Self-management of Stage 2 Parkinson’s disease

Vandenberg, Brooke, E., et al. Mindfulness-based lifestyle programs for the self-management of Parkinson’s disease in Australia, Health Promotion Internationalhttps://doi.org/10.1093/heapro/day021.

Abstract. Despite emerging evidence suggesting positive outcomes of mindfulness training for the self-management of other neuro-degenerative diseases, limited research has explored its effect on the self-management of Parkinson’s disease (PD).

We aimed to characterize the experiences of individuals participating in a facilitated, group mindfulness-based lifestyle program for community living adults with Stage 2 PD and explore how the program influenced beliefs about self-management of their disease.

Our longitudinal qualitative study was embedded within a randomized controlled trial exploring the impact of a 6-week mindfulness-based lifestyle program on patient-reported function. The study was set in Melbourne, Australia in 2012–2013. We conducted semi-structured interviews with participants before, immediately after, and 6 months following participation in the program. Sixteen participants were interviewed prior to commencing the program. Of these, 12 were interviewed shortly after its conclusion, and 9 interviewed at 6 months.

Prior to the program, participants felt a lack of control over their illness. A desire for control and a need for alternative tools for managing the progression of PD motivated many to engage with the program. Following the program, where participants experienced an increase in mindfulness, many became more accepting of disease progression and reported improved social relationships and self-confidence in managing their disease.

Mindfulness-based lifestyle programs have the potential for increasing both participants’ sense of control over their reactions to disease symptoms as well as social connectedness. Community-based mindfulness training may provide participants with tools for self-managing a number of the consequences of Stage 2 PD.

Advertisements

Questions that warrant research attention

Davidson, R. J., & Dahl, C. J. (2018). Outstanding challenges in scientific research on mindfulness and meditation. Perspectives on Psychological Science, vol 13, no. 1, pp. 62-5, DOI: 10.1177/1745691617718358. Full text.

From the Introduction. The article by Van Dam and colleagues (see previous post in this blog) presents a very useful corrective to the hype and claims associated with the burgeoning interest in mindfulness and meditation. The authors review a number of key issues and concerns with research in this domain including the problematic meaning of the term “mindfulness,” the differing measures of mindfulness and challenges to their construct validity, challenges for clinical intervention methodology including the variations in the types and content of various mindfulness-based interventions (MBIs) that have been examined, the growing evidence of potential adverse effects in a small subset of individuals who partake of MBIs, and the challenge of conducting neuro-scientific research in this area. For each of these topics, the authors also provide a prescriptive vision for the types of research that are needed to address the concerns and challenges that are described.

While we wholeheartedly agree with the central issues highlighted in this article and believe that this article, along with several other critical articles that have appeared recently, will provide an important recalibration of the claims and conclusions that are warranted from the contemporary scientific literature on this topic, we believe that the prescriptive agenda offered in their article can be usefully expanded.

In this commentary, we address a few of the specific concerns raised by the authors and show that they are not specific to mindfulness or meditation research and that attention to the broader context of these challenges can be helpful in addressing them. Second, we widen the prescriptive agenda offered in their article and underscore several key questions that the authors did not raise that warrant serious research attention for this
field to have impact. In this commentary we make five key points that build from the issues raised by Van Dam and colleagues.

Towards understanding neuronal mechanisms of meditative states

Irrmischer, M., et al. (2018). Controlling the Temporal Structure of Brain Oscillations by Focused Attention Meditation. Human brain mapping. Vol. 39, no 4, pp. 1825-38, https://doi.org/10.1002/hbm.23971. Full text.

From the Introduction. Meditation is frequently described as a form of mental training to cultivate cognitive capabilities, including attention, concentration, and emotion regulation. With its popularity for attaining relaxation, for physical and mental health, and enhanced awareness and absorption, there is increasing scientific interest in understanding the brain mechanisms involved. . . .

We hypothesized that attention is balanced at a point of instability between order and disorder, characteristic of so‐called critical systems, which allows transient focus and swift change. As practitioners restrain from distraction during meditation to maintain a single focus, we predict that they might experience a shift from more complex brain dynamics to a state of reduced information propagation and reduced temporal complexity of oscillations. Using data from two independent laboratories, we here show that the temporal complexity of neuronal oscillations is affected by FA (focused attention) meditation training. Furthermore, it is sensitive to the meditative state and the subjective experience of absorption.

Interpersonal mindfulness

Pratscher, S. D., et al. (2017). Interpersonal Mindfulness: Investigating Mindfulness in Interpersonal Interactions, co-Rumination, and Friendship Quality. Mindfulness, pp. 1-10, https://doi.org/10.1007/s12671-017-0859-y. Abstract and references only.

Abstract. There is growing interest in understanding the ways in which mindfulness influences interpersonal relationships. Two studies investigated the relationship between a newly proposed construct, interpersonal mindfulness, and the quality of a best or close friend.

Interpersonal mindfulness is conceptualized as mindfulness during interpersonal interactions and includes awareness of self and others, accompanied with the qualities of nonjudgmental and nonreactive presence. Study 1 showed that interpersonal mindfulness was correlated with friendship quality, while accounting for trait mindfulness. Study 2 replicated and extended these findings by identifying and testing three possible mediators (i.e., perspective taking, basic psychological need satisfaction, and empathy) of the association between interpersonal mindfulness and friendship quality. Interrelations with co-rumination, or excessive talk about problems, were examined as well. Investigation of the psychometrics of the interpersonal mindfulness scale provided initial support for the reliability and validity.

Results suggest that (1) interpersonal mindfulness is uniquely associated with the interpersonal outcome of friendship quality (controlling for trait mindfulness), whereas trait mindfulness is uniquely associated with the intrapersonal outcomes of depression and anxiety (while controlling for interpersonal mindfulness), (2) interpersonal mindfulness moderates the association of co-rumination and friendship quality, and (3) the association of interpersonal mindfulness and friendship quality is mediated by perspective taking and psychological need satisfaction.

Neuroscience and mindfulness meditation

Tang, Y.-Y., & Leve, L. D. (2016). A translational neuroscience perspective on mindfulness meditation as a prevention strategy. Translational Behavioral Medicine, vol. 6, no. 1, pp. 63–72. http://doi.org/10.1007/s13142-015-0360-x. Full text.

See also: MacKinnon, M. (2015). The neuroscience of mindfulness: How the default mode network helps explain the benefit of a deep breath. Psychology Today. Full text.

Mindfulness meditation research mainly focuses on psychological outcomes such as behavioral, cognitive, and emotional functioning. However, the neuroscience literature on mindfulness meditation has grown in recent years.

This paper provides an overview of relevant neuroscience and psychological research on the effects of mindfulness meditation. We propose a translational* prevention framework of mindfulness and its effects. Drawing upon the principles of prevention science, this framework integrates neuroscience and prevention research and postulates underlying brain regulatory mechanisms that explain the impact of mindfulness on psychological outcomes via self-regulation mechanisms linked to underlying brain systems.

We conclude by discussing potential clinical and practice implications of this model and directions for future research.


* “The term translational medicine was introduced in the 1990s but only gained wide usage in the early 2000s. Its definition varies according to the stakeholder. Patients, physicians, and other practitioners tend to use the term to refer to the need to accelerate the incorporation of benefits of research into clinical medicine and to close the gap between “what we know” and “what we practice.” Academics tend to interpret translational medicine as the testing of novel concepts from basic research in clinical situations, which in turn provide opportunity for the identification of new concepts. In industry it is used in reference to a process that is aimed at expediting the development and commercialization of known therapies. Although different, these interpretations are not mutually exclusive. Rather, they reflect different priorities for achieving a common goal.” (https://www.britannica.com/science/translational-medicine

Promising psychological treatments for fibromyalgia

Pérez-Aranda, A., et al. (2017). Description and narrative review of well-established and promising psychological treatments for fibromyalgia. Mindfulness & Compassion, http://www.sciencedirect.com/science/article/pii/S2445407917300319

Abstract. Fibromyalgia (FMS) is a prevalent, disabling syndrome characterized by chronic widespread musculoskeletal pain and symptoms such as sleep disturbance, fatigue, stiffness, distress, cognitive impairments and a high comorbidity with anxiety and depressive disorders. Although no curative treatment has yet been found, various therapeutic approaches have been developed in the fields of pharmacology and psychology.

The present paper aims to offer a narrative review and a description for clinicians and researchers of psychological therapies that have been applied in a format group in FMS with strong or promising empirical support: i.e., Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR), Psychoeducational program for FMS (FibroQoL), Amygdala Retraining Therapy (ART), and Attachment-Based Compassion Therapy (ABCT).

This review will offer a brief practical summary of each therapy protocol (session-by-session), their rationale and available evidence of their effectiveness.

Effect of online mindfulness intervention on well-being

Bailey, N. W., et al. (2018). Effect on Well-Being from an Online Mindfulness Intervention: “Mindful in May”. Mindfulness, 1-11. First online March 18, 2018. DOI: https://doi.org/10.1007/s12671-018-0910-7.

Abstract (excerpt). Mindfulness has been shown to improve mental health and well-being both in clinical populations and in healthy controls. However, while most mindfulness interventions have been assessed in a research context, demonstrating efficacy, the majority of mindfulness interventions in the public sphere are not assessed, and there has been little research examining the effectiveness of these interventions in the public context.

As such, this study explored whether a public online mindfulness intervention providing 10-min daily guided meditations was associated with improvements in well-being, and whether these improvements were related to the number of days participants practiced mindfulness meditation. Two hundred and nineteen participants took part in the study. Participants were aged 22–75, and the majority of participants were female. The majority of participants undertook mindfulness practice on 25+ days.

Participants completed both baseline and post-intervention assessments of perceived stress, positive and negative affect, mindfulness, flourishing, and self-compassion. Results indicated that all measures improved from baseline to post-intervention and that number of days practiced predicted increased mindfulness, and increased mindfulness predicted improvements in positive affect. These results suggest that online mindfulness interventions may be effective at improving mental health in the general population.