Stress
Breast cancer survivors benefit from practicing mindfulness-based stress reduction
Women recently diagnosed with breast
cancer have higher survival rates than those diagnosed in previous decades,
according to the American Cancer Society. However, survivors continue to face
health challenges after their treatments end. Previous research reports as many
as 50 percent of breast cancer survivors are depressed. Now, University of
Missouri researchers in the Sinclair School of Nursing say a meditation
technique can help breast cancer survivors improve their emotional and physical
well-being.
"MBSR is another tool to enhance the lives of breast cancer survivors," Armer said. "Patients often are given a variety of options to reduce stress, but they should choose what works for them according to their lifestyles and belief systems."
The MBSR program consists of group sessions throughout a period of eight to ten weeks. During the sessions, participants practice meditation skills, discuss how bodies respond to stress and learn coping techniques. The researchers found that survivors who learned MBSR lowered their blood pressure, heart rate and respiratory rate. In addition, participants' mood improved, and their level of mindfulness increased after taking the class. Armer says, for best results, participants should continue MBSR after the class ends to maintain the positive effects.
"Mindfulness-based meditation, ideally, should be practiced every day or at least on a routine schedule," Armer said. "MBSR teaches patients new ways of thinking that will give them short- and long-term benefits."
Armer says the non-pharmaceutical approach works best as a complement to other treatment options such as chemotherapy, radiation and surgery.
"Post diagnosis, breast cancer patients often feel like they have no control over their lives," Armer said. "Knowing that they can control something -- such as meditation -- and that it will improve their health, gives them hope that life will be normal again."
The study, "Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors," was published in the Western Journal of Nursing Research.
'Mindfulness'
exercises help curb stress and fatigue associated with arthritis
"Mindfulness" exercises, which focus on experiencing
the present moment, no matter how difficult, can help curb the stress and
fatigue associated with painful rheumatoid joint disease, indicates a small
study published December 2011 online in the Annals of Rheumatic Diseases.
The authors base their findings on 73 patients between the ages
of 20 and 70, all of whom had had painful joint disease, caused by rheumatoid
arthritis, ankylosing spondylitis, or psoriatic arthritis for at least a year.
Half of them were randomly allocated to scheduled
"mindfulness" exercises, which took place in 10 group sessions over a
period of 15 weeks, plus a booster session around six months after the course
had completed.
The sessions, which were facilitated by healthcare professionals
trained in mindfulness techniques, addressed particular topics, such as
recognising individual limitations, and strong emotions, such as anger, joy,
and sorrow.
The exercises, which were part of the Vitality Training
Programme of VTP, encouraged participants to become aware of, and deliberately
concentrate on their feelings, thoughts and bodily experiences, including pain,
without judging or trying to avoid them.
Participants were also given creative exercises, such as guided
imagery, music and drawing, and shared their experiences with other members of
the group.
The rest of the volunteers randomly allocated to the comparison
group were given standard care plus a CD containing similar exercises for use
at home, as and when they wanted.
Stress levels, coping abilities, and symptom control, including
pain and fatigue, were assessed, using validated scores, immediately after all
10 sessions had finished, and again 12 months later.
In total, 67 participants completed all the assessments. These
showed no differences in pain levels, disease activity or the ability to talk
about feelings.
But there were significant differences in levels of stress and
fatigue.
The number of participants with a high stress score of above 23
in the GHQ-20 questionnaire fell from 13 at the start of the study to two, just
12 months after the sessions had finished. Comparable figures in the comparison
group were 10 and eight, respectively.
There was, however, a tangible fall in measured levels of
fatigue in the intervention group: no such change was evident in the comparison
group.
There have been previous attempts to use psychological and
educational tactics to help people with arthritis cope better with the
distressing aspects of the disease, but they have tended to be short term, say
the authors.
The lasting improvements found with the VTP course
"indicate that the participants may have incorporated some mindfulness
strategies into their daily lives and that these strategies have strengthened
their ability to respond to their stressful experience in a more flexible
way," they say.
The authors emphasise that while the treatment of rheumatoid
arthritis has improved greatly, it is less effective in those with more
established disease, and that ultimately the disease can only be partly
controlled, forcing many patients to make very demanding lifestyle changes.
"There is therefore a need for complementary interventions
that enhance individuals' health-promoting resources and help them adjust to
their disease," they conclude.
Depression
Mindfulness
techniques can help protect pregnant women against depression
Pregnant women with histories of major depression are at high
risk of becoming depressed again in the months before and after their babies
are born. A new study led by the University of Colorado Boulder found that
practicing mindfulness techniques--such as meditation, breathing exercises and
yoga--could help protect these women against a recurrence.
About 30 percent of women who have struggled with depression in
the past relapse during pregnancy, according to past research. In the new
study, published November 2014 in the journal Archives of Women's Mental
Health, the research team found that pregnant women with histories of
depression who participated in Mindfulness Based Cognitive Therapy had a
relapse rate of just 18 percent.
"It's important for pregnant women who are at high risk of
depression to have options for treatment and prevention," said Sona
Dimidjian, an associate professor in CU-Boulder's Department of Psychology and
Neuroscience and lead author of the study. "For some women, antidepressant
medication is truly a lifesaver, but others want a non-pharmacological
intervention. This program focuses on teaching women skills and practices that
are designed to help them stay well and care for themselves and their babies
during this important time of life."
Mindfulness Based Cognitive Therapy--which combines mindfulness
practice with more traditional cognitive behavioral therapy--has been shown to
be effective at preventing recurrent episodes of depression in the general
population. But few studies of any kind have looked at the effect of
mindfulness or cognitive behavioral therapies among pregnant women.
For the current study, funded by the National Institutes of
Mental Health, and conducted in collaboration with Sherryl Goodman, a professor
at Emory University in Atlanta, 49 women in Colorado and Georgia with at least
one prior episode of major depression enrolled in an eight-session class during
their pregnancies. During class and using homework assignments, the women
worked to develop mindfulness skills.
"Mindfulness is about how to pay attention to your own
moment-to-moment experience in a way that is suffused with an openness,
curiosity, gentleness and kindness towards oneself," Dimidjian said.
The standard mindfulness practices used in class were tweaked to
be more valuable to pregnant women. Lessons included prenatal yoga, walking
meditation exercises that could be done later while soothing a baby, and
shorter practices that could be easily integrated into the busy lives of new
moms. The lessons also specifically addressed worry, which can be common during
pregnancy, and put particular focus on kindness for oneself and one's baby.
The research team--which also included CU-Boulder doctoral
student Jennifer Felder; Amanda Brown of Emory University in Atlanta; and
Robert Gallop of West Chester University in Pennsylvania--surveyed the women
for symptoms of depression during their pregnancy and through six months
postpartum.
A high percentage of the women who began the courses--86
percent--completed the study, a sign that the women found the sessions
valuable, Dimidjian said. The researchers also were struck by the number of
pregnant women who expressed interest in participating in a mindfulness
program, even though they didn't meet the criteria to participate in this
study.
"I was surprised by the level of interest, even among women
who didn't have a history of depression," Dimidjian said. "Pregnant
women know that the experience of having a child is going to change their
lives, and they want to be ready."
Dimidjian has worked to create an online program of Mindfulness
Based Cognitive Therapy that could be used as a tool to address the demand by
pregnant women and others to develop these skills.
To test the effectiveness of the online program, Dimidjian is
now recruiting adult women with a prior history of depression to participate in
a new study. The women do not need to be pregnant.
Mindfulness
meditation found to be as effective as antidepressants to prevent depression
relapse
A new study from the Centre for Addiction and Mental Health
(CAMH) has found that mindfulness-based cognitive therapy--using
meditation--provides equivalent protection against depressive relapse as
traditional antidepressant medication.
The study published in the December 2010 issue of the Archives
of General Psychiatry compared the effectiveness of pharmacotherapy with
mindfulness-based cognitive therapy (MBCT) by studying people who were
initially treated with an antidepressant and then, either stopped taking the
medication in order to receive MBCT, or continued taking medication for 18
months.
"With the growing recognition that major depression is a
recurrent disorder, patients need treatment options for preventing depression
from returning to their lives." said Dr. Zindel Segal, Head of the
Cognitive Behaviour Therapy Clinic in the Clinical Research Department at CAMH.
"Data from the community suggest that many depressed
patients discontinue antidepressant medication far too soon, either because of
side effect burden, or an unwillingness to take medicine for years. Mindfulness-based
cognitive therapy is a non pharmacological approach that teaches skills in
emotion regulation so that patients can monitor possible relapse triggers as
well as adopt lifestyle changes conducive to sustaining mood balance.
Study participants who were diagnosed with major depressive
disorder were all treated with an antidepressant until their symptoms remitted.
They were then randomly assigned to come off their medication and receive MBCT;
come off their medication and receive a placebo; or stay on their medication.
The novelty of this design permits comparing the effectiveness of sequencing
pharmacological and psychological treatments versus maintaining the same
treatment - antidepressants - over time
Participants in MBCT attended 8 weekly group sessions and
practiced mindfulness as part of daily homework assignments. Clinical
assessments were conducted at regular intervals, and over an 18 month period,
relapse rates for patients in the MBCT group did not differ from patients
receiving antidepressants (both in the 30% range), whereas patients receiving
placebo relapsed at a significantly higher rate (70%).
"The real world implications of these findings bear
directly on the front line treatment of depression. For that sizeable group of
patients who are unwilling or unable to tolerate maintenance antidepressant
treatment, MBCT offers equal protection from relapse,".said Dr. Zindel
Segal. "Sequential intervention-- offering pharmacological and
psychological interventions-- may keep more patients in treatment and thereby
reduce the high risk of recurrence that is characteristic of this disorder.
Mindfulness-based therapy could offer an alternative to antidepressants for preventing depression relapse
The results
come from the first ever large study to compare MBCT -- structured training for
the mind and body which aims to change the way people think and feel about
their experiences -- with maintenance antidepressant medication for reducing
the risk of relapse in depression.
The study
aimed to establish whether MBCT is superior to maintenance antidepressant
treatment in terms of preventing relapse of depression. Although the findings
show that MBCT isn't any more effective than maintenance antidepressant
treatment in preventing relapse of depression, the results, combined with those
of previous trials, suggest that MCBT may offer similar protection against
depressive relapse or recurrence for people who have experienced multiple
episodes of depression, with no significant difference in cost.
"Depression
is a recurrent disorder. Without ongoing treatment, as many as four out of five
people with depression relapse at some point," explains Willem Kuyken,
lead author and Professor of Clinical Psychology at the University of Oxford in
the UK.
"Currently,
maintenance antidepressant medication is the key treatment for preventing
relapse, reducing the likelihood of relapse or recurrence by up to two-thirds
when taken correctly," adds study co-author Professor Richard Byng, from
the Plymouth University Peninsula Schools of Medicine and Dentistry, UK.
"However, there are many people who, for a number of different reasons,
are unable to keep on a course of medication for depression. Moreover, many
people do not wish to remain on medication for indefinite periods, or cannot
tolerate its side effects."
MBCT was
developed to help people who have experienced repeated bouts of depression by
teaching them the skills to recognise and to respond constructively to the
thoughts and feelings associated with relapse, thereby preventing a downward
spiral into depression.
In this trial,
which was conducted from the University of Exeter, UK, 424 adults with
recurrent major depression and taking maintenance antidepressant medication were
recruited from 95 primary care general practices across the South West of
England. Participants were randomly assigned to come off their antidepressant
medication slowly and receive MBCT (212 participants) or to stay on their
medication (212 participants).
Participants
in the MBCT group attended eight 2 ¼ hour group sessions and were given daily
home practice. After the group they had the option of attending 4 follow up
sessions over a 12 month period. The MBCT course consists of guided mindfulness
practices, group discussion and other cognitive behavioural exercises. Those in
the maintenance antidepressant group continued their medication for two years.
All trial
participants were assessed at regular intervals over 2 years for a major
depressive episode using a psychiatric diagnostic interview tool -- the
Structured Clinical Interview for DSM-IV.
Over 2 years,
relapse rates in both groups were similar (44% in the MBCT group vs 47% in the
maintenance antidepressant medication group). Although five adverse events were
reported, including two deaths, across both groups, they were not judged to be
attributable to the interventions or the trial.
According to
study co-author Professor Sarah Byford, from the Institute of Psychiatry,
Psychology & Neuroscience (IoPPN) at King's College London, UK, "As a
group intervention, mindfulness-based cognitive therapy was relatively low cost
compared to therapies provided on an individual basis and, in terms of the cost
of all health and social care services used by participants during the study,
we found no significant difference between the two treatments."
According to
Professor Kuyken, "Whilst this study doesn't show that mindfulness-based
cognitive therapy works any better than maintenance antidepressant medication
in reducing the rate of relapse in depression, we believe these results suggest
a new choice for the millions of people with recurrent depression on repeat
prescriptions. "*
Study
participant Mr Nigel Reed from Sidmouth, Devon, UK, comments that,
"Mindfulness gives me a set of skills which I use to keep well in the long
term. Rather than relying on the continuing use of antidepressants mindfulness
puts me in charge, allowing me to take control of my own future, to spot when I
am at risk and to make the changes I need to stay well."
Writing in a
linked Comment, Professor Roger Mulder from the University of Otago in New
Zealand says, "Because it is a group treatment that reduces costs and the
number of trained staff needed, it might be feasible to offer
[mindfulness-based cognitive therapy] as a choice to patients in general
practice…We therefore have a promising new treatment that is reasonably cost
effective and applicable to the large group of patients with recurrent
depression."
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