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According to the Center for Disease Control, about 70 million Americans suffer from sleep difficulties, with less than half of adult Americans getting the recommended 7-9 hours a night of sleep. Sleep disturbances can lead to daytime sleepiness and impaired daytime cognitive performance as well as increase the risk for cardiovascular diseases including high blood pressure, heart attack, and stroke.
Several behavioral interventions are shown to have some efficacy in improving sleep quality, yet little is known about their relative effectiveness. Kirk et al. [Journal of Cognitive Enhancement] tested the relative efficacy of three different pre-sleep interventions compared to a no-treatment control on sleep outcomes.
Healthy Danish participants (N=38; average age = 28 years; 53% male) completed a cross-over study to assess the effects of three pre-sleep interventions. All participants received all three interventions after an initial one-week baseline period that served as a control condition.
Each intervention lasted one week, with a one-week washout period between each intervention trial. Participants received treatments in a randomized order to counterbalance any order effects.
Participants wore a chest-strapped heart rate monitor to measure heart rate variability and a wrist-worn actigraph. Participants slept wearing this equipment nightly during the baseline period and during the intervention periods to measure parasympathetic activity, sleep time and sleep efficiency.
All three interventions were app-based on a smartphone and listened to for 15-45 minutes at bedtime. Interventions compared were restful instrumental music, sleepcasts (narrative tours of dreamy landscapes), guided mindfulness meditation, and the baseline control period where they slept as normal without an intervention. Mindfulness exercises involved non-judgmental present-moment experiencing of body, breath, and mind.
Participants completed daily sleep diaries as well as self-report sleep and stress questionnaires and a computerized sustained attention task at baseline and post-intervention.
The results showed that only the mindfulness app condition resulted in improved self-report sleep quality (partial η2 = 0.25), lower perceived stress (η2 =0.27) and improved sustained attention on the computerized task (η2 = 0.21). All three treatments showed improved actigraph-measured sleep efficiency compared to the control condition (η2p = 0.71), but sleep efficiency was highest for the mindfulness group (η2 = 0.08).
All three interventions increased heat rate variability during the pre-sleep period compared to the control period (η2 = 0.25), but only the mindfulness group showed higher heart rate variability while asleep (η2 = 0.32).
The study shows an app-delivered guided mindfulness meditation intervention is more effective than two other active pre-sleep interventions in improving perceived subjective sleep quality and objective sleep efficiency in healthy participants. Mindfulness was also most effective in reducing perceived stress and overnight physiological arousal, and improving daytime sustained attention.
Kirk, U., Ngnoumen, C., Clausel, A., & Purvis, C. K. (2021). Using Actigraphy and Heart Rate Variability (HRV) to Assess Sleep Quality and Sleep Arousal of Three App-Based Interventions: Sleep Music, Sleepcasts, and Guided Mindfulness. Journal of Cognitive Enhancement.
Link to study
Public school teachers often report high levels of job-related stress, burnout, and low job satisfaction. 40% of teachers leave the profession within their first 5 years of teaching. While studies show mindfulness-based interventions can improve teacher well-being, many of these studies lack long-term follow-up, active comparison groups, and objective outcome measures.
Carroll et al. [Mindfulness] evaluated the relative efficacy of Mindfulness-Based Stress Reduction (MBSR) compared to an active comparator program on measures of teacher well-being, emotional regulation, and neuro-cognitive functioning.
The researchers assigned 83 Australian K-12 teachers (average age = 45 years; 88% female) experiencing work-related stress to MBSR or a Health Enhancement Program (HEP). Groups were matched on age, gender, and fMRI eligibility. The 8-week MBSR and HEP programs met weekly in 2.5-hour group sessions with a full-day retreat in week 5 or 6. The MBSR program was a standard MBSR program tailored for teachers.
The HEP program included music therapy, physical activity and functional movement (e.g., walking, stretching, posture, balance, and core strength), and stress management education.
Participants were assessed at baseline, post-intervention, and 5-month follow-up on a battery of self-report measures and computer-administered neuropsychological tests. Self-report measures assessed perceived stress, mood, affect, emotional regulation difficulties, and mindfulness (Five Facet Mindfulness Questionnaire or FFMQ).
The computer-administered neuropsychological tests assessed facial expression recognition, attention, vigilance, executive function, cognitive flexibility, and working visual memory.
A subset of 55 participants also underwent fMRI scanning at baseline and immediate post-intervention. fMRI scans were performed while participants counted the number of words displayed on a computer screen. The words varied in emotional valence, and the researchers expected negative emotional words would slow down response time compared to neutral words (an expectation not borne out in the data). The negative emotional words included words related to the stresses teachers would normally encounter such as “paperwork.”
Attendance in both study groups was high, with participants attending 88% and 89% of the sessions. Both programs received high satisfaction ratings.
All of the self-report measures showed significant improvement over time, regardless of group assignment. In both groups, there were large effect size decreases in stress and burnout, large-to-medium effect size increases in mindfulness, and medium effect size increases in well-being and emotional regulation. Improvements were maintained at 5-month follow-up.
In the overall sample, the percent of teachers stating they intended to quit teaching decreased from 54% at baseline to 31% at post-intervention and 35% at 5-month follow-up. However, there was no group differences detected for intention to quit teaching.
Neuropsychological measures of visual working memory, sustained attention, and cognitive flexibility showed improvement from baseline to post-intervention in both groups. These improvements were maintained on 5-month follow-up.
While the researchers state the MBSR group showed a greater improvement in accuracy on a sustained attention task than controls, the lack of a significant interaction term suggests the groups improved similarly.
The fMRI scans showed that MBSR participants exhibited post-intervention decreases in brain activation in regions associated with emotional processing, while the HEP group did not. These regions included the inferior temporal gyri, left and posterior cingulate gyri, left claustrum, insula, amygdala and cerebellum, and right hippocampus and parahippocampus.
This result suggests the possibility that MBSR participants had become less reactive to negative emotional stimuli as a result of the intervention.
The study shows MBSR and HEP were equally effective in decreasing stress and burnout and improving mindfulness, well-being, emotional regulation, and neurocognitive functioning out to 5 months after intervention.
The only between-group difference was that MBSR participants showed reduced brain reactivity to negative emotional stimuli. This may be an objective brain measure of improved emotional regulation untapped by the self-report measures.
Carroll, A., Sanders-O’Connor, E., Forrest, K., Fynes-Clinton, S., York, A., Ziaei, M., Flynn, L., Bower, J. M., & Reutens, D. (2021). Improving Emotion Regulation, Well-being, and Neuro-cognitive Functioning in Teachers: A Matched Controlled Study Comparing the Mindfulness-Based Stress Reduction and Health Enhancement Programs. Mindfulness.
Prolonged psychological stress can induce a state of chronic low-grade systemic inflammation. Inflammation, in turn, can contribute to the onset or worsening of many physical and mental conditions. Mindfulness-based interventions that reduce stress may also help reduce systemic inflammation.
The body’s inflammatory response is a complex process that involves the activation of immune system cells and the release of proteins known as cytokines. Different cytokines can promote or inhibit inflammation.
Gardi et al. [Psychoneuroimmunology] tested the effects of a 3-day resort-based mindfulness meditation retreat compared to a vacation retreat on perceived stress, stress hormones, and cytokine levels.
The researchers randomly assigned 95 healthy Italian adults (average age = 47 years; 51% male) to a 3-day intensive mindfulness retreat or a 3-day vacation control. The retreat and vacations were held at the same resort. The mindfulness retreat involved 10-hours a day of alternating sitting and walking meditation taught by experienced meditation teachers. Meditations involved attention to and acceptance of the breath, physical sensations, thoughts, and feelings.
The vacation retreat involved unstructured free time allowing participants to rest, walk in nature, read, or socialize with others.
Participants were assessed before and after the 3-day interventions on self-report measures of perceived stress, anxiety, and mindfulness (using the Mindful Attention Awareness Scale) and provided one saliva sample between 5:00-6:00 AM upon awakening before and after retreat.
Saliva samples were assayed for levels of cortisol (a stress hormone) and a panel of pro- and anti-inflammatory cytokines (IL-2, IL-4, IL-6, IL-8, IL-10, IFN- γ, TNF-α, and GM-CSF). Only cortisol and cytokines IL-6, IL-8, and IL-10 were detectable and included in subsequent analyses.
The results showed while both groups reduced perceived stress, only the mindfulness group exhibited significantly decreased anxiety, increased mindfulness, decreased levels of cortisol and pro-inflammatory IL-6 and IL-8, and increased levels of anti-inflammatory IL-10 after the retreat.
Salivary cortisol levels were highly correlated with anxiety and stress in both groups. For example, before the retreat salivary cortisol correlated with anxiety (r=.64) and with perceived stress (r=.98) within the mindfulness group. Similar large correlations were obtained for the vacation group, and for both groups following the retreat.
This is the first study to show a saliva-based anti-inflammatory effect of an intensive mindfulness retreat in a healthy sample. The salutary effects of a 3-day mindfulness retreat were beyond those of 3 days of vacationing.
Salivary cytokine levels differ from blood serum cytokine levels, thus the study is limited when inferring to systemic inflammation. Although correlations between cortisol and stress are quite high in this study, single measures of morning salivary cortisol are not generally considered to be reliable measures of physiological stress.
Gardi, C., Fazia, T., Stringa, B., & Giommi, F. (2022). A short Mindfulness retreat can improve biological markers of stress and inflammation. Psychoneuroendocrinology, 135, 105579.
Newborns delivered before the eighth month of pregnancy sometimes exhibit deficits in cognitive and socio-emotional functioning that persist into adulthood. Mindfulness-based interventions that can improve cognitive and socio-emotional regulation may help remediate such lasting deficits.
Siffredi et al. [Scientific Reports] performed a randomized trial to test the effects of a mindfulness-based intervention on cognitive, social-emotional, and behavioral competencies in children born prior to 7.5 gestational months of age.
The researchers randomly assigned 56 very prematurely born Swiss children (age range = 10-14 years; average gestational age = 29 weeks; 54% female) to a mindfulness-based intervention or wait-list control. The mindfulness training was an 8-week intervention consisting of weekly 90-minute group sessions.
The program modeled Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy but was adapted for age. It included the body scan and sitting, walking, and movement meditations as well as didactic education on kindness, non-judgment, letting go, and gratitude.
Participants were assessed at baseline, immediate post-intervention, and 3-month follow-up on parent ratings of the child as well as child self-reports of cognitive, social-emotional, and behavioral competencies. Children also completed a battery of neuropsychological tests (pertaining to number sequencing and timed math ability) and computerized attentional tasks.
The results showed children in the mindfulness group scored significantly better at post-intervention on parent ratings of emotional control, the ability to focus and shift attention, and to initiate, plan, organize, and self-monitor behavior. Children in the mindfulness group also showed larger decreases in reaction times than controls on a computerized attentional task assessing the ability to ignore irrelevant stimuli.
There were no significant group differences on any of the child self-report measures or neuropsychological test ability scores at post-intervention. At 3 months, the mindfulness group maintained its improved reaction time on the computerized attention task and improved on self-compassion compared to controls.
There were no other improvements on 3-month follow-up, and the previously noted improvements in parental ratings were no longer significant.
When participants were divided analytically into high and moderate risk groups based on birth weight and gestational age, the high risk group was more likely to maintain gains in parent-rated executive and metacognitive functioning at 3-month follow-up. The moderate risk group was more likely to maintain their faster reaction times on the computerized attentional task.
The high-risk group showed significant gains in self-compassion immediately after the intervention, while the moderate-risk group only showed improved self-compassion at 3-month follow-up.
The study shows that a mindfulness-based intervention delivered to children who were preterm at birth led to improvements in parental ratings of their child’s emotional control and cognitive function. Children in the mindfulness group also showed improved reaction time on a computerized attentional task.
Effect sizes were not reported for study outcomes, making it hard to discern the clinical utility of these findings. Lack of an active control group in the study may have led parents to report improvements in their child simply due to the expectation that any support program should be helpful.
Siffredi, V., Liverani, M. C., Hüppi, P. S., Freitas, L. G. A., De Albuquerque, J., Gimbert, F., Merglen, A., Meskaldji, D. E., Borradori Tolsa, C., & Hà-Vinh Leuchter, R. (2021). The effect of a mindfulness-based intervention on executive, behavioural and socio-emotional competencies in very preterm young adolescents. Scientific Reports, 11(1), 19876.
Elevated psychological stress over time can increase risk for disease. Some studies point to increased inflammation and oxidative damage to cells as the pathway. Mindfulness meditation has been shown to reduce circulating levels of proinflammatory biomarkers in the blood.
It remains unknown whether meditation also increases naturally occurring antioxidants such as glutathione that protect our cells from oxidative stress.
Rodrigues de Oliveira et al. [Brain, Behavior, & Immunity] conducted a randomized controlled trial to test the effects of a mindfulness-based intervention on well-being as well as proinflammatory and antioxidant biomarkers in public school teachers.
The researchers randomly assigned 76 meditation-naïve Brazilian public school teachers (average age = 45; 71% White, 100% female) to an 8-week mindfulness-based health program for educators or an 8-week applied neuroscience course for educators. Respective groups convened once weekly, and 10-30 minutes of homework was assigned daily for everyone.
Mindfulness training included mindful breathing, compassionate communication, loving-kindness and self-compassion, mindful listening, walking meditation, and the body scan. The neuroscience psychoeducation curriculum covered topics such as neuron biology, nervous system development, neuroplasticity, and the biology of memory and emotion.
Participants were assessed at baseline and immediate post-intervention on self-report measures of stress, quality of life, mood, resilience, and plasma biomarkers of inflammation (IL-1 β, IL-6, IL-8, IL-10, IL-12, TNF) and antioxidant glutathione metabolic activity (cystine, homocysteine and glutathione).
The results showed the mindfulness group significantly increased quality of life and resilience and decreased perceived stress and negative affect compared to controls at immediate post-intervention.
The mindfulness group also showed significant decreases in pro-inflammatory markers (IL-6 and IL-8) and increases in antioxidant activity (glutathione and cystine) compared to controls at immediate post-intervention.
There were no group differences in IL-12 or homocysteine after the intervention. Levels of IL-1 β, IL-10, and TNF were undetectable in these physically healthy teachers. This was in part because these cytokines are usually only elevated due to certain illnesses, and in part because the assay technique used was unable to detect very low levels of IL-1 β and TNF.
The study shows a mindfulness-based intervention can improve well-being and reduce perceived stress in public school teachers better than a control group. Mindfulness training also impacted physical health in terms of reducing biomarkers of inflammation and oxidative stress.
While prior studies showed increased glutathione levels in Zen, Tai Chi, and yoga practitioners, this is the first study to show increases due to a mindfulness-based intervention. The study is limited by the absence of longer-term follow-up data, initially planned on, that could not be obtained during COVID-19 pandemic social restrictions.
Rodrigues de Oliveira, D., Wilson, D., Palace-Berl, F.,... Demarzo, M. (2021). Mindfulness meditation training effects on quality of life, immune function and glutathione metabolism in service healthy female teachers: A randomized pilot clinical trial. Brain, Behavior, & Immunity, 18, 100372.
People who suffer from bipolar disorder are prone to episodes of depression and mania and often show heightened psychological and physiological responses to emotion-provoking stimuli. Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for people with affective disorders that is designed to improve emotional regulation and decease dysfunctional beliefs. Dysfunctional beliefs include the beliefs that one must always be perfect or that one must be loved by everyone.
Docteur at al. [Journal of Clinical Psychology] tested the association between participation in the MBCT program and physiological response to emotional stimuli among adults diagnosed with bipolar disorder who are in remission.
The researchers assigned 67 adults diagnosed with bipolar disorder in remission (age = 47 years; 64% female) to an 8-week MBCT program. The program met weekly in 2-hour group sessions. Participants were assessed at three time points: 2 months prior to treatment (baseline), immediately before treatment, and immediately after treatment.
Participants served as their own controls, allowing researchers to compare changes occurring between baseline and pre-MBCT with changes occurring between pre-MBCT and post-MBCT.
At each assessment point, participants completed a self-report measure of dysfunctional beliefs and had their skin conductance captured in response to a set of 36 positive (e.g., puppies), negative (e.g., accidents) and neutral (e.g., landscapes) images.
The skin conductance response (SCR) is a measure of changes in the skin’s ability to conduct an electrical current due to changes in sweat gland activity. When people are emotionally aroused, sweat gland activity increases thereby increasing skin electrical conductance.
The results showed that dysfunctional attitudes did not change in the interval between baseline and pre-MBCT, but they did decrease significantly from pre- to post-MBCT.
Analyses of SCR changes were only performed on that one-third of the sample that showed SCR changes greater than 0.04 μSv. In that subsample, there was no change in average SCR to negative images from baseline to pre-MBCT, but a significant decrease in average SCR to negative images from pre- to post-MBCT (Cohen’s d=0.73). Changes in dysfunctional beliefs were correlated with changes in SCR, but did not mediate that change.
The study shows that participation in MBCT is associated with reduced dysfunctional beliefs and physiological responses to negatively emotionally charged images in people with bipolar disorder in remission. It is possible that such changes, if in fact due to the intervention, may help prevent the recurrence of bipolar episodes. SCR potentially offers an objective marker of response to behavioral intervention.
The study is limited by the absence of a randomized comparison condition and the small size of the subset of participants included in the SCR analyses that limited the power of the mediation analyses.
Docteur, A., Gorwood, P., Mirabel-Sarron, C., Kaya Lefèvre, H., Sala, L., & Duriez, P. (n.d.). Mindfulness-based cognitive therapy efficacy in reducing physiological response to emotional stimuli in patients with bipolar I disorder and the intermediate role of cognitive reactivity. Journal of Clinical Psychology.
The military veteran population has an increased risk for suicide when compared to non-vets. Almost 18 veterans are lost to suicide each day. The Veterans Health Administration has prioritized investigating ways to lower suicide risk, and mindfulness interventions might be protective against mental health disruptions that are linked with suicide.
Interian et al. [Journal of Clinical Psychiatry] tested the effects of Mindfulness-Based Cognitive Therapy for Suicide (MBCT-S) on suicide-related events when added to the Veterans Health Administration enhanced standard treatment in a cohort of veterans at high risk for suicide.
The researchers randomly assigned 140 veterans at high risk for suicide (average age = 47; 88% male; 45% White, 28% Black, 21% Latino, 6% other) to enhanced treatment-as-usual alone, or enhanced treatment-as-usual with adjunctive MBCT-S. Eighty-four percent of the participants had histories of a prior suicide attempt, and 79% had made multiple attempts.
Most of the participants began the study as inpatients when hospitalized for suicidal behavior or ideation and then continued the study as outpatients while under psychiatric monitoring.
MBCT-S consisted of two individual treatment sessions during inpatient care, 8 weekly group sessions after transition to outpatient care, and optional monthly after-care booster sessions. The curriculum modeled MBCT for recurrent depression with added emphasis on accepting and disengaging from suicide related thoughts, feelings, and behaviors.
Enhanced treatment-as-usual included suicide safety planning while still an inpatient and 6 post-hospitalization mental health visits to monitor suicidal status and bolster safety planning. These specific enhancements are above and beyond the usual care offered for low-suicide risk psychiatric disorders.
Participants received routine standard health services in the veterans system including outpatient psychotherapy, medication, and residential support.
Participants were assessed on measures of depression, hopelessness, suicidal ideation and distress tolerance at baseline, mid-treatment, post-treatment, and 6-and 12-month follow-up. Medical records were assessed for suicide-related events (attempts, preparations for suicide, and hospitalizations for suicidal thinking).
Over the course of the 12 months, 148 suicide-related events occurred with 19% of the cohort attempting suicide. The results showed a significantly fewer number of suicide-related events in the MBCT-S group (56 vs. 92) with a significantly smaller proportion of the MBCT-S group making suicide attempts (13% vs. 26%) or being hospitalized for suicidal thinking (30% vs 46%).
Participants improved significantly, and to an equivalent degree, on measures of depression, hopelessness, suicidal ideation, and distress tolerance.
The study shows MBCT-S added to enhanced standard psychiatric care can reduce the proportion of high-risk veterans who make suicide attempts or require hospitalization for suicidal thoughts when compared to enhanced standard psychiatric care alone. This was an impressive finding given the intensity of services received by the standard care group.
Interian, A., Chesin, M. S., Stanley, B., Latorre, M., Hill, L. M. S., Miller, R. B., King, A. R., Boschulte, D. R., Rodriguez, K. M., & Kline, A. (2021). Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans: A Randomized Clinical Trial. The Journal of Clinical Psychiatry.
Schizophrenia is a persistent mental illness with positive (hallucinations and delusions), negative (lack of motivation, social withdrawal, flat affect) and cognitive (impaired executive functioning) symptoms. While medications can often reduce positive symptoms, negative and cognitive symptoms often persist. Psychiatrists are interested in psychosocial treatments that can reduce these residual symptoms.
Mindfulness training targets emotion regulation and executive functioning and may serve as an adjunctive treatment for schizophrenia. Shen et al. [Psychological Medicine] conducted a randomized controlled trial to test the effect of mindfulness training on residual negative and cognitive symptoms beyond the combined effects of routine medication and psychosocial rehabilitation among patient with schizophrenia.
The researchers randomly assigned 100 Han Chinese patients with non-acute schizophrenia and residual symptoms (68% male; average age = 60 years) to a 6-week general rehabilitation control or a 6-week general rehabilitation plus mindfulness group.
Controls attended 90-minute general rehabilitation group workshops on weekdays, while the mindfulness group attended daily general rehabilitation (45 minutes) and mindfulness training (45 minutes) group workshops.
General rehabilitation included health education, reading, painting, gardening, manual work, and daily life skill training. Mindfulness training included didactic material on mindfulness and rumination, focusing on sensations and thoughts, identifying emotions, self-acceptance, and relapse prevention.
All participants continued their prior psychotropic medications throughout the study as usual. Participants were assessed on clinical positive and negative symptoms and neuropsychological functioning at baseline and immediately following the intervention period.
After treatment, the mindfulness group showed moderate-sized improvements in total symptoms (Cohen’s d=0.51), depression (d=0.41), and anxiety (d=0.42) relative to controls and had significantly fewer negative symptoms.
The mindfulness group also showed small-sized relative improvements in general cognitive functioning (d=0.26), especially with regard to being able to remember verbal and visual information immediately after hearing or seeing it (d=0.31) and after a time delay (d=0.29).
The study shows adjunctive mindfulness training in a psychiatric treatment setting can reduce affective and cognitive symptoms in patients with non-acute schizophrenia above and beyond general rehabilitation and medication alone.
These findings are important because negative symptoms are often treatment-resistant, and mindfulness training can be an important new add-on modality to the treatment of schizophrenia. The study is limited by the absence of long-term follow-up.
Shen, H., Zhang, L., Li, Y., Zheng, D., Du, L., Xu, F., Xu, C., Liu, Y., Shen, J., Li, Z., & Cui, D. (2021). Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: A randomized controlled follow-up study. Psychological Medicine.
The goal of psychological and behavioral intervention is to help people live better lives. It is possible, however, that such interventions can also cause harm for select individuals. This is as true of mindfulness meditation as it is of other cognitive-behavioral and therapeutic interventions. Researchers want to learn who might be most vulnerable to adverse effects and under what circumstances. Examples of adverse effects include anxiety, depression, flashbacks, psychotic symptoms, and alterations in identity.
There is anecdotal evidence that adverse effects may be more common in intensive meditation retreats than in standard mindfulness-based interventions (MBIs). Aizik-Reebs et. Al [Behaviour Research and Therapy] used experience sampling (checking in on how participants felt at random moments) to evaluate the frequency of momentary and persistent adverse effects associated with participation in a MBI.
The researchers recruited 82 meditation-naïve Israelis (52% female; average age = 25 years) seeking stress-reduction. Prior to starting the MBI, participants were assessed on measures of mindfulness, anxiety, depression, worry, rumination, and distress tolerance.
The 21-day MBI included 3 group-based session held once per week for 90 minutes each, and 3 web-based 30-minute individual sessions. Session content included focused-attention, open monitoring, and movement meditations with encouragement for daily home practice.
Participant experience sampling was conducted several times a day over a 28-day period beginning 3.5 days before and ending 3.5 days after the MBI. During sampling, participants rated the extent of their negative emotions and cognitions. Experience samples were taken immediately after three mindfulness meditation sessions, and at random times throughout the day.
Momentary adverse effects were defined as significant (>1.96 standard deviations) deteriorations in mood during meditation compared to participant mood during normal daily activities. Sustained adverse effects were defined as significant deteriorations in mood during the 3.5 days after the MBI relative to the 3.5 days prior to the MBI.
The results showed 87% of participants experienced at least one momentary adverse effect during the three sampled meditation sessions, with 42% having them during two and 28% in all three sessions. The most common adverse events were momentary increases in anxiety (70% of adverse events), rumination (29%), sadness (22%), and depressed mood (17%).
Twenty-five percent of the participants showed a sustained adverse effect (poorer mood after the MBI than before). The most common sustained adverse effects were increases in worry (9%), decreases in happiness (7%), and increases in rumination (6%). Momentary adverse effects and measures of pre-intervention emotional vulnerability were uncorrelated with sustained adverse effects.
The study shows moments of anxiety, worry, and negative mood are commonplace in novice meditators during early stages of a meditation program, but these momentary experiences are not predictive of sustained adverse effects. About a quarter of meditation-naïve participants experienced poorer mood after completing the MBI program than before.
It is possible that increases in negative mood are due to facing previously avoided problems, transitioning to new coping strategies, increased awareness of feelings, or a genuine deterioration in functioning. The study is limited by a brief follow-up period and the absence of a control group.
Aizik-Reebs, A., Shoham, A., & Bernstein, A. (2021). First, do no harm: An intensive experience sampling study of adverse effects to mindfulness training. Behaviour Research and Therapy.
Social anxiety disorder is a diagnosis of unreasonable fear of embarrassment in social situations. People with social anxiety disorder often avoid social situations, thereby limiting the quality of their lives. Cognitive-Behavioral Therapy (CBT) uses cognitive reappraisal to reduce social anxiety through questioning irrational beliefs about feared outcomes. Mindfulness-Based Stress Reduction (MBSR) stresses the acceptance of thoughts, rather than altering them.
While CBT and MBSR are both effective in treating social anxiety disorder, it is not clear whether their benefits are due to unique or shared therapeutic elements. Goldin et al. [JAMA Psychiatry] conducted a randomized controlled trial of CBT and MBSR to test the efficacy of each program on anxiety among people with social anxiety disorder, and tested the neural activity associated with each program.
The researchers randomly assigned 108 unmedicated generalized social anxiety disorder patients (56% female; average age=33 years; 44% White; 39% Asian-American, 9% Latino, 9% Other) to CBT, MBSR, or a waitlist control. Patients completed self-report measures of anxiety symptoms at baseline, posttreatment, and one year follow-up, and an fMRI task at baseline and posttreatment.
CBT and MBSR were delivered in 12 weekly 2.5-hour group sessions. CBT included cognitive restructuring, exposure, and relapse prevention. MBSR used a standard 8-week protocol with four additional weekly sessions substituting for the all-day retreat.
Before undergoing functional brain imaging, participants wrote down scenarios for the social situations that personally caused them anxiety along with the negative self-beliefs associated with those scenarios. Participants then imagined the feared social situations and associated self-beliefs, and either reacted to, reappraised, or accepted them while undergoing imaging.
Brain regions selected for analysis were previously associated with cognitive restructuring and attentional regulation (e.g., prefrontal and anterior cingulate cortices).
Previously published results from this study showed CBT and MBSR both reduced social anxiety symptoms significantly more than waitlist controls at post-treatment and one-year follow-up. The effects of CBT and MBSR were equivalent in size.
CBT and MBSR groups showed similar significant reductions in negative emotions during reacting, reappraising, and accepting trials from pre- to post-testing (partial η2 range=0.38-0.53). These changes were significantly greater than changes in the control group.
Both treatment groups showed increased brain activation in regions of interest compared to controls, and these changes were similar across CBT and MBSR groups.
The study shows CBT and MBSR are similarly effective in reducing social anxiety compared to a wait-list control, and that improvement is maintained at one-year follow-up. It suggests that, despite contrasting models of therapeutic change, CBT and MBSR have overlapping effects on brain activity. Despite their application of differing strategies, they both refine awareness, weaken avoidant behavior, and decrease the influence of negative self-beliefs. Acceptance and reappraisal strategies may involve brain regions that share substantial overlap.
The study is limited by excluding other brain regions previously associated with MBSR that may differ from CBT.
Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J. (2021). Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry.
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