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MBSR helps soothe pain after joint replacement surgery

Posted 09.20.2019 | by AMRA

Total hip and knee replacements are among the highest volume elective surgical procedures performed today. The vast majority of joint replacement patients report significant post-operative reductions in pain and disability. Nonetheless, about 15% of patients report poor surgical outcomes marked by continuing pain, disability, and dissatisfaction.

Pre-surgical levels of distress related to depression and anxiety are the best predictors of which patients are likely to fare poorly after surgery.

Medical professionals are interested in psychological interventions that could improve post-surgical outcomes. Dowsey et al. [Complementary Therapies in Medicine] tested whether pre-surgical Mindfulness-Based Stress Reduction (MBSR) could improve physical and psychological wellbeing outcomes after joint replacement surgery.

The researchers randomly assigned 127 Australian arthritis patients (average age = 65 years; female = 72%) with moderate-to-severe psychological distress (based on a psychological assessment cut-off score) who were surgically approved for knee or hip replacement to either surgery and post-operative care as usual, or a standard 8-week MBSR program followed by surgery and post-operative care as usual. Out of this sample, 45 MBSR assignees and 56 treatment-as-usual assignees eventually underwent surgery. Surgical patients were seen by their treating surgeons during 12-month surgical follow-up appointments.

Patients completed a self-report osteoarthritis measure that included subscales assessing pain, stiffness, and functional disability, as well as a total overall score that can serve as a single measure of global symptom severity. They also completed measures of general physical and psychological wellbeing, pain-management self-efficacy, and mindfulness (using the Five Facet Mindfulness Questionnaire). Assessments were completed at baseline, 3 months, and 12 months.

MBSR participants reported significantly less pain at 12 months than controls. They also reported significantly greater improvement on the global measure of overall […]

September 20th, 2019|News|

MBSR shows cost benefit for fibromyalgia, fewer sick days

Posted 08.30.2019 | by AMRA

Fibromyalgia is a chronic disorder affecting approximately 10,000,000 Americans. The disorder presents with symptoms of widespread musculoskeletal pain, fatigue, and mood, sleep, and cognitive difficulties. The cause of fibromyalgia is unknown, and its treatment is largely palliative, consisting of medication to reduce pain and inflammation, graded physical exercise and/or cognitive-behavioral therapy. The disorder incurs a wide variety of costs including high rates of unemployment, sick leave, disability claims, and direct medical care utilization.

Perez-Aranda et al. [Journal of Clinical Medicine] compared the cost-effectiveness and clinical utility of adjunctive Mindfulness-Based Stress Reduction (MBSR) to a previously validated comparator intervention and treatment-as-usual in the treatment of fibromyalgia.

The researchers randomly assigned 225 fibromyalgia patients recruited from a Spanish hospital to one of three treatment interventions: 1) MBSR + treatment-as-usual, 2) FibroQoL + treatment-as-usual, and 3) treatment-as-usual alone. MBSR was delivered using the standard 8-week group protocol with minimal adaptations. FibroQoL is a fibromyalgia intervention with previously demonstrated superiority to treatment-as-usual. It consists of 8 weekly 2-hour group sessions that include fibromyalgia psycho-education, relaxation, and self-hypnosis to help patients control pain and visualize a future pain-free life. Treatment-as-usual involved prescription medications for pain, inflammation, depression, and anxiety, along with recommendations for daily exercise.

Cost-utility data was only available for a final sample of 204 participants (98% female; average age = 53 years). Analyses were performed separately for the full intention-to-treat sample and for 107 patients who attended at least 6 of the 8 intervention sessions and their 12-month follow-up appointments.

Self-ratings of quality-of-life were obtained at baseline and 12 months using the EuroQol EQ-5D to assess disease impingement on mobility, self-care, and activities of daily living, as well as […]

August 30th, 2019|News|

MBSR supports less stress and fear extinction via hippocampus

Posted 07.23.2019 | by AMRA

Overcoming irrational fears involves recognizing when stimuli previously associated with danger have ceased their association with that danger. This means “extinguishing” a learned connection between a stimulus and its previously feared negative consequences.

Mindfulness can help with fear extinction by enabling individuals to approach previously feared stimuli with an attitude of non-reactive acceptance. Sevinc et al. [Biological Psychiatry] studied whether a mindfulness-based intervention affects the brain activity underlying the fear extinction process.

The researchers assigned 94 meditation-naive adults (average age = 32 years; 64% female) to either an 8-week mindfulness-based stress reduction (MBSR) program or an 8-week exercise-based stress management education program. Stress education consisted of 8 weekly 2 hour group sessions that included 40 minutes of light aerobic exercise and didactic presentations on coping with stress through exercise, nutrition, humor, and sleep hygiene.

Two weeks before and after intervention, participants underwent a two-day classical fear conditioning and fear extinction paradigm while being monitored by brain imaging (fMRI).

In the fear conditioning paradigm, participants were presented with images of rooms with either red, blue, or yellow lights. An annoying electric shock immediately followed the images of the rooms with the red or blue lights, but not the yellow lights. Fear was considered “conditioned” to the red or blue lights when exposure to those images led to an increase in skin conductance.

After the conditioned skin conductance response (SCR) was acquired, participants were then repeatedly exposed to the image with the red light without a consequent shock in order to extinguish the skin conductance response to that image while maintaining the conditioned skin conductance response to the blue light.

The next day, participant SCRs to the images were reassessed […]

July 23rd, 2019|News|

MBSR supports immune health among breast cancer survivors

Posted 05.28.2019 | by AMRA

Newly diagnosed breast cancer patients often experience significant psychological distress including symptoms of depression, sleep disturbance, and fatigue. They can also exhibit stress-induced immune system compromises that have the potential to accelerate tumor growth and metastasis. Interventions that restore psycho-immunological balance may also help improve cancer treatment outcomes.

Witek-Janusek et al. [Brain, Behavior, and Immunity] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on psychological and immunological functioning in newly diagnosed breast cancer patients in an experimental trial.

The researchers randomly assigned 164 women (average age = 55 years; 77% Caucasian) recently diagnosed with early stage breast cancer who had undergone surgery to either a standard MBSR or an active control condition. The active control consisted of eight 2.5 hour group sessions providing information on breast cancer, cancer treatment, communication with health providers, and other health-related topics. Attendance in both programs was fairly good, with 68% of MBSR and 78% of control participants attending at least 7 of the group sessions.

Each participant’s psychological status was assessed pre-intervention, mid-intervention, post-intervention, and at 1- and 6-month follow-ups for perceived stress, depression, sleep quality, fatigue, and mindfulness (Five Facet Mindfulness Questionnaire).

The researchers also measured natural killer cell anti-tumor activity (NKCA), monocyte production of Interleukin-6 (IL-6) and Interferon-gamma (INF-ɣ), and the amount of IL-6 and Tumor Necrosis Factor-alpha (TNF-α) present in blood plasma. NKCA prevents tumor growth and metastasis, and is thus associated with longer cancer-free periods. NK cells produce INF-ɣ, an anti-tumor cytokine which is a key immune system activator. IL-6 and TNF-α are pro-inflammatory cytokines that promote tumor progression and aggressiveness.

The results showed that the MBSR group had significantly greater increases in two protective immunological factors […]

May 28th, 2019|News|

Experienced MBSR teachers show higher cortisol, unrelated to stress

Posted 04.23.2019 | by AMRA

Little is known about the impact of many years of mindfulness practice on the body’s response to stress. Robb et al. [Complementary Medicine Research] conducted a pilot study that measured salivary cortisol levels in a group of long-term mindfulness practitioners. Salivary cortisol is a biological measure that is highly reactive to stress. The researchers predicted that morning cortisol levels would be lowest for meditators with the most meditative experience.

Salivary cortisol levels typically peak during the first hour after waking up, and then decline throughout the rest of the day. Morning cortisol levels tend to be higher when under acute stress, and tend to be lower in states of exhaustion and burnout following long-term stress.

The authors recruited 83 certified Mindfulness-Based Stress Reduction (MBSR) teachers (73% female; 96% Caucasian; average age = 58; 92% with graduate degrees) to participate in the study. The participants completed an online questionnaire assessing a variety of health and lifestyle variables, perceived stress, and the extent of their meditation practice. They were then asked to produce a saliva sample upon first waking up, followed by 3 additional samples collected at 15-minute intervals. The total amount of cortisol produced during the first 45 minutes after awakening was then estimated using area under the curve (AUC) calculations.

The results showed that participants in the upper quartile of meditative experience (>26 years) had significantly higher (48%) total estimated morning cortisol amounts than those in the lowest (<10 years) quartile. The relationship between years of meditative experience and total morning cortisol remained significant when meditation experience was treated as a continuous variable.

In a closer examination of the data, this difference between participants in the […]

April 23rd, 2019|News|

MBSR added to residential mental health treatment for adolescents

Posted 12.04.2018 | by AMRA

While there is a fairly extensive research literature evaluating the benefits of Mindfulness Based Stress Reduction (MBSR) for adults with depression and anxiety, research into the benefits of MBSR for adolescents with mental health problems is sparse.

Vohra et al. [Child and Adolescent Mental Health] conducted a controlled trial of MBSR as an adjunctive treatment for adolescents attending an intensive residential mental health treatment program.

The researchers studied 85 non-psychotic adolescent patients (average age = 14 years; 59% male; 73% Caucasian) residing in an intensive residential mental health treatment program. Half of the residents received standard residential care and half received standard residential care plus adjunctive MBSR. Assignment to condition was based on the time of year that patients resided in the treatment program, rather than on individual randomization.

Standard residential care consisted of a structured program including daily group therapy, medication, education, recreation, and weekly family therapy. Adjunctive MBSR was offered in eight two-hour weekly sessions with a three-hour retreat in week eight. The standard MBSR protocol was modified for the age group and homework was less demanding.

Outcome measures assessed at baseline, 10 weeks, and 3 months included parent, teacher, and self-ratings using the Behavioral Assessment System for Children System (BASC) as well as self-ratings on perceived stress, mindfulness (using the Child Acceptance and Mindfulness Measure), and emotional regulation. During the course of the study, 4 participants were discharged early and one participant declined further participation. Average MBSR session attendance was 88%.

BASC teacher ratings showed significant improvements for the adjunctive MBSR group on measures of internalizing problems (depression, anxiety, somatization) and adaptive skills (social skills, study skills, leadership) compared to standard care alone. Average […]

December 4th, 2018|News|

Brain connectivity differs for short- and long-term meditators

Posted 08.28.2018 | by AMRA

Mindfulness-based interventions can enhance emotional regulation and improve mood, but we are only just beginning to understand the brain mechanisms responsible for these benefits. Kral et al. [Neuroimage] compared the brain activity of long-term meditators, short-term meditators, and non-meditators in response to emotionally positive, negative, and neutral images. The researchers sought to discover whether or not the amount of an individual’s meditation practice correlated with their response to emotional stimuli.

The researchers recruited a sample of 31 long-term Vipassana mediators (average age = 50 years, 55% female, average meditation practice = 9,000 hours) and compared them to a sample of 127 meditation-naive recruits. Following initial data collection, 86 of the meditation-naïve recruits (average age = 48, 63% female) were randomly assigned to a standard 8-week Mindfulness-Based Stress Reduction (MBSR) program or a Health Enhancement program (HEP) which served as a time-and-attention control.

The long-term mediators and the meditation-naive participants spent a day in the laboratory prior to the meditation-naive group’s random assignment to intervention. Following intervention, the meditation-naive group returned to the laboratory for re-assessment.

In the laboratory, participants were shown emotionally positive, negative, and neutral images while undergoing functional magnetic resonance imaging (fMRI), a procedure that measures metabolic activity in different regions of the brain. The researchers measured fMRI activity in two specific brain regions: the amygdala, which plays a role in generating emotion, and the ventromedial prefrontal cortex (VMPFC), which plays a role in regulating emotion. Participants also completed a self-report measure of mindfulness, the Five Facet Mindfulness Questionnaire (FFMQ).

Results from the pre-intervention data showed that meditation-naive participants had significantly greater right amygdala activity in response to positive images than long-term meditators. While […]

August 28th, 2018|News|

MBSR program safe and feasible for people with multiple sclerosis

Posted 08.16.2018 | by AMRA

Multiple sclerosis is a central nervous system disorder in which the body’s immune system attacks the fatty layer of insulation surrounding nerve cells. Symptoms may include visual and sensory disturbances, muscle weakness and discoordination, fatigue, pain, and problems with mood and cognition. Stress can worsen these symptoms, and stress management can reduce the risk of the illness spreading to other brain regions.

Senders et al. [Multiple Sclerosis Journal] tested the feasibility of using Mindfulness-Based Stress Reduction (MBSR) with multiple sclerosis patients, and whether MBSR worked better than an active control intervention in improving psychological symptoms and wellbeing.

The researchers randomly assigned 67 patients with multiple sclerosis (average age = 53 years, 77% female, 97% Caucasian) to a standard 8-week MBSR intervention or to an education control group matched for time and attention. The control group curriculum covered topics such as medication, symptom management, financial planning, knowing one’s rights, and connecting with resources.

The groups were assessed on a variety of self-report measures of psychological symptoms, stress, and wellbeing at baseline, immediately after program completion, and at twelve months post-intervention.

Attention and cognition were assessed using a serial addition task in which participants listened to an audio recording of single digits presented at three-second intervals. Participants had to add each newly presented digit to the previously presented one. Participant expectations for the success of their respective interventions were assessed at baseline, with MBSR assignees having significantly higher expectations.

In regard to feasibility, 85% of the MBSR patients attended at least 6 of the 8 group sessions, thus meeting the author’s standard for course completion. They completed their at-home meditation on 55% of the assigned days for an average […]

August 16th, 2018|News|

MBSR and exercise both reduce cold and flu frequency, severity

Posted 07.17.2018 | by AMRA

Acute respiratory infections including colds and flu affect over 50% of the population annually. Interestingly, our psychological states and behaviors can affect our susceptibility to these infections. People who are under stress or otherwise unhappy are more likely to catch acute respiratory infections, while people who exercise regularly are less likely to catch them.

Barrett et al. [PLOS One] conducted a randomized controlled study to test the effects of Mindfulness-Based Stress Reduction (MBSR) and moderate intensity sustained exercise on the frequency, duration, and severity of colds and flu compared to a control group.

The researchers recruited 413 volunteers (average age = 50 years, 76% female, 85% white, 77% college educated) and randomly assigned them to a MBSR, exercise, or non-active control group. The MBSR and exercise interventions were matched on group size, program length, session frequency, and the amount of home practice (20-45 minutes).

The interventions were conducted in the fall, and participants were monitored for colds and flu from fall through spring. During this time, participants completed weekly health reports. If participants developed an infection, they completed daily reports until symptoms abated.

Additionally, they provided oral and nasal swabs to assess their immune response and identify viruses. Participants completed a variety of mental health and personality measures at baseline and at various points along the study timeline. Absenteeism, the number of respiratory infection-related medical appointments, and illness related costs were also assessed.

The study found that the MBSR and exercise groups both reduced acute respiratory infection incidence, duration, and severity. Compared to controls, the MBSR group showed a 16%, reduction in incidence, a 14% reduction in duration, and a 21% reduction in severity. Compared to controls, […]

July 17th, 2018|News|

MBSR and relaxation both reduce stress, but brain activity differs

Posted 05.17.2018 | by AMRA

Mindfulness-Based Stress Reduction (MBSR) and Relaxation Response (RR) training are both well-established mind-body interventions designed to reduce stress. While there is some overlap between these modalities—both involve meditative attention to bodily sensations—there are also significant differences. MBSR emphasizes non-judgmental awareness to increase acceptance of the present moment, while RR employs muscle relaxation to induce a parasympathetic state that interferes with the fight-or-flight response.

To understand the ways in which these two programs function, Sevinc et al. [Psychosomatic Medicine] tested for commonalties and differences in terms of psychological effects and brain correlates.

The researchers randomly assigned 50 volunteers (64% female, average age = 38 years) to either MBSR or RR with 40 of the volunteers completing the programs. Both programs involved 8 weekly 2-hour group sessions with 20 minutes of daily home practice. RR included a body scan meditation emphasizing muscle relaxation along with breath-focused and mantra-focused meditations.

Participants were assessed at baseline and after the intervention on self-report measures of mindfulness (using the Five Facet Mindfulness Questionnaire or FFMQ), perceived stress, self-compassion, and rumination.

After the intervention, participants underwent fMRI brain scanning while at rest and while engaging in the body scan meditation specific to each program: the RR body scan emphasized relaxing various muscle groups, whereas the MBSR body scan emphasized mindful awareness of body sensations.

The researchers were interested in exploring changes in functional connectivity in specific brain regions of interest. Brain regions exhibiting simultaneous increases and decreases in activity are said to be functionally connected. Usable fMRI data was obtained from 34 participants.

The results showed that both programs significantly reduced perceived stress (RR Cohen’s d=0.5; MBSR d=1.0). After the intervention, RR participants showed significant […]

May 24th, 2018|News|