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Mindfulness Meditation, Anxiety Reduction, and Heart Disease: A Pilot Study
Abstract
Heart disease is the leading cause of death among Americans each year, yet the misperception still exists that cardiovascular disease is not a serious health problem for women. Evidence indicates that anxiety contributes to the development of heart disease. The primary purpose of this study was to assess the effectiveness of Kabat-Zinn's mindfulness-based stress reduction program to reduce anxiety in women with heart disease. Anxiety, emotional control, coping styles, and health locus of control were compared in a treatment and control group of women with heart disease. Post-intervention analyses provide initial support for beneficial effects of this program.
... Mindfulness promotes detached, non-judgmental observation of thoughts, perceptions, sensations, and emotions, enabling self-monitoring and arousal regulation through detached awareness. Mindfulness-Based Stress Reduction (MBSR) has demonstrated success in alleviating anxiety, chronic pain, fibromyalgia, mood, and stress, fostering an increased sense of control, particularly in individuals with cancer [16,17]. Mindfulness-Based Cognitive Therapy (MBCT) integrates elements from mindfulness-based and cognitive behavior therapy, initially designed as a preventive and therapeutic measure for individuals prone to depression relapse, but later adapted for various populations and environments [18,19]. ...
Background
People with schizophrenia often face challenges such as lower psychological resilience, reduced self-worth, and increased social stigma, hindering their recovery. Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in boosting psychological resilience and self-esteem while diminishing stigma. However, MBCT demands professional involvement and substantial expenses, adding to the workload of professionals and the financial strain on patients. Mixed-mode Mindfulness-Based Cognitive Therapy (M-MBCT) integrates both “face-to-face” and “self-help” approaches to minimize staff effort and costs. This study aims to assess the impact of M-MBCT on the psychological resilience, self-esteem, and stigma in schizophrenia patients.
Methods
This randomized, controlled, parallel-group, assessor-blinded clinical trial enrolled 174 inpatients with schizophrenia. Participants were randomly assigned to either the experimental or control group. The experimental group underwent an 8-week M-MBCT intervention, while the control group received standard treatment. Data collection employed the Connor-Davidson Resilience Scale (CD-RISC), Internalized Stigma of Mental Illness Scale (ISMI), and Rosenberg Self-Esteem Scale (RSES) before and after the intervention. Post-intervention, significant differences in ISMI, CD-RISC, and RSES scores were observed between the experimental and control groups.
Results
In the experimental group, ISMI scores notably decreased, while CD-RISC and RSES scores significantly increased (P < 0.05). Multiple linear regression analysis identified age, education, and family history of mental illness as significant factors related to stigma (P < 0.05). Additionally, correlation analysis indicated a significant negative relationship between the reduction in CD-RISC scores and the reduction in ISMI scores (P < 0.05).
Conclusion
M-MBCT effectively enhanced psychological resilience and self-esteem while diminishing stigma in individuals with schizophrenia. M-MBCT emerges as a promising treatment option for schizophrenia sufferers.
Trial registration
The trial was registered at the Chinese Clinical Trial Registry on 03/06/2023 (www.chictr.org.cn; ChiCTR ID: ChiCTR2300069071).
Definitions of disability abound, but it has been represented in prevailing social discourses as both proper to the individual and the medical institution. Discourses that portray disability as such are inherently interdiscursive in nature, as they draw upon, and are embedded within, larger discourses of what counts as evidence of not only knowledge, but knowledge of disability in particular. By employing a discourse analytic approach to analyzing in-depth interviews with members of a university accommodations office, I show how they locally reproduce and inadvertently reaffirm such discourses of disability, as they organize disability according to type: physical and cognitive. In their talk, these categories of disability are presented as oppositional and hierarchical constructs, with physical disability being discursively constructed as preferable to cognitive disability. I consider how this practice ties into an empiricist tradition that argues that to know disability means that it must be observable, measurable, or otherwise verifiable.
Objective: College students experience intense anxiety, for which biofeedback mindfulness techniques show effectiveness in relief. However, typical biofeedback products often lead to user fatigue and boredom because of a single or fixed feedback and lack of focus on mindfulness enhancement. Materials and Methods: In this research, we developed Mindjourney, a VR-based respiratory feedback mindfulness system, designed to enhance mindfulness and alleviate anxiety through continuous/noncontinuous feedback and nonjudgmental reward/punishment for self-perception and attention management. A randomized controlled trial involved 72 college students, split equally into short-term (n = 34, age: 23.11 ± 1.729) and 4-week long-term (n = 38, age: 24.12 ± 1.408) groups, with equal randomization for intervention and control groups. Pre/postintervention tests were measured by using Trait Anxiety Inventory (TAI) and Five Facet Mindfulness Questionnaire (FFMQ) for long-term groups and Galvanic Skin Response and State Anxiety Inventory (SAI) for short-term groups. Results: Results showed that the long-term intervention group showed a significant increase in mindfulness (P = 0.001 for FFMQ total score). Furthermore, observe and act with awareness subscales showed significant increase after intervention (P = 0.034 for observe, P < 0.001 for act with awareness) compared with the control group. Both intervention groups demonstrated a significant decrease in anxiety levels compared with the control groups (P = 0.049 for SAI, P = 0.01 for TAI). Moreover, participants expressed high interest in this biofeedback mindfulness system and willingness for long-term usage. Conclusion: The proposed biofeedback mindfulness practice system could potentially facilitate mindfulness practice and serve as a convenient tool for anxiety relief in campus college students.
In the present time, it is a big challenge to enhance mental health which is one of the important aspects of life for
every individual. But the fact is that it is one of the neglected parts of human life. Everyone wants to achieve a
healthy and happy life. Brock Chisholm, the first Director-General of WHO (1954) stated that “without mental
health, there can be no true physical health.” Positive mental health is required for every individual, family,
community, nation and is an indivisible part of our general health that aids social functioning and affects our overall
performance. Thus, it is necessary to maintain harmonious relations, achieve a healthy, happy, and stress-less life,
execute our tasks with full potential, maintain consistency in work and easily cope with stressful situations. By
being aware about own health, one can improve own mental health and that awareness can be learnt by learning
mindfulness-related skills. Mindfulness is a good exercise as it enhances the stress coping skills and promotes selfcare. Mindfulness-based interventions are typically used to reduce the symptoms of stress, psychological problems,
and physical pain. A number of interventions are there which are based on the fundamental idea of mindfulness
including Mindfulness Meditation, Mindfulness-Based Stress Reduction Therapy (MBSSR), Mindfulness-Based
Cognitive Therapy (MBCT), Mindfulness-Based Self-Management Therapy (MBSMT), and others. Practicing
mindfulness leads to a healthy and happy life which directly affects mental health and well-being of every
individual. The review of related researches revealed that mindfulness-based interventions have a significant
impact on positive mental health.
Interventions that target mental health symptoms and stress among those with established cardiac disease have included predominately male samples despite female patients reporting greater severity of these symptoms. The aim of this scoping review was to synthesize the published literature on psychological interventions for females with cardiac disease. We conducted a systematic search of peer-reviewed randomized clinical trials (RCTs) published in the English language from 2003 to 2023, in three databases: Medline (Ovid), PsycInfo (Ovid), and CINAHL (EBSCO). Articles that included female samples, a control or comparison group, implemented psychological interventions, and measured depression, anxiety, or stress as an outcome were included in the review. Nine articles describing eight RCTs of psychological interventions, with a total of 1587 female patients with cardiac disease, were included. Interventions were most successful at reducing stress (75% of studies measuring stress reported efficacy), while symptoms of depression and anxiety were less responsive to intervention (∼30% of studies targeting these symptoms reported improvements) in comparison to a control condition. This scoping review highlights that further advancement in knowledge is required to better address the needs of females with cardiac disease and distress, particularly depression and anxiety.
Executive Summary:
• There is a need for peer-reviewed scholarship on the effectiveness of musicians’ mental health interventions.
• An initial review of global mental health interventions for musicians was undertaken as part of this report from which four models of practice were discernible: telephone helplines; preventative models; therapeutic approaches, and peer support models. These are not mutually exclusive nor necessarily exhaustive.
• We have named examples of organisations throughout who are included as examples of best practice that draw on these models (wholly or in part).
• Of the four models explored below, and with reference to our survey findings on Danish music creators, we would suggest that both therapeutic and peer support models offer the most favourable evidence base. Resilience-based, preventative methods are potentially promising for musical performers at specific career stages and in certain demographics despite a lack of peer-reviewed evidence to date, and helplines based on need in a crisis are, on balance, likely to offer less utility in the Danish context given our survey data.
• Of all of the four models we have explored, a more holistic and/or multi-faceted approach is likely to yield the best results, which is indeed adopted by many of the organisations named.
• The best examples of musicians’ mental health interventions embed mechanisms in order to rigorously evaluate effectiveness amongst service users across different modalities, time scales and musician demographics, and share these findings with stakeholders, with service offerings adapted accordingly.
Background:
Interventions incorporating meditation to address stress, anxiety, and depression, and improve self-management, are becoming popular for many health conditions. Stress is a risk factor for cardiovascular disease (CVD) and clusters with other modifiable behavioural risk factors, such as smoking. Meditation may therefore be a useful CVD prevention strategy.
Objectives:
To determine the effectiveness of meditation, primarily mindfulness-based interventions (MBIs) and transcendental meditation (TM), for the primary and secondary prevention of CVD.
Search methods:
We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 14 November 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.
Selection criteria:
We included randomised controlled trials (RCTs) of 12 weeks or more in adults at high risk of CVD and those with established CVD. We explored four comparisons: MBIs versus active comparators (alternative interventions); MBIs versus non-active comparators (no intervention, wait list, usual care); TM versus active comparators; TM versus non-active comparators.
Data collection and analysis:
We used standard Cochrane methods. Our primary outcomes were CVD clinical events (e.g. cardiovascular mortality), blood pressure, measures of psychological distress and well-being, and adverse events. Secondary outcomes included other CVD risk factors (e.g. blood lipid levels), quality of life, and coping abilities. We used GRADE to assess the certainty of evidence.
Main results:
We included 81 RCTs (6971 participants), with most studies at unclear risk of bias. MBIs versus active comparators (29 RCTs, 2883 participants) Systolic (SBP) and diastolic (DBP) blood pressure were reported in six trials (388 participants) where heterogeneity was considerable (SBP: MD -6.08 mmHg, 95% CI -12.79 to 0.63, I2 = 88%; DBP: MD -5.18 mmHg, 95% CI -10.65 to 0.29, I2 = 91%; both outcomes based on low-certainty evidence). There was little or no effect of MBIs on anxiety (SMD -0.06 units, 95% CI -0.25 to 0.13; I2 = 0%; 9 trials, 438 participants; moderate-certainty evidence), or depression (SMD 0.08 units, 95% CI -0.08 to 0.24; I2 = 0%; 11 trials, 595 participants; moderate-certainty evidence). Perceived stress was reduced with MBIs (SMD -0.24 units, 95% CI -0.45 to -0.03; I2 = 0%; P = 0.03; 6 trials, 357 participants; moderate-certainty evidence). There was little to no effect on well-being (SMD -0.18 units, 95% CI -0.67 to 0.32; 1 trial, 63 participants; low-certainty evidence). There was little to no effect on smoking cessation (RR 1.45, 95% CI 0.78 to 2.68; I2 = 79%; 6 trials, 1087 participants; low-certainty evidence). None of the trials reported CVD clinical events or adverse events. MBIs versus non-active comparators (38 RCTs, 2905 participants) Clinical events were reported in one trial (110 participants), providing very low-certainty evidence (RR 0.94, 95% CI 0.37 to 2.42). SBP and DBP were reduced in nine trials (379 participants) but heterogeneity was substantial (SBP: MD -6.62 mmHg, 95% CI -13.15 to -0.1, I2 = 87%; DBP: MD -3.35 mmHg, 95% CI -5.86 to -0.85, I2 = 61%; both outcomes based on low-certainty evidence). There was low-certainty evidence of reductions in anxiety (SMD -0.78 units, 95% CI -1.09 to -0.41; I2 = 61%; 9 trials, 533 participants; low-certainty evidence), depression (SMD -0.66 units, 95% CI -0.91 to -0.41; I2 = 67%; 15 trials, 912 participants; low-certainty evidence) and perceived stress (SMD -0.59 units, 95% CI -0.89 to -0.29; I2 = 70%; 11 trials, 708 participants; low-certainty evidence) but heterogeneity was substantial. Well-being increased (SMD 0.5 units, 95% CI 0.09 to 0.91; I2 = 47%; 2 trials, 198 participants; moderate-certainty evidence). There was little to no effect on smoking cessation (RR 1.36, 95% CI 0.86 to 2.13; I2 = 0%; 2 trials, 453 participants; low-certainty evidence). One small study (18 participants) reported two adverse events in the MBI group, which were not regarded as serious by the study investigators (RR 5.0, 95% CI 0.27 to 91.52; low-certainty evidence). No subgroup effects were seen for SBP, DBP, anxiety, depression, or perceived stress by primary and secondary prevention. TM versus active comparators (8 RCTs, 830 participants) Clinical events were reported in one trial (201 participants) based on low-certainty evidence (RR 0.91, 95% CI 0.56 to 1.49). SBP was reduced (MD -2.33 mmHg, 95% CI -3.99 to -0.68; I2 = 2%; 8 trials, 774 participants; moderate-certainty evidence), with an uncertain effect on DBP (MD -1.15 mmHg, 95% CI -2.85 to 0.55; I2 = 53%; low-certainty evidence). There was little or no effect on anxiety (SMD 0.06 units, 95% CI -0.22 to 0.33; I2 = 0%; 3 trials, 200 participants; low-certainty evidence), depression (SMD -0.12 units, 95% CI -0.31 to 0.07; I2 = 0%; 5 trials, 421 participants; moderate-certainty evidence), or perceived stress (SMD 0.04 units, 95% CI -0.49 to 0.57; I2 = 70%; 3 trials, 194 participants; very low-certainty evidence). None of the trials reported adverse events or smoking rates. No subgroup effects were seen for SBP or DBP by primary and secondary prevention. TM versus non-active comparators (2 RCTs, 186 participants) Two trials (139 participants) reported blood pressure, where reductions were seen in SBP (MD -6.34 mmHg, 95% CI -9.86 to -2.81; I2 = 0%; low-certainty evidence) and DBP (MD -5.13 mmHg, 95% CI -9.07 to -1.19; I2 = 18%; very low-certainty evidence). One trial (112 participants) reported anxiety and depression and found reductions in both (anxiety SMD -0.71 units, 95% CI -1.09 to -0.32; depression SMD -0.48 units, 95% CI -0.86 to -0.11; low-certainty evidence). None of the trials reported CVD clinical events, adverse events, or smoking rates.
Authors' conclusions:
Despite the large number of studies included in the review, heterogeneity was substantial for many of the outcomes, which reduced the certainty of our findings. We attempted to address this by presenting four main comparisons of MBIs or TM versus active or inactive comparators, and by subgroup analyses according to primary or secondary prevention, where there were sufficient studies. The majority of studies were small and there was unclear risk of bias for most domains. Overall, we found very little information on the effects of meditation on CVD clinical endpoints, and limited information on blood pressure and psychological outcomes, for people at risk of or with established CVD. This is a very active area of research as shown by the large number of ongoing studies, with some having been completed at the time of writing this review. The status of all ongoing studies will be formally assessed and incorporated in further updates.
Over 75% of pediatric surgery patients experience preoperative anxiety, which can lead to complicated recoveries. Current interventions are less effective for children over 12 years old. New interventions, like mindfulness-based ones (MBIs), are needed to address this issue. MBIs work well for reducing mental health symptoms in youth, but they can be challenging for beginners. Virtual reality (VR) nature settings can help bridge this gap, providing an engaging 3-D practice environment that minimizes distractions and enhances presence. However, no study has investigated the combined effects of mindfulness training in natural VR settings for pediatric surgery patients, creating a significant gap for a novel intervention. This paper aims to fill that gap by presenting a narrative review exploring the potential of a nature-based mindfulness program using VR to reduce pediatric preoperative anxiety. It begins by addressing the risks of anxiety in children undergoing surgery, emphasizing its impact on physical recovery, and supporting the use of VR for anxiety reduction in hospitals. The review then delves into VR's role in nature and mindfulness, discussing theoretical concepts, clinical applications, and effectiveness. It also examines how the combination of mindfulness, nature, and VR can create an effective intervention, supported by relevant literature. Finally, it synthesizes the existing literature's limitations, findings, gaps, and contradictions, concluding with research and clinical implications.
Highlights theory and research concerning internal vs external locus of control of reinforcement (IE) and explores the ways in which the IE dimension is related to attributions and personal styles such as perceived control, helplessness, and optimism, particularly in regard to health. Discussed are (1) J. B. Rotter's (1954) social learning theory and early IE research, (2) the Nowicki-Strickland Internal–External Scale, (3) contemporary cognitive-expectancy variables and health, and (4) IE in relation to creativity. It is suggested that the strategies that individuals use to understand and control events in their lives depend on understanding of contingencies between behavior and subsequent events and include the creation of new patterns of contingencies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This investigation reports the development of a multidimensional instrument of stable coping styles that focused on whether one's problem-focused coping efforts were facilitating or inhibiting progress toward resolution of a problem. Study 1 describes the steps in scale construction, including the factor analyses, normative information, and reliability estimates. Study 2 provides initial estimates of the stability of the factor structure and construct, concurrent, and discriminant validity. Study 3 provides evidence for the test–retest stability of the Problem-Focused Style of Coping (PF-SOC) factors, an examination of the relations between the PF-SOC factors and neuroticism as another estimate of discriminant validity, and additional concurrent validity by comparisons with a well-developed coping styles inventory. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined the effects of breast cancer on avoidant attachment and emotional control behavior. 52 females with breast cancer (aged 35–55 yrs) completed the Adult Attachment Questionnaire (J. A. Simpson et al, 1996) concerning attachment style, the Courtauld Emotional Control Scale (M. Watson and S. Greer, 1983), and other questionnaires concerning demographic characteristics. Results show that Ss scored significantly higher on avoidant attachment, compared to controls not stricken with breast cancer. As well, Ss reported a significantly higher degree of emotional control compared to controls. It is concluded that there is a need to differentiate avoidance as a coping strategy or as an attachment pattern prior to cancer. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The development of the Multidimensional Health Locus of Control scales is described. Scales have been developed to tap beliefs that the source of reinforcements for health-related behaviors is primarily internal, a matter of chance, or under the control of powerful others. These scales are based on earlier work with a general Health Locus of Control Scale, which, in turn, was developed from Rotter's social learning theory. Equivalent forms of the scales are presented along with initial internal consistency and validity data. Possible means of utilizing these scales are provided.
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 agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period.
Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings.
A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
Objective.
—To quantify changes in size and severity of myocardial perfusion abnormalities by positron emission tomography (PET) in patients with coronary artery disease after 5 years of risk factor modification.Design.
—Randomized controlled trial.Setting.
—Outpatient community setting.Intervention.
—Randomization of patients to risk factor modification consisting of very low-fat vegetarian diet, mild to moderate exercise, stress management, and group support (experimental group, n=20) or to usual care by their own physicians, consisting principally of antianginal therapy (control group, n=15).Main Outcome Measures.
—Quantitative coronary arteriography and PET at baseline and 5 years after randomization. Automated, objective measures of size and severity of perfusion abnormalities on rest-dipyridamole PET images and of stenosis severity on arteriograms were made by computer algorithms.Results.
—Size and severity of perfusion abnormalities on dipyridamole PET images decreased (improved) after risk factor modification in the experimental group compared with an increase (worsening) of size and severity in controls. The percentage of left ventricle perfusion abnormalities outside 2.5 SDs of those of normal persons (based on 20 disease-free individuals) on the dipyridamole PET image of normalized counts worsened in controls (mean ±SE, +10.3%±5.6%) and improved in the experimental group (mean ±SE, −5.1 %±4.8%) (P=.02); the percentage of left ventricle with activity less than 60% of the maximum activity on the dipyridamole PET image of normalized counts worsened in controls (+13.5%± 3.8%) and improved in the experimental group (−4.2%±3.8%) (P=.002); and the myocardial quadrant on the PET image with the lowest average activity expressed as a percentage of maximum activity worsened in controls (−8.8%±2.3%) and improved in the experimental group (+4.9%±3.3%)(P=.001 ). The size and severity of perfusion abnormalities on resting PET images were also significantly improved in the experimental group as compared with controls. The relative magnitude of changes in size and severity of PET perfusion abnormalities was comparable to or greater than the magnitude of changes in percent diameter stenosis, absolute stenosis lumen area, or stenosis flow reserve documented by quantitative coronary arteriography.Conclusions.
—Modest regression of coronary artery stenoses after risk factor modification is associated with decreased size and severity of perfusion abnormalities on rest-dipyridamole PET images. Progression or regression of coronary artery disease can be followed noninvasively by dipyridamole PET reflecting the integrated flow capacity of the entire coronary arterial circulation.(JAMA. 1995;274:894-901)
Hostility, depression, and anxiety have been associated with coronary heart disease (CHD), but the role of emotional distress in the development of CHD is still a controversial issue. Evidence shows, however, that emotional distress plays a key role in the progression of CHD: (i) emotional distress is associated with pathophysiological mechanisms and cardiac events in coronary patients, (ii) psychosocial treatments of emotional stress may reduce mortality and morbidity in these patients, and (iii) inhibition of negative emotions may accelerate CHD. Evidence also shows that emotional stress as a risk factor for CHD is a chronic characteristic; research has, however, largely ignored the role of personality in this context. The approach to personality and CHD that is presented in this paper revisits the tradition of global personality traits, and is based on the notion that the interaction between negative affectivity (the tendency to experience negative emotions) and social inhibition (the tendency to inhibit self-expression in social interaction) has potential explanatory power in coronary patients. The construct of type-D personality is introduced to designate those coronary patients who experience difficulties in the areas of negative emotions and self-expression. Type-D patients typically report high levels of depressive symptoms and poor levels of social support. Evidence is presented which suggests that, eventually, the emotional difficulties of type-D patients may result in hard endpoints such as increased risk for long-term mortality. It is concluded that, in addition to assessing specific psychosocial factors, it is equally important to assess the effect of global traits and their interaction on prognosis in patients with CHD. © 1997 John Wiley & Sons, Ltd.
Two hundred twenty-five chronic pain patients were studied following training in mindfulness meditation. Large and significant overall improvements were recorded post-intervention in physical and psychological status. These gains were maintained at follow-up in the majority of subjects. Follow-up times ranged from 2.5-48 months. Status on the McUill Melzack Fain Rating Index (PRI). however, tended to revert to preintervention levels following the intervention. Most subjects reported a high degree of adherence with the meditation techniques, maintenance of improved status over time, and a high degree of importance attributed to the training program. We conclude that such training can have long-term benefit for chronic pain patients.
(C) Lippincott-Raven Publishers.
Decreased heart rate (HR) variability is associated with increased mortality after myocardial infarction, but the prognostic value of HR variability in patients without recent myocardial infarction and its correlation with other clinical and angiographic data have not previously been reported. In the present study, detailed clinical assessments and 24-hour ambulatory electrocardiograms were performed prospectively on 100 patients undergoing elective coronary angiography. HR variability was inversely correlated with HR (r = -0.38, p = 0.001), diabetes mellitus (r = -0.22, p = 0.025) and digoxin use (r = -0.29, p = 0.004), but not with left ventricular ejection fraction, extent of coronary artery disease or other clinical, electrocardiographic or angiographic variables. All patients were followed for 1 year. Major clinical events after initial discharge occurred in 10 patients and included 6 deaths and 4 coronary bypass operations. Left ventricular ejection fraction was the only variable that correlated with the occurrence of a clinical event (p = 0.002). Decreased HR variability and ejection fraction were the best predictors of mortality (both p less than 0.01), and the contribution of HR variability to mortality was independent of ejection fraction, extent of coronary artery disease and other variables. Furthermore, 11 patients with HR variability less than 50 ms had an 18-fold increase in mortality compared with patients with HR variability greater than 50 ms (36 vs 2%, p = 0.001). Thus, decreased HR variability is a potent independent predictor of mortality in the 12 months following elective coronary angiography in patients without recent myocardial infarction.
Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.