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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|

Mothers’ mindfulness and infant brain development

Posted: 07.11.2014 | by AMRA

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Previous studies have shown that expectant mothers’ anxiety and stress can adversely affect their children’s brain development. If this is so, is it possible that expectant mothers’ levels of mindfulness can have a positive, protective effect on their children’s brain development?

van den Heuvel et al. [Social Cognitive and Affective Neuroscience] tested this possibility by assessing mindfulness (using a short form of the Freiburg Mindfulness Inventory) and anxiety (using a symptom checklist) in 78 expectant mothers during the second trimester of pregnancy. Nine months after their infants were born, the research team assessed the infants’ auditory processing by measuring their brain’s electrical responsiveness to sounds, or “auditory evoked event related potentials” (ERPs) using an electroencephalogram (EEG) to measure this responsiveness.

The infants were presented with series of sounds: a frequently presented tone with a base frequency of 500 vibrations per second interspersed with less frequently presented sounds such as the sound of a door slamming or a dog barking. The researchers analyzed two waveform components of the infants’ brain responses to sounds: a “P150” component (an electrically positive component of an EEG wave occurring at approximately 150 milliseconds after the presentation of a sound) reflecting selective attention to a particular stimulus together with suppression of attention to other stimuli, and an “N250” component (an electrically negative component of an EEG wave occurring at approximately 250 milliseconds after the presentation of a sound) tied to turning one’s attention to a novel stimulus.

Mothers’ mindfulness during pregnancy was associated with significantly larger infant P150 wave amplitudes and significantly smaller infant N250 wave amplitudes. Maternal anxiety during pregnancy was associated with significantly larger infant N250 wave amplitudes. […]

July 11th, 2014|News|

More needed beyond the present moment

Posted: 05.29.2014 | by AMRA

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Present-moment awareness is usually considered a desirable mental state, but prior research using the Five Factor Mindfulness Questionnaire (FFMQ) has shown that the factor of observing present-moment experience is counterintuitively correlated with increased anxiety and inconsistently correlated with depression. Under what circumstances does the observation of present-moment experience improve well-being and under what circumstances does it exacerbate symptoms of depression and anxiety?

Desrosiers et al. [Journal of Affective Disorders] hypothesized that present-moment observation must be coupled with the factor of non-reactivity in order to optimize its benefits. Observation alone can trigger rumination and worry, resulting in elevated distress, but when coupled with non-reactivity, it provides a space that allows for subsequent higher-level cognitive reappraisal.

The authors tested whether non-reactivity moderates the after-effects of observing depressive and anxiety symptoms, i.e, whether it decreases subsequent rumination and worry and facilitates cognitive reappraisal. They administered the FFMQ along with self-report measures of mood, worry, rumination, and cognitive reappraisal to 189 adults with depressive and anxiety disorders, and conducted an analysis of the intercorrelations between those measures. Findings were largely supportive of a crucial role for non-reactivity.

Observing present-moment experience significantly increased depressive symptoms in those participants who had the lowest levels of non-reactivity, while higher levels of non-reactivity were correlated with significantly decreased observation-induced rumination and worry, and increased observation-related cognitive reappraisal. For participants with low levels of non-reactivity, high levels of observation led to increased worry and rumination, whereas greater observation was related to less rumination among participants with high levels of non-reactivity. Similarly, the greater their non-reactivity, the greater the odds that participants would make use of cognitive reappraisal.

Observing was positively correlated with worry for […]

May 29th, 2014|News|

CALM Pregnancy Program Targets Perinatal Anxiety

Posted: 02.07.2014 | by AMRA

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Between 10-40% of women develop significant anxiety during pregnancy, an unsurprising fact given the associated physiological, hormonal, and lifestyle changes, and concerns about the impending responsibilities of parenthood. Perinatal anxiety is a risk factor for obstetrical complications and postpartum depression, and pharmacologic interventions are often contra-indicated. This underscores the need for effective behavioral treatments. Goodman et al. [Archives of Women’s Mental Health] designed an MBCT-derived intervention called CALM (Coping with Anxiety through Living Mindfully) Pregnancy to treat perinatal anxiety. A sample of 24 pregnant women with either generalized anxiety disorder (GAD) or significant GAD symptoms (as assessed through structured clinical interview) were enrolled in the program. Attendance and compliance were good, with 23 women (96%) successfully completing the 8-week group-based program.

Participants reported large and significant reductions in anxiety, worry and depression, and large and significant increases in self-compassion and dispositional mindfulness (as measured by the MAAS). Of the 16 participants who met the full diagnostic criteria for GAD at baseline, only 1 met the criteria at program completion. Similarly, the two women who met the diagnostic criteria for major depressive disorder at baseline no longer met the criteria at program completion. In an open-ended interview about what they had found most helpful, participants mentioned skill building, connection, universality, acceptance and self-kindness, decreased reactivity, cognitive changes, and insight.

This pilot study demonstrates the feasibility, acceptability, and potential effectiveness of the CALM Pregnancy program, at least for a population of mostly Caucasian, middle class, well-educated women. Future studies using randomly assigned controls will be needed to confirm the early promise of these findings in this and more diverse groups of women.

Reference:

Goodman, J. H., Guarino, A., […]

February 7th, 2014|News|

MBSR Reduces Burnout in Primary Care Providers

Posted from archive: 10.07.2013 | by AMRA

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Previous studies have shown that health care providers can be taught to be mindful, but busy clinicians often don’t have the time to attend lengthy programs. Fortney et al. [Annals of Family Medicine] tested the efficacy of an abbreviated form of MBSR in alleviating/ preventing symptoms of clinician burnout. The program offered 14 hours of mindfulness instruction over a three-day weekend, followed by two 2-hour post-training sessions. Exercises emphasized mindfulness while sitting, walking, listening and speaking, mindfulness in interaction with patients, and compassion for self and others. Participants were encouraged to practice 10 to 20 minutes per day at home.

Thirty primary care providers (physicians, nurse practitioners and physician assistants) participated in the program. They were assessed at baseline, immediately after the intervention, and at 8-week and 9-month follow-up on measures of burnout, depression, anxiety, stress, resilience, and compassion. While 63 of the participants had some prior meditation experience at some point in their life, only 7 were actively practicing meditation at the start of the study.

After the intervention, the clinicians reported significant decreases in emotional exhaustion, depersonalization, anxiety, and stress, and significant increases in a sense of personal accomplishment. All of these differences were significant at nine-month follow-up. No changes in clinician resilience or compassion were found, but the clinicians’ high scores on the brief five-item compassion scale at baseline left little room for improvement. These preliminary results suggest that abbreviated MBSR holds promise as a time, efficient means of improving clinician well-being, and, as a consequence, the quality of patient care.

Reference:

Fortney, L., Luchterhand, C., Zakletskaia, L., Zgierska, A., & Rakel, D. (2013). Abbreviated mindfulness intervention for job satisfaction, quality […]

January 21st, 2014|News|