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Traditional medical systems, like those preserved in Asia, pose a challenge because they involve theories and practices that strike many conventionally trained physicians and researchers as incomprehensible, even nonsensical. Should modern medicine continue to dismiss these systems as unscientific, therefore worthy of debunking rather than serious study; view them as sources of alternatives, possibly effective but hidden in a matrix of prescientific custom and belief; or do they represent something like a complementary science of medicine? We make the latter argument using the example of Indo-Tibetan medicine. Indo-Tibetan medicine is based on analytic models and methods that are rationally defined, internally coherent, and make testable predictions, therefore meeting current definitions of "science." The possibility of multiple, complementary sciences is a consequence of certain findings in physics that have led to a view of science as a set of tools-instruments of social activity that depend on learned agreement in aims and methods-rather than as a monolith of absolute objective truth. Implications of this pluralistic view of science for medical research and practice are discussed.

This article discusses the moral ethos behind the effective altruism movement.

India and China face the same challenge of having too few trained psychiatric personnel to manage effectively the substantial burden of mental illness within their population. At the same time, both countries have many practitioners of traditional, complementary, and alternative medicine who are a potential resource for delivery of mental health care. In our paper, part of The Lancet and Lancet Psychiatry's Series about the China-India Mental Health Alliance, we describe and compare types of traditional, complementary, and alternative medicine in India and China. Further, we provide a systematic overview of evidence assessing the effectiveness of these alternative approaches for mental illness and discuss challenges in research. We suggest how practitioners of traditional, complementary, and alternative medicine and mental health professionals might forge collaborative relationships to provide more accessible, affordable, and acceptable mental health care in India and China. A substantial proportion of individuals with mental illness use traditional, complementary, and alternative medicine, either exclusively or with biomedicine, for reasons ranging from faith and cultural congruence to accessibility, cost, and belief that these approaches are safe. Systematic reviews of the effectiveness of traditional, complementary, and alternative medicine find several approaches to be promising for treatment of mental illness, but most clinical trials included in these systematic reviews have methodological limitations. Contemporary methods to establish efficacy and safety-typically through randomised controlled trials-need to be complemented by other means. The community of practice built on collaborative relationships between practitioners of traditional, complementary, and alternative medicine and providers of mental health care holds promise in bridging the treatment gap in mental health care in India and China.

Several randomised controlled trials suggest that mindfulness-based approaches are helpful in preventing depressive relapse and recurrence, and the UK Government’s National Institute for Health and Clinical Excellence has recommended these interventions for use in the National Health Service. There are good grounds to suggest that mindfulness-based approaches are also helpful with anxiety disorders and a range of chronic physical health problems, and there is much clinical and research interest in applying mindfulness approaches to other populations and problems such as people with personality disorders, substance abuse, and eating disorders. We review the UK context for developments in mindfulness-based approaches and set out criteria for mindfulness teacher competence and training steps, as well as some of the challenges and future directions that can be anticipated in ensuring that evidence-based mindfulness approaches are available in health care and other settings.
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Several randomised controlled trials suggest that mindfulness-based approaches are helpful in preventing depressive relapse and recurrence, and the UK Government’s National Institute for Health and Clinical Excellence has recommended these interventions for use in the National Health Service. There are good grounds to suggest that mindfulness-based approaches are also helpful with anxiety disorders and a range of chronic physical health problems, and there is much clinical and research interest in applying mindfulness approaches to other populations and problems such as people with personality disorders, substance abuse, and eating disorders. We review the UK context for developments in mindfulness-based approaches and set out criteria for mindfulness teacher competence and training steps, as well as some of the challenges and future directions that can be anticipated in ensuring that evidence-based mindfulness approaches are available in health care and other settings.

Early theorists (Freud and Darwin) speculated that extremely shy children, or those with anxious temperament, were likely to have anxiety problems as adults. More recent studies demonstrate that these children have heightened responses to potentially threatening situations reacting with intense defensive responses that are characterized by behavioral inhibition (BI) (inhibited motor behavior and decreased vocalizations) and physiological arousal. Confirming the earlier impressions, data now demonstrate that children with this disposition are at increased risk to develop anxiety, depression, and comorbid substance abuse. Additional key features of anxious temperament are that it appears at a young age, it is a stable characteristic of individuals, and even in non-threatening environments it is associated with increased psychic anxiety and somatic tension. To understand the neural underpinnings of anxious temperament, we performed imaging studies with 18-fluoro-deoxyglucose (FDG) high-resolution Positron Emission Tomography (PET) in young rhesus monkeys. Rhesus monkeys were used because they provide a well validated model of anxious temperament for studies that cannot be performed in human children. Imaging the same animal in stressful and secure contexts, we examined the relation between regional metabolic brain activity and a trait-like measure of anxious temperament that encompasses measures of BI and pituitary-adrenal reactivity. Regardless of context, results demonstrated a trait-like pattern of brain activity (amygdala, bed nucleus of stria terminalis, hippocampus, and periaqueductal gray) that is predictive of individual phenotypic differences. Importantly, individuals with extreme anxious temperament also displayed increased activity of this circuit when assessed in the security of their home environment. These findings suggest that increased activity of this circuit early in life mediates the childhood temperamental risk to develop anxiety and depression. In addition, the findings provide an explanation for why individuals with anxious temperament have difficulty relaxing in environments that others perceive as non-stressful.
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A number of experts have described mindfulness as a naturally occurring quality in the human mind that is present to some degree in all people, even without training in mindfulness or meditation. This study examined whether trait mindfulness is associated with reduced stress response activation and enhanced self-regulatory activity with recurrent stress. Self-ratings of mindfulness and continuous measures of physiological reactivity before, during, and after an interview about a recurrent stressful issue were collected from 47 undergraduate participants to examine our primary objective. Findings indicated that mindful individuals were less likely to engage in metabolically costly physiological activation in response to an emotionally challenging task, but were more likely to engage parasympathetic responding following the task, a response which is associated with effective downregulation following stress. Results from our study suggest that “natively mindful” individuals have the ability to engage self-regulatory physiological responding associated with improved adaptability and flexibility in a changing environment. Thus, mindfulness may be associated with physical indices of emotional well-being. Furthermore, our data adds evidence for the validity of self-report measures of mindfulness.

Mindfulness has been suggested to be an important protective factor for emotional health. However, this effect might vary with regard to context. This study applied a novel statistical approach, quantile regression, in order to investigate the relation between trait mindfulness and residual depressive symptoms in individuals with a history of recurrent depression, while taking into account symptom severity and number of episodes as contextual factors. Rather than fitting to a single indicator of central tendency, quantile regression allows exploration of relations across the entire range of the response variable. Analysis of self-report data from 274 participants with a history of three or more previous episodes of depression showed that relatively higher levels of mindfulness were associated with relatively lower levels of residual depressive symptoms. This relationship was most pronounced near the upper end of the response distribution and moderated by the number of previous episodes of depression at the higher quantiles. The findings suggest that with lower levels of mindfulness, residual symptoms are less constrained and more likely to be influenced by other factors. Further, the limiting effect of mindfulness on residual symptoms is most salient in those with higher numbers of episodes.

Previous research has demonstrated that depressive symptoms are positively linked to early maladaptive schemas and negatively linked to trait mindfulness. However, the role trait mindfulness may play in buffering the effect of early maladaptive schemas on depressive symptoms has not yet been studied. Therefore, in the current study, we examined whether trait mindfulness moderates this relationship. Specifically, using a community sample of 207 Australian adults, we administered the Mindful Attention and Awareness Scale, the Young Schema Questionnaire-Short Form-3rd Edition, and the Depression subscale of the Depression Anxiety Stress Scale. Results revealed that trait mindfulness moderated the relationship between early maladaptive schema endorsement and depressive symptoms. The findings are consistent with the proposition that trait mindfulness acts as a protective mechanism in limiting depressive symptomatology. Theoretical implications are discussed, with a focus on understanding how and why mindfulness-based affect regulation strategies can be used to help buffer the effect of early maladaptive schemas on depression.

Cognitive-Behavioral Group Therapy (CBGT) and Mindfulness-Based Stress Reduction (MBSR) are efficacious in treating social anxiety disorder (SAD). It is not yet clear, however, whether they share similar trajectories of change and underlying mechanisms in the context of SAD. This randomized controlled study of 108 unmedicated adults with generalized SAD investigated the impact of CBGT vs. MBSR on trajectories of social anxiety, cognitive reappraisal, and mindfulness during 12 weeks of treatment. CBGT and MBSR produced similar trajectories showing decreases in social anxiety and increases in reappraisal (changing the way of thinking) and mindfulness (mindful attitude). Compared to MBSR, CBGT produced greater increases in disputing anxious thoughts/feelings and reappraisal success. Compared to CBGT, MBSR produced greater acceptance of anxiety and acceptance success. Granger Causality analyses revealed that increases in weekly reappraisal and reappraisal success predicted subsequent decreases in weekly social anxiety during CBGT (but not MBSR), and that increases in weekly mindful attitude and disputing anxious thoughts/feelings predicted subsequent decreases in weekly social anxiety during MBSR (but not CBGT). This examination of temporal dynamics identified shared and distinct changes during CBGT and MBSR that both support and challenge current conceptualizations of these clinical interventions.

This paper discusses the hypothesis that the symptoms of functional psychoses can be caused by culturally structured spontaneous trances that may be reactions to environmental stress and psychological trauma. Findings are reviewed of anthropological studies of meditative trance experiences in Indian yogis characterized by divided consciousness (dissociation), religious auditory and visual hallucinations, and beliefs in their own spiritual powers. An explanation of the psychological mechanisms of meditative trance is also provided, highlighting trance-related alteration of consciousness within an Indian cultural context. It is suggested that the psychological mechanisms of meditative trance are similar in structure to spontaneous trances underlying the symptoms of some functional psychoses. Findings from cross-cultural studies are also reviewed, highlighting the effects of culture on the symptoms, indigenous diagnoses, treatments, and outcomes of functional psychoses. In non-Western cultures, transient functional psychoses with complete recovery are 10 times more common than in Western cultures. It is suggested that egocentrism and a loss of spiritual explanations for psychosis in Western cultures constructs a clinical situation in which persons with functional psychoses are treated for a biogenetic (incurable) brain disease rather than a curable spiritual illness. This difference in cultural belief systems leads to poorer outcomes for Western patients compared to non-Western patients. Recognizing cultural differences in symptoms, indigenous diagnoses, and treatment for functional psychoses can help explain the dramatic cross-cultural differences in outcome.

Students who practiced Transcendental Meditation (TM) from four university and college campuses were individually matched on seven variables with students from the general population of the same campuses (N # 23 matches). Results of a questionnaire designed to tap six social psychological attitudes indicated significant differences between these groups on five attitudes, with meditating students indicating more positive attitudes. In addition, matched meditating students (N # 6 matches) were compared on the variables of exposure to the TM philosophy and length of time meditating. Results on the exposure dimension found no significant difference between those with high or low exposure on the measured attitudes. Results on the length dimension found long term meditators with significantly more positive attitudes than short term meditators.

Empirical research suggests that yoga may positively influence the negative psychosocial and physical side effects associated with cancer and its treatment. The translation of these findings into sustainable, evidence-informed yoga programming for cancer survivors has lagged behind the research. This article provides (a) an overview of the yoga and cancer research, (b) a framework for successfully developing and delivering yoga to cancer populations, and (c) an example of a successful community-based program. The importance of continued research and knowledge translation efforts in the context of yoga and integrative oncology are highlighted.

<p>This study is an open clinical trial that examined the feasibility and acceptability of a mindfulness training program for anxious children. We based this pilot initiative on a cognitively oriented model, which suggests that, since impaired attention is a core symptom of anxiety, enhancing self-management of attention should effect reductions in anxiety. Mindfulness practices are essentially attention enhancing techniques that have shown promise as clinical treatments for adult anxiety and depression (Baer, 2003). However, little research explores the potential benefits of mindfulness to treat anxious children. The present study provided preliminary support for our model of treating childhood anxiety with mindfulness. A 6-week trial was conducted with five anxious children aged 7 to 8 years old. The results of this study suggest that mindfulness can be taught to children and holds promise as an intervention for anxiety symptoms. Results suggest that clinical improvements may be related to initial levels of attention.</p>

This study is an open clinical trial that examined the feasibility and acceptability of a mindfulness training program for anxious children. We based this pilot initiative on a cognitively oriented model, which suggests that, since impaired attention is a core symptom of anxiety, enhancing self-management of attention should effect reductions in anxiety. Mindfulness practices are essentially attention enhancing techniques that have shown promise as clinical treatments for adult anxiety and depression (Baer, 2003). However, little research explores the potential benefits of mindfulness to treat anxious children. The present study provided preliminary support for our model of treating childhood anxiety with mindfulness. A 6-week trial was conducted with five anxious children aged 7 to 8 years old. The results of this study suggest that mindfulness can be taught to children and holds promise as an intervention for anxiety symptoms. Results suggest that clinical improvements may be related to initial levels of attention.

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.

In this article, we propose a clinical model for treating anxiety-related sexual dysfunctions that hinges on the use of mindfulness meditation practices. First, theoretical and empirical evidence for anxiety as either a cause or condition of several different sexual dysfunctions is provided. Next, the concept of mindfulness and the research that supports the use of mindfulness meditation practices in addressing anxiety are explained. The inherent link between mindfulness and sex-positivity is also addressed while acknowledging the need to emphasize both mindfulness and sex-positivity in therapy. The proposed model for the treatment of anxiety-related sexual dysfunctions using mindfulness practices within a sex-positive framework is outlined. It utilizes mindfulness-based practices such as body scan meditation and sitting meditation as well as several preexisting sex therapy interventions, including directed masturbation and sensate focus assignments. A case study is provided as an example of the progression of therapy and as a demonstration of the clinical viability of the model. Ultimately, this model illustrates a potential way in which mindfulness practices can be utilized within a sex-positive approach to sex therapy.

Objective: To examine whether metacognitive psychological skills, acquired in mindfulness-based cognitive therapy (MBCT), are also present in patients receiving medication treatments for prevention of depressive relapse and whether these skills mediate MBCT's effectiveness. Method: This study, embedded within a randomized efficacy trial of MBCT, was the first to examine changes in mindfulness and decentering during 6–8 months of antidepressant treatment and then during an 18-month maintenance phase in which patients discontinued medication and received MBCT, continued on antidepressants, or were switched to a placebo. In total, 84 patients (mean age = 44 years, 58% female) were randomized to 1 of these 3 prevention conditions. In addition to symptom variables, changes in mindfulness, rumination, and decentering were assessed during the phases of the study. Results: Pharmacological treatment of acute depression was associated with reductions in scores for rumination and increased wider experiences. During the maintenance phase, only patients receiving MBCT showed significant increases in the ability to monitor and observe thoughts and feelings as measured by the Wider Experiences (p < .01) and Decentering (p < .01) subscales of the Experiences Questionnaire and by the Toronto Mindfulness Scale. In addition, changes in Wider Experiences (p < .05) and Curiosity (p < .01) predicted lower Hamilton Rating Scale for Depression scores at 6-month follow-up. Conclusions: An increased capacity for decentering and curiosity may be fostered during MBCT and may underlie its effectiveness. With practice, patients can learn to counter habitual avoidance tendencies and to regulate dysphoric affect in ways that support recovery.

OBJECTIVES: This study aimed to compare the effects of true and sham acupuncture in relieving symptoms of irritable bowel syndrome (IBS). METHODS: A total of 230 adult IBS patients (75% females, average age: 38.4 years) were randomly assigned to 3 weeks of true or sham acupuncture (6 treatments) after a 3-week "run-in" with sham acupuncture in an "augmented" or "limited" patient–practitioner interaction. A third arm of the study included a waitlist control group. The primary outcome was the IBS Global Improvement Scale (IBS-GIS) (range: 1–7); secondary outcomes included the IBS Symptom Severity Scale (IBS-SSS), the IBS Adequate Relief (IBS-AR), and the IBS Quality of Life (IBS-QOL). RESULTS: Although there was no statistically significant difference between acupuncture and sham acupuncture on the IBS-GIS (41 vs. 32%, P=0.25), both groups improved significantly compared with the waitlist control group (37 vs. 4%, P=0.001). Similarly, small differences that were not statistically significant favored acupuncture over the other three outcomes: IBS-AR (59 vs. 57%, P=0.83), IBS-SSS (31 vs. 21%, P=0.18), and IBS-QOL (17 vs. 13%, P=0.56). Eliminating responders during the run-in period did not substantively change the results. Side effects were generally mild and only slightly greater in the acupuncture group. CONCLUSIONS: This study did not find evidence to support the superiority of acupuncture compared with sham acupuncture in the treatment of IBS.
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