Jean Kristeller

• Ph.D.
• Professor Emeritus at Indiana State University

Introduction: Weight regain after bariatric surgery remains a relevant and worrisome topic, requiring greater understanding and involvement in research into new adjuvant treatments. This study aims to compare the preliminary effectiveness and feasibility of the Mindfulness-Based Health Promotion and Attachment-Based Compassion Therapy programs as o...

Objective: People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions. Me...

Over the last decades, eating episodes in addition to the three daily main meals have been observed worldwide; the prevalence of these “snacking” episodes raises health questions that mindful eating may contribute to answering. The goal of the symposium entitled “Mindful eating applied to snacking: a promising behavioral approach supported by resea...

Objectives Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the “challenge and threat” framework, which defines...

Objective: We aimed to understand the associations of compulsive eating (CE) and stress eating (SE) with metabolic health among adults with obesity and whether mindfulness-based weight loss training may buffer these associations. Method: We used data from a trial in which we randomized 194 participants with obesity to a diet-exercise weight loss...

Background: Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized...

Cambridge Core - Health and Clinical Psychology - Psychological Care in Severe Obesity - edited by Stephanie Cassin

Psychological Care in Severe Obesity - edited by Stephanie Cassin June 2018

Background: Mindfulness has been applied in the United States and Europe to improve physical and psychological health; however, little is known about its feasibility and efficacy in a Brazilian population. Mindfulness may also be relevant in tackling obesity and eating disorders by decreasing binge eating episodes-partly responsible for weight reg...

Background High stress and depression during pregnancy are risk factors for worsened health trajectories for both mother and offspring. This is also true for pre-pregnancy obesity and excessive gestational weight gain. Reducing stress and depression may be one path to prevent excessive caloric intake and gestational weight gain. Study Purpose We te...

Meditative practices have a long history in India and have influenced contemporary meditative programs elsewhere in the world. Over the last several decades, the use of meditation as a therapeutic tool has been investigated in regard to physical, emotional and behavioral effects with impressive results. In parallel to this has been a growing intere...

Eating disorders and concern about weight are generally associated with younger women. This article first reviews the limited literature addressing the prevalence of disordered eating concerns in older women, both related to and independent of weight issues. Excessive concern about weight, body image and restricted eating/fasting appears to continu...

We evaluated changes in mindful eating as a potential mechanism underlying the effects of a mindfulness-based intervention for weight loss on eating of sweet foods and fasting glucose levels. We randomized 194 obese individuals (M age = 47.0 ± 12.7 years; BMI = 35.5 ± 3.6; 78 % women) to a 5.5-month diet-exercise program with or without mindfulness...

Supporting Information

Objective: To determine whether adding mindfulness-based eating and stress management practices to a diet-exercise program improves weight loss and metabolic syndrome components. Methods: In this study 194 adults with obesity were randomized to a 5.5-month program with or without mindfulness training and identical diet-exercise guidelines. Inten...

Many individuals with obesity report overeating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoti...

This chapter explores unique elements in teaching Mindfulness-Based Eating Awareness (MB-EAT) to individuals with a range of eating issues, including binge eating disorder. Eating involves complex processes, related to biological needs for food and to social, hedonic and non-nutritive needs. The underlying principle of MB-EAT is that healthy eating...

This report describes the results of a randomized controlled feasibility study of the Mindfulness Intervention for Rehabilitation and Recovery in Schizophrenia (MIRRORS). MIRRORS is an adaptation of Mindfulness-Based Stress Reduction designed to help persons with schizophrenia to persist and perform better at work. Thirty-four participants with sch...

Eating encompasses multiple self-regulatory processes, including physiological, behavioral, emotional, and social. This chapter reviews the application of self-regulation theory to mindfulness approaches to treating eating problems and obesity, with a particular focus on Mindfulness-Based Eating Awareness Training (MB-EAT). Eating behavior and the...

Obesity affects more than one-third of American adults and has recently been recognized as a disease by the American Medical Association. Interventions that incorporate mindfulness meditation, with a goal of increasing self-regulation, are well suited to the complexities of the behavioral, physiological, emotional, and cognitive dysregulation obser...

lthough people are often successful in losing weight, sustaining weight loss and healthy eating over the long term is challenging for many. New behavioral strategies can be used to help patients use acceptance and mindfulness to improve decision making. Additionally, behavioral strategies can help to promote a healthy environment for children, redu...

Overeating is probably the most common unintentional health harming behavior in westernized countries. The process of eating is one that richly lends itself to exploring the effects of mindfulness. Eating is biologically, psychologically, and culturally influenced. While necessary for day-to-day functioning, the parameters of what to eat and how to...

Overweight and obese individuals differ in their degree of hedonic eating. This may reflect adaptations in reward-related neural circuits, regulated in part by opioidergic activity. We examined an indirect, functional measure of central opioidergic activity by assessing cortisol and nausea responses to acute opioid blockade using the opioid antagon...

The First International Conference on Mindfulness was held in Rome, Italy, in May 2013, sponsored by the American Health and Wellness Institute, Sapienza University (Rome, Italy) and the Associazione Italiana Mindfulness. Over 330 participants from a wide range of disciplines representing 35 countries attended this first European conference. In add...

Mindful eating may be an effective intervention for increasing awareness of hunger and satiety cues, improving eating regulation and dietary patterns, reducing symptoms of depression and anxiety, and promoting weight loss. Diabetes self-management education (DSME), which addresses knowledge, self-efficacy, and outcome expectations for improving foo...

Binge eating is characterized by significant imbalance in food intake regulation and is often comorbid with obesity and depression. Mindfulness-based approaches may reduce compulsive overeating, address associated behavioral and emotional dysregulation, and promote internalization of change. This randomized trial explored the efficacy of Mindfulnes...

Objective: Binge eating disorder (BED) is prevalent among individuals from minority racial/ethnic groups and among individuals with lower levels of education, yet the efficacy of psychosocial treatments for these groups has not been examined in adequately powered analyses. This study investigated the relative variance in treatment retention and po...

Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes. Diabetes self-management education (DSME) is an essential component of effective self-care. Yet, little research has compared the effect of mindful eating to DSME-based treatment. This study compared the impact of these two int...

Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in...

Psychological distress and metabolic dysregulation are associated with markers of accelerated cellular aging, including reduced telomerase activity and shortened telomere length. We examined whether participation in a mindfulness-based intervention, and, secondarily, improvements in psychological distress, eating behavior, and metabolic factors are...

Higher levels of religious and spiritual engagement have been shown to be associated with better adjustment in dealing with serious illness. Nevertheless, the pattern of such engagement may vary substantially among individuals. This paper presents exploratory research with the goal of identifying subgroups of individuals with non-terminal cancer wh...

This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, beha...

Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program...

Unlabelled: This single-blind, randomized controlled trial evaluated the impact of the Transcendental Meditation program plus standard care as compared with standard care alone on the quality of life (QOL) of older women (>or=55 years) with stage II to IV breast cancer. One hundred and thirty women (mean age = 63.8) were randomly assigned to eithe...

Numerous measures of Religiousness and Spirituality (R/S) exist, but the number and type of dimensions represented by these measures remain unclear. We used exploratory and confirmatory analyses in two U.S. college-student samples to identify five dimensions of R/S: Religious/Spiritual Involvement, Search for Meaning, Religious Struggle, Quest, and...

Although the relationship between religious practice and health is well established, the relationship between spirituality and health is not as well studied. The objective of this study was to ascertain whether participation in the mindfulness-based stress reduction (MBSR) program was associated with increases in mindfulness and spirituality, and t...

Religiousness is known to be inversely related to alcohol use and problems, but few studies have attempted to identify mediators of this relationship. We examined beliefs about alcohol, social influences, well-being, and motives for drinking as potential mediators of the relationship between religiousness/spirituality and alcohol use and problems....

Meditation refers to a group of practices that cultivate focused attention and moment-to-moment awareness of one's experience in order to heighten the capacity to bring conscious choice to responses and reactions. Research supports the value of both concentrative and mindfulness meditation in improving physiological well-being, emotional regulation...

(Sternberg, 1990; Sternber & 2005; Baltes & Staudinger, 2000); the discussion, while primarily informed by Western and intellectual perspectives of what is meant by this term, acknowledges certain core elements, primarily the ability to fruitfully engage conflicting knowledge or aspects of a situation or goal, as central to what is meant by wisdom....

This chapter discusses the treatment for eating disorders. The Diagnostic and Statistical Manual of Mental Disorders recognizes two primary eating disorders: anorexia nervosa (AN) and bulimia nervosa (BN). It also includes binge eating disorder (BED), sub threshold versions of AN and BN, and other disordered eating patterns. The most widely researc...

Individuals with serious illness often desire to discuss spiritual concerns with their physician, yet substantial barriers exist to doing so, including limited evidence of value. This study evaluated acceptability, impact on satisfaction with care and on quality of life (QOL) of a brief (5-7 minute) semi-structured exploration of spiritual/religiou...

We explore the role of meditative practice in cultivating experiences of compassion, empathy, and altruism and address an apparent paradox: Meditation often is associated with solitary retreat, if not preoccupation with one's own concerns. How, then, does such a practice promote compassion for others? We propose a two-stage model. The first stage i...

This study investigated symptoms of distress and nicotine dependence as predictors of nicotine withdrawal symptoms among 188 incarcerated male smokers during a mandated smoking ban. Participants completed a smoking history questionnaire and measures of nicotine dependence, withdrawal, cravings, and distress before the ban and two follow-up times. T...

Fluoxetine improves affect in clinical syndromes such as depression and premenstrual dysphoric disorder. Little is known about fluoxetine's influence on mood changes after quitting smoking, which often resemble sub-clinical depression. The present study, a re-analysis of previously published data (Niaura et al. 2002), examined fluoxetine's effect o...

Motivational factors and initial stages of change (precontemplation vs. contemplation) were investigated among incarcerated male smokers forced to quit smoking due to a statewide smoking ban. All smokers completed a baseline questionnaire, which assessed smoking history, nicotine dependence [Fagerstrom Test for Nicotine Dependence (FTND)], nicotine...

To evaluate the association between quality-of-life (QOL) impairment as reported by patients and QOL impairment as judged by nurses or physicians, with and without consideration of spiritual well-being (SWB). A total of 163 patients with advanced cancer were enrolled onto a therapeutic trial, and cross-sectional data were derived from clinical and...

To determine whether fluoxetine improves overall quality of life (QOL) in advanced cancer patients with symptoms of depression revealed by a simple survey. One hundred sixty-three patients with an advanced solid tumor and expected survival between 3 and 24 months were randomly assigned in a double-blinded fashion to receive either fluoxetine (20 mg...

This program, a joint collaboration between the LSI Center for the Study of Health, Religion, and Spirituality at Indiana State University, and independent filmmaker Carolyn Speranza, will use video to express both the range of experiences that are engendered by meditation practice, and the depth of change that even brief training can produce. Medi...

On my meditation stand is a slender bronze Buddha figure, about a foot tall, seated on a lotus pad inscribed with om mani padme hum, the Sanskrit mantra of enlightenment, around the base. I searched for this figure several years ago on a trip to Nepal, going into small dark shops that reminded me of the travelogue/spiritual journal Shopping for Bud...

The authors evaluated the efficacy of fluoxetine hydrochloride (Prozac; Eli Lilly and Company, Indianapolis, IN) as an adjunct to behavioral treatment for smoking cessation. Sixteen sites randomized 989 smokers to 3 dose conditions: 10 weeks of placebo, 30 mg, or 60 mg fluoxetine per day. Smokers received 9 sessions of individualized cognitive-beha...

Medical providers are called upon to address a wide range of psychosocial issues, under increasing time constraints. Spiritual/existential distress was one of 18 issues covered in a survey of oncologists' (n=94) and oncology nurses' (n=267) attitudes and practices regarding psychosocial issues. The survey included patient vignettes at good, moderat...

Adult smokers (N = 253) without clinically significant depression were randomized on a double-blind basis to receive fluoxetine (30 or 60 mg daily) or a placebo for 10 weeks in combination with cognitive-behavioral therapy (CBT). It was predicted that fluoxetine would selectively benefit smokers with higher baseline depression, nicotine dependence,...

The purpose of this study was to test the effect of a chart reminder system on referral of inpatients to a hospital smoking cessation intervention pilot program. An A1-B-A2 reversal design was used to test the hypothesis that a chart reminder to nursing staff would increase the proportion of smokers referred for smoking cessation intervention over...

The efficacy of a 6-week meditation-based group intervention for Binge Eating Disorder (BED) was evaluated in 18 obese women, using standard and eating-specific mindfulness meditation exercises. A single-group extended baseline design assessed all variables at 3 weeks pre-and post-, and at 1, 3, and 6 weeks; briefer assessment occurred weekly. Bing...

Fluoxetine's effect (30 mg, 60 mg, and placebo) on postcessation weight gain was studied among participants from a randomized, double-blind 10-week smoking cessation trial who met strict criteria for abstinence and drug levels. It was hypothesized that (a) fluoxetine would dose-dependently suppress postcessation weight gain and (b) drug discontinua...

How people draw on religious and spiritual resources during times of stress varies considerably (Kristeller et al., in press), but raising these issues in the therapeutic context is often greatly appreciated by patients and can help individuals integrate this aspect of their lives into the healing process more fully. While a variety of perceived an...

This chapter focuses on the role of meditation and mindfulness in clinical therapy, and on how meditation as part of the therapeutic process relates to spiritual growth and development. Definitions and types of meditation practice are discussed, followed by a brief review of theories about how meditation may work. Various applications and examples...

Recently, researchers have suggested the possible importance of weight-related vari-ables, particularly among women, in relapse to smoking. The present study prospec-tively examined the prediction of success versus failure (both relapse and dropout) in a smoking-cessation program using several weight-related variables and gender. Weight-related var...

The Healthy People 2000 report recommended that physicians more actively address obesity, but little is known about current attitudes and practices of physicians, particularly across specialty areas relevant to obesity as a medical risk factor. A mail survey of 1,222 physicians from six specialties (family practice, internal medicine, gynecology, e...

Targeted health promotion requires an identifiable subpopulation which is accessible, at increased risk, receptive to input, and receptive to change. Relatives of recently diagnosed cancer patients may meet these criteria and have not previously been investigated as recipients of preventive education regarding smoking and diet. This study investiga...

Smoking and other tobacco exposure have been recognized for several decades as the most significant preventable factors in premature morbidity and mortality. Most physicians believe they should address the issue of tobacco intake with their patients but are rarely provided with adequate training or support to do so effectively. Recent research iden...

Patterns of smoking cessation using 6- and 12-month follow-up data are reported for 1,261 primary care patients randomized to 3 physician-delivered smoking interventions: advice only (AO), counseling (CI), and counseling plus availability of nicotine-containing gum (CI + NCG). One-week-point-prevalence cessation rates at 12 months did not differ am...

Patterns of smoking cessation using 6- and 12-month follow-up data are reported for 1,261 primary care patients randomized to 3 physician-delivered smoking interventions: advice only (AO), counseling (CI), and counseling plus availability of nicotine-containing gum (CI + NCG). One-week-point-prevalence cessation rates at 12 months did not differ am...

To date, relatively little work has been done to develop or evaluate effective inpatient quit-smoking treatment programs. However, there is growing interest in programs that motivate and assist the hospitalized smoker to quit smoking and remain abstinent. This article presents the rationale for hospital-based smoking treatment programs and introduc...

As part of a randomized trial that compared the effects of three physician-delivered smoking interventions on patients' long-term cessation rates, we examined factors associated with the extent of baseline cigarette smoking separately in 546 men and 715 women who were enrolled in this trial. Several baseline characteristics were significantly relat...

Smoking cessation greatly reduces morbidity and mortality associated with coronary artery disease (CAD). This paper presents details of an individually delivered smoking intervention program for patients with CAD that had been shown to be effective in a previously reported randomized clinical trial. Treatment components include inpatient counseling...

The objective of this study was to examine differences in the attitudes and reported practices toward smoking intervention of 224 internal medicine, family practice, and surgical physicians from one medical school faculty. Most internists and family practice physicians reported intervening with their patients who smoke, whereas only 50% of surgeons...

BACKGROUND. This paper investigates individual patient characteristics predicting differential response to each of three physician-delivered smoking interventions after 6 months. METHODS. Participants were 1,286 currently smoking patients seen by 196 medical and family practice residents in five primary care clinics affiliated with the University o...

This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders. The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agora...

We surveyed 375 10th grade students on present behaviors regarding cigarette use and on attitudes concerning smoking cessation. Fourteen percent of students were daily smokers and 7% were occasional smokers. Of the daily smokers, 28% said their most important reason for continued smoking was because they were addicted, and 52% reported two or more...

We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively. Logistic re...

The processes of change associated with smoking cessation were examined for 213 smokers and recent exsmokers who were scheduled for cardiac catheterization and compared to the processes reported by a sample of 180 nonmedical smokers and exsmokers. Subjects were classified into one of three stages of change depending on their readiness to quit smoki...

We tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients after coronary arteriography. After 6 months, 51% of AO patients and 62% of SI patients reported abstinence. Validated rates were 34% and 45% for AO and SI patients, respectively. Logistic re...

This article discusses three broad topics: (a) how beliefs about weight control influence smoking initiation and how preventive interventions might affect these beliefs, (b) whether weight gain affects smoking cessation and relapse, and (c) what primary gaps in our information still remain. Beliefs and behaviors relating to weight and their consequ...

We investigated the relationship between the extent of coronary artery disease (CAD) and the likelihood of cigarette smoking cessation in a population of 84 smokers between 21 and 75 years of age undergoing elective or urgent coronary angiography at the University of Massachusetts Medical Center. The smokers were enrolled in a pilot study investiga...

This investigation builds on an earlier study by describing the final results of a training program that teaches internal medicine and family practice residents to counsel patients to stop smoking. In this study, 198 residents participated in a three-hour training program which included small group discussion and role-playing exercises. Videotaped...

To assess the relative impacts of three physician-delivered smoking interventions in combination with follow-up contact from behavioral counselors. Randomized controlled trial with pre- post measures of smoking rates. This paper reports six-month outcome data. Participants were recruited from among patients seen by 196 medical and family practice r...

Although there is substantial research on eating patterns, little effort has been paid to developing a classification of eating behavior applicable to the general population, rather than to people seeking help for obesity or eating disorders. Using cluster analysis, this study identified six types of eating patterns among normal volunteers. One hun...