Article

Comparison of Psychological and Physiological Measures of Stress in Health Care Professionals during an Eight-Week Mindfulness Meditation Program

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Abstract

Work stress, burnout, and diminished empathy are prevalent issues for health-care professionals. Mindfulness meditation (MM) is one commonly used strategy to manage stress. Measuring salivary cortisol allows for the assessment of serum cortisol level, a known stress level indicator. This study evaluated the association of subject-reported stress symptoms and salivary cortisol in health-care professionals, in an 8-week MM program, with data collected prospectively at baseline and 8 weeks after program completion. Questionnaires [Profile of Mood States—Short Form (POMS-SF), Maslach Burnout Inventory (MBI), and Interpersonal Reactivity Index (IRI)] measured mood, burnout and empathy.A paired t-test between groups for pre/post-salivary cortisol yielded no significant change. The POMS-SF was most sensitive to change (mean increase 12.4; p = 0.020). Emotional exhaustion, measured in the MBI, was also affected by MM (mean decrease 4.54; p = 0.001). Changes in empathy may not have been captured due to either absence of effect of MM on empathy, subject number or scale sensitivity. Baseline and 8-week correlations between salivary cortisol and survey results, and correlations between changes in these measures, were weak and not statistically significant. Nevertheless, psychometric results present a strong case for additional clinical trials of MM to reduce stress for health-care professionals. Copyright © 2005 John Wiley & Sons, Ltd.

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... ( Galantino, Baime, Maguire, Szapary, & Farrar, 2005 ...
... The results were generally favourable with respect to depression, as shown in Copenhagen Burnout Inventory ( Bazarko et al., 2013) ( Brooker et al., 2013) ( Di Benedetto & Swadling, 2014) Maslach Burnout Inventory ( Barbosa et al., 2013) ( Brady et al., 2012) ( Cohen-Katz, Wiley, Capuano, Baker, Kimmel, et al., 2005) ( Fortney et al., 2013) ( Galantino et al., 2005) ( Krasner et al., 2009 Westphal et al., 2015) Professional Quality of Life Scale [Burnout] ( Horner et al., 2014) Profile of Mood States [Fatigue] ( Martín-Asuero et al., 2014) Profile of Mood States [Vigour] ( Galantino et al., 2005) ( Krasner et al., 2009) Qualitative Interviews ( Christopher et al., 2006) SF-12-V2 Health Survey [Vitality] ( McCracken & Yang, 2008) Note: Authors in bold denote RCT studies. Cohen & Miller, 2009) Depression Anxiety Stress Scale [Depression] ( Fortney et al., 2013) ( Song & Lindquist, 2015) ( Brooker et al., 2013) ( Dobie et al., 2015) ( ) ( Foureur et al., 2013) Emotional Control Questionnaire (Martín Asuero & García-Banda, 2010) Hospital Anxiety & Depression Scale [Depression] ( Mealer et al., 2014) ( Westphal et al., 2015) Patient Health Questionnaire ( Johnson et al., 2015) Profile of Mood States [Depression] ( Galantino et al., 2005) ( Martín-Asuero et al., 2014) Reflection-Rumination Questionnaire ( Rimes & Wingrove, 2011) ( Shapiro et al., 2007) Symptom Checklist-90-R [Depression] ( Shapiro et al., 1998a) ( Pipe et al., 2009) Note. ...
... The results were generally favourable with respect to depression, as shown in Copenhagen Burnout Inventory ( Bazarko et al., 2013) ( Brooker et al., 2013) ( Di Benedetto & Swadling, 2014) Maslach Burnout Inventory ( Barbosa et al., 2013) ( Brady et al., 2012) ( Cohen-Katz, Wiley, Capuano, Baker, Kimmel, et al., 2005) ( Fortney et al., 2013) ( Galantino et al., 2005) ( Krasner et al., 2009 Westphal et al., 2015) Professional Quality of Life Scale [Burnout] ( Horner et al., 2014) Profile of Mood States [Fatigue] ( Martín-Asuero et al., 2014) Profile of Mood States [Vigour] ( Galantino et al., 2005) ( Krasner et al., 2009) Qualitative Interviews ( Christopher et al., 2006) SF-12-V2 Health Survey [Vitality] ( McCracken & Yang, 2008) Note: Authors in bold denote RCT studies. Cohen & Miller, 2009) Depression Anxiety Stress Scale [Depression] ( Fortney et al., 2013) ( Song & Lindquist, 2015) ( Brooker et al., 2013) ( Dobie et al., 2015) ( ) ( Foureur et al., 2013) Emotional Control Questionnaire (Martín Asuero & García-Banda, 2010) Hospital Anxiety & Depression Scale [Depression] ( Mealer et al., 2014) ( Westphal et al., 2015) Patient Health Questionnaire ( Johnson et al., 2015) Profile of Mood States [Depression] ( Galantino et al., 2005) ( Martín-Asuero et al., 2014) Reflection-Rumination Questionnaire ( Rimes & Wingrove, 2011) ( Shapiro et al., 2007) Symptom Checklist-90-R [Depression] ( Shapiro et al., 1998a) ( Pipe et al., 2009) Note. ...
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Objective: Among efforts to improve the well-being of healthcare professionals are initiatives based around mindfulness meditation. To understand the value of such initiatives, we conducted a systematic review of empirical studies pertaining to mindfulness in healthcare professionals. Method: Databases were reviewed from the start of records to January 2016. Eligibility criteria included empirical analyses of mindfulness and well-being outcomes acquired in relation to practice. 81 papers met the eligibility criteria, comprising a total of 3,805 participants. Studies were principally examined for outcomes such as burnout, distress, anxiety, depression, and stress. Results: Mindfulness was generally associated with positive outcomes in relation to most measures (although results were more equivocal with respect to some outcomes, most notably burnout). Conclusion: Overall, mindfulness does appear to improve the well-being of healthcare professionals. However, the quality of the studies was inconsistent, so further research is needed, particularly high-quality randomized controlled trials.
... [31][32][33][34][35][36][37] The remaining 18 studies included mixed populations. 17,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] Among the latter, three failed to report the number of participants for each occupation. [40][41][42] Fourteen studies recruited professionals from a single medical specialty (e.g. ...
... 31,32,40,41,48 Three articles failed to report the gender ratio of its sample. 23,33,42 Twenty-one of the reviewed articles reported studies conducted in the USA or Canada (61.8%), 17,18,[23][24][25][26]31,32,34,35,[40][41][42][43][44][45][47][48][49]51,52 seven reported studies in Europe (20.1%), [27][28][29]36,38,46,53 two in Australia, 30,37 one simultaneously in the USA and Israel, 39 one in Iran, 33 one in Brazil, 50 and one in Singapore. ...
... Eleven of the 34 studies (32,4%) applied the full MBSR protocol. 17,18,27,28,33,38,41,42,46,48,51 The other studies altered the original protocol in different ways: ...
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Objective: Healthcare professional burnout affects performance and has a negative impact on healthcare as a whole. Mindfulness-based Interventions (MIs), developed over the last 30 years, are increasingly used by healthcare professionals to reduce the risk of burnout. Yet the impact of MIs on burnout remains to be clarified. This review aimed to summarize and evaluate the existing literature on the potential benefits of MIs to minimize burnout risk. Methods: We conducted a systematic review of the literature, reporting according to the PRISMA standards. PubMed, Psychinfo, Web of Science and Science Direct databases were screened for original articles. Articles in English assessing an MI in combination with burnout measures were included up to September 2018. Results: Thirty-four articles were included. Only four randomised controlled trials concluded to burnout improvement after several weeks of MIs (11,8%). In the remaining five randomised controlled trials, results did not reach statistical significance. Of the four controlled, non-randomised studies, three showed significant improvements on burnout. Twenty-one studies did not report a controlled trial design. Overall the results appeared to be widely heterogeneous and several methodological concerns arose from the review. Conclusion: This review shows the overall insufficient level of evidence offered by the literature assessing the effects of MIs on burnout in health professional populations. However, some studies have reported promising results and future research should address methodological issues and define more precise contexts of interventions and target populations that could benefit from MIs.
... Prior interventions have looked at a range of other wellbeing outcome measures including burnout, resilience, vitality, and vigor, often using participants working in healthcare, such as physicians and nurses, and have reported that mindfulness interventions reduce burnout, and increase resilience, vigor, and vitality ( Galantino et al., 2005;Mackenzie et al., 2006;Krasner et al., 2009;Bazarko et al., 2013;see Virgili, 2015 for a meta-analysis). We were interested in whether employees in a non-healthcare setting, who were also not employed in the service industry (which can require large amounts of emotion regulation and surface acting, e.g., Michel et al., 2014;Hülsheger et al., 2013) would show improvements in self-reported resilience following the mindfulness intervention. ...
... Further, if mindfulness enhances the ability to pay attention as evidenced by Jha et al. (2007) and based on accounts of how mindfulness interventions enhance attention and awareness (Shapiro et al., 2006), we expected that the intervention could also increase selfperceived recognition of emotion in others and potentially selfperceived regulation of emotion in others. Prior research on the impact of mindfulness interventions on self-reported empathy has been mixed ( Shapiro et al., 1998;Beddoe and Murphy, 2004;Galantino et al., 2005), so our inclusion and examination of this component was more exploratory, as was the inclusion of selfperceived non-verbal emotional expression. It is possible that some interventions highlight the importance of empathy more than others, for instance, those conducted in healthcare with "helping" occupations such as nurses may be more successful in enhancing empathy than those conducted in office-based organizational settings. ...
... The results show that in addition to enhancing the self-perceived recognition and regulation of emotions in the self, people who completed the mindfulness intervention were more likely to feel they were more likely to display how they were feeling through body language and facial expressions (i.e., non-verbal emotional expression), and more likely to feel they were paying attention to and attempting to regulate the emotions of others (i.e., regulation of emotion in others). Prior research has shown inconsistent effects of mindfulness training on empathy, with some studies reporting increases ( Shapiro et al., 1998;Birnie et al., 2010), and others reporting null results ( Beddoe and Murphy, 2004;Galantino et al., 2005). In the present research self-perceived trait empathy (the tendency to draw upon empathy at work), did not change following the intervention. ...
Article
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A randomized waitlist-controlled trial was conducted to assess the effectiveness of an online 8-week mindfulness-based training program in a sample of adults employed fulltime at a Fortune 100 company in the United States. Baseline measures were collected in both intervention and control groups. Following training, the intervention group (N = 37) showed statistically significant increases in resilience and positive mood, and significant decreases in stress and negative mood. There were no reported improvements in the wait-list control group (N = 65). Trait mindfulness and emotional intelligence (EI) were also assessed. Following the intervention mindfulness intervention participants reported increases in trait mindfulness and increases on all trait EI facets with the exception of empathy. The control group did not report any positive changes in these variables, and reported reductions in resilience and increases in negative mood. Finally, both self and colleague ratings of workplace competencies were collected in the intervention group only and provided preliminary evidence that mindfulness training enhanced performance on key leadership competencies including competencies related to decisiveness and creativity. The present study demonstrates the effectiveness of an online-based mindfulness training program for enhancing well-being, self-perceptions of emotional intelligence, and workplace performance.
... Stress/Strain Frank, Reibel, Broderick, Cantrell, & Metz (2015) United States Education Secondary school teachers, administrators, and staff 36 Non-randomized waitlist control group Inactive Immediate Compassion, Health Behaviors, Mindfulness, Self-regulation, Stress/Strain Galantino, Baime, Maguire, Szapary, & Farrar (2005) Unspecified Healthcare Direct care providers and administrators 42-69 Pre-test/Post-test only None Immediate Compassion, HPA, Stress/Strain Gauthier, Meyer, Grefe, & Gold (2015) Unspecified Healthcare Pediatric ICU nurses 38-45 Pre-test/Post-test only None Immediate and 1-month ...
... Appendix B. Additional information on training program, design, and delivery characteristics of studies included in the review Adapted MBSR 52 19 150-480 Audio Recordings, Lecture, Retreat In-session, homework Ancona & Mendelson (2014) Yoga-based 3 6 45 Group discussion, Lecture In-session, at work, homework Baccarani, Mascherpa, & Minozzo (2013) Meditation-based 4 8 90 Lecture In-session, homework Bazarko, Cate, Azocar, & Kreitzer (2013) Adapted MBSR 8 8 90-480 Audio recording, Group discussion, Lecture, Retreat, Written materials In-session, at work, homework Beshai, McAlpine, Weare, & Kuyken (2015) Adapted MBSR & MBCT 8 9 75 Audio recordings, Lecture In-session, homework Brady, O′Connor, Burgermeister, & Hanson (2012) Adapted MBSR 4 4 60 Audio recordings, Group discussion, Lecture In-session, homework Brooker et al. (2013) In-session, at work, homework Burnett & Pettijohn (2015) Adapted MBSR 5 25 10 Audio recordings, Lecture In-session, at work Bush, Rossy, Mintz, & Schopp (2014) Targeted mindfulness 10 11 60-90 Audio recordings, Group discussion, Lecture, Written materials In-session, at work, homework Christopher et al. (2015) Adapted MBSR 8 9 120-360 Group discussion, Lecture In-session, homework Davidson et al. (2003) High Fidelity MBSR 8 8 150-420 Audio recordings, Lecture, Retreat In-session, homework Duchemin, Steinberg, Marks, Vanover, & Klatt (2015) Yoga-based 8 8 60-120 Audio recordings, Group discussion, Lecture, In-session, at work, homework Flaxman & Bond (2010) ACT-Based 24 3 150-180 Lecture In session Flook, Goldberg, Pinger, Bonus, & Davidson (2013) Adapted MBSR 8 8 150-360 Audio recordings, Lecture In-session, at work, homework Fortney, Luchterhand, Zakletskaia, Zgierska, & Rakel (2013) Adapted MBSR 0.71 3 180-420 Audio recordings, Group discussion, Lecture In-session, at work, homework Foureur, Besley, Burton, Yu, & Adapted ACT & 8 1 Not Audio recordings, Group In-session, Author/Publication date Training program Total training duration a Number of Training Sessions Session length b Modes of delivery Type(s) of practice Crisp (2013) MBSR reported discussion, Lecture, Written materials homework Franco, Mañas, Cangas, Moreno, & Gallego (2010) Other 10 10 90 Lecture In-session, homework Frank, Reibel, Broderick, Cantrell, & Metz (2015) Adapted MBSR 8 8 120 Audio recordings, Group discussion, Lecture In-session, at work, homework Galantino, Baime, Maguire, Szapary, & Farrar (2005) Adapted MBSR & MBCT 8 8 120 Audio recordings, Group discussion, Lecture, Written materials In-session, homework ...
Article
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We provide a comprehensive qualitative review of 67 published studies that have examined mindfulness-based training interventions conducted with employees. The findings indicate that the most common research designs were the pre-test/post-test only design (35.8%) and the randomized waitlist control group design (26.9%). About two-thirds of the studies included a control group (61.2%), with approximately three-quarters (75.6%) of these studies using random assignment. Of the 63 studies that used a conventional experimental design, the majority (65.1%) included only one follow-up assessment, most often immediately after training. Results indicated a great degree of heterogeneity in terms of program content, although many studies used some adaptation of Kabat-Zinn's (1990) Mindfulness-Based Stress Reduction (41.8%), an approach with a strong evidentiary base with clinical populations. All training programs incorporated practice, most (85.1%) used multiple methods of delivering the training material, and training varied considerably in total duration, session length, and the number of training sessions. Our review also found that the intended purpose of mindfulness-based training for employees was most commonly the reduction of stress/strain (80.6%), although a wide range of other targeted outcomes were documented. Based on our findings, we offer suggestions for future research aimed at advancing our understanding of mindfulness-based training interventions with employees. Published by Elsevier Inc.
... 20,21 Workplace mindfulness interventions have been shown to increase indicators of positive mental health, including mindfulness, [22][23][24] job satisfaction, 23 work engagement, 25 self-compassion, 26 and resiliency. 25 In addition to their effects on boosting positive functioning, mindfulness interventions have been effective in decreasing indicators of distress, including burnout, 22,23,27 perceived stress, 22,24,26,[28][29][30] sickness-related absence, negative affect, 31 number of primary care visits and hospital admissions among employees, 32 and the stress-related hormone cortisol. 33 Although many of these studies were randomized controlled trials, 22,[24][25][26]29,31,33,34 none compared a mindfulness intervention to an active treatment condition. ...
... [56][57][58] These findings replicate those of other occupational mindfulness interventions. 22,23,27 The significant effect on emotional exhaustion in the MBRT group may be due to the content and structure of that intervention, which emphasized mindfulness of the present moment to a greater degree than the smartphone intervention, and was delivered in a group format. Mindfulness encourages people to take a nonjudgmental approach toward internal and external experiences, including social experiences. ...
Article
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Objective: The aim of this study was to assess whether an in-person mindfulness-based resilience training (MBRT) program or a smartphone-delivered resiliency-based intervention improved stress, well-being, and burnout in employees at a major tertiary health care institution. Methods: Sixty participants were randomized to a 6-week MBRT, a resiliency-based smartphone intervention, or an active control group. Stress, well-being, and burnout were assessed at baseline, at program completion, and 3 months postintervention. Results: Both the MBRT and the smartphone groups showed improvements in well-being, whereas only the MBRT group showed improvements in stress and emotional burnout over time. The control group did not demonstrate sustained improvement on any outcome. Conclusion: Findings suggest that brief, targeted interventions improve psychological outcomes and point to the need for larger scale studies comparing the individual and combined treatments that can inform development of tailored, effective, and low-cost programs for health care workers.
... Studies exploring the effectiveness of MBSR interventions report increased self-care among nurses (Cohen-Katz et al., 2005a), improved feelings of empowerment and selflearning (Birnbaum, 2008), increased feelings of personal accomplishment (Cohen-Katz et al., 2005b), improved mood (Galantino et al., 2005), decreased depression (Shapiro et al., 1998), increased mindful presence and greater ability to self-care, which enhances nursing practice (Brady et al., 2012). Furthermore, White (2014) suggests that MBSR has the potential to enhance the caring environment by promoting empathy, self-awareness and compassion. ...
... No attendance records were kept throughout the intervention so it is unknown whether those who did not attend the final session had failed to attend earlier sessions. This attrition rate of 29%, although relatively high, is consistent with previous studies, where issues such as shift work and 24-hour provision of healthcare affected attendance (Galantino et al., 2005;Moody et al., 2013). Furthermore, similar studies with nurses have achieved comparable samples, for instance Penque (2009), who achieved a sample of 71 and Cohen-Katz et al. (2005a) who achieved 25. ...
Article
This pilot study explored the effects of a mindfulness meditation intervention on nurses’ perceived stress and compassion. A quasi-experimental pre-test/post-test design was used. Nurses (n = 90) working at three university teaching hospitals completed the Perceived Stress Scale and Compassion Scale at the beginning of the training and 64 completed the scales at the end of the training. The 64 matched data sets were analysed using the t-test, chi-square test and analysis of variance. The findings indicated that the nurses’ perceived stress was significantly reduced after the intervention. Notably, compassion scores were increased after the intervention, and this finding was significant for nurses working at one of the hospitals. There were no significant differences between results from a 6-week and an 8-week mindfulness intervention. The results suggest that mindfulness meditation training can impact positively on nurses’ perceived stress and also enhance nurses’ compassion. Mindfulness may well be a suitable self-care, stress-management intervention that can effectively teach nurses coping skills to assist them in managing the daily stressors inherent in their home and work life.
... As anxiety levels increase for an individual, whether in the classroom or out, levels of the hormone cortisol increase; conversely, when anxiety levels go down, cortisol levels decrease (Galantino, Baime, Maguire, Szapary, & Farrar, 2005). In addition, positive emotional experiences such as enjoyment can help reduce anxiety and thereby indirectly decrease cortisol production (Ruini & Ryff, 2016). ...
... Physiological signs have been used to measure stress levels (i.e., anxiety levels using our label) in medical and psychological studies (e.g., Galantino et al., 2005). Stress and anxiety have been associated with observable physical manifestations including higher blood pressure; faster breathing and heart rate; changes in leukocyte and adrenaline levels in saliva, urine, or blood samples; and so forth (Langewitz, Rüddel, & Von, 1987;Vincent, Boomsma, & Schalekamp, 1986;Wright, Hickman, & Laudenslager, 2015). ...
Article
Anxiety is among the most frequently studied emotions in second language acquisition (SLA). Study abroad (SA) researchers have examined its effects on SLA in that setting in a number of studies. The current study goes beyond previous SA research by examining how anxiety develops and connects with language proficiency development over SA. Specifically, it uses anxiety-related measures of foreign language classroom anxiety (FLCA), foreign language enjoyment (FLE), and a physiological manifestation of anxiety (hair cortisol). As far as the classroom is concerned, learners grew more comfortable, experiencing less anxiety and more enjoyment over the period of SA. However, learners showed physiological signs of overall elevated anxiety despite these increasing classroom comfort levels. Two key factors that may have influenced their anxiety levels abroad were tendency toward anxiety prior to SA and language proficiency upon departure for SA. The latter provides support for having students more proficient prior to SA, since doing so may lead to less anxiety during SA.
... Hospital employees may experience significant occupational stress and burnout, which negatively impact their mental health, quality of life, and job performance (Galantino et al. 2005;McVicar 2003). For example, nurses experience stress due to their workload, the structure of their work (i.e., shift work), and the emotional demands of their work, resulting in high levels of mental health problems (Bourbonnais et al. 1999;McVicar 2003). ...
... Mindfulness-based interventions have also been shown to improve psychological outcomes for healthcare providers. Interventions similar to MBCT (but not MBCT specifically) have been associated with significant improvements in stress and burnout, as well as other psychological outcomes, among nurses, physicians, physical therapists, and social workers (Cohen-Katz et al. 2004Galantino et al. 2005;Goodman and Schorling 2012;Klatt et al. 2015;Shapiro et al. 2005). Indeed, a review of ten controlled trials of MBSR for healthcare professionals found significant improvements in anxiety, depression, empathy, compassion, stress, burnout, spirituality, life satisfaction, rumination, and positive and negative affect after 4 to 8 weeks of mindfulness training (Irving et al. 2009). ...
Article
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Hospital employees may experience occupational stress and burnout, which negatively impact quality of life and job performance. Evidence-based interventions implemented within the hospital setting are needed to promote employees’ well-being. We offered a 4-week mindfulness-based cognitive therapy (MBCT) group program for hospital employees and used a mixed-methods practice-based research approach to explore feasibility, acceptability, and effects on stress and burnout. Participants were 65 hospital employees (Mage = 44.06; 85% white) who participated between September 2015 and January 2016. Participants completed validated measures of stress and burnout before and after the program and answered open-ended satisfaction questions after the program. Groups consistently enrolled at least ten participants, but attendance rates declined across sessions (76% at session 2 vs. 54% at session 4) due primarily to work-related scheduling conflicts. The program content was acceptable as evidenced by high perceived value (M = 9.18 out of 10), homework compliance (51% practicing at least three times/week), and qualitative requests for program expansion. There were large, statistically significant decreases in stress (ΔM = 2.1, p < .001, d = 0.85) and medium decreases in burnout (ΔM = 0.46, p = .01, d = 0.57), which were supported by qualitative themes of improved self-regulation and mindfulness skills, stress reduction, emotional well-being, and improved work productivity and patient care skills. Findings suggest that 4-week MBCT is acceptable and useful for hospital employees, though research is needed to identify alternate delivery methods or strategies to enhance session attendance.
... In any case, we did not find any significant differences in other aspects of the diurnal or overall cortisol levels from pre-to post-retreat. While some have reported an overall decrease in daily cortisol secretion following mindfulness practice (Carlson et al., 2003(Carlson et al., , 2007Witek-Janusek et al., 2008), others have found no change (Robinson et al., 2003;Galantino et al., 2005;Klatt et al., 2009). Matousek et al. (2010) reasonably suggest that such discrepancies might be attributed to methodological differences, such as sample size and population characteristics. ...
Article
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Thirty-eight individuals (mean age: 34.8 years old) participating in a 3-month yoga and meditation retreat were assessed before and after the intervention for psychometric measures, brain derived neurotrophic factor (BDNF), circadian salivary cortisol levels, and pro- and anti-inflammatory cytokines. Participation in the retreat was found to be associated with decreases in self-reported anxiety and depression as well as increases in mindfulness. As hypothesized, increases in the plasma levels of BDNF and increases in the magnitude of the cortisol awakening response (CAR) were also observed. The normalized change in BDNF levels was inversely correlated with BSI-18 anxiety scores at both the pre-retreat (r = 0.40, p < 0.05) and post-retreat (r = 0.52, p < 0.005) such that those with greater anxiety scores tended to exhibit smaller pre- to post-retreat increases in plasma BDNF levels. In line with a hypothesized decrease in inflammatory processes resulting from the yoga and meditation practices, we found that the plasma level of the anti-inflammatory cytokine Interleukin-10 was increased and the pro-inflammatory cytokine Interleukin-12 was reduced after the retreat. Contrary to our initial hypotheses, plasma levels of other pro-inflammatory cytokines, including Interferon Gamma (IFN-γ), Tumor Necrosis Factor (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were increased after the retreat. Given evidence from previous studies of the positive effects of meditative practices on mental fitness, autonomic homeostasis and inflammatory status, we hypothesize that these findings are related to the meditative practices throughout the retreat; however, some of the observed changes may also be related to other aspects of the retreat such as physical exercise-related components of the yoga practice and diet. We hypothesize that the patterns of change observed here reflect mind-body integration and well-being. The increased BDNF levels observed is a potential mediator between meditative practices and brain health, the increased CAR is likely a reflection of increased dynamic physiological arousal, and the relationship of the dual enhancement of pro- and anti-inflammatory cytokine changes to healthy immunologic functioning is discussed.
... Much of the existing research discussed in the literature review of this dissertation focuses on changes to emotional states and awareness, and evidence of other potential correlations with mindfulness that are also known to influence leadership effectiveness, such as reductions in anxiety and stress levels and positive changes in mood, emotional self-regulation, and cognitive function (Bao, 2015;Johnson et al., 2014;Rosenkranz et ! 13! al., 2013;Ortner, Kilner, & Zelazo, 2007;Galantino et al., 2005;Carmody, Baer, Lykins, & Olendzki, 2009;Kabat-Zinn et al., 1998;Davidson, 2012;Lazar, 2005;Kerr et al., 2013). ...
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This qualitative research study examined detailed reports by senior organizational leaders linking mindfulness to improved leadership effectiveness. Extensive research supports the existence of a relationship between mindfulness and cognitive, physiological, and psychological benefits that may also have a positive impact on leadership effectiveness. Currently, however, little is known about the processes potentially enabling mindfulness to directly influence leadership effectiveness, and as a result this study was designed to explore this gap in the literature. Data was collected through in-depth interviews with forty-two organizational leaders in North and South America and Europe, many with a history of leadership roles at multiple global organizations. Participants credited mindfulness for contributing to enduring improvements to leadership capabilities, and data analysis revealed new findings clarifying the perceived relationship between mindfulness and tangible results for organizational leaders. Specifically, the results indicate that mindfulness is perceived to contribute to the development of behaviors and changes to awareness associated with improved leadership effectiveness. A potential relationship between mindfulness and the development of emotional intelligence competencies linked to increased leadership performance was also revealed through ESCI 360 analysis. The contribution of this study to current literature is also discussed, as are recommendations for future research.
... In another intervention study examining the relationship between mindfulness and specific facets of empathy, Birnie et al. (2010) reported that participants demonstrated an increase in cognitive empathy (i.e., perspectivetaking) following an MBSR intervention. Despite these compelling findings, the literature investigating the effects of mindfulness-based interventions on empathy is mixed, and some studies have failed to find an association (e.g., Beddoe and Murphy 2004;Galantino et al. 2005). ...
Article
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The positive mental health correlates of mindfulness have become increasingly well-established. Recent literature has documented an association between the present-moment awareness and attention that is characteristic of mindfulness, and the capacity to adopt the emotions, cognitions, and perspectives of another individual, as displayed in empathy. The mechanisms underlying this relationship, however, are still poorly understood. This study aimed to examine alexithymia—or the difficulty identifying, labeling, understanding, and processing one’s own emotions—as a mediator of the relationship between five facets of dispositional mindfulness (i.e., observing, describing, acting with awareness, nonjudging, and nonreacting) and empathy in a sample of 616 undergraduate college students. Results revealed that alexithymia mediated the relationships between the describing and acting with awareness domains of mindfulness and cognitive empathy, while accounting for the effects of the other mindfulness subscales and participant sex. These findings suggest that the relationship between specific mindfulness skills and greater understanding of another individual’s emotional and cognitive experiences may be explained in part by one’s emotional self-awareness.
... Some researchers and clinicians have suggested that mindfulness practices should be integrated into Western health and social care systems [42]. Mindfulness has been reported as an effective approach for decreasing stress and anxiety levels within individuals [43,44]. ...
Article
Background: Investigations into the use of mindfulness with allied health and social care students, many of whom ultimately work in rehabilitation settings, is in the nascent stages and no systematic mapping of the literature has occurred. The purpose of this scoping review was to identify, summarise, and describe the current state of knowledge on mindfulness in allied health and social care professional education. Methods: Arksey and O’Malley’s scoping review methodology was adopted. Five data bases were searched; inclusion and exclusion criteria were applied; and 50 papers were identified for inclusion in the study. Results: Quantitative studies depicted mindfulness interventions as contributing to: improved capacities for mindfulness; decreases in stress, anxiety, and depression; improvements in academic skills, quality of life and well-being, and empathy; improved physiological measures and emotional regulation; and mixed effects on burn-out. Qualitative studies highlighted: 1) mindfulness and self-care, 2) mindfulness within professional practice placements, 3) mindfulness in the classroom, and 4) the cultivation of mindful qualities. Conclusions: The study has important implications for the education of future rehabilitation professions and suggests that learning about mindfulness may be useful in assisting students to: manage academic stress, anxiety, and depression; cultivate a physical and mental state of calm; be more present and empathetic with clients; and be more focused and attentive in professional practice settings. • Implications for rehabilitation • Further exploration of mindfulness as a promising educational intervention for the professional preparation of future rehabilitation practitioners in allied health and social care fields is recommended. • Education and research about mindfulness and its potential opportunities for students in terms of the mediation of stress, anxiety, depression, and the cultivation of empathy, academic skills, quality of life, and resilience are recommended. • Education and research about mindfulness and its potential for the cultivation of beneficial qualities of mind such as attention, self-awareness, compassion, non-judgment, and acceptance are recommended. • Education and research about mindfulness as a potential means to develop capacities related to self-care, professional practice placements, and classroom performance in students is recommended.
... Mirroring the wider literature, findings from these studies, including from robust randomized controlled trials (Hülsheger et al., 2013;Manotas, Segura, Eraso, Oggins, & McGovern, 2014;McConachie, McKenzie, Morris, & Walley, 2014), reveal a range of potential benefits for worker health and well-being. Emerging from this body of work is preliminary evidence that mindfulness interventions may also benefit important organizational criteria such as job satisfaction (Hülsheger et al., 2013), work engagement (Leroy, Anseel, Dimitrova, & Sels, 2013), observer-rated school classroom organization (Flook, Goldberg, Pinger, Bonus, & Davidson, 2013), patient satisfaction, and adverse patient safety events (Brady, O'Connor, Burgermeister, & Hanson, 2012; see Jamieson & Tuckey, 2017;Sutcliffe, Vogus, & Dane, 2016, for reviews), although results have not been as consistent as those for health and well-being (Galantino, Baime, Maguire, Szapary, & Farrar, 2005;Wolever et al., 2012). A few studies have also documented the benefits of trait mindfulness for work-related outcomes such as safety behavior (Zhang & Wu, 2014) and supervisor-rated task performance (Dane & Brummel, 2014;Reb, Narayanan, & Ho, 2015). ...
Article
Despite a surge in workplace mindfulness research, virtually nothing is known about how organizations can cultivate everyday mindfulness at work. Using the extended job demands–resources model, we explored daily psychological demands and job control as potential antecedents of daily mindfulness, and the moderating effect of psychosocial safety climate (PSC, which relates to the value organizations place on psychological health at work). We also examined the relationship between mindfulness and learning to augment understanding of the benefits of everyday mindfulness at work. A sample of 57 employees, primarily working in education, health care, and finance, completed a diary for five days within a 2-week period, covering mindfulness, psychological demands, job control, and learning. PSC was measured in a baseline survey, with individual ratings combined with those of up to four colleagues to tap objective (shared) climate. Hierarchical linear modeling showed that daily psychological demands were negatively related to daily mindfulness, and daily job control was positively related to daily mindfulness especially as PSC increased. Additionally, daily mindfulness was positively associated with daily workplace learning. This study is one of the first to identify work-related antecedents to everyday mindfulness. The findings suggest that (a) to support everyday mindfulness at work, jobs must be designed with manageable demands and a variety of tasks that allow for creativity and skill discretion, and (b) the benefits of mindfulness interventions for employee psychological health and well-being may not be sustainable unless employees have influence over when and how they do their work, in the “right” climate.
... Much of the existing research discussed in the literature review of this dissertation focuses on changes to emotional states and awareness, and evidence of other potential correlations with mindfulness that are also known to influence leadership effectiveness, such as reductions in anxiety and stress levels and positive changes in mood, emotional self-regulation, and cognitive function (Bao, 2015;Johnson et al., 2014;Rosenkranz et al., 2013;Ortner, Kilner, & Zelazo, 2007;Galantino et al., 2005;Carmody, Baer, Lykins, & Olendzki, 2009;Kabat-Zinn et al., 1998;Davidson, 2012;Lazar, 2005;Kerr et al., 2013). ...
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This qualitative research study examined detailed reports by senior organizational leaders linking mindfulness to improved leadership effectiveness. Extensive research supports the existence of a relationship between mindfulness and cognitive, physiological, and psychological benefits that may also have a positive impact on leadership effectiveness. Currently, however, little is known about the processes potentially enabling mindfulness to directly influence leadership effectiveness, and as a result this study was designed to explore this gap in the literature. Data was collected through in-depth interviews with forty-two organizational leaders in North and South America and Europe, many with a history of leadership roles at multiple global organizations. Participants credited mindfulness for contributing to enduring improvements to leadership capabilities, and data analysis revealed new findings clarifying the perceived relationship between mindfulness and tangible results for organizational leaders. Specifically, the results indicate that mindfulness is perceived to contribute to the development of behaviors and changes to awareness associated with improved leadership effectiveness. A potential relationship between mindfulness and the development of emotional intelligence competencies linked to increased leadership performance was revealed as well. The contribution of this study to current literature is also discussed, as are recommendations for future research.^ Keywords: mindfulness, organizational leadership, emotional intelligence, leadership effectiveness, leadership development, mindful leadership, leader empathy, leader emotional self-awareness, leader emotional self-management, leader social awareness, leader relationship management
... This result is also in line with previous results on healthcare providers, which found no significant change on the IRI's EC. 50 51 Perhaps mindfulness does not affect EC: a study found that mindfulness increases PT, but not EC. 52 Future research should disentangle cognitive and affective aspects of empathy as they seem differently impacted by mindfulness and have been shown to interact when explaining burnout. ...
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Objectives To assess the feasibility and acceptability of a mindfulness-based stress reduction (MBSR)-based intervention and determine if the intervention is associated with a significant signal on empathy and emotional competencies. Design Two pre–post proof-of-concept studies. Setting Participants were recruited at the University of Montreal’s Psychology Department (Study 1) and the CHU Sainte-Justine Department of Hematology-Oncology (Study 2). Participants Study 1: 12 students completed the 8-week programme (mean age 24, range 18–34). Study 2: 25 professionals completed the 8-week programme (mean age 48, range 27–63). Intervention Standard MBSR programme including 8-week mindfulness programme consisting of 8 consecutive weekly 2-hour sessions and a full-day silent retreat. Outcomes measures Mindfulness as measured by the Mindful Attention Awareness Scale; empathy as measured by the Interpersonal Reactivity Index (IRI)’s Perspective Taking and Empathic Concern subscales; identification of one’s own emotions and those of others as measured by the Profile of Emotional Competence (PEC)’s Identify my Emotions and Identify Others’ Emotions subscales; emotional acceptance as measured by the Acceptance and Action Questionnaire-II (AAQ-II) and the Emotion Regulation Scale (ERQ)’s Expressive Suppression subscale; and recognition of emotions in others as measured by the Geneva Emotion Recognition Test (GERT). Results In both studies, retention rates (80%–81%) were acceptable. Participants who completed the programme improved on all measures except the PEC’s Identify Others’ Emotions and the IRI’s Empathic Concern (Cohen’s d median=0.92, range 45–1.72). In Study 2, favourable effects associated with the programme were maintained over 3 months on the PEC’s Identify my Emotions, the AAQ-II, the ERQ’s Expressive Suppression and the GERT. Conclusions The programme was feasible and acceptable. It was associated with a significant signal on the following outcomes: perspective taking, the identification of one’s own emotions and emotional acceptance, thus, justifying moving towards efficacy trials using these outcomes.
... Some studies that have tested MBSR effects on empathy using the same instruments as in the present study (the four subscales of the Interpersonal Reactivity Index, IRI) found no effect on any subscale (Galantino et al. 2005), only reductions in empathic distress (Beddoe and Murphy 2004) or, similar to the present study, a reduction in empathic distress and an increase in cognitive empathy (Birnie et al. 2010). No increases in empathic concern have been found in MBSR studies. ...
Article
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Mindfulness-based interventions generally include compassion implicitly, but it remains to be seen whether implicit compassion training can be effective, or if it needs to be trained explicitly through specific meditations and relational practices. This research study had two specific goals. The first was to expand the literature on the effects of compassion-based interventions (CBIs) by assessing the impact of the Compassion Cultivation Training program (CCT) on anxiety, depression, stress, life satisfaction, happiness, mindfulness, empathy, self-compassion, compassion for others, and identification with all humanity, through a wait-list randomized controlled trial in a community sample (study 1). Secondly, this research addressed the following question: Does a CBI—an explicit compassion training—have a differential impact in terms of empathy, compassion, and identification with all humanity, compared to a mindfulness-based intervention (mindfulness-based stress reduction (MBSR)) in which compassion is taught implicitly? (study 2). Groups were assessed at baseline, post-intervention, and 2-month follow-up, and analyses involved repeated-measures of analysis of variance (ANOVA) for group contrasts. Compared to the wait-list group, CCT participants showed significant improvements in psychological well-being (decreased depression and stress, increases in life satisfaction, happiness, mindfulness, and self-compassion) and compassion skills. Both MBSR and CCT were effective in generally enhancing psychological well-being and increasing mindfulness and compassion, but CCT had a greater impact on developing compassionate skills, especially empathic concern and identification with all humanity. This research highlights the potential for a complementary (rather than competitive) relationship between mindfulness- and compassion-based interventions.
... This lack of an effect may reflect the emotionally charged nature of the story, but evidence that mindfulness training increases empathy is mixed. Some studies support the idea that mindfulness training enhances empathy (Birnie et al. 2010;Shapiro et al. 1998), whereas others do not (Beddoe and Murphy 2004;Galantino et al. 2005;Ridderinkhof et al. 2017). Nevertheless, our results suggest that mindfulness training with an ethical focus can enhance prosocial behavior without a mediating effect of empathic concern or perspective taking. ...
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Mainstream mindfulness programs, as in first-generation mindfulness-based interventions, generally do not incorporate Buddhist ethics, causing some scholars to worry that they may encourage self-indulgence and have limited capacity to promote well-being. We compare the effects of practicing mindfulness with additional ethical instruction (EthicalM) or without such instruction (SecularM) on well-being and prosocial behavior. Participants (N = 621) completed 6 days of ethical or secular mindfulness exercises or active control exercises. Secular and ethical mindfulness both reduced stress (EthicalM: p = 0.011, d = − 0.25; SecularM: p = 0.005, d = − 0.28) and increased life satisfaction (EthicalM: p = 0.008, d = 0.26; SecularM: p = 0.069, d = 0.18) and self-awareness (EthicalM: p = 0.011, d = 0.25; SecularM: p = 0.051, d = 0.19). Ethical mindfulness also enhanced personal growth (p = 0.032, d = 0.21). Ethical, relative to secular, mindfulness also increased prosocial behavior—money donated to a charity (p = 0.020, d = 0.24). This effect was moderated by trait empathy: Trait empathy predicted donation amounts for participants who had completed mindfulness exercises (ethical or secular) but not controls. Furthermore, low trait empathy participants gave significantly less money following secular mindfulness practice than control exercises, whereas high trait empathy participants gave more money following ethical mindfulness practice than control exercises. Mindfulness training may thus have unintended consequences, making some people less charitable, though incorporating instruction on ethics, as in some second-generation mindfulness-based interventions, may forestall such effects.
... Una explicación plausible puede ser la escala en sí misma, aunque lo más probable sea que los niveles previos de empatía de la muestra estudiada eran considerablemente altos. Este resultado se encuentra en línea con los de Amutio et al. 23 y Galantino et al. 38 , que tampoco encontraron diferencias significativas en la variable empatía en profesionales de la salud al cabo de 8 semanas de entrenamiento. ...
Article
Objective: To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. Design: A longitudinal study with an intrasubject pre-post intervention design was carried out. Setting: Intensive Care Unit of a tertiary hospital. Participants: A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. Intervention: A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. Main measurements: Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. Results: Among the factors affecting burnout, the level of emotional exhaustion decreased (-3.78 points; P=.012), mindfulness levels measured by the FFMQ were not globally modified, though "observation" and "non-reacting" factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; P=.001). Satisfaction and program adherence levels were very high. Conclusions: In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion -these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.
... In their study on employees in two companies, Van Berkel et al. [39] did not find significant differences in work engagement, mental health, need for recovery and mindfulness between the intervention and control groups in 6 or 12-month follow-up. Galantino et al. [40] found significant improvements in reducing work-related stress after mindfulness meditation in health-care professionals; however, they did not find satisfactory significant differences in correlations between salivary cortisol and survey results (mood, burnout, empathy) and correlations between changes in these measures. ...
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Purpose: The aim of the article was to check if mindfulness based stress reduction (MBSR) is an effective intervention in reducing work-related stress in the case of workers of a copper mine. Material and methods: 66 employees were randomized to the experimental group (32 participants) or to the control group (34 participants). Work-related stress was measured using Job Content Questionnaire (JCQ) (Karasek, 1979) and mental health was measured using General Health Questionnaire (GHQ-28) (Goldberg, 1990). Experimental manipulation was 40-hour-long MBSR training. Results: MANOVA has revealed significant increase of JCQ decision latitude (F=17.36, p=.00) and social support (supervisor. F=9.00, p<.004; coworker. F=5.61, p<.02), a significant decrease in GHQ anxiety (F=5.28, p<.079) and depression (F=3.95, p<.048) due to the intervention. Conclusions: The study confirms that MBSR can also be effective in reducing stress resulting from the external risk (and/or imagined fear) of losing one’s health or life. The use of MBSR could be recommended in health & safety activities in difficult and dangerous work conditions, such as mining, to promote workers’ well-being.
... Nevertheless, the evidence is inconclusive. In fact, some studies that have tested MBSR effects on empathy using the same instruments used in the present study (the four subscales of the Interpersonal Reactivity Index, IRI) have either found no effect in any subscale (Galantino, Baime, Maguire, Szapary, & Farrar, 2005), only reductions in empathic distress (Beddoe & Murphy, 2004), or, similar to the present study, a reduction in empathic distress and an increase in cognitive empathy (Birnie, Speca, & Carlson, 2010). No increases in empathic concern has been found in any of these MBSR studies. ...
Thesis
Although research on contemplative practices has increased in the last few decades, empirical research assessing compassion-based interventions is still in its infancy, and none of this research has been carried out in South America. Using a mixed-method approach, this study investigated the effects of the first implementation in Spanish of the Compassion Cultivation Training (CCT) with a community sample in Santiago de Chile. CCT is a 9-week contemplative group education protocol based on traditional Tibetan Buddhist teachings and contemporary psychology, developed by the Center for Compassion and Altruism in Research and Education at Stanford University. Compassion cultivation training (26 participants) was compared to a randomized waitlist control group (24 participants) and an active matched control group trained in an 8-week Mindfulness-Based Stress Reduction program (MBSR; 32 participants). The groups were assessed using measures of Psychological Wellbeing (depression, anxiety, stress, life satisfaction, and happiness), Contemplative Skills (mindfulness and self-compassion), and Altruistic Orientation (empathic concern, empathic distress, cognitive empathy, compassion for others, and identification with all humanity) at baseline, postintervention, and 2-month follow-up. Semi-structured interviews were carried out with 12 CCT participants. To offset self-report bias, friendly observer reports (questionnaires for friends and family members of participants) of CCT and MBSR participants were contrasted with participant data. Whereas the waitlist group did not show statistically significant pre-post changes in any outcome measure, CCT participants showed significant improvements in all three areas: Psychological Wellbeing (decreased depression and stress [ps < .001], increases in life satisfaction and happiness [ps < .05], and a trend toward significance for decreased anxiety [p < .07]); Contemplative Skills (increased mindfulness and self-compassion; ps < .001), and Altruistic Orientation (increased cognitive empathy, empathic concern, compassion for others, and identification with all humanity; and decreased empathic distress; all ps < .005). The MBSR comparison group also presented significant enhancements in psychological well-being and contemplative skills after the training; however, this group did not significantly change in empathic concern, compassion for others, and identification with all humanity. Friendly observer reports confirmed that cultivating compassion not only enhances personal well-being but also positively impacts relationships with others.
... Some methods of measurement may induce stress (e.g. blood samples), thereby distorting the pattern of outcomes produced by the intervention (Galantino et al., 2005). For example, wearing a blood pressure cuff can have a negative impact on the experience of people about to hear live music (Garabedian, 2014). ...
Article
The dementias are a group of progressive symptoms that have multiple causes, usually caused by disease or injury of the brain, affecting higher brain functions such as language, perception, memory, reasoning and mood; they can also be associated with changes in personality. Arts interventions and interaction with the arts can create meaningful, positive experiences for people with a dementia, as well as improve quality of life. Qualitative research in particular, has been able to describe the emotional responses the arts can produce, but quantifiable changes have not been well documented. Physiological measurements such as stress hormone levels and galvanic skin response show promise in being able to quantify such responses. When taken together, these can give a picture of the kinds of physiological outcomes that are associated with positive affect and improvements in mental wellbeing in the context of arts interventions. This review provides a critical overview of the studies which measure some form of physiological outcome in response to the arts or an arts intervention in people with dementia, and indicates how future research in this area can help to broaden our understanding of the effects of the arts in dementia research and care.
... In a more recent study, Magan et al. demonstrated that long-term meditators have significantly lower plasma cortisol levels when compared to controls [160]. However, it is important to mention that numerous studies have not found any effect of yoga and meditation on cortisol levels [161][162][163]. ...
Article
Alzheimer’s disease (AD) is a complex, multifactorial neurodegenerative disorder that represents a major and increasing global health challenge. In most cases, the first clinical symptoms of AD are preceded by neuropathological changes in the brain that develop years to decades before their onset. Therefore, research in the last years has focused on this preclinical stage of AD trying to discover intervention strategies that might, if implemented effectively, delay or prevent disease progression. Among those strategies, mind-body therapies such as yoga and meditation have gained increasing interest as complementary alternative interventions. Several studies have reported a positive impact of yoga and meditation on brain health in both healthy older adults and dementia patients. However, the underlying neurobiological mechanisms contributing to these effects are currently not known in detail. More specifically, it is not known whether yogic interventions, directly or indirectly, can modulate risk factors or pathological mechanisms involved in the development of dementia. In this article, we first review the literature on the effects of yogic practices on outcomes such as cognitive functioning and neuropsychiatric symptoms in patients with mild cognitive impairment and dementia. Then, we analyze how yogic interventions affect different risk factors as well as aspects of AD pathophysiology based on observations of studies in healthy individuals or subjects with other conditions than dementia. Finally, we integrate this evidence and propose possible mechanisms that might explain the positive effects of yogic interventions in cognitively impaired individuals.
... Findings, however, have been inconsistent. While a number of studies have found that improvements in cortisol regulation are associated with participation in a mindfulness intervention (Brand, Holsboer-Trachsler, Naranjo, & Schmidt, 2012;Galantino, Baime, Maguire, Szapary, & Farrar, 2005;Kang & Oh, 2012;Lengacher et al., 2012), others have failed to find similarly significant results (Klatt, Buckworth, & Malarkey, 2009;Lipschitz, Kuhn, Kinney, Donaldson, & Nakamura, 2013;Matchim, Armer, & Stewart, 2011). Researchers have looked into the impact of mindfulness specifically using the CAR (Brand et al., 2012;Christopher et al., 2015;Daubenmier et al., 2011;Matousek et al., 2010;Matousek et al., 2011), diurnal cortisol slope (Carlson et al., 2013;Daubenmier et al., 2011;Gex-Fabry et al., 2012;Malarkey, Jarjoura, & Klatt, 2013), and cross-sectional cortisol levels (Jacobs et al., 2013;Lengacher et al., 2012). ...
Article
Background Many parents of children with developmental delays (DDs) experience high levels of parental stress, and young children with DDs are likely to exhibit clinical levels of behavioral problems. The reciprocal relationship between the two issues makes these families vulnerable to stress-related health risks. To address this, the current study aims to investigate the effectiveness of mindfulness-based stress reduction (MBSR) at reducing parent stress, as measured by both psychological self-report and a physiological biomarker. Method A pretest–posttest design with a 6-month follow-up assessment was used to establish effectiveness with analyses of within-subject effects. Parents ( N = 47) of children (2.5–5 years of age) with DDs participated in a standard 8-week MBSR intervention. Measures included the Parenting Daily Hassles, a self-report measure of perceived frequency and intensity of parenting stress, and salivary samples for measurement of the cortisol awakening response (CAR), a biological marker of stress response. Results Both self-reported parenting stress and CAR decreased following MBSR for parents of children with DDs. The greatest difference in means over time was between baseline and follow-up, where changes in effect size were even stronger for biological markers than for self-report measures. Conclusion The MBSR intervention reduced both perceived and physiologic stress. Health-care professionals caring for these families might consider encouraging parents to participate in MBSR as both treatment and prevention of parenting stress.
... Research on mindfulness-based courses in workplace contexts is growing including successful findings for stress, anxiety, depression, distress and emotional exhaustion in healthcare professionals ( Burton et al. 2017;Galantino et al. 2005; Martín-Asuero and García-Banda 2010; Morgan et al. 2015;Shapiro et al. 1998). One qualitative review also showed perceived benefits to compassion to the self and others and enhanced presence when relating to others (Morgan et al. 2015). ...
Article
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Objectives Healthcare staff can be prone to high levels of stress and research investigating mindfulness-based courses for this population is showing promise. Given the demands of healthcare work, shortened mindfulness courses may be more appropriate. The aim of the study was to evaluate the utility of a workplace-adapted mindfulness course (MBOE) in a hospital setting, including research on workplace-specific outcomes beyond stress reduction and data relating to home practice with a mobile app. Method The effects of assignment to a workplace-adapted, 6-week mindfulness course or a waitlist control condition on dispositional mindfulness, perceived stress and fulfilment of basic psychological needs at work were examined in a sample of 65 hospital staff. Results Compared with waitlist, staff taking the course showed significant increases in mindfulness and psychological need fulfilment and reductions in perceived stress. Mean levels of perceived stress reduced from a high level to within published norms. Reductions in stress and increases in mindfulness, autonomy and competence remained stable at follow-up. Increased mindfulness mediated improvements in need fulfilment and reductions in stress. Attendance and use of a mobile app for home practice were associated with positive outcomes. Social factors (relatedness) associated with the delivery and outcome of the course were also explored. Conclusions The results indicate that a workplace-adapted, short-format mindfulness course can achieve positive results in line with mindfulness courses for other contexts. Questions were raised regarding which distinct elements may improve outcomes, e.g. home practice and dispositional mindfulness vs. learning environment on more general improvements.
... Mindfulness training can increase mood among employees in high-stress jobs [20] as well as reduce the extent to which they experience emotional exhaustion in their jobs [21]. This effect appears to be pronounced in jobs that are in high-stress fields [22]. Mindfulness also reduces reactivity and improves personal relationships with colleagues [23,24]. ...
Article
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As space missions move from low-earth orbit operations to long duration exploration, the mission's crews will face a different set of experiences and stressors. In order to help prevent the development of cognitive or behavioral symptoms during these missions it is important to define preventative countermeasures. Recent evidence points to mindfulness and relaxation techniques as promising countermeasures for promoting cognitive and behavioral health. We conducted a narrative review of the scientific literature to identify key factors relevant to the role of mindfulness and relaxation techniques in the military and other analog settings, which share some important similarities with the space exploration context. Our results indicate that cognitive (non-meditative) mindfulness is an important psychological construct that can help to promote resilience and to reduce stress in analog environments and particularly in the military. While the literature suggests that mindfulness can be promoted through focused interventions, most of the studied interventions to date are based on meditation. While efficacious, meditation-based interventions generally require a significant amount of time for training. Alternative mindfulness approaches have not yet been explored in these settings but have yielded potentially relevant results for space. Relaxation training is a helpful tool to manage stress and to reduce anxiety. In the military, relaxation techniques are sometimes integrated into psychological training before deployment, leading to improved performance and reduced negative emotions. Even with a lack of specific literature about the application of these concepts in space, literature that describes the experiences from analog environments and military contexts as well as other studies on challenging conditions, suggest further exploration of interventions in these areas.
... These findings are also consistent with previous studies. For example, Galantino et al. (2010) observed no significant changes in empathy levels after a mindfulness meditation intervention for healthcare professionals when assessed using the IRI. Birnie et al. (2010) found MBSR to be successful at increasing participants' levels of self-compassion but that this occurred in the absence of significant changes in empathic concern. ...
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Objectives In prior studies, mixed results have been obtained regarding the relations between mindfulness, moral judgment, and prosocial behavior. We conducted two studies to better clarify the connections between mindfulness and several moral variables.Methods In Study 1, a cross-sectional survey (N = 554) was conducted to test the possible associations between mindfulness, moral sensitivity, moral identity, and prosocial behavior. In Study 2, a randomized controlled experiment was conducted to examine the impact of a mindfulness intervention on moral identity and prosocial behavior. A total of 99 participants (n = 49, mindfulness group; n = 50, wait-list control group), all of whom were undergraduate students on an optional 11-week mindfulness-based self-exploration course, were recruited via the campus network system.ResultsIn Study 1, we found that mindfulness, moral sensitivity, moral identity, and prosocial behavior were all positively correlated. Results of the mediation analysis suggested that dispositional mindfulness had significant effects on prosocial tendencies both directly and indirectly via the mediator variables of moral sensitivity and moral identity. In Study 2, mindfulness practice was found to significantly improve the levels of mindfulness and self-compassion in participants but only had a significant effect on willingness toward prosocial behavior for those participants with existing high moral identity.Conclusions Study 1 confirmed the predicted links between mindfulness, moral sensitivity, moral identity, and prosocial behavior. Study 2 suggested that moral identity influences the effect of mindfulness practice on willingness toward prosocial behavior. However, the underlying mechanisms and causes of this effect require further study.
... Una explicación plausible puede ser la escala en sí misma, aunque lo más probable sea que los niveles previos de empatía de la muestra estudiada eran considerablemente altos. Este resultado se encuentra en línea con los de Amutio et al. 23 y Galantino et al. 38 , que tampoco encontraron diferencias significativas en la variable empatía en profesionales de la salud al cabo de 8 semanas de entrenamiento. ...
Article
Objective To evaluate the effect of a mindfulness training program on the levels of burnout, mindfulness, empathy and self-compassion among healthcare professionals in an Intensive Care Unit of a tertiary hospital. Design A longitudinal study with an intrasubject pre–post intervention design was carried out. Setting Intensive Care Unit of a tertiary hospital. Participants A total of 32 subjects (physicians, nurses and nursing assistants) participated in the study. Intervention A clinical session/workshop was held on the practice of mindfulness and its usefulness. The possibility of following an 8-week training program with specifically designed short guided practices supported by a virtual community based on a WhatsApp group was offered. A weekly proposal in audio and text format and daily reminders with stimulating messages of practice were sent. Main measurements Various psychometric measures were self-reported: burnout (MBI), mindfulness (FFMQ), empathy (Jefferson) and self-compassion (SCS), before and after the training program. Demographic and workplace variables were also compiled. Results Among the factors affecting burnout, the level of emotional exhaustion decreased (−3.78 points; p = 0.012), mindfulness levels measured by the FFMQ were not globally modified, though “observation” and “non-reacting” factors increased. Empathy was not modified, and self-compassion levels increased (3.7 points; p = 0.001). Satisfaction and program adherence levels were very high. Conclusions In the population described, this program showed a decrease in emotional exhaustion and an increase in self-compassion — these being factors that can produce well-being and exert a positive impact upon burnout in this vulnerable group.
... 16 Both programs have been extensively researched and shown to be effective in conditions ranging from affective disorders such as anxiety and depression, 32,37,38 chronic physical conditions such as chronic pain and cancer, [39][40][41] to stress and burnout in healthcare workers. 42,43 Consequently, MBCT has been incorporated into NICE guidance for the management of recurring depression. 44 What are the mechanisms of action? ...
Article
The menopause presents many challenges for middle-aged women worldwide, often highly productive women who are in the prime of their lives juggling busy careers and family responsibilities, when good quality of life and functional ability is an imperative. Some women cope well with their menopausal symptoms and seem to embrace this time of change, while others struggle psychologically to adjust to the changes. Mindfulness-based interventions have a robust evidence base in relation to their efficacy in both physical and psychological conditions. Both programs have been adapted for conditions where difficulties in psychological adjustment to change and/or loss are amongst the core mechanisms that maintain distress. I explored the potential aetiology of distress in the menopause and evaluated existing empirical literature to ascertain whether there is a role for mindfulness-based interventions to facilitate optimal psychological adjustment to changes in the menopause, paying particular attention to the mechanisms that lend themselves to mindfulness training being efficacious. Current available evidence is promising and supports the hypothesis that mindfulness-based interventions may have a role in facilitating psychological adjustment during the menopause transition. The dearth of literature specific to mindfulness-based interventions and the menopause was noted.
... La práctica de la atención plena ha demostrado ser útil para la mejora de la salud mental en general, ya que reduce significativamente el estrés de los empleados (Chu, 2010;Foureur, Besley, Burton, Yu y Crisp, 2013;Galantino, Baime, Maguire, Szapary y Farrar, 2005). También produce disminución de la ansiedad en el trabajo (Orzech, Shapiro, Brown y McKay, 2009;Roeser et al., 2013), reduce la depresión (Farb et al., 2010;McCraty, 2003), y provoca un mayor nivel de humor, bienestar y felicidad en empleados con un trabajo estresante (Wolever et al., 2012) Hallazgos similares se han obtenido en profesionales de la salud (Orzech et al., 2009;McCraty, 2003). ...
... t that depressed patients tend to avoid relapse when they are able to see their emotions and thought processes from a larger perspective. Even in non clinical patients reported increase in mood and affect after practicing mindfulness; Better mood and happiness in employees in stressful jobs (Davidson et. al., 2003) and in health care professionals (Galantino et. al., 2005); enhanced subjective wellbeing (Orzech et al, 2009). ...
Article
This empirical study was conducted to study the relations between Vipassana meditation (VM) and different facets of Psychological well-being (PWB). For this purpose a standardized scale based on Ryff 's PWB scale was used (Ryff & Keyes, 1995). The sample of 240 subjects consisted of regular Vipassana meditator employees, practicing VM in Theravada tradition. The effect of VM is studied with respect to three meditation variables namely; number of courses undertaken, daily practice of VM and overall number of years of practice of VM undertaken. For statistical analysis SPSS 20.0 version was used and the relationship between independent and dependent variables is studied by using univariate (Anova) and multivariate (Manova) analysis of variance. The results obtained are encouraging and agree with the existing literature that VM fosters psychological wellbeing in the practitioners. Thus the practitioner enjoys qualities such as openness, trusting relationships, readiness to continue learning and positive attitude towards life, to name a few. Therefore it can be stated that if employees practice VM it will help to generate a conducive atmosphere in the organizations leading to overall growth and harmony.
... 12 Indeed, studies reveal benefits for healthcare providers trained in mindfulness, including increased selfcompassion, improved mood state, as well as reduced stress, burnout, distress, emotional exhaustion, anger, anxiety, and depression. [13][14][15][16][17][18] Additionally, it has been posited that clinician mindfulness may reduce medical errors and enhance patient safety. 12,19 Yet how mindfulness in healthcare providers may enhance patient care has not been well-studied. ...
Article
Concern for the high prevalence and pervasive negative effects of clinician burnout has led to greater focus on clinician wellness programs, such as Mindfulness-Based Stress Reduction (MBSR). Our goal was to study MBSR feasibility and potential impact on clinician burnout, clinician–patient communication, and patient care and safety at a community hospital.
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Work can be demanding, imposing challenges that can be detrimental to the physical and mental health of workers. Efforts are therefore underway to develop practices and initiatives that may improve occupational wellbeing. These include interventions based on mindfulness meditation. This paper offers a systematic review of empirical studies featuring analyses of mindfulness in occupational contexts. Databases were reviewed from the start of records to January 2016. Eligibility criteria included experimental and correlative studies of mindfulness conducted in work settings, with a variety of wellbeing and performance measures. 153 papers met the eligibility criteria and were included in the systematic review, comprising 12,571 participants. Mindfulness was generally associated with positive outcomes in relation to most measures. However, the quality of the studies was inconsistent, so further research is needed, particularly involving high-quality randomised control trials.
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Objectives Health care professionals have elevated rates of burnout and compassion fatigue which are correlated with poorer quality of life and patient care, and inversely correlated with self-compassion. Primary studies have evaluated the extent to which mindfulness-based interventions increase self-compassion with contradictory findings. A meta-analytic review of the literature was conducted to quantitatively synthesize the effects of mindfulness-based interventions on self-compassion among health care professionals.Methods Twenty-eight treatment outcome studies were identified eligible for inclusion. Five cumulative effect sizes were calculated using random-effects models to evaluate differences of changes in self-compassion for treatment and control groups. Within and between group comparisons were evaluated. Sub-group and moderator analyses were conducted to explore potential moderating variables.ResultsTwenty-seven articles (k = 29, N = 1020) were utilized in the pre-post-treatment meta-analysis. Fifteen samples (52%) included health care professionals and fourteen (48%) professional health care students. Results showed a moderate effect size between pre-post-treatment comparisons (g = .61, 95% CI = .47 to .76) for self-compassion and a strong effect size for pre-treatment to follow-up (g = .76, 95% CI = .41 to 1.12). The effect size comparing post-treatment versus post-control was moderate. One exploratory moderator analysis was significant, with stronger effects for interventions with a retreat component.Conclusions Findings suggest mindfulness-based interventions improve self-compassion in health care professionals. Additionally, a variety of mindfulness-based programs may be useful for employees and trainees. Future studies with rigorous methodology evaluating effects on self-compassion and patient care from mindfulness-based interventions are warranted to extend findings and explore moderators.
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Background and Objectives The objective of mindfulness‐based stress reduction (MBSR) programmes is to promote awareness of the present moment without judging, evaluating or reacting to the different thoughts or emotions that may arise. Development of these abilities appears especially important for healthcare professionals. The objective of this study was to evaluate the effectiveness and medium‐ and long‐term effects of a MBSR programme for primary care (PC) health professionals on their health‐related quality of life and quality of work life. Design Randomised clinical trial using an intervention and control group with follow‐up of the experimental group. Setting Primary Care centres in the Alicante Public Health Service (Spain). Participants Participants were PC health professionals (N = 58) divided between an intervention group receiving the 8‐week MBSR programme and a control group receiving a theoretical training session alone. Method Both groups were evaluated at baseline and at 8 weeks, and the intervention group was additionally evaluated at 3‐, 6‐, 9‐ and 12‐month postprogramme. Results In comparison to the control group, the intervention group obtained higher scores postintervention for mindfulness, health‐related quality of life, mood and compassion satisfaction and a lower score for burnout. Improvements in mindfulness, mood and burnout syndrome persisted at 12 months after the programme. Conclusions In conclusion, MBSR is an effective intervention to enhance the health‐related quality of life and quality of work life of Primary Care Health professionals.
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Habilitation, rehabilitation and promotion of well-being is the ultimate goal of the occupational therapy process. Occupational therapy interventions take advantages from interdisciplinary approach, implying that classic rehabilitative models are constantly enhanced by updated evidences in rehabilitation literature and enriched with competences from different fields. Recent literature has showed how music interventions can improve clinical and rehabilitative outcomes at different levels. Physical or occupational therapists, caregivers and care staffs are frequently involved in providing music interventions with or without the support of a music therapist. In particular, occupational therapists can use music as support to the rehabilitation of daily living activities and, in general, as a complementary tool of their work. This paper wants to stress the implementation of music and music therapy techniques and related specific training programs in the field of occupational therapy, pointing and summarizing main workable evidence-based approaches with music in occupational therapy settings.
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Background: Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. Objectives: To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. Methods: The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Results: Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Conclusions: Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians.
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Mental health, once defined in terms of absence of illness, has gradually become understood in a more holistic way, which includes the positive qualities that help people flourish. This evolving definition of mental health has led to an exploration of other traditions and practices, including mindfulness meditation, which for thousands of years have been devoted to developing an expanded vision of human potential. One result was the introduction of the practice of mindfulness into Western scientific study. However, the original intentions of mindfulness meditation, to catalyze our potential for healing and development, have been largely ignored by the scientific community. Yet a small number of researchers and theorists have explored and continue to explore the positive effects of mindfulness practice. The chapter focuses on this pioneering work.
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Background Stress and compassion fatigue are widely acknowledged as prevalent in workers in ‘caring’ roles, however this has not been widely documented in New Zealand veterinary nurses. Aim This project aimed to investigate the prevalence of stress and compassion fatigue in New Zealand veterinary nurses. Method Using an online survey, veterinary nurses were asked to self-report their incidence of stress or compassion fatigue felt as a result of their working environment. Veterinary nurses were also asked to report the ways in which they cope with stress and compassion fatigue, and their likelihood of changing jobs. Results There were 288 responses to the survey. Of these, 94% of respondents reported feeling stressed and 82% reported experiencing compassion fatigue as a result of their work. 30% of respondents reported an increase in the consumption of alcohol/cigarettes and drugs as a result of stress. Most respondents reported managing their stress and compassion fatigue by talking to colleagues or family. A large number of respondents reported having considered a career change at some stage due to stress or compassion fatigue. Conclusion This research demonstrates a high incidence of stress and compassion fatigue in New Zealand veterinary nurses, with a low percentage of those seeking professional support. Further investigation into combatable causal factors for stress as it differs from compassion fatigue is warranted to ultimately offer support to veterinary nurses to continue their vocation.
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Stress and stress‐related mental health problems are major causes of illness and disability. Mindfulness‐based stress reduction (‘MBSR’) is a group‐based health promotion intervention to improve health and the way people deal with stress and life?s challenges. The core ingredient is mindfulness training through physical and mental exercises practiced daily for eight weeks. The mindful non‐judgmental attitude of being present with what arises is practiced in the formal exercises and in everyday situations. This review assesses the effect of MBSR programs on outcome measures of mental and physical health, quality of life and social functioning in adults. MBSR has a moderately large effect on outcome measures of mental health, somatic health, and quality of life including social function at post‐intervention when compared to an inactive control. If 100 people go through the MBSR program, 21 more people will have a favourable mental health outcome compared to if they had been put on a wait‐list or gotten only the usual treatment. These results may be inflated by underreporting of negative trials and moderate heterogeneity (indicating differences between the trials). MBSR has a small but significant effect on improving mental health at post‐intervention compared to other active treatments. MBSR has the same effect as other active interventions on somatic health, and quality of life (including social function). There was no underreporting of negative trials, and heterogeneity (differences between trials) were small for mental health, moderate for quality of life and large for somatic health. The effects were similar across all target groups and were generally maintained at follow‐up (1?34 months). The effects were largely independent of gender and study sample. The effects seemed also largely independent of duration and compliance with the MBSR intervention. No studies report results regarding side‐effects or costs. Effects were strongly correlated to the effects on measures of mindfulness, indicating that the effects may be related to the increase in self‐reported mindfulness. Two thirds of the included studies showed a considerable risk of bias, which was higher among studies with inactive than active control groups. Studies of higher quality reported lower effects than studies with low quality. The overall quality of the evidence was moderate, indicating moderate confidence in the reported effect sizes. Further research may change the estimate of effect. Plain language summary Mindfulness training improves health and quality of life for adults Mindfulness‐based stress reduction (MBSR) is used to improve health, quality of life and social functioning. MBSR has a positive effect on mental health outcomes measured right after the intervention and at follow up. It also improves personal development, quality of life, and self‐reported mindfulness. What is this review about? Stress and stress‐related mental health problems are major causes of illness and disability. MBSR is a group‐based health promotion intervention to improve health and the way people deal with stress and life's challenges. The core ingredient is mindfulness training through physical and mental exercises practiced daily for eight weeks. The mindful non‐judgmental attitude of being present with what arises is practiced in the formal exercises and in everyday situations. This review assesses the effect of MBSR programs on outcome measures of mental and physical health, quality of life and social functioning in adults. What is the aim of this review? This review summarizes all studies that compare the effect of a MBSR program to a control group intervention, in which the participants had been randomly allocated to be in either the MBSR group or a control group. The review summarizes the results in two categories. First, where the effect of the MBSR program was compared to an inactive group (either a wait list group or one receiving ordinary care also received by the MBSR group). Second, where MBSR was compared with an alternative active group intervention. What studies are included? The review summarizes 101 randomized controlled trials with a total of 8,135 participants from USA, Europe, Asia and Australia. Twenty‐two trials included persons with mild or moderate psychological problems, 47 targeted people with various somatic conditions and 32 of the studies recruited people from the general population. Seventy‐two studies compared MBSR to an inactive control group, while 37 compared MBSR to an active control intervention. Seven studies compared MBSR to both. Ninety‐six studies contributed data to the meta‐analyses, with data from 7,647 participants. Is mindfulness effective? MBSR has a moderately large effect on outcome measures of mental health, somatic health, and quality of life including social function at post‐intervention when compared to an inactive control. If 100 people go through the MBSR program, 21 more people will have a favourable mental health outcome compared to if they had been put on a wait‐list or gotten only the usual treatment. These results may be inflated by underreporting of negative trials and moderate heterogeneity (indicating differences between the trials). MBSR has a small but significant effect on improving mental health at post‐intervention compared to other active treatments. MBSR has the same effect as other active interventions on somatic health, and quality of life (including social function). There was no underreporting of negative trials, and heterogeneity (differences between trials) were small for mental health, moderate for quality of life and large for somatic health. The effects were similar across all target groups and were generally maintained at follow‐up (1–34 months). The effects were largely independent of gender and study sample. The effects seemed also largely independent of duration and compliance with the MBSR intervention. No studies report results regarding side‐effects or costs. Effects were strongly correlated to the effects on measures of mindfulness, indicating that the effects may be related to the increase in self‐reported mindfulness. Two thirds of the included studies showed a considerable risk of bias, which was higher among studies with inactive than active control groups. Studies of higher quality reported lower effects than studies with low quality. The overall quality of the evidence was moderate, indicating moderate confidence in the reported effect sizes. Further research may change the estimate of effect. What do the findings of this review mean? Based on this review it is reasonable to consider MBSR a moderately well‐documented method for helping adults improve their health and cope better with the challenges and stress that life brings. New research should improve the way the trials are conducted addressing the pitfalls in research on mind‐body interventions. How up‐to‐date is this review? The review authors searched for studies up to November 2015. This Campbell Systematic Review was published in October 2017. Executive summary/Abstract Background There is an increasing focus on mind‐body interventions for relieving stress, and improving health and quality of life, accompanied by a growing body of research trying to evaluate such interventions. One of the most well‐known Programs is Mindfulness‐Based Stress Reduction (MBSR), which was developed by Kabat‐Zinn in 1979. Mindfulness is paying attention to the present moment in a non‐judgmental way. The Program is based on old contemplative traditions and involves regular meditation practice. A number of reviews and meta‐analyses have been carried out to evaluate the effects of meditation and mindfulness training, but few have adhered to the meta‐analytic protocol set out by the Cochrane Collaboration and Campbell Collaboration, or focused on MBSR only. The first edition of this review was published in 2012 with a literature search done in 2010, comprising 31 studies. As the field is rapidly developing, an update is called for. Objectives To evaluate the effect of Mindfulness‐Based Stress Reduction (MBSR) on health, quality of life and social functioning in adults. Search methods The following sources were searched, most recently in November 2015: PsycINFO (Ovid), MEDLINE (Ovid), EMBASE (Ovid), AMED (Allied and Complementary Medicine) (Ovid), CINAHL (Ebsco), Ovid Nursing Full Text Plus (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), British Nursing Index, (ProQuest), Eric (ProQuest), ProQuest Medical Library, ProQuest Nursing & Allied Health Source, ProQuest Psychology Journals, Web of Science, SveMed+, Social Services Abstracts, Sociological Abstracts and International Bibliography of Social Sciences. Selection criteria The review included randomised controlled trials (RCTs) where the intervention followed the MBSR protocol developed by Kabat‐Zinn, allowing for variations in the length of the MBSR courses. All target groups were accepted, as were all types of control groups, and no language restrictions were imposed. Data collection and analysis Two reviewers read titles, retrieved studies, and extracted data from all included studies. Standardized mean differences (as Hedges’ g) from all study outcomes were calculated using the software Comprehensive Meta Analysis. The meta‐analyses were carried out using the Robumeta Package within the statistical program R, with a technique for handling clusters of internally correlated effect estimates. We performed separate meta‐analyses for MBSR compared to either waitlists or treatment as usual (WL/TAU – named inactive), and for MBSR compared to control groups that were offered another active intervention. Results The review identified 101 RCTs including the 31 from the first review, with a total of 8,135 participants. Twenty‐two trials included persons with mild or moderate psychological problems, 47 targeted people with various somatic conditions and 32 of the studies recruited people from the general population. Seventy‐two studies compared MBSR to a WL/TAU control group, while 37 compared MBSR to an active control intervention. Seven studies compared MBSR to both a WL/TAU condition and to an active control group. Ninety‐six studies contributed to the meta‐analyses (based on information from 7,647 participants). Two thirds of the included studies showed a considerable risk of bias, and risk of bias was higher among studies with inactive than active control groups. Post‐intervention Hedges’ g effect sizes for MBSR versus WL/TAU for the outcome measures of mental health, somatic health, and quality of life including social function were, respectively, 0.54 (95% CI 0.44, 0.63), 0.39 (95% CI 0.24, 0.54), and 0.44 (95% CI 0.31, 0.56). Some funnel‐plot asymmetry points to a small degree of underreporting of negative trials. Heterogeneity was moderate for mental health and quality of life, and high for somatic health. Assuming a favourable outcome for 50% of the control group, the main finding of an effect size of 0.54 for improving mental health corresponds to a 65% chance that a random person from the treatment group will have a higher score than a person picked at random from the control group (probability of superiority). Another way of putting it, is that in order to have one more favourable mental health outcome in the treatment group compared to the control group at end of intervention, five people need to be treated (NNT=4.9, 95% CI 4.2, 5.9). Thus, if 100 people go through the treatment, 21 more people will have a favourable outcome compared to if they had been put on a wait‐list or gotten the usual treatment. For 21 studies with follow‐up data, the effect size was generally maintained at follow‐up (1–32 months). For the comparison of MBSR versus alternative psychosocial interventions at post‐intervention there was a small, statistically significant difference in favour of MBSR improving mental health with a Hedges’ g effect of 0.18 (95% CI 0.05, 0.30), and MBSR was not more effective than other active interventions on outcome measures of somatic health, 0.13 (95% CI ‐0.08, 0.34) and quality of life (including social function), 0.17 (95% CI ‐0.02, 0.35). Heterogeneity was low for mental health, moderate for quality of life and high for somatic health, and there was no funnel‐plot asymmetry. Assuming a favourable outcome for 50% of the control group, the main finding of an effect size of 0.18 for improving mental health corresponds to a 57% chance that a random person from the treatment group will have a higher score than a person picked at random from the control group and the NNT=14, 95% CI 8, 50). Since the measure of mental health includes outcomes from a larger proportion of the included studies compared to somatic health or quality of life, it is a more robust measure for the effect of the MBSR intervention. It is therefore treated as the main primary outcome for the meta‐analyses. For all comparisons effect sizes were fairly similar across the range of target groups and the effects were generally maintained at follow‐up (1–34 months). Effect sizes for measures of mental health were not particularly influenced by length of intervention, attendance or self‐reported practice, but they were strongly correlated to the effects on measures of mindfulness, indicating that the effects of the MBSR intervention may be related to the increase in self‐reported mindfulness. Sensitivity analyses with exclusion of studies with exceptional findings did not substantially change the results. A majority of studies suffered from risk of bias, and studies of higher quality reported lower effects than studies with low quality. We found no reports of side‐effects or costs in any of the trials. The overall quality of the evidence was moderate, indicating moderate confidence in the reported effect sizes. However, further research could impact on our confidence in the estimate of effect and may change the estimate. Authors’ conclusions MBSR has moderate effect on mental health across a number of outcome measures, for a range of target groups and in a variety of settings, compared to a WL or TAU control group. NNT was 4.9 (95% CI 4.2, 5.9) post‐intervention; on par with other well‐established interventions in the health service. The effect on somatic health is smaller, but still statistically significant. MBSR also seems to improve measures of quality of life and social function when compared to inactive control groups. MBSR improved mental health compared to other active psychosocial interventions, with a NNT = 14 (95% CI 8, 50), and had a similar effect on improving somatic health, and quality of life and social function. For all comparisons, the effects were maintained at follow‐up and correlated to effects on mindfulness. The quality of the evidence was moderate and should be improved in future studies. There were many studies with considerable bias, and heterogeneity was mostly moderate. In addition, there is indication of underreporting of negative studies when MBSR was compared to inactive controls. These factors might have influenced the results found. MBSR might be an attractive option to improve health, handle stress, and cope with the strains of life. Ways to further strengthen the effect should be sought. All new trials should include measures of mindfulness and explore moderators and mediators of effects. New studies should register study protocols and adhere to guidelines for reporting of randomized controlled trials.
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Thesis
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Mindfulness-based stress reduction (MBSR) has grown in popularity over the last two decades, showing efficacy for a variety of health issues. In the current study, we examined the effects of an MBSR intervention on pain, positive states of mind, stress, and mindfulness self-efficacy. These measures were collected before and following an 8-week intervention. Post-intervention levels of stress were significantly lower than pre-intervention levels, while mindfulness self-efficacy and positive states of mind were at significantly higher levels. The findings underscore the potential for stress management, awareness and attention training, and positive states of mind using MBSR. Copyright © 2004 John Wiley & Sons, Ltd.
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Recent research indicates that an affective state termed empathic emotion, and characterized by feelings of sympathy and compassion for another, is associated with altruistic responding. That is, persons experiencing high levels of empathic emotion offer help to another even when escape from the situation is easy. Persons experiencing high levels of another emotional state—personal distress—help much less when escape from the situation is easy. A study was conducted to test two related hypotheses. The first was that individual differences in empathy can influence empathic emotion and personal distress, above and beyond the influence of situational factors. The second hypothesis was that this effect of individual differences is due to variation in emotional and not cognitive empathy. The results provide support for both hypotheses. Regarding hypothesis 1, a significantly greater proportion of the variance in emotional reactions was accounted for when individual difference factors were included as predictors. Hypothesis 2 was also supported: It was found that a dispositional measure of emotional empathy was clearly related, and a dispositional measure of cognitive empathy was clearly unrelated, to these emotional reactions. The results provide support for a multidimensional view of empathy.
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This study examined salivary cortisol and mood during relaxation training in 30 symptomatic, HIV+ gay men participating in a 10-week, group-based cognitive-behavioral stress management intervention. Cortisol levels and mood were assessed within these sessions just before and after 45-min relaxation exercises given as part of each session. Participants also recorded their stress level and compliance with daily home relaxation practice. Presession cortisol levels decreased across the 10-week period and were related to decreases in global measures of total mood disturbance and anxious mood. Reductions in presession cortisol levels were also associated with decreases in self-reported stress level during home practice. Greater reductions in cortisol during the first three sessions were associated with more frequent relaxation practice at home. These findings suggest that salivary cortisol represents an objective neuroendocrine marker for changes in anxiety and distress observed during relaxation training in symptomatic, HIV-seropositive men.
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This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
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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.
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Tai Chi, a moving meditation, is examined for its efficacy in post-stressor recovery. Forty-eight male and 48 female Tai Chi practitioners were randomly assigned to four treatment groups: Tai Chi, brisk walking, mediation and neutral reading. Mental arithmetic and other difficult tests were chosen as mental challenges, and a stressful film was used to produce emotional disturbance. Tai Chi and the other treatments were applied after these stressors. After all treatments, the salivary cortisol level dropped significantly, and the mood states were also improved. In general the stress-reduction effect of Tai Chi characterized moderate physical exercise. Heart rate, blood pressure, and urinary catecholamine changes for Tai Chi were found to be similar to those for walking at a speed of 6 km/hr. Although Tai Chi appeared to be superior to neutral reading in the reduction of state anxiety and the enhancement of vigour, this effect could be partially accounted for by the subjects' high expectations about gains from Tai Chi. Approaches controlling for expectancy level are recommended for further assessment.
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The aim of this work was to study the clinical utility of salivary cortisol concentrations in a group of depressed patients undergoing the dexamethasone suppression test (DST) and the correlation of these concentrations with plasma ACTH levels. Twenty outpatients from the psychiatric department of a Barcelona hospital who were diagnosed as having nonendogenous (N = 9) or endogenous (N = 11) depression according to DSM-III criteria and the Newcastle scale participated in the study. The comparison group consisted of 12 healthy volunteers. Blood and saliva samples were taken before and after administration of 1 mg of dexamethasone Salivary cortisol and plasma ACTH concentrations were determined by direct iodine-125 radioimmunoassay with commercial kit reagents. Predexamethasone salivary cortisol concentrations were significantly higher in the group with endogenous depression than in the comparison group. A significant correlation was obtained between plasma ACTH and predexamethasone salivary cortisol levels in the group with nonendogenous depression and in the comparison subjects. These preliminary findings indicate that salivary cortisol could substitute for plasma cortisol in clinical studies in which the DST and hypercortisolemia are evaluated. The lack of correlation between ACTH and cortisol levels in saliva in the group of endogenously depressed patients could indicate a disturbance in the regulation of cortisol secretion in major depression.
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Salivary cortisol represents a simple, noninvasive, stress-free measure that can greatly facilitate the longitudinal study of hypothalamic-pituitary-adrenal axis activity in patients with psychiatric disorders. By means of a slight modification of a commercially available radioimmunoassay kit, we studied the stability of salivary cortisol under different conditions, as well as the relationship between plasma and salivary cortisol under basal circadian conditions and following stimulation (CRH) and suppression (dexamethasone). We observed that salivary cortisol was quite stable at room temperature without centrifugation and that salivary and plasma cortisol values were highly correlated. Additionally, we observed a close correspondence in circadian and ultradian fluctuations in salivary and plasma cortisol. The salivary cortisol response to ovine and human CRH was similar to that observed with plasma cortisol, but was greater in magnitude. Finally, employing a plasma criterion as the standard, salivary measures identified 48% of the nonsuppressed Dexamethasone Suppression Tests (DSTs) and 97% of the suppressed DSTs.
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The concept of mechanisms that protect people against the psychological risks associated with adversity is discussed in relation to four main processes: reduction of risk impact, reduction of negative chain reactions, establishment and maintenance of self-esteem and self-efficacy, and opening up of opportunities. The mechanisms operating at key turning points in people's lives must be given special attention.
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This article updates and extends Jeannette Gagan's "Methodological notes on empathy," published in the January 1983 issue of ANS. The evolving conceptualization of empathy as a complex, intrapsychic, and interpersonal process suggests that the inconclusiveness and apparent contradictions of research to date might be substantially clarified by considering data from a multidimensional perspective. Attention to the conceptual bases underlying diverse measurement approaches is key to understanding the data produced. Notwithstanding the limitations of their paradigms and models for nursing, the debates and knowledge accumulated in other disciplines can inform a broad range of inquiry relevant to nursing.
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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.
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There is encouraging evidence that structured psychological treatments for depression, in particular cognitive therapy, can reduce subsequent relapse after the period of initial treatment has been completed. However, there is a continuing need for prophylactic psychological approaches that can be administered to recovered patients in euthymic mood. An information-processing analysis of depressive maintenance and relapse is used to define the requirements for effective prevention, and to propose mechanisms through which cognitive therapy achieves its prophylactic effects. This analysis suggests that similar effects can be achieved using techniques of stress-reduction based on the skills of attentional control taught in mindfulness meditation. An information-processing analysis is presented of mindfulness and mindlessness, and of their relevance to preventing depressive relapse. This analysis provides the basis for the development of Attentional Control Training, a new approach to preventing relapse that integrates features of cognitive therapy and mindfulness training and is applicable to recovered depressed patients.
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Cognitive behavioral treatment has been used extensively in the acute phase of depression. The purpose of this study was to determine the applicability and effectiveness of this treatment modality in addressing the residual symptoms of primary major depressive illness. The subjects were 40 patients with major depressive disorder who were successfully treated with antidepressant drugs. They were then randomly assigned to either cognitive behavioral treatment or clinical management of residual symptoms. In both subgroups, antidepressant drugs were tapered and discontinued. The group that received cognitive behavioral treatment had a significantly lower level of residual symptoms after drug discontinuation in comparison with the clinical management group. Cognitive behavioral treatment also resulted in a lower rate of relapse (15%) at a 2-year follow-up than did clinical management (35%), although this difference did not reach statistical significance. Most of the residual symptoms were found to have occurred also in the prodromal phase of illness. This preliminary study points to the potential clinical advantages of cognitive behavioral treatment targeted to the residual symptoms of depression.
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Central nervous, endocrine and immune systems (IS) are all considered to be important regulators of psychological and physical wellbeing. Research into psychoneuroimmunology became relatively widespread in the 1970s. More and more studies considered these systems to be interactive units. Disciplines ranging from anatomy to psychology revealed the IS as the target of brain and endocrine signals. Findings also suggest that the IS is active even in a bidirectional feedback loop. Today the IS is no longer regarded as autonomous and scientists begin to see the emergence of a new psychosomatic paradigm. So far, evidence for the mind-body interaction paradigm has been collected with regard to the role of nerve fibres in lymphatic tissues, the effects of brain lesions on the IS, the interplay of neurotransmitters, hormones and immunotransmitters in a network of bidirectional feedback loops between the brain and the IS, the effects of ontogeny, learning and conditioning on the development of the IS, the impact of experimental and naturally occurring stressors on the IS, the possible immune modulating effects of personality characteristics, life style and psychodynamic processes and the role of the IS in disease. Research findings in most of the mentioned topics are presented.
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The present study, aimed at investigating effects of film-induced amusement on saliva cortisol levels, was performed on 52 healthy male volunteers, aged 19-31 years. They were assigned to an amusement or a control condition. Saliva cortisol and affective film ratings were the dependent variables. During amusement 50% of the subjects showed changes in saliva cortisol correlated positively with ratings of funniness. Thus, cortisol secretion may be linked to emotional arousal, regardless of the emotional valence.
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The authors' goal was to determine whether cognitive behavioral treatment of residual symptoms of depression might have a significant effect on relapse rate. In an earlier study, 40 patients with primary major depressive disorder who had been successfully treated with antidepressant drugs were randomly assigned to either cognitive behavioral treatment of residual symptoms or standard clinical management. In both types of treatment, antidepressant drugs were gradually tapered and discontinued. In this study, a 4-year follow-up assessment was performed. Cognitive behavioral treatment resulted in a substantially lower relapse rate (35%) than did clinical management (70%). Cognitive behavioral treatment of residual symptoms reduces the risk of relapse in depressed patients, probably by affecting the progression of residual symptoms to prodromes of relapse.
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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.
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Testosterone (T) and cortisol (C) were determined in serum and saliva, sampled simultaneously, from triathletes and karate athletes, in order to determine the T:C ratios in those body fluids and the relationship between them, as well as to assess the salivary T:C ratio as a measure of the so-called anabolic-catabolic index. Mean salivary T:C (value (1.67 +/- 0.85) was nearly 3-fold lower than that obtained for serum (4.87 +/- 1.86). Salivary and serum values were strongly correlated with one another (r = 0.874, p < 0.001) but the relationship depended on the range of cortisol concentrations in serum, the slope of the salive-serum regression line being significantly lower for serum cortisol concentrations over 600 nmol.l-1 than for concentrations below that value (0.305 and 0.380, p < 0.05, respectively). It has been concluded that the salivary T:C ratio, based on values reflecting the levels of biologically active fractions of T and C in circulation, is a better measure of metabolic equilibrium conditioned by those hormones than the corresponding ratio obtained from total concentrations in serum.
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Salivary cortisol was measured as an alternative to serum cortisol as a marker for adrenocortical function following insulin tolerance test, corticotropin-releasing-hormone stimulation and adreno-corticotrophic hormone stimulation. During insulin tolerance test and corticotropin-releasing-hormone stimulation adreno-corticotrophic hormone was also measured. The tests were performed on healthy control subjects as well as on patients under investigation for various disturbances in the hypothalamic-pituitary-adrenocortical axis (insulin tolerance test: 3 controls on two occasions and 14 patients; corticotropin-releasing-hormone stimulation: 4 controls and 18 patients; adreno-corticotrophic hormone stimulation: 6 controls and 10 patients). Five patients underwent both insulin tolerance test and corticotropin-releasing-hormone stimulation. Using criteria for adequate cortisol response in serum, the patients were classified as good or poor responders. In 42 of the 45 tests performed the same conclusion as to cortisol status was drawn when based on serum and salivary cortisol responses. In healthy subjects and good responders the mean cortisol relative increase was greater in saliva than in serum in all three tests (p < 0.05). Characteristic of the results for the insulin tolerance test was a significant initial mean decrease (p < 0.05), not found in serum, and the highest observed salivary cortisol value was delayed for at least 30 minutes compared to that in serum. Plasma adreno-corticotrophic hormone correlated significantly with the cortisol concentrations determined 15 minutes later in serum (r = 0.54-0.64) and in saliva (r = 0.76-0.85). The more pronounced cortisol response in saliva than in serum and its closer correlation with adreno-corticotrophic hormone offer advantages over serum cortisol, suggesting salivary cortisol measurement may be used as an alternative parameter in dynamic endocrine test.
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Surveys those forms of psychotherapeutic practice in which meditation (i.e., the induction of a trance state) plays a central role. The order in which they are reviewed follows approximately the temporal sequence of their appearance. Autogenic training (J. H. Schultz, 1932; W. Luthe, 1963; and W. Linden, 1990), the relaxation response (H. Benson and M. Z. Zipper, 1976; Benson et al, 1974), and the author's (P. Snaith, 1981, 1991; Snaith et al, 1992) technique of anxiety control training are described. Meditation is a seldom-used therapeutic practice and the reasons for this neglect are worth consideration; however, all reviews of the topic point to benefits reported in reduction in anxiety. The advantages of self-management, by meditation or other means, include the abbreviation of therapist time; perceived self-efficacy; and the importance to the individual of the realization that he or she has played the major part in improvement, with consequent increase in self-esteem having wide implications for generalization of the beneficial effect. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
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.
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Because health care professionals must provide high-quality care while simultaneously adjusting to the new demands of a rapidly changing health care system, work stress and possibly even burnout are prevalent issues for both senior professionals and recent health science graduates upon entry into the workforce. This article examines the experience of stress and the importance of