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Many situations in human life present choices between (a) narrowly preferred particular alternatives and (b) narrowly less preferred (or aversive) particular alternatives that nevertheless form part of highly preferred abstract behavioral patterns. Such alternatives characterize problems of self-control. For example, at any given moment, a person may accept alcoholic drinks yet also prefer being sober to being drunk over the next few days. Other situations present choices between (a) alternatives beneficial to an individual and (b) alternatives that are less beneficial (or harmful) to the individual that would nevertheless be beneficial if chosen by many individuals. Such alternatives characterize problems of social cooperation; choices of the latter alternative are generally considered to be altruistic. Altruism, like self-control, is a valuable temporally-extended pattern of behavior. Like self-control, altruism may be learned and maintained over an individual's lifetime. It needs no special inherited mechanism. Individual acts of altruism, each of which may be of no benefit (or of possible harm) to the actor, may nevertheless be beneficial when repeated over time. However, because each selfish decision is individually preferred to each altruistic decision, people can benefit from altruistic behavior only when they are committed to an altruistic pattern of acts and refuse to make decisions on a case-by-case basis.

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.

Mindfulness-based interventions have been heralded as promising means of alleviating chronic stress. While meta-analyses indicate that mindfulness-based interventions significantly reduce global measures of stress, how mindfulness-based interventions modulate the specific mechanisms underpinning chronic stress as operationalized by the National Institute of Mental Health research domain criteria (RDoC) of sustained threat has not yet been detailed in the literature. To address this knowledge gap, this article aims to (1) review evidence that mindfulness-based interventions ameliorate each of the 10 elements of behavioral dysregulation characterizing sustained threat via an array of mindful counter-regulatory strategies; (2) review evidence that mindfulness-based interventions modify biological domains implicated in sustained threat, such as the hypothalamic-pituitary-adrenal axis, as well as brain circuits involved in attentional function, limbic reactivity, habit behavior, and the default mode network; and (3) integrate these findings into a novel conceptual framework of mindful self-regulation in the face of stress-the Mindfulness-to-Meaning Theory. Taken together, the extant body of scientific evidence suggests that the practice of mindfulness enhances a range biobehavioral factors implicated in adaptive stress coping and induces self-referential plasticity, leading to the ability to find meaning in adversity. These mechanistic findings can inform the treatment development process to optimize the next generation of mindfulness-based interventions for greater therapeutic efficacy.

The article discusses the exhibition "Bodies in Balance: The Art of Tibetan Medicine," featuring Tibetan works of art that present visual expressions of traditional Tibetan medicine, on view at the Rubin Museum of Art in New York City.

The anterior medial prefrontal (AMPFC) and retrosplenial (RSC) cortices are active during self-referential decision-making tasks such as when participants appraise traits and abilities, or current affect. Other appraisal tasks requiring an evaluative decision or mental representation, such as theory of mind and perspective-taking tasks, also involve these regions. In many instances, these types of decisions involve a subjective opinion or preference, but also a degree of ambiguity in the decision, rather than a strictly veridical response. However, this ambiguity is generally not controlled for in studies that examine self-referential decision-making. In this functional magnetic resonance imaging experiment with 17 healthy adults, we examined neural processes associated with subjective decision-making with and without an overt self-referential component. The task required subjective decisions about colors-regarding self-preference (internal subjective decision) or color similarity (external subjective decision) under conditions where there was no objectively correct response. Results indicated greater activation in the AMPFC, RSC, and caudate nucleus during internal subjective decision-making. The findings suggest that self-referential processing, rather than subjective judgments among ambiguous response alternatives, accounted for the AMPFC and RSC response.
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The frontal lobes are responsible for many of the aspects of cognition that seem uniquely human, including aspects of planning, language, emotional control, and personality. Disorders of the frontal lobes take many forms, but ultimately their impact on our cognition and behavior depends on their location and how they disrupt normal neuronal functioning. This chapter reviews the neuroanatomy of the frontal lobes as relevant to movement, attention, memory, executive functioning, language, emotion, motivation, and social behavior. The disruptive influences of different neurological disorders illustrate the significance of frontal brain regions.

This research examined whether cognitive behavioral therapy and mindfulness interventions that target responses to chronic stress, pain, and depression reduce pain and improve the quality of everyday life for adults with rheumatoid arthritis (RA). The 144 RA participants were clustered into groups of 6–10 participants and randomly assigned to 1 of 3 treatments: cognitive behavioral therapy for pain (P); mindfulness meditation and emotion regulation therapy (M); or education-only group (E), which served as an attention placebo control. The authors took a multimethod approach, employing daily diaries and laboratory assessment of pain and mitogen-stimulated levels of interleukin-6 (IL-6), a proinflammatory cytokine. Participants receiving P showed the greatest Pre to Post improvement in self-reported pain control and reductions in the IL-6; both P and M groups showed more improvement in coping efficacy than did the E group. The relative value of the treatments varied as a function of depression history. RA patients with recurrent depression benefited most from M across several measures, including negative and positive affect and physicians' ratings of joint tenderness, indicating that the emotion regulation aspects of that treatment were most beneficial to those with chronic depressive features.

Richard Louv explains how society can overcome nature-deficit disorder.

Richard Louv explains how society can overcome nature-deficit disorder.

BACKGROUND:The EUDAIMON study focuses on fibromyalgia syndrome (FMS), a prevalent chronic condition characterized by pain, fatigue, cognitive problems and distress. According to recent reviews and meta-analyses, Mindfulness-Based Stress Reduction (MBSR) is a promising therapeutic approach for patients with FMS. The measurement of biomarkers as part of the analysis of MBSR effects would help to identify the neurobiological underpinnings of MBSR and increase our knowledge of FMS pathophysiology. The main objectives of this 12-month RCT are: firstly, to examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational programme FibroQoL, and versus TAU only; secondly, to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms and; thirdly, to analyse the role of some psychological variables as mediators of 12-month clinical outcomes. METHODS: Effectiveness, cost-utility, and neurobiological analyses performed alongside a 12-month RCT. The participants will be 180 adult patients with FMS recruited at the Sant Joan de Déu hospital (St. Boi de Llobregat, Spain), randomly allocated to one of the three study arms: TAU + MBSR vs. TAU + FibroQol vs. TAU. A comprehensive assessment to collect functional, quality of life, distress, costs, and psychological variables will be conducted pre-, post-intervention, and at 12-month post-intervention. Fifty per cent of study participants will be evaluated at pre- and post-treatment using Voxel-Based Morphometry, Diffusion Tensor Imaging, pseudo-continuous Arterial Spin Labeling, and resting state fMRI. A cytokine multiplex kit of high-sensitivity will be applied (cytokines IL-6, IL-8, IL-10 + high-sensitivity CRP test). DISCUSSION: The findings obtained from this RCT will indicate whether MBSR is potentially cost-effective for FMS and contribute to knowledge of any brain and inflammatory changes associated with MBSR in FMS patients. Specifically, we will determine whether there are morphometric and functional changes associated with participation in MBSR in brain regions related to meta-awareness, body awareness, memory consolidation-reconsolidation, emotion regulation and in networks postulated to underpin the sensory-discriminative, cognitive-evaluative and affective-motivational aspects of the pain experience.

This preliminary study examined intervention effects of a universal prevention program offered by classroom teachers to public elementary school students. The Unique Minds School Program (M.B. Stern, 1999) is a teacher-led program designed to promote cognitive-social-emotional (CSE) skills, including student self-efficacy, problem solving, social-emotional competence, and a positive classroom climate, with the dual goal of preventing youth behavioral problems and promoting academic learning. During 2 consecutive school years, 119 students and their teachers were assessed in the fall and spring of Grade 4 and again in the spring of Grade 5. As compared to students in the comparison school, students in the intervention showed gains in student self-efficacy, problem solving, social-emotional competencies, and math grades. Incremental gains within CSE domains were found after 1 and 2 years of intervention. (Contains 1 table.)

Education is central to two recent international efforts to address an impending ecological global crisis. The Earth Charter and the UN document Decade for Education for Sustainable Development 2005–2014 challenge all people to consider the socio-ecological, ethical, local and global dimensions of human life. These documents state clearly the international community now strongly believes we need to foster through education the competencies of heart and mind required for a sustainable future. In light of the current ideology driving education today, the proposed re-orientation of education will require challenging taken-for-granted cultural assumptions and deeply re-examining our relationship with the Earth. In this article, I argue that an international effort to re-orient education is at heart a phenomenological task. Understanding the lived experience of the person-environment relationship must be the starting point of such educational efforts and the development of a language to describe person-environment relationship is essential to the goal of re-orienting education for the values of sustainability.

Here is a trailblazing book on issues of vital interest to the future of humankind. Ecotherapy: Healing Ourselves, Healing the Earth sheds light on humankind’s most serious health challenge ever--how to save our precious planet as a clean, viable habitat. As a guide for therapists, health professionals, pastoral counselors, teachers, medical healers, and especially parents, Ecotherapy: Healing Ourselves, Healing the Earth highlights readers’strategic opportunities to help our endangered human species cope constructively with the unprecedented challenge of saving a healthful planet for future generations.

Here is a trailblazing book on issues of vital interest to the future of humankind. Ecotherapy: Healing Ourselves, Healing the Earth sheds light on humankind''s most serious health challenge ever--how to save our precious planet as a clean, viable habitat. As a guide for therapists, health professionals, pastoral counselors, teachers, medical healers, and especially parents, Ecotherapy: Healing Ourselves, Healing the Earth highlights readers''strategic opportunities to help our endangered human species cope constructively with the unprecedented challenge of saving a healthful planet for future generations. Ecotherapy: Healing Ourselves, Healing the Earth introduces readers to an innovative approach to ecologically-grounded personality theory, spirituality, ecotherapy, and education. The book shares the author''s well-developed theories and methods of ecological diagnosis, treatment, and education so professionals and parents, our most influential teachers, can rise to the challenge of saving our planet. Readers will find that the book helps them accomplish this goal as it: explores an expanded, ecologically grounded theory of personality development, the missing dimension in understanding human identity formation outlines a model for doing ecologically oriented psychotherapy, counseling, medical healing, teaching, and parenting describes life-saving perspectives for making one''s lifestyle more earth-caring demonstrates the importance of hope, humor, and love suggests how these earthy approaches may be utilized in a variety of social contexts and cultures A systematic theory and practice guidebook, Ecotherapy: Healing Ourselves, Healing the Earth fills a wide gap in both the counseling and therapy literature and the ecology literature. It offers an innovative model for fulfilling the "ecological circle" between humans and nature with three action dimensions. These are self-care by being intentionally nurtured by nature; spiritual enrichment by enjoying the transcendent Spirit in nature; and responding by nurturing nature more responsibly and lovingly. The theories and practical applications presented in the book come together to explore long-overlooked issues at the boundary between human health and the health of the natural environment. Psychotherapists, health professionals, and teachers; pastoral counselors and other clergy who counsel and teach; laypersons who are parents and grandparents; and individuals and groups interested in environmental issues will find Ecotherapy: Healing Ourselves, Healing the Earth essential for approaching the long-neglected earthy roots of the total human mind-body-spirit organism. ng our planet. Readers will find that the book helps them accomplish this goal as it: explores an expanded, ecologically grounded theory of personality development, the missing dimension in understanding human identity formation outlines a model for doing ecologically oriented psychotherapy, counseling, medical healing, teaching, and parenting describes life-saving perspectives for making one''s lifestyle more earth-caring demonstrates the importance of hope, humor, and love suggests how these earthy approaches may be utilized in a variety of social contexts and cultures A systematic theory and practice guidebook, Ecotherapy: Healing Ourselves, Healing the Earth fills a wide gap in both the counseling and therapy literature and the ecology literature. It offers an innovative model for fulfilling the "ecological circle" between humans and nature with three action dimensions. These are self-care by being intentionally nurtured by nature; spiritual enrichment by enjoying the transcendent Spirit in nature; and responding by nurturing nature more responsibly and lovingly. The theories and practical applications presented in the book come together to explore long-overlooked issues at the boundary between human health and the health of the natural environment. Psychotherapists, health professionals, and teachers; pastoral counselors and other clergy who counsel and teach; laypersons who are parents and grandparents; and individuals and groups interested in environmental issues will find Ecotherapy: Healing Ourselves, Healing the Earth essential for approaching the long-neglected earthy roots of the total human mind-body-spirit organism. y nature; spiritual enrichment by enjoying the transcendent Spirit in nature; and responding by nurturing nature more responsibly and lovingly. The theories and practical applications presented in the book come together to explore long-overlooked issues at the boundary between human health and the health of the natural environment. Psychotherapists, health professionals, and teachers; pastoral counselors and other clergy who counsel and teach; laypersons who are parents and grandparents; and individuals and groups interested in environmental issues will find Ecotherapy: Healing Ourselves, Healing the Earth essential for approaching the long-neglected earthy roots of the total human mind-body-spirit organism.

CONTEXT: Stress, both psychological and physiological, has been implicated as having a role in the onset and exacerbations of rheumatoid arthritis (RA). OBJECTIVE: This study investigated whether neuroendocrine and physical function in women with RA can be altered through a yoga intervention. DESIGN: Exercise intervention. SETTING: University research conducted at a medical clinic. PARTICIPANTS: Sixteen independently living, postmenopausal women with an RA classification of I, II, or III according to the American College of Rheumatology functional classification system served as either participants or controls. INTERVENTION: The study group participated in three 75-minute yoga classes a week over a 10-week period. MAIN OUTCOME MEASURES: At baseline and on completion of the 10-week intervention, diurnal cortisol patterns and resting heart rate were measured. Balance was measured using the Berg Balance Test. Participants completed the Health Assessment Questionnaire (HIQ), a visual analog pain scale, and the Beck Depression Inventory. RESULTS: Yoga resulted in a significantly decreased HAQ disability index, decreased perception of pain and depression, and improved balance. Yoga did not result in a significant change in awakening or diurnal cortisol patterns (P = .12).

Background. A majority of cancer survivors experience debilitating effect(s) related to their cancer diagnosis and treatments across physical, psychological, social, and spiritual domains. Timely and innovative solutions are needed to address the adverse treatment-related effects and often disjointed services that breast cancer patients face. Recent studies suggest that the majority of breast cancer survivors are using complementary and alternative medicine at some point along their cancer trajectory. In recent years, scientists and clinicians have examined the effects of yoga therapy among cancer patients and survivors. The current study examined the perceived feasibility of implementing yoga therapy as a treatment service for breast cancer patients at a large urban cancer center in Canada. Methods. A mixed-methods approach that included focus groups and self-reported surveys with health care providers (HCPs) and breast cancer patients was used in this research. Results. Overall, results indicated that breast cancer patients and HCPs were supportive and eager for the implementation of a yoga therapy program. Six themes emerged from the analysis of the focus group and the survey data: (1) the availability of resources and accessibility of yoga therapy, (2) the credibility and transparency of yoga therapy, (3) the understanding of yoga therapy, (4) an educational component, (5) the therapeutic context, and (6) the integration of yoga therapy. Specific facilitators and barriers became evident within these themes. Conclusions. Although enthusiasm for the implementation of an integrative yoga therapy program was apparent among both breast cancer survivors and HCPs, barriers were also identified. The findings of this study are currently being used to inform a large-scale program of research aimed at developing integrative treatment services for breast cancer patients, beginning with yoga therapy.

BACKGROUND: A majority of cancer survivors experience debilitating effect(s) related to their cancer diagnosis and treatments across physical, psychological, social, and spiritual domains. Timely and innovative solutions are needed to address the adverse treatment-related effects and often disjointed services that breast cancer patients face. Recent studies suggest that the majority of breast cancer survivors are using complementary and alternative medicine at some point along their cancer trajectory. In recent years, scientists and clinicians have examined the effects of yoga therapy among cancer patients and survivors. The current study examined the perceived feasibility of implementing yoga therapy as a treatment service for breast cancer patients at a large urban cancer center in Canada.METHODS: A mixed-methods approach that included focus groups and self-reported surveys with health care providers (HCPs) and breast cancer patients was used in this research. RESULTS: Overall, results indicated that breast cancer patients and HCPs were supportive and eager for the implementation of a yoga therapy program. Six themes emerged from the analysis of the focus group and the survey data: (1) the availability of resources and accessibility of yoga therapy, (2) the credibility and transparency of yoga therapy, (3) the understanding of yoga therapy, (4) an educational component, (5) the therapeutic context, and (6) the integration of yoga therapy. Specific facilitators and barriers became evident within these themes. CONCLUSIONS: Although enthusiasm for the implementation of an integrative yoga therapy program was apparent among both breast cancer survivors and HCPs, barriers were also identified. The findings of this study are currently being used to inform a large-scale program of research aimed at developing integrative treatment services for breast cancer patients, beginning with yoga therapy.

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