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<p>BACKGROUND: Many antidepressant medications (ADM) are associated with disruptions in sleep continuity that can compromise medication adherence and impede successful treatment. The present study investigated whether mindfulness meditation (MM) training could improve self-reported and objectively measured polysomnographic (PSG) sleep profiles in depressed individuals who had achieved at least partial remission with ADM, but still had residual sleep complaints. METHODS: Twenty-three ADM users with sleep complaints were randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post measurements included PSG sleep studies and subjectively reported sleep, residual depression symptoms. RESULTS: Compared to controls, the MBCT participants improved on both PSG and subjective measures of sleep. They showed a pattern of decreased wake time and increased sleep efficiency. Sleep depth, as measured by stage 1 and slow-wave sleep, did not change as a result of mindfulness training. CONCLUSIONS: MM is associated with increases in both objectively and subjectively measured sleep continuity in ADM users. MM training may serve as more desirable and cost-effective alternative to discontinuation or supplementation with hypnotics, and may contribute to a more sustainable recovery from depression.</p>
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Objective: Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders. The program, nonreligious and nonesoteric, is based upon a systematic procedure to develop enhanced awareness of moment-to-moment experience of perceptible mental processes. The approach assumes that greater awareness will provide more veridical perception, reduce negative affect and improve vitality and coping. In the last two decades, a number of research reports appeared that seem to support many of these claims. We performed a comprehensive review and meta-analysis of published and unpublished studies of health-related studies related to MBSR. Methods: Sixty-four empirical studies were found, but only 20 reports met criteria of acceptable quality or relevance to be included in the meta-analysis. Reports were excluded due to (I) insufficient information about interventions, (2) poor quantitative health evaluation, (3) inadequate statistical analysis, (4) mindfulness not being the central component of intervention, or (5) the setting of intervention or sample composition deviating too widely from the health-related MBSR program. Acceptable studies covered a wide spectrum of clinical populations (e.g., pain, cancer, heart disease, depression, and anxiety), as well as stressed nonclinical groups. Both controlled and observational investigations were included. Standardized measures of physical and mental well-being constituted the dependent variables of the analysis. Results: Overall, both controlled and uncontrolled studies showed similar effect sizes of approximately 0.5 (P <.0001) with homogeneity of distribution. Conclusion: Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems.

OBJECTIVES: The objectives of this study were to assess the general acceptability and to assess domains of potential effect of a mindfulness-based stress reduction (MBSR) program for human immunodeficiency virus (HIV)-infected and at-risk urban youth. METHODS: Thirteen-to twenty-one-year-old youth were recruited from the pediatric primary care clinic of an urban tertiary care hospital to participate in 4 MBSR groups. Each MBSR group consisted of nine weekly sessions of MBSR instruction. This mixed-methods evaluation consisted of quantitative data--attendance, psychologic symptoms (Symptom Checklist 90-Revised), and quality of life (Child Health and Illness Profile-Adolescent Edition)--and qualitative data--in-depth individual interviews conducted in a convenience sample of participants until interview themes were saturated. Analysis involved comparison of pre- and postintervention surveys and content analysis of interviews. RESULTS: Thirty-three (33) youth attended at least one MBSR session. Of the 33 who attended any sessions, 26 youth (79%) attended the majority of the MBSR sessions and were considered "program completers." Among program completers, 11 were HIV-infected, 77% were female, all were African American, and the average age was 16.8 years. Quantitative data show that following the MBSR program, participants had a significant reduction in hostility (p = 0.02), general discomfort (p = 0.01), and emotional discomfort (p = 0.02). Qualitative data (n = 10) show perceived improvements in interpersonal relationships (including less conflict), school achievement, physical health, and reduced stress. CONCLUSIONS: The data suggest that MBSR instruction for urban youth may have a positive effect in domains related to hostility, interpersonal relationships, school achievement, and physical health. However, because of the small sample size and lack of control group, it cannot be distinguished whether the changes observed are due to MBSR or to nonspecific group effects. Further controlled trials should include assessment of the MBSR program's efficacy in these domains.

OBJECTIVES: This study investigated the relationships between a mindfulness-based stress reduction meditation program for early stage breast and prostate cancer patients and quality of life, mood states, stress symptoms, lymphocyte counts, and cytokine production. METHODS: Forty-nine patients with breast cancer and 10 with prostate cancer participated in an 8-week MBSR program that incorporated relaxation, meditation, gentle yoga, and daily home practice. Demographic and health behavior variables, quality of life (EORTC QLQ C-30), mood (POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper, and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-γ, IL-4, and IL-10 were assessed pre- and postintervention. RESULTS: Fifty-nine and 42 patients were assessed pre- and postintervention, respectively. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality. Although there were no significant changes in the overall number of lymphocytes or cell subsets, T cell production of IL-4 increased and IFN-γ decreased, whereas NK cell production of IL-10 decreased. These results are consistent with a shift in immune profile from one associated with depressive symptoms to a more normal profile. CONCLUSIONS: MBSR participation was associated with enhanced quality of life and decreased stress symptoms in breast and prostate cancer patients. This study is also the first to show changes in cancer-related cytokine production associated with program participation.

Although research has found that long-term mindfulness meditation practice promotes executive functioning and the ability to sustain attention, the effects of brief mindfulness meditation training have not been fully explored. We examined whether brief meditation training affects cognition and mood when compared to an active control group. After four sessions of either meditation training or listening to a recorded book, participants with no prior meditation experience were assessed with measures of mood, verbal fluency, visual coding, and working memory. Both interventions were effective at improving mood but only brief meditation training reduced fatigue, anxiety, and increased mindfulness. Moreover, brief mindfulness training significantly improved visuo-spatial processing, working memory, and executive functioning. Our findings suggest that 4 days of meditation training can enhance the ability to sustain attention; benefits that have previously been reported with long-term meditators.

Mindfulness-based interventions have been shown to alleviate symptoms of a wide range of physical and mental health conditions. Regular between-session practice of mindfulness meditation is among the key factors proposed to produce the therapeutic benefits of mindfulness-based programs. This article reviews the mindfulness intervention literature with a focus on the status of home practice research and the relationship of practice to mindfulness program outcomes. Of 98 studies reviewed, nearly one-quarter (N = 24) evaluated the associations between home practice and measures of clinical functioning, with just over half (N = 13) demonstrating at least partial support for the benefits of practice. These findings indicate a substantial disparity between what is espoused clinically and what is known empirically about the benefits of mindfulness practice. Improved methodologies for tracking and evaluating the effects of home practice are recommended.
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<p>Mindfulness refers to a set of practices as well as the psychological state and trait produced by such practices. The state, trait, and practice of mindfulness may be broadly characterized by a present-oriented, nonjudgmental awareness of cognitions, emotions, sensations, and perceptions without fixation on thoughts of past or future. Research on mindfulness has proliferated over the past decade. Given the explosion of scientific interest in this topic, mindfulness-based therapies are attracting the attention of clinical social workers, who seek to implement these interventions in numerous practice settings. Concomitantly, research on mindfulness is now falling within the scope and purview of social work scholars. In response to the growing interest in mindfulness within academic social work, the present article outlines six conceptual and methodological recommendations for the conduct of future empirical studies on mindfulness. These recommendations have practical importance for advancing mindfulness research within and beyond social work.</p>
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<p>Interest in mindfulness and its enhancement has burgeoned in recent years. In this article, we discuss in detail the nature of mindfulness and its relation to other, established theories of attention and awareness in day-to-day life. We then examine theory and evidence for the role of mindfulness in curtailing negative functioning and enhancing positive outcomes in several important life domains, including mental health, physical health, behavioral regulation, and interpersonal relationships. The processes through which mindfulness is theorized to have its beneficial effects are then discussed, along with proposed directions for theoretical development and empirical research.</p>

Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test. Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.
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Lesion and neuroimaging studies suggest the amygdala is important in the perception and production of negative emotion; however, the effects of emotion regulation on the amygdalar response to negative stimuli remain unknown. Using event-related fMRI, we tested the hypothesis that voluntary modulation of negative emotion is associated with changes in neural activity within the amygdala. Negative and neutral pictures were presented with instructions to either "maintain" the emotional response or "passively view" the picture without regulating the emotion. Each picture presentation was followed by a delay, after which subjects indicated how they currently felt via a response keypad. Consistent with previous reports, greater signal change was observed in the amygdala during the presentation of negative compared to neutral pictures. No significant effect of instruction was found during the picture presentation component of the trial. However, a prolonged increase in signal change was observed in the amygdala when subjects maintained the negative emotional response during the delay following negative picture offset. This increase in amygdalar signal due to the active maintenance of negative emotion was significantly correlated with subjects' self-reported dispositional levels of negative affect. These results suggest that consciously evoked cognitive mechanisms that alter the emotional response of the subject operate, at least in part, by altering the degree of neural activity within the amygdala.
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This pilot study tested the efficacy of a brief intervention using motivational interviewing (MI) plus mindfulness meditation (MM) to reduce marijuana use among young adult females. Thirty-four female marijuana users between the ages of 18 and 29 were randomized to either the intervention group (n = 22), consisting of two sessions of MI-MM, or an assessment-only control group (n = 12). The participants' marijuana use was assessed at baseline and at 1, 2, and 3 months posttreatment. Fixed-effects regression modeling was used to analyze treatment effects. Participants randomized to the intervention group were found to use marijuana on 6.15 (z = -2.42, p = .015), 7.81 (z = -2.78, p = .005), and 6.83 (z = -2.23, p = .026) fewer days at Months 1, 2, and 3, respectively, than controls. Findings from this pilot study provide preliminary evidence for the feasibility and effectiveness of a brief MI-MM for young adult female marijuana users.
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In 2 daily experience studies and a laboratory study, the authors test predictions from approach-avoidance motivational theory to understand how dating couples can maintain feelings of relationship satisfaction in their daily lives and over the course of time. Approach goals were associated with increased relationship satisfaction on a daily basis and over time, particularly when both partners were high in approach goals. Avoidance goals were associated with decreases in relationship satisfaction over time, and people were particularly dissatisfied when they were involved with a partner with high avoidance goals. People high in approach goals and their partners were rated as relatively more satisfied and responsive to a partner's needs by outside observers in the lab, whereas people with high avoidance goals and their partners were rated as less satisfied and responsive. Positive emotions mediated the link between approach goals and daily satisfaction in both studies, and responsiveness to the partner's needs was an additional behavioral mechanism in Study 2. Implications of these findings for approach-avoidance motivational theory and for the maintenance of satisfying relationships over time are discussed.
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Although there is much evidence demonstrating muscle tension changes during mental work, there are few data concerning muscle tension patterns during effortful attention to simple sensory stimuli. In the present study, sensory attention was evoked by a pitch discrimination task at three levels of difficulty, with a digit retention task administered for comparison. Twenty-four females each performed both tasks at all levels of difficulty, while the EKG, and the corrugator supercilii, frontalis, lip, jaw, chin, and forearm area EMG were recorded. As expected, heart rate decreased significantly with increasing difficulty of the pitch task. A pattern of facial EMG responses accompanied the pitch task, which included significant increases in corrugator and frontalis, and decreases in the jaw as a function of difficulty, and time within trials. The tension pattern observed during sensory intake is discussed in terms of its relation to emotional expressions and motor theories of attention.
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OBJECTIVE: Positron emission tomography was used to investigate the neural substrates of normal human emotional and their dependence on the types of emotional stimulus. METHOD: Twelve healthy female subjects underwent 12 measurements of regional brain activity following the intravenous bolus administration of [15O]H2O as they alternated between emotion-generating and control film and recall tasks. Automated image analysis techniques were used to characterize and compare the increases in regional brain activity associated with the emotional response to complex visual (film) and cognitive (recall) stimuli. RESULTS: Film- and recall-generated emotion were each associated with significantly increased activity in the vicinity of the medial prefrontal cortex and thalamus, suggesting that these regions participate in aspects of emotion that do not depend on the nature of the emotional stimulus. Film-generated emotion was associated with significantly greater increases in activity bilaterally in the occipitotemporparietal cortex, lateral cerebellum, hypothalamus, and a region that includes the anterior temporal cortex, amygdala, and hippocampal formation, suggesting that these regions participate in the emotional response to certain exteroceptive sensory stimuli. Recall-generated sadness was associated with significantly greater increases in activity in the vicinity of the anterior insular cortex, suggesting that this region participates in the emotional response to potentially distressing cognitive or interoceptive sensory stimuli. CONCLUSIONS: While this study should be considered preliminary, it identified brain regions that participate in externally and internally generated human emotion.
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OBJECTIVE: Happiness, sadness, and disgust are three emotions that differ in their valence (positive or negative) and associated action tendencies (approach or withdrawal). This study was designed to investigate the neuroanatomical correlates of these discrete emotions. METHOD: Twelve healthy female subjects were studied. Positron emission tomography and [15O]H2O were used to measure regional brain activity. There were 12 conditions per subject: happiness, sadness, and disgust and three control conditions, each induced by film and recall. Emotion and control tasks were alternated throughout. Condition order was pseudo-randomized and counterbalanced across subjects. Analyses focused on brain activity patterns for each emotion when combining film and recall data. RESULTS: Happiness, sadness, and disgust were each associated with increases in activity in the thalamus and medial prefrontal cortex (Brodmann's area 9). These three emotions were also associated with activation of anterior and posterior temporal structures, primarily when induced by film. Recalled sadness was associated with increased activation in the anterior insula. Happiness was distinguished from sadness by greater activity in the vicinity of ventral mesial frontal cortex. CONCLUSIONS: While this study should be considered preliminary, it identifies regions of the brain that participate in happiness, sadness, and disgust, regions that distinguish between positive and negative emotions, and regions that depend on both the elicitor and valence of emotion or their interaction.
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Meditation comprises a series of practices mainly developed in eastern cultures aiming at controlling emotions and enhancing attentional processes. Several authors proposed to divide meditation techniques in focused attention (FA) and open monitoring (OM) techniques. Previous studies have reported differences in brain networks underlying FA and OM. On the other hand common activations across different meditative practices have been reported. Despite differences between forms of meditation and their underlying cognitive processes, we propose that all meditative techniques could share a central process that would be supported by a core network for meditation since their general common goal is to induce relaxation, regulating attention and developing an attitude of detachment from one’s own thoughts. To test this hypothesis, we conducted a quantitative meta-analysis based on activation likelihood estimation (ALE) of 10 neuroimaging studies (91 subjects) on different meditative techniques to evidence the core cortical network subserving meditation. We showed activation of basal ganglia (caudate body), limbic system (enthorinal cortex) and medial prefrontal cortex (MPFC). We discuss the functional role of these structures in meditation and we tentatively propose a neurocognitive model of meditation that could guide future research.

There is mounting evidence that prefrontal cortex (PFC) is activated during mnemonic operations such as working memory maintenance and also during response-related operations. In the current study, we examine the neural organization of mnemonic and response operations with respect to each other within PFC. Stimulus-evoked and sustained functional MRI activity was recorded during performance of a mental calculation task. The presence or absence of mnemonic and response demands was manipulated in a 2 x 2 factorial design with conditions requiring: (1) memory encoding and maintenance (M+); (2) response selection and execution (R+); (3) encoding, maintenance, and response execution (M+R+); (4) neither mnemonic nor response-related processes (M-R-). The first step of the analyses identified PFC voxels exhibiting differential activity during (M+) vs. (R+) trials. Within these voxels, we then examined activity during multiple phases of (M+R+) trials. Greater stimulus-evoked and sustained activity was observed within the anterior extent of dorsolateral prefrontal cortex (BA 46) during R+ vs. M+ trials. In contrast, greater activity was observed in the posterior extent of dorsolateral PFC during M+ vs. R+ trials. Importantly, both regions were activated during (M+R+) trials. Activity levels during all of these conditions exceeded levels observed during (M-R-) control trials. These results suggest that integrative functions of PFC that allow past information to guide future actions may emerge from communication between discrete subregions supporting mnemonic and response operations.
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Our outside world changes continuously, for example, when driving through traffic. An important question is how our brain deals with this constant barrage of rapidly changing sensory input and flexibly selects only newly goal-relevant information for further capacity-limited processing in working memory. The challenge our brain faces is experimentally captured by the attentional blink (AB): an impairment in detecting the second of two target stimuli presented in close temporal proximity among distracters. Many theories have been proposed to explain this deficit in processing goal-relevant information, with some attributing the AB to capacity limitations related to encoding of the first target and others assigning a critical role to on-line selection mechanisms that control access to working memory. The current study examined the role of striatal dopamine in the AB, given its known role in regulating the contents of working memory. Specifically, participants performed an AB task and their basal level of dopamine D2-like receptor binding was measured using PET and [F-18]fallypride. As predicted, individual differences analyses showed that greater D2-like receptor binding in the striatum was associated with a larger AB, implicating striatal dopamine and mechanisms that control access to working memory in the AB. Specifically, we propose that striatal dopamine may determine the AB by regulating the threshold for working memory updating, providing a testable physiological basis for this deficit in gating rapidly changing visual information. A challenge for current models of the AB lies in connecting more directly to these neurobiological data.
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BACKGROUND: Despite the apparent high placebo response rate in randomized placebo-controlled trials (RCT) of patients with irritable bowel syndrome (IBS), little is known about the variability and predictors of this response. OBJECTIVES: To describe the magnitude of response in placebo arms of IBS clinical trials and to identify which factors predict the variability of the placebo response. METHODS: We performed a meta-analysis of published, English language, RCT with 20 or more IBS patients who were treated for at least 2 weeks. This analysis is limited to studies that assessed global response (improvement in overall symptoms). The variables considered as potential placebo modifiers were study design, study duration, use of a run-in phase, Jadad score, entry criteria, number of office visits, number of office visits/study duration, use of diagnostic testing, gender, age and type of medication studied. FINDINGS: Forty-five placebo-controlled RCTs met the inclusion criteria. The placebo response ranged from 16.0 to 71.4% with a population-weighted average of 40.2%, 95% CI (35.9-44.4). Significant associations with lower placebo response rates were fulfillment of the Rome criteria for study entry (P=0.049) and an increased number of office visits (P=0.026). CONCLUSIONS: Placebo effects in IBS clinical trials measuring a global outcome are highly variable. Entry criteria and number of office visits are significant predictors of the placebo response. More stringent entry criteria and an increased number of office visits appear to independently decrease the placebo response.
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Abstract  Background:  Despite the apparent high placebo response rate in randomized placebo-controlled trials (RCT) of patients with irritable bowel syndrome (IBS), little is known about the variability and predictors of this response. Objectives:  To describe the magnitude of response in placebo arms of IBS clinical trials and to identify which factors predict the variability of the placebo response. Methods:  We performed a meta-analysis of published, English language, RCT with 20 or more IBS patients who were treated for at least 2 weeks. This analysis is limited to studies that assessed global response (improvement in overall symptoms). The variables considered as potential placebo modifiers were study design, study duration, use of a run-in phase, Jadad score, entry criteria, number of office visits, number of office visits/study duration, use of diagnostic testing, gender, age and type of medication studied. Findings:  Forty-five placebo-controlled RCTs met the inclusion criteria. The placebo response ranged from 16.0 to 71.4% with a population-weighted average of 40.2%, 95% CI (35.9–44.4). Significant associations with lower placebo response rates were fulfilment of the Rome criteria for study entry (P = 0.049) and an increased number of office visits (P = 0.026). Conclusions:  Placebo effects in IBS clinical trials measuring a global outcome are highly variable. Entry criteria and number of office visits are significant predictors of the placebo response. More stringent entry criteria and an increased number of office visits appear to independently decrease the placebo response.

Publisher's description: This book teaches us how to fully connect with the visual richness of our ordinary, daily experience. Photography is not just a mechanical process; it requires learning how to see. As you develop your ability to look and see, you will open, more and more, to the natural inspiration of your surroundings. Filled with practical exercises, photographic assignments, and techniques for working with texture, light, and color, this book offers a system of training that draws on both Buddhist mindfulness practice and the insights of master photographers such as Alfred Stieglitz, Edward Weston, and Henri Cartier-Bresson.

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