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MBCT reduces migraine-related disability among chronic sufferers

Posted 10.15.2019 | by AMRA

Episodic and chronic migraines affect approximately one billion people worldwide. Symptoms including migraine aura, headache, nausea, and light sensitivity can significantly impair functioning at work, home, and in social situations. Existing behavioral treatments including biofeedback, relaxation and cognitive therapy, and pharmacological treatments have limited efficacy, but no treatment works for everyone.

Seng et al. [Headache] evaluated the efficacy of Mindfulness-Based Cognitive Therapy for Migraine (MBCT-M) compared to a control in reducing migraine-related disability.

The authors randomly assigned 60 migraine patients (average age=40 years; 82% Caucasian; 92% female; average headache days per month=16) to MBCT-M or a treatment-as-usual waitlist control. Thirty-six percent of MBCT-M participants and 62% of control participants came to the study on prescribed prophylactic migraine medication that was continued throughout the study. The groups did not differ on headache frequency, intensity, or disability at baseline.

All participants kept a 30-day headache diary both before and after intervention. In addition, participants were assessed on two measures of headache disability: the Headache Disability Inventory (HDI) and Migraine Disability Assessment (MIDAS) at baseline, and 1, 2, and 4 months.

MBCT-M consisted of once weekly 75-minute individual training sessions for 8 weeks. Sessions included didactic training, cognitive exercises, mindfulness meditation practice and homework review. Most sessions were conducted in person; however, participants were allowed up to 3 telephone-delivered sessions when headaches prevented in-person attendance.

The trainers were clinical psychology graduate students with 12 hours of MBCT training. The trainers received continuous supervision from licensed psychologists with expertise in headaches, and sessions were monitored to assure treatment fidelity. The control group continued whatever treatment they were getting prior to the onset of the study and were placed on an MBCT-M […]

October 15th, 2019|News|

Brain changes in children after school-based mindfulness program

Posted 09.24.2019 | by AMRA

The stress response is associated with brain activity in the amygdala and the prefrontal cortex. The amygdala initiates the fight, flight, or freeze response to fear-inducing stimuli, while the prefrontal cortex helps modulate this response. A higher degree of connectivity between these brain regions is thought to enhance emotional regulation. These conclusions are based on research with adults. Little is known about the neural basis for children’s responses to stress, however, and whether it can be beneficially modified by mindfulness-based interventions.

Bauer et al. [Behavioral Neuroscience] tested whether mindfulness training reduces stress levels in middle school children, and if so, whether it is done by inducing changes in the amygdala and its connectivity to a region of the prefrontal cortex. This is the first study investigating the effects of a mindfulness-based intervention on children’s brain activity.

All 6th graders in a Boston charter school were randomly assigned to an 8-week mindfulness training program or an 8-week computer coding training program. The researchers requested the 6th graders’ families to permit their children to participate in the functional magnetic imaging (fMRI) portion of the study. Forty children received permission (average age = 12 years; 70% female; 53% Caucasian; Average WASI IQ = 98), and 33 of their fMRI protocols were usable.

Mindfulness and computer coding groups met four times a week for 45 minutes during the last class of the school day. Each mindfulness session included 15 minutes of mindfulness exercises involving focused attention on the present moment and related didactic instruction and group discussion. Exercises included focused breath meditations, attention to the senses, open monitoring, and practice in noticing thoughts.

Control group sessions involved teaching the SCRATCH […]

September 24th, 2019|News|

MBSR helps soothe pain after joint replacement surgery

Posted 09.20.2019 | by AMRA

Total hip and knee replacements are among the highest volume elective surgical procedures performed today. The vast majority of joint replacement patients report significant post-operative reductions in pain and disability. Nonetheless, about 15% of patients report poor surgical outcomes marked by continuing pain, disability, and dissatisfaction.

Pre-surgical levels of distress related to depression and anxiety are the best predictors of which patients are likely to fare poorly after surgery.

Medical professionals are interested in psychological interventions that could improve post-surgical outcomes. Dowsey et al. [Complementary Therapies in Medicine] tested whether pre-surgical Mindfulness-Based Stress Reduction (MBSR) could improve physical and psychological wellbeing outcomes after joint replacement surgery.

The researchers randomly assigned 127 Australian arthritis patients (average age = 65 years; female = 72%) with moderate-to-severe psychological distress (based on a psychological assessment cut-off score) who were surgically approved for knee or hip replacement to either surgery and post-operative care as usual, or a standard 8-week MBSR program followed by surgery and post-operative care as usual. Out of this sample, 45 MBSR assignees and 56 treatment-as-usual assignees eventually underwent surgery. Surgical patients were seen by their treating surgeons during 12-month surgical follow-up appointments.

Patients completed a self-report osteoarthritis measure that included subscales assessing pain, stiffness, and functional disability, as well as a total overall score that can serve as a single measure of global symptom severity. They also completed measures of general physical and psychological wellbeing, pain-management self-efficacy, and mindfulness (using the Five Facet Mindfulness Questionnaire). Assessments were completed at baseline, 3 months, and 12 months.

MBSR participants reported significantly less pain at 12 months than controls. They also reported significantly greater improvement on the global measure of overall […]

September 20th, 2019|News|

MBSR shows cost benefit for fibromyalgia, fewer sick days

Posted 08.30.2019 | by AMRA

Fibromyalgia is a chronic disorder affecting approximately 10,000,000 Americans. The disorder presents with symptoms of widespread musculoskeletal pain, fatigue, and mood, sleep, and cognitive difficulties. The cause of fibromyalgia is unknown, and its treatment is largely palliative, consisting of medication to reduce pain and inflammation, graded physical exercise and/or cognitive-behavioral therapy. The disorder incurs a wide variety of costs including high rates of unemployment, sick leave, disability claims, and direct medical care utilization.

Perez-Aranda et al. [Journal of Clinical Medicine] compared the cost-effectiveness and clinical utility of adjunctive Mindfulness-Based Stress Reduction (MBSR) to a previously validated comparator intervention and treatment-as-usual in the treatment of fibromyalgia.

The researchers randomly assigned 225 fibromyalgia patients recruited from a Spanish hospital to one of three treatment interventions: 1) MBSR + treatment-as-usual, 2) FibroQoL + treatment-as-usual, and 3) treatment-as-usual alone. MBSR was delivered using the standard 8-week group protocol with minimal adaptations. FibroQoL is a fibromyalgia intervention with previously demonstrated superiority to treatment-as-usual. It consists of 8 weekly 2-hour group sessions that include fibromyalgia psycho-education, relaxation, and self-hypnosis to help patients control pain and visualize a future pain-free life. Treatment-as-usual involved prescription medications for pain, inflammation, depression, and anxiety, along with recommendations for daily exercise.

Cost-utility data was only available for a final sample of 204 participants (98% female; average age = 53 years). Analyses were performed separately for the full intention-to-treat sample and for 107 patients who attended at least 6 of the 8 intervention sessions and their 12-month follow-up appointments.

Self-ratings of quality-of-life were obtained at baseline and 12 months using the EuroQol EQ-5D to assess disease impingement on mobility, self-care, and activities of daily living, as well as […]

August 30th, 2019|News|

Mindfulness program prevents dropout from addictions treatment

Posted 08.19.2019 | by AMRA

Many women attending residential substance use disorder treatment fail to successfully complete their program. These women often have complex social histories, multiple psychiatric and medical diagnoses, and histories of incarceration. They may also have trouble adjusting to the programs due to conflicts with staff and peers, substance withdrawal and cravings, and difficulty abiding by program rules and structure. Mindfulness may help women negotiate these difficulties by reducing their automatic reactivity to cravings, interpersonal conflicts, and other emotional triggers.

Black et al. [Behaviour Research and Therapy] studied whether a mindfulness-based intervention specifically designed for women in residential substance use disorder treatment settings could reduce the likelihood of prematurely leaving the program in unimproved condition.

The researchers randomly assigned 200 women in residential substance use disorder treatment (average age = 33 years; 58% Hispanic; 62% with incarceration history; 76% with amphetamine/methamphetamine abuse) to either the Moment-by-Moment Women’s Recovery (MMWR) program or a time-matched psycho-educational control.

Both were add-on interventions with participants continuing to receive all of the services ordinarily provided by the residential treatment program. In both of the interventions, the participants met twice weekly for 80-minute group sessions over the course of six weeks.

The MMWR program was based on Mindfulness-Based Stress Reduction, but specifically designed for ethnoracially diverse women in residential substance use treatment. The program addressed the role of mindfulness in dealing with cravings and relapse, trauma, parenting, conflicts with staff and peers, and other issues likely to arise in treatment.

The psycho-educational control consisted of didactic material regarding brain structure, function, and biochemical changes pertaining to substance abuse. Attendance in both groups averaged 9 out of 12 classes, and participants rated both groups highly in […]

August 19th, 2019|News|

MBSR supports less stress and fear extinction via hippocampus

Posted 07.23.2019 | by AMRA

Overcoming irrational fears involves recognizing when stimuli previously associated with danger have ceased their association with that danger. This means “extinguishing” a learned connection between a stimulus and its previously feared negative consequences.

Mindfulness can help with fear extinction by enabling individuals to approach previously feared stimuli with an attitude of non-reactive acceptance. Sevinc et al. [Biological Psychiatry] studied whether a mindfulness-based intervention affects the brain activity underlying the fear extinction process.

The researchers assigned 94 meditation-naive adults (average age = 32 years; 64% female) to either an 8-week mindfulness-based stress reduction (MBSR) program or an 8-week exercise-based stress management education program. Stress education consisted of 8 weekly 2 hour group sessions that included 40 minutes of light aerobic exercise and didactic presentations on coping with stress through exercise, nutrition, humor, and sleep hygiene.

Two weeks before and after intervention, participants underwent a two-day classical fear conditioning and fear extinction paradigm while being monitored by brain imaging (fMRI).

In the fear conditioning paradigm, participants were presented with images of rooms with either red, blue, or yellow lights. An annoying electric shock immediately followed the images of the rooms with the red or blue lights, but not the yellow lights. Fear was considered “conditioned” to the red or blue lights when exposure to those images led to an increase in skin conductance.

After the conditioned skin conductance response (SCR) was acquired, participants were then repeatedly exposed to the image with the red light without a consequent shock in order to extinguish the skin conductance response to that image while maintaining the conditioned skin conductance response to the blue light.

The next day, participant SCRs to the images were reassessed […]

July 23rd, 2019|News|

Online mindfulness training for emergency medical dispatchers

Posted 07.16.2019 | by AMRA

Emergency medical dispatchers (EMDs) face stressful job demands. In addition to dispatching emergency medical personnel, EMDs provide emergency advice over the phone and may be the last person to speak to an injured party alive. They are also subject to rotating shifts and mandatory overtime.

While EMDs might benefit from stress reduction interventions, the nature of their workplaces makes it difficult to implement time-intensive group-based trainings. Lily et al. [Occupational and Environmental Medicine] conducted a randomized controlled study to discover whether an on-line mindfulness-based intervention could successfully reduce stress among EMDs.

The researchers randomly assigned 323 North American EMDs (82% female; 90% Caucasian; modal age = 25-55 years) to either a mindfulness-based intervention or a wait list control. The mindfulness program (Destress 9-1-1) was delivered once per week for seven weeks in 20-30 minute online modules.

Each module included a brief video introduction to the theme of the week, an audio-guided mindfulness exercise, and suggestions for mindfulness activities to engage in during the week. The program was modeled after mindfulness-based stress reduction (MBSR), but required less time in terms of coursework, meditation length, and suggested weekly practice.

Participants were assessed on measures of stress and mindfulness (using the Mindful Attention Awareness Scale, or MAAS) at baseline, post-intervention, and 3-month follow-up.

Attrition was fairly high with 32% of mindfulness assignees and 18% of controls failing to complete the post-intervention assessment, and 47% of mindfulness assignees and 38% of controls failing to complete the 3-month follow-up.

Of those assigned to the mindfulness intervention, 25% completed 0 modules, 20% completed 1-5 modules, and 55% completed 6-7 modules over the seven weeks. Mindfulness assignees engaged in practice an average of twice per […]

July 16th, 2019|News|

Mindfulness app associated with brain function and less smoking

Posted 06.26.2019 | by AMRA

Although most cigarette smokers want to quit, only 5% succeed in doing so each year. One reason for this low success rate is that smoking-related cues stimulate strong urges to smoke. Cues include observing someone else smoking, or engaging in activities previously associated with smoking (e.g., work breaks, meals, a cup of coffee, sex). Finding ways to reduce cue-induced urges may help more people quit.

Research shows that a brain area called the posterior cingulate cortex (PCC) becomes activated whenever cigarette smokers are exposed to smoking-related cues. Research also indicates that mindfulness meditation as an intervention reduces PCC activity. Janes et al. [Neuropsychopharmacology] tested whether a smartphone mindfulness app reduced smokers’ PCC reactivity to smoking-related cues and their smoking behavior.

The researchers recruited 83 adult smokers who were interested in quitting, 67 of whom completed the study and were included in the final data analysis (average age = 44; 67% female; 91% Caucasian). PCC-reactivity to smoking cues was assessed by functional magnetic resonance imaging (fMRI) and participants were then randomly assigned to either mindfulness training or a control condition. Both conditions used smartphone apps for 4 weeks to help quit smoking. Participants’ PCC reactivity to smoking-related cues was re-assessed via fMRI after the intervention.

The mindfulness app consisted of 22 modules that offered daily training videos and on-demand exercises to teach the core elements of mindfulness. The app also helped participants identity triggers, monitor smoking habits, increase awareness of urges, and use mindfulness as a coping mechanism.

The control group used the National Cancer Institute’s QuitGuide App to help monitor motivation and triggers, as well as offer inspirational messages and tips for dealing with cravings and […]

June 26th, 2019|News|

Less cellular aging with loving-kindness meditation

Posted 06.19.2019 | by AMRA

Telomeres are repetitive nucleotide sequences at the end of chromosomes that protect coding regions of DNA from deteriorating during cell division. Telomeres shorten not only as we age, but also when we are under stress. Shorter telomeres are linked to an increased incidence of age-related diseases such as cardiovascular disease, and to an increased risk of death. The enzyme telomerase lengthens telomeres through the addition of nucleotide repeats.

Preliminary studies show that meditation can have a protective effect on telomeres, most likely by increasing telomerase activity. Specific types of meditation may be more effective than others in maintaining telomere length. Nuygen et al. [Psychoneuroimmunology] tested whether specific types of meditation practice have a protective effect on telomere length.

The researchers randomly assigned recruits to mindfulness meditation (MM), loving-kindness meditation (LKM), or a wait-list control. Their final sample (excluding dropouts and participants with inadequate DNA samples) consisted of 142 meditation-naive recruits (average age = 49; 70% female; 81% Caucasian). MM and LKM participants attended six, hour-long, group meditation training workshops held once per week. They also received 20-minute audio-recorded guided meditations to assist in daily home practice.

MM training focused on developing open, non-judgmental attention towards breath, bodily sensations, thoughts, and feelings, as well as choiceless awareness. LKM training focused on cultivating warm feelings towards oneself, a loved one, an acquaintance, a difficult person, and all beings.

Two weeks prior to the workshops (and three weeks after) participants donated a blood sample that was used to assess white blood cell (monocyte and lymphocyte) telomere length. Participant moods and extent of meditation practice were assessed by daily diary.

All groups showed a decrease in telomere length over the course […]

June 19th, 2019|News|

MBSR supports immune health among breast cancer survivors

Posted 05.28.2019 | by AMRA

Newly diagnosed breast cancer patients often experience significant psychological distress including symptoms of depression, sleep disturbance, and fatigue. They can also exhibit stress-induced immune system compromises that have the potential to accelerate tumor growth and metastasis. Interventions that restore psycho-immunological balance may also help improve cancer treatment outcomes.

Witek-Janusek et al. [Brain, Behavior, and Immunity] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on psychological and immunological functioning in newly diagnosed breast cancer patients in an experimental trial.

The researchers randomly assigned 164 women (average age = 55 years; 77% Caucasian) recently diagnosed with early stage breast cancer who had undergone surgery to either a standard MBSR or an active control condition. The active control consisted of eight 2.5 hour group sessions providing information on breast cancer, cancer treatment, communication with health providers, and other health-related topics. Attendance in both programs was fairly good, with 68% of MBSR and 78% of control participants attending at least 7 of the group sessions.

Each participant’s psychological status was assessed pre-intervention, mid-intervention, post-intervention, and at 1- and 6-month follow-ups for perceived stress, depression, sleep quality, fatigue, and mindfulness (Five Facet Mindfulness Questionnaire).

The researchers also measured natural killer cell anti-tumor activity (NKCA), monocyte production of Interleukin-6 (IL-6) and Interferon-gamma (INF-ɣ), and the amount of IL-6 and Tumor Necrosis Factor-alpha (TNF-α) present in blood plasma. NKCA prevents tumor growth and metastasis, and is thus associated with longer cancer-free periods. NK cells produce INF-ɣ, an anti-tumor cytokine which is a key immune system activator. IL-6 and TNF-α are pro-inflammatory cytokines that promote tumor progression and aggressiveness.

The results showed that the MBSR group had significantly greater increases in two protective immunological factors […]

May 28th, 2019|News|