Mindfulness Based Stress Reduction (MBSR) was originally created by Jon Kabat-Zinn, PhD, in 1979 as a treatment for individuals with chronic pain. Longitudinal studies of patients completing this 8-week program that incorporates meditation, gentle stretching yoga, and the development of mindful communication skills, show that the majority of class participants demonstrate moderate to great improvements in pain status at 6 months, 1 year, and 3 years (Kabat-Zinn, et al, 1984, Kabat-Zinn et al, 1987). Further, over 75% of patients maintain a formal meditation practice (at least once weekly) at 12 months. A treatment modality creating such high success rates in a population so refractory to treatment (due to lack of effective surgical interventions or effective pharmaceutical interventions without adverse side effects) was unheard of at the time, catching the attention of the health care community. MBSR was subsequently implemented in hospitals and clinics across the country.
Over the past 35 years, MBSR has been proven effective for a myriad of other health-related issues. The first randomized, controlled study on the effects of mindfulness on immune function was conducted in 2003, when a group of healthy employees in a work environment underwent a traditional 8-week course in MBSR (Davidson et al, 2003). Results showed that those taking MBSR increased antibody production after being vaccinated with the influenza vaccine, when compared to a wait-list control group. Today, we are coming to a greater understanding as to how our immune system improves with MBSR. After taking an MBSR class, breast cancer survivors demonstrated increased levels of telomerase activity (which is linked to cell longevity at the cellular level), compared wait-listed controls (Lengacher et al, 2014). More research is to be done to more clearly understand this phenomenon.
There is evidence of a strong connection between psychological health and cardiovascular functioning. Negative affect has been associated with elevated blood pressure (Raikkonen, Matthews & Kuller, 2001), lower vagal input to the heart (Martens, Nyklicek, Szabo, & Jupper, 2008), and altered function of the hypothalamus-pituitary-adrenocortical (HPA) axis (Pruessner, Hellhammer, Pruessner, & Lupien, 2003). Mindfulness based interventions are therefore more frequently being incorporated within cardiac rehabilitation programs. According to Nyklicek (2013), people who participated in an MBSR class demonstrated larger pre to post intervention decreases in blood pressure, and smaller stress related changes after being exposed to an acute stressor (mental arithmetic and speech tasks) than a waitlist control group.
Studies supporting the use of meditation to improve our cognitive abilities have been equivocal, largely due to methodological limitations, differences in study design, study duration and patient populations. However, some patterns are beginning to emerge. In general, meditation training cultivates two disparate types of meditation; concentrative attention (e.g. focusing on one specific thing, like the breath), and receptive attention (e.g. choiceless awareness). The former appears to be a precursor for the latter. This is likely why concentrative attention is the first type of meditation taught in an MBSR class, with choiceless awareness being introduced weeks later. In 2007, Jha found support for the presence of these two types of attention, in that experienced meditators were more efficient than novice meditators at concentrative attention, novice meditators improved their concentrative attention after taking an 8-week MBSR class, and experienced meditators completing a month-long meditation retreat demonstrated greater efficiency in receptive awareness than the group of novices completing MBSR. Lutz et al (2009) found that experienced meditators were better able to sustain their attention on a dichotic listening task, and had more consistent EEGs than a group of novice meditators. In another study by Jensen et al (2012), subjects participating in an MBSR group demonstrated better vigilance on an attention task than a non-mindfulness-based stress reduction group, and a control group incentivized to perform well. Taken together, these findings support the theory that mindfulness training improves attention, while simultaneously reducing the task demands of brain functioning. Further high quality studies investigating more standardized mindfulness meditation programs are needed.
Mindfulness-based interventions are also being incorporated in the treatment of aggression for individuals with developmental disabilities, such as Autism. “Meditation on the Soles of the Feet” (SoF) (Singh et al, 2011) shows great promise in teaching autistic adolescents to self-manage their aggression. It is a treatment that is easily generalized beyond the treatment setting, can be maintained without extensive programming, and is not reliant on external agents (parents, caregivers, teachers, or medication.
Many studies support the use of mindfulness-based interventions in mental health. In one randomized clinical trial of psychiatric patients, participation in an 8-week MBSR class produced significant reductions in symptoms of depression and anxiety, and these gains were maintained at six-month follow-up (Vollestad et al, 2011). Meta-analysis shows meditation to be just as effective as antidepressants, but without the associated toxicities (Goyal, et al., 2014), prompting the medical journal, JAMA Internal Medicine, to recommend that clinicians be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. In the field of addictions, an 8-week program in Mindfulness-Based Relapse Prevention (MBRP) provided benefits over and above traditional (12-step) or cognitive-behavioral therapy (RP) groups at reducing drug use and heavy drinking at 12-month follow-up (Bowen, 2013). In this study, MBRP participants, compared to RP participants, reported 31% fewer drug use days, and a significantly higher probability of not engaging in any heavy drinking.
MBSR has also proven effective in reducing stress and enhancing spirituality values in healthy people. In 2009, Chiesa and Serretti’s review of 10 studies found significant reductions in ruminative thinking, as well as increased empathy and self-compassion when compared to interventions that were structurally equivalent to the meditation program.
Finally, mindfulness-based practices have proven effective in helping our care-givers. Up to 60% of practicing physicians report symptoms of burnout, defined as emotional exhaustion, depersonalization (treating patients as objects) and low sense of accomplishment (Krasner et al, 2009). In 2005, in a randomized clinical trial, psychologists, physicians, nurses, social workers, and physical therapists who participated in an 8-week MBSR class demonstrated significant reductions in perceived stress, and increases in self-compassion when compared to a wait-list control group (Shapiro et al, 2005). Primary care doctors who participated in an 8-week CME course in mindfulness adapted for physicians showed not only improvements on measures of well-being, but they demonstrated an enhancement in personal characteristics associated with a more patient-centered orientation to clinical care (Krasner, 2009). More recently, observational research has shown that patients are more likely to give high ratings and report high overall satisfaction with high-mindfulness clinicians (Beach, et al, 2013). As of 2013, there are 14 medical schools that teach mindfulness to medical students and residents, including The University of Rochester, Brown University, Duke University, and Georgetown University Schools of Medicine (Dobkin & Hutchinson, 2013).
Compassion fatigue is quite common among health care professionals, and is defined as a secondary traumatic stress reaction resulting from helping, or desiring to help, a person suffering from traumatic events (Najjar et al, 2009). In contrast, compassion satisfaction is defined as the satisfaction attained by helping people. Professionals most vulnerable to compassion fatigue include those who are overly conscientious, perfectionistic and self-giving (Keidel, 2002). Management of compassion fatigue has included the incorporation of personal strategies (striking an appropriate work-life balance, identifying healing activities), professional strategies (regular supervision, appropriate self-care practices), and organizational ones (developing a comfortable workplace environment). According to Harrison (2009), successful therapists list mindful self-awareness as a protective practice to prevent vicarious traumatization. Research is now showing a positive correlation between mindfulness and compassion satisfaction, and a negative correlation between mindfulness and compassion fatigue and burnout (Thieleman, 2014).
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