Objective To investigate whether placebo effects can experimentally be separated into the response to three components—assessment and observation, a therapeutic ritual (placebo treatment), and a supportive patient-practitioner relationship—and then progressively combined to produce incremental clinical improvement in patients with irritable bowel syndrome. To assess the relative magnitude of these components.
Design A six week single blind three arm randomised controlled trial.
Setting Academic medical centre.
Participants 262 adults (76% women), mean (SD) age 39 (14), diagnosed by Rome II criteria for and with a score of ≥150 on the symptom severity scale.
Interventions For three weeks either waiting list (observation), placebo acupuncture alone (“limited”), or placebo acupuncture with a patient-practitioner relationship augmented by warmth, attention, and confidence (“augmented”). At three weeks, half of the patients were randomly assigned to continue in their originally assigned group for an additional three weeks.
Main outcome measures Global improvement scale (range 1-7), adequate relief of symptoms, symptom severity score, and quality of life.
Results At three weeks, scores on the global improvement scale were 3.8 (SD 1.0) v 4.3 (SD 1.4) v 5.0 (SD 1.3) for waiting list versus “limited” versus “augmented,” respectively (P<0.001 for trend). The proportion of patients reporting adequate relief showed a similar pattern: 28% on waiting list, 44% in limited group, and 62% in augmented group (P<0.001 for trend). The same trend in response existed in symptom severity score (30 (63) v 42 (67) v 82 (89), P<0.001) and quality of life (3.6 (8.1) v 4.1 (9.4) v 9.3 (14.0), P<0.001). All pairwise comparisons between augmented and limited patient-practitioner relationship were significant: global improvement scale (P<0.001), adequate relief of symptoms (P<0.001), symptom severity score (P=0.007), quality of life (P=0.01).Results were similar at six week follow-up.
Conclusion Factors contributing to the placebo effect can be progressively combined in a manner resembling a graded dose escalation of component parts. Non-specific effects can produce statistically and clinically significant outcomes and the patient-practitioner relationship is the most robust component.
Trial registration Clinical Trials NCT00065403.
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Most of the policy debate surrounding the actions needed to mitigate and adapt to anthropogenic climate change has been framed by observations of the past 150 years as well as climate and sea-level projections for the twenty-first century. The focus on this 250-year window, however, obscures some of the most profound problems associated with climate change. Here, we argue that the twentieth and twenty-first centuries, a period during which the overwhelming majority of human-caused carbon emissions are likely to occur, need to be placed into a long-term context that includes the past 20 millennia, when the last Ice Age ended and human civilization developed, and the next ten millennia, over which time the projected impacts of anthropogenic climate change will grow and persist. This long-term perspective illustrates that policy decisions made in the next few years to decades will have profound impacts on global climate, ecosystems and human societies — not just for this century, but for the next ten millennia and beyond.
In answering these questions, conservation cannot promise a return to pristine, prehuman landscapes. Humankind has already profoundly transformed the planet and will continue to do so.6 What conservation could promise instead is a new vision of a planet in which nature -- forests, wetlands, diverse species, and other ancient ecosystems -- exists amid a wide variety of modern, human landscapes. For this to happen, conservationists will have to jettison their idealized notions of nature, parks, and wilderness -- ideas that have never been supported by good conservation science -- and forge a more optimistic, human-friendly vision.
Careful observation of one’s experience provides access to present-moment information, the foundation for mindfulness practice and contemplative education more generally. Contemplative observation comprises a set of trainable skills, including noticing, slowing, and reflecting. Skillful ways to work with observation, including distinguishing (between observation and interpretation), recalling, and describing, can also be taught, learned, practiced, and applied. Two assignments drawn from a course on the psychology of perception, sensory awareness practice and sensory description, are presented as tandem means for teaching all six observation skills. Several aspects of this contemplative observation pedagogy make it useful in higher education generally, and it is also well suited for content-specific use in or adaptation to courses across a variety of disciplines. The aim is to foster (instructor and) student engagement with discovering lived experience through the refinement and focusing of observation skills.
Susan Burggraf and Peter Grossenbacher, professors of contemplative psychology at Naropa University, write about contemplative pedagogy and its use as a complement to traditional modes of inquiry in liberal arts education.
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Cooperative behavior has been one of the enigmas of evolutionary theory since the days of Darwin. The contributions to this book examine the many facets of cooperative behavior in primates and humans. Some of the world’s leading experts summarize and review the state of the art of theoretical and empirical studies of cooperation. This is the first attempt to bridge the gap between parallel research activities in primatology and studies of humans. This comparative approach highlights both common principles as well as aspects of human uniqueness with respect to cooperative behavior.
The locus coeruleus (LC) has established functions in both attention and respiration. Good attentional performance requires optimal levels of tonic LC activity, and must be matched to task consistently. LC neurons are chemosensitive, causing respiratory phrenic nerve firing to increase frequency with higher CO2 levels, and as CO2 level varies with the phase of respiration, tonic LC activity should exhibit fluctuations at respiratory frequency. Top-down modulation of tonic LC activity from brain areas involved in attentional regulation, intended to optimize LC firing to suit task requirements, may have respiratory consequences as well, as increases in LC activity influence phrenic nerve firing. We hypothesize that, due to the physiological and functional overlaps of attentional and respiratory functions of the LC, this small neuromodulatory nucleus is ideally situated to act as a mechanism of synchronization between respiratory and attentional systems, giving rise to a low-amplitude oscillation that enables attentional flexibility, but may also contribute to unintended destabilization of attention. Meditative and pranayama practices result in attentional, emotional, and physiological enhancements that may be partially due to the LC's pivotal role as the nexus in this coupled system. We present original findings of synchronization between respiration and LC activity (via fMRI and pupil dilation) and provide evidence of a relationship between respiratory phase modulation and attentional performance. We also present a mathematical dynamical systems model of respiratory-LC-attentional coupling, review candidate neurophysiological mechanisms of changes in coupling dynamics, and discuss implications for attentional theory, meditation, and pranayama, and possible therapeutic applications.
In this paper, I make a case for a critical contemplative pedagogy that synthesizes critical pedagogy and contemplative pedagogy. A critical contemplative pedagogy may seem like a merger of two vastly distinct educational practices. Contemplative pedagogy is often posited as an inner-directed practice of helping students find balance and wholeness in their lives. Critical pedagogy is generally viewed as a form of education that is outer-directed and attempts to foster radical social change. I suggest that there is a logical and maybe even necessary fit between contemplative and critical educational practices. I offer the following five dimensions of critical contemplative pedagogy as a way to explain what is meant by this hybrid approach and why contemplative and critical educators might adopt it: (1) Establishes a foundation of nonduality; (2) Promotes an awareness of interdependence; (3) Encourages us to embrace impermanence; (4) Fosters intentionality; (5) Grounds the political with the personal.
The challenges of achieving environmental sustainability and of generating decent work for all are closely linked. In this timely book, Poschen argues that an integrated approach to tackle these challenges is a necessity: the goal of environmentally sustainable economies will not be attained without the active contribution of the world of work. Decent Work, Green Jobs and the Sustainable Economy demonstrates that green jobs can be a key economic driver, as the world steps into the largely uncharted territory of building a sustainable and low-carbon global economy. Poschen shows that positive outcomes are possible, but require a clear understanding of the opportunities and challenges.Enterprises, workers and governments are not passive bystanders in the great transformation that is urgently needed in our economies. They are essential agents of change, able to develop new ways of working in sustainable enterprises that safeguard the environment, create decent jobs and foster social inclusion. This book highlights the solutions that the world of work offers for policy and practice to tackle climate change, achieve environmental sustainability and to build prosperous and cohesive societies. It is essential reading for those in business, academia and government.
The challenges of achieving environmental sustainability and of generating decent work for all are closely linked. In this timely book, Poschen argues that an integrated approach to tackle these challenges is a necessity: the goal of environmentally sustainable economies will not be attained without the active contribution of the world of work. Decent Work, Green Jobs and the Sustainable Economy demonstrates that green jobs can be a key economic driver, as the world steps into the largely uncharted territory of building a sustainable and low-carbon global economy. Poschen shows that positive outcomes are possible, but require a clear understanding of the opportunities and challenges.Enterprises, workers and governments are not passive bystanders in the great transformation that is urgently needed in our economies. They are essential agents of change, able to develop new ways of working in sustainable enterprises that safeguard the environment, create decent jobs and foster social inclusion. This book highlights the solutions that the world of work offers for policy and practice to tackle climate change, achieve environmental sustainability and to build prosperous and cohesive societies. It is essential reading for those in business, academia and government.
Negative humor styles are associated with rumination, aggression, and suicidal ideation. BPD features are positively associated with negative humor styles; however, few studies have identified factors that mediate this relationship. The present study examines mindfulness skills as a mediator of the link between BPD features and negative humor styles, in a sample of undergraduate students (N = 197), many reporting clinically significant levels of BPD features. Significant indirect effects suggest that individuals with higher BPD features engage in more aggressive humor style partially due to lower levels of nonreactivity. However, individuals with higher BPD features engage in more self-defeating humor style partially due to lower levels of acting with awareness. Higher BPD features were related to less positive humor styles partially due to low describe scores. These findings suggest that different facets of mindfulness skills may assist in decreasing negative and increasing positive humor styles.
Background: The diagnostic framework and clinical reasoning process in Chinese medicine emphasizes the contextual and qualitative nature of a patient's illness. Chinese medicine assessment data may help interpret clinical outcomes. Objectives: As part of a study aimed at assessing the validity and improving the inter-rater reliability of the Chinese diagnostic process, a structured assessment instrument was developed for use in clinical trials of acupuncture and other Chinese medical therapies. Study design: To foster collaboration and maximize resources and information, an interdisciplinary advisory team was assembled. Under the guidance of two group process facilitators, and in order to establish whether the assessment instrument was consistent with accepted Chinese medicine diagnostic categories (face validity) and included the full range of each concept's meaning (content validity), a panel of Traditional Chinese Medicine (TCM) expert clinicians was convened and their responses were organized using the Delphi process, an iterative, anonymous, idea-generating and consensus-building process. An aggregate rating measure was obtained by taking the mean of mean ratings for each question across all 10 experts. Results: Over three rounds, the overall rating increased from 7.4 (SD = 1.3) in Round 1 to 9.1 (SD = 0.5) in Round 3. The level of agreement among clinicians was measured by a decrease in SD. Conclusions: The final instrument TEAMSI-TCM (Traditional East Asian Medicine Structured Interview, TCM version) uses the pattern differentiation model characteristic of TCM. This modular, dynamic version was specifically designed to assess women, with a focus on gynecologic conditions; with modifications it can be adapted for use with other populations and conditions. TEAMSI-TCM is a prescriptive instrument that guides clinicians to use the proper indicators, combine them in a systematic manner, and generate conclusions. In conjunction with treatment manualization and training it may serve to increase inter-rater reliability and inter-trial reproducibility in Chinese medicine clinical trials. Testing of the validity and reliability of this instrument currently is underway.
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<p>…a meeting convened … to identify priorities for providing guidance to educators and policy makers on appropriate assessment strategies and systems in order to promote and ensure high-quality educational opportunities that foster the social-emotional development and academic performance of preschool and elementary-school children…</p>
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BackgroundNursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities.
Aim
This paper investigates the predictors of resilience, including dispositional mindfulness and employment status of third year nursing students from three Australian universities.
Design
Participants were 240 undergraduate, third year, nursing students. Participants completed a resilience measure (Connor–Davidson Resilience Scale, CD‐RISC), measures of dispositional mindfulness (Cognitive and Affective Mindfulness Scale Revised, CAMS‐R) and professional quality of life (The Professional Quality of Life Scale version 5, PROQOL5), such as compassion satisfaction, compassion fatigue and burnout.
Method
An observational quantitative successive independent samples survey design was employed. A stepwise linear regression was used to evaluate the extent to which predictive variables were related each to resilience.
Results
The predictive model explained 57% of the variance in resilience. Dispositional mindfulness subset acceptance made the strongest contribution, followed by the expectation of a graduate nurse transition programme acceptance, with dispositional mindfulness total score and employment greater than 20 hours per week making the smallest contribution. This was a resilient group of nursing students who rated high with dispositional mindfulness and exhibited hopeful and positive aspirations for obtaining a position in a competitive graduate nurse transition programme after graduation.
The pain of rejection is a crucial component of normal social functioning; however, heightened sensitivity to rejection can be impairing in numerous ways. Mindfulness-based interventions have been effective with several populations characterized by elevated sensitivity to rejection; however, the relationship between mindfulness and rejection sensitivity has been largely unstudied. The present study examines associations between rejection sensitivity and multiple dimensions of dispositional mindfulness, with the hypothesis that a nonjudgmental orientation to inner experiences would be both associated with decreased rejection sensitivity and attenuate the impact of sensitivity to rejection on general negative affect. A cross-sectional sample of undergraduates (n = 451) completed self-report measures of rejection sensitivity, dispositional mindfulness, and trait-level negative affect. Significant zero-order correlations and independent effects were observed between most facets of dispositional mindfulness and rejection sensitivity, with nonjudging demonstrating the largest effects. As predicted, rejection sensitivity was associated with negative affectivity for people low in nonjudging (β = .27, t = 5.12, p < .001) but not for people high in nonjudging (β = .06, t = .99, p = .324). These findings provide preliminary support for mindfulness, specifically the nonjudging dimension, as a protective factor against rejection sensitivity and its effects on affect.
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Ecological Economics for the Anthropocene provides an urgently needed alternative to the long-dominant neoclassical economic paradigm of the free market, which has focused myopically—even fatally—on the boundless production and consumption of goods and services without heed to environmental consequences. The emerging paradigm for ecological economics championed in this new book recenters the field of economics on the fact of the Earth's limitations, requiring a total reconfiguration of the goals of the economy, how we understand the fundamentals of human prosperity, and, ultimately, how we assess humanity's place in the community of beings.Each essay in this volume contributes to an emerging, revolutionary agenda based on the tenets of ecological economics and advances new conceptions of justice, liberty, and the meaning of an ethical life in the era of the Anthropocene. Essays highlight the need to create alternative signals to balance one-dimensional market-price measurements in judging the relationships between the economy and the Earth's life-support systems. In a lively exchange, the authors question whether such ideas as "ecosystem health" and the environmental data that support them are robust enough to inform policy. Essays explain what a taking-it-slow or no-growth approach to economics looks like and explore how to generate the cultural and political will to implement this agenda. This collection represents one of the most sophisticated and realistic strategies for neutralizing the threat of our current economic order, envisioning an Earth-embedded society committed to the commonwealth of life and the security and true prosperity of human society.
OBJECTIVES: Randomized controlled studies on the effectiveness of body-oriented methods of treatment for children with attention-deficit hyperactivity disorder (ADHD) are lacking. Our aim was to compare the effectiveness of two methods of treatment (yoga for children vs. conventional motor exercises) in a randomized controlled pilot study.
METHODS: Nineteen children with a clinical diagnosis of ADHD (according to ICD-10 criteria) were included and randomly assigned to treatment conditions according to a 2x2 cross-over design. Effects of treatment were analyzed by means of an analysis of variance for repeated measurements.
RESULTS: For all outcome measures (test scores on an attention task, and parent ratings of ADHD symptoms) the yoga training was superior to the conventional motor training, with effect sizes in the medium-to-high range (0.60-0.97). All children showed sizable reductions in symptoms over time, and at the end of the study, the group means for the ADHD scales did not differ significantly from those for a representative control group. Furthermore, the training was particularly effective for children undergoing pharmacotherapy (MPH).
CONCLUSIONS: The findings from this pilot study demonstrate that yoga can be an effective complementary or concomitant treatment for attention-deficit hyperactivity disorder. The study advocates further research into the impact of yoga or body-oriented therapies on the prevention and treatment of ADHD.
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Objectives: converging research suggests that mindfulness training exerts its therapeutic effects on depression by reducing rumination. Theoretically, rumination is a multifaceted construct that aggregates multiple neurocognitive aspects of depression, including poor executive control, negative and overgeneral memory bias, and persistence or stickiness of negative mind states. Current measures of rumination, most-often self-reports, do not capture these different aspects of ruminative tendencies, and therefore are limited in providing detailed information about the mechanisms of mindfulness. Methods: we developed new insight into the potential mechanisms of rumination, based on three model-based metrics of free recall dynamics. These three measures reflect the patterns of memory retrieval of valenced information: the probability of first recall (Pstart) which represents initial affective bias, the probability of staying with the same valence category rather than switching, which indicates strength of positive or negative association networks (Pstay), and probability of stopping (Pstop) or ending recall within a given valence, which indicates persistence or stickiness of a mind state. We investigated the effects of Mindfulness-Based Cognitive Therapy (MBCT; N = 29) vs. wait-list control (N = 23) on these recall dynamics in a randomized controlled trial in individuals with recurrent depression. Participants completed a standard laboratory stressor, the Trier Social Stress Test, to induce negative mood and activate ruminative tendencies. Following that, participants completed a free recall task consisting of three word lists. This assessment was conducted both before and after treatment or wait-list. Results: while MBCT participant’s Pstart remained relatively stable, controls showed multiple indications of depression-related deterioration toward more negative and less positive bias. Following the intervention, MBCT participants decreased in their tendency to sustain trains of negative words and increased their tendency to sustain trains of positive words. Conversely, controls showed the opposite tendency: controls stayed in trains of negative words for longer, and stayed in trains of positive words for less time relative to pre-intervention scores. MBCT participants tended to stop recall less often with negative words, which indicates less persistence or stickiness of negatively valenced mental context. Conclusion: MBCT participants showed a decrease in patterns that may perpetuate rumination on all three types of recall dynamics (Pstart, Pstay, and Pstop), compared to controls. MBCT may weaken the strength of self-perpetuating negative associations networks that are responsible for the persistent and “sticky” negative mind states observed in depression, and increase the positive associations that are lacking in depression. This study also offers a novel, objective method of measuring several indices of ruminative tendencies indicative of the underlying mechanisms of rumination.
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