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MBSR impacts hippocampus size and connectivity, linked with anxiety

Posted 08.19.2020 | by AMRA

Mindfulness training can reduce anxiety for some people, yet it is not fully clear how it operates. At the neural level, the brain’s hippocampus is one possible target given its involvement in learning to be afraid when in danger, and unlearning fear once danger is gone. Mindfulness-induced hippocampal changes may play a critical role in anxiety reduction.

Sevinc et al. [Brain and Behavior] tested mindfulness training against a stress management intervention on hippocampal volume and hippocampal connectivity to other brain regions during fear conditioning and extinction.

The researchers randomly assigned 89 participants (female=64%; average age=32 years) to either Mindfulness-Based Stress Reduction (MBSR) or Stress Management Education as a control group. The control group consisted of didactic presentation and discussion of nutrition, exercise, sleep hygiene, coping skills, and humor. Both 8-week interventions were delivered in weekly 2-hour group sessions, and both were assigned 40-minutes of daily homework (strength training and aerobic exercise for the control group) and a 4-hour intensive session in week six.

Before and after the intervention, all participants underwent fMRI scanning on two consecutive days. On the first day, the researchers induced a classically conditioned fear response by exposing participants to three neutral stimuli (pictures of different colored lamps) and pairing two of them with an annoying electrical shock delivered to their fingers. On the second day, one of the conditioned fear responses was extinguished by exposing participants to the same colored lamp stimuli, but only pairing one color with the electrical shock.

While participants underwent the fear conditioning and extinction activities, the researchers measured their hippocampal volumes and hippocampal connectivity with other brain regions. Participants also […]

August 18th, 2020|News|

Public health mindfulness program saves on mental health costs

Posted 12.27.2019 | by AMRA

National health care spending for mental disorders in the United States exceeds $200 billion a year. Public health promotion programs that aim to reduce the incidence of mental disorders have the potential to reduce the direct and indirect social and health care costs involved in mental health care.

A previous study showed that a mindfulness-based universal health promotion program called the Life Balance program prevented the emergence of new psychological symptoms in 1 of every 16 people treated at one year follow up. While these results were promising, this study did not address whether the program was cost-effective.

Müller et al. [BMC Public Health] used insurance fund cost data and a measure of anxiety and depressive symptoms to analyze the program’s cost-effectiveness over the course of a year.

The Life Balance program, a mindfulness-based health promotion program implemented in the German state of Baden-Wüerttemberg in 2014, trained 240 health coaches to deliver preventative mental health services at 80 different health care centers. The Life Balance program consisted of 6 weekly 90-minute group sessions drawing on strategies from Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, and Compassion-Focused Therapy.

A total of 583 Life Balance participants who were associated with a statutorily mandated health insurance fund (average age = 50 years; 85% female) agreed to participate in the study. They were compared to a group of 583 controls drawn from the same insurance fund pool and matched on Hospital Anxiety and Depression Scale (HADS) scores, age, sex, health status, activity level, and prior health care costs.

HADS scores were collected at baseline, post-intervention, and 6- and 12-month follow-up. Costs for medications, hospital stays, outpatient and rehabilitation visits, and lost […]

November 27th, 2019|News|

Primary care mindfulness program supports patient self care

Posted 01.18.2019 | by AMRA

While people with chronic illnesses can benefit from modifications in diet, exercise, and stress management, initiating and maintaining behavioral changes can be difficult. People with mental health problems can find it even harder to self-manage healthy lifestyle changes. Health care providers are interested in behavioral interventions that can be delivered directly in primary care settings to help patients better manage their illnesses.

Gawande et al. [Journal of General Internal Medicine] studied whether a primary care mindfulness-based intervention could promote improved patient self-management of behaviors that might favorably impact their health. They compared the effectiveness of an intensive in-house mindfulness training to a brief orientation to mindfulness coupled with referral to potential community and online mindfulness resources.

The researchers randomly assigned 136 primary care patients with depressive, anxiety, stress, adjustment, or traumatic stress diagnoses (65% female; 77% Caucasian; average age = 41 years) to either a Mindfulness Training for Primary Care (MTPC) group or a low dose comparator control. Participants who were already receiving mental health treatment were encouraged to continue it during the study.

MTPC was delivered in 8 weekly 2-hour group sessions along with a 7-hour retreat. The program was based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. It included instruction on self-compassion, illness self-management, values clarification, communication, and mindful action planning.

Prior to randomization, all participants attended a one-hour orientation to mindfulness that included didactic and practice elements. Following randomization, participants in the low dose comparator control were encouraged to practice mindfulness on their own, advised to seek out mindfulness resources, and placed on a 6-month MTPC waiting list. Both MTPC and control participants received biweekly phone calls encouraging continued home practice.

In the […]

January 18th, 2019|News|

Medication and mindfulness meditation to treat hypertension

Posted 12.21.2018 | by AMRA

High blood pressure is a major cardiovascular risk factor impacting 35% of U.S. adults. Stress, anxiety, and depression can contribute to its onset and intensification. The condition is usually treated with antihypertensive medications, but a significant proportion of patients fail to achieve adequate control with medication alone.

Researchers are interested in whether stress-reduction interventions together with conventional medical care can improve outcomes compared to medication alone. In a randomized controlled trial, Marquez et al. [Journal of Human Hypertension] compared relative effectiveness of mindfulness meditation and health education programs in reducing blood pressure as well as levels of stress, anxiety, and depression.

The researchers randomly assigned 42 meditation-naïve participants (average age = 57 years; 43% male; 69% on antihypertensive medication) with high-normal blood pressure or stage 1 hypertension to a Mindfulness Meditation or Health Education intervention. Both interventions were offered in two-hour group sessions that met weekly over the course of 8 weeks.

Mindfulness Meditation content was similar to that offered in Mindfulness-Based Stress Reduction (MBSR). The Health Education intervention offered didactic information on hypertension risk factors, along with methods of prevention through medication, diet, and exercise. Participants were assessed at baseline, 4, 8, and 20 weeks on measures of mindfulness (evaluated using the Five Facet Mindfulness Questionnaire), mood, perceived stress, anxiety, depression, and clinically assessed blood pressure (BP).

Additionally, each participant’s ambulatory BP was assessed over a 24-hour period at baseline and at week 8 using a body-worn automated device that measured BP at 15-30 minute intervals throughout the day and night. Ambulatory BP is a sound measure because it eliminates the error associated with the “white coat” effect—the spurious elevation in BP that occurs when […]

December 21st, 2018|News|

Mindful people cope better during stressful waiting periods

Posted 07.26.2017 | by AMRA

Waiting to learn the outcome of an important event can be quite stressful. People employ a variety of strategies to cope with waiting. These may include, “bracing for the worst” or trying to maintain a positive attitude, but the employed strategies are often ineffective and sometimes counterproductive. For example, “bracing for the worst” can help when deployed at the very end of a waiting period but make things worse if engaged right from the outset.

In two related studies, Sweeny & Howell [Personality and Social Psychology Bulletin] first explored how mindfulness disposition affects coping when people wait for their performance results. They then tested whether mindfulness meditation outperforms loving-kindness meditation in helping people cope with this stressful waiting period.

In the first study, 150 law school graduates (61% female; 61% Caucasian) completed questionnaires at five different times during the 4-month period of waiting for their bar exam results. The first questionnaire was completed three days after taking the bar exam, the last within a day of getting their results. The questionnaires assessed mindfulness disposition (using the Freiburg Mindfulness Inventory), “bracing for the worst,” “hoping for the best,” and self-rated coping and worry.

The results showed that more mindful graduates used “bracing for the worst” significantly less, and reserved it only for the end of the waiting period when it was likely to be of actual benefit. More mindful graduates were also significantly more likely to maintain an optimistic mindset, worry less, and report better coping.

In the second study, 90 law school graduates (56% female; 61% Caucasian) completed a questionnaire assessing dispositional optimism and intolerance for uncertainty one week before taking their bar exam. Participants were […]

July 26th, 2017|News|

MBSR participants with generalized anxiety disorder miss less work

Posted 03.21.2017 | by AMRA

People with generalized anxiety disorder (GAD) suffer from excessive and uncontrollable worry concerning a broad array of everyday matters (work, money, health, relationships, etc.) along with a range of physical symptoms (headache, fatigue, muscle tension, etc.) associated with stress. As a result, people with GAD often miss days at work and tend to use medical and mental health services at a higher rate than the average person.

GAD is often treated with medication and psychotherapy, and in recent years, mindfulness-based interventions have been added as an additional treatment alongside more traditional approaches.

In a secondary analysis of a previously published randomized, controlled clinical trial, Hoge et al. [Journal of Psychosomatic Medicine] investigated whether Mindfulness-Based Stress Reduction (MBSR) reduced the number of GAD sufferers’ missed days at work and the number of their visits to primary care and mental health care professionals to a greater degree than a stress management education (SME) control.

The 57 individuals with GAD (mean age = 39; 56% female; 83% Caucasian) whose data were analyzed in this study were a subset of a larger cohort of individuals with GAD who were randomly assigned to either a standard 8-week MBSR program or an 8-week SME program. The SME program covered topics relevant to stress including time management, nutrition, exercise, and sleep.

The subgroup of patients whose data was included in this analysis completed the World Health Organization Health Performance and Work Questionnaire (HPQ) at baseline, after intervention, and at 24-week follow-up. The HPQ is a self-report measure of illness-related absences from work and visits to primary care and mental health professionals.

At immediate post-intervention, the MBSR group had significantly decreased the number of partial […]

March 21st, 2017|News|

MBSR for Social Anxiety Disorder promotes positive self-view

Posted 02.16.2017 | by AMRA

Social Anxiety Disorder (SAD) is a psychiatric condition affecting approximately 7% of Americans. Symptoms include fear, embarrassment, and humiliation in social situations, along with avoidance of social interactions. People with SAD have negative beliefs about their social acceptability and self-worth, creating fear that others will discover their self-perceived negative qualities. Altering these negative self-beliefs may be an effective way to reduce the severity of SAD symptoms.

Thurston et al. [Journal of Anxiety Disorders] conducted a randomized, controlled study to test the effects of Mindfulness-Based Stress Reduction (MBSR) and Cognitive Behavioral Group Therapy (CBGT) on positive and negative self-evaluations and their relationship to social anxiety symptoms in patients with SAD.

The researchers randomly assigned 108 volunteers (56% female; mean age = 33 years; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) with SAD to a 12-week MBSR program, CBGT program, or wait-list control. The volunteers completed a Self-Referential Encoding Task (SRET) and a self-report scale of social anxiety at baseline and after the assigned intervention. The SRET was also completed by a separate group of 40 healthy controls that served as a baseline comparison group. The SRET measures participants’ positive and negative self-views by having them select the words that best describe themselves from pairs of computer-presented negative and positive adjectives.

The standard curriculum-based MBSR intervention omitted the usual “retreat day” in the sixth week of the program, but extended the program by adding four additional weekly group sessions so that it better matched the 12-week CBGT program. The CBGT program taught cognitive restructuring and relapse prevention and offered graded exposure to feared social situations, both in-program and the “real world.” Wait-listed controls did not participate […]

February 16th, 2017|News|

Mindfulness practice found to benefit drug-resistant epileptics

Posted 10.23.2015 | by AMRA

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Epileptic disorders are neurological disorders characterized by recurrent seizures. About 30% of people with epilepsy are drug resistant, meaning that despite trials of at least two different anti-epileptic medications, they are unable to rid themselves of seizures. Because people with epilepsy are prone to depression and anxiety, and because stress plays a significant role in provoking seizures, people with epilepsy may benefit from mindfulness-based interventions (MBIs).

In a randomized, controlled study, Tang, et al. [Neurology] tested the impact of a MBI on quality of life, seizure frequency, and cognition in drug-resistant epileptics.

The researchers recruited 60 drug-resistant epileptics (53% female, average age = 35) from neurology practices in Hong Kong, and randomly assigned them to either a 6-week MBI program that included social support or a 6-week program of social support (SS) alone. Both interventions provided didactic information about epilepsy along with the opportunity to share experiences related to seizures and their management. The MBI also offered practice in the body scan, mindful breathing, listening, and eating, and non-judgmental awareness of thoughts.

Both interventions were offered in four 2.5-hour biweekly classes, and in addition, MBI participants were encouraged to practice mindfulness for 45 minutes per day at home. Participants kept daily diaries of seizure frequency for 6 weeks prior to the intervention and during a 6-week post-intervention follow-up. They also completed a battery of self-report and cognitive measures at baseline and post-intervention.

Both groups showed significant improvement on a 100-point Quality of Life (QOL) scale, but a significantly greater percentage of MBI participants (37%) showed clinically meaningful QOL improvement (a 12-point or greater increase) compared to SS participants (13%). Both groups significantly reduced their symptoms […]

October 23rd, 2015|News|

Mindfulness training shows promise for MS patients

Posted 04.20.2015 | by AMRA

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Multiple Sclerosis (MS) is an autoimmune disease that damages the integrity of nerve cells in the brain and spinal cord resulting in a variety of sensory and motor deficits and often leading to mobility impairment, pain, and fatigue. MS patients frequently suffer from depression and anxiety, and there is some evidence that stress may play a role in precipitating tissue damage. MS can manifest as either a relapsing and remitting disease with symptoms that wax and wane, or as a progressive disease with a degenerative course.

Bogosian et al. [Multiple Sclerosis Journal] completed a pilot study of the effectiveness of a mindfulness-based intervention (MBI) for reducing distress in patients with progressive MS. The intervention, adapted from Mindfulness-Based Cognitive Therapy (MBCT) and tailored to the specific needs of MS patients, was delivered via eight teleconferenced one-hour group sessions. Meditations were kept brief (10-20 minutes) and the mindful movement component was eliminated.

Forty British patients with progressive MS were randomly assigned to either the MBI or a waitlist control. They completed a variety of self-report measures at baseline, immediate post-intervention, and three-month follow-up. The cohort was 90% Caucasian and 55% female (average age = 53 years).

The MBI participants reported significantly lower rates of distress at immediate post-intervention (moderate effect size) and three-month follow-up (large effect size) compared to the waitlist controls. They also reported significantly greater reductions in depression and the psychological impact of their MS (moderate to large effect sizes) at both assessment points. Anxiety was significantly lower (moderate effect size) at three month follow-up, but not at post-intervention.

Group differences in physical symptoms (e.g., pain and fatigue) tended to be non-significant except for pain […]

April 20th, 2015|News|

MBSR trainees reduce their healthcare utilization

Posted: 11.21.2014 | by AMRA

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Since stress often contributes to medical illness, it is possible that mindfulness-based interventions (MBIs) that contain a stress reduction component might reduce the need for subsequent medical services. Few studies actually measure post-MBI medical utilization however, probably due to the difficulty in gathering data from an often fragmented healthcare delivery system.

Integrated healthcare systems offer better opportunities for such research. At Kaiser Permanente Colorado, McCubbin et al. [The Permanente Journal] studied the impact of Mindfulness Based Stress Reduction (MBSR) on self-reported physical and mental health, work productivity, and objectively measured healthcare utilization using an uncontrolled pre-post design.

The 38 participants were mostly female (79%) and Hispanic (68%) with an average age of 53 years. Participants being treated for chronic pain, chronic illness, or stress-related disorders were referred to the study by their primary care physicians. Participants were evaluated at baseline, on the final day of the 8-week program, and one year following their last class.

Health care utilization by the study participants was assessed using Kaiser Permanente Colorado electronic administrative and claims data for a six-month period prior to starting the program, and for a 6-month period following the 1-year anniversary of completing the program. Participants showed significant reductions from baseline in their self-rated pain, depression, anxiety, and somatization at the end of the 8-week program. All of these improvements were maintained at one-year follow-up, with some symptoms (pain, depression, anxiety) showing continued significant improvement beyond the initial gains.

Compared to the six-month period prior to the program, in the six-month period following the one year anniversary of program completion, participants made significantly fewer primary care visits (1.8 vs. 0.9), specialty care visits (7.8 vs. […]

November 21st, 2014|News|