Tuesday, November 30, 2010

Yoga May Improve Social, Occupational Functioning in Schizophrenia Patients

I came across this on a listserv. PsychCentral has an article about a study by Dr. Gangadhar of the National Institute of Mental Health and Neurosciences and colleagues in Bangalore, India. People with schizophrenia were assigned to receive yoga, exercise, or placed on a wait list. The article states there were significant improvements for people in the yoga group for positive (e.g., voices) and negative (e.g., apathy) symptoms of schizophrenia and socio-occupational abilities. Interestingly, ability to recognize facial emotions--an area of weakness for those with schizophrenia-- also improved. The article doesn't indicate whether there were comparable results for people in the exercise condition, which I'm interested in as a point of comparison,

From the article:

“Yoga as an add-on treatment improves positive and negative symptoms, and emotion recognition abilities in antipsychotic-stabilized patients with schizophrenia, which in turn might improve their socio-occupational functioning,” Gangadhar and the research team concluded.

To read the PsychCentral article, click here.

Wednesday, November 24, 2010

Vipassana Meditation: Systematic Review of Current Evidence

In the 1980-1990's Kabat-Zinn's Mindfulness-Based Stress Reduction (MBSR) and Linehan's Dialectical Behavior Therapy (DBT) helped kick off the recent wave of mindfulness research. Prior to that, there had been an accumulating body of research on the usefulness of Buddhist meditation in the 1970's and 80's, which had begun to trickle in as early as the 50's.

Although research of mindfulness-based treatments such as MBSR and DBT make up the majority of the currently published literature, there remains an interest in particular Buddhist meditative traditions. Dr. Chiesa of the University of Bologna, Italy, who also authored a review of neuroimaging studies of mindfulness meditation, recently reviewed research on Vipassana Meditation. Vipassana is a Pali word commonly translated as "insight" or "clear seeing." It is a mindfulness meditation, and is distinguished from meditative practices that emphasize concentration. The counterpart to Vipassana is Samatha ("calm abiding"in Pali), which is a way to calm the mind and develop one's ability to focus through concentrating on a particular object, often the breath.

Although I'm not a Buddhist scholar by any means, Chiesa's understanding of Vipassana appears to be a little shaky. Contrary to Chiesa's claim thar Vipassana is the "most ancient of Buddhist traditions," it is perhaps more accurate to say that Vipassana is a style of meditation attributed to the Buddha, which he is said to have developed after finding that concentration meditation failed to bring about lasting transformation and enlightenment. Concentrative practices such as Shamatha are believed to have been practiced thousands of years before the Buddha.

Vipassana is a general term and encompasses a number of traditions such as the Insight Meditation Society that inspired Kabat-Zinn and S.N. Goenka's promulgation of the tradition of U Ba Khin. It is Goenka's program that Chiesa focuses on in his review. Goenka has been hugely influential in creating a network of rigorously organized 10-day Vipassana retreats all over the world.

Chiesa uncovered 18 articles on Vipassana in his search but found only 7 met his inclusion criteria. Three of them came out of Dr. Marlatt's lab and were briefly mentioned in a previous post on Mindfulness-Based Relapse Prevention (Bowen et al., 2007, 2008; Simpson et al., 2007). One is by Dr. Lazar, whose work was also briefly discussed in a previous post, which looks at differences in cortical thickness in meditators (Lazar et al, 2005). Two were by Dr. Holzel (Holzel et al., 2007, 2008), and the remaining one I had never heard of (Emavardhana & Tori, 1997).

A problem I have with the way the review is the set-up: Dr. Chiesa links Vipassana to Goenka's organization in his introduction but does not mention other Vipassana traditions such as Insight Meditation. This would be fine if Dr. Chiesa only included studies of participants in Goenka's retreats (i.e., Bowen et al., 2006, 2007; Holzel et al., 2007, 2008; Simpson et al., 2007); however, he includes two studies with meditators that appear to be from Vipassana traditions other than Goenka's (Emavardhana & Tori, 1997; Lazar, 2005). One is through the Young Buddhist Association of Thailand (i.e., Emavardhana & Tori); the other appears to be of Insight Meditation meditators (i.e., Lazar). None of this is necessarily a problem, but it should have been made clearer in the introduction.

Chiesa makes the important point that these initial studies show great promise for continued research of Vipassana meditation, but that more higher quality studies are needed. Given that Goenka's retreats are donation only (i.e., you pay only what you want and can for the retreat), they offer a potentially untapped resource for people who cannot afford ongoing psychotherapy. (However, they do require an initial 10-day investment.) Chiesa also suggests that Vipassana meditation be compared against Transcendental Meditation (TM) for treatment of addiction. Unless things have changed, however, my understanding is that the TM organization is open to research but has more rigid requirements to allowing itself to be studied; for example, it rarely allows TM to be compared to another technique (See Rao, 1998).

Overall, this review is useful in drawing attention to the growing body of research on Vipassana meditation. Because it is so standardized, Goenka's program would be a great resource for continued research; however, from what I've heard from Dr. Marlatt's lab, they found it impossible to secure grant funding for continuing their inquiries. For now, research on Buddhist meditation remains much less cohesive than research on particular mindfulness and acceptance-based treatments. I would love to see continued exploration of the benefits of these forms of Buddhist practice, but it may take commitment of a researcher or group of researchers to develop a series of studies that build upon one another.

For the full citation:

Chiesa, A. (2010): Vipassana Meditation: Systematic Review of Current Evidence. Journal of Alternative and Complementary Medicine, 1(16), 37-46.

For those interested, I've tracked down downloadable files of some of the articles Dr. Chiesa's review discusses. Just click on the citation:

Friday, November 19, 2010

Is Learning Mindfulness Associated with Improved Affect After Mindfulness-Based Cognitive Therapy?

 Research suggests mindfulness is a multifaceted construct. We know that people develop greater mindfulness during mindfulness-based interventions, but we are less sure what aspects of mindfulness are most important to improved outcomes. Two researchers in the Netherlands have an article just published in the British Journal of Psychological attempting to link changes in specific aspects of mindfulness with particular outcomes following involvement in a Mindfulness-Based Cognitive Therapy (MBCT) program.

Schroevers and Brandsma collected self-report measures from a heterogeneous community sample of adults at the beginning and end of 8-week MBCT programs. Post-interventions were collected for 64 of the 85 people who filled out pre-intention measures.

To measure mindfulness, the researchers used the Mindful Attention Awareness Scale (MAAS), and select items from the Kentucky Inventory of Mindfulness Skills (KIMS; "observing" and "accept without judgment" subscales) and the Self-Compassion Scale (SCS; "mindfulness" and "over-identification" subscales). (Click here for a post on self-compassion.)

At the end of the program, people showed an improvement in awareness of daily activities (MAAS), ability to observe experiences (KIMS), acceptance of experiences (KIMS), and being able to disengage from pleasant experiences (SCS), but there was no change in being open and curious about experiences (SCS).

What I found most interesting about this article are the more specific findings. Learning to engage in activities with a more present-centered focus was the most important aspect of mindfulness in increasing one's experience of positive emotions--although improvements were unrelated to reducing negative emotions. Learning to become more accepting and less judgmental of experiences was related to lower negative affect. These results suggest that the increase of positive emotions and decrease of negative emotions through the cultivation of mindfulness are related to the development of different skills to some extent. Acceptance was related to improvements in positive and negative emotions; increasing one's ability to mindfully engage in activity appeared to increase positive emotions but didn't impact the experience of negative emotions.

As the authors admit, there are some weaknesses in this study. As data was collected before and after an 8-week MBCT program, it's unclear whether these gains are maintained over time or whether more improvements may eventually emerge. Additionally, there was no control group, so we can't be certain these changes wouldn't have happened over time without the MBCT program--although there is enough research on MBCT to support its impact.

To download the article, click on the full citation below:

 Schroevers, M. J., & Brandsma, R. (2010). Is Learning Mindfulness Associated with Improved Affect After Mindfulness-Based Cognitive Therapy? British Journal of Psychology, 101, 95-107.

Saturday, November 13, 2010

Mind-Wandering and Happiness

There's a new study accepted in Science by Dr. Daniel Gilbert and Matthew Killingsworth at Harvard University. Dr. Gilbert is also the author of Stumbling on Happiness. I haven't read the journal article yet, and as far as I can tell, it hasn't been published, but PhysOrg.com has a write up about it.

The researchers created an iPhone app that volunteers could download. At random intervals, they were asked: 1.) what they were doing; 2.) how happy they were; 3.) and whether they were focused on their current situation or thinking about something else--rating it pleasant, neutral, or unpleasant. Thinking about something other than the task at hand was referred to as "mind-wandering."

According to the article:

"Mind-wandering is an excellent predictor of people's happiness," Killingsworth says. "In fact, how often our minds leave the present and where they tend to go is a better predictor of our happiness than the activities in which we are engaged."

This is an interesting finding, and one that, as the researchers note, supports the various mindfulness traditions. Ecological momentary assessments such as the app used in this study may be more accurate in sampling mindfulness than self-report questionnaires. Whether iPhone users make up a representative sample is another question...

To read the PhysOrg.com article, click here.

To download the iPhone app and become part of the research, go to trackyourhappiness.org.

For the full citation of the upcoming Science article:

Killingsworth, M. A., & Gilbert, D. T. (in press). A wandering mind is an unhappy mind. Science.

Wednesday, November 10, 2010

Being Present in the Face of Existential Threat

A recent article in the Journal of Personality and Social Psychology examines the impact of mindfulness on mortality salience. Mortality salience refers to being made aware of death--one's own specifically. There's a body of researching suggesting that being made aware of our own mortality increases distress and influences us to behave more defensively than when we're not confronted with the fact that our time here is limited.

The first author is Christopher Niemiec from the University of Rochester, who, I believe, is a doctoral student there. I recall hearing about Niemiec's study on mortality salience and mindfulness three years ago. I tried unsuccessfully to track it down at the time. It looks like the reason for that is that the research question grew into a pretty major undertaking. The article is authored by seven researchers from five universities and encompasses seven different studies with samples from three universities--all the king's horses and all the king's men!

The researchers measured trait mindfulness; that is, they looked at naturally occurring levels of mindfulness in their samples, and no one was exposed to any practices aimed at increasing mindfulness as part of the study. Mindfulness was measured by the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003). The MAAS is a uni-dimensional measure of mindfulness and was, to my knowledge, the first self-report measure of mindfulness. It may be downloaded here.

As this article covers seven studies, it would be too time-consuming to discuss them all in detail. Consequently, I'll mainly focus on the results. Overall, people higher in mindfulness were less likely to behave in more reactive and defensive ways when made aware of their mortality. For example, after being exposed to questions that made them consider their own death, less mindful participants were more likely to demonstrate: 1.) a pro-United States bias when evaluating essays they were told were written by foreigners; 2.) a pro-Caucasian bias when given a hypothetical court case file involving White and Black defendants; 3.) harsher judgment of a hypothetical social transgression. The fourth study ruled out the possibility that the differences in the first three studies were related to a shared worldview by people higher in mindfulness. The remaining studies found that people higher in mindfulness responded less defensively to threatening and aversive experiences and were less likely to suppress death-related thoughts.

This is a lot to digest. In a nutshell, the seven studies suggest that people lower in mindfulness respond more defensively to potentially threatening situations--even hypothetical ones--when made aware of their mortality. By contrast, those higher in mindfulness are less affected, if not unaffected entirely. Mindfulness appears to act as a buffer against mortality salience.

It should be noted, as the researchers do, that this study involved no manipulation of mindfulness. Therefore, we cannot say for certain that greater mindfulness causes these differences. To test the latter, we would need a study that manipulates mindfulness (e.g., has people participate in mindfulness training). Also, the entire sample consisted of undergraduate students. Nonetheless, the study adds to the growing body of literature showing that more mindful people are less swayed by unpleasant experiences. (For example, check out a recent post on a study using a 15-minute mindful breathing induction, and one on a pilot study of a Mindfulness-Based Relapse Prevention program.)

To download a copy of the article, click on the full citation below:

Niemiec, C.P., Brown, K.W., Kashdan, T.B., Cozzolino, P.J., Breen, W.E., et al. (2010). Being Present in the Face of Existential Threat: The Role of Trait Mindfulness in Reducing Defensive Responses to Mortality Salience. Journal of Personality and Social Psychology, 99(2), 344-365.

Friday, November 5, 2010

The Experience and Meaning of Compassion and Self-Compassion for Individuals with Depression or Anxiety

Drs. Pauly and MacPherson, two researchers in the United Kingdom, recently published a qualitative of self-compassion. Using Dr. Kristin Neff's conceptualization of self-compassion, the researchers explored the self-compassion in a small group of people with anxiety and depressive disorders.

Participants saw "kindness" as the key component of compassion, and they indicated compassion is best expressed through action. Other insights are discussed in the article. As the sample consisted of 10 Caucasian British participants, all but one of whom were female, it's unclear how representative the sample is. One neat thing about the article is that it contains the researchers' self-compassion interview in the Appendix.

If you're interested, you can download the article in Neff's Self-Compassion website here.

For the full citation:

Pauley, G. & McPherson, S. (2010). The experience and meaning of compassion and self-compassion for individuals with depression or anxiety. Psychology and Psychotherapy: Theory, Research and Practice, 83, 129–143.

Tuesday, November 2, 2010

On Being Aware and Accepting: A One-Year Longitudinal Study into Adolescent Well-Being

As my work is with adults, I don't tend to read a lot of research on children and adolescents. However, this article came up on a listserv and sounded interesting. It's currently in press at the Journal of Adolescence and hasn't made print yet.  Dr. Joseph Ciarrochi and colleagues, mainly located in Australia, looked at how aspects of mindfulness--specifically the ability to observe one's experience and engage one's life with awareness--predicted adolescent well-being.

The researchers gave a battery of measures to adolescents across five Catholic high school in Australia in 10th grade and again in 11th grade. They were able to collect the second data set for 572 of the original 776 participants. Reasons students couldn't complete the second battery included absence, conflicting school activities, changing schools, and leaving school for technical training.

One thing that impressed me about this study is how precise the researchers were in selecting the constructs they wanted to measure. For example, they specifically selected items in the Child and Adolescent Mindfulness Measure reflecting the mindfulness facets "observing" and "acting with awareness"; they left out questions related non-judgment of experience, explaining that they had a another measure of what the called emotional acceptance, which they noted overlapped with non-judgment. There are too many measures to go through one-by-one, but I recommend checking out the article if you're interested.

Engaging one's life with awareness, emotional acceptance, and acceptance of experiences were all related to well-being and a lower tendency to experience negative emotions. Additionally, the longitudinal aspect of the study allowed the researchers to suggest there may be a causal role between awareness and acceptance and well-being: greater awareness and acceptance preceded increases in well-being, and decreases in sadness, fear, and hostility. However, because the study is not experimental, we can't say for certain there is a causal relationship.

The results suggest that teenagers may benefit from interventions that promote awareness and acceptance of internal (e.g., thoughts, emotions) and external experiences. As the researchers suggest, a longitudinal study with a mindfulness and acceptance-based intervention for adolescents would be a really interesting next step. It would great to see a study that shows that adolescents respond to an intervention that increases awareness and acceptance, and that these increases lead to greater well-being over time. Hopefully, this study provides some momentum towards that aim.

To download a PDF of the full article, click here. For a selection of other downloadable articles by Dr. Ciarrochi, click here.

For the full citation:

Ciarrochi, J., Kashdan, T. B., Leeson, P., Heaven, P., & Jordan, C. (2010). On being aware and accepting: A one-year longitudinal study into adolescent well-being. Journal of Adolescence.