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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|

Psilocybin increases self-transcendence among meditators

Posted 05.15.2019 | by AMRA

There are certain similarities between the increased awareness associated with the practice of mindfulness and the expanded consciousness associated with the use of psychedelic substances. Both are capable of promoting states of self-transcendence in which the boundary between one’s self and the world is erased, leading to a boundless sense of connection with the universe.

Smigielski et al. [Neuroimage] experimentally tested the effects of psilocybin, a psychedelic mushroom plant derivative, on self-reported, neurological, and behavioral outcomes among experienced meditators attending a meditation retreat.

The researchers randomly assigned 38 experienced meditators (average meditation experience = 5,000 hours; 61% male; average age = 52 years) on a five-day Zen meditation retreat to a psilocybin or placebo control condition. On the morning of the fourth retreat day, participants were administered either psilocybin (315 μgs/kg) or a placebo (lactose), and continued on with the regular retreat schedule. The research participants and assessors were blinded to the study group assignment.

Six hours after psilocybin or placebo administration, participants completed a questionnaire measuring psychological factors such as “oceanic self-boundlessness,” “dread of ego dissolution,” visual and auditory hallucinations, synesthesia, and “vigilance reduction.”

On the day before and after the retreat, participants underwent brain imaging (fMRI) to measure functional connectivity in the Default Mode Network (DMN) while resting, while engaging in focused attention meditation, and while engaging in open awareness meditation. The DMN is a network of brain regions that operates collectively when a person is simply resting and “doing nothing.”

DMN activity has been implicated in self-referential thinking, maintaining a unitary sense of identity, and maintaining the self-other boundary. Functional connectivity is a measure of the degree to which different brain regions are operationally […]

May 14th, 2019|News|

Experienced MBSR teachers show higher cortisol, unrelated to stress

Posted 04.23.2019 | by AMRA

Little is known about the impact of many years of mindfulness practice on the body’s response to stress. Robb et al. [Complementary Medicine Research] conducted a pilot study that measured salivary cortisol levels in a group of long-term mindfulness practitioners. Salivary cortisol is a biological measure that is highly reactive to stress. The researchers predicted that morning cortisol levels would be lowest for meditators with the most meditative experience.

Salivary cortisol levels typically peak during the first hour after waking up, and then decline throughout the rest of the day. Morning cortisol levels tend to be higher when under acute stress, and tend to be lower in states of exhaustion and burnout following long-term stress.

The authors recruited 83 certified Mindfulness-Based Stress Reduction (MBSR) teachers (73% female; 96% Caucasian; average age = 58; 92% with graduate degrees) to participate in the study. The participants completed an online questionnaire assessing a variety of health and lifestyle variables, perceived stress, and the extent of their meditation practice. They were then asked to produce a saliva sample upon first waking up, followed by 3 additional samples collected at 15-minute intervals. The total amount of cortisol produced during the first 45 minutes after awakening was then estimated using area under the curve (AUC) calculations.

The results showed that participants in the upper quartile of meditative experience (>26 years) had significantly higher (48%) total estimated morning cortisol amounts than those in the lowest (<10 years) quartile. The relationship between years of meditative experience and total morning cortisol remained significant when meditation experience was treated as a continuous variable.

In a closer examination of the data, this difference between participants in the […]

April 23rd, 2019|News|

Insurance reimbursement for a primary care mindfulness program

Posted 04.15.2019 | by AMRA

Most patients with mild-to-moderate psychological problems are diagnosed and treated in primary care rather than mental health settings. Many of these patients also suffer from physical disorders, or from physical symptoms caused or made worse by psychological factors. Mindfulness-based programs that reduce anxiety and depression and promote self-care are useful supplements to primary care treatments; however, existing barriers hinder their successful implementation. These barriers include limitations on staff time and training, staff unfamiliarity with mindfulness, and problems with insurance reimbursement.

Gawande et al [Mindfulness] studied the feasibility, acceptability, and effectiveness of a mindfulness-based primary care program in reducing symptoms and improving self-care for patients with mild-to-moderate psychological problems.

The researchers randomly assigned 81 primary care patients (69% female; average age = 44; 78% Caucasian; 44% meditation naive) with anxiety, depressive, stress- or trauma-related disorders to either a Mindfulness Training for Primary Care (MTPC) program or a low-dose comparison group. If participants were already receiving psychological help in the primary care setting, they continued to receive it as usual.

MTPC is an 8-week group program based on Mindfulness-Based Cognitive Therapy that incorporates elements of self-compassion training, values clarification, and relapse prevention. MTPC and low dose comparison group participants were asked to develop a self-care plan together with their primary care providers during the sixth week of the program. MTPC group leaders were either appropriately trained mental health clinicians or primary care physicians, with the groups being tailored to meet the insurance requirements of each discipline.

The low dose comparison control consisted of a one-hour didactic/experiential introduction to mindfulness with information on how to access community and digital mindfulness resources. Low dose comparison participants were also placed on […]

April 15th, 2019|News|