OBJECTIVES: Adequate relief (AR) of irritable bowel syndrome (IBS) symptoms (IBS-AR) has been used as a primary end point in many randomized controlled trials of IBS and is considered by the Rome III committee to be an acceptable primary end point. However, controversy exists on whether baseline severity confounds the effect of the treatment outcome. The aim (1) is to compare a subjective report of IBS-AR with global assessment of improvement (IBS-GAI), change in IBS symptom severity scale (IBS-SSS), and IBS quality of life (IBS-QOL); (2) to explore whether initial IBS symptom severity influences the ability of these outcome measures to detect differences post treatment; and (3) to determine whether psychological symptoms influence the sensitivity of these measures, in a randomized controlled treatment trial.
METHODS: A total of 289 adult IBS patients were recruited to a treatment trial. Baseline IBS-SSS scores were used to classify IBS severity as mild (<175), moderate (175–300), or severe (>300). Questionnaires were completed at baseline and after 3 weeks of treatment with sham acupuncture or wait-list control.
RESULTS: IBS baseline severity (IBS-SSS) significantly affected the proportion of patients who reported IBS-AR at 3 weeks (mild, 70%; moderate, 49.7%; severe, 38.8%) (P<0.05). However, once the patients who reported IBS-AR at baseline (28.0%) were excluded from the analysis, baseline severity no longer affected the proportion of patients reporting IBS-AR. Baseline severity did not have a significant effect on patients reporting moderate or significant improvement on the IBS-GAI (mild, 30%; moderate, 25.3%; severe, 18.8%) (P=NS). Psychological symptoms had no significant correlations with responders after adjusting for baseline severity.
CONCLUSIONS: These data suggest that IBS-AR as an end point is inversely related to baseline symptom severity. However, if patients who report AR at screening were excluded from study participation, baseline symptom severity was no longer confounded with a report of AR at the study end point.
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<h2>Abstract</h2><p>Thirteen adolescents with Attention Deficit Hyperactivity Disorder (ADHD) participated in Tai Chi classes twice a week for 5 weeks. Teachers rated the children's behaviour on the Conners Scale during the baseline period, after the 5 week Tai Chi session period and 2 weeks later. After the 10 Tai Chi sessions the adolescents displayed less anxiety, improved conduct, less daydreaming behaviours, less inappropriate emotions, and less hyperactivity. These improved scores persisted over the 2-week follow up (no Tai Chi period).</p>
Several letters to the editor are presented in response to the article on the research on collaborative event ethnography (CEE).
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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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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BackgroundWhile mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage.
Methods
Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training).
Results
The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired).
Conclusions
These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.
As mobile data capture tools for patient-reported outcomes proliferate in clinical research, a key dimension of measure performance is sensitivity to change. This study compared performance of patient-reported measures of mindfulness, depression, and anxiety symptoms using traditional paper-and-pencil forms versus real-time, ambulatory measurement of symptoms via ecological momentary assessment (EMA). Sixty-seven emotionally distressed older adults completed paper-and-pencil measures of mindfulness, depression, and anxiety along with two weeks of identical items reported during ambulatory monitoring via EMA before and after participation in a randomized trial of Mindfulness-Based Stress Reduction (MBSR) or a health education intervention. We calculated effect sizes for these measures across both measurement approaches and estimated the Number-Needed-to-Treat (NNT) in both measurement conditions. Study outcomes greatly differed depending on which measurement method was used. When EMA was used to measure clinical symptoms, older adults who participated in the MBSR intervention had significantly higher mindfulness and significantly lower depression and anxiety than participants in the health education intervention at post-treatment. However, these significant changes in symptoms were not found when outcomes were measured with paper-and-pencil measures. The NNT for mindfulness and depression measures administered through EMA were approximately 25–50% lower than NNTs derived from paper-and-pencil administration. Sensitivity to change in anxiety was similar across administration modes. In conclusion, EMA measures of depression and mindfulness substantially outperformed paper-and-pencil measures with the same items. The additional resources associated with EMA in clinical trials would seem to be offset by its greater sensitivity to detect change in key outcome variables.
We know that our gas-guzzling cars are warming the planet, the pesticides and fertilizers from farms are turning rivers toxic, and the earth has run out of space for the mountains of unrecycled waste our daily consumption has left in its wake. We’ve heard copious accounts of our impact—as humans, as a society—on the natural world. But this is not a one-sided relationship. Lost in these dire and scolding accounts has been the impact on us and our well-being. You sense it while walking on a sandy beach, or in a wild, woody forest, or when you catch sight of wildlife, or even while gardening in your backyard. Could it be that the natural environment is an essential part of our happiness? Yes, says Eric Lambin emphatically in An Ecology of Happiness. Using a very different strategy in addressing environmental concerns, he asks us to consider that there may be no better reason to value and protect the health of the planet than for our own personal well-being.In this clever and wide-ranging work, Lambin draws on new scientific evidence in the fields of geography, political ecology, environmental psychology, urban studies, and disease ecology, among others, to answer such questions as: To what extent do we need nature for our well-being? How does environmental degradation affect our happiness? What can be done to protect the environment and increase our well-being at the same time? Drawing on case studies from Asia, Africa, Europe, and North America, Lambin makes a persuasive case for the strong link between healthy ecosystems and happy humans. Unique in its scope and evenhanded synthesis of research from many fields, An Ecology of Happiness offers a compelling human-centered argument that is impossible to overlook when we marvel at murmurations of starlings or seek out the most brilliant fall foliage: nature makes our steps a little lighter and our eyes a little brighter. What better reason to protect an ecosystem or save a species than for our own pleasure?
<p>A school-based program of mindful awareness practices (MAPs) was evaluated in a randomized control study of 64 second- and third-grade children ages 7–9 years. The program was delivered for 30 minutes, twice per week, for 8 weeks. Teachers and parents completed questionnaires assessing children's executive function immediately before and following the 8-week period. Multivariate analysis of covariance on teacher and parent reports of executive function (EF) indicated an interaction effect between baseline EF score and group status on posttest EF. That is, children in the MAPs group who were less well regulated showed greater improvement in EF compared with controls. Specifically, those children starting out with poor EF who went through the MAPs training showed gains in behavioral regulation, metacognition, and overall global executive control. These results indicate a stronger effect of MAPs on children with executive function difficulties. The finding that both teachers and parents reported changes suggests that improvements in children's behavioral regulation generalized across settings. Future work is warranted using neurocognitive tasks of executive functions, behavioral observation, and multiple classroom samples to replicate and extend these preliminary findings.</p>
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Objectives: Yoga and exercise have beneficial effects on mood and anxiety. gamma-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Methods: Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. Results: The yoga subjects (n - 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n - 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. Conclusions: The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
Objectives: Yoga and exercise have beneficial effects on mood and anxiety. gamma-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Methods: Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. Results: The yoga subjects (n - 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n - 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. Conclusions: The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
Abstract Extreme sports and extreme sports participants have been most commonly explored from a negative perspective, for example the ?need to take unnecessary risks?. This study reports on findings that indicate a more positive experience. A phenomenological method was used via unstructured interviews with 15 extreme sports participants and other first hand accounts. The extreme sports included B.A.S.E. jumping, big wave surfing, extreme skiing, waterfall kayaking, extreme mountaineering and solo rope-free climbing. Results indicate that participating in activities that involve a real chance of death, fear and the realisation that nature in its extreme is far greater and more powerful than humanity triggers positive life changes, and an eco-centric standpoint.
This timely and important Handbook takes stock of progress made in our understanding of what sustainable development actually is and how it can be measured and achieved.ø
Drawing upon phenomenology and psychoanalytic concepts, we explore and explicate participants' lived experience of the natural world. The authors draw upon Husserl's description of consciousness as intentionality and his later work on the life-world, in exploring experiences which provide a basis for a psychochoanalytic understanding of the human-nature experience. Unstructured interviews were undertaken with nine participants, each of whom regarded nature as being significant for their sense of wellbeing. The lived experiences were explicated drawing upon the two processes: Giorgi's descriptive phenomenological psychological methodology and psychoanalytic researcher reflexivity. Data analysis and explication involved the following steps: (1) a thorough reading of each interview transcript, (2) breaking data into parts by demarcating meaning units, (3) organizing data by translating meaning units into units of psychological experience through coding, and (4) arriving at a summary of the data which involved organizing and reviewing units of psychological experience. The process of reflection led to the formulation of an essential psychological structure of participants' lived experience of the natural world. We argue that the human-nature relationship can be conceived in terms of psychoanalytic concepts, and in particular, constructs based upon an understanding of the primacy of attachment relationships. The natural world is elucidated as (a) nature being experienced as a primary attachment, (b) nature experienced as a secure base, (c) nature experienced as twinship, (d) nature experienced as containing, and (e) nature experienced as embodied. This paper extends previous empirical descriptions of the human-nature relationship by incorporating psychoanalytic processes and theory into a theoretically informed qualitative methodological stance. Beyond the traditional notion of nature as something out there' that we can interact with for cognitive or emotional restoration, participants in this study described the experience of nature as being integral to their sense of self. This study suggests that experiences that facilitate immersion in nature provide opportunities for the development of an integrated sense of self that has a profound impact on a participant's sense of wellbeing. The findings further demonstrate the convergence between phenomenology and psychoanalytic constructs which offers a richness to our understanding the subjectivity of participants and their relationship with nature, a perspective not often attainable through more traditional quantitative research methodologies.
Much research has investigated the cognitive-perceptual factors that promote empathic concern. However, little research has investigated such factors for a related emotion: empathic embarrassment. We suggest that 2 factors promote empathic embarrassment for a target in a compromising situation: liking the target, and imagining oneself in the target’s situation. Results revealed that liking a socially compromised target increases both empathic concern and empathic embarrassment (Experiment 1). Furthermore, imagining the person’s thoughts and feelings increases empathic concern and a desire for future exposure to the person, whereas imagining oneself in the person’s situation primarily increases empathic embarrassment (Experiment 2). Implications of these results for future empathy research and appli-cations for those who suffer from chronic embarrassability are discussed.jasp_699 1..26 Imagine overhearing two people conversing, during which details about a rather unpleasant first date are recounted. Although you are not directly involved in the situation, it is nonetheless possible to experience a range of emotions for, or about, the person describing that unpleasant experience. For example, one might feel embarrassment on the other’s behalf. Or, one might experience compassion for his or her troubles. In some cases, one might feel nothing at all in response to the other’s plight. This rather commonplace scenario raises important questions about when—and for whom—one will experience various empathic emotions in response to events in the lives of others. Personal Embarrassment Personal embarrassment is an unpleasant emotional response to public
Little is known about placebo effects with scientific precision. Poor methodology has confounded our understanding of the magnitude and even the existence of the placebo effect. Investigating placebo effects presents special research challenges including: the design of appropriate controls for studying placebo effects including separating such effects from natural history and regression to the mean, the need for large sample sizes to capture expected small effects, and the need to understand such potential effects from a patient's perspective. This article summarizes the methodology of an ongoing NIH-funded randomized controlled trial aimed at investigating whether the placebo effect in irritable bowel syndrome (IBS) exists and whether the magnitude of such an effect can be manipulated to vary in a manner analogous to “dose dependence.” The trial also uses an innovative combination of quantitative and qualitative methods.
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<p>Buddhists have enjoyed the benefits of meditation for millennia. Here, renowned Buddhist teacher Yongey Mingyur invites us to join him in unlocking the secrets behind this practice. Working with neuroscientists at the Waisman Laboratory for Brain Imaging and Behavior, Yongey Mingyur provides insights into modern research indicating that systematic training in meditation can enhance activity in areas of the brain associated with happiness and compassion. He has also worked with physicists across the country to develop a scientifically based interpretation of the Buddhist understanding of the nature of reality. Yongey Mingyur weaves together the principles of Tibetan Buddhism, neuroscience, and quantum physics in a way that will change the way we understand the human experience. Using the basic meditation practices he provides, we can discover paths through everyday problems, transforming obstacles into opportunities to recognize the unlimited potential of our own minds.--From publisher description.</p>
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- Buddhist Contemplation by Applied Subject,
- Contemplation by Applied Subject,
- Contemplation by Tradition,
- Physics and Buddhism,
- Neuroscience and Buddhist Contemplation,
- Science and Buddhist Contemplation,
- Neuroscience and Contemplation,
- Physics and Contemplation,
- Literature of Buddhist Contemplation,
- Introductions to Buddhist Contemplation,
- Science and Contemplation,
- Buddhist Contemplation
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