BackgroundDepression is a common condition that typically has a relapsing course. Effective interventions targeting relapse have the potential to dramatically reduce the point prevalence of the condition. Mindfulness-based cognitive therapy (MBCT) is a group-based intervention that has shown efficacy in reducing depressive relapse. While trials of MBCT to date have met the core requirements of phase 1 translational research, there is a need now to move to phase 2 translational research - the application of MBCT within real-world settings with a view to informing policy and clinical practice. The aim of this trial is to examine the clinical impact and health economics of MBCT under real-world conditions and where efforts have been made to assess for and prevent resentful demoralization among the control group. Secondary aims of the project involve extending the phase 1 agenda to an examination of the effects of co-morbidity and mechanisms of action.
Methods/Design
This study is designed as a prospective, multi-site, single-blind, randomised controlled trial using a group comparison design between involving the intervention, MBCT, and a self-monitoring comparison condition, Depression Relapse Active Monitoring (DRAM). Follow-up is over 2 years. The design of the study indicates recruitment from primary and secondary care of 204 participants who have a history of 3 or more episodes of Major Depression but who are currently well. Measures assessing depressive relapse/recurrence, time to first clinical intervention, treatment expectancy and a range of secondary outcomes and process variables are included. A health economics evaluation will be undertaken to assess the incremental cost of MBCT.
Discussion
The results of this trial, including an examination of clinical, functional and health economic outcomes, will be used to assess the role that this treatment approach may have in recommendations for treatment of depression in Australia and elsewhere. If the findings are positive, we expect that this research will consolidate the evidence base to guide the decision to fund MBCT and to seek to promote its availability to those who have experienced at least 3 episodes of depression.
Negative humor styles are associated with rumination, aggression, and suicidal ideation. BPD features are positively associated with negative humor styles; however, few studies have identified factors that mediate this relationship. The present study examines mindfulness skills as a mediator of the link between BPD features and negative humor styles, in a sample of undergraduate students (N = 197), many reporting clinically significant levels of BPD features. Significant indirect effects suggest that individuals with higher BPD features engage in more aggressive humor style partially due to lower levels of nonreactivity. However, individuals with higher BPD features engage in more self-defeating humor style partially due to lower levels of acting with awareness. Higher BPD features were related to less positive humor styles partially due to low describe scores. These findings suggest that different facets of mindfulness skills may assist in decreasing negative and increasing positive humor styles.
OBJECTIVES:Major depressive disorder is a significant mental illness that is highly likely to recur, particularly after three or more previous episodes. Increased mindfulness and decreased rumination have both been associated with decreased depressive relapse. The aim of this study was to investigate whether rumination mediates the relationship between mindfulness and depressive relapse.
DESIGN:
This prospective design involved a secondary data analysis for identifying causal mechanisms using mediation analysis.
METHODS:
This study was embedded in a pragmatic randomized controlled trial of mindfulness-based cognitive therapy (MBCT) in which 203 participants (165 females, 38 males; mean age: 48 years), with a history of at least three previous episodes of depression, completed measures of mindfulness, rumination, and depressive relapse over a 2-year follow-up period. Specific components of mindfulness and rumination, being nonjudging and brooding, respectively, were also explored.
RESULTS:
While higher mindfulness scores predicted reductions in rumination and depressive relapse, the relationship between mindfulness and relapse was not found to be mediated by rumination, although there appeared to be a trend.
CONCLUSIONS:
Our results strengthen the argument that mindfulness may be important in preventing relapse but that rumination is not a significant mediator of its effects. The study was adequately powered to detect medium mediation effects, but it is possible that smaller effects were present but not detected.
PRACTITIONER POINTS:
Mindfulness may be one of several components of MBCT contributing to prevention of depressive relapse. Although the original rationale for MBCT rested largely on a model of relapse causally linked to rumination, our findings suggest that the mechanism by which mindfulness impacts relapse is more complex than a simple effect on rumination.
Have we used up all our resources? Have we filled up all the livable space on Earth? Paul Gilding suggests we have, and the possibility of devastating consequences, in a talk that's equal parts terrifying and, oddly, hopeful.
Have we used up all our resources? Have we filled up all the livable space on Earth? Paul Gilding suggests we have, and the possibility of devastating consequences, in a talk that's equal parts terrifying and, oddly, hopeful.
Hawken's impassioned argument—that business both causes the most egregious abuses of the environment and, crucially, holds the most potential for solving our sustainability problems—is more relevant and resonant than ever.Containing updated and revised material for a new audience, The Ecology of Commerce presents a compelling vision of the restorative (rather than destructive) economy we must create, centered on eight imperatives:
Reduce energy carbon emissions 80 percent by 2030 and total natural resource usage 80 percent by 2050.
Provide secure, stable, and meaningful employment to people everywhere.
Be self-organizing rather than regulated or morally mandated.
Honor market principles.
Restore habitats, ecosystems, and societies to their optimum.
Rely on current income.
Be fun and engaging, and strive for an aesthetic outcome.
The world has changed in the seventeen years since the controversial initial publication of Paul Hawken's Ecology of Commerce, a stirring treatise about the perceived antagonism between ecology and business. Yet Hawken's impassioned argument—that business both causes the most egregious abuses of the environment and, crucially, holds the most potential for solving our sustainability problems—is more relevant and resonant than ever.Containing updated and revised material for a new audience, The Ecology of Commerce presents a compelling vision of the restorative (rather than destructive) economy we must create, centered on eight imperatives: Reduce energy carbon emissions 80 percent by 2030 and total natural resource usage 80 percent by 2050. Provide secure, stable, and meaningful employment to people everywhere. Be self-organizing rather than regulated or morally mandated. Honor market principles. Restore habitats, ecosystems, and societies to their optimum. Rely on current income. Be fun and engaging, and strive for an aesthetic outcome.
PURPOSE: A randomized phase II study was performed to measure the potential therapeutic effects of yoga on fatigue, erectile dysfunction, urinary incontinence, and overall quality of life (QOL) in prostate cancer (PCa) patients undergoing external beam radiation therapy (RT).METHODS AND MATERIALS: The participants were randomized to yoga and no-yoga cohorts (1:1). Twice-weekly yoga interventions were offered throughout the 6- to 9-week courses of RT. Comparisons of standardized assessments were performed between the 2 cohorts for the primary endpoint of fatigue and the secondary endpoints of erectile dysfunction, urinary incontinence, and QOL before, during, and after RT.
RESULTS: From October 2014 to January 2016, 68 eligible PCa patients underwent informed consent and agreed to participate in the study. Of the 68 patients, 18 withdrew early, mostly because of treatment schedule-related time constraints, resulting in 22 and 28 patients in the yoga and no-yoga groups, respectively. Throughout treatment, those in the yoga arm reported less fatigue than those in the control arm, with global fatigue, effect of fatigue, and severity of fatigue subscales showing statistically significant interactions (P<.0001). The sexual health scores (International Index of Erectile Function Questionnaire) also displayed a statistically significant interaction (P=.0333). The International Prostate Symptom Score revealed a statistically significant effect of time (P<.0001) but no significant effect of treatment (P=.1022). The QOL measures had mixed results, with yoga having a significant time by treatment effect on the emotional, physical, and social scores but not on functional scores.
CONCLUSIONS: A structured yoga intervention of twice-weekly classes during a course of RT was associated with a significant reduction in pre-existing and RT-related fatigue and urinary and sexual dysfunction in PCa patients.
BACKGROUND:Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial.
OBJECTIVES:
To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action.
DESIGN:
Single-blind, parallel, individual randomised controlled trial.
SETTING:
UK general practices.
PARTICIPANTS:
Adult patients with a diagnosis of recurrent depression and who were taking m-ADM.
INTERVENTIONS:
Participants were randomised to MBCT-TS or m-ADM with stratification by centre and symptomatic status. Outcome data were collected blind to treatment allocation and the primary analysis was based on the principle of intention to treat. Process studies using quantitative and qualitative methods examined MBCT's acceptability and mechanism of action.
MAIN OUTCOMES MEASURES:
The primary outcome measure was time to relapse/recurrence of depression. At each follow-up the following secondary outcomes were recorded: number of depression-free days, residual depressive symptoms, quality of life, health-related quality of life and psychiatric and medical comorbidities.
RESULTS:
In total, 212 patients were randomised to MBCT-TS and 212 to m-ADM. The primary analysis did not find any evidence that MBCT-TS was superior to m-ADM in terms of the primary outcome of time to depressive relapse/recurrence over 24 months [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.67 to 1.18] or for any of the secondary outcomes. Cost-effectiveness analysis did not support the hypothesis that MBCT-TS is more cost-effective than m-ADM in terms of either relapse/recurrence or quality-adjusted life-years. In planned subgroup analyses, a significant interaction was found between treatment group and reported childhood abuse (HR 1.89, 95% CI 1.06 to 3.38), with delayed time to relapse/recurrence for MBCT-TS participants with a more abusive childhood compared with those with a less abusive history. Although changes in mindfulness were specific to MBCT (and not m-ADM), they did not predict outcome in terms of relapse/recurrence at 24 months. In terms of acceptability, the qualitative analyses suggest that many people have views about (dis)/continuing their ADM, which can serve as a facilitator or a barrier to taking part in a trial that requires either continuation for 2 years or discontinuation.
CONCLUSIONS:
There is no support for the hypothesis that MBCT-TS is superior to m-ADM in preventing depressive relapse/recurrence among individuals at risk for depressive relapse/recurrence. Both treatments appear to confer protection against relapse/recurrence. There is an indication that MBCT may be most indicated for individuals at greatest risk of relapse/recurrence. It is important to characterise those most at risk and carefully establish if and why MBCT may be most indicated for this group.
Stress-induced disorders such as anxiety represent the leading causes of adult disability worldwide. Previous studies indicate that yoga and other contemplative practices such as pranayama, or controlled yogic breathing techniques, may be effective in the treatment of mood disorders and stress. In this study, 142 individuals (mean age = 43 years; SD = 13.90) participated in a 3-day retreat program during which they learned Shambhavi Mahamudra kriya, which is a yogic practice that includes both deep breathing and meditation techniques. Participants were instructed to practice the kriya each day for 21 minutes. After 6 weeks of daily practice, participants reported subjectively lower levels of perceived stress (Perceived Stress Scale) and higher levels of general well-being (General Well-Being Scale) compared to baseline. These results support the notion that Shambhavi Mahamudra kriya may represent a natural treatment for stress reduction.
<h3>Objective</h3><p>To conduct a systematic review of reports on the physical and psychological effects of Tai Chi on various chronic medical conditions.</p><h3>Data Sources</h3><p>Search of 11 computerized English and Chinese databases.</p><h3>Study Selection</h3><p>Randomized controlled trials, nonrandomized controlled studies, and observational studies published in English or Chinese.</p><h3>Data Extraction</h3><p>Data were extracted for the study objective, population characteristics, study setting, type of Tai Chi intervention, study design, outcome assessment, duration of follow-up, and key results.</p><h3>Data Synthesis</h3><p>There were 9 randomized controlled trials, 23 nonrandomized controlled studies, and 15 observational studies in this review. Benefits were reported in balance and strength, cardiovascular and respiratory function, flexibility, immune system, symptoms of arthritis, muscular strength, and psychological effects.</p><h3>Conclusions</h3><p>Tai Chi appears to have physiological and psychosocial benefits and also appears to be safe and effective in promoting balance control, flexibility, and cardiovascular fitness in older patients with chronic conditions. However, limitations or biases exist in most studies, and it is difficult to draw firm conclusions about the benefits reported. Most indications in which Tai Chi was applied lack a theoretical foundation concerning the mechanism of benefit. Well-designed studies are needed.</p>
Objective: To compare the efficacy of Mindfulness-Based Addiction Treatment (MBAT) to a Cognitive Behavioral Treatment (CBT) that matched MBAT on treatment contact time, and a Usual Care (UC) condition that comprised brief individual counseling. Method: Participants (N = 412) were 48.2% African American, 41.5% non-Latino White, 5.4% Latino, and 4.9% other, and 57.6% reported a total annual household income < $30,000. The majority of participants were female (54.9%). Mean cigarettes per day was 19.9 (SD = 10.1). Following the baseline visit, participants were randomized to UC (n = 103), CBT (n = 155), or MBAT (n = 154). All participants were given self-help materials and nicotine patch therapy. CBT and MBAT groups received 8 2-hr in-person group counseling sessions. UC participants received 4 brief individual counseling sessions. Biochemically verified smoking abstinence was assessed 4 and 26 weeks after the quit date. Results: Logistic random effects model analyses over time indicated no overall significant treatment effects (completers only: F(2, 236) = 0.29, p = .749; intent-to-treat: F(2, 401) = 0.9, p = .407). Among participants classified as smoking at the last treatment session, analyses examining the recovery of abstinence revealed a significant overall treatment effect, F(2, 103) = 4.41, p = .015 (MBAT vs. CBT: OR = 4.94, 95% CI: 1.47 to 16.59, p = .010, Effect Size = .88; MBAT vs. UC: OR = 4.18, 95% CI: 1.04 to 16.75, p = .043, Effect Size = .79). Conclusion: Although there were no overall significant effects of treatment on abstinence, MBAT may be more effective than CBT or UC in promoting recovery from lapses.
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Petroleum is now so deeply entrenched in our economy, our politics, and our personal expectations that even modest efforts to phase it out are fought tooth and nail by the most powerful forces in the world: companies and governments that depend on oil revenues; the developing nations that see oil as the only means to industrial success; and a Western middle class that refuses to modify its energy-dependent lifestyle. But within thirty years, by even conservative estimates, we will have burned our way through most of the oil that is easily accessible. And well before then, the side effects of an oil-based society—economic volatility, geopolitical conflict, and the climate-changing impact of hydrocarbon pollution—will render fossil fuels an all but unacceptable solution. How will we break our addiction to oil? And what will we use in its place to maintain a global economy and political system that are entirely reliant on cheap, readily available energy? Brilliantly reported from around the globe, The End of Oil brings the world situation into fresh and dramatic focus for business and general readers alike. Roberts talks to both oil optimists and oil pessimists, delves deep into the economics and politics of oil, considers the promises and pitfalls of alternatives, and shows that, although the world energy system has begun its epoch-defining transition, disruption and violent dislocation are almost assured if we do not take a more proactive stance. With the topicality and readability of Fast Food Nation and the scope and trenchant analysis of Guns, Germs, and Steel, this is a vitally important book for the new century.
<p>"Analysis of the debate over mahāmudrā between Sa skya pas and Bka' brgyud pas; contains much useful information on and extracts from the writings of Sgam po pa and Zhang tshal pa" (Roger R. Jackson, “Mahāmudrā,” in <em>Encyclopedia of Religion</em>, ed. Lindsay Jones, 2nd ed. (Detroit: Macmillan Reference USA, 2005), vol. 8, p. 5601).</p>
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I present the foundational structure for a life-centered theory of environmental ethics. The structure consists of three interrelated components. First is the adopting of a certain ultimate moral attitude toward nature, which I call “respect for nature.” Second is a belief system that constitutes a way of conceiving of the natural world and of our place in it. This belief system underlies and supports the attitude in a way that makes it an appropriate attitude to take toward the Earth’s natural ecosystems and their life communities. Third is a system of moral rules and standards for guiding our treatment of those ecosystems and life communities, a set of normative principles which give concrete embodiment or expression to the attitude of respect for nature. The theory set forth and defended here is, I hold, structurally symmetrical with a theory of human ethics based on the principle of respect for persons.
OBJECTIVE: As pain during childbirth is very intense, several educational programs exist to help women prepare for the event. This study evaluates the efficacy of a specific pain management program, the Bonapace Method (BM), to reduce the perception of pain during childbirth. The BM involves the father, or a significant partner, in the use of several pain control techniques based on three neurophysiological pain modulation models: (1) controlling the central nervous system through breathing, relaxation, and cognitive structuring; (2) using non-painful stimuli as described in the Gate Control Theory; and (3) recruiting descending inhibition by hyperstimulation of acupressure trigger points. METHODS: A multicenter case control study in Quebec on pain perception during labor and delivery compared traditional childbirth training programs (TCTPs) and the BM. Visual analog scales were used to measure pain perception during labor. In all, 25 women (TCTP: n = 12; BM: n = 13) successfully reported their perceptions of pain intensity and unpleasantness every 15 minutes. RESULTS: A POSITIVE CORRELATION BETWEEN THE PROGRESSION OF LABOR AND PAIN WAS FOUND (PAIN INTENSITY: P < 0.01; pain unpleasantness: P < 0.01). When compared to TCTP, the BM showed an overall significant lower pain perception for both intensity (45%; P < 0.01) and unpleasantness (46%; P < 0.01). CONCLUSION: These significant differences in pain perception between TCTP and the BM suggest that the emphasis on pain modulation models and techniques during labor combined with the active participation of a partner in BM are important variables to be added to the traditional childbirth training programs for childbirth pain management.
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