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OBJECTIVE: The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees. METHODS: We measured brain electrical activity before and immediately after, and then 4 months after an 8-week training program in mindfulness meditation. Twenty-five subjects were tested in the meditation group. A wait-list control group (N = 16) was tested at the same points in time as the meditators. At the end of the 8-week period, subjects in both groups were vaccinated with influenza vaccine. RESULTS: We report for the first time significant increases in left-sided anterior activation, a pattern previously associated with positive affect, in the meditators compared with the nonmeditators. We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait-list control group. Finally, the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine. CONCLUSIONS: These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function. These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research.

While much attention has been devoted to examining the beneficial effects of Mindfulness-Based Stress Reduction programs on patients' ability to cope with various chronic medical conditions, most studies have relied on self-report measures of improvement. Given that these measures may not accurately reflect physiological conditions, there is a need for an objective marker of improvement in research evaluating the beneficial effects of stress management programs. Cortisol is the major stress hormone in the human organism and as such is a promising candidate measure in the study of the effects of Mindfulness-Based Stress Reduction programs. In conjunction with other biological measures, the use of cortisol levels as a physiological marker of stress may be useful to validate self-reported benefits attributed to this program. In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs.

Demands faced by health care professionals include heavy caseloads, limited control over the work environment, long hours, as well as organizational structures and systems in transition. Such conditions have been directly linked to increased stress and symptoms of burnout, which in turn, have adverse consequences for clinicians and the quality of care that is provided to patients. Consequently, there exists an impetus for the development of curriculum aimed at fostering wellness and the necessary self-care skills for clinicians. This review will examine the potential benefits of mindfulness-based stress reduction (MBSR) programs aimed at enhancing well-being and coping with stress in this population. Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health. Conceptual and methodological limitations of the existing studies and suggestions for future research are discussed.

Mindfulness meditation practices (MMPs) are a subgroup of meditation practices which are receiving growing attention. The present paper reviews current evidence about the effects of MMPs on objective measures of cognitive functions. Five databases were searched. Twenty three studies providing measures of attention, memory, executive functions and further miscellaneous measures of cognition were included. Fifteen were controlled or randomized controlled studies and 8 were case–control studies. Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions. However, many of the included studies show methodological limitations and negative results have been reported as well, plausibly reflecting differences in study design, study duration and patients' populations. Accordingly, even though findings here reviewed provided preliminary evidence suggesting that MMPs could enhance cognitive functions, available evidence should be considered with caution and further high quality studies investigating more standardized mindfulness meditation programs are needed.

The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.

Mindfulness-based Stress Reduction, a stress-reduction program, has increasing empirical support as a patient-care intervention. Its emphasis on self-care, compassion, and healing makes it relevant as an intervention for helping nurses manage stress and reduce burnout. This article describes the implementation of Mindfulness-based Stress Reduction in a hospital system as a way to lower burnout and improve well-being among nurses, using both quantitative and qualitative data.

This article is the second in a series reporting on research exploring the effects of Mindfulness-based Stress Reduction on nurses and describes the quantitative data. The third article describes qualitative data. Treatment group participants reduced scores on 2 of 3 subscales of the Maslach Burn...

Part III of the study on mindfulness-based stress reduction (MBSR) describes qualitative data and discusses the implications of the findings. Study analysis revealed that nurses found MBSR helpful. Greater relaxation and self-care and improvement in work and family relationships were among reported benefits. Challenges included restlessness, physical pain, and dealing with difficult emotions.

A number of issues important to the clinical utility of mindfulness require systematic study. These include the most parsimonious definition of mindfulness for clinical purposes, how mindfulness is best described to be most approachable to patients, and the extent to which mindfulness shares common mechanisms with other mind-body programs. The discussion includes a brief review of the transition of mindfulness from traditional into clinical settings as well as the components commonly contained within clinical descriptions of mindfulness. A model based on facility in the use of attention is proposed, and a description of mechanisms by which attentional skill may lead to the recognition of internal associational processes and account for psychological outcomes is given. Using constructs already familiar to patients, an attention-based conception may also be more accessible to patients than more elaborate descriptions and have greater utility in identifying commonalities that mindfulness training may have with other mind-body programs.

The mindfulness-based stress reduction (MBSR) program was designed to be long enough for participants to grasp the principles of self-regulation through mindfulness and develop skill and autonomy in mindfulness practice. It traditionally consists of 26 hours of session time including eight classes of 2-1/2 hours and an all-day class. The circumstances of some groups exclude them from participating in this standard form and a number of trials have evaluated programs with abbreviated class time. If lower program time demands can lead to similar outcomes in psychological functioning, it would support their utility in these settings and might lead to greater participation. However, the effect of variation in class hours on outcomes has not been systematically studied. To obtain preliminary information related to this question we examined effect sizes for psychological outcome variables in published studies of MBSR, some of which had adapted the standard number of class hours. The correlation between mean effect size and number of in-class hours was nonsignificant for both clinical and nonclinical samples and suggests that adaptations that include less class time may be worthwhile for populations for whom reduction of psychological distress is an important goal and for whom longer time commitment may be a barrier to their ability or willingness to participate. However, the standard MBSR format has accrued the most empirical support for its efficacy and session time may be important to the development of other kinds of program outcomes. The result points to the importance of empirical studies systematically examining this question. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–12, 2009.

In this article the author examines the use of meditation as an aid to conventional medicine, examines the increased research on the subject, and offers a critique of Mindfulness-Based Stress Reduction (MBSR), the therapeutic meditation method developed by molecular biologist Jon Kabat-Zinn. A number of topics are addressed including Kabat-Zinn's perception of MBSR as Buddhist meditation without a religious element, the moral framework of yoga and meditation, and the lack of interaction and community in the practice of MBSR.

Objective and Participants: The authors evaluated the effects on stress, rumination, forgiveness, and hope of two 8-week, 90-min/wk training programs for college undergraduates in meditation-based stress-management tools. Methods: After a pretest, the authors randomly allocated college undergraduates to training in mindfulness-based stress reduction (MBSR; n = 15), Easwaran's Eight-Point Program (EPP; n = 14), or wait-list control ( n = 15). The authors gathered pretest, posttest, and 8-week follow-up data on self-report outcome measures. Results: The authors observed no post-treatment differences between MBSR and EPP or between posttest and 8-week follow-up ( p > .10). Compared with controls, treated participants ( n = 29) demonstrated significant benefits for stress ( p < .05, Cohen's d = -.45) and forgiveness ( p < .05, d = .34) and marginal benefits for rumination ( p < .10, d = -.34). Conclusions: Evidence suggests that meditation-based stress-management practices reduce stress and enhance forgiveness among college undergraduates. Such programs merit further study as potential health-promotion tools for college populations.

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.

Baer's review (2003; this issue) suggests that mindf ulness-based interventions are clinically efficacious, but that better designed studies are now needed to substantiate the field and place it on a firm foundation for future growth. Her review, coupled with other lines of evidence, suggests that interest in incorporating mindfulness into clinical interventions in medicine and psychology is growing. It is thus important that professionals coming to this field understand some of the unique factors associated with the delivery of mindfulness-based interventions and the potential conceptual and practical pitfalls of not recognizing the features of this broadly unfamiliar landscape. This commentary highlights and contextualizes (1) what exactly mindfulness is, (2) where it came from, (3) how it came to be introduced into medicine and health care, (4) issues of cross-cultural sensitivity and understanding in the study of meditative practices stemming from other cultures and in applications of them in novel settings, (5) why it is important for people who are teaching mind-fulness to practice themselves, (6) results from 3 recent studies from the Center for Mindfulness in Medicine, Health Care, and Society not reviewed by Baer but which raise a number of key questions about clinical applicability, study design, and mechanism of action, and (7) current opportunities for professional training and development in mindfulness and its clinical applications.

Background: Medical students confront significant academic, psychosocial, and existential stressors throughout their training. Mindfulness-based stress reduction (MBSR) is an educational intervention designed to improve coping skills and reduce emotional distress. Purpose: The purpose of this study was to examine the effectiveness of the MBSR intervention in a prospective, nonrandomized, cohort-controlled study. Methods: Second-year students (n = 140) elected to participate in a 10-week MBSR seminar. Controls (n = 162) participated in a didactic seminar on complementary medicine. Profile of Mood States (POMS) was administered preintervention and postintervention. Results: Baseline total mood disturbance (TMD) was greater in the MBSR group compared with controls (38.7 ±33.3 vs. 28.0 ±31.2; p <. 01). Despite this initial difference, the MBSR group scored significantly lower in TMD at the completion of the intervention period (31.8 ±33.8 vs. 38.6 ±32.8; p < . 05). Significant effects were also observed on Tension-Anxiety, Confusion-Bewilderment, Fatigue-Inertia, and Vigor-Activity subscales. Conclusion: MBSR may be an effective stress management intervention for medical students.

OBJECTIVES: This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production. METHODS: Forty-nine patients with breast cancer and 10 with prostate cancer participated in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C-30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-γ, IL-4, and IL-10 were assessed pre- and postintervention. RESULTS: Fifty-nine and 42 patients were assessed pre- and postintervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL-4 increased and IFN-γ decreased, whereas NK cell production of IL-10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile. CONCLUSIONS: MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer-related cytokine production associated with program participation.

OBJECTIVE: To determine whether completing a mindfulness-based stress reduction (MBSR) program would affect the general health, health-related quality of life, sleep quality, and family harmony of Spanish- and English-speaking medical patients at an inner-city health center. MATERIALS AND METHODS: An intervention group of 68 patients (48 Spanish-speaking and 20 English-speaking) completed the SF-36 Health Survey and two additional questions about sleep quality and family harmony before and after completing the 8-week MBSR program. A comparison group of 18 Spanish-speaking patients who received no intervention completed the same questionnaire at the same intervals. RESULTS: Sixty-six percent of the total intervention group completed the 8-week MBSR program. There was significant comorbidity of medical and mental health diagnoses among the intervention and comparison groups, with no differences in the mean number of diagnoses of the total intervention group, the comparison group, or the Spanish- or English-speaking intervention subgroups. Compared with the comparison group, the intervention group showed statistically significant improvement on five of the eight SF-36 measures, and no improvement on the sleep quality or family harmony items. CONCLUSIONS: MBSR may be an effective behavioral medicine program for Spanish- and English-speaking inner-city medical patients. Suggestions are given for future research to help clarify the program’s effectiveness for this population.

The literature is replete with evidence that the stress inherent in health care negatively impacts health care professionals, leading to increased depression, decreased job satisfaction, and psychological distress. In an attempt to address this, the current study examined the effects of a short-term stress management program, mindfulness-based stress reduction (MBSR), on health care professionals. Results from this prospective randomized controlled pilot study suggest that an 8-week MBSR intervention may be effective for reducing stress and increasing quality of life and self-compassion in health care professionals. Implications for future research and practice are discussed.

Mindfulness-based approaches are among the most innovative and interesting new approaches to mental health treatment. Mindfulness refers to patients developing an "awareness of present experience with acceptance." Interest in them is widespread, with presentations and workshops drawing large audiences all over the US and many other countries. This book provides a comprehensive introduction to the best-researched mindfulness-based treatments. It emphasizes detailed clinical illustration providing a close-up view of how these treatments are conducted, the skills required of therapists, and how they work. The book also has a solid foundation in theory and research and shows clearly how these treatments can be understood using accepted psychological principles and concepts. The evidence base for these treatments is concisely reviewed.* Comprehensive introduction to the best-researched mindfulness-based treatments* Covers wide range of problems & disorders (anxiety, depression, eating, psychosis, personality disorders, stress, pain, relationship problems, etc)* Discusses a wide range of populations (children, adolescents, older adults, couples)* Includes wide range of settings (outpatient, inpatient, medical, mental health, workplace)* Clinically rich, illustrative case study in every chapter* International perspectives represented (authors from US, Canada, Britain, Sweden)

Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems. Such approaches include ancient Buddhist mindfulness meditations such as Vipassana and Zen meditations, modern group-based standardized meditations, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, and further psychological interventions, such as dialectical behavioral therapy and acceptance and commitment therapy. We review commonalities and differences of these interventions regarding philosophical background, main techniques, aims, outcomes, neurobiology and psychological mechanisms. In sum, the currently applied mindfulness-based interventions show large differences in the way mindfulness is conceptualized and practiced. The decision to consider such practices as unitary or as distinct phenomena will probably influence the direction of future research. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1-21, 2011.

Summary Mindfulness-Based Stress Reduction (MBSR) is a program that has been shown to be beneficial for clinical and non-clinical populations. While much attention has been paid to participants’ outcomes, little work has been published concerning processes underlying improvements. Herein, women who had finished medical treatment for breast cancer completed questionnaires pre- and post-MBSR and were interviewed using focus group methodology such that quantitative and qualitative data were combined to explore potential mechanisms underlying changes. It was found that the Mindfulness Attention Awareness Scale was a useful process measure to assess changes in mindfulness and that the Coping with Health Injuries and Problems questionnaire was useful in documenting changes in palliative (self-care) coping over the course of the 8 week program. Moreover, the Sense of Coherence questionnaire suggested that the women viewed life as more meaningful and manageable following MSBR. Our findings fit with Shapiro et al.'s theory that, over time, participants in an MBSR program “reperceive” what they encounter in their daily experiences.

This study was designed to test the hypothesis that mindfulness involves sustained attention, attention switching, inhibition of elaborative processing and non-directed attention. Healthy adults were tested before and after random assignment to an 8-week Mindfulness-Based Stress Reduction (MBSR) course (n = 39) or a wait-list control (n = 33). Testing included measures of sustained attention, attention switching, Stroop interference (as a measure of inhibition of elaborative processing), detection of objects in consistent or inconsistent scenes (as a measure of non-directed attention), as well as self-report measures of emotional well-being and mindfulness. Participation in the MBSR course was associated with significantly greater improvements in emotional well-being and mindfulness, but no improvements in attentional control relative to the control group. However, improvements in mindfulness after MBSR were correlated with improvements in object detection. We discuss the implications of these results as they relate to the role of attention in mindfulness. Copyright © 2007 John Wiley & Sons, Ltd.

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