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Western psychotherapy tends to regard the mind and mental distress in terms of differing theoretical models. Mental distress can be also be usefully viewed as the result of erroneous reification—the confusing of symbols and concepts with reality. This paper describes the theory and practice of analytic meditative therapy. Inspired by non-dual Buddhist and other eastern wisdom traditions, it uses meditative and cognitive processes to control anxiety, deconstruct reified symbols and encourage contemplative resting in non-dual mental space, where reality and its appearance are coemergent and coalesced but distinct, and healing occurs naturally without the need for any specific additional effort.
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OBJECTIVE: The anterior cingulate cortex has been implicated in depression. Results are best interpreted by considering anatomic and cytoarchitectonic subdivisions. Evidence suggests depression is characterized by hypoactivity in the dorsal anterior cingulate, whereas hyperactivity in the rostral anterior cingulate is associated with good response to treatment. The authors tested the hypothesis that activity in the rostral anterior cingulate during the depressed state has prognostic value for the degree of eventual response to treatment. Whereas prior studies used hemodynamic imaging, this investigation used EEG. METHOD: The authors recorded 28-channel EEG data for 18 unmedicated patients with major depression and 18 matched comparison subjects. Clinical outcome was assessed after nortriptyline treatment. Of the 18 depressed patients, 16 were considered responders 4-6 months after initial assessment. A median split was used to classify response, and the pretreatment EEG data of patients showing better (N=9) and worse (N=9) responses were analyzed with low-resolution electromagnetic tomography, a new method to compute three-dimensional cortical current density for given EEG frequency bands according to a Talairach brain atlas. RESULTS: The patients with better responses showed hyperactivity (higher theta activity) in the rostral anterior cingulate (Brodmann's area 24/32). Follow-up analyses demonstrated the specificity of this finding, which was not confounded by age or pretreatment depression severity. CONCLUSIONS: These results, based on electrophysiological imaging, not only support hemodynamic findings implicating activation of the anterior cingulate as a predictor of response in depression, but they also suggest that differential activity in the rostral anterior cingulate is associated with gradations of response.
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Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as manifest in salivary cortisol measures. About 23% of the 360 children (ages 6-10 years, primarily 7-8) showed at least 1 expression of CI anger in situations designed to elicit positive affect. Expression of anger across 2 positive assessments was less common (around 4%). CI anger predicted the hypothesized lower levels of cortisol beyond that attributed to context appropriate anger. Boys' CI anger predicted lower morning cortisol and flatter slopes. Results suggest that this novel approach to studying children's emotion across varying contexts can provide insight into affective style.
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Psychological stress is a major provocative factor of symptoms in chronic inflammatory conditions. In recent years, interest in addressing stress responsivity through meditation training in health-related domains has increased astoundingly, despite a paucity of evidence that reported benefits are specific to meditation practice. We designed the present study to rigorously compare an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention to a well-matched active control intervention, the Health Enhancement Program (HEP) in ability to reduce psychological stress and experimentally-induced inflammation. The Trier Social Stress Test (TSST) was used to induce psychological stress and inflammation was produced using topical application of capsaicin cream to forearm skin. Immune and endocrine measures of inflammation and stress were collected both before and after MBSR training. Results show those randomized to MBSR and HEP training had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms. However, MBSR training resulted in a significantly smaller post-stress inflammatory response compared to HEP, despite equivalent levels of stress hormones. These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions. Moreover, mindfulness practice, in particular, may be more efficacious in symptom relief than the well-being promoting activities cultivated in the HEP program.

Psychological stress is a major provocative factor of symptoms in chronic inflammatory conditions. In recent years, interest in addressing stress responsivity through meditation training in health-related domains has increased astoundingly, despite a paucity of evidence that reported benefits are specific to meditation practice. We designed the present study to rigorously compare an 8-week Mindfulness-Based Stress Reduction (MBSR) intervention to a well-matched active control intervention, the Health Enhancement Program (HEP) in ability to reduce psychological stress and experimentally-induced inflammation. The Trier Social Stress Test (TSST) was used to induce psychological stress and inflammation was produced using topical application of capsaicin cream to forearm skin. Immune and endocrine measures of inflammation and stress were collected both before and after MBSR training. Results show those randomized to MBSR and HEP training had comparable post-training stress-evoked cortisol responses, as well as equivalent reductions in self-reported psychological distress and physical symptoms. However, MBSR training resulted in a significantly smaller post-stress inflammatory response compared to HEP, despite equivalent levels of stress hormones. These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions. Moreover, mindfulness practice, in particular, may be more efficacious in symptom relief than the well-being promoting activities cultivated in the HEP program.
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The goal of this course is to explore meditative and contemplative tradition in various cultures and spiritual traditions, and study the ways in which contemplative practice can contribute to psychotherapy, both indirectly through the meditative practice of the therapist, and directly through application in the therapy proper.

Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.

Poor sleep is common in substance use disorders (SUDs) and is a risk factor for relapse. Within the context of a multicomponent, mindfulness-based sleep intervention that included mindfulness meditation (MM) for adolescent outpatients with SUDs (n = 55), this analysis assessed the contributions of MM practice intensity to gains in sleep quality and self-efficacy related to SUDs. Eighteen adolescents completed a 6-session study intervention and questionnaires on psychological distress, sleep quality, mindfulness practice, and substance use at baseline, 8, 20, and 60 weeks postentry. Program participation was associated with improvements in sleep and emotional distress, and reduced substance use. MM practice frequency correlated with increased sleep duration and improvement in self-efficacy about substance use. Increased sleep duration was associated with improvements in psychological distress, relapse resistance, and substance use-related problems. These findings suggest that sleep is an important therapeutic target in substance abusing adolescents and that MM may be a useful component to promote improved sleep.
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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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Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy, yet its effects in mothers during the early parenting period are unknown. The purpose of the present pilot study was to examine the effectiveness of a mindfulness-based intervention in breast-feeding mothers. We developed and tested an 8-week mindfulness-based intervention aimed at improving maternal self-efficacy, mindfulness, self-compassion, satisfaction with life, and subjective happiness, and at reducing psychological distress. A randomized controlled, between-groups design was used with treatment and control groups (n = 26) and pretest and posttest measures. ANCOVA results indicated that, compared to the control group, mothers in the treatment group scored significantly higher on maternal self-efficacy, some dimensions of mindfulness (observing, acting with awareness, non-judging, and non-reactivity), and self-compassion (self-kindness, mindfulness, over-identification, and total self-compassion). In addition, mothers who received the treatment exhibited significantly less anxiety, stress, and psychological distress. The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period. Additional research is needed to validate our findings in non-breast-feeding mothers and to examine the intervention’s indirect benefits in terms of family relationships and child development.

OBJECTIVES: Previously it was shown that a brief yoga-based lifestyle intervention was efficacious in reducing oxidative stress and risk of chronic diseases even in a short duration. The objective of this study was to assess the efficacy of this intervention in reducing stress and inflammation in patients with chronic inflammatory diseases. DESIGN: This study reports preliminary results from a nonrandomized prospective ongoing study with pre-post design. SETTING/LOCATION: The study was conducted at the Integral Health Clinic, an outpatient facility conducting these yoga-based lifestyle intervention programs for prevention and management of chronic diseases. SUBJECTS: Patients with chronic inflammatory diseases and overweight/obese subjects were included while physically challenged, and those on other interventions were excluded from the study. INTERVENTION: A pretested intervention program included asanas (postures), pranayama (breathing exercises), stress management, group discussions, lectures, and individualized advice. OUTCOME MEASURES: There was a reduction in stress (plasma cortisol and β-endorphin) and inflammation (interleukin [IL]-6 and tumor necrosis factor [TNF]-α) at day 0 versus day 10. RESULTS: Eighty-six (86) patients (44 female, 42 male, 40.07 ± 13.91 years) attended this program. Overall, the mean level of cortisol decreased from baseline to day 10 (149.95 ± 46.07, 129.07 ± 33.30 ng/mL; p=0.001) while β-endorphins increased from baseline to day 10 (3.53 ± 0.88, 4.06 ± 0.79 ng/mL; p=0.024). Also, there was reduction from baseline to day 10 in mean levels of IL-6 (2.16 ± 0.42, 1.94 ± 0.10 pg/mL, p=0.036) and TNF-α (2.85 ± 0.59, 1.95 ± 0.32 pg/mL, p=0.002). CONCLUSIONS: This brief yoga-based lifestyle intervention reduced the markers of stress and inflammation as early as 10 days in patients with chronic diseases; however, complete results of this study will confirm whether this program has utility as complementary and alternative therapy.
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Neurophenomenological studies seek to utilize first-person self-report to elucidate cognitive processes related to physiological data. Grounded theory offers an approach to the qualitative analysis of self-report, whereby theoretical constructs are derived from empirical data. Here we used grounded theory methodology (GTM) to assess how the first-person experience of meditation relates to neural activity in a core region of the default mode network—the posterior cingulate cortex (PCC). We analyzed first-person data consisting of meditators' accounts of their subjective experience during runs of a real time fMRI neurofeedback study of meditation, and third-person data consisting of corresponding feedback graphs of PCC activity during the same runs. We found that for meditators, the subjective experiences of “undistracted awareness” such as “concentration” and “observing sensory experience,” and “effortless doing” such as “observing sensory experience,” “not efforting,” and “contentment,” correspond with PCC deactivation. Further, the subjective experiences of “distracted awareness” such as “distraction” and “interpreting,” and “controlling” such as “efforting” and “discontentment,” correspond with PCC activation. Moreover, we derived several novel hypotheses about how specific qualities of cognitive processes during meditation relate to PCC activity, such as the difference between meditation and “trying to meditate.” These findings offer novel insights into the relationship between meditation and mind wandering or self-related thinking and neural activity in the default mode network, driven by first-person reports.
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OBJECTIVE: This study was undertaken to identify brain structures associated with emotion in normal elderly subjects. METHOD: Eight normal subjects aged 55-78 years were shown film clips intended to provoke the emotions of happiness, fear, or disgust as well as a neutral state. During emotional activation, regional cerebral blood flow was measured with the use of [15O]H2O positron emission tomography imaging, and subjective emotional responses were recorded. Data were analyzed by subtracting the values during the neutral condition from the values in the various emotional activations. RESULTS: The stimuli produced a general activation in visual pathways that included the primary and secondary visual cortex, involving regions associated with object and spatial recognition. In addition, the specific emotions produced different regional limbic activations, which suggests that different pathways may be used for different types of emotional stimuli. CONCLUSIONS: Emotional activation in normal elderly subjects was associated with increases in blood flow in limbic and paralimbic brain structures. Brain activation may be specific to the emotion being elicited but probably involves complex sensory, association, and memory circuitry. Further studies are needed to identify activations that are specific for emotion.
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This commentary reflects on the articles in this Special Issue. The appearance of this group of articles underscores the important idea that a major target of mindfulness practice is on emotion. Transformation in trait affect is a key goal of all contemplative traditions. This commentary addresses several key methodological and conceptual issues in the empirical study of mindfulness. The many ways in which the term "mindfulness" is used in the articles in this Special Issue are noted, and they include its reference to states, traits, and independent variables that are manipulated in an experimental context. How the term "mindfulness" is conceptualized and operationalized is crucial, and for progress to be made it is essential that we qualify the use of this term by reference to how it is being operationalized in each context. Other methodological issues are considered, such as the duration of training and how it should be measured, and the nature of control and comparison groups in studies of mindfulness-based interventions. Finally, the commentary ends with a consideration of the targets within emotion processing that are likely to be impacted by mindfulness. This collection of articles underscores the substantial progress that has occurred in the empirical study of mindfulness and it is a harbinger of a very promising future in this area.
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Mindfulness meditation is an increasingly popular intervention for the treatment of physical illnesses and psychological difficulties. Using intervention strategies with mechanisms familiar to cognitive behavioral therapists, the principles and practice of mindfulness meditation offer promise for promoting many of the most basic elements of positive psychology. It is proposed that mindfulness meditation promotes positive adjustment by strengthening metacognitive skills and by changing schemas related to emotion, health, and illness. Additionally, the benefits of yoga as a mindfulness practice are explored. Even though much empirical work is needed to determine the parameters of mindfulness meditation's benefits, and the mechanisms by which it may achieve these benefits, theory and data thus far clearly suggest the promise of mindfulness as a link between positive psychology and cognitive behavioral therapies.

OBJECTIVES: Given the demands of caring for chronically ill children, it is not surprising that caregivers often experience high levels of chronic stress. A Mindfulness-Based Stress Reduction (MBSR) program may offer relief to these caregivers by providing tools for self-care and heath promotion that otherwise may be lacking. METHODS: MBSR classes were offered without restriction to parents of children attending various clinics at a large urban children's medical centre. Caregivers completed the Profile of Mood States (POMS) and Symptoms of Stress Inventory (SOSI) both before and after program participation. RESULTS: Forty-four caregivers participated in one of seven group MBSR sessions that were offered between August 2001 and February 2004. Most were mothers of children with special needs and various chronic conditions, who had been diagnosed an average of 7 years previous. Prior to the intervention, caregivers reported very high levels of stress and mood disturbance. These decreased substantially over the 8-week program, with an overall reduction in stress symptoms of 32% (p < .001), and in total mood disturbance of 56% (p < .001). CONCLUSIONS: This brief MBSR program for caregivers of chronically ill children was successful in significantly decreasing substantial stress symptoms and mood disturbance. Further studies would benefit from using more rigorous methodology and applying the program to other groups of chronically stressed caregivers.

BACKGROUND: Relationships between aberrant social functioning and depression have been explored via behavioral, clinical, and survey methodologies, highlighting their importance in the etiology of depression. The neural underpinnings of these relationships, however, have not been explored. METHODS: Nine depressed participants and 14 never-depressed control subjects viewed emotional and neutral pictures at two functional magnetic resonance imaging (fMRI) scanning sessions approximately 22 weeks apart. In the interim, depressed patients received the antidepressant Venlafaxine. Positively rated images were parsed into three separate comparisons: social interaction, human faces, and sexual images; across scanning session, activation to these images was compared with other positively rated images. RESULTS: For each of the three social stimulus types (social interaction, faces, sexual images), a distinguishable circuitry was activated equally in non-depressed control subjects and post-treatment depressed subjects but showed a hypo-response in the depressed group pre-treatment. These structures include regions of prefrontal, temporal, and parietal cortices, insula, basal ganglia, and the hippocampus. CONCLUSIONS: The neural hypo-response to positively valenced social stimuli that is observed in depression remits as response to antidepressant medication occurs, suggesting a state-dependent deficiency in response to positive social incentives. These findings underscore the importance of addressing social dysfunction in research and treatment of depression.
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BACKGROUND: Functional magnetic resonance imaging (fMRI) holds promise as a noninvasive means of identifying neural responses that can be used to predict treatment response before beginning a drug trial. Imaging paradigms employing facial expressions as presented stimuli have been shown to activate the amygdala and anterior cingulate cortex (ACC). Here, we sought to determine whether pretreatment amygdala and rostral ACC (rACC) reactivity to facial expressions could predict treatment outcomes in patients with generalized anxiety disorder (GAD). METHODS: Fifteen subjects (12 female subjects) with GAD participated in an open-label venlafaxine treatment trial. Functional magnetic resonance imaging responses to facial expressions of emotion collected before subjects began treatment were compared with changes in anxiety following 8 weeks of venlafaxine administration. In addition, the magnitude of fMRI responses of subjects with GAD were compared with that of 15 control subjects (12 female subjects) who did not have GAD and did not receive venlafaxine treatment. RESULTS: The magnitude of treatment response was predicted by greater pretreatment reactivity to fearful faces in rACC and lesser reactivity in the amygdala. These individual differences in pretreatment rACC and amygdala reactivity within the GAD group were observed despite the fact that 1) the overall magnitude of pretreatment rACC and amygdala reactivity did not differ between subjects with GAD and control subjects and 2) there was no main effect of treatment on rACC-amygdala reactivity in the GAD group. CONCLUSIONS: These findings show that this pattern of rACC-amygdala responsivity could prove useful as a predictor of venlafaxine treatment response in patients with GAD.
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BACKGROUND: Functional magnetic resonance imaging (fMRI) techniques were used to identify the neural circuitry underlying emotional processing in control and depressed subjects. Depressed subjects were studied before and after treatment with venlafaxine. This new technique provides a method to noninvasively image regional brain function with unprecedented spatial and temporal resolution. METHOD: Echo-planar imaging was used to acquire whole brain images while subjects viewed positively and negatively valenced visual stimuli. Two control subjects and two depressed subjects who met DSM-IV criteria for major depression were scanned at baseline and 2 weeks later. Depressed subjects were treated with venlafaxine after the baseline scan. RESULTS: Preliminary results from this ongoing study revealed three interesting trends in the data. Both depressed patients demonstrated considerable symptomatic improvement at the time of the second scan. Across control and depressed subjects, the negative compared with the positive pictures elicited greater global activation. In both groups, activation induced by the negative pictures decreased from the baseline scan to the 2-week scan. This decrease in activation was also present in the control subjects when they were exposed to the positive pictures. In contrast, when the depressed subjects were presented with the positive pictures they showed no activation at baseline, whereas after 2 weeks of treatment an area of activation emerged in right secondary visual cortex. CONCLUSION: While preliminary, these results demonstrate the power of using fMRI to study emotional processes in normal and depressed subjects and to examine mechanisms of action of antidepressant drugs.
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