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OBJECTIVE: Evidence suggests increased cardiovascular risk and autonomic impairment among individuals with chronic anxiety. Little attention, however, has been paid to the anxiety disorder of social phobia despite its high prevalence. Additionally, gender- and age-related cardiovascular profiles have not been examined in relation to social phobia. This study investigated cardiovascular responses to a socially threatening situation among older men and women with social phobia and control subjects. METHODS: Thirty subjects with social phobia and 30 control subjects (mean age = 65 years) were assessed during baseline, paced breathing, speech preparation, and speech presentation. Electrocardiographic variables, blood pressure, respiration, and emotional state (self-reported) were monitored. Hemodynamic variables included heart rate, blood pressure, cardiac output, and systemic vascular resistance; autonomic measures were respiratory sinus arrhythmia and baroreflex sensitivity, both markers of cardiac vagal control, and 0.10-Hz systolic blood pressure variability, an index of sympathetic vasomotor tone. RESULTS: Subjects with social phobia, in contrast to nonanxious control subjects, manifested more anxiety, embarrassment, and somatic complaints in response to stress; however, physiological measures generally did not distinguish groups. Interaction effects indicated that socially phobic women were hyperresponsive to the stressor with respect to self-reported, hemodynamic, and autonomic parameters. Socially phobic men manifested no physiological differences in comparison with control subjects, but they reported more psychological and somatic complaints. CONCLUSIONS: Gender differences in subjective and physiological responses to a socially threatening situation indicate congruence between perceived social anxiety and physiological responses in older women but not men. We found no evidence of impaired cardiovascular autonomic regulation among socially phobic men despite other reports that phobically anxious men are at greater cardiovascular risk.
OBJECTIVE: Evidence suggests increased cardiovascular risk and autonomic impairment among individuals with chronic anxiety. Little attention, however, has been paid to the anxiety disorder of social phobia despite its high prevalence. Additionally, gender- and age-related cardiovascular profiles have not been examined in relation to social phobia. This study investigated cardiovascular responses to a socially threatening situation among older men and women with social phobia and control subjects. METHODS: Thirty subjects with social phobia and 30 control subjects (mean age = 65 years) were assessed during baseline, paced breathing, speech preparation, and speech presentation. Electrocardiographic variables, blood pressure, respiration, and emotional state (self-reported) were monitored. Hemodynamic variables included heart rate, blood pressure, cardiac output, and systemic vascular resistance; autonomic measures were respiratory sinus arrhythmia and baroreflex sensitivity, both markers of cardiac vagal control, and 0.10-Hz systolic blood pressure variability, an index of sympathetic vasomotor tone. RESULTS: Subjects with social phobia, in contrast to nonanxious control subjects, manifested more anxiety, embarrassment, and somatic complaints in response to stress; however, physiological measures generally did not distinguish groups. Interaction effects indicated that socially phobic women were hyperresponsive to the stressor with respect to self-reported, hemodynamic, and autonomic parameters. Socially phobic men manifested no physiological differences in comparison with control subjects, but they reported more psychological and somatic complaints. CONCLUSIONS: Gender differences in subjective and physiological responses to a socially threatening situation indicate congruence between perceived social anxiety and physiological responses in older women but not men. We found no evidence of impaired cardiovascular autonomic regulation among socially phobic men despite other reports that phobically anxious men are at greater cardiovascular risk.
OBJECTIVE:Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS.
METHODS:
A total of 150 patients were randomly assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes.
RESULTS:
Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4-0.9 posttreatment and 0.3-0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample.
CONCLUSIONS:
In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL.
CLASSIFICATION OF EVIDENCE:
This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention.
OBJECTIVE:Health-related quality of life (HRQOL) is often much reduced among individuals with multiple sclerosis (MS), and incidences of depression, fatigue, and anxiety are high. We examined effects of a mindfulness-based intervention (MBI) compared to usual care (UC) upon HRQOL, depression, and fatigue among adults with relapsing-remitting or secondary progressive MS.
METHODS:
A total of 150 patients were randomly assigned to the intervention (n = 76) or to UC (n = 74). MBI consisted of a structured 8-week program of mindfulness training. Assessments were made at baseline, postintervention, and 6 months follow-up. Primary outcomes included disease-specific and disease-aspecific HRQOL, depression, and fatigue. Anxiety, personal goal attainment, and adherence to homework were secondary outcomes.
RESULTS:
Attrition was low in the intervention group (5%) and attendance rate high (92%). Employing intention-to-treat analysis, MBI, compared with UC, improved nonphysical dimensions of primary outcomes at postintervention and follow-up (p < 0.002); effect sizes, 0.4-0.9 posttreatment and 0.3-0.5 at follow-up. When analyses were repeated among subgroups with clinically relevant levels of preintervention depression, fatigue, or anxiety, postintervention and follow-up effects remained significant and effect sizes were larger than for the total sample.
CONCLUSIONS:
In addition to evidence of improved HRQOL and well-being, these findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL.
CLASSIFICATION OF EVIDENCE:
This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention.
Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list. The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study. There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P = 0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P = 0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post- intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2. In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.
Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list. The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study. There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P = 0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P = 0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post- intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2. In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention. © 2010 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.