Integrative Body-Mind Training

A psychologist at the University of Oregon Michael Posner has teamed up with a group of Chinese researchers lead by Dr. Yi-Yuan Tang at Dalian University of Technology. They are studying a form of meditation called Integrative Body-Mind Training (IBMT) developed and adapted by Dr. Tang from traditional Chinese medicine.

IBMT involves mindfulness training, relaxation of muscle groups, and guided imagery, and it is accompanied by music played in the background. It's unclear to me how IBMT differs from mindfulness meditation--with the exception of the addition of background music--but there appears to be significant overlap in these types of meditation.

In a recent study using neuroimaging, changes in brain activity were observed in participants practicing IBMT after 11 hours of training compared to a control group who received only relaxation training. (More than 6 hours appear to be required for changes to be measurable.) Changes were most pronounced in the anterior cingulate, a part of the brain associated with the ability to regulate emotions and behavior.

According to a Science Daily article, IBMT is not available outside of China, so I don't know much about it. As I noted, I'm unclear whether there are any fundamental differences between IBMT and mindfulness meditation. This is a danger of some of the neuroimaging research: so many different types of meditation have been examined using different kinds of equipment that it can be difficult to make sense of the results other than that meditation appears to affect the brain. (Click here for a previous post about a review of the literature, and here for a previous post about some of the problems of the neuroimaging literature.) That said, any attempts at controlled studies of meditation are exciting, and what is unique about this one is that the researchers observed changes after only 11 hours of training! A number of studies draw from either experienced Buddhist meditators or people who have completed an 8-week mindfulness meditation program (e.g., MBSR), so this is a pretty cool finding.

To download and read a PDF of the published scientific article, click here.

To read a Science Daily article about the study, click here.

For the full citation:

Tang, Y. Y., Lu, Q., Geng, X., Stein, E. A., Yang, Y., & Posner, M. I. (2010). Short-term meditation induces white matter changes in the anterior cingulate. Proceedings of the National Academy of Sciences.

Thought Suppression and Smoking

In mindfulness, we attempt to cultivate awareness of our thoughts without trying to alter or push them away. There's a growing research literature on the dangers of thought suppression--not only does it not work but it may actual increase the incidence of the behavior one is trying to suppression.

The LA Times published an article last week on a study involving a group of smokers. They were split into three group: one group was told to simply record use; one was told to think more about smoking; and one group was asked to actively suppress thoughts about smoking. Although smokers asked to suppress thoughts smoked less the first week, their stress and discomfort increased the the second week, and by the third week, they were smoking more. As noted in the article, this has implications for any sort of habit change.

Click here to read the full newspaper article.

The Effectiveness of an Acceptance and Commitment Therapy Self-Help Intervention for Chronic Pain

Originally considered a medical problem, newer biopsychosocial models of pain address physical, psychological, and environmental factors that influence how people experience pain. Interestingly, the first mindfulness meditation program Kabat-Zinn’s Mindfulness-Based Stress Reduction was developed for people with chronic pain for whom other medical treatments had failed. There is growing research on the use of mindful acceptance in allowing people to live more effectively with their pain. Recently, a group of researchers in New Zealand led by Marnie Johnston evaluated an Acceptance and Commitment Therapy (ACT) self-help book for chronic pain called Living Beyond Your Pain. ACT emphasizes active acceptance of one’s experiences and movement towards meaningful life directions.

Researchers randomly assigned participants to either receive a copy of the book that they reviewed over a 6-week period, or to remain on a waitlist for 6 weeks before receiving the book. For participants who received the book, the researchers also conducted weekly phone check-ins, asking whether they had done any of the reading and exercises, how easy the reading was, and how useful they found the book. The researchers then answered any questions participants had about the book. Participants in the waitlist condition simply received weekly phone calls evaluating their pain. Everyone completed a battery of tests at the beginning and end of the study.

Results indicate that people who used the book reported reduced pain. Additionally, they reported improvements in acceptance, quality of life, satisfaction with their lives, and living according to their values. The results suggest people with chronic pain may successfully use Living Beyond Your Pain as a self-help book—with minimal support. This latter point is worth emphasizing. As participants received weekly phone calls—which they commented were helpful in increasing motivation and allowing them to ask questions—it remains unclear whether people using the book alone would be as successful. (By contrast, John Forsyth has conducted a more naturalistic study of his self-help book, the Mindfulness and Acceptance Workbook for Anxiety).

Overall, these results are very promising. At the very least this study suggests Living Beyond Your Pain may be a useful adjunct to psychotherapy, something clients can work on between sessions with a little therapist guidance. It also adds to the growing body of literature on the use of mindfulness and acceptance-based treatments for pain.

For members of Association for Contextual Behavioral Science, you can download a copy of the article here. You can find a copy of the book here.

For the full article:

Johnston, M., Foster, M., Shennan, J., Starkey, N. J., &; Johnson, A. (2010). The effectiveness of an Acceptance and Commitment Therapy self-help intervention for chronic pain. Clinical Journal of Pain, 26(5), 393-402.

The full title for the self-help book is:

Dahl, J., & Lundgren, T. (2008). Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain. Oakland, CA: New Harbinger.

Functional Neural Correlates of Mindfulness Meditations in Comparison with Psychotherapy, Pharmacotherapy, and Placebo Effect

In a recent issue of Acta Neuropsychiatrica, Chiesa and colleagues, a group of researchers in Italy, published a review article of neuro-imaging studies. They were interested in comparing neural correlates of mindfulness meditation with those of psychotherapy, pharmacotherapy (e.g., antidepressants), and placebo. The main areas of the brain the researchers focused on were the prefrontal cortex, the anterior cingulate cortex, and the amygdala.

I found the placebo piece of the review particularly interesting as there’s a huge research literature showing placebo effects are powerful enough to be a treatment in themselves. Like psychotherapy, it’s hard to create an adequate placebo substitute for something like meditation, especially as people know more about it today than they did decades ago when this research began.

The authors’ findings suggest that mindfulness meditation may help facilitate a greater flexibility in emotion regulation, and an improved ability to step back from negative mood states by engaging the frontal cortex (higher order functions) in order to dampen amygdala activation (emotion response, especially fear). The authors also found there’s a great deal of overlap in the brain structures activated by mindfulness meditation, psychotherapy, pharmacotherapy, and placebo effects.

They make a preliminary suggestion that mindfulness meditation, psychotherapy, and placebo act through “top down” regulation (i.e., through other processes), whereas antidepressants have a “bottom-up” effect (i.e., more directly). For example, they suggest mindfulness meditation may regulate the amygdala through frontal brain areas whereas antidepressants target the amygdala directly. I found this curious, as Irving Kirsch and others have recently suggested that much of the benefit from antidepressants is through placebo or expectancy effects (here's a short review of this debate). I am not trained as a neuroscientist nor am I an expert in this area of research, so I won’t directly challenge the authors’ conclusions. Nonetheless, I was left uncertain how much of the notion of grouping meditation, psychotherapy, and placebos into one category, and antidepressants in another, is based more on theory than on data.

Nonetheless, I think the authors did a nice job of trying to organize and summarize a growing but somewhat disparate body of research. Additionally, they’ve raised some important questions for other researchers to begin to explore in a more systematic manner. As I blogged about last week, Fletcher and colleagues (2010) recently suggested ways in which a neuroscientific understanding of mindfulness may be refined. This is a really exciting avenue of study, but I agree with the latter authors in that what researchers should really focus on is building our understanding of the neurological underpinnings of mindfulness and meditation in a very deliberate and step-by-step approach.

Full Citation:

Chiesa, A., Brambilla, P., & Serretti, A. (2010). Functional neural correlates of mindfulness meditations in comparison with psychotherapy, pharmacotherapy and placebo effect. Is there a link? Acta Neuropsychiatrica, 22(3), 104-117.