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Efficacy of frequent mantram repetition on stress, quality of life, and spiritual wellbeing in veterans: A pilot study
... Meditation has been shown to reduce some of the negative psychological side effects associated with PTSD and AUD [7,8] such as stress and anxiety, [7] which impact on quality of life and social functioning [8]. Meditation requires an individual to focus their attention on a single point of reference [7], directing attention on the current moment and not on disturbing thoughts. ...
... Meditation has been shown to reduce some of the negative psychological side effects associated with PTSD and AUD [7,8] such as stress and anxiety, [7] which impact on quality of life and social functioning [8]. Meditation requires an individual to focus their attention on a single point of reference [7], directing attention on the current moment and not on disturbing thoughts. ...
... Meditation has been shown to reduce some of the negative psychological side effects associated with PTSD and AUD [7,8] such as stress and anxiety, [7] which impact on quality of life and social functioning [8]. Meditation requires an individual to focus their attention on a single point of reference [7], directing attention on the current moment and not on disturbing thoughts. Additionally, mantram, an important element of meditation, is utilised to calm the body, occupy and calm the mind and improve awareness through the daily practice of word repetition to oneself [8]. ...
BACKGROUND: Post traumatic stress disorder (PTSD) and alcohol use disorder (AUD) comorbidity is becoming a rising issue within the military veteran community, highlighted by research indicating individuals diagnosed with PTSD are more likely to have a drinking problem [1]. The implementation of meditation as an alternative form of stress release was aimed at reducing PTSD symptomology and therefore reducing factors that lead to drinking.
METHODS: One male veteran (28y of age) was recruited to complete a two-week intervention. The participant completed a behavioural diary noting alcohol consumption and mood. Following a one-week baseline period, an interview was undertaken to determine reasons for alcohol consumption and potential reasons and motivations for the cessation of drinking. A meditation and mantra intervention was implemented for one week.
RESULTS: Meditation was able to decrease alcohol consumption by reducing PTSD symptomology (baseline consumption 6.26 (SD 4.38) standard drinks per day vs 3.53 (SD 3.44) standard drinks per day during the intervention, however day-to-day variability was evident.
CONCLUSIONS: These results indicate that meditation as an alternative to drinking alcohol can be implemented as a successful form of treatment for PTSD symptomology in the short term. However, these findings are specific to this case study and need to be reproduced in larger samples and over a longer period of time to determine if they can be applied to the general population.
KEYWORDS: PTSD, alcohol use, behavioural intervention, meditation, military.
A Case Study of Meditation to Reduce Alcohol Use Disorder Symptomology in Veteran PTSD Comorbidity. Available from: https://www.researchgate.net/publication/326113162_A_Case_Study_of_Meditation_to_Reduce_Alcohol_Use_Disorder_Symptomology_in_Veteran_PTSD_Comorbidity [accessed Jul 03 2018].
... Bormann and colleagues at the VA San Diego Healthcare System have published nine MRP studies in veterans as subjects (Bormann et al. 2005Bormann et al. , 2006bBormann et al. , 2008Bormann et al. , 2012Bormann et al. , 2013a, b, 2014a; Oman andPlumb et al. 2014). The first mantram research studies used simple one group, quasi-experimental designs. ...
The Mantram Repetition Program (MRP) developed and studied at the Veterans Affairs (VA) San Diego Healthcare System since 2001 is comprised of a set of portable mindful techniques that veterans can use to mitigate posttraumatic stress disorder (PTSD) symptoms. Mantram repetition is invisible, personal, practical, portable, and specific. Three basic skills are taught in the MRP with the goal of training attention, raising awareness, calming the mind, and nourishing the spirit. The skills of the MRP – mantram repetition, slowing down, and one-pointed attention – together provide a portable, practical, and effective strategy for self-regulating emotions and behaviors. There is growing empirical evidence that the MRP may be an effective, sustainable program for symptom and stress management in military personnel and veterans who suffer from PTSD. MRP also has the potential to provide stress relief and spiritual well-being to those who care for service men and women, both family caregivers and professional providers alike.
... 49 The improvement of slightly more than three points on the MAAS seen here is similar to that observed with a 6-week in-person training program. 50 This raises questions about ceiling effects in studies on MBST and whether briefer training might have similar effects as more expensive, lengthier, and demanding in-person training. ...
Background:
Online training is feasible, but the impact of brief mindfulness training on health professionals needs to be better understood.
Methods:
We analyzed data from health professionals and trainees who completed self-reflection exercises embedded in online mindfulness training between May 2014 and September, 2015; their changes in mindfulness were measured using standardized scales.
Results:
Participants included nurses (34%), physicians (24%), social workers and psychologists (10%), dietitians (8%), and others (25%); 85% were women, and 20% were trainees. The most popular module was Introduction to Mindfulness (n = 161), followed by Mindfulness in Daily Life (n = 146), and Mindful Breathing and Walking (n = 129); most (68%) participants who took 1 module took all 3 modules. There were no differences in participation in any module by gender, trainee status, or profession. Completing modules was associated with small but significant improvements on the Cognitive and Affective Mindfulness Scale-Revised, the Mindful Attention Awareness Scale, and the Five Facet Mindfulness Questionnaire (P < 0.001 for all).
Conclusion:
Online training reaches diverse health professionals and is associated with immediate improvements in mindfulness. Additional research is warranted to compare the long-term cost-effectiveness of different doses of online and in-person mindfulness training on clinician burnout and quality of care.
... A study done by White (1992) suggested listening to relaxing music helped to reduce heart rates, respiratory rates, and anxiety scores. Praying or performing spiritual activities was also a popular stress reduction technique among students, since it provides calmness and hope for a better life (Bormann et al, 2005). Malaysian students wishing to study dentistry should be exposed to the nature of the profession and the study environment prior to applying to this program. ...
This study was conducted to identify the prevalence of stress, types of stressors, consequences of stress and stress relievers among undergraduate dental students at the University of Malaya during the different years of study. A descriptive cross-sectional quantitative study was conducted using a self-administered questionnaire among Bachelor of Dental Surgery students during Years 2 to 5. A 100% response rate was obtained. The instrument asked questions about the preceding academic year. The results of the questionnaire reveal the prevalence of stress was 100%. The most common cause of stress among preclinical students was academic concerns and among clinical students was patient management and clinical performance. Physical and behavioral problems were reported as consequences of stress. Most students overcame stress by having strong interpersonal relationships.
... Mantram repetition is an ancient traditional practice of repeating a spiritual word or phrase, sometimes called a holy name [43,44], continuously throughout the day454647. It has been associated with decreased symptoms of psychological distress and increased quality of life and spiritual well-being in veterans and healthcare employees [43],484950. In a randomized clinical trial previously conducted, HIV-infected adults who completed a 5-week mantram intervention program reported significant increases in spiritual faith/assurance and decreases in trait-anger compared to an attention-matched educational control condition [40]. ...
Previous research among HIV-infected individuals suggests that spiritual well-being is inversely related to psychological distress and rates of disease progression. Use of a mantram, a spiritual word or phrase repeated frequently and silently throughout the day, has been associated with decreased psychological distress and increased spiritual well-being. This study compared the effects of 2 interventions-a spiritually-based mantram intervention versus an attention-matched control group-on faith/assurance and average salivary cortisol levels among HIV-infected individuals.
Using a randomized design, HIV-infected adults were assigned to the intervention (n = 36) or control condition (n = 35). Faith scores and saliva (collected at 7 a.m., 11 a.m., 4 p.m., and 9 p.m.) were assessed at preintervention, postintervention, and 5-week follow-up. Path analyses tested competing models that specify both concurrent and sequential relationships between faith and average daily cortisol levels while comparing groups.
Faith levels increased among mantram participants from pre- to postintervention. Greater faith at preintervention was significantly associated with lower average cortisol at postintervention in the mantram group but not in the controls. The associations between faith at postintervention and cortisol levels at 5-week follow-up were significant among both groups but weaker than the pre- to postintervention association identified in the mantram group.
These results suggest the presence of lagged or antecedent consequent relationships between faith and cortisol, which may be enhanced by mantram use. Decreased cortisol could potentially benefit immune functioning among HIV-infected individuals.
There is increasing popularity among researchers, scholars, and policymakers concerning the efficacy of prayer as a coping strategy for job stress. This study examines the moderating effects of prayer and age on the relationship between job stress and nurses’ well-being in UMMC. Three hundred (300) Muslim nursing staff working at the University of Malaya Medical Centre were sampled. Data were collected via questionnaires. The findings of this study show that the effect of job stress on well-being is significant for nurses and that prayer of nurses contributed to alleviating job stress and enhancing well-being. This study is limited to nurses in one public hospital in a developing country. Thus, it would be more interesting if the study could be extended to other public and private institutions in a Muslim country, and a comparison could be done between other religions as well.
This article reports the results of a systematic review on the effectiveness of religious/spiritually (R/S)-based interventions in veterans with post-traumatic stress disorder (PTSD). A total of 385 unique records were identified with eight meeting the inclusion criteria. Seven studies reported significant improvement in reported outcome measures demonstrating the effectiveness of R/S-based interventions in PTSD, with the eighth study reporting positive improvements. We conclude that the few existing published studies report significant benefits to veterans on several outcomes. R/S interventions for veterans with PTSD need to be further developed and tested to determine their efficacy and safety.
Posttraumatic stress disorder (PTSD) is a debilitating condition that emerges after exposure to a traumatic event. Meditation may provide a safe, self-administered, and inexpensive complement to first-line treatments for PTSD. This systematic review synthesized evidence on meditation interventions for the treatment of PTSD (PROSPERO 2015: CRD42015025782).
We searched eight electronic databases from inception to November 2015 and bibliographies of existing systematic reviews to identify English-language randomized controlled trials (RCTs) evaluating the efficacy and safety of meditation interventions in patients with PTSD. Two independent reviewers screened identified literature using predetermined eligibility criteria, abstracted study-level information, and assessed study quality. Meta-analyses used the Hartung-Knapp-Sidik-Jonkman method for random-effects models. The quality of evidence was assessed using the GRADE approach. The primary outcome was PTSD symptom severity, and other outcomes included depression, anxiety, quality of life, functional status, and adverse events. Ten RCTs on meditation interventions for PTSD met inclusion criteria, including five studies of mindfulness-based stress reduction, three of yoga, and two of the mantram repetition program. Meditation approach, intervention intensity, and study quality varied considerably. Eight RCTs included patients exposed to combat-associated trauma, six of which focused exclusively on combat-related trauma. Meditation interventions offered as adjunctive therapy reduced PTSD symptoms postintervention compared with all comparators (treatment as usual alone, attention-matched control groups, present-centered group therapy) across all types of trauma (SMD −0.41; CI −0.81, −0.01; 8 RCTs; I 2 67%; n=517; low quality of evidence). Meditation was also effective
in reducing depression symptoms (SMD −0.34; CI −0.59, −0.08; 8 RCTs; I 2 24%; n=523; moderate quality of evidence). Effects were not statistically significant for quality of life (SMD 0.52; CI −0.24, 1.28; 4 RCTs; I 2 64%; n=337; very low quality of evidence) and anxiety (SMD −0.14; CI −0.63, 0.36; 3 RCTs; I 2 0%; n=234; moderate quality of evidence). No studies addressed functional status. There were no adverse events reported in intervention groups; however, only five RCTs assessed safety. No head-to-head trials compared different meditation approaches; indirect comparisons did not systematically favor one type of meditation over
another, but only a small number of studies were available per approach. It was not possible to determine the differential effect of meditation as monotherapy versus adjunctive therapy, and meta-regressions did not identify a systematic effect of the intervention intensity, trauma type, or type of comparator.
Across interventions, meditation improved PTSD symptoms and depression symptoms. However, these positive findings are based on low to moderate ratings of quality of evidence, and only a small number of studies were available in each meditation category. Additional high-quality trials with adequate power, and longer follow-ups are suggested.
p class="abstract"> Background: Work in a healthcare setting can affect the psychological wellbeing of healthcare professionals (HCPs). Emotional exhaustion among HCPs can have a significant negative impact on the quality of healthcare provided to patients in terms of increased medical errors and decreased patient satisfaction. There is a need for an effective stress-reducing intervention, such as mantra meditation. This feasibility study will examine the suitability of random controlled trial (RCT) methodology to assess the efficacy of mantra meditation at reducing emotional exhaustion among emergency department (ED) staff .
Methods: This is a mixed methods, stratified feasibility study with intent-to-treat protocol, using two study arms (passive control and intervention), the purpose of which is to examine (1) recruitment, retention, and adherence; (2) outcome measures (psychological wellbeing and stress-related biological parameters such as blood pressure, heart rate variability and salivary cortisol); and (3) data management, control, and dissemination prior to conducting a full RCT .
Results Eligible ED staff allocated to the intervention group ( n = 30) will be taught mantra meditation and discuss prescribed texts (4 x 4 hour session over 6 weeks), as well as engage in 20 minutes of twice-daily mantra meditation practice. Participants in the passive control group ( n = 30) will work as usual. Data will be collected pre (T1), post (week 11; T2) and at follow-up (week 19; T3) .
Conclusions: This study will pave the way for a larger RCT that will investigate mantra meditation as a definitive intervention to reduce emotional exhaustion among ED staff.</p
Background:
Chronic low back pain is the most frequent pain condition in Veterans and causes substantial suffering, decreased functional capacity, and lower quality of life. Symptoms of post-traumatic stress, depression, and mild traumatic brain injury are highly prevalent in Veterans with back pain. Yoga for low back pain has been demonstrated to be effective for civilians in randomized controlled trials. However, it is unknown if results from previously published trials generalize to military populations.
Methods/design:
This study is a parallel randomized controlled trial comparing yoga to education for 120 Veterans with chronic low back pain. Participants are Veterans ≥18 years old with low back pain present on at least half the days in the past six months and a self-reported average pain intensity in the previous week of ≥4 on a 0-10 scale. The 24-week study has an initial 12-week intervention period, where participants are randomized equally into (1) a standardized weekly group yoga class with home practice or (2) education delivered with a self-care book. Primary outcome measures are change at 12 weeks in low back pain intensity measured by the Defense and Veterans Pain Rating Scale (0-10) and back-related function using the 23-point Roland Morris Disability Questionnaire. In the subsequent 12-week follow-up period, yoga participants are encouraged to continue home yoga practice and education participants continue following recommendations from the book. Qualitative interviews with Veterans in the yoga group and their partners explore the impact of chronic low back pain and yoga on family relationships. We also assess cost-effectiveness from three perspectives: the Veteran, the Veterans Health Administration, and society using electronic medical records, self-reported cost data, and study records.
Discussion:
This study will help determine if yoga can become an effective treatment for Veterans with chronic low back pain and psychological comorbidities.
Trial registration:
ClinicalTrials.gov: NCT02224183.
Background:
Meditation, imagery, acupuncture, and yoga are the most frequently offered mind and body practices in the Department of Veterans Affairs. Yet, the research on mind and body practices has been critiqued as being too limited in evidence and scope to inform clinical treatment.
Objectives:
We conducted a systematic scoping review of mind and body practices used with veterans or active duty military personnel to identify gaps in the literature and make recommendations for future primary research.
Research design:
Following systematic literature review methodology, we searched 5 databases using 27 different National Center for Complementary and Alternative Medicine-defined mind and body practices as text words, keywords, and MeSH terms through June 30, 2014. We also conducted handsearches of 4 previous reviews.
Subjects:
Active duty military members or veterans 18 years or older participating in mind and body practice interventions globally.
Measures:
Data were extracted from studies meeting 5 inclusion criteria. The quality of randomized controlled trials (RCTs) was assessed using an existing checklist.
Results:
Of 1819 studies identified, 89 interventions (50 RCTs) published between 1976 and 2014, conducted in 9 countries, using 152 different measures to assess 65 health and well-being outcomes met our inclusion criteria. Most interventions took place in the United States (n=78). Meditation practices (n=25), relaxation techniques including imagery (n=20), spinal manipulation including physical therapy (n=16), and acupuncture (n=11) were the most frequently studied practices. Methodological quality of most RCTs was rated poorly.
Conclusions:
Meditation and acupuncture practices are among the most frequently offered and studied mind and body practices. Future research should include yoga as it is currently understudied among veterans and military personnel. A repository of mind and body intervention outcome measures may further future research efforts, as would conducting pragmatic trials and more robust RCTs.
Background:
Several evidence-based treatments are available to veterans diagnosed with posttraumatic stress disorder (PTSD). However, not all veterans benefit from these treatments or prefer to engage in them.
Objectives:
The current study explored whether (1) a mantram repetition program (MRP) increased mindful attention among veterans with PTSD, (2) mindful attention mediated reduced PTSD symptom severity and enhanced psychological well-being, and (3) improvement in mindful attention was due to the frequency of mantram repetition practice.
Research design:
Data from a randomized controlled trial comparing MRP plus treatment as usual (MRP+TAU) or TAU were analyzed using hierarchical linear models.
Subjects:
A total of 146 veterans with PTSD from military-related trauma were recruited from a Veterans Affairs outpatient PTSD clinic (71 MRP+TAU; 75 TAU).
Measures:
The Clinician Administered PTSD Scale (CAPS), PTSD Checklist (PCL), the Brief Symptom Inventory-18 depression subscale, Health Survey SF-12v2, and Mindfulness Attention Awareness Scale (MAAS) were used. Frequency of mantram repetition practice was measured using wrist-worn counters and daily logs.
Results:
Intent-to-treat analyses indicated greater increases in mindful attention, as measured by the MAAS, for MRP+TAU as compared with TAU participants (P<0.01). Mindful attention gains mediated previously reported treatment effects on reduced PTSD symptoms (using both CAPS and PCL), reduced depression, and improved psychological well-being. Frequency of mantram repetition practice in turn mediated increased mindful attention.
Conclusions:
The MRP intervention and specifically, mantram practice, improved mindful attention in veterans with PTSD, yielding improved overall psychological well-being. MRP may be a beneficial adjunct to usual care in veterans with PTSD.
Few complementary therapies for posttraumatic stress disorder (PTSD) have been empirically tested. This study explored the efficacy of a portable, private meditation-based mantram (sacred word) intervention for veterans with chronic posttraumatic stress disorder. A prospective, single-blind randomized clinical trial was conducted with 146 outpatient veterans diagnosed with military-related PTSD. Subjects were randomly assigned to either (a) medication and case management alone (i.e., treatment-as-usual [TAU]), or (b) TAU augmented by a 6-week group mantram repetition program (MRP + TAU). A total of 136 veterans (66 in MRP + TAU; 70 in TAU) completed posttreatment assessments. An intent-to-treat analysis indicated significantly greater symptom reductions in self-reported and clinician-rated PTSD symptoms in the MRP + TAU compared with TAU alone. At posttreatment, 24% of MRP + TAU subjects, compared with 12% TAU subjects, had clinically meaningful improvements in PTSD symptom severity. MRP + TAU subjects also reported significant improvements in depression, mental health status, and existential spiritual well-being compared with TAU subjects. There was a 7% dropout rate in both treatment conditions. A meditation-based mantram repetition intervention shows potential when used as an adjunct to TAU for mitigating chronic PTSD symptoms in veterans. Veterans may seek this type of treatment because it is nonpharmacological and does not focus on trauma. It also has potential as a facilitator of exposure-based therapy or to enhance spiritual well-being. More research is needed using a longitudinal effectiveness design with an active comparison control group.
The purpose of this pilot study was to evaluate the feasibility and effectiveness of a yoga program as an adjunctive therapy for improving post-traumatic stress disorder (PTSD) symptoms in Veterans with military-related PTSD. Veterans (n = 12) participated in a 6 week yoga intervention held twice a week. There was significant improvement in PTSD hyperarousal symptoms and overall sleep quality as well as daytime dysfunction related to sleep. There were no significant improvements in the total PTSD, anger, or quality of life outcome scores. These results suggest that this yoga program may be an effective adjunctive therapy for improving hyperarousal symptoms of PTSD including sleep quality. This study demonstrates that the yoga program is acceptable, feasible, and that there is good adherence in a Veteran population.
Introduction Ayurvedic Medicine: Basic Principles Benefits of Meditation and Yoga Herbals and Remedies from other Sources Efficacy of Ayurvedic Medicine Dangers of Ayurvedic Medicines: Heavy Metal Toxicity Conclusions References
This study assesses changes in mood and anxiety in a cohort of subjects with memory loss who participated in an 8-week Kirtan Kriya meditation program. Perceived spirituality also was assessed. Previous reports from this cohort showed changes in cognitive function and cerebral blood flow (CBF). The purpose of this analysis was to assess outcome measures of mood and affect, and also spirituality, and to determine whether or not results correlated with changes in CBF.
Fifteen (15) subjects (mean age 62±7 years) with memory problems were enrolled in an 8-week meditation program. Before and after the 8-week meditation, subjects were given a battery of neuropsychologic tests as well as measures of mood, anxiety, and spirituality. In addition, they underwent single photon emission computed tomography scans before and after the program. A region-of-interest template obtained counts in several brain structures that could also be compared to the results from the affect and spirituality measures.
The meditation training program resulted in notable improvement trends in mood, anxiety, tension, and fatigue, with some parameters reaching statistical significance. All major trends correlated with changes in CBF. There were nonsignificant trends in spirituality scores that did not correlate with changes in CBF.
An 8-week, 12 minute a day meditation program in patients with memory loss was associated with positive changes in mood, anxiety, and other neuropsychologic parameters, and these changes correlated with changes in CBF. A larger-scale study is needed to confirm these findings and better elucidate mechanisms of change.
Background
A portable practice of repeating a mantram—a sacred word or phrase—has been shown to reduce the severity of posttraumatic stress disorder (PTSD) symptoms in veterans with military trauma. It is thought that the intervention re-directs attention and initiates relaxation to decrease symptom severity, but there may be other mechanisms that may contribute to this improvement.
Purpose
We tested the hypothesis that increases in existential spiritual wellbeing (ESWB) would mediate reductions in self-reported PTSD symptoms following a group mantram intervention.
Method
Veterans diagnosed with PTSD from war-related trauma completed 6 weeks of case management plus a group mantram intervention (n = 66) as part of a randomized trial. Measures included PTSD Checklist (PCL) and Functional Assessment of Chronic Illness Therapy–Spiritual Wellbeing. Path analysis was conducted on those who completed treatment to assess ESWB as a possible mediator of change in PCL from baseline to post-treatment.
Results
A significant indirect effect, −2.24, 95% CI (−4.17, −1.05) of the mantram intervention on PCL change was found. The path from the mantram intervention to ESWB change was significant and positive (B = 4.89, p < 0.0001), and the path from ESWB change to PCL change was significant and negative (B = −0.46, p = 0.001), thus supporting the hypothesis.
Conclusions
Findings suggest that one contributing mechanism that partially explains how the mantram intervention reduces PTSD symptom severity in veterans may be by increasing levels of ESWB.
Numerous instruments have been developed to assess spirituality and measure its association with health outcomes. This study's aims were to identify instruments used in clinical research that measure spirituality; to propose a classification of these instruments; and to identify those instruments that could provide information on the need for spiritual intervention.
A systematic literature search in MEDLINE, CINHAL, PsycINFO, ATLA, and EMBASE databases, using the terms "spirituality" and "adult$," and limited to journal articles was performed to identify clinical studies that used a spiritual assessment instrument. For each instrument identified, measured constructs, intended goals, and data on psychometric properties were retrieved. A conceptual and a functional classification of instruments were developed.
Thirty-five instruments were retrieved and classified into measures of general spirituality (N = 22), spiritual well-being (N = 5), spiritual coping (N = 4), and spiritual needs (N = 4) according to the conceptual classification. Instruments most frequently used in clinical research were the FACIT-Sp and the Spiritual Well-Being Scale. Data on psychometric properties were mostly limited to content validity and inter-item reliability. According to the functional classification, 16 instruments were identified that included at least one item measuring a current spiritual state, but only three of those appeared suitable to address the need for spiritual intervention.
Instruments identified in this systematic review assess multiple dimensions of spirituality, and the proposed classifications should help clinical researchers interested in investigating the complex relationship between spirituality and health. Findings underscore the scarcity of instruments specifically designed to measure a patient's current spiritual state. Moreover, the relatively limited data available on psychometric properties of these instruments highlight the need for additional research to determine whether they are suitable in identifying the need for spiritual interventions.
We conducted an uncontrolled pilot study to determine whether transcendental meditation (TM) might be helpful in treating veterans from Operation Enduring Freedom or Operation Iraqi Freedom with combat-related posttraumatic stress disorder (PTSD). Five veterans were trained in the technique and followed for 12 weeks. All subjects improved on the primary outcome measure, the Clinician Administered PTSD Scale (mean change score, 31.4; p = 0.02; df = 4). Significant improvements were also observed for 3 secondary outcome measures: Clinician's Global Inventory-Severity (mean change score, 1.60; p < 0.04; df = 4), Quality of Life Enjoyment and Satisfaction Questionnaire (mean change score, -13.00; p < 0.01; df = 4), and the PTSD Checklist-Military Version (mean change score, 24.00; p < 0.02; df = 4). TM may have helped to alleviate symptoms of PTSD and improve quality of life in this small group of veterans. Larger, placebo-controlled studies should be undertaken to further determine the efficacy of TM in this population.
This study assessed patient satisfaction with the use of a spiritually based (mantram/sacred word) intervention in expecting couples. A mixed-methods design, experimental repeated measures with interviews at 6-month follow-up was conducted. Satisfaction was moderate to high. Mantram was used for labor pains and uncertainty. Implications include scheduling flexible classes earlier in pregnancy. A larger randomized study is needed to assess intervention effectiveness.
"Awareness and meditation are, form fundamental to the deep change that is necessary for healing. Chronic illness is a way of life as well as, perhaps even more than, a disease entity. Before we can be free of the symptoms of illness and the role of the sick person, we need to know what has precipitated those symptoms, and how we are responding to our sickness, We need to recognize in our own lives the psychological, biological, and sociological factors that may affect our health. Awareness allows us to see where we are; to stand for a moment outside ourselves; to appreciate in a powerful, personal way, how the world around us affects us; to observe the thoughts, feelings, and sensations that arise in us. Meditation is a state of moment-to-moment awareness that over time may help to dissolve physical symptoms and habitual ways of thinking and acting, Both awareness and meditation enable us to experience the way our mind may limit or free us. Together they prepare us to use our mind to make the deep changes in thought, feeling, and action that are necessary for our healing." -James S. Gordon, MD(1)
Caring for veterans with dementia is burdensome for family caregivers. This exploratory study tested the efficacy of an innovative, spiritually based mantram caregiver intervention delivered using teleconference calls. A prospective, within-subjects, mixed-methods, and 3-time repeated-measures design with 36-week follow-up telephone interviews was conducted. Sixteen caregivers (94% women, 94% Whites with mean age 69.2 years, SD = 10.35 years) completed the intervention. Significant effects for time and linear terms were found for decreasing caregiver burden, perceived stress, depression, and rumination and for increasing quality of life enjoyment and satisfaction, all with large effect sizes. Findings suggest that teleconference delivery of a spiritually based caregiver intervention is feasible.
There is evidence that various meditation practices reduce distress, but little is known about the mechanisms of frequently repeating a mantram-a spiritual word or phrase-on distress reduction. Mantram repetition is the portable practice of focusing attention frequently on a mantram throughout the day without a specific time, place, or posture.
We examined the hypothesis of whether increases in positive reappraisal coping or distancing coping mediated the sustained decreases in anger found following a group-based mantram intervention that was designed to train attention and promote awareness of internal experiences.
A secondary analysis was performed on data collected from a randomized controlled trial that compared a group-based mantram intervention (n = 46) to an attention-matched control (n = 47) in a community sample of human immunodeficiency virus-positive adults. Positive reappraisal and distancing coping were explored as potential mediators of anger reduction.
Participants in the mantram intervention reported significant increases in positive reappraisal coping over the 5-week intervention period, whereas the control group reported decreases. Increases in positive reappraisal coping during the 5-week intervention period appear to mediate the effect of mantram on decreased anger at 22-week follow-up.
Findings suggest that a group-based mantram intervention may reduce anger by enhancing positive reappraisal coping.
We examined the efficacy of a psycho-spiritual intervention of mantram repetition--a word or phrase with spiritual associations repeated silently throughout the day--on psychological distress (intrusive thoughts, stress, anxiety, anger, depression), quality of life enjoyment and satisfaction, and existential spiritual well-being in HIV-infected adults. Using a 2-group by 4-time repeated measures design, 93 participants were randomly assigned to mantram (n = 46) or attention control group (n = 47). Over time, the mantram group improved significantly more than the control group in reducing trait-anger and increasing spiritual faith and spiritual connectedness. Actual mantram practice measured by wrist counters was inversely associated with non-HIV related intrusive thoughts and positively associated with quality of life, total existential spiritual well-being, meaning/peace, and spiritual faith. Intent-to-treat findings suggest that a mantram group intervention and actual mantram practice each make unique contributions for managing psychological distress and enhancing existential spiritual well-being in adults living with HIV/AIDS.
In a study of 59 veterans and healthcare workers, the reliability of a self-monitoring method used to track the frequency of a spiritually oriented stress reduction technique was assessed. During a 5-week program of silently repeating a mantram (a spiritual word or phrase) to lower stress and anger and improve spiritual well-being, portable wrist-worn counters were used to track daily mantram practice sessions. All outcomes significantly improved in the hypothesized direction. Mantram practice tracked by the counters was highly correlated (r = .84) with retrospective self-reports, indicating that such counters may be a reliable self-monitoring tool and could be used to measure a variety of other behavioral health quality indicators.
The study of complementary and alternative medicine (CAM) using a randomized, controlled trial (RCT) design poses challenges, such as treatment standardization and blinding. We designed an RCT, which avoided these two common challenges, to evaluate the effect of adding the relaxation response (RR) to usual acupuncture treatment. In this paper, we report on the feasibility and patients' experience from the study participation.
Our study was a two-arm, double-blind RCT conducted in an acupuncture clinic in Boston. Study subjects were patients with human immunodeficiency virus/autoimmunodeficiency syndrome (HIV/AIDS), who reported having at least one of the highly prevalent HIV-related symptoms, and were receiving acupuncture treatment.
The intervention group wore earphones to listen to tapes with instructions to elicit the RR and also soft music while receiving acupuncture treatment, while the control group only listened to soft music. The intervention group was also required to listen to the RR tapes at home daily.
A study evaluation was completed upon termination of the 12-week study (36 intervention and 44 control patients).
A majority of participants in both groups reported: no discomfort wearing earphones (82.9%, 81.8%); the study met their expectations (87.1%, 85.4%); and they would recommend the study to others (91.1%, 90.5%). Intervention participants reported better experiences with the tapes than the control group (p = 0.056) (72.4% versus 52.8% felt better with tapes; 3.5% versus 16.7% felt better without tapes; and 24.1% versus 30.6% felt no difference). Intervention participants were also more likely than the control group (p = 0.02) to report positive emotional/physical/spiritual changes (45.5% vs. 20.9%) and relaxed/peaceful/calm feelings (30.3% vs. 25.6%) from the study participation.
We demonstrated the feasibility of conducting a unique trial that examined the synergistic effects of two types of CAM practices. The intervention group reported more positive study-related experiences than the control group.
Presents test–retest and internal consistency reliability coefficients and descriptive data for several religious, student, and client groups who were administered the Spiritual Well-Being Scale developed by R. F. Paloutzian and C. W. Ellison (1982). Because of ceiling effects, in evangelical samples, the typical respondent received the maximum score; thus, the scale was not useful in distinguishing among individuals for purposes such as selection of spiritual leaders. The scale is useful for research and as a global index of lack of well-being. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background: The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. To date, there has been no systematic measurement of health status in the VA. The Veterans Health Study has developed methods to assess patient-based health status in ambulatory populations. Objectives: To describe the health status of veterans and examine the relationships between their healthrelated quality of life, age, comorbidity, and socioeconomic and service-connected disability status.
Methods: Participants in the Veterans Health Study, a 2-year longitudinal study, were recruited from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Study patients received questionnaires of health status, including the Medical Outcomes Study Short Form 36-Item Health Survey; and a health examination, clinical assessments, and medical history taking. Sixteen hundred sixty-seven patients for whom we conducted baseline assessments are described. Results: TheVAoutpatients had poor health status scores across all measures of the Medical Outcomes Study Short Form 36-Item Health Survey compared with scores in non-VA populations (at least 50% of 1 SD worse). Striking differences also were found with the sample stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), scores were
considerably lower among the younger patients; for the eighth scale (physical function), scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (.65 years). The mental health scores of young veterans were substantially worse than all other age groups (P,.001) and scores of screening measures for depression were significantly higher in the youngest age group (51%) compared with the oldest age groups (33% and 16%) (P,.001). Conclusions: The VA outpatients have substantially
worse health status than non-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; the young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health-related quality of life in young veterans. As health care systems continue to undergo a radical transformation, the Department of Veterans Affairs should focus on the provision of mental health services for its younger veteran.
The relation of perceived stress and psychosocial dysfunction was examined in two clinical samples identifying stress as a personal problem. Perceived stress was significantly correlated with self-reported negative affect and physical symptoms. Negative and total major life event scores also were significantly correlated with self-reported negative affect and physical symptoms. However, the perceived stress scale and the life events measures were moderately correlated, indicating that the two scales assess different features of the stress experience. A major finding of this study was that perceived stress scores were significantly correlated with affective and physical symptoms even after the variance associated with life events had been partialed out.
This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders.
The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period.
Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings.
A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.
We tested the short-term efficacy and feasibility of two stress education approaches toe the treatment of mild hypertension in older African Americans. This was a randomized, controlled, single-blind trial with 3 months of follow-up in primary care, inner-city health center. Of 213 African American men and women screened, 127 individuals (aged 55 to 85 years with initial diastolic pressure of 90 to 109 mm Hg, systolic pressure of < or = 189 mm Hg, and final baseline blood pressure of < or = 179/104 mm Hg) were selected. Of these, 16 did not complete follow-up blood pressure measurements. Mental and physical stress reduction approaches (Transcendental Meditation and progressive muscle relaxation) were compared with a lifestyle modification education control program and with each other. The primary outcome measures were changes in clinic diastolic and systolic pressures from baseline to final follow-up, measured by blinded observers. The secondary measures were linear blood pressure trends, changes in home blood pressure, and intervention compliance. Adjusted for significant baseline differences and compared with control, Transcendental Meditation reduced systolic pressure by 10.7 mm Hg (P < .0003) and diastolic pressure by 6.4 mm Hg (P <.00005). Progressive muscle relaxation lowered systolic pressure by 4.7 mm Hg (P = 0054) and diastolic pressure by 3.3 mm Hg (P <.02). The reductions in the Transcendental Meditation group were significantly greater than in the progressive muscle relaxation group for both systolic blood pressure (P = .02) and diastolic blood pressure (P = .03). Linear trend analysis confirmed these patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors sought to determine the effect of clinically equivalent doses of fluoxetine on mood and other psychological variables in normal subjects.
Fifteen healthy volunteers received placebo for 2 weeks; fluoxetine, 10 mg/day, for 1 week; fluoxetine, 20 mg/day, for 5 weeks; and then an additional 2 weeks of placebo in the context of a single-blind study. The subjects were evaluated with a series of self- and observer-rated instruments.
No significant effects attributable to fluoxetine were observed on any of the psychological variables examined. Minimal adverse effects were reported.
Significant mood-elevating and other psychological effects of fluoxetine would appear to be induced only when symptomatic targets exist.
Complementary and alternative medicine (CAM) use and expenditures are on the rise in the United States. Although civilian users of CAM have been well described, little is known about military veteran users of CAM.
To describe military veteran CAM users in the southwestern United States.
The study population comprised 508 military veterans randomly selected from Southern Arizona Veterans Administration Health Care System (Tucson) primary care patient lists, who had agreed to participate in a telephone interview. The chi(2) test was used to analyze CAM use by demographic characteristics, military service, military-related health outcomes, and physician-diagnosed health complaints. Logistic regression was used to determine predictor variables.
Of the 508 subjects, 252 (49.6%) reported CAM use. Military veteran CAM users were significantly more likely to be non-Hispanic white, earn more than $50 000 per year (both P<.05), and have greater than 12 years of education (P<.01). Current high daily stress, perceived negative impact of military life on physical or mental health, and physician-diagnosed chronic illnesses (eg, gastrointestinal problems, insomnia, and asthma) were statistically associated with CAM use. Regression analysis provided adjusted odds ratios and indicated that ethnicity (non-Hispanic white), higher education, greater current daily stress, and overseas military experience were significant predictors of CAM use by these veterans (each P<.05).
Ethnicity, education, income, and several chronic health complaints are consistent with civilian CAM use. Findings also suggest, however, that physicians providing conventional medical care need to be aware of experiences unique to CAM-using military veterans.
There is scant literature describing the effect of glomerular disease on health-related quality of life (HRQOL). The Cure Glomerulonephropathy study (CureGN) is an international longitudinal cohort study of children and adults with four primary glomerular diseases (minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy). HRQOL is systematically assessed using items from the Patient-Reported Outcomes Measurement Informative System (PROMIS). We assessed the relationship between HRQOL and demographic and clinical variables in 478 children and 1115 adults at the time of enrollment into CureGN. Domains measured by PROMIS items included global assessments of health, mobility, anxiety, fatigue, and sleep impairment, as well as a derived composite measure incorporating all measured domains. Multivariable models were created that explained 7 to 32% of variance in HRQOL. Patient-reported edema consistently had the strongest and most robust association with each measured domain of HRQOL in multivariable analysis (adjusted β [95% CI] for composite PROMIS score in children, -5.2 [-7.1 to -3.4]; for composite PROMIS score in adults, -6.1 [-7.4 to -4.9]). Female sex, weight (particularly obesity), and estimated glomerular filtration rate were also associated with some, but not all, domains of HRQOL. Primary diagnosis, disease duration, and exposure to immunosuppression were not associated with HRQOL after adjustment. Sensitivity analyses and interaction testing demonstrated no significant association between disease duration or immunosuppression and any measured domain of HRQOL. Thus, patient-reported edema has a consistent negative association with HRQOL in patients with primary glomerular diseases, with substantially greater impact than other demographic and clinical variables.
This book, the first of its kind, reviews and discusses the full range of research on religion and a variety of mental and physical health outcomes. Based on this research, the authors build theoretical models illustrating the various behavioural, psychological, and physiological pathways by which religion might affect health. They also review research that has explored the impact of religious affiliation, belief, and practice one use of health services and compliance with medical treatment. Finally, they discuss the implications of these findings, examine a number of possible clinical applications, and make recommendations for future research in this area
The relaxation response is a self-induced altered state of consciousness. During the last 15 years, our laboratory has worked to define its physiology, to establish its subjective and objective historical precedents, and to test its clinical usefulness. The relaxation response is believed to be the counterpart of the emergency response and is characterized by acute and chronic changes consistent with decreased sympathetic nervous system activity.
Investigations in both healthy and clinical populations support the effectiveness of cognitive-behavioral interventions for immune enhancement and symptom reduction. However, there is a paucity of research examining these interventions in human immunodeficiency virus (HIV) positive populations, and existing studies lack precision in design. In this study, HIV seropositive subjects, blocked by illness stage, were randomized to a guided imagery (N=23) or progressive muscle relaxation (PMR) (N=22) treatment, or a control group (N = 24). The six-week treatments were delivered via audiotape following brief face-to-face instruction, and effects on fatigue, depression, and three measures of cellular immunity were examined. Pre and posttreatment measures included the Center for Epidemiologic Studies Depression Scale (CES-D), Sleep and Rest subscale of the Sickness Impact Profile (SIP), CD4+ and CD16+ lymphocyte numbers, and CD4+:CD8 + T lymphocyte ratio. Data were analyzed using a hierarchical multiple regression model, holding pretreatment effects constant while assessing the contribution of each treatment to the dependent variables. The guided imagery group had a significant decrease in depression and fatigue, while the PMR group demonstrated an increased CD4+ T lymphocyte count and a reduction in depression. Findings supported the effectiveness of both interventions for symptom alleviation, and of PMR for immune enhancement in persons with HIV, and suggest a differential effect for the two treatments in this population.
Recent attempts to measure the quality of life or subjective well-being show promise for a more helpful and accurate appraisal of the collective and individual state of people than objective, economically-oriented indicators have allowed. Unfortunately, the quality of life movement has virtually ignored the religious dimension of life and the part that such beliefs and practices play in well-being. In response to this void, Paloutzian and Ellison (1982) have developed a Spiritual Well-Being Scale which measures both religious and existential well-being. This article reports on the conceptualization of the spiritual well-being dimension, development of the scale, research which has utilized the scale, and suggests directions for future research.
HIV infection is disproportionately more common among ethnic/racial minorities in the U. S., yet little research has examined how this population copes with their chronic illness. The available studies have primarily focused on white, middle class gay males. Little is known about the specific psychological responses and specific coping strategies of men from communities of color. While all people infected with HIV must cope with significant psychosocial stressors such as social stigmatization, and coping with a chronic and terminal illness, people of color likely face additional stressors related to homophobia and racism. This article presents a study of 100 men, 92% of which are men of color. Participants were recruited from a midwestern medical center and data were collected regarding the presence of psychological distress, coping styles, spirituality and sexual orientation. A series of analyses examined the relationship between these variables and specific coping methods. Results included a strong relationship between increased positive mood when participants used an active coping style as compared with a passive-avoidant coping style. Greater levels of spiritual well being were correlated with positive mood. This article presents information on the psychological experience of ethnic/racial minority men who are HIV positive, have different coping styles and examines the role spirituality has in managing one's illness.
Describes the relaxation response (RR), an innate physiologic response that has been elicited by many techniques for centuries. Research is presented (e.g., J. W. Hoffman et al [see PA, Vol 68:2977]) showing that the RR acts by reducing central nervous system (CNS) responsivity to norepinephrine. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Employed an electromyogram (EMG) biofeedback-induced desensitization procedure (EMG—D) in the treatment of 8 Vietnam combat veterans with a 7-yr history of chronic post-traumatic stress disorder (PTSD) and frequent recurring nightmares and/or flashbacks that were anxiety-evoking events. 16 PTSD Ss (aged 29–42 yrs) were assigned to the EMG—D group or a control group. Analysis of forehead muscle tension over a 2 yr follow-up indicated that the Ss in the EMG—D condition had significantly reduced their muscle tension and showed continued improved functioning. Ss reported a few instances of recurrence of their nightmares and/or flashbacks; however, they were essentially anxiety-free episodes. No significant reduction in muscle tension, recurring nightmares, or flashbacks was found for Ss in the control group. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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.
This study was conducted to explicate the role of spirituality in dealing with the many struggles of advanced HIV disease. The research question that guided the study was: How is spiritual meaning structured in advanced stages of HIV disease? Published articles have lacked sound conceptions of spirituality that would allow it to be described apart from religion as a concept within humanistic science. Qualitative methodological assumptions were derived from interpretive interactionism. The spiritual experiences of 10 men and women in advanced-stage (symptomatic) HIV disease who self-identified that they had either spiritual or religious experiences that had helped them cope with HIV disease were interpreted. Data were collapsed, over three iterations, into three major themes to build the meaning of spirituality in HIV. Extracted themes were: purpose in life emerges from stigmatization; opportunities for meaning arise from a disease without a cure; and after suffering, spirituality frames the life.
Clinical, field, and experimental studies of response to potentially stressful life events give concordant findings: there is a general human tendency to undergo episodes of intrusive thinking and periods of avoidance. A scale of current subjective distress, related to a specific event, was based on a list of items composed of commonly reported experiences of intrusion and avoidance. Responses of 66 persons admitted to an outpatient clinic for the treatment of stress response syndromes indicated that the scale had a useful degree of significance and homogeneity. Empirical clusters supported the concept of subscores for intrusions and avoidance responses.
The rate at which medical patients physician-referred to an 8-week stress reduction program completed the prescribed intervention was measured and predictors of compliance sought. Seven hundred eighty-four consecutive patients who enrolled in the program over a 2-year period were studied. Of these, 598 (76%) completed the program and 186 (24%) did not. Multiple regression analysis showed that (1) among chronic pain patients, only sex discriminated between completers and noncompleters, with females more than twice as likely to complete the program as males (odds ratio = 2.4; 95% CI = 1.2, 4.4); (2) among patients with stress-related disorders, only the OC scores of the SCL-90-R discriminated between completers and noncompleters (odds ratio = 2.0; 95% CI = 1.2, 3.4). Completion rates for specific diagnoses are reported and discussed. The high rate of completion observed for this intensive program in health behavior change is discussed in terms of the design features and therapeutic modalities of the intervention.
The signs and symptoms of response to a stressful life event are expressed in two predominant phases: the intrusive state, characterized by unbidden ideas and feelings and even compulsive actions, and the denial state, characterized by emotional numbing and constriction of ideation. In this review of stress-response syndromes, the author outlines those phases, discusses the DSM-III diagnoses for stress-response disorders, and considers the mutual etiologic effects of stressful life events, psychiatric disorders, and preexisting conflicts or functional deficits. Guidelines for brief dynamic psychotherapy for patients who need more than transient support are presented.
This paper presents evidence from three samples, two of college students and one of participants in a community smoking-cessation program, for the reliability and validity of a 14-item instrument, the Perceived Stress Scale (PSS), designed to measure the degree to which situations in one's life are appraised as stressful. The PSS showed adequate reliability and, as predicted, was correlated with life-event scores, depressive and physical symptomatology, utilization of health services, social anxiety, and smoking-reduction maintenance. In all comparisons, the PSS was a better predictor of the outcome in question than were life-event scores. When compared to a depressive symptomatology scale, the PSS was found to measure a different and independently predictive construct. Additional data indicate adequate reliability and validity of a four-item version of the PSS for telephone interviews. The PSS is suggested for examining the role of nonspecific appraised stress in the etiology of disease and behavioral disorders and as an outcome measure of experienced levels of stress.
The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.
The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) is a self-report measure designed to enable investigators to easily obtain sensitive measures of the degree of enjoyment and satisfaction experienced by subjects in various areas of daily functioning. The summary scores were found to be reliable and valid measures of these dimensions in a group of depressed outpatients. The Q-LES-Q measures were related to, but not redundant with, measures of overall severity of illness or severity of depression within this sample. These findings suggest that the Q-LES-Q measures may be sensitive to important differences among depressed patients that are not detected by the measures usually employed.
The use of medical services is a function of several interacting psychological and social variables as well as a function of physical malfunction. The clinical significance of addressing patients' psychosocial issues has only occasionally been considered. However, the shift in health care economics toward health care maintenance is responsible for the increased interest in interventions in the domain of behavioral medicine and health psychology. Evidence is reviewed for 6 mechanistic pathways by which behavioral interventions can maximize clinical care and result in significant economic benefits. The rationale for further integration of behavioral and biomedicine interventions is also reviewed.
Health care concepts and practices are changing dramatically because of demographic and economic factors. The routine integration of behavioral and biomedical care is completely compatible with these changes and such integration would provide clinical and economic benefits to patients and to society.
This study tests the hypothesis that stress reduction methods based on mindfulness meditation can positively influence the rate at which psoriasis clears in patients undergoing phototherapy or photochemotherapy treatment.
Thirty-seven patients with psoriasis about to undergo ultraviolet phototherapy (UVB) or photochemotherapy (PUVA) were randomly assigned to one of two conditions: a mindfulness meditation-based stress reduction intervention guided by audiotaped instructions during light treatments, or a control condition consisting of the light treatments alone with no taped instructions. Psoriasis status was assessed in three ways: direct inspection by unblinded clinic nurses; direct inspection by physicians blinded to the patient's study condition (tape or no-tape); and blinded physician evaluation of photographs of psoriasis lesions. Four sequential indicators of skin status were monitored during the study: a First Response Point, a Turning Point, a Halfway Point, and a Clearing Point.
Cox-proportional hazards regression analysis showed that subjects in the tape groups reached the Halfway Point (p = .013) and the Clearing Point (p = .033) significantly more rapidly than those in the no-tape condition, for both UVB and PUVA treatments.
A brief mindfulness meditation-based stress reduction intervention delivered by audiotape during ultraviolet light therapy can increase the rate of resolution of psoriatic lesions in patients with psoriasis.
This study explored the effects of cognitive-behavioral interventions on quality of life in persons with HIV. In a randomized, 3 x 3 block design, 69 participants were assigned to a guided imagery, progressive muscle relaxation or control group. Following brief instruction, subjects practiced their respective intervention over six weeks. Post intervention, perceived health status, but not quality of life, was significantly different across treatment groups. Findings suggested differential effects for guided imagery and progressive muscle relaxation, with larger effects for those at mid-stage disease and for low frequency users of guided imagery.
So-called "intrusive thoughts" appear independently from external stimuli and are the cause of severe disturbances in depressed patients. Following Baddeley's 1986 discoveries regarding "articulatory suppression," we investigated the influence of praying and of a working memory task on the number of spontaneous thoughts reported by 20 subjects compared to the control (quiet) state. Two groups of subjects were tested: those trained in meditation and controls. Significant reduction in simultaneous thought arousal was obtained during both the working memory task and the recitation of prayer. In all three experimental conditions, meditation practitioners reported significantly fewer spontaneous thoughts.
The importance of religion and spirituality to the American public has been highlighted by recent opinion polls, media attention and empirical studies. Psychosocial researchers are incorporating these variables into studies of emotional and physical illness. A number of studies have found that, for cancer patients, religious, spiritual and quality of life concerns are paramount. This paper reviews the literature relating religion and spirituality to physical and emotional health and quality of life. Definitions and measurement issues related to religiosity/spirituality and quality of life are discussed. The paper provides a rationale and methodological suggestions for future studies assessing religious and spiritual beliefs of cancer patients in relation to quality of life. The authors conclude that regular inclusion of religiosity and spirituality measures in quality of life studies is needed in order to understand the integration of mind, body and spirit in cancer care.
Most of the commonly used quality of life (QOL) instruments in oncology do not include spirituality as a core domain. However, previous research suggests that spirituality might be an important aspect of QOL for cancer patients and that it may, in fact, be especially salient in the context of life-threatening illness. This study used a large (n=1610) and ethnically diverse sample to address three questions relevant to including spirituality in QOL measurement: (1) Does spirituality demonstrate a positive association with QOL?; (2) Is this association unique?; and (3) Is there clinical utility in including spirituality in QOL measurement? Spirituality, as measured by the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was found to be associated with QOL to the same degree as physical well-being, a domain unquestioned in its importance to QOL. The significant association between spirituality and QOL was unique, remaining after controlling for core QOL domains as well as other possible confounding variables. Furthermore, spiritual well-being was found to be related to the ability to enjoy life even in the midst of symptoms, making this domain a potentially important clinical target. It is concluded that these results support the move to the biopsychosocialspiritual model for QOL measurement in oncology.
This article explores the relationship of spirituality to health care and bioethics in terms of the need and efforts of people to make sense of their lives in the face of illness, injury, or impending death. Moving beyond earlier associations with specific religious traditions, spirituality has come to designate the way in which people can integrate their experiences with their sense of ultimate meaning and related values. The holistic model of health care also affirms that one should not simply treat a body in pain, but respond to the suffering of the whole person within his or her full life. A narrative emphasis in ethics also maintains that ethical decisions occur within the framework of interacting life-stories, each of which embodies a certain core vision and set of values. In each instance it is the life stories of people, their lived narratives, that provide a common thread. The telling of these stories and the discernment of the lived spirituality they contain may assist persons in the process of achieving understanding, making decisions, and finding purpose in the experience of illness, injury, or disability.
To test whether rhythmic formulas such as the rosary and yoga mantras can synchronise and reinforce inherent cardiovascular rhythms and modify baroreflex sensitivity.
Comparison of effects of recitation of the Ave Maria (in Latin) or of a mantra, during spontaneous and metronome controlled breathing, on breathing rate and on spontaneous oscillations in RR interval, and on blood pressure and cerebral circulation.
Florence and Pavia, Italy.
23 healthy adults.
Breathing rate, regularity of breathing, baroreflex sensitivity, frequency of cardiovascular oscillations.
Both prayer and mantra caused striking, powerful, and synchronous increases in existing cardiovascular rhythms when recited six times a minute. Baroreflex sensitivity also increased significantly, from 9.5 (SD 4.6) to 11.5 (4.9) ms/mm Hg, P<0.05.
Rhythm formulas that involve breathing at six breaths per minute induce favourable psychological and possibly physiological effects.
Several hundred peer-reviewed studies in the past 20 years have shown that the relaxation response and mind-body interventions are clinically effective in the treatment of many health problems that are caused or made worse by stress. Recent studies show that mind-body interventions may improve prognosis in coronary heart disease and can enhance immune functioning. It is hypothesized that mind-body interventions reduce sympathetic nervous system activation and increase parasympathetic nervous system activity, and thereby restore homeostasis. Researchers have also concluded that cognitive therapy is as effective, and possibly more effective than antidepressant medication in the treatment of major depression. This report provides an overview of some studies that have shown a beneficial role of the relaxation response and cognitive restructuring in the treatment of headaches, insomnia, and cardiovascular disorders. Studies to date suggest that mind-body interventions are effective and can also provide cost savings in patient treatment. It is also clear, however, that mind-body therapies are not panaceas, and should be used in conjunction with standard medical care.
There are key differences between mind-body medicine and alternative medicine. A central tenet of mind-body medicine is the recognition that the mind plays a key role in health and that any presumed separation of mind and body is false. Alternative medicine, however, does not focus on the role of thoughts and emotions in health and, therefore, is separate from mind-body medicine. Also, while there has been little scientific research on alternative medicine, the literature on mind-body medicine comprises more than 2000 peer-reviewed studies published in the past 25 years. The groundwork for understanding the physiology of mind-body interactions was established by pioneering studies in the 1930s by Walter Cannon, and in the 1950s by Walter Hess and by Hans Selye that led to an understanding of the fight-or-flight response. Later work by Holmes and Rahe documented measurable relationships between stressful life events and illness. Other research has shown clinical improvement in patients treated with a placebo for a variety of medical problems. The effectiveness of placebo treatment can be interpreted as compelling evidence that expectation and belief can affect physiological response. Recent studies using spectral analysis and topographic electroencephalographic (EEG) mapping of the relaxation response demonstrate that by changing mental activity we can demonstrate measurable changes in central nervous system activity. These, and other, studies demonstrate that mind-body interactions are real and can be measured.
Although emerging evidence during the past several decades suggests that psychosocial factors can directly influence both physiologic function and health outcomes, medicine had failed to move beyond the biomedical model, in part because of lack of exposure to the evidence base supporting the biopsychosocial model. The literature was reviewed to examine the efficacy of representative psychosocial-mind-body interventions, including relaxation, (cognitive) behavioral therapies, meditation, imagery, biofeedback, and hypnosis for several common clinical conditions.
An electronic search was undertaken of the MEDLINE, PsycLIT, and the Cochrane Library databases and a manual search of the reference sections of relevant articles for related clinical trials and reviews of the literature. Studies examining mind-body interventions for psychological disorders were excluded. Owing to space limitations, studies examining more body-based therapies, such as yoga and tai chi chuan, were also not included. Data were extracted from relevant systematic reviews, meta-analyses, and randomized controlled trials.
Drawing principally from systematic reviews and meta-analyses, there is considerable evidence of efficacy for several mind-body therapies in the treatment of coronary artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. We found moderate evidence of efficacy for mind-body therapies in the areas of hypertension and arthritis. Additional research is required to clarify the relative efficacy of different mind-body therapies, factors (such as specific patient characteristics) that might predict more or less successful outcomes, and mechanisms of action. Research is also necessary to examine the cost offsets associated with mind-body therapies.
There is now considerable evidence that an array of mind-body therapies can be used as effective adjuncts to conventional medical treatment for a number of common clinical conditions.
Mindfulness-based stress reduction (MBSR) programs may mitigate the effects of stress and disease. This integrative review identified 21 clinical studies on MBSR interventions. Although preliminary findings suggest health enhancement from MBSR, controlled, randomized studies, the operationalization of constructs, and qualitative research are needed.
Mind/body medicine: How to use your mind for better health
- H Benson
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Frequent, silent mantram repetition: A jacuzzi for the mind
- J E Bormann
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- G M Williamson
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