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Brain and immune changes in cancer survivors after mindfulness

Posted 01.19.2021 | by AMRA

Research shows that mindfulness practice can reduce pro-inflammatory biomarkers related to illness onset and disease progression. Little is known, however, about how meditation-induced changes in inflammation are connected to brain activity. Mindfulness training can reduce fear in response to threat by reducing activity in the amygdala. It can also increase or decrease response to various rewards by modifying activity in the ventral striatum. Fear reduction and reward enhancement are important aspects of how mindfulness facilitates well-being.

Dutcher et al. [Psychoneuroimmunology] studied whether meditation-induced changes in brain activity were correlated with changes in pro-inflammatory biomarkers among breast cancer survivors.

The researchers assigned 22 female breast cancer survivors who had completed primary treatment (average age = 47 years; 60% white) to a Mindfulness Awareness Practices program developed by the UCLA Mindful Awareness Research Center. Participants met in weekly 2-hour groups over 6 weeks. Class sessions included didactic material on mindfulness, relaxation, and mind-body relationships, and experiential practice with a variety of meditation techniques to cultivate positive emotions.

Participant blood was collected by venipuncture before and after intervention to quantify levels of two pro-inflammatory biomarkers, the cytokine Interleukin-6 (IL-6) and C-reactive protein (CRP). Participants also underwent fMRI brain scans before and after intervention.

Participants engaged in two tasks while being scanned. The first task, intended to stimulate amygdala activity, was a threat reactivity task involving viewing images of threatening facial expressions interspersed with an emotionally neutral task. The second, intended to stimulate ventral striatum activity, was a reward reactivity task involving viewing positively emotionally-toned images of landscapes, sunsets, smiling faces interspersed with neutrally emotionally-toned images of common household objects.

Results showed the women reported significantly decreased depression (d=-0.57) and […]

January 19th, 2021|News|

Mindfulness primer boosts physician communication skills

Posted 12.22.2020 | by AMRA

Delivering bad news to patients is one of the many challenges physicians face. The exchange can be emotionally taxing for both the physician and patient, and if communicated poorly, can lead to misunderstanding, emotional devastation, and low treatment compliance. Cultivating a mindful state before delivering bad news may potentially help physicians communicate bad news more skillfully.

Mengin et al. [Journal of Surgical Education] conducted a pilot study to test if a brief guided mindfulness meditation could improve bad news communication skills in medical residents.

The researchers randomized 53 French ear, nose, and throat (ENT) residents to a brief mindfulness meditation and a control condition. Participants in both conditions attended a 45-minute lecture on how to communicate bad news to patients. After the lecture they completed self-report measures of anxiety, fear of evaluation, and mindfulness (Mindful Attention Awareness Scale, MAAS).

The residents completed a bad news consultation training session that consisted of preparation, simulation, and post-simulation phases. The preparation phase included having residents self-rate their stress and self-confidence and then listen to either a 5-minute guided mindfulness meditation audio track or an information-only control audio track on the definition of atoms.

After listening to the audio tracks, residents again rated their stress and self-confidence. In the simulation phase, residents engaged in an 8-minute simulated consultation in which they disclosed a diagnosis of laryngeal cancer to a person acting as a patient.

A psychiatrist and ENT specialist blind to the resident’s study group rated each resident on skill performance. Ratings were made for respect, efficacy, knowledge, communication, and overall impression.

The evaluators also passed or failed each resident based on their belief that the resident was now ready to […]

December 23rd, 2020|News|

MBSR better than stress management for heath worker distress

Posted 12.17.2020 | by AMRA

Work-related stress is a major cause of employee dissatisfaction, absenteeism, turnover, and ill-health. Hospital healthcare workers face a number of significant work-related stresses including the physical, cognitive, and emotional demands of caring for seriously ill people. Hospitals can benefit from interventions designed to reduce occupational stress, retain personnel, and prevent burnout.

Errazuriz et al. [Journal of Psychiatric Research] tested the efficacy of a mindfulness intervention on hospital healthcare worker distress when compared to a stress management course or waitlist control.

The researchers randomly assigned 105 Chilean non-physician hospital healthcare workers (average age = 40 years; 98% female) to Mindfulness Based Stress Reduction (MBSR), a stress management course, or a waitlist control. Twenty-three percent of participants met the pretest cut-off criteria for being psychologically distressed.

MBSR and stress management groups met in 2-hour weekly group sessions for 8 weeks. The MBSR intervention followed the usual MBSR protocol minus the all-day retreat. The stress management course was a pre-existing hospital program comprised of lectures, interpersonal support and experiential activities on topics such as visualizing strengths, relaxation, self-care, resilience, and seeking social support.

Participants were assessed at baseline, after intervention, and at 4-month follow-up on self-report measures of general and occupational psychological distress, job satisfaction, perceived stress, and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ). Cortisol in saliva, a stress hormone, was collected three times over the course of a single day at baseline and post- intervention.

Participant attrition was high, with 73% completing at least one measure at post-intervention, and 50% completing at least one measure at follow-up.

Immediate post-intervention results showed the MBSR group had significantly less distress and reported higher job satisfaction than the stress management and waitlist […]

December 17th, 2020|News|

MBCT reduces symptoms of children hospitalized with cancer

Posted 11.30.2020 | by AMRA

Children with cancer often have significant cognitive, emotional, behavioral, and academic problems. These result not only from the illness itself, but also the anxieties associated with diagnosis and prognosis, the negative side-effects of oncology treatments, and the lengthy separations from familiar settings and social supports entailed by hospitalization. Psychosocial interventions are needed that can more effectively bolster children’s resilience over the course of arduous treatment.

Abedini et al. [Mindfulness] assessed the value of a modified version of Mindfulness-Based Cognitive Therapy for Children (MBCT-C) in reducing internalizing psychological problems (anxiety, depression, and somatization) and attentional problems in school-age children undergoing hospitalization for cancer.

The researchers randomly assigned 40 Iranian children hospitalized for cancer (age range = 11-13 years; 53% male) who met the diagnostic criteria for acute stress disorder and showed elevated internalizing and attentional problems to a modified version of MBCT-C or to treatment as usual. The children were continuously hospitalized throughout the length of the intervention.

MBCT-C was delivered in the Farsi language to small groups of 2-4 participants meeting 5 times a week. The standard MBCT-C protocol was modified to meet the children’s physical, motivational, and attentional needs and the demands of the hospital schedule. Group sessions were shortened to 45 minutes each, delivered over a shortened 4-week time-course, and without the usual raisin, yoga, and mindful movement meditations.

Treatment as usual included limited medical social worker support and a playroom available for 2 hours daily. Children were assessed before and after treatment and at 2-month follow-up for internalizing behavioral problems and attentional difficulties using a parent-completed behavioral checklist, and a child-completed self-report inventory.

The results showed significantly greater reductions in parent-rated (η2=.53) and […]

November 30th, 2020|News|

Mindfulness app sustains attention after cold temperature stressor

Posted 11.17.2020 | by AMRA

Many critical tasks in daily life require sustained attention under stressful circumstances (e.g., air traffic control, combat, and emergency medical response) despite the fact that stress can deplete attention by overtaxing cognitive resources. Lapses of attention increase under conditions of acute stress.

Mindfulness training can have beneficial effects on attention and stress, and researchers are interested in knowing the degree to which it can prevent stress-induced attentional impairment. Piil et al. [Journal of Cognitive Enhancement] tested the effects of mindfulness training compared to cognitive performance training on sustained attention following a stressor.

The researchers randomly assigned 48 Danish university students and staff members (average age = 38 years; 58% female) to either 30 days of mindfulness training using the Headspace app, or 30 days of cognitive training using the NeuroNation app. Headspace is a meditation application that teaches core mindfulness skills through guided audio meditations that include mindful breathing, open monitoring, and body scanning. NeuroNation is a cognitive training application consisting of short games intended to strengthen working memory, perceptual accuracy, verbal and arithmetic skills, and logical reasoning.

Participants were instructed to use the apps 10 minutes daily for 10 days, 15 minutes daily for the next 10 days, and 20 minutes daily for the final 10 days.

At baseline and after completing one month of training, participants were exposed to a cold pressor stress task and then immediately asked to perform a sustained attention task. The cold pressor task in known to increase stress as measured by increases in sympathetic nervous system arousal (heart rate, blood pressure, stress hormones). Participants were instructed to put their non-dominant hand in a tank of circulating ice water […]

November 17th, 2020|News|

Autonomic activity while meditating linked to less opioid use

Posted 10.28.2020 | by AMRA

The over-prescription of opioids for chronic pain is a significant risk factor for drug abuse and addiction. About one-fifth of chronic pain patients double their opioid dosage over the course of two years, and so primary care psychological interventions are needed to reduce the risk of eventual misuse and dependence.

In a previous clinical trial, a mindfulness training program for opioid users reduced pain and opioid dosage in chronic pain patients. Garland et al. [American Psychologist] conducted a secondary analysis of that clinical trial, now examining whether physiological changes in heart rate variability (HRV) predict opioid dose reduction. HRV is the variation of time between each heartbeat and serves as a biomarker for increased autonomic nervous system self-regulation. Greater HRV is associated with relaxation and greater emotional and behavioral self-control.

The researchers randomly assigned 95 primary care patients who were prescribed opioids for the management of chronic musculoskeletal pain (66% female; 90% Caucasian; average age = 57 years) to Mindfulness-Oriented Recovery Enhancement (MORE) or a support group. Both MORE and support groups were delivered once weekly for 2 hours across 8 weeks.

MORE included didactics and practice in mindfulness, cognitive reappraisal, and savoring naturally occurring rewards that included 15 minutes a day of home practice in these skills. Emphasis was placed on making the skills relevant to substance abuse, pain, stress reduction and self-regulation. The support group included nondirective counseling, social support, home journaling, and discussions of chronic pain, stigma, and stress.

Daily opioid dosage before and after intervention was assessed using retrospective self-report and prescription data from the medical record. After intervention, HRV was measured via electrocardiogram during a 5-minute baseline recording and a […]

October 28th, 2020|News|

School-based mindfulness aids child attention, brain connectivity

Posted 10.22.2020 | by AMRA

Children who have a greater cognitive capacity to sustain attention often perform better in school. Cognitive capacities such as increased attentional control can result from mindfulness training, as shown previously in samples of children. Little is known about the brain activity that links such training to sustained attention in children.

A promising mechanism to test is the functional relationship between areas of the brain that support sustained attention (the Central Executive Network, CEN) and mind wandering (the Default Mode Network, DMN). The activity of these two networks is positively correlated in very young children, and becomes increasingly anticorrelated as children develop the capacity to sustain attention and mature into adulthood.

Bauer et al. [Human Brain Mapping] tested the effects of an in-school mindfulness training on sustained attention performance as well as CEN and DMN brain activity in school children.

The researchers randomly assigned 99 sixth-graders (70% female; 53% Caucasian; average age = 12 years) to in-school mindfulness or computer coding training. Mindfulness classes incorporated 5-15 minutes of mindfulness practice per class, involving attention to breathing, body sensations, sounds, thoughts and emotions. The classes also included didactic mindfulness instruction, group discussion, and instructor feedback.

The coding intervention taught children to use a novel programming language and was designed to train creative thinking, systematic reasoning, and collaborative group work. Both interventions took place 4 times per week in 45-minute sessions across 8 weeks.

All children completed a 15-minute sustained attention task before and after intervention that required them to press a button whenever a digit appeared on a computer screen, except when the digit was the number three. A subsample of 40 children had parental permission for brain […]

October 22nd, 2020|News|

Brain gray and white matter reorganize with focused meditation

Posted 09.23.2020 | by AMRA

Meditation practice reportedly affects the gray (cell bodies) and white matter (axons) of the brain. However, cross-sectional studies comparing meditators to non-meditators are inconclusive, while many longitudinal studies employ multiple meditation techniques. This makes it difficult to pinpoint the meditation practices responsible for specific brain changes.

Lenhart et al. [Behavior Brain Research] tested for brain changes in gray and white matter in meditation-naïve adults who completed a seven-week focused-attention meditation training.

The researchers studied 27 meditation-naïve adult Austrian participants (63% female; average age=43 years) who attended all fourteen 45-minute sessions of a seven-week focused-attention meditation training program. The program taught a breath-body-mind centered raja yoga method that involved elements of focused attention to breathing (pranayama) and retraction of the senses (pratyahara). The training also required 15-30 minutes of daily home practice.

Participants underwent magnetic resonance imaging (MRI) before and after the training program. They also completed a pre- and post-training self-report assessment of anxiety symptoms. Gray matter volume changes were assessed using whole-brain voxel-based morphometry, and white matter integrity changes were assessed using fractional anisotropy.

Results showed significant gray matter volume increases in the anterior insula, inferior frontal gyrus, superior frontal gyrus, caudate nucleus, and right cerebellum after the intervention. Significant gray matter volume decreases were detected in inferior parietal lobe, superior and middle temporal gyri, inferior frontal gyrus, medial prefrontal cortex, parahippocampal gyrus, and posterior cingulate cortex.

White matter showed increased integrity in the right basal ganglia, right hippocampus, and supraventricular region after the intervention.

The sample had a significant decrease in anxiety after the intervention, and decreases in anxiety were significantly associated with gray matter volume changes in the right-mid cingulate cortex, posterior cingulate cortex, […]

September 23rd, 2020|News|

MBCT supports vocational competencies in couseling trainees

Posted 09.14.2020 | by AMRA

Psychological counseling as a profession can be emotionally taxing, and counseling trainees may experience compassion fatigue and elevated stress. Counseling training programs focus on teaching counseling skills, yet they often are insufficient to support trainee self-care and wellness.

Teaching trainees mindfulness may enhance their professional growth and increase their resistance to vocational stressors.

Chan et al. [Patient Education and Counseling] conducted a randomized crossover study to test the effects of Mindfulness-Based Cognitive Therapy (MBCT) on wellness and perceived vocational competencies among undergraduate counseling trainees.

The researchers randomly assigned 50 undergraduate counseling trainees (60% female; age range 18-23 years) at a Hong Kong university to either MBCT or a wait-list control. MBCT was delivered once per week for 8 weeks in 2-hour group sessions.

Trainees were assessed at baseline and 3 months on self-report measures of empathy, self-compassion, psychological distress, counseling self-efficacy, and mindfulness (Five Facet Mindfulness Questionnaire). Self-efficacy assessed trainee self-confidence in applying helping skills (e.g., being attentive, listening, reflecting feelings, asking open-ended questions) and managing boundaries and problematic client behaviors.

Brain activity and physiology were also assessed. Trainees had their brain EEG frontal midline theta-wave activity (a measure of internal attention), and their respiration rate and skin conductance (measures of autonomic arousal) measured while resting listening to either classical music or a guided meditation audiotape.

At baseline both groups listened to classical music, and at 3- month assessment the MBCT group listened to the meditation audiotape while the control group listened to classical music. After the 3-month assessment, the wait-list controls then completed MBCT as part of the crossover design.

Both groups were then reassessed on all measures at 6 months after baseline. At the 6-months, both groups […]

September 14th, 2020|News|

Post-chemo cancer survivors have less cognitive impairment after mindfulness training

Posted 08.26.2020 | by AMRA

Up to 78% of women undergoing chemotherapy for cancer report impairment in cognitive functioning, commonly referred to as “chemo fog.” These complaints are accompanied by functional connectivity changes in regions of the brain involved in attention and executive functioning. Functional connectivity is a measure of the degree to which different brain regions act in tandem. While the efficacy of mindfulness training for cancer-related emotional difficulties is supported, the effect on cognitive impairment remains unknown.

Gucht et al. [Cancer] tested mindfulness training against a wait-list control on cancer survivors’ subjective and objective cognitive impairment, psychological symptoms, and brain connectivity.

The researchers randomly assigned 33 Belgian female breast cancer survivors (average age = 45 years) with self-reported subjective cognitive impairment to either mindfulness training or a wait-list control. Mindfulness training was based on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT), and delivered in four group-based sessions, each lasting three hours. Home practice was encouraged and brief between-session telephone calls for encouragement and support were offered over an 8-week period.

Participants were assessed at baseline, one week after the intervention, and at 3 months after on a subjective measure of cognitive functioning and an objective battery of attention, concentration, memory, executive functioning, and processing speed. Other subjective measures were used to assess emotional distress, fatigue, and mindfulness (Comprehensive Inventory of Mindfulness Experiences).

Participants also underwent resting-state fMRI brain scans at all three assessment points. Six mindfulness participants and one control did not complete the study.

Results showed the mindfulness training group had significantly greater improvement in subjective cognitive impairment at post-treatment (Hedge’s g=0.99) and follow-up (g=0.95) than controls. The mindfulness group also had significantly greater decreases in […]

August 26th, 2020|News|