Background: This paper describes the experiences of 8 licensed acupuncturists in a placebo-controlled randomized clinical trial (RCT). This information is important to the design and conduct of high-quality trials. Methods: We conducted a RCT (N = 135) with a 2-week placebo run-in followed by 4 weeks of twice-weekly treatments comparing genuine to sham acupuncture (using the Streitberger placebo needle) in the treatment of arm pain caused by repetitive use. At the end of this study, we conducted written structured interviews with 8 participating acupuncturists. The acupuncturists were not aware of the study's results at the time of these interviews. The questions focused on their experiences in the study, adherence to study protocols, their thoughts about the technical and ethical issues involved in using a sham needling device, and their expectations of trial outcomes. The questions were motivated by expressions of concerns the acupuncturists raised in feedback groups during the course of the study, and our desire to improve further trials. Results: The acupuncturists differed widely in their comfort levels with the research methods used, their adherence to the study protocol, and their expectations of trial outcomes. Conclusions: We conclude that careful monitoring of acupuncturists, including observation of treatments and frequent meetings to support them throughout the trial, is necessary to maintain a high degree of quality control.
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Mindfulness has transdiagnostic applicability, but little is known about how people first begin to practice mindfulness and what sustains practice in the long term. The aim of the present research was to explore the experiences of a large sample of people practicing mindfulness, including difficulties with practice and associations between formal and informal mindfulness practice and wellbeing. In this cross-sectional study, 218 participants who were practicing mindfulness or had practiced in the past completed an online survey about how they first began to practice mindfulness, difficulties and supportive factors for continuing to practice, current wellbeing, and psychological flexibility. Participants had practiced mindfulness from under a year up to 43 years. There was no significant difference in the frequency of formal mindfulness practice between those who had attended a face-to-face taught course and those who had not. Common difficulties included finding time to practice formally and falling asleep during formal practice. Content analysis revealed “practical resources,” “time/routine,” “support from others,” and “attitudes and beliefs,” which were supportive factors for maintaining mindfulness practice. Informal mindfulness practice was related to positive wellbeing and psychological flexibility. Frequency (but not duration) of formal mindfulness practice was associated with positive wellbeing; however, neither frequency nor duration of formal mindfulness practice was significantly associated with psychological flexibility. Mindfulness teachers will be able to use the present findings to further support their students by reminding them of the benefits as well as normalising some of the challenges of mindfulness practice including falling asleep.
The benefits of a Mindfulness-Based Cognitive Therapy (MBCT) group for older people with recurrent and/or chronic depression were explored using a measure of mood (DASS-21) and well-being (Ryff Psychological Well-being Inventory). Thirteen participants started the study and outcome measures were recorded at baseline, post-MBCT group and at a 6-month follow-up. Although there was only a small sample size that had complete pre- and post-group data (n = 9), improvements in depression and anxiety severity were noted and there was a significant improvement on ‘purpose in life’ and marginally significant improvement of ‘personal growth’, two of six domains on a measure of well-being. Participants were satisfied with the structure of the course but were less confident about committing to the daily practice after the group than pre-group. At 6 months follow-up, none of the group had relapsed into a major depressive episode. Further research with larger sample sizes and a control group to control for nonspecific therapeutic group factors is recommended.
The benefits of a Mindfulness-Based Cognitive Therapy (MBCT) group for older people with recurrent and/or chronic depression were explored using a measure of mood (DASS-21) and well-being (Ryff Psychological Well-being Inventory). Thirteen participants started the study and outcome measures were recorded at baseline, post-MBCT group and at a 6-month follow-up. Although there was only a small sample size that had complete pre- and post-group data (n = 9), improvements in depression and anxiety severity were noted and there was a significant improvement on ‘purpose in life’ and marginally significant improvement of ‘personal growth’, two of six domains on a measure of well-being. Participants were satisfied with the structure of the course but were less confident about committing to the daily practice after the group than pre-group. At 6 months follow-up, none of the group had relapsed into a major depressive episode. Further research with larger sample sizes and a control group to control for nonspecific therapeutic group factors is recommended.
Objective: Unilateral nostril breathing (UNB) is a yogic pranayama technique that has been shown to improve verbal and spatial cognition in neurologically intact individuals. Early study of UNB in healthy individuals has shown benefits for attention and memory. This preliminary study explored whether UNB influenced various measures of attention, language, spatial abilities, depression, and anxiety in post-stroke individuals, both with and without aphasia. Design: A within-subjects repeated-measures design was used to determine whether UNB improved cognitive, linguistic, and affect variables in post-stroke individuals. Within-subjects comparisons determined UNB’s effects over time, and between-subjects comparison was used to determine whether changes in these variables differed between post-stroke individuals with and without aphasia. Setting: Athens and Atlanta, Georgia. Participants: Eleven post-stroke individuals participated in a 10-week UNB program. Five individuals had stroke-induced left hemisphere damage with no diagnosis of aphasia (left hemisphere damage control group; LHD), and six individuals experienced left hemisphere damage with a diagnosis of aphasia (individuals with aphasia group; IWA). Measures: Individuals were assessed on measures of attention, language, spatial abilities, depression, and anxiety before, during, and after UNB treatment.Results: UNB significantly decreased levels of anxiety for individuals in both groups. Performance on language measures increased for the individuals with aphasia.
Conclusions: Significant findings for language and affect measures indicate that further investigation regarding duration of UNB treatment and use of UNB treatment alongside traditional speech-language therapy in poststroke individuals is warranted.
We report data from a randomised controlled trial of mindfulness-based cognitive therapy to pilot procedures for people with a history of suicidal ideation or behaviour, focusing in particular on the variables that distinguish those who complete an adequate ‘dose’ of treatment, from those who drop out. Sixty-eight participants were randomised to either immediate treatment with mindfulness-based cognitive therapy (MBCT) (n = 33) or to the waitlist (n = 36) arm of the trial. In addition to collecting demographic and clinical information, we assessed participants’ cognitive reactivity using the means end problem-solving task, completed before and after a mood induction procedure. Ten participants dropped out of treatment, and eight dropped out of the waitlist condition. Those who dropped out of MBCT were significantly younger than those who completed treatment, less likely to be on antidepressants, had higher levels of depressive rumination and brooding and showed significantly greater levels of problem-solving deterioration following mood challenge. None of these factors distinguished participants in the waiting list condition who remained in the study from those who dropped out. Our results suggest that individuals with high levels of cognitive reactivity, brooding and depressive rumination may find it particularly difficult to engage with MBCT, although paradoxically they are likely to have the most to gain from the development of mindfulness skills if they remain in class. Addressing how such patients can be best prepared for treatment and supported to remain in treatment when difficulties arise is an important challenge.
Forgiveness and mindfulness have both been associated with a variety of salutary health-related outcomes. Though thought to be related to one another, very little empirical work has examined the association of forgiveness and mindfulness, including in the context of health. Consistent with theory regarding the forgiveness–health association and the definition of health behavior, we hypothesized that mindfulness would play a role in the relationship between forgiveness and health. Cross-sectional mediation-based analyses were conducted on data collected from a sample of 368 undergraduate students in southern Appalachia. Participants were 73.64% female and 88.32% Caucasian, with an average age of 21.62 years. Mindfulness played a role in the association of forgiveness of self, forgiveness of others, and forgiveness of situations with physical health status, somatic symptoms, mental health status, and psychological distress. In the context of the forgiveness–health association, mindfulness may play a primary role for forgiveness of others and largely a secondary role for forgiveness of self and forgiveness of situations. The role of mindfulness may be explained by the (un)forgiveness–energy hypothesis, such that forgiveness may allow energy to be invested in mindful processes. Religious/spiritual diversity may impact the association of forgiveness and mindfulness. As this study may be the first to examine mindfulness as a health behavior and only the second empirical study to explicitly examine the association between forgiveness and mindfulness, more research is needed to understand the relationships among forgiveness, mindfulness, and health.
A path from adolescence into adulthood is mapped from the accounts of college students. The evolution in students' interpretation of their lives is seen and understood through changes in the "forms" in which they conceptualize the issues they face. These forms characterize the underlying structures that students explicitly or implicitly impute to the world, especially those structures in which they construe the nature and origins of knowledge, of value, and of responsibility. Their journey and their unfolding views of the world are illustrated in their own words. This work is reissued in its entirety with additions reflecting elaborations on the model over the past thirty years and application of the findings to a broader population of students. The original four-year study is reported, including the development of the project, sample, interviewing process, ratings, analysis, limits, and significance of the study. The phenomenology of the students' experience is discussed. The model, a nine-position developmental scheme through which students move as they mature from "Basic Duality" toward "Commitment," is presented. Alternatives to growth are also discussed. In a final critique the psychological and philosophical setting of the study, its educational implications, and contributions are discussed. (EMK)
Discussion of the problem of "whiteness" in American Buddhism and what can be done-- and in some cases is being done--to create a more diverse American sangha, Introduction by Charles Johnson
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<p>Despite a growing interest among college and university students in exploring questions about spirituality through higher education, few are provided with opportunities to do so. An integral approach to the study of consciousness addresses this gap by examining theories of consciousness and spirituality from diverse epistemological perspectives, includingWestern science and non-Western wisdom traditions. This study explored the intellectual and personal effects of this approach for undergraduate students who were enrolled in an Honors course about consciousness at the University ofWashington duringWinter Quarter 2008. Results indicated that students became more open to diverse ideas about consciousness, more self-aware, and more committed to meditation and self-reflection. Implications for the growing discourse about spirituality in higher education and the development of spiritual intelligence are discussed.</p>
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The rise of plastics since the mid-20th century, both as a material element of modern life and as a growing environmental pollutant, has been widely described. Their distribution in both the terrestrial and marine realms suggests that they are a key geological indicator of the Anthropocene, as a distinctive stratal component. Most immediately evident in terrestrial deposits, they are clearly becoming widespread in marine sedimentary deposits in both shallow- and deep-water settings. They are abundant and widespread as macroscopic fragments and virtually ubiquitous as microplastic particles; these are dispersed by both physical and biological processes, not least via the food chain and the ‘faecal express’ route from surface to sea floor. Plastics are already widely dispersed in sedimentary deposits, and their amount seems likely to grow several-fold over the next few decades. They will continue to be input into the sedimentary cycle over coming millennia as temporary stores – landfill sites – are eroded. Plastics already enable fine time resolution within Anthropocene deposits via the development of their different types and via the artefacts (‘technofossils’) they are moulded into, and many of these may have long-term preservation potential when buried in strata.
In God of Justice, anthropologist William S. Sax offers a fascinating glimpse into the world of cursing, black magic, and ritual healing in the Central Himalayas of North India. Based on ten years' ethnographic fieldwork, God of Justice shows how these practices are part of a moral system based on the principle of family unity.
Increased tendencies towards ruminative responses to negative mood and anxious worry are important vulnerability factors for relapse to depression. In this study, we investigated the trajectories of change in rumination and anxious worry over the course of an eight-week programme of mindfulness-based cognitive therapy (MBCT) for relapse prevention in patients with a history of recurrent depression. One hundred and four participants from the MBCT-arm of a randomized-controlled trial provided weekly ratings. Mixed linear models indicated that changes in rumination and worry over the course of the programme followed a general linear trend, with considerable variation around this trend as indicated by significant increases in model fit following inclusion of random slopes. Exploration of individual trajectories showed that, despite considerable fluctuation, there is little evidence to suggest that sudden gains are a common occurrence. The findings are in line with the general notion that, in MBCT, reductions in vulnerability are driven mainly through regular and consistent practice, and that sudden cognitive insights alone are unlikely to lead into lasting effects.
For older adults, social integration and the strength of social ties are profoundly important predictors of well-being and longevity. Can the physical environment be designed to promote older adults' social integration with their neighbors? We examined this possibility by testing the relationships between varying amount of exposure to green outdoor common spaces and the strength of ties among neighbors. Results of interviews with 91 older adults (between the ages of 64 and 91 years) from one inner-city neighborhood show that the use of green outdoor common spaces predicted both the strength of neighborhood social ties and sense of community. Although the strength of these relationships were modest, the findings suggest that the characteristics of outdoor common spaces can play a role in the formation and maintenance of social ties among older adult residents of inner-city neighborhoods. The results have implications for designers, managers, and residents of housing developments.
Background. Complementary and integrative health approaches such as yoga provide support for psychosocial health. We explored the effects of group-based yoga classes offered through an integrative medicine center at a comprehensive cancer center. Methods. Patients and caregivers had access to two yoga group classes: a lower intensity (YLow) or higher intensity (YHigh) class. Participants completed the Edmonton Symptom Assessment System (ESAS; scale 0-10, 10 most severe) immediately before and after the class. ESAS subscales analyzed included global (GDS; score 0-90), physical (PHS; 0-60), and psychological distress (PSS; 0-20). Data were analyzed examining pre-yoga and post-yoga symptom scores using paired t-tests and between types of classes using ANOVAs. Results. From July 18, 2016, to August 8, 2017, 282 unique participants (205 patients, 77 caregivers; 85% female; ages 20-79 years) attended one or more yoga groups (mean 2.3). For all participants, we observed clinically significant reduction/improvement in GDS, PHS, and PSS scores and in symptoms (ESAS decrease >= 1; means) of anxiety, fatigue, well-being, depression, appetite, drowsiness, and sleep. Clinically significant improvement for both patients and caregivers was observed for anxiety, depression, fatigue, well-being, and all ESAS subscales. Comparing yoga groups, YLow contributed to greater improvement in sleep versus YHigh (-1.33 vs -0.50, P = .054). Improvement in fatigue for YLow was the greatest mean change (YLow -2.12). Conclusion. A single yoga group class resulted in clinically meaningful improvement of multiple self-reported symptoms. Further research is needed to better understand how yoga class content, intensity, and duration can affect outcomes.
The authors discuss the components of consensual qualitative research (CQR) using open-ended questions to gather data, using words to describe phenomena, studying a few cases intensively, recognizing the importance of context, using an inductive analytic process, using a team and making decisions by consensus, using auditors, and verifying results by systematically checking against the raw data. The three steps for conducting CQR are developing and coding domains, constructing core ideas, and developing categories to describe consistencies across cases (cross analysis). Criteria for evaluating CQR are trustworthiness of the method, coherence of the results, representativeness of the results to the sample, testimonial validity, applicability of the results, and replicability across samples. Finally, the authors discuss implications for research, practice, and training.
Breast cancer-related lymphoedema (BCRL) is a chronic condition that requires lifelong management to prevent the condition worsening and to reduce the threat of infection. Women are affected in all domains of their life. As a holistic practice, yoga may be of benefit by reducing both the physical and psychosocial effects of lymphoedema. Women with BCRL are attending yoga classes in increasing numbers, so it is essential that yoga be based on principles that ensure lymphoedema is controlled and not exacerbated. Two Randomised Controlled Trials with a yoga intervention have had positive results after an 8-week intervention (n=28) and 6-months after a 4-week intervention (n=18). The first study had several significant results and women reported increased biopsychosocial improvements. Both studies showed trends to improved lymphoedema status. The yoga interventions compromised breathing, physical postures, meditation and relaxation practices based on Satyananda Yoga®, with modifications to promote lymphatic drainage and following principles of best current care for those with BCRL. Individual needs were considered. The yoga protocol that was used in the 8-week trial is presented. Our aim is to provide principles for yoga teachers/therapists working with this clientele that can be adapted to other yoga styles. Further, these principles may provide a basis for the development of yoga programs for people with secondary lymphoedema in other areas of their body as the population requiring cancer treatment continues to increase. Whilst the style of yoga presented here has had positive outcomes, further application and research is needed to fully demonstrate its effectiveness.
Breast cancer-related lymphoedema (BCRL) is a chronic condition that requires lifelong management to prevent the condition worsening and to reduce the threat of infection. Women are affected in all domains of their life. As a holistic practice, yoga may be of benefit by reducing both the physical and psychosocial effects of lymphoedema. Women with BCRL are attending yoga classes in increasing numbers, so it is essential that yoga be based on principles that ensure lymphoedema is controlled and not exacerbated. Two Randomised Controlled Trials with a yoga intervention have had positive results after an 8-week intervention (n=28) and 6-months after a 4-week intervention (n=18). The first study had several significant results and women reported increased biopsychosocial improvements. Both studies showed trends to improved lymphoedema status. The yoga interventions compromised breathing, physical postures, meditation and relaxation practices based on Satyananda Yoga®, with modifications to promote lymphatic drainage and following principles of best current care for those with BCRL. Individual needs were considered. The yoga protocol that was used in the 8-week trial is presented. Our aim is to provide principles for yoga teachers/therapists working with this clientele that can be adapted to other yoga styles. Further, these principles may provide a basis for the development of yoga programs for people with secondary lymphoedema in other areas of their body as the population requiring cancer treatment continues to increase. Whilst the style of yoga presented here has had positive outcomes, further application and research is needed to fully demonstrate its effectiveness.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT.METHODS: A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention.
RESULTS: Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people.
CONCLUSION: MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
A Tibetan translation of William Shakespeare's <i>Hamlet</i>, including an introduction to the work and explanatory footnotes. The original English is given on facing pages with corresponding line numbers. At the back, there are a table with corresponding Old English and modern English as well as several illustrations. (Ben Deitle 2005-11-09)
<p>A Tibetan translation of William Shakespeare's <em>Hamlet</em>, including an introduction to the work and explanatory footnotes. The original English is given on facing pages with corresponding line numbers. At the back, there are a table with corresponding Old English and modern English as well as several illustrations. (Ben Deitle 2005-11-09)</p>
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