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Context  Primary care physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Programs to reduce burnout before it results in impairment are rare; data on these programs are scarce.Objective  To determine whether an intensive educational program in mindfulness, communication, and self-awareness is associated with improvement in primary care physicians' well-being, psychological distress, burnout, and capacity for relating to patients.Design, Setting, and Participants  Before-and-after study of 70 primary care physicians in Rochester, New York, in a continuing medical education (CME) course in 2007-2008. The course included mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material, and discussion. An 8-week intensive phase (2.5 h/wk, 7-hour retreat) was followed by a 10-month maintenance phase (2.5 h/mo).Main Outcome Measures  Mindfulness (2 subscales), burnout (3 subscales), empathy (3 subscales), psychosocial orientation, personality (5 factors), and mood (6 subscales) measured at baseline and at 2, 12, and 15 months.Results  Over the course of the program and follow-up, participants demonstrated improvements in mindfulness (raw score, 45.2 to 54.1; raw score change [Δ], 8.9; 95% confidence interval [CI], 7.0 to 10.8); burnout (emotional exhaustion, 26.8 to 20.0; Δ = −6.8; 95% CI, −4.8 to −8.8; depersonalization, 8.4 to 5.9; Δ = −2.5; 95% CI, −1.4 to −3.6; and personal accomplishment, 40.2 to 42.6; Δ = 2.4; 95% CI, 1.2 to 3.6); empathy (116.6 to 121.2; Δ = 4.6; 95% CI, 2.2 to 7.0); physician belief scale (76.7 to 72.6; Δ = −4.1; 95% CI, −1.8 to −6.4); total mood disturbance (33.2 to 16.1; Δ = −17.1; 95% CI, −11 to −23.2), and personality (conscientiousness, 6.5 to 6.8; Δ = 0.3; 95% CI, 0.1 to 5 and emotional stability, 6.1 to 6.6; Δ = 0.5; 95% CI, 0.3 to 0.7). Improvements in mindfulness were correlated with improvements in total mood disturbance (r = −0.39, P < .001), perspective taking subscale of physician empathy (r = 0.31, P < .001), burnout (emotional exhaustion and personal accomplishment subscales, r = −0.32 and 0.33, respectively; P < .001), and personality factors (conscientiousness and emotional stability, r = 0.29 and 0.25, respectively; P < .001).Conclusions  Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Because before-and-after designs limit inferences about intervention effects, these findings warrant randomized trials involving a variety of practicing physicians.

Buddhism has made its way into American popular culture, particularly within the arena of death and dying. The growing influence of Buddhism on the American way of dying has been fostered through its connection with the American hospice movement. This paper describes the developing contact between Buddhism and hospice and documents the efforts of several prominent Buddhist organizations to revolutionize American death practices. The Buddhist approach to death has captured the interest of an American public attracted to its nonsectarian language of spirituality and pragmatic techniques for dealing with death.

Compared to the general population, youth in foster care experience multiple psychosocial difficulties due to exceptionally high rates of maltreatment. Many youth in care receive psychological and/or psychotropic treatment but not all require or are willing to accept that level of intervention. For many, a “mental health” approach feels pathologizing. Nevertheless, these youth have suffered maltreatment and interventions to improve their ability to cope with past trauma and their often uncertain present are clearly needed. Cognitively-Based Compassion Training (CBCT) provides an alternative perspective on suffering and can be framed as a wellness intervention that is appropriate for all humans. The present study examined whether a 6-week CBCT intervention would improve psychosocial functioning among adolescents in foster care. Seventy adolescents were randomized to CBCT (twice weekly) or a wait-list condition. Youth were assessed at baseline and after 6 weeks. Groups did not differ on measures of psychosocial functioning following training; however practice frequency was associated with increased hopefulness and a trend for a decrease in generalized anxiety. Qualitative results indicated that participants found CBCT useful for dealing with daily life stressors. Adolescents in care were willing to engage in CBCT. The majority reported CBCT was very helpful and almost all reported they would recommend CBCT to a friend. Participants reported specific instances of using CBCT strategies to regulate emotion, manage stress, or to respond more compassionately towards others. Standardized self-report measures were not sensitive to qualitative reports of improved functioning, suggesting the need for measures more sensitive to the positive changes noted or longer training periods to demonstrate effects. Practical issues surrounding implementation of such programs in high-risk youth populations are identified. Recommendations are provided for further development.
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This new and up-to-the-minute compendium of reliable and authoritative information on complementary and alternative therapies seeks to provide information that older adults may use as they seek to improve their health and quality of life. Covering dietary means; physical, mental, and spiritual methods of treatment; and various types of therapies, this handbook is the most comprehensive and up-to-date resource on complementary and alternative medicine available today.

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.

OBJECTIVES: Randomized controlled studies on the effectiveness of body-oriented methods of treatment for children with attention-deficit hyperactivity disorder (ADHD) are lacking. Our aim was to compare the effectiveness of two methods of treatment (yoga for children vs. conventional motor exercises) in a randomized controlled pilot study. METHODS: Nineteen children with a clinical diagnosis of ADHD (according to ICD-10 criteria) were included and randomly assigned to treatment conditions according to a 2x2 cross-over design. Effects of treatment were analyzed by means of an analysis of variance for repeated measurements. RESULTS: For all outcome measures (test scores on an attention task, and parent ratings of ADHD symptoms) the yoga training was superior to the conventional motor training, with effect sizes in the medium-to-high range (0.60-0.97). All children showed sizable reductions in symptoms over time, and at the end of the study, the group means for the ADHD scales did not differ significantly from those for a representative control group. Furthermore, the training was particularly effective for children undergoing pharmacotherapy (MPH). CONCLUSIONS: The findings from this pilot study demonstrate that yoga can be an effective complementary or concomitant treatment for attention-deficit hyperactivity disorder. The study advocates further research into the impact of yoga or body-oriented therapies on the prevention and treatment of ADHD.
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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.

Cultivating Awareness and Resilience in Education (CARE) is a professional development program designed to reduce stress and improve teachers' performance. Two pilot studies examined program feasibility and attractiveness and preliminary evidence of efficacy. Study 1 involved educators from a high-poverty urban setting (n = 31). Study 2 involved student teachers and 10 of their mentors working in a suburban/semi-rural setting (n = 43) (treatment and control groups). While urban educators showed significant pre-post improvements in mindfulness and time urgency, the other sample did not, suggesting that CARE may be more efficacious in supporting teachers working in high-risk settings. (Contains 2 tables, 1 figure and 1 footnote.)

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.

In order to gain a deeper understanding of the mindfulness construct and the mental health benefits associated with mindfulness-based programmes, the relation between mindfulness and its proposed core component attention was studied. Buddhist and Western mindfulness meditators were compared with non-meditators on tasks of sustained (SART) and executive (the Stroop Task) attention. Relations between self-reported mindfulness (FFMQ) and sustained and executive attention were also analysed. No significant differences were found between meditators and non-meditators either in sustained or executive attention. High scores on the FFMQ total scale and on Describe were related to fewer SART errors. High scores on Describe were also related to low Stroop interference. Mindfulness meditators may have an increased awareness of internal processes and the ability to quickly attend to them but this type of refined attentional ability does not seem to be related to performance on attention tests requiring responses to external targets.

Responding to growing interest among psychotherapists of all theoretical orientations, this practical book provides a comprehensive introduction to mindfulness and its clinical applications. The authors, who have been practicing both mindfulness and psychotherapy for decades, present a range of clear-cut procedures for implementing mindfulness techniques and teaching them to patients experiencing depression, anxiety, chronic pain, and other problems. Also addressed are ways that mindfulness practices can increase acceptance and empathy in the therapeutic relationship. The book reviews the philosophical underpinnings of mindfulness and presents compelling empirical findings. User-friendly features include illustrative case examples, practice exercises, and resource listings.

BACKGROUND: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. METHODS: Twenty-three ADM users with sleep complaints 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, residual depression symptoms. RESULTS: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. CONCLUSIONS: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.

BACKGROUND: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. METHODS: Twenty-three ADM users with sleep complaints 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, residual depression symptoms. RESULTS: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. CONCLUSIONS: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.
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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.

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