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Serious Illness, Overwhelmingly Unpleasant Feeling Tone of Life, and How Even Incipient Mindfulness Training May Sometimes Help
Abstract
Seriously ill people typically confront an abundance of overwhelmingly unpleasant stimuli, events and processes. Long-term or acute serious disease, modalities of therapy, inhospitable treatment environments and loss of normal functions and roles, are all likely to create a feeling tone (i.e. Vedana) of extreme unpleasantness that can lead to emotions of sadness, anxiety, despair, depression, sense of isolation, alienation and betrayal. Nevertheless, research indicates that patients with serious disease may sometimes be able to cultivate a more benevolent stance to life circumstances by means of mindfulness practice, which may open them to new perspectives towards existential challenge. An analysis of the interplay between mindful awareness and the Vedana may provide insight into why sick people are motivated to ‘pay attention’ – even during highly unpleasant circumstances. The cultivation of qualities, such as kindness, non-conditionality, courage and equanimity, are integral to the practice of mindfulness and may provide an explanatory mechanism.
... meditation on complicated feelings, thoughts, and emotions) may develop better regulation of craving and, with it, their decrease. Finally, these results may be related to improved emotional regulation of the unpleasant bodily sensations or negative affect states, reducing affective and cognitive reactivity (Grossman, 2018;Tang et al., 2016). Therefore, the long-term effectiveness of the I-MBRP on these symptoms is a relevant result since craving is a primary predictor of drug use relapse, and their long-term decrease is a central objective in SUD relapse prevention programs. ...
Objectives
High relapse rates following a substance use disorder (SUD) treatment highlight the importance of effective therapies. The mindfulness-based relapse prevention (MBRP) program stands as a potentially effective group-based treatment. The present study examines the feasibility and effectiveness of an individualized adaptation of the MBRP (I-MBRP).
Methods
The feasibility of the I-MBRP was examined according to eight dimensions: demand, acceptability, implementation, practicality, adaptation, integration, expansion, and effectiveness. A randomized controlled trial (RCT) was designed to examine the I-MBRP program’s effectiveness compared to individual relaxation training (I-RT). A sample of 108 Spanish detoxified outpatients in treatment as usual (TAU) treatment (i.e., relapse prevention program) for SUDs were randomized to a TAU + I-MBRP group (n = 54) or TAU + I-RT group (n = 54). Participants completed self-reports measuring substance use, craving, impulsivity, well-being, and mindfulness at pre-treatment, post-treatment, and follow-up at 2 months and 4 months.
Results
I-MBRP was feasible in all domains. The I-MBRP, compared with the I-RT, significantly reduced the frequency of substance use and craving and improved mindfulness skills at the end of treatment. The benefits were maintained at 4 months.
Conclusions
I-MBRP is a feasible program for the SUD treatment as a complementary treatment to TAU interventions and shows potential effects on relapse prevention.
... Very differently, interviews of mindfulness practitioners or participants in mindfulness-based programs are employed qualitatively to estimate how lived experience is characterized by respondents as a consequence of cultivation of mindfulness [41,42]. Observational and experimental approaches may explore the degree to which participants attend to visual stimuli or cognitive stimuli, show acts of kindness, display emotional reactivity or exhibit different types of cognitive biases [43][44][45][46]. ...
Mindfulness, derived from Buddhist psychology and philosophy, has gained broad popularity in the last decades, due importantly to scientific interest and findings. Yet Buddhist mindfulness developed in Asian pre-scientific culture and religion, and is predicated upon long-term cultivation of introspective awareness of lived experience, not highly accessible to empirical study. Further complicating the ‘science’ of mindfulness, mindfulness's very definition is multifaceted, resistant to dismantling and requires substantial amounts of personal practice to gain expertise. Most scientists investigating mindfulness have not achieved a high level of this expertise. Here I address how mindfulness is currently being invented as a scientific fact or object of inquiry. The intrinsic porosity of subjective and objective factors influencing the investigation of mindfulness is highlighted: the evolving body of ‘scientific’ experts, instruments used to measure mindfulness, the alliances of funders and other supporters of mindfulness research, and the public representation of the related findings.
... Very differently, interviews of mindfulness practitioners or participants in mindfulness-based programs are employed qualitatively to estimate how lived experience is characterized by respondents as a consequence of cultivation of mindfulness [41,42]. Observational and experimental approaches may explore the degree to which participants attend to visual stimuli or cognitive stimuli, show acts of kindness, display emotional reactivity or exhibit different types of cognitive biases [43][44][45][46]. ...
Mindfulness, derived from Buddhist psychology and philosophy, has gained broad popularity in the last decades, due importantly to scientific interest and findings. Yet Buddhist mindfulness developed in Asian pre-scientific culture and religion, and is predicated upon long-term cultivation of introspective awareness of lived experience, not highly accessible to empirical study. Further complicating the “science” of mindfulness, mindfulness’s very definition is multifaceted, resistant to dismantling and requires substantial amounts of personal practice to gain expertise. Most scientists investigating mindfulness have not achieved a high level of this expertise. Here I address how mindfulness is currently being invented as a scientific fact or object of inquiry. The intrinsic porosity of subjective and objective factors influencing the investigation of mindfulness is highlighted: the evolving body of “scientific” experts, instruments used to measure mindfulness, the alliances of funders and other supporters of mindfulness research, and the public representation of the related findings.
Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS.
A total of 150 patients were randomly assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes.
Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4-0.9 posttreatment and 0.3-0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample.
In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL. Classification of evidence: This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention.
Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders. The program, nonreligious and nonesoteric, is based upon a systematic procedure to develop enhanced awareness of moment-to-moment experience of perceptible mental processes. The approach assumes that greater awareness will provide more veridical perception, reduce negative affect and improve vitality and coping. In the last two decades, a number of research reports appeared that seem to support many of these claims. We performed a comprehensive review and meta-analysis of published and unpublished studies of health-related studies related to MBSR.
Sixty-four empirical studies were found, but only 20 reports met criteria of acceptable quality or relevance to be included in the meta-analysis. Reports were excluded due to (1) insufficient information about interventions, (2) poor quantitative health evaluation, (3) inadequate statistical analysis, (4) mindfulness not being the central component of intervention, or (5) the setting of intervention or sample composition deviating too widely from the health-related MBSR program. Acceptable studies covered a wide spectrum of clinical populations (e.g., pain, cancer, heart disease, depression, and anxiety), as well as stressed nonclinical groups. Both controlled and observational investigations were included. Standardized measures of physical and mental well-being constituted the dependent variables of the analysis.
Overall, both controlled and uncontrolled studies showed similar effect sizes of approximately 0.5 (P<.0001) with homogeneity of distribution.
Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems.
Mindfulness-based stress reduction (MBSR) proposes a systematic program for reduction of suffering associated with a wide range of medical conditions. Studies suggest improvements in general aspects of well-being, including quality of life (QoL), coping and positive affect, as well as decreased anxiety and depression.
A quasi-experimental study examined effects of an 8-week MBSR intervention among 58 female patients with fibromyalgia (mean, 52 +/- 8 years) who underwent MBSR or an active social support procedure. Participants were assigned to groups by date of entry, and 6 subjects dropped out during the study. Self-report measures were validated German inventories and included the following scales: visual analog pain, pain perception, coping with pain, a symptom checklist and QoL. Pre- and postintervention measurements were made. Additionally, a 3-year follow-up was carried out on a subgroup of 26 participants.
Pre- to postintervention analyses indicated MBSR to provide significantly greater benefits than the control intervention on most dimensions, including visual analog pain, QoL subscales, coping with pain, anxiety, depression and somatic complaints (Cohen d effect size, 0.40-1.10). Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures (effect size, 0.50-0.65).
Based upon a quasi-randomized trial and long-term observational follow-up, results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients.
Mindfulness is examined using the Abhidhamma system of classification of phenomena (dharmas) as found in the Pali work Abhidhammattha-sa[ndot]gaha. In this model the mental factors constituting the aggregate of formations (sa[ndot]khāra) are grouped so as to describe a layered approach to the practice of mental development. Thus all mental states involve a certain set of mental factors, while others are added as the training of the mind takes place. Both unwholesome and wholesome configurations also occur, and mindfulness turns out to be a rather advanced state of wholesome constructed experience. Wisdom, the prime transformative factor in Buddhist thought and practice, arises only under special conditions. This system is then contrasted with the different parsing of phenomena presented in the Sanskrit Abhidharmakośa, where both mindfulness and wisdom are counted among the universal factors, which provides a basis for an innatist model of development; this is then critiqued from a constructivist perspective.
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