Friday, February 27, 2015

Mindfulness = Emotional and Physical Well Being

Mindfulness meditation appears to help improve sleep quality

Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance in a clinical trial comparing meditation to a more structured program focusing on changing poor sleep habits and establishing a bedtime routine, according to a new article.

Mindfulness meditation practices resulted in improved sleep quality for older adults with moderate sleep disturbance in a clinical trial comparing meditation to a more structured program focusing on changing poor sleep habits and establishing a bedtime routine, according to an article published online February 2015 by JAMA Internal Medicine.

Sleep disturbances are a medical and public health concern for our nation's aging population. An estimated 50 percent of individuals 55 years and older have some sort of sleep problem. Moderate sleep disturbances in older adults are associated with higher levels of fatigue, disturbed mood, such as depressive symptoms, and a reduced quality of life, according to the study background.

David S. Black, Ph.D., M.P.H., of the University of Southern California, Los Angeles, and coauthors conducted the small clinical trial in Los Angeles in 2012 and their analysis included 49 individuals (average age 66). The trial included 24 individuals who took part in a standardized mindful awareness practices (MAPs) intervention and 25 individuals who participated in a sleep hygiene education (SHE) intervention. Differences between the groups were measured using the Pittsburgh Sleep Quality Index (PSQI), a widely used self-reported questionnaire of sleep disturbances.

Participants in the MAPs group showed improvement relative to those in the SHE group. The MAPs group had average PSQI scores of 10.2 at baseline and 7.4 after the intervention. The SHE group had average PSQIs of 10.2 at baseline and 9.1 after the intervention, study results show. The MAPs group also showed improvement relative to the SHE group on secondary measures of insomnia symptoms, depression symptoms, fatigue interference and fatigue severity. However, differences between the groups were not seen for anxiety, stress or inflammatory signaling, a measure of which declined in both groups over time.

"According to our findings, mindfulness meditation appears to have a role in addressing the prevalent burden of sleep problems among older adults by remediating their moderate sleep disturbances and deficits in daytime functioning, with short-term effect sizes commensurate with the status quo of clinical treatment approaches for sleep problems. ... Given that standardized mindfulness programs are readily delivered in many communities, dissemination efforts do not serve as a barrier in this instance. ... Pending future replication of these findings, structured mindfulness mediation training appears to have at least some clinical usefulness to remediate moderate sleep problems and sleep-related daytime impairment in older adults," the study concludes.

Commentary: Being Mindful of Later-Life Sleep Quality

In a related commentary, Adam P. Spira, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, writes: "As the authors explain, effective nonpharmacological interventions that are both 'scalable' and 'community accessible' are needed to improve disturbed sleep and prevent clinical levels of insomnia. This is imperative given links between insomnia and poor health outcomes, risks of sleep medication use and the limited availability of health care professionals trained in effective nondrug treatments such as behavior therapy and cognitive behavioral therapy for insomnia. This context makes the positive results of this RCT [randomized clinical trial] compelling."

"This excellent study raises some questions that need to be answered in future research," Spira continues.

"In summary, Black et al are to be applauded for their intriguing study. Other community-based nonpharmacological interventions are needed that improve sleep and perhaps prevent insomnia among older adults. Such interventions may have a key role in safely reducing the morbidity associated with disturbed sleep in later life," Spira concludes.

Mindfulness decreased patients’ desire for prescription drugs
How can people who are dependent on prescription opioids reduce their cravings? Learn to enjoy other aspects of their lives.
That’s the key finding in a new (December 2014) study published in the Journal of Behavioral Medicine by Eric L. Garland, associate professor at the University of Utah College of Social Work. Garland and colleagues studied how an intervention program for chronic pain patients called Mindfulness-Oriented Recovery Enhancement (MORE) decreased patients’ desire for prescription drugs.
The MORE intervention concentrates on helping people to recover a sense of meaning and fulfillment in everyday life, embracing its pleasures and pain without turning to substance use as a coping mechanism. It integrates the latest research on addiction, cognitive neuroscience, positive psychology and mindfulness.  Participants in Garland’s study received eight weeks of instruction in applying mindfulness-oriented techniques to alleviate pain and craving while strengthening positive emotions and the sense of reward and meaning in life.
For example, to enhance their sense of reward in life, participants in Garland’s study were taught a “mindful savoring practice,” in which they focused attention on pleasant experiences such as a beautiful nature scene, sunset or feeling of connection with a loved one. In a meditation session, participants were taught to focus their awareness on colors, textures and scents of a bouquet of fresh flowers and to appreciate joy arising from the experience. As part of their daily homework, they were then asked to practice the meditation technique as a way to enjoy other pleasant life experiences.
Results from Garland’s new research shows that after a sample of chronic pain patients misusing opioids went through MORE, they exhibited increased brain activation on an EEG to natural healthy pleasures. The more their brains became active in response to natural healthy pleasure, the less the patients craved opioids.
“These findings are scientifically important because one of the major theories about how and why addiction occurs asserts that over time drug abusers become dulled to the experience of joy in everyday life, and this pushes them to use higher and higher doses of drugs to feel happiness,” said Garland.
“This study suggests that this process can be reversed. We can teach people to use mindfulness to appreciate and enjoy life more, and by doing that, they may feel less of a need for addictive drugs. It’s a powerful finding.”
Garland’s latest study builds on earlier work published in February in The Journal of Consulting and Clinical Psychology, in which the MORE intervention was found to reduce opioid misuse among a sample of chronic pain patients compared to another sample of chronic pain patients participating in a conventional support group.
The results are of particular interest in Utah, which claims one of the highest prescription drug abuse rates in the U.S.  According to the most recent statistics available from the state Division of Substance Abuse and Mental Health, Utah ranks eighth in the U.S. for its number of deaths attributed to prescription drug overdose.

Evidence supports health benefits of 'mindfulness-based practices'

Specific types of "mindfulness practices" including Zen meditation have demonstrated benefits for patients with certain physical and mental health problems, according to a report in the July Journal of Psychiatric Practice.

"An extensive review of therapies that include meditation as a key component -- referred to as mindfulness-based practices -- shows convincing evidence that such interventions are effective in the treatment of psychiatric symptoms and pain, when used in combination with more conventional therapies," according to Dr William R. Marchand of the George E. Wahlen Veterans Affairs Medical Center and the University of Utah in Salt Lake City.

Mindfulness Techniques Show Health Benefits Dr Marchand reviewed published studies evaluating the health benefits of mindfulness-based practices. Mindfulness has been described as "the practice of learning to focus attention on moment-by-moment experience with an attitude of curiosity, openness, and acceptance." Put another way, "Practicing mindfulness is simply experiencing the present moment, without trying to change anything."

The review focused on three techniques:
• Zen meditation, a Buddhist spiritual practice that involves the practice of developing mindfulness by meditation, typically focusing on awareness of breathing patterns.
• Mindfulness-based stress reduction (MBSR), a secular method of using Buddhist mindfulness, combining meditation with elements of yoga and education about stress and coping strategies.
• Mindfulness-based cognitive therapy (MBCT), which combines MBSR with principles of cognitive therapy (for example, recognizing and disengaging from negative thoughts) to prevent relapse of depression.

Dr Marchand found evidence that MBSR and MBCT have "broad-spectrum" effects against depression and anxiety and can also decrease general psychological distress. Based on the evidence, MBCT can be "strongly recommended" as an addition to conventional treatments (adjunctive treatment) for unipolar depression. Both MBSR and MBCT were effective adjunctive treatments for anxiety.

Research data also supported the effectiveness of MBSR to help reduce stress and promote general psychological health in patients with various medical and/or psychiatric illnesses. On its own, MBSR was helpful in managing stress and promoting general psychological health in healthy people. There was also evidence that Zen meditation and MBSR were useful adjunctive treatments for pain management.

How do these practices work to affect mental and physical health? Dr Marchand discusses recent research showing the impact of mindfulness practices on brain function and structure, which may in part account for their psychological benefits. "These mindfulness practices show considerable promise and the available evidence indicates their use is currently warranted in a variety of clinical situations," he concludes.

The article includes some proposed evidence-based guidelines for incorporating mindfulness-based practices into health care. So far there's little evidence on which patients are most likely to benefit, but Dr Marchand suggests that patient preferences and enthusiasm are a good guide. 

He comments, "The most important considerations may be desire to try a mindfulness-based practice and willingness to engage in the regular practice of seated meditation."

The Importance of Cultivating Mindfulness for Cognitive and Emotional Well-Being in Late Life

The cultivation of mindfulness has received increasing attention over the past 2 decades because of its association with increased psychological well-being and reduced stress-related health disorders. Given the robust positive association between perceived stress and cognitive impairment in late life, a new (October, 2014) study evaluated the association between trait mindfulness, psychological well-being, and cognitive function in 73 healthy community-dwelling older adults.

Controlling for a priori covariates, multivariate regression analyses showed a significant association between trait mindfulness and measures of psychological well-being, including self-reported depressive symptoms, quality of life, and stress profile.

Analyses further showed a significant association between trait mindfulness and executive function, namely set shifting. No association was found for declarative memory. Mediation analyses showed that the association between mindfulness and cognitive function is mediated by perceived stress.

This research supports the importance of cultivating mindfulness in late life to ensure cognitive and emotional well-being.

Just 25 minutes of mindfulness meditation alleviates stress, study shows

Mindfulness meditation has become an increasingly popular way for people to improve their mental and physical health, yet most research supporting its benefits has focused on lengthy, weeks-long training programs. New research is the first to show that brief mindfulness meditation practice -- 25 minutes for three consecutive days -- alleviates psychological stress. The study investigates how mindfulness meditation affects people's ability to be resilient under stress.

Mindfulness meditation has become an increasingly popular way for people to improve their mental and physical health, yet most research supporting its benefits has focused on lengthy, weeks-long training programs.

New research from Carnegie Mellon University is the first to show that brief mindfulness meditation practice -- 25 minutes for three consecutive days -- alleviates psychological stress. Published in the journal Psychoneuroendocrinology, the study investigates how mindfulness meditation affects people's ability to be resilient under stress.

"More and more people report using meditation practices for stress reduction, but we know very little about how much you need to do for stress reduction and health benefits," said lead author J. David Creswell, associate professor of psychology in the Dietrich College of Humanities and Social Sciences.

For the study, Creswell and his research team had 66 healthy individuals aged 18-30 years old participate in a three-day experiment. Some participants went through a brief mindfulness meditation training program; for 25 minutes for three consecutive days, the individuals were given breathing exercises to help them monitor their breath and pay attention to their present moment experiences. A second group of participants completed a matched three-day cognitive training program in which they were asked to critically analyze poetry in an effort to enhance problem-solving skills.

Following the final training activity, all participants were asked to complete stressful speech and math tasks in front of stern-faced evaluators. Each individual reported their stress levels in response to stressful speech and math performance stress tasks, and provided saliva samples for measurement of cortisol, commonly referred to as the stress hormone.

The participants who received the brief mindfulness meditation training reported reduced stress perceptions to the speech and math tasks, indicating that the mindfulness meditation fostered psychological stress resilience. More interestingly, on the biological side, the mindfulness mediation participants showed greater cortisol reactivity.

"When you initially learn mindfulness mediation practices, you have to cognitively work at it -- especially during a stressful task," said Creswell. "And, these active cognitive efforts may result in the task feeling less stressful, but they may also have physiological costs with higher cortisol production."

Creswell's group is now testing the possibility that mindfulness can become more automatic and easy to use with long-term mindfulness meditation training, which may result in reduced cortisol reactivity.

Mindfulness -- awareness of the present moment -- may be an important contributor to better emotional well-being

A new study from the University of Utah shows that individuals who describe themselves as being more mindful have more stable emotions and perceive themselves to have better control over their mood and behavior throughout the day. Higher mindful people also describe less cognitive and physiological activation before bedtime, suggesting that greater emotional stability during the day might even translate into better sleep.

The study results were presented at the annual meeting of the American Psychosomatic Society.

Prior studies of mindfulness -- paying attention in a particular way, on purpose in the present moment and non-judgmentally -- have typically been conducted with participants trained in mindfulness, for example meditation or other interventions. In contrast, this study examines naturally-occurring traits of mindfulness. Using a novel method for data collection, the participants wore a monitor that measured cardiac functioning and were prompted periodically throughout the day to rate their emotional state and mental functioning. Examining these processes during normal daily living builds on prior mindfulness research conducted in laboratory-controlled settings.

"This study gives us a better understanding of how mindfulness affects stress responses throughout the day," says Holly Rau, a graduate student involved with this research. "People who reported higher levels of mindfulness described better control over their emotions and behaviors during the day. In addition, higher mindfulness was associated with lower activation at bedtime, which could have benefits for sleep quality and future ability to manage stress."

How the study was conducted

A total of 38 subjects, recruited from the community and University of Utah undergraduate psychology courses, participated in the study. They ranged in age from 20 to 45, and one-third were male. On the first day of the study, each participant completed a baseline assessment that included standard questionnaires, resting physiological assessment, and cognitive testing before beginning two days of experience sampling.

In the daily life portion of the study, participants wore a cardiac impedance monitor and responded to questions about their emotional state several times a day for two days. At the end of each day, participants also completed questionnaires about their ability to regulate their emotions and behaviors and were asked to rate their level of cognitive and physical arousal before falling asleep.

Researchers found that greater emotional stability, better self-rated control of emotions and behaviors and lower pre-sleep arousal (a measurement of cognitive and physical symptoms of anxiety) were all significantly associated with higher trait mindfulness. Results suggest that mindfulness may be linked to self-regulation throughout the day, and that this may be an important way that mindfulness contributes to better emotional and physical well-being.

Future research will examine the link between moment-to-moment mindfulness, physiological markers of stress throughout the day and sleep quality. Examination of similar measures of mood, self-regulation and sleep quality in everyday life in the context of mindfulness intervention is another important direction for research.

Mindfulness meditation reduces loneliness in older adults

For older adults, loneliness is a major risk factor for health problems -- such as cardiovascular disease and Alzheimer's -- and death. Attempts to diminish loneliness with social networking programs like creating community centers to encourage new relationships have not been effective.

However, a new study led by Carnegie Mellon University's J. David Creswell offers the first evidence that mindfulness meditation reduces loneliness in older adults. Published in "Brain, Behavior & Immunity," the researchers also found that mindfulness meditation -- a 2,500-year-old practice dating back to Buddha that focuses on creating an attentive awareness of the present moment -- lowered inflammation levels, which is thought to promote the development and progression of many diseases. These findings provide valuable insights into how mindfulness meditation training can be used as a novel approach for reducing loneliness and the risk of disease in older adults.

"We always tell people to quit smoking for health reasons, but rarely do we think about loneliness in the same way," said Creswell, assistant professor of psychology within CMU's Dietrich College of Humanities and Social Sciences. "We know that loneliness is a major risk factor for health problems and mortality in older adults. This research suggests that mindfulness meditation training is a promising intervention for improving the health of older adults."

For the study, the research team recruited 40 healthy adults aged 55-85 who indicated an interest in learning mindfulness meditation techniques. Each person was assessed at the beginning and end of the study using an established loneliness scale. Blood samples also were collected.

The participants were randomly assigned to receive either the eight-week Mindfulness-Based Stress Reduction (MBSR) program or no treatment. The MBSR program consisted of weekly two-hour meetings in which participants learned body awareness techniques -- noticing sensations and working on breathing -- and worked their way toward understanding how to mindfully attend to their emotions and daily life practices. They also were asked to practice mindfulness meditation exercises for 30 minutes each day at home and attended a daylong retreat.

The researchers found that eight weeks of the mindfulness meditation training decreased the participants' loneliness. Using the blood samples collected, they found that the older adult sample had elevated pro-inflammatory gene expression in their immune cells at the beginning of the study, and that the training reduced this pro-inflammatory gene expression, as well as a measure of C-Reactive Protein (CRP). These findings suggest that mindfulness meditation training may reduce older adults' inflammatory disease risk.

"Reductions in the expression of inflammation-related genes were particularly significant because inflammation contributes to a wide variety of the health threats including cancer, cardiovascular diseases and neurodegenerative diseases," said study collaborator Steven Cole, professor of medicine and psychiatry and biobehavioral sciences at the UCLA School of Medicine.

While the health effects of the observed gene expression changes were not directly measured in the study, Cole noted that "these results provide some of the first indications that immune cell gene expression profiles can be modulated by a psychological intervention."

Creswell added that while this research suggests a promising new approach for treating loneliness and inflammatory disease risk in older adults, more work needs to be done. "If you're interested in using mindfulness meditation, find an instructor in your city," he said. "It's important to train your mind like you train your biceps in the gym."

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