Relieve Insomnia in Older Adults with Tai Chi or Exercise

Relieve Insomnia in Older Adults with Tai Chi or Exercise

 

By John M. de Castro, Ph.D.

 

“Tai Chi significantly improved sleep quality in both healthy adults and patients with chronic health conditions, which suggests that Tai Chi may be considered as an alternative behavioral therapy in the treatment of insomnia.” – Gown Raman

 

Modern society has become more around-the-clock and more complex producing considerable pressure and stress on the individual. The advent of the internet and smart phones has exacerbated the problem. The resultant stress can impair sleep. Indeed, it is estimated that over half of Americans sleep too little due to stress. As a result, people today sleep 20% less than they did 100 years ago. Not having a good night’s sleep has adverse effects upon the individual’s health, well-being, and happiness. It has been estimated that 30 to 35% of adults have brief symptoms of insomnia, 15 to 20% have a short-term insomnia disorder, and 10% have chronic insomnia

 

Insomnia is more than just an irritant. Sleep deprivation is associated with decreased alertness and a consequent reduction in performance of even simple tasks, decreased quality of life, increased difficulties with memory and problem solving, increased likelihood of accidental injury including automobile accidents, and increased risk of dementia and Alzheimer’s disease. It also can lead to anxiety about sleep itself. This is stressful and can produce even more anxiety about being able to sleep. About 4% of Americans revert to sleeping pills. But these do not always produce high quality sleep and can have problematic side effects. So, there is a need to find better methods to treat insomnia. Mindfulness-based practices have been reported to improve sleep amount and quality and help with insomnia.

 

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 sleep. But Tai Chi is both a mindfulness practice and an exercise. It is unclear whether its effects on insomnia are due to the exercise provided or the mindfulness practice.

 

In today’s Research News article “). Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: ) Siu and colleagues recruited older sedentary adults over 60 years of age who were diagnosed with chronic insomnia and randomly assigned them to receive either treatment as usual, or 12 weeks of 3 weekly 1-hour sessions of  exercise, or Tai Chi practice. Exercise consisted of brisk walking and muscle strengthening. Tai Chi practice consisted of the 24 form Yang style Tai Chi. They were measured before and after treatment and 24 months later for objective sleep quality with actigraphy and subjectively for remission of insomnia, insomnia treatment response, perceived sleep quality, insomnia severity, self-reported sleep parameters, and the use of hypnotic medication.

 

They found that in comparison to baseline and the usual care group, the actigraphy and Tai Chi groups had significant improvements in objective sleep measures of sleep efficiency, sleep onset, wake time after sleep onset, and number of awakenings, and subjective measures of remission of insomnia, perceived sleep quality, insomnia severity, and lower use of hypnotic medications. Importantly, these improvements were still present 2 years later.

 

Hence, both objective and subjective measures of sleep revealed that both exercise and Tai Chi practice produced moderate significant and enduring improvements in sleep in older adults with insomnia. The fact that exercise and Tai Chi practice produced equivalent benefits suggests that the ability of Tai Chi practice to improve sleep is due to the exercise provided by the practice and not to the mindfulness aspects of the practice.

 

So, relieve insomnia in older adults with tai chi or exercise.

 

“TCC [Tai Chi Chih] produce clinically meaningful improvements in insomnia.” – Michael Irwin

 

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

 

Siu, P. M., Yu, A. P., Tam, B. T., Chin, E. C., Yu, D. S., Chung, K. F., Hui, S. S., Woo, J., Fong, D. Y., Lee, P. H., Wei, G. X., & Irwin, M. R. (2021). Effects of Tai Chi or Exercise on Sleep in Older Adults With Insomnia: A Randomized Clinical Trial. JAMA network open, 4(2), e2037199. https://doi.org/10.1001/jamanetworkopen.2020.37199

 

Key Points

Question

Can tai chi improve sleep as effectively as conventional exercise in older adults with insomnia?

Findings

In this randomized clinical trial using data collected from 320 older adults, both tai chi and conventional exercise were associated with improved sleep. Both interventions were equally effective in improving various actigraphy-assessed sleep parameters, and these beneficial effects remained persistent 24 months after the intervention with no significant differences between the 2 intervention groups.

Meaning

Given that tai chi is an accepted form of physical activity among older people because of its gentle, low-impact exercises, it can represent an alternative approach to fulfill the physical activity recommendations for improving sleep for individuals who are averse to conventional exercise.

Abstract

Importance

Previous studies that have shown tai chi to improve sleep were mainly based on subjective assessments, which might have produced results confounded by self-reporting bias.

Objective

To compare the effectiveness of tai chi for improving sleep in older adults with insomnia with conventional exercise and a passive control group using actigraphy-based objective measurements.

Design, Setting, and Participants

This randomized, 3-arm, parallel group, assessor-masked clinical trial was conducted at a single research unit in Hong Kong between August 2014 and August 2018. Eligible participants, aged 60 years or older and with chronic insomnia, were randomly allocated into tai chi training, exercise, and control groups.

Interventions

12-week tai chi training, 12-week conventional exercise, and no intervention control.

Main Outcomes and Measures

Primary outcomes were measures taken from actigraphy sleep assessment. Secondary outcomes included remission of insomnia, insomnia treatment response, Pittsburgh Sleep Quality Index score, Insomnia Severity Index score, and self-reported sleep using a 7-day sleep diary. Assessments were performed at baseline, end of the intervention (postintervention), and 24 months after the intervention (follow-up). Data analysis was performed from September 2018 to August 2020.

Results

A total of 320 participants (mean [SD] age, 67.3 [6.8] years; mean [SD] insomnia duration, 124.4 [134.5] months; 256 [80.0%] women) were randomly allocated into control (110 participants), exercise (105 participants), and tai chi (105 participants) groups and included in the data analysis. Compared with the control group, the exercise and tai chi groups showed improved sleep efficiency (exercise vs control: adjusted mean difference, +3.5%; 95% CI, 1.8-5.2; P < .001; tai chi vs control: adjusted mean difference, +3.4%; 95% CI, 1.6-5.1; P < .001) and reductions of wake time after sleep onset (exercise vs control: −17.0 minutes; 95% CI, −24.9 to −9.0; P < .001; tai chi vs control: −13.3 minutes; 95% CI, −21.3 to −5.2; P = .001) and number of awakenings (exercise vs control: −2.8 times; 95% CI, −4.0 to −1.6; P < .001; tai chi vs control: −2.2 times; 95% CI, −3.5 to −1.0; P < .001) as assessed by actigraphy at postintervention; although there were no significant differences between the exercise and tai chi groups. The actigraphy-assessed beneficial effects were maintained in both intervention groups at follow-up.

Conclusions and Relevance

Conventional exercise and tai chi improved sleep and the beneficial effects sustained for 24 months, although the absolute improvements in sleep parameters were modest. Improvements in objective sleep parameters were not different between the tai chi and exercise groups, suggesting that tai chi can be an alternative approach for managing insomnia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885034/

 

Yoga Practitioners Cope Better with the Stress and Psychological Distress During Covid-19 Pandemic

Yoga Practitioners Cope Better with the Stress and Psychological Distress During Covid-19 Pandemic

 

By John M. de Castro, Ph.D.

 

“As the lockdown cannot last forever and workplaces will have to be functional soon, there is an increased possibility of recurrent infection. Therefore, Yoga can provide the necessary tool for risk reduction, amelioration of stress and anxiety and strengthening of the immune function.” – Kanupriya Sharma 

 

Mindfulness training and yoga practices have been shown to improve health and well-being in healthy individuals. They have also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress and yoga practice also produces similar improvements. So, yoga practice may be helpful in coping with the mental and physical challenges resulting from the lockdown during the COVID-19 pandemic.

 

In today’s Research News article “Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257944/ ) Nagarathna and colleagues recruited adult (>18 years of age) participants in India online during the Covid-19 lockdown and had them complete a questionnaire measuring demographics, Covid-19 exposure, physical health, mental health, coping strategies, lifestyle, and physical activities.

 

They defined a yoga group as those participants who practiced yoga before and during the Covid-19 lockdown and the non-yoga group as those who did not. They report that the yoga group had a significantly greater proportion of females and students, were younger, were less likely to use alcohol, tobacco, or other substances and eat junk food, more likely to be vegetarian, were disciplined in their diet, and had greater sleep quality, physical strength and endurance, and energy, have lower levels of anxiety and fear, but did not differ in Covid-19 exposure. In addition, the yoga group indicated more adaptive coping strategies.

 

This study was a comparison between groups defined by whether they were yoga practitioners or not. Any observed differences could well be due to the types of people attracted to yoga practice versus those who are not. It cannot be concluded that the practice of yoga was responsible for the differences. But prior research has demonstrated in controlled trials that the practice of yoga produces many physical and psychological benefits. So, the differences observed here may well be due to causal effects of yoga practice. Regardless of causation, the results clearly show that during the Covid-19 lockdown, yoga practitioners have greater physical and mental well-being and have healthier lifestyles.

 

So, yoga practitioners cope better with the stress and psychological distress during Covid-19 pandemic.

 

Yoga can be a powerful tool to deal with the lockdown’s uncertainty and isolation, as well as to maintain physical well-being.” – United Nations

 

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

Nagarathna, R., Anand, A., Rain, M., Srivastava, V., Sivapuram, M. S., Kulkarni, R., Ilavarasu, J., Sharma, M., Singh, A., & Nagendra, H. R. (2021). Yoga Practice Is Beneficial for Maintaining Healthy Lifestyle and Endurance Under Restrictions and Stress Imposed by Lockdown During COVID-19 Pandemic. Frontiers in psychiatry, 12, 613762. https://doi.org/10.3389/fpsyt.2021.613762

 

Abstract

Uncertainty about Coronavirus disease 2019 (COVID-19) and resulting lockdown caused widespread panic, stress, and anxiety. Yoga is a known practice that reduces stress and anxiety and may enhance immunity. This study aimed to (1) investigate that including Yoga in daily routine is beneficial for physical and mental health, and (2) to evaluate lifestyle of Yoga practitioners that may be instrumental in coping with stress associated with lockdown. This is a pan-India cross-sectional survey study, which was conducted during the lockdown. A self-rated scale, COVID Health Assessment Scale (CHAS), was designed by 11 experts in 3 Delphi rounds (Content valid ratio = 0.85) to evaluate the physical health, mental health, lifestyle, and coping skills of the individuals. The survey was made available digitally using Google forms and collected 23,760 CHAS responses. There were 23,290 valid responses (98%). After the study’s inclusion and exclusion criteria of yogic practices, the respondents were categorized into the Yoga (n = 9,840) and Non-Yoga (n = 3,377) groups, who actively practiced Yoga during the lockdown in India. The statistical analyses were performed running logistic and multinomial regression and calculating odds ratio estimation using R software version 4.0.0. The non-Yoga group was more likely to use substances and unhealthy food and less likely to have good quality sleep. Yoga practitioners reported good physical ability and endurance. Yoga group also showed less anxiety, stress, fear, and having better coping strategies than the non-Yoga group. The Yoga group displayed striking and superior ability to cope with stress and anxiety associated with lockdown and COVID-19. In the Yoga group, participants performing meditation reportedly had relatively better mental health. Yoga may lead to risk reduction of COVID-19 by decreasing stress and improving immunity if specific yoga protocols are implemented through a global public health initiative.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257944/

 

Produce Lasting Improvements in Resilience and Well-Being in Pre-Retirement Employees with Mindfulness

Produce Lasting Improvements in Resilience and Well-Being in Pre-Retirement Employees with Mindfulness

 

By John M. de Castro, Ph.D.

 

workers who took the mindfulness class reported feeling much better. They had less prolonged fatigue — that feeling of exhaustion that doesn’t go away even after having a chance to rest. They also felt less stressed, reported reduced anxiety and depression, and had fewer sleep difficulties, aches and pains, and problems getting along with others.” – Ronald Siegel

 

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, social, and physical health. But nearly 2/3 of employees 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. This can lead to early retirement.

 

To help overcome unhappiness, stress, and burnoutmindfulness 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. It is not known whether mindfulness will be similarly effective for older employees who are approaching retirement.

 

In today’s Research News article “Pre-retirement Employees Experience Lasting Improvements in Resilience and Well-Being After Mindfulness-Based Stress Reduction.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.699088/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1684212_a0P58000000G0YfEAK_Psycho_20210720_arts_A ) Diachenko and colleagues recruited active employees between the ages of 60-65 years and randomly assigned them to either receive an 8-week program of Mindfulness-Based Stress reduction (MBSR) or to a wait-list control condition. MBSR was delivered in weekly 2.5-hour sessions consisting of meditation, body scan, and yoga along with group discussion and daily 45 minute home practice. After training the participants received monthly 2-hour booster sessions delivered online. They were measured before and after training and 12 months later for perceived stress, resilience, well-being, distress, anxiety, depression, satisfaction with life, quality of thoughts and feelings at rest, and prior experience with yoga and meditation.

 

They found that in comparison to baseline and the wait-list controls, the participants who received Mindfulness-Based Stress reduction (MBSR) had significantly higher levels of resilience, well-being, and comfort in their thoughts at rest, and lower levels of sleepiness that were still significant 12 months later. These findings suggest that MBSR training improves the psychological health of older employees nearing retirement.

 

Mindfulness training has been shown in past research to improve resilience, well-being, and sleep. So, these findings are not surprising. What is new here is that these improvements in psychological health occurred in individuals approaching retirement and these improvements lasted for at least a year after training. It is possible, but not measured, that these improvements may lead to the employees staying in their jobs longer before retirement.

 

So, produce lasting improvements in resilience and well-being in pre-retirement employees with mindfulness.

 

The most vital parts of mindfulness come not from positive thinking and meditation alone but the business’s approach to its employees.” – Forbes

 

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

 

Diachenko M, Smith KK, Fjorback L, Hansen NV, Linkenkaer-Hansen K and Pallesen KJ (2021) Pre-retirement Employees Experience Lasting Improvements in Resilience and Well-Being After Mindfulness-Based Stress Reduction. Front. Psychol. 12:699088. doi: 10.3389/fpsyg.2021.699088

 

The socio-economic benefits of interventions to prevent stress and related mental health problems are enormous. In the labor market, it is becoming desirable to keep employees for as long as possible. Since aging implies additional stressors such as increased risk of illness, and added pressure by professional tasks such as transferring knowledge, or learning new technologies, it is of particular relevance to offer stress-reduction to pre-retirement employees. Here, we report the effects of an eight-week Mindfulness-Based Stress Reduction (MBSR) intervention on mental well-being in 60–65-year-old work-active Danish employees, compared to a waiting-list control group. We observed improvements in resilience (Brief Resilience Scale) and mental well-being (WHO-5) not only at the end of the intervention, but also at the 12-month follow-up measurement that was preceded by monthly booster sessions. Interestingly, whereas well-being usually refers to experiences in the past weeks or months, we observed increasing Comfort in the MBSR-intervention group during a 5-minute eyes-closed rest session suggesting that this therapeutic effect of MBSR is measurable in how we feel even during short periods of time. We argue that MBSR is a cost-effective intervention suited for pre-retirement employees to cultivate resilience to prevent stress, feel more comfortable with themselves, maintain a healthy work-life in the last years before retirement, and, potentially, stay in their work-life a few more years than originally planned.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.699088/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1684212_a0P58000000G0YfEAK_Psycho_20210720_arts_A

 

Improve Psychological Health with Extended Confinement with Mindfulness

Improve Psychological Health with Extended Confinement with Mindfulness

 

By John M. de Castro, Ph.D.

 

“During a long-term professional containment, as implied by a long-term submarine patrol, mindful disposition appears as a protective functioning to efficiently manage with the constraints due to the confinement.” – Barbara Lefranc

 

Confinement for extended periods of time can have very detrimental effects on the psychological well-being of individuals. Solitary confinement is thought of as extreme punishment due to its negative psychological impact. But even when prolonged confinement is social, as in submarine deployment, it also has psychological consequences including problematic moods and decreases in cognitive ability. Mindfulness has been shown to improve cognition and mood even in confinement as occurs in prisons. So, it would be expected that mindfulness would be related to an individual’s ability to cope with the stresses of the prolonged confinement characteristic of life on deployed submarines.

 

In today’s Research News article “Subsurface Confinement: Evidence from Submariners of the Benefits of Mindfulness.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267514/ ) Aufauvre-Poupon and colleagues recruited male submariners and had them complete measures of mindfulness, psychological functioning, interoception, sleep, food and appetite, and physical activity before during and after a deployment of at least 60 days. They then separated the participants based on factor analysis into a mindful and non-mindful group.

 

They report that as the patrol progressed the participants had significant decreases in positive experiences, sleep, and interoception and significant increases in negative experiences and emotions. In comparison to the non-mindful group, the mindfulness group had significantly greater positive experiences and interoception and significantly lower negative experiences and emotions during the deployment.

 

These results suggest not surprisingly that during a deployment in a confined space interoceptive ability and psychological health deteriorates. It should be noted that mindfulness was not manipulated. Rather those participants who were already mindful were compared to those who were not. Hence, the two groups were composed of different individuals who likely differed in many ways other than mindfulness and these differences may account for the results. Nevertheless, the mindful group had significantly less deterioration during the deployment.

 

A deployment in a confined space is very stressful and this could produce the deterioration in psychological well-being. Mindfulness though may be an antidote. It is known to improve the individual’s psychological and physical responses to stress. It is possible, then, that mindful submariners are better able to cope with the stress and thereby have smaller deceases in psychological health during the extended confinement of the deployment. This improved ability to cope with confinement may account for the ability of mindfulness to improve psychological health during confinement due to the Covid-19 pandemic.

 

So, improve psychological health with extended confinement with mindfulness.

 

On many journeys, the hours are long and the days blend together. Nonetheless, these seafaring professionals have systems in place that allow them to be productive, keep their sanity, and even enjoy themselves.” – Kelly Chase

 

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

 

Aufauvre-Poupon, C., Martin-Krumm, C., Duffaud, A., Lafontaine, A., Gibert, L., Roynard, F., Rouquet, C., Bouillon-Minois, J. B., Dutheil, F., Canini, F., Pontis, J., Leclerq, F., Vannier, A., & Trousselard, M. (2021). Subsurface Confinement: Evidence from Submariners of the Benefits of Mindfulness. Mindfulness, 1–11. Advance online publication. https://doi.org/10.1007/s12671-021-01677-7

 

Abstract

Objectives

The subsurface ballistic missile nuclear submarine (SSBN) is an extreme professional environment in which personnel are both isolated and confined during patrols, which can last longer than 2 months. This environment is known to degrade submariners’ mood and cognition.

Methods

This exploratory, empirical study followed a cohort of 24 volunteer submariners. Dispositional mindfulness was assessed with the Freiburg Mindfulness Inventory, in order to identify two groups (mindful and non-mindful) and compare change in emotional state, interoception, and health behaviors during the patrol.

Results

Overall, psychological health deteriorated during the patrol. However, mindful submariners demonstrated better psychological adaptation and interoception than the non-mindful group. This was associated with better subjective health behaviors (sleeping and eating).

Conclusions

Dispositional mindfulness appears to protect against the negative effects of long-term containment in a professional environment, such as a submarine patrol. Our work highlights that mindfulness may help individuals to cope with stress in such situations. Developing mindfulness could also be an important preventive healthcare measure during quarantine imposed by the outbreak of a serious infectious disease.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267514/

 

Improve Perceived Stress and Sleep Disturbance During Covid-19 Pandemic with Mindfulness

Improve Perceived Stress and Sleep Disturbance During Covid-19 Pandemic with Mindfulness

 

By John M. de Castro, Ph.D.

 

Right now it’s very easy to let your brain spin out with the frightening possibilities. Practicing mindfulness helps bring us back to the present, and away from the brink.” – David Anderson

 

Mindfulness training has been shown to improve health and well-being in healthy individuals. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress. So, mindfulness training may be helpful in coping with the mental and physical challenges resulting from the COVID-19 pandemic.

 

In today’s Research News article “Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962857/ ) Lim and colleagues recruited participants who received mindfulness training prior to the Covid-19 lockdown or during the lockdown either in person training or over videoconference. The trainings were based upon the Mindfulness-Based Stress Reduction (MBSR) program. They were measured before and after training for perceived stress and sleep disturbance and quality of sleep.

 

They found that after training all three groups had equivalent significant reductions in perceived stress and sleep disturbance. On the other hand, sleep quality and the time to fall asleep were significantly improved in the group that received mindfulness training before the Covid-19 lockdown but not during the lockdown.

 

Previous research has repeatedly demonstrated that mindfulness training reduces perceived stress and sleep. The present study adds to these findings by demonstrating these effects during the Covid-19 lockdown. But during the lockdown, mindfulness training was effective in reducing sleep disturbance but not effective in improving sleep quality. Mindfulness training either in person or via videoconference was unable to overcome the effects of the lockdown on quality of sleep.

 

So, improve perceived stress and sleep disturbance during Covid-19 pandemic with mindfulness.

 

mindfulness is one tool that can help promote mental wellness throughout the COVID-19 pandemic and beyond.” – Julie Dunne

 

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

 

Lim, J., Leow, Z., Ong, J., Pang, L. S., & Lim, E. (2021). Effects of Web-Based Group Mindfulness Training on Stress and Sleep Quality in Singapore During the COVID-19 Pandemic: Retrospective Equivalence Analysis. JMIR mental health, 8(3), e21757. https://doi.org/10.2196/21757

 

Abstract

Background

The COVID-19 pandemic has negatively impacted psychological health. Mindfulness training, which helps individuals attend to the present moment with a nonjudgmental attitude, improves sleep and reduces stress during regular times. Mindfulness training may also be relevant to the mitigation of harmful health consequences during acute crises. However, certain restrictions may necessitate the web-based delivery of mindfulness training (ie, rather than in-person group training settings).

Objective

The objective of our study was to examine the effects of mindfulness interventions during the COVID-19 pandemic and to evaluate the effectiveness of web-based interventions.

Methods

Data from an ongoing study were used for this retrospective equivalence analysis. Recruited participants were enrollees from mindfulness courses at a local charity organization that promoted mental wellness. This study had no exclusion criteria. We created three groups; two groups received their training during the COVID-19 pandemic (in-person training group: n=36; videoconferencing group: n=38), and a second control group included participants who were trained before the pandemic (n=86). Our primary outcomes were self-reported stress and sleep quality. Baseline levels and changes in these variables due to mindfulness training were compared among the groups via an analysis of covariance test and two one-tailed t tests.

Results

Baseline perceived stress (P=.50) and sleep quality (P=.22) did not differ significantly among the three groups. Mindfulness training significantly reduced stress in all three groups (P<.001), and this effect was statistically significant when comparing videoconferencing to in-person training (P=.002). Sleep quality improved significantly in the prepandemic training group (P<.001). However, sleep quality did not improve in the groups that received training during the pandemic. Participants reported that they required shorter times to initiate sleep following prepandemic mindfulness training (P<.001), but this was not true for those who received training during the pandemic. Course attendance was high and equivalent across the videoconferencing and comparison groups (P=.02), and participants in the videoconferencing group engaged in marginally more daily practice than the in-person training group.

Conclusions

Web-based mindfulness training via videoconferencing may be a useful intervention for reducing stress during times when traditional, in-person training is not feasible. However, it may not be useful for improving sleep quality.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962857/

Improve Well-Being During Covid-19 Lockdown with Yoga and Meditation

Improve Well-Being During Covid-19 Lockdown with Yoga and Meditation

 

By John M. de Castro, Ph.D.

 

Practicing mindfulness and meditation may help you manage stress and high blood pressure, sleep better, feel more balanced and connected, and even lower your risk of heart disease.” American Heart Association

 

The Covid-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness training has been shown to improve health and well-being in healthy individuals and those with medical and psychiatric conditions, Similarly, yoga practice has been shown to improve health and well-being in healthy individuals and those with medical and psychiatric conditions.  Meditation practice is known to decrease the psychological and physical responses to stress. Similarly, yoga practice has been shown to decrease the psychological and physical responses to stress. So, mindfulness and yoga practices may be helpful in coping with the mental and physical challenges resulting from the Covid-19 pandemic and lockdown.

 

In today’s Research News article “A cross–sectional study of mental wellbeing with practice of yoga and meditation during Covid-19 pandemic.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144767/ ) Priyanka and colleagues recruited adults over the internet during the Covid-19 pandemic lockdown and had them complete a questionnaire measuring yoga practice, meditation practice, mental well-being, change in eating and sleeping, and the effects of the lockdown on mental health. The participants were separated into 4 groups, yoga only (18%), meditation only (21%), meditation plus yoga (35%), and no yoga or meditation.

 

They found that normal well-being scores were present in 66% of participants who practiced both yoga and meditation, 62% of those practicing meditation only, 60% of those practicing yoga only and 50.6% of people who practiced none. They also found that the greater the number of years practicing and the more frequent the practice the greater the proportion of participants with normal well-being scores.  A similar association of yoga and meditation practices was found with the change in eating, sleeping pattern, and family relations.

 

These results are correlational and as such caution must be exercised in concluding causation. But it has been previously shown that contemplative practices improve well-being, sleep, eating, and family relations. So, it is likely that the present results are due to yoga and meditation producing these benefits. The results, then, suggest that practicing yoga and meditation help to maintain mental well-being during a stressful pandemic lockdown and practicing both produces optimum benefits. They also suggest that the greater the frequency of practice and years practicing the greater the benefits. This suggests that practicing yoga and meditation help to relieve stress during difficult times, improving overall well-being.

 

So, improve well-being during Covid-19 lockdown with yoga and meditation.

 

mindfulness meditation is related to improved mental health across a variety of disorders, including different anxiety disorders, depression, eating disorders, substance abuse, and chronic pain symptom reduction.” – Jennifer Wolkin

 

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

 

Priyanka, & Rasania, S. K. (2021). A cross–sectional study of mental wellbeing with practice of yoga and meditation during COVID-19 pandemic. Journal of family medicine and primary care, 10(4), 1576–1581. https://doi.org/10.4103/jfmpc.jfmpc_2367_20

 

Abstract

Background:

COVID-19 pandemic has resulted in increased mental health issues. Yoga and meditation can help in alleviating mental stress and improving psychological wellbeing.

Methods:

It was a community-based online cross-sectional study involving adult general population. Data collection was done by using a Google form link that was circulated via online platforms. The data were analyzed using Microsoft Excel and SPSS version 22. Qualitative data were expressed in proportions or percentages and quantitative data were expressed in mean and standard deviation. Chi-square test was used to check the association of various factors and mental wellbeing.

Results:

A total of 649 (58.4%) subjects had normal mental wellbeing score, whereas 279 (25.1%) were found to be at risk of developing psychological distress and 184 (16.5%) were at risk of depression. A significantly larger proportion of subjects with normal mental wellbeing was found with the practice of both yoga and meditation (66.2%), followed by practice of only meditation (62.1%), only yoga (59.9%), and none of them (50.6%). A similar association of yoga and meditation practices was found with the change in eating, sleeping patterns, and family relations. The frequency of practice was positively associated with a higher level of mental wellbeing in the case of both yoga as well as meditation, with daily practice having the highest wellbeing scores.

Conclusion:

The practice of yoga and meditation, preferably both of them, is associated with higher level of mental wellbeing during the COVID-19 pandemic.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8144767/

 

Reduce Insomnia and Rumination in Pregnant Women with Mindfulness

Reduce Insomnia and Rumination in Pregnant Women with Mindfulness

 

By John M. de Castro, Ph.D.

 

“practicing mindfulness during the day, ideally for 20 minutes, . . The idea is to create a reflex to more easily bring forth a sense of relaxation. That way, it’s easier to evoke the relaxation response at night when you can’t sleep.” – Herbert Benson

 

Pregnancy is a time of intense physiological and psychological change. Anxiety, depression, and insomnia are quite common during pregnancy. More than 20 percent of pregnant women have an anxiety disorder, depressive symptoms, or both during pregnancy. Sleep disturbance including insomnia is also common affecting around 75% of pregnant women. The psychological health of pregnant women has consequences for fetal development, birthing, and consequently, child outcomes. Depression during pregnancy is associated with premature delivery and low birth weight. Insomnia has been linked to an increased risk of giving birth to a baby that’s too large or too small for its age, longer labor, and higher likelihood of a cesarean section.

 

Hence, it is clear that there is a need for methods to treat depression, anxiety, and insomnia during pregnancy. Since the fetus can be negatively impacted by drugs, it would be preferable to find a treatment that did not require drugs. Mindfulness training has been shown to improve anxiety, depression, and sleep normally and to relieve maternal anxiety and depression during pregnancy. In addition, mindfulness is known to reduce worry and rumination which can also lead to restlessness and sleep disturbance. So, it would make sense to study the relationship of mindfulness during the pregnancy to depression, rumination, and insomnia.

 

In today’s Research News article “Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190270/ )  Kalmbach and colleagues recruited pregnant women in their third trimester and had them complete measures of mindfulness, rumination, insomnia, and depression. These data were subjected to multivariate linear regression analysis.

 

They found that women who were high in mindfulness had significantly lower levels of rumination, insomnia, and depression. Women who were high in rumination had significantly lower levels of mindfulness and higher levels of insomnia, and depression. Employing multivariate modelling they found that mindfulness and rumination separately and independently were related to insomnia and that mindfulness and rumination separately and independently were related to depression.

 

These results were correlational and as such causation cannot be determined. But previous research has demonstrated that mindfulness training reduces rumination, insomnia, and depression. So, the relationships observed here are likely due to causal relationships among the variables. It appears that mindfulness and rumination work in opposite directions. Mindfulness helps pregnant women sleep better and helps relieve depression while rumination does the opposite of interfering with sleep and increasing depression.

 

Interestingly, mindfulness and rumination affect sleep and depression independently but are negatively related such that mindfulness decreases rumination while rumination lowers mindfulness. Mindfulness is an asset to pregnant women while worry produces problems. This suggests that pregnant women should be trained in mindfulness and also trained to reduce worry. Both of these goals can be accomplished with Mindfulness-Based Cognitive Therapy (MBCT). Future research should investigate this possibility.

 

So, reduce insomnia and rumination in pregnant women with mindfulness.

 

It seems important to develop mindfulness to improve sleep in pregnancy or reduce the impact of insomnia symptoms (common at pregnancy).” – M. Marques

 

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

 

Kalmbach, D. A., Roth, T., Cheng, P., Ong, J. C., Rosenbaum, E., & Drake, C. L. (2020). Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep health, 6(2), 185–191. https://doi.org/10.1016/j.sleh.2019.11.011

 

Abstract

Background:

Insomnia and depression are highly prevalent perinatal complications. Ruminating on stress is etiologically implicated in both disorders, and ruminating while trying to fall asleep has been linked to insomnia and depression during pregnancy. Incompatible with rumination is everyday mindfulness, i.e., living with intentional and nonjudgmental awareness of internal and external experiences in the present moment. Responding to stress mindfully may protect against stress-related perinatal complications such as insomnia and depression. The present study described the association between everyday mindfulness and nocturnal rumination, and examined whether these trait characteristics were independently related to perinatal insomnia and depression.

Methods:

Cross-sectional and secondary analysis of existing data from 65 pregnant women recruited from a multisite hospital in Metro Detroit, MI, USA. Subjects completed online surveys including the Insomnia Severity Index, Edinburgh Postnatal Depression Scale, Presleep Arousal Scale, and the revised Cognitive and Affective Mindfulness Scale.

Results:

Over half (53.8%) of women screened positive for clinical insomnia and 12.3% screened positive for major depression. Women high in mindfulness, relative to those low in mindfulness, reported less nocturnal rumination (Cohen’s d=1.16), insomnia symptoms (Cohen’s d=1.24), and depressive symptoms (Cohen’s d=1.35). Multivariate linear regression revealed that both mindfulness (β=−.24, p=.03) and rumination (β=.38, p<.01) were independently associated with insomnia. Similarly, a multivariate model showed that mindfulness (β=−.41, p<.001) and rumination (β=.35, p<.01) were independently associated with depression.

Conclusions:

Ruminating in bed at night is strongly associated with insomnia and depression during pregnancy, whereas mindfulness may potentially protect against these stress-related perinatal complications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190270/

 

Yoga Improves Resident Physician Psychological Health But Doesn’t Appear to be Feasible and Acceptable.

Yoga Improves Resident Physician Psychological Health But Doesn’t Appear to be Feasible and Acceptable.

 

By John M. de Castro, Ph.D.

 

Slammed by long and unpredictable hours, heavy clinical workloads, fatigue and limited professional control, many medical residents experience stress and even burnout. And surveys indicate this burnout can seriously impact physician well-being and patient care outcomes.” – Jennifer Huber

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnoutincreasing resilience, and improving sleep. Yoga is a mind-body practice that includes mindfulness and exercise. Yoga practice has been shown to improve the symptoms of burnout. But it is unclear whether it would be feasible and effective for resident physicians.

 

In today’s Research News article “Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961714/ ) Loewenthal and colleagues recruited resident physicians and randomly assigned them to a wait-list control condition or to receive 1-hour, once a week for 6-weeks yoga training with daily home practice. They completed a questionnaire regarding the feasibility of the program. They were also measured before and after training and 2-months later for psychological health, including mindfulness, resilience, perceived stress, professional fulfillment, depression, anxiety, sleep disturbance, and resident well-being.

 

The participants rated the feasibility and acceptability of the program as low and they averaged attending only 1.93 of the 6 sessions with no one completing all 6 sessions. They found that the yoga group had significant increases in mindfulness, resilience, professional fulfillment, and resident well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. While the wait-list group did not.

 

These efficacy findings are similar to those reported in other studies that yoga training results in increases in mindfulness, resilience, and well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. But the program was very disappointing in feasibility and acceptability. Resident physicians are pressed for time and stressed and may not have the time too attend classes and practice yoga. Other mindfulness programs, particularly those implemented online have been found to be feasible, acceptable, and effective for health care workers. They would appear to be preferable to yoga for resident physicians.

 

So, yoga improves resident physician psychological health but doesn’t appear to be feasible and acceptable.

 

So often we treat others’ bodies and minds, yet often neglect our own. While we encourage our patients to roll out their mats and settle into their asanas, we can remember to do it ourselves. When we treat our stress and anxiety, we will be better able to treat our patients.” – Julia Michie Bruckner,

 

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

 

Loewenthal, J., Dyer, N. L., Lipsyc-Sharf, M., Borden, S., Mehta, D. H., Dusek, J. A., & Khalsa, S. (2021). Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial. Global advances in health and medicine10, 21649561211001038. https://doi.org/10.1177/21649561211001038

 

Abstract

Background and Objective

Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers.

Methods

We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up.

Results

Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up.

Conclusion

This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961714/

 

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