American Mindfulness Research Association News

Single session mindfulness before hernia surgery and post-op pain

Mon, 16 Feb 2026 19:55:29 GMT

Surgical patients’ preoperative cognitive-emotional states may influence postoperative recovery and pain-related distress. Fear of pain and rumination about potential pain can interfere with successful postsurgical recovery. Mindfulness-based preoperative education may help reduce catastrophizing and rumination and, in turn, support recovery.

Kılıç et al. [BMC Psychology] conducted a randomized controlled study examining whether mindfulness-based preoperative education reduces postoperative fear of pain and pain-related cognitive intrusion in patients undergoing elective inguinal hernia surgery.

The researchers randomly assigned 68 Turkish patients (average age 55 years; 91% male) scheduled for mesh-based inguinal hernia surgery to one of four groups: (1) a mindfulness group with pretesting; (2) a mindfulness group without pretesting, (3) a control group with pretesting; and (4) a control group without pretesting. This experimental design was intended to help distinguish effects due to pretesting from those due to mindfulness training itself.

The mindfulness training education was delivered individually in a single face-to-face session lasting approximately 45-minutes and focused on present-moment awareness, attentional regulation, and cognitive coping with pain. One brief mindfulness exercise was completed during the session and a mindful eating activity was assigned as homework prior to surgery. Control groups received standard care at the clinic site. Preoperative self-report measures (administered only to the pretested experimental and control groups) and postoperative measures (administered to all groups) included the Experience of Cognitive Intrusion of Pain Scale (ECIPS) and the Fear of Pain Questionnaire-III (FPQ-III).

The results showed no significant postoperative differences between assigned groups. However, comparisons of pre-post change scores revealed a significant group difference within the pretested groups: the mindfulness group decreased average pain-related cognitive intrusion scores by 5.9 points, whereas the control group increased by 10.2 points (a reported medium-to-large effect). There were no significant between-groups differences on fear-of-pain scores.

The study suggests that a single session of preoperative mindfulness training education can reduce postoperative intrusive pain-related thoughts. The study is limited by the absence of significant postoperative between-group differences and, given the Solomon four-group design, by the possibility that pretesting produced differential responding to the intervention. Further, the single-session format is brief considering typical mindfulness programs (often 8 weeks), and it remains unclear whether changes in pain cognitions translate to improvements in postoperative pain or tissue recovery.

Reference:

Saray Kılıç, H., İbrahimoğlu, Ö., Mercan, N., & Güneri, G. (2026). The effect of mindfulness-based preoperative education on postoperative pain: A Solomon four-group randomized controlled trial. BMC Psychology.

Link to study

Mindfulness-based self management for pulmonary hypertension

Sat, 31 Jan 2026 17:42:32 GMT

Pulmonary hypertension is a progressive lung disease characterized by shortness of breath. Patients often have limitations on their daily activities and social roles. Treatment primarily involves pulmonary vasodilative medications, which can cause headaches, nausea, diarrhea, and other side effects. Severe cases carry an elevated risk for heart failure and sudden death.

Many patients experience depressive and anxiety symptoms as well as elevated perceived stress. While mindfulness-based interventions (MBIs) may lower psychological distress, there have been no MBIs specifically designed for pulmonary hypertension patients. Takita et al. [Journal of Medical Internet Research] conducted a pilot single-arm, pre-post study to describe the acceptability, feasibility, and adherence of an online MBI self-management program for patients with pulmonary hypertension.

The researchers recruited 12 Japanese pulmonary hypertension patients (average age = 42 years; 75% female) to participate in a novel MBI based on Mindfulness-Based Cognitive Therapy. The program also included elements of psychoeducation and self-management skill building. To accommodate patient limitations due to their disease status, session lengths were shortened to one hour, and the yoga component typically included in the original program was eliminated.

The program was delivered in eight weekly synchronous online sessions. Each session included 10-30 minutes of meditation practice, group discussion, and was led by a trained facilitator. Homework included daily meditation practice and reflection journaling. Each participant also used a smartwatch-linked self-management app integrated into the intervention to record daily physical condition and activity.

Feasibility was assessed using participation and completion rates, and acceptability was evaluated through post-intervention interviews. Participants completed self-report questionnaires at baseline, 4 weeks, and 8 weeks (program completion), with an additional 12-week follow-up assessment. These questionnaires served as secondary outcome measures of quality of life, resilience, and psychological symptoms.

Results showed that 75% of the patients completed the intervention. Those who dropped out did so for medical reasons, including hospitalization and catheter infection. Most participants rated the overall program length, session duration, and session intervals as generally acceptable. Questionnaires were pencil-and-paper-based and returned by mail. Response rates were good at baseline and week 4 (75%), but declined at week 8 (67%) and week 12 (56%). Some participants expressed a preference for fewer sessions or for incorporating on-demand sessions rather than requiring attendance at fixed times.

Patient-rated pulmonary hypertension health and resilience scores significantly improved at 4 and 8 weeks compared to baseline, but these improvements were not maintained at the 12-week follow-up, likely in part due to reduced response rates.

This pilot study suggests that a synchronous online MBI self-management research protocol is feasible and acceptable for many pulmonary hypertension patients who are willing to participate in research. Reducing the number of synchronous sessions and replacing some with on-demand sessions may further improve acceptability. There is evidence of temporary subjective health benefits based on self-report. The study is limited by its lack of a control group, its small sample size, and declining response rates at post-intervention and follow-up assessments.

Reference:

Takita, Y., Morishita, J., Park, S., Goda, A., Inami, T., Kikuchi, H., Kohno, T., Kataoka, M., & Fujisawa, D. (2025). Mindfulness-Based Self-Management Program Using a Mobile Application for Patients with Pulmonary Hypertension: A Single-Arm Feasibility Study. JMIR Cardio.

Link to article

Mindfulness improves internal time monitoring accuracy

Tue, 20 Jan 2026 17:14:33 GMT

We sometimes need to perform specific actions at specific future times, such as remembering to take a medication an hour before dinner. Successfully completing these time-based prospective memory tasks requires keeping the task in mind while monitoring the passage of time. Because they require sustained attention and monitoring, these tasks place high demands on cognitive resources. Mindfulness training may improve the attentional allocation and monitoring capacities critical for successful task performance.

Wang and Guo [Consciousness and Cognition] tested the effects of mindfulness training on time-based prospective memory under conditions in which participants could either check the time freely or were limited in how often they could do. They hypothesized that mindfulness training would increase task accuracy, especially when opportunities to check the time were limited.

The researchers assigned 95 Chinese undergraduate students (mean age = 22 years; 76% male) to either a mindfulness training group or a control group. Mindfulness participants listened to five 12-minute, breath-centered guided mindfulness meditation recordings over the course of one week. Control participants spent the same amount of time engaging in non-mindfulness related activities, such as reading.

Following the intervention, all participants completed two simultaneous laboratory tasks. One task involved letters presented on a computer screen; participants pressed computer keys to indicate whether a letter just seen was the same or different from a letter presented half a second earlier. Concurrently, participants were required to remember to press a separate computer key once every minute.

Half of the participants in each group could press a space bar whenever they liked to reveal how much time had elapsed since the start of the trial, whereas the other half were permitted to check elapsed time only once per trial. Time judgments were deemed accurate if key presses occurred within a window of 57 to 63 seconds.

Results showed that the mindfulness group was significantly more accurate in judging when one minute had elapsed compared to the control group (ηp2 = 0.05; a small-to-moderate effect size). Participants with unlimited opportunity to check the time were also more accurate than those with limited opportunity (ηp2 = 0.29; a large effect size).

Importantly, there was a significant interaction between the training conditions (mindfulness vs. control) and checking condition (ηp2 = 0.04). Specifically, the mindfulness group was more accurate than the control group only when time checking was limited (ηp2 = 0.20).

These findings suggest that mindfulness training may enhance time-based prospective memory performance when people cannot rely on external time cues and must instead depend on their internal sense of time passage.

However, the study has limited ecological validity because it examined prospective memory over a very short interval of one minute, whereas time-based prospective memory tasks often involve monitoring time over hours or days. Also, the authors did not explicitly report whether random assignment was applied.

Reference:

Wang, M., & Guo, Y. (2026). Mindfulness meditation can improve time-based prospective memory performance in restricted monitoring situation. Consciousness and Cognition.

Link to study

Cluster randomized Danish school trial evaluating mindfulness

Mon, 29 Dec 2025 23:05:13 GMT

About 60% of U.S. teachers report high levels of work-related stress. Teaching is stressful in Denmark as well, where one in four teachers report feeling frequently or constantly stressed during the last two weeks. In 2017, the Danish Parliament allocated funds to train lower secondary school teachers to teach mindfulness to their students.

The training was one aspect of implementing a nation-wide school-based mindfulness initiative, broadly aligned with similar efforts such as the British MYRIAD project to improve student wellbeing.

Axelsen et al. [Social Science and Medicine] evaluated the effect of this teacher-focused mindfulness training program on perceived stress levels over one year.

Schools in five Danish geographic regions where randomly assigned to mindfulness or waitlist control conditions. Ninety-seven teachers in 54 schools were assigned to mindfulness training, and 94 teachers in 56 schools were assigned to the control group. Ninety-two percent of the teachers were women, and their average age was 45 years.

Teacher recruitment combined website and social media advertising with invitations sent to schools. Each school could assign up to three teachers to the mindfulness training program or waitlist control.

The year-long teacher training program included three components: a standard 8-week Mindfulness-Based Stress Reduction (MBSR) course, a four-day residential course on the school-based mindfulness curriculum called “.b”, and three two-day seminars (six days total) of additional training on mindfulness-related teaching competencies and implementation practices.

Teachers completed self-report questionnaires at baseline, 3, 6, and 12 months. The primary outcome was change in perceived stress scores from baseline to 12 months, measured with the 10-item Perceived Stress Scale. Only 44% of the teachers assigned to the intervention completed the full training program. At 12 months, 59% of intervention teachers and 69% of control teachers provided follow-up data. Analyses were conducted on an intent-to-treat basis using mixed-effects models.

At 12 months, teachers in the mindfulness group showed an average reduction in stress of over two points compared to baseline, while the control group remained essentially unchanged (Cohen’s d=0.38). An earlier publication on this cohort showed a 1.7-point improvement in stress at 3 months and a 2.1-point improvement at 6 months.

The Danish trial suggests that training schoolteachers to teach mindfulness may produce a small overall reduction in perceived stress that persists over their year of their involvement as teachers transitioned through the rest of the training. However, participating teachers were self-selected and likely more interested in mindfulness from the outset, and many did not complete the full training or the final assessment.

Taken together with other large-scale British and European trials of school-based mindfulness trials, these results fit a broader pattern of small or null benefits for teachers or students, rather than large, transformative effects.

Reference:

Axelsen, H. L., Müller, A. G., Fjorback, L. O., Goetzsche, K., Nielsen, H. B., & Juul, L. (2026). Effectiveness of a one-year teacher training program in delivering school-based mindfulness on schoolteachers’ mental health: A nationwide cluster-randomized trial. Social Science & Medicine.

Link to study

Cold water immersion add on to mindfulness for improved mood

Fri, 19 Dec 2025 22:51:16 GMT

People even join “polar bear clubs,” where they swim in the winter ocean for purported longevity. Cold-water immersion can stimulate the production of norepinephrine, a neurotransmitter linked to attention and mood regulation. Combining mindfulness with cold water immersion might be more effective than mindfulness alone for improving mood and forestalling cognitive decline in middle age and beyond.

Gentile et al. [Frontiers in Public Health] studied the feasibility of combining two interventions—mindfulness and cold-water immersion—and examined their joint effects on mood and perceived executive functioning in adults.

The researchers recruited a sample of 54 healthy adult volunteers aged 50 years or older (average age about 61) from Italy, Croatia, Austria, Belgium, Czechia. Participants enrolled in a 20-week program consisting of 40 twice-weekly group sessions that combined mindfulness practice with supervised cold-water immersion. Each session began with 40 minutes of mindfulness practice, including present-moment awareness, a body scan with progressive muscle relaxation, and guided breathing exercises, followed by a brief group discussion.

Afterward, participants stood immersed from feet to shoulders in cold water. They started with a 1-minute immersion at 57°F, and over subsequent sessions the water temperature was gradually cooled and immersion time increased until they were able to remain in 46°F water for up to 20 minutes.

For analysis, participants were grouped as middle-aged (50-59 years) and older adults (60+ years). They completed questionnaires at baseline and after the intervention assessing depressive symptoms, anxiety, and perceived executive functioning (attention, planning, and self-control).

Due to withdrawal from the program and non-completion of the post assessment, the final analyzed sample consisted of 46 participants (63% female). All 46 participants attended all of the training sessions and all were able to remain in cold water for the targeted length of time by the end of the program.

In within-subject analysis, results showed a moderate-sized, significant drop in depressive symptoms (Cohen’s d=0.58) and anxiety (d=0.42) scores immediately after the intervention. The small improvement in perceived executive functioning scores did not reach statistical significance in their mixed-model analysis (p=.06). Older adults showed a larger reduction in depressive symptoms than middle-aged participants, whereas anxiety improvements were similar across age groups.

This novel pilot study suggests that mindfulness training combined with cold-water immersion can improve mood in healthy middle-aged and older adults, with greatest benefit for depressive symptoms.

The study is limited by lack of a comparison group, no follow-up beyond the immediate post-treatment assessment, and no assessment of factors such as prior cold-water exposure. Because all participants received both interventions, there is no way to determine whether the combined treatment is superior, equivalent to, or inferior to its component alone.

Reference:

Gentile, A., Vivirito, S., Kirkar, M., Paschos, K., Tuđan, L., Kulhánek, J., Öztürk, P., & Alesi, M. (2025). Mindfulness training combined with cold water immersion effects on mood and perception of executive functioning in middle-aged and older adults: A pilot study. Frontiers in Public Health.

Link to study

Low completion rates with online mindfulness program for caregivers

Fri, 28 Nov 2025 17:59:57 GMT

Parental caregivers of children with intellectual and developmental disabilities often experience high levels of stress, and growing empirical evidence suggests that mindfulness training programs can help reduce this burden. Research in this population frequently employs the Be Mindful program, an asynchronous, individually accessed online mindfulness course based on Mindfulness-Based Cognitive Therapy (MBCT). However, online mindfulness programs, commonly face challenges in retaining participants through course completion. Coupling online programs with individual peer-mentor telephone support may enhance their effectiveness.

Murray et al. [Journal of Intellectual Disability Research] implemented a pre-post intervention design to evaluate the feasibility of coupling the Be Mindful program with additional peer support for parent and adult sibling caregivers of children with intellectual and developmental disabilities. The study also examined the program’s association with changes in participant reported well-being

The researchers recruited 101 British family caregivers (58% parents, 43% siblings; 85% female; average age = 44 years old; 81% white; 66% below UK median income) of children with intellectual and developmental disabilities. They placed particular emphasis on enrolling participants from previously understudied groups, including sibling caregivers and caregivers from low socioeconomic status or ethnic minority backgrounds.

In this single-group observational trial, participants were offered the Be Mindful program, which consisted of 10 online sessions,12 homework assignments, and 6 course handouts. The program contained all core elements of MBCT but was delivered in an individual online format rather than a group setting. It also emphasized on cultivating wellness rather than alleviating depression.

Participants were also offered three 30-minute peer-support telephone calls that provided encouragement and guidance. Peer mentors were family caregivers who had previously completed the Be Mindful course and a 1.5-day virtual training workshop. These mentors were compensated, provided with a structured manual to follow, and given access to an online peer group for support.

The primary outcome was a seven-item self-rated mental well-being scale (Short Warwick-Edinburgh Mental Well-Being Scale) administered at baseline and 12 weeks.

Of the 101 participants who began the study, six withdrew before follow-up assessment, 37 completed the full course, and 36 completed the post-intervention assessment. Only 49% of participants received all three peer-support phone calls due to cancellations or failure to answer. Those who completed post-intervention assessment were observed to have a significant within-group increase in psychological well-being scores (Cohen’s d=0.91) from pre- to post-survey.

The study suggests that while the Be Mindful program can benefit well-being among those who complete it, most caregivers of children with intellectual and developmental disabilities do not finish the program, even when additional peer support is provided. Furthermore, the majority of participating parents were mothers, with few fathers represented.

Given the low completion and engagement rates, the feasibility of this approach is questionable. The study was also limited by the absence of a comparison group.

Reference:

Murray, C. A., Hayden, N. K., Gordon-Brown, A., ... Hastings, R. P. (2025). Implementation of Online Mindfulness With Peer Mentoring for Parent and Sibling Carers of People With Intellectual and Developmental Disabilities. Journal of Intellectual Disability Research.

Link to study

MBCT boosts OCD remission rates without altering brain connectivity

Mon, 10 Nov 2025 17:50:24 GMT

Patients with Obsessive-Compulsive Disorder (OCD) experience repetitive intrusive thoughts and feel compelled to engage in ritualistic behaviors to reduce anxiety. Treatment with selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) that combines exposure therapy and response prevention can alleviate some symptoms. Yet treatment failure rates remain high (40-60%), and complete remission is rare.

Adjunctive Mindfulness-Based Cognitive Therapy (MBCT) may be beneficial by helping patients observe their obsessive thoughts without becoming emotionally disturbed by them.

OCD is increasingly characterized as a brain-based disorder involving dysfunctional neural pathways. Functional connectivity studies with OCD patients have shown both hyperconnectivity and hypoconnectivity in regions associated with threat monitoring and executive control. These are areas of the brain where MBCT has been shown to alter functional connectivity in nonclinical populations.

Serra-Blasco et al. [Psychotherapy and Psychosomatics] conducted a randomized single-blind controlled trial to examine the clinical and neuropsychological effects of adjunctive MBCT in patients with OCD.

The researchers randomly assigned 68 Spanish patients with OCD (average age = 39; 54% female) who had previously undergone SSRI and CBT treatment without remission to either MBCT plus treatment-as-usual or treatment-as-usual alone. MBCT was adapted for patients with OCD and consisted of eight weekly group sessions emphasizing present-moment awareness, challenging irrational beliefs, accepting thoughts and emotions without judgment, promoting self-care, and using mindfulness skills to manage difficult emotions. Treatment-as usual consisted of continued SSRI treatment.

Participants were assessed before and after treatment using the clinician-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the self-rated Obsessive Compulsive Inventory-Revised (OCI-R). Forty-four of the patients also underwent fMRI brain scanning to assess resting-state functional connectivity at both time points. Psychologists administering the Y-BOCS and conducting the fMRI scans were masked to group assignment. The study retention rate was 67%.

Results showed that the MBCT group had a 32% reduction in Y-BOCS scores, compared to an 8% reduction in the control group (Cohen’s d=1.05). Clinician-rated remission (≥50% improvement) was achieved by 25% of the MBCT group and 4% of the control group. No group differences were detected on the self-reported OCI-R, and MBCT did not produce identifiable changes in resting-state functional connectivity compared to controls.

However, baseline functional connectivity patterns predicted treatment response. Greater connectivity between the cuneus and ventral default mode network predicted poorer outcomes, whereas lower connectivity between the lower left dorsomedial prefrontal cortex within the salience network predicted greater improvement. Reduced connectivity in the right pallidum and thalamus also predicted greater clinical improvement.

The study demonstrates that adjunctive MBCT can increase clinician-rated symptom improvement and remission rates in OCD compared to usual care with SSRIs. Although MBCT did not alter brain functional connectivity after treatment, baseline brain networks predicted clinical outcomes. Patients with lower baseline OCD severity were less likely to complete self-report measures, and this, combined with the small sample size, may have reduced power to detect self-reported changes. Because all participants were taking SSRIs and had prior CBT, these treatments may have already influenced neural connectivity, potentially obscuring MBCT-related effects.

Reference:

Serra-Blasco, M., Miquel-Giner, N., Vicent-Gil, M., ... López-Solà, C. (2025). Clinical and Neuroimaging Effects of Mindfulness-Based Cognitive Therapy for Symptomatic OCD Patients after First-Line Treatments: A Randomised Controlled Trial. Psychotherapy and Psychosomatics.

Link to study

Limited stress relief from universal school-based mindfulness

Fri, 31 Oct 2025 17:45:52 GMT

Historical results for school-based mindfulness programs originally appeared promising, but recent large-scale school-based interventions in Great Britain and Denmark have failed to demonstrate significant mental health benefits. The reason for these underperforming outcomes remains unclear: were these programs poorly designed or implemented, are mandatory programs for general student populations inherently ineffective, or are non-clinical populations simply less responsive to mindfulness training?

Volanen et al. [Psychology in Schools] examined the effectiveness of a school-based mindfulness program, closely aligned with the British and Danish interventions, in reducing stress and promoting self-kindness among middle school students.

The researchers enlisted 56 schools in southern Finland for the study, randomly selecting several classes within each school to one of three conditions: receiving a mindfulness-based intervention (MBI), a relaxation intervention, or no treatment. A total of 210 classes participated, comprising over 3,500 sixth- through eighth-grade students (51% girls).

The MBI closely resembled the programs used in the prior British and Danish school-based studies. It consisted of nine weekly 45-minute sessions accompanied by brief (3-15 minute) daily homework exercises. Classroom lessons focused on understanding mindfulness, anchoring attention in the body, recognizing worry, responding rather than reacting, practicing mindful movement, relating to thoughts, and managing difficult emotions. The relaxation program was matched in frequency and duration, emphasizing progressive muscle relaxation, breathing exercises, and visualization.

Students were assessed on self-reported stress symptoms and self-kindness at baseline, post-intervention, and 26-week follow-up. Stress was measured using a 20-item self-rated perceived stress scale, and self-kindness was measured using the Self-Kindness subscale of Neff’s Self-Compassion Scale. At follow-up, students also reported how frequently they continued mindfulness practice on their own after intervention completion.

The results showed that the MBI group had significantly lowered average perceived stress scores compared to the relaxation group immediately after the intervention (d=-0.29) and at 26-week follow-up (d=-0.28). There were no group differences in stress between MBI and no-treatment participants. There were no group differences in self-kindness.

Findings from this large trial of over 200 school classes suggest a slight reduction in average perceived stress associated with a nine-week MBI training program compared to a relaxation program. The no-treatment control group was much smaller than the active groups, which may have reduced statistical power to detect group contrasts. Moreover, baseline stress levels were low, perhaps leaving little room for measurable improvement by self-report.

A key difference between this study and the British and Danish trials is that its primary outcome was perceived stress rather than mental health or well-being. School-based mindfulness programs may therefore be more effective at reducing stress than at improving overall mental health.

Nonetheless, this represents the third large-scale study to show only modest benefits for students participating in universal, school-based mindfulness classes. It remains possible that mindfulness interventions are more effective when individuals voluntarily seek them out to address personal challenges, rather than when they are delivered as compulsory classroom activities.

Reference:

Volanen, S.-M., Holopainen, M., Lahti, J., Vahlberg, T., & Hintsanen, M. (2025). The Healthy Learning Mind Project: Does a Universal Mindfulness Programme Reduce Stress Symptoms and Increase Self-Kindness Among Adolescents in Schools? Psychology in the Schools.

Link to study

MBSR yields modest impact on loneliness in older adults

Mon, 27 Oct 2025 20:47:25 GMT

Over one-third of older adults report feeling lonely, and loneliness is a stronger predictor of mortality than smoking, physical inactivity, or obesity. It also increases the risk of numerous adverse outcomes, including dementia, type 2 diabetes, hypertension, and suicide. Psychosocial interventions that simply increase the frequency of social contact are often ineffective. It may be more important to target the psychological factors that make social interactions feel unrewarding.

Mindfulness-based interventions may help alleviate loneliness by promoting acceptance of difficult emotions and increasing awareness of habitual reactive patterns within the context of social life.

Dutcher et al. [Journal of Gerontology: Series B] tested the effectiveness of Mindfulness-Based Stress Reduction (MBSR) in reducing loneliness among older adults in two controlled studies. One study compared MBSR to a waitlist control, and another compared MBSR with a Health Enhancement Program (HEP), a standard active comparator often used in behavioral trials.

In the first study, the researchers randomly assigned 219 older adults (average age = 73 years; 62% female; 98% White) to MBSR or a waitlist control. The MBSR program followed the standard 8-week curriculum of two-hour weekly group sessions, a 7-hour retreat, and 45 minutes of daily home practice. Loneliness was assessed at baseline, post-treatment, and 6-month follow-up using the 7-item UCLA Loneliness Scale, which asks participants to rate how lonely they felt in the past month on a four-point Likert scale.

In the second study, 190 older adults (average age = 70 years; 78% female; 85% White) who reported moderate loneliness on a short version of the UCLA Loneliness Scale were randomly assigned to MBSR or HEP. MBSR followed the same format as in Study 1. HEP matched MBSR in duration, frequency of meetings, and homework assignments. HEP content emphasized strength, balance, flexibility, aerobic exercise, nutrition, and managing emotions through writing and music. Loneliness in this study was assessed with the full 20-item UCLA Loneliness Scale, and follow-up occurred at 3 months rather than 6.

In the first study, there were no significant group differences immediately after the intervention, but by the 6-month follow-up, the MBSR group had a significant reduction in average loneliness scores compared with waitlist controls. Score improvements were small, decreasing from 12.4 to 11.9 in the MBSR group and remaining unchanged at 11.9 in the control group.

In the second study, both groups showed significant decreases in average loneliness scores from baseline to post-treatment and from post-treatment to follow-up, with no significant differences between groups. MBSR scores declined from 43.1 to 39.8 and HEP scores declined from 41.7 to 38.6 from baseline to follow-up.

Both groups also demonstrated increased mindfulness scores on the Five Facet Mindfulness Questionnaire over time, though with null between-group differences. While higher mindfulness scores correlated with lower loneliness at one time point, mindfulness and loneliness change scores were not correlated.

Overall, findings from two studies suggest that MBSR and the general health promotion program (HEP) each led to small reductions in self-reported loneliness scores among older adults. These improvements emerged or persisted three to six months after the intervention, indicating that simply receiving structured attention within a research study may partly or fully account for the observed effects.

The specific mechanisms for these modest improvements remain uncertain, including whether they stem from shared group experiences or from distinct components of each intervention.

Reference:

Dutcher, J. M., Brown, K. W., Lindsay, E. K., Greco, C. M., Wright, A. G. C., Gallegos, A. M., Heffner, K. L., & Creswell, J. D. (2025). Mindfulness-Based Stress Reduction and Loneliness in Older Adults: Two Randomized Controlled Trials. The Journals of Gerontology: Series B.

Link to study

Dose response effects of meditation on mental health

Thu, 25 Sep 2025 22:41:42 GMT

How much meditation practice is needed before meaningful, lasting change occurs? This is an important question because newer mindfulness-based interventions (MBIs), such as meditation apps, often rely on less intensive practice than traditional in-person interventions.

Bowles & Van Dam [Applied Psychology: Health & Wellbeing] conducted a longitudinal analysis examining dose-response relationships between meditation practice and wellbeing in meditators with varied personality types and practice histories.

Participants were 1,052 meditators (average age = 47 years; 69% female; average lifetime meditation practice = 1,172 hours) from Australia (50%), North America (27%), and Europe (19%). Volunteering participants were drawn from an earlier cross-sectional study of 1,668 meditators recruited from online forums, social media platforms, and meditation communities.

Data were collected in two phases: In the first 8-week phase, participants completed weekly surveys about their meditation practice. In the second phase, participants were recontacted 3 to 4 years later and asked to complete another survey.

Only 578 participants from the original sample completed the later survey. Those who continued into Phase 2 tended to be older, more experienced, and to report greater baseline wellbeing and conscientiousness. Measures included practice frequency and duration, goals, personality traits, and self-reported outcomes (life satisfaction, positive and negative affect, and distress).

Observational results suggested that both lifetime meditation experience and recent practice dose statistically predicted lower distress and greater life satisfaction. Clinically meaningful improvements were estimated at 25 meditation hours per month for life satisfaction, 41 hours per month for positive affect, 18 hours per month for negative affect, and 33 hours per month for distress. Practice frequency was generally a stronger predictor of benefit than practice session length, although time spent sitting contributed modestly to higher life satisfaction and lower negative affect.

Meditators with higher baseline negative emotionality benefited most in terms of reduced distress and negative affect. Over time, greater cumulative practice also predicted a higher valuation of spiritual growth as a practice goal.

The longitudinal observation of self-selected meditators over time suggests dose-dependent benefits of meditation on wellness outcomes in a large sample of meditators. The amount of practice time needed for improvement seems consistent with practice times suggested in 8-week MBI programs modeled after Mindfulness-Based Stress Reduction (MBSR), but exceeds the amount of practice typically involved in app-based programs.

Limitations of the study include the absence of random assignment to different meditation practice doses, differences in the composition of the retained sample, and reliance on self-reported practice amounts.

Reference:

Bowles, N. I., & Van Dam, N. T. (2025). Dose–response effects of reported meditation practice on mental-health and wellbeing: A prospective longitudinal study. Applied Psychology: Health and Well-Being.

Link to study

Short term benefits of mindfulness for children with epilepsy

Mon, 15 Sep 2025 15:25:23 GMT

Children with epilepsy and their families face the stress of unpredictable seizures, frequent cognitive, psychiatric, and behavioral comorbidities, and the challenges of treatment. Anxiety and depression are known to reduce the effectiveness of antiepileptic drugs and surgery, making it important to address stress and coping in children with epilepsy and their families.

Research on older children and adults with chronic illnesses suggests that mindfulness-based interventions (MBIs) can improve quality of life and reduce stress.

Tassiopoulos et al [Pediatrics Open Science] conducted a randomized, controlled pilot study of an MBI to evaluate its efficacy on quality of life for young children with epilepsy.

The researchers enrolled 72 Canadian parents (94% female) and their 4-10 year-old children (average age = 8 years; 58% male). Families having a child with epilepsy were randomly assigned to an MBI called Making Mindfulness Matter or a waitlist control.

Making Mindfulness Matter was delivered online in eight weekly synchronous group sessions: 1.5 hours for parents (focused on mindful parenting) and separate 1-hour session for children (focusing on age-appropriate mindfulness skills). Topics included the stress response, mindful awareness of breathing, thinking, sensing, and movement, responding rather than reacting, perspective-taking, and cultivating optimism, gratitude, and kindness.

Children were assigned either a 4-6 year-old group or a 6-10 year-old to ensure age appropriateness of content. All children continued to receive standard pediatric neurological care.

The primary outcome was parent-reported total scores on the 55-item Quality of Life in Childhood Epilepsy (QOLCE) questionnaire. Secondary outcomes included cognitive, emotional, social, and physical QOLCE subscale scores. A 10-point improvement on the QOLCE total score was defined as a minimal clinically important difference. Parents completed the QOLCE at baseline and one week post-treatment; intervention group parents also completed it at a 10-week follow-up.

Results showed no significant group differences in QOLCE total scores at baseline. At post-treatment, the MBI group of children had an average 7-point higher QOLCE total score than the control group (d=0.40). Clinically important improvement was observed in 28% of children in the MBI group compared with 3% of controls. Subscale analyses showed advantages for the MBI group at post-treatment of 12 points in cognitive functioning, 6 points in emotional functioning, and 5 points in social functioning.

The average post-treatment total QOLCE score for the MBI group of children was 5 points higher than their baseline, and at 10-week follow-up, that difference had declined to 4 points higher, suggesting some fading of benefit over time.

The pilot findings initially suggest that Making Mindfulness Matter may offer moderate short-term benefits to young children with epilepsy by improving overall quality of life. Benefits appeared to diminish at ten weeks.

Study limitations include the lack of child-reported or objective outcome measures, the absence of an active time-matched control, and a sample size that was smaller than planned due to recruitment challenges. Further, there was no follow-up in the control group.

Reference:

Tassiopoulos, K. N., Puka, K., Bax, K., Secco, M., Andrade, A., DeVries-Rizzo, M., Franklin, M., Gangam, H., Levin, S., Nouri, M. N., Prasad, A. N., Spinelli, E., Zou, G., Vingilis, E., & Nixon Speechley, K. (2025). Making Mindfulness Matter© May Improve Quality of Life in Young Children With Epilepsy: Pilot RCT. Pediatrics Open Science.

Link to study

MBCT reduces distress and calprotectin levels in IBD

Fri, 29 Aug 2025 15:08:11 GMT

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are typically treated with immunosuppressant medication and surgery. These conditions cause both physical symptoms (abdominal pain and bloody diarrhea) and mental distress (anxiety, depression, fatigue). Because distress can worsen disease progression, mindfulness training has been proposed as an adjunctive treatment to reduce illness burden.

Previous research on mindfulness training for IBD has yielded mixed results and has rarely included objective measures of symptom-related sleep disturbance. ter Avest et al. [Inflammatory Bowel Diseases] examined the effects of Mindfulness-Based Cognitive Therapy (MBCT) versus treatment-as-usual (TAU) on mental and physical health symptoms in IBD patients, incorporating objective assessments of disease severity and sleep.

In this randomized controlled trial, researchers assigned 142 Dutch adults (average age = 49 years; 64% female) with IBD in remission and Hospital Anxiety and Depression Scale (HADS) scores ≥11 to TAU alone or TAU plus MBCT. The MBCT program consisted of eight weekly 150-minute group sessions, a retreat day, and regular home practice. TAU consisted of medication and surgical interventions following Dutch and European treatment guidelines. Assessments were conducted at baseline, post-intervention, and 6-,9-, and 12-month follow-ups, including self-report of distress and disease severity, as well as stool samples for fecal calprotectin (a marker of intestinal inflammation).

Sleep quality was objectively assessed at baseline and post-intervention using three consecutive nights of home EEG recordings. The primary outcome was HADS score; while secondary outcomes included total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset.

By post-intervention, the MBCT group had significantly greater reductions in HADS distress scores than the TAU group (d=-0.61). MBCT showed reduced total sleep time (d=-0.67) and increased deep sleep proportion (d=0.70) compared with TAU. Improvements in HADS scores in the MBCT group persisted throughout the 12-month study period but were no longer statistically significant at 12 months because the TAU group showed gradual improvement over the follow period. At 12 months, the MBCT group had significantly decreased fecal calprotectin levels compared to TAU (d=-0.49).

This trial demonstrates that MBCT can reduce distress in IBD patients for up to a year and may increase the proportion of deep sleep without extending total sleep time. However, the study was limited by technical issues with EEG recordings which prevented complete sleep assessments for all participants. Seventy of the 142 randomized participants provided usable EEG data at baseline and 56 provided useable data at post-intervention without a between-groups difference in usable data. The lack of correlation between fecal calprotectin levels and disease improvement may reflect the selection of IBD patients in remission with a low incidence of flares. Although MBCT reduced mean HADS scores from 16.4 to 11.6, post-intervention averages remained above the threshold for clinical concern.

Reference:

ter Avest, M. M., Huijbers, M. J., Horjus, C. S., ... Speckens, A. E. M. (2025). Group-Delivered Mindfulness-Based Cognitive Therapy to Reduce Psychological Distress and Improve Sleep in Patients With Inflammatory Bowel Diseases: A Multicenter Randomized Controlled Trial (MindIBD). Inflammatory Bowel Diseases.

Link to study

Mind-body training can impact amino and lipid metabolites

Tue, 19 Aug 2025 21:42:31 GMT

Researchers are increasingly using advanced tools to study complex biological systems, such as the epigenetics of thousands of genes or the diversity of gut microbiome species. Mass spectrometry, for example, can measure thousands of metabolites in a single blood sample.

While prior mindfulness research has examined its effects on neurotransmitters, stress hormones, and inflammatory markers, no prior study has explored its influence on the broader metabolome, which is the full range of metabolites possibly affecting mental and physiological health.

Tang et al. [Scientific Reports] compared Integrative Mind-Body Training (IMBT), an adapted form of mindfulness training, with relaxation training (RT) to assess their relative impact on serum metabolites.

The researchers randomly assigned 42 meditation-naïve healthy adults (mean age = 54 years; 86% female; 88% White) to either IMBT or relaxation training. Both interventions consisted of 10 one-hour group sessions. IMBT combined gentle stretching postures aimed at cultivating presence, balance, and a calm, alert, and effortless open awareness. Relaxation training used progressive muscle relaxation to promote physical and mental calmness.

Fasting blood samples were collected before and after the intervention period, then analyzed via liquid chromatography-mass spectrometry. Changes in 923 serum metabolites were tested with paired t-tests.

The results showed the IMBT group had significant within-group changes in 13 metabolites related to carbon, amino acid, and lipid metabolism, with amino acid and lipid metabolites increasing and many sulfur metabolites decreasing. The RT group showed no within-group changes that reached statistical significance. Post-intervention comparisons revealed 106 metabolites, particularly glycine-related amino acid metabolites, differed significantly between groups.

These exploratory findings suggest IMBT might affect the metabolome more than progressive muscle relaxation training. The changes detected in relation to IMBT may have clinical relevance given that glycine has been implicated in Type 2 diabetes, fatty liver disease, stress, depression, cortical excitability, memory, and cognition. Further, the lowering of sulfate levels may be important as sulfates are implicated in cognitive dysfunction and dementia.

The study is limited by its small, mostly female sample, and its reliance on multiple unadjusted t-tests, which makes it vulnerable to identifying untrue associations.

Reference:

Tang, Y.-Y., Patterson, J. S., Tang, R., Chi, J., Ho, N. B. P., Sears, D. D., & Gu, H. (2025). Metabolomic profiles impacted by brief mindfulness intervention with contributions to improved health. Scientific Reports.

Link to study

Mindfulness Targets Serotonin, Dopamine in Headache Relief

Mon, 21 Jul 2025 21:42:53 GMT

Overuse of medication for chronic migraines can lead to medication overuse headaches, a paradoxical condition in which the medications intended to relieve migraines actually contribute to their persistence. Mindfulness-based interventions (MBIs) have shown some efficacy as a non-pharmacological adjunctive treatment for migraines and may help reduce reliance on medication.

Recent studies have advanced knowledge of how mindfulness may influence the biology underlying migraine headaches. One study found MBIs can alter functional connectivity between the brain’s salience network, insula, and sensorimotor facial area—regions associated with pain perception and appraisal.

Other studies suggest MBIs may affect serotonin transporter (5-HTT) gene epigenetics or help normalize serotonin levels. These findings are relevant because serotonin and dopamine play key roles in migraine pathophysiology. However, no studies had previously examined the relationship between changes in brain functional connectivity and changes in neurotransmitter system activity.

Fedeli et al. [Cephalgia] investigated changes in brain functional connectivity associated with serotonin, dopamine, and norepinephrine receptors in chronic migraine patients with medication overuse headaches who participated in a mindfulness training or control group.

The researchers randomly assigned 34 Italian chronic migraine headache patients with medication overuse headaches (average age=50 years; 88% female) to either a treatment as usual (TAU) control or TAU+MBI. The control condition involved withdrawal from overused medications, prescription of antidepressant or neuromodulator medications, and education on healthy lifestyle.

The MBI consisted of six weekly 90-minute guided sessions involving body scan and attention to breath and bodily sensations. From the third session onward, MBI participants were instructed to engage in audio recording-guided home practice 7 to 10 minutes daily.

Patients underwent resting state fMRI brain scans at baseline and one year follow-up. Neurotransmitter-specific functional connectivity maps were generated using open-source PET scan data from healthy participants to approximate serotonin, dopamine, and norepinephrine receptor systems.

At one-year follow-up, both treatment groups showed significant clinical improvement, but the TAU+MBI group improved significantly more than TAU. The TAU group had a reduced average headache frequency from 19 to 11 per month compared to a change from 20 to 8 per month in the TAU+MBI group.

At baseline, there were no group differences in neurotransmitter systems. After one year, the TAU+MBI group exhibited a larger increase in connectivity in serotonergic systems in the caudate and accumbens nuclei than the TAU group. Additionally, the TAU+MBI group displayed a relatively greater degree of increased functional connectivity in dopaminergic systems in the right insular cortex compared to the TAU group. However, these brain changes were not significantly correlated with the degree of clinical improvement.

The early pilot study suggests that a mindfulness training program can be associated with reduced headache frequency in patients with medication overuse headaches and can correlate with brain connectivity in serotonin and dopamine receptor systems. These systems are involved in processes such as pain perception, reward, addiction, and emotional regulation.

Nevertheless, the study should be considered preliminary due to its small sample size and reliance on neurotransmitter receptor maps derived from healthy individuals rather than direct PET scans of the study participants themselves.

Reference:

Fedeli, D., Ciullo, G., Demichelis, G., Medina Carrion, J. P., Bruzzone, M. G., Ciusani, E., Erbetta, A., Ferraro, S., Grisoli, M., Guastafierro, E., Montisano, D. A., D’Amico, D., Raggi, A., Nigri, A., & Grazzi, L. (2025). Neurotransmitter-related functional connectivity changes in serotonin and dopamine systems after mindfulness in medication overuse headache. Cephalalgia.

Link to study

Does Treatment Choice Improve Cancer Patient Outcomes?

Tue, 15 Jul 2025 18:57:51 GMT

Cancer patients often experience a reduced quality of life due to symptoms such as anxiety, stress, depression, fatigue, pain, and sleep disturbances. Mind-body therapies like Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong have been shown to alleviate distress, but little is known about their comparative efficacy. Additionally, it remains unclear whether allowing patients to choose their preferred treatment leads to better outcomes than assigning them randomly.

Carlson et al. [Journal of Clinical Oncology] compared the efficacy of MBCR and Tai Chi/Qigong and examined whether treatment outcomes differ between patients who receive their preferred treatment and those who are randomly assigned by study protocol.

The researchers enrolled 587 cancer patients (average age=61 years; 75% female) from two Canadian cancer treatment centers. The most common diagnoses were breast, prostate, and gastrointestinal cancers, and half were in early disease stages 0-II. At baseline, 64% of participants expressed a preference for one of the available treatments. Those who expressed a treatment preference were assigned to their chosen intervention but were randomly assigned to begin immediately or be placed on a waitlist. Patients without a preference were randomly assigned to either immediate or waitlisted MBCR or Tai Chi/Qigong.

The MBCR program followed the structure that was similar to Mindfulness-Based Stress Reduction, consisting of nine weekly 105-minute group sessions and a six-hour retreat. The Tai Chi/Qigong program involved 11 weekly 90-minute sessions and a 4-hour retreat. It incorporated the Cheng Man Ching Yang-style short form of Tai Chi and emphasized flowing movements, breath and body awareness, focused attention, and imagery. Both treatments recommended 30 to 40 minutes of daily home practice.

Participants completed assessments of mood at baseline and after the intervention using the Profile of Mood States. The primary outcome included a total mood score and subscale scores for tension-anxiety, depression, anger-hostility, vigor-activity, fatigue, and confusion.

Results showed that the MBCR group, including both those assigned to their preferred treatment and those randomized, showed significantly reduced total mood scores compared to MBCR waitlist controls (d=0.44). The Tai Chi/Qigong group (also combined) showed reduced total mood scores (d=0.25) compared to Tai Chi/Qigong waitlist controls; this effect was significant in the as-treated analysis but only trended toward significance in the intention-to-treat analysis.

There was no significant difference in the overall size of improvement in total mood scores between the group assigned to their preferred treatment and those randomly assigned.

When comparing the two treatment groups, Tai Chi/Qigong produced greater improvements in vigor-activity and greater reductions in anger-hostility and depression. MBCR was more effective in reducing tension-anxiety. The effect sizes of group contrast for subscale improvements were in the small-to-moderate range. For example, the effect sizes for differences between active and waitlisted treatments on vigor-activity for randomized participants ranged from d=0.24 to d=0.53. Similar differences for depression ranged from d=0.37 to 0.40.

This large trial shows that both MBCR and Tai Chi/Qigong treatments modestly improved mood in cancer patients, regardless of whether participants received their preferred treatment or were randomly assigned by the research protocol.

Notably, because no patient was assigned to a treatment they did not prefer (those with a preference received it, and those without preference were randomized), this study did not assess the impact of being assigned to a non-preferred treatment. This design feature may account for the difference between these findings and previous studies suggesting that patient preference influences treatment effectiveness.

Reference:

Carlson, L. E., Jones, J. M., Oberoi, D., Piedalue, K.-A., Wayne, P. M., Santa Mina, D., Lawal, O. A., & Speca, M. (2025). Mindfulness and Tai Chi for Cancer Health (MATCH) Study: Primary Outcomes of a Preference-Based Multisite Randomized Comparative Effectiveness Trial. Journal of Clinical Oncology.

Link to study

Group mindfulness therapy aids hard to treat depression

Fri, 27 Jun 2025 17:45:06 GMT

According to the U.K. National Health Service (NHS), half of patients treated for depression continue to experience symptoms above clinical thresholds after completing a course of NHS-delivered individual psychotherapy. Standard treatment typically involves cognitive-behavioral therapy, with patients attending an average of eight sessions.

There is the question of what is the best and most cost-efficient way to treat patients whose symptoms fail to remit following standard treatment, which typically combines medication and short-term psychotherapy.

Mindfulness-Based Cognitive Therapy (MBCT), which integrates mindfulness training into cognitive therapy, may offer added value for patients who have not fully responded to conventional treatments. As a short-term, group-based intervention treatment, MBCT may also be less expensive than other adjunct options.

Barnhofer et al. [The Lancet Psychiatry] examined the clinical effect and cost-effectiveness of group-based MBCT for patients whose depressive symptoms remained unremitted after individual psychotherapy. They compared MBCT plus treatment-as-usual (TAU) to TAU alone.

The researchers recruited 234 adult patients (average age = 42 years; 71% female; 86% White) from 20 NHS clinics. Eligible participants either still had clinical levels of depressive symptoms after receiving at least 12 sessions of psychotherapy or showed clinical levels of symptoms of depression six months post-treatment. On average, participants reported six prior depression episodes, and about two-thirds also had a comorbid anxiety disorder.

Patients were randomly assigned to MBCT plus TAU or TAU alone. MBCT involved eight weekly group sessions delivered via synchronous videoconferencing. All participants were permitted to continue any ongoing care and follow recommendations from their general practitioners.

In the MBCT group, 69% of participants were taking medication, compared to 74% in the TAU group. Additionally, 27% of MBCT participants received outside psychological services (e.g., counseling), versus 40% in the control group. The primary outcome was self-reported depression.

Assessments were conducted at baseline, 10 weeks, and 34 weeks. Cost data were collected from NHS records, and quality-adjusted life years (QALYs) were calculated according to National Institute for Health and Care Excellence (NICE) guidelines.

Results showed that MBCT plus TAU was superior to TAU. At 34 weeks, the MBCT group had significantly greater reductions in depression scores (Cohen’s d=-0.41). Moreover, 27% of participants in the MBCT group met recovery criteria, compared to 15% in the control group.

MBCT also resulted in $331 lower per-participant costs over the study period. Cost analysis indicated MBCT was likely a cost-effective option.

The study demonstrates that adding MBCT can reduce residual depressive symptom scores above TAU for patients who have not responded fully to prior psychotherapy. The study is limited by the lack of long-term follow-up and the sample’s limited demographic diversity, with a predominance of White and female participants.

Reference:

Barnhofer, T., Dunn, B. D., Strauss, C.,...Warren, F. C. (2025). Mindfulness-based cognitive therapy versus treatment as usual after non-remission with NHS Talking Therapies high-intensity psychological therapy for depression: A UK-based clinical effectiveness and cost-effectiveness randomised, controlled, superiority trial. The Lancet Psychiatry.

Link to study

Is virtual mindfulness enough for anxiety relief?

Tue, 17 Jun 2025 19:35:37 GMT

Telemedicine refers to the remote delivery of medical or health-related treatment through the Internet. It has become increasingly common and acceptable since the COVID pandemic. It is especially useful when travel to a treatment-delivery site is difficult or inconvenient. Research studies are beginning to employ videoconference-delivered mindfulness training as a treatment of convenience. It allows patients to receive treatment in the comfort of their own homes without requiring travel time. Little is known, however, about whether videoconferencing Mindfulness-Based Stress Reduction (MBSR) is as effective as traditional in-person MBSR.

In the initial phase of a study, Hoge et al. [Journal of Affective Disorders] tested the efficacy of traditional MBSR compared with in-person medication management with escitalopram for anxiety disorders. The previously published results of the initial phase of the trial showed that MBSR was non-inferior to escitalopram. “Non-inferiority” is a technical term meaning an intervention is not unacceptably worse than a comparison treatment, although it does not imply treatment equivalence. Before the initial phase results were analyzed, the COVID pandemic regulations forced the researchers to shift the study to remote, synchronous videoconferencing. This allowed them to compare the efficacy of escitalopram and MBSR when delivered remotely and in person.

In the second phase of the study, 202 adults with clinically diagnosed anxiety disorders (average age = 35 years old; 76% female; 71% White) received random assignment of MBSR by videoconference (MBSR-VC) or videoconference-delivered escitalopram medication check-ins (escitalopram-VC). This second-phase cohort was then compared to the first-phase cohort of 276 adults with anxiety disorders (average age = 33 years; 75% female; 60% White) who received traditional MBSR or in-person escitalopram medication check-ins.

The primary outcome was self-reported anxiety, assessed at baseline, mid-intervention, post-intervention, and at 1- and 3-months following the intervention. Secondary outcomes included self-reported social anxiety and panic disorder, and participants completed satisfaction surveys. MBSR followed the standard format of eight weekly 2.5-hour group sessions, a day-long retreat, and intensive home practice.

The results showed no significant difference in score improvement between MBSR-VC and remote escitalopram-VC on the primary anxiety measure at post-treatment. A statistical test of MBSR-VC non-inferiority to escitalopram-VC proved inconclusive. This was because, although the observed difference between the groups’ scores was small and below the prespecified non-inferiority margin, the upper boundary of the margin of error slightly exceeded that margin.

Despite the lack of group difference on the primary anxiety measure, participants in the escitalopram-VC group experienced significantly greater improvement on the secondary measure of panic attacks, and treatment satisfaction was significantly higher for the escitalopram-VC group (85 vs. 78 on a 100-point scale) than for the MBSR-VC group.

There was no significant difference in improvement on the primary anxiety scores between MBSR-VC and traditional MBSR, and MBSR-VC was found to be non-inferior to traditional MBSR. However, social anxiety symptom scores improved more in the traditional MBSR group than in the MBSR-VC group. Additionally, the MBSR group engaged in significantly more home practice (694 minutes) than the MBSR-VC group (478 minutes).

While the amount of MBSR-VC home practice was not significantly associated with symptom improvement, it was significantly associated in the traditional MBSR group. The escitalopram-VC group had better outcomes than the in-person escitalopram group at post-treatment and 1- and 3-month follow-ups.

The study suggests that although traditional MBSR did not prove non-inferior to ESC-VC, their outcomes on the primary anxiety measure did not differ significantly. Further, MBSR-VC was found to be non-inferior to traditional MBSR. The study suggests videoconference-delivered MBSR is an acceptable substitute for in-person MBSR for patients with generalized anxiety and panic disorder, but not for those with social anxiety.

The study is limited because assignment to videoconference and in person groups was not random. Synchronous videoconferencing involves real-time engagement with a group and teacher, thus results of this study are not generalizable to asynchronous telemedicine mindfulness modules that lack real-time interpersonal engagement.

Reference:

Hoge, E. A., Mete, M., Baker, A. W., Szuhany, K. L., Armstrong, C. H., Steinberg, M. H., Dutton, M. A., Bui, E., & Simon, N. M. (2025). A randomized controlled trial comparing mindfulness to escitalopram for anxiety: In-person and remote, synchronous delivery pre and post COVID-19 pandemic. Journal of Affective Disorders.

Link to study

Stress reduction from MBSR with and without smartwatch aided feedback

Sat, 31 May 2025 15:57:34 GMT

Mindfulness-Based Stress Reduction (MBSR) is designed to help individuals regulate emotional and physiological states by increasing non-reactive awareness of internal experiences such as bodily sensations correlated with emotional states. Biofeedback also provides people with information about their internal physical states and could be combined with MBSR to make it more effective.

Sumińska et al. [PLOS One] tested if the effects of MBSR training could be enhanced with the aid of smartwatch-delivered physiological feedback. Their study compared outcomes from standard MBSR, MBSR augmented with smartwatch biofeedback, and a no-treatment control group on measures of stress and wellbeing.

The researchers randomly assigned 72 healthy Polish adults (average age = 29 years; 79% female) who had no prior meditation experience and reported high levels of stress to one of three study groups. The MBSR group followed the traditional eight-week group-based curriculum with a half-day retreat and daily home practice. The MBSR plus smartwatch group included an identical MBSR training and were given smartwatches which measured heart rate, breath frequency, and movement. The watches provided wearers with data on daily stress levels, sleep quality, and a balance indicator of sympathetic versus parasympathetic nervous system activity.

Participants were instructed to view their smartwatch data twice daily, record their readings in a diary, and attend to notifications when their stress levels were elevated. All participants were assessed at baseline and after the 8-week intervention on conventional mental health self-report measures. Perceived stress was the primary outcome measure, and depression, anxiety, rumination, and general psychological functioning served as secondary measures.

The results showed both MBSR groups reported significantly decreased levels of stress (Cohen’s d=0.63 and 0.49), eating disorder symptoms (d=0.47 and 0.59) and rumination (d= 0.44 and 0.64) compared to their own baselines. The MBSR group had significant decreases in anxiety (d=0.50), cognitive difficulties (d=0.65), sleep problems (d=0.58) and a decrease in poor psychological functioning (d=0.54) compared to baseline. The control group reported a significant decrease in poor psychological functioning (d=0.68) compared to baseline.

Comparisons of post-intervention scores between groups showed the MBSR plus smartwatch group showed a significantly lower level of stress (η2 = 0.10) than the other groups, and the MBSR only group had significantly lower levels of rumination (η2 =0.15) than the other groups.

The study findings suggest that adding smartwatch biofeedback to MBSR may modestly enhance its effect in reducing perceived stress. However, adding a smartwatch does not appear to extend additional benefits to anxiety, rumination, cognitive difficulties, and sleep problems, and may even interfere with those benefits. A main limitation was the lack of testing for formal group-by-time interactions to clearly evaluate the between-group contrasts in this trial. Thus, all results are preliminary.

Reference:

Sumińska, S., & Rynkiewicz, A. (2025). Mindfulness-based stress reduction training supplemented with physiological signals from smartwatch improves mindfulness and reduces stress, but not anxiety and depression. PLOS One.

Link to study

Online mindfulness curriculum has limited impact across Denmark

Tue, 27 May 2025 14:33:22 GMT

Child mental health is reportedly declining across many Western societies, with increasing levels of anxiety, depression, and loneliness detected. Some countries, such as the United Kingdom and Denmark, have introduced nationwide school-based mindfulness programs to explore whether such interventions can improve student mental health.

In Denmark, the government established the Danish Center for Mindfulness at Aarhus University to train schoolteachers to deliver mindfulness-based training to elementary school students across the country. The program was modeled after the United Kingdom’s Mindfulness in Schools Project.

Juul et al. [Social Science and Medicine] conducted a nationwide cluster-randomized trial to evaluate the effectiveness of the Danish elementary school mindfulness-based curriculum on child mental health in both the general student population and among students identified as at risk.

The Center for Mindfulness invited Danish elementary schools to voluntarily participate in the program. Schools opting in sent teachers to the Center for training. The training instructors were experienced Mindfulness-Based Stress Reduction (MBSR) teachers and received additional training through the United Kingdom’s Mindfulness in Schools Project.

Schoolteacher training involved completion of an MBSR course, a 4-day residential training, and three 2-day seminars. The school-based program consisted of a 10-week intervention delivered in ten 60-minute classroom sessions to students in grades 4 through 9. Due to the COVID pandemic, all sessions were conducted online. Students attending schools in the program were compared to students in schools on a waiting list that offered their normal curriculum.

Students were assessed at baseline, post-intervention, and 3 months after the intervention using a variety of self-report measures. The primary outcome was the Total Difficulties Score from the Strengths and Difficulties Questionnaire (SDQ). Secondary outcome measures included SDQ subscales assessing emotional, conduct, and peer relationship problems, hyperactivity/inattention, and prosocial behavior. Students scoring above the 80th percentile on the baseline total difficulties score were classified as “at risk.”

Of the 1,669 students who completed baseline assessments, 351 were identified as at risk. Attrition was high given over 44% of students failed to complete post-intervention assessments. Students from control schools were significantly more likely to provide data at post-intervention periods.

The results showed that among-at-risk students, both study groups had a small improvement on the total difficulties measure, but without a statistically significant difference between groups. At-risk students who received the intervention performed worse than their control counterparts on measures of hyperactivity/inattention (Cohen’s d = 0.34) and on a self-rated visual analog health scale (d = 0.26). At the 3-month follow-up, boys in the intervention group reported significantly increased hyperactivity/inattention (d = 0.89), while girls showed no such effect (d = -0.07).

In the general student population, there was no evidence of improvement on the primary outcome immediately following the intervention. At the 3-month follow-up, both intervention and control groups showed modest improvements in the Total Difficulties Score, again without significant differences between them.

The study shows that a universal school-based mindfulness curriculum does not appear to improve mental health outcomes either for the general student population or for at-risk students. Moreover, the intervention may perhaps worsen some outcomes such as hyperactivity/ inattention among at-risk children, especially boys.

The study is limited by the social and institutional complications posed by the COVID pandemic and online format as well as the lack of fidelity checks to determine if teachers correctly implemented the curriculum as intended.

Reference:

Juul, L., Frydenberg, M., Bonde, E. H., Beck, M. S., Goetzsche, K., Nielsen, H. B., & Fjorback, L. O. (2025). Mindfulness in the school curriculum? A nationwide cluster-randomized trial of the effectiveness of implementing a mindfulness-based intervention for 9–16-year-olds students in Danish elementary schools. Social Science & Medicine.

Link to study

State-oriented people may struggle with solo mindfulness

Thu, 01 May 2025 03:32:16 GMT

According to Personality Systems Interaction theory, there are two types of people: action-oriented types who are good at self-regulating affect, and state-oriented types who tend to get stuck in their moods. State-oriented types make up about 50% of the general population and have trouble staying aligned with their needs and goals when affectively disturbed.

Recent research suggests that mindfulness practice may not help state-oriented types. For example, mindfulness practice tends to make state-oriented types more inconsistent in how they evaluate their own preferences. However, social support may buffer this self-alienation, as state-oriented types often rely on others to regulate their mood.

Thakur and Baumann [Motivation and Emotion] conducted two studies: the first aimed to replicate the prior finding that mindfulness induction increases self-alienation in state-oriented types, and the second testing whether invoking social support could buffer mindfulness-induced self-alienation.

In the first study, the researchers recruited 238 German adults (average age=32 years; 66% female) who were asked to rate the attractiveness of 12 Chinese characters. They then completed questionnaires assessing action versus state orientation. The orientation scale contained items such as “When I have lost something that is very valuable to me and I can’t find it anywhere, (A) I have a hard time concentrating on something else or (B) I put it out of my mind after a little while.” Choosing option A indicates a state-oriented tendency, while option B indicates an action-oriented style. Next, participants were asked to re-rate the same 12 Chinese characters and rate a new set of 12 characters.

Participants were then randomly assigned to one of three conditions: a mindfulness group, a social mindfulness group, or a control group. The mindfulness group listened to a 5-minute guided recording focused on mindful attention to the breath and being in the present moment. The social mindfulness group listened to the same meditation but were instructed to imagine they were meditating alongside a friend or loved one. The control group listened to a neutral audio on the topic of attention from a psychology textbook. Participants then reported state mindfulness again and re-evaluated the second set of Chinese characters.

The researchers calculated 1) the consistency between the ratings and re-ratings of the first set of Chinese characters and 2) the consistency between ratings and re-ratings of the second set of characters. The first set of ratings and re-ratings occurred before the interventions, and the second set of ratings and re-ratings were separated by the mindfulness, social mindfulness, or control intervention. The change in the consistency across the two rating tasks served as an indirect measure of self-alienation.

The results showed the control group had no rating inconsistency among action-oriented or state-oriented participants. In the mindfulness group, action-oriented types maintained consistent rating, but state-oriented types significantly decreased in rating consistency. In the social mindfulness group, both types maintained rating consistency.

Furthermore, state-oriented participants in the mindfulness condition showed significantly lower consistency than their counterparts in the control and social mindfulness conditions. No significant differences were found between state-oriented participants in the control and social mindfulness groups.

Study 2 replicated the first study with a larger sample of 300 participants (mean age=27 years; 83% female), a different method of prompting social support. In this second study, the social mindfulness group included instructions to write about personal similarities to a close friend before imagining themselves meditating with them.

The results mirrored those of the first study: mindfulness practice was associated with reduced consistency only among state-oriented types. Action-oriented types and the control and social mindfulness groups maintained consistency in their ratings. Once again, state-oriented participants in the mindfulness condition were significantly less consistent than state-oriented participants in the other two groups or any of the action-oriented participants.

These studies suggest that brief mindfulness practice can make state-oriented individuals more inconsistent in self-assessments, indicating increased self-alienation. This effect appears to be reduced when a social contact is invoked during practice.

The authors argue that mindfulness may have unintended effects for state-oriented individuals, especially when practiced alone. However, this conclusion rests on the assumption that inconsistency in rating visual stimuli reflects deeper disruptions in self-alignment and is limited by reliance on a single measure.

Reference:

Thakur, N., & Baumann, N. (2025). You make it work for me: Priming social support reduces alienating effects of short mindfulness meditation among poor self-regulators. Motivation and Emotion.

Link to study

Mental health gains from meditation in Parkinson’s disease

Tue, 29 Apr 2025 18:49:04 GMT

Parkinson’s disease is a neurodegenerative disorder that affects motor, mood, and cognitive functioning. About half of individuals with Parkinson’s report symptoms of anxiety and depression. Poor mood and high perceived stress are associated with faster disease progression, highlighting the potential value of interventions targeting psychological wellbeing. Mindfulness-based interventions, which can improve mood and reduce acute stress, may enhance quality of life and potentially slow disease progression in people with Parkinson’s.

Kwok et al. [Psychotherapy and Psychosomatics] tested the effects of mindfulness meditation and mindful yoga on mental health symptoms in people with Parkinson’s disease.

The researchers randomly assigned 159 Hong Kong residents with mild-to-moderate Parkinson’s disease (average age=75 years; 52% female) to one of three groups: mindfulness meditation, mindful yoga, or waitlist control. Outcome assessors were masked to group assignment. The mindfulness meditation program followed the structure and practices of Mindfulness-Based Stress Reduction (MBSR) and included eight weekly 90-minute group sessions along with assigned home meditation practice. The mindful yoga program had a similar format and dosage, with sessions incorporating controlled breathing, modiﬁed sun salutation postures, guided body scan, visualization, mantra, and loving-kindness meditations.

The waitlist control group received routine outpatient Parkinson’s care including medication management and minimal health management information. Assessments were conducted at baseline, post intervention, and 6-month follow-up.

Primary outcomes included self-reported anxiety and depression on the Hospital Anxiety and Depression Scale (HADS). Clinically-relevant secondary outcomes included disease severity, quality of life, and plasma levels of the proinflammatory biomarkers cortisol, IL-6, and TNF-α.

Adherence across groups differed, with 70% of the meditation and 96% of the yoga participants attending at least six sessions. Dropout rates did not differ significantly across groups. At all assessment points, the yoga group had highest ratings for the value of the program.

At the post-intervention assessment both the meditation group (Cohen’s d=0.57) and yoga group (d=0.69) showed significant reductions in anxiety scores compared to the control group, while only the meditation group (d=0.59) showed a significant reduction in depression scores compared to controls. There were no significant differences between the meditation and yoga groups on primary outcome scores. In addition, improvements in depression and anxiety scores were no longer significant at six-month follow-up.

Regarding secondary outcomes, both intervention groups showed significant post-intervention improvements in motor symptoms and quality of life compared to the control group, but only the meditation group maintained these improvements at follow-up. Both intervention groups had significant reductions in immune-related IL-6 levels compared to controls, but there was no difference for cortisol and TNF-α.

The study demonstrates moderate alleviation of select mental health symptoms immediately following meditation or yoga interventions in people with Parkinson’s disease, with a possible improved inflammatory signal. The study is limited by the absence of an active control and failure to measure diurnal cortisol slopes. The results do not yet generalize to patients with more severe stages of disease who might be limited in their ability to adhere to instructional practices.

Reference:

Kwok, J. Y. Y., Chan, L. M. L., Lai, C. A., Ho, P. W. L., ... Ho, R. T. H. (2025). Effects of Meditation and Yoga on Anxiety, Depression and Chronic Inflammation in Patients with Parkinson’s Disease: A Randomized Clinical Trial. Psychotherapy and Psychosomatics.

Link to study

Mind Guide app reduces PTSD symptoms but not alcohol cravings

Wed, 23 Apr 2025 16:25:11 GMT

A significant number (16-69%) of soldiers returning from deployment struggle with the dual challenges of PTSD and alcohol use disorder. However, 50% of affected veterans do not seek treatment, and 57% of those who begin treatment discontinue it early. There is a need for treatment options that are accessible, acceptable, and effective for veterans with dual diagnoses.

Mindfulness-based interventions have been shown to be of some benefit in reducing PTSD severity and substance use urges, but often present significant barriers to access. Mobile apps are more accessible, yet sustaining motivation to continue their use can be challenging. In a pilot study, Davis et al. [Journal of Clinical and Consulting Psychology] compared their newly developed mindfulness app (Mind Guide) to a stress management control app in veterans with PTSD and alcohol use symptoms. The researchers aimed to compare acceptability, usage, and efficacy across apps.

The researchers randomly assigned 201 military veterans (average age = 23; 84% male; 53% White) who scored high on self-report measures of alcohol use and PTSD symptoms to either the Mind Guide app or a stress management app. Mind Guide is a 16-module, self-guided training program that includes audio-based mindfulness exercises, self-assessments, journaling, goal setting and relapse prevention. Participants were instructed to complete two modules per week over eight weeks, with periodic text and email reminders from a program coordinator.

The stress management control app included an eight-week psychoeducational program focusing on stress, sleep, the immune system, time management, nutrition, and exercise.

Participants were assessed at baseline, 4 weeks, 8 weeks, and on 1-and 2-month follow-ups on primary outcome measures of PTSD symptoms and alcohol use. Most veterans completed at least half of the Mind Guide modules, with 32% completing at least 75%. On average, veterans spent five hours logged into the app.

The results showed that the Mind Guide group reported significantly reduced PTSD symptoms compared to the control group at weeks 8 (d=-0.25) and 16 (d=-0.36). Alcohol cravings and alcohol drinking days improved within each group, but without any between-group differences. In a post-hoc analysis of PTSD checklist subscales, hyperarousal and avoidance symptoms improved, but not re-experiencing symptoms.

This pilot study suggests that using Mind Guide can lead to small-to-moderate reductions in the hyperarousal and avoidance symptoms of PTSD for up to 16 weeks. While it also reduces alcohol use and cravings, it does not do so better than the control app. The study revealed that nearly one-third of Mind Guide users completed at least 75% of its modules - a rate higher than that of many similar apps.

The study is limited by its reliance on self-reported PTSD and alcohol use screening measures, the absence of a biochemical measure of abstinence, and the lack of participant ratings on app acceptability and satisfaction.

Reference:

Davis, J. P., Pedersen, E. R., Borsari, B., ... Canning, L. (2025). Effects of a mobile mindfulness smartphone app on posttraumatic stress disorder symptoms and alcohol use problems for veterans: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology. https://doi.org/10.1037/ccp0000940

Childhood trauma and PTSD predict MBCT outcomes and adverse effects

Mon, 17 Mar 2025 17:45:54 GMT

Knowledge is lacking regarding who is most likely to benefit from mindfulness-based interventions (MBIs) and who may be at risk of harm. Several studies suggest that patients with recurrent depression in remission are more likely to benefit from Mindfulness-Based Cognitive Therapy (MBCT) if they have histories of childhood trauma.

However, one study on MBCT for active depression found that patients with histories of childhood trauma had poorer treatment outcomes. Additionally, preliminary data suggest that meditators with histories of childhood trauma may be more vulnerable to meditation-related adverse experiences.

Canby et al. [PLOS ONE] conducted two studies to examine whether histories of childhood trauma and PTSD symptoms predict variability in MBCT outcomes in patients with active depression. The first study explored childhood trauma as a predictor of depressive symptom improvement and therapy attrition, while the second, larger replication study also assessed meditation-related adverse experiences and side effects.

In the first study, the researchers randomly assigned 52 patients (average age = 47 years; 79% female) with histories of recurrent depression in partial remission to either an 8-week MBCT program or a waitlist control. At baseline, patients were assessed using the Beck Depression Inventory (BDI), a structured clinical interview, and a self-report measure of childhood trauma (including life-threatening illness or injury, the death of a loved one, physical/sexual abuse, rape, and assault). Post-treatment outcomes were assessed using the BDI.

Results showed that the MBCT group significantly lowered their average BDI scores more than controls. Childhood trauma history and histories of physical and sexual abuse scores were associated with significantly poorer BDI improvement in the MBCT group. In the control group, childhood trauma and sexual abuse scores were associated with significantly poorer improvement over time. Trauma histories did not predict study dropout rates in either condition.

In study 2, part of a larger dismantling study, the researchers randomly assigned 104 patients with mild-to-severe depression or high negative affect (average age = 40 years; 74% female) to MBCT, MBCT with only focused-attention meditation, or MBCT with only open-monitoring meditation. While patients who met the full diagnostic criteria for PTSD were excluded, those with past or sub-clinical PTSD were included.

Participants completed a trauma questionnaire, a self-report measure of depressive symptoms, and a structured clinical interview at baseline. These assessments were repeated at 4 weeks, 8 weeks, and 3-months. At the 3-month assessment, participants also completed a questionnaire assessing meditation-related adverse experiences (MBAEs), meditation-related side effects (MRSEs), and long-lasting adverse effects.

Results showed that 58% of participants reported unpleasant MRAEs, 37% reported MRAEs that negatively impacted daily functioning,14% reported adverse effects lasting more than a day, 9% reported adverse effects lasting more than a week, and 6% reported adverse effects lasting over a month. Long-lasting adverse effects included executive dysfunction, insomnia, emotional blunting, identity disturbance, anxiety, time-space distortions, traumatic re-experiencing, derealization, and social impairment.

Average depressive symptoms improved significantly in all groups at all time points. Participants with greater total trauma, sexual abuse, or emotional neglect scores improved significantly less on self-reported depression scores. All trauma types predicted a greater likelihood of MSREs, while all trauma variables except physical abuse predicted a greater likelihood of unpleasant MRAEs. MRAEs that interfered with daily functioning were predicted by total trauma, emotional abuse, sexual abuse, and current and past PTSD symptoms.

Persistent adverse effects were predicted by total trauma history, emotional abuse, and current and past PTSD symptoms. Patients with past histories of sexual abuse were more likely to drop out of the study.

Together, the studies show that actively depressed patients with childhood abuse histories and PTSD symptoms are significantly less likely to benefit from MBCT and more likely to experience adverse meditation-related effects. The second study lacked non-meditation and no-treatment controls so one cannot infer whether a different treatment or the simple passage of time might have led to similar, lower, or higher rates of adverse experiences.

Reference:

Canby NK, Cosby EA, Palitsky R, Kaplan DM, Lee J, Mahdavi G, et al. Childhood trauma and subclinical PTSD symptoms predict adverse effects and worse outcomes across two mindfulness-based programs for active depression. PLOS ONE.

Link to study

Mindfulness app feasible for Brazilian and U.S. patients with advanced cancer

Sat, 01 Mar 2025 00:01:51 GMT

Patients with metastatic renal cell carcinoma—a type of kidney cancer that has spread to other organs—often experience distress, functional impairment, treatment side effects, and reduced quality of life. They may benefit from adjunctive treatments that help reduce distress and support effective coping. Studies have demonstrated the benefits of mindfulness-based programs for cancer patients, but access to these programs is not always easy. Patients may face financial or mobility constraints, lack the time, or live in geographically remote areas.

Delivering mindfulness training through smartphone apps offers a potential solution to these access barriers. Bergerot et al. [The Oncologist] evaluated the feasibility and acceptability of a mindfulness-based app for cancer patients in Brazil and the United States undergoing immunotherapy for advanced renal cell cancer who were experiencing heightened anxiety.

The researchers recruited 50 Brazilian and U.S. patients receiving immunotherapy for Stage 4 renal cell carcinoma who reported high levels of anxiety (average age = 59 years; 68% Brazilian; 68% male; 64% White). Participants received free access to the Mindfulness-Based Cancer Survivorship Journey (MBCSJ) app. Brazilian patients used the app in Portuguese, while U.S. patients used it in English. They were encouraged to use the app 20-30 minutes daily for a minimum of four days per week across four weeks.

The MBCSJ content included guided body, breath-focused, open awareness, compassion, walking, and mindful movement meditations. It also included suggestions for coping with cancer, mindful imagery exercises, and opportunities for journaling.

Patients were assessed at baseline and at weeks 2,4, and 12 for anxiety, depression, fatigue, fear of recurrence, quality of life, and mindfulness (using the Mindful Attention Awareness Scale). Feasibility was defined aa at least 50% of patients completing three or more sessions per week for at least two weeks. Acceptability was measured by an open-ended post-intervention survey.

The results showed that by week 4, 75% of patients reported high adherence to the app and symptom improvement. The cohort reported significant improvements in anxiety (d = 1.82), depression (d= 0.99), fear of recurrence (d= 1.55), fatigue (d=0.74), mindfulness (d = 1.03) and quality of life (d = 0.91) over time. Patients with high adherence reported liking the app, while those with low adherence cited difficulties using the app, lack of improvement, lack of interest, or interfering life events.

The study observes that a mindfulness-based cancer support digital app is feasible and acceptable for most Brazilian and U.S. metastatic renal cancer patients receiving immunotherapy and experiencing high levels of anxiety. However, as a pilot study, the interpretation is limited by its small sample size and lack of a control condition.

Most studies of mindfulness-based cancer treatments have focused on patient with localized cancers who have competed active treatment. This study suggests a mindfulness app may be helpful for people with metastatic disease who are still undergoing intensive treatment.

Reference:

Bergerot, C. D., Bergerot, P. G., Philip, E. J., ... Pal, S. K. (2025). Feasibility and acceptability of a mindfulness app-based intervention among patients with metastatic renal cell carcinoma: A multinational study. The Oncologist.

Link to study

Online mindfulness lowers opioid cravings without enhanced abstinence

Thu, 27 Feb 2025 16:39:49 GMT

Buprenorphine is an opioid receptor modulator used in recovery programs for opioid misuse. While it effectively reduces the harm associated with opioid misuse, most patients drop out of buprenorphine treatment within six months. This is often due to persistent cravings triggered after exposure to drug-related cues or stressful events. Research is needed to identify which adjunctive interventions can best enhance treatment effectiveness.

Previous research has shown that mindfulness training can reduce opioid cravings and use in chronic pain patients on methadone maintenance. Schuman-Olivier et al. [JAMA Network Open] compared the efficacy of buprenorphine plus an adjunctive online mindfulness intervention to buprenorphine plus an online support group in reducing opioid cravings and misuse.

The researchers randomly assigned 196 patients (mean age = 41 years; 61% female; 92% White) receiving buprenorphine for opioid misuse, who reported high anxiety levels or recent substance misuse, to either an online group-based Mindful Recovery Opioid Use Disorder Care Continuum (M-ROCC) program or an online recovery support group. M-ROCC included four weeks of fostering group engagement followed by four weeks of a low-dose mindfulness program.

Patients who successfully completed the initial mindfulness program were offered the opportunity to continue with a 16-week intensive mindfulness program focusing on mindfulness, self-compassion, emotional regulation, savoring, and urge surfing. Ninety percent of the participants who completed the initial eight-week program elected to continue with the 16-week program.

The support group included an eight-week program to foster group cohesion, followed by 16 weeks incorporating elements of cognitive behavioral therapy, motivational interviewing, community reinforcement, and 12-step programs. Both interventions met once weekly, opening with a 30-minute check-in that included weekly surveys and video-monitored oral toxicology screens, followed by a 60-minute group intervention.

The primary outcome was the number of two-week periods of self-reported and toxicology-confirmed abstinence from opioids during weeks 13 to 24. Secondary outcomes included self-reported anxiety and opioid craving levels, as well as the number of two-week periods free from benzodiazepine and cocaine use.

The results showed no significant differences between groups in terms of opioid, benzodiazepine, or cocaine abstinence during weeks 13 to 24 of the study. For example, opioid use in the M-ROCC group occurred during an average 13.4% of the two-week time periods compared to 12.7% in the support group.

Both groups had significantly reductions in anxiety scores from baseline to post-intervention (M-ROCC Cohen’s d = -1.1; Control Cohen’s d = -1.3), with no significant between-group difference. Opioid cravings significantly decreased in both groups from baseline to postintervention (M-ROCC Cohen’s d = -1.3; Control Cohen’s d = -0.7). The reduction in craving scores was significantly greater in the M-ROCC group compared to the support group (Cohen’s d = -0.5).

The study found that adding adjunctive online mindfulness training to buprenorphine treatment did not improve the criteria for abstinence from substances compared to a support group involving multiple treatment modalities. While the mindfulness intervention led to greater reductions in craving scores ,this did not correlate with improved abstinence.

The study was limited by the absence of a buprenorphine-only or attention placebo control group. Another limitation was the differential attrition rate: 51% of the M-ROCC group and 31% of the support group did not complete the study, meaning that more support group members received active treatment and this was likely to impact any between-group effect.

Reference:

Schuman-Olivier, Z., Goodman, H., Rosansky, J., Fredericksen, A. K., Barria, J., Parry, G., Sokol, R., Gardiner, P., Lê Cook, B., & Weiss, R. D. (2025). Mindfulness Training vs Recovery Support for Opioid Use, Craving, and Anxiety During Buprenorphine Treatment: A Randomized Clinical Trial. JAMA Network Open, 8(1), e2454950.

Link to study

Mindfulness program for chronic pain patients aids depression

Fri, 31 Jan 2025 17:07:59 GMT

While mindfulness-based interventions (MBIs) appear to have small-to-moderate efficacy in treating chronic pain, the extent to which these effects are mediated by improvements in cognitive functioning remains unclear.

Mohr et al. [Social Science and Humanities Open] conducted two studies to explore this question: (1) a cross-sectional study comparing the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain to those of healthy controls, and (2) an experiment examining the effects of Mindfulness-Based Pain Management (MBPM) compared to treatment-as-usual on the cognitive and emotional regulation abilities and interoceptive awareness of patients with chronic pain.

In the cross-sectional study, researchers compared 24 patients with chronic pain (mean age=43 years; 88% female; 100% White) to 11 healthy controls (mean age = 43 years; 82% female; 82% White) on self-report measures of pain, depression, interoceptive awareness (using the Multidimensional Assessment of Interoceptive Awareness scale, MAIA), and mindfulness (using the Five Facet Mindfulness Questionnaire, FFMQ).

Participants also completed computerized tasks measuring executive functioning (including an emotional Go/No-Go task) and working memory. The emotional Go/No-Go task instructed participants to press a computer key when presented with a specific word and refrain from pressing for other words, which included emotionally neutral, positive, and pain-related words.

Results showed that patients with chronic pain tended to report significantly higher levels of depression and pain, and significantly lower levels of mindfulness and interoceptive awareness, compared to controls. Exploratory analysis suggested that patients with chronic pain and controls differed in terms of how several of their MAIA subscales correlated with various cognitive executive functioning and working memory measures.

In the experiment, the researchers assigned patients with chronic pain who were interested and willing to commit to attending (N=16; mean age=42; 88% female; 100% White) the MBPM program, and those who were uninterested or unwilling to commit (N=14; mean age=38; 86% White) were assigned to treatment-as-usual.

MBPM is an 8-week group program based on Mindfulness-Based Stress Reduction (MBSR) and modified to meet the needs of patients with chronic pain. Due to the COVID pandemic, groups met online for 2-hour weekly group sessions. The pandemic also impacted participation and data collection, with only 47% of the MBPM group attending and completing all evaluations. Participants were assessed pre- and post-intervention using the same measures as in the prior cross-sectional study.

The preliminary results indicated the MBPM group had significantly greater decreases in depression, pain interference, and pain intensity, and significantly greater improvements on several subscales of the FFMQ and MAIA compared to controls.

While there were some pre-to-post improvements on cognitive and memory tasks, the groups did not significantly differ in their degrees of improvement. For example, while the MBPM group significantly improved its false positive rate on the Go/No-Go task when pain-related stimuli were involved and controls did not, the difference in their improvement rates did not reach statistical significance.

The experiment suggests that MBPM might improve depression, pain intensity and interference, mindfulness, and interoceptive awareness in chronic pain patients. Decreased depression and increased interoceptive awareness may, in turn, benefit cognitive executive functioning and working memory.

However, the study’s limitations—including a lack of randomization, high attrition rates, small sample size, and lack of adequate correction for multiple comparisons—should be considered carefully when interpreting the findings.

Reference:

Mohr, E., Matthew, S., Narisetti, L., Duff, C., & Schoenberg, P. (2025). Cognitive mechanisms of mindfulness-based pain management in chronic pain. Social Sciences & Humanities Open.

Link to study

Mindfulness plus mentoring program for juvenile justice youth

Thu, 30 Jan 2025 17:30:39 GMT

Adolescents subjected to chronic stress are at greater risk for developing mental and physical health difficulties. Mindfulness-based interventions (MBIs) may buffer the effects of chronic stress by enhancing cognitive executive function and emotional regulation. Since adolescents are still developing these cognitive and emotional resources, mindfulness training may accelerate their development.

Using ecological momentary assessment, Miller-Chagnon et al. [Journal of Consulting and Clinical Psychology] tested whether an MBI, taught within a community mentoring program, improved mindfulness and emotional regulation in chronically stressed adolescents better than the mentoring program alone.

The researchers randomly assigned 81 adolescents (mean age = 14 years; 56% male, 37% female, 7% other; 57% White) referred to a community-based mentoring program due to juvenile justice and/or emotional or behavioral problems to either the mentoring program alone or the mentoring program plus an MBI. Half of the adolescents’ families reported annual incomes below $20,000, 55% rated themselves on the bottom rung of a subjective social status scale, and 56% had mental health diagnoses.

The mentoring program met 3 nights per week across 12 weeks. The MBI group received nine weekly 30-minute mindfulness training sessions during weeks 2-10 of the mentoring program, while the control group continued mentored activities as usual. The MBI, adapted from the Learning to Breathe program, emphasized mindfulness of the body, senses, thoughts, emotions, and speech, as well as lovingkindness, gratitude, and compassion.

In the mentoring program, mentors engaged mentees in activities designed to promote positive relationships, academic success, and prosocial interests. A part of the cohort met face-to-face while others participated only online due to the COVID pandemic.

Participants were assessed using ecological momentary assessment at three time points: one week before the intervention, one week mid-intervention, and one-week post-intervention. During each 7-day assessment period, participants replied to three 13-item questionnaires delivered to their smartphones at semi-random intervals. The questionnaires assessed acute stressors, mindfulness (using the Mindful Attention and Awareness scale), self-judgment, and difficulties with emotional regulation experienced during the past hour.

The results showed that in the MBI group, the negative association between acute stressors and mindful attention was significantly weaker at postintervention compared to baseline. The presence of an acute stressor was associated with less self-judgment and less emotional regulation difficulty at postintervention than at baseline.

For the control group, acute stressors were associated with lower mindfulness scores and greater emotion regulation difﬁculty at postintervention than at baseline. All effect sizes were small.

The study demonstrates an MBI can potentially buffer the negative effects of stressor exposure on the ability to stay mindful and regulate emotion among adolescents with social and behavioral problems. A key strength of the study was its use of ecological momentary assessment across three distinct week-long periods, providing a more nuanced understanding of changes over time. The study is limited by the absence of long-term follow-up to assess whether and how long these effects persist.

Reference:

Miller-Chagnon, R. L., Shomaker, L. B., Prince, M. A., Krause, J. T., Rzonca, A., Haddock, S. A., Zimmerman, T. S., Lavender, J. M., Sibinga, E., & Lucas-Thompson, R. G. (2024). The benefits of mindfulness training for momentary mindfulness and emotion regulation: A randomized controlled trial for adolescents exposed to chronic stressors. Journal of Consulting and Clinical Psychology, 92(12), 800–813.

Link to study

Meditators detect faint tactile touch similar to non-meditators

Mon, 30 Dec 2024 16:29:17 GMT

Mindfulness meditation practitioners often report an increased awareness of body sensations. Some neuroimaging studies support this claim, revealing that meditators, compared to non-meditators, tend to have denser and more active anterior insulas--a brain region involved in body awareness. This enhanced body awareness linked with meditation may play a significant role in improving emotional self-regulation and stress management.

Humans can be sensitive to sensations arising both spontaneously from within the body and those generated externally, such as being touched. Signal detection theory claims that people differ not only in their sensitivity to touch but also in the strictness of the criteria they use to decide whether they have been touched. Sensitive individuals are better at accurately detecting faint touch stimuli, while those with more lax criteria are more likely to incorrectly report being touched when no stimulus is present.

Prior research shows that meditators exhibit reduced EEG alpha power after being cued to begin a signal detection trial, compared to non-meditators. This reduction likely reflects attentional preparation to receive a stimulus. Lower alpha power during this period has been linked to better performance on signal detection tasks. However, it remains unclear whether this improvement is due to increased sensitivity or more lax reporting criteria.

Mylius et al [Psychophysiology] contrasted the ability of meditators and non-meditators to detect very faint tactile sensations during a signal detection task. They also examined whether variations in electroencephalogram (EEG) alpha wave modulation could account for differences in signal detection accuracy between the two groups.

The researchers compared 31 German expert meditators (average age = 35 years; 61% male; average lifetime meditation hours = 2,628 hours) to 33 German non-meditator controls (average age = 32 years; 67% male). Meditators had a history of meditating ≥ 5 hours per week for at least two years, while controls reported reading books for ≥5 hours per week for at least two years. Participants completed on-line self-report survey of mindfulness (Mindful Attention Awareness Scale or MAAS), body sensory awareness (Multidimensional Assessment of Interoceptive Awareness or MAIA-2), and emotion regulation.

Participants then completed an in-person laboratory task to determine their threshold for mild electrical stimulation--the intensity accurately detected 50% of the time. They subsequently engaged in a signal detection task. At the start of each trial, a gray disc appeared on a computer screen, serving as a cue that the trial was about to begin. Half the time, the cue was followed by threshold level electrical stimulation delivered to the left index finger; the other half, no stimulation occurred. At the end of each trial, participants indicated whether they perceived a tactile stimulation. Throughout the task, EEG recorded participants’ brain alpha power.

Results indicated that the meditator group scored significantly higher than controls on seven of the eight MAIA-2 subscales (Cohen’s d range = 0.90 to 1.52), indicating greater body awareness. The meditator group also reported significantly less expressive suppression (d = 0.94) and less difficulty describing their feelings (d =.64). MAAS scores did not differ by group. The meditator group was not significantly more sensitive to the tactile stimulus but employed significantly laxer criteria when determining whether a stimulus had occurred (η2 = 0.56).

The meditator group also had lower EEG-based alpha power levels at baseline and a greater drop-off of alpha power after task cueing than controls. Lower alpha power after task cueing was associated with a greater likelihood of reporting a stimulus, whether or not it had occurred.

The investigators found that while meditators self-reported significantly greater body awareness, they were not more sensitive to faint external tactile stimulation compared to non-meditators. However, meditators exhibited significant differences in baseline and post-cueing alpha power during the signal detection task.

Meditators employed laxer criteria in determining whether a tactile stimulus had occurred. What might “laxer criteria” involve? Perhaps the greater attentional readiness associated with lowered alpha power by cueing led to heightened awareness of tiny spontaneous finger sensations, which were misperceived as the touch stimulus.

Reference:

Mylius, M., Guendelman, S., Iliopoulos, F., Gallese, V., & Kaltwasser, L. (2024). Meditation expertise influences response bias and prestimulus alpha activity in the somatosensory signal detection task. Psychophysiology.

Link to study

Physiological effects of MBSR with and without mindful breathing

Wed, 18 Dec 2024 19:56:06 GMT

Mindfulness-Based Stress Reduction (MBSR) integrates various meditation practices, including focused attention on breathing, open-monitoring, body scanning, walking meditation, and mindful yoga. Attention to diaphragmatic breathing is a key element, and some researchers theorize it may be critical to MBSR’s efficacy in alleviating symptoms. Deep breathing has a direct physiological effect on emotions by regulating vagal tone and sympathetic-parasympathetic balance. Perhaps breathing alone can explain much of the effect of meditation.

Wu et al. [Mindfulness] compared the diaphragmatic and core muscle changes among meditators in a standard MBSR program with those in an alternative form of MBSR that did not instruct on mindful breathing.

The researchers randomly assigned 48 meditation-naïve Chinese college students (average age = 20 years old; 71% female) to either standard MBSR or a MBSR without mindful breathing instruction. Both groups were taught in 8 weekly 2.5 hour sessions with a full-day retreat and daily homework. Both groups were taught by the same instructor, but one group was not directed to observe abdominal movement or concentrate on their breath. For example, during the body scan, control participants were simply told to focus on sensations in their fingers rather than to “maintain awareness of the breath, feeling it move in and out of your nose, concentrate on the breath, and visualize the airflow reaching your fingers.”

Ultrasound measures assessed the range of diaphragmatic movement and the thickness and elasticity of two core muscles: the transversus abdominis involved in abdominal expansion and contraction, and the multifidus involved in aligning the spine. Participants completed a survey before and after the intervention on mindfulness (the Five Facet Mindfulness Questionnaire), depression, anxiety, stress, and perceived self-efficacy in managing emotions.

Ultrasound results showed the standard MBSR group significantly increased their diaphragmatic range of movement and multifidus thickness in the contracted state compared to controls. Transversus abdominis elasticity during contraction decreased in both groups, while multifidus elasticity increased in both groups, but there were no between-group differences. The researchers suggested such changes represent greater muscle activation, strength, and control.

Both MBSR groups significantly increased their mindfulness and total self-efficacy scores without significant between-group differences There were no significant between-group differences in depression, anxiety, or stress scores.

The study reveals that instructions to focus attention on abdominal breathing in MBSR can increase ultrasound-assessed physiological changes in breathing anatomy while not necessarily resulting in different psychological outcomes. Interestingly, psychological benefits appear to be roughly equal in both standard MBSR and an alternative version of MBSR without a focus on attention to breath. However, the the study was not powered to test non-equivalence. The study is limited by its small sample size and the lack of detailed procedures regarding the ultrasound assessment.

Reference:

Wu, M., Fan, C., Zhao, X., Zhou, J., Liu, H., Li, H., Zhan, X., & Jiang, Z. (2024). The Effects of Mindfulness-Based Stress Reduction in Mental and Physical Health: Is Mindful Breathing Key? Mindfulness, 15(10), 2582–2594.

Link to study

Neurofeedback mindfulness alters brain connectivity without psychological change

Sat, 30 Nov 2024 18:40:09 GMT

Brain imaging studies such as those using fMRI typically find that mindfulness meditation training decreases resting-state activity and neural connectivity within the brain’s default mode network (DMN) and increases connectivity between nodes of the DMN and the salience network.

The DMN is associated with mind-wandering and self-referential thinking, with the posterior cingulate cortex (PCC) as a key hub. The salience network is associated with bodily and emotional awareness. This has led to speculation that neurofeedback could facilitate and enhance mindfulness training.

Neurofeedback Augmented Mindfulness Training (NAMT) is a newer approach that combines neurofeedback to decrease PCC activity with traditional instruction to cultivate non-judgmental awareness. Cosgrove et al. [Frontiers of Neuroscience] conducted a pilot study that explored fMRI resting-state brain functional connectivity before and after NAMT in a group of healthy adolescents.

They hypothesized NAMT would reduce connectivity between the PCC and other regions of the DMN while increasing connectivity between the PCC and regions of the salience network.

The researchers assigned 31 healthy adolescents (average age=15 years; 55% male; 74% White) who were part of a larger neuroimaging study to undergo fMRI while completing a variety of tasks, including an NAMT task. Participants completed pre- and post-fMRI self-report measures of perceived stress, mood, and mindfulness. Before imaging, they received a brief introduction to mindfulness, which included guided breath-focused meditation.

Participants then underwent fMRI scanning that included 1) an initial resting-state measure , 2) breath-focused mindfulness meditation with and without PCC neurofeedback, and 3) a concluding resting-state measure. In the neurofeedback condition, participants watched a bar on a screen that turned red when PCC activation increased and blue when it decreased. They were instructed that focusing on their breath would turn the bar blue, and mind-wandering would turn it red, and were encouraged to keep the bar blue. The fMRI data analysis compared resting-state connectivity before and after NAMT, rather than during NAMT.

The results showed significant resting-state increases in PCC connectivity with regions of the hippocampus and amygdala following the NAMT task. These connectivity changes were not associated with score changes on the self-reported psychological measures.

The findings did not support the hypothesis that NAMT training would decrease connectivity between the PCC and other DMN regions, though they did support the hypothesis of increased connectivity between the PCC and salience network regions. Greater PCC-salience network connectivity could theoretically linked to heightened emotional awareness, though this was not reflected in the psychological measures.

The pilot study observes changes in resting-state brain connectivity following brief neurofeedback-augmented mindfulness training but fails to show any associated psychological change scores associated with those connectivity changes.

The results differ somewhat from a previous study that sampled from a clinical adolescent population, found decreased DMN interconnectivity following neurofeedback, and linked connectivity changes to changes in self-report scores. Study limitations include the lack of a sham NAMT treatment to rule out placebo or time-related effects.

Reference:

Cosgrove, K. T., Tsuchiyagaito, A., Cohen, Z. P., Cochran, G., Yu, X., Misaki, M., Aupperle, R. L., Singh, M. K., Paulus, M. P., & Kirlic, N. (2024). Augmenting mindfulness training through neurofeedback: A pilot study of the pre-post changes on resting-state functional connectivity in typically developing adolescents. Frontiers in Neuroscience, 18.

Link to study

Internet-delivered CBT and MBI equally boost women's sexual desire

Wed, 27 Nov 2024 22:14:54 GMT

About a third of sexually active women experience either no or very low levels of sexual interest, desire, and arousal which can sometimes be a source of unhappiness and distress. Psychological treatments for low sexual desire include cognitive behavioral approaches (CBT) to challenge negative thoughts that can interfere with sexual arousal, and mindfulness-based approaches (MBI) to help focus on pleasurable sensations without distraction from interfering thoughts.

Both treatments have been shown to be more effective than no-treatment controls. Internet-based CBT and MBI for low sexual desire have the potential to make treatment more affordable and accessible.

Velten et al. [Journal of Clinical and Consulting Psychology] tested the relative efficacy of internet-based CBT and MBI approaches vs. a waitlist control on symptoms of low sexual desire and sexual distress among women with low sexual desire.

The researchers randomly assigned 266 German women (average age=36 years) who met the diagnostic criteria for both hyposexual desire dysfunction (ICD-11 diagnosis) and sexual interest and arousal disorder (DSM-5 diagnosis) to an internet-based CBT, an internet-based MBI, or a waitlist control. Both active treatments consisted of eight online individual treatment modules, with participants instructed to complete one module per week. CBT and MBI included didactic presentations, guided exercises, and standard elements of sex education and therapy.

Participants were assessed on sexual desire (primary outcome) and sexual distress (secondary outcome) with online self-report questionnaires at baseline, 5 weeks, and 3-, 6-, and 12-month follow-ups. The intent-to-treat analytic results showed that both treatment groups had significant large-sized increases (d=1.14 and 1.11) in sexual desire at 5 weeks and moderate-sized increases (d=0.75 and 0.74) in sexual desire at 3 months compared to the control group.

There were also significant, large-sized decreases in sexual distress (d=-1.14 and -0.98) at 5 weeks, which were sustained at 3 months (d=-1.18 and -1.00). All shorter-term improvements were maintained at 6- and 12-month follow-up.

However, not all participants improved in the treatment groups based on a predetermined objective score set by the researchers. At 12-month follow-up, only 20-24% of the women showed clinically meaningful improvement in sexual desire, and only 37-42% had showed clinically meaningful improvement in sexual distress. Indeed, 35-45% of the women showed no improvement in sexual desire, and 12-16% showed no improvement in sexual distress.

The study reveals that internet-based CBT and MBI treatments show equal benefit in increasing sexual desire and decreasing sexual distress among women with low sexual desire, though most participants do not achieve clinically meaningful improvement.

The study is limited by a high dropout rate that was similar across all groups, a common problem in internet-based treatment studies, with only 46% of participants completing the 3-month follow-up and 31% completing the 12-month follow-up.

Reference:

Velten, J., Hirschfeld, G., Meyers, M., & Margraf, J. (2024). Results of a randomized waitlist-controlled trial of online cognitive behavioral sex therapy and online mindfulness-based sex therapy for hypoactive sexual desire dysfunction in women. Journal of Consulting and Clinical Psychology.

Link to study

Large data with machine learning predicts veteran suicide events

Wed, 30 Oct 2024 16:09:11 GMT

The goal of individualized medicine is to determine which therapy works best for each individual patient. Predicting optimal treatments for individuals involves collecting large data sets of potential predictive variables, each with small non-linear effects and complex interactions. Machine learning methods can generate predictions from these vast datasets more efficiently than humans can.

Computers can also calculate Personalized Advantage Indexes (PAIs), which compare the likelihood of a successful outcome from one treatment to that of an alternative treatment. PAIs can then be used to guide physicians to offer patients their optimal treatment.

Meyers et al. [Behaviour Research and Therapy] developed and tested a treatment-matching algorithm for veterans at high risk for suicide, aiming to predict which veterans would benefit more from Mindfulness-Based Cognitive Therapy for Suicide Prevention (MBCT-S) or enhanced treatment-as-usual (TAU).

The researchers performed a secondary analysis of data from a 2021 study in which 140 veterans at high risk for suicide were randomly assigned to either MBCT-S or enhanced TAU within the Veterans Administration (VA) system. The primary outcome measured was the number of suicide attempts or hospitalizations and emergency room visits for severe suicidal ideation over the ensuing 12-month period. The study collected a vast array of data that could be used as potential outcome predictors.

The researchers aimed to: 1) develop machine learning models to predict outcomes within each study arm, 2) identify key variables that predicted suicidal behavior, and 3) generate PAIs for each patient and evaluate their utility.

MBCT-S was delivered in eight group and two individual sessions. TAU consisted of usual VA care (including access to psychopharmacology, psychotherapy, and residential care as needed) and attention from suicide prevention coordinators, who helped patients develop safety plans, encouraged compliance, and monitored progress.

The researchers selected 55 potential predictor variables from the demographic, clinical, and neurocognitive study data and the electronic medical records. Data were processed using a machine learning “random forest” approach. Data from 80% of the patients were used to train the predictive models, while data from the remaining 20% were reserved for subsequent model validation.

The results showed that the suicide prediction model was 73% accurate in the training sample and 67% accurate in the validation sample for the MBCT-S group. The predictive model for the TAU group was 66% accurate in the training sample and 60% accurate in the validation sample. The MBCT-S predictive model met the researcher’s standards of acceptability, but the TAU predictive model did not.

Within the MBCT-S group, the variables that best predicted future suicidal behavior were a diagnosis of PTSD, history of parasuicidal behavior, residential care in the past year, number of acute psychiatric admissions in the past year, and poor performance on a sustained attention task. In the TAU group, the best predictors were the number of acute hospitalizations and outpatient visits in the past year, severity of suicidal ideation, and better attentional control.

PAIs indicated that 63% of MBCT-S patients were in their PAI-indicated optimal treatment group compared to 39% of the TAU patients. Patients in their PAI-indicated optimal treatment were significantly less likely to have a suicidal event in the next year. While the main effect of treatment assignment on suicidal events was not significant, the interaction between treatment assignment and PAI indication was significant.

The findings support the use of large dataset machine learning to generate predictions about which patients may benefit most from particular therapies. It serves as a demonstration of what may be possible in the future, though creating a truly predictive model requires larger patient datasets and cross-validation on independent samples. The study was also limited by the use of a TAU control, which did not offer a uniform treatment experience to all participants.

Reference:

Myers, C. E., Dave, C. V., Chesin, M. S., Marx, B. P., St. Hill, L. M., Reddy, V., Miller, R. B., King, A., & Interian, A. (2024). Initial evaluation of a personalized advantage index to determine which individuals may benefit from mindfulness-based cognitive therapy for suicide prevention. Behaviour Research and Therapy.

Link to study

DMT-Harmine combo elevates emotional breakthroughs in meditators

Mon, 21 Oct 2024 22:52:45 GMT

Some early studies suggest that combining meditation with a psychedelic substance may increase mindfulness, compassion, and well-being beyond meditation practice alone. Most of this research involves psilocybin, but little is known about whether other psychedelics might have a similar synergistic effect when combined with meditation.

Meling et al. [Journal of Psychopharmacology] tested whether a combination of Dimethyltryptamine (DMT) and Harmine had psychologically beneficial effects when compared to a placebo. DMT is one of the psychoactive substances in ayahuasca, a plant that contains the monoamine oxidase inhibitor Harmine. The combination of DMT and Harmine is often considered an “ayahuasca analog” because Harmine slows the biodegradation of DMT, thereby prolonging its effects.

The researchers randomly assigned 40 experienced meditators with an interest in DMT research (average age = 44 years; average meditative experience = 2,400 hours; 55% male; 83% with postgraduate degrees, 95% White) to either a DMT-Harmine group or a placebo group. All participants attended a 3-day meditation retreat at a Swiss Zen Meditation Center focused on mindfulness, compassion, and walking meditations. On the second day of the retreat, participants received four sublingual doses of DMT-Harmine or placebo over a 2-hour period. Each active dose contained 30mg of DMT and 30mg of Harmine.

Participants completed self-report measures one day before the retreat, on each of the three retreat days, one day after the retreat, and at 1- week and 1-month follow-up. Measures included state and trait mindfulness, compassion, insight, emotional breakthrough, and mystical and non-dual experience.

Insight was a measure of how much participants thought they learned new information about their personalities and lives, while emotional breakthrough was a measure of how much participants experienced a cathartic emotional release, explored their emotions, or resolved an emotional issue.

At 1-month follow-up, participants were asked whether they could guess whether they had received the substance or placebo (83% correctly identified their group) and how meaningful, spiritually significant, and beneficial the retreat had been.

The results showed that DMT-Harmine did not offer advantages over the placebo in terms of enhanced mindfulness or compassion scores. However, DMT-Harmine significantly enhanced psychological insight (ηp2 = 013), emotional breakthrough (ηp2=0.21), and mystical (ηp2=0.30) and non-dual (ηp2=0.13) experience on the day it was administered.

At 1-month follow-up, the group receiving DMT-Harmine rated their experience as significantly more personally meaningful, spiritually significant, and more positively impactful in terms of well-being and life-satisfaction.

The study shows that while DMT-Harmine did not offer improved mindfulness or compassion scores in experienced meditators beyond the meditation retreat, it does boost psychological insight, emotional breakthrough, and transcendent experience. Forty-five percent of the DMT-Harmine group rated their experience as one of the top five spiritual experiences of their lives.

The study’s limitations include the absence of a non-meditation control group and the fact that participants detected their study group. It remains unclear how divided doses of DMT-Harmine compare to a single dose, or how the low dose of Harmine in this study compares to studies that employ ayahuasca which has higher naturally occurring amounts of Harmine.

Reference:

Meling, D., Egger, K., Aicher, H. D., Jareño Redondo, J., Mueller, J., Dornbierer, J., Temperli, E., Vasella, E. A., Caflisch, L., Pfeiffer, D. J., Schlomberg, J. T., Smallridge, J. W., Dornbierer, D. A., & Scheidegger, M. (2024). Meditating on psychedelics. A randomized placebo-controlled study of DMT and harmine in a mindfulness retreat. Journal of Psychopharmacology.

Link to study

Less pain interference in veterans after a VA mindfulness program

Wed, 25 Sep 2024 21:41:50 GMT

Mindfulness-based interventions (MBIs) are often recommended as first-line or ancillary treatments for chronic pain. However, several barriers prevent widespread access to these programs. including cost, the availability of nearby programs, and the challenge of coordinating patients’ schedules with group session times .

Newer programs using smartphone and telehealth technologies allow chronic pain patients to learn mindfulness at home, often on their own schedule and at a lower cost. Burgess et al. [JAMA Internal Medicine] conducted a randomized controlled trial to compare the effect of a group-based and a self-paced telehealth MBIs in treating veterans with chronic pain, compared to a treatment-as-usual (TAU) control group.

The researchers randomly assigned 811 American veterans with moderate-to-severe chronic pain (average age = 55; 52% male; 66% White), recruited from three Veterans Affairs (VA) facilities, into one of three groups: a group-based telehealth MBI with treatment as usual, a self-paced telehealth MBI with treatment as usual, or a treatment-as-usual only group. Both MBIs were 8-week programs modeled the after Mindfulness-Based Stress Reduction program.

The group-based MBI included an orientation session and eight 90-minute synchronous group telehealth sessions, featuring pre-recorded mindfulness education and exercises, followed by facilitated discussions. Participants were encouraged to practice at home using a workbook, smartphone app, and website with guided meditations.

TAU included the availability of acupuncture, massage, exercise, yoga, tai chi, meditation, medication, spinal injections, and counseling and psychotherapy. All groups used the non-meditation TAU modalities to a similar extent, and 42% of the TAU group also accessed some form of meditation or mindfulness training on their own.

Patients were assessed at 10 weeks, 6 months, and 12 months on primary and secondary outcomes. The primary outcome was improvement in pain-related impairment of daily activities. Secondary outcomes included anxiety, depression, fatigue, sleep disturbance, PTSD, and social role functioning. Sixty-nine percent of the group-based MBI participants completed 6 or more of the group sessions, while 76% of the self-paced group participated in at least two facilitator calls.

The group-based MBI had significantly lower pain-related interference scores at 10 weeks and 6 months, while the self-paced MBI outperformed the TAU group at all time points.

A greater percentage of patients in both MBI groups attained 30% and 50% pain improvement over baseline compared to controls. MBI groups showed significantly better improvement on almost all the secondary measures compared to the TAU group. There were no differences between the MBI groups on these secondary measures. No adverse events were reported in any of the study groups

Reference:

Burgess, D. J., Calvert, C., Hagel Campbell, E. M., … Taylor, B. C. (2024). Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine.

Link to study

Mindfulness versus attention control apps for subjective well-being

Mon, 16 Sep 2024 16:33:49 GMT

The self-paced MBI group consisted of eight 30- to 60-minute asynchronous sessions using the same pre-recorded materials as the group-based MBI but without facilitated discussion. Instead, participants received three phone calls from facilitators to address problems, monitor progress, and discuss strategies. TAU included the availability of acupuncture, massage, exercise, yoga, tai chi, meditation, medication, spinal injections, and counseling and psychotherapy. All groups used the non-meditation TAU modalities to a similar extent, and 42% of the TAU group also accessed some form of meditation or mindfulness training on their own.

Averaged over the three assessment periods, the group-based MBI (effect size = -0.20) and the self-paced MBI (effect size= -0.40) had significantly lower pain interference scores with their daily lives compared to the TAU controls. There was no significant difference in effect between the two MBI groups. The group-based MBI had significantly lower pain-related interference scores at 10 weeks and 6 months, while the self-paced MBI outperformed the TAU group at all time points.

The study reveals that telehealth-delivered MBIs can reduce veteran pain interference with daily life scores compared to TAU. Although the effect sizes were small, they persisted throughout the follow-up period. Notably, the group-based MBI conferred no additional benefit over a self-paced MBI. The study is limited by the lack of comparison between telehealth and in-person treatment, as well as MBIs and other evidenced-based treatments like cognitive-behavioral therapy.

Reference:

Burgess, D. J., Calvert, C., Hagel Campbell, E. M.,… Taylor, B. C. (2024). Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Internal Medicine.

Link to study

Various digital health apps equally mitigate psychiatric symptoms

Tue, 27 Aug 2024 16:25:38 GMT

The demand for psychiatric services far exceeds availability, and there are barriers such as cost and time to accessing services, even when they are available. Recently, various digital mental health interventions (DMHI) have been developed to help address the gap between mental health care need and publicly available services. These interventions are accessible by smartphone, available at any time, and have lower costs than personnel-delivered mental health services.

While studies show that specific cognitive-behavioral DMHIs and Mindfulness-Based DMHIs are more effective than no-treatment controls, there is little research comparing their relative effectiveness. Horwitz et al. [JAMA Network Open] compared the relative effectiveness of five different DMHIs in reducing depressive symptoms within an adult general outpatient psychiatric population.

The researchers recruited 2,079 adults (average age = 37 years; 68% female; 77% white) who had sought mental health services within the University of Michigan Health System and had scheduled an appointment or recently had their first appointment. Participants were paid $20 for completing the initial assessment and an additional $20 for completing the 6-week follow-up assessment. They agreed to pair their smartphones with a smartphone app, sync their smartphones with a wrist-worn activity monitor, and use the smartphone app for 6 weeks. The primary study outcome was improvement in depressive symptoms, with secondary outcomes including improvements in anxiety, substance use, and suicidal ideation.

Five digital treatment interventions were randomly assigned to participants: 1) enhanced personal feedback (EPF), 2) cognitive-behavioral therapy, 3) mindfulness meditation, 4) cognitive-behavioral therapy + EPT, and 5) mindfulness meditation + EPT. EPF consisted of sending pop-up notifications to smartphones twice daily. For example, if the activity monitor showed relative inactivity, a message might be sent to encourage more walking. Other notifications suggested participants be kind to others or engage more with the cognitive-behavioral and mindfulness meditation apps.

Cognitive-behavioral therapy was delivered via the Silvercloud app, which helped participants monitor mood, activity schedule, and engage in cognitive restructuring through text, video, and journaling. Mindfulness meditation involved access to the library of guided meditations on the Headspace app.

The results showed that depressive symptom scores significantly decreased in all five digital intervention groups, but without between-group differences reaching significance. Depressive symptoms initially averaged 12.7 on a 27-point scale at baseline and decreased by a range of 2.1 to 2.9 points below baseline across the various interventions.

There were similar improvements for secondary outcomes. The Headspace app interventions showed a significantly greater (but probably not clinically meaningful) decrease in suicidal ideation compared to the other intervention groups. The degree of improvement in these groups was the same regardless of whether participants attended 0, 1, 2, or more treatment meetings with therapists during the 6-week trial suggesting that clinic visits did not contribute to symptom changes across study groups.

The study shows that psychiatric outpatients experience a small but significant degree of improvement in psychiatric symptoms after being assigned digital mental health interventions regardless of intervention content.

The authors suggest that digital mental health interventions may be helpful for patients awaiting assignment for first visits to therapists. However, the study is limited by the absence of a no-treatment group to eliminate the claim that simple engagement in a research study as a participant also improves depressive symptoms. It also did not measure the extent to which participants actually used their assigned apps.

Reference:

Horwitz, A. G., Mills, E. D., Sen, S., & Bohnert, A. S. B. (2024). Comparative Effectiveness of Three Digital Interventions for Adults Seeking Psychiatric Services: A Randomized Clinical Trial. JAMA Network Open, 7(7), e2422115.

Link to study

Mediterranean diet and MBSR reduce risk of very small placenta

Fri, 16 Aug 2024 15:31:31 GMT

Very low birthweight is associated with physical, psychological, and social difficulties during early childhood development. In studies previously reported in our September and November 2023 issues, newborns from a large cohort of women at high risk for very low-birthweight delivery benefited from both the Mediterranean Diet and from Mindfulness-Based Stress Reduction (MBSR). Both interventions resulted in fewer very low-birthweight deliveries, better early childhood developmental scores, and measurable differences in fetal brain development.

Very low birthweight is usually due to placental dysfunction, but those earlier analyses did not assess whether the treatments affected placental health. In a secondary analysis, Nakaki et al. [Acta Obstetricia et Gynecologica Scandinavica] used Magnetic Resonance Imaging (MRI) to assess placental volume and blood perfusion in a subset of the women from the original study.

The original study recruited 1,221 pregnant Spanish women who were at risk for delivering very low birthweight infants based on clinical guidelines. MBSR, the Mediterranean Diet, or treatment-as-usual conditions were randomly assigned to women. MBSR included 2.5-hour weekly group sessions, a full-day retreat, and home meditation practice.

The Mediterranean diet intervention involved monthly group assessment and education sessions along with the provision of extra virgin olive oil and walnuts for consumption. The usual care group received pregnancy care following current obstetrical protocols.

The authors invited a randomly selected subset of 350 of these women to undergo magnetic resonance imaging (MRI) of the placenta to assess placental volume and perfusion during the 36th week of pregnancy, and 165 women(average age = 38 years; 79% white) agreed to participate in this additional protocol.

The results show that while there was no significant between-group difference in average placental volume, there were significant differences in the likelihood of having a placental volume below the 10th percentile. Only 3.9% of the Mediterranean Diet group had volumes below the 10thpercentile, compared to 5% of the MBSR group and 17% of the treatment-as-usual group. Very small placental volumes were associated with significantly increased odds of giving birth to a very low birthweight infant.

No significant differences in blood perfusion were detected. Blood perfusion is a measure of the blood flow between the placenta and the fetus which is in turn related to the amount of nutrition and oxygen the fetus receives.

The study shows that the Mediterranean Diet and MBSR both lower the odds of having a very small placenta, which is in turn associated with the odds of giving birth to a very low weight infant. The authors discuss how the anti-inflammatory effects of the Mediterranean diet can beneficially affect placental development, and how lower levels of stress-related glucocorticoids can beneficially impact placental growth and nutrient transport.

The study’s method of measuring blood perfusion may not have been sensitive enough to detect meaningful differences. This relatively highly educated sample of pregnant women had low rates of obesity and gestational diabetes and may not be typical of the general obstetric population.

Reference:

Nakaki, A., Denaro, E., Crimella, M., Castellani, R., Vellvé, K., Izquierdo, N., Basso, A., Paules, C., Casas, R., Benitez, L., Casas, I., Larroya, M., Genero, M., Castro-Barquero, S., Gomez-Gomez, A., Pozo, Ó. J., Vieta, E., Estruch, R., Nadal, A., … Youssef, L. (2024). Effect of Mediterranean diet or mindfulness-based stress reduction during pregnancy on placental volume and perfusion: A subanalysis of the IMPACT BCN randomized clinical trial. Acta Obstetricia et Gynecologica Scandinavica.

Link to study

Wearable smartband detects smoking and delivers mindfulness

Tue, 23 Jul 2024 17:59:53 GMT

Most cigarette smokers want to quit, but only 7% succeed in any given year. While smoking cessation interventions can be helpful for some, most people attempt to quit without professional assistance. The widespread use of smartphones and the growing popularity of wearable smart bands and watches suggests new mediums for supporting targeted smoking cessation efforts.

Horvath et al. [Annals of Medicine] conducted an uncontrolled study to investigate the feasibility of a wearable smartband designed to detect smoking episodes and subsequently deliver a brief mindfulness session. The aim of the technology was to improve the timeliness of the intervention content in relation to smoking occurrences.

The researchers recruited a sample of 155 adult smokers who owned smartphones (average age = 46 years; 54% female; 76% white) and wanted to quit smoking in response to posted Facebook ads. Participants were given a wearable smartband that paired with their personal smartphones. The bands used accelerometer and gyroscopic sensors to identify hand-to-mouth movements correlated with cigarette smoking behavior.

When smoking movement was detected, the band vibrated and sent a message via smartphone prompting participants to confirm or deny they were smoking. Participants were instructed to wear the band on the hand they used for smoking 12 hours a day for 60 consecutive days. Participants could smoke as much or as little as they liked but set the 30th day of smart band wear as their intended “quit day.”

At 21 days, participants completed a survey and a brief online mindfulness training. From day 21 to 28, whenever their band detected smoking, they were sent a two-minute audio “mindful smoking” exercise. On the 28th day, participants completed another survey and viewed a brief online training on using RAIN (Recognize, Allow, Investigate, Non-identification) to manage cravings.

From day 28 onwards, the smartphone delivered a two-minute audio-guided RAIN exercise when the band detected smoking. The completion of mindfulness exercises was time-stamped, and real-time data was gathered on cravings, mood, and the exercises’ helpfulness. At 60 days, participants completed another online survey.

The primary outcomes measured were the smartband’s accuracy to detect smoking, protocol adherence, and protocol acceptability. The secondary outcomes related to smoking included cigarette dependence, withdrawal symptoms, and abstinence.

The results showed that the band detected smoking with 90% accuracy. Twenty-six percent of the participants did not complete study enrollment, never succeeded in paring the band with their phones, or never tried wearing the bands. Among the 115 participants who wore the band at least once, bands were worn on 70% of the treatment days and for at least 12 hours a day on 41% of those days.

The part of the sample that wore the band at least once completed 40% of the mindful smoking exercises and 86% of the RAIN exercises. Eighty-two percent of the participants who wore the bands at least once completed their surveys at all data points.

While participants found the mindful smoking and RAIN exercises helpful (79% and 75%, respectively) only a small majority liked them (58% and 52%, respectively). On average, participants reduced their smoking by 9 cigarettes per day, and 12% reported achieving one-week point prevalence abstinence.

The study suggests that a smartband can reliably detect smoking episodes and deliver subsequent prompting for interventions. While study retention was good, adherence and acceptability were variable in the sample of smokers. Some participants reported difficulty keeping the band paired with their phones, and some felt they received an excessive number of daily intervention prompts.

Reference:

Horvath, M., Pittman, B., O’Malley, S. S., Grutman, A., Khan, N., Gueorguieva, R., Brewer, J. A., & Garrison, K. A. (2024). Smartband-based smoking detection and real-time brief mindfulness intervention: Findings from a feasibility clinical trial. Annals of Medicine.

Link to study

Esketamine boosts engagement in mindfulness for alcohol use disorder

Wed, 17 Jul 2024 16:33:39 GMT

Alcohol misuse is a significant contributor to poor mental and physical health in people under age 50 worldwide. Existing interventions for alcohol misuse suffer from high attrition and relapse, prompting the search for more effective treatments.

Esketamine, a novel glutamatergic drug with dissociative, anesthetic, hallucinogenic and psychedelic properties has demonstrated antidepressant effects. A few studies suggest it may work synergistically with behavioral treatments to reduce alcohol use. Some researchers propose that esketamine facilitates greater psychological engagement with treatment in terms of motivation, commitment, and belief in the treatment process.

Gent et al. [Journal of Psychopharmacology] tested whether combining esketamine with a mindfulness training enhances treatment psychological engagement among individuals with alcohol use disorder.

The researchers randomly assigned 28 British adults (mean age = 22 years; 57% male; 93% white) with moderate to severe alcohol use disorder to a mindfulness training combined with either a single dose of esketamine or a vitamin C placebo administered on the eighth day of the intervention phase.

Participants attended the study center on day one for a baseline assessment. They were shown three brief videos introducing mindfulness and outlining its benefits for relapse prevention. They were also given a set of 14 daily mindfulness exercises, each lasting 5 to 25 minutes, to complete on their own over the following 14 days.

They returned to the study center on the eighth day of the study for a single dose of either esketamine or placebo. After dosing, participants wore an eye mask and listened to soothing music for 40 minutes. Following this, they completed a post-intervention assessment. Participants also completed a final online assessment on day 14.

The mindfulness exercises emphasized relaxation and accepting thoughts and sensations. Two of the exercises specifically addressed managing alcohol cravings through mindfulness. Assessments measured the primary outcomes of engagement with treatment and alcohol cravings and use.

The results showed a significant difference in treatment psychological engagement between esketamine and placebo groups. Engagement scores did not differ by groups during day 1-7, but after drug administration, self-reported engagement increased and remained higher for the esketamine group but not the placebo group.

There was also a significant but transient post-drug decrease in alcohol cravings on day 8 for the esketamine group, but not the placebo group. The esketamine group showed significantly more dissociative and mystical experiences after drug administration than placebo. Both groups decreased alcohol use, without a significant difference between. The groups did not differ in terms of self-reports of how many days or how many times a day they performed the mindfulness exercises.

The study shows a single dose of esketamine increased psychological engagement with a daily brief mindfulness training and transiently reduced alcohol cravings. However, it did not improve alcohol-related outcomes at the study’s 2-week endpoint.

The study’s limitations include its small sample size, the limited number of data points for assessing daily alcohol cravings, and the brevity of the mindfulness training.

Reference:

Gent, E. M., Bryan, J. W., Cleary, M. A., Clarke, T. I., Holmwood, H. D., Nassereddine, R. O., Salway, C., Depla, S., Statton, S., Krecké, J., & Morgan, C. J. (2024). Esketamine combined with a mindfulness-based intervention for individuals with alcohol problems. Journal of Psychopharmacology, 38(6), 541–550.

Link to study

Parents report fewer behavioral problems in youth following MBSR

Thu, 20 Jun 2024 15:25:02 GMT

Children born very prematurely, defined as under 32 weeks gestational age, are at a greater risk for developing a wide spectrum of disorders including ADHD, autistic spectrum, and anxiety disorders. Functional connectivity is a measure of the degree to which large-scale brain networks synchronize their activity.

From birth through adulthood, children born very prematurely often show atypical functional connectivity patterns, which are associated with problems in cognitive and emotional functioning. Since mindfulness-based interventions (MBIs) can improve executive cognitive function and emotional regulation in some samples, MBIs may benefit children born very prematurely.

Siffredi et al. [Psychiatry and Clinical Neuroscience] studied the effects of a MBI on neurobehavioral and functional connectivity measures in young adolescents born very prematurely, comparing them to an independent cohort of adolescents born full term.

The researchers enrolled 63 young Swiss adolescents (average age=12 years; 56% female) born very prematurely in an 8-week mindfulness program modeled after Mindfulness-Based Stress Reduction (MBSR) but modified for younger adolescents. Weekly in-person group MBI sessions were 90 minutes long, and meditations were brief (2-10 minutes) and guided by trained mindfulness teachers.

Participants completed neurobehavioral assessments before and after intervention, and 39 of the participants also underwent functional magnetic resonance imaging (fMRI) before and after the intervention. A comparison group of 24 young adolescents born full term (average age=12 years; 38% female) also underwent neurobehavioral assessments and fMRI scanning but did not participate in the MBI.

Neurobehavioral assessments included self-rated and parent-rated questionnaires and computerized tasks measuring executive and socio-emotional functioning. fMRIs assessed resting-state dynamic brain functional connectivity: the ways in which correlations and anticorrelations between large-scale brain networks changed over time.

The results found the prematurely born cohort had significantly greater scores for executive and behavioral difficulties on parent-report questionnaires than full-term adolescents at baseline. Parents in the MBI group reported significantly improved executive function, metacognition, and behavioral regulation scores over time. Score improvements were correlated with longer activations in the frontolimbic and amygdala-hippocampus self-regulation networks, dorsolateral prefrontal attentional control network, and visual networks related to attention to relevant stimuli.

There was no evidence that score improvements were associated with functional connectivity changes between large-scale brain systems.

This study reports that a MBI reduces parental ratings of behavioral problems in adolescents who were born very prematurely. These improvements in parental ratings are correlated with longer activation times in brain networks associated with attentional control and emotional regulation.

The study is limited by the absence of a comparator group that also underwent a MBI. All significant between-group differences and MBI-associated changes were at the level of self- and parent-report, and not on objective neuropsychological measures. Thus, some or all the improvement in parental-ratings may be due to expectancy bias.

Reference:

Siffredi, V., Liverani, M. C., Fernandez, N., Freitas, L. G. A., Borradori Tolsa, C., Van De Ville, D., Hüppi, P. S., & Ha-Vinh Leuchter, R. (2024). Impact of a mindfulness-based intervention on neurobehavioral functioning and its association with large-scale brain networks in preterm young adolescents. Psychiatry and Clinical Neurosciences.

Link to study

Mindfulness app for distress relief in ICU patients after hospital discharge

Fri, 14 Jun 2024 15:09:34 GMT

Patients discharged from intensive care units (ICUs) often report persistent psychological distress. This distress can result from a combination of factors: life-threatening illness, medical procedures, the financial burden of illness and treatment, and adjustment to residual disabilities and role changes. A previous pilot study showed that post-discharge use of a mindfulness meditation mobile app could reduce average levels of psychological distress in some participants.

Cox et al. [JAMA Internal Medicine] investigated ways to optimize their previously piloted mindfulness app by varying the number of app-based meditations and phone contact with a human therapist.

Participants were 247 ICU patients (average age=50 years; 58% male; 73% white; average ICU stay length=7 days) with moderate or higher levels of psychological distress at discharge. All participants were discharged home with free access to a mindfulness meditation smartphone app. The app offered a month-long training program containing four week-long themes. The themes covered awareness of the breath, body, thoughts and emotions, and activities of daily living, as well as cultivating kindness and compassion.

Participants were randomly assigned to one of eight meditation groups that comprised combinations of: 1) whether the themed units were introduced by an app video or a live therapist phone call; 2) whether reported increases in symptoms were responded to by the app or a live therapist phone call; 3) whether participants engaged in an 8-to-10-minute audio-guided meditation once or twice a day.

Psychological symptoms were assessed at baseline and at 1- and 3-months post-randomization. The primary outcome was self-reported depressive symptoms, and self-reported anxiety and PTSD symptoms were secondary outcomes. The statistical test was not a between-groups analysis but rather assessed the degree to which each of the variables—meditation frequency, live therapist vs. app introductions, and live therapist vs. app response to symptoms—affected outcomes across groups.

The sample viewed on average 71% of the total app content, 89% of the sample were still actively viewing content by the fourth week, and 74% of the sample completed the 3-month follow-up assessment. All groups showed clinically meaningful improvement in depression and PTSD symptoms at 1- and 3-month follow-up.

The group meditating twice daily showed significantly more improved depression scores (from 10.4 to 5.6 points) than the group meditating once daily (from 10.4 to 7.0 points). Retention and outcomes weren’t improved in groups having live therapists introduce themes or respond to symptoms increases by telephone.

The study shows discharged ICU patients with elevated distress using a mindfulness smartphone app report decreased distress scores over time, that meditating twice daily is associated with reducing such symptoms more than meditating once daily, and that talking by phone with live therapists neither improves study retention nor distress outcomes.

The study is limited by its lack of a non-mindfulness app comparator and low rate of ICU patients agreeing to participate (47%). Further, the number of patients reporting increased distress symptoms was too low (8%) to effectively test the value of having a therapist respond to symptoms.

Reference:

Cox, C. E., Gallis, J. A., Olsen, M. K., Porter, L. S., Gremore, T., Greeson, J. M., Morris, C., Moss, M., & Hough, C. L. (2024). Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors: A Randomized Clinical Trial. JAMA Internal Medicine.

Link to study

MBCT and grief therapy offer similar acute relief for prolonged grief

Fri, 31 May 2024 16:34:09 GMT

Up to 10% of bereaved people suffer from prolonged grief disorder, characterized by persistent yearning for lost loved ones and emotional pain that interferes with daily living. Grief-focused cognitive behavioral therapy (GF-CBT) has been shown to be more effective than either antidepressant medication or interpersonal psychotherapy in reducing grief symptoms.

However, many bereaved individuals have trouble tolerating GF-CBT’s emphasis on actively recalling their loved one’s death. Up to 25% of those offered GF-CBT decline it, while up to 50% fail to respond, and 22% find it excessively challenging.

For this reason, the search continues for therapies for bereaved people who cannot tolerate or fail to respond to GF-CBT. Mindfulness-Based Cognitive Therapy (MBCT), proven somewhat effective in treating some forms of depression presents one such possibility.

Bryant et al. [JAMA Psychiatry] compared the effects of GF-CBT and MBCT in reducing prolonged grief symptoms in patients with prolonged grief disorder.

The researchers randomly assigned 100 Australian patients with prolonged grief disorder (average age=47 years; 87% female; 71% white) to either GF-CBT or MBCT. Both programs consisted of 90-minute, weekly individual sessions over an 11-week period. GF-CBT entailed didactic training, thought monitoring, and revisiting memories of the loved one’s death. Participants were instructed to reframe maladaptive grief-related thoughts, write letters to the deceased, and cultivate positive memories of them.

The standard MBCT protocol was modified to focus on problematic grief. MBCT participants were assigned 40 minutes of daily homework.

Assessments were conducted at baseline, post-treatment, and 6-month follow-up using a primary outcome measure of prolonged grief symptoms. Secondary outcomes involved the assessment of mental health symptoms, grief-related cognition, and quality of life. The primary prolonged grief measure assessed symptoms such as loneliness, numbness, meaninglessness, emotional detachment, obsessive thoughts of loss, avoidance of loss reminders, and disengagement from life.

The results showed that at 6 months, the GF-CBT group had significantly greater reductions in prolonged grief symptoms (Cohen’s d=0.80), depressive symptoms (d=0.60), and grief related cognitions (d=0.70) compared to the MBCT group.

Both groups showed clinical improvements in prolonged grief, depression, and grief-related cognitions. For example, the GF-CBT group’s prolonged grief symptoms decreased from 43.6 points to 28.7 points while the MBCT group’s symptoms decreased from 40.6 to 32.8 points.

The superiority of GF-CBT was not apparent at post-treatment but emerged at the 6-month follow-up. Both groups had significant reductions in anxiety and improvements in quality of life, without significant differences between groups.

The study demonstrates that both MBCT and GF-CBT can reduce symptoms of prolonged grief immediately after treatment, but GF-CBT shows greater effectiveness at 6-month follow-up. The study is limited by its not including an analysis of home practice during and after treatment. Further, only 60% participants from each treatment group were retained at the 6-month follow-up.

Reference:

Bryant, R. A., Azevedo, S., Yadav, S., ... Dawson, K. S. (2024). Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder: A Randomized Clinical Trial. JAMA Psychiatry.

Link to study

MBSR aids vision improvement in eye disease patients

Wed, 29 May 2024 17:43:29 GMT

Central serous chorioretinopathy (CSCR) is an eye disease characterized by the accumulation of fluid between the choroid tissue layer and the retina, leading to retinal bulging and visual impairment. While this condition typically resolves within three months, it can sometimes persist chronically or recur.

Chronic CSCR treatment involves a variety of therapies including laser treatment, photodynamic therapy, and medication. Stress has been identified as a risk factor for CSCR, with elevated stress hormones like cortisol and epinephrine implicated in the buildup of sub-retinal fluid.

Stress reduction techniques might promote healing and restore vision for CSCR. Özcan and Karapapak [International Ophthalmology] tested the effects of Mindfulness-Based Stress Reduction (MBSR) compared to a no-treatment control on visual acuity and macular thickness in patients with a recent onset of CSCR.

The researchers randomly assigned 60 Turkish meditation-naïve adults (average age=40; 88% male) with a recent onset of CSCR to MBSR or a monitoring only control group. Recent onset of CSCR is usually not actively treated unless symptoms fail to resolve after three months. MBSR sessions consisted of daily one-hour sessions spanning three months, during which participants engaged in breath, body, and sensation-focused meditations.

Participants’ best vision while wearing corrective lenses was assessed using a Snelling eye chart at 1, 3, and 6 months. The thickness of each participant’s retinal macula was measured by Spectral Domain Optical Coherence Tomography at each assessment point. The retinal macula thickens in CSCR due to excess fluid absorption, and a thinner macula is a sign of recovery.

Six of the initial MBSR participants were excluded from the analysis due to not completing MBSR training. Trial results showed that, at 1, 3, and 6 months, the MBSR group had significantly better visual acuity and lower macular thickness compared to controls. Controls also improved from baseline to follow-up, but their visual acuity recovery was slower, and both their visual acuity and macular thickness had less improvement compared to the MBSR group.

The findings underscore the potential of MBSR in ameliorating vision impairments and reducing macular thickness in CSCR patients. The researchers cautioned that maintaining patient engagement with MBSR was challenging.

Limitations of the study include the absence of an active control group, the lack of a stress measurement to elucidate stress as a key mechanism, and not including an intention-to-treat analysis of all individuals randomized. The description of MBSR provided was insufficient, hindering understanding of intervention components and implementation method.

Reference:

Özcan, D., & Karapapak, M. (2024). Effect of mindfulness-based stress reduction on acute central serous chorioretinopathy: A randomized control trial. International Ophthalmology, 44(1), 183.

Link to study

Cognitive benefit not supported for MBSR targeting older adults with HIV

Thu, 25 Apr 2024 19:26:00 GMT

Antiretroviral medications have enabled people living with HIV to live normal lifespans but about half of those with HIV meet diagnostic criteria for HIV-associated neurocognitive disorder (HAND). People diagnosed with HAND show deficits in attention, memory, verbal fluency, and visuospatial ability and are susceptible to depression, lower quality of life, and poorer medication compliance. Existing treatments for HAND include computerized cognitive training and interventions to increase levels of physical activity.

Mindfulness training might also be a promising intervention because of its established beneficial effects on depression and quality of life for patients with a variety of chronic illnesses, as well as its potential benefit for executive cognitive function. Moskowitz et al. [AIDS and Behavior] tested the ability of Mindfulness-Based Stress Reduction (MBSR) to alleviate distress and neurocognitive symptoms and improve quality of life in older patients diagnosed with HAND.

The researchers randomly assigned 180 patients (mean age=65 years; 80% male; 73% white; average HIV duration=30 years) aged 55 years and over who were currently on antiretroviral medication, had undetectable serum HIV levels, and were diagnosed with HAND to either MBSR or a waitlist control.

Recruitment efforts targeted participants from the San Francisco Bay Area using various methods, such as community outreach talks, recommendations from healthcare providers, advertising on buses and in newspapers, and direct outreach facilitated by the UCSF Electronic Health Record Recruitment Service. The MBSR intervention followed the standard 8-week group-based protocol.

Participants were assessed at baseline, post-intervention, and one-month follow-up using self-report measures of anxiety, depression, quality of life, and activities of daily living. The activities of daily living measures assessed participants’ basic abilities to shop, cook, do laundry, bathe, clean house, and take their medications, They were also assessed at all three time points on neurocognitive measures of information processing speed (a symbol-digit test), working memory (a letter number sequencing task), and vigilance (a continuous performance task).

The trial results showed that the MBSR group had a significant decrease in depressive symptoms at post-intervention compared to the control group, but this difference was no longer significant at one month follow-up. The MBSR group showed a significant improvement in quality of life compared to the control group at one month follow-up.

No significant group differences were observed in terms of anxiety, neurocognitive scores, or activities of daily living at either immediate post-intervention or one-month follow-up assessment.

The trial findings suggest that MBSR can reduce depressive symptoms and improve quality of life for older patients with HIV-associated neurocognitive disorder in the shorter term but does not improve anxiety, neurocognitive symptoms, or activities of daily living. The study is limited by reliance on a waitlist control and lack of long-term follow-up.

Reference:

Moskowitz, J. T., Sharma, B., Javandel, S., Moran, P., Paul, R., De Gruttola, V., Tomov, D., Azmy, H., Sandoval, R., Hillis, M., Chen, K. P., Tsuei, T., Addington, E. L., Cummings, P. D., Hellmuth, J., Allen, I. E., Ances, B. M., Valcour, V., & Milanini, B. (2024). Mindfulness-Based Stress Reduction for Symptom Management in Older Individuals with HIV-Associated Neurocognitive Disorder. AIDS and Behavior.

Link to study

Idealized body images less hurtful to females after brief meditation

Fri, 19 Apr 2024 17:24:34 GMT

Rates of adolescent and young adult depression and anxiety have risen since 2010 in many industrialized societies, especially for young women. Some experts attribute this increase to heightened exposure to social media. Research shows that such exposure can diminish women’s body satisfaction and self-esteem, likely stemming from the portrayal of idealized thinness and fitness standards in images and messages. Researchers are interested in developing practical strategies to mitigate the adverse impacts of social media on body image.

Mindfulness meditation, with its emphasis on acceptance, non-reactivity, non-judgment, and non-rumination, could serve to mitigate the negative impacts of social media. Hooper et al. [Body Image] investigated the effects of brief mindfulness meditation on women’s body appreciation, mood, and self-esteem after viewing idealized thinness and fitness images obtained from social media posts.

In this online study, researchers randomly assigned 162 English-speaking women (mean age = 26 years; 62% white) who typically spent an average of 2 to 3 hours daily on Instagram to either a brief mindfulness meditation or an audio control group.

All participants were exposed to 12 Instagram photos, each viewed for at least 20 seconds, featuring idealized images of female thinness or fitness. Following exposure to the images, participants listened to either a 10-minute guided mindfulness meditation or a 10-minute podcast providing general information about Brazilian jujitsu. The guided meditation emphasized attention to breathing and cultivation of concentration and calmness.

Participants completed self-report measures at baseline, immediately after viewing the images, and immediately after listening to the meditation or podcast session. These measures assessed mood, self-esteem, and body appreciation, with the body appreciation measure including statements such as “At this moment I feel good about my body.”

The results revealed that viewing the idealized thinness and fitness images led to immediate and significant decreases in self-esteem (partial η2=0.69), body appreciation (η2=0.71) and positive mood (η2=0.63) and increases in negative mood (η2 =0.58) for the total sample.

However, the mindfulness meditation group significantly increased self-esteem (η2=0.69), body appreciation (η2=0.66) and positive mood (η2=0.54) and reduced negative mood (η2=0.57) compared to the podcast control immediately following the audio exposure. Additionally, all of these self-report measures were significantly better after meditation than they were at baseline.

The study demonstrates that visual exposure to idealized thinness and fitness images obtained from Instagram posts worsens women’s mood, self-esteem, and body appreciation. These adverse effects can be mitigated, at least in the very short term, through brief mindfulness meditation as compared to listening to general information on a podcast not involving meditation.

The study's limitations include the use of a mundane control audio as opposed to a comparator like deep breathing or breath counting. The inclusion of such comparators could potentially alter reports of self-esteem, body appreciation, and mood following the image task.

Reference:

Hooper, R., Guest, E., Ramsey-Wade, C., & Slater, A. (2024). A brief mindfulness meditation can ameliorate the effects of exposure to idealised social media images on self-esteem, mood, and body appreciation in young women: An online randomised controlled experiment. Body Image.

Link to study

Family mindfulness program versus medication for ADHD children

Tue, 26 Mar 2024 20:49:35 GMT

Stimulant medications are often the first-line treatment for childhood attention deficit/hyperactivity disorder. Medication has shown to be more effective than behavioral treatment for ADHD, and it is still unclear whether behavioral treatments provide any additional value when used in conjunction with medication.

While medication can significantly reduce inattention, impulsivity, and hyperactivity for most children with ADHD, about 20-35% of children do not appear to benefit from it. Additionally, medication side effects such as insomnia, loss of appetite, and anxiety are common. About 50% of children opt to eventually discontinue its use. As a result, there remains a need for effective non-pharmacological treatments.

Mindfulness-based treatments, with their demonstrated effects on attention and emotional regulation, are worth exploring in this regard. Meppelink et al. [Mindfulness] tested the effectiveness of conjoint child-and-family mindfulness-based intervention against methylphenidate medication in children with ADHD.

The researchers randomly assigned 91 Dutch children with ADHD (average age = 11 years; 71% male), along with 91 of their mothers and 81 of their fathers, to either mindfulness-based or medication treatment groups. Children in the medication group received methylphenidate, titrated until reaching an optimal response. The mindfulness intervention included 8 weekly 1.5-hour group sessions for the children and 8 weekly 1.5-hours group sessions for their parent(s), focusing on mindful parenting.

After the initial training, families attended a 1.5-hour booster session. They were required to follow their assigned protocol for 4 months but could switch treatment afterwards.

About 50% of the families in the mindfulness group kept their protocol, while the other half switched to medication. About 75% of the families in the medication group stayed with medication, while a quarter discontinued it. Many families sought additional help from outside providers during the study. Thirty-five percent of the medication group sought out mindfulness-based treatments, and 23% of the medication group and 35% of the mindfulness group sought out other behavioral treatments.

Children were assessed at baseline and 2, 4, and 10 months on self-, parent-, and teacher-report behavioral measures. They were also assessed on neuropsychological measures of attention at baseline and 2 months.

The results showed that while both groups significantly improved on child-, parent-, and teacher-rated symptoms at 2 and 4 months (d = -0.20 to -0.57), improvements were significantly greater for the medication group (d = -0.28 to -0.76) . At two months, both groups fared significantly better on neuropsychological measures (d = 0.38 to 1.11) , but there were no significant between-group differences. At 10 months, maternal behavioral ratings no longer differed between the groups, although fathers still rated medication as more effective.

The treatment effects remained consistent for both mindfulness and medication participants who stayed the course with their initial treatment assignment. Mindfulness participants who switched to medication deteriorated at 4 months (before switching) but showed improvements at 10 months. Medication participants who stopped medication either deteriorated at 4 months (before switching) or at 10 months.

A second cohort of 29 children with ADHD and their families refused randomization and were assigned to their preferred treatment. Once again, while children in both treatment groups showed reduced symptoms, medication demonstrated superiority.

The findings suggest that both mindfulness and medication improve behavioral and neuropsychological measures in children with ADHD. In the short-term, medication showed superiority to mindfulness on behavioral measures, but no difference on neuropsychological measures. However, the superiority of medication declined over 10 months in maternal ratings, but not paternal ratings.

The study is limited by the many families who opted to switch protocols after four months or received adjunctive treatments outside the protocol complicating the interpretation of longer-term effects.

Reference:

Meppelink, R., de Bruin, E. I., Zoller, B. K., Oort, F. J., & Bögels, S. M. (2024). Child and Parent Mindfulness-Based Training Versus Medication for Childhood ADHD: A Randomised Clinical Trial. Mindfulness.

Link to study

Mindfulness effect on saliva cortisol response in young males

Wed, 13 Mar 2024 16:28:37 GMT

Acute stressful events can trigger the release of cortisol and testosterone into the human bloodstream. While cortisol prepares us to fight or flee in the context of threat, testosterone may amplify male dominance and competitive behavior in socially stressful situations. Chronic or frequent exposure to stressors, however, can alter hormonal levels and potentially lead to the development of physical and psychiatric disease.

While significant knowledge has been gained regarding the cortisol stress response, less is known about complex feedback between these hormones and how they are mutually affected by stress reduction techniques.

Fan et al. [Stress] tested the effects of mindfulness meditation and muscle relaxation on male college students’ salivary cortisol and testosterone levels before and after exposure to a stressor and after practicing a stress reduction technique.

The researchers randomly assigned 32 meditation-naïve Chinese college men (average age = 21 years) to either Integrative Body Mind Training (IBMT) or a muscle relaxation control group. Both treatments were delivered in 20-minute group training sessions conducted over the course of 7 consecutive days. IBMT included mindful stretching poses followed by open-monitoring sitting meditation emphasizing acceptance of experience.

The muscle relaxation control involved sequentially focusing attention on different muscle groups and relaxing them through focusing on sensations of warmth and heaviness.

After training, both groups participated in an experimental session consisting of 5 minutes of rest followed by a 3-minute stressor task. During the task, participants were instructed to subtract 47 from a 4-digit number sequentially. If participants failed to respond with a correct subtraction answer within 5 seconds, the computer emitted a harsh sound, and the participant had to restart the task.

The task was followed by a 20-minute relaxation period, during which the participants followed the IBMT or relaxation protocol they had trained on. Salivary cortisol and testosterone samples were drawn immediately after the rest, stressor, and relaxation periods.

The results showed both groups significantly increased their cortisol and testosterone levels in response to the stressor task. After the relaxation period, muscle relaxation participants’ cortisol levels continued to rise (d=0.76), whereas IBMT participants’ did not. IBMT participants’ cortisol levels were significantly lower than muscle relaxation participants’ after the relaxation period (d=0.34).

Testosterone levels rose in response to the task and continued to rise for both groups during the relaxation period. However, this rise was significantly steeper for the IBMT group (d=1.07). Changes in cortisol and testosterone levels were uncorrelated.

The findings suggests that IBMT could potentially reduce the acute cortisol stress response while increasing testosterone levels in young adult males encountering an acute stressor. In contrast, progressive muscle relaxation was found to be less effective in reducing cortisol response and resulted in a weaker increase in testosterone levels. However, the study has limitations in determining whether these cortisol and testosterone responses are adaptive.

Reference:

Fan, Y., Cui, Y., Tang, R., Sarkar, A., Mehta, P., & Tang, Y.-Y. (2024). Salivary testosterone and cortisol response in acute stress modulated by seven sessions of mindfulness meditation in young males. Stress.

Link to study

Combining oxytocin and mindfulness for schizophrenic disorder spectrum

Fri, 01 Mar 2024 02:00:42 GMT

People with schizophrenic spectrum disorders (SSDs) often exhibit both positive (hallucinations, delusions) and negative (apathy, social withdrawal, lack of affect) symptoms. Negative symptoms respond poorly to current medications, and there is a need for novel treatments that can help minimize them.

Oxytocin is a naturally occurring hormone associated with higher levels of emotional bonding and pro-social behavior in social contexts. It’s possible that administering oxytocin within a positive social context such as a group mindfulness-based intervention might improve empathy and lessen negative symptoms.

Zierhut et al. [Journal of Psychiatric Research] conducted pilot a study to test the effects of administering oxytocin vs. placebo in patients with SSDs participating in Mindfulness-Based Group Therapy.

The researchers randomly assigned 41 German adults diagnosed with an SSD (average age = 42 years; 68% male) to oxytocin + MBGT or a placebo + MBGT. Oxytocin (and placebo) were intranasally administered 45 minutes prior to group therapy sessions.

MBGT is a mindfulness-based intervention designed for adults with SSDs. It was delivered in two 50-minute small group sessions over the course of a single week. The first session included an introduction to mindfulness, a 15-minute breath awareness exercise, and the group sharing of experiences and goals. The second session focused on engaging all the senses and included a nature walk.

Participants were assessed before and after the week-long intervention on measures of empathy, negative symptoms, stress, affect, and mindfulness (using the Southampton Mindfulness Questionnaire). Blood oxytocin levels were also assessed at multiple time points.

The results showed the combined sample reported significant increases in self-rated empathy (d=0.56) and perspective taking (d=0.69) from pre- to post-intervention, without significant between group differences. There was no improvement in either group, however, on a measure of empathy involving inferring the mental state of people depicted in pictures on a computer screen.

The oxytocin group showed significantly greater self-rated improvements in diminished emotional range (ηp2= 0.11) and lack of motivation (ηp2= 0.11) compared to the placebo controls. Self-reported negative affect decreased (d = -0.86 and -0.57) and positive affect increased significantly (d=0.44 and 0.69) for both group. Both groups also reported significant decreases in perceived stress.

The study shows Mindfulness-Based Group Therapy can potentially improve self-reported empathy. Adding oxytocin leads to greater improvement in self-reported negative symptoms of diminished emotional range and lack of motivation. The study is a pilot study that needs replication with a larger sample size, longer treatment duration, the inclusion of a no-treatment control, and long-term follow-up.

Reference:

Zierhut, M., Bergmann, N., Hahne, I., Wohlthan, J., Kraft, J., Braun, A., Tam Ta, T. M., Hellmann-Regen, J., Ripke, S., Bajbouj, M., Hahn, E., & Böge, K. (2024). The combination of oxytocin and mindfulness-based group therapy for empathy and negative symptoms in schizophrenia spectrum disorders – A double-blinded, randomized, placebo-controlled pilot study. Journal of Psychiatric Research.

Link to study

Less pain meds used by military personnel post-mindfulness program

Wed, 14 Feb 2024 16:54:53 GMT

Over 40% of U.S. military personnel report post-deployment chronic pain, and up to a third of military veterans are prescribed opioids for long-term pain management. Over a quarter of these veterans go on to engage in some form of opioid misuse, either taking more than their prescribed doses, using opioids to manage negative emotions, or taking non-prescribed drugs.

Therapists are always looking for ways to manage pain more safely and effectively, and mindfulness training may have a role to play in reducing chronic pain and opioid misuse.

Garland et al. [American Journal of Psychiatry] compared the efficacy of Mindfulness-Oriented Recovery Enhancement (MORE) and supportive psychotherapy in reducing self-reported pain and opioid misuse in past and present U.S. military personnel prescribed long-term opioids for chronic pain.

The researchers randomly assigned 230 past and present U.S. military personnel (average age = 58 years; average length of chronic pain = 19 years; 91% veterans; 83% male; 86% white) prescribed long-term opioid treatment for chronic pain to either MORE or supportive psychotherapy. Both treatments were delivered by the same licensed psychologists in 8 weekly two-hour group formats. While 63% of the participants received treatment in person, the onset of the COVID pandemic caused 39% to receive treatment on-line.

The MORE curriculum combines elements of mindfulness training, cognitive reappraisal, and savoring of positive experiences, and psychoeducation on chronic pain and opioid misuse. The mindfulness component included breath- and body-focused meditations. In addition to 15 minutes of daily guided home mindfulness, reappraisal and savoring practice, participants were to engage in 3 minutes of mindful awareness prior to taking doses of their medication.

The supportive therapy control used a non-directive client-centered approach that included discussion of thoughts and emotions around pain, opioid use, and emotional distress, but did not include skills training.

Participants were assessed at baseline, post-treatment, and 4-and 6-month follow-up on measures of pain, opioid use and misuse, and a variety of psychological variables. Participants also rated their opioid cravings three times daily throughout the six months of the study.

The results showed that the MORE group reduced average chronic pain severity, pain-related interference with daily activities, and daily opioid cravings to a significantly greater degree than controls. They also reduced their average daily opioid dosage (by 21%) significantly more than controls (by 4%). Both groups significantly reduced opioid misuse from baseline but did not differ from each other in that regard.

This trial suggests MORE for patients with chronic pain who are prescribed long-term opioid treatment attenuates self-reported pain outcomes. The study population of predominantly white, middle-aged males may restrict the degree to which these results may generalize to other populations. It is also not clear how switching from an in-person to on-line therapy format midway through the study might have affected the outcomes.

Reference:

Garland, E. L., Nakamura, Y., Bryan, C. J., Hanley, A. W., Parisi, A., Froeliger, B., Marchand, W. R., & Donaldson, G. W. (2024). Mindfulness-Oriented Recovery Enhancement for Veterans and Military Personnel on Long-Term Opioid Therapy for Chronic Pain: A Randomized Clinical Trial. American Journal of Psychiatry.

Link to study

Mindfulness-based vs. cognitive behavioral courses for child ADHD

Mon, 29 Jan 2024 20:54:45 GMT

Children diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) typically display symptoms of inattention, hyperactivity, and impulsivity as well as difficulties in family, social, and academic life. While medication is often the first-line treatment, there is evidence that children with ADHD may also benefit from cognitive behavioral and mindfulness-based interventions (MBIs). However, studies evaluating the efficacy of MBIs for this demographic often suffer from the limitations of small sample sizes, absence of evidence-based comparators, and insufficient long-term follow-up.

Wong et al. [Psychotherapy and Psychosomatics] compared the efficacy of mindfulness-based and cognitive behavioral interventions designed for children with ADHD and their parents in improving children’s attention and well-being while reducing parental stress.

The researchers randomly assigned 138 Cantonese-speaking parent-child pairs, with children aged between 8 and 12 years (average age = 9 years; 72% male) diagnosed with ADHD, to either a MBI or cognitive behavioral intervention. The MBI comprised 8 weekly 90-minute group sessions modeled after Mindfulness-Based Stress Reduction but tailored for school age children. Children and parents met in separate concurrently running groups.

The control intervention involved 8-week cognitive-behavioral groups for the children and psychoeducational groups for the parents. The cognitive behavioral intervention focused on handling problems, improving self-control, understanding emotions, perspective taking, conversational skills, and managing social problems. The parental psychoeducational group reinforced concepts covered in the cognitive behavioral sessions and included discussion and role playing as well as self-care and relaxation skills.

Due to COVID-related lockdowns in Hong Kong, about 6% of the child-parent pairs received most of their training remotely via Zoom.

The primary outcome was children’s selective attention, assessed at baseline, 8 weeks, and 3 and 6 months using the Sky Search subtest of the Test of Everyday Attention. The subtest requires children to circle target spaceships on a sheet filled with distractor items. Secondary outcomes included various aspects of attention, executive function, parent-rated ADHD symptoms and behavioral problems, mindfulness, and well-being, as well as parental stress, rumination, and their own ADHD and well-being.

Results showed that the MBI group had significantly improved selective memory over baseline at six months (d=0.32), while the cognitive behavioral group had significantly improved selective memory over baseline at post-intervention (d=0.27), 3 months (d=0.45), and 6 months (d=0.27). There were no significant differences in selective memory between the two study groups, however. While there were several significant small-to-moderate within-group improvements on other measures of children’s attention, executive function, and behavioral and ADHD symptoms, there were no significant differences between group on any of these variables.

There were no within- or between-group improvements for parental well-being, perhaps reflecting the stress of COVID lockdown periods in China.

The study shows a mindfulness-based and a cognitive-behavioral intervention show the same small-to-moderate improvements in selective attention and behavior in children with ADHD on six-month follow-up, and shows no effect for relative changes in parents of children with ADHD.

The study is limited by the absence of an inactive control comparator that could rule out regression to the mean, repeat testing, or the passage of time.

Reference:

Wong, S. Y. S., Chan, S. K. C., Yip, B. H. K.,... Bögels, S. M. (2023). The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial. Psychotherapy and Psychosomatics.

Link to study

Teacher-led meditation breaks and primary school test scores

Tue, 16 Jan 2024 19:42:32 GMT

There is a growing body of evidence suggesting that mindfulness-based interventions not only improve school-aged children’s executive functioning and emotional regulation, but also their academic performance. Voltmer et al. [Scientific Reports] tested the effects of teacher-led meditation breaks on primary school children’s performance on a standardized arithmetic test.

The researchers randomly assigned nine 3rd and 4th grade classrooms containing a total of 140 students (51% male) in six German elementary schools to either a meditation or active control group. Teachers in the mindfulness group received 15 hours of instruction in mindfulness. They then led up to three 3- to 5-minute Breathing Break Intervention (BBI) sessions for their students per school day. These BBIs were selected from a set of 15 exercises designed to teach breath and body awareness, relaxation and self-calming, present-moment attention, and letting go. Control group students engaged in up to three 3- to 5-minute periods of coloring a mandala with crayons each school day.

Students completed standardized arithmetic tests at baseline assessment , 9 weeks into the intervention, and 5 month follow-up. Arithmetic test scores were reported as age-normed T-scores with a mean of 50 and standard deviation of 10.

Teachers also rated student arithmetic ability on a five-point scale at all three assessments. Parental educational level and children’s working memory (measured using a test of repeating digit span backwards) were used as covariates in predicting intervention effects on arithmetic performance.

The research was conducted during the second year of the COVID pandemic. The previous school year had been interrupted by COVID-related shutdowns, and school administrators, anxious about student performance, had the 3rd graders take the 2nd grade test and 4th graders take the 3rd grade test at baseline. At week 9 and follow up assessments, however, students took the test appropriate for their grade level. The week 9 and follow up assessment interval was disrupted by further COVID shutdowns, and by shortened school weeks. Teachers during this interval stopped performing the interventions on any regular basis.

About 40% of the BBI group students continued sporadically taking breathing breaks on their own while engaging in distance learning from home, but rarely more than once a week.

The results showed the BBI group had considerably higher arithmetic T-scores than controls prior to intervention (50 vs. 42). After nine weeks of intervention, both study groups’ performances dropped, but the BBI group had a steeper drop so that their T-scores were now only marginally higher than controls (41 vs. 39).

At 5 months, the BBI group showed a steeper increase in scores so that their T-scores were again substantially higher than controls (49 vs. 41). Teacher-rated arithmetic ability did not differ between groups.

Breathing Break Interventions are an age-appropriate way to introduce mindfulness to grade schoolers. The researchers attributed the BBI group’s steeper improvement in arithmetic scores from baseline to 9 weeks to the intervention, but this interpretation does not account for the BBI group’s initially higher pre-intervention scores. At five months both groups essentially returned to their pre-intervention baselines.

Given the shifting use of grade-appropriate tests and COVID-related complications, the results are difficult to interpret and may reflect a null effect between groups.

Reference:

Voltmer, K., Hondrich, F., & von Salisch, M. (2023). Daily breath-based mindfulness exercises in a randomized controlled trial improve primary school children’s performance in arithmetic. Scientific Reports.

Link to study

Cost-effectiveness of mindfulness skills for university students

Fri, 22 Dec 2023 15:38:28 GMT

The incidence of psychological symptoms in adolescents and young adults has risen significantly over the past decade, placing increased stress on university counseling resources. Mindfulness-based interventions may be less staff and time intensive than many traditional mental health interventions. Further, they might achieve positive outcomes at lower cost.

Wagner et al. [BMJ Open] evaluated the cost-effectiveness of a Mindfulness Skills for Students (MSS) program added to mental health services-as-usual to a control group that had access solely to mental health services-as-usual alone.

The researchers randomly assigned 616 British university students (mean age = 23 years; 63% female) with an expressed interest in the MSS program to either the MSS program with access to mental health services-as-usual when needed, or a control group with access to treatment-as-usual when needed. The control group was guaranteed slots in the following year’s MSS program.

The MSS program consisted of 8 weekly 75-90 minute group sessions, each incorporating two periods of meditation, as well as opportunities for reflection and inquiry. Students were encouraged to dedicate 8-25 minutes of daily home practice. Mental health services-as-usual involved access to university individual and group counseling services, along with counseling service workshops. The MSS program was offered during the winter and spring semesters, with results reported separately for these cohorts.

Participants underwent assessments using self-report questionnaires measuring psychological distress and well-being at time of recruitment, post-intervention, during exam week, and at 12 month follow-up. The psychological distress questionnaire formed the basis for computing quality-adjusted life years (QALYs), a standard metric for evaluating quality of life in cost-effectiveness studies.

The cost of the MSS program was determined by calculating the staff time cost per participant. Meanwhile, the cost of treatment-as-usual was calculated based on the staff cost for delivering services at the university counseling center per participant, derived from counseling center records. A small percentage of the participants (<18%) used counselling center resources, and there was no difference in usage between the study groups.

The results indicated that MSS groups had lower levels of distress than the control group at all three outcomes assessments. These differences were statistically significant at all three times for the winter cohort, and at post-intervention and exam time for the spring cohort. Well-being scores were significantly higher for MSS group than controls at all assessment times.

A cost-benefit analysis revealed that the MSS group achieved significantly better mental health outcomes at significantly higher cost than controls. On average, the cost for each MSS participant was $84.96 USD, whereas for those in the control group, it was $24.66 USD.

Using the British National Institute for Health and Care Excellence estimates of willingness to pay for an increase of one quality-adjusted life year, the MSS program was deemed by the authors to be cost-effective.

The study shows that the Mindfulness Skills for Students program significantly decreases psychological distress and improves well-being in university students in a cost-effective manner compared to treatment-as-usual.

The study is limited by relying on students with an interest in mindfulness and the absence of another short-term treatment as a comparator.

Reference:

Wagner, A. P., Galante, J., Dufour, G., Barton, G., Stochl, J., Vainre, M., & Jones, P. B. (2023). Cost-effectiveness of providing university students with a mindfulness-based intervention to reduce psychological distress: Economic evaluation of a pragmatic randomised controlled trial. BMJ Open, 13(11), e071724.

Link to study

Effects of mindfulness and sham meditation on evoked pain

Thu, 14 Dec 2023 17:55:03 GMT

At any given time, 8% of adults experience chronic low back pain. Some studies indicate that mindfulness meditation can alleviate the pain and disability associated with this condition. However, the precise mechanism behind this benefit is not clear. Does it involve engaging the body’s endogenous opioid system, teaching individuals to become psychologically non-reactive, or operating through a placebo effect?

Khatib et al. [Neuropsychopharmacology] tested the effects of mindfulness meditation versus sham mindfulness meditation, both with and without the opioid antagonist Naloxone, on evoked chronic low back pain.

The researchers randomly assigned 71 patients (average age = 46 years; 51% female; 87% Caucasian) experiencing chronic low back pain persisting for at least 3 months to either mindfulness or sham mindfulness meditation groups. Both groups participated in four 20-minute meditation training sessions.

The mindfulness training focused on accepting thoughts and feelings, recognizing their transient nature, and returning attention to the breath. In contrast, sham meditation training emphasized breathing slowly and deeply in a meditative posture without additional instructions.

Participants met with researchers seven times. The first session was a pre-intervention assessment. During sessions 1, 6, and 7, the researchers induced pain in participants using a straight leg raise procedure. Participants lay supine while the researchers raised one of their legs to a 90-degree angle while keeping the knee straight. Participants alerted researchers when their pain rose by 2 points on a 10-point scale. Researchers continued to raise their legs up to 6 times until a 2-point increase in pain was induced. Patients then rated post-leg raise pain on a 10-point scale.

Participants practiced mindfulness or sham mindfulness meditation during sessions 2-5 and completed questionnaires of pain severity, catastrophizing, and disability before and after each session. During sessions 6 and 7, pain was evoked by straight leg raises after seven minutes of rest.

Participants then received either intravenous Naloxone (which blocks the endogenous opioid system) or saline (a placebo). Participants then meditated or sham meditated for 7 minutes before once again reporting evoked pain both before and after leg raises.

The results indicated that both mindfulness and sham meditation significantly reduced evoked pain following both Naloxone and saline administration. However, the mindfulness group reported significantly lower evoked pain after rest, Naloxone, and saline compared to the sham meditation group (partial η2= .09).

Sixty percent of the mindfulness group reported practicing non-reactive attention during meditation, while 20% of the sham mindfulness group did. Practicing non-reactive attention during meditation was associated with lower evoked pain in the mindfulness group (r = -.35) but not in the sham group (r = .04).

The study shows that both mindfulness and sham meditation effectively decrease evoked pain in chronic low back pain patients. However, mindfulness meditation outperformed sham meditation in this aspect.

The finding that Naloxone fails to block this effect suggests that meditation does not rely on endogenous opioids to achieve pain reduction. This does not rule out contributions from non-opioid systems like the dopaminergic, glutaminergic, or endocannabinoid systems. The correlation between non-reactive attention and pain reduction suggests that mindfulness meditation’s pain-reduction effect is due, at least partially, to non-reactive reappraisal processes.

Reference:

Khatib, L., Dean, J. G., Oliva, V., Riegner, G., Gonzalez, N. E., Birenbaum, J., Cruanes, G. F., Miller, J., Patterson, M., Kim, H.-C., Chakravarthy, K., & Zeidan, F. (2023). The role of endogenous opioids in mindfulness and sham mindfulness-meditation for the direct alleviation of evoked chronic low back pain: A randomized clinical trial. Neuropsychopharmacology.

Link to study

Mindfulness practice reduces deception during a card game

Tue, 21 Nov 2023 17:29:25 GMT

Mindfulness-based interventions (MBIs) can enhance attention and emotional regulation in certain practitioners, but can they also foster ethical behavior? Studies examining the effects of MBIs on helping behavior, cheating, generosity, compassion, or willingness to inflict harm have produced mixed results. Some studies show MBIs can facilitate prosocial behavior, while others suggest MBIs may make people more self-focused.

Feruglio et al. [Mindfulness] conducted a randomized, controlled study to discover whether a MBI could reduce lying for financial gain in a card game.

The researchers randomly assigned 69 Italian university students (average age = 26; 80% female) who had expressed an interest in participating in a MBI to either a MBI or waitlist control. The MBI was an on-line 8-week course modeled after the Mindfulness-Based Stress Reduction curriculum, delivered in 8 weekly 2-hour sessions via participants’ personal computers.

Each session included 30-minute guided meditations incorporating elements of breath-focused, body scan, and open-monitoring meditation. Participants were also instructed to engage in daily home meditation practice using a guided audio recording.

Participants were assessed before and after intervention using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and the Five Facet Mindfulness Questionnaire (FFMQ). They were also evaluated pre- and post-intervention on their willingness to lie while playing 48 hands of a computer-administered zero-sum card game against an ostensible live opponent, which was actually a computer algorithm.

Players were informed of the monetary value of each hand in the card game. The computer opponent initially chose a card, either the Ace of Hearts or Ace of Spades, which was concealed from the opponent player so it could not see the card’s face value. The Ace of Hearts always won. Participants, however, could see the card faces and choose to lie or tell the truth to the opponent about which card the opponents had selected and whether they had won. Players earned money for each hand they claimed to have won.

The results showed that the MBI group had significantly increased scores on the MAIA Self-Regulation (partial η2 = 0.33), Attention Regulation (partial η2 = 0.21), Body Listening (partial η2 = 0.14) and FFMQ Non-Reactive (partial η2 = 0.10) subscales more than the control group. Additionally, the MBI group showed decreased frequency of lying in the card game (d = 0.41), while the control group did not (d = 0.16).

More meditative practice minutes during the course was linked with less lying, but only among those MBI participants who scored at least one standard deviation above the mean on the MAIA Attention Regulation subscale.

The study demonstrates that a MBI can reduce deceit for minimal financial gain in a simulated card game. This decreased deceit is correlated with improved interoceptive awareness. Further, this reduction in deceit appears to be partly dependent on more minutes of meditation practice.

Study limitations include enrolling participants already interested in a MBI, the absence of an active control group, and the lack of a post-assessment to determine whether participants believed they were playing against a live opponent rather than a computer simulation during the card game.

Reference:

Feruglio, S., Panasiti, M. S., Crescentini, C., Aglioti, S. M., & Ponsi, G. (2023). Training the Moral Self: An 8-Week Mindfulness Meditation Program Leads to Reduced Dishonest Behavior and Increased Regulation of Interoceptive Awareness. Mindfulness.

Link to study

MBSR and healthy diet both influence fetal brain development

Wed, 15 Nov 2023 16:29:29 GMT

Inadequate maternal diet and high stress during pregnancy are risk factors for poorer cognitive and social development in early childhood. In a study previously highlighted in the September 2023 issue of the Mindfulness Research Monthly, Crovetto et al. investigated the effects of Mindfulness-Based Stress Reduction (MBSR) or a Mediterranean diet on toddlers whose mothers received treatment during pregnancy.

As a secondary outcome of that trial, Nakaki et al. [American Journal of Obstetrics and Gynecology] newly examined fetal MRI and infant neurobehavioral outcomes from a subsample of participants in the original study.

The original study recruited 1,221 pregnant women from Barcelona who were assessed as being at risk for delivering low birthweight infants. The expectant mothers were randomly assigned to one of three study groups: usual treatment, usual treatment plus MBSR, or usual treatment plus a Mediterranean diet. MBSR consisted of eight 2.5 hour weekly group sessions, a full-day retreat, and home practice. It followed a MBSR syllabus that included a specialized focus on maternal yoga and mothers’ relationships with their fetuses.

The Mediterranean diet intervention involved monthly 30-minute assessments and 1-hour group sessions conducted by trained nutritionists. Participants received monthly supplies of extra virgin olive oil and walnuts, along with weekly suggested shopping lists, detailed meal plans, and menus. The usual care group received pregnancy care following current institutional protocols.

A randomly selected subset of 692 infants from the original trial underwent assessment using the Neonatal Neurobehavioral Assessment Scale (NBAS) at 1-3 months of age. The NBAS provides measures of infant sensory, motor, arousal, and autonomic nervous system development. Additionally, a smaller subset of 90 mothers underwent MRI scanning at 35-39 weeks into their pregnancies to assess brain development of their unborn fetus.

The results showed that fetuses of mothers who participated in the Mediterranean Diet intervention had significantly larger total brain volumes, corpus callosa, and right frontal lobes compared to fetuses of mothers in the usual treatment group. Fetuses of mothers who received MBSR had significantly larger left anterior cingulate gyri than fetuses in the usual treatment group. There were no significant differences in fetal brain development between MBSR and Diet groups.

Mediterranean Diet infants scored higher on NBAS measures of autonomic stability, attentiveness to external stimuli, and range of arousal compared to infants in the usual treatment group, while MBSR infants scored higher on arousal regulation.

The study reveals that maternal Mediterranean Diet and MBSR interventions during pregnancy each both yield observable structural and behavioral effects on fetal and infant development phases.

The limitations of this analysis include the evaluation of only a small subset of the original study participants, and the possibility that findings applicable to a higher-risk population of expectant mothers may not hold in the broader population.

Reference:

Nakaki, A., Crovetto, F., Urru, A., Piella, G., … Gratacos, E. (2023). Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on fetal and neonatal brain development A secondary analysis of a Randomized Clinical Trial (IMPACT BCN). American Journal of Obstetrics & Gynecology.

Link to study

MBSR slows breathing among new meditators and lessens distress

Tue, 24 Oct 2023 22:12:00 GMT

Respiration rate, which denotes the number of times we breathe each minute, holds promise as a potential biomarker for subjective well-being. Respiration rate tends to increase during periods of stress, anxiety, or pain, while it tends to decrease during periods of calm and relaxation. Rates are potentially modifiable: the more meditation hours long-term meditators have cumulatively, the slower their baseline respiration rates. Perhaps it is respiration rate that improves subjective well-being in meditators.

Kral et al. [Scientific Reports] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on the respiration rates and well-being of people who were naïve to meditation. They also conducted a cross-sectional analysis to test for a possible association between respiration rate and well-being in more experienced meditators not involved in the MBSR trial.

The researchers randomized 203 meditation-naïve adults (average age = 42 years; 61% female; 90% Caucasian) to MBSR, a Health Enhancement Program (HEP), or a waitlist control. This secondary analysis is part of a larger study of MBSR and asthma. Out of the 203 participants, 70 had been diagnosed with asthma. Participants with asthma were assigned to either MBSR or HEP, while those without asthma were assigned to MBSR, HEP, or the waitlist control.

The MBSR intervention followed standard protocol. HEP matched MBSR in terms of the length and frequency of group sessions and homework. HEP sessions did not teach mindfulness but instead focused on nutrition, music therapy, balance and agility, and aerobic exercise. Participants completed assessments at pre-randomization, post-intervention, and 6-month follow-up, which included baseline respiration rate and self-report measures of physical and subjective well-being and distress. Respiration rates were measured using an abdominally-placed pneumatic belt while participants underwent fMRI scans (fMRI data were not reported in this article).

The researchers also recruited a cohort of 42 long-term meditators (mean age = 44 years; 62% male; 88% Caucasian) with a minimum of 5 years of daily meditation practice and at least 5 weeks of meditation retreat experience. Long-term meditators were not assigned to interventions and were evaluated once.

The results for the long-term meditators showed a significant association between slower respiration rates and lower distress and greater well-being scores. The meditation-naïve MBSR group showed significantly lowered respiration rates compared to waitlist controls, but this difference was no longer significant at six months. The MBSR group had decreased distress symptoms at post-intervention compared to both HEP and control groups, but scores on well-being showed no group differences after the intervention.

The study suggests that slower respiration rates are associated with greater subjective well-being in long-term meditators. MBSR can lower respiration rates and reduce distress in meditation-naïve participants, but slowed respiration rates do not persist over time, and there is no significant improvement in well-being beyond some stress and anxiety reduction.

The study has limitations, including the differential enrollment and assignment to groups of asthmatic and non-asthmatic samples, as well as by its reliance on a single measure of respiration rate captured only in a controlled laboratory setting. Additionally, the measure of subjective well-being used in this study may not be sensitive to short-term interventions but may primarily reflect long-term shifts in other factors such as relationships and achievements.

Reference:

Kral, T. R. A., Weng, H. Y., Mitra, V., Imhoff-Smith, T. P., Azemi, E., Goldman, R. I., Rosenkranz, M. A., Wu, S., Chen, A., & Davidson, R. J. (2023). Slower respiration rate is associated with higher self-reported well-being after wellness training. Scientific Reports, 13(1), 15953.

Link to study

The Mindfulness-Based Kindness Curriculum and child development

Wed, 11 Oct 2023 18:09:57 GMT

A child’s ability to self-regulate emotions and attention is the foundation for later social and emotional development. Programs that foster these abilities can have beneficial effects on later academic, work, family, social, and civic functioning. Many primary schools already employ social-emotional learning curricula around the globe, but could those curricula be improved by adding a mindfulness-based component?

Haines et al. [Mindfulness] conducted a randomized controlled study to test the effects of a Mindfulness-Based Kindness Curriculum (MBKC) on early childhood social-emotional, executive, and academic functioning.

The researchers randomly assigned 16 pre-school and 4 kindergarten classrooms, comprising 245 children(mean age = 4 years; 77% lower income; 54% male; 42% Caucasian, 24% Hispanic, 13% Black, 12% Asian, 8% mixed ethnicity), to a classroom curriculum-as-usual or the classroom curriculum with the addition of MBKC. Fourteen of the 16 classrooms (including all of the control classrooms) already had established social-emotional learning programs as part of their regular curricula.

The 12-week MBKC program consisted of 24 lessons, each lasting 15-20 minutes, and these lessons taught by the children’s regular classroom teachers, each of whom received 26 hours of training. The MBKC lessons incorporated children’s literature, music, and movement, and they were organized into 8 thematic categories: mindful bodies, inside emotions, emotional expression, emotional caretaking, self-calming, gratitude, caring for others, and caring for the world. The overarching focus of the program was on teaching non-judgmental acceptance, present-moment awareness, and kindness.

To assess the impact of the intervention, students were evaluated 6 weeks before the program's initiation and 4 weeks after its completion. The assessments included a set of social and cognitive tasks, which were scored by blinded raters. Additionally, self-assessments, teacher evaluations, and parent ratings were used to measure social-emotional, academic, and developmental competencies.

The results showed that the MBKC group outperformed controls on a generosity task in which they could keep stickers for themselves or dole them out to various others, including a sick child (partial η2 = .02).

According to teacher reports, the MBKC group was rated as more prosocial (.07) and empathic (.08) and as showing greater social emotional intelligence (.08), cognitive development (.19), physical development (.41), language ability (.10), math ability (.20), and literacy (.43). According to parent reports, the MBKC group showed higher levels of cognitive empathy (.05) and social-emotional functioning (.02).

On many of the measures, children who initially performed poorly on pre-intervention measures benefitted the least from MBKC, while those who initially performed the best on the baseline showed the greatest improvements. For example, when it came to a task measuring the ability to remain undistracted by extraneous cues (known as the Flanker task), children who initially scored the lowest on the pretest benefitted more from the routine curriculum, while those who initially scored the highest on the pretest benefitted more from MBKC (.07).

The study demonstrates that MBKC has the potential to enhance generosity, empathy, and social-emotional functioning in young children, particularly in those who already possess baseline social-emotional and cognitive competencies.

The study suffers some limitations. Ratings provided by teachers and parents who were not blinded to the study group yielded results that were more pronounced than those provided by objective measures that were scored by blind raters. Also, the significant improvements in teacher ratings for children’s physical, language, and math competencies were unexpected.

Reference:

Haines, B. A., Hong, P. Y., Immel, K. R., & Lishner, D. A. (2023). The Mindfulness-Based Kindness Curriculum for Preschoolers: An Applied Multi-Site Randomized Control Trial. Mindfulness.

Link to study

Comparing meditation to social-emotional app for calming the mind

Tue, 26 Sep 2023 16:18:13 GMT

Contemplative practices such as mindfulness, lovingkindness, and self-compassion may have different effects on humans, and these differences may become obscured when they are combined in interventions. Certain practices may prove more effective than others in remedying specific types of mental and physical health problems.

Petzold et al. [Scientific Reports] compared the immediate mental effects of using two different types of contemplative practice apps: a mindfulness meditation app and a social-emotional app.

The researchers randomly assigned 212 German-speaking Berlin residents (average age = 44 years; 73% Female) to use either a mindfulness meditation app or a social-emotional Affect Dyad app. Participants in both conditions participated in 2.5-hour orientation webinars and proceeded to 10 weeks of app use. Participants used the apps six days a week, and on the seventh day of each week participated in 2-hour on-line group coaching sessions.

The mindfulness app contained 12-minute guided breath-focused, sensory, and open monitoring meditations. Mindfulness coaching sessions emphasized bodily and sensory awareness, dealing with difficult emotions, and cultivating an attitude of dignity and respect towards oneself.

The Affect Dyad app paired participants with another participant to discuss two recent events—one that elicited difficult emotions and one that elicited gratitude—and describe how those emotions affected their bodies. Participants spoke for 6 minutes while their partner listened without interruption, and then switched roles.

Affect Dyad coaching sessions emphasized social connectedness, non-judgmental listening, bodily awareness, dealing with difficult emotions, and cultivating care and gratitude.

Participants rated their thoughts and affect prior to and after daily app sessions. Thoughts were rated for temporality (about past, present, or future), social orientation (about self or other) and emotional valence (positive or negative). Affect was rated for emotional valence and intensity. The data enabled researchers to compare immediate changes in thought and affect resulting from app use and analyze group differences in these changes. These were immediate mental changes due to engaging with the app and not long-term results from engaging in these interventions over a period of 10 weeks. There were no significant between- or within-group long-term changes in thought and affect.

The results showed that mindfulness meditation app group significantly reduced future-oriented, negative, and other-oriented thoughts while increasing positive affect and affect intensity.

In contrast, the Affect Dyad app group significantly reduced future-oriented thoughts, increased past-oriented and other-oriented thoughts, and raised positive affect and affect intensity.

Self-oriented thoughts increased for both groups but did so significantly more for the Affect Dyad group compared to the mindfulness group.

The researchers interpreted these results as showing that mindfulness meditation app reduces thinking and improves mood through “calming the mind,” whereas the Affect Dyad app increases past-, self-, and other-directed thoughts and improves mood through enhancing social connection and caring. While both apps showed substantial immediate short-term effects, it is unclear whether they yield meaningful long-term effects.

Smartphone apps are becoming an increasingly important way people engage with contemplative practices—meditation apps now have 185 million users—and this study’s combining of daily app practice with weekly on-line coaching seems one promising way to scale-up engagement with these practices.

Reference:

Petzold, P., Silveira, S., Godara, M., Matthaeus, H., & Singer, T. (2023). A randomized trial on differential changes in thought and affect after mindfulness versus dyadic practice indicates phenomenological fingerprints of app-based interventions. Scientific Reports.

Link to study

Mediterranean diet or MBSR during pregnancy for toddler development

Wed, 13 Sep 2023 15:51:25 GMT

Inadequate diet and high stress during pregnancy are risk factors for having low birthweight infants and experiencing poorer cognitive and social development in early childhood. Improving dietary intake and reducing maternal stress during pregnancy may yield long-term benefits for their children’s later development.

Crovetto et al. [JAMA Network Open] conducted a study to test the long-term effects of Mindfulness-Based Stress Reduction (MBSR) or a Mediterranean diet intervention compared to treatment as usual for pregnant women on toddler development.

The study recruited 1,221 Barcelonian mid-gestation pregnant women who were assessed as being at high-risk for delivering low birthweight infants. The prospective mothers were randomly assigned to usual treatment alone, usual treatment plus MBSR, or usual treatment plus a Mediterranean diet. MBSR consisted of eight 2.5 hour weekly group sessions, a full day retreat, and home practice. It used a standard MBSR syllabus that included a specialized focus on maternal yoga and mothers’ relationships with their fetuses.

The Mediterranean diet intervention consisted of monthly 30-minute assessments and 1-hour group sessions conducted by trained nutritionists. Participants were provided with 2 liters of extra virgin olive oil and 450 grams of walnuts each month, along with weekly suggested shopping lists, detailed meal plans, and menus. The usual care group received pregnancy care according to institutional protocols.

Adherence was 72% in the Mediterranean diet group (based on a ≥ 3 point pre-post improvement on a 17 item dietary adherence questionnaire) and 64% in the MBSR group (based on attendance of ≥6 group sessions).

All participants completed dietary questionnaires, and a randomly selected subset (47%) of the sample underwent blood and urine draws to assess biomarkers of walnut and olive oil consumption at both baseline and the final visit. Participants were also assessed on measures of stress, anxiety, wellbeing, and mindfulness. A separate randomly selected subset (27%) of the sample had 24-hour measures of urinary stress hormones at both baseline and the final visit.

In a separately published study, MBSR mothers (16%) and Mediterranean diet mothers (15%) were less likely to deliver low birthweight infants than usual care mothers (22%). In the present study, 626 toddlers (53% male; average age = 25 months) from the women in that original study were assessed on cognitive, language, motor, and social-emotional development and adaptive behavior using the Bayley Scales of Infant and Toddler Development. The number of toddlers is lower than the study sample of mothers, mainly due to difficulties in locating mothers for follow-up or obtaining their consent.

The results showed that Mediterranean diet toddlers had significantly higher Bayley cognitive and social-emotional scores than usual care toddlers. MBSR toddlers had significantly higher Bayley social-emotional scores than usual care toddlers, although the effect size was small.

Mediterranean diet adherence (regardless of group) was significantly positively associated with Bayley cognitive and language scores. Higher levels of consumption of foods containing docosahexaenoic acid was associated with significantly better language scores, while higher consumption of foods containing trans fats was inversely associated with social-emotional scores and language scores.

Maternal levels of stress and anxiety during pregnancy, irrespective of the group, showed significant negative associations with all five Bayley scales. Several FFMQ subscales (especially Describing and Acting with Awareness) showed significant positive associations with multiple Bayley scales.

The study shows improved maternal diet and MBSR during pregnancy have positive long-term effects on early childhood development for mothers at risk of having low birthweight babies. Adding nutritional support and mindfulness meditation to maternity care-as-usual for high-risk mothers could have a significant impact on the lives of children, their families, and on the social competencies gained by society in general.

Reference:

Crovetto, F., Nakaki, A., Arranz, A.,… Gratacós, E. (2023). Effect of a Mediterranean Diet or Mindfulness-Based Stress Reduction During Pregnancy on Child Neurodevelopment: A Prespecified Analysis of the IMPACT BCN Randomized Clinical Trial. JAMA Network Open, 6(8), e2330255.

Link to study

Managing diabetes with exercise and meditation controls glucose

Tue, 22 Aug 2023 21:47:36 GMT

Stress can affect people with Type 2 Diabetes by raising stress-associated cortisol levels that stimulate greater production of blood sugar (glucose). Aerobic exercise can improve health in persons with diabetes by improving insulin sensitivity, lowering glycated hemoglobin (HbA1c) levels, and promoting cardiovascular fitness. Intentional slow breathing and mindfulness meditation may offer additional benefit to persons with diabetes by reducing stress-related cortisol levels that show an association with glucose levels.

Obaya et al. [Frontiers of Physiology] conducted a study to compare the effects of aerobics exercise alone versus aerobics exercise combined with intentional slow breathing and mindfulness meditation on cortisol and glucose levels in women with Type 2 Diabetes.

The researchers randomly assigned 58 Middle-Eastern women (average age = 46 years) to either an aerobics training group (AT) or an aerobics training group that also included slow, deep breathing and mindfulness meditation (AT+DMM). All participants met the following criteria: 1) diagnosed with Type 2 Diabetes, 2) experiencing moderate-to-high stress levels, and 3) engaging in low levels of physical activity. Both groups met for three sessions per week for six weeks with sessions lasting 40 minutes for the AT group and 60 minutes for the AT+DMM group.

Aerobics training involved using a treadmill at an intensity of 60-75% of each participant’s maximum heart rate. Following aerobics training, the AT+DMM group added 10 minutes of slow and deep abdominal breathing, followed by 10 minutes of mindfulness meditation.

During mindfulness practice, participants sat upright while attending to their breath and listening to relaxing music. Blood draws were collected at pre- and post-intervention at 8:00AM to quantify serum cortisol and fasting blood glucose.

The results revealed that both study groups significantly reduced their blood serum cortisol and fasting blood glucose after the intervention. The AT+DMM group had significantly larger decreases in blood serum cortisol (d=0.69) and fasting blood glucose (d=0.94) than the AT group, achieving a 30% decrease in serum cortisol and a 15% reduction in fasting blood glucose compared to baseline levels.

The study shows that intentional slow breathing and mindfulness meditation adds to the benefits of aerobic exercise in reducing cortisol and glucose levels in a sample of stressed women with Type 2 Diabetes. These findings suggests that slow breathing and breath-focused meditation may be a useful adjunctive treatment in managing high blood sugar when combined with exercise for people experiencing heightened levels of stress.

The study is limited by its not exploring the differential effects of slow breathing and meditation and by the brief duration of the intervention which prevented it from yielding interpretable change in HbA1c given that HbA1c provides a measure of the average blood sugar level over the preceding three months.

Reference:

Obaya, H. E., Abdeen, H. A., Salem, A. A., Shehata, M. A., Aldhahi, M. I., Muka, T., Marques-Sule, E., Taha, M. M., Gaber, M., & Atef, H. (2023). Effect of aerobic exercise, slow deep breathing and mindfulness meditation on cortisol and glucose levels in women with type 2 diabetes mellitus: A randomized controlled trial. Frontiers in Physiology.

Link to study

Mindfulness training cuts healthcare costs in severe migraine phase-III trial

Thu, 10 Aug 2023 16:07:43 GMT

About a third of chronic migraine sufferers overuse their prescribed pain medications. Medication overuse creates an additional problem because the medication effects wear off over the course of a day, triggering medication-withdrawal headaches. Standard treatment involves a gradual reduction in medication followed by the prescription of prophylactic medication and patient education. There have been some uncontrolled pilot studies suggested that mindfulness training may also be helpful for migraine sufferers.

Grazzi et al. [Journal of Headache and Pain] conducted a phase-III randomized, controlled trial to test whether adding mindfulness training to treatment-as-usual (TAU) could improve headache frequency, medication overuse, and quality of life in chronic migraine sufferers.

The researchers randomly assigned 177 patients at an Italian specialty headache treatment center (average age = 48 years; 89% female) who met two criteria: 1) experienced at least 15 days of migraine and medication-withdrawal headaches per month, and 2) were overusing their medication. These patients were assigned to one of two groups: TAU or TAU plus mindfulness training.

All patients went through an intensive 5-8 day titrated medication withdrawal protocol as either inpatients or day patients. After discharge, they were provided with individually-tailored prophylactic medication regimes and received education on medication use, diet, exercise, sleep hygiene, and related health issues.

Patients in the TAU plus mindfulness group also participated in six weekly 90-minute group mindfulness training sessions. Each session included mindfulness meditation practice (ranging in length from 5 minutes in the first sessions to 25 minutes by the fifth and sixth sessions). Additionally, participants were asked to engage in 3-10 minutes of home meditation practice during weeks 3 to 6.

Patients were assessed at baseline and 3, 6, and 12 months using measures of headache frequency, disability, quality of life, and medication use.

By 12 months, a significantly higher proportion of patients in the TAU plus mindfulness group (78%) achieved a ≥50% reduction in headache frequency compared to the TAU group (48%). The TAU Plus mindfulness group showed significantly more improvement on measures of migraine-related quality of life and disability than the control group.

Further, the mindfulness group showed significantly greater reductions in pain medication use and lost productivity than the control group. Total migraine-related healthcare costs were $938 lower in the TAU plus mindfulness group as compared to controls at 12 month follow-up.

The study demonstrates that mindfulness training provides additional benefits beyond treatment-as-usual for migraine sufferers in terms of headache frequency, disability, lost productivity, medication usage, and associated healthcare costs.

The study focused on a specific patient population of severe migraineurs who were treated in an intensive headache specialty center. As such, the findings may not apply to other populations with different migraine severities or treatment settings. Patients in the mindfulness group received more attention and may have received more didactic information than TAU patients so all improvement may not be attributed to mindfulness practice.

Reference:

Grazzi, L., D’Amico, D., Guastafierro, E., Demichelis, G., Erbetta, A., Fedeli, D., Nigri, A., Ciusani, E., Barbara, C., & Raggi, A. (2023). Efficacy of mindfulness added to treatment as usual in patients with chronic migraine and medication overuse headache: A phase-III single-blind randomized-controlled trial (the MIND-CM study). The Journal of Headache and Pain, 24(1), 86.

Link to study

Employee sick days in years before and after a mindfulness program

Tue, 25 Jul 2023 19:10:43 GMT

Workplace Mindfulness-Based Interventions (MBIs) can result in increased well-being for employees, but do these benefits translate into objective measures such as reduced absenteeism? In a previously published study, researchers demonstrated that a workplace MBI could reduce the mental distress of supervisory staff and improve their health-related self-care.

Using a quasi-experimental design, Vonderlin et al. [Mindfulness] examined sick days from participants in the earlier study relative to a comparison group to test whether the MBI also reduced supervisor and supervisee absenteeism.

Twelve German corporations participated in the original study, with five of those corporations agreeing to have employee data used for the current study. Employee sick days were extracted from health insurance company records, limiting the data to employees insured by the cooperating health insurance company. As a result, the available sample comprised 13 supervisors out of the 147 who initially took part in the MBI. These supervisors supervised a total of 186 employees who were also covered by the cooperating insurance company and whose data could be retrieved.

Supervisor and supervisee sick day data were then compared with sick day data from a propensity score matched comparison group of 269 supervisors and 1,352 supervisees selected from a larger pool of enrollees from the cooperating health insurance company. Propensity score matching included matching for age, sex, employment status, and whether they were supervisory or supervised staff. The final sample averaged 44 years of age and was 78% female. The majority (88%) were employed in health care facilities such as hospitals and nursing homes.

The MBI program consisted of three full-day training sessions and two 3-hour booster sessions, with each session scheduled 4 weeks apart. The content of the MBI emphasized health-promoting self-care, health-promoting staff care, and addressing issues faced by stressed employees.

The mindfulness training was derived from Dialectical Behavioral Therapy’s mindfulness skills training module which involves mindfulness under daily life conditions rather than formal meditation practice. Sick days were recorded for two years before and two years after the MBI program.

The results showed that the group of MBI-trained supervisors had significantly reduced their average non-mental health related sick days from 33 days per two years to 14 sick days per two years, while the control group slightly increased sick days from an average of 32 to 34 days per two year period, a between group difference with a Cohen’s d=0.47. There was no group difference for mental health related sick days.

It is worth noting that a closer analysis of the MBI-trained supervisor group indicated that the average non-mental health sick days can mislead. This was primarily due to one supervisor who took 215 sick days prior to the intervention. When median sick days were considered instead of mean sick days, the median for MBI-trained supervisors increased from 6 to 7 days, while the comparison group's median increased from 9 to 11 days.

German historical workplace data show that average sick days tend to increase annually. No significance test was offered for this difference. There were no within- or between-group significant differences in supervisee sick days.

The study suggests a workplace MBI, in addition to reducing mental distress and improving health related self-care, may reduce or slow the annual increase in supervisors’ sick days. The interpretation is complicated by multiple factors, including: 1) German health insurance companies only record sick days when there are more than three consecutive days absent, 2) the intervention group was small and had one influential outlier, 3) the comparison group was not a randomly-assigned control group, and 4) the mindfulness intervention did not involve formal meditation practice.

Reference:

Vonderlin, R., Schmidt, B., Biermann, M., Lyssenko, L., Heinzel-Gutenbrunner, M., Kleindienst, N., Bohus, M., & Müller, G. (2023). Improving Health and Reducing Absence Days at Work: Effects of a Mindfulness- and Skill-Based Leadership Intervention on Supervisor and Employee Sick Days. Mindfulness.

Link to study

MBSR compared to medication calms fear response in people with anxiety

Tue, 18 Jul 2023 18:51:58 GMT

Almost one-third of all Americans will experience some form of anxiety disorder at some point in their lives. Behavioral scientists are trying to improve their understanding of anxiety disorders and find the most effective treatments. In one recent experimental paradigm, fear was defined as a response to a specific threat, while anxiety was defined as a response to the unpredictable possibility of encountering a threat. Within this paradigm, people with anxiety disorders show higher levels of anxiety compared to healthy controls, but not higher levels of fear.

Hoge et al. [Biological Psychiatry] used this paradigm to compare the effects of Mindfulness-Based Stress Reduction (MBSR) and antidepressant medication on objective and subjective measures of fear and anxiety in individuals with anxiety disorders.

The researchers recruited a sample of 93 adults with anxiety disorders and 66 healthy controls (average age=33 years; 72% female; 63% Caucasian). Participants attended baseline lab sessions to measure their startle responses to fear- and anxiety-provoking stimuli. Participants with anxiety disorders were then randomly assigned to either participate in a standard 8-week MBSR program or receive a daily dose of escitalopram (the generic form of Lexapro) for eight weeks. The healthy controls received no intervention. At the end of the eight weeks, participants repeated the lab measure again to assess anxiety and fear responses. Participants also completed self-report measures of anxiety during both the baseline and post-intervention evaluations.

During the lab sessions, participants sat at a computer that displayed a series of images consisting of green circles, blue triangles, and red squares. Participants were administered annoying (but not painful) electrical shocks in conjunction with these visual stimuli. Prior to the presentation of each image series, the computer screen provided information about the nature of the trial. Some trials involved no electrical shocks (neutral trials), while in others, shocks were administered only when a red triangle was present (predictable shock trials). There were also trials where shocks could occur during any stimulus (unpredictable shock trials).

An electromyogram (EMG) was used to measure the magnitude of each participants’ eye blinks—an objective measure of startle response—after exposure to each image. Eye blinks during predictable shock trials were classified as fear startle responses, whereas those during unpredictable shock trials were classified as anxiety startle responses.

Results showed that the group with anxiety disorders had significantly higher anxiety startle responses at baseline compared to the healthy control group. However, their response magnitudes significantly decreased after the intervention, leading to no significant difference between the two groups post-intervention. The reduction in anxiety startle responses was significantly greater for the escitalopram group than the MBSR group.

Subjective anxiety ratings decreased significantly for both intervention groups, a change that was significantly correlated with decreases in the anxiety startle response (r=.27) but not the fear startle response (r=.07). Intervention and control groups did not differ in the magnitude of their fear startle responses at baseline or post-intervention. While the MBSR group significantly reduced fear startle responses and fear subjective ratings from pre- to post-intervention, the escitalopram group did not.

The study shows that both MBSR and escitalopram reduce objective and subjective levels of anxiety so that participants with anxiety-disorders in both interventions no longer differed from healthy controls after intervention. Escitalopram reduced the magnitude of anxiety startle responses more than MBSR, whereas MBSR reduced the magnitude of fear startle responses more than escitalopram. This discrepancy suggests the involvement of distinct mechanisms of action for each intervention.

The study is limited by the absence of a non-intervention control condition for participants with anxiety disorders.

Reference:

Hoge, E. A., Armstrong, C. H., Mete, M., Oliva, I., Lazar, S. W., Lago, T. R., & Grillon, C. (2023). Attenuation of Anxiety-Potentiated Startle After Treatment with Escitalopram or Mindfulness Meditation in Anxiety Disorders. Biological Psychiatry.

Link to study

Linking brain iron to changes following MBCT for depression

Tue, 20 Jun 2023 15:37:49 GMT

The relation between major depressive disorder and brain iron concentrations remains speculative. The brain requires iron for various functions, including dopamine synthesis, myelin formation, oxygen transport, and energy metabolism. However too much iron can cause inflammation and neurotoxicity. Studies have shown that depressed patients have increased concentrations of iron in their hair and nails and decreased concentrations of iron in their blood, but these studies tell us nothing about iron levels in the brain.

Since iron is ferromagnetic, Magnetic Resonance Imaging (MRI) offers a non-invasive method to measure brain iron concentrations. Several studies employing older MRI technology demonstrated elevated levels of iron in specific brain regions among patients with severe depression.

Jakary et al. [Journal of Affective Diseases] used a newer and more powerful ultra-high field 7 Tesla MRI method, which offers increased sensitivity in measuring brain iron concentration. The researchers used this technology to quantify brain iron concentrations in individuals with major depressive disorder participating in Mindfulness-Based Cognitive Therapy (MBCT) and compared their iron levels and cognitive functioning to that of healthy controls.

The researchers recruited 17 medication-free patients diagnosed with major depressive disorder (76% female; average age = 31) and 14 age- and gender-matched healthy controls. Participants with depression were assessed for brain iron concentrations, depressive symptoms, and cognitive functioning before and after participating in MBCT. The regions of interest for MRI brain analysis included the anterior cingulate cortex, caudate, putamen, globus pallidus, and thalamus. The MRI measurements involved assessing local field shifts (LFS) in gradient-recalled echo phase images, where lower LFS values indicate higher iron concentration levels.

MBCT was delivered in 8 weekly 2.5 hour group sessions with 30-45 minutes of daily home practice. Twelve of the patients successfully completed MBCT and all the MRI assessments. Healthy controls did not participate in MBCT and were assessed on all measures at baseline only.

The results showed that, at baseline, depressed patients exhibited significantly higher iron concentrations in the left global pallidus and putamen, as well as significantly slower information processing speed on cognitive tests compared to healthy controls. Depressive severity in depressed patient group was correlated with significantly higher iron concentrations in five brain regions of interest.

All MBCT participants experienced a meaningful improvement in their depressive symptoms after MBCT, with six individuals experiencing complete depression remission. Depressed patients also significantly improved on measures of executive function and attention after MBCT.

Brain iron concentrations did not change significantly from baseline to post-treatment, and changes in values were uncorrelated with improvements in depression scores. However, patients with higher iron concentrations in the right caudate nucleus at baseline showed significantly greater posttreatment improvement in depressive symptoms.

In addition, patients with higher iron concentrations in three regions of interest at baseline showed significantly greater improvement on a measure of verbal learning and memory after MBCT.

The study demonstrates that using the ultra-high field MRI method enables the detection of brain iron concentrations in specific regions of interest, which can serve as biomarkers for depression and its response to MBCT. The study is limited by technical factors (e.g., how myelin alterations may affect LFS values) that may reduce the validity LFS values as a surrogate measure of iron concentration and the absence of a no-treatment control.

Reference:

Jakary, A., Lupo, J. M., Mackin, S., Yin, A., Murray, D., Yang, T., Mukherjee, P., Larson, P., Xu, D., Eisendrath, S., Luks, T., & Li, Y. (2023). Evaluation of major depressive disorder using 7 Tesla phase sensitive neuroimaging before and after mindfulness-based cognitive therapy. Journal of Affective Disorders, 335, 383–391.

Link to study

MBCT feasibility in chronic pain patients with opioid addiction low

Tue, 13 Jun 2023 15:02:51 GMT

About 10% of patients who are prescribed opioids for their chronic pain go on to develop opioid use disorders, which are characterized by urges to use, difficulty in tapering off use, and impairment in daily activities. Given that mindfulness-based interventions have been used for the treatment of chronic pain and substance abuse disorders, they may also offer potential benefits to people who are diagnosed with both disorders concurrently.

Ellerbroek et al. [Brain and Behavior] conducted a pilot study aimed at assessing the feasibility of using Mindfulness-Based Cognitive Therapy (MBCT) among patients with co-occurring chronic pain and opioid use disorder.

The researchers recruited 23 Dutch patients (60% female; average age = 48 years) who had dual diagnoses of chronic pain and opioid use disorder and were hospitalized for the initiation of opioid-agonist buprenorphine/naloxone treatment. All participants were given the opportunity to participate in outpatient MBCT three months after their hospitalization. MBCT was delivered in the standard curriculum format of 8-week 2.5 hour group sessions and a 6-hour retreat.

The MBCT groups were not restricted to study patients alone, but also included patients with other psychiatric diagnoses. Study patients were interviewed prior to the start of MBCT to assess factors that might facilitate or hinder their participation. Patients who initially agreed to participate in MBCT but later declined were interviewed on two occasions. Patients who participated in MBCT were also interviewed post-intervention to assess their perception of whether and how they had changed. Interviews were audiotaped, transcribed, coded, and thematically analyzed.

Nine patients initially declined to participate in MBCT. Their reasons included previous MBI experience, being in too much pain, fear that participation could exacerbate pain and negative mood, challenges related to travel and scheduling conflicts with sessions, and a general lack of interest in psychosocial interventions. Twelve patients initially expressed interest in participating, but during the three months leading up to the start of the intervention, eight of them changed their minds. Many of those thought MBCT was occurring too late in their treatment process or were anticipating practical difficulties that would hinder their attendance.

Four patients participated in MBCT: one attended all 8 sessions, two attended 7 sessions, one attended 6 sessions, and all attended the 6-hour retreat. Participants reported being more in touch with their emotions and better able to focus their attention, diminished self-blame, anxiety, and anger, and a greater ability to experience happiness and calm. While their pain levels did not generally decrease, they reported coping better with pain by employing strategies of acceptance, letting go, and seeking distraction.

The researchers concluded that although patients derived benefits from participating in the intervention, MBCT was not feasible for most individuals with co-occurring chronic pain and opioid use disorder. Offering MBCT earlier in the treatment cycle, providing a trial session prior to requiring a commitment, or offering MBCT in an individualized online format were noted as potential strategies to address barriers to feasibility.

The study is limited by its small number of participants and lack of objective outcome measures.

Reference:

Ellerbroek, H., Hanssen, I., Lathouwers, K., Cillessen, L., Dekkers, S., Veldman, S. E., van den Heuvel, S. A. S., Speckens, A. E. M., & Schellekens, A. F. A. (2023). Mindfulness-based cognitive therapy for chronic noncancer pain and prescription opioid use disorder: A qualitative pilot study of its feasibility and the perceived process of change. Brain and Behavior.

Link to study

Mindfulness audio aids reward learning by heightening awareness

Tue, 23 May 2023 17:08:42 GMT

Although behavior therapies are increasingly integrating mindfulness meditation, little is known about how this practice affects reward-based conditioning. Some research suggests that mindfulness can assist individuals in responding more rapidly to changes in reward contingencies, but it is not clear why.

One possibility is that people learn verbal rules that help them respond to specific reward schedules, and mindfulness enables people to let go of previously learned verbal rules that no longer apply when reward schedules change. Another possibility is that mindfulness helps people pay closer attention to the reward schedule that is currently in effect.

Reed [Journal of Experimental Psychology: Animal Learning and Cognition] conducted four experiments to investigate how mindfulness affects responses to changes in reward schedule. Two different reward schedules were used in the experiments: 1) a random ratio (RR) schedule, which rewarded participants only after a certain number of responses, and 2) a random interval (RI) schedule, which rewarded participants only after a certain amount of time had elapsed. The RR schedule encouraged rapid bursts of responses, whereas the RI schedule encouraged participants to pause for a while after receiving a reward. All four studies used healthy, meditation-naïve participants drawn from a university psychology department.

The first study explored whether mindfulness could help people better differentiate between schedules—that is, to respond at higher rates during an RR schedule and lower rates during an RI schedule. Forty participants (58% male; average age = 21 years) sat at a computer and pressed a space bar with the goal of maximizing game points. Every participant completed 8 alternating RR and RI schedule trials. A yellow or brown screen icon appeared that indicated the trial was an RR or RI trial, but participants were not informed of what the color signified.

A rewarded trial earned participants 60 points, but each space bar press cost them one point. The RR schedule offered a reward after 20 space bar presses, whereas the RI schedule offered a reward for the first space bar press after a certain period of time had elapsed.

Prior to playing the game, participants were randomly assigned to a 10-minute mindfulness or relaxation intervention, delivered via audio recording. The mindfulness intervention asked participants to focus on their breath and return to it whenever their minds wandered. The relaxation intervention asked participants to relax and let their minds wander.

Both groups gradually increased their response rates during RR and decreased them during RI, but the mindfulness group showed a significantly greater differentiation between the schedules. This supports the hypothesis that mindfulness helps one pay better attention to reward schedules.

The second study investigated whether a mindfulness group would respond faster to a change in contingency schedule than a relaxation control. Thirty-two participants (75% male, average age = 21 years) were randomly assigned to a mindfulness or relaxation intervention. The experimental situation was the same as in study 1, except that the color icons associated with each schedule were switched midway through the game.

The results showed that, once again, the mindfulness group was better able to differentiate between the schedules than the control group. In addition, they responded faster to changes in reward contingency and to changes in the color signaling the contingency, compared to the controls.

The third study compared the effects of mindfulness versus a no-intervention control on the speed of contingency reversal learning using 32 participants (69% male; average age = 24 years). In this study, participants were asked to verbalize the rule they thought was in effect after each trial.

In study 3, participants first completed four trials of the game before experiencing the mindfulness or control intervention. They then played eight trials, as in study 2. The mindfulness group significantly outperformed controls in differentiating between the RR and RI schedules and accurately verbalizing the contingency in effect for each trial.

The forth study examined whether mindfulness works by promoting awareness of current contingencies or by reducing interference from previously learned contingencies using 80 participants (64% female; average age = 21 years). Participants were trained on an alternating RR/RI schedule until their response rate was higher during the RR schedule. They then randomly assigned to mindfulness or relaxation training. Half of each group play the game as noted before, while the other half played the game with the color icon signaling the reward contingency switched.

The results were consistent with the prior studies. The mindfulness group recognized changes in contingency faster and showed a more differentiated response to them than controls. Moreover, the mindfulness group responded appropriately to the changed contingencies after the icon switching faster than controls. The results support the hypothesis that mindfulness promotes situational awareness, leading to more appropriate responding to reward contingencies.

Taken together, these studies demonstrate mindfulness increases behavior differentiation between reward schedules compared to relaxation and no-treatment controls. Mindfulness also leads to faster learning of reward schedule switches. Finally, it appears to enhance performance by increasing present-moment awareness, rather than by reducing interference from previous learning. Although the study’s “relaxation” intervention conflates relaxation with mind-wandering, it does not alter the overall interpretation of the findings.

Reference:

Reed, P. (2023). Focused-attention mindfulness increases sensitivity to current schedules of reinforcement. Journal of Experimental Psychology: Animal Learning and Cognition, 49, 127–137.

Link to study

Mindfulness program enhances middle schoolers' math exam scores

Fri, 19 May 2023 15:10:53 GMT

High-stakes exams can determine one’s future in terms of promotion, graduation, acceptance into a university, or employment. School mathematics exams are especially high-stake in East-Asian cultures where examinations have long been a prime means of advancement. Fears over how math test performance may affect one’s future, or how family and peers might react can lead to considerable test anxiety. This can create a cycle where anxiety impairs performance, and impaired performance exacerbates anxiety.

Zuo & Wang [Frontiers in Psychology] used quantitative and qualitative methods to investigate how a mindfulness-based intervention affected math test performance in Chinese middle-school students.

The researchers selected an eighth-grade class of middle school students (67% male: age range = 12-13 years) in an urban area of Jiangsu Province, China. The study lasted for one month, during which the students took four weekly geometry tests rated as equivalent in difficulty. The first and third tests were taken as usual, but for the second and fourth tests, the students listened to a 15-minute audio tape prior to the test.

The audio tape contained a breath-and-body focused meditation and included relaxation instructions. The tape also instructed students to imagine having negative thoughts and emotions during a math test, and to identify these thoughts and emotions non-judgmentally and return to present-moment awareness.

After the fourth test, students participated in group discussions about whether they found the meditations useful. Two students who benefitted from meditation and two students who did not were selected for subsequent in-depth interviews. The discussion and interviews were transcribed, coded, and thematized to offer qualitative insights into how the meditations affected student math anxiety and self-efficacy.

The results showed that students performed better on average after the meditations than without them (Cohen’s d = 0.27). All math tests were scored on a 10-point scale, with an average score of 6.73 without meditation and 7.11 with meditation.

The qualitative analysis revealed that the meditations helped students to focus more on math problems in the moment, worry less about performance outcomes, and obsess less over test time-constraints or difficult problems. The students who didn’t benefit reported finding the meditations “mysterious” or “magic” and associated them negatively with Buddhist religion.

The study shows a mindfulness meditation specifically designed to address math anxiety can objectively improve math exam performance. Qualitative interviews revealed that the students who benefited from meditation were able to focus more on solving math problems without being distracted. The study is limited by its reliance on a single classroom sample and only four measurement points.

Reference:

Zuo, H., & Wang, L. (2023). The influences of mindfulness on high-stakes mathematics test achievement of middle school students. Frontiers in Psychology, 14.

Link to study

Ten minutes of meditation slows heart, profits cognition

Sat, 29 Apr 2023 17:47:09 GMT

Studies of the short-term effects of mindfulness meditation on cognitive performance often show conflicting findings. These differences in study findings may result from heterogeneity in the populations, meditation methods, cognitive tasks, and study designs used, and the extent of participant’s prior meditation experience.

Sleimen-Malkoun, et al. [PLOS One] attempted to clarify the effects of short-term mindfulness meditation on cognitive performance by comparing it to a control intervention and studying its effect on cognitive reaction time in both experienced and novice meditators.

Forty-two healthy French adults, including 22 experienced meditators (64% female; mean age = 49 years) and 20 meditation-naïve participants (55% female; mean age = 42 years), were enrolled in the study. Experienced meditators meditated at least 3 times weekly over an average of over 5 years (range = 5-250 months), while meditation-naïve participants had no prior meditation experience.

Participants’ resting heart rates were recorded and they then performed a baseline Stroop task. Afterwards, half the participants engaged in 10 minutes of guided breath-focused mindfulness meditation while the other half actively listened to a 10 minute pre-recorded audio on the history, origins, and philosophy of mindfulness meditation without guided practice.

Participants then performed a repeat Stroop task. At this point, participants initially in the mindfulness condition were now assigned to the listening condition, and vice versa so that participants served as their own controls. Participants then completed a third Stroop task. Heart rate was monitored during both interventions.

The Stroop task was a cognitive performance task that involved showing participants computer-presented slides of colored words. Sometimes the words spelled the names of colors (e.g., “RED”), and when that happened, sometimes the text color agreed with the word name (congruent condition), and at other times text color and word name were discordant (incongruent condition). There were also times when the words named parts of the body, so that their color was irrelevant (neutral condition).

Participants were asked to identify the color the words were printed in and their reaction times were recorded. The Stroop task is a commonly used measure of participants’ attentiveness and ability to ignore distracting information.

The results showed Stroop reaction times to congruent and incongruent color word presentations were significantly faster after mindfulness meditation than after active listening. Average heart rates were significantly slower during active listening than while at rest, and significantly slower still while meditating.

The extent of participants’ prior meditation experience did not interact with experimental condition to affect Stroop reaction time or heart rate.

The study shows that a brief 10-minute mindfulness meditation is associated with slowed heart rate and improved Stroop task reaction times in both experienced and novice meditators. Acute cognitive benefit accrues after a brief meditation, even for novices.

The study is limited by its reliance on the Stroop task as the single outcome measure representing cognitive performance.

Reference:

Sleimen-Malkoun, R., Devillers-Réolon, L., & Temprado, J.-J. (2023). A single session of mindfulness meditation may acutely enhance cognitive performance regardless of meditation experience. PLOS ONE, 18(3), e0282188.

Link to study

MBCT superior to British NHS standard for depression

Fri, 28 Apr 2023 14:11:32 GMT

Our mental health system is unable to provide care to all who need it: there are too few providers and many clients cannot afford or access it. There is a need to creatively rethink how to offer care to more in need. One way is through self-help workbooks that allow clients to work on problems at their own pace while assisted by limited paraprofessional support.

British National Health Service guidelines currently endorse practitioner-supported Cognitive Behavioral Therapy Self-Help (CBT-SH) for depression. The National Health Service currently offers CBT-SH to over 100,000 clients annually, but the intervention suffers from a high drop-out rate.

Practitioner-supported Mindfulness-Based Cognitive Therapy Self-Help (MBCT-SH) is one possible alternative to CBT-SH, but its comparative efficacy is unknown. Strauss et al. [JAMA Psychiatry] conducted a randomized controlled trial comparing CBT-SH to MBCT-SH on clinical outcomes and cost effectiveness.

The researchers randomly assigned 410 clients with mild-to-moderate depression (62% female; 86% Caucasian; median age = 32) to practitioner-supported CBT-SH or MBCT-SH. Initial diagnosis and level of depression was established by structured clinical interview and self-report.

Participants were handed CBT or MBCT self-help workbooks and provided with six structured face-to-face or telephone 30-45 minute sessions with a psychological well-being practitioner focused on workbook material. “Psychological well-being practitioner” is a paraprofessional designation created through the British National Health Service’s Improving Access to Psychological Services (IAPS) initiative.

The CBT workbook used in this study was one already in wide use in IAPS programs. The MBCT workbook was The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress written by the MBCT co-founders. Participants were given up to 16 weeks to complete the workbook curricula.

Participants were assessed on measures of depression, anxiety, quality of life and mindfulness at baseline, 16 weeks (post-intervention) and 42-week follow-up. Drop-out rates for both groups were similar (28%).

MBCT-SH participants reported greater reductions in depression at post-intervention than CBT-SH participants (d=-0.36) but the group difference was no longer significant at 42 weeks. MBCT-SH participants also reported greater improvement in anxiety than CBT-SH participants at postintervention (d=-0.23), but not at 42 weeks. The absence of significant differences at 42 weeks reflects a continued improvement in depression for both groups.

The direct costs of providing treatment were $209 for MBCT-SH and $202 for CBT-SH. Other health care and social costs were higher for the CBT-SH group ($1,684) than the MBCT-SH group ($923). The increased CBT-SH costs were due to participants receiving more individual psychotherapy outside of the program, receiving more general practitioner visits, and the higher psychotropic medication usage.

The results show MBCT-SH superior to CBT-SH as a treatment for mild-moderate depression in terms of post-intervention mental health outcome and lower health care and social costs. Findings make a case for considering MBCT-SH to be at least as effective as CBT-SH and including it within the IAPS initiative.

Reference:

Strauss, C., Bibby-Jones, A.-M., Jones, F.,... Cavanagh, K. (2023). Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression: The Low-Intensity Guided Help Through Mindfulness (LIGHTMind) Randomized Clinical Trial. JAMA Psychiatry.

Link to study

MBRP exceeds relapse prevention on reducing heavy drinking days

Tue, 28 Mar 2023 15:42:49 GMT

Treatments for excessive alcohol use are often only moderately successful, and clinicians are always on the lookout for more effective interventions. Mindfulness-Based Relapse Prevention (MBRP) is a promising intervention that combines standard cognitive-behavioral relapse prevention with teaching substance users to mindfully resist acting impulsively on urges.

Most existing MBRP research with persons with alcohol use disorders does not compare MBRP to other empirically validated treatments. Skrzynski et al. [Journal of Studies on Alcohol and Drugs] tested the relative efficacy of MBRP to standard relapse prevention alone in reducing alcohol use in heavy alcohol users.

The researchers randomly assigned 182 heavy alcohol users (52% male; 92% Caucasian; average age = 44 years) who volunteered because they wished to reduce their drinking to MBRP or relapse prevention alone. At baseline, participants drank an average of 5 drinks per day, and had 12 heavy drinking days per month when they consumed more than 4 drinks per day. Forty-two percent also used cannabis at least once the past month.

Both treatments were delivered in eight weekly individual therapy sessions delivered over the course of 2 months, with follow-up appointments at weeks 20 and 32. Therapy was delivered by doctoral and post-doctoral psychology students with 3 days of specialized training in motivational interviewing, MBRP, and relapse prevention.

Assessments at baseline, 4, 8, 20, and 32 weeks included an alcohol use questionnaire and timeline follow-back measures of alcohol use based on self-report.

The results showed that both groups significantly reduced their scores on an alcohol use questionnaire, and their average number of drinks per day and total number of heavy drinking days significantly declined from baseline to posttreatment.

While reduction in heavy drinking days was equal for both groups at posttreatment, MBRP participants maintained their improvement in heavy drinking days in subsequent follow-up, whereas the relapse prevention group did not. By the end of the study, the MBRP participants had significantly fewer heavy drinking days than controls.

The efficacy of the treatment was equal for males and females. High levels of cannabis use led to continued decreases in the MBRP group in drinks per day and heavy drinking days in the follow-up period, but to increases in heavy drinking days in controls.

The study showed that MBRP and relapse prevention alone were equally effective in reducing drinks per day and heavy drinking days in alcohol users who wished to reduce their drinking, but only MBRP helped participants maintain their reduction in heavy drinking days out to 32 weeks.

The study is limited by potential participants being aware that the study treatment included mindfulness, and 18% of the sample had a history of experience with mindfulness. It is unclear whether the same results would obtain in a meditation-naïve cohort or one less favorable to the idea of mindfulness.

The study is also limited by the relative inexperience of the students conducting the MBRP and relapse prevention interventions.

Reference:

Skrzynski, C. J., Karoly, H., Ellingson, J., Hangerty, S., Bryan, A. D., & Hutchison, K. E. (2023). Comparing the efficacy of mindfulness-based relapse prevention versus relapse prevention for alcohol use disorder: A randomized control trial. Journal of Studies on Alcohol and Drugs.

Link to study

MBSR affects moral decisions for tradeoffs involving self-other harm

Wed, 22 Mar 2023 15:34:00 GMT

Moral decision making sometimes involves weighing trade-offs between self-serving interests and causing harm to others. Social psychology experiments reveal a moral “slippery slope.” That is, once experimental participants begin making decisions that serve their own interests but harm others, they progressively become more self-serving and less concerned about harm to others as time goes on. Moral decision-making includes decisions about what actions to take as well as judgments about how ethical those decisions are.

Mindfulness training might affect how moral decisions are made and judged by cultivating a present-moment focus that reduces goal-oriented behavior (seeking future gain) or by increasing empathy for others. Du et al. [Scientific Reports] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on moral decision-making involving tradeoffs between benefits to self and harm to self and others.

The researchers randomly assigned 68 meditation-naïve Chinese participants (75% female; Average age = 30 years) to either an 8-week MBSR course or a wait-list control. The MBSR protocol was the standard MBSR protocol delivered in a Chinese-language format. All participants engaged in moral decision making and judgment tasks and completed Chinese-language versions of mindfulness (the Five Factor Mindfulness Questionnaire), emotional regulation, and failures in executive control (problems in planning, impulsivity, and motivation) questionnaires one week prior to and after intervention.

In the moral decision-making task, participant pain thresholds were assessed to determine the level of electric shock needed to evoke a pain of “8” on a 10-point pain scale. Participants then engaged in a series of 96 decision making trials in which they chose between receiving various amounts of money while receiving painful shocks or giving them to another “person” in the next room. There was, in fact, no other person in the next room. Participants then rated the other “person’s” choices on the same task in terms of how moral their decisions were

Results from the study showed that mindfulness and executive control scores were significantly higher in the MBSR group as compared to controls after the intervention. While the control group showed an increased willingness to inflict harm on another as compared to oneself from pre- to post-testing (the “slippery slope” effect), the MBSR group did not (partial η2= 0.08).

Using Bayesian hierarchical drift diffusion modeling, the researchers established that the amount of money participants received for each decision had less of an effect on MBSR decision-makers than controls. In other words, MBSR suppressed the influence of increases in money on moral decision-making, whereas controls were more likely to morally justify causing harm to others when the amount of monetary compensation was sufficiently high.

MBSR did not make participants more moral compared to their own baseline but reduced the magnitude of the slippery slope compared to controls.

In terms of moral judgment, participants became less judgmental of other’s choices from pretesting to post-testing. Participants weighted the importance of money more and the importance of pain less during post-testing than pretesting. There was a difference between groups in this effect, however. For controls, the same amount of money justified more harm in post-testing than pretesting, whereas the amount of money had less of an effect on the mindfulness group’s judgment.

The study shows MBSR can shift the relative value of monetary gain in moral decision making and judgment involving harm compared to a wait-list control.

The study is limited by the lack of an active control and the possibility that group differences in moral performance may owe more to the demand characteristics of having been in a mindfulness condition than to cognitive changes due to mindfulness per se.

Reference:

Du, W., Yu, H., Liu, X., & Zhou, X. (2023). Mindfulness training reduces slippery slope effects in moral decision-making and moral judgment. Scientific Reports, 13(1), 2967.

Link to study

Teen rumination declines for six weeks after mindfulness app use

Tue, 07 Mar 2023 17:03:14 GMT

Ruminative thinking involves repetitively dwelling on negative experiences. A high level of ruminative thinking is a risk factor for depressive and anxiety disorders and is also a major feature of these disorders. Mindfulness offers a way to attend to negative experience and let content of thinking arise and fall without elaboration.

Reducing ruminative thinking may be a way to reduce the risk of developing future psychological disorders. Hilt et al. [Journal of Clinical Child and Adolescent Psychology] tested whether a mobile mindfulness app could reduce ruminative thinking in adolescents.

The researchers randomly assigned 152 adolescents (average age = 14; 59% female; 82% Caucasian) with high levels of rumination to a mindfulness or a mood-monitoring only group. Both groups downloaded the mobile CARE app on their smartphones. The app requested participants to rate their rumination and mood three times daily: once before and after school, and once before bedtime.

After completing ratings, mindfulness group participants engaged in mindfulness meditations of varying lengths depending on the free time they had available.

Meditations were guided by written instruction (1 minute meditations) or audio recordings (3-12 minute meditations). The meditations involved focus on the breath, body sensations, or sound. Meditation opportunities were provided 67% of the time at the end of rating sessions, and 85% of the time when participants reported sadness or anxiety. The mood-monitoring only group rated rumination and mood without the opportunities for meditation.

After three weeks, participants were no longer prompted to use the app but could continue using it if they liked. Participants were assessed at baseline, post-treatment, and 6-week, 12-week, and 6-month follow-up on self-report measures of rumination, depression, and anxiety.

The results show the mindfulness group had significantly reduced levels of rumination (d=0.43), depression (d=0.24), and anxiety (d=0.25) compared to controls at immediate post-test. The aggregate rumination scores (but not depression and anxiety scores) in the mindfulness group remained significantly lower than controls at 6-week follow-up, but not on the subsequent follow-ups.

A mediation analysis showed that post-treatment decreases in depression and anxiety were due to the decreased rumination scores predicted by the mindfulness group.

The study shows that brief app-prompted mindfulness meditations can reduce rumination, depression, and anxiety in ruminative adolescents better than mood-monitoring alone. These effects are not long-lasting and tend to fade within 6-12 weeks.

The study is important because most adolescents who ruminate do not receive any professional psychological care, and an inexpensive, easily deployable app may reduce some degree of rumination. The study is limited by the absence of a no treatment control or a meditation app without mood-monitoring.

Reference:

Hilt, L. M., Swords, C. M., & Webb, C. A. (2023). Randomized Controlled Trial of a Mindfulness Mobile Application for Ruminative Adolescents. Journal of Clinical Child & Adolescent Psychology.

Link to study

Academic performance differs by compassion and mindfulness training

Mon, 20 Feb 2023 19:46:04 GMT

Mindfulness interventions often combine teaching a skill (attentional focus) with teaching an attitude (non-judgmental compassion). When mindfulness interventions successfully affect a target behavior, it can be challenging to discern which of these two training features effectively caused the change. To disambiguate these factors, O’Hare & Gemelli [PLOS One] tested the effects of focused-attention training versus self-compassion training on college students’ well-being, academic performance, and brain activity.

The researchers assigned 37 students in one undergraduate biopsychology class to focused attention training and 35 students in a separate undergraduate biopsychology class to self-compassion training. Both classes were taught by the same instructor and all non-study intervention content was standardized. Classes were similar in student age and gender distribution (average age = 23 years; 86% female).

Students received extra credit for participating in each of three baseline assessment activities: granting permission to have their class academic test grades analyzed; completing self-report measures related to health; and having their EEGs monitored while engaging in a computer-presented attentional task.

Following baseline assessment, students participated in 10 weeks of in-class focused-attention or self-compassion training. The first five minutes of one class was devoted to focusing attention on the breath without mind-wandering, and the first five minutes of the other class was devoted to focusing on self-compassion phrases (“may I be happy,” “may I be calm,” “may I be well”). The classes met twice a week for a total of 20 possible sessions. At the end of the semester, students were reassessed on self-report measures and the computer-presented attentional task.

The attentional task involved correctly identifying the direction a computer cursor faces (either < or >) when flanked by distracting cursors facing in the same or the opposite direction. Each trial was preceded by the presentation of an emotionally negative or neutral word.

EEGs were recorded, and evoked-response potentials (ERPs) to each trial analyzed for the magnitude of N2 and P3 waveform components. N2 is a negative waveform occurring about 200 milliseconds (ms) after stimulus presentation that is associated with conflict monitoring. N2 is larger when incongruent flanking stimuli are present. P3 is a positive waveform occurring about 300 ms after stimulus presentation and associated with selective attention. P3 is smaller when people are better able to ignore irrelevant emotional stimuli.

The results showed the self-compassion group showed significantly larger improvements on measures of anxiety (d =0.70), stress (d =0.80), and depression (d=0.92) than the focused-attention group. Positive affect decreased for the focused-attention group while remaining stable for the self-compassion group (d=0.63). The self-compassion group also outperformed the focused-attention group on two of four academic exams covering the course material (d=0.56 and d=0.79).

The focused-attention group showed significantly (partial η2=.13) shorter attention task reaction times (average = 80 ms) as compared to the self-compassion group when flanking cursors were incongruent with the target cursor compared to the self-compassion group (109 ms).

Only 22 students (11 in each class) had useable EEG ERP data. The self-compassion group had significant reductions in N2 from pre- to post-testing for those trials preceded by negative emotional words, while the focused-attention group did not (partial η2=0.36). The self-compassion group also had significant pre-post reductions in P3 for those trials preceded by negative emotional words, while the focused-attention students did not (partial η2=0.40). These results suggest better emotional regulation for the self-compassion group.

The study shows that short bouts of self-compassion training delivered in class over the course of one semester improves academic test performance and self-reported well-being, as well as emotional regulation as measured by ERPs. The focused-attention group had faster reaction times on an attentional task.

The study is limited by the absence of random assignment of students to class, the lack of an inactive control, the small number of students with useable ERP data, and the brevity of its intervention.

Reference:

O’Hare, A. J., & Gemelli, Z. T. (2023). The effects of short interventions of focused-attention vs. self-compassion mindfulness meditation on undergraduate students: Evidence from self-report, classroom performance, and ERPs. PLOS ONE.

Link to study

Brief meditation makes habitual responses more sensitive to reward

Tue, 31 Jan 2023 22:37:39 GMT

Some types of human behavior are habit-like. That is, an individual will respond to a stimulus with little-to-no awareness of the reward for performing the behavior. Other responses appear to be more intentional and goal directed. That is, an individual acts with conscious awareness of the relationship between the behavior and likely rewards.

Mindfulness training may make people more sensitive to and aware of reward contingencies, thereby giving them greater control over their behavior.

Chen & Reed [Journal of Behavior Therapy and Experimental Psychiatry] performed an experiment to see whether a brief mindfulness intervention could make an operantly conditioned behavior less like habitual and more like goal-directed behavior. Goal-directed behaviors are more under conscious control, more easily guided by verbal behavior, and more easily deliberately modified.

The researchers randomly assigned 52 meditation-naïve college undergraduates (average age = 20 years; 64% female) to a mindfulness, mind-wandering, or “no treatment” condition. The mindfulness condition involved 15 minutes of breath-focused meditation after one-time brief verbal instruction. Mind-wandering participants were told to “let their mind wander” for 15 minutes. “No treatment” participants were given 15 minutes to do whatever they wanted (look at their phones, read, rest, etc.).

After the 15 minutes were up, participants engaged in a conditioning “game” on a computer. The aim of the game was to earn as many points as possible by pressing a computer space bar, but participants were not informed about how many or what frequency of space bar presses would earn points and had to learn the optimal strategy by experience.

The researchers compared rates of responding to random ratio versus random interval reward schedules following a mindfulness, mind-wandering, or control intervention. Ratio schedules provide rewards after a set number of responses, while interval schedules provide rewards for responses after a set time interval has elapsed.

Behavior typically occurs in bursts of activity called “bouts.” The initial response at the onset of a bout (“bout-initiation”) is “habit-like” in that it is relatively insensitive to reinforcement schedules.

Responses after a bout has already begun (“within-bout” behavior) are more sensitive to reinforcement schedule and more goal directed. Within-bout response rates are higher during ratio than interval reward schedules, while bout-initiation rates are the same for either schedule. The researchers sought to discover whether mindfulness training could make bout-initiation responses more sensitive to the influence of reward schedule.

Participants started off with 100 points and pressed the computer space bar to earn additional points. Each space bar press cost 1 point, but if they were on a trial for which a reward was available, the space bar press earned 40 points. There were four eight-minute periods of play with each period divided into 4 minutes on a ratio schedule followed by 4 minutes on an interval schedule.

The changeover from ratio to interval was signaled by a color change in a box on the computer screen. The number of reward points available within each 4-minute interval schedule was yoked to the number of reward points received during the prior ratio schedule.

The results showed that, as expected, overall response rates were significantly higher during the ratio than during the interval schedule (η2p = .72) for all groups. Also, as expected, within-bout response rates were higher during ratio than interval without any between experimental group differences.

Most importantly, bout-initiation rates were the same for the ratio and interval schedules for the mind-wandering and control groups but not for the mindfulness group (η2p = .12). The mindfulness group alone had a significantly higher rate of bout-initiation responses to the ratio than the interval schedule (η2p = .26).

The study shows that a brief mindfulness meditation can make habit-like behavioral responses more sensitive to reward schedules. This supports the hypothesis that mindfulness increases awareness of previously unconscious reward contingencies related to performing a behavior.

The researchers did not check to see if there was a difference to the extent in which participants in different groups could verbalize their awareness of the reward contingencies in relation to their behavior.

Reference:

Chen, X., & Reed, P. (2022). The effect of brief mindfulness training on the micro-structure of human free-operant responding: Mindfulness affects stimulus-driven responding. Journal of Behavior Therapy and Experimental Psychiatry.

Link to study

MBSR and exercise show null effect on older adult cognitive decline

Tue, 24 Jan 2023 16:59:38 GMT

Older adults on average exhibit signs of mild cognitive impairment compared to younger adults. It is not clear how much of this normal decline in memory and cognitive functioning is inevitably due to aging, and how much might be counteracted by healthy lifestyle changes.

Lenze et al. [JAMA] conducted a large-scale, multi-site, randomized, controlled trial to test whether mindfulness meditation and/or daily exercise could reduce cognitive impairment in older adults compared to an active control group. Prior studies had shown some support for both types of intervention, and many health experts recommend exercise to counteract cognitive impairment.

The researchers randomized 585 older adults with subjective mental decline but without dementia (average age = 71 years; 72% female; 82% Caucasian) to Mindfulness-Based Stress Reduction (MBSR), an exercise group, MBSR + exercise, or a health education control. MBSR was delivered in the standard 8-week plus half-day retreat format.

After the initial eight week course, participants received monthly booster classes for the remaining 16 months of the study. The program encouraged 60 minutes of daily home meditation practice throughout the length of the study.

The exercise program focused on aerobic exercise, resistance training, and functional exercises. The program met for two 1.5 hour classes weekly for the first six months, and then once weekly for the remaining 12 months of the study. A combined total of 300 minutes of exercise per week was recommended. Participants in the combined MBSR+exercise group participated in both full programs simultaneously.

The health education control met for the same session length and frequency as the MBSR group and offered a didactic curriculum focused on leading a healthy lifestyle.

Participants were assessed at baseline and 6- and 18-month follow-up on a neuropsychological battery assessing memory and cognitive functioning as well as measures of functioning in activities of daily life and quality of life. Participants had structural MRIs taken of hippocampal volume and dorsolateral pre-frontal cortex (dlPFC) surface area and cortical thickness.

Additionally, participants were assessed on measures of physical health and fitness including aerobic fitness, insulin sensitivity, body fat, plasma cortisol, sleep quality, and body strength. Retention in the trial was good, with 97% of participants completing the 6-month assessment and 81% completing the 18-month assessment.

The results showed no significant differences between study groups on memory and cognitive function at either 6- or 18-month follow-up. All groups showed a reduction in hippocampal volume and dlPFC surface area and cortical thickness at 18 months consistent with normal atrophy due to aging.

Contrary to expectation, the reduction in hippocampal volume was significantly greater in the MBSR group. Only the exercise groups showed significant improvement in aerobic fitness, physical strength, and sleep quality over time.

The study showed that, relative to a health education curriculum, neither mindfulness nor exercise improved memory or cognitive functioning or slowed brain tissue atrophy in this cohort of older adults with subjective cognitive complaints. The study participants were mostly college educated, Caucasian females with no evidence of dementia, and these findings may not generalize to clinical populations.

Reference:

Lenze, E. J., Voegtle, M., Miller, J. P.,... Wetherell, J. L. (2022). Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults: A Randomized Clinical Trial. JAMA, 328(22), 2218–2229.

Link to study

Online MBCT effective for reducing sarcoidosis-related fatigue

Fri, 06 Jan 2023 18:02:26 GMT

Sarcoidosis is a relatively rare multisystem immune disorder that causes inflamed lumps of tissue (called granulomas) to form and adhere to various body organs. Common symptoms include fatigue, lack of energy, shortness of breath, cough, and skin rashes/nodules. Treatment may involve the use of nonsteroidal anti-inflammatory drugs, corticosteroids, pulmonary rehabilitation, and/or physical training.

Kahlmann at al. [Lancet Respiratory Medicine] tested whether an on-line version of Mindfulness-Based Cognitive Therapy (eMBCT) reduces stress and fatigue in patients with sarcoidosis.

The study randomly assigned 99 Dutch adults with sarcoidosis (average age = 50 years; 59% female) who scored >21 points on a fatigue scale to receive standard care plus eMBCT or standard care alone. eMBCT is an 8-session online mindfulness-based cognitive therapy program initially designed to treat fatigue in cancer patients.

Participants were deemed to have completed the program if they completed 6 of the 8 sessions within a six-month window. They were also encouraged to engage in additional audio-guided home practice 30-minutes a day, 6 days a week.

Seventy-eight percent of the participants who began eMBCT completed at least 6 sessions in six months. It should be also noted, however, that a third of the potential participants assigned to eMBCT declined participation following an initial explanation of what the program entailed. Many thought it too time-consuming or had negative associations with mindfulness. This high decline rate (and the COVID pandemic) caused researchers to change their assignment protocol midway through, assigning a higher proportion of participants to the eMBCT than initially planned.

Participants were assessed at baseline, after program completion (or for controls at 3 months) and at three months after completion (or for controls at six-month follow-up). The study primary outcome was a change in fatigue ratings. Secondary outcomes were changes in sarcoidosis health status, anxiety, depression, and mindfulness (Frieburg Mindfulness Inventory).

Results showed that by post-intervention, the fatigue levels in the eMBCT group decreased significantly from baseline (-4.5 points) while controls showed no such significant decline (-0.9 points).

At six-month follow-up, eMBCT participants largely maintained their improvement (-4.0 from baseline), while controls slightly improved (-1.9 from baseline).

At post-intervention, 60% of the eMBCT group had a clinically meaningful improvement in fatigue level (defined by either a ≥ 4 point or 10% change) while only 26% of the controls had a clinically meaningful improvement.

Patients in the eMBCT group also showed significantly larger decreases in anxiety and depression and improvements in mindfulness and overall health status than controls at post-intervention and follow-up.

The study supports eMBCT as an effective treatment for reducing sarcoidosis-related fatigue. The study is limited by its reliance on a treatment-as-usual control instead of an active comparator. The fact that many mindfulness and control patients were assessed at different time intervals relative to the completion of the intervention also complicates study interpretation.

Reference:

Kahlmann, V., Moor, C. C., van Helmondt, S. J., et al. (2022). Online mindfulness-based cognitive therapy for fatigue in patients with sarcoidosis (TIRED): A randomised controlled trial. The Lancet Respiratory Medicine.

Link to study

Curbing post-operative pain after total knee surgery

Tue, 03 Jan 2023 19:18:57 GMT

Many older adults suffer from chronic arthritic knee pain. Over 700,000 Americans undergo total knee replacement surgery every year. While most patients benefit from knee replacement, up to a third of patients report persistent post-operative pain.

Pester et al. [Pain Medicine] conducted a pilot trial to test whether a brief mindfulness-based program reduces postoperative pain levels in a sample of patients undergoing total knee replacement.

The study recruited a sample of 22 Boston-area patients (age = 68 years; 55% female; 82% Caucasian) planning to undergo knee replacement and willing to participate in a mindfulness training intervention with a matched control sample of 22 Boston-area patients (age = 66 years; 55 % female; 91% Caucasian) participating in a larger knee replacement study not involving mindfulness training.

The samples were matched on age, arthritis diagnosis, stable medication dosage, and English language proficiency as well as the absence a variety of comorbid conditions (substance abuse, sleep disorder, autoimmune disease, neuropathy, dementia, and psychosis).

The mindfulness program was called Mindfulness-Based Cognitive Behavioral Therapy and was delivered in four single-hour sessions. The first and last sessions were delivered in person, and the second and third sessions were delivered via telephone. The first two sessions were delivered pre-surgically and the last two sessions post-surgically.

All sessions were taught by a clinical pain psychologist. The program included in-session practice and homework involving the body scan, sitting meditation, and lovingkindness meditation as well as cognitive-behavioral psychoeducation focusing on pacing physical activity, coping strategies, and avoiding catastrophizing about pain. The control group received knee surgery care treatment as usual.

Participants were assessed at baseline, six-weeks, and 3-and-6 months post-surgically on self-report measures of pain severity, catastrophizing, and interference with activities of daily living as well as measures of depression, and anxiety.

The results indicated that the mindfulness group showed a significantly lower pain score than controls at six weeks (partial η2=.12) with a non-significant trend towards reduced pain interference in their daily activities compared to controls (partial η2=.08).

An analysis of within-group effects at six weeks showed the mindfulness group experienced significantly reduced pain levels compared to their own baseline (partial η2=.33) but controls did not (partial η2=.00).

The groups did not differ at 3- and 6-month follow-up when both groups showed significant large reductions in pain over baseline. This was to be expected given most post-surgical pain resolves on its own over time.

The mindfulness group showed a significant reduction in pain catastrophizing scores at six weeks compared to their own baseline, but the control group did not. There were no between group or within group changes in depression and anxiety.

Reductions in pain catastrophizing scores were significantly associated with reductions in pain severity scores (r=.51).

The study shows that brief mindfulness training that includes elements of cognitive-behavioral therapy can reduce post-operative pain and speed recovery immediately after total knee replacement surgery. It appears this effect is due, at least in part, to a reduction in pain catastrophizing.

The study is limited by its lack of randomization, small sample size, and reliance on a standard care control.

Reference:

Pester, B. D., Wilson, J. M., Yoon, J., Lazaridou, A., et al. (2022). Brief Mindfulness-based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial. Pain Medicine.

Link to study

Surgeons who meditate prior to arthroscopic simulation perform better

Wed, 30 Nov 2022 19:46:48 GMT

Arthroscopic surgery of the knee and shoulder involves inserting a pencil-thin lens and lighting system though a small incision in the human body to view injured connective tissue. Joint repair is then performed with specialized instruments inserted through separate small incisions.

Although orthopedic residents learn to perform this precise surgery on arthroscopy simulators, it is often hard for trainees to retain a high level of proficiency. In part, this is because surgical performance is negatively impacted by factors such as operating room distractions and the surgeon’s mental state.

Li et al. [Arthroscopy] tested whether a mindfulness meditation app could improve orthopedic residents’ performance during arthroscopic surgical simulation as well as reduce stress and distraction.

The researchers randomly assigned 43 male meditation-naïve and arthroscopically-naive orthopedic residents in Guangzhou, China (average age = 26 years) to one of three training conditions. On the first day of the study, all residents attended a didactic lecture on knee arthroscopic surgery and performed practice surgery using an arthroscopic simulator. Residents continued simulator practice until they attained two consecutive perfect scores on a set of surgical tasks.

Performance scoring was calculated by a pre-programmed simulator algorithm using a scoring system developed by the Arthoscopy Association of North America. It included measures like procedure time, camera path length, and degree of simulated cartilage injury.

After that initial arthroscopic training, two of the groups meditated 10-minutes a day for a total of 10 days using the Tide smartphone app. The app included guided audio meditations focusing on topics such as acceptance, calmness, and bodily and emotional awareness.

On day 11, residents were re-evaluated on the arthroscopic simulator performance. One-half of the meditation-trained residents meditated for 10 minutes immediately prior to the evaluation, and the other half did not. Residents reported their stress and mindfulness (Cognitive and Affective Mindfulness Scale-Revised) on day 1 and day 11 of the study.

The results showed that meditation-trained residents who meditated immediately before the simulator evaluation performed significantly better than meditation-trained residents who did not meditate immediately before the evaluation. This improvement was noted on several measures including total simulator score, surgery completion time, and injury to cartilage.

In addition, meditation-trained residents who did not meditate immediately prior to the evaluation showed significantly less skill deterioration over the course of the eleven days than residents in the non-meditation control.

Both groups of meditators showed significantly reduced stress over time compared to the non-meditators who reported increased stress levels (partial η2=0.67). Mindfulness scores improved for both mindfulness groups and declined for non-meditating controls (partial η2=0.50).

The study shows meditation app use can reduce the normal deterioration in arthroscopic surgical skills over time, and that meditating immediately before a surgical evaluation can improve surgical performance by orthopedic residents. Meditation may accomplish this by reducing stress and improving attentional skills during a surgical task.

The study’s generalizability is limited by its reliance on a male-only sample and a simulated rather than real-life surgical outcome, and by the absence of an active control group.

Reference:

Li, W., Meng, X., Zhang, K.-J., Yang, Z., Feng, Z., Tong, K., & Tian, J. (2022). Meditation Using a Mobile App Improves Surgery Trainee Performance: A Simulation-Based Randomized Controlled Trial. Arthroscopy: The Journal of Arthroscopic & Related Surgery.

Link to study

Youth show lower amygdala response after mindfulness curriculum

Tue, 22 Nov 2022 20:39:09 GMT

There is some evidence that mindfulness training improves cognitive function and emotion regulation in adult samples. Less is known whether a similar effect generalizes to adolescents, given that adolescence is a developmental period in which cognitive and self-regulation functions are in the process of maturing.

Dumontheil et al. [Journal of Adolescence] tested the effect of mindfulness versus relaxation training on task-based cognitive performance and brain responsiveness to emotional stimuli in adolescents and adults. Their intent was to discern whether adults and adolescents responded to mindfulness training in the same way.

The researchers randomly assigned healthy, meditation-naïve British adolescent (N=28; average age = 14 years) and adult females (N= 23; average age = 28 years) to mindfulness or relaxation training. Trainings were offered in 8 weekly 90-minute group-based sessions with daily homework practice assigned.

Mindfulness training was based on “Learning to BREATHE,” a public school-based program founded on the principles of Mindfulness-Based Stress Reduction. Relaxation training taught a variety of unspecified relaxation techniques and skills.

Participants were assessed before and immediately after the training conditions on two computerized tasks. One task was used to assess attention control and a second emotional “N-back” task was used to assess emotion regulation. Participants completed these tasks while undergoing functional brain scans (fMRI).

The attention control task had participants view computer presented slides with a fixation cross with asterisks above or below the cross. The asterisks cued participants to look where a stimulus would most likely subsequently appear. The stimulus consisted of a set of arrows either all aligned in the same direction or with one misaligned arrow.

The attention control task required participants had to judge whether the stimulus arrows were all in alignment. The asterisk cueing where the stimulus was likely to appear was misleading 20% of the time. This required participants to reorient their attention when the stimulus finally appeared.

The emotional “N-back” task had participants view a series of computer-presented slides with a numeral appearing on each slide. Participants had to respond whenever a numeral was identical to one presented two slides earlier. Some numerals were presented alone, but others were flanked by pictures of happy, sad, or fearful faces that served as emotional distractors.

The results showed the misleading asterisks slowed attention task reaction time for the entire sample. Over the course of multiple trials, this slowing in reaction time significantly decreased in the mindfulness group but not in the relaxation control (d = -0.57). This effect was similar for adults and adolescents.

The study groups were similar on emotional “N-back task” accuracy and reaction time. However, adolescents in the mindfulness group showed a significant decrease in left amygdala activation in response to the emotional faces, whereas adolescents in the relaxation group and adults in either training group did not.

The amygdala is a part of the brain’s limbic system that is implicated in emotional responding. Decreased amygdala activation may indicate that the adolescent mindfulness group was better able to focus on the stimulus and ignore the task-irrelevant distracting emotional faces.

This study shows that mindfulness as compared to relaxation training results in improved reorientation of attention for adults and adolescents and improved emotional regulation in adolescents but not adults. This suggests that mindfulness training might offer a unique benefit for adolescents in terms of emotion regulation.

The study is limited by its small sample size, lack of predefined fMRI regions of interest, and by the use of a single teacher facilitating both groups.

Reference:

Dumontheil, I., Lyons, K. E., Russell, T. A., & Zelazo, P. D. (2022). A preliminary neuroimaging investigation of the effects of mindfulness training on attention reorienting and amygdala reactivity to emotional faces in adolescent and adult females. Journal of Adolescence.

Link to study

MBSR affects nitric oxide levels in people with asthma

Tue, 25 Oct 2022 20:47:06 GMT

Asthma is a chronic disease characterized by airway inflammation, obstruction, and hyper-reactivity that affects 8% of the U.S. population. Symptom severity is often exacerbated by psychological stress, and stress-reduction techniques may have an important role in asthma control.

Higgins et al. [Brain, Behavior, & Immunity] conducted a randomized, controlled study to test whether Mindfulness-Based Stress Reduction (MBSR) improves asthma control and reduces airway inflammation.

The researchers randomly assigned 73 adults with clinically diagnosed asthma (average age = 38 years; 59% female) to either MBSR or a wait-list control. MBSR was the standard 8-week group intervention including the intensive one-day meditation retreat.

Study assessments were conducted at baseline, the midpoint of the intervention, post-intervention, and at four monthly follow-ups. Participants were assessed on self-reported asthma severity, the amount of nitric oxide in their breath, sputum and blood eosinophil counts, and self-report measures of stress and mindfulness (the Five Facet Mindfulness Questionnaire).

Nitric oxide is a biomarker for airway inflammation. Eosinophils are white cells in the blood that are elevated in inflammatory diseases. Nitric oxide and eosinophil levels are up-regulated by separate interleukin pathways (IL-13 and IL-5 respectively). Nitric oxide is a specific biomarker for Type 2 asthma, the most common asthma subtype.

At baseline, asthma severity was significantly associated with higher levels of stress and general psychological symptomatology. Over the course of treatment, the MBSR group showed increased levels of mindfulness and decreased levels of psychological symptomatology compared to the control group.

Self-reported asthma severity showed significantly greater improvement in the MBSR group as compared to the control group (d = 0.76), and this benefit was maintained throughout the 4-month follow-up period.

Thirty-two percent of participants in the MBSR group showed clinically meaningful asthma improvement compared to only 13% of the control group. There was a modest but significant decrease in nitric oxide levels for MBSR group compared to the control group. Sputum and blood eosinophils showed no significant differences by study group.

The study shows MBSR improves self-reported asthma control and decreases nitric oxide levels in people with asthma. The study was limited by its use of a waiting list control and by measuring only two inflammatory biomarkers.

Reference:

Higgins, E. T., Davidson, R. J., Busse, W. W., Klaus, D. R., Bednarek, G. T., Goldman, R. I., Sachs, J., & Rosenkranz, M. A. (2022). Clinically relevant effects of Mindfulness-Based Stress Reduction in individuals with asthma. Brain, Behavior, & Immunity - Health.

Link to study

Stool bacteria in newborns linked with mother's mindfulness

Wed, 19 Oct 2022 17:05:35 GMT

The meconium, a newborn infant’s first stool, contains a rich diversity of bacterial species. Observational studies show that newborns from distressed mothers differ in terms of the frequency of bacterial species in their meconium. Differences in gut bacteria are associated with health in adults, and these differences could also play a role in newborn development.

Zhang et al. [Psychoneuroendocrinology] tested the effect of a mindfulness-based intervention on distress among pregnant mothers reporting elevated distress and examined their newborn infants’ meconium bacteria.

The researchers randomly assigned 160 distressed pregnant women in Shandong Province, China (mean age = 30 years) to either prenatal care as usual or prenatal care plus a 6-week mindfulness-based intervention. The women were classified as distressed based on baseline cut-off scores on self-report measures of anxiety and depression.

Mindfulness training was delivered individually over six weeks via a WeChat cellphone app. On the first day of each of the six weeks, the women viewed a 10 to 20-minute pre-recorded introduction to the topic of the week. On the following six days of each week, they engaged in 10-30 minutes of formal and informal theme-related mindfulness practices.

Themes included an introduction to mindfulness, awareness of present-moment experience, identifying avoidances, automatic vs. mindful responding, and mindfulness in childbirth. Meditation exercises were like those in Mindfulness-Based Stress Reduction (MBSR).

Maternal anxiety and depression self-report scores were collected at post-intervention. Stool from infant bowel movements during their first 48 hours after delivery were collected by maternity ward staff and sequenced for bacterial DNA identification.

There are two types of measures of bacterial diversity in stool samples: alpha and beta diversity. Alpha diversity is a measure of biodiversity within a single sample, whereas beta diversity is a measure of the similarity or dissimilarity of two samples.

Post-intervention results showed significantly lower average anxiety and depression self-report scores among women in the mindfulness compared to the control group. The study groups did not differ in stool alpha diversity.

Significant differences emerged by group, however, in stool beta diversity. Specifically, infant stools in the mindfulness group had higher levels of Bifidobacterium and Blautia, while infant stools from control mothers had higher levels of Staphylococcus.

The study shows that a mindfulness intervention for psychologically distressed pregnant women raises the level of “healthy” bacteria in their newborn infants’ gut systems Studies show Bifidobacterium levels are associated with neuropsychological development in children, and Blautia levels are shown to be lower in depressed adults.

The study is limited by its measuring stool meconium bacteria at only one time point, and the DNA sequencing method used could not correlate specific bacterial strains with maternal psychological variables.

Reference:

Zhang, X., Mao, F., Li, Y., Wang, J., Wu, L., Sun, J., & Cao, F. (2022). Effects of a maternal mindfulness intervention targeting prenatal psychological distress on infants’ meconium microbiota: A randomized controlled trial. Psychoneuroendocrinology, 145, 105913.

Link to study

Brain functional connectivity suggests awareness of mind wandering

Tue, 20 Sep 2022 15:38:33 GMT

Differing regions of the human brain work in tandem to form large-scale integrated brain networks. Three large-scale brain region networks organize much of human brain activity: the Central Executive Network (CEN), the Salience Network (SN), and the Default Mode Network (DMN).

The CEN is dominant when we are deliberately focusing on a task, the SN is dominant when we are evaluating sensory input in preparing to respond, and the DMN is dominant when we are off-task and mind-wandering.

These networks are relevant to mindfulness meditation which involves deliberate attentional focus (CEN) on bodily sensations (SN) that minimizes mind-wandering (DMN). Much of the research on the effect of mindfulness meditation training on these brain networks is limited by small sample sizes, correlational findings, and the lack of control groups.

Bremer et al. [Scientific Reports] tested the longitudinal effect of mindfulness training on the functional connectivity between these brain networks using functional magnetic resonance imaging (fMRI) with adult participants.

The researchers assigned 46 German meditation-naïve adults (50% male; average age = 35) to 31 days of either web-based mindfulness or health education training. Initial assignment was random, but researchers slightly adjusted the assignments to equalize the sex and age of the groups.

Participants underwent resting-state fMRI brain scans before and after intervention. Trainings involved daily 10-15-minute audio and video content. Mindfulness training was developed by a MBSR instructor. Health training involved excerpts from popular science broadcasts on a broad array of health topics. Participants needed to complete at least 23 sessions to be included in the data analysis.

fMRI data were analyzed for functional connectivity, dynamic functional connectivity, and seed-based connectivity. Functional connectivity measures how much two brain networks are interconnected at a given time. Dynamic functional connectivity measures how much connectivity between networks fluctuates in tandem over time. Seed-based connectivity measures how regions of interest interact with the whole brain.

While the functional connectivity analysis showed no significant effects, the dynamic functional connectivity analysis showed the mindfulness training group had increased dynamic functional connectivity between regions of the DMN and regions of the SN while controls did not.

Seed-based connectivity analysis (using the DMN and SN regions identified in the prior analysis as seeds) found similar increases in connectivity between regions of the DMN and SN in the mindfulness group but not controls.

The researchers interpret this greater functional connectivity as reflecting an individual’s growing awareness of when they are mind-wandering during mindfulness practice and using that awareness as a signal to return to focusing.

This study shows an increased DMN-SN dynamic functional connectivity after mindfulness training in naïve meditators. These brain findings offer some neural function correlates of how meditators track mind-wandering and re-focus attention.

The researchers caution that focused-attention and open-monitoring meditations would probably result in different patterns of connectivity.

Reference:

Bremer, B., Wu, Q., Mora Álvarez, M. G., Hölzel, B. K., Wilhelm, M., Hell, E., Tavacioglu, E. E., Torske, A., & Koch, K. (2022). Mindfulness meditation increases default mode, salience, and central executive network connectivity. Scientific Reports.

Link to study

Brief mindfulness training ups willingness to volunteer help

Tue, 13 Sep 2022 16:23:10 GMT

Does mindfulness practice increase altruism? Research suggests the answer is mixed. For example, mindfulness practice is shown to increase altruistic behavior among people who have a strong predisposition to altruism but decrease it when they are self-centered.

Interpreting the data from existing studies can be difficult because studies vary as to whether they teach mindfulness in conjunction with lovingkindness and compassion or as a stand-alone attentional practice.

Malin & Gumpel [Mindfulness] conducted an experiment to test whether a brief mindfulness practice affected people’s willingness to help someone in distress. They also examined whether mindfulness practice had a larger effect on helping behavior in people with higher initial levels of empathy.

The researchers randomly assigned 189 Israeli undergraduates (85% female; mean age = 21 years) to either mindfulness practice, listening to music, or listening to a lecture. Interventions and data collection were administered by Zoom.

The mindfulness group involved two 30-minute guided meditations offered one week apart. Meditation focused on non-judgmental observation of sensations, thoughts, and feelings during a body scan. Meditation training did not include training in loving-kindness or compassion.

Music and lecture control conditions were also offered in two 30-minute Zoom sessions one week apart. The music intervention consisted of relaxing classical music, and the lecture topics focused on empathy and help-giving. Participants were assessed prior to the intervention on a self-report measure of capacity for empathy.

At the end of the second intervention session, participants listened to a pre-recorded sham interview with a college student named “Anna.” Anna was alleged to be part of the college radio station’s effort to determine what content interested students. In the interview, Anna described her difficulties struggling with a chronic illness.

Study participants then completed questionnaires measuring state mindfulness and their empathic response to Anna. They were also provided an opportunity to register to volunteer for an organization that helped people like Anna. Participants intending to volunteer could also submit their personal information so that the volunteer organization could contact them.

Study results showed the mindfulness group had a significantly greater proportion of participants willing to volunteer to help people like Anna than the control groups. Thirty-six percent of the mindfulness group left contact information so that they could volunteer, while 14% of the music and 16% of the lecture group did.

Baseline empathy levels significantly predicted self-reported empathy for “Anna” in the mindfulness group (b=1.40), but not in the music (b=0.28) or lecture (b=0.09) groups. Specifically, mindfulness practice increased empathic responding in participants with high baseline levels of empathy and decreased empathic responding in those with low baseline levels of empathy. Listening to music or a lecture on empathy did not show this effect.

Self-reported empathy for “Anna” correlated with a willingness to volunteer in the mindfulness (r=.38) and music groups (r=.30) but not in the lecture group (r=.04).

The results show that guided meditation practice can increase the intention to volunteer to help a stranger in distress (at least shortly after mindfulness practice). People with high baseline levels of empathy have higher levels of empathic response to a person in distress after mindfulness practice. On the other hand, mindfulness decreases empathic responsiveness in people with low baseline levels of empathy.

The study is limited to the degree that it measures intent to volunteer rather than actual volunteering.

Reference:

Malin, Y., & Gumpel, T. P. (2022). Short Mindfulness Meditation Increases Help-Giving Intention Towards a Stranger in Distress. Mindfulness.

Link to study

HIV medication adherence in youth improves after MBSR

Wed, 24 Aug 2022 18:31:12 GMT

Adolescents and young adults are more likely to newly acquire HIV infections than other age groups. This young cohort is also less likely to access medical care, adhere to antiretroviral therapy, or achieve viral suppression when compared to older age cohorts.

Sibinga et al. [AIDS Care] evaluated whether Mindfulness-Based Stress Reduction (MBSR) could increase medication compliance and help reduce HIV viral load in adolescents and young adults living with HIV infection.

The researchers randomly assigned 74 HIV positive adolescents and young adults aged 13-24 (average age = 21; 92% Black) to MBSR, health education, or medical treatment as usual. The MBSR program included 8 weekly 2-hour sessions and a 3-hour retreat. MBSR content was modified to make it more relevant to urban youth.

The 8-week health education control was matched to MBSR in terms of the length and frequency of meetings and group size. It offered didactic information on physical activity, nutrition, weight, and personal care. Treatment as usual consisted of clinic visits and lab work every 3-6 months.

Data analysis showed no significant differences between the health education (N=32) and treatment as usual (N= 8) groups on any variables, and so the groups were combined as a single control group to compare against the MBSR group. While this was not the original plan for the trial, it added more power to compare MBSR to a study control group.

Average MBSR attendance was 6 sessions with 5 participants attending no sessions. Average health education attendance was 5 sessions with 7 participants attending no sessions.

Participants were assessed at baseline, post-treatment, and 6- and 12-month follow up on medication adherence (as measured by a self-report questionnaire of pills prescribed and taken and of missed doses per week), HIV viral load, and CD4 cell counts. Viral load is a measure of the presence of the virus in the bloodstream. CD4 count is a measure of cellular-based immunity. Higher viral load and lower CD4 count are indicators of disease progression.

Within-group results showed participants in both MBSR and the combined control group attained significantly higher rates of medication adherence at post-treatment (OR = 1.81) and 6-month follow-up (OR = 3.95) than at baseline. The MBSR group had a significantly greater increase in medication adherence at post-treatment than the control group (OR = 2.50). This relative improvement did not persist at 12 months.

At immediate post-treatment, there was a trend toward a greater MBSR HIV viral load decrease compared to the control group. This trend became significant when only participants who attended at least one intervention session were included in the analysis. CD4 levels were unchanged in both groups after the intervention.

The study shows a MBSR program modified to meet the needs of urban youth can significantly improve antiretroviral medication adherence for up to six months relative to a health education intervention. The study is limited by its reliance on a self-report measure of medication adherence given the limitations of human recall of taking pills as well as reporting bias.

Reference:

Sibinga, E. M. S., Webb, L., Perin, J., Tepper, V., Kerrigan, D., Grieb, S., Denison, J., & Ellen, J. (2022). Mindfulness instruction for medication adherence among adolescents and young adults living with HIV: A randomized controlled trial. AIDS Care.

Link to study

Less self-bias in personal ownership after mindfulness instruction

Thu, 11 Aug 2022 17:18:43 GMT

Our decision making is often biased in favor of benefit to ourselves. When categorizing whether possessions belong to us or someone else, we tend to be more accurate and make the decision more rapidly when the possessions are our own. This experimental result has been found so often that some researchers believe self-prioritizing is an inevitable part of decision-making. Interventions that reduce ego-involvement may reduce this type of self-bias.

In two separate experiments, Golubickis et al. [Psychonomic Bulletin and Review] tested whether a brief mindfulness meditation could reduce or eliminate decision-making self-bias compared to a control intervention.

In the first experiment, the researchers randomly assigned 160 undergraduates (83% female; average age = 22 years) to a brief mindfulness meditation or a control group. Participants accessed the experiment through an internet web portal. Once on the website, participants engaged in a 5-minute pre-recorded guided exercise. The mindfulness group was instructed to attend to their breathing non-judgmentally and to disidentify with thoughts. The control group was instructed to allow their minds to wander and immerse themselves in their thoughts, emotions, and memories.

After the guided exercises, participants were shown images on the computer of pens and pencils. Half of each study group was instructed to think of the pencils as their own and the pens as belonging to a friend. The other half of each study group was told to think of the pencils as their own and the pens as belonging to a friend. Participants were then shown 200 images of pens and pencils for 100 milliseconds each and asked to indicate whether each object was their own or belonged to the friend by pushing keyboard keys.

The second experiment was identical to the first, except the control group was assigned a different task. Participants were 160 undergraduates (74% female; average age = 22 years). In this study, the study control group was given 5 minutes to solve a visual puzzle task which involved constructing shapes out of polygons. This problem-solving task was selected by the researchers to rule out the possibility that the control group task in the first study may have inadvertently increased self-focused ego involvement.

Control groups in both studies were significantly more accurate in identifying items belonging to themselves than those belonging to friends. They also had quicker reaction times to their own objects as opposed to objects belonging to friends. Conversely, the mindfulness group responded to self-identified and other-identified items with equal accuracy and speed.

The researchers subsequently performed a computer modeling drift diffusion analysis. This type of analysis is designed to sort out whether study group differences are due to differences in processing stimulus information or due to differences in preparing to respond. Computer modeling in this way suggested the mindfulness group was more cautious about making a response about ownership, needed more information before deciding, and more quickly absorbed information about the pens and pencils.

This study shows a brief web-based guided mindfulness meditation can reduce self-bias in categorizing possessions as belonging to oneself. Thus, it supports the idea that mindfulness helps reduce certain types of ego-bias in cognitive processing related to ownership of inexpensive items.

Reference:

Golubickis, M., Tan, L. B. G., Saini, S., Catterall, K., Morozovaite, A., Khasa, S., & Macrae, C. N. (2022). Knock yourself out: Brief mindfulness-based meditation eliminates self-prioritization. Psychonomic Bulletin & Review.

Link to study

MBSR affects the human physiological response to a stress test

Mon, 08 Aug 2022 21:15:21 GMT

Our body’s adaptive response to a stressor occurs in temporal phases and is the outcome of complex interactions between the sympathetic and parasympathetic nervous systems and the endocrine system. This phased time scale is the outcome of feedback loops between the systems and the time it takes for stress hormones to both enter the blood stream and subsequently be deactivated. Many studies ignore this complexity by measuring stress at a single timepoint or with only a sole biomarker.

Gamaiunova, et al. [Biological Psychology] tested the effects of two different mindfulness-based interventions on multiple biological measures of stress across different temporal phases of the stress response. A better understanding of the temporal dynamics of these measures might help us better understand discrepancies between studies that show different results.

The researchers randomly assigned 99 healthy Swiss adult volunteers to Mindfulness-Based Stress Reduction (MBSR), Buddhist-enhanced Mindfulness-Based Stress Reduction (MBSR-B), or a waitlist control. Attrition was high, and data from only 65 participants (average age = 29 years; 65% female) were analyzed. MBSR was taught in 8 weekly 2.5-hour sessions with a 7th week retreat day and 55 minutes a day of homework. MBSR-B was similarly structured but included additional material on the Buddhist themes of impermanence, ethics, lovingkindness, compassion, non-self, and craving.

Following the study interventions, participants completed a social stress task in a laboratory setting. After being hooked up to an electrocardiograph (EKG), participants rested for ten minutes. Participants were then given 15 minutes to prepare a talk as part of a stress task. During the stress task, participants gave 5-minute speeches and engaged in 5 minutes of mental arithmetic while being recorded on camera and observed by two research assistants wearing white lab coats. The participants then remained in the lab for a 30-minute recovery period. EKGs were recorded from the start of the rest period through the recovery period.

Saliva samples of cortisol (a stress hormone) and α-amylase (a surrogate for serum epinephrine and norepinephrine) were drawn during the rest, anticipation, task, and recovery periods. EKGs were analyzed for heart rate variability and the duration of the pre-ejection period. Heart rate variability increases due to parasympathetic activity, and the pre-ejection period shortens due to sympathetic activity. Participants were also asked to rate their positive and negative affect during rest, anticipation, task, and recovery.

The results showed both MBSR groups had significantly lower cortisol levels under the curve during the anticipatory period than controls (d=0.78-0.82). They also showed significantly lower relative percent decreases in pre-ejection period duration than controls during the anticipatory (d=0.71-0.82) and task (d=0.70-0.87) periods, but not during the recovery period. Both MBSR groups showed a significantly lesser relative percent decrease in heart rate variability during the anticipatory (d = 0.72-0.88) and task (d = 0.88-1.05) periods than controls, but only the MBSR-B group showed a significant effect (d = 1.10) during the recovery period when compared to the control group.

The MBSR-B group reported smaller increases in negative affect than controls during the anticipatory phase (d=.97) while both treatment groups reported smaller increases in negative affect during the task phase (d=0.95-0.88). The treatment groups also reported smaller declines in positive affect than controls during the task phase (d =0.95-0.91). No between-group differences were noted for α-amylase levels.

The study shows MBSR and MBSR-B both reduce subjective and biological components of the laboratory-induced stress response, but these effects vary depending on the measure used and the phase of the stress response during which they were measured. The study was limited in its power to detect significant differences due to its relatively high attrition rate.

Reference:

Gamaiunova, L., Kreibig, S. D., Dan-Glauser, E., Pellerin, N., Brandt, P.-Y., & Kliegel, M. (2022). Effects of Two Mindfulness Based Interventions on the Distinct Phases of the Stress Response Across Different Physiological Systems. Biological Psychology.

Link to study

MBSR lessens frequency of ulcerative colitis flares

Wed, 03 Aug 2022 18:51:18 GMT

Ulcerative colitis is a debilitating chronic inflammatory bowel disease with symptoms that include diarrhea, abdominal pain, fecal incontinence, fever, and fatigue. The disease is characterized by acute symptomatic flares interspersed with periods of asymptomatic remission. Flares can be triggered by stress, and mindfulness-based interventions may have a role to play in disease management.

Jedel et al. [Inflammatory Bowel Diseases] tested whether mindfulness-based stress reduction (MBSR) could reduce symptom flare frequency and severity in patients with inactive ulcerative colitis.

The researchers randomly assigned 43 meditation-naïve ulcerative colitis patients with inactive disease (average age = 42 years; 58% female; 72% Caucasian) to either modified MBSR or a psychoeducational control. MBSR was delivered in 8 weekly 1½-2-hour weekly group sessions with a 4-hour retreat in the 7th week. The shortened session lengths were made to accommodate the very small class sizes.

The psychoeducational control consisted of similarly structured group sessions with didactic material on the causes of physical illness, the effects of stress on physical health, the protective role of exercise, and cardiovascular disease risk factors.

Participants completed assessments at baseline, post-intervention, and 6- and 12-month follow-up. Participants completed measures of perceived stress, depression, anxiety, sleep quality, mindfulness (Five-Facet Mindfulness Questionnaire), disease symptoms and quality of life. They also submitted stool, urine, and blood samples, and were given sigmoidoscopies.

Stool samples were evaluated for levels of calprotectin which is associated with bowel inflammation, and urine samples were evaluated for levels of cortisol (a stress hormone). Blood samples were assessed for the proinflammatory biomarkers IL-6, IL-8, and C-reactive protein.

The results showed MBSR participants experienced significantly fewer flares: none of the 20 MBSR participants experienced flares while 5 of the 23 controls did. There were no significant between-group differences on any biological or psychological measure once participants who experienced flares were excluded. Those who experienced flares were excluded because the steroid treatment they received for their flares would have influenced their biological markers.

Mindfulness scores were significantly correlated with decreased perceived stress scores (r= -.54) and calprotectin levels were correlated with elevated urinary cortisol (r = .37), supporting the role of stress in ulcerative colitis.

The study shows that MBSR reduced the incidence of symptom flares in ulcerative colitis patients relative to a psychoeducation program.

The study is limited by its small sample size. The researchers also interpreted MBSR as having a positive effect on several psychological variables (e.g., mindfulness, depression) because of significant within-group improvements on these variables over time even though there were no between-group differences on these variables.

Reference:

Jedel, S., Beck, T., Swanson, G., Hood, M. M., Voigt, R. M., Gorenz, A., Jakate, S., Raeisi, S., Hobfoll, S., & Keshavarzian, A. (2022). Mindfulness Intervention Decreases Frequency and Severity of Flares in Inactive Ulcerative Colitis Patients: Results of a Phase II, Randomized, Placebo-Controlled Trial. Inflammatory Bowel Diseases.

Link to study

MBSR enhances worker authenticity but not hiding of medical errors

Wed, 29 Jun 2022 16:10:33 GMT

To err is human, but for organizations like hospitals even small errors can cost lives. Organizations try to anticipate and avoid errors, and high-stake demands to not err can motivate employees to hide mistakes when they occur. People who are more “authentic” may be less likely to hide their errors because their self-worth is less dependent on what others think of them.

Mindfulness may aid authenticity by facilitating greater self-awareness and self-acceptance, thereby enabling people to act in accord with their values.

Choi et al. [Journal of Occupational Health Psychology] explored how changes in mindfulness affect authenticity and error hiding. They also studied the effects of mindfulness training compared to exercise or a wait-list control on mindfulness, authenticity, error hiding, and qualitative interview content.

The researchers randomly assigned 230 employees (94% female; age range=25-54 years; 35% held front-line clinical roles) from four Canadian hospitals to Mindfulness-Based Stress Reduction (MBSR), Pilates training, or a wait-list control.

The 8-week MBSR program was modified so that weekly group-based classes were one hour long. Pilates exercise training was also taught in a series of 8 one-hour weekly group sessions and was designed to improve core strength, balance, flexibility, and relaxation.

Participants were assessed at baseline, post-intervention, and one-month follow-up on measures of mindfulness (5 items from the Mindful Attention and Awareness Scale), authentic functioning (12 items from the Authentic Functioning Scale) and error hiding (3 items from the Error Orientation and Motivation Scale).

The authentic functioning measure included items like “I frequently pretend to enjoy something when in actuality I really don’t.” The error hiding measure included items like “I do what I can to make sure that no one knows I make mistakes.”

The results show that all three groups showed increases in mindfulness scores over time but there were no significant between-group differences. The MBSR group showed significantly greater increases in authentic functioning than both comparison groups at post-intervention and follow-up. There were no significant differences in error hiding over time or between conditions.

The researchers then examined the interrelationship between changes in variables over time regardless of group assignment. They found that the rate of increase in mindfulness correlated with the rate of increase in authentic functioning (r = .76), which in turn correlated with the rate of decrease in error hiding (r = -.45).

A qualitative analysis of post-intervention interviews with MBSR and Pilates participants showed increases in self-acceptance, self-awareness, self-compassion, self-esteem, and self-determination. There were dramatic between-group differences in how often these themes were reported. For example, 71% of the MBSR group reported improvements in attention and awareness, while only 21% of the Pilates exercise group did.

Similarly 50% of the MBSR group reported greater life fulfillment, while 0% of the Pilates group did. The same magnitude of differences occurred with greater reports of improved work-related outcomes, interpersonal effects, emotional regulation, and relationship with oneself in the MBSR group.

The study shows MBSR is more effective in increasing authentic functioning than Pilates exercise or a wait-list control. There was no evidence MBSR reduces error hiding, but the error hiding measure used was probably too brief to show much variability in scores. It also only measured what people were willing to say about how they viewed making errors, and did not measure actual errors, either hidden or unhidden.

The study is limited by its reliance on self-report measures, and the fact that qualitative analysis raters were not blinded to condition.

Reference:

Choi, E., Leroy, H., Johnson, A., & Nguyen, H. (2022). Flaws and all: How mindfulness reduces error hiding by enhancing authentic functioning. Journal of Occupational Health Psychology.

Link to study

Structural brain changes not replicated for MBSR

Mon, 27 Jun 2022 18:55:35 GMT

Findings from several pilot studies have led many to believe that just 8 weeks of Mindfulness-Based Stress Reduction (MBSR) can induce measurable brain structural changes. These changes, if true, would be important to highlight the mechanisms underlying gains in attention and emotion regulation after individuals participate in MBSR.

MBSR studies that show structural brain changes, however, rely on small participant samples and either use participants as their own controls or lack active controls. Such preliminary study designs tend to err on the side of detecting effects that are not always genuine or robust.

Kral et al. [Science Advances] attempted to replicate the previous findings that showed brain structural changes occurring after MBSR. The investigators pooled Magnetic Resonance Imaging (MRI) data from two previously published studies that had sufficient sample sizes and used randomization to groups as well as an active control comparison condition. Pooling data from two studies can increase power to detect significant brain change differences by study group.

The researchers pooled then analyzed data from two published studies (N=218, average age = 46; 61% female; 84% Caucasian). Participants were drawn from a non-patient population and were meditation naïve. They were randomly assigned to a standard 8-week MBSR program, a Health Education Program, or a wait-list control. MBSR and Health Education

Programs were matched on the number and length of group classes and the amount of homework assigned. The Health Education Program included exercise, music therapy, and nutrition education and practice.

Participants were assessed at baseline and post-intervention on a variety of psychological measures including the Five Facet Mindfulness Questionnaire, and on MRI scans that yielded brain structural measures of gray matter density, gray matter volume, and cortical thickness. Brain regions of interest included the amygdala, hippocampus, cerebellum, posterior parietal cortex, temporal-parietal junction, caudate, and insula.

The pooled results showed no significant between-group differences on any brain structural changes in the areas of interest. The only significant result was an association between the amount of MBSR home practice and reduced right amygdala volume (partial η2=0.08), but there was no significant group x home practice time interaction.

While brain structure remained unchanged, previously published data from these studies showed significant between-group differences in mindfulness, psychological well-being, and brain region functional connectivity.

This replication analysis of pooled data from two controlled trials does not support results from previous studies showing that 8-weeks of MBSR induces structural brain changes. The study does not rule out the possibility that longer amounts of mindfulness practice, beyond eight weeks, may induce structural brain changes.

The study is important in that it underscores the importance of conducting well-controlled replication studies before pilot study results can be interpreted with confidence.

Reference:

Kral, T. R. A., Davis, K., Korponay, C., Hirshberg, M. J., Hoel, R., Tello, L. Y., Goldman, R. I., Rosenkranz, M. A., Lutz, A., & Davidson, R. J. (2022). Absence of structural brain changes from mindfulness-based stress reduction: Two combined randomized controlled trials. Science Advances.

Link to study

Headspace app bests music listening on immune cell epigenetic activity

Thu, 02 Jun 2022 16:05:22 GMT

Epigenetics is the study of how behaviors and environments turn the genes of our fixed DNA “on” or “off” to produce proteins and so alter cellular activity. NF-κB (Nuclear Factor kappa B) refers to a family of naturally occurring protein transcription factors that activate DNA to regulate our immune cells.

In response to stress in humans and other animals, there is often increased NF-κB activity that functions as an evolved inflammatory response to address the physical injury often accompanying stress.

Prior research shows that mindfulness training can down-regulate pro-inflammatory gene expression in samples experiencing elevated stress including lonely older adults, breast cancer survivors, and people with sleep disorders.

Dutcher et al. [Brain, Behavior, and Immunity] conducted a randomized controlled trial to test whether mindfulness training down-regulates pro-inflammatory gene expression in elevated stress adults who lack pre-existing medical conditions.

The researchers randomly assigned 100 generally healthy call-center customer service employees (average age= 34 years; 67% female; 64% Caucasian) who reported elevated subjective levels of stress to a mindfulness training or active control condition.

Participants listened to 10-20-minute daily audio lessons on their smartphones across 30 days. Compliance was high, with each groups completing 97% of their smartphone assignments.

The mindfulness group listened to audio content of the Headspace app basics program that offers guided mindful awareness practices. The control group listened to audio content for a similar amount of time that focused on problem solving, planning, analytic thinking, self-reflection, and guided imagery. This comparator was intended to also reduce levels of perceived stress.

Participants completed a perceived stress scale and donated blood samples at baseline and one-week post-intervention. RNA was extracted from blood samples and analyzed for gene expression patterns.

The results showed both the mindfulness group (d = 0.87) and the active control group (d = 0.86) showed significant large-sized reductions in subjectively reported stress. There was no significant between-group difference.

The mindfulness group showed a greater reduction in gene activation in the pro-inflammatory NF-κB pathway than did controls (d = -0.30). The effect size for the difference in gene activation between groups was small.

This human subjects trial showed both mindfulness training and psychoeducation apps reduce subjectively reported stress levels in people who are generally healthy and employed yet with elevated stress. Only the mindfulness group showed a significant reduction in pro-inflammatory gene expression activity. This finding is potentially important because elevated inflammation is associated with a variety of physical and mental illnesses.

The study is limited by its lack of long-term follow-up as well as a lack of a waitlist control to account for extraneous factors influencing genomic activity.

Reference:

Dutcher, J. M., Cole, S. W., Williams, A. C., & Creswell, J. D. (2022). Smartphone mindfulness meditation training reduces Pro-inflammatory gene expression in stressed adults: A randomized controlled trial. Brain, Behavior, and Immunity, 103, 171–177.

Link to study

Smartphone games to assess cognitive shift after mindfulness

Wed, 01 Jun 2022 17:43:51 GMT

Smartphone apps are handy for collecting data as well as for delivering intervention content. This opens the possibility of collecting objective data from large samples of participants without tying up limited research laboratory time and budgets.

Axelsen et al. [BMC Psychology] tested the effect of smartphone app-based mindfulness training against app-based music listening on attention and cognitive working memory in a large sample of business employees. A novelty of this study was the use of smartphone-based cognitive games to assess changes in participant attention and working memory.

The researchers used social media ads to recruit 623 Danish business employees to participate in a stress-reduction study. Participants were randomly assigned to a mindfulness, music-listening, or wait-list control condition. After excluding drop-outs and participants with incomplete data, data were analyzed from a sample of 459 participants (average age = 39 years; 50% male).

Drop-out and noncompletion rates were similar for the mindfulness (32%) and music (29%) groups, and lower for the wait-list controls (14%).

The mindfulness group listened to audio lessons on the Headspace apps basics program for 10 minutes daily for 30 days. The music group listened to music selections from four playlists (“focus,” “binaural beats,” “piano, “Low-Fi”) for 10 minutes daily for 30 days.

Prior studies show that music listening can improve sustained attention and reduce mental fatigue, while listening to binaural beats in the beta wave range can improve mood and vigilance.

Participants completed baseline and post-intervention measures using a perceived stress scale and two smartphone games related to cognitive performance. The “Go Sushi Go” game served as a measure sustained attention, that is, the ability to maintain focus on a task over time. Whenever participants saw an image of fresh sushi, they were to tap the screen, and whenever they saw a piece of spoiled sushi, they were to do nothing.

The “Animal Parade” game served as a measure of working memory, that is, holding previously observed information in mind and then recalling that information. As images of animals floated by one at a time, participants tapped the screen whenever an image was the exact same they saw two animals before that image. Participants earned points for correct answers that they could then use to access new “worlds” within the app.

Results showed both the mindfulness (d = 0.67) and the music (d = 0.60) groups experienced decreased perceived stress, while the control group did not (η2p = 0.05). The mindfulness (d = -0.8) and music (d = -0.3) groups showed improved sustained attention scores on the “Go Sushi Go” game but the control group did not (η2p = 0.07); score improvement in the mindfulness group was significantly greater than that of the music and control groups.

Only the mindfulness group (d = 0.95) showed improved working memory scores on “Animal Parade” game (η2p=0.17).

The study shows that mindfulness training or music app use for 10 minutes daily reduces aggregate group levels of perceived stress relative to a waitlist control. The mindfulness app also improves performance scores related to sustained attention and working memory better than an active music-listening control.

The study demonstrates the potential of using smartphones to deliver interventions as well as to assess outcomes, allowing researchers to obtain adequate sample sizes with less inconvenience to participants and researchers.

Reference:

Axelsen, J. L., Meline, J. S. J., Staiano, W., & Kirk, U. (2022). Mindfulness and music interventions in the workplace: Assessment of sustained attention and working memory using a crowdsourcing approach. BMC Psychology, 10(1), 108.

Link to study

Self-regulation after MBSR linked to acceptance, reappraisal

Tue, 26 Apr 2022 22:14:48 GMT

We often comfort those who are distraught by offering them the same advice we would offer ourselves were we in the same situation. Helping others to emotionally self-regulate can sometimes be stressful, however, especially when one’s efforts fail. Mindfulness-Based Stress Reduction (MBSR) can help people regulate their own stress but little is known about whether it can also reduce the stress of trying to help others.

Guendelman et al. [Neuroimgage] used a randomized controlled trial to test the effect of MBSR on participants’ use of acceptance, permission, and cognitive reappraisal strategies to regulate their own stress as well as the stress of another person and examined the brain regions associated with self- and other-regulation.

The researchers randomly assigned 68 German adults (average age = 38 years; 83% female) to either MBSR or a control condition. The MBSR program met in 8 standard weekly 2.5-hour group sessions with an all-day retreat and homework.

The control group met with the same frequency and read, listened to, shared, and discussed works of fiction, myth, and poetry in group and listened to audiobooks at home.

Participants were assessed at baseline and after intervention on a self-other emotional regulation task while undergoing brain functional magnetic resonance imaging (fMRI). The task required participants to alternately try to regulate their own emotions and the emotions of a confederate as they both viewed aversive and neutral photographs.

The photographs included the instructions “Gently accept!”, “Permit the reaction!”, or “This is just a photo!” which the participants alternately voiced to either themselves or the confederate. Participants were instructed as to what these acceptance, permission, and reappraisal strategies involved before beginning the task. These strategies were designed to reflect the strategies often presumed to underlie the effectiveness of MBSR.

Participants were also given false feedback on some trials that they had failed to successfully regulate their own or the confederate’s stress. Participants rated their stress after each photograph.

Study results showed the MBSR group showed significantly lower stress over time during self-regulation reappraisal trials while controls did not (η2p= .11). During self-regulation acceptance trials, the control group experienced increasing levels of stress, while the MBSR group did not (η2p= .09). No significant group x time interactions were found during the other-regulation trials or during any of the “permission” trials.

A complex pattern of significant brain region activation differences were found between the MBSR and control group during self-regulation acceptance, other-regulation reappraisal, and other-regulation acceptance trials.

The group of MBSR participants displayed greater brain activation in the parietal and insular cortices when regulating self-stress and in the precuneus and temporo-parietal junction when regulating other’s stress, especially while using the acceptance strategy. Brain region activation levels were not correlated with changes in self-reported stress.

The study shows MBSR can help participants self-regulate their own stress through both acceptance and cognitive reappraisal strategies but has no effect on the stress of attempting to regulate another person’s emotions.

Interpretation of the study is complicated by the fact that MBSR participants reported significantly greater stress during self-regulation reappraisal trials at baseline.

Reference:

Guendelman, S., Bayer, M., Prehn, K., & Dziobek, I. (2022). Towards a mechanistic understanding of mindfulness-based stress reduction (MBSR) using an RCT neuroimaging approach: Effects on regulating own stress in social and non-social situations. NeuroImage, 119059.

Link to study

Infant nervous system activity gains after mom practices mindfulness

Mon, 25 Apr 2022 18:16:39 GMT

Infants whose mothers were highly stressed during pregnancy often show altered autonomic nervous system responsiveness to stress after birth. This is important because autonomic responsiveness is associated with childhood behavioral problems. For example, dysregulated sympathetic reactivity is associated with antisocial behavior, substance use, and anxiety. Mindfulness-based interventions that reduce maternal stress may potentially exert influence on fetal development.

Noroña-Zhou et al. [Psychosomatic Medicine] compared autonomic and behavioral reactivity and regulation in infants whose mothers with elevated stress had previously participated in either a mindfulness-based program or a control group during pregnancy.

The researchers identified 135 6-month-old infants (46% Mixed Race, 36% Black, 17% White) whose mothers had previously completed an 8-week Mindful Moms Training intervention during pregnancy or had served as controls for that study. The mothers were primarily low-income (median income = $18,000) who reported high levels of stress.

The Mindful Moms program was delivered in eight 2-hour weekly group sessions that combined Mindfulness-Based Stress Reduction, mindful-eating, and support for nutrition and exercise. The control condition was maternity care provided as usual. Previously published results from this trial showed Mindful Moms improved mothers’ levels of stress, depression, activity level, and glucose tolerance relative to controls.

Sixty-five of the infant-mother pairs were assessed at 6 months of age using a five phase “still face” paradigm to induce infant stress. In this, mothers played normally with their infants for 30 seconds, then stopped interacting with or responding to them and maintained a neutral facial expression for another 30 seconds. The parents then resumed normal responsiveness followed by another “still face” episode and a final resumption of normal responsiveness.

Infant electrocardiograms (EKGs) were monitored throughout the task. EKG respiratory sinus arrythmias served as a measure of parasympathetic reactivity and the length of EKG pre-ejection periods served as a measure of sympathetic reactivity. Infant behaviors were videotaped and rated by study blinded observers for fussing, withdrawal, and protest as well as visual engagement with objects in the environment.

Results showed infants in the Mindful Moms group increased their sympathetic activity earlier on in the first still face episode than controls, but that controls showed persistent elevated sympathetic activity throughout the remainder of the task whereas mindful infants returned towards baseline.

While all infants showed some decline in positive visual engagement with objects after the first still face episode, mindful infants declined less and showed greater positive visual engagement than controls during the remainder of the task.

There were no group differences in parasympathetic activity or negative behaviors like fussing or withdrawal.

The findings of the study reveal that infants of stressed mothers who participated in a mindfulness intervention show increased sympathetic responsiveness, better sympathetic recovery, and more persistent visual engagement with the environment in response to stress than controls.

The study is limited by its lack of baseline equivalence for gestational age yet this variable was not influential on the treatment effect when covaried statistically.

Reference:

Noroña-Zhou, A. N., Coccia, M., Epel, E., Vieten, C., Adler, N. E., Laraia, B., Jones-Mason, K., Alkon, A., & Bush, N. R. (2022). The Effects of a Prenatal Mindfulness Intervention on Infant Autonomic and Behavioral Reactivity and Regulation. Psychosomatic Medicine.

Link to study

Six-week mindfulness training linked to 39% decrease in glaucoma risk

Mon, 04 Apr 2022 16:13:51 GMT

Elevations and large fluctuations in eye fluid pressure are risk factors for glaucoma, a disease that results in optic nerve damage and blindness. Experts disagree on when it is best to monitor eye fluid pressure and when it is best to initiate medical treatment.

While pharmacological treatments reduce glaucoma risk, they can be expensive and cause unwanted side effects. In addition, knowing one is at risk for glaucoma can increase stress which can further elevate eye fluid pressure and decrease quality of life.

Dada et al. [American Journal of Ophthalmology] investigated whether mindfulness meditation could reduce eye fluid pressure and fluid pressure fluctuations, thus delaying or reducing the need for pharmaceutical treatment. Normal eye fluid pressure is ≤ 20 mm Hg, and every 1 mm Hg decrease in pressure results in a 10% decrease in glaucoma risk.

The researchers randomly assigned 60 patients attending a New Delhi glaucoma clinic with eye fluid pressure elevations of 21-30 mm Hg (average age = 52 years) to mindfulness meditation or a wait-list control group. The mindfulness group included two one-hour trainings in breath-focused mindfulness meditation and 60-minutes of daily practice at home for 6 weeks.

Study personnel called participants on a weekly basis to encourage continued practice and insure correct technique. Participants completed assessments at baseline and six weeks after baseline (or after intervention) on measures of eye fluid pressure (taken every 3 hours across a 15-hour interval), optic disc blood vessel density and perfusion, a single 8:00 AM blood serum cortisol, and self-reported quality-of-life.

The results showed the mindfulness group had a significantly greater reduction in eye fluid pressure (-3.9 mm Hg) than controls (-0.18 mm Hg). The mindfulness group also showed significant reductions in diurnal pressure fluctuation (-2.14 mm Hg) while controls did not (-0.20 mm Hg).

Average optic disc blood vessel density and perfusion improved more for mindfulness than control participants. The mindfulness group also reported a significantly greater improvement in quality of life than controls.

Lastly, mindfulness practitioners saw a significantly greater decrease in morning serum cortisol (-2.54 μg/dl) than controls (+0.38 μg/dl). Serum cortisol reductions were correlated with decreased eye fluid pressure (r=-.73), reduced diurnal fluctuation in pressure (r=-.56), and improved quality of life (r=.62).

The study shows mindfulness mediation training can reduce clinically-evaluated risk factors for developing glaucoma. The reported average drop in eye fluid pressure for mindfulness participants reflects a 39% decrease in risk for glaucoma progression.

It is unclear how long this improvement persists, and how much daily meditation practice is needed to maintain it. The study is limited by its lack of published information on the extent of home practice compliance and the absence of an active control.

Reference:

Dada, T., Mondal, S., Midha, N., Mahalingam, K., Sihota, R., Gupta, S., Angmo, D., & Yadav, R. K. (2022). Effect of mindfulness-based stress reduction on IOP in patients with ocular hypertension: A randomized control trial. American Journal of Ophthalmology.

Link to study

Meditation styles differ in their brain frontal lobe activity

Thu, 17 Mar 2022 15:56:44 GMT

Mindfulness-based trainings typically combine focused-attention meditation with open-monitoring meditation that involves attending to the entire field of awareness. Little is known about how these different types of meditation uniquely contribute to emotional well-being.

Brown at al. [Psychophysiology] investigated the effects of these meditations, separately and combined, on measures of emotional reactivity and regulation.

The researchers randomly assigned 104 meditation-naïve predominantly female, Caucasian adults (average age = 40 years) with persistent mild-to-severe depression, anxiety, and/or stress to a focused-attention meditation training program, an open-monitoring meditation program, or a Mindfulness-Based Cognitive Therapy (MBCT) program that includes both types of meditation training.

All three programs were offered in formats that included 8 three-hour weekly groups and a full-day retreat. Participants were encouraged to engage in 45 minutes of daily home meditation practice. The focused-attention group used sensations such as the breath to anchor their meditations, while the open-monitoring group used mental noting to attend to the full range of sensory, cognitive, and emotional experiences.

Participants completed baseline and post-training electroencephalographic (EEG) measures of emotional reactivity and regulation. They were presented with a series of computerized positive, negative, and neutral images.

For the first 4 seconds of each image presentation, participants simply looked at the image allowing emotional reactions to arise. During the following 10 seconds they employed the meditative strategy they had been taught to regulate their emotional reactions to the picture—either breathing or mental noting. Participants also rated their mood after each viewing.

An EEG recorded any frontal lobe alpha wave asymmetry in response to the images. Greater left > right frontal alpha wave activity is associated with an approach response to stimuli, while greater right > left frontal alpha wave activity is associated with an avoidance response. Increased left > right activity reflects a decrease in negative emotional responsiveness to a stimulus.

Over the course of training, the MBCT and focused-attention groups showed significantly greater increased leftward shifts in alpha wave asymmetry compared to the open-monitoring group. This was true for both the emotional reactivity and the emotional regulation phases of EEG recording.

All three groups reported improved self-reported mood while viewing negative images from baseline to post-training with open-monitoring (d=0.63) and focused-attention groups (d=0.54) showing larger mood improvements than the MBCT group (d=0.21).

The study shows greater shifts in frontal lobe alpha wave asymmetry for focused-attention and MBCT training, but greater improvement in self-reported mood for open-monitoring training. It is not clear why these EEG and self-report results diverge. The study is limited by the lack of a non-meditation control group.

Reference:

Brown, K. W., Berry, D., Eichel, K., Beloborodova, P., Rahrig, H., Britton, W. B. (2022). Comparing impacts of meditation training in focused attention, open monitoring, and mindfulness-based cognitive therapy on emotion reactivity and regulation: Neural and subjective evidence from a dismantling study. Psychophysiology.

Link to study

Once per month mindfulness course does not ease resident burnout

Tue, 08 Mar 2022 17:02:08 GMT

Trainees in pediatric medical residencies face a high level of occupational demand. Between 39-75% of residents report occupational burnout. This is experienced as emotional exhaustion, impaired work performance, and decreased empathy for patients. Mindfulness training might prevent burnout through its focus on stress management and empathy; however, it requires extra time which overburdened residents lack.

Fraiman et al. [JAMA Pediatrics] developed a mindfulness-based training that could be practically integrated into pediatric residencies and tested whether it could help prevent emotional exhaustion and burnout.

The researchers recruited 15 pediatric medical residency programs that included a total of 365 eligible pediatric residents to participate in the study. Programs were randomly assigned to the mindfulness training or control arm after pairing them on location and size. Six residents declined participation, leading to an initial sample of 359 participants (75% female).

The mindfulness program included 1-hour monthly meetings for the first 7 months of the program. Residents were encouraged but not required to attend, and attendance was not taken. Each monthly meeting began with a social lunch followed by a minute of silence, introductory remarks, a mindfulness exercise, and a subsequent debriefing.

Mindfulness exercises were designed to be ones residents could integrate into their busy days and be relevant to their work. Two weeks after each meeting, residents were invited to utilize a 10-minute pre-recorded guided body scan.

The control arm of the study involved 7 one-hour social lunches without instruction. Residents in both arms were assessed at baseline, 6 months, and 15 months on self-report measures of emotional exhaustion (study primary outcome), depersonalization, empathy, personal accomplishment, burnout, perspective taking, and mindfulness (Five Facet Mindfulness Questionnaire).

Participant dropout rates from the study follow up were 20% at 6 months and 43% at 15 months, and were roughly equal across groups

The results showed no difference between the mindfulness and socializing groups over time on emotional exhaustion, burnout, empathy, perspective taking, or mindfulness. Most residents reported burnout at baseline (75% in the mindfulness group and 60% in the control arm) and burnout increased over time in each group.

By month 15, 84% of the mindfulness group and 88% of the control group reported burnout. Self-reported frequency in use of mindfulness practices did not differ by group, indicating both groups used mindfulness to a similar degree.

The study showed a low-dose, once per monthly mindfulness intervention adapted to the occupational needs of pediatric residents did not outperform a time-matched socializing group on reducing emotional exhaustion and burnout.

Resident burnout rates at baseline were much higher than those reported in prior studies. The adapted program used in this study was much less intensive than most mindfulness programs, not taught by trained mindfulness teachers, and no records were kept of attendance or home practice.

Reference:

Fraiman, Y. S., Cheston, C. C., Cabral, H. J.,... Sox, C. M. (2022). Effect of a Novel Mindfulness Curriculum on Burnout During Pediatric Internship: A Cluster Randomized Clinical Trial. JAMA Pediatrics.

Link to study

MBSR reduces negativity bias to ambiguous social cues

Wed, 16 Feb 2022 18:43:57 GMT

Our ability to get along well with others depends on being able to read social cues. When a social cue such as a facial expression has an unclear meaning, people are often biased in the way they interpret it. For example, when viewing a facial expression of surprise, some people tend to interpret the expression positively (the person received a gift) while others tend to interpret it negatively (the person witnessed an accident). However, facial expressions alone do not indicate their cause, so the viewers’ assumptions are a function of their unique cognitive bias.

Biases in attributing emotion and cause are tied to brain activity. Negative attributions are associated with activity in emotional centers of the brain (the amygdala), while positive attributions are associated with problem solving regions (the frontal lobes). Negative attributions tend to be more automatic, but positive attributions require more cognitive processing and emotional regulation.

Harp et al. [Journal of Experimental Psychology: General] tested the effects of Mindfulness-Based Stress Reduction (MBSR) on negative and positive biases in response to viewing surprised faces.

The researchers relied on three samples: a cohort of 58 MBSR participants (mean age = 42 years; 90% white), and two independent comparison cohorts drawn from two separate longitudinal studies (Cohort 1: mean age = 45 years; 93% White; Cohort 2: mean age = 40 years; 93% White). MBSR was delivered using the standard 8-week group format with the 8-hour retreat.

Participants in all three cohorts were assessed on an ambiguous social cue task at five separate time points over 16 weeks. For the MBSR cohort, this occurred at baseline, after the first MBSR class, before the last MBSR class, after the last MBSR class, and 8 weeks after the last class. During these assessment sessions, participants viewed computer-presented photographs of happy, angry, and surprised faces and asked to categorize the expressions as positive or negative by clicking on the words “positive” or “negative” with a computer mouse.

The primary outcome measure was the percent of surprised faces that were judged as negative. Participants also completed the Five Facet Mindfulness Questionnaire (FFMQ) at baseline, 8 weeks, and 16 weeks.

The results showed the MBSR group’s judgments of surprised faces became significantly more positive over the course of training and that this shift towards positivity continued to grow though during the two months post-training. This shift to increased positivity was significantly correlated with increased non-reactivity on the FFMQ (r =-.38). This kind of shift towards positivity did not occur in the two untreated comparison groups.

An analysis of computer mouse movements found that the MBSR group’s computer mouse trajectories for surprised faces became significantly more direct over the course of training suggesting the training was helping participants to override their initial negativity bias.

The study shows MBSR decreases participants’ bias to view ambiguous social cues in a negative way, and that this decreased response bias is associated with increased mindful non-reactivity. The study is limited by the absence of a randomized control group.

Reference:

Harp, N. R., Freeman, J. B., & Neta, M. (2022). Mindfulness-based stress reduction triggers a long-term shift toward more positive appraisals of emotional ambiguity. Journal of Experimental Psychology: General.

Link to study

Balance training and mindful walking equal for older adult mobility

Wed, 26 Jan 2022 16:44:13 GMT

Falls are the leading cause of fatal and nonfatal injuries in the elderly. One-third of adults older than 65 and half of those older than 80 fall at least once a year, with 5% of these falls resulting in fracture or hospitalization. Several interventions are shown to be effective in reducing falls including balance training, tai chi, and treadmill exercise.

There is reason to think that greater mindfulness while walking might also be helpful given its attentional focus to sensory experience while walking. Phoobangkerdphol et al. [Clinical Rehabilitation] tested the efficacy of walking meditation practice against conventional balance training in reducing falls in older adults with elevated fall risk.

The researchers randomly assigned 68 Thai Buddhist adults over age 60 who had fallen at least once in the past year (age range = 60-85; 85% female) to either a walking meditation or balance training intervention. Participants attended a training session and were given a brochure and instructional CD to aid practice on their own at home.

All participants were told to practice 20-30 minutes a day, 5-7 days a week and keep daily logs of their assigned practice. At 6 months, participants were given the option of continuing to practice for an additional 3 months, and most of the participants who had completed the six-month program elected to continue to practice.

Walking meditation involved slow paced walking along a 5-meter course with attention to lifting, moving, and placing the feet, shifting weight, and breathing. Balance training included practice marching, reaching, chair standing, and sideways, backwards, and tandem walking.

Participants were assessed at baseline, 6 and 9 months on the time it took to stand up, walk 3-meters, return to the chair, and sit down, the degree they could bend at the waist while standing, and the length of time they could stand on one leg. They were also assessed on a self-report geriatric mental health screening measure and a measure of quality of life.

The results showed improvement on all physical mobility measures for both groups, and to a similar degree at both 6 and 9 months. Improvements were small and below the level of set for minimal clinically important differences.

There were no group differences on the mental health or quality of life measures. Compliance (68% vs. 48%) and program satisfaction (79% vs. 62%) were significantly higher for the balance training group. None of the participants experienced falls by 6 months, but 2 individuals in each group experienced falls by 9 months.

The study shows walking meditation and balance training were equally effective in improving performance of balance and mobility tasks among older adults. The researchers conclude walking meditation could be an alternative to balance training in the elderly to help prevent falls. Participants were less satisfied and compliant with the walking meditation program.

Given improvements in both groups were below the minimal clinically important difference level, a no-treatment control group would have been a useful additional comparator.

Reference:

Phoobangkerdphol, C., Limampai, P., Dasri, S., & Kuptniratsaikul, V. (2021). Walking meditation versus balance training for improving balance abilities among older adults with history of fall: A randomized controlled trial. Clinical Rehabilitation.

Link to study

A comparison of three phone apps for better sleep

Fri, 21 Jan 2022 21:46:02 GMT

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.

Reference:

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

Teachers in MBSR show less brain reactivity to negative emotion stimuli

Tue, 28 Dec 2021 18:09:03 GMT

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.

Reference:

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.

Link to study

Three-day meditation retreat better than vacation on inflammation maker

Tue, 21 Dec 2021 18:32:00 GMT

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.

Reference:

Gardi, C., Fazia, T., Stringa, B., & Giommi, F. (2022). A short Mindfulness retreat can improve biological markers of stress and inflammation. Psychoneuroendocrinology, 135, 105579.

Link to study

Children preterm at birth gain cognitively post mindfulness training

Mon, 29 Nov 2021 17:01:07 GMT

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.

Reference:

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.

Link to study

School teachers show more antioxidant activity after mindfulness

Tue, 23 Nov 2021 20:52:03 GMT

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.

Reference:

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.

Link to study

Skin sweat biomarker responds to MBCT for bipolar disorder

Thu, 28 Oct 2021 16:06:43 GMT

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.

Reference:

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.

Link to study

MBCT reduces suicide attempts in high risk military veterans

Tue, 19 Oct 2021 21:37:31 GMT

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.

Reference:

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.

Link to study

Mindfulness aids treatment-resistant schizophrenia symptoms

Thu, 23 Sep 2021 22:30:11 GMT

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.

Reference:

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.

Link to study

Some adverse events occur alongside mindfulness training

Tue, 14 Sep 2021 15:41:01 GMT

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.

Reference:

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.

Link to study

Brain activity similar after CBT and MBSR for people with social anxiety

Tue, 24 Aug 2021 21:17:08 GMT

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.

Reference:

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.

Link to study

App-based mindfulness tool lessens expected reward of eating food

Mon, 16 Aug 2021 19:47:50 GMT

An epidemic of obesity has been reported in the United States. Over 40% of Americans are classified as overweight and at elevated risk for diabetes, heart disease, and stroke. Obesity-associated medical costs are estimated at $147 billion yearly. Cognitive-behavioral programs are used in an attempt to support weight loss, but often fail because cognitive control over emotionally rewarding eating is difficult to sustain.

Mindful attention to eating, however, may reduce binge eating by lowering our expectations of just how rewarding eating a craved food will be. Taylor et al. [Journal of Behavioral Addictions] conducted two studies to test if mindfulness alters expectations of the reward of eating, and whether such changes result in decreased binge eating behavior.

In the first study, 64 overweight women (average age=53 years; 92% Caucasian; average BMI=33) participated in an 8-week app-based mindful eating program. The mindful eating app contained 28 self-paced sequential modules introducing mindfulness in brief video format. Modules were designed to help participants become mindful of eating triggers and learn mindful eating skills.

The app included a tool that participants used when they experienced cravings to binge eat. The tool had them rate their craving intensity, then imagine themselves eating the desired food and how that would make them feel, then rate their subsequent craving intensity, and finally decide whether or not to yield to the craving. If participants decided to go ahead and binge eat, they then rated how much food they ate and the level of contentment they felt after mindfully attending to their body, thoughts, and emotions.

The tool intended to help participants become aware of discrepancies between how they expected to feel and how they actually felt after yielding to cravings, and to ultimately update their expectancies in accordance with this realization.

Participants completed several eating-related self-report measures before and after the 8-week intervention. Results showed significant reductions in food craving (Cohen’s d=1.25) and stress-based (d=1.35) and reward-based (d=1.19) eating after the intervention. Decreases in the expected reward value of food were significantly associated with increased use of the app-based craving tool. The more frequently the participants used the tool, the less they binge ate.

The authors conducted a second naturalistic community-based study examining data from a pool of 1,119 mindfulness app users. The pool was subdivided into a “low use” group of 1,044 participants who used the craving tool <10 times (females=78%; average age=45 years) and a “high use” group of 75 participants who used the craving tool ≥10 times (females=79%; average age=49 years).

Results from the second study showed the more participants used the craving tool, the smaller their anticipated rewards from eating craved foods. Unlike the first study, binge eating did not decrease with increased tool use. A post-hoc analysis of the low use group showed binge eating increased for participants who used the craving tool 1-3 times and decreased for those using it 5 or more times.

These two studies showed a mindful eating app reduced the frequency and amount of binge eating in an experimental setting, but not in a naturalistic community setting. More use of the mindful craving tool resulted in lower reward expectancies about the benefit of eating, and to less binge eating for participants who used the tool at least five times. The study is limited by the absence of a control group.

Reference:

Taylor, V. A., Moseley, I., Sun, S., Smith, R., Roy, A., Ludwig, V. U., & Brewer, J. A. (2021). Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating. Journal of Behavioral Addictions.

Link to study

Mindfulness versus suppression aligns learned pain expectations

Tue, 27 Jul 2021 20:24:23 GMT

How does mindfulness reduce the experience of pain? One theory has it that focusing mindfully on present-moment sensory experience reduces the influence of held beliefs. For example, past experiences with pain shape expectations about what pain will be like in the future.

Using a pain conditioning experiment, Vencatachellum et al. [European Journal of Pain] tested the effect of inducing mindfulness compared to pain-suppression strategies on pain expectations.

The researchers enrolled 68 healthy meditation-naive participants (50% female; average age=27 years) from three European countries in a laboratory study. All participants first underwent sensory conditioning that paired a computer-presented visual cue with a heat stimulus delivered a few seconds later to their forearm. The heat stimulus was calibrated to each participant to induce low, moderate, or high levels of heat-induced pain.

Color cues were consistently paired with subsequent pain stimuli so that the colors became associated with an expected degree of pain. As such, participants now learned what to expect. Participants rated their anxiety and pain intensity and unpleasantness on each trial.

After the cue conditioning, participants were randomly assigned to receive 10 minutes of audio training in either mindfully attending to pain or suppressing pain. Participants were then exposed to the previously conditioned color cues along with a novel color cue, each followed by a moderate pain stimulus. The novel color was added because it was not conditioned with pain and so served as comparison to the conditioned colors. Participants again rated their anxiety and pain.

The researchers then assessed whether the moderate pain stimulus was rated as more painful following the high-pain color cue, or less painful following the low-pain color cue than after the unconditioned color cue.

Results showed that after the low-pain cue, the suppression group judged the moderate pain stimulus as less-than-moderate. The mindfulness group judged it, accurately, as moderate. No group difference was found for judgements about the high-pain cue.

The study findings offered partial support for a theory proposing that mindfulness reduces the influence of learned expectancies on future pain judgments, but only when expectancies signal a lower level of pain. The study is limited by the brevity of its mindfulness induction and the absence of a control group instructed merely to rest during the pain task.

Reference:

Vencatachellum, S., Meulen, M. van der, Ryckeghem, D. M. L. V., Damme, S. V., & Vögele, C. (2021). Brief mindfulness training can mitigate the influence of prior expectations on pain perception. European Journal of Pain.

Link to study

MBSR has pain effect same as cognitive and behavior therapies

Wed, 21 Jul 2021 16:09:42 GMT

Many psychotherapeutic interventions are available to treat pain. Mindfulness-Based Stress Reduction, Cognitive Therapy, and Behavior Therapy are shown to be effective in improving pain-related outcomes among patients with chronic pain. However, little is known about whether one of these treatments is superior.

Burns et al. [Pain] conducted a randomized controlled trial to compare the effect of these three interventions relative to each other as well as to a treatment-as-usual control group on pain-related outcomes. Relative efficacy, rate of benefit gained, and persistence of effect at follow up were compared across groups.

The researchers randomly assigned 521 participants (51% Black; 58% female; average age = 53 years; average duration of pain = 12 years) with chronic lower back pain to Mindfulness-Based Stress Reduction (MBSR), Cognitive Therapy, Behavioral Therapy, or a treatment-as-usual control. Participants had significant daily back pain and related impairments in activities of daily living for at least six-months.

All treatments were manualized and delivered in eight weekly 90-minute individual therapy sessions by clinical psychologists with prior experience in psychosocial interventions for pain. Participants were assessed on pain interference and intensity and pain-related outcomes of mood, sleep disturbance, and physical functioning at study baseline, weekly during the treatment period, and at 6-month follow-up.

MBSR participants engaged in body scan, sitting, and gentle movement meditations, and focused on cultivating mindfulness in activities of daily life. Cognitive Therapy participants learned to identify, evaluate, and correct automatic pain-related thoughts. Behavior Therapy participants learned how to set and track realistic daily activity goals aimed at graded increases in activities such as walking and standing, as well as increased engagement in pleasure-generating activities.

Treatment-as-usual was whatever standard care participants received before the start of the study, usually pain medication and social support from a medical team.

The results showed that all three therapy groups were superior to the control group. The range of effect sizes for treatment groups compared to the control group were of small size for pain interference and physical functioning (Cohen’s d=0.21-0.26) and up to medium size for pain intensity (d=0.30-0.48), mood (d=0.26-0.53), and sleep disturbance (d=0.26-0.61). This superiority over the control group was statistically equivalent across the therapy groups, and no one therapy (MBSR, CT, BT) showed superiority over any other therapy group.

All three therapy groups diverged from the control group by week six of therapy on all measures, thus shedding light on an important time signal of change. All therapy group gains over the control group were maintained at six-month follow-up. Again, no single treatment group was significantly superior to any other treatment group at follow-up.

The study shows that three different psychotherapeutic interventions lend benefit on pain-related outcomes beyond that of standard care practices for patients with long-term pain. Findings uncover that multiple therapies can aid in improving pain outcomes, giving patients the option to select a therapy they prefer.

The study is limited given that the MBSR group did not receive the full curriculum, and there was no indication of whether therapists delivering MBSR had adequate training in the program and a personal meditation practice.

Reference:

Burns, J. W., Jensen, M. P., Thorn, B. E., Lillis, T. A., Carmody, J., Newman, A. K., & Keefe, F. (2021). Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: A single-blind randomized controlled trial. Pain.

Link to study

Depression in menopause curbed by MBSR, most for mood sensitive

Wed, 30 Jun 2021 18:03:59 GMT

Perimenopause, the multiyear transition from regular menses to their complete cessation, places women at increased risk for depression, with 45-68% of perimenopausal women reporting depressive symptoms.

Erratic levels of the reproductive hormone estradiol play a role in this increased vulnerability for depression, but not all women have moods that fluctuate with estradiol levels. Women with wider hormonal-related mood fluctuations are more vulnerable to stress and more likely to experience depressive symptoms.

Gordon et al. [Psychoneuroendocrinology] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on women’s perimenopausal depressive symptoms, and then explored whether the program might prove especially helpful for women with elevated hormonal-related mood fluctuations.

The researchers randomly assigned 104 mediation-naïve Canadian healthy perimenopausal women (average age = 49 years; 89% Caucasian; early menopause = 69%, late menopause = 31%) to MBSR or a wait-list control. MBSR was taught by experienced MBSR teachers and delivered in 2.5-hour group sessions over an 8-week period, with a 7-hour silent retreat in the sixth week.

Baseline urine estradiol levels and daily moods were assessed over a period of 30-50 days prior to randomization, and the researchers calculated a standardized mood sensitivity to estradial changes based on these data. Self-report measures, histories of trauma, and recent stressful events were also assessed at baseline.

Depressive symptoms were assessed at baseline, immediately after intervention, and every two weeks during a 6-month follow-up. Perceived stress, anxiety, mindfulness, resilience, and sleep quality were assessed at baseline, immediately after intervention, and at 2-, 4-, and 6-month follow-up. Participants with high levels of self-reported depressive symptoms were assessed for major depression in structured clinical interviews.

The results showed that the MBSR group showed significantly greater reductions in depressive symptoms (d = -0.34), perceived stress (d = -0.55), and anxiety (d = -0.53), and greater increases in mindfulness (d = -0.46) and resilience (d = -0.30) than controls at postintervention and throughout follow-up.

The subgroup of participants displaying elevated mood sensitivity to estradiol benefited most from MBSR. Women in early perimenopause benefitted more than those in late perimenopause from MBSR, and decreases in depressive symptoms were dose-dependent on home meditation practice.

The study shows MBSR is more effective in reducing depressive symptoms in perimenopausal women than a wait-list control. Women early in menopause and women sensitive to hormonal-related mood changes appear to gain the most benefit from MBSR practices.

The study is limited by the absence of an active comparison group, support group, or clinical monitoring program that might improve depressive symptoms in a similar fashion.

Reference:

Gordon, J. L., Halleran, M., Beshai, S., Eisenlohr-Moul, T. A., Frederick, J., & Campbell, T. S. (2021). Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial. Psychoneuroendocrinology.

Link to study

Virtual reality ups attendance to mindfulness course

Fri, 18 Jun 2021 20:08:23 GMT

College can be demanding, and up to one-third of college students report feeling highly stressed. High stress levels can be a significant problem since a third of all college students report current or past mood, anxiety, or substance use disorders which can be retriggered or worsened by stress.

Mindfulness training can effectively reduce stress, but many students who enroll in mindfulness programs drop out before completion. Virtual reality (VR) technology has shown promise to improve learning, and may perhaps increase treatment adherence.

Mondrego-Alarcón et al. [Behaviour Research and Therapy] compared the relative efficacy of mindfulness versus relaxation training in reducing college student stress, and explored whether VR added to the mindfulness program reduces attrition.

The researchers randomly assigned 280 Spanish college students (79% female; average age = 22 years) to a standard mindfulness program, a VR-enhanced mindfulness program, or an active relaxation control. All groups met in person once weekly for six weeks. The mindfulness programs emphasized mindfulness and self-compassion using the body scan, and sitting, walking, movement, and self-compassion meditations.

The standard mindfulness condition met in 90-minute group sessions, while the VR-enhanced mindfulness condition met in 75-minute group sessions coupled with brief individual VR-guided meditations.

The body scan VR-meditation included a visual simulation of the human body which successively highlighted body parts as participants attended to those parts. Another VR meditation involved a virtual nature walk with participants mindfully observing their thoughts.

The relaxation control group utilized progressive muscle relaxation and visual imagery but did not use VR. All participants were assessed at baseline, post-treatment, and 6-month follow-up on the primary self-report measure of perceived stress as well as on the secondary outcomes.

The results show that, relative to the relaxation group, mindfulness (d=-0.72) and VR-enhanced mindfulness (d=-0.59) groups showed less perceived stress after intervention. This superiority remained at 6-month follow-up. The effect was dose dependent for mindfulness—the more sessions participants attended, the less their stress—but not for relaxation. Increases in mindfulness and self-compassion both contributed to decreased stress.

At post-treatment, the standard mindfulness group also showed significantly greater improvements on the secondary outcome measures of trait anxiety (d = -.90), emotional suppression (d = -0.71), mindfulness (d = 1.01), and self-compassion (d = .1.10) than the relaxation group.

These relative improvements persisted at 6-month follow-up and were joined by additional improvements in state anxiety (d = -1.37), affect balance (d = 1.02), academic engagement (d = 1.14) and burnout (d = -1.60). The VR-enhanced mindfulness group performed similarly on these measures but did not outperform the standard mindfulness group.

VR-enhanced participants had significantly better attendance than standard mindfulness participants, who in turn had significantly better attendance than relaxation participants. Ninety-six percent of the VR-enhanced group attended at least half of all sessions, compared with 83% of the standard mindfulness and 70% of the relaxation group.

The study shows mindfulness training to be superior to relaxation training in reducing stress in college students. Adding VR correlates with improved attendance in this younger sample, but did not yield superior efficacy on stress reduction.

The study is limited by its reliance on self-report measures, and inability to determine whether any novel activity for young adults like VR would increase motivation to attend a behavioral intervention.

Reference:

Modrego-Alarcón, M., López-del-Hoyo, Y., García-Campayo, J., Pérez-Aranda, A., Navarro-Gil, M., Beltrán-Ruiz, M., Morillo, H., Delgado-Suarez, I., Oliván-Arévalo, R., & Montero-Marin, J. (2021). Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behaviour Research and Therapy.

Link to study

Mindfulness to target anxiety in seniors with cognitive decline

Tue, 25 May 2021 16:26:40 GMT

A common worry among older adults is cognitive decline. Older adults may worry about possible cognitive decline even when standardized tests fail to reveal signs of cognitive deficits. Adults with subjective cognitive decline are often anxious about their perceived loss of ability and emotionally reactive to minor acts of forgetfulness.

Marchant et al. [Psychotherapy and Psychosomatics] conducted a randomized controlled study to test the effect of a mindfulness-based intervention on anxiety in older adults with subjective cognitive decline compared to health self-management program.

The researchers recruited 147 participants (average age=73 years; 65% female) from memory clinics located in four European cities. Participants were self-referred or referred by physicians to the clinics because of their subjective memory complaints, but performed normally on standardized cognitive tests. Clinic patients with mild cognitive impairment, dementia, depression and anxiety disorders were excluded from the study.

Participants were randomly assigned to a Caring Mindfulness Approach for Seniors (CMBAS) program, or a health self-management program. CMBAS was modeled after the Mindfulness Based Stress Reduction program, and held in groups for 2-hours per week for 8 weeks. The program was tailored to the needs of older adults and emphasized compassion and lovingkindness meditation.

The health self-management program had the same structure and format as CMBAS, and emphasized sleep hygiene, stress management, exercise, diet, communication, memory, and action plans for improving health. Participants completed the State-Trait Anxiety Inventory and the Geriatric Depression Scale at baseline, post-intervention, and 6-month follow-up.

The results showed significant reductions at post-intervention in trait anxiety for both CMBAS (d=0.31) and health self-management (d=0.26) groups without any statistically significant superiority found for CMBAS. The reductions in trait anxiety were maintained at 6-month follow-up for both groups.

The CMBAS group had a significant decline in state-anxiety at post-intervention, but this was not significantly different from the smaller decline in the health self-management group.

Approximately equal percentages of CMBAS (15%) and health self-management (14%) participants experienced clinically meaningful anxiety improvements. Neither intervention reduced depressive symptoms, but depressive symptoms were already low at baseline.

The multinational clinical trial showed an adapted mindfulness or health self-management intervention reduced trait anxiety in older adults with subjective cognitive decline immediately after intervention and at 6-months after intervention end.

The study is limited by its lack of a passive control group to determine if mere monitoring over time by the study team tends to reduce anxiety among people concerned over cognitive decline. The findings cannot be generalized to those with anxiety disorders as those eligible had only subclinical symptoms of anxiety.

Reference:

Marchant, N. L., Barnhofer, T., Coueron, R.,...Molinuevo, J. L. (2021). Effects of a Mindfulness-Based Intervention versus Health Self-Management on Subclinical Anxiety in Older Adults with Subjective Cognitive Decline: The SCD-Well Randomized Superiority Trial. Psychotherapy and Psychosomatics.

Link to study

MBSR lessens daily emotional volatility over music therapy

Wed, 19 May 2021 15:37:42 GMT

Mindfulness training often results in mood benefits given that practitioners learn to experience discomfort without reactivity and cultivate positive emotions. However, little is known how mindfulness training affects shifts in daily positive and negative emotions.

People differ in how much their emotions vary over the course of a day (affect variability), how easily their emotions are aroused (affect instability), and how persistent emotions are once they are once aroused (affect inertia). Higher levels of negative emotional variability, instability, and inertia are observed in people with various mental health disorders. By contrast, people who are more mindful generally experience less negative affect variability, instability, and inertia.

Keng et al. [Mindfulness] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on daily emotional shifts in a randomized study compared to an active control.

The researchers randomly assigned a non-clinical sample of 158 adult ethnic Chinese Singaporeans (average age=29 years; 59% female) to either MBSR or a music therapy-based stress reduction program. MBSR was delivered using the standard 8-week group protocol that included a half-day meditation retreat.

The music therapy control was matched to MBSR in terms of time duration and retreat, structure, and social support. Music therapy included supportive music and imagery, performance, receptive listening, composition, and improvisation.

Participants reported on their emotions 12 times daily for 3 days prior to and 3 days after the interventions in response to smartphone-delivered prompts. Prompts were issued an average of every half-hour between 9AM and 5PM. At each prompt, participants rated their experience of 17 different emotions.

Affect variability was measured using the standard deviation of ratings, inertia by rating intercorrelations between time points, and instability by the average squared differences between successive time points. Participants also completed a questionnaire of self-reported emotional regulation difficulties before and after the intervention.

The results showed that the MBSR group significantly decreased the variability and instability of negative emotions with a small-to-medium effect size, and significantly decreased emotional regulation difficulties relative to the music therapy group. MBSR showed significantly greater decreases in variability for anger, fear, guilt/shame, and sadness, and significantly greater decreases in instability for anger, fear guilt/shame, sadness, worry, frustration, and disgust.

MBSR participants were significantly less likely than those in music therapy to experience any increases in negative emotion larger than two standard deviations in magnitude. There were no differences by group on the average intensity of negative emotions, negative affect inertia, or any of the positive emotion variables.

The study shows MBSR, relative to music therapy, reduces the volatility of daily negative emotions and improves self-report of emotional regulation without necessarily changing the intensity of participants’ average daily positive or negative moods.

These findings are in accord with the common training principle that mindfulness does not necessarily stamp out negative emotions, but helps one experience them with diminished reactivity.

Reference:

Keng, S.-L., Tong, E. M. W., Yan, E. T. L., Ebstein, R. P., & Lai, P.-S. (2021). Effects of Mindfulness-Based Stress Reduction on Affect Dynamics: A Randomized Controlled Trial. Mindfulness.

Link to study

Single dose modafinil drug increases home practice of meditation and relaxation

Wed, 28 Apr 2021 15:59:15 GMT

Mindfulness requires cognitive effort and so practice places demands on a meditator’s attention. Many psychological disorders include impairment in attention as a symptom, and patients with attentional impairment may find mindfulness practice too frustrating to sustain. Medications that improve attentional focus may help mindfulness practitioners gain more from their practice.

Modafinil is a medication that improves attention in patients with daytime sleepiness due to problems sleeping. Its psychopharmacologic effects mirror some of the attentional improvements seen in mindfulness training.

Thomas et al. [Journal of Psychopharmacology] tested the effects of modafinil on self-reported state mindfulness, mind wandering, and vigilance among participants practicing mindfulness or relaxation training.

The researchers randomly assigned 80 healthy meditation-naïve participants (average age=25 years; 50% male) to one of four groups: modafinil + mindfulness, modafinil + relaxation, placebo + mindfulness, and placebo + relaxation. Participants were blinded to drug and practice type. On the first day of an eight-day intervention, participants received 200mg of modafinil or a placebo pill and trained in mindfulness or relaxation.

Participants completed assessments immediately before and two hours after medication delivery, and again immediately after initial meditation or relaxation on a variety of measures.

Over the next six days, participants engaged in daily home practice of mindfulness or relaxation techniques, and were then reassessed on the eighth day. Outcome measures included state and trait mindfulness, mood, mind-wandering, heart rate variability, and sustained attention.

Mindfulness and relaxation trainings were delivered as 10-minute audio recordings that contained brief instruction and practice. Mindfulness instructions involved focused attention on the breath.

Relaxation instructions involved abdominal breathing and intentional muscle relaxation. Both sets of instructions emphasized returning to task if one’s mind wandered.

Post-training mind-wandering was assessed by having participants practice either mindfulness or relaxation for 16 minutes, and click on a keyboard mouse whenever their minds wandered. Sustained attention was measured by response times to stimuli randomly presented on a computer screen. This task is known to be sensitive to both mindfulness training and modafinil.

Results from the single day experiment showed modafinil improved state mindfulness before (d=0.34) and after both mindfulness and relaxation training (d=0.45), and to a similar extent by group. Modafinil improved positive mood before (d=0.54) and after the trainings (d=0.60), and to a similar extent by group.

Heart rate variability (a sign of increased parasympathetic activity) increased in the mindfulness group but not the relaxation group (d=0.52). Modafinil significantly improved sustained attention in both groups (partial η2=0.07). There were no drug or group effects on subjective mind-wandering.

After eight days of home meditation or relaxation practice, all groups significantly improved on state mindfulness. Groups who received modafinil on the first day of the intervention showed significantly more weekly home practice (average = 55 mins) than those who received placebo (average = 36 mins).

The study shows that modafinil improves state mindfulness, sustained attention, and positive mood in a single-day experiment. When given at baseline, it increases practice effort over the course of about a week. Mindfulness training increases heart rate variability more than relaxation training, but there were no differences between the trainings on state mindfulness.

The absence of any difference between the groups on state mindfulness may be due to similarities between the trainings, as both involved breathing and instructions to maintain focus. The study is limited by the brevity of its trainings, and lack of emphasis on non-judgmental awareness in the mindfulness group.

Reference:

Thomas, E. M., Freeman, T. P., Poplutz, P., Howden, K., Hindocha, C., Bloomfield, M., & Kamboj, S. K. (2021). Stimulating meditation: A pre-registered randomised controlled experiment combining a single dose of the cognitive enhancer, modafinil, with brief mindfulness training. Journal of Psychopharmacology.

[Link to study]

Mindful walking increases walking distance in COPD patients

Mon, 19 Apr 2021 20:17:14 GMT

People with chronic obstructive pulmonary disease (COPD) suffer from shortness of breath that limits their physical activity. Other symptoms include wheezing, coughing, and an unpleasant awareness of breathing difficulty known as dyspnea. Standard care treatment includes medication and physical rehabilitation focused on breathing exercises.

Lin & Yeh [Clinical Rehabilitation] conducted a randomized controlled trial to test if a mindful walking program improves exercise capacity and reduces perceived difficulty in breathing among older adults with COPD compared to a standard care control.

The researchers randomly assigned 84 older adult Taiwanese clinic patients (average age=72 years; 97% male) with mild-to-severe COPD to mindful walking added to treatment-as-usual or treatment-as-usual only. Participants in the mindful walking group engaged in mindful walking 5 days a week for 8 weeks.

The 35-minute daily mindful walking program included 5 minutes of meditation with focused diaphragmatic breathing, 5 minutes of stretching, 20 minutes of walking with controlled breathing, and a 5-minute cool down with gradually decelerating walking.

Controlled breathing while walking involved 3-second inhalations using diaphragmatic breathing and 6-second exhalations through pursed lips. Participants were trained on mindful walking on the first day of the program, then did their daily walking independently at home.

Treatment-as-usual included standard care medical education focused on medication, diet, and smoking cessation as well as a monthly telephone medical consultation.

Participants were evaluated at baseline, week 4 and 8 of treatment, and at 12-week follow-up after study end on walking distance within 10 minutes, perceived difficulty in breathing, heart rate variability, and interoceptive awareness.

Perceived difficulty in breathing was measured on a 10-point scale, with low scores indicating the absence of symptoms and the highest score indicating severe shortness of breath accompanied by panic. The interoceptive awareness measure included subscales on emotional awareness, attentional regulation, body listening, and noticing.

The results showed that the mindful walking group significantly increased distance walked in 10 minutes, whereas the control group decreased distance walked. The mindful walking group increased distance walked by an average of 29 meters, a clinically meaningful increase, while the control group decreased distance walked by an average of 8 meters.

This between-group difference was significant at 4, 8, and 12 weeks. Mindful walkers reported significantly less difficulty in breathing than controls.

This study shows that a mindful walking program can increase walking distance and decrease perceived breathing difficulties in COPD patients compared to a clinical treatment-as-usual.

The study is limited by the absence of an active control group, especially one that includes walking without mindfulness training. It is unclear how much benefit was gained from the mindfulness component relative to the physical demands of daily walking.

Reference:

Lin, F.-L., & Yeh, M.-L. (2021). Walking and mindfulness improve the exercise capacity of patients with chronic obstructive pulmonary disease: A randomised controlled trial. Clinical Rehabilitation.

Link to study

Leisure vacations with added mindfulness extend lasting welless

Wed, 31 Mar 2021 23:15:07 GMT

People often look forward to leisure vacations as relief from work and life routines, and to improve their well-being. Little is known about what types of vacations yield the most enduring benefits. For example, would a person benefit more from a leisure vacation, a meditation retreat, or a mixture of both?

It is commonly reported that the benefits of leisure-only vacations are short-lived upon return to mundane routines, and so it is possible that adding meditation to leisure vacations might support a more enduring sense of well-being.

Blasche et al. [PLOS One] conducting a naturalistic study to observe the relative psychological benefits of intensive meditation retreats, leisure vacations with meditation, and leisure vacations without meditation in a sample of people with previous meditation experience.

The researchers assessed 120 experienced meditators (average age=52 years, 59% female, average weekly meditation practice=5 hours) before and after an intensive meditation retreat, a leisure vacation with some mediation practice, or a leisure vacation without meditation. All participants were members or affiliates of a Buddhist organization who were planning a retreat or vacation.

The average length of retreats and vacations was 14-15 days. Intensive retreats included an average of 34 hours of meditation practice per week. Vacations with meditation included an average of 3 hours of meditation per week. Leisure-only vacations did not include meditation. Primary forms of meditation used were focused-attention and/or open monitoring meditation.

Participants were assessed 10 days before, 10 days after, and 10 weeks after their retreat or vacation on measures of fatigue, emotional well-being, and acting with mindful awareness. The study period was similar for all participants and spanned August to October of the same year.

The results show that all three retreats/vacations led to significant decreases in fatigue and increases in well-being and acting with awareness at immediate post assessment and 10-week follow-up. The intensive retreat and the vacation-with-meditation groups, however, had significantly higher levels of acting with awareness (d=0.50) than the leisure-only group at immediate post assessment and 10-week follow-up.

At 10-week follow-up, the intensive retreat and the vacation-with-meditation groups had significantly higher well-being (d=0.81; d=0.70) and significantly lower fatigue scores (d=0.60; d=0.62) than the leisure-only group.

This study finds that intensive retreats and vacations infused with some meditation practice enhance acting with mindful awareness better than leisure-only vacations out to 10 weeks after the vacation ends. The well-being and fatigue benefits of a vacation lacking meditation fade more quickly over time than similar benefits derived from intensive retreats or vacations that include some meditation practice.

It is surprising that the results did not show a superiority of intensive retreats over vacations that included meditation in terms of acting with awareness. These were all experienced meditators, however, and so there may be a ceiling on their ability to improve on a mindfulness measure. Findings are limited by the use of a naturalistic study design that lacked randomization to groups.

Reference:

Blasche, G., deBloom, J., Chang, A., & Pichlhoefer, O. (2021). Is a meditation retreat the better vacation? Effect of retreats and vacations on fatigue, emotional well-being, and acting with awareness. PLOS ONE, 16(2), e0246038.

Link to study

Novel imaging technique shows brain activity sequence after MBSR

Tue, 23 Mar 2021 18:54:27 GMT

Brain imaging studies find that mindfulness training can change the human brain’s functional connectivity. That is, the degree to which various brain regions jointly covary in their activity. However, the causal direction of brain connectivity remains unknown due to the limitations of functional connectivity analyses that only indicate if synchrony occurs, but cannot clarify the brain regions that initiate these changes.

Effective connectivity analyses is a newer method that may be able to uncover the temporal sequence of brain functional activity

Santarnecchi et al. [Journal of Neuroscience Research] tested the effects of MBSR on brain activity compared to an inactive control group of healthy participants using fMRI functional and effective connectivity analyses of brain regions in a randomized controlled trial.

The researchers randomly assigned 46 meditation-naïve Italian adults (average age=30 years; 52% female) to either MBSR program or a wait-list control. MBSR was delivered in the standard 8-week group-based format that included 45 minutes of daily homework and a 7-hour retreat.

All participants underwent neuroimaging before and after the intervention period, both during a resting state and while engaging in mindfulness of the breath and body. Pre-treatment conditions and the post-treatment control condition were told to attend to sensations of breathing and bodily sensations, while the post-treatment MBSR condition was instructed to meditate as they had been taught in MBSR.

Imaging results showed that MBSR resulted in significant decreases in local regional homogeneity in the right anterior putamen and the right insula during the resting state compared to controls.

MBSR also resulted in a significant decrease in right cerebellum regional homogeneity during mindfulness practice compared to controls. Regional homogeneity is a measure of the degree to which adjacent fMRI voxels within a brain region show synchronous activity.

The effective connectivity analysis using the above regions as seeds revealed a number of functional changes as a result of mindfulness training:

During the resting state, the anterior cingulate cortex decreased its excitatory influence on the right anterior putamen.

During mindfulness practice, the right cerebellum decreased its inhibitory effect on the right posterior putamen and right orbitofrontal cortex; the left posterior putamen decreased its excitatory influence on the right cerebellum; and the left somatosensory cortex increased its inhibitory effect on the right cerebellum.

The role of the putamen is prominent in several of these findings. This makes sense as the anterior putamen is involved in executive functioning and attention, while the posterior putamen is involved in somatosensory processing. These processes play key roles in the attentional control and awareness of bodily sensations that are central to mindfulness.

This study uses a novel brain imaging methodology and shows that MBSR alters the influences of the anterior cingulate and orbitofrontal cortexes on the putamen, and the putamen on the cerebellum. Findings highlight the temporal patterns that play a key role in brain activity correlated with mindfulness training.

The study interpretation is limited by not including respiration and cardiac rates as covariates, as these might affect changes in the blood oxygenation levels that generate fMRI images.

Reference

Santarnecchi, E., Egiziano, E., D’Arista, S., Gardi, C., Romanella, S. M., Mencarelli, L., Rossi, S., Reda, M., & Rossi, A. (2021). Mindfulness-based stress reduction training modulates striatal and cerebellar connectivity. Journal of Neuroscience Research.

Link to article

Cortical thickness ups in seniors after group-based mindfulness

Sat, 27 Feb 2021 06:13:29 GMT

Mild Cognitive Impairment (MCI) is a decline in cognitive performance that is more severe than that of normal aging, yet less severe than that of dementia. Patients with MCI are at risk for developing dementia, and researchers are interested in treatments that can forestall or prevent the progression to dementia onset.

Since mindfulness-based interventions are associated with improvements in attention and increases in brain gray matter cortical thickness, they may be able to help slow or prevent the progression to dementia.

Yu et al. [Journal of Psychiatric Research] compared changes in cognitive functioning and brain cortical thickness in older adults with MCI who participated in either a nine-month mindfulness-based intervention or a control group.

The researchers randomly assigned 54 Singaporean adults (average age=71; 74% female) diagnosed with MCI to either a mindfulness training or health education program. MCI diagnosis was based on subjective reports of cognitive difficulty and a battery of objective neuropsychological tests with final diagnosis made by expert panel consensus. Both interventions met in 45-minute group sessions on a weekly basis for the first 3 months, and then on a monthly basis for the final 6 months of the study.

The mindfulness program included exercises in focused sensory attention, the body scan, walking meditation, and gentle movement meditation. The health education control included didactic instruction on chronic illness, medication compliance, diet, exercise, and relaxation.

Participants were assessed at baseline, 3 months, and 9 months. Assessments included CT scans of the brain and neuropsychological measures of working memory (digit span), divided attention (a trail making task with interference), verbal memory, verbal fluency and, visuospatial processing. CT scans of the brain were evaluated for region of interest changes in gray matter cortical thickness. Regions of interest, including the anterior cingulate cortex, orbitofrontal cortex, frontal pole, and insula, were based on findings from previous mindfulness studies.

Neuropsychological test results at 9 months showed the mindfulness group improved significantly more on cognitive performance than controls (partial η2= 0.44). Subsequent post-hoc analyses showed this superiority was mostly due to improvements in working memory (partial η2= 0.18) and divided attention (partial η2= 0.13). The significance of the post-hoc analyses did not survive correction for multiple tests of significance.

CT scan results at 9 months showed that the mindfulness group showed significantly greater CT scan region of interest increases in cortical thickness (partial η2= 0.67) than controls. Subsequent post-hoc analyses showed this was primarily due to significantly greater increases in right frontal pole (partial η2= 0.21) cortical thickness, and significantly greater decreases in left anterior cingulate cortex cortical thickness (partial η2= 0.21).

The gains in right frontal cortical thickness are consonant with gains in executive cognitive function. The decrease in cingulate cortex cortical thickness was unexpected, but not necessarily a bad outcome as it could reflect reductions in negative emotional reactivity. The significance of these post-hoc analyses did not survive correction for multiple tests of significance.

Reference

Yu, J., Rawtaer, I., Feng, L., Fam, J., Kumar, A. P., Kee-Mun Cheah, I., Honer, W. G., Su, W., Lee, Y. K., Tan, E. C., Kua, E. H., & Mahendran, R. (2021). Mindfulness intervention for mild cognitive impairment led to attention-related improvements and neuroplastic changes: Results from a 9-month randomized control trial. Journal of Psychiatric Research, 135, 203–211.

Link to article

Mindfulness app yields less daytime fatigue in poor sleepers

Wed, 24 Feb 2021 06:02:47 GMT

A majority of Americans report sleep problems, and over 50 million Americans meet diagnostic criteria for a sleep disorder. Sleep disorders are associated with many impairments in daytime functioning such as work performance, fatigue, and sleepiness. Sleep aid medications can help in the short-term but are not recommended for long-term use.

Cognitive-behavioral therapies show promise yet can be costly and difficult to access in some regions. Since stress and worry are known to contribute to sleep difficulties, mindfulness training may also aid in resolving problems sleeping.

Huberty et al. [PLOS One] tested the effects of a brief daily use of a mindfulness meditation smartphone app compared to waitlist controls on sleep disturbance symptoms among people reporting elevated insomnia symptoms.

The researchers randomly assigned 263 participants (average age=45 years; 75% female; 57% Caucasian) reporting elevated insomnia symptoms (an Insomnia Severity Index Score >10) to an app-based mindfulness training or a waitlist control. Many of the participants reported having received prior diagnoses such as insomnia (25%), restless leg syndrome (22%), sleep apnea (16%), night terrors (12%) and narcolepsy (5%).

The mindfulness group was assigned to meditate at least 10 minutes daily using the smartphone Calm app over an 8-week period. The Calm app is a commercially available app containing guided meditations derived from Mindfulness-Based Stress Reduction (MBSR) and Vipassana meditation.

Self-report ratings of daytime fatigue, daytime sleepiness, and cognitive and somatic pre-sleep arousal were assessed at baseline, mid-treatment (4 weeks) and post-treatment (8 weeks). Participants in the mindfulness group also kept a daily sleep quality diary for the 8-week period.

The results showed that the mindfulness group spent an average of 15 minutes per day using the Calm app. At post-treatment, the mindfulness group reported significantly greater decreases in fatigue (d=0.23), daytime sleepiness (d=0.30), and cognitive (d=0.33), and somatic pre-sleep arousal (d=0.46) than controls. Mindfulness participants also reported significant improvements in sleep quality (d=0.13) over time, reporting that they fell asleep faster (d=-0.03) and slept longer (d=0.90).

This experimental study shows a mindfulness training app reduces pre-sleep arousal and daytime fatigue and sleepiness in persons reporting sleep difficulties. App users also reported improved sleep quality. These results are important because they show the promise of an easily-accessed, inexpensive, non-intensive mindfulness training people can perform on their own at home.

The study is limited by reliance only on self-report measures and a control group that received no intervention nor completed sleep diaries. It is possible that any app supporting daily wellness and motivating new behavior could lead to similar improvements in sleep.

Reference:

Huberty, J. L., Green, J., Puzia, M. E., Larkey, L., Laird, B., Vranceanu, A.-M., Vlisides-Henry, R., & Irwin, M. R. (2021). Testing a mindfulness meditation mobile app for the treatment of sleep-related symptoms in adults with sleep disturbance: A randomized controlled trial. PLOS ONE, 16(1), e0244717.

Link to article

After 10 days of mindfulness app, heart shows less stress

Mon, 25 Jan 2021 22:28:33 GMT

The human heart beats about 100,000 times per day. The time interval between each heartbeat changes from moment to moment. Heart rate variability (HRV) is a measure of these time fluctuations between heartbeats over time. When relaxed, our hearts show greater momentary beat-to-beat variation, and so greater HRV. This is due to the predominance of parasympathetic over sympathetic nervous system activity when we are not under stress. Researchers consider increases in HRV to be an objective measure of stress reduction.

Preliminary studies show mindfulness meditation increases HRV. However, these studies often rely on one-time measurements, leaving little known about the persistence of HRV changes over time. Kirk et al. [PLOS One] studied short- and longer-term changes in HRV before, during, and after an app-based mindfulness training compared to two control groups. The study is unique in obtaining HRV measures in participants’ home environments rather than in a laboratory setting.

The researchers randomly assigned 90 Danish participants (average age = 37 years; 70% female) to a 10-day mindfulness training using the Headspace app, a 10-day app-based music listening control condition, or a no-intervention control. The Headspace guided meditation sessions were 20-minutes in length on days 1-5, and 30-minutes in length on days 6-10. Mindfulness training included focused-attention on the breath and body, awareness of mind-wandering, and developing a non-judgmental attitude.

The music listening app consisted of a playlist of 20 two- to four-minute music tracks offered in 20- and 30-minute installments. The inactive control group conducted their lives as usual during the 10-day intervention period.

All participants had their HRVs continuously monitored using a wearable device while going about their normal daily activities for 48 hours prior to and 48 hours following the intervention period. In addition, participants in the mindfulness and music groups had their HRVs monitored whenever they were using the assigned intervention app, allowing researchers to monitor HRV over the 10 intervention days. They also completed self-report measures of perceived stress and mindfulness (the Mindful Attention Awareness Scale).

Results showed significantly larger increases in mindfulness (η2p=.14) and larger decreases in perceived stress (η2p=.08) after intervention for the mindfulness group over each control groups. The mindfulness group showed significantly greater increases in average daytime (η2p=.12) and nighttime (η2p=.30) HRV after intervention than each control group.

Increases in post-intervention daytime HRV (r=.47) and nighttime HRV (r=.44) were significantly correlated with total minutes of meditation practice during intervention. Music group nighttime increases in HRV were also correlated with time spent listening to music (r=.36).

There were also acute HRV effects that occurred while meditating or listening to music. The mindfulness group showed a significant 13 millisecond average increase in HRV over baseline while meditating. The music group showed a significant 9 millisecond increase over baseline while listening to music.

The mindfulness group showed a respiration rate that significantly decreased by four breaths a minute compared to baseline while meditating, while the music group did not slow respiration while listening to music.

The study shows that an app-delivered 10-day mindfulness intervention increases HRV while meditating, and that increases in HRV persist for 48 hours after the 10-day training period. Total minutes of meditation correlated with increased HRV. The study demonstrates the feasibility of assessing HRV as an objective biomarker in naturalistic environments outside the laboratory. The analysis in the study is limited by not adjusting for respiration rate and tidal volume which can directly impact HRV.

Reference:

Kirk, U., & Axelsen, J. L. (2020). Heart rate variability is enhanced during mindfulness practice: A randomized controlled trial involving a 10-day online-based mindfulness intervention. PLOS ONE, 15(12), e0243488.

[Link to study]

Brain and immune changes in cancer survivors after mindfulness

Tue, 19 Jan 2021 19:34:50 GMT

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 increased subjective well-being (d=0.57) after intervention. Right amygdala activity in response to threatening images significantly decreased after intervention (d=-0.49). Left ventral striatal activity in response to the landscapes and sunsets significantly increased after intervention (d=0.54).

There were no significant changes in IL-6 or CRP levels after intervention; however, there was a significant association between increases in left ventral striatal activity and changes in IL-6 and CRP. That is, the greater the increase in left ventral striatal activity to landscapes and sunsets, the lower the IL-6 (β=-1.64) and CRP levels (β=-3.07).

The study shows that a mindfulness training program delivered to breast cancer survivors in a group format is associated with changes in brain activity in the amygdala and ventral striatum immediately after intervention. Increased ventral striatal reactivity to positively emotionally-toned nature images inversely correlated with pro-inflammatory markers.

The study lacked a control group, had a small sample size, and included group social support, thus limiting any interpretation of causa

Reference:

Dutcher, J. M., Boyle, C. C., Eisenberger, N. I., Cole, S. W., & Bower, J. E. (2021). Neural responses to threat and reward and changes in inflammation following a mindfulness intervention. Psychoneuroendocrinology, 125, 105114.

[Link to study]

Mindfulness primer boosts physician communication skills

Tue, 22 Dec 2020 18:49:03 GMT

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 perform bad news consultations independently. In the post-simulation phase residents again rated their stress, self-confidence, and empathy. The patient actors also rated resident empathy.

The results showed that the mindfulness group performed significantly better overall in the simulated bad news consultation (Cohen’s d=0.67) compared to controls, and this effect was driven, in part, by significantly higher scores on knowledge and communication skills.

Only 4% of residents in the mindfulness group failed their simulated consultation, while 30% of the controls failed. There were no between-group differences in either self-rated empathy or empathy as perceived by the patient actor. In addition, there were no differences in perceived stress before and after the mindfulness meditation.

The study shows that a brief mindfulness meditation immediately prior to a simulated bad news consultation significantly improves resident bad news communication. Based on medical specialist evaluator reports, residents who briefly meditate communicate better, appear more knowledgeable, and are less likely to fail a communication task.

The meditation proved effective even though it did not affect residents’ perceived stress or empathy. The fact that the meditation enhanced performance in the absence of prior extensive training suggests that physicians could use mindfulness as a stand-alone technique prior to engaging in bad news delivery to patients. The study is limited by use of a simulation performance rating scale not previously validated.

Reference:

Mengin, A. C., Kayser, C., Tuzin, N., Perruisseau-Carrier, J., Charpiot, A., Berna, F., Lilot, M., & Vidailhet, P. (2020). Mindfulness Improves Otolaryngology Residents’ Performance in a Simulated Bad-News Consultation: A Pilot Study. Journal of Surgical Education.

MBSR better than stress management for heath worker distress

Thu, 17 Dec 2020 12:33:42 GMT

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 groups. The MBSR group also scored significantly higher on FFMQ “describing” and “acting with awareness” facets than stress management group.

For the physiological marker, the MBSR group had a significantly smaller increase in cortisol during the first 45 minutes after morning awakening relative to the comparison groups.

There were no significant differences between stress management and waitlist controls on any measure. At 4-month follow-up, the MBSR group showed significantly less social role dysfunction and significantly higher FFMQ “observing” compared to the stress management group.

The study shows MBSR is more effective than a hospital-delivered stress management course in reducing short-term distress and increasing short-term work satisfaction in Chilean hospital healthcare workers. Most of these effects did not persist on 4-month follow-up, suggesting the need for continued practice to maintain gains. The study is limited by its small sample size and high rate of attrition.

Reference:

Errazuriz, A., Schmidt, K., Undurraga, E. A., Medeiros, S., Baudrand, R., Cussen, D., Henriquez, M., Celhay, P., & Figueroa, R. A. (2020). Effects of mindfulness-based stress reduction on psychological distress in health workers: A three-arm parallel randomized controlled trial. Journal of Psychiatric Research.

MBCT reduces symptoms of children hospitalized with cancer

Mon, 30 Nov 2020 11:36:13 GMT

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 child-rated (η2=.57) internalizing symptoms for the mindfulness group compared to controls. Parent-rated symptoms decreased 19 points and child-rated symptoms 20 points, while control parent- and child-rated symptoms dropped only 1 point.

The mindfulness group also showed significantly greater decreases in attentional problems compared to controls on both parental (η2=.76) and child ratings (η2=.36). Parent-rated attentional problems decreased 15 points and child-rated attentional problems decreased 19 points for the mindfulness group while the control group remained essentially unchanged.

The study shows that MBCT-C modified to meet the needs of hospitalized children with cancer and acute stress disorder can significantly improve symptoms of anxiety, depression, somatization, and impairments in attention compared to treatment as usual. These improvements are sustained for at least 2-months after intervention.

The study is limited by the absence of post-intervention outcome ratings by clinicians blind to group assignment, and the lack of an active control group which also promoted social interaction with other children with cancer.

Reference:

Abedini, S., Habibi, M., Abedini, N., Achenbach, T. M., & Semple, R. J. (2020). A Randomized Clinical Trial of a Modified Mindfulness-Based Cognitive Therapy for Children Hospitalized with Cancer. Mindfulness.

Mindfulness app sustains attention after cold temperature stressor

Wed, 18 Nov 2020 04:27:48 GMT

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 until it became too uncomfortable to keep it there.

Participants were then placed in front of a computer screen and instructed to press a space bar whenever a numeral between 0-9 appeared, except when the numeral was “3.” The researchers measured the percent of times participants refrained from pressing the space bar when a “3” appeared. Participants were also assessed on a measure of dispositional mindfulness (the Mindfulness Attention Awareness Scale) before and after training.

The results showed the mindfulness group performed significantly better on the computer-based sustained attention task than the cognitive training group (partial η2=0.12; medium effect size). The amount of total time spent using the Headspace app correlated with better sustained attention performance (r=.56) while time spent on the NeuroNation app did not (r=.23). The mindfulness group had significantly higher mindfulness scores than the cognitive training group immediately following the intervention (partial η2=0.28; large effect size).

Before training, the longer participants kept their hand in the ice water, the poorer their subsequent ability to sustain attention (r=-.64 for mindfulness trainees; r=-.76 for controls). After training, this held true for the cognitive trainees (r=-.71) but not for the mindfulness trainees (r = .10). If keeping one’s hand in ice water longer is more physiologically stressful, this means stress levels were no longer correlated with attentional degradation within the mindfulness group.

The study shows that an app-based mindfulness training can improve sustained attention after a stressor and mindfulness disposition compared to a cognitive training app. The study is limited by its lack of physiological stress measures, an assessment of sustained attention under non-stress conditions, and the unknown amount of time each group spent using the app. There is also inconclusive efficacy research on the NeuroNation app.

Reference:

Piil, F., Axelsen, J. L., Staiano, W., & Kirk, U. (2020). Mindfulness Passes the Stress Test: Attenuation of Behavioral Markers of Mind Wandering During Acute Stress. Journal of Cognitive Enhancement.

[Link to study]