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MBSR & health-related quality of life in a heterogeneous patient population
Abstract
This study examined the effects of mindfulness-based stress reduction (MBSR) on health-related quality of life and physical and psychological symptomatology in a heterogeneous patient population. Patients (n=136) participated in an 8-week MBSR program and were required to practice 20 min of meditation daily. Pre- and post-intervention data were collected by using the Short-Form Health Survey (SF-36), Medical Symptom Checklist (MSCL) and Symptom Checklist-90 Revised (SCL-90-R). Health-related quality of life was enhanced as demonstrated by improvement on all indices of the SF-36, including vitality, bodily pain, role limitations caused by physical health, and social functioning (all P<.01). Alleviation of physical symptoms was revealed by a 28% reduction on the MSCL (P<.0001). Decreased psychological distress was indicated on the SCL-90-R by a 38% reduction on the Global Severity Index, a 44% reduction on the anxiety subscale, and a 34% reduction on the depression subscale (all P<.0001). One-year follow-up revealed maintenance of initial improvements on several outcome parameters. We conclude that a group mindfulness meditation training program can enhance functional status and well-being and reduce physical symptoms and psychological distress in a heterogeneous patient population and that the intervention may have long-term beneficial effects.
... Additionally, it is in accordance with studies that have reported that mindfulness reduces negative emotions 52,54 and alleviates physical symptoms induced by anxiety, depression, and stress. 55 The participants also felt a sense of affiliation. In the process of sharing common topics, discussing their bodies and minds, sharing with others, and empathizing with others' stories, a sense of affinity and unity was evoked, forming a community. ...
Objective This study aims to determine the effects of online mindful somatic psychoeducation program (o-MSP) on mental health in female university students during the coronavirus disease-2019 (COVID-19).Methods Thirty-eight female university students were randomly assigned to an intervention group (IG, n=19) or a control group (CG, n=19). IG received o-MSP for 2-hours per session, twice weekly for 4-weeks; CG maintained their usual daily routine for 4-weeks. Measurements were performed pre- and post-intervention to assess stress, anxiety, and social connectedness using Perceived Stress Scale, State-Trait Anxiety Inventory, and Social Connectedness Scale. A qualitative analysis of changes in soma and social connectedness, subjectification of the soma, and mind–body integration was conducted through online interviews.Results Regarding stress and social connectedness, there were no significant difference between the groups (p>0.05). However, significant differences were observed in the main effect of time of measurement and time×group interaction, with IG showing significant improvement post-intervention, unlike CG (p<0.05). Regarding anxiety, there were significant differences in the main effect of time of measurement, time×group interaction, and group factor (p<0.05). Post-intervention, CG did not show a significant change, while IG showed a significant decrease (p<0.05). Qualitative analysis revealed that participants experienced “changes in soma and social connectedness,” “subjectification of soma–body,” and “embodiment of mind–body integration,” and reported improved mental health.Conclusion The o-MSP effectively reduced stress and anxiety in female university students and improved social connectedness. This suggests that o-MSP can be used to manage the mental health of university students in various settings.
... Snippe et al., 2015). Other studies have yielded that mindfulness-based trainings have found with significant reduction in psychological distress, level of perceived stress, and mental illness(Reibel et al., 2001;Carmody & Baer, 2008). Similarly, findings of another study have suggested that higher levels of mindfulness meditation helped in reducing higher levels of stress, better psychological health, and increased concern for the purpose of life and environment (Roshni et al., 2017). ...
Researches on mindfulness practice and well-being began in the last several decades and the practice's significance has expanded steadily. The empirical research on the effects of mindfulness on subjective well-being is examined in this review article. Researchers begin with a review of wellbeing, subjective wellbeing as a central theme of positive psychology, ideas of psychological and subjective wellbeing, distinctions and connections between mindfulness and meditation, and the contribution of mindfulness to overall wellbeing. As a foundation for this study, researchers examined a variety of mindfulness-related research methodologies, including surveys, non-lab-based experiments, correlational studies, and interventional studies. Review findings yielded that mindfulness has a positive impact on promoting overall wellness, including stress reduction, happiness promotion, positive acts, and emotional complexity management.
... Mindfulness refers to "the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment" [5]. Over the past decades, some research has demonstrated that mindfulness can be instrumental in promoting well-being as higher mindfulness level has been found to link to higher level of positive emotions [6,7], self-esteem [8], self-compassion [9], life satisfaction [10,11], and quality of life [12][13][14]; and associated with lower levels of depression [15,16] and anxiety [15,17]. ...
Objectives
To examine the relationships of age and sex with mindfulness traits among Chinese adults with controlling for measurement invariance.
Methods
A total of 1777 participants completing the Five-Facet Mindfulness Questionnaire were included for analysis. Their age and sex information were also collected. Descriptive analysis, Pearson's Chi-Square test and analysis of variance were performed to test the age- and sex-specific differences, measurement invariance was examined by confirmatory factor analysis.
Results
Excellent data fit to the model indicated configural, metric, and scalar invariance across age and sex. Participants aged 60 or above scored significantly higher in dimensions of acting with awareness, nonjudging of inner experience, nonreactivity to inner experience, and the total scores than younger individuals, who had higher scores in the observing domain. In addition, females scored higher in describing and observing than males, while the latter had higher score in nonreactivity to inner experience.
Conclusions
The Five-Facet Mindfulness Questionnaire Mindfulness showed acceptable measurement invariance across age and sex in Chinese adult population. The old and the young differs in the traits of awareness, observing, nonjudging of inner experience, nonreactivity to inner experience and the total mindfulness level, while males and females varied in describing, observing and nonreactivity to inner experience. Individual differences should be considered and well addressed in future studies on mindfulness.
... This approach is in line with the original mindfulness-based stress reduction program, which was designed not for any specific diagnosis or gender but to alleviate suffering no matter the circumstances. 36,37 This alleviation can diminish the mental and emotional distress regarding a sexual dysfunction. 28 The present pilot study aimed to evaluate whether it is feasible and acceptable to apply an 8-week MSIR as a supplement to treatment as usual (TAU) in a clinical setting. ...
Background
Mindfulness facets can be trained with structured mindfulness interventions, but little is known regarding application on a broader level within sex therapy (e.g. men, partners and different sexual dysfunctions).
Aim
To evaluate the feasibility and preliminary efficacy of an 8-week intervention—specifically, mindfulness for sex and intimacy in relationships (MSIR)—as a supplement to treatment as usual (TAU) as compared with only TAU in a clinical sample of men and women referred for sexual difficulties with or without a partner.
Methods
In this randomized controlled feasibility pilot study, 34 participants were randomized to MSIR + TAU (n = 15) or TAU (n = 19). Six healthy partners were also included in the study. MSIR was administered as 2 individual evaluations and six 2-hour group sessions of mixed gender and different types of sexual dysfunction.
Outcomes
The primary outcome measures were as follows: (1) feasibility, defined as the implementation of recruitment, acceptance, and attendance of intervention in daily clinical practice and the MSIR completion rate; (2) sexual functioning, as measured on a visual analog scale (“bothered by problem”) and by validated questionnaires (Changes in Sexual Function Questionnaire for Females and Males, Female Sexual Function Index, Female Sexual Distress Scale, International Index of Erectile Function).
Results
MSIR was feasible and well received by patients, with high rates of acceptance and intervention completion. As compared with pretreatment, the MSIR + TAU group and TAU control group were significantly less bothered by their sexual problems at the end of treatment, but the change was significantly larger in the MSIR + TAU group (P = .04). Participants in the MSIR + TAU group did not receive fewer TAU sessions than the TAU group (MSIR + TAU mean, 6 sessions; TAU mean, 8 sessions).
Clinical Implications
MSIR could be effectively used in a clinical setting as an add-on to TAU in the treatment of female and male sexual dysfunction and healthy partners.
Strengths and Limitations
The major strength of the study is that it is a randomized controlled study. This study is novel in the sense that it included men and women with different types of sexual dysfunction in the same mindfulness group. Limitations include the pilot nature of the study (e.g. a small sample size), and statistical conclusions should be made with caution. More accurate results may be found in a larger sample.
Conclusion
Results from this study support already existing evidence that mindfulness-based interventions are feasible and effective for targeting sexual dysfunctions in men and women.
... Por otro lado, Randolph et al. (1999) hallaron que el 98 % de sus pacientes con dolor crónico, puntuaron un valor de mejoría de 8.3 sobre una escala de 10, gracias al MBSR. Asimismo, Reibel et al. (2001) indicaron que sus pacientes calificaron en promedio 4.9 en una escala de 5, la experiencia de tomar el programa MBSR durante su tratamiento. ...
La industria 4.0 es el futuro de la humanidad, ya que con ella se ha llevado a cabo un proceso de digitalización en los sectores educativos, empresariales y urbanos, todo ello con el objetivo de ayudar a mejorar el desempeño de la ciudad para transformarla en una Smart City. Los Rankings Smart City evalúan la calidad de vida con base en factores externos, como movilidad, infraestructura y energía, pero no evalúan el impacto del uso excesivo de la tecnología, por ejemplo, la adicción alsmartphone, situación que --según indican diversos estudios-- afecta al desempeño académico y laboral produciendo estados emocionales negativos. La neurociencia demuestra que hábitos como gratitud, espiritualidad y mindfulness, generan estados emocionales positivos que previenen y reducen adicciones. En este sentido, el presente trabajo evalúa el impacto de la práctica de mindfulness en estudiantes universitarios de la Universidad Popular Autónoma del Estado de Puebla. Losresultados demuestran una relación positiva entre mindfulness y desempeño académico, así como una relación inversa entre mindfulness y ansiedad, estrés y depresión.
... The COVID-19 epidemic adversely affects people's mental health and physical injuries (5). In China, 35.1% of people in a study had a general anxiety disorder, 20.1% had a depression disorder, and 18.2% had a sleep disorder during ease risk, and wrong information among people in society are stressful factors that can cause anxiety and depression in become people (8). ...
Background: COVID-19 is not just a severe threat to the human body but can also jeopardize mental health. Thus, the prevalence of anxiety and depression has increased during the COVID-19 pandemic. Objectives: The present study aimed to evaluate the effectiveness of cognitive-behavioral stress management training on the anxiety and stress of COVID-19 patients in Masih Daneshvari Hospital, Tehran, Iran. Methods: The present study used a quasi-experimental pretest-posttest design with a control group. The population included all COVID-19 patients in Masih Daneshvari Hospital in April-May 2021, of whom 120 patients were selected using the convenience sampling method and randomly divided into an experimental group (60 participants) and a control group (60 participants). The data were collected using the Corona Disease Anxiety Scale (CDAS) by Alipour et al. (2020) and Beck’s Depression Inventory. The collected data were analyzed using the COVARIANCE analysis in SPSS24. Results: The results showed that cognitive-behavioral stress management training significantly affected the COVID-19 patients of Masih Daneshvari Hospital. Conclusions: There was a significant implication for counselors and psychologists. Cognitive-behavioral stress management training reduced anxiety and depression in COVID-19 patients and improved mental health.
... Other studies report even higher rates of continued mindfulness meditation after the initial training (e.g. 70% meditating more than three times per week for 10-20 min per day a year after the MBSR course) albeit with considerable missing data Reibel et al., 2001). ...
Millions of people globally have learned mindfulness meditation with the goal of improving health and well-being outcomes in both clinical and non-clinical contexts. An estimated half of these practitioners follow mindfulness teachers’ recommendations to continue regular meditation after completion of initial instruction, but it is unclear whether benefits are strengthened by regular practice and whether harm can occur. Increasing evidence shows a wide range of experiences that can arise with regular mindfulness meditation, from profoundly positive to challenging and potentially harmful. Initial research suggests that complex interactions and temporal sequences may explain these experiential phenomena and their relations to health and well-being. We believe further study of the effects of mindfulness meditation is urgently needed to better understand the benefits and challenges of continued practice after initial instructions. Effects may vary systematically over time due to factors such as initial dosage, accumulation of ongoing practice, developing skill of the meditator, and complex interactions with the subjects’ past experiences and present environment. We propose that framing mindfulness meditation experiences and any associated health and well-being benefits within integrated longitudinal models may be more illuminating than treating them as discrete, unrelated events. We call for ontologically agnostic, collaborative, and interdisciplinary research to study the effects of continued mindfulness meditation and their contexts, advancing the view that practical information found within religious and spiritual contemplative traditions can serve to develop initial theories and scientifically falsifiable hypotheses. Such investigation could inform safer and more effective applications of mindfulness meditation training for improving health and well-being.
... Several studies have shown that mindfulness can reduce stress. More clearly, mindfulness can effectively reduce stress in students (Burgstahler & Stenson, 2020;Kaiseler et al., 2017;Palmer & Rodger, 2009;Petterson & Olson, 2017;Shearer et al., 2016;Song & Lindquist, 2015;Warnecke et al., 2011), reduce stress in the workplace (Brinkmann et al., 2020;Chin et al., 2019;Grégoire & Lachance, 2015;Vella & McIver, 2019;Zeller & Levin, 2013;Zołnierczyk-Zreda et al., 2016) and reduce stress in patients (Kvillemo & Bränström, 2011;Ledesma & Kumano, 2009;Pradhan et al., 2007;Praissman, 2008;Reibel et al., 2001;Zainal et al., 2013). In addition, according to research by Ioannou & Papazafeiropoulou (2017) and Ioannou et al. (2022), mindfulness can also play a role in reducing technostress. ...
Research aims: This study aims to investigate how IT mindfulness and digital technostress affect the Y and Z generation of consumers' intentions to adopt Fintech in Indonesia.
Design/Methodology/Approach: Consumer respondents from Indonesia's Y and Z generations were selected in this study. SEM-PLS was employed to examine the 309 respondents.
Research findings: The study suggested that while IT mindfulness could decrease the adverse effects of digital technostress on the intention to use Fintech and increase it, digital technostress did not influence the intention to use Fintech.
Theoretical contribution/Originality: This is the first study to examine how IT mindfulness and digital technostress affect customers in Indonesian Y and Z generation’s intention to use Fintech. The findings of this study add to the body of knowledge on IT mindfulness and will guide future research in this area and also be helpful to innovators and decision-makers in the field of financial technology so that consumers will continue to use it and, ultimately, support sustainable development.
... However, education and self-care programs have an effect on improving the quality of life, but what is certain is that the quality of effectiveness is more effective in the treatment of stress reduction based on mindfulness. Reibel, Greeson, Brainard, and Rosenzweig (2001), have also confirmed that mindfulness-based stress reduction therapy leads to extensive and uniform improvement in patients' quality of life. In fact, knowledge and understanding are two essential factors in better understanding the conditions and environment, which can be transmitted through education and force the recipient to compromise. ...
Almost most of the treatment interventions for chronic pain, including drug interventions, surgery and cognitive therapies, have been aimed at eliminating pain, but sometimes these treatments do not help and may be more harmful than useful. In recent decades and in the third generation of psychological treatments, new treatments have been developed that use the meditation method to help with side effects, special conditions such as rheumatoid arthritis, a solution under the titles "mindfulness-based stress reduction" and "self-care training" have been used. Accordingly, in this article, the effectiveness of these two treatments on the quality of life of patients has been compared. The effectiveness of self-care training on the quality of life related to the health of patients has had a significant effect, and the stress reduction training based on mindfulness has also had a significant effect on the quality of life related to the health of patients; There was also a significant difference between the effectiveness of the two interventions on the health-related quality of life of the patients, so that the stress reduction training based on mindfulness had a higher effectiveness.
... Thus, behavioral interventions designed to reduce emotional responses and negative appraisal of illness, such as Mind-Body interventions and Mindfulness meditation, could represent an effective and innovative approach for SSc patients. Mindfulness meditation has shown effectiveness in alleviating emotional distress and improving well-being in many populations [21][22][23]. In particular, Mindfulness-Based Stress Reduction (MBSR) was developed for patients with chronic pain and stress-related conditions [24,25], while today it is widely diffused and applied to many other conditions with successful results. ...
Psychological concerns in Systemic Sclerosis (SSc) patients represent an important issue and should be addressed through non-pharmacological treatments. Thus, the aim of the present study was to assess the effects of the Mindfulness-Based Stress Reduction (MBSR) program on psychological variables and the perspectives and experiences of patients with an SSc diagnosis. Notably, 32 SSc patients were enrolled and assigned to either the intervention (MBSR) group or the waitlist group. Inclusion criteria were (i) age ≥ 18 years, SSc diagnosis according to EULAR/ACR diagnostic criteria and informed consent. Exclusion criteria were previous participation in any Mind-Body Therapy or psychiatric diagnosis. Quantitative and qualitative outcomes were investigated through clinometric questionnaires and individual interviews. MBSR did not significantly impact outcomes such as physical functionality, anxiety, hopelessness, depression, physical health status, perceived stress, mindfulness and mental health status. For the anger evaluation, statistically significant differences are found for both controlling and expressing anger, indicating that the MBSR program had a favorable impact. As for qualitative results, more awareness of daily activities, stress reduction in terms of recognizing the causes and implementing self-strategies to prevent them, adherence to therapy, and recognition of the effect of medication on their bodies were reported. In conclusion, it is important to highlight the absence of negative or side effects of the MBSR program and the positive impact on patients’ experience and perspective; thus, we suggest this approach should be taken into account for SSc patients.
... In contrast with our results that showed little adherence from patients in the ME and ME + MCR groups, it has been described that subjects who participate in mindfulness-based interventions are able to comply with the recommendation of home practice and continue to practice regularly after the end of the intervention (66) . It is possible that in the studied population, low adherence to mindfulness practice may be due to the lack of interest in the approach. ...
Mindful eating has been linked to improvement in binge eating disorder, but this approach in obesity management has shown conflicting results. Our aim was to assess the effect of mindful eating associated with moderate calorie restriction on weight loss in women with obesity. Metabolic parameters, dietary assessment, eating behavior, depression, anxiety, and stress were also evaluated. A total of 138 women with obesity were randomly assigned to three intervention groups: mindful eating associated with moderate calorie restriction (ME + MCR), moderate calorie restriction (MCR), and mindful eating (ME), and they were followed up monthly for 6 months. ME + MCR joined seven monthly mindfulness-based intervention group sessions each lasting 90 minutes and received an individualized food plan with moderate calorie restriction (deficit of 500 kcal/d). MCR received an individualized food plan with moderate calorie restriction (deficit of 500 kcal/d), and ME joined seven monthly mindfulness-based intervention group sessions each lasting 90 minutes. Seventy patients completed the intervention. Weight loss was significant, but no statistically significant difference was found between the groups. There was a greater reduction in uncontrolled eating in the ME group than in the MCR group and a greater reduction in emotional eating in the ME group than in both the MCR and the ME+MCR groups. No statistically significant differences were found in the other variables evaluated between groups. The association between mindful eating with calorie restriction did not promote greater weight loss than mindful eating or moderate calorie restriction.
... MBSR and MBCT rely heavily on formal practice as a primary treatment method. Participants are asked to practice for 45 minutes daily during a typical 8-week course, though shorter periods of practice have also been used with comparable outcomes (Reibel, Greeson, Brainard, & Rosenzweig, 2001). The primary meditation practices taught are sitting meditation, body scan, and Hatha yoga (Kabat-Zinn, 2009). ...
Present moment awareness (PMA) is one of six interrelated processes that facilitate psychological flexibility within acceptance and commitment therapy (ACT). The process of PMA (1) brings deliberate attention to inner experiences such as thoughts, emotions, and physical sensations in the service of building psychological flexibility, and (2) increases the opportunity to come in contact with valued outer experiences. Thus, PMA can be considered a foundational process upon which other ACT processes rest, making it difficult to clearly distinguish PMA from the other ACT processes and study the unique impact of PMA in ACT interventions. This challenge is further complicated by inadequate measurement tools for PMA or mindfulness. The growing literature on the potential neurophysiological mechanisms of mindfulness in general suggests that this is a worthy area of study within ACT. Future studies should examine the potential benefits of formal mindfulness meditation practice in the context of ACT and capitalize on ecological momentary assessment and other technology to measure and support PMA and other ACT processes in real-world and real-time settings.
Mental stability, besides absence of mental illness, refers to one's ability at sustaining psychological well-being and quality of life. Conversely, one is deemed “mentally destabilized” by society, when one's moods, feelings, and/or actions are consistently unpredictable. As stabilization process is a very important factor in mental health care, this chapter aims to explore and explain the mindfulness process/strategy in stabilizing the affected participants at preventive, during, and post treatment stages as stand-alone or in conjunction with other pharmacological treatment. Relevant information was collected through the individual databases like Psych info, Sciencedirect.com, Embase, PubMed, Scholar.google.com, Medline, and research journals from open access university websites for writing.
Stress plays a role in altering people's lifestyles. When individuals experience stress and its associated pressures and anxiety, they often respond by engaging in unhealthy behaviors that can have a negative impact on their health. Assessing the impact of perceived stress is crucial in motivating students to adopt positive health behaviors as long-term coping strategies.
Study the link between perceived stress and lifestyle behaviors among medical students. Additionally, to explore how health-related behaviors impact the association between perceived stress and lifestyle in the same group of medical students.
: To investigate the impact of perceived academic stress on the lifestyle habits of the medical students and to explore how health-related lifestyle factors mediate the relationship between increased perceived stress and changes in lifestyle. Perceived stress will serve as the independent variable in this non-experimental, descriptive cross-sectional study, where the focus is on observing the effects of academic stress on the lifestyle habits of the participants.
Significant association between levels of stress and both real change of lifestyle and perceived change of lifestyle risk factors were increased.
Promoting positive health behaviors among students for coping purposes is crucial. By helping young individuals develop these coping techniques for handling stressful situations, we offer them the chance to enhance their appearance, boost body image and self-esteem, improve academic and work performance, lower the risk of depression, and ultimately enhance their overall quality of life.
In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non‐communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control.
Este artículo presenta una sistematización del Proyecto Redes, Salud y Alimentos llevado adelante por un equipo interdisciplinario de docentes de la Universidad de la República (Udelar) en 2018 en la localidad de San Antonio, Departamento de Canelones, Uruguay. El proyecto tuvo como objetivo promover la creación de un espacio para la promoción integral de la salud y la agroecología desde el enfoque de la Ecosalud. A nivel académico el proyecto se propuso promover la producción de conocimiento interdisciplinario en torno a los ejes de salud humana, construcción social de la salud y producción agroecológica de alimentos. Material y métodos. En el territorio, desde un enfoque de Ecosalud, se generaron acciones de prevención y promoción de la salud a partir de una concepción holística y sistémica de las relaciones ambientales y humanas. Se incorporó la perspectiva agroecológica, considerando a los alimentos y su sistema de producción como determinantes de la sustentabilidad ambiental y de la seguridad y soberanía alimentaria. Resultados. Como resultados destacamos el logro de los objetivos de promover la participación e integración del saber comunitario y haber creado un espacio de promoción de la salud integral, en sintonía con los pilares de la Carta de Shangai, “Promoción de la salud en la Agenda 2030 para el desarrollo sostenible”. Discusión. Esta experiencia es una respuesta a los desafíos que enfrenta la academia, en su afán de aportar al desarrollo de la sociedad. Sus desarrollos pueden verse también son pilares teóricos y ejes de acción de una nueva Salud Pública.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
Editor's note
To most psychiatrists the phenomenon of gender identity is a mystery at the edges of their consciousness. This is not surprising, for the conditions subsuming it are rare, and not specifically associated with other psychopathology. The people who have these conditions are now getting increasingly well informed and therefore funnel towards clinics that specialize in the management of these conditions, which often require surgical intervention and close liaison between medical disciplines. This chapter shows a great deal has been learnt in the 40 years since this group first attracted real attention, and the evidence, although limited, indicates the value of intervention.
Note: throughout this chapter the terms ‘male’ and ‘female’ refer to sex assigned at birth.
Introduction
Disorders of gender identity have probably always existed, inside and outside Europe (Vietnam, in the case described by Heiman et al., 1975), and as demonstrated in the nineteenth century historical study by Ball et al. (1978). It seems that incidence of transsexualism is very roughly one in 60 000 males and one in every 100 000 females and seems to have remained constant (Landen et al., 1996). These disorders did not come to the attention of psychiatric services, though, until 1966, when Dr Harry Benjamin (then just retired) started to see people with disorders of gender identity in the USA.
From the early 1950s, there were attempts to offer some sort of gender reassignment surgery to people with disorders of gender identity, with some of these cases gaining wider public attention.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
A 36-item short-form (SF-36) was constructed to survey health status in the Medical Outcomes Study. The SF-36 was designed for use in clinical practice and research, health policy evaluations, and general population surveys. The SF-36 includes one multi-item scale that assesses eight health concepts: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The survey was constructed for self-administration by persons 14 years of age and older, and for administration by a trained interviewer in person or by telephone. The history of the development of the SF-36, the origin of specific items, and the logic underlying their selection are summarized. The content and features of the SF-36 are compared with the 20-item Medical Outcomes Study short-form.
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.
The present study compared the relative efficacy of comprehensive group coping skills training and supportive group therapy for enhancing cancer patients' adjustment to their disease. Forty-one cancer patients exhibiting a marked degree of psychosocial distress were randomized to one of three conditions: (a) group coping skills instruction, (b) support group therapy, and (c) no-treatment control. Support group sessions were nondirective and emphasized the mutual sharing of feelings and concerns. Coping skills training included instruction in: (a) relaxation and stress management, (b) assertive communication, (c) cognitive restructuring and problem solving, (d) feelings management, and (e) pleasant activity planning. Results demonstrated a consistent superiority of the coping skills intervention over supportive group therapy and the no-treatment control. Patients receiving supportive group therapy exhibited little improvement, and untreated patients evidenced a significant deterioration in psychological adjustment. These results support providing psychologically distressed cancer patients with multifaceted coping skills training.
We tested the short-term efficacy and feasibility of two stress education approaches toe the treatment of mild hypertension in older African Americans. This was a randomized, controlled, single-blind trial with 3 months of follow-up in primary care, inner-city health center. Of 213 African American men and women screened, 127 individuals (aged 55 to 85 years with initial diastolic pressure of 90 to 109 mm Hg, systolic pressure of < or = 189 mm Hg, and final baseline blood pressure of < or = 179/104 mm Hg) were selected. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress reduction approaches (Transcendental Meditation and progressive muscle relaxation) were compared with a lifestyle modification education control program and with each other. The primary outcome measures were changes in clinic diastolic and systolic pressures from baseline to final follow-up, measured by blinded observers. The secondary measures were linear blood pressure trends, changes in home blood pressure, and intervention compliance. Adjusted for significant baseline differences and compared with control, Transcendental Meditation reduced systolic pressure by 10.7 mm Hg (P < .0003) and diastolic pressure by 6.4 mm Hg (P <.00005). Progressive muscle relaxation lowered systolic pressure by 4.7 mm Hg (P = 0054) and diastolic pressure by 3.3 mm Hg (P <.02). The reductions in the Transcendental Meditation group were significantly greater than in the progressive muscle relaxation group for both systolic blood pressure (P = .02) and diastolic blood pressure (P = .03). Linear trend analysis confirmed these patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.
African Americans suffer disproportionately higher cardiovascular disease mortality rates than do whites. Psychosocial stress influences the development and progression of atherosclerosis. Carotid intima-media thickness (IMT) is a valid surrogate measure for coronary atherosclerosis, is a predictor of coronary outcomes and stroke, and is associated with psychosocial stress factors. Stress reduction with the Transcendental Meditation (TM) program decreases coronary heart disease risk factors and cardiovascular mortality in African Americans. B-mode ultrasound is useful for the noninvasive evaluation of carotid atherosclerosis.
This randomized controlled clinical trial evaluated the effects of the TM program on carotid IMT in hypertensive African American men and women, aged >20 years, over a 6- to 9-month period. From the initially enrolled 138 volunteers, 60 subjects completed pretest and posttest carotid IMT data. The assigned interventions were either the TM program or a health education group. By use of B-mode ultrasound, mean maximum IMT from 6 carotid segments was used to determine pretest and posttest IMT values. Regression analysis and ANCOVA were performed.
Age and pretest IMT were found to be predictors of posttest IMT values and were used as covariates. The TM group showed a significant decrease of -0.098 mm (95% CI -0. 198 to 0.003 mm) compared with an increase of 0.054 mm (95% CI -0.05 to 0.158 mm) in the control group (P=0.038, 2-tailed).
Stress reduction with the TM program is associated with reduced carotid atherosclerosis compared with health education in hypertensive African Americans. Further research with this stress-reduction technique is warranted to confirm these preliminary findings.
The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.
This article describes a mindfulness-based stress reduction program presented in either English or Spanish in an inner-city setting. The demographic profile of patients who complete the Stress Reduction and Relaxation Program at the Community Health Center in Meriden, Connecticut, is presented. Mindfulness meditation is defined, and the practices of breathing meditation, eating meditation, walking meditation, and mindful yoga are described. The relationship of mindfulness practice to patients' suffering and to physical and emotional pain is discussed. The article concludes with an exploration of how mindfulness practice facilitates profound personal change as well as symptom relief and health improvement.
Objectives.
—To determine (1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct costs (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death).
Design.
—Analysis of the 1987 National Medical Expenditure Survey for prevalence and direct health care costs; indirect costs based on the 1990 National Health Interview Survey and Vital Statistics of the United States.
Setting.
—US population.
Participants.
—For the estimate of prevalence and direct costs, the National Medical Expenditure Survey sample of persons who reported health conditions associated with (1) use of health services or supplies or (2) periods of disability.
Interventions.
—None.
Main Outcome Measures.
—The number of persons with chronic conditions, their annual direct health care costs, and indirect costs from lost productivity and premature deaths.
Results.
—In 1987, 90 million Americans were living with chronic conditions, 39 million of whom were living with more than 1 chronic condition. Over 45% of non-institutionalized Americans have 1 or more chronic conditions and their direct health care costs account for three fourths of US health care expenditures. Total costs projected to 1990 for people with chronic conditions amounted to $659 billion—$425 billion for direct health care costs and $234 billion in indirect costs.
Conclusions.
—The prevalence and costs of chronic conditions as a whole have rarely been estimated. Because the number of persons with limitations due to chronic conditions is more regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majority of persons with chronic conditions are not disabled, nor are they elderly. Chronic conditions affect all ages. Because persons with chronic conditions have greater health needs at any age, their costs are disproportionately high.
Reviews literature comparing relaxation and meditation techniques. Meta-analyses show transcendental meditation (TM) to be significantly more effective than other forms of relaxation or meditation in (1) reducing psychophysiological arousal, (2) decreasing trait anxiety, (3) increasing positive mental health on measures of self-actualization, and (4) reducing alcohol, nicotine, and illicit drug use relative to standard treatment and prevention programs. Randomized controlled trials show that the TM technique significantly reduced hypertension and mortality in the elderly compared with a mental or physical relaxation technique. Epidemiological studies show that TM Ss had significantly lower inpatient and outpatient visits and medical expenditures than comparable groups over a 5- to 6-yr period. TM's effects on stress-related endocrine and homeostatic imbalances implicated in heart disease and other chronic illnesses are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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.
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 McGill Melzack Pain 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.
Stimulated by patient need and encouraged by results from randomized studies in academic centers, many community organizations have initiated cancer support groups in order to improve the psychosocial adjustment of people coping with cancer. For a variety of reasons, little research has been done to evaluate these community support groups. The efficacy of cancer support groups, which has been demonstrated in academic centers, therefore awaits demonstration in community settings.
This paper provides process and outcome data from 77 people with cancer who completed an 8-week support group facilitated by licensed and trained mental health professionals in a local community cancer support organization. Similar to the experience of others, participants were primarily female, of European descent, well-educated, and relatively young (mean age 50 years, S.D. = 12). As predicted, their self-reported quality of life (as measured by the Functional Living Index—Cancer) improved significantly, paired t = − 2.06, p < 0.05. Five-point ratings (poor, fair, good, very good, excellent) were assigned either ‘very good’ or ‘excellent’ for the overall group (90%) and facilitator (87%). More detailed ratings of group and facilitator qualities were consistently and strikingly positive. While facilitators were rated positively and appreciated for their presence, peer support exceeded facilitator skill/input as the primary ingredient noted by participants to be the most helpful aspect of the group. Community-based cancer support groups appear to provide measurable benefit to participants who complete the group. The benefit is consistent with that demonstrated in randomized studies and emphasizes improvement in coping stimulated by mutual support in a safe environment.
A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty-five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty-three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.
This paper gives a report on the benefits of self-help groups as depicted by 232 members from 65 different disease-related groups. Intensive interviews and participant observation enabled us to formulate a questionnaire with 125 mostly standardized questions. The questions referred mainly to motives for membership, working procedures within the groups, goals and effectiveness, outcome of participation and need for outside support. The focus of this paper will be on what the members reported about the changes and effects induced by their participation in self-help groups. The interviewed group members reported a wide variety of goals. These were classified into two categories according to their range. Goals directed towards the group or group members were achieved (at least partly) by more than 90%. Goals directed towards persons outside the group (e.g. to change opinions of the family or of the professional system) were mentioned by about two thirds of the interviewed members. About three quarters of them achieved these goals at least partly. The effects of participation were grouped into the following categories. 1--Impact on disease-related stress (positive health effects, general enlargement of competence, general social activation); 2--impact on the relationship with family and friends (relationship with partner, changes in personal network); 3--impact on patient behaviour and professional services (general enlargement of competence in relation to the professional care system, social activation in relation to the professional care system, utilization of professional services). Most of the members reported considerable positive changes in these dimensions. Negative impacts were mentioned by a very small minority (between 1 and 4%).(ABSTRACT TRUNCATED AT 250 WORDS)
It is hypothesized that situations requiring continous behavioral adjustment activate an integrated, hypothalamic response, the emergency reaction. The frequent elicitation of the physiologic changes associated with the emergency reaction has been implicated in the development of diseases such as hypertension. Prevention and treatment of these diseases may be through the use of the relaxation response, an integrated hypothalamic response whose physiologic changes appear to be the counterpart of the emergency reaction. This article describes the basic elements of techniques which elicit the relaxation response and discusses the results of clinical investigations which employ the relaxation response as a therapeutic intervention.
The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.
The rate at which medical patients physician-referred to an 8-week stress reduction program completed the prescribed intervention was measured and predictors of compliance sought. Seven hundred eighty-four consecutive patients who enrolled in the program over a 2-year period were studied. Of these, 598 (76%) completed the program and 186 (24%) did not. Multiple regression analysis showed that (1) among chronic pain patients, only sex discriminated between completers and noncompleters, with females more than twice as likely to complete the program as males (odds ratio = 2.4; 95% CI = 1.2, 4.4); (2) among patients with stress-related disorders, only the OC scores of the SCL-90-R discriminated between completers and noncompleters (odds ratio = 2.0; 95% CI = 1.2, 3.4). Completion rates for specific diagnoses are reported and discussed. The high rate of completion observed for this intensive program in health behavior change is discussed in terms of the design features and therapeutic modalities of the intervention.
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.
The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.
A large number of individuals with rheumatoid arthritis have been studied in order to better delineate the sociomedical problems experienced by patients with this chronic disease. Two hundred forty-five respondents were surveyed by use of a detailed questionnaire and interview, and the results indicate that major losses in the areas of work, finances, and family structure are extremely common. The majority of workers were totally disabled as a result of their disease. On the average, subjects in the group were earning only 50% of the income predicted for them had they not had arthritis. Sixty-three percent experienced a major change in their psychosocial status as a result of their disease. Work disability appears to be the most important sociomedical impact of rheumatoid arthritis since it is associated with significantly greater income and psychosocial losses. This evidence of numerous and serious sociomedical problems in persons with rheumatoid arthritis raises questions of emphasis and approach for physicians involved in the clinical care of chronic rheumatic disease patients.
Sample size requirements are given for intervention trials in which the unit of randomization is the cluster. Cases dealt with include the comparison of two means and the comparison of two proportions. Required modifications to the standard statistical analyses are also discussed.
A previous study of 22 medical patients with DSM-III-R-defined anxiety disorders showed clinically and statistically significant improvements in subjective and objective symptoms of anxiety and panic following an 8-week outpatient physician-referred group stress reduction intervention based on mindfulness meditation. Twenty subjects demonstrated significant reductions in Hamilton and Beck Anxiety and Depression scores postintervention and at 3-month follow-up. In this study, 3-year follow-up data were obtained and analyzed on 18 of the original 22 subjects to probe long-term effects. Repeated measures analysis showed maintenance of the gains obtained in the original study on the Hamilton [F(2,32) = 13.22; p < 0.001] and Beck [F(2,32) = 9.83; p < 0.001] anxiety scales as well as on their respective depression scales, on the Hamilton panic score, the number and severity of panic attacks, and on the Mobility Index-Accompanied and the Fear Survey. A 3-year follow-up comparison of this cohort with a larger group of subjects from the intervention who had met criteria for screening for the original study suggests generalizability of the results obtained with the smaller, more intensively studied cohort. Ongoing compliance with the meditation practice was also demonstrated in the majority of subjects at 3 years. We conclude that an intensive but time-limited group stress reduction intervention based on mindfulness meditation can have long-term beneficial effects in the treatment of people diagnosed with anxiety disorders.
Fibromyalgia is a chronic illness characterized by widespread pain, fatigue, sleep disturbance, and resistance to treatment. The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia. Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program. Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity. Patients were evaluated before and after the program. Initial evaluation included a psychiatric structured clinical interview (SCID). Outcome measures included visual analog scales to measure global well-being, pain, sleep, fatigue, and feeling refreshed in the morning. Patients also completed a medical symptom checklist, SCL-90-R, Coping Strategies Questionnaire, Fibromyalgia Impact Questionnaire, and the Fibromyalgia Attitude Index. Although the mean scores of all the patients completing the program showed improvement, 51% showed moderate to marked improvement and only they were counted as "responders." These preliminary findings suggest that a meditation-based stress reduction program is effective for patients with fibromyalgia.
To examine the effects of stress-management training on clinical outcomes in persons with rheumatoid arthritis (RA).
Patients with RA (n = 141) were randomly assigned to 1 of 3 groups: a stress management group, an attention control group, or a standard care control group. The stress management and the attention control groups received a 10-week intervention followed by an additional 15-month maintenance phase.
The stress management group showed statistically significant improvements on measures of helplessness, self-efficacy, coping, pain, and health status. Selected beneficial effects were still detectable at the 15-month followup evaluation.
The data indicated that stress management interventions are capable of producing important clinical benefits for persons with RA.
To determine (1) the number and proportion of Americans living with chronic conditions, and (2) the magnitude of their costs, including direct costs (annual personal health expenditures) and indirect costs to society (lost productivity due to chronic conditions and premature death).
Analysis of the 1987 National Medical Expenditure Survey for prevalence and direct health care costs; indirect costs based on the 1990 National Health Interview Survey and Vital Statistics of the United States.
US population.
For the estimate of prevalence and direct costs, the National Medical Expenditure Survey sample of persons who reported health conditions associated with (1) use of health services or supplies or (2) periods of disability.
None.
The number of persons with chronic conditions, their annual direct health care costs, and indirect costs from lost productivity and premature deaths.
In 1987, 90 million Americans were living with chronic conditions, 39 million of whom were living with more than 1 chronic condition. Over 45% of noninstitutionalized Americans have 1 or more chronic conditions and their direct health care costs account for three fourths of US health care expenditures. Total costs projected to 1990 for people with chronic conditions amounted to $659 billion--$425 billion for direct health care costs and $234 billion in indirect costs.
The prevalence and costs of chronic conditions as a whole have rarely been estimated. Because the number of persons with limitations due to chronic conditions is more regularly reported in the literature, the total prevalence of chronic conditions has perhaps been minimized. The majority of persons with chronic conditions are not disabled, nor are they elderly. Chronic conditions affect all ages. Because persons with chronic conditions have greater health needs at any age, their costs are disproportionately high.
This article describes a bilingual mindfulness meditation-based stress reduction program in an inner-city setting. Mindfulness meditation is defined, and the practices of breathing meditation, eating meditation, walking meditation, and mindful yoga are described. Data analysis examined compliance, medical and psychologic symptom reduction, and changes in self-esteem, of English- and Spanish-speaking patients who completed the 8-week Stress Reduction and Relaxation Program at the Community Health Center in Meriden, Conn. Statistically significant decreases in medical and psychologic symptoms and improvement in self-esteem were found. Many program completers reported dramatic changes in attitudes, beliefs, habits, and behaviors. Despite the limitations of the research design, these findings suggest that a mindfulness meditation course can be an effective health care intervention when utilized by English- and Spanish-speaking patients in an inner-city community health center. The article includes a discussion of factors to be considered when establishing a mindfulness meditation-based stress reduction program in a health care setting.
This study examined the effects of an 8-week stress reduction program based on training in mindfulness meditation. Previous research efforts suggesting this program may be beneficial in terms of reducing stress-related symptomatology and helping patients cope with chronic pain have been limited by a lack of adequate comparison control group.
Twenty-eight individuals who volunteered to participate in the present study were randomized into either an experimental group or a nonintervention control group.
Following participation, experimental subjects, when compared with controls, evidenced significantly greater changes in terms of: (1) reductions in overall psychological symptomatology; (2) increase in overall domain-specific sense of control and utilization of an accepting or yielding mode of control in their lives, and (3) higher scores on a measure of spiritual experiences.
The techniques of mindfulness meditation, with their emphasis on developing detached observation and awareness of the contents of consciousness, may represent a powerful cognitive behavioral coping strategy for transforming the ways in which we respond to life events. They may also have potential for relapse prevention in affective disorders.
Successful wound management requires an understanding of the normal healing process and the factors that can interrupt it. Studies have shown that wounds heal more readily in a moist, physiologic environment. Clinicians can improve the outcome of wound care by applying these research findings and by identifying and correcting impediments to healing. This article provides a basic understanding of the healing process and a clinical approach to optimal care of acute and chronic wounds.
This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment.
Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient's study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point.
Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point (p = .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments.
A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.
The objective of this study was to assess the effects of participation in a mindfulness meditation-based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients.
A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice.
Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients' mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress.
This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages. cancer, stress, mood, intervention, mindfulness.
Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress
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Living a Healthy Life with Chronic Conditions: Self Management of Heart Disease, Arthritis, Stroke, Diabetes, Asthma, Bronchitis, Emphysema and Others
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Love and Survival. The Scientific Basis for the Healing Power of Intimacy
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Effects of stress reduction on carotid atherosclerosis in hypertensive African-Americans
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