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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.

Meditation can be conceptualized as a family of complex emotional and attentional regulatory training regimes developed for various ends, including the cultivation of well-being and emotional balance. Among these various practices, there are two styles that are commonly studied. One style, focused attention meditation, entails the voluntary focusing of attention on a chosen object. The other style, open monitoring meditation, involves nonreactive monitoring of the content of experience from moment to moment. The potential regulatory functions of these practices on attention and emotion processes could have a long-term impact on the brain and behavior.

Buddhist meditation practices have become a topic of widespread interest in both science and medicine. Traditional Buddhist formulations describe meditation as a state of relaxed alertness that must guard against both excessive hyperarousal (restlessness) and excessive hypoarousal (drowsiness, sleep). Modern applications of meditation have emphasized the hypoarousing and relaxing effects without as much emphasis on the arousing or alertness-promoting effects. In an attempt to counterbalance the plethora of data demonstrating the relaxing and hypoarousing effects of Buddhist meditation, this interdisciplinary review aims to provide evidence of meditation's arousing or wake-promoting effects by drawing both from Buddhist textual sources and from scientific studies, including subjective, behavioral, and neuroimaging studies during wakefulness, meditation, and sleep. Factors that may influence whether meditation increases or decreases arousal are discussed, with particular emphasis on dose, expertise, and contemplative trajectory. The course of meditative progress suggests a nonlinear multiphasic trajectory, such that early phases that are more effortful may produce more fatigue and sleep propensity, while later stages produce greater wakefulness as a result of neuroplastic changes and more efficient processing.
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Thirty-two participants were tested for both resting electroencephalography (EEG) and neuropsychological function. Eight one-minute trials of resting EEG were recorded from 14 channels referenced to linked ears, which was rederived to an average reference. Neuropsychological tasks included Verbal Fluency, the Tower of London, and Corsi's Recurring Blocks. Asymmetries in EEG alpha activity were correlated with performance on these tasks. Similar patterns were obtained for delta and theta bands. Factor analyses of resting EEG asymmetries over particular regions suggested that asymmetries over anterior scalp regions may be partly independent from those over posterior scalp regions. These results support the notions that resting EEG asymmetries are specified by multiple mechanisms along the rostral/caudal plane, and that these asymmetries predict task performance in a manner consistent with lesion and neuroimaging studies.
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Drawing its main source of inspiration from a naturalized interpretation of Husserlian phenomenology, On Becoming Aware: A Pragmatics of Experiencing attempts to examine closely the nature of experience and how we may become aware of our own mental life. The authors also focus on how this project fits into the larger context of cognitive science, psychology, neurosciences, and philosophy. Additional partners in the effort to better understand experience are the contemplative systems of the world's spiritual or wisdom traditions, including particularly that of Buddhism. The book includes three separate glossaries of technical terms in phenomenology, the cognitive sciences, and Tibetan Buddhism. The book On Becoming Aware seeks a disciplined and practical approach to exploring human experience. While much of the book draws its inspiration from the phenomenological theories of Husserl, other approaches to the direct study of experience are also explored in depth. One of these approaches is embodied by the world's spiritual or wisdom or contemplative traditions such as Sufism, Buddhism, the Philokalia tradition, and others. Collectively, these traditions have come upon a variety of their own insights and methods for understanding experience, or, to use words from the phenomenological tradition, has developed its own ways of phenomenological reduction Amongst the various wisdom traditions, the authors focus mainly on Buddhism. The authors give an introduction to Buddhist theory and history, followed by an in-depth discussion of the Buddhist contemplative practices of mindfulness, śamatha, vipaśyanā, tonglen (gtong len), lojong (blo sbyong), dzokchen (rdzogs chen), and mahāmudrā. The authors then relate this discussion to themes from philosophy and phenomenology explored earlier in the book, paricularly Husserl's concept of épochè. (Zach Rowinski 2005-01-17) Publisher's description: This book searches for the sources and means for a disciplined practical approach to exploring human experience. The spirit of this book is pragmatic and relies on a Husserlian phenomenology primarily understood as a method of exploring our experience. The authors do not aim at a neo-Kantian a priori ‘new theory’ of experience but instead they describe a concrete activity: how we examine what we live through, how we become aware of our own mental life. The range of experiences of which we can become aware is vast: all the normal dimensions of human life (perception, motion, memory, imagination, speech, everyday social interactions), cognitive events that can be precisely defined as tasks in laboratory experiments (e.g., a protocol for visual attention), but also manifestations of mental life more fraught with meaning (dreaming, intense emotions, social tensions, altered states of consciousness). The central assertion in this work is that this immanent ability is habitually ignored or at best practiced unsystematically, that is to say, blindly. Exploring human experience amounts to developing and cultivating this basic ability through specific training. Only a hands-on, non-dogmatic approach can lead to progress, and that is what animates this book.

Many of us go through our daily lives on autopilot, not fully aware of our conscious experiences. In a discussion moderated by Steve Paulson, executive producer and host of To the Best of Our Knowledge, neuroscientists Richard Davidson and Amishi Jha and clinical mindfulness expert Jon Kabat-Zinn explore the role of consciousness in mental and physical health, how we can train our minds to be more flexible and adaptable, and cutting-edge neuroscience findings about the transformation of consciousness through mindfulness and contemplative practice. The following is an edited transcript of the discussion that occurred February 6, 2013, 7:00-8:15 PM, at the New York Academy of Sciences in New York City.

Many of us go through our daily lives on autopilot, not fully aware of our conscious experiences. In a discussion moderated by Steve Paulson, executive producer and host of To the Best of Our Knowledge, neuroscientists Richard Davidson and Amishi Jha and clinical mindfulness expert Jon Kabat-Zinn explore the role of consciousness in mental and physical health, how we can train our minds to be more flexible and adaptable, and cutting-edge neuroscience findings about the transformation of consciousness through mindfulness and contemplative practice. The following is an edited transcript of the discussion that occurred February 6, 2013, 7:00-8:15 PM, at the New York Academy of Sciences in New York City.
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Terror management theory posits that people tend to respond defensively to reminders of death, including worldview defense, self-esteem striving, and suppression of death thoughts. Seven experiments examined whether trait mindfulness--a disposition characterized by receptive attention to present experience--reduced defensive responses to mortality salience (MS). Under MS, less mindful individuals showed higher worldview defense (Studies 1-3) and self-esteem striving (Study 5), yet more mindful individuals did not defend a constellation of values theoretically associated with mindfulness (Study 4). To explain these findings through proximal defense processes, Study 6 showed that more mindful individuals wrote about their death for a longer period of time, which partially mediated the inverse association between trait mindfulness and worldview defense. Study 7 demonstrated that trait mindfulness predicted less suppression of death thoughts immediately following MS. The discussion highlights the relevance of mindfulness to theories that emphasize the nature of conscious processing in understanding responses to threat. Keywords: mindfulness, mortality salience, self-determination theory, terror management theory DOI: 10.1037/a0019388

The brain and the cardiovascular system influence each other during the processing of emotion. The study of the interactions of these systems during emotion regulation has been limited in human functional neuroimaging, despite its potential importance for physical health. We have previously reported that mental expertise in cultivation of compassion alters the activation of circuits linked with empathy and theory of mind in response to emotional stimuli. Guided by the finding that heart rate increases more during blocks of compassion meditation than neutral states, especially for experts, we examined the interaction between state (compassion vs. neutral) and group (novice, expert) on the relation between heart rate and BOLD signal during presentation of emotional sounds presented during each state. Our findings revealed that BOLD signal in the right middle insula showed a significant association with heart rate (HR) across state and group. This association was stronger in the left middle/posterior insula when experts were compared to novices. The positive coupling of HR and BOLD was higher within the compassion state than within the neutral state in the dorsal anterior cingulate cortex for both groups, underlining the role of this region in the modulation of bodily arousal states. This state effect was stronger for experts than novices in somatosensory cortices and the right inferior parietal lobule (group by state interaction). These data confirm that compassion enhances the emotional and somatosensory brain representations of others' emotions, and that this effect is modulated by expertise. Future studies are needed to further investigate the impact of compassion training on these circuits.
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