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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

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-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

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

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

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

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

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

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

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