1. Study suggests exercise may be beneficial to mental health regimen

    November 17, 2017 by Ashley

    From the Michigan State University press release:

    More mental health providers may want to take a closer look at including exercise in their patients’ treatment plans, a new study suggests.

    Michigan State University and University of Michigan researchers asked 295 patients receiving treatment at a mental health clinic whether they wanted to be more physically active and if exercise helped improve their mood and anxiety. They also asked if patients wanted their therapist to help them become more active.

    Eighty-five percent said they wanted to exercise more and over 80 percent believed exercise helped improve their moods and anxiety much of the time. Almost half expressed interest in a one-time discussion, with many participants also wanting ongoing advice about physical activity with their mental health provider.

    The study is now published in the journal General Hospital Psychiatry.

    Physical activity has been shown to be effective in alleviating mild to moderate depression and anxiety,” said Carol Janney, lead author of the study and an MSU assistant professor of epidemiology. “Current physical activity guidelines advise at least 30 minutes, five days a week to promote mental and physical health, yet many of those surveyed weren’t meeting these recommendations.”

    More than half of the participants said their mood limited their ability to exercise, which Janney said provides an opportunity for physicians and therapists in clinics to offer additional support.

    “Offering physical activity programs inside the mental health clinics may be one of many patient-centered approaches that can improve the mental and physical health of patients,” Janney said.

    Marcia Valenstein, senior author and professor emeritus in psychiatry at U-M, agreed.

    “Mental health treatment programs need to partner with fitness programs to support their patients’ willingness to exercise more,” she said. “This support might come from integrating personal trainers into mental health clinics or having strong partnerships with the YMCA or other community recreational facilities.”

    Both Valenstein and Janney said that psychiatrists and other providers might discuss with patients the general need to exercise, but few actually sit down with patients and create a comprehensive exercise plan for them or regularly make sure they are adhering to a specific goal.

    “Mental health providers such as psychiatrists and therapists may not have the necessary training to prescribe physical activity as part of their mental health practice,” Janney said. “But by teaming up with certified personal trainers or other exercise programs, it may help them prescribe or offer more recommendations for physical activity in the clinic setting.”

    Results also showed that over half of the patients surveyed showed interest in getting help from a personal trainer and were willing to pay a bit extra, but that the topic of physical activity was rarely discussed by their physician.

    “This is a missed opportunity,” Valenstein said. “If we can make it easier for both therapists and their patients to have easier access to physical activity services, then we are likely to help more patients reduce their depression and anxiety.”

    Once the effectiveness of this approach is proven, she added, health insurers might consider moving in the direction of covering services that help people exercise.

    “Several insurers already do this for diabetes prevention, so it’s not out of the question.”


  2. Study examines CBT use for chronic pain

    by Ashley

    From the Wolters Kluwer Health press release:

    By teaching patients better strategies for coping with chronic pain, cognitive behavioral therapy (CBT) is a valuable treatment alternative for the millions of Americans taking opioids for noncancer pain, according to an article in the Journal of Psychiatric Practice. The journal is published by Wolters Kluwer.

    “Cognitive behavioral therapy is a useful and empirically based method of treatment for pain disorders that can decrease reliance on the excessive use of opiates,” write Drs. Muhammad Hassan Majeed of Natchaug Hospital, Mansfield Center, Conn., and Donna M. Sudak of Drexel University College of Medicine, Philadelphia. They discuss evidence supporting the use of CBT to avoid or reduce the use of opioids for chronic pain.

    CBT Offers Effective, Safer Alternative to Opioids for Chronic Pain

    Rising use of opioid (sometimes called opiate) medications to treat chronic noncancer pain is a major contributor to the US opioid crisis. But despite the aggressive marketing and prescribing of these powerful painkillers, there has been little change in the amount and severity of pain reported by Americans over the past decade. “There is no evidence that supports the use of opioids for the treatment of chronic pain for more than one year, and chronic use increases the serious risks of misuse, abuse, addiction, overdose, and death,” Drs. Majeed and Sudak write.

    They believe that CBT is an important alternative to opioids for treatment of chronic pain. The goal of CBT is to help patients change the way they think about and manage their pain. The idea is not that pain (in the absence of tissue damage) “is all in your head” — but rather that all pain is “in the head.” Cognitive behavioral therapy helps patients understand that pain is a stressor and, like other stressors, is something they can adapt to and cope with.

    Interventions may include relaxation training, scheduling pleasant activities, cognitive restructuring, and guided exercise — all in the context of an “empathic and validating” relationship with the therapist. These interventions “have the potential to relieve pain intensity, improve the quality of life, and improve physical and emotional function,” according to the authors.

    “Therapy helps the patient see that emotional and psychological factors influence perception of pain and behaviors that are associated with having pain,” Drs. Majeed and Sudak write. “Therapy…puts in place cognitive and behavioral strategies to help patients cope more successfully.”

    The authors cite several recent original studies and review articles supporting the effectiveness of CBT and other alternative approaches for chronic pain. Studies suggest that CBT has a “top-down” effect on pain control and perception of painful stimuli. It can also normalize reductions in the brain’s gray matter volume, which are thought to result from the effects of chronic stress.

    Cognitive behavioral therapy is moderately effective in reducing pain scores, while avoiding or reducing the opioid risks of overuse, addiction, overdose, and death. It can be used as a standalone treatment; in combination with other treatments, including effective non-opioid medications; or as part of efforts to reduce the opioid doses required to control chronic pain.

    Unfortunately, CBT and other nondrug treatments are underused due to unfamiliarity, time pressure, patient demands, ease of prescribing medications, and low reimbursement rates. Drs. Majeed and Sudak note that significant investment of resources will be needed to train practitioners and to widely integrate the use of CBT into chronic pain treatment. The authors suggest that the President’s Commission on the opioid crisis might fund such training programs as a preventive strategy to curb opioid abuse.

    “There is a need for a paradigm shift from a biomedical to a biopsychosocial model for effective pain treatment and prevention of opioid use disorder,” Dr. Majeed comments. “Increased use of CBT as an alternative to opioids may help to ease the clinical, financial, and social burden of pain disorders on society.”


  3. Mental training changes brain structure and reduces social stress

    October 13, 2017 by Ashley

    From the Max Planck Institute for Human Cognitive and Brain Sciences press release:

    Meditation is beneficial for our well-being. This ancient wisdom has been supported by scientific studies focusing on the practice of mindfulness. However, the words “mindfulness” and “meditation” denote a variety of mental training techniques that aim at the cultivation of various different competencies. In other words, despite growing interest in meditation research, it remains unclear which type of mental practice is particularly useful for improving either attention and mindfulness or social competencies, such as compassion and perspective-taking.

    Other open questions are, for example, whether such practices can induce structural brain plasticity and alter brain networks underlying the processing of such competencies, and which training methods are most effective in reducing social stress. To answer these questions, researchers from the Department of Social Neuroscience at the Max Planck Institute of Human Cognitive and Brain Sciences in Leipzig, Germany conducted the large-scale ReSource Project aiming at teasing apart the unique effects of different methods of mental training on the brain, body, and on social behaviour.

    The ReSource Project consisted of three 3-month training modules, each focusing on a different competency. The first module trained mindfulness-based attention and interoception. Participants were instructed in classical meditation techniques similar to those taught in the 8-week Mindfulness-based Stress Reduction Program (MBSR), which requires one to focus attention on the breath (Breathing Meditation), on sensations in different parts of the body (Body Scan), or on visual or auditory cues in the environment. Both exercises were practised in solitude.

    Training in the second module focused on socio-affective competencies, such as compassion, gratitude, and dealing with difficult emotions. In addition to classical meditation exercises, participants learnt a new technique requiring them to practise each day for 10 minutes in pairs. These partner exercises, or so-called “contemplative dyads,” were characterised by a focused exchange of every-day life affective experiences aiming to train gratitude, dealing with difficult emotions, and empathic listening.

    In the third module, participants trained socio-cognitive abilities, such as metacognition and perspective-taking on aspects of themselves and on the minds of others. Again, besides classical meditation exercises, this module also offered dyadic practices focusing on improving perspective-taking abilities. In pairs, participants learnt to mentally take the perspective of an “inner part” or aspect of their personality. Examples of inner parts were the “worried mother,” the “curious child,” or the “inner judge.”

    By reflecting on a recent experience from this perspective, the speaker in dyadic pair-exercise trained in perspective-taking on the self, thus gaining a more comprehensive understanding of his or her inner world. By trying to infer which inner part is speaking, the listener practices taking the perspective of the other.

    All exercises were trained on six days a week for a total of 30 minutes a day. Researchers assessed a variety of measures such as psychological behavioural tests, brain measures by means of magnetic resonance-imaging (MRI), and stress markers such as cortisol release before and after each of the three three-month training modules.

    Depending on which mental training technique was practised over a period of three months, specific brain structures and related behavioural markers changed significantly in the participants. For example, after the training of mindfulness-based attention for three months, we observed changes in the cortex in areas previously shown to be related to attention and executive functioning.

    Simultaneously, attention increased in computer-based tasks measuring executive aspects of attention, while performance in measures of compassion or perspective-taking had not increased significantly. These social abilities were only impacted in our participants during the other two more intersubjective modules,” states Sofie Valk, first author of the publication, which has just been released by the journal Science Advances.

    “In the two social modules, focusing either on socio-affective or socio-cognitive competencies, we were able to show selective behavioural improvements with regard to compassion and perspective-taking. These changes in behaviour corresponded with the degree of structural brain plasticity in specific regions in the cortex which support these capacities,” according to Valk.

    “Even though brain plasticity in general has long been studied in neuroscience, until now little was known about the plasticity of the social brain. Our results provide impressive evidence for brain plasticity in adults through brief and concentrated daily mental practice, leading to an increase in social intelligence. As empathy, compassion, and perspective-taking are crucial competencies for successful social interactions, conflict resolution, and cooperation, these findings are highly relevant to our educational systems as well as for clinical application,” explains Prof. Tania Singer, principal investigator of the ReSource Project.

    Besides differentially affecting brain plasticity, the different types of mental training also differentially affected the stress response. “We discovered that in participants subjected to a psychosocial stress test, the secretion of the stress hormone cortisol was diminished by up to 51%. However, this reduced stress sensitivity was dependent on the types of previously trained mental practice,” says Dr Veronika Engert, first author of another publication from the ReSource Project, which describes the connection between mental training and the acute psychosocial stress response, also recently published in Science Advances. “Only the two modules focusing on social competencies significantly reduced cortisol release after a social stressor. We speculate that the cortisol stress response was affected particularly by the dyadic exercises practised in the social modules. The daily disclosure of personal information to a stranger coupled with the non-judgmental, empathic listening experience in the dyads may have “immunised” participants against the fear of social shame and judgment by others — typically a salient trigger of social stress. The concentrated training of mindfulness-based attention and interoceptive awareness, on the other hand, had no dampening effect on the release of cortisol after experiencing a social stressor.”

    Interestingly, despite these differences on the level of stress physiology, each of the 3-month training modules reduced the subjective perception of stress. This means that although objective, physiological changes in social stress reactivity were only seen when participants engaged with others and trained their inter-subjective abilities, and participants felt subjectively less stressed after all mental training modules.

    “The current results highlight not only that crucial social competencies necessary for successful social interaction and cooperation can still be improved in healthy adults and that such mental training leads to structural brain changes and to social stress reduction, but also that different methods of mental training have differential effects on the brain, on health, and behaviour. It matters what you train,” suggests Prof. Singer. “Once we have understood which mental training techniques have which effects, we will be able to employ these techniques in a targeted way to support mental and physical health.”

    For example, many currently popular mindfulness programmes may be a valid method to foster attention and strengthen cognitive efficiency. However, if we as a society want to become less vulnerable to social stress or train social competencies, such as empathy, compassion, and perspective-taking, mental training techniques focusing more on the “we” and social connectedness among people may be a better choice.


  4. Study suggests yoga, meditation improve brain function and energy levels

    September 18, 2017 by Ashley

    From the University of Waterloo press release:

    Practicing brief sessions of Hatha yoga and mindfulness meditation can significantly improve brain function and energy levels, according to a new study from the University of Waterloo.

    The study found that practicing just 25 minutes of Hatha yoga or mindfulness meditation per day can boost the brain’s executive functions, cognitive abilities linked to goal-directed behavior and the ability to control knee-jerk emotional responses, habitual thinking patterns and actions.

    “Hatha yoga and mindfulness meditation both focus the brain’s conscious processing power on a limited number of targets like breathing and posing, and also reduce processing of nonessential information,” said Peter Hall, associate professor in the School of Public Health & Health Systems. “These two functions might have some positive carryover effect in the near- term following the session, such that people are able to focus more easily on what they choose to attend to in everyday life.”

    Thirty-one study participants completed 25 minutes of Hatha yoga, 25 minutes of mindfulness meditation, and 25 minutes of quiet reading (a control task) in randomized order. Following both the yoga and meditation activities, participants performed significantly better on executive function tasks compared to the reading task.

    “This finding suggests that there may be something special about meditation — as opposed to the physical posing — that carries a lot of the cognitive benefits of yoga,” said Kimberley Luu, lead author on the paper.

    The study also found that mindfulness meditation and Hatha yoga were both effective for improving energy levels, but Hatha yoga had significantly more powerful effects than meditation alone.

    “There are a number of theories about why physical exercises like yoga improve energy levels and cognitive test performance,” said Luu. “These include the release of endorphins, increased blood flow to the brain, and reduced focus on ruminative thoughts. Though ultimately, it is still an open question.”

    Hatha yoga is one of the most common styles of yoga practiced in Western countries.

    It involves physical postures and breathing exercises combined with meditation. Mindfulness mediation involves observing thoughts, emotions and body sensations with openness and acceptance.

    Although the meditative aspect might be even more important than the physical posing for improving executive functions, there are additional benefits to Hatha yoga including improvements in flexibility and strength,” said Hall. “These benefits may make Hatha yoga superior to meditation alone, in terms of overall health benefits.”


  5. Eleven minutes of mindfulness training helps drinkers cut back

    September 6, 2017 by Ashley

    From the University College London press release:

    Brief training in mindfulness strategies could help heavy drinkers start to cut back on alcohol consumption, finds a new UCL study.

    After an 11-minute training session and encouragement to continue practising mindfulness — which involves focusing on what’s happening in the present moment — heavy drinkers drank less over the next week than people who were taught relaxation techniques, according to the study published in the International Journal of Neuropsychopharmacology.

    “We found that a very brief, simple exercise in mindfulness can help drinkers cut back, and the benefits can be seen quite quickly,” said the study’s lead author, Dr Sunjeev Kamboj (UCL Clinical Psychopharmacology Unit).

    The researchers brought in 68 drinkers, who drink heavily but not to the point of having an alcohol use disorder.

    Half of them were trained to practise mindfulness, which teaches a heightened awareness of one’s feelings and bodily sensations, so that they pay attention to cravings instead of suppressing them. They were told that by noticing bodily sensations, they could tolerate them as temporary events without needing to act on them. The training was delivered through audio recordings, and only took 11 minutes. At the end of the training participants were encouraged to continue practising the techniques for the next week.

    The other half were taught relaxation strategies, chosen as a control condition that appeared to be just as credible as the mindfulness exercise for reducing alcohol use. The study was double-blind, meaning neither experimenters nor participants knew which strategy was being delivered.

    “We used a highly controlled experimental design, to ensure that any benefits of mindfulness training were not likely explained by people believing it was a better treatment,” said co-author Dr Tom Freeman (Senior fellow of the Society for the Study of Addiction), who was part of the research team while based at UCL.

    The mindfulness group drank 9.3 fewer units of alcohol (roughly equivalent to three pints of beer) in the following week compared to the week preceding the study, while there was no significant reduction in alcohol consumption among those who had learned relaxation techniques.

    “Practising mindfulness can make a person more aware of their tendency to respond reflexively to urges. By being more aware of their cravings, we think the study participants were able to bring intention back into the equation, instead of automatically reaching for the drink when they feel a craving,” Dr Kamboj said.

    Severe alcohol problems are often preceded by patterns of heavy drinking, so the researchers are hopeful that mindfulness could help to reduce drinking before more severe problems develop.

    “Some might think that mindfulness is something that takes a long time to learn properly, so we found it encouraging that limited training and limited encouragement could have a significant effect to reduce alcohol consumption,” said co-author Damla Irez (UCL Clinical, Educational and Health Psychology).

    “We’re hopeful that further studies will replicate our findings and provide more insight into how mindfulness training could be most effective in practice. Our team is also looking into how mindfulness might help people with other substance use problems,” said co-author Shirley Serfaty (UCL Clinical, Educational and Health Psychology).


  6. Study suggests elderly yoginis have greater cortical thickness

    August 1, 2017 by Ashley

    From the Frontiers press release:

    Scientists in Brazil have imaged elderly female yoga practitioners’ brains and found they have greater cortical thickness in the left prefrontal cortex, in brain areas associated with cognitive functions like attention and memory. The results suggest that yoga could be a way to protect against cognitive decline in old age.

    As we age, the structure and functionality of our brains change and this often leads to cognitive decline, including impaired attention or memory. One such change in the brain involves the cerebral cortex becoming thinner, which scientists have shown is correlated with cognitive decline. So, how can we slow or reverse these changes?

    You might think medication would be required, but surprisingly, the answer could lie in contemplative practices like yoga. Yoga practitioners consciously maintain postures, and perform breathing exercises and meditation.

    “In the same way as muscles, the brain develops through training,” explains Elisa Kozasa of Hospital Israelita Albert Einstein in São Paulo, Brazil, a researcher involved in the study, which was recently published in Frontiers in Aging Neuroscience. “Like any contemplative practice, yoga has a cognitive component in which attention and concentration are important.”

    Previous studies have suggested that yoga can have greater health benefits than similar aerobic exercises, and yoga practitioners have shown improved awareness, attention and memory. Older adults with mild cognitive impairment have also shown improvements after a short yoga training program.

    But can practicing yoga over several years significantly shape your brain and if so, could it offset some of the changes that happen in the aging brain? The research team wanted to see if elderly long-term yoga practitioners had any differences in terms of brain structure compared with healthy elderly people who had never practiced yoga.

    They recruited 21 female yoga practitioners (also known as yoginis) who had practiced yoga at least twice a week for a minimum of 8 years, although the group had an average of nearly 15 years of yoga practice. The researchers compared the yoginis with another group of 21 healthy women, who had never practiced yoga, meditation or any other contemplative practices, but who were well-matched to the yoginis in terms of their age (all the participants were 60 or over) and levels of physical activity. For more consistent results, the researchers only recruited women, and the participants completed surveys to see if there were any other factors at work that could affect brain structure, such as depression or level of formal education.

    The researchers scanned the participants’ brains using magnetic resonance imaging to see if there were any differences in brain structure. “We found greater thickness in the left prefrontal cortex in the yoginis, in brain regions associated with cognitive functions such as attention and memory,” says Rui Afonso, another researcher involved in the study. As the groups were well-matched in terms of other factors that can change brain structure, such as education and levels of depression, yoga practice appears to underlie the yoginis’ different brain structure.

    The results suggest that practicing yoga in the long-term can change the structure of your brain and could protect against cognitive decline in old age. However, the team plan to carry out more studies to see if these brain changes result in enhanced cognitive performance in elderly yoginis.

    Another possibility is that people with these brain features are more likely to be attracted to yoga. “We have compared experienced yoginis with non-practitioners, so we do not know if the yoginis already had these differences before they started yoga,” explains Afonso. “This can only be confirmed by studying people for a few years from the time they start yoga.”


  7. Study suggests meditation and yoga can ‘reverse’ DNA reactions which cause stress

    June 26, 2017 by Ashley

    From the Coventry University press release:

    Mind-body interventions (MBIs) such as meditation, yoga and Tai Chi don’t simply relax us; they can ‘reverse’ the molecular reactions in our DNA which cause ill-health and depression, according to a study by the universities of Coventry and Radboud.

    The research, published in the journal Frontiers in Immunology, reviews over a decade of studies analysing how the behaviour of our genes is affected by different MBIs including mindfulness and yoga.

    Experts from the universities conclude that, when examined together, the 18 studies — featuring 846 participants over 11 years — reveal a pattern in the molecular changes which happen to the body as a result of MBIs, and how those changes benefit our mental and physical health.

    The researchers focus on how gene expression is affected; in other words the way that genes activate to produce proteins which influence the biological make-up of the body, the brain and the immune system.

    When a person is exposed to a stressful event, their sympathetic nervous system (SNS) — the system responsible for the ‘fight-or-flight’ response — is triggered, in turn increasing production of a molecule called nuclear factor kappa B (NF-kB) which regulates how our genes are expressed.

    NF-kB translates stress by activating genes to produce proteins called cytokines that cause inflammation at cellular level — a reaction that is useful as a short-lived fight-or-flight reaction, but if persistent leads to a higher risk of cancer, accelerated aging and psychiatric disorders like depression.

    According to the study, however, people who practise MBIs exhibit the opposite effect — namely a decrease in production of NF-kB and cytokines, leading to a reversal of the pro-inflammatory gene expression pattern and a reduction in the risk of inflammation-related diseases and conditions.

    The study’s authors say the inflammatory effect of the fight-or-flight response — which also serves to temporarily bolster the immune system — would have played an important role in humankind’s hunter-gatherer prehistory, when there was a higher risk of infection from wounds.

    In today’s society, however, where stress is increasingly psychological and often longer-term, pro-inflammatory gene expression can be persistent and therefore more likely to cause psychiatric and medical problems.

    Lead investigator Ivana Buric from the Brain, Belief and Behaviour Lab in Coventry University’s Centre for Psychology, Behaviour and Achievement said:

    “Millions of people around the world already enjoy the health benefits of mind-body interventions like yoga or meditation, but what they perhaps don’t realise is that these benefits begin at a molecular level and can change the way our genetic code goes about its business.

    “These activities are leaving what we call a molecular signature in our cells, which reverses the effect that stress or anxiety would have on the body by changing how our genes are expressed. Put simply, MBIs cause the brain to steer our DNA processes along a path which improves our wellbeing.

    “More needs to be done to understand these effects in greater depth, for example how they compare with other healthy interventions like exercise or nutrition. But this is an important foundation to build on to help future researchers explore the benefits of increasingly popular mind-body activities.”


  8. Study suggests meditation as a possible alternative to traditional pain medication

    June 25, 2017 by Ashley

    From the Leeds Beckett University press release:

    Just ten minutes of mindfulness meditation could be used as an alternative to painkillers, according to research by Leeds Beckett University.

    Results of the study suggest that a single ten-minute mindfulness meditation session administered by a novice therapist can improve pain tolerance, pain threshold and decrease anxiety towards pain.

    The research was carried out by the School of Clinical and Applied Sciences at Leeds Beckett and used a group of 24 healthy university-aged students (12 men and 12 women). They were randomly split into a control group and a meditation group.

    A cold-pressor task was used to cause pain to the participants; they put their hand in warm water for two minutes before removing it and placing it immediately into ice water for as long as they could manage and only removed it when the pain became too much and could no longer be tolerated. They then either sat quietly for ten minutes (control group) or meditated for ten minutes before repeating the cold-pressor task.

    Five groups of data were then collected; anxiety towards pain, pain threshold, pain tolerance, pain intensity and pain unpleasantness. Pre-intervention the figures didn’t differ greatly between the control and meditation groups but following the ten-minute meditation session, the participants from the meditation group saw a significant decrease in anxiety towards pain and a significant increase in pain threshold and pain tolerance.

    Speaking about the results of the study, Dr Osama Tashani, Senior Research Fellow in Pain Studies, said: “While further research is needed to explore this in a more clinical setting on chronic pain patients, these results do show that a brief mindfulness meditation intervention can be of benefit in pain relief. The ease of application and cost effectiveness of the mindfulness meditation may also make it a viable addition to the arsenal of therapies for pain management.

    “The mindfulness mediation was led by a researcher who was a novice; so in theory clinicians could administer this with little training needed. It’s based on traditional Buddhist teachings which focuses attention and awareness on your breathing.”


  9. Study examines range of challenging meditation experiences

    June 10, 2017 by Ashley

    From the Brown University press release:

    Meditation is increasingly being marketed as a treatment for conditions such as pain, depression, stress and addiction, and while many people achieve therapeutic goals, other meditators encounter a much broader range of experiences — sometimes distressing and even impairing ones — along the way.

    That’s according to a new study in PLOS ONE, in which Willoughby Britton, assistant professor in the Department of Psychiatry and Human Behavior at Brown University, and co-authors chronicled and categorized such experiences as well as the factors that influence them.

    Many effects of meditation are well known, like increased awareness of thoughts and emotions, or improved calm and well-being,” said study lead author Jared Lindahl, visiting assistant professor in Brown’s Cogut Center for the Humanities. “But there is a much broader range of possible experiences. Exactly what those experiences are, how they affect individuals and which ones show up as difficult is going to be based on a range of personal, interpersonal and contextual factors.”

    The Varieties of Contemplative Experience study

    The study purposely sought out “challenging” experiences because they are underrepresented in the scientific literature, the authors said. With that goal, the study therefore was not designed to estimate how common those experiences are among all meditators. Instead the purpose of the Varieties of Contemplative Experience study was to provide detailed descriptions of experiences and to start to understand the multiple ways they are interpreted, why they might happen and what meditators and teachers do to deal with them.

    Though rare in the scientific literature, the broader range of effects including meditation-related difficulties have been documented in Buddhist traditions, the researchers wrote. For example, Tibetans refer to a wide range of experiences — some blissful but some painful or disturbing — as “nyams.” Zen Buddhists use the term “maky?” to refer to certain perceptual disturbances.

    “While the positive effects have made the transition from Buddhist texts and traditions to contemporary clinical applications, the use of meditation for health and well-being has obscured the wider range of experiences and purposes traditionally associated with Buddhist meditation,” Lindahl said.

    To understand the range of experiences encountered among Western Buddhists practicing meditation, Britton, Lindahl and their co-authors interviewed nearly 100 meditators and meditation teachers from each of three main traditions: Therav?da, Zen and Tibetan. Each interview told a story, which the researchers meticulously coded and analyzed using qualitative research methodology.

    The researchers also employed standardized causality assessment methods that are used by agencies like the U.S. Food and Drug Adminisration to ensure that meditation likely played a causal role in the experiences they documented.

    Experiences and influences

    Based upon their interviews, the researchers developed a taxonomy of 59 experiences organized into seven types, or “domains”: cognitive, perceptual, affective (i.e. emotions and moods), somatic (relating to the body), conative (i.e. motivation or will), sense of self and social. They also identified another 26 categories of “influencing factors” or conditions that may impact the intensity, duration or associated distress or impairment.

    All meditators reported multiple unexpected experiences from across the seven domains of experience. For example, a commonly reported challenging experience in the perceptual domain was hypersensitivity to light or sound, while somatic changes such as insomnia or involuntary body movements were also reported. Challenging emotional experiences could include fear, anxiety, panic or a loss of emotions altogether.

    Britton noted that the duration of the effects people described in their interviews also varied widely, ranging from a few days to months to more than a decade.

    Sometimes experiences were ostensibly desirable, such as feelings of unity or oneness with others, but some meditators reported them going too far, lasting too long or feeling violated, exposed or disoriented. Others who had meditation experiences that felt positive during retreats reported that the persistence of these experiences interfered with their ability to function or work when they left the retreat and returned to normal life.

    “This is a good example of how a contextual factor can affect associated distress and functioning,” Lindahl said. “An experience that is positive and desirable in one situation may become a burden in another.”

    Moreover, in some cases, an experience that some meditators reported as challenging, others reported as positive. To understand why this was the case, the researchers also aimed to determine the “influencing factors” that affect the desirability, intensity, duration and impact of a given experience.

    The researchers documented four main domains of influencing factors: practitioner-related (i.e. the meditator’s personal attributes), practice-related (such as how they meditated), relationships (interpersonal factors) and health behaviors (such as diet, sleep or exercise). For example, a meditator’s relationship with the instructor was for some people a source of support and for others a source of distress.

    While many teachers cited the meditator’s practice intensity, psychiatric history or trauma history, and quality of supervision as important, these factors appeared to play a role only for some meditators. The researchers wrote in PLOS ONE that in many cases, challenging experiences could not be attributed to just those factors:

    “The results also challenge other common causal attributions, such as the assumption that meditation-related difficulties only happen to individuals with a pre-existing condition (psychiatric or trauma history), who are on long or intensive retreats, who are poorly supervised, who are practicing incorrectly, or who have inadequate preparation.”

    Toward improved understanding and support

    Rather than conclusive causes, Britton described the influencing factors the research identified as “testable hypotheses” of what might impact a meditator’s trajectory. For example, future research could investigate whether certain types of practice are associated with different kinds of challenging experiences, or whether the degree of perceived social support influences the duration of distress and impairment.

    “It is likely that an interaction of multiple factors is at play,” Lindahl said. “Each meditator had their own unique story.”

    I i’s important to acknowledge that this study represents an initial step in a much longer discussion and investigation, Britton said: “The take-home message is that meditation-related challenges are a topic worthy of further investigation, but there is still a lot more to understand.”

    For example, the study did not investigate meditation-related challenges in the context of mindfulness-based interventions, in children or in clinical populations. Furthermore, Britton said, little is known about the neurobiological mechanisms of these experiences. The authors have already developed one potential model for some experiences, but there likely will be different mechanisms for different experiences, and they hope other researchers will join the inquiry.

    If research can uncover why challenging experiences arise, then meditators and teachers might be in a better position to manage them, Britton and Lindahl said. But even before that, they hope the new study can help people recognize that adverse experiences are not necessarily unique to them or their fault. Britton noted that in a societal context in which meditation is often discussed as producing only positive results, meditators can feel stigmatized and isolated if they experience a problem.

    “During the interviews, some people learned for the first time that they are not completely alone in having had this experience,” Lindahl said. “The social awareness we think this project can raise could be a key way of addressing some of the problems.”

    One of the remedies people cited for dealing with problems was simply having someone they could talk to who was familiar with challenging meditation experiences, the researchers said. Britton recently started a weekly online support group where meditators can share their challenges with each other.

    “Our long-term hope is that this research, and the research that follows, can be used by the meditation community to create support systems for the full range of meditation-related experiences,” Britton said. “Really, the first step is acknowledging the diversity of experiences that different people can have.”


  10. Does stress lead to lengthier periods of sick leave?

    June 5, 2017 by Ashley

    From the Deutsches Ärzteblatt International press release:

    The duration of a person’s unfitness for work is determined by more than his/her primary diagnosis. Patients often report psychological problems and a feeling of being burnt out. Antonius Schneider and colleagues analyzed whether an association exists between such psychological symptoms and the length of sick leave, even if patients received their sick note because of purely physical symptoms, such as back pain.

    The researchers studied the data of 225 patients, from 14 general practices, who had been issued with a sickness certificate. The diagnoses that prompted the sick leave varied. Respiratory disorders and disorders of the musculoskeletal system were the most common diagnoses. The longest mean periods of sick leave were documented for patients with diagnoses of skin diseases and mental disorders. All study participants completed a questionnaire that included the Maslach Burnout Inventory, General Survey, and Patient Health Questionnaire, with the scales depression, somatization, and anxiety. Patients’ characteristics such as sex, age, relationship status, and educational attainment were also captured.

    For the total study population, doctors’ sick notes were associated with longer periods of sick leave in patients with a lower level of educational attainment (less than 10 years of schooling), independently of the primary diagnosis. An association existed between the length of the sick leave period and emotional exhaustion, depersonalization, depression, anxiety, and somatization. When study participants were excluded whose unfitness for work was primarily due to psychological and psychiatric diagnoses, the sick leave period correlated with emotional exhaustion, somatization, and — almost statistically significantly — with depression. Sex and relationship status were not relevant.

    In a secondary analysis, age and formal education were associated with the duration of sick leave. Each year of increase in age led to an increase in the length of the sick leave period by 1.7%. In persons with higher levels of education, the length of sick leave was reduced by 40%. In terms of the psychological burden, an association of anxiety symptoms with the duration of unfitness to work was primarily noted.

    The authors conclude that a holistic approach in patient-centered communication, such as is applied in case of depression and anxiety, may be helpful in psychological or physical symptoms of unknown origin during the consultation with the primary care physician.