A mindful approach to diabetes self-management

DiNardo, Monica, et al. “A Mindful Approach to Diabetes Self-Management Education and Support for Veterans.” The Diabetes Educator, vol. 43, no. 6, pp. 608-20. https://doi.org/10.1177/0145721717738019

From the Abstract. The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic.

Following initial training, participants were asked to practice mindfulness at home for 10 minutes each day during the 3-month study. Study recruitment and retention were calculated as rates. Veteran and diabetes educator satisfaction were assessed by rating scales and open-ended comments. Psychosocial-behavioral and metabolic outcomes were assessed at baseline and 3 months after initial training.

Overall, participants and diabetes educators were highly satisfied with the Mind-STRIDE intervention. Significant improvements were found in diabetes distress, diabetes self-efficacy, [and] diabetes self-management behaviors.

Results suggest feasibility, satisfaction, and positive preliminary effects. Efficacy testing by randomized controlled trial with analysis of covariance structures is warranted.


MBSR and Dialogical Self Theory

Mamberg, M.H. & Bassarear, T. (2015). From reified self to being mindful. International Journal for Dialogical Science, 9 (1), 11-37. Full text.

Mindfulness-Based Stress Reduction (MBSR), a Western intervention whose theoretical roots are in Buddhist psychology. Dialogical Self Theory (DST) seeks to integrate William James’ and Mikhail Bakhtin’s ideas by highlighting the social embeddedness of constitutions of self. For this paper, dialogicality and discourse are emphasized: persons are seen explicitly as comprised of varying perspectives that are in dialogue with each other. Specific forms of language are assumed to constitute different aspects of self.

The neurobiology of mindfulness (review)

Zeidan, F. (2014). The Neurobiology of Mindfulness Meditation. In The Handbook of Mindfulness. New York: Guilford Press. In press. Full text.

From the Introduction. For thousands of years, contemplatives have reported that enhancements in sensory awareness, cognition, and health can be accomplished through meditation practice. Before the development and utilization of neuroimaging and other scientific methodologies, the scientific world cast these descriptions as reflections of a relaxation response at best, and report biases associated with practitioner zeal at worst.

The recent surge in number of mindfulness-based studies has supported the claim that mindfulness meditation can improve a range of mental and physical health outcomes, and neuroimaging studies are beginning to identify the brain mechanisms that mediate the relationships between mindfulness meditation and such outcomes.

Although the neuroscientific investigation of mindfulness meditation is in its infancy, the premise of this chapter is that mindfulness meditation engages a unique, distributed network of brain regions. This chapter builds on previous neuroscientific work by offering a complementary perspective that focuses on a temporal account of the neurobiology of mindfulness, which considers the neurobiological basis of how mindfulness engages the brain over time. I first provide a brief overview describing some key neuroimaging methodologies used in research.

In the sections to follow, I provide a descriptive account of the neurobiological correlates of dispositional mindfulness, brief meditation training (1 week or less), the mindfulness based stress reduction (MBSR) program (approximately 8 weeks), and finally expert meditators (more than 1,000 hours of practice).

The subsequent section, concerning mindfulness and the default mode network, briefly describes how different levels of mindfulness-related experience affect task- independent neural processing. I then provide a longitudinal perspective of the brain structural correlates associated with different levels of mindfulness. Finally, I discuss considerations for future mindfulnessbased and other contemplative practice research.

Mindfulness and behavioral intervention for stress-eating

Corsica, J., et al. (2014). Development of a novel mindfulness and behavioral intervention for stress-eating: A comparative pilot study. Eating Behaviors. In-press. Abstract.

Stress-related eating is increasingly cited as a difficulty in managing healthy eating behaviors and weight. However few interventions have been designed to specifically target stress-related eating. In addition, the optimal target of such an intervention is unclear, as the target might be conceptualized as overall stress reduction or changing emotional eating-related thoughts and behaviors.

This pilot study compared the effects of three interventions targeting those components individually and in combination on stress-related eating, perceived stress, and weight loss to determine whether the two intervention components are effective alone or are more effective when combined. Fifty-three overweight participants (98% female) who reported elevated levels of stress and stress-eating and were at risk for obesity were randomly assigned to one of three six- week interventions: A modified mindfulness-based stress reduction (MBSR) intervention, a cognitive behavioral stress-eating intervention (SEI), and a combined intervention that included all MBSR and SEI components.

All three interventions significantly reduced perceived stress and stress-eating, but the combination intervention resulted in greater reductions and also produced a moderate effect on short term weight loss. Benefits persisted at six week follow-up. The pattern of results preliminarily suggests that the combination intervention (MBSR + SEI) may yield promise in the treatment of stress-related eating.

Beneficial for dementia patients and their caregivers

Paller, K. A., et al. (2014). Benefits of Mindfulness Training for Patients With Progressive Cognitive Decline and Their Caregivers. American Journal of Alzheimer’s Disease and Other Dementias. Full Text (accepted prepublication version with authors’ names in different order).

Abstract. New strategies are needed to help people cope with the repercussions of neurodegenerative disorders such as Alzheimer’s disease. Patients and caregivers face different challenges, but here we investigated an intervention tailored for this combined population. The program focused on training skills such as attending to the present moment nonjudgmentally, which may help reduce maladaptive emotional responses. Patients participated together with caregivers in weekly group sessions over 8 weeks.

An assessment battery was individually administered before and after the program. Pre–post analyses revealed several benefits, including increased quality-of-life ratings, fewer depressive symptoms, and better subjective sleep quality. In addition, participants indicated that they were grateful for the opportunity to learn to apply mindfulness skills and that they would recommend the program to others.

In conclusion, mindfulness training can be beneficial for patients and their caregivers, it can be delivered at low cost to combined groups, and it is worthy of further investigation.

Meditation for migraines

Wells, R. E., et al. (2014). Meditation for Migraines: A Pilot Randomized Controlled Trial. Headache: The Journal of Head and Face Pain. Epub ahead of print.

From the Abstract: Our objective was to assess the safety, feasibility, and effects of the standardized 8-week mindfulness-based stress reduction (MBSR) course in adults with migraines.

Stress is a well-known trigger for headaches. Research supports the general benefits of mind/body interventions for migraines, but there are few rigorous studies supporting the use of specific standardized interventions. MBSR is a standardized 8-week mind/body intervention that teaches mindfulness meditation/yoga. Preliminary research has shown MBSR to be effective for chronic pain syndromes, but it has not been evaluated for migraines.

We conducted a randomized controlled trial with 19 episodic migraineurs randomized to either MBSR (n = 10) or usual care (n = 9). Our primary outcome was change in migraine frequency from baseline to initial follow-up. Secondary outcomes included change in headache severity, duration, self-efficacy, perceived stress, migraine-related disability/impact, anxiety, depression, mindfulness, and quality of life from baseline to initial follow-up.

CONCLUSIONS: MBSR is safe and feasible for adults with migraines. Although the small sample size of this pilot trial did not provide power to detect statistically significant changes in migraine frequency or severity, secondary outcomes demonstrated this intervention had a beneficial effect on headache duration, disability, self-efficacy, and mindfulness.

Effect of MBSR on spirituality and post-traumatic growth

Labelle, L. E., et al. (2014). Does self-report mindfulness mediate the effect of Mindfulness-Based Stress Reduction (MBSR) on spirituality and posttraumatic growth in cancer patients?. The Journal of Positive Psychology, (ahead-of-print), 1-14.

From the Abstract. This longitudinal waitlist-controlled study evaluated the effects of Mindfulness-Based Stress Reduction (MBSR) on spirituality, posttraumatic growth (PTG), and mindfulness in cancer patients. The study also assessed whether increased mindfulness mediated the effects of MBSR on spirituality and PTG.

Patients were either registered for immediate participation in MBSR (n = 135), or were naturally waiting for the next program (n = 76). Participants completed questionnaires pre-, mid-, and post-MBSR, or waiting period.

MBSR participants demonstrated increased spirituality, PTG, and mindfulness, relative to controls. Change in all mindfulness facets mediated the effect of MBSR on spirituality and PTG. The development of mindfulness skills through MBSR may facilitate a sense of meaning, peacefulness, connectedness, and personal growth in cancer patients. This investigation contributes to an emerging focus on determining ‘how’ mindfulness-based interventions work.