, S., Dressler, D., Höglinger, G. U., & Wegner, F. (2020). Mindfulness and Psychological Flexibility are Inversely Associated with Caregiver Burden in Parkinson’s Disease. Brain sciences, 10(2), 111. https://doi.org/10.3390/brainsci10020111

 

Abstract

Parkinson’s disease (PD) is a neurodegenerative movement disorder with progressive impairments in activities of daily living. With disease progression, people with PD (PwP) need more help and care from their spouses or professional caregivers. Identifying factors that help caregivers to cope with their burden is needed to frame future interventions for PwP caregivers. Mindfulness and psychological flexibility might be factors contributing to resilience against the burden of giving care. In this cross-sectional questionnaire-based study, 118 PwP and their respective primary caregivers were included. Caregivers reported moderate burden and only mild depressive symptoms. Mindfulness measured by the Mindfulness Attention and Awareness scale (p 0.003) and psychological flexibility measured by Acceptance and Actions Questionnaire II (p 0.001) correlated negatively with caregiver burden. Data from this study indicate mindfulness and psychological flexibility are factors contributing to resilience against caregiver burden. Future interventions to reduce burden in PwP caregivers might be improved by the inclusion of mindfulness training programs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071391/