Empirical Support for Training in Meditation and
Mind-Body Synchronization
for
Transformational Healing and Insight
The ideas and practices of the Dangerous Wisdom approach has a long empirical history in the venerable spiritual, religious, and philosophical traditions of the world. Thankfully, they now enjoy increasing support in the science of the dominant culture as well. This allows us to have a solid feeling of confidence in them.
This page contains abstracts from many studies on the power of meditation and the Alexander Technique.
Executive Summary
Φ Empirical support for meditation, mind-body synchronization, and a healthy relationship with nature has become substantial, and continues to grow.
Φ Many approaches lack holism, which includes integration of the client’s sense of purpose, values, and philosophical sensibilities, particularly in an ecologically-rooted educational model that supplements, without supplanting, a more clinical model.
Φ I offer an inclusive, secular, and spiritual/philosophical approach drawn from doctoral work in philosophy, certification in mind-body education, and extensive experience practicing in the wisdom traditions, including formal training in trauma-informed meditation instruction.
Φ A wisdom-based, ecologically-informed approach can offer a powerful, synergetic supplementary support for your clients that empowers greater progress in their healing journey.
Clients Who Might Benefit
Clients who could use extra support in integrating therapeutic insights into everyday life
Clients who could use support that primes them for greater insight and healing
Clients plateauing in their therapy or in some way stuck
Clients transitioning out of therapy who want support for cultivating their insights onward
Clients with a hunger for more spiritual and philosophical context to support their healing
Clients facing issues that would benefit from psycho-physical-spiritual holism
Common Diagnoses for Which This Approach Can Offer Significant Supplementary Benefits, According to the Empirical Literature—see below for a selection of papers:
Anxiety
Depression
Chronic illnesses such as cancer (quality of life, pain reduction, emotional stability, etc.)
Back pain, including chronic back pain
Other forms of chronic pain
Injury recovery and prevention, including chronic issues such as carpal tunnel syndrome
ADD/ADHD
Certain forms of personal crisis that bring up existential questions
Performance enhancement, flourishing, personal development
Stress and burnout
PTSD
Overview
Meditation and the synchronization of heart, mind, body, and world have consistently proven supportive for mental and physical health, healing, and vitality. In the chapter on attention in his Principles of Psychology, the great psychologist William James writes the following:
the faculty of voluntarily bringing back a wandering attention, over and over again, is the very root of judgment, character, and will. No one is compos sui if he have it not. An education which should improve this faculty would be the education par excellence. But it is easier to define this ideal than to give practical directions for bringing it about.
The very root of judgment, character, and will? How so?
Because we cannot avoid attending. At every moment of life, we must attend in some way or other, to something or other. We can get trapped in attending to unhelpful or even unethical things, and we may get further trapped in attending to whatever we attend to in ways that tend toward distraction, depression, anxiety, spaciness, instability, and so on. We cannot avoid the activity of attention itself.
This is why interventions that do nothing more than change patterns of attention can prove useful (see research selection below), to say nothing of more holistic interventions that integrate a shift in attention with a more comprehensive education oriented toward transformative insight and healing.
We cannot find real freedom, genuine happiness, true peace, and a meaningful life outside of attention. We can hardly consider ourselves free, mature, peaceful, and joyful people if our attention remains unstable, unclear, and prone to negative spirals.
Thus, we need this education par excellence, and, fortunately for us, we now have the practical directions for bringing it about that James wished for. In the same chapter on attention in which we find the passage above, James also claims that, “each of us literally chooses, by [their] ways of attending to things, what sort of a universe [they] shall appear to [themselves] to inhabit.” We thus also have the ability to renew ourselves and our world in the same gesture.
The Training
The training is something like the course our souls wish we could have taken in college, a course which remains unavailable at any university in the dominant culture. It includes an array of holistic interventions with extensive empirical support, interventions which many physicians and therapists have little time for, and in many cases no specialized training to provide.
The efficacy of these interventions, especially in concert with conventional therapies and health protocols, makes it surprising that more people don’t take advantage of them. Far from anything marginal or “woo,” these interventions enjoy ample empirical support. They include:
Φ An uncovering of and reflection on the client’s central values in life.
Φ A grounding education in the philosophical ideas that properly support a healthy mind and body, and a healthy, meaningful lifestyle.
Φ A training of the attention that begins with compassion practice as its foundation.
Φ A training in meditation rooted in teachings and practices that have been exquisitely refined over centuries of experimentation.
Φ An introduction to ecological thinking and the cultivation of ecological awareness and nature-connectedness.
Φ An introduction to mind-body synchronization via the Alexander Technique.
In some ways, the latter ties all of the former together. In a 1941 article in the Saturday Review of Literature, Aldous Huxley argued that the principles of the Alexander Technique make it possible,
to conceive of a totally new type of education affecting the entire range of human activity, from the physiological, through the intellectual, moral and practical, to the spiritual—an education which, by teaching them the proper use of the self, would preserve children and adults from most of the diseases and evil habits that now afflict them; an education whose training . . . would provide men and women with the psycho-physical means for behaving rationally and morally; an education which, in its upper reaches, would make possible the experience of ultimate reality . . .
And a little further in that essay he touches on something quite essential:
Those who control the educational machine ignore [Alexander’s] discovery. Instead of working to make available to all this newly discovered bridge between idealistic theory and actual practice, they waste their own and their pupils’ time in carrying out crusades for Liberal Education, Modern Education, Scientific Education, or whatever it may be, in selecting the Hundred Best Books, in conducting metaphysical cock fights between Thomas Aquinas and William James. Never for a moment does it seem to occur to them that there is really very little point in reading the best, or most scientific, or most modern, or most medieval books, unless the reader is provided with a technique that permits his Self to implement in psychophysical practice the ideals set forth in these volumes.
I put emphasis in the last line because of the way it reiterates the importance of this kind of education for your clients. We cannot realize our ideals without a better education regarding how the self as a whole can make these ideals a reality. Your clients will become better equipped to achieve their own personal ideals, as well as the ideals for healing set out in your healing relationship with them, by means of a holistic education that integrates the principles of the Alexander Technique with the empirically validated teachings and practices of the wisdom traditions.
Training occurs in person, online, or in a mixed in-person/online format, depending on the needs of the client. Training will include visits to naturalistic settings, as part of the direct training and/or as “homework” for the client. The introductory course generally lasts 12 weeks, with sessions once or twice per week, but an even more basic set of teachings can be arranged for a shorter period. Many clients will continue beyond the 12 weeks to deepen their education, especially if they are also continuing with psychotherapy or medical treatments.
The Empirical Record—in brief
Meditation, Mindfulness, and Attention: a Meta-analysis
REVIEW
Published: 02 February 2021
Volume 12, pages 1332–1349, (2021)
https://link.springer.com/article/10.1007/s12671-021-01593-w
Objectives
Despite being an ancient tradition, meditation has only become a popular inquiry of research over the past few decades. This resurgence can partially be attributed to the popularization of Eastern meditative practices, such as mindfulness, into Western culture. Though the mechanisms of meditation are not yet scientifically well-understood, systems of attention and executive control may play an important role. The present study aimed to examine potential attentional mechanisms of attention-based meditations across studies.
Methods
This paper examines behavioral measures of attention across literature. Studies (K = 87) that assigned participants to or recruited participants who use techniques common in mindfulness practices (focused attention, open monitoring, or both) were meta-analyzed. Outcomes were coded according to attentional network (alerting, orienting, executive control) or facet of executive control (inhibition, shifting, updating).
Results
Meta-analytic results suggest that generalized attention (g = 0.171, 95% CI [0.119, 0.224]), its alerting (g = 0.158, 95% CI [0.059, 0.256]) and executive control (g = 0.203, 95% CI [0.143, 0.264]) networks, and the inhibition (g = 0.159, 95% CI [0.064, 0.253]) and updating (g = 0.256 [0.176, 0.337]) facets of executive control are improved by meditation. There was significant heterogeneity in attention, the alerting and executive control networks, and the inhibition facet. Studies that taught both FA and OM techniques did not show attentional improvements over those that taught the techniques in isolation. Meditation led to greater improvements in accuracy-based tasks than reaction time tasks.
The benefits of meditation and mindfulness practices during times of crisis such as COVID-19
Published online by Cambridge University Press: 14 May 2020
Abstract
Meditation and mindfulness are practices that can support healthcare professionals, patients, carers and the general public during times of crisis such as the current global pandemic caused by COVID-19. While there are many forms of meditation and mindfulness, of particular interest to healthcare professionals are those with an evidence base such as mindfulness-based stress reduction (MBSR). Systematic reviews of such practices have shown improvements in measures of anxiety, depression and pain scores. Structural and functional brain changes have been demonstrated in the brains of people with a long-term traditional meditation practice, and in people who have completed a MBSR programme. Mindfulness and meditation practices translate well to different populations across the lifespan and range of ability. Introducing a mindfulness and meditation practice during this pandemic has the potential to complement treatment and is a low-cost beneficial method of providing support with anxiety for all.
Meditation-Based Lifestyle Modification: Development of an Integrative Mind-Body Program for Mental Health and Human Flourishing
Complement Med Research (2021) 28 (3): 252–262.
https://doi.org/10.1159/000512333
Abstract
Mental disorders are a core health challenge in the 21st century. Integrative mental health care takes an individual, lifestyle-modifying, salutogenic approach, combining somatic, psychosocial, and spiritual perspectives from evidence-based conventional and complementary medicine. In particular, meditation and mindfulness have received growing research interest in the last decade. In this article, we present Meditation-Based Lifestyle Modification (MBLM), a new, complex mind-body intervention for mental health care. It is the first program to intensify meditation practice using classical yoga. The program (a) covers all areas of classical yoga, (b) considers ethical and spiritual aspects of daily life, (c) orients participants toward sustained lifestyle modification, and (d) is applicable in a clinical context. The scientific rationale of the program is outlined in this article, based on the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare. Further research is planned to show the clinical feasibility of MBLM and evaluate its efficacy, processes of change, and cost-effectiveness.
Dose–response Relationship of Reported Lifetime Meditation Practice with Mental Health and Wellbeing: a Cross-sectional Study
ORIGINAL PAPER
Open access
Published: 28 September 2022
Volume 13, pages 2529–2546, (2022)
https://link.springer.com/article/10.1007/s12671-022-01977-6
Objectives
Meta-analyses of meditation studies have revealed mixed modest evidence of benefits across a range of outcomes. However, because this evidence-base is predominantly from brief interventions, it is unclear whether it accurately reflects how contemporary meditators practice or the dose–response relationship between amount of practice and outcome. This study sought to characterize how contemporary meditators practice, examine any possible dose–response relationships between historical practice and measures of psychological wellbeing, and explore which characteristics of practice most strongly predict favorable psychological outcomes.
Methods
One thousand six hundred and sixty-eight meditators (M = 1095 h practice, SD = 2365) responded to advertisements in meditation practice communities and social media. We explored associations between demographics, meditation practice characteristics, and outcomes including positive and negative affect, psychological distress, and life satisfaction in a cross-sectional study design.
Results
Historical meditation practice (accumulated lifetime hours) was significantly associated with favorable psychological outcomes (|r| ranging from .18 to .28). Model fit was optimized with a generalized additive model (average increase in R2 = 2.22), indicating non-linear effects. The strength of association between practice time and outcomes was generally strongest for approximately the first 500 h, before plateauing. Several practice types including Vipassana (as taught by S.N. Goenka) and cultivating practices (e.g. compassion, lovingkindness) were more strongly predictive of favorable psychological outcomes.
Conclusions
Benefits of meditation accrue over time in a non-linear manner, and show variation based on practice context. These results highlight the importance of understanding how the benefits of meditation accrue over longer time durations than typical standardized programs.
Self-compassion, meaning in life, and experiential avoidance explain the relationship between meditation and positive mental health outcomes
José Ramón Yela, Antonio Crego, María Ángeles Gómez-Martínez, Laura Jiménez
First published: 24 January 2020
https://doi.org/10.1002/jclp.22932
Abstract
Objective
Despite consistent evidence for the beneficial effects of meditation on mental health, little is known about the mechanisms that make mindfulness meditation effective.
Method
The levels of mental health, self-compassion, presence of meaning in life, and experiential avoidance of meditators (n = 414) and nonmeditators (n = 414) were measured and compared. Bootstrap-based structural equation modeling (SEM) modeling analyses were used to test multiple-step multiple-mediator models.
Results
Meditation was positively associated with mental health, although the regularity of practice was an influential element to be considered. Significant indirect effects of meditation on mental health through self-compassion, meaning in life, and experiential avoidance were found. SEM models were able to account for 58% of the variance in mental health scores.
Conclusions
Self-compassion, presence of meaning in life, and reduced experiential avoidance may be active components of healthy meditation practices. Identifying the mechanisms involved in effective meditation practices has relevant implications for well-being and mental health-promoting interventions.
The efficacy of meditation-based mind-body interventions for mental disorders: A meta-review of 17 meta-analyses of randomized controlled trials
https://doi.org/10.1016/j.jpsychires.2020.12.048
Abstract
There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.
Meditation: Evidence Map of Systematic Reviews
Caio Fábio Schlechta Portella
Ricardo GhelmanRicardo Ghelman
Veronica AbdalaVeronica Abdala
Mariana Cabral Schveitzer Mariana Cabral Schveitzer
Rui Ferreira AfonsoRui Ferreira Afonso
SYSTEMATIC REVIEW article
Front. Public Health, 01 December 2021
Sec. Public Mental Health
Volume 9 - 2021 | https://doi.org/10.3389/fpubh.2021.742715
Study Basis: This evidence map presents a summary of studies that addressed the effects of meditation on various clinical and health conditions. Meditation is a contemplative practice that has been used for the promotion of health, and the treatment of different conditions.
Method: The study is based on the search of four electronic databases for the period 1994-November 2019 and includes systematic reviews, meta-analyses, meta-syntheses, and integrative reviews. 3iE evidence gap map was the methodology of choice, and AMSTAR 2 was used for the analyses. Tableau was used to graphically display the confidence level, number of reviews, health outcomes, and intervention effects.
Results: This map encompasses 191 studies, with Mindfulness being the key word that retrieved the highest number of results. Several meditation techniques were evaluated in different contexts, and the confidence levels of 22 studies were high, 84 were moderate, and 82 were low. Two 2 meta-syntheses and 1 integrative review were also included. Most of the studies reported positive effects and a beneficial potential of the practice of meditation. Health outcomes were divided into five groups out of which mental health and vitality, and well-being and quality of life stood out with the largest number of studies.
Nature-Based Meditation, Rumination and Mental Wellbeing
Matthew Owens and Hannah L. I. Bunce
Int. J. Environ. Res. Public Health 2022, 19(15), 9118; https://doi.org/10.3390/ijerph19159118
Nature-Based Meditation, Rumination and Mental Wellbeing
by Matthew Owens 1,2,* and Hannah L. I. Bunce 2,3,4
Int. J. Environ. Res. Public Health 2022, 19(15), 9118; https://doi.org/10.3390/ijerph19159118
Submission received: 3 July 2022 / Revised: 19 July 2022 / Accepted: 22 July 2022 / Published: 26 July 2022
(This article belongs to the Special Issue Advances in Nature-Based Therapies and Human Health)
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Review Reports Versions Notes
Abstract
Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings.
Alteration of faecal microbiota balance related to long-term deep meditation
Ying Sun, Peijun Ju, Ting Xue, Usman Ali, Donghong Cui, Jinghong Chen
Abstract
Background
Advancements in research have confirmed that gut microbiota can influence health through the microbiota–gut–brain axis. Meditation, as an inner mental exercise, can positively impact the regulation of an individual’s physical and mental health. However, few studies have comprehensively investigated faecal microbiota following long-term (several years) deep meditation. Therefore, we propose that long-term meditation may regulate gut microbiota homeostasis and, in turn, affect physical and mental health.
Aims
To investigate the effects of long-term deep meditation on the gut microbiome structure.
Methods
To examine the intestinal flora, 16S rRNA gene sequencing was performed on faecal samples of 56 Tibetan Buddhist monks and neighbouring residents. Based on the sequencing data, linear discriminant analysis effect size (LEfSe) was employed to identify differential intestinal microbial communities between the two groups. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) analysis was used to predict the function of faecal microbiota. In addition, we evaluated biochemical indices in the plasma.
Results
The α-diversity indices of the meditation and control groups differed significantly. At the genus level, Prevotella and Bacteroides were significantly enriched in the meditation group. According to the LEfSe analysis, two beneficial bacterial genera (Megamonas and Faecalibacterium) were significantly enriched in the meditation group. Functional predictive analysis further showed that several pathways—including glycan biosynthesis, metabolism and lipopolysaccharide biosynthesis—were significantly enriched in the meditation group. Moreover, plasma levels of clinical risk factors were significantly decreased in the meditation group, including total cholesterol and apolipoprotein B.
Conclusions
Long-term traditional Tibetan Buddhist meditation may positively impact physical and mental health. We confirmed that the gut microbiota composition differed between the monks and control subjects. The microbiota enriched in monks was associated with a reduced risk of anxiety, depression and cardiovascular disease and could enhance immune function. Overall, these results suggest that meditation plays a positive role in psychosomatic conditions and well-being.
Effects of mindfulness meditation interventions on depression in older adults: A meta-analysis
Chuntana Reangsing, Tanapa Rittiwong, & Joanne Kraenzle Schneider
Pages 1181-1190 | Received 18 Feb 2020, Accepted 05 Jul 2020, Published online: 15 Jul 2020
https://doi.org/10.1080/13607863.2020.1793901
Abstract
Objective
We examined the effects of MMIs on depression in older adults and explored the moderating effects of participant, methods, and intervention characteristics.
Methods
We systematically searched 15 databases through June 2019 without date restrictions using the following search terms: (mindful* OR meditat*) AND depress* AND (older adult* OR elder OR aging OR senior OR geriatric*). Inclusion criteria were primary studies evaluating MMIs with adults ≥65 years old with depression measured as an outcome, a control group, and written in English. Two researchers independently coded each study and compared for discrepancies and consulted a third researcher in cases of disagreement. We used random-effects model to compute effect sizes (ESs) using Hedges’ g, a forest plot, and Q and I2 statistics as measures of heterogeneity; we also examined moderator analyses.
Results
Nineteen studies included 1,076 participants (71.8 ± 5.2 years old). Overall, MMIs showed significantly improved depression (ES=.65, 95%CI 0.35, 0.94) compared to controls. With regards to moderators, Asians had a greater improvement in depression (1.28) than Europeans (.59) and North Americans (.32). Less than 5 weeks of MMIs showed greater improvement in depression (1.47) than longer periods (.55). MMIs with guided meditation reduced depression (.91) more than MMIs without (.42). Only one quality indicator, a priori power analysis, showed greater effects on depression (g = 1.0) than no power analysis (g=.35).
Conclusion
MMIs improved depressive symptoms in older adults. MMIs might be used as adjunctive or alternative to conventional treatment for depressed older adults.
The Effect of Meditation, Mindfulness, and Yoga in Patients with Rheumatoid Arthritis
by Laura Slagter, Koen Demyttenaere, Patrick Verschueren, and Diederik De Cock
J. Pers. Med. 2022, 12(11), 1905; https://doi.org/10.3390/jpm12111905
Abstract
Objectives: Mind–body therapies (MBTs), including meditation, yoga, and mindfulness, create an interaction between the mind and body to enhance health. MBTs are perceived by both patients and healthcare professionals as valuable in the management of rheumatoid arthritis (RA), but the extent of this contribution is unclear, as are the patient subgroups who benefit most from MBTs. Therefore, this systematic literature review investigates the effects of meditation, mindfulness, and yoga in patients with RA. Methods: We searched four databases (PubMed, Embase, Web of Science (core collection, Chinese and Korean collection), and CINAHL). All studies were screened by two independent reviewers via the title/abstract/full text. The studies included any form of meditation/mindfulness/yoga as an intervention for RA. Animal studies, case reports, non-English articles, qualitative studies, conference abstracts, and articles without full-text access were excluded. Each study was assessed for its quality. Results: Out of 1527 potentially eligible records, 23 studies were included. All three MBTs showed various effects on patient-reported outcomes, such as vitality, functioning, and mental health, as well as on disease activity markers. Mindfulness-based interventions mainly reduced the subjective disease activity parameters (e.g., joint tenderness, morning stiffness, and pain), rather than the objective disease activity parameters (e.g., swollen joints and C-reactive protein (CRP)). RA patients with recurrent depression may benefit more from these non-pharmacological therapies than patients without recurrent depression. Discussion: This systematic literature review found that MBTs show added value in RA management, especially for patients with depressive symptoms. These non-pharmacological approaches, when used in addition to medication, might diminish polypharmacy in specific RA patient populations. Lay Summary: In recent decades, more attention has been given to the management of rheumatoid arthritis (RA) with options other than solely using medication. Such alternative options for patients to increase their quality of life are, for instance, meditation, yoga, and mindfulness. These examples of mind–body therapies (MBTs) are techniques that create an interaction between the mind and the bodily functions in order to obtain relaxation and enhance overall health. Although it is believed that these mind–body techniques are valuable in the management of RA, the extent of their contribution is still unclear, as is the question of if certain subgroups of patients benefit more from these complementary therapies. This systematic literature review investigated the effects of meditation, mindfulness, and yoga in patients with rheumatoid arthritis. A literature search was systematically performed within four different scientific databases by two independent reviewers. Out of 1527 potentially eligible articles, 23 studies were included. All three MBTs showed beneficial effects, which were mostly on the vitality, functioning, and mental health of patients with RA, but also on symptoms related to disease activity. RA patients with recurrent depression seemed to benefit more from these non-pharmacological therapies than patients without recurrent depression. Hence, we can conclude that MBTs show added value in the management of RA.
Therapeutic Effects of Meditation, Yoga, and Mindfulness-Based Interventions for Chronic Symptoms of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis
Rebecca L. Acabchuk, Julie M. Brisson, Crystal L. Park, Noah Babbott-Bryan, Olivia A. Parmelee, Blair T. Johnson
First published: 02 November 2020
https://doi.org/10.1111/aphw.12244
Abstract
Background
Chronic symptoms of mild traumatic brain injury (mTBI) vary greatly and are difficult to treat; we investigate the impact of meditation, yoga, and mindfulness-based interventions on this treatment group.
Method
Search included four databases, allowing studies of any design containing pre/post outcomes for meditation, yoga, or mindfulness-based interventions in people suffering from brain injury acquired by mechanical force. Analyses used robust variance estimation to assess overall effects and random-effects models for selected outcomes; we evaluated both between- and within-group changes.
Results
Twenty studies (N = 539) were included. Results revealed significant improvement of overall symptoms compared to controls (d = 0.41; 95% CI [0.04, 0.77]; τ2 = 0.06), with significant within-group improvements in mental health (d = 0.39), physical health (d = 0.39), cognitive performance (d = 0.24), quality of life (d = 0.39), and self-related processing (d = 0.38). Symptoms showing greatest improvement were fatigue (d = 0.96) and depression (d = 0.40). Findings were homogeneous across studies. Study quality concerns include lack of randomisation, blinding, and recording of adverse events.
Meditation experience is associated with lower levels of repetitive negative thinking: The key role of self-compassion.
Schlosser, M., Jones, R., Demnitz-King, H. et al.
Curr Psychol 41, 3144–3155 (2022). https://doi.org/10.1007/s12144-020-00839-5
Published09 June 2020
Issue DateMay 2022
https://doi.org/10.1007/s12144-020-00839-5
Abstract
The primary aim of this study was to investigate the relationship between meditation experience and repetitive negative thinking (RNT) in regular meditators with a wide range of experience, and to examine the extent to which self-compassion and mindfulness mediate this relationship. RNT is a transdiagnostic process that is implicated in the development and maintenance of several mental health disorders. Converging evidence suggests that meditation practice is associated with improved mental health and may reduce levels of RNT. Increased levels of self-compassion and mindfulness have been associated with decreased levels of RNT and proposed as theoretically consistent mediators by which meditation practice exerts its beneficial effects; however, they are seldom considered in combination. In a cross-sectional design, 1281 meditators (mean age = 44.7 years, SD = 13.9, 53.7% female) completed questionnaires about meditation experience, RNT, self-compassion, and mindfulness. Linear regression and generalised structural equation models were used to examine the data. Longer duration of meditation experience was associated with lower levels of RNT and higher levels of self-compassion and mindfulness. Meditation experience was associated with RNT indirectly through self-compassion, but not through mindfulness. The results offer preliminary support for longer-term meditation as a potential means for reducing the maladaptive process of RNT. Clinically, self-compassion could be identified as a promising treatment target for interventions.
The Effects of Mindfulness Meditation on Stress and Burnout in Nurses
Alyssa A. Green, BSN, RN and Elizabeth V. Kinchen, PhD, RN, AHN-BC
Volume 39, Issue 4
https://doi.org/10.1177/08980101211015818
Abstract
Background: Occupational burnout related to stress in the workplace is experienced by nurses who are regularly confronted with trauma, suffering, and high workloads. Burnout can negatively impact patient care and have detrimental effects on nurses’ physical and mental health. Mindfulness-based stress reduction programs have been researched as a potential holistic intervention for reducing stress and burnout in nurses through cultivating present awareness, emotional regulation, and positive thinking. Purpose: This critical review of the literature explores current knowledge on the effectiveness of mindfulness meditation on stress and burnout in nurses, examines gaps in the current literature, and provides recommendations for future research on this topic. Methods: Search terms included mindfulness, meditation, mindfulness-based stress reduction, occupational stress, stress, burnout. Peer-reviewed research directly related to the impact of mindfulness-based stress reduction on nurses experiencing stress and/or burnout was reviewed. Findings: Findings reveal evidence that mindfulness meditation is effective in decreasing stress and burnout in nurses. Mindfulness-based interventions have been shown to significantly decrease stress, improve all aspects of burnout, and increase self-compassion and compassion satisfaction in practicing nurses. Conclusions: Mindfulness meditation has the potential to decrease stress and burnout in nurses by decreasing self-judgment and overidentification with experience, and by increasing resiliency, compassion, and emotional regulation.
Military-related posttraumatic stress disorder and mindfulness meditation: A systematic review and meta-analysis
Lu-Na Sun et al. 2021
https://doi.org/10.1016/j.cjtee.2021.05.003
Abstract
Purpose
Posttraumatic stress disorder (PTSD) is a significant global mental health concern, especially in the military. This study aims to estimate the efficacy of mindfulness meditation in the treatment of military-related PTSD, by synthesizing evidences from randomized controlled trials.
Methods
Five electronic databases (Pubmed, EBSCO Medline, Embase, PsychINFO and Cochrane Library) were searched for randomized controlled trials focusing on the treatment effect of mindfulness meditation on military-related PTSD. The selection of eligible studies was based on identical inclusion and exclusion criteria. Information about study characteristics, participant characteristics, intervention details, PTSD outcomes, as well as potential adverse effects was extracted from the included studies. Risk of bias of all the included studies was critically assessed using the Cochrane Collaboration's tool. R Statistical software was performed for data analysis.
Results
A total of 1902 records were initially identified and screened. After duplicates removal and title & abstract review, finally, 19 articles in English language with 1326 participants were included through strict inclusion and exclusion criteria. The results revealed that mindfulness meditation had a significantly larger effect on alleviating military-related PTSD symptoms compared with control conditions, such as treatment as usual, present-centered group therapy and PTSD health education (standardized mean difference (SMD) = −0.33; 95% CI [−0.45, −0.21]; p < 0.0001). Mindfulness interventions with different control conditions (active or non-active control, SMD = −0.33, 95% CI [−0.46, −0.19]; SMD = −0.49, 95% CI [−0.88, −0.10], respectively), formats of delivery (group-based or individual-based, SMD = −0.30, 95% CI [−0.42, −0.17], SMD = −0.49, 95% CI [−0.90, −0.08], respectively) and intervention durations (short-term or standard duration, SMD = −0.27, 95% CI [−0.46, −0.08], SMD = −0.40, 95% CI [−0.58, −0.21], respectively) were equally effective in improving military-related PTSD symptoms.
Conclusion
Findings from this meta-analysis consolidate the efficacy and feasibility of mindfulness meditation in the treatment of military-related PTSD. Further evidence with higher quality and more rigorous design is needed in the future.
A Systematic Review of Literature: Alternative Offender Rehabilitation—Prison Yoga, Mindfulness, and Meditation
Dragana Derlic
Published Online:1 Oct 2020
https://doi.org/10.1177/1078345820953837
Mindfulness in Prison
It is said that mindfulness-based activities help inmates understand themselves, discover how they “do gender,” and unlearn or let go of crime-prone behavior (Crichlow & Joseph, 2015). Studies looking at mindfulness have reported reductions in violence, aggression, and anger as well as increased self-awareness and inspiration in inmates (Parkum & Stultz, 2000). Research has shown that mindful practice(s) can foster environments tolerant of different religious beliefs, ones with flexible treatment goals, and less association with stigma than traditional treatment programs (Teasdale et al., 1995). Ruedy and Schweitzer (2010) found that mindful individuals were more likely to act ethically, uphold ethical standards, and use a principled approach to all decision making. Further, Shapiro and colleagues (2012) looked at mindfulness-based stress reduction effects and found improved psychological functioning in inmates. They also found that the amount of time inmates spent in meditation was associated with improvements in mindful attention. Overall, these findings show that mindfulness-based stress reduction can potentially facilitate moral reasoning and decision making in its participants.
Mindfulness has beneficial outcomes for both psychological and physiological purposes. Psychological benefits are those that enhance cognitive functions and creativity, such as attention and concentration, or one’s self-esteem, self-reflection, empathy, and interpersonal functioning (Shapiro et al., 2012). Physiological benefits are those that improve the immune system, modify cortisol, and increase blood flow (Shapiro et al., 2012). Shapiro and colleagues (2012) argue that mindfulness-based stress reduction reduced stress and depression and at the same time enhanced the well-being of the practitioner. A year later, Milani and colleagues (2013) found that mindfulness-based cognitive therapy had been effective in reducing aggression in its participants and, more importantly, had encouraged practitioners (in this case juveniles) to learn concentration, nonjudgment, and acceptance.
Meditation in Prison
One of the first studies to test the effects of meditation on prison inmates came from Orme-Johnson and Moore (2003) in 1971. They found that over a 2-month period, participants in the meditation showed an increase in the stability of the nervous system and reductions in rigidity, obsessive thoughts, and compulsive behavior (Orme-Johnson & Moore, 2003). In addition, there were improvements in inmates’ functioning of the frontal lobes of the brain in a manner useful for rehabilitation of offenders. More importantly, Orme-Johnson and Moore found that those prisoners who stuck to their daily practice of meditation had the most benefits from the practice (Orme-Johnson & Moore, 2003). Although inmate behavior improved and less chaos occurred, it was only because of those who were fixed on practicing every day that this change occurred. Orme-Johnson and Moore found that length of time and persistence in meditation was a key to this change.
Vipassana Meditation
Bowen and colleagues (2006) evaluated the effects of Vipassana meditation on substance use and psychosocial outcomes of inmates. They found that after release, there was a significant reduction in the use of alcohol, marijuana, and crack cocaine for those who had participated in the meditation. Results illustrated a decrease in alcohol-related problems and psychiatric symptoms. In addition, the researchers found short-term effects of Vipassana meditation on reducing postincarceration substance use and its accompanying problems. Most importantly, the study found support for the effectiveness of Vipassana meditation as a treatment for substance use disorder in the correctional setting (Bowen et al., 2006). Those who participated in Vipassana meditation reported significantly less use of each substance and significantly fewer alcohol-related negative consequences 3 months following release. In addition, participants reported significantly lower levels of psychiatric symptoms, more internal alcohol-related control, and higher levels of optimism.
Perelman and colleagues (2012) tested the impact of Vipassana meditation in a Deep South, maximum-security prison. Specifically, they examined the psychological and behavioral effects of a 10-day Vipassana meditation class. The pretreatment measures assessed inmates’ mindfulness, anger, emotional intelligence, levels of distress, and/or mood status. Perelman and colleagues found that those who participated in the 10-day Vipassana meditation achieved enhanced levels of mindfulness and emotional intelligence and decreased mood disturbance relative to the comparison group. In addition, participants were notably positive in their reviews of the mediation experience and had greater levels of mindfulness and lower levels of mood distress at all times. Perelman and colleagues conclude that Vipassana meditation fits well as a potential antidote to the stressors and chaos of prison life.
Meditation in a Deep South Prison: A Longitudinal Study of the Effects of Vipassana
Abigayl M. Perelman
, Sarah L. Miller
, Carl B. Clements
, Amy Rodriguez
, Kathryn Allen
& Ron Cavanaugh
Pages 176-198 | Published online: 19 Apr 2012
https://doi.org/10.1080/10509674.2011.632814
Abstract
In an era marked by pronounced overcrowding, including an increasing number of offenders serving long-term sentences, correctional systems continue to search for innovative and effective treatments. Few jurisdictions have attempted non-Western approaches such as meditative practice to reduce stress, conflict, and rule infractions. The current study examined the psychological and behavioral effects of intensive ten-day Vipassana Meditation (VM) retreats in a maximum security prison. VM goals and practice are consistent with evidence-based methods such as cognitive behavioral treatment and Risk-Need-Responsivity principles, as well as newer conceptions such as the Good Lives Model. Long-term offenders were followed over a one-year period. These included three retreat cohorts (n = 60) as well as an alternative treatment comparison group (n = 67). Pretreatment measures assessed mindfulness, anger, emotional intelligence, and mood states. Baseline rates of prison infractions, segregation time, and health visits were also recorded. VM participants achieved enhanced levels of mindfulness and emotional intelligence and had decreased mood disturbance relative to a comparison group. Both groups' rates of behavioral infractions were reduced at one-year follow-up. Clinically, VM holds promise for addressing self-regulation and impulse control, among other barriers to prisoner adjustment and community reentry. Additional study of VM across diverse offender groups is warranted.
Mindfulness meditation and substance use in an incarcerated population.
Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B. D., Larimer, M. E., Blume, A. W., Parks, G. A., & Marlatt, G. A. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive Behaviors, 20(3), 343–347. https://doi.org/10.1037/0893-164X.20.3.343
Abstract
Despite the availability of various substance abuse treatments, alcohol and drug misuse and related negative consequences remain prevalent. Vipassana meditation (VM), a Buddhist mindfulness-based practice, provides an alternative for individuals who do not wish to attend or have not succeeded with traditional addiction treatments. In this study, the authors evaluated the effectiveness of a VM course on substance use and psychosocial outcomes in an incarcerated population. Results indicate that after release from jail, participants in the VM course, as compared with those in a treatment-as-usual control condition, showed significant reductions in alcohol, marijuana, and crack cocaine use. VM participants showed decreases in alcohol-related problems and psychiatric symptoms as well as increases in positive psychosocial outcomes. The utility of mindfulness-based treatments for substance use is discussed.
Mindfulness-based stress reduction effects on moral reasoning and decision making
Shauna L. Shapiro, Hooria Jazaieri, & Philippe R. Goldin
Pages 504-515 | Received 29 Jun 2012, Accepted 13 Aug 2012, Published online: 11 Sep 2012
https://doi.org/10.1080/17439760.2012.723732
Abstract
Previous research has demonstrated that mindfulness-based stress reduction (MBSR) improves psychological functioning in multiple domains. However, to date, no studies have examined the effects of MBSR on moral reasoning and decision making. This single group design study examined the effect of MBSR on moral reasoning and ethical decision making, mindfulness, emotion, and well-being. Additionally, we investigated whether there was an association between the amount of meditation practice during MBSR and changes in moral reasoning and ethical decision making, emotions, mindfulness, and well-being. Results indicated that MBSR was associated with improvements in mindful attention, emotion and well-being. Further, amount of meditation practice was associated with greater improvement in mindful attention. Two-month follow-up results showed that, MBSR resulted in improvements in moral reasoning and ethical decision making, mindful attention, emotion, and well-being. This study provides preliminary evidence that MBSR may potentially facilitate moral reasoning and decision making in adults.
In the Moment: The Effect of Mindfulness on Ethical Decision Making
Ruedy, N.E., Schweitzer, M.E.
Published: 18 February 2011
Business Ethics Volume 95, pages 73–87, (2010)
https://doi.org/10.1007/s10551-011-0796-y
Abstract
Many unethical decisions stem from a lack of awareness. In this article, we consider how mindfulness, an individual’s awareness of his or her present experience, impacts ethical decision making. In our first study, we demonstrate that compared to individuals low in mindfulness, individuals high in mindfulness report that they are more likely to act ethically, are more likely to value upholding ethical standards (self-importance of moral identity, SMI), and are more likely to use a principled approach to ethical decision making (formalism). In our second study, we test this relationship with a novel behavioral measure of unethical behavior: the carbonless anagram method (CAM). We find that of participants who cheated, compared to individuals low in mindfulness, individuals high in mindfulness cheated less. Taken together, our results demonstrate important connections between mindfulness and ethical decision making.
Mindfulness-Based Stress Reduction in Massachusetts Correctional Facilities
Marlene Samuelson, James Carmody, […], and Michael A. Bratt
Volume 87, Issue 2
https://doi.org/10.1177/0032885507303753
Abstract
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Abstract
Mindfulness-based stress-reduction courses were offered in drug units in six Massachusetts Department of Corrections prisons. A total of 1,350 inmates completed the 113 courses. Evaluation assessments were held before and after each course, and highly significant pre- to post-course improvements were found on widely accepted self-report measures of hostility, self-esteem, and mood disturbance. Improvements for women were greater than those for men, and improvements were also greater for men in a minimum-security, pre-release facility than for those in four medium-security facilities. The results encourage further study and wider use of mindfulness-based stress reduction in correctional facilities.
The effects of meditation on individuals facing loneliness: a scoping review
Saini, G.K., Haseeb, S.B., Taghi-Zada, Z. et al. The effects of meditation on individuals facing loneliness: a scoping review. BMC Psychol 9, 88 (2021). https://doi.org/10.1186/s40359-021-00585-8
Abstract
Background
Meditation is defined as a mind and body practice focused on interactions between the brain, mind, body, and behaviour, containing four key elements: a quiet location with little distractions, a comfortable posture, a focus of attention, and an open attitude. We sought to review the benefits of meditation on the alleviation of loneliness.
Methods
A scoping review was conducted based on Arksey and O’Malley’s five-stage framework. Eligibility criteria included primary studies of any type that investigated the effects of meditation on loneliness. Search strategies were developed and conducted on MEDLINE, EMBASE, AMED, and CINAHL. The National Center for Complementary and Integrative Health, and American Psychological Association websites were also searched. Articles meeting the inclusion criteria were critically reviewed using a descriptive-analytical narrative method.
Results
Thirteen studies met our inclusion criteria and were published between 2012 and 2020 across 10 countries. Eleven studies reported improvements in relation to loneliness. Of the remaining two studies (15%), one mentioned the alleviation of loneliness, but only looked primarily at social closeness in lonely individuals. The other study found a correlation between loneliness and nuclear factor (NF)-κB levels, which was the measured outcome; however, the direct effects of meditation on loneliness were unclear. Three main themes emerged from our analysis, as follows: 1) positive results across all studies, 2) relatively small randomized control trials conducted over the last decade, and 3) lack of diverse demographic information.
Conclusions
While a small number of studies exist at this intersection, given all included studies indicated positive findings, the effects of meditation in alleviating loneliness are promising. Future research should be directed at understanding how meditation mitigates loneliness and how this intervention can impact practice for healthcare professionals.
Mindfulness, happiness, and anxiety in a sample of college students before and after taking a meditation course
Claire Crowley, MM, Laura Ring Kapitula, PhD & Dana Munk, PhD
Pages 493-500 | Received 21 May 2019, Accepted 29 Mar 2020, Published online: 05 May 2020
https://doi.org/10.1080/07448481.2020.1754839
Abstract
Objective
To explore differences in mindfulness, happiness, and perceived anxiety in a sample of college students before and after taking a meditation course.
Participants
Participants were college students at a primarily undergraduate institution enrolled in an experiential meditation class (n = 74) and a non-meditation class comparison group (n = 73).
Methods
The study design was a before-after observational study with two groups and three dependent variables: the Mindfulness Attention Awareness Scale, the State Trait Anxiety Inventory and the Subjective Happiness Scale.
Results
Students in the meditation course increased average subjective happiness and mindfulness attention awareness. Mindfulness scores increased and anxiety decreased more for students in the meditation class compared to students in the psychosocial class.
Mindfulness Meditation and Anxiety in Nursing Students
Stinson, Cynthia; Curl, Eileen Deges; Hale, Gina; Knight, Stacey; Pipkins, Cynthia; Hall, Iva; White, Kelli; Thompson, Nancy; Wright, Christy
Author Information
Nursing Education Perspectives 41(4):p 244-245, 7/8 2020. | DOI: 10.1097/01.NEP.0000000000000635
Abstract
This quasi-experimental study used a convenience sample of nursing students (n = 49) to evaluate the effectiveness of mindfulness meditation on anxiety. Students participated in mindfulness meditation sessions and completed the State-Trait Anxiety Inventory. A statistically significant reduction in trait anxiety was found in the intervention group (p = .000); state anxiety decreased but not significantly. In contrast, anxiety increased significantly in the comparison group, but progression was not significantly different between groups. Trait anxiety may decrease with mindfulness meditation.
Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial
Elizabeth A. Hoge, MD1; Eric Bui, MD, PhD2; Mihriye Mete, PhD3; et al Mary Ann Dutton, PhD1; Amanda W. Baker, PhD4; Naomi M. Simon, MD, MSc5
Author Affiliations Article Information
JAMA Psychiatry. 2023;80(1):13-21. doi:10.1001/jamapsychiatry.2022.3679
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2798510
Abstract
Importance Anxiety disorders are common, highly distressing, and impairing conditions. Effective treatments exist, but many patients do not access or respond to them. Mindfulness-based interventions, such as mindfulness-based stress reduction (MBSR) are popular and can decrease anxiety, but it is unknown how they compare to standard first-line treatments.
Objective To determine whether MBSR is noninferior to escitalopram, a commonly used first-line psychopharmacological treatment for anxiety disorders.
Design, Setting, and Participants This randomized clinical trial (Treatments for Anxiety: Meditation and Escitalopram [TAME]) included a noninferiority design with a prespecified noninferiority margin. Patients were recruited between June 2018 and February 2020. The outcome assessments were performed by blinded clinical interviewer at baseline, week 8 end point, and follow-up visits at 12 and 24 weeks. Of 430 individuals assessed for inclusion, 276 adults with a diagnosed anxiety disorder from 3 urban academic medical centers in the US were recruited for the trial, and 208 completed the trial.
Interventions Participants were 1:1 randomized to 8 weeks of the weekly MBSR course or the antidepressant escitalopram, flexibly dosed from 10 to 20 mg.
Main Outcomes and Measures The primary outcome measure was anxiety levels as assessed with the Clinical Global Impression of Severity scale (CGI-S), with a predetermined noninferiority margin of −0.495 points.
Results The primary noninferiority sample consisted of 208 patients (102 in MBSR and 106 in escitalopram), with a mean (SD) age of 33 (13) years; 156 participants (75%) were female; 32 participants (15%) were African American, 41 (20%) were Asian, 18 (9%) were Hispanic/Latino, 122 (59%) were White, and 13 (6%) were of another race or ethnicity (including Native American or Alaska Native, more than one race, or other, consolidated owing to low numbers). Baseline mean (SD) CGI-S score was 4.44 (0.79) for the MBSR group and 4.51 (0.78) for the escitalopram group in the per-protocol sample and 4.49 (0.77) vs 4.54 (0.83), respectively, in the randomized sample. At end point, the mean (SD) CGI-S score was reduced by 1.35 (1.06) for MBSR and 1.43 (1.17) for escitalopram. The difference between groups was −0.07 (0.16; 95% CI, −0.38 to 0.23; P = .65), where the lower bound of the interval fell within the predefined noninferiority margin of −0.495, indicating noninferiority of MBSR compared with escitalopram. Secondary intent-to-treat analyses using imputed data also showed the noninferiority of MBSR compared with escitalopram based on the improvement in CGI-S score. Of patients who started treatment, 10 (8%) dropped out of the escitalopram group and none from the MBSR group due to adverse events. At least 1 study-related adverse event occurred for 110 participants randomized to escitalopram (78.6%) and 21 participants randomized to MBSR (15.4%).
Conclusions and Relevance The results from this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with pharmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram.
Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training
Alexandra Roy; Susan Druker; Elizabeth A Hoge; Judson A Brewer
Abstract
Background: Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments.
Objective: The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout.
Methods: This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory.
Results: GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48% reduction, P<.001) and at the 3-month follow-up (57% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50% reduction, P=.003 at posttreatment; 50% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20% reduction, P<.001 at posttreatment; 20% reduction, P=.003 at follow-up).
Conclusions: This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians.
Meditation-Based Therapy for Chronic Low Back Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Pain Medicine, Volume 23, Issue 10, October 2022, Pages 1800–1811, https://doi.org/10.1093/pm/pnac037
Abstract
Background
Chronic low back pain (CLBP) is among the most common types of pain in adults. Currently, injections and analgesic and nonsteroidal anti-inflammatory drugs are often provided for patients with CLBP. However, their effectiveness remains questionable, and the safest approach to CLBP remains debated. Meditation-based therapies constitute an alternative treatment with high potential for widespread availability. We evaluated the applicability of meditation-based therapies for CLBP management.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of meditation-based therapies for CLBP management. The primary outcomes were pain intensity, quality of life, and pain-related disability; the secondary outcomes were the experienced distress or anxiety and pain bothersomeness in the patients. The PubMed, Embase, and Cochrane databases were searched for studies published from the databases’ inception dates until July 2021, without language restrictions.
Results
We reviewed 12 randomized controlled trials with 1,153 patients. In 10 trials, meditation-based therapies significantly reduced the CLBP pain intensity compared with nonmeditation therapies (standardized mean difference [SMD] −0.27, 95% confidence interval [CI] = −0.43 to −0.12, P = 0.0006). In seven trials, meditation-based therapies also significantly reduced CLBP bothersomeness compared with nonmeditation therapies (SMD −0.21, 95% CI = −0.34 to −0.08, P = 0.002). In three trials, meditation-based therapies significantly improved patient quality of life compared with nonmeditation therapies (SMD 0.27, 95% CI = 0.17 to 0.37, P < 0.00001).
Conclusions
In conclusion, meditation-based therapies constitute a safe and effective alternative approach to CLBP management.
Pain regulation during mindfulness meditation: Phenomenological fingerprints in novices and experts practitioners
Stefano Poletti, Oussama Abdoun, Jelle Zorn, Antoine Lutz
First published: 02 April 2021
https://doi.org/10.1002/ejp.1774
Abstract
Background
The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored.
Methods
The present mixed-methods study combined an interpretative-phenomenological qualitative approach with an experimental thermal pain paradigm to explore and compare the meaning of experiencing pain in 32 novices who received short meditation training and 30 experts in meditation practice (more than 10, 000 hr in life). We collected the qualitative data during in-depth semi-structured interviews where we probed participants’ response strategies. During the pain task, we collected self-reports of intensity and unpleasantness, while after the task we collected self-reports of avoidance, openness, vividness and blissfulness.
Results
Five phenomenological clusters (PhC) emerged from the interviews, including three which described pain as an unpleasant sensation calling for: (1) experiential avoidance-suppression, (2) volitional agency-distanciation, or (3) a positive cognitive reappraisal and flexibility. Two additional clusters (4–5), containing mostly expert meditators, thematized pain sensation as an opportunity to gain metacognitive insights about mental processes, and to deconstruct one's suffering through these insights. PhC5 further integrates these insights with the recognition that suffering is part of the shared human experience and with the aspiration to relieve others from suffering. Each PhC was correlated to a unique profile of self-reports during the pain paradigm.
Conclusion
These findings need to be replicated in patients and practicing MM. They also warrant the integration of this mixed-method approach with brain imaging data to refine the experiential neuroscience of pain.
Significance
We compared the meaning of experiencing and regulating pain in novices and expert meditators using qualitative interviews. We identified five phenomenological clusters describing relevant features implicated in pain response strategies and meditation. These clusters were organized along a pseudo-gradient, which captured meditation expertise and predicted self-reports related to a pain paradigm and psychometric scales associated with pain and its regulation. These findings advance our understanding of the metacognitive mechanisms and beliefs underlying mindfulness meditation and can inform pain treatment strategies.
Mindfulness meditation is related to sensory-affective uncoupling of pain in trained novice and expert practitioners
Jelle Zorn, Oussama Abdoun, Romain Bouet, Antoine Lutz
First published: 20 April 2020
https://doi.org/10.1002/ejp.1576
Abstract
Background
Mindfulness meditation can alleviate acute and chronic pain. It has been proposed that mindfulness meditation reduces pain by uncoupling sensory and affective pain dimensions. However, studies to date have reported mixed results, possibly due to a diversity of styles of and expertise in mindfulness meditation. Furthermore, the interrelations between mindfulness meditation and pain catastrophizing during acute pain remain little known.
Methods
This cross-sectional study investigated the effect of a style of mindfulness meditation called Open Monitoring (OM) on sensory and affective pain experience by comparing novice (2-day formal training; average ~20 hr practice) to expert practitioners (>10.000 hr practice). We implemented a paradigm that was designed to amplify the cognitive-affective aspects of pain experience by the manipulation of pain anticipation and uncertainty of stimulus length (8 or 16 s thermal pain stimuli). We collected pain intensity and unpleasantness ratings and assessed trait pain catastrophizing with the Pain Catastrophizing Scale (PCS).
Results
Across groups, mindfulness meditation reduced unpleasantness, but not intensity ratings compared to attentional distraction. Experts reported a lower score on PCS, reduced amplification of unpleasantness by long painful stimuli, and larger sensory-affective uncoupling than novices particularly during long painful stimuli. In experts, meditation-induced uncoupling spilled over the control condition. Across groups and task conditions, a higher score on PCS predicted lower sensory-affective uncoupling during long painful stimuli and higher ratings of pain intensity during short painful stimuli.
Conclusion
These findings suggest that mindfulness meditation specifically down-regulates pain affect as opposed to pain intensity, and that pain catastrophizing undermines sensory-affective uncoupling of pain.
Significance
In this study, we found that a style of mindfulness meditation referred to as OM reduced unpleasantness but not intensity ratings compared to attentional distraction in trained novice (state effect) and expert meditators (state and trait effects). We also observed that trait pain catastrophizing scores predicted this sensory-affective uncoupling. These findings advance our understanding of the cognitive mechanisms underlying mindfulness meditation and can inform treatment strategies for chronic pain.
The Two Arrows of Pain: Mechanisms of Pain Related to Meditation and Mental States of Aversion and Identification
Nicolardi, V., Simione, L., Scaringi, D. et al. The Two Arrows of Pain: Mechanisms of Pain Related to Meditation and Mental States of Aversion and Identification. Mindfulness (2022). https://doi.org/10.1007/s12671-021-01797-0
Abstract
Objectives
According to the core Buddhist psychology models of the “two arrows of pain” and “co-dependent origination,” pain is the resultant of bodily and mental factors, which can be regulated by meditation states and traits. Here we investigated how pain and the related aversion and identification (self-involvement) experiences are modulated by focused attention meditation (FAM), open monitoring meditation (OMM), and loving kindness meditation (LKM), as well as by meditation expertise.
Methods
Theravada Buddhist long-term meditators were matched with a group of short-term meditators. Nociceptive electrical stimulation was administered during FAM, OMM, and LKM, and in a non-meditative rest condition. Experience reports of pain, aversion, and identification were collected in each trial.
Results
Pain thresholds were higher in long-term meditators than in short-term meditators. In the short-term meditators, as compared to rest, pain was reduced in FAM and OMM, and aversion and identification in all meditation conditions. In the long-term meditators, pain was reduced only in LKM. Identification was reduced in the three forms of meditation, while aversion was not affected by meditation. Further analyses with a particular focus on long-term meditators showed that pain was predicted to increase with meditation expertise, aversion, and identification. Granger causality analysis revealed that aversion and pain, as well as aversion and identification, causally influenced each other; identification causally influenced pain. This pattern of results about the relationships between pain, aversion, and identification was largely overlapping in the group of short-term meditators.
Conclusions
The findings reveal mechanisms of pain in interaction with aversive and identification mental states, as well as their modulation by meditation states and traits. They also suggest that pain feeling is the resultant of coupling of sensory and mental factors, thus highlighting the relevance of the second arrow of pain and providing a clarification of the epistemological gap between sensory causation and mental state causation of pain, in terms of a co-production mechanism with multiple stages. In particular, the evidence about the causal influences of identification on pain highlights a self-related factor of relevance in pain experiences that can be modulated by mindfulness. The study also inspires new testable neuroscientific hypotheses, and sheds new light on core Buddhist psychology models, based on evidence from a controlled experimental setting and experience dimension reports by long-term meditators with enhanced mindfulness skills.
The Impact of Mindful Meditation in Nature on Self-Nature Interconnectedness
Unsworth, S., Palicki, SK. & Lustig, J. The Impact of Mindful Meditation in Nature on Self-Nature Interconnectedness. Mindfulness 7, 1052–1060 (2016). https://doi.org/10.1007/s12671-016-0542-8
Abstract
Previous research has shown that mindfulness and spending time in nature are both related to perceived self-nature interconnectedness, with implications for environmental and psychological well-being. More research is needed to better understand the relative influence of mindful meditation and nature exposure on self-nature interconnectedness. In study 1, we replicated evidence for a relationship between mindfulness and self-nature interconnectedness in a sample of Buddhist meditators attending a nature and meditation retreat. In study 2, undergraduate students participated in 3-day nature trips that were randomly assigned to either a meditation condition (which included formal meditation in the mornings) or a non-meditation condition (which did not include formal meditation practices). The results from pre- and post-trip surveys showed that the combined influence of mindful meditation in nature on self-nature interconnectedness is greater than nature exposure that does not include mindful meditation. One focus of the present research was to examine cognitive dimensions of nature connectedness, given that mindfulness meditation is based on cognitive processes such as selective attention. Study 2 revealed three types of concepts underlying self-nature interconnectedness: (1) mental models for behaviors in nature, (2) self-nature categorization, and (3) self-nature associations. In addition, participants who meditated in nature were more likely to foreground nature in their memories of the trip by emphasizing nature rather than other aspects (such as social interactions). Together, the results from the present research suggest that mindful meditation in nature can be used to reestablish or strengthen concepts of self-nature interconnectedness nature for urban adults.
Building mindfulness bottom-up: Meditation in natural settings supports open monitoring and attention restoration
Lymeus, Freddie; Lindberg, Per; Hartig, Terry
https://doi.org/10.1016/j.concog.2018.01.008
Highlights
•
Mindfulness meditation purportedly enhances attention through effortful training.
•
We found meditation in nature was effortless and restored attention resources.
•
We found conventional meditation incurred effort only after several weeks’ training.
•
Restoration is a potential pathway to attentional improvements with meditation.
Abstract
Mindfulness courses conventionally use effortful, focused meditation to train attention. In contrast, natural settings can effortlessly support state mindfulness and restore depleted attention resources, which could facilitate meditation. We performed two studies that compared conventional training with restoration skills training (ReST) that taught low-effort open monitoring meditation in a garden over five weeks. Assessments before and after meditation on multiple occasions showed that ReST meditation increasingly enhanced attention performance. Conventional meditation enhanced attention initially but increasingly incurred effort, reflected in performance decrements toward the course end. With both courses, attentional improvements generalized in the first weeks of training. Against established accounts, the generalized improvements thus occurred before any effort was incurred by the conventional exercises. We propose that restoration rather than attention training can account for early attentional improvements with meditation. ReST holds promise as an undemanding introduction to mindfulness and as a method to enhance restoration in nature contacts.
The effect of contact with natural environments on positive and negative affect: A meta-analysis
Ethan A. McMahan & David Estes
Pages 507-519 | Received 15 Apr 2014, Accepted 10 Nov 2014, Published online: 13 Jan 2015
https://doi.org/10.1080/17439760.2014.994224
Abstract
A growing body of empirical research suggests that brief contact with natural environments improves emotional well-being. The current study synthesizes this body of research using meta-analytic techniques and assesses the mean effect size of exposure to natural environments on both positive and negative affect. Thirty-two studies with a total of 2356 participants were included. Across these studies, exposure to natural environments was associated with a moderate increase in positive affect and a smaller, yet consistent, decrease in negative affect relative to comparison conditions. Significant heterogeneity was found for the effect of nature on positive affect, and type of emotion assessment, type of exposure to nature, location of study, and mean age of sample were found to moderate this effect. The implications of these findings for existing theory and research are discussed, with particular emphasis placed on potential avenues for fruitful future research examining the effects of nature on well-being.
Mindfulness in Nature Enhances Connectedness and Mood
Elizabeth K. Nisbet, John M. Zelenski, and Zsuzsa Grandpierre
Published Online:30 May 2019
https://doi.org/10.1089/eco.2018.0061
Abstract
Previous research has demonstrated that brief contact with the natural environment can boost feelings of connectedness with nature (nature relatedness) and mood. Less is known about whether mindful awareness of nature improves outdoor experiences, however. We tested the possibility that mindfulness instruction would enhance mood during nature exposure in an urban setting. Participants (n = 100) were randomly assigned to a 20 min guided walk outdoors, outdoors with mindfulness, or indoors. Participants who walked outdoors reported substantially more nature relatedness and better moods than those who walked indoors. Participants who also received mindfulness training reported greater awareness of their surroundings, stronger connectedness with nature, and less negative affect, even compared to outdoor walkers without mindfulness instruction. However, mindfulness did not produce significantly more positive affect outdoors in nearby nature. Results suggest that mindfulness may enhance some beneficial effects of nature exposure.
Doses of Neighborhood Nature: The Benefits for Mental Health of Living with Nature
BioScience, Volume 67, Issue 2, February 2017, Pages 147–155, https://doi.org/10.1093/biosci/biw173
Abstract
Experiences of nature provide many mental-health benefits, particularly for people living in urban areas. The natural characteristics of city residents’ neighborhoods are likely to be crucial determinants of the daily nature dose that they receive; however, which characteristics are important remains unclear. One possibility is that the greatest benefits are provided by characteristics that are most visible during the day and so most likely to be experienced by people. We demonstrate that of five neighborhood nature characteristics tested, vegetation cover and afternoon bird abundances were positively associated with a lower prevalence of depression, anxiety, and stress. Furthermore, dose–response modeling shows a threshold response at which the population prevalence of mental-health issues is significantly lower beyond minimum limits of neighborhood vegetation cover (depression more than 20% cover, anxiety more than 30% cover, stress more than 20% cover). Our findings demonstrate quantifiable associations of mental health with the characteristics of nearby nature that people actually experience.
Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis
SSM - Population Health
Volume 16, December 2021, 100934
https://doi.org/10.1016/j.ssmph.2021.100934
Abstract
Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood −0.64 (95% CI: 1.05 to −0.23), reducing anxiety −0.94 (95% CI: 0.94 to −0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect −0.52 (95% CI: 0.77 to −0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.
Nature experience reduces rumination and subgenual prefrontal cortex activation
Gregory N. Bratman gbratman@stanford.edu, J. Paul Hamilton, Kevin S. Hahn, +1 , and James J. GrossAuthors Info & Affiliations
Contributed by Gretchen C. Daily, May 28, 2015 (sent for review March 9, 2015; reviewed by Leslie Baxter, Elliot T. Berkman, and Andreas Meyer-Lindenberg)
June 29, 2015
112 (28) 8567-8572
https://doi.org/10.1073/pnas.1510459112
Significance
More than 50% of people now live in urban areas. By 2050 this proportion will be 70%. Urbanization is associated with increased levels of mental illness, but it’s not yet clear why. Through a controlled experiment, we investigated whether nature experience would influence rumination (repetitive thought focused on negative aspects of the self), a known risk factor for mental illness. Participants who went on a 90-min walk through a natural environment reported lower levels of rumination and showed reduced neural activity in an area of the brain linked to risk for mental illness compared with those who walked through an urban environment. These results suggest that accessible natural areas may be vital for mental health in our rapidly urbanizing world.
Abstract
Urbanization has many benefits, but it also is associated with increased levels of mental illness, including depression. It has been suggested that decreased nature experience may help to explain the link between urbanization and mental illness. This suggestion is supported by a growing body of correlational and experimental evidence, which raises a further question: what mechanism(s) link decreased nature experience to the development of mental illness? One such mechanism might be the impact of nature exposure on rumination, a maladaptive pattern of self-referential thought that is associated with heightened risk for depression and other mental illnesses. We show in healthy participants that a brief nature experience, a 90-min walk in a natural setting, decreases both self-reported rumination and neural activity in the subgenual prefrontal cortex (sgPFC), whereas a 90-min walk in an urban setting has no such effects on self-reported rumination or neural activity. In other studies, the sgPFC has been associated with a self-focused behavioral withdrawal linked to rumination in both depressed and healthy individuals. This study reveals a pathway by which nature experience may improve mental well-being and suggests that accessible natural areas within urban contexts may be a critical resource for mental health in our rapidly urbanizing world.
Visiting green space is associated with mental health and vitality: A cross-sectional study in four european cities
https://doi.org/10.1016/j.healthplace.2016.01.003
Abstract
Many epidemiological studies have found that people living in environments with more green space report better physical and mental health than those with less green space. However, the association between visits to green space and mental health has seldom been studied. The current study explored the associations between time spent in green spaces by purposeful visits and perceived mental health and vitality in four different European cities, and to what extent gender, age, level of education, attitude towards nature and childhood nature experience moderate these associations. Data was gathered using a questionnaire administered in four European cities (total n=3748). Multilevel analyses showed significant positive associations between time spent visiting green spaces and mental health and vitality in the pooled data, as well as across the four cities. Significant effect modification was found for level of education and childhood nature experience. The findings confirm the hypothesis that more time spent in green space is associated with higher scores on mental health and vitality scales, independent of cultural and climatic contexts.
Does a natural environment enhance the effectiveness of Mindfulness-Based Stress Reduction (MBSR)? Examining the mental health and wellbeing, and nature connectedness benefits
Landscape and Urban Planning
Volume 202, October 2020
https://doi.org/10.1016/j.landurbplan.2020.103886
Highlights
• Participants in natural environment showed less stress and rumination and enhanced reflection.
• Participants in natural environment showed greater nature connectedness than other groups.
• The change in nature connectedness mediated the changes in participants’ levels of reflection.
Abstract
This study investigated whether the impacts of a commonly used wellbeing intervention, Mindfulness-Based Stress Reduction (MBSR), are enhanced when combined with the benefits of exposure to a natural environment. Participants (n = 99) were randomly assigned to a weekly one-hour MBSR in one of three different environments (i.e. natural outdoor, built outdoor and indoor environments) over a six-week period. Participants’ wellbeing outcomes and nature connectedness were measured at baseline, during the intervention and at one-week and one-month follow up. The results show that the mental health and wellbeing outcomes of MBSR are greater when it carried out in a natural outdoor environment compared with indoor or built environments. Moreover, participants in the natural outdoor environment showed sustained improvements even after one month from completion of the intervention. This study supports the potential value of natural environments as settings for the enhancement of health care delivery and therapeutic interventions.
A natural meditation setting improves compliance with mindfulness training
https://doi.org/10.1016/j.jenvp.2019.05.008
Highlights
• Conventional mindfulness courses require effort too high for some beginners.
• Complementary processes link mindfulness and restorative nature experience.
• Restoration skills training (ReST) is a meditation course that draws on those links.
• ReST meditation in nature facilitates mindfulness and improves compliance.
• Learning mindfulness skills enhances restorative experiences.
Abstract
The setting matters in meditation, but most research has neglected it. Many mindfulness-based health interventions emphasize effortful attention training exercises in sparsely furnished indoor settings. However, many beginners with attention regulation problems struggle with the exercises and drop out. In contrast, restoration skills training (ReST) – a five-week course set in a garden environment – builds on mindfulness practices adapted to draw on restorative processes stimulated effortlessly in nature contacts. Expecting that the ReST approach will facilitate the introduction to mindfulness, we compared drop-out and homework completion records from four rounds of ReST vs. conventional mindfulness training (N = 139). Randomly assigned ReST participants had lower drop-out and more sustained homework completion over the course weeks. Supporting the theoretical assumptions, higher restorative environmental qualities and state mindfulness mediated the compliance differences. The improved acceptability with ReST means that more people can enjoy the long-term benefits of establishing a meditation practice.
Inter-brain co-activations during mindfulness meditation. Implications for devotional and clinical settings
https://doi.org/10.1016/j.concog.2021.103210
Highlights
• Couples of expert meditators meditated together in the same room and in two rooms.
• Concurrent EEG activity was recorded (hyperscanning).
• EEG activity is different when meditating together or alone.
• Differences found in frontal, temporo-occipital and limbic sources of the EEG signal.
Abstract
Mindfulness meditation usually takes place as personal, introspective activity. It is not known if this practice activates the brain differently when done alone or with someone else.
Sixteen couples of expert meditators performed mindfulness-oriented meditation (MOM) and instructed mind-wandering (IMW) tasks in two conditions: once sitting in the same room (SR) and once in two different rooms (DR). Spontaneous electroencephalographic (EEG) data was collected during 7-minute recording sessions in the four experimental settings (MOM/SR, MOM/DR, IMW/SR, IMW/DR). Power in band was computed in separate clusters of independent components of the EEG signals.
In addition to significant task effects, found in frontolimbic (MOM > IMW in gamma) and frontoparietal locations (MOM < IMW in theta), significant condition effects were found in frontal (SR > DR in delta) and in temporo-occipital regions (SR > DR in theta and alpha). Moreover, a significant interaction between task and condition revealed higher gamma activity in limbic areas during MOM/SR vs. MOM/DR settings. This effect was not attributable to gender, age nor the meditation expertise of participants.
We thus show that the brains of two people work differently when they are doing something together or alone; some of these differences are specific to mindfulness meditation. Implications for devotional and clinical settings are discussed.
Introduction
For thousands of years human beings have been using mental control techniques, such as yoga, repetitive praying, religious chanting and meditation (James, 1902). These practices operate by “imposing some discipline on a normally unregulated mental habit” (Davidson et al., 2012) and have been developed inside definite cultural and religious contexts, in which social factors clearly have had a fundamental importance. Nowadays, some of these techniques have been reframed within secular settings and adapted in psychological interventions for the promotion of personal well-being (Ospina, 2007), with applications in clinical and nonclinical settings (Arias et al., 2006, Balasubramaniam et al., 2013, Cramer et al., 2013, Goyal et al., 2014). These interventions are often delivered as group training courses.
Mindfulness-based interventions fall into this category (Kabat-Zinn, 2003), as they employ the practice of mindfulness meditation. This form of meditation emerged from Buddhism and consists in exercises for training voluntary attention and the cultivation of self-awareness. The standard western contemporary format of this approach, developed in the 1980s (Mindfulness-Based Stress Reduction, MBSR; Kabat-Zinn, 1990), is based on one group meeting per week over an eight week course plus daily individual practice at home. Since the introduction of this program, several studies have highlighted the benefits of mindfulness meditation. From self-report measures, these effects have been described in terms of reductions in stress, anxiety and depression levels (Chiesa and Serretti, 2009, Goldberg et al., 2018, Hofmann et al., 2010). Using more objective measurements, mindfulness meditation has been associated with enhanced attention control and better interoceptive awareness (Fox et al., 2012, Jha et al., 2007, Tang et al., 2007, van den Hurk et al., 2010). Through neuroimaging techniques, scientists have also observed the neurofunctional and neurostructural correlates of mindfulness meditation (Fox et al., 2014, Fox et al., 2016, Gotink et al., 2016, Young et al., 2018) and the brain responses of mindfulness meditators during various cognitive tasks (Chiesa et al., 2011, Lomas et al., 2015).
In exploring cerebral activity during meditation, in general, and during mindfulness meditation, in particular, scientists have exclusively studied individual brains (Cahn and Polich, 2006, Davis and Hayes, 2011). This is probably because concurrent analysis of more than one brain has to be associated with an hypothesis of brain interaction through the intermediary of the body (Hari & Kujala, 2009); the practice of mindfulness meditation usually demands silence, immobility, sensory self-limitation, and voluntary blindness, which is opposed to the idea of communication between people.
Nevertheless, in the field of individual psychotherapy, silently listening and empathically resonating with a communicative yet, at times, silent patient is common practice (Lane, Koetting, & Bishop, 2002). Moreover, it is known that the mental stance and behavior of a person engaged in a task may change due to performing the task in a group or in isolation. Under different conditions the presence of others can trigger social facilitation or inhibition (i.e., increase or decrease performance of many kinds of tasks) (Aiello & Douthitt, 2001). There are many factors that can determine the effect of others on the individual’s performance, including: the characteristics of the individual (Uziel, 2007), the group (Campion, Medsker, & Higgs, 1993) and the task (Zajonc, 1965); the dominant response to the task (Lambert et al., 2003); and the relationship between the individual and others (Karau & Williams, 1993).
Therefore, it is plausible that when two individuals meditate together, they perform differently than when they meditate alone. During mindfulness training courses, practitioners very often report that meditating together seems easier than meditating alone at home and this is probably one of the reasons why group practice is a constituent component of these courses. On the other hand, research of mindfulness-based interventions delivered in individual vs. group settings showed comparable effects for the two settings as far as character traits and mindfulness skills components are concerned (Matiz, Fabbro, & Crescentini, 2018); this is similar to the results of internet-based vs. group-based mindfulness courses (Spijkerman, Pots, & Bohlmeijer, 2016). Moreover, a large survey on mystical/transcendent and extraordinary experiences during meditation indicates that they occur more frequently when people meditate alone as opposed to in groups (Vieten et al., 2018). All this findings show the need for clarification of the social aspects embedded in mindfulness meditation practice, as is already being undertaken in the field of psychotherapy, where group treatments are frequently compared to individual treatments (Burlingame, Fuhriman, & Mosier, 2003).
In this study, we compared neural activity observed during mindfulness meditation performed in individual vs. couple settings using spontaneous electroencephalographic (EEG) recordings. In our exploratory study, EEG was chosen over other neuroimaging techniques due to its low intrusiveness for expert meditators, allowing them to complete the experimental tasks in a silent environment and in their usual sitting position for breath mindfulness meditation. Previous EEG studies of mindfulness meditation, in which one subject at a time was recorded, provided quite different findings. This is seemingly due to the varying meditation expertise of participants, the methods used for data analysis, the control conditions and the mindfulness meditation tasks employed. Braboszcz et al. (2017) studied expert meditators (N = 16) during vipassana meditation (a form of mindfulness meditation) vs. an instructed mind-wandering task (a task in which participants were instructed to recall autobiographical memories) and found no between-task differences in any of the five EEG frequency bands. Cahn, Delorme, and Polich (2010) had previously compared data obtained from expert meditators (N = 16) during the same two tasks and found significant decreases during meditation in frontal regions in the delta band and increases in frontal midline areas in theta band. Yet, in meditators with different degrees of expertise (N = 67), Kakumanu et al. (2018) have reported global increases in each of the four considered bands (delta, theta, alpha and low-beta) during vipassana practice vs. resting-state. Moreover, once again in meditators of varying expertise (N = 36), Berkovich-Ohana, Glicksohn, and Goldstein (2012) focused on gamma activity during an unspecified mindfulness meditation practice vs. a resting-state condition: during meditation, gamma activity was globally increased, in particular in left temporal and parieto-occipital regions, and in right central, temporal and parieto-occipital regions. Finally, Ahani et al. (2014) compared a body-awareness mindfulness meditation practice vs. a resting state condition in a sample of stressed elderly people (N = 34) after completion of a 6-week mindfulness meditation intervention: using six regions of interest, the authors observed significant increases during the meditation task in all regions in the beta band, in all regions except the frontal area in the theta band, and in occipital and right temporal regions in the alpha band.
The current study aims to: (1) further investigate the EEG correlates of mindfulness meditation; and (2) explore potential differences in EEG activity due to meditation practice occurring in single vs. couple settings. Previous research on the neurobiological or physiological effects of meditating in pairs/group vs. meditating alone is indeed very limited (Mason et al., 2007, Newandee and Reisman, 1996, Orme-Johnson et al., 1982). For this purpose, couples of mindfulness practitioners were recorded with EEG while performing a focused-attention breath mindfulness-oriented meditation (MOM) task, once when sitting side by side in the same room (SR) and once when separated in two different, adjacent rooms (DR). The technique employed for simultaneously recording the two subjects is known as “hyperscanning” (Montague et al., 2002). As a control condition, participants were also asked to engage in an instructed mind-wandering task (IMW). During the experiment, no participant was informed of the task requested of the other. Based on previous EEG and fMRI studies, it was hypothesized that: (1) neural activations would be different during the two tasks (mindfulness meditation and instructed mind-wandering); and (2) neural activations would be different when people meditated together as opposed to in two separate rooms, based on the aforementioned behavioral findings collected outside mindfulness meditation studies (Aiello and Douthitt, 2001, Hill, 1982).
Mindfulness-induced changes in gamma band activity – Implications for the default mode network, self-reference and attention
https://doi.org/10.1016/j.clinph.2011.07.048
Abstract
Objective
There is a growing scientific interest in mindfulness meditation (MM), yet its underlying neurophysiological mechanism is still uncertain. We investigated whether MM affects self-referential processing, associated with default mode network (DMN), either as short (state) – or long-term (trait) effects.
Methods
Three levels of MM expertise were compared with controls (n = 12 each) by electroencephalography (EEG).
Results
DMN deactivation was identified during the transition from resting state to a time production task, as lower gamma (25–45 Hz) power over frontal and midline regions. MM practitioners exhibited a trait lower frontal gamma activity, related to narrative self-reference and DMN activity, as well as producing longer durations, these being negatively correlated with frontal gamma activity. Additionally, we found state increases in posterior gamma power, suggesting increased attention and sensory awareness. MM proficiency did not affect the results.
Conclusions
Gamma power over frontal midline areas reflects DMN activity. MM practitioners exhibit lower trait frontal gamma activity, as well as a state and trait increases in posterior gamma power, irrespective of practice proficiency.
Significance
First, the DMN can be studied non-invasively by EEG. Second, MM induces from the early stages of practice neuroplasticity in self-referential and attentional networks.
Highlights
► EEG gamma power over frontal and midline areas reflects default mode network (DMN) activity. ► Mindfulness Meditation (MM) practitioners show lower frontal gamma activity, related to DMN and narrative self-reference. ► MM practitioners produce longer time durations, these being negatively correlated with frontal gamma activity.
EEG manifestations of nondual experiences in meditators
https://doi.org/10.1016/j.concog.2014.10.002
Highlights
•
Nondual states of consciousness reflect the culminating meditation experience.
•
These resulting states are differentiated from method or type of practice.
•
EEGs were recorded during meditation and states of nonduality.
•
Results suggest nondual states are neurologically distinct from general meditation.
•
Differentiating method and state will contribute to a more comprehensive taxonomy.
Abstract
The holistic experiential benefits of meditation among a widely ranging population have been well established within the empirical literature. What remain less clear are the underlying mechanisms of the meditative process. A large impediment to this clarity is attributable to the lack of a unified and comprehensive taxonomy, as well as to the absence of clear differentiation within the literature between method of practice and resulting state. The present study discusses and then attempts to identify within our sample a theoretically universal culminating meditative state known as Nondual Awareness, which is differentiated from the method or practice state. Participants completed an in-lab meditation, during which neurological patterns were analyzed using electroencephalography (EEG). Analyses indicated significantly higher EEG power among slower wave frequencies (delta, theta, alpha) during the reported nondual events. These events appear neurologically distinct from meditation sessions as a whole, which interestingly demonstrated significant elevation within the gamma range.
Introduction
Empirical investigation into the phenomenology of meditation to date has evidenced strong support for numerous potential benefits of practice. A 2012 review of the effects of meditation on psychological health, which examined nearly 250 studies, concluded that overall “engaging in meditation results in individuals self reporting beneficial outcomes” across highly varied techniques and populations (Ireland, 2012, p. 8). Another recent review of studies examining the effects of mindfulness meditation as a psychotherapeutic intervention found strong evidence of affective, interpersonal and intrapersonal benefits of practice, both for clients and practitioners (Davis & Hayes, 2011). A third review specific to mindfulness and its effects on clinical as well as neurobiological features concluded that meditation is efficacious in the treatment of various psychological as well as physical difficulties and is also beneficial for healthy subjects (Chiesa & Serretti, 2010). The connection between meditation practice and clinical benefit within a variety of settings and populations seems clear. What remain less clear are the underlying mechanisms that contribute to these consistently observed specific clinical benefits of meditation practice. Differentiating between specific and nonspecific effects could offer a useful contribution to our understanding of these mental processes, providing some insight into which aspects of the meditative procedure are related to the greatest potential clinical benefit and perhaps also into why this simple practice is a component of virtually every major spiritual tradition and has persisted over millennia.
One of the greatest obstacles to clear empirical interpretation of the mechanisms of meditation is the enormous heterogeneity of different techniques in practice, resulting in inherent variability in examined states (Lutz, Slagter, Dunne, & Davidson, 2008). Indeed, a vast number of different styles of meditation are practiced all over the world, in many incarnations stemming from various cultures and contemplative traditions, making observed effects difficult to translate neatly into contemporary scientific models. This stylistic variability can present a challenge when trying to establish taxonomies that are both consistent and sufficiently encompassing. There is consensus within the current literature that the need for a more clearly delineated operational definition of meditation is a key concern within the field of contemplative neuroscience (Awasthi, 2013, p. 1).
Lutz et al. (2008) offered a notable contribution toward this end by conceptually dividing meditation into two categories based on attentional deployment strategies which, although not completely exhaustive, appear to cover a large majority of commonly practiced meditation styles. The first of these two categories is focused attention (FA) meditation, which is characterized by the cognitive focus and re-focus of attention toward a particular mental object and is conceptually similar to mantra meditation or concentrative meditation (Valentine & Sweet, 1999). The second category defined by Lutz et al. (2008) is open monitoring (OM) meditation, which is characterized by nonreactive monitoring of the content of experience from moment to moment, with a calm awareness of any thoughts or sensations (Edwards et al., 2012, Lutz et al., 2008). This type of meditation is reflected within styles such as Vipassana meditation or mindfulness meditation. Travis and Shear (2010a) proposed a third meditation category, automatic self-transcending (AST), to be added to the FA and OM categories identified by Lutz et al. (2008). Techniques classified into the AST category are identified as those “designed to transcend their own activity” (Travis & Shear, 2010a, p. 1110). While these efforts offer productive distinctions and represent a valuable conceptualization of how meditation techniques might be properly operationalized, further refinement is needed as the field remains “devoid of a consensual paradigm” (Awasthi, 2013, Nash and Newberg, 2013).
In a commentary regarding Travis and Shear, 2010a, Josipovic, 2010 points out that the experience of transcendence is also “common among experienced practitioners of other meditation styles”, not just AST methods (p. 1119). Travis and Shear (2010a) suggest that a distinguishing element of the Transcendental Meditation (TM) technique, the only style of meditation included in the AST category (with a solitary exception of a 45-year case study of a QiGong practitioner) is that the ensuing transcendence is “automatic at the outset, rather than through extensive practice” (p. 1116). They also concede that diligent practice of FA and OM meditations can eventually lead to similar effortlessness and that one could conceivably expect to observe characteristic EEG signatures of AST in other types of meditation after extended practice. Thus, the primary difference that seems to emerge between Travis and Shear’s conceptualization of AST meditation and other meditation styles does not seem to be the ultimate state achieved (i.e., transcendence), but rather the relative speed with which it can be achieved (i.e., automaticity). Further, the “effortlessness” that seems to be congruent across all proposed categories is likely related to the observation of enduring brain changes and capacity for neuroplasticity that co-occur with meditation (Davidson & Lutz, 2008), which again is likely at least partially a function of practice, in addition to particular meditation style.
Baerentsen et al. (2010) suggest that the efforts of these distinct types of meditation share a common “ultimate aim”, which is to cultivate a particular, underlying state of mind (p. 58). This ultimate state is described as a calming of the mind’s usual fluctuations and as a “detachment from the contents of conscious sensory experience” (Baerentsen et al., 2010, p. 59). This depiction is analogous to both historical and contemporary descriptions of mental states akin to nondual awareness, which generally refer to a mental state absent of phenomenological content, characterized by a pure awareness “free from fragmenting into opposing dualities” and a dissipation of any sense of separateness between self and other, hence the term “nondual” (Josipovic, 2013, p.12). Inclusions of ideas consistent with nondual awareness among contemporary conceptualizations of meditation within the empirical literature have increased in recent years, to include states known as Absolute Unitary Being (d’Aquili and Newberg, 1993), Pure Consciousness (Travis & Pearson, 2000), The Gap (between thoughts) (Chopra, 2007), as well as nonduality, which has emerged more recently (Josipovic, 2010, Josipovic, 2013, Travis and Shear, 2010b).
The construct can be easily identified among traditional conceptualizations of meditation as well. Nondual consciousness has been likened to the concept known within certain mystical traditions as “enlightenment”, being described as “the culminating stage of psychospiritual development” (Costeines, 2009, p. 1). The concept of nonduality is also consistent with the definition of meditation according to the Yoga Sutras, a Hindu scripture and foundational text of yoga, which describes meditation as “the act of inward contemplation and the intermediate state between mere attention to an object and complete fusion with it” (Chiesa, Brambilla, & Serretti, 2010, p. 104). Indeed, it seems that evidence of the concept of nonduality can be found anywhere from ancient spiritual texts and traditions to contemporary culture and scientific journals.
Another construct that has emerged from contemporary meditation literature is mental silence, which appears conceptually identical to nondual awareness (Manocha, 2011). Mental silence is described as “a state of no mental content at all”, which embodies an essential defining feature of meditation practice as it is more traditionally conceptualized, one that Western definitions have consistently left out (Manocha, 2011, p. 47). Western conceptualizations tend to liken meditation to patterns of focused attention occurring together with states of relaxation (Takahashi et al., 2005). However, the crucial and ancient component of meditation that Manocha calls “mental silence” has begun to emerge within the Western literature under the aliases of “transcendence” or “nonduality” (Josipovic, 2010, Travis and Shear, 2010a). There seems to be an emerging consensus regarding the essentiality of placing meditation practice within its original, philosophical context before proceeding with further empirical investigations (Awasthi, 2013). The concluding notion is that while conceptually dividing and operationalizing differing styles of meditation is essential in its proper study, the universal defining feature and ultimate goal of any meditation practice is the same: the attainment of a nondual state (Sheela, 2012). This resultant, target state is differentiated from experiences of increased mindfulness or mental quiescence, which are manifestations of the practice state. Meditation, when taken as a whole, could be conceptualized as a set of various tools that are ultimately intended to produce the experience of nonduality. It is further hypothesized that the experience of mental silence, or nondual awareness, may be connected to specific clinical effects related to meditation, although this connection is theoretical and has yet to be tested (Manocha, 2011). Given the conceptual emergence of this fundamental and previously overlooked component of meditation, its integration into the taxonomic framework seems justified.
An issue that naturally arises along with the identification of this shared mutual goal of nondual awareness among various meditation styles is the potential of “confounding the neural correlates of the meditation techniques that are used to get to particular ‘states’ of consciousness, with the correlates of the ‘states’ themselves”, highlighting the importance of differentiating between the practice state and the target state (Josipovic, 2010, p. 1120). In a discussion of momentum toward a unifying taxonomy in the field of contemplative neuroscience, Nash and Newberg (2013) point out that “several authors have stressed the importance of making an explicit distinction between method and state”, where “the state is considered to be the causal result of successful application of the method” (p. 2). The lack of clarity in these distinctions is posited to be responsible for much of the inconsistency that has emerged from prior research (Nash & Newberg, 2013, p.2).
The concept of nondual awareness therefore highlights another possible dimension in which one might contextualize meditation practices in order to foster a more complete understanding of the process. As many meditation practices share this common end result, it is noted that “while the initial neurophysiological activation occurring during any given data may differ, there should eventually be a convergence of data” (Edwards et al., 2012, p.99). Nash and Newberg (2013) describe this general resulting meditative state as an “altered state of consciousness” that is the common goal of all practice (p. 5). The authors use the term Enhanced Mental State (EMS) to describe this culminating experience, which also appears functionally analogous to the construct we refer to here as nondual awareness.
It is not surprising that the idea of a nondual state of consciousness has been systematically unacknowledged in Western scientific investigation. Perhaps this oversight results from the fact that it is characterized by the absence of everything substantive, making it quite puzzling to measure and to operationalize into the framework of cognitive neuroscience, or even into that of everyday waking experience. Lutz, Dunne, and Davidson (2007) point out that the scientific investigation of meditation
begins from a set of hypotheses difficult to test because they assume that the common element in mystical experience necessarily transcends thought, language, reason and ordinary perception – most of which are required for any reliable neuroscientific procedure to test the hypothesis (p. 500).
The scientific method, it seems, is presented with quite a challenge in its pursuit of capturing the neurobiological and experiential correlates of this elusive mental state. However, it is possible to measure physiological and subjective manifestations of a human experiencing nondual awareness. Nash and Newberg (2013) point out that since meditation method and state produce distinct neurobiological correlates, researchers are compelled to recognize and carefully distinguish between the two. Hence, the present study considered physiological correlates of nondualistic experiences as measured by EEG signatures, identified via subjective self-report to aide in distinguishing method and state during the in-lab meditation session.
The hypothesis examined here is that any form of meditation is indeed designed to transcend its own activity and can be used as a vehicle toward nonduality. Therefore, it was hypothesized that practitioners of any type of meditation can attain a nondualistic state given individually conducive circumstances and that EEG signatures of nondual states are distinct from those of general meditation or resting states. Specifically, based on prior EEG research examining meditation styles explicitly inducing states consistent with nondual awareness, we hypothesized that experiences of nonduality would be consistent with EEG signatures in the theta2 (∼6–8 Hz) to alpha1 (∼8–10 Hz) range (Aftanas and Golocheikine, 2002, Baijal and Srinivasan, 2010, d’Aquili and Newberg, 1993, Takahashi et al., 2005, Travis and Shear, 2010a).
Mindfulness-oriented meditation improves self-related character scales in healthy individuals
https://doi.org/10.1016/j.comppsych.2014.03.009
Abstract
Previous studies have shown that mindfulness meditation may improve well-being in healthy individuals and be effective in the treatment of mental and neurological disorders. Here, we investigated the effects of an 8-week mindfulness-mediation program on the personality profiles of three groups of healthy individuals with no previous experience with meditation as compared to a control group not enrolled in any training. Personality profiles were obtained through the Temperament and Character Inventory (Cloninger et al., 1993). In the experimental groups, significant increments after the training were obtained in all the three character scales describing the levels of self maturity at the intrapersonal (Self-Directedness), interpersonal (Cooperativeness), and transpersonal (Self-Transcendence) levels. No changes were found in the control group. Strikingly, these effects were significant only in those groups who were engaged in consistent daily meditation practice but not in the group who attended the meditation training but were less consistent in home practice. Since higher scores in the character scales are associated to a lower risk of personality disorder, we propose that the increase of self maturity after the training may be an important mechanism for the effectiveness of mindfulness-oriented meditation in psychotherapeutic contexts.
Introduction
The most common forms of meditation have their roots in healing and spiritual Hinduism and Buddhist traditions and can be referred to as attentional and emotional regulatory training practices followed with the aim of developing psychophysical balance and well-being [2], [3]. Despite the existence of several types of meditation techniques, open monitoring meditation and focused attention meditation are probably the two most common styles and are combined in contemporary clinical interventions based on mindfulness-meditation [2]. Mindful awareness, which is effectively cultivated through the practice of meditation, is an attribute of consciousness consisting of being attentive to and aware of present-moment events and experiences; this generally occurs with a non-judgmental attitude of openness and acceptance [2], [4], [5], [6], in which activated self-feelings, thoughts, and sensations are not attempted to be changed by the perceiver but are instead observed and accepted.
Thus, key aspects of mindful awareness are concepts like “openness” and “receptiveness” to the present-moment experience [4]; these concepts are in contrast with the lack of awareness (mindlessness) we typically experience when we are entangled in everyday thoughts and rumination and are tied into past or future concerns. This lack of mindful awareness may hinder the individuals’ awareness of cues and alarm signals coming from the internal or external environment, thus making the regulation of one’s behavior less efficient in relation to the situations and relations of the outside world. This in turn may ensue into several negative effects on self-regulatory processes and psychological well-being.
The scientific interest on mindfulness mediation has greatly increased in the last two decades [7] and this is probably due to the beneficial effects that this practice seems to have on psychological well-being. Indeed, a variety of mindfulness-based interventions have been found to be effective in the treatment of a number of clinical disorders including chronic pain, eating disorders, anxiety, and depression [8], [9], [10], [11], [12]. Meditative practices have also been found to produce beneficial effects on the well-being of healthy individuals [13], [14], [15]. Mindfulness meditation, in particular, has been proposed to improve well-being through a series of interacting mechanisms (see [16] for review) that include: i) more efficient attention regulation (e.g. [17]; see also [18], [19]), ii) increased body awareness (e.g. [13], [20]), and iii) more efficient emotional regulation abilities (e.g. [21], [22]).
Only a few studies, however, have so far investigated whether and how mindfulness meditation may promote changes in personality and self-perception (see [16] for review). Changes in individuals’ self-concept have been found in some previous studies adopting many different types of meditative practices. For example, in a study by Emavardhana and Tori [23], two large cohorts of young participants (18 years old) attending a 7-day Vipassana meditation retreat were compared with a control sample on several aspects of self-representations. The authors found significant increments for the meditator vs. the control group in several self-representation subscales of the Tennessee Self-Concept Scale [24], a personality inventory measuring the “completeness” of the concept of Self under many different internal and external perspectives such as Self-Criticism, Identity, Self-Satisfaction, Physical-, Moral-, Personal-, Social- and Family-Self. In another study, Nystul and Garde [25] compared transcendental meditators and non-meditators on the Tennessee Self-Concept Scale [26] and found that the former, with respect to the latter group, reported a more positive concept of self at the intrasubjective and intersubjective levels. Moreover, Turnbull and Norris [27] found that, after transcendental meditation practice, a group of healthy individuals changed their self-concepts and perceived their actual-self as being increasingly more similar to their “ideal- and social-self”.
From the point of view of personality, the possible correlation between mindfulness and personality traits has been explored in a variety of studies using in particular the well-known and diffuse Big-Five model of personality (e.g. [28]; see e.g. [29] for a meta-analysis with respect to the Big-Five model). For example, Ortner et al. [21] found that greater mindfulness scores were correlated with lower emotional interference and lower neuroticism. Moreover, in her meta-analysis on the relation between the Big-Five model and mindfulness, Giluk [29] found that the strongest negative correlations with mindfulness involved neuroticism and negative affect, while positive correlations involved especially conscientiousness. While neurotic individuals tend to be anxious, moody, and insecure and more susceptible to psychological distress, self-conscious individuals are dependable, goal-directed and with good self-regulation skills.
Another well-known model of personality dimensions, which is widely used especially in biological psychiatry studies, is the so-called “biosocial” model of personality developed by Cloninger [30], [31]. In this model, personality is characterized by two components: Temperament and Character. Based on a neurobiologically-based model of operant conditioning, Cloninger defines the “Temperament” as a complex system of automatic responses to environmental stimuli: the individual tends to respond in a similar way in similar situations [31]. There are 4 temperamental systems in the brain, each responsible for the activation, maintenance and inhibition of behaviors in response to specific classes of stimuli. Cloninger’s model captures the essence of each of these systems in 4 separate dimensions: i) Novelty Seeking encompasses exploratory excitability, impulsiveness and curiosity, ii) Harm Avoidance captures levels of anticipatory worry, pessimism, and fear of uncertainty, iii) Reward Dependency refers to attachment, independency and sentimentality, and iv) Persistence refers to industriousness and resistance to frustration. The combination and relative arrangement of different levels of each temperament dimension describe the way the individual reacts and behaves in the environment, thus delineating the basic subtypes of personality and personality disorders; however, when considered alone, they are unable to predict whether or not a person will develop a personality disorder.
Accordingly, an additional aspect of personality, the “character”, has to be taken into account in order to better identify adaptive and maladaptive personality subtypes. Character refers to a more “conceptualized” (“mentalized”) knowledge and evaluation of the self (the conceptual idea one has of himself) and is responsible for efficient self-regulation. In Cloninger’s terms, the character consists of three levels of “completeness” and maturity of the self: “intrapersonal”, “interpersonal” and “transpersonal”. Self Directedness (intrapersonal level) defines the maturity of the self as an autonomous individual; it is linked to concepts of self-efficacy and self-esteem; Cooperativeness (interpersonal level) defines the maturity of the self as part of a community or society and is linked to concepts like compassion, empathy, and tolerance; Self Transcendence (transpersonal level) defines the maturity of the self as integrating part of a transpersonal, universal reality and is linked to concepts like spirituality and creativeness. According to Cloninger, in order to obtain efficient self-regulation and be protected against personality disorder, an appropriate level of maturity has to be reached in these three scales, and particularly in the Self Directedness and Cooperativeness dimensions. Individuals with low levels of Self Directedness and Cooperativeness are at high risk of developing personality disorders, which would in turn follow the specific temperamental profiles. Within this theoretical framework, and in two subsequent steps [31], [32] Cloninger developed a personality inventory called Temperament and Character Inventory (TCI) consisting of 240 questions investigating all the 7 relevant facets of personality (the four Temperament and the three Character dimensions).
Very few studies have correlated personality traits within the TCI framework with mindfulness levels or meditative practice in general. In a study by Smalley and colleagues [33] it was found that adults suffering from ADHD showed lower mindfulness skills (as measured by the Kentucky Inventory of Mindfulness Skills: [34]), which were in turn positively correlated with the scores obtained in the Self Directedness and Self Transcendence subscales of the TCI. Furthermore, in a between-group investigation, Haimerl and Valentine [35] compared the personality profiles of three groups of meditators with different levels of expertise in Buddhist meditation: “prospective” (no experience), “beginner” (less than 2 years) and “advanced” (more than 2 years) meditators. The authors found significant differences between the three groups of individuals in all three TCI character scales, with advanced meditators obtaining the highest scores.
It seems therefore that the few studies reviewed above suggest a positive relation between meditative practice and greater maturity of the Self. However, cross-sectional comparisons between experts and nonexperts meditators cannot establish whether the expertise-related effects are due to meditation practice per se rather than to basic interindividual differences that pre-existed the meditation training and led only expert meditators to approach and persist in meditation practice. Therefore, the direct effect of mindfulness meditation on personality dimensions and, in particular, on character maturity must be yet documented in a longitudinal, within-subject design.
The present study was aimed at investigating the effects of consistent mindfulness meditation over the personality profiles of three groups of naïve individuals, directly comparing their temperament and character dimensions before and after the training. In particular, we aimed to investigate whether the beneficial effects of mindfulness meditation on psychological well-being are related to a better development of Self-concepts (Character) measures. Furthermore, we also aimed to assess how the potential effects on the character scales were related to the consistency of the mindfulness meditation practice in each group (e.g. [13]). Finally, to control for possible test–retest effects, the performance of the participants who underwent the mindfulness meditation training was compared with that of a control group who was not involved in any meditative activity between the two testing sessions.
Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia
https://doi.org/10.1515/revneuro-2017-0066
Abstract
This study investigates the relationship between mindfulness, meditation, cognition and stress in people with Alzheimer’s disease (AD), dementia, mild cognitive impairment and subjective cognitive decline. Accordingly, we explore how the use of meditation as a behavioural intervention can reduce stress and enhance cognition, which in turn ameliorates some dementia symptoms. A narrative review of the literature was conducted with any studies using meditation as an intervention for dementia or dementia-related memory conditions meeting inclusion criteria. Studies where moving meditation was the main intervention were excluded due to the possible confounding of exercise. Ten papers were identified and reviewed. There was a broad use of measures across all studies, with cognitive assessment, quality of life and perceived stress being the most common. Three studies used functional magnetic resonance imaging to measure functional changes to brain regions during meditation. The interventions fell into the following three categories: mindfulness, most commonly mindfulness-based stress reduction (six studies); Kirtan Kriya meditation (three studies); and mindfulness-based Alzheimer’s stimulation (one study). Three of these studies were randomised controlled trials. All studies reported significant findings or trends towards significance in a broad range of measures, including a reduction of cognitive decline, reduction in perceived stress, increase in quality of life, as well as increases in functional connectivity, percent volume brain change and cerebral blood flow in areas of the cortex. Limitations and directions for future studies on meditation-based treatment for AD and stress management are suggested.
Meditation and Cognitive Ageing: the Role of Mindfulness Meditation in Building Cognitive Reserve
https://link.springer.com/article/10.1007/s41465-017-0022-7
Abstract
Mindfulness-related meditation practices engage various cognitive skills including the ability to focus and sustain attention, which in itself requires several interacting attentional subfunctions. There is increasing behavioural and neuroscientific evidence that mindfulness meditation improves these functions and associated neural processes. More so than other cognitive training programmes, the effects of meditation appear to generalise to other cognitive tasks, thus demonstrating far transfer effects. As these attentional functions have been linked to age-related cognitive decline, there is growing interest in the question whether meditation can slowdown or even prevent such decline. The cognitive reserve hypothesis builds on evidence that various lifestyle factors can lead to better cognitive performance in older age than would be predicted by the existing degree of brain pathology. We argue that mindfulness meditation, as a combination of brain network and brain state training, may increase cognitive reserve capacity and may mitigate age-related declines in cognitive functions. We consider available direct and indirect evidence from the perspective of cognitive reserve theory. The limited available evidence suggests that MM may enhance cognitive reserve capacity directly through the repeated activation of attentional functions and of the multiple demand system and indirectly through the improvement of physiological mechanisms associated with stress and immune function. The article concludes with outlining research strategies for addressing underlying empirical questions in more substantial ways.
Effects of Meditation and Mind–Body Exercises on Older Adults’ Cognitive Performance: A Meta-analysis
https://doi.org/10.1093/geront/gnz022
Abstract
Background and Objectives
Meditation and mind–body exercises are suggested to delay decline or enhance cognitive capabilities in older adults. However, their effectiveness remains uncertain. This study assessed the effectiveness of meditation and mind–body exercises to improve cognition in elderly people aged 60 years or above. Moderator variables were also explored.
Research Design and Methods
A databases search (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, Web of Science, CNKI, and Wangfang) was conducted from the first available date to January 10, 2018. Inclusion criteria include (a) human older adults aged 60 years or above, (b) meditation, Tai Chi, Qigong, or yoga intervention, (c) intervention should be structured, (d) inclusion of a control group, (e) at least one outcome measure of cognition was measured at baseline and post-training, and (f) peer-reviewed journal articles in English or Chinese.
Results
Forty-one studies (N = 3,551) were included in the meta-analysis. In general, meditation and mind–body exercises improve cognition in the elderly people (SMD = 0.34, 95% CI: 0.19 to 0.48), but the cognition-enhancing effects depend on the type of exercise. In addition, cognitive performance is only improved when the length of intervention is longer than 12 weeks, exercise frequency is 3–7 times/week, or duration of an exercise session is 45–60 min/session.
Discussion and Implications
This study suggests that meditation and mind–body exercises are effective to improve cognition of older adults aged 60 years or above, and exercise parameters should be considered for intervention planning.
Effects of Meditation and Mind–Body Exercises on Cognition
Results of this meta-analysis show that meditation and mind–body exercises, relative to controls, improve cognition in the elderly people (SMD = 0.34, 95% CI: 0.19 to 0.48, p < .001), and there is significant heterogeneity across studies (Q(152) = 604.30, p < .001).
Exercise moderators
Concerning the type of exercise, only meditation (p < .001) and Qigong (p = .001) produce significant positive effects on cognition. Studies, where the program length is medium to high [13-26 weeks or greater than 26 weeks], have shown significant cognitive improvement (p < .001). Only medium-to-high exercise frequency [3-4 or 5-7 times per week] is related to cognitive improvement (p < .02). In terms of exercise duration, only medium duration [45-60 minutes] is associated with positive effects on cognition (p < .001), whereas short and long durations [greater than 60 minutes] produce nonsignificant effects on cognition (p > .34).
Cognitive moderators
The effect of meditation and mind–body exercises on cognition is significant for all cognitive domains (p < .01), except processing speed (p = .06). The cognition-enhancing effects are only observed in studies of participants with MCI (p < .001) or unclear cognitive status (p = .006). Furthermore, there is a significant interaction between type of exercise and cognitive domain (p < .001) (Table 2), suggesting that the effectiveness of different types of exercise may vary in different cognitive domains. It is shown that meditation improves attention, global cognition, and working memory (moderate-to-large effects). Qigong improves global cognition, short-term memory, and working memory (moderate-to-large effects). Tai Chi improves executive function and global cognition (small effects). Yoga improves executive function (small effect) and processing speed (large effect). There is no significant difference of change in executive function following Tai Chi and Yoga interventions (p = .89). In addition, the change in global cognition following meditation does not differ from those following Qigong (p = .54) or Tai Chi (p = .14). However, the improvement in global cognition after Qigong intervention is greater than that after Tai Chi intervention (p = .04). The changes in working memory following meditation and Qigong interventions do not differ significantly (p = .95).
Meditation and neurodegenerative diseases
https://doi.org/10.1111/nyas.12187
Abstract
Neurodegenerative diseases pose a significant problem for the healthcare system, doctors, and patients. With an aging population, more and more individuals are developing neurodegenerative diseases and there are few treatment options at the present time. Meditation techniques present an interesting potential adjuvant treatment for patients with neurodegenerative diseases and have the advantage of being inexpensive, and easy to teach and perform. There is increasing research evidence to support the application of meditation techniques to help improve cognition and memory in patients with neurodegenerative diseases. This review discusses the current data on meditation, memory, and attention, and the potential applications of meditation techniques in patients with neurodegenerative diseases.
Effect of Meditation on Cognitive Functions in Context of Aging and Neurodegenerative Diseases
https://doi.org/10.3389/fnbeh.2014.00017
Effect of different meditation practices on various aspects of mental and physical health is receiving growing attention. The present paper reviews evidence on the effects of several mediation practices on cognitive functions in the context of aging and neurodegenerative diseases. The effect of meditation in this area is still poorly explored. Seven studies were detected through the databases search, which explores the effect of meditation on attention, memory, executive functions, and other miscellaneous measures of cognition in a sample of older people and people suffering from neurodegenerative diseases. Overall, reviewed studies suggested a positive effect of meditation techniques, particularly in the area of attention, as well as memory, verbal fluency, and cognitive flexibility. These findings are discussed in the context of MRI studies suggesting structural correlates of the effects. Meditation can be a potentially suitable non-pharmacological intervention aimed at the prevention of cognitive decline in the elderly. However, the conclusions of these studies are limited by their methodological flaws and differences of various types of meditation techniques. Further research in this direction could help to verify the validity of the findings and clarify the problematic aspects.
Meditation, mindfulness and cognitive flexibility
https://doi.org/10.1016/j.concog.2008.12.008
Abstract
This study investigated the link between meditation, self-reported mindfulness and cognitive flexibility as well as other attentional functions. It compared a group of meditators experienced in mindfulness meditation with a meditation-naïve control group on measures of Stroop interference and the "d2-concentration and endurance test". Overall the results suggest that attentional performance and cognitive flexibility are positively related to meditation practice and levels of mindfulness. Meditators performed significantly better than non-meditators on all measures of attention. Furthermore, self-reported mindfulness was higher in meditators than non-meditators and correlations with all attention measures were of moderate to high strength. This pattern of results suggests that mindfulness is intimately linked to improvements of attentional functions and cognitive flexibility. The relevance of these findings for mental balance and well-being are discussed.
Introduction
In recent years the interest in the effects of buddhist meditation practice has been growing rapidly (Barinaga, 2003, Ekman et al., 2005, Knight, 2004). In particular, the benefits of utilising meditation as therapeutic measure in the health care setting have been discussed and meditation-based interventions are increasingly being implemented adjunct or complementary to classical medical or psychological approaches. The most popular approach within this emerging field is probably the mindfulness-based stress reduction programme (MBSR) developed by Jon Kabat-Zinn in the early 1980s (e.g. Kabat-Zinn, 1984, Kabat-Zinn, 1990, Kabat-Zinn et al., 1985). While the programme is rapidly gaining in popularity and has been subjected to numerous evaluation studies covering a variety of physical and psychological disorders, its effectiveness is not yet established beyond any doubt (Baer, 2003, Bishop, 2002, Grossman et al., 2004). Similarly, the mechanisms how meditation practice and improvement in mindfulness contribute to physical as well as psychological well-being are not well understood (Brown et al., 2007, Malinowski, 2009).
An alternative perspective on buddhist meditation practice is concerned with cognitive, emotional and neurophysiological changes resulting from extensive meditation practice, where meditation is often conceptualised in terms of mental or cognitive training (e.g. Cahn and Polich, 2006, Carter et al., 2005, Slagter et al., 2007). Results are frequently discussed with respect to neuroplasticity, as several findings suggest that extended meditation training may lead to functional as well as structural changes of the brain (e.g. Davidson et al., 2003, Lazar et al., 2005, Lutz et al., 2004, Pagnoni and Cekic, 2007).
These two approaches provide different perspectives which contribute to a broader understanding of the processes and effects of meditation practice. In an attempt to align western psychological and buddhist thinking about this topic, Wallace and Shapiro (2006) provide a framework that facilitates the integration of such different perspectives. Drawing from buddhist sources as well as psychological theory and evidence they propose a four-component model, outlining areas for development that contribute to overall psychological well-being. According to their mental balance model the components conation (motivation, intention), attention, cognition and affect/emotion need to be developed and balanced to achieve profound well-being. In particular, though not exclusively, the components attention and cognition bear a close relationship to mindfulness (see Malinowski, 2009), which has been conceptualised in terms of self-regulation of attention and orientation towards one’s experiences (Bishop et al., 2004). Also Kabat-Zinn’s operational definition of mindfulness as “the awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment by moment” (Kabat-Zinn, 2003, p. 145) acknowledges these two aspects. Thus, mindfulness meditation encompasses various aspects of attention as for instance the ability to focus and sustain ones attention and a reduced proneness to distraction. Cahn & Polich’s definition of meditation as “practices that self-regulate the body and mind, thereby affecting mental events by engaging a specific attentional set” (Cahn & Polich, 2006, p. 180), also indicates that training of attentional functions is an essential aspect of any form of meditation practice. In a similar way traditional buddhist texts describe the practice of bare attention, the attending “to the bare facts of perception without reacting to them by deed, speech or mental comment”, as a corner stone of mindfulness (Thera, 2005, p. 3). To cultivate mindful awareness, attention needs to be combined with a non-judgmental orientation towards and openness for the flow of one’s experiences.
The aim of the current study is to investigate attentional functions and in particular cognitive flexibility within the theoretical framework outlined above. As Roemer and Orsillo (2003) argue, research that examines the effect of mindfulness on cognitive flexibility is currently lacking. Cognitive flexibility is here understood as the human ability to adapt cognitive processing strategies to face new and unexpected conditions and is intrinsically linked to attentional processes (Cañas, Quesada, Antolí, & Fajardo, 2003). As mindfulness meditation is dependant on the (re-)investment of attention on a moment by moment basis, mindfulness training should hypothetically lead to increased cognitive flexibility and an increased ability to respond in a non-habitual fashion.
In this study we are employing two well-established measures, the Stroop task (Stroop, 1935) and the d2-test of attention (Brickenkamp & Zilmer, 1998), to test participants’ ability to suppress interfering information and to focus and direct their attention. As these skills are characteristic of good cognitive flexibility and are practiced during mindfulness training, individuals who practice mindfulness meditation should perform well on such tasks. Although recent research suggests a positive relation between meditative practice and attentional function (Jha et al., 2007, Pagnoni and Cekic, 2007, Slagter et al., 2007, Valentine and Sweet, 1999), a clear link between mindfulness and cognitive flexibility still needs to be established. Only few studies attempted to do so by employing the Stroop paradigm. Wenk-Sormaz’s (2005) showed that engaging in meditative practice resulted in a reduction of Stroop interference. However, a study by Anderson and co-workers failed to find an improvement of attentional functions after participation in an 8-week MBSR-programme as assessed by various measures of attention, attention switching and Stroop interference (Anderson, Lau, Segal, & Bishop, 2007). Thus, evidence for a relation between mindfulness and attentional functions remains ambiguous. An important difference between Anderson et al.’s (2007) study and that by Wenk-Sormaz (2005) is that the latter measured the effects of brief exposure to mindfulness meditation immediately after the end of the last of three 20 min meditation sessions, administered over the course of 2 weeks. In comparison, Anderson et al. investigated the effects of a more expansive mindfulness training (8-weeks) which usually also includes other aspects such as psychological education and physical exercises, and the tests took place up to 4 weeks after completion of the programme, preceded by a 10 min meditation session. A further difference between these studies is that Anderson et al. employed a modified version of the Stroop task, which originally was developed to assess the self-representation of clinical patients (Segal, Gemar, Truchon, Guirguis, & Horowitz, 1995) rather than the standard Stroop task employed by Wenk-Sormaz. Thus, not finding a reduction of Stroop interference in Anderson et al.’s study may be attributed to the fact that the employed task does not tap attentional functions per se but rather measures the interference of cognitive and affective content on behavioural responses. As in both studies the tests were carried out immediately following the experimental induction of mindfulness, one may, furthermore, argue that the findings only apply to this specific situation, whereas the ecologically more important question regarding changes that pertain to everyday life, were not addressed.
To sum up, the link between cognitive flexibility and mindfulness and its possible relevance for everyday life remains unclear.
Following these ideas, in our study we are comparing a group of meditators with experience in mindfulness meditation with a group of non-meditators on several tests of attention and assess them in a quiet experimental situation, but without inducing a meditative state or state of mindfulness. Furthermore, for estimating their levels of mindfulness, they are required to complete a mindfulness self-report questionnaire, the Kentucky Inventory of Mindfulness Skills (KIMS, Baer, Smith, & Allen, 2004). This approach allows us to compare between meditators and non-meditators and additionally to investigate the relation between mindfulness and cognitive control more closely.
The concurrent use of the d2-test of attention and the Stroop task enables us to test the ability to focus, sustain and direct ones attention and to suppress interfering information. As cognitive flexibility implies the ability to interrupt or deautomatise automated responses, that is to respond non-habitually, we shall briefly introduce the concepts of automatisation and deautomatisation in relation to meditative practice.
According to Shiffrin and Schneider (1977) cognitive processes can typically be classified as being either controlled or automatic. They suggested that automatic processes operate in parallel and independent of attention, “automatic [processes] do not require attention, though they may attract it if training is inappropriate, and they do not use up short-term memory capacity” (Shiffrin & Schneider, 1977, p. 38). Spelke, Hirst, and Neisser (1976) have also stressed that behaviour should only be termed ‘automatic’ if it did not involve certain high-order attentional skills. Additionally, Spelke et al. have shown that whilst certain processes may be thought of as innately automatic, others may become automatic through practice. It is generally accepted that once automated these processes are thought to be initiated unintentionally and effortlessly. Consequently they cannot be easily interrupted or prevented. Numerous researchers (for example Dyer, 1973, Virzi and Egeth, 1985) have proposed that reading is seen as an automatic process, acquired through extensive practice and long-term learning literate adults experienced. The Stroop effect (Stroop, 1935) evidences the difficulty of interrupting the automatic process of reading of words in proficient readers. During the Stroop task participants are asked to attend to the colour in which words are printed, not to the semantics of the words. Participant’s responses are significantly slower and less accurate when asked to identify the colour of an incongruent colour word compared with responses to neutral and congruent words (MacLeod, 1991). In line with Stroop’s account, theories most often explain the Stroop asymmetry as a consequence of automaticity (see Hasher and Zacks, 1979, LaBerge and Samuels, 1974, Logan, 1980). The automatic semantic activation of the word meaning must be overridden in order for participants to respond correctly when faced with incongruent words. As reading is automatic for proficient readers less attentional resources are required for reading irrelevant (neutral) words than for ink colour naming. Consequently, the reading of the word appears obligatory and results in an increase in reaction times and errors when attempting to process incongruent colour words. Increasing the performance in this task would therefore require the reinvestment of attention (deautomatisation) and a non-habitual response.
There is much debate as to whether processes that have become automatised can be brought back under top down control. In view of Shiffrin and Schneider’s (1977) suggestion that automatised processes act independently of attention, it has been proposed that deautomatisation is achieved through the reinvestment of attention in actions and behaviours (Deikman, 1963, Deikman, 1966, Deikman, 2000). Considering the definition of mindfulness as “bringing one’s complete attention to the present experience on a moment-to-moment basis” (Marlatt & Kristeller, 1999, p. 68), the potential link to processes of deautomatisation becomes obvious. If mindfulness-based meditation training improves the ability to invest one’s attention to the present moment, it should be possible to bring processes that became automatised by extensive practice back under cognitive control.
In the current study we thus expected to find a reduction in Stroop interference as well as improvement in focused attention and processing speed (as measure of sustained attention) in a group of buddhist meditators experienced in mindfulness meditation compared to a meditation-naïve control group.
We furthermore expected to find higher self-reported mindfulness in the meditation group and a positive correlation between mindfulness and the different measures of attentional performance and cognitive control. The KIMS consists of four sub-scales which allows breaking down mindfulness into several components (Baer et al., 2004). Observing (1) highlights the importance of observing and noticing the full variety of external and internal stimuli. As many forms of mindfulness training include the practice of naming and labelling of the observed phenomena (e.g. Thera, 2005), describing (2) captures the resulting ability to verbalise experiences. Acting with awareness (3) implies the ability to pay undivided attention to the activity one is carrying out (e.g. Hanh, 1987), without getting distracted. Finally, accepting without judgment (4) covers the aspect of being non-judgemental or non-evaluative about the present moment and thus implies the ability to refrain from automatic responses.
When investigating these sub-components of mindfulness, we expected that the two facets acting with awareness and accepting without judgment will exhibit the strongest correlations with task performance as these two facets most clearly capture the aspects of inhibition of irrelevant and distracting information as well as the deautomatisation of cognitive function.
Conclusion
The finding that regaining or increasing attentional control and cognitive flexibility seems possible may have further implications beyond the domain of cognitive psychology. Within Wallace and Shapiro’s (2006) mental balance model, attentional and cognitive balance play an important role in promoting well-being. They make the case that meditation training and the cultivation of mindfulness improve these aspects of mental balance and in conjunction with conative and affective balance contribute to overall well-being of the individual. While in our study we did not assess levels of well-being, our data corroborate their model in so far as they show a clear positive link between meditation, mindfulness and attentional/cognitive flexibility. Meditators showed higher levels of mindfulness, better attentional performance and higher cognitive flexibility. Attentional performance as well as cognitive flexibility were positively related to levels of mindfulness. As Wallace and Shapiro outline, according to buddhist principles of mental training and well-being, cognitive flexibility can be fostered by building on improved attentional abilities, which are initially trained and cultivated. The gained cognitive flexibility provides the mental space to detect incorrect and unwholesome cognitive evaluations, which would usually go unnoticed and would lead to mistaken attitudes and emotions, which in turn would affect our well-being (see also Malinowski, 2009). While empirical evidence for a direct link between well-being and cognitive performance is currently sparse, a recent representative study of a population above 50 years of age reported that ‘‘higher levels of psychological well-being were associated with better global cognitive function and performance in multiple cognitive domains” (Llewellyn, Lang, Langa, & Huppert, 2008, p. 688). More extensive studies will have to scrutinise whether the hypothesised link between mindfulness and well-being can be confirmed empirically. As the assumed mechanism, outlined above, is implied in a variety of mindfulness-based therapeutic interventions, as for instance the mindfulness-based cognitive therapy (Teasdale, Segal, & Williams, 1995), such studies may have far-reaching relevance. The current study indicates how mindfulness, attentional performance and cognitive flexibility may usefully be assessed.
Based on our own data, we may tentatively conclude that meditation practices that improve mindfulness skills will have a positive effect on cognitive flexibility and the ability to focus and sustain attention. . . .While ultimately only longitudinal studies with experimental manipulation of meditation and/or mindfulness will be able to fully resolve . . . uncertainties, the fact that we found significant linear relations between mindfulness and attentional performance and cognitive flexibility suggests that our findings not merely reflect a selection bias or motivational differences. This is even more relevant as the correlations between cognitive flexibility (SE) and overall mindfulness (KIMS-total) remained significant also within each group (non-meditators: r = -.71, p < .001; meditators: r = -.80, p < .001), highlighting a general link between mindfulness and cognitive flexibility independent of meditation practice. It seems unlikely that, while there is a relation between cognitive flexibility and naturally occurring mindfulness, the systematic development of mindfulness would not lead to an enhancement of cognitive flexibility. Thus, this study indicates that, as hypothesised, meditation and mindfulness training may improve attentional performance, in particular with respect to processing speed, susceptibility to interference and cognitive flexibility. The results make a strong case for further investigating the underlying processes in a longitudinal study with experimental manipulation of meditation practice.
Meditative analgesia: the current state of the field
https://doi.org/10.1111/nyas.12282
Abstract
Since the first demonstrations that mindfulness-based therapies could have a positive influence on chronic pain patients, numerous studies have been conducted with healthy individuals in an attempt to understand meditative analgesia. This review focuses explicitly on experimental pain studies of meditation and attempts to draw preliminary conclusions based on the work completed in this new field over the past 6 years. Dividing meditative practices into the broad categories of focused attention (FA) and open monitoring (OM) techniques allowed several patterns to emerge. The majority of evidence for FA practices suggests they are not particularly effective in reducing pain. OM, on the other hand, seems to influence both sensory and affective pain ratings depending on the tradition or on whether the practitioners were meditating. The neural pattern underlying pain modulation during OM suggests meditators actively focus on the noxious stimulation while inhibiting other mental processes, consistent with descriptions of mindfulness. A preliminary model is presented for explaining the influence of mindfulness practice on pain. Finally, the potential analgesic effect of the currently unexplored technique of compassion meditation is discussed.
Mindfulness meditation and the immune system: a systematic review of randomized controlled trials
https://doi.org/10.1111/nyas.12998
Abstract
Mindfulness meditation represents a mental training framework for cultivating the state of mindful awareness in daily life. Recently, there has been a surge of interest in how mindfulness meditation improves human health and well-being. Although studies have shown that mindfulness meditation can improve self-reported measures of disease symptomatology, the effect that mindfulness meditation has on biological mechanisms underlying human aging and disease is less clear. To address this issue, we conducted the first comprehensive review of randomized controlled trials examining the effects of mindfulness meditation on immune system parameters, with a specific focus on five outcomes: (1) circulating and stimulated inflammatory proteins, (2) cellular transcription factors and gene expression, (3) immune cell count, (4) immune cell aging, and (5) antibody response. This analysis revealed substantial heterogeneity across studies with respect to patient population, study design, and assay procedures. The findings suggest possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging, but these results are tentative and require further replication. On the basis of this analysis, we describe the limitations of existing work and suggest possible avenues for future research. Mindfulness meditation may be salutogenic for immune system dynamics, but additional work is needed to examine these effects.
Meditation and Immune Function: The Impact of Stress Management on the Immune System
http://dx.doi.org/10.21926/obm.icm.1804032
Abstract
As alternative forms of medicine have become increasingly popular, research on the health benefits of meditation has grown. Specifically, Mindfulness Meditation, Transcendental Meditation, and Qigong have been shown to be effective in treating psychological disorders, enhancing immune function, and in delaying disease progression in patients diagnosed with HIV, the varicella-zoster virus, and dermatomyositis. This paper briefly reviews the historical background of the many forms of meditation and examines in detail the effects meditation has on several markers of immune function including Natural Killer cell activity, B-lymphocytes, telomerase activity, and CD8 T-cells.
Epigenetics and meditation
https://doi.org/10.1016/j.copsyc.2018.11.010
Highlights
• Epigenetic mechanisms are associated with the development of stress-related psychopathologies in animal models and humans.
• Pilot studies suggest that MBIs may downregulate epigenetic pathways related with inflammation, cell aging and depression.
• The potential health implications of epigenetic mechanisms sensitive to MBIs need to be further investigated.
In the last decade, epigenetics has taken center stage to explain the relationships between stress exposure, health and behavior. Acquired or inherited epigenetic changes modulate gene expression states without modifying the DNA sequence itself, they can be long-lasting, yet, they are potentially reversible. Several studies have explored whether meditation-based interventions can influence gene expression profiles towards healthier directions, identifying candidate genes and biological pathways that seem to be sensitive to contemplative practices. However, to date, the clinical implications of these molecular outcomes and their potential long-lasting epigenetic bases remain mostly unknown. The present article addresses these topics from a broad perspective and analyzes future research questions and perspectives at the crossroads of contemplative sciences and epigenetics.
Introduction
In the beginning of the 20th century, a dominant view in biology was that hereditary substances provided the information necessary to construct an organism. Genocentric ideas strongly influenced the turbulent sociopolitical climate of the time. For example, they were used to justify the approval of a law by the United States Supreme Court in 1927, which permitted compulsory sterilization procedures on human beings to decrease the propagation of undesired traits [e.g. lower cognitive skills, unfitness] ‘for the protection and health of the state’ [Buck v. Bell, 274 U.S. 200; 1927] [1]. The atrocious human right violations that arose from the eugenic movement had been based on a rhetoric that completely disregarded scientific thinking acknowledging the power of the environment. Back in 1899, the biologist William Morton Wheeler stated that both tendencies, preformationism [heredity and stability] and epigenesis [changes and processes], ‘will find their correctives in investigation’ [2]. Confirming Wheeler’s vision, it is nowadays indisputable that the inherited genetic information is strongly influenced by a broad range of environmental and lifestyle factors [3]. Research over the past years is revealing the complex mechanisms by which cells can become ‘structurally modified’, even by ‘changed habits of body or mind’ as Charles Darwin suspected 150 years ago [4]. Environmental factors dynamically generate layers of molecular data that fine-tune the information contained in the genetic code. This epigenetic information [epi, from the Greek, means around] stably modulates gene expression without altering the DNA primary structure [5].
Over the last 15 years, numerous studies have associated neurophysiological and behavioral alterations triggered by psychosocial stress with the acquisition of stable epigenetic marks. The inheritability of epigenetic information through cell division in somatic cells seems to explain the enduring effects of environmental exposures at the individual level. Epigenetic mechanisms such as DNA methylation within the hypothalamic-pituitary-adrenal (HPA) axis, changes in the activity of histone deacetylases (HDACs, a family of enzymes that remove acetyl groups from histones and promote gene silencing) and different types of small non-coding RNAs are associated with the development of stress-related psychopathologies in animal models and humans [6, 7, 8, 9,10••,11, 12, 13].
Epigenetic information can either be inherited or acquired, yet, importantly for biomedical research, it is potentially reversible. Drugs are being actively designed and tested to restore gene activity in diseases caused or aggravated by epigenetic mechanisms [e.g. cancer, inflammation] [14,15]. Similarly, there is increasing evidence on the epigenetic response of pharmacotherapeutic interventions for stress-related disorders [16,17]. However, limited research to date has explored the epigenetic potential of non-pharmacological approaches to improve mental health. Recent encouraging evidence describes changes in DNA methylation profiles in response to cognitive behavior therapy and social support [18,19]. Moreover, findings in rodents suggest that an environmental model which includes cognitive, somatosensorial, motor and visual enrichment may efficiently reduce psychological and behavioral consequences of trauma and stress by removing epigenetic tags and improving adult neurogenesis and synaptic plasticity [20••,21,22]. In humans, environmental enrichment can be considered inherent to the cultivation of awareness through meditation training, especially at the cognitive and somatosensorial levels. Whether meditation-based interventions [MBIs] could reproduce in humans, some of the epigenetic-based health benefits of the enriched environment model certainly is a thrilling hypothesis.
Rapid changes in histone deacetylases and inflammatory gene expression in expert meditators
https://doi.org/10.1016/j.psyneuen.2013.11.004
Summary
Background
A growing body of research shows that mindfulness meditation can alter neural, behavioral and biochemical processes. However, the mechanisms responsible for such clinically relevant effects remain elusive.
Methods
Here we explored the impact of a day of intensive practice of mindfulness meditation in experienced subjects (n = 19) on the expression of circadian, chromatin modulatory and inflammatory genes in peripheral blood mononuclear cells (PBMC). In parallel, we analyzed a control group of subjects with no meditation experience who engaged in leisure activities in the same environment (n = 21). PBMC from all participants were obtained before (t1) and after (t2) the intervention (t2 − t1 = 8 h) and gene expression was analyzed using custom pathway focused quantitative-real time PCR assays. Both groups were also presented with the Trier Social Stress Test (TSST).
Results
Core clock gene expression at baseline (t1) was similar between groups and their rhythmicity was not influenced in meditators by the intensive day of practice. Similarly, we found that all the epigenetic regulatory enzymes and inflammatory genes analyzed exhibited similar basal expression levels in the two groups. In contrast, after the brief intervention we detected reduced expression of histone deacetylase genes (HDAC 2, 3 and 9), alterations in global modification of histones (H4ac; H3K4me3) and decreased expression of pro-inflammatory genes (RIPK2 and COX2) in meditators compared with controls. We found that the expression of RIPK2 and HDAC2 genes was associated with a faster cortisol recovery to the TSST in both groups.
Conclusions
The regulation of HDACs and inflammatory pathways may represent some of the mechanisms underlying the therapeutic potential of mindfulness-based interventions. Our findings set the foundation for future studies to further assess meditation strategies for the treatment of chronic inflammatory conditions.
Introduction
Poor stress-coping contributes to the development of chronic diseases and accelerated aging (Epel et al., 2009, Juster et al., 2010, Karatsoreos and McEwen, 2011). Therefore, a growing body of scientific research is devoted to understanding the neurophysiological and cellular responses induced by methods that improve stress management. Among them, mindfulness-based meditation practices, which intentionally cultivate attentional skills, have become an increasingly popular approach, with accumulating experimental evidence of beneficial effects on psychological, neurological, endocrine and immune variables (Kabat-Zinn et al., 1998, Ludwig and Kabat-Zinn, 2008, Lutz et al., 2008, Schmidt et al., 2011, Farb et al., 2012, Rosenkranz et al., 2013). However, our molecular understanding of how they can influence a broad range of biological processes, from brain networks to the immune system, remains limited.
To date, few studies have analyzed the effects of mindfulness techniques at the cellular level. Studies in blood cells have found that the mindfulness-based stress reduction (MBSR) program reduced cytokine secretion, oxidative stress and DNA damage (Carlson et al., 2003), increased natural killer cell activity and decreased interleukin secretion in women recently diagnosed with early stage breast cancer (Witek-Janusek et al., 2008), and increased CD4+ T lymphocyte counts in HIV infected subjects (Creswell et al., 2009). Some reports have also described the molecular impact of other meditation-based interventions using blood cells; for example, RNA microarray studies suggested that the expression of genes involved in cellular metabolism and oxidative stress pathways in blood cells are modulated by body–mind relaxation response training (Dusek et al., 2008, Bhasin et al., 2013). Recent bioinformatic analyses from PBMC genome-wide microarrays have suggested that yogic meditation in family dementia caregivers decreased pro-inflammatory NFκ-B signaling and increased the activity of interferon response factors (Black et al., 2013). Increased telomerase activity was detected in response to the same intervention (Lavretsky et al., 2013).
Environmental stimuli influence most body functions, including stress responsiveness and behavior, through extracellular and intracellular pathways that interact with the epigenetic machinery (Graff et al., 2011). In rodents, psychological stress during adulthood induces dynamic epigenetic events such histone acetylation and phosphorylation in the dentate gyrus as soon as 2 h after the start of exposure to a novel environment or forced swimming (Chandramohan et al., 2007, Chandramohan et al., 2008) and in the hippocampus 1 h after training using a fear conditioning paradigm (Chwang et al., 2007). Rapid epigenetic changes in response to environmental exposures such as diet and physical exercise have also been detected in human peripheral tissues (Kaliman et al., 2011, Pham and Lee, 2012). However, no data are currently available regarding the possibility of an epigenetic basis for the effects of mindfulness meditation. Here we show evidence of rapid gene expression changes in chromatin regulatory enzymes, alterations in histone modifications and downregulation of proinflammatory genes after a short intensive session of mindfulness meditation in experienced subjects. In addition, we observe relations between these changes and stress-evoked cortisol responses.
Genome-wide expression changes in a higher state of consciousness
https://doi.org/10.1016/j.concog.2012.06.003
Abstract
Higher states of consciousness in which the human mind can transcend the boundaries of logic and reason are envisioned as natural to the experience and potential growth of every human being. So far they have been mostly monitored by electrophysiological methods. In this study we were particularly interested in discovering the molecular transcriptional basis of higher states of consciousness. In addition to phenomenological reports of meditators who participated in this study the generated higher states of consciousness were also EEG recorded. We assessed the whole genome gene expression analysis of long-term meditators in four separate trials and detected significant differential gene expression in association with higher states of consciousness. The number of differently expressed genes as well as high proportion of genes themselves differed between meditators. Despite this, gene ontology enrichment analysis found significant biological and molecular processes shared among meditators’ higher state of consciousness.
Highlights
► We assessed whole genome expression profile of meditators during higher state of consciousness. ► We observed statistically significant differential expression of several biological and molecular functions. ► Molecular signiture of higher state of consciousness might depend on meditation technique.
Introduction
Science and spirituality have been becoming closer and closer in recent years. Increasing basic scientific interest in the effects of meditation, especially on the brain, has led to a dialogue between neuroscientists and prominent members of the Buddhist tradition in order to foster research that aims at understanding in particular the neuroscientific aspects of consciousness and thus combines neuroscientific knowledge with more experiential or phenomenological perspective of meditators. It is important that science has accepted the role of introspection, or reporting personal mental experience as a form of data (Barinaga, 2003). A neurophenomenology approach (Lutz et al., 2008, Lutz et al., 2002, Lutz et al., 2008, Varela, 1996) thus combines quantitative measures of neural activity with specific and stable experiential and phenomenal categories of the meditator who is generating and describing them.
Several recent studies have reported the influence of meditation on neural function (Brefczynski-Lewis et al., 2007, Chan et al., 2008, Hankey, 2006, Lutz et al., 2004, Lutz et al., 2008, Lutz et al., 2008, Pagnoni and Cekic, 2007, Travis and Shear, 2010). However, there are not many studies on how meditation influences peripheral biological processes important for health and illness, especially on the molecular level using modern molecular approaches. It was shown recently with a gene expression studies that long-term and short-term meditation practitioners may regulate immunity, metabolic rate, response to oxidative stress, cell death (Dusek et al., 2008, Engel et al., 2001, Li et al., 2005, Sharma et al., 2008). Although similar genomic pattern changes occurred overall, indicating a common relaxation response state in practitioners regardless of the techniques used to elicit it, it was not clear from these studies what subjective levels of meditation were achieved by different practices and practitioners. Larger groups of meditators are essential for the generalization of original findings, although it may unfortunately result in an averaging out of important details that might be specific to more advanced stages of consciousness developed by meditation techniques.
Meditation can be considered to be a universal human capacity, which, it is proposed, fosters clear thinking and open-heartedness, thereby developing a greater sense of emotional balance and well-being (Ludwig & Kabat-Zinn, 2008). However, there are reports of further states of the human mind, known to oriental thinkers for many centuries, in which the brain can transcend the boundaries of logic and reason, and experience states of extended awareness, commonly unrecognized (Ramamurthi, 1995). The culminating state of awareness is a state of thoughtless awareness also known as the advanced stage of meditation (Hankey, 2006), the fourth state of consciousness (Ramamurthi, 1995), pure consciousness (Bloomfield, Cain, & Jaffe, 1975), Samadhi, Dhyana-Yoga, or enlightenment (Deshmukh, 2006). Maharishi Mahesh Yogi has systemized the understanding of the seven states of consciousness described in the ancient Vedic literature. English names for these states, on a continuum from least aware to most aware, are “deep sleep,” “dreaming sleep,” “waking,” “transcendental consciousness,” “cosmic consciousness,” “refined cosmic consciousness,” and “unity consciousness.” These seven states are envisioned as natural to the experience and potential growth of every human being. However, without a special technique or techniques, the top four states are rarely if ever experienced. A few individuals in any generation may spontaneously experience one or more of the four higher states, but during the present age, for most people these states are accessible only as a result of regular practice of a meditation technique (Alexander et al., 1990, Travis and Pearson, 2000, Travis and Shear, 2010, Travis et al., 2002).
Gaining access to appropriate long-term meditators with authentic experience in advanced stages of consciousness is rare. However, long-term meditators of Transcendental meditation techniques are described who have experienced periods of pure consciousness characterized by breath suspension episodes without compensatory hyperventilation, accompanied by high intra- and interhemispheric EEG coherence in alpha and theta frequencies, especially in the frontal areas of the brain, periods of low metabolic rate and stable autonomic activity (Alexander et al., 1990, Orme-Johnson and Haynes, 1981, Travis and Shear, 2010). They could also sustain the state of pure consciousness during sleeping and walking states indicating the growth towards cosmic consciousness (Travis et al., 2002).
In this study, we were particularly interested in discovering the molecular transcriptional basis of higher states of consciousness.
We designed this preliminary study in such a way as to show whether differences in the subjective perception of a precisely experienced and defined higher states of consciousness are connected with significant and specific/consistent molecular genetic changes. In addition to phenomenological reports of the two long-term meditation practitioners who have generated higher states of consciousness in four separate experiments these states of consciousness were EEG recorded on a digital EEG system with a 128-channel cap using active electrodes. We report here the results of a whole genome expression study of the higher states of consciousness compared to ordinary states of consciousness of a long-term meditator who is living ordinary life and a long-term Buddhist lama.
Mindfulness-Based Stress Reduction training reduces loneliness and pro-inflammatory gene expression in older adults: A small randomized controlled trial
https://doi.org/10.1016/j.bbi.2012.07.006
Abstract
Lonely older adults have increased expression of pro-inflammatory genes as well as increased risk for morbidity and mortality. Previous behavioral treatments have attempted to reduce loneliness and its concomitant health risks, but have had limited success. The present study tested whether the 8-week Mindfulness-Based Stress Reduction (MBSR) program (compared to a Wait-List control group) reduces loneliness and downregulates loneliness-related pro-inflammatory gene expression in older adults (N = 40). Consistent with study predictions, mixed effect linear models indicated that the MBSR program reduced loneliness, compared to small increases in loneliness in the control group (treatment condition × time interaction: F(1,35) = 7.86, p = .008). Moreover, at baseline, there was an association between reported loneliness and upregulated pro-inflammatory NF-κB-related gene expression in circulating leukocytes, and MBSR downregulated this NF-κB-associated gene expression profile at post-treatment. Finally, there was a trend for MBSR to reduce C Reactive Protein (treatment condition × time interaction: (F(1,33) = 3.39, p = .075). This work provides an initial indication that MBSR may be a novel treatment approach for reducing loneliness and related pro-inflammatory gene expression in older adults.
Highlight
► Mindfulness meditation training reduces loneliness and pro-inflammatory gene expression in older adults.
Molecules of Silence: Effects of Meditation on Gene Expression and Epigenetics
MINI REVIEW article
Front. Psychol., 10 August 2020
Sec. Consciousness Research
Volume 11 - 2020 | https://doi.org/10.3389/fpsyg.2020.01767
Many studies have consistently demonstrated an epigenetic link between environmental stimuli and physiological as well as cognitive responses. Epigenetic mechanisms represent a way to regulate gene activity in real time without modifying the DNA sequence, thus allowing the genome to adapt its functions to changing environmental contexts. Factors such as lifestyle, behavior, and the practice of sitting and moving mindful activities have been shown to be important means of environmental enrichment. Such practices, which include mindfulness meditation, Vipassana, Yoga, Tai Chi, and Quadrato Motor Training, have been reported to positively impact well-being. In fact, they can be considered emotional and attentional regulatory activities, which, by inducing a state of greater inner silence, allow the development of increased self-awareness. Inner silence can therefore be considered a powerful tool to counteract the negative effects of overabundant environmental noise, thanks to its power to relieve stress-related symptoms. Since all these positive outcomes rely on physiological and biochemical activities, the molecular and epigenetic mechanisms influenced by different mindful practices have recently started to be investigated. Here, we review some of the findings that could allow us to uncover the mechanisms by which specific practices influence well-being.
Regulation of gene expression by yoga, meditation and related practices: A review of recent studies
https://doi.org/10.1016/j.ajp.2012.10.002
Abstract
Integrative medicine (IM) approaches have gained significant interest in recent years to provide a solution for the health care challenges we face today. Yogic cognitive-behavioral practices are among the most widely used IM approaches and include diverse practices such as yoga asanas, meditation, breathing exercises, Qi Gong, Tai Chi Chih, and various others. Studies to date suggest that these yogic/meditative practices have significant positive effects on the mind–body system and thereby can increase wellness and support the healing process from disease. Previous work has provided evidence for both psychological and physiological effects of these practices; however, the mechanisms of these effects, especially at the molecular level, have largely been missing. Three recent studies started to provide some of this information through gene expression profiling in circulating immune cells, which support the hypothesis that yogic/meditative practices have a measurable effect at the molecular level. These studies are reviewed herein and some future perspectives are considered.
Highlights
► Yogic/meditative practices may have significant health benefits. ► Recent studies suggest that they affect gene expression in circulating immune cells. ► There are some similarities in the genes affected, but also differences. ► Data indicate the involvement of similar signaling pathways by different practices ► More detailed studies are required to evaluate the validity of these findings.
Conclusion
It is now well established that there are distinct gene expression changes induced by the environment, not only by physical influences, but also via psychological, social, and cultural components, studied by the emerging field of psychosocial genomics (for a review, see Garland and Howard 2009). For example, example, previous work on social genomics has suggested that
adverse life experiences give rise to significant changes in gene expression in circulating immune cells (for a review, see Cole, 2010). The first set of studies on yogic/meditative practices
reviewed above are consistent with this framework and suggest that these practices positively affect gene expression profiles in immune cells in the circulation demonstrating that the ‘mind–
body’ practices may benefit the physiology at its most fundamental level. More detailed studies are required to evaluate the validity of these findings and the precise molecular networks that are responsible for the gene expression patterns that are observed upon yogic/meditative practices and their possible therapeutic efficacy. Gene expression profiling can also have utility in comparative analysis of different practices, such as different types of meditation, and help delineate the different effects that they may induce at the molecular to systemic levels.
Mindfulness Meditation and Psychopathology
Vol. 15:285-316 (Volume publication date May 2019)
https://doi.org/10.1146/annurev-clinpsy-021815-093423
ABSTRACT
Mindfulness meditation is increasingly incorporated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology. Here, we review the current understanding of mindfulness meditation through the lens of clinical neuroscience, outlining the core capacities targeted by mindfulness meditation and mapping them onto cognitive and affective constructs of the Research Domain Criteria matrix proposed by the National Institute of Mental Health. We review efficacious applications of mindfulness meditation to specific domains of psychopathology including depression, anxiety, chronic pain, and substance abuse, as well as emerging efforts related to attention disorders, traumatic stress, dysregulated eating, and serious mental illness. Priorities for future research include pinpointing mechanisms, refining methodology, and improving implementation. Mindfulness meditation is a promising basis for interventions, with particular potential relevance to psychiatric comorbidity. The successes and challenges of mindfulness meditation research are instructive for broader interactions between contemplative traditions and clinical psychological science.
The heart-brain axis: A proteomics study of meditation on the cardiovascular system of Tibetan Monks
https://doi.org/10.1016/j.ebiom.2022.104026
Background
There have been mixed reports on the beneficial effects of meditation in cardiovascular disease (CVD), which is widely considered the leading cause of death worldwide.
Methods
To clarify the role of meditation in modulating the heart-brain axis, we implemented an extreme phenotype strategy, i.e., Tibetan monks (BMI > 30) who practised 19.20 ± 7.82 years of meditation on average and their strictly matched non-meditative Tibetan controls. Hypothesis-free advanced proteomics strategies (Data Independent Acquisition and Targeted Parallel Reaction Monitoring) were jointly applied to systematically investigate and target the plasma proteome underlying meditation. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B) and lipoprotein (a) [Lp(a)] as the potential cardiovascular risk factors were evaluated. Heart rate variability (HRV) was assessed by electrocardiogram.
Findings
Obesity, hypertension, and reduced HRV is offset by long-term meditation. Notably, meditative monks have blood pressure and HRV comparable to their matched Tibetan controls. Meditative monks have a protective plasma proteome, related to decreased atherosclerosis, enhanced glycolysis, and oxygen release, that confers resilience to the development of CVD. In addition, clinical risk factors in plasma were significantly decreased in monks compared with controls, including total cholesterol, LDL-C, Apo B, and Lp(a).
Interpretation
To our knowledge, this work is the first well-controlled proteomics investigation of long-term meditation, which opens up a window for individuals characterized by a sedentary lifestyle to improve their cardiovascular health with an accessible method practised for more than two millennia.
Short-term meditation induces changes in brain resting EEG theta networks
https://doi.org/10.1016/j.bandc.2014.02.008
Highlights
• IBMT showed significantly smaller average path length of the entire network.
• IBMT showed significantly larger clustering coefficient of the entire network.
• IBMT enhanced brain capacity of local specialization and global information integration.
• Short-term meditation may be helpful for alterations in brain networks.
Abstract
Many studies have reported meditation training has beneficial effects on brain structure and function. However, very little is known about meditation-induced changes in brain complex networks. We used network analysis of electroencephalography theta activity data at rest before and after 1-week of integrative body–mind training (IBMT) and relaxation training. The results demonstrated the IBMT group (but not the relaxation group) exhibited significantly smaller average path length and larger clustering coefficient of the entire network and two midline electrode nodes (Fz and Pz) after training, indicating enhanced capacity of local specialization and global information integration in the brain. The findings provide the evidence for meditation-induced network plasticity and suggest that IBMT might be helpful for alterations in brain networks.
Conclusion
In conclusion, we have provided the empirical support for meditation-induced network plasticity. Our results indicate the network topological pattern during resting state is altered by short-term IBMT, and may provide an interpretation of improvement of information processing in the brain.
Meditation and the Brain: Attention, Control and Emotion**
https://doi.org/10.4103%2F0973-1229.77444
Abstract
Meditation has been for long time avoided as a scientific theme because of its complexity and its religious connotations. Fortunately, in the last years, it has increasingly been studied within different neuroscientific experimental protocols. Attention and concentration are surely among the most important topics in these experiments. Notwithstanding this, inhibition of emotions and discursive thoughts are equally important to understand what is at stake during those types of mental processes. I philosophically and technically analyse and compare results from neuroimaging studies, produced by leading authorities on the theme, dealing with two types of meditation: “one-pointed concentration” and “compassion meditation”. Analysing “one-pointed concentration”, I show the differences between novice and expert meditation practitioners in terms of brain activity and connectivity, considering the relationship among increased attention and concentration and decreased activity in areas related to discursive thought and emotion. Analysing “compassion meditation”, I show the importance of the limbic circuitry in emotion sharing. I follow the same strategy of comparing novice and expert meditation practitioners. The conclusion establishes a common structure to those different ways of dealing with emotion during meditation.
8-week Mindfulness Based Stress Reduction induces brain changes similar to traditional long-term meditation practice – A systematic review
https://doi.org/10.1016/j.bandc.2016.07.001
Highlights
• Literature reports that long-term meditators show altered brain activations and structure.
• Post-MBSR, prefrontal cortex, insula, cingulate cortex and hippocampus show similar results to traditional meditation.
• In addition, the amygdala shows earlier deactivation, less gray matter and better connectivity.
• These changes indicate a neuronal working mechanism of MBSR.
Abstract
The objective of the current study was to systematically review the evidence of the effect of secular mindfulness techniques on function and structure of the brain. Based on areas known from traditional meditation neuroimaging results, we aimed to explore a neuronal explanation of the stress-reducing effects of the 8-week Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) program.
Methods
We assessed the effect of MBSR and MBCT (N = 11, all MBSR), components of the programs (N = 15), and dispositional mindfulness (N = 4) on brain function and/or structure as assessed by (functional) magnetic resonance imaging. 21 fMRI studies and seven MRI studies were included (two studies performed both).
Results
The prefrontal cortex, the cingulate cortex, the insula and the hippocampus showed increased activity, connectivity and volume in stressed, anxious and healthy participants. Additionally, the amygdala showed decreased functional activity, improved functional connectivity with the prefrontal cortex, and earlier deactivation after exposure to emotional stimuli.
Conclusion
Demonstrable functional and structural changes in the prefrontal cortex, cingulate cortex, insula and hippocampus are similar to changes described in studies on traditional meditation practice. In addition, MBSR led to changes in the amygdala consistent with improved emotion regulation. These findings indicate that MBSR-induced emotional and behavioral changes are related to functional and structural changes in the brain.
Introduction
Mindfulness has a millennia old history and is usually referred to as a mental state characterized by ‘full attention to internal and external experiences as they occur in the present moment’, and ‘an attitude characterized by non-judgment of, and openness to, this current experience’ (Bishop et al., 2004, Brown and Ryan, 2003, Kabat-Zinn et al., 1985). Stripped of all religious aspects, application of Mindfulness Based Stress Reduction (MBSR) (Kabat-Zinn et al., 1985) as a stress reduction method, and Mindfulness Based Cognitive Therapy to prevent relapse in depression (Teasdale et al., 2000), has increased over the past 35 years. In 8 weeks, MBSR and MBCT participants learn to cope with stress by means of cognitive exercises, concentration training and mental exposure, using a standardized evidence based protocol (Substance Abuse & Mental Health Services Administration, 2014). The MBSR- and MBCT protocol comprises both focused attention, open monitoring, and breathing meditation but without the transcending atmosphere of traditional meditative practice. The goal is not to reach Nirvana or Enlightenment. Instead, by learning to recognize automatic reactions, and letting go of dysfunctional ones in a non-judgmental manner, participants gain a new coping mechanism that studies have shown to improve perceived stress, anxiety, depression, and quality of life in all types of patients (Gotink et al., 2015, Vibe de, 2012).
Previous research on traditional meditation styles (i.e. Zen, Vipassana, Tibetan etc.) found that individuals who have regularly practiced meditation for several years exhibit significant altered brain structure, when compared to demographically matched controls (Holzel et al., 2008, Lazar et al., 2005, Luders et al., 2009, Pagnoni and Cekic, 2007, Tang et al., 2015, Vestergaard-Poulsen et al., 2009). Recent meta-analyses report eight regions to consistently show structural and functional differences in long-term meditators: the prefrontal cortex (related to enhanced meta-awareness and reappraisal), the sensory cortices and insula (related to body awareness), the hippocampus (related to memory processes), and the cingulate cortex (related to self and emotion regulation) (Boccia et al., 2015, Fox et al., 2014, Holzel et al., 2007, Manna et al., 2010, Tomasino et al., 2012).
Former neuroimaging literature focused on traditional meditation styles, or a combination of traditional and secular mindfulness. MBSR and MBCT are in some core aspects different from traditional meditation (i.e. duration and goal), and may therefore have different neuronal effects. In this article, we want to explore how the distilled mindfulness techniques in MBSR and MBCT, rather than spirituality of the traditional styles, are related to changes in brain structures and activity. We focus on regions described in studies on long-term meditators, but have not restricted ourselves to these areas. The current systematic review focusses on functional and structural magnetic resonance imaging (MRI) in order to understand the neuronal base of the psychological effects of MBSR and MBCT.
Three months-longitudinal changes in relative telomere length, blood chemistries, and self-report questionnaires in meditation practitioners compared to novice individuals during midlife
https://journals.lww.com/md-journal/toc/2022/10140
Abstract
Aging accelerates during midlife. Researches have shown the health benefits of mind-body intervention (MBI). However, whether MBI is involved with aging process has not been well understood. In this study, we approach to examine the relations of MBI with this process by investigating an aging marker of the peripheral blood, blood chemistry, and self-report questionnaires. A quasi-experimental design was applied. Experienced MBI practitioners participated in a 3-month intensive meditation training, while the age, gender-matched MBI-naïve controls led a normal daily life. Measurements were taken at before and after the 3 months for relative telomere length (RTL), blood chemistry, and self-report questionnaires including items about sleep quality, somatic symptoms, depression, anxiety, stress, emotional intelligence (EI), and self-regulation. For RTL, the repeated measures analysis of variance showed a significant group*time interaction (P = .013) with a significant post hoc result (P = .030) within the control group: RTL was significantly reduced in the control while it was maintained in the meditation group. In repeated measures analysis of variance for blood chemistries, there were significant group differences between the groups in glucose and total protein. In the post hoc comparison analysis, at post measurements, the meditation group exhibited significantly lower values than the control group in both glucose and total protein. There were significant group-wise differences in the correlations of RTL with triglyceride (TG), high-density lipoprotein (HDL), glutamic oxaloacetic transaminase and glutamic pyruvic transaminase. Any of self-report results did not show significant changes in group*time interaction. However, there were group differences with significant (P < .05) or a tendency (.05 < P < .1) level. There were significant improvements in depression, stress and EI as well as tendencies of improvement in sleep quality and anxiety, in the meditation group compared to the control group. Our results suggest that meditation practice may have a potential to modify aging process in molecular cellular level combined with changes in psychological dimension.
Investigating cognitive flexibility as a potential mechanism of mindfulness in Generalized Anxiety Disorder
https://doi.org/10.1016/j.jbtep.2013.10.008
Highlights
• Cognitive inflexibility may be a characteristic of Generalized Anxiety Disorder.
• Brief mindfulness induction may improve some aspects of cognitive flexibility.
• Relaxation and mindfulness may share cognitive flexibility as a mechanism.
Abstract
Background and objectives
Research suggests mindfulness-based treatments may enhance efficacy of CBT for Generalized Anxiety Disorder (GAD). One hypothesized mechanism of mindfulness is cognitive flexibility; however, research findings to date are mixed as to a) whether cognitive inflexibility represents a characteristic of GAD, and b) whether mindfulness impacts cognitive flexibility. It is proposed that limitations in study methodology may partially account for these mixed findings. The present study investigated cognitive flexibility as a potential mechanism of mindfulness in a sample with elevated GAD symptoms using a modified emotional Stroop switching task while attempting to control for limitations of previous research. The purpose of the study was: 1) to explore cognitive inflexibility as a potential characteristic of GAD, and 2) to examine whether a brief mindfulness induction has measurable impact on cognitive flexibility.
Methods
A total of 66 participants (53 with elevated GAD symptoms, and 13 non-anxious) were randomized to a mindful-breathing, music-assisted relaxation, or thought wandering condition prior to completing an emotional Stroop and emotional Stroop switching task.
Results
Results suggest that GAD may be characterized by an inflexible style of responding, and exposure to mindfulness and relaxation result in partial improvements in cognitive flexibility.
Limitations
Limitations of this study include small sample size, brief induction period, and use of an analog sample.
Conclusions
The present findings suggest that mindfulness may be associated with partial improvement in cognitive flexibility.
Evolving an idionomic approach to processes of change: Towards a unified personalized science of human improvement
https://doi.org/10.1016/j.brat.2022.104155
[np: This team undertook a massive meta-analysis to determine to the highest standard how we might explain why therapy works when it works. They initially included 54,633 studies, each rated twice to see if the analyses were properly done. Seeking to uphold the most rigorous standards, the team ended up 281 clear findings using 73 different measures.
They verified many valid pathways of change. However, among all these pathways of change, they uncovered a set of two core skills that proved far more effective than any others. These two skills appeared more frequently than support from friends, family, or the therapist; more frequently than self-esteem; and more frequently than whether or not clients experienced negative, dysfunctional thoughts.
By far, the most common pathway of change depended on psychological flexibility and mindfulness skills, accounting for 45% of everything we know about why therapy works. Moreover, when the researchers added in concepts directly related to or overlapping these central skills (such as self-compassion or anxiety sensitivity) the results accounted for roughly 55 percent of all the successful mediational findings.
The wisdom traditions have long emphasized precisely these two skills: cognitive flexibility and awareness (including mindfulness). Holistic training in meditation thus promises to significantly empower whatever pathway of change you provide for your clients.]
Concentrative meditation influences creativity by increasing cognitive flexibility.
https://psycnet.apa.org/doi/10.1037/a0040335
Abstract
Given the great importance of creativity in society, it is worth investigating how creative thinking can be enhanced. The link between meditation and enhanced creativity has been proposed by a number of authors; however, the reason why meditation leads to an increase in creativity is not clear. The current study aims to investigate the underlying mechanisms of different meditation styles on creative performance. A nonstudent sample was used and the experiment took place outside of the lab environment to maximize external validity. Two groups of experienced meditation practitioners performed a meditation session (either mindfulness or concentrative meditation). Participants’ creativity and cognitive flexibility were assessed before and after the meditation session. The current findings demonstrate that meditation increases creative performance, irrespective of meditation style. Interestingly, only concentrative meditation led to an increase in cognitive flexibility.
Alterations in Brain Structure and Amplitude of Low-frequency after 8 weeks of Mindfulness Meditation Training in Meditation-Naïve Subjects
https://www.nature.com/articles/s41598-019-47470-4
Abstract
Increasing neuroimaging evidence suggests that mindfulness meditation expertise is related to different functional and structural configurations of the default mode network (DMN), the salience network (SN) and the executive network at rest. However, longitudinal studies observing resting network plasticity effects in brains of novices who started to practice meditation are scarce and generally related to one dimension, such as structural or functional effects. The purpose of this study was to investigate structural and functional brain network changes (e.g. DMN) after 40 days of mindfulness meditation training in novices and set these in the context of potentially altered depression symptomatology and anxiety. We found overlapping structural and functional effects in precuneus, a posterior DMN region, where cortical thickness increased and low-frequency amplitudes (ALFF) decreased, while decreased ALFF in left precuneus/posterior cingulate cortex correlates with the reduction of (CES-D) depression scores. In conclusion, regional overlapping of structural and functional changes in precuneus may capture different components of the complex changes of mindfulness meditation training.
Loving-kindness meditation slows biological aging in novices: Evidence from a 12-week randomized controlled trial
https://doi.org/10.1016/j.psyneuen.2019.05.020
Highlights
• Over 12 weeks, loving-kindness meditation buffered telomere attrition.
• Telomere length decreased in the mindfulness group and the control group.
• The loving-kindness group showed less telomere attrition than the control group.
Abstract
Combinations of multiple meditation practices have been shown to reduce the attrition of telomeres, the protective caps of chromosomes (Carlson et al., 2015). Here, we probed the distinct effects on telomere length (TL) of mindfulness meditation (MM) and loving-kindness meditation (LKM). Midlife adults (N = 142) were randomized to be in a waitlist control condition or to learn either MM or LKM in a 6-week workshop. Telomere length was assessed 2 weeks before the start of the workshops and 3 weeks after their termination. After controlling for appropriate demographic covariates and baseline TL, we found TL decreased significantly in the MM group and the control group, but not in the LKM group. There was also significantly less TL attrition in the LKM group than the control group. The MM group showed changes in TL that were intermediate between the LKM and control groups yet not significantly different from either. Self-reported emotions and practice intensity (duration and frequency) did not mediate these observed group differences. This study is the first to disentangle the effects of LKM and MM on TL and suggests that LKM may buffer telomere attrition.
The effect of loving-kindness meditation on positive emotions: a meta-analytic review
Front. Psychol., 02 November 2015
Sec. Psychology for Clinical Settings
Volume 6 - 2015 | https://doi.org/10.3389/fpsyg.2015.01693
While it has been suggested that loving-kindness meditation (LKM) is an effective practice for promoting positive emotions, the empirical evidence in the literature remains unclear. Here, we provide a systematic review of 24 empirical studies (N = 1759) on LKM with self-reported positive emotions. The effect of LKM on positive emotions was estimated with meta-analysis, and the influence of variations across LKM interventions was further explored with subgroup analysis and meta-regression. The meta-analysis showed that (1) medium effect sizes for LKM interventions on daily positive emotions in both wait-list controlled RCTs and non-RCT studies; and (2) small to large effect sizes for the on-going practice of LKM on immediate positive emotions across different comparisons. Further analysis showed that (1) interventions focused on loving-kindness had medium effect size, but interventions focused on compassion showed small effect sizes; (2) the length of interventions and the time spent on meditation did not influence the effect sizes, but the studies without didactic components in interventions had small effect sizes. A few individual studies reported that the nature of positive emotions and individual differences also influenced the results. In sum, LKM practice and interventions are effective in enhancing positive emotions, but more studies are needed to identify the active components of the interventions, to compare different psychological operations, and to explore the applicability in clinical populations.
Loving-kindness meditation increases social connectedness.
Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8(5), 720–724. https://doi.org/10.1037/a0013237
Abstract
The need for social connection is a fundamental human motive, and it is increasingly clear that feeling socially connected confers mental and physical health benefits. However, in many cultures, societal changes are leading to growing social distrust and alienation. Can feelings of social connection and positivity toward others be increased? Is it possible to self-generate these feelings? In this study, the authors used a brief loving-kindness meditation exercise to examine whether social connection could be created toward strangers in a controlled laboratory context. Compared with a closely matched control task, even just a few minutes of loving-kindness meditation increased feelings of social connection and positivity toward novel individuals on both explicit and implicit levels. These results suggest that this easily implemented technique may help to increase positive social emotions and decrease social isolation.
Loving-Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study
https://doi.org/10.1002/jts.21832
Abstract
Loving-kindness meditation is a practice designed to enhance feelings of kindness and compassion for self and others. Loving-kindness meditation involves repetition of phrases of positive intention for self and others. We undertook an open pilot trial of loving-kindness meditation for veterans with posttraumatic stress disorder (PTSD). Measures of PTSD, depression, self-compassion, and mindfulness were obtained at baseline, after a 12-week loving-kindness meditation course, and 3 months later. Effect sizes were calculated from baseline to each follow-up point, and self-compassion was assessed as a mediator. Attendance was high; 74% attended 9–12 classes. Self-compassion increased with large effect sizes and mindfulness increased with medium to large effect sizes. A large effect size was found for PTSD symptoms at 3-month follow-up (d = −0.89), and a medium effect size was found for depression at 3-month follow-up (d = −0.49). There was evidence of mediation of reductions in PTSD symptoms and depression by enhanced self-compassion. Overall, loving-kindness meditation appeared safe and acceptable and was associated with reduced symptoms of PTSD and depression. Additional study of loving-kindness meditation for PTSD is warranted to determine whether the changes seen are due to the loving-kindness meditation intervention versus other influences, including concurrent receipt of other treatments.
A Trauma-Adapted Mindfulness and Loving-Kindness Intervention for Patients with PTSD After Interpersonal Violence: a Multiple-Baseline Study
https://link.springer.com/article/10.1007/s12671-018-1068-z
Abstract
The aim of this study was to evaluate a trauma-adapted intervention for survivors of interpersonal violence that combines psychoeducation and specific mindfulness-based exercises developed for patients with posttraumatic stress disorder (PTSD) with formal practices from mindfulness-based stress reduction and loving-kindness meditation. Fourteen patients with PTSD after interpersonal violence participated in eight treatment sessions. The intervention was evaluated in a nonconcurrent multiple-baseline across-individuals design. From baseline (2, 3, and 4 weeks, randomly assigned) until 8 weeks after the intervention, self-reported PTSD symptoms and well-being were measured on a weekly basis. The intervention was further assessed through self-ratings and the Clinician-Administered PTSD Scale (CAPS-5) administered prior to treatment, immediately after treatment and at a 6-week follow-up. Tau-U analyses showed for the majority of the 12 completers a significant reduction of PTSD symptoms and a significant increase in well-being. Furthermore, we found large effects on PTSD symptoms as measured by the CAPS-5 (Hedges’ g = 1.66), as well as on depression (Hedges’ g = 1.08) and psychological distress (Hedges’ g = 0.85), complemented by relevant increases in mindfulness skills and self-compassion. This study contributes evidence that mindfulness and loving-kindness are useful for reducing PTSD in victims of interpersonal violence, especially when the intervention is tailored to the specific needs of these patients.
Loving-Kindness Meditation and the Broaden-and-Build Theory of Positive Emotions Among Veterans With Posttraumatic Stress Disorder
Abstract
Background:
Loving-kindness meditation (LKM) is a practice intended to enhance feelings of kindness and compassion for self and others.
Objectives:
To assess whether participation in a 12-week course of LKM for veterans with posttraumatic stress disorder (PTSD) is associated with improved positive emotions, decentering, and personal resources.
Research Design:
In an open-pilot trial, veterans were assessed at baseline, after the course, and 3 months later. Effect sizes were calculated from baseline to each follow-up point for each construct of interest. Measures were chosen as an initial investigation of the broaden-and-build theory of positive emotions.
Subjects:
A total of 42 veterans with active PTSD (40% female) participated.
Measures:
Emotions, decentering, psychological wellbeing including autonomy, environmental mastery, personal growth, positive relations, purpose in life, self-acceptance, and sense of social support were measured at each time point.
Results:
Significant increases in unactivated pleasant (d=0.73), but not activated pleasant, emotions were found over time. Activated and unactivated unpleasant emotions decreased over time (d=−0.69 and −0.53, respectively). There were also increases in environmental mastery (d=0.61), personal growth (d=0.54), purpose in life (d=0.71), self-acceptance (d=0.68), and decentering (d=0.96) at 3-month follow-up.
Conclusions:
Overall, positive emotions increased, and enhancement of personal resources occurred over time. Further investigation of LKM for PTSD is warranted.
Symptoms of posttraumatic stress disorder (PTSD) often persist for decades and result in reduced quality of life.1 In the US general population, the lifetime risk of PTSD is estimated to be 8.7%,2 whereas the rate of PTSD among returning combat veterans may be as high as 20%–30%.3,4 In a large analysis, 13% of returning Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) veterans received a diagnosis of PTSD when they accessed VA health care.5 Clinical hallmarks of PTSD include recurrent, intrusive memories of a traumatic event, persistent avoidance of stimuli associated with the traumatic event, hyperarousal, and negative mood and cognitions associated with the traumatic event.6 The VA recommends medications (selective serotonin-reuptake inhibitors and prazosin), and psychotherapeutic approaches (cognitive processing therapy, exposure therapy, stress management skills training, and eye movement desensitization reprocessing) for PTSD.7 Despite the availability of these interventions, many people with PTSD continue to experience persistent PTSD symptoms, as well as anger, difficulties with interpersonal relationships, shame, and grief.8 To respond to the growing demand for mental health services, consensus recommendations have recommended the development of cost-effective nontraditional delivery systems, such as group interventions, to expand the availability of therapies.9
Emerging evidence indicates that veterans use complementary and alternative medicine (CAM) at high rates. A large multisite study found that 27% of VA outpatients utilized CAM within the past year.10 Another study found that nearly 50% of veterans reported use of CAM, with high stress, chronic medical illness, and a perceived negative impact of military service on health as significant predictors of CAM use.11 In addition, dissatisfaction with reliance on prescription medication and the desire to address social and spiritual aspects of health have been shown to influence CAM use.12
Loving-kindness meditation (LKM) is a CAM approach intended to develop an enhanced ability to experience kindness, openheartedness, and compassion for self and others. LKM originated in the Buddhist tradition, but can be taught as a secular practice. An emerging literature suggests that self-compassion is associated with healthy psychological functioning (including life satisfaction and social connectedness), and negatively associated with self-criticism, rumination, thought suppression, anxiety, and depression.13 Self-criticism, shame,14 rumination, and thought suppression are frequently associated with PTSD.15 Therefore, an intervention that increases self-compassion might favorably influence clinical manifestations of PTSD, and a small body of literature supports this hypothesis. A study of PTSD symptoms among university students found a correlation between greater self-compassion and lower rates of avoidance symptoms.16 An intervention called “compassionate mind training” designed to teach self-compassion, was beneficial for individuals who had experienced trauma in a small pilot study.17
The phrase loving-kindness describes an emotional state of kindness or goodwill, rather than sentimental love. In LKM, a practitioner brings to mind a particular person (eg, a good friend) and silently repeats phrases of positive intention for that person. These phrases may express a desire for safety, happiness, health, and ease or peace for the person held in mind. Classically, 4 phrases are used, such as: “may you be safe,” “may you be happy,” “may you be healthy,” and “may your life unfold with ease.”18 As practitioners continue to practice LKM, they are then asked to bring to mind other individuals or categories of people, including themselves, neutral persons, and persons who have caused them difficulty or harm, while changing the phrases as needed (ie, “may you be safe” becomes “may I be safe”).18
When practicing LKM, a person is asked to notice and feel the positive emotion elicited by each of the phrases of positive intention, or to notice whether there is a sense of reluctance, hesitation, or even aversion for the self or another. The practitioner is encouraged to greet these responses with kindness, and to notice them without judgment. More generally, during LKM, when practitioners become distracted by thoughts that arise during the practice, they are instructed to notice what has distracted them with an attitude of nonjudgmental, mindful attention, and then return to the LKM phrases and the breath without self-criticism. Walking meditation may also be used as a method to teach LKM. Informal LKM practices are also encouraged—practitioners are asked to practice LKM toward themselves or others during everyday activities such as walking, eating, washing the dishes, or standing in line at the grocery store. This systematic development of kindness toward self and others is intended to change the orientation to oneself, others, one’s life experiences, and to result in a broadening of the range of emotional responses and choices available.
LKM AND THE BROADEN-AND-BUILD THEORY OF POSITIVE EMOTIONS
The broaden-and-build theory of positive emotions provides a framework for understanding how LKM practice may influence affect, behaviors, and clinical outcomes.19,20 The broaden-and-build theory proposes that positive emotions broaden a person’s perceptual and cognitive abilities, and with this broadened outlook one is able to build personal resources.21 This broadened mindset is characterized by openness to new situations and ideas rather than the narrow focus typically associated with negative emotions and habitual responses (eg, fight or flight).19 Personal and social resources that are postulated to be enhanced by positive emotions can include the ability to mindfully attend to experience, a sense of environmental mastery, a sense of purpose in life, enhanced self-compassion, or improved ability to give and receive social support.19
There is accumulating evidence in support of the broaden-and-build theory. Studies of experimentally induced positive emotional states that show that positive emotions broaden the scope of visual attention,22–24 enhance openness to new experiences,25 improve ability to accept feedback,26,27 and enhance a sense of connection with others.19 In a randomized controlled trial of LKM versus a waitlist control, findings supported both the “broaden” aspect (enhanced positive emotions), the “build” part of the theory (enhanced personal resources), as well as improved mood and quality of life.19
LKM, THE BROADEN-AND-BUILD THEORY, AND PTSD
The lives of many people with PTSD are marked by ongoing severe emotional (and often accompanying physical) pain, including the hallmark emotion of fear. According to the broaden-and-build theory, negative emotions arise in response to perceived threats and undesirable circumstances, whereas positive emotions arise through identification of perceived opportunities in the environment.21 One of the core features of PTSD is a phobic response to reminders of a traumatic event and to the memories associated with that event, which in conjunction with information-processing problems, leads to pervasive fear and poor functioning.28 LKM practice may provide individuals with PTSD a means to identify additional opportunities/resources in their environment, and to temper the often habitual preoccupation with the past and the narrow focus on negative aspects of one’s situation. In addition, many survivors of trauma carry a strong sense of shame, such that their fundamental view of themselves is negative and is characterized by self-alienation.14,29 LKM’s emphasis on cultivation of goodwill toward oneself may help to repair the tendency toward shame that many individuals with PTSD suffer. This may prove particularly helpful when kindness and support are lacking in the environment.
Trauma can also shatter the sense of basic trust in others, oneself, and the world at large. Disruptions in basic trust, as well the tendency to avoid reminders of the trauma in social situations, often result in withdrawal from close relationships.30 The repetition of LKM phrases can also be conceived of as a mechanism to recreate a safe “holding environment,” which in LKM is created by phrases of positive intention. Social support has been shown to be an important factor in recovery from PTSD.31 The incremental restoration of a sense of basic trust in self and others, as well as an increased ability to self-modulate pervasive feelings of shame, guilt, and inferiority may lead to an enhanced sense of self-efficacy. Over time, enhancement of these factors might be expected to play a role in restoration of a connection to the sense of self that has been lost through traumatic experiences, and may lead to a sense of reconnection with the community as well.
The cultivation of positive emotions through LKM might be also particularly helpful for the numbing and constrictive symptoms characteristic of chronic PTSD, which can present as feelings of chronic alienation and deadness. Providing a technique through which positive emotions can repeatedly be enhanced, as in LKM practice, might provide an innovative pathway to address these numbing and constrictive symptoms. It is also possible that a meditation practice that encourages observation of one’s thoughts and feelings as temporary mental events could help address the tendency for distressed individuals to identify personally with thoughts and feelings as reflections of their true nature. This can be particularly distressing if much of one’s internal experience is characterized by painful, traumatic memories that may include beliefs that one failed in crucial ways that led to bad outcomes.
Although we know of no formal comparison of rates of adopting a regular LKM practice as compared with other meditation practices, in our experience it is not uncommon for people in severe distress to find it easier to practice LKM than mindfulness practices, such as the breathing and body scan meditations. LKM relies on the repetition of simple phrases intended to elicit feelings of kindness for self and others, and these phrases may serve as a readily accessible anchor to the present moment for people in severe distress. As part of LKM instructions, participants are also often asked to notice the thoughts and feelings that arise during the course of practice, and to regard passing thoughts and feelings as objects of attention, to be viewed with curiosity and openness. This capacity—to regard thoughts and feelings as temporary, objective events in the mind—is termed decentering. It has been hypothesized that in the setting of aversive emotional states, mindfulness interventions promote exposure-based learning and extinction through the combined effects of decentering (which allows a person to observe and label experience) and curiosity (which maintains attentional focus).32,33 LKM can be hypothesized to have similar effects.
We previously reported the results of an open-pilot trial of LKM for veterans with PTSD.34 In that publication, we reported on the primary clinical outcomes (PTSD symptoms and depression) as well as changes in mindfulness and compassion for self and others. Briefly, we found that participation in the LKM intervention was associated with clinically significant improvements in PTSD and depression as well as increased compassion and mindfulness. As part of the pilot, we also collected preliminary data pertaining to the broaden-and-build theory of positive emotions; these are reported here. We hypothesized that enhanced positive emotions, attentional broadening, and built personal resources would occur following participation in a 12-week course of LKM.
The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial
https://doi.org/10.1080/20008066.2024.2308439
ABSTRACT
Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.
Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.
Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.
Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = −1.09), guilt (d = −2.85), shame (d = −2.14), psychopathology and self-criticism.
Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).
HIGHLIGHTS
C-METTA is an intervention that addresses trauma-related guilt and shame and combines cognitive interventions with loving-kindness meditations.
A proof-of-concept study was conducted examining C-METTA in a wait-list randomized controlled trial
C-METTA led to reductions in trauma-related guilt and shame and PTSD symptoms.
Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study
https://doi.org/10.1002/jts.22397
Abstract
There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT®), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre- and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = −0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.
Buddhist-Derived Loving-Kindness and Compassion Meditation for the Treatment of Psychopathology: a Systematic Review
https://link.springer.com/article/10.1007/s12671-014-0368-1
Abstract
Although clinical interest has predominantly focused on mindfulness meditation, interest into the clinical utility of Buddhist-derived loving-kindness meditation (LKM) and compassion meditation (CM) is also growing. This paper follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and provides an evaluative systematic review of LKM and CM intervention studies. Five electronic academic databases were systematically searched to identify all intervention studies assessing changes in the symptom severity of Diagnostic and Statistical Manual of Mental Disorders (text revision fourth edition) Axis I disorders in clinical samples and/or known concomitants thereof in subclinical/healthy samples. The comprehensive database search yielded 342 papers and 20 studies (comprising a total of 1,312 participants) were eligible for inclusion. The Quality Assessment Tool for Quantitative Studies was then used to assess study quality. Participants demonstrated significant improvements across five psychopathology-relevant outcome domains: (i) positive and negative affect, (ii) psychological distress, (iii) positive thinking, (iv) interpersonal relations, and (v) empathic accuracy. It is concluded that LKM and CM interventions may have utility for treating a variety of psychopathologies. However, to overcome obstacles to clinical integration, a lessons-learned approach is recommended whereby issues encountered during the (ongoing) operationalization of mindfulness interventions are duly considered. In particular, there is a need to establish accurate working definitions for LKM and CM.
Compassion Meditation for Veterans with Posttraumatic Stress Disorder (PTSD): a Nonrandomized Study
https://link.springer.com/article/10.1007/s12671-017-0866-z
Abstract
Compassion meditation (CM) is a contemplative practice that is intended to cultivate the ability to extend and sustain compassion toward self and others. Although research documents the benefits of CM in healthy populations, its use in the context of psychopathology is largely unexamined. The purpose of this study was to refine and initially evaluate a CM protocol, Cognitively Based Compassion Training (CBCT®), for use with Veterans with PTSD. To this end, our research team developed and refined a manualized protocol, CBCT-Vet, over 4 sets of groups involving 36 Veterans. This protocol was delivered in 8–10 sessions, each lasting 90–120 min and led by a CBCT®-trained clinical psychologist. Quantitative and qualitative data were used to identify areas to be improved and to assess change that occurred during the treatment period. Based on pooled data from this series of groups, CM appears to be acceptable to Veterans with PTSD. Group participation was associated with reduced symptoms of PTSD (partial eta squared = .27) and depression (partial eta squared = .19), but causality should not be inferred given the nonrandomized design. No change was observed in additional outcomes, including positive emotion and social connectedness. The results of this open trial support additional exploration of CM as part of the recovery process for Veterans with PTSD.
Self-compassion influences PTSD symptoms in the process of change in trauma-focused cognitive-behavioral therapies: a study of within-person processes
Front. Psychol., 26 August 2015
Sec. Psychology for Clinical Settings
Volume 6 - 2015 | https://doi.org/10.3389/fpsyg.2015.01273
Although self-compassion is considered a promising change agent in the treatment of posttraumatic stress disorder (PTSD), no studies of this hypothesis exist. This study examined the within-person relationship of self-compassion components (self-kindness, common humanity, mindfulness, self-judgment, isolation, over-identification) and subsequent PTSD symptoms over the course of therapy.
Method: PTSD patients (n = 65) were randomized to either standard prolonged exposure, which includes imaginal exposure (IE) to the traumatic memory, or modified prolonged exposure, where imagery re-scripting (IR) of the memory replaced IE as the imagery component of prolonged exposure in a 10 weeks residential program. They were assessed weekly on self-compassion and PTSD symptom measures. The centering method of detrending was used to separate the variance related to the within-person process of change over the course of treatment from between-person variance.
Results: The self-compassion components self-kindness, self-judgment, isolation, and over-identification had a within-person effect on subsequent PTSD symptoms. These relationships were independent of therapy form. The within-person relationship between self-judgment and subsequent PTSD symptoms was stronger in patients with higher initial self-judgment. By contrast, there were few indications that within-person variations in PTSD symptoms predict subsequent self-compassion components.
Conclusion: The results support the role of self-compassion components in maintaining PTSD and imply the recommendation to facilitate decrease of self-judgment, isolation, and over-identification and increase of self-kindness in the treatment of PTSD patients. The reduction of self-judgment appears to be most important, especially for patients with a high initial level of self-judgment.
Introduction
Some trauma-exposed individuals develop posttraumatic stress disorder (PTSD) as a consequence of the traumatic experience. PTSD individuals are intensely preoccupied with current threat from external (e.g., be attacked again) as well as internal (e.g., self-criticism) sources (Ehlers and Clark, 2000). Indeed, self-criticism and associated shame may be central maintaining factors in many cases of PTSD (Cox et al., 2004; Matos and Pinto-Gouveia, 2010; Øktedalen et al., 2014). As compassion from others and self-compassion is the most important factor in the adaptive regulation of emotional reactions to threat (Gilbert, 2000), developing self-compassion could be particularly helpful for PTSD individuals. This development should be especially relevant when the trauma survivor is facing the internal threat of self-criticism (Gilbert, 2000). If he/she can be kind, understanding and mindful toward the self when things are difficult, then the resulting response is likely to be one of feeling cared for and understood. This can be contrasted to the feelings of shame, defeat and submission elicited by self-criticism and attack.
According to Neff’s (2003) initial formulation, self-compassion entails three bipolar components: (a) self-kindness – being kind and understanding toward oneself in instances of pain or failure versus being harshly self-critical, (b) common humanity – perceiving one’s experiences as part of the larger human experience versus seeing them as separating and isolating, and (c) mindfulness – holding painful thoughts and feelings in balanced awareness versus over-identifying with them. However, empirical analysis by use of the Self-Compassion Scale (SCS; Neff, 2003) indicated that the six poles rather represented six separate but correlated factors. Thus, for instance self-judgment and self-kindness are not mutually exclusive, so that having low levels of one behavior do not necessarily mean having high levels of the other. As a result, Neff proposed a six-factor structure with one higher-order factor of self-compassion.
A few studies have examined the relationship between self-compassion and PTSD. Thompson and Waltz (2008) administered the SCS to students and among those who had experienced a trauma, SCS correlated negatively with PTSD avoidance symptoms. Harman and Lee (2010) suggested that lack of self-compassion may be accentuated in shame-based PTSD and found that high levels of self-critical thinking and low levels of self-reassuring thinking were associated with high levels of shame within a PTSD sample. They concluded that it might be an inability to develop self-kindness and self-reassurance, as much as self-criticism, that may contribute to the maintenance of PTSD.
Self-compassion has not been a central target in trauma-focused cognitive-behavioral therapies, which are the ones that so far have been documented to be efficacious for PTSD (NICE, 2005). For instance, prolonged exposure (PE; Foa et al., 2007), which is the most extensively documented one, consists of imaginal exposure (IE) to the traumatic memory, repeated listening to tapes of the imagery sessions, and in vivo exposure to avoided situations and stimuli. PE focuses more on the reduction of fear and other trauma-related negative emotions than on fostering self-compassion. However, in a modified version of the imagery component of PE – imagery re-scripting (IR; Smucker et al., 1996) – the fostering of self-compassion is one of the goals. The re-scripting involves that the patient’s Current Self – after an initial phase of reliving the traumatic memory in imagery – is invited to enter the imagery at the worst moment of the trauma, bring the situation to a solution (e.g., overpower a perpetrator), and then interact with the Traumatized Self back-then. The Current Self-Traumatized Self interaction may stimulate the development of self-compassion instead of shame, guilt, and self-critique. In an open trial, IR was found extremely helpful for PTSD patients who had previously not profited from standard PE (using IE as the imagery component; Grunert et al., 2007). In pilot studies, both loving-kindness meditation and mindfulness based stress reduction have shown promising results for veterans with PTSD (Kearney et al., 2013, 2014).
Understanding the role of self-compassion in the process of therapeutic change depends on the method used to examine it. Therapy process research has mainly focused between-patient data, that is, how differences in process among patients are related to differences in outcome among the patients. However, this level of analysis partly misses its target because psychotherapy theories and therapists focus primarily on within-patient processes of change without the confounding influence of variance related to individual differences. For instance, a therapist is interested in whether a successful facilitation of self-compassion in a patient at a certain point in therapy may lead to subsequent reduction of that patient’s symptoms. Only repeated measures data allow for the proper disaggregation of between-person and within-person effects (Curran and Bauer, 2011). When a set of measures is collected at a single point of time from multiple individuals, the resulting data provide information only about between-person relationships. In contrast, when a set of measures are collected at multiple points in time from multiple individuals, the resulting data contain information about both between-person and within-person differences. Such data must be carefully specified to avoid confounding the two sources of variability. A disaggregation of the between-person and within-person variance components of a predictor not only allows the study of within-person processes separated from between-person effects, but also is able to examine cross-level interactions of between- and within-person effects. For instance, the effect of experiencing more self-compassion than expected for a particular patient may matter more for patients who have lower self-compassion in general. When the general (between-person) level of self-compassion is low, for example when the patient usually exhibits no self-kindness and longs for this, the occurrence of some self-kindness in a particular session might be a valued event with an immediate effect on symptoms. On the other hand, when the patient’s self-kindness is high already and not an issue for him/her, the same increase would probably have less consequence.
Compassion-Based Therapy for Trauma-Related Shame and Posttraumatic Stress: Initial Evaluation Using a Multiple Baseline Design☆
Highlights
•A compassion-based therapy was developed for trauma-related shame and PTSD.
•The intervention was evaluated in a multiple baseline experimental study.
•Treatment was associated with large, reliable reductions in PTSD symptoms and shame.
•Treatment gains were maintained at 4-week follow-up.
•Compassion-based therapy may be an effective treatment for shame-based PTSD.
Abstract
Accumulating research suggests that shame can strongly contribute to the development and maintenance of posttraumatic stress disorder (PTSD). Interventions that promote self-compassion have shown promise for reducing shame related to various clinical problems, but this approach has not been systematically evaluated for traumatized individuals. The aim of this study was to develop a brief compassion-based therapy and assess its efficacy for reducing trauma-related shame and PTSD symptoms. Using a multiple baseline experimental design, the intervention was evaluated in a community sample of trauma-exposed adults (N = 10) with elevated trauma-related shame and PTSD symptoms. Participants completed weekly assessments during a 2-, 4-, or 6-week baseline phase and a 6-week treatment phase, and at 2 and 4 weeks after the intervention. By the end of treatment, 9 of 10 participants demonstrated reliable decreases in PTSD symptom severity, while 8 of 10 participants showed reliable reductions in shame. These improvements were maintained at 2- and 4-week follow-up. The intervention was also associated with improvements in self-compassion and self-blame. Participants reported high levels of satisfaction with the intervention. Results suggest that the intervention may be useful as either a stand-alone treatment or as a supplement to other treatments.
Relations Among Self-Compassion, PTSD Symptoms, and Psychological Health in a Trauma-Exposed Sample
Seligowski, A.V., Miron, L.R. & Orcutt, H.K. Relations Among Self-Compassion, PTSD Symptoms, and Psychological Health in a Trauma-Exposed Sample. Mindfulness 6, 1033–1041 (2015). https://doi.org/10.1007/s12671-014-0351-x
Abstract
Emerging literature on self-compassion suggests that establishing and maintaining a compassionate perspective toward oneself and one’s experiences may help buffer against the negative effects of trauma exposure, such as psychopathology and reduced quality of life. The goal of the current study was to examine relations among self-compassion, posttraumatic stress disorder (PTSD) symptom severity, and overall psychological health in a sample of trauma-exposed university students. Further, the current study explored these associations while controlling for a theoretically related construct, psychological inflexibility. Participants were 453 undergraduate students enrolled in an introductory psychology course at a large Midwestern University (M age = 19.75, SD = 3.07). A structural equation model (SEM) approach was used. Results indicated that a two-factor solution for the Self-Compassion Scale defined by subscale valence (i.e., positive and negative components) demonstrated improved fit over a single-factor model. The overall model demonstrated good fit: comparative fit index (CFI) = 0.96, Tucker-Lewis index (TLI) = 0.93, root-mean-square residual (RMSEA) = 0.08 (90 % confidence interval (CI) 0.07 to 0.09). The two observed factors of self-compassion emerged as strong predictors of variation in overall psychological health, even in the context of PTSD symptoms and psychological inflexibility. Additionally, the two self-compassion factors accounted for significant variance in psychological inflexibility, but not PTSD symptoms. Results demonstrate that increasing levels of self-compassion may represent an important area of intervention for trauma-exposed individuals.
Self-compassion and cognitive flexibility in trauma-exposed individuals with and without PTSD
Daneshvar, S., Basharpoor, S. & Shafiei, M. Self-compassion and cognitive flexibility in trauma-exposed individuals with and without PTSD. Curr Psychol 41, 2045–2052 (2022). https://doi.org/10.1007/s12144-020-00732-1
Abstract
Considering the importance of cognitive processes in controlling behavior and emotion, and also individuals’ different reactions toward traumatic events; the current study was carried out to compare self-compassion and cognitive flexibility in trauma-exposed individuals with and without post-traumatic stress disorder. In this cross-sectional study, subjects were recruited among individuals exposed to at least one traumatic event in Gilan-Gharb city (Iran). Through the available sampling method, the numbers of 400 people were selected, and after exerting inclusion and exclusion criterions, 252 individuals concluded the final sample of the study. Subjects were divided into two groups of with and without post-traumatic stress disorder based on clinical interview and the cut-off scores higher than 103 in the Civilian Mississippi Post-Traumatic Stress Disorder scale; Then responded to the demographic questionnaire, Self-Compassion Scale and Cognitive Abilities Questionnaire individually. Collected data were analyzed using descriptive statistics and the Multivariate Analysis of Variance test. Results revealed that the mean scores of the group with post-traumatic stress disorder were significantly lower than the group without post-traumatic stress disorder in variables of Cognitive Flexibility, Self-Compassion, and components of self-compassion including Self-Kindness, Common Humanity, and Mindfulness; the mean scores of the group with post-traumatic stress disorder were significantly higher than the group without post-traumatic stress disorder in components of self-compassion including Self-judgment, Isolation, and Over-Identification. Findings of the present study suggest that self-compassionate attitude toward shortcomings and failures of self, and cognitive flexibility is lower in people suffering from post-traumatic stress disorder than those trauma-exposed individuals without post-traumatic stress disorder.
Evaluation of Self-Compassion Focused Group Treatment for Co-Occurring PTSD and Substance Use in Veterans with Posttraumatic Guilt: A Case Study
https://doi.org/10.1080/00207284.2020.1805617
ABSTRACT
Co-occurring posttraumatic stress disorder (PTSD) and substance use disorders (SUD) following combat exposure affects a significant proportion of military veterans. Guilt and shame are common to PTSD-SUD, suggesting a possible role as a mechanism underlying both disorders. Cultivating self-compassion (SC) among veterans is a logical approach to treating guilt and shame. The purpose of this article is threefold: (a) present scientific theories of SC in the veteran population with emphasis on PTSD, substance use, and guilt and shame; (b) present a case study that highlights how self-compassion-focused treatment (SCFT) can be utilized in a group format with veterans with PTSD-SUD and posttraumatic guilt; and (c) discuss implications of our findings for refining SCFT within a group intervention setting among this population and for future research.
Self-compassion in PTSD
https://doi.org/10.1016/B978-0-12-816022-0.00020-X
Abstract
Self-compassion refers to healthy ways of relating to oneself in times of suffering, whether suffering is caused by failure, perceived inadequacy, or general life difficulties. Self-compassion allows individuals to accept themselves as they are, including the limitations and imperfections that make them human. Informally, it is defined as treating yourself with the same care with which you would treat a good friend who is struggling. Self-compassion helps people to better tolerate painful emotions such as grief, despair, anxiety, anger, and shame. The inherent challenge, however, is to extend a loving embrace to ourselves when we like ourselves the least, such as when we feel unworthy and isolated. In this chapter, we highlight the potential of self-compassion to alleviate some of the suffering caused by shame in PTSD. We explain how high shame and low self-compassion maintain and exacerbate PTSD and how existing psychological treatments for PTSD may be enhanced by integrating self-compassion. We focus on the adverse reactions to compassion in trauma survivors and give examples of how to safely work with such resistances.
Nature Enhanced Meditation: Effects on Mindfulness, Connectedness to Nature, and Pro-Environmental Behavior
Travis N. Ray https://orcid.org/0000-0002-3703-5691, Scott A. Franz, […], and Scott M. Pickett scott.pickett@med.fsu.edu+1View all authors and affiliations
https://doi.org/10.1177/0013916520952452
Abstract
Previous research suggests that meditation, a mindfulness exercise, could result in increased connectedness to nature and pro-environmental behavior. Exposure to nature also is associated with these outcomes. It was hypothesized that meditation alongside stimuli reminiscent of the natural environment would produce enhanced effects. Participants (N = 97) were randomly assigned to complete a 4-week online meditation program consisting of a guided meditation paired with either nature sounds (“nature group”) or spa-like sounds (“control group”). Mindfulness, connectedness to nature, and pro-environmental behavior were assessed before and after the program. Meditation, in general, produced increases in mindfulness, connectedness to nature, and pro-environmental behavior. Additionally, the nature group had a greater rate of change in connectedness to nature when compared to the control group. The results extend previous cross-sectional research by demonstrating the beneficial effects of meditation on pro-environmental behavior and its theorized mechanisms, which may be informative for future research and interventions.
Mindfulness as a Moderator in the Relation Among Core Belief Disruption, Rumination, Posttraumatic Symptoms, and Growth
Haspolat, A., Çırakoğlu, O.C. Mindfulness as a Moderator in the Relation Among Core Belief Disruption, Rumination, Posttraumatic Symptoms, and Growth. Mindfulness 12, 186–197 (2021). https://doi.org/10.1007/s12671-020-01511-6
Abstract
Objectives
In the present study, we tested moderated mediation models where the moderator role of mindfulness and its subscales has an indirect effect of core belief disruption (CBD) on posttraumatic symptoms (PTS) and posttraumatic growth (PTG) through intrusive (IR) and deliberate (DR) ruminations.
Methods
Two hundred forty-six individuals, ages ranging between 19 and 77, with traumatic experiences participated in the study. The data were collected by Traumatic Experience Screening List, Core Beliefs Inventory (CBI), Impact of Event Scale-Revised Form (IES-R), Event-Related Rumination Inventory, Posttraumatic Growth Inventory (PTGI), and Five Facet Mindfulness Questionnaire (FFMQ).
Results
The moderator role of mindfulness was supported both for PTS and PTG. The analysis indicated that the indirect effect of CBD on PTS only through IR was moderated by mindfulness total score (MF-T) and nonreactivity (NR) subscales. The analysis revealed that the MF-T × IR interaction effect was statistically significant. The interaction effect was significant for only low and medium levels of MF-T. When the model was analyzed for PTG, it was observed that the indirect effect of CBD on PTG through IR and DR was moderated significantly only for describing (DES) subscale of mindfulness. In addition, the DES × IR interaction effect was significant only for medium and higher levels of DES. It was also observed that the DES × DR interaction effect was significant only for medium and high levels of DES.
Conclusions
Mindfulness and its components should be taken into consideration when assessing posttraumatic symptoms and growth.
Relationship between mindfulness, meaning in life and post-traumatic growth among Nigerian cancer patients
Chinenye Joseph Aliche
ORCID Icon, Chuka Mike Ifeagwazi
& Michael O. Ezenwa
Pages 475-485 | Received 02 Jun 2021, Accepted 23 Jun 2022, Published online: 30 Jun 2022
Cite this article https://doi.org/10.1080/13548506.2022.2095576
ABSTRACT
Understanding the psychosocial factors that predict recovery and promote growth from trauma is critical to effective management of oncology patients. Although previous studies have shown that mindfulness and meaning in life could be predictors of post-traumatic growth (PTG), no study to date has explored the combined role of mindfulness and meaning in life in the development of PTG among cancer patients. Using a cross-sectional design, data were collected from 957 cancer patients (46.8% male, 53.2% female) who completed relevant self-report measures. Results showed that the presence of meaning in life mediated the relationship between mindfulness and PTG. However, the mediation effect of search for meaning in life was not significant. These findings indicate that the presence of meaning in life is an essential mechanism of mindfulness in facilitating PTG. Therefore, psychosocial interventions geared towards promoting PTG should consider mindfulness as a potential effective component in improving cancer patients’ ability to find meaning in life and possibly promote recovery
The effects of the Alexander Technique on Chronic Non-specific Neck Pain: A Systematic Review and Meta-analysis
https://doi.org/10.21203/rs.3.rs-2446823/v1
Objective
To evaluate the clinical efficacy of the Alexander Technique courses compared to the conventional therapy in patients with chronic Non-specific neck pain.
Methods
According to PICO (participant, intervention, comparison, outcome) elements, the effects of Alexander Technique on chronic Non-specific neck pain were evaluated in this paper. PubMed, Web of Science, EBSCO, EMBESE, and Cochrane Library et al English databases were searched with a search time frame from databases build to December 31, 2021. Weighted mean differences (WMD), Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated. We used a random-effects model to minimize the heterogeneity, and I2 test was used to assess heterogeneity.
Results
Three studies were included according to the predetermined eligibility criteria. Compared with the conventional therapy group, the merge of included studies showed that the Alexander Technique could significantly improve the pain for chronic neck pain patients, and the treatment effects can be maintained for 3–6 months with a very low heterogeneity (six-month follow-up pain outcome: SMD: -0.20, 95%CI: -0.38–0.01, P = 0.035, I2 = 15.7%; three-month follow-up pain outcome: -0.33, 95%CI: -0.53-0.13, P = 0.001, I2 = 0%). In addition, compared with the conventional therapy group, the Alexander Technique would not significantly increase adverse events (AE: RR = 1.690, 95% CI: 0.67–4.27, P = 0.267, I2 = 44.3%).
Conclusion
Although the number of studies and personnel involved was limited, the meta-analysis preliminarily indicated that the Alexander Technique courses is effective for chronic Non-specific neck pain, which is related to the follow-up time of the post-intervention. However, it’s necessary to interpret and apply the outcome of this research cautiously and the specific efficacy and mechanisms of Alexander Technique therapy are needed to be investigated to demonstrate further.
Older adult Alexander Technique practitioners walk differently than healthy age-matched controls
https://doi.org/10.1016/j.jbmt.2016.04.009
Summary
The Alexander Technique (AT) seeks to eliminate harmful patterns of tension that interfere with the control of posture and movement and in doing so, it may serve as a viable intervention method for increasing gait efficacy in older adults. The purpose of this study was to compare the comfortable pace gait kinematics of older AT practitioners with those of healthy, age-matched controls. Participants were six licensed AT practitioners and seven healthy age-matched controls between the ages of 61–76. During the stance phase, AT participants exhibited significantly greater ankle stance range of motion (ROM) and plantar flexion at toe off, as well as lower ROM of the trunk and head compared to controls. During the swing phase, the AT practitioners had significantly increased hip and knee flexion and a trend toward significantly increased dorsiflexion. The findings suggest that the older AT practitioners walked with gait patterns more similar to those found in the literature for younger adults. These promising results highlight the need for further research to assess the AT's potential role as an intervention method for ameliorating the deleterious changes in gait that occur with aging.
Introduction
Gait dysfunction in older adults commonly results in a loss of independence and an increased vulnerability to falls (Ambrose et al., 2013, Kerrigan et al., 1998, Salzman, 2010). The percentage of older adults afflicted with gait dysfunction increases from 24 percent at ages 70–74, to 59 percent at ages 80–84 (Verghese et al., 2006). Gait disorders are believed to be the direct and indirect result of aging – specifically after the sixth decade of life – and serve as a robust predictor of morbidity and mortality (Kerrigan et al., 1998, Lo et al., 2015, Mahlknecht et al., 2013, Salzman, 2010). For example, an analysis of 9 cohort studies by Studenski et al. (2011) revealed that gait speed predicted survival rate in older men and women, with 0.8 m/s associated with median life expectancy and 1.0 m/s with better than anticipated life expectancy. Characteristics of older adult gait, such as knee flexion contracture and reduced swing dorsiflexion, have been linked with a loss of mobility and increased risk of falling as well as a reduced capacity to adapt to unexpected perturbations (Begg and Sparrow, 2006, Jensen et al., 2001, Kim et al., 2005, Mollinger and Steffen, 1993). Research on the efficacy of exercise and balance interventions for improving gait have shown some promising results, however the structure and application of these interventions are inconsistent and lack a unified approach (Abbema et al., 2015, Finbarr, 2011). It is vital that researchers identify and validate intervention methods that not only effectively ameliorate the underlying mechanisms of the age-related changes in gait, but also offer a systematic approach for improving gait.
Although research has yet to identify all possible contributors, current literature suggests that dysfunction of gait in older adults stems from musculoskeletal hindrances such as a loss of muscle cross sectional area or arthritis, neurological impairments that reduce speed of movement and make it difficult to process important sources of information like somatosensory input, and psychological constraints such as a fear of falling (Frontera et al., 2000, Gilsing et al., 1995, Huang, 2005, McGibbon and Krebs, 2004, Verghese et al., 2006). Comfortable pace gait, which is a strong determinant of gait efficacy and morbidity, has been shown to decrease by 23% after the age of 65. This reduction is related, in part, to lower muscle torque and power production during the pushoff phase of the gait cycle (Abbema et al., 2015, Anderson and Madigan, 2014, Jerome et al., 2015, Lo et al., 2015, Muir et al., 2014, Studenski et al., 2011). Older adults exhibit observable differences in lower limb coordination with redistribution of torque and power production during the stance phase to more proximal joints such as the hip when compared to younger counterparts (Devita and Hortobaygi, 2000, Anderson and Madigan, 2014). In addition to the reduction of plantar flexor power generation and redistribution of torque and power production to the hip, lower muscular force production has also been linked to kinematic differences between young and older adults that are relevant to whole body dynamic stability. For example, Kang and Dingwell (2008) attributed significantly greater variability of frontal plane trunk roll and sagittal plane trunk pitch in older adults to a loss of leg strength. This may be compounded by fear of falling in older adults, as Sawa et al. (2014) recorded significantly larger trunk anterior/posterior motion variability during gait in afflicted individuals compared to older adults without fear of falling. Clearly, there are both neuromuscular and cognitive factors that contribute significantly to the decline of gait in older adults.
At the ankle, older adults exhibit diminished peak plantar flexion range of motion and plantar flexor torque and power, which may result in a shorter step length and a higher cadence, particularly at faster walking velocities (Anderson and Madigan, 2014, McGibbon and Krebs, 2004, Kerrigan et al., 1998, Prince et al., 1997). Moreover, when older adults achieve faster than comfortable pace velocities, they do so without the aid of an increase in ankle plantar flexion (Kerrigan et al., 1998). The lower values for plantar flexion in older adults are considerably different from values observed in young adults, who achieve anywhere from 3.5 to 13° greater plantar flexion at toe off (Devita and Hortobaygi, 2000, McGibbon and Krebs, 2004, Begg and Sparrow, 2006). The reduction in peak plantar flexion angle at pushoff has been shown to directly correlate with the reduction in plantar flexor power generation in late stance in older adults (McGibbon and Krebs, 2004). In addition to the changes that occur at the ankle during the stance phase, older adults exhibit reduced dorsiflexion during the swing phase, which could result in an increased risk of tripping (Begg and Sparrow, 2006, Mickelborough et al., 2004).
Studies on age-related changes in knee kinematics at heel contact and during the weight absorption phase in early stance are mixed with some authors reporting a more flexed knee at heel contact in older adults (Devita and Hortobaygi, 2000) or no difference between young and older adults (Begg and Sparrow, 2006) and either an increase in knee flexion during weight absorption in older adults (McGibbon and Krebs, 2004) or a decrease in knee flexion in older adults during this phase (Devita and Hortobaygi, 2000, Begg and Sparrow, 2006). Additionally, older adults have been shown to suffer a significant loss in knee extensor strength as well as diminished extensor torque and power absorption during the early stance phase (Frontera et al., 2000, Devita and Hortobaygi, 2000). Later in the stance phase at toe-off and during the early swing phase, Begg and Sparrow (2006) found that older adults demonstrated significantly reduced knee flexion angles when compared to younger participants and speculated that the limited knee flexion may have hindered foot clearance, especially when coupled with the reduction in ankle dorsiflexion.
Hip contractures in older adults are common and often result in increased anterior pelvic tilt during comfortable pace and fast paced walking (Kerrigan et al., 2003). This typically results in a more flexed position at the hip throughout the gait cycle (Devita and Hortobaygi, 2000, Anderson and Madigan, 2014). This impairment in hip function was further demonstrated by Anderson and Madigan (2014), who observed a 30% smaller hip extension angle in older adults compared to younger adults. When the hip extension used during gait was compared to the older adult's available hip range of motion, Anderson and Madigan (2014) concluded that older adults lacked sufficient hip extension range of motion to walk with the hip extension angles elicited during gait by young adults. When coupled with reduced plantar flexion range of motion, torque and power production, hip extension range of motion is a key limiting factor in the gait of older adults.
The Alexander Technique (AT) is an educational method designed to prevent habitual interference with the processes that underlie the control of posture and movement (e.g., Alexander, 1923, Alexander, 1932, Cacciatore et al., 2005). Alexander believed that maladaptive control of posture and movement is difficult to change via direct procedures because the very nature of the maladaptive control had rendered sensory feedback processing unreliable. Thus, individuals attempting to make changes would find it difficult to assess whether they had made intended changes or not. Moreover, he argued that specific problems, like dysfunctional gait for example, were best addressed by procedures that initially reorganized the dynamic relations among the head, neck, and spine, what Alexander referred to as the “primary control” (Alexander, 1923), because he thought that axial coordination conditioned muscular tone and movement in the entire musculoskeletal system. The primary control was considered by Alexander and some of his advocates (Alexander, 1932, Alexander, 1941, Jones, 1997, Ludovici, 1933, Macdonald, 1926) as similar to Magnus's (1924) central control, which Magnus thought organized the reflexes that contributed to posture, righting, and the normal distribution of muscle tone. Alexander argued that attempts to address a specific problem without first taking into consideration the integrated working of the whole body, particularly with respect to the primary control, were futile. His rationale was that changes in one part would be achieved by making compensations in other parts and those compensations would inevitably lead to consequences that were more harmful than those associated with the original problem.
Two main processes are involved in initiating a general process of change via the AT. The first is inhibition and the second is direction. Inhibition involves withholding one's initial reaction to a stimulus to move. For example, the thought of rising from a chair leads to an anticipatory set that prepares the body to move in a habitual way to accomplish the intended outcome. Inhibiting the thought (stimulus) to rise from the chair short-circuits the establishment of the anticipatory set and begins to break the habitual reaction to the stimulus to rise from the chair. The second process, direction, follows inhibition, though inhibition and direction also happen concurrently. Direction involves commanding body parts to change their spatial relations without attempting to overtly carry out those commands. Directions are thoughts or wishes and have been described as sending a flow of force to alter the condition of a body part or parts, similar to the way electricity flows along a wire (Macdonald, 1989). The primary directions “let the neck be free to, let the head go forward and up to, let the back lengthen and widen” (Macdonald, 1989, p. 47) are aimed at the primary control to ensure the movement is not compromised by compression of the axial skeleton. Secondary directions, such as “let the knees float forward” can be applied to any body part. The primary and secondary directions serve the important role of directing attention to the means whereby a particular end (goal) can be accomplished. Alexander argued emphatically that focusing on the appropriate means whereby an end could be secured, rather than on the end itself, was the only way to ensure the end was accomplished using a different pattern of coordination. He maintained that end gaining simply reinstated and reinforced the habitual way of moving.
Repeated application of inhibition and direction to specific activities, initially, and then to all activities of daily living, is associated with a gradual reorganization in primary control, an improvement in the reliability of sensory feedback, greater self-awareness and self-control, and ultimately, and indirectly, to remediation of a host of specific problems for which an individual might have originally sought the Alexander Technique. The whole process brings habitual psychophysical reactions to stimuli under conscious control so that maladaptive postures and movements can be replaced by more appropriate ones (e.g., Alexander, 1923, Alexander, 1932).
An expanding body of research suggests that the AT can relieve specific chronic conditions that interfere with activities of daily living. For example, in a large randomized controlled trial, Little et al. (2008) found that exercise prescription and nurse counseling, 6 sessions of massage, 6 lessons in the AT, and 24 lesson in the AT were associated with a reduction in days of back pain and a reduction in activities impeded by back pain at a 3-month follow up after the interventions. However, only lessons in the AT still had a beneficial effect on pain and activity participation at a 12-month follow up. Similarly, a case study by Cacciatore et al. (2005), showed that a participant with left-sided idiopathic lumbosacral pain not only showed a marked decrease in back pain after receiving 20 AT lessons, but also exhibited better balance, and more appropriate and less asymmetric automatic postural responses to unexpected lateral surface translations.
A later study by Cacciatore et al. (2011b) found that licensed AT teachers exhibited lower axial rigidity when standing upon a surface that oscillated around the vertical axis when either their neck, trunk, or hips were experimentally fixated compared to age-matched controls. The differences suggested enhanced dynamic regulation of postural tone in the AT teachers. In a companion study, participants with lower back pain showed a 29% reduction in axial stiffness following 20 lessons in the AT over a 10-week period. Other reported effects of the AT include reductions in chronic neck pain (MacPherson et al., 2015), greater respiratory capacity (Austin and Ausubel, 1992), improved functional reach (Dennis, 1999), reduced symptoms of Parkinson's disease (Stallibrass, 1997, Stallibrass et al., 2002, Cohen et al., 2015), better control over sit-to-stand movements (Cacciatore et al., 2011a, Cacciatore et al., 2011b, 2014) and a reduced sense of effort when movements are performed (Jones, 1965).
Most centrally relevant to the current study are three studies that have examined the effects of the AT on balance and gait in older adults. Batson and Barker (2008) reported that ambulatory older adults with a history of falls showed a significant improvement in the Timed Up and Go (TUG; Podsiadlo and Richardson, 1991) test and in the composite score for the Fullerton Advanced Balance scale (FAB; Rose, 2010) after a two-week AT intervention. In a recent randomized, control trial of the effects of twelve weeks of AT training on balance and mobility in older adults with visual impairment, Gleeson and colleagues reported a significant reduction in postural sway in the AT intervention group and a significantly greater AT intervention effect on gait speed and step length for those with a history of multiple falls (Gleeson et al., 2015).
In order to further delineate the effects of AT training on gait behavior in older adults, we conducted a study in our laboratory to compare the gait characteristics of experienced AT teachers with healthy age-matched controls between the ages of 63–75 years (O'Neill et al., 2015). The participants walked along an instrumented walkway at fast and comfortable paces. The AT teachers exhibited a decrease in medio-lateral center of mass (COM) displacement from comfortably paced walking to fast paced walking that was not present in controls. Consequently, the AT teachers had a smaller medio-lateral COM displacement than controls during fast paced walking. AT teachers also demonstrated significantly smaller stride width and lower gait timing variability than controls. These findings suggest that AT teachers have superior control of dynamic stability during gait and potentially a reduced fall risk.
The purpose of the current manuscript is to supplement the temporospatial data reported by O'Neill et al. (2015) with kinematic data collected on the same participants. Given the significant changes that occur with aging in sagittal plane kinematic measures, such as reduced plantar flexion and hip extension at terminal stance and reduced knee and ankle dorsiflexion during swing, our aim was to explore the potential differences in sagittal plane kinematics between AT practitioners and healthy, age-matched controls.
Women's experiences of using the Alexander Technique in the postpartum: ‘…in a way, it's just as beneficial as sleep’
https://doi.org/10.1016/j.midw.2021.103155
Abstract
Background
The postpartum is a transitional period and potentially challenging time of heightened vulnerability for women where self-care is compromised. Mothers can ignore their needs while prioritising baby care. The Alexander Technique (AT) is a holistic self-management technique shown to be effective in managing some psycho-physical tension issues and heightening self-efficacy and self-care. The AT has potential to help compromised aspects of maternal well-being in the postpartum.
Objective
To explore how women familiar with the AT use it for the key postpartum issues of Sleep and rest, one of three superordinate themes identified in a qualitative interview study.
Design
Semi-structured interviews via Skype. Research approach: Interpretative Phenomenological Analysis.
Participants
Seven women, with varying levels of AT experience, 4–13 months postpartum.
Findings
Participants used a variety of self-care strategies through modifying their self-management with respect to Sleep and rest. Identified sub-themes were the ‘knitting’ of maternal and infant sleep, how participants rested using the AT and recognising maladaptive habits.
Key conclusions
Further research into the AT as an approach to supporting perinatal well-being is warranted.
Implications for practice
The AT has significance for self-management, self-care, addressing maternal needs for rest, restorative sleep as well as tension issues in the postpartum.
Introduction
The postpartum is acknowledged as challenging and a time of potential stress due to sleep disruption, hormonal changes and the demands of caring for a newborn, amongst other reasons (Osman, 2014); (Park, 2015). This paper addresses the issues of sleep and rest. Research on perinatal mental health with postnatal depression has received much attention (Silverman et al., 2017; Huang et al., 2020; Alves et al., 2018). Thompson et al. (2002) findings on persisting health problems between eight and 24 weeks postpartum suggest that extreme tiredness was one of the least resolved issues in the postpartum and Doering (2013) notes that few care approaches are available to manage fatigue. Lawson et al. (2015) found evidence revealing an association between poor sleep and impacts on women’s mental health. Sleep, rest and fatigue span the psycho-physical/mind-body realm and can impact well-being. The focus of research into perinatal well-being tends to separate physical from psychological well-being which is a rather reductionist approach based on mind-body duality, separating the physical from the psychological (Wadephul et al., 2020). Additionally, maternal self-care needs may be ignored as mothers respond to their newborn’s demands (Lambermon et al., 2020) leading to feelings of frustration and sacrifice as their own needs become secondary (Kurth et al., 2016).
The Alexander Technique (AT) is a long-established but under-utilised holistic self-management method for bringing about constructive self-change (Woodman et al., 2018). The method is educational, not a passive therapy, although it may have therapeutic effects (Woods et al., 2020). Three central tenets of the AT are that the body and mind cannot be separated, self-management is formed by unconscious habits and the quality of how individuals do what they do (their self-management) has implications for how well they function 1932 (Alexander, 1932, Alexander et al., 2018). The AT therefore ascribes to psycho-physical unity with well-being understood as a whole-person experience.
Stallibrass et al., (2005:151) describe practically that:
‘Pupils of the Alexander technique learn how to change their unconscious habitual responses to stimuli by applying a set of conscious strategies. They learn to consciously inhibit rushing into action (called inhibiting). They also learn how to consciously organise themselves prior to action and during action (called directing) so that movement is led by the head. In particular, they learn how to re-organise the balance of the head in relation to the rest of the body in order to lessen the effort needed to stay upright in gravity.’
The physiological mechanisms of the AT are not understood (Woodman and Moore, 2012) although Cacciatore et al. (2020) suggest that changes in postural tone and body schema play a role in demonstrated clinical effects. Klein et al. (2014) summarise: the AT is a psycho-physical method that helps release unnecessary muscle tension to re-educate detrimental movement patterns through intentional inhibition of unwanted habitual behaviours. The AT is traditionally taught to clients (pupils or students) by qualified Alexander teachers who have undergone a three-year training.
Eldred et al. (2015) found that while the primary motivation for taking AT lessons is to resolve persistent pain, experiencing tension, stress, anxiety or headache are also reasons to learn the AT. Increased coping ability and a reduced sense of stress were found as a benefit for people with Parkinson’s disease alongside reducing associated disability (Stallibrass et al., 2002). Wenham et al. (2018) observed an increase in self-efficacy and self-care through taking AT lessons. Woods et al. (2020) suggest that changes from learning the Technique come from an alteration of a person's relationship to themselves which gives a sense of control, self-acceptance and includes self-compassion. In addition, they report that those learning the AT have described less negative thinking. Psychological aspects of a woman's health impact her pregnancy, the birthing experience and postpartum mental health (Jomeen, 2008). This interview study aimed to explore and gain an understanding of how postpartum women with a range of prior experience of the Alexander Technique use it to manage their psycho-physical health and their maternity experience; specifically how they use it to manage sleep and rest is reported in the following.
Chapter
Teaching Alexander Technique (without Hands) Online
A Study of Kindness
BookTeaching Performance Practices in Remote and Hybrid Spaces
Edition 1st Edition
First Published 2022
Imprint Routledge
Pages 14
eBook ISBN 9781003229056
ABSTRACT
In March 2020, I suddenly had to move my Alexander Technique course online due to the pandemic. Alexander Technique is partially taught through example and description, but primarily taught through the use of the instructors’ hands gently guiding the students to freer movement. In moving the course online, I discovered that Alexander Technique is a study in kindness. I needed to be kind to myself (and playful) to be able to explore new online content successfully and my students needed to be kind to themselves to be able to be open enough physically to take in the work. Alexander Technique is about letting go of harmful habits that you may have learned in your life. It teaches you to release tension and move through the world in a more easeful and energized way. Where kindness comes into play is that the way you speak to yourself in your head causes your body to react in related ways. If you are unkind to yourself, then your body will react to that by creating tension. If you are kind to yourself, your body will react to that by creating ease. The way I describe it to my students is that how you think determines the quality of your container (your body). The quality of your container determines the quality of your life.
Effects of Implementing the Alexander Technique on Enjoying the Sense of Motherhood in the Postpartum Period
Banoofatemeh, Somayeh1; Oreyzi, Hamid Reza2; Bahadoran, Parvin3,
Author Information
Iranian Journal of Nursing and Midwifery Research 22(5):p 392-397, Sep–Oct 2017. | DOI:
10.4103/ijnmr.IJNMR_26_16
Abstract
Background:
The broad concept of maternal well-being includes psychological concepts, social aspects, and aspects of becoming a mother. The present study aimed to investigate the effects of implementing the Alexander technique on enjoying the sense of motherhood.
Materials and Methods:
This study was a clinical trial conducted in two phases. In the first phase, using the exploratory and confirmatory factor analysis, 226 mothers were asked to undergo a scale test of enjoying the sense of motherhood after childbirth. In the second phase, 88 pregnant women were divided into two experimental groups. The data collection tool was a researcher-made questionnaire about enjoying the sense of motherhood. Independent samples t-test, Mann–Whitney test, Chi-square test, Fisher's exact test, analysis of variance test, Box test, and Levine test were used to analyze the data.
Results:
Results of this study showed that the mean scores of the constructs of enjoying pregnancy (P > 0.001), motherhood, and child care satisfaction (P > 0.001) in the experimental group were significantly higher than the control group. Moreover, the construct of trusting their own abilities to cope with maternal duties (P > 0.01) did not show significant differences between the two groups.
Conclusions:
The findings indicated that the Alexander technique can promote mothers’ psychological well-being and their pleasure of becoming a mother and the related constructs. Results also revealed that using this technique, educating and recommending pregnant women to use this technique will be beneficial.
Introduction
Pregnancy is generally considered as a good emotional period for a woman and her family. At the same time, it can endanger pregnant women's psychological health.[1] Pregnancy brings with it different physiological, social, and emotional changes which all influence the maternal well-being.[2] Part of maternal well-being can be enjoying the sense of motherhood which includes constructs such as enjoying the experience of the pregnancy period, trusting one's ability to cope with motherhood duties, and being satisfied with becoming a mother and child care. Contentment and satisfaction with the pregnancy period and childbirth, minimizing problems and limitations, and keeping all aspects of mothers’ health are all effective in the experience of mother from childbirth. Many items are at work in the childbirth experience, particularly the distance between home and hospital, how equipped the hospital is, medical expenses, and even the number of previous children staying alone during the hospitalization of the mother.[3] Trusting one's abilities in coping with parental duties, called self-efficiency, is defined as the ability of parents to organize and perform a series of tasks to raise the child including power and the ability to organize and perform actions to produce better results and situations, which are very important in improving the role of the parents.[4]
Satisfaction with motherhood and parenting is another aspect of enjoying the mother's sense of maternal well-being. Merser (1986) maintains that satisfaction as a father and mother can be defined as a pleasurable sense and contentment, which includes maternal and paternal roles necessary for child care and relationship with the child.[5] During this period, mothers experience plenty of challenges, which can significantly influence enjoyment and satisfaction of child care.[6] The importance of such factors is quite obvious during pregnancy and after childbirth. Because a pregnant woman should promote her physical and mental abilities to become a mother, her well-being is of prime importance compared to other stages of life.[7] The Alexander technique is one of the methods and behaviors used in improving health and mental well-being.[8]. It is a motor skill which helps people how to treat their body. This method corrects body stance, relieves muscle contraction, and makes body movement easier. This technique is very helpful, especially during pregnancy when one must carry the embryo.[9] In fact, this technique claims that an improper body posture not only has a devastating effect on the body but also affects the psyche and well-being of the person involved. Alexander, as a technique involving different experiences, showed that it improves neuromuscular coordination and leads to a better performance of the individual as a part of the whole. Pregnancy is a period full of tension, and practicing the Alexander technique helps the mother to keep her balance.[10] This technique can be used in pregnancy in different cases. It decreases or even prevents irritation or pain in the back, shoulder, hip, knee, or feet, difficulty in breathing, digestion problems, carpal tunnel syndrome, boredom, and depression,[11] however, most of these items have not been studied enough.
Using this technique is beneficial after childbirth when the body slowly regains its former shape. Moreover, this technique helps create a positive attitude towards changes taking place in family roles. The basic principles of this technique are very easy; they provide comfort and convenience.[12] When physical structure of the mother is free from pain and tension, she would have a positive outlook about life, and maternal well-being improves as a result.[8] There is definite evidence about the fact that physical exercise decreases depression and anxiety and improves women's well-being by creating a positive outlook.[13] Because this technique is a subcategory of massage therapy of complementary medicine, it can be implemented by midwives.[14] Bahadoran et al. (2012) showed that physical exercise improves maternal well-being and decreases depression.[15] Moreover, Deli et al. (2007) showed that teaching well-being promotion behaviors such as exercising is an effective way to cure depression and other postpartum problems.[16] In a study by Margarret Christel (2001), the Alexander technique was used as a powerful method to improve mental and physical well-being in connective tissue disorders. She believed that this technique is a tool to improve physical health and a sense of well-being because of meditation and attention to everyday life activities.[17]
Mother's mental disorder can have negative effects on family performance, as well as the cognitive, emotional, and social development of the child apart from short-term side effects. Therefore, interventions in the prenatal period seem to be integral in improving the mother's mental well-being.
The Alexander technique is the type of method that can be used very easily. Moreover, the application of this technique is inexpensive and affordable because it does not require any special expertise and equipment.[18] This study aimed at studying the effects of the Alexander technique on enjoying motherhood sense of maternal well-being in women who went to health care institutes in Golpayegan.
“I never thought I could do that…”: Findings from an Alexander Technique pilot group for older people with a fear of falling
https://doi.org/10.1016/j.eujim.2017.11.008
Abstract
Introduction
Fear of falling is a major problem facing the health care system. No clear evidence exists as to the most effective management approach although a need for both psychological and physical intervention is recognised. The Alexander Technique (AT) is primarily an educational holistic self-management approach which improves balance and has psychological benefits. This small scale mixed methods exploratory pilot study investigated changes following, and acceptability of, an AT group intervention for older people with a fear of falling.
Methods
Twelve volunteers aged ≥ 65 years with a fear of falling took part in a nine-week, 12 session AT group intervention. They completed a range of standardised measures at 4 time points (baseline, immediately pre and post intervention, and one month post intervention). A sub-group participated in a focus group discussion following the group intervention. Quantitative data were analysed using non-parametric statistics, with thematic analysis employed for qualitative data.
Results
The fear of falling primary outcome measure and other quantitative results were inconclusive, however focus group qualitative data suggested some profound changes with improvements in movement, mood and confidence. A combination of awareness and acceptance led participants to feel empowered to make adjustments to their activity. Participants found learning the AT enjoyable and were able to use it to advantage in everyday activities.
Conclusions
The intervention had a positive impact on falls-related and physical skills, and psychological well-being. This supports its potential as a useful intervention for older people with a fear of falling, larger scale studies are merited.
Introduction
Fear of falling is a major problem facing the health care system, [1] and one which is likely to increase as the population ages. Fear of falling is both a predictor of actual falls [2] and a cause of inactivity and social withdrawal, with all the attendant physical and psychological issues [2], [3]. The UK National Service Framework for older people [4] and UK National Institute for Health and Care Excellence guidance [5] highlight the potential for increased dependency, social isolation and psychological health problems as a consequence of falls. There is no clear evidence as to the most effective approach to managing fear of falling except that there seems to be a need for both a psychological and physical intervention [6]. Approaches combining Tai chi and cognitive behavioural therapy (CBT) have shown promising outcomes [7] but, to date, a single integrated approach to managing this significant problem has remained elusive.
Despite the evidence that fear of falling is a major risk factor for actual falling, UK falls services tend to work with those who have already fallen and focus on exercises to develop strength and improve balance, alongside practical assessments of hazards within the person’s home, their vision and medication [5]. This approach, however, does not provide strategies which can be used in the context of daily life inside and outside the home. An approach that not only helps to prevent falls but also increases confidence and wellbeing is likely to yield much greater benefits. For example, increased confidence may lead to greater social participation, particularly outside of the home, thus ameliorating the negative effects of social isolation on older people’s health [8]. Additionally, group interventions which aim to increase social participation have been shown not only to improve physical health, but also to reduce the number of falls [9]. An intervention that aims to reduce fear of falling may, therefore, reduce the number of falls through both increased confidence and resultant increased social participation.
The Alexander Technique (AT) is primarily an educational holistic self-management approach which helps people gain greater control over their reactions, increase their self-awareness and recognise and reduce harmful postural and movement habits through cognitive change. The AT can be used and applied in all situations in everyday life. The AT is based on the premise that mind and body are indivisible and outcomes of training in the AT reflect this in that they encompass changes in movement co-ordination, adaptability of muscle tone, posture and gait [10], [11], [12], [13], [14], [15], improvement in mood [16], confidence and sense of wellbeing [17]. A systematic literature review suggests that the AT is beneficial in health settings [18].
Three group studies of older people have reported improvement in balance following training in AT [19], [20], [13]. Two studies [20], [13] included a fear of falling measure, however, no significant improvement was found. The short time period of one study and the visual impairment of participants in the other may explain this lack of significance. One case study has also reported significant improvements in balance and automatic balance recovery following one-to-one AT lessons [21].
Studies have shown psychological benefits for individuals who learn the AT. Participants with Parkinson’s disease with an age range of 64 to 66 used the AT to help them relax and cope with panic and stress [22], they also experienced a reduction in depression [16]. People learning the AT have qualitatively reported psychological benefits, including an increase in self-awareness and presence in the world; they have also talked about feeling more optimistic about growing older [17]. There are reports of greater perceptions of control and increased confidence following AT lessons [23], [17].
In addition, AT lessons have been found to be acceptable to trial participants who, in the main, enjoy the process of learning the AT [23]. There is also evidence that individuals who learn the AT continue to use their skills in the long term. At six months follow up, in the study of a one to one AT intervention for people with Parkinson’s disease, all participants were still using their AT skills in their daily lives [22].
The AT is therefore a self-management approach which can help people to develop the ability to co-ordinate themselves quickly and efficiently in any situation thus allowing improved balance and movement. In addition it can build confidence and increase a sense of wellbeing. It is acceptable to individuals and is used in the long term by those who have learnt it. The AT has the potential to provide a much needed holistic approach to address fear of falling which presents a major risk in the older population. This pilot study had the primary aim of investigating outcomes following an AT group intervention for older people with a fear of falling. A secondary aim was to explore feasibility and acceptability of the AT delivered in a group format.
Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial
Authors: Hugh MacPherson, BSc, PhD, Helen Tilbrook, BSc, MSc, Stewart Richmond, BSc, MSc, PhD, Julia Woodman, BSc, PhD, Kathleen Ballard, BSc, PhD, Karl Atkin, BA, DPhil, Martin Bland, BSc, PhD, … Show All … , and Ian Watt, BSc, MB, ChB, MPHAuthor, Article, & Disclosure Information
Publication: Annals of Internal Medicine
Volume 163, Number 9
https://doi.org/10.7326/M15-0667
Background:
Management of chronic neck pain may benefit from additional active self-care–oriented approaches.
Objective:
To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.
Design:
Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354)
Setting:
U.K. primary care.
Participants:
Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology.
Intervention:
12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone.
Measurements:
NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes).
Results:
517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention.
Limitation:
Practitioners belonged to the 2 main U.K.-based professional associations, which may limit generalizability of the findings.
Conclusion:
Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained.
Primary Funding Source:
Arthritis Research UK.
Self-efficacy and embodiment associated with Alexander Technique lessons or with acupuncture sessions: A longitudinal qualitative sub-study within the ATLAS trial
https://doi.org/10.1016/j.ctcp.2018.03.009
Abstract
Background and purpose
A large randomised controlled trial found that the provision of either Alexander Technique lessons or acupuncture, for those with chronic neck pain, resulted in significantly increased self-efficacy when compared with usual care alone. In turn, enhanced self-efficacy was associated with significant reductions in neck pain at 6 and 12 months. In this analysis we explore the perspectives of participants within the trial, with the aim of gaining a better understanding of how these interventions had an impact.
Methods
We used a longitudinal qualitative approach; in-depth interviews, informed by a topic guide, were conducted with a sample of the trial population. Participants were interviewed twice: at around six months (n = 30) and twelve months (n = 26) after trial entry. Analysis was guided by the principles of grounded theory, and key themes were developed.
Results
Five key themes emerged: pre-trial experiences of biomedical treatment against which subsequent interventions were compared; emergence of tangible benefits from the interventions; factors that contributed to the observed benefits, notably growing self-care and self-efficacy; a developing sense of embodiment as an integral part of the transformative process; and contribution of these factors to sustaining benefits over the longer term.
Conclusions
In-depth interviews revealed a rich array of experiences. They gave insight into the positive impact of the interventions on development of self-care, self-efficacy and embodiment. These findings complement the quantitative trial data, providing a more nuanced understanding of the factors that underpin the previously quantified improvement in self-efficacy and its association with longer-term reductions in pain.
Iran Red Crescent Med J. 2016 Sep; 18(9): e31218.
Published online 2016 Aug 9. doi: 10.5812/ircmj.31218
PMCID: PMC5253206
PMID: 28144457
Alexander Technique Training Coupled With an Integrative Model of Behavioral Prediction in Teachers With Low Back Pain
Abstract
Background
Individuals suffering from chronic low back pain (CLBP) experience major physical, social, and occupational disruptions. Strong evidence confirms the effectiveness of Alexander technique (AT) training for CLBP.
Objectives
The present study applied an integrative model (IM) of behavioral prediction for improvement of AT training.
Methods
This was a quasi-experimental study of female teachers with nonspecific LBP in southern Tehran in 2014. Group A contained 42 subjects and group B had 35 subjects. In group A, AT lessons were designed based on IM constructs, while in group B, AT lessons only were taught. The validity and reliability of the AT questionnaire were confirmed using content validity (CVR 0.91, CVI 0.96) and Cronbach’s α (0.80). The IM constructs of both groups were measured after the completion of training. Statistical analysis used independent and paired samples t-tests and the univariate generalized linear model (GLM).
Results
Significant differences were recorded before and after intervention (P < 0.001) for the model constructs of intention, perceived risk, direct attitude, behavioral beliefs, and knowledge in both groups. Direct attitude and behavioral beliefs in group A were higher than in group B after the intervention (P < 0.03).
Conclusions
The educational framework provided by IM for AT training improved attitude and behavioral beliefs that can facilitate the adoption of AT behavior and decreased CLBP.