Mindfulness and Health Flashcards
What are “mind-body” interventions
National Center for Complementary and Alternative Medicine (NCCAM) defines mind-body interventions as “anything that uses the mind’s capacity to affect bodily function and symptoms”
Types of mind-body interventions
Traditional:
Cognitive behavioral therapy
Stress management
Support groups
Alternative/CAM: Meditation Tai Chi Yoga Relaxation Hypnosis Imagery Biofeedback Qi Gong Spirituality Dance, art, music therapy
Prevalence of CAM therapies in US adults (in 2007)
38% of Americans reported use of CAM in 2007 survey
CAM interventions
Growing use of CAM interventions
-40-45% of the adult US population have used CAM therapies in the past 12 months
-In CA, 65% have used CAM therapies in past 12 months
Particularly high use among people with chronic medical conditions
-use CAM when you feel like it’s things your Dr can’t help you with
Prevalence in cancer populations
80% of 2562 breast cancer survivors in CA reported use of CAM in 2011 report
Mind wandering and happiness
2250 adults contacted via iPhones at random moments during the day and asked:
How are you doing right now?
0 = very bad, 100 = very good
Are you thinking about something other than what you are doing?
Bubble area = frequency of occurrence
Mind wandering occurred in 46.9% of samples
People were less happy when their minds were wandering
-people are happier when they’re concentrating on what they’re doing (their current task)
-this is true even if it’s neutral mind wandering
Mind wandering and telomere length
267 midlife women completed questionnaires and provided blood samples for evaluation of telomere length (marker of cell aging)
-stress is associated with decreased telomeres
two questions:
- How often have you felt totally engaged in what you were doing?
- How often did you feel you didn’t want to be where you were?
Women who reported more mind wandering had shorter telomeres
- this is after just 4 years!
- mind wandering may be linked to some biological process
Mindfulness meditation
Mindfulness meditation is currently the most popular type of meditative practice
Mindfulness is “paying attention to present moment experiences with openness and curiosity”, without judgment
Originated in Eastern meditation practices, non-secular version popularized by John Kabat-Zinn
Mindfulness-based stress reduction
Eight weekly 2.5-3 hour group classes
+ Silent 7-hour retreat
+ Daily homework
Focus on cultivating mindfulness through formal practices, such as sitting and walking meditations
Also, integrating mindfulness into daily life to help cope with physical symptoms and emotional situations
Empirical research on mindfulness
Mindfulness has been investigated in trials conducted with clinical and non-clinical populations
- Medical conditions (e.g., heart disease, HIV, cancer, diabetes, autoimmune disease, fibromyalgia, pain, obesity, etc.)
- Psychiatric conditions (e.g., depression, anxiety, eating disorders, insomnia, etc.)
- Other (e.g., Veterans, low-income African American older adults, medical students, urban youth, etc.)
Mindfulness effects on psychological and physical outcomes
Meta-analysis of 47 randomized controlled meditation trials with ACTIVE control groups (Goyal et al., 2014)
-usually they will use a usual care control group and show that mindfulness is better than nothing but this meta-analysis used only trials with active control groups (they actually did SOMETHING)
- 15 with psychiatric populations
- 5 with smokers and alcoholics
- 5 with chronic pain
- 16 with diverse medical conditions
Showed positive effects on mental and physical health
- mindfulness does something to improve mental and physical health
- Mental health = depression, anxiety
- Physical health = pain
- wasn’t shown to do anything for stress
Mindfulness and the X-Y-Z model
Few (if any studies) have examined health effects of mindfulness programs
-So, can’t determine X to Z
What about effects of mindfulness on mechanisms (the “Y”)?
-Immune system
-HPA axis
-Sympathetic nervous system
Davidson et al. MBSR trial: antibody response to vaccination
Richard Davidson is a psychologist at University of Wisconsin who has been studying the neural effects of meditation for years
Conducted one of first MBSR trials to look at immune outcomes
Focus on antibody response to vaccination
Results:
Decreases in anxiety - beneficial effects on anxiety
Increases in antibody response to influenza vaccine - one of the only studies that has been able to manipulate and influence the body’s response to vaccination
Mindfulness and HIV
MBSR trials for individuals with HIV have shown positive effects:
Reduction in medication-related side effects and distress (Duncan et al., 2012)
Lower avoidance, higher positive affect (Gayner et al., 2011)
Both of these have been linked to health outcomes in HIV!
Creswell et al. MBSR trial:
Two arm RCT comparing 8 week MBSR to one-day stress reduction seminar
Participants were 47 HIV+ men
Outcomes:
CD4+ T cells
Results:
-1 day group had decline in CD4+ cells and that decline was buffered in 8 week MBSR group (remain stable)
-MBSR buffers CD4+ T cell decline in HIV+ men
Mindfulness and inflammation
Two arm RCT comparing mindfulness and “lifestyle education” (Malarkey et al., 2013)
Participants were 186 OSU faculty and staff with elevated CRP (looked for people with high levels of inflammation to begin with and tried to bring the inflammation down)
Did “low dose” MBSR – had one-hour lunchtime meeting per week for 8 weeks
Outcomes:
-CRP, IL-6
-Perceived stress, depression
Results:
- NO change in perceived stress or depression
- Decrease in CRP in mindfulness group, though NOTsignificant
- NO change in other inflammatory markers
they are all about 5 to begin with - if CRP goes over 3 then you are at a higher risk for inflammation
-this is looking at resting inflammation rate
Mindfulness and stress-induced inflammation
Two arm RCT comparing 6-week compassion meditation to health education (Pace et al., 2009)
Cognitive, analytic approach designed to challenge one’s unexamined thoughts and emotions towards other people
Goal is to develop altruistic emotions and behavior - for some people that is easy but they have to do this for the people that they hate
Participants were 61 healthy undergraduates
Outcomes:
Cortisol, inflammatory, and behavioral responses to acute stressor
No intervention effect on cortisol, IL-6, or distress following acute stressor (they look similar)
But…
if you practiced this a lot it buffered the effects:
-IL-6 responses were correlated with meditation practice
-Those who practiced more show lower IL-6 levels after stressor
Mindfulness for lonely older adults
Two arm RCT comparing mindfulness to wait-list control (Creswell et al., 2013)
Participants were 40 lonely older adults
Results showed decreased loneliness and decreased expression of genes that make pro-inflammatory in mindfulness group vs. controls
-genomic indicators seem to be more sensitive (at the level of the cell but it gets more “noisy” as you get further out)
Mindfulness for younger breast cancer survivors
25% of breast cancer cases occur in premenopausal women (targeted because of their high levels of stress)
Younger survivors report higher levels of stress and distress, with potential negative implications for cancer outcomes
Inflammation predicts poor survival in breast cancer survivors (Pierce et al., 2009)
Can a mindfulness intervention reduce stress and inflammation in younger BCS?
Trial design:
Two arm RCT comparing mindfulness to wait-list control
6-week “mindful awareness program” tailored for breast cancer survivors
-Formal meditation practice
-Informal use of mindfulness
-Information on health and well-being after cancer
Results:
stress and depression
-See declines in perceived stress and depressive symptoms from baseline to post-treatment in mindfulness group vs. controls
-decreases from pre to post treatments - hoped to see decreases maintained but it comes back up at the follow up - still trying to figure that out
self-compassion
-See improvements in self-compassion
Sample items:
-I try to be loving towards myself when I’m feeling emotional pain
-I’m tolerant of my own flaws and inadequacies
inflammation
-See decreased expression of genes that make pro-inflammatory cytokines in MAPS group vs. controls
-Also see decreases in a key transcription factor that regulates pro-inflammatory gene expression: NF-kB
NF-κB: pro-inflammatory transcription factor (turns pro inflammatory cytokines on and off - master controller of pro inflammatory cytokines)
Summary
What can we conclude about effects of mindfulness?
Strong evidence for effect on anxiety and depression
Emerging evidence for effects on immune markers and inflammation
-Beneficial effects observed on some immune outcomes – CD4 T cells in HIV, antibody response
-Recent trials have shown reductions in inflammatory gene expression
Diana’s Definition of Mindfulness
paying attention to our present experience with openness and curiosity and a willingness to be with what is
- we’re often in the moment wishing we were in a different moment (looking back at the past or planning for our future)
- try to live in a world where we aren’t so much at the mercy of our reactions (gives us a chance to act outside of these unconscious patterns)
