<p>Abstract Narrative is ever present in medicine and is an integral aspect of the doctor and patient relationship. Although theoretical discussions of narrative medicine and narrative ethics are important, they may serve to reify the patient's story, to make it a specific entity. In practice, the patient's story unfolds in the moment of communication depending on the individuals and the circumstances; the story is not an "object." Patients' narratives heard in clinical settings are often limited by physician behaviors, especially the tendency of physicians to control the interaction with the patient. To develop individual narratives effectively and competently, physicians must be able to help the patient tell the story that is most important, meaningful, and descriptive of the situation. If the patient's narrative is not heard fully, the possibility of diagnostic and therapeutic error increases, the likelihood of personal connections resulting from a shared experience diminishes, empathic opportunities are missed, and patients may not feel understood or cared for. The practice of mindfulness—moment-to-moment, nonjudgmental awareness—opens a doorway into the patient's story as it unfolds. Such mindful practice develops the physician's focus of attention and offers the possibility for a meaningful and important narrative to arise between patient and physician.</p>
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Summary
This paper reviews the philosophical origins, current scientific evidence, and clinical promise of yoga and mindfulness as complementary therapies for addiction. Historically, there are eight elements of yoga that, together, comprise ethical principles and practices for living a meaningful, purposeful, moral and self-disciplined life. Traditional yoga practices, including postures and meditation, direct attention toward one's health, while acknowledging the spiritual aspects of one's nature. Mindfulness derives from ancient Buddhist philosophy, and mindfulness meditation practices, such as gentle Hatha yoga and mindful breathing, are increasingly integrated into secular health care settings. Current theoretical models suggest that the skills, insights, and self-awareness learned through yoga and mindfulness practice can target multiple psychological, neural, physiological, and behavioral processes implicated in addiction and relapse. A small but growing number of well-designed clinical trials and experimental laboratory studies on smoking, alcohol dependence, and illicit substance use support the clinical effectiveness and hypothesized mechanisms of action underlying mindfulness-based interventions for treating addiction. Because very few studies have been conducted on the specific role of yoga in treating or preventing addiction, we propose a conceptual model to inform future studies on outcomes and possible mechanisms. Additional research is also needed to better understand what types of yoga and mindfulness-based interventions work best for what types of addiction, what types of patients, and under what conditions. Overall, current findings increasingly support yoga and mindfulness as promising complementary therapies for treating and preventing addictive behaviors.
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<p>This special issue focuses on new developments that make up the expanding envelope of mindfulness-based psychological research. Briefly, the articles in this issue include the description and validation of a trait version of the Toronto Mindfulness Scale, an exploration of the mechanisms underlying the association between increased mindfulness and psychological adjustment, an investigation of whether practicing mindfulness between sessions contributes to symptom improvement, a study of the neural mechanisms underlying increased mindfulness in social anxiety disorder (SAD), and finally an evaluation of whether attachment style moderates participant response to mindfulness-based stress reduction (MBSR). The articles in this current special issue provide examples of recent areas of investigation in the pursuit of better understanding the growing clinical application of mindfulness-based interventions in Western health care. Potentially, these ongoing efforts will further improve the effectiveness of these treatments to reduce suffering.</p>
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After years of meditating, are you still saddled with many of the same personal conflicts and interpersonal inhibitions that plagued you before you began? Rubin explores the hidden flaws in the meditative method itself. He explores Buddhism's ambivalent relationship to emotional life, and the negative consequences of "letting go" of experience. Detaching from experience may result in renouncing vital aspects of ourselves, such as constructive passion. The author argues that real meditation is transformative not tranquilizing, fostering a dynamic way of living.
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Most research on the impact of mind-body training does not ask about participants' baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable.
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<p>Abstract— This article reviews the current state of research on contemplative practices with children and youth. It reviews contemplative practices used both in treatment settings and in prevention or health promotion contexts, including school-based programs. Although there is great interest and potential promise for contemplative interventions, enthusiasm for promoting such practices outweighs the current evidence supporting them. Interventions that nurture mindfulness in children and youth may be a feasible and effective method of building resilience in universal populations and in the treatment of disorders in clinical populations. This review suggests that meditation and yoga may be associated with beneficial outcomes for children and youth, but the generally limited quality of research tempers the allowable conclusions. Well-designed experimental studies that are grounded in developmental theory and measure multiple indicators of change must fully test the efficacy of such interventions.</p>
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<p>ABSTRACTIn order to identify potential training to enhance comprehensive soldier fitness, this analysis searched MEDLINE via PubMed and elsewhere for 33 reasonably significant modalities, screening over 11,500 articles for relevance regarding soldier resilience. Evaluation of modalities that are exclusively educational or cognitive/behavioral in nature is deferred. Using the volume and quality of research over 40 parameters distributed among the five domains of resilience (physical, emotional, spiritual, social, and family life), these data allow culling of most of the meditative modalities and discrimination among the remaining techniques. The resulting order of merit is Transcendental Meditation, mindfulness, and progressive muscle relaxation. Transcendental Meditation, mindfulness, and progressive muscle relaxation, in that order, have the most supporting data. Fortuitously, they also represent a cross section of the domain of techniques regarded as meditation, stress management, or relaxation, with three very different mechanisms of action. They are suitable potential options for improving soldier resilience.</p>
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Oxygen consumption, heart rate, skin resistance, and electroenceph-alograph measurements were recorded before, during, and after subjects practiced a technique called transcendental meditation. There were significant changes between the control period and the meditation period in all measurements. During meditation, oxygen consumption and heart rate decreased, skin resistance increased, and the electroencephalogram showed specific changes in certain frequencies. These results seem to distinguish the state produced by transcendental meditation from commonly encountered states of consciousness and suggest that it may have practical applications.
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Objectives: To examine whether mindfulness meditation (MM) was associated with changes in objectively measured polysomnographic (PSG) sleep profiles and to relate changes in PSG sleep to subjectively reported changes in sleep and depression within the context of a randomized controlled trial. Previous studies have indicated that mindfulness and other forms of meditation training are associated with improvements in sleep quality. However, none of these studies used objective PSG sleep recordings within longitudinal randomized controlled trials of naïve subjects.
Methods: Twenty-six individuals with partially remitted depression were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep and depression symptoms.
Results: According to PSG sleep, MM practice was associated with several indices of increased cortical arousal, including more awakenings and stage 1 sleep and less slow-wave sleep relative to controls, in proportion to amount of MM practice. According to sleep diaries, subjectively reported sleep improved post MBCT but not above and beyond controls. Beck Depression Inventory scores decreased more in the MBCT group than controls. Improvements in depression were associated with increased subjective sleep continuity and increased PSG arousal.
Conclusions: MM is associated with increases in objectively measured arousal during sleep with simultaneous improvements in subjectively reported sleep quality and mood disturbance. This pattern is similar to the profiles of positive responders to common antidepressant medications.
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<p>Early childhood is marked by substantial development in the self-regulatory skills supporting school readiness and socioemotional competence. Evidence from developmental social cognitive neuroscience suggests that these skills develop as a function of changes in a dynamic interaction between more top-down (controlled) regulatory processes and more bottom-up (automatic) influences on behavior. Mindfulness training—using age-appropriate activities to exercise children's reflection on their moment-to-moment experiences—may support the development of self-regulation by targeting top-down processes while lessening bottom-up influences (such as anxiety, stress, curiosity) to create conditions conducive to reflection, both during problem solving and in more playful, exploratory ways.</p>
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<p>This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients ( n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.</p>
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Objective: A cross-sectional survey of quality of life of people attending a self-development course involving psychophysiological mind-body medicine (MBM) activities. Design: A questionnaire study using a health-related quality of life (HRQoL) instrument, the SWED-QUAL, with 13 subscales scored 0-100, and questions about utilisation of alternative and standard health care, medication and sick leave. Setting: A training centre for MBM, established 15 years ago. Study group: One hundred and seven eligible course attendants (response rate 88%, age 20-70 years) during the year 2000 assessed their HRQoL just before entering the course. Attendance was self-initiated, without referral. The results on HRQoL were compared with those of control subjects from the general Swedish population. Results: Six of the thirteen HRQoL subscales were strongly and significantly reduced (p < 0.0001) in the study group: Negative affectivity, Role limitation due to emotional health, Positive affectivity, Cognitive functioning, Family functioning and Marital functioning. Long-term sick leave (>6 months) was three times as frequent in the study group as in the general population. Use of psychotropic medication was slightly increased compared to the general population, at least among the younger male participants. The education level was high, health care utilisation was average and body functioning was good. Conclusions: This group of well-educated men and women gave their emotional health an unexpectedly low rating, on a par with that given by people with chronic diseases.
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Objectives: Considerable morbidity persists among survivors of breast cancer (BC) including high levels of psychological stress, anxiety, depression, fear of recurrence, and physical symptoms including pain, fatigue, and sleep disturbances, and impaired quality of life. Effective interventions are needed during this difficult transitional period. Methods: We conducted a randomized controlled trial of 84 female BC survivors (Stages 0–III) recruited from the H. Lee Moffitt Cancer and Research Institute. All subjects were within 18 months of treatment completion with surgery and adjuvant radiation and/or chemotherapy. Subjects were randomly assigned to a 6-week Mindfulness-Based Stress Reduction (MBSR) program designed to self-regulate arousal to stressful circumstances or symptoms (n=41) or to usual care (n=43). Outcome measures compared at 6 weeks by random assignment included validated measures of psychological status (depression, anxiety, perceived stress, fear of recurrence, optimism, social support) and psychological and physical subscales of quality of life (SF-36). Results: Compared with usual care, subjects assigned to MBSR(BC) had significantly lower (two-sided p<0.05) adjusted mean levels of depression (6.3 vs 9.6), anxiety (28.3 vs 33.0), and fear of recurrence (9.3 vs 11.6) at 6 weeks, along with higher energy (53.5 vs 49.2), physical functioning (50.1 vs 47.0), and physical role functioning (49.1 vs 42.8). In stratified analyses, subjects more compliant with MBSR tended to experience greater improvements in measures of energy and physical functioning. Conclusions: Among BC survivors within 18 months of treatment completion, a 6-week MBSR(BC) program resulted in significant improvements in psychological status and quality of life compared with usual care. Copyright © 2009 John Wiley & Sons, Ltd
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Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being
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When Dr. Herbert Benson introduced this simple, effective, mind/body approach to relieving stress twenty-five years ag, his book became an instant national bestseller. Since that time, millions of people have learned the secret--without high-priced lectures or prescription medicines. The Relaxation Response has become the classic reference recommended by most health care professionals and authorities to treat the harmful effects of stress.Discovered by Dr. Benson and his colleagues in the laboratories of Harvard Medical School and its teaching hospitals, this revitalizing, therapeutic approach is now routinely recommended to treat patients suffering from heart conditions, high blood pressure, chronic pain, insomnia, and many other physical ailments. It requires only minutes to learn, and just ten to twenty minutes of practice twice a day.
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The current study investigated the effects of an 8-week mindfulness-based meditation training (MMT) intervention on attentional bias, engagement and disengagement of pain-related threat in fibromyalgia patients as compared to an age-matched control group. A well validated dot-probe task was used to explore early versus later stages of attentional processing through the use of two stimulus exposure durations (100, 500 ms) of pain-related threat words. The enduring effects of MMT were assessed 6-months after completion of MMT. Preliminary results suggest that MMT reduces avoidance of pain-related threat at early levels of processing, and facilitates disengagement from threat at later stages of processing. Furthermore, it appears that effects of MMT on early attentional threat processing do not remain stable after long-term follow-up.
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<p>Background : Recent research suggests that the Mindfulness-Based Stress Reduction program has positive effects on health, but little is known about the immediate physiological effects of different components of the program. Purpose : To examine the short-term autonomic and cardiovascular effects of one of the techniques employed in mindfulness meditation training, a basic body scan meditation. Methods : In Study 1, 32 healthy young adults (23 women, 9 men) were assigned randomly to either a meditation, progressive muscular relaxation or wait-list control group. Each participated in two laboratory sessions 4 weeks apart in which they practiced their assigned technique. In Study 2, using a within-subjects design, 30 healthy young adults (15 women, 15 men) participated in two laboratory sessions in which they practiced meditation or listened to an audiotape of a popular novel in counterbalanced order. Heart rate, cardiac respiratory sinus arrhythmia (RSA), and blood pressure were measured in both studies. Additional measures derived from impedance cardiography were obtained in Study 2. Results : In both studies, participants displayed significantly greater increases in RSA while meditating than while engaging in other relaxing activities. A significant decrease in cardiac pre-ejection period was observed while participants meditated in Study 2. This suggests that simultaneous increases in cardiac parasympathetic and sympathetic activity may explain the lack of an effect on heart rate. Female participants in Study 2 exhibited a significantly larger decrease in diastolic blood pressure during meditation than the novel, whereas men had greater increases in cardiac output during meditation compared to the novel. Conclusions : The results indicate both similarities and differences in the physiological responses to body scan meditation and other relaxing activities.</p>
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<p>Counselling psychology is increasingly curious regarding the benefits of mindfulness and meditation. This research explores the relationship between the clinical work of psychotherapists and their long-term Buddhist-informed meditation. This is an emerging and cross-cultural field. Thorne's (2008) interpretive description guided this exploratory qualitative study of the experiences of four registered psychologists. This study finds that meditation supports an unconditional, compassionate therapeutic stance that serves therapy through the development of the therapeutic relationship. Further, Buddhist-informed meditation appears to promote integrative functioning in the therapists and is related to integrated clinical decision-making. This study dips into areas of transpersonal and Buddhist psychology that require further culturally-sensitive investigation. Future directions for research are presented.</p>
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