Complementary and Integrative Health Practices Among Hispanics Diagnosed with Colorectal Cancer: Utilization and Communication with Physicians

OBJECTIVE

Complementary and integrative health (CIH) use among Hispanic adults with colorectal cancer (CRC) diagnosis is not well documented. Understanding the prevalence and patterns of CIH use among Hispanics offers insights to uncover potential needs for clinical services.

DESIGN

Participants were age 21 years or older with a first-time diagnosis of CRC from population-based cancer registries in California. In-person and/or telephone-based interviews were administered to collect data on CIH use. Demographic and clinical diagnosis data were abstracted from medical records. Descriptive statistical and logistic regression was used to analyze the frequencies and associations between selected patient characteristics and CIH use.

RESULTS

Among 631 Hispanic patients, 40.1% reported ever using CIH. Herbal products/dietary supplements were used most often (35.3%), followed by bodywork (16.5%), mind-body practices (7.8%), and homeopathy (6.7%). About 60% of participants reported CIH use to address specific health conditions; however, most patients did not discuss CIH use with their physicians (76.3%). Women reported higher CIH use than did men (45.1% versus 35.9%; odds ratio, 1.49 [95% confidence interval, 1.07-2.08]; p = 0.02). CIH use did not differ by clinical stage, time since diagnosis, or preferred language.

CONCLUSIONS

CIH use is prevalent among Hispanic patients with CRC, especially women. Little communication about CIH use occurs between participants and their healthcare providers. Efforts aimed at improving integrative oncology services provide an opportunity to address such gaps in healthcare service.

The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions

OBJECTIVE

Mindfulness-based interventions (MBIs) include the application of meditation and mind-body practices used to promote mindful awareness in daily life. Operationalizing the construct of mindfulness is important in order to determine mechanisms of therapeutic change elicited by mindfulness practice. In addition to existing state and trait measures of mindfulness, process measures are needed to assess the ways in which individuals apply mindfulness in the context of their practice.

METHOD

This report details three independent studies (qualitative interview, N = 8; scale validation, N = 134; and replication study, N = 180) and the mixed qualitative-quantitative methodology used to develop and validate the Applied Mindfulness Process Scale (AMPS), a 15-item process measure designed to quantify how mindfulness practitioners actively use mindfulness to remediate psychological suffering in their daily lives.

RESULTS

In Study 1, cognitive interviewing yielded a readily comprehensible and accessible scale of 15 items. In Study 2, exploratory factor analysis derived a potential three-factor solution: decentering, positive emotion regulation, and negative emotion regulation. In Study 3, confirmatory factor analysis verified better model fit with the three-factor structure over the one-factor structure.

CONCLUSIONS

AMPS functions as a measure to quantify the application of mindfulness and processes of change in the context of MBIs and general mindfulness practice.

Mindfulness meditation and the immune system: a systematic review of randomized controlled trials

Mindfulness meditation represents a mental training framework for cultivating the state of mindful awareness in daily life. Recently, there has been a surge of interest in how mindfulness meditation improves human health and well-being. Although studies have shown that mindfulness meditation can improve self-reported measures of disease symptomatology, the effect that mindfulness meditation has on biological mechanisms underlying human aging and disease is less clear. To address this issue, we conducted the first comprehensive review of randomized controlled trials examining the effects of mindfulness meditation on immune system parameters, with a specific focus on five outcomes: (1) circulating and stimulated inflammatory proteins, (2) cellular transcription factors and gene expression, (3) immune cell count, (4) immune cell aging, and (5) antibody response. This analysis revealed substantial heterogeneity across studies with respect to patient population, study design, and assay procedures. The findings suggest possible effects of mindfulness meditation on specific markers of inflammation, cell-mediated immunity, and biological aging, but these results are tentative and require further replication. On the basis of this analysis, we describe the limitations of existing work and suggest possible avenues for future research. Mindfulness meditation may be salutogenic for immune system dynamics, but additional work is needed to examine these effects.

Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial

IMPORTANCE

Sleep disturbances are most prevalent among older adults and often go untreated. Treatment options for sleep disturbances remain limited, and there is a need for community-accessible programs that can improve sleep.

OBJECTIVE

To determine the efficacy of a mind-body medicine intervention, called mindfulness meditation, to promote sleep quality in older adults with moderate sleep disturbances.

DESIGN, SETTING, AND PARTICIPANTS

Randomized clinical trial with 2 parallel groups conducted from January 1 to December 31, 2012, at a medical research center among an older adult sample (mean [SD] age, 66.3 [7.4] years) with moderate sleep disturbances (Pittsburgh Sleep Quality Index [PSQI] >5).

INTERVENTIONS

A standardized mindful awareness practices (MAPs) intervention (n = 24) or a sleep hygiene education (SHE) intervention (n = 25) was randomized to participants, who received a 6-week intervention (2 hours per week) with assigned homework.

MAIN OUTCOMES AND MEASURES

The study was powered to detect between-group differences in moderate sleep disturbance measured via the PSQI at postintervention. Secondary outcomes pertained to sleep-related daytime impairment and included validated measures of insomnia symptoms, depression, anxiety, stress, and fatigue, as well as inflammatory signaling via nuclear factor (NF)-κB.

RESULTS

Using an intent-to-treat analysis, participants in the MAPs group showed significant improvement relative to those in the SHE group on the PSQI. With the MAPs intervention, the mean (SD) PSQIs were 10.2 (1.7) at baseline and 7.4 (1.9) at postintervention. With the SHE intervention, the mean (SD) PSQIs were 10.2 (1.8) at baseline and 9.1 (2.0) at postintervention. The between-group mean difference was 1.8 (95% CI, 0.6-2.9), with an effect size of 0.89. The MAPs group showed significant improvement relative to the SHE group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity (P < .05 for all). Between-group differences were not observed for anxiety, stress, or NF-κB, although NF-κB concentrations significantly declined over time in both groups (P < .05).

CONCLUSIONS AND RELEVANCE

The use of a community-accessible MAPs intervention resulted in improvements in sleep quality at immediate postintervention, which was superior to a highly structured SHE intervention. Formalized mindfulness-based interventions have clinical importance by possibly serving to remediate sleep problems among older adults in the short term, and this effect appears to carry over into reducing sleep-related daytime impairment that has implications for quality of life.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01534338.

Brain Gray Matter Changes Associated with Mindfulness Meditation in Older Adults: An Exploratory Pilot Study using Voxel-based Morphometry

Background

Mindfulness-based interventions (MBIs) have previously been associated with structural gray matter changes in normal healthy adults. However, it remains unknown if standardized MBIs can induce similar changes in older adults and those with health complaints as well. The objective of this investigation was to examine the effect of a standardized MBI on the gray matter tissue of older adults with sleep disturbances.

Methods

This exploratory single-group pilot longitudinal study examined local gray matter changes over a six-week MBI period. Participants included six older adult community volunteers (M=66.5 years of age, SD=5.5, range=58–75; 66% female) with sleep disturbances recruited through advertisement in local newspapers/flyers posted at a university medical center and affiliated clinics in Los Angeles, CA. The MBI was delivered as a weekly, two-hour, six-session, group-based course in mindfulness meditation. Gray matter was measured voxel-wise pre- and post-intervention.

Results

A significant gray matter increase was identified within the precuneus, possibly implicating meditation-induced changes of the default mode network. In contrast, observed significant gray matter decreases may have been driven by MBI-related remediation of brain architecture subserving sleep complaints.

Conclusions

Exploratory findings suggest that mindfulness meditation practice is associated with a detectable alteration of cerebral gray matter in older adults.

Mindfulness Training and Classroom Behavior Among Lower-Income and Ethnic Minority Elementary School Children

This field intervention trial evaluated the effect of a 5-week mindfulness-based curriculum on teacher-ratings of student classroom behavior at a Richmond, CA public elementary school, and examined if the addition of more sessions provided added benefit to student outcomes. Seventeen teachers reported on the classroom behaviors of 409 children (83 % enrolled in a California free lunch program and 95.7 % ethnic minority) in kindergarten through sixth grade at pre-intervention, immediate post-intervention, and 7 weeks post-intervention. Results showed that teachers reported improved classroom behavior of their students (i.e., paying attention, self-control, participation in activities, and caring/respect for others) that lasted up to 7 weeks post-intervention. Overall, improvements were not bolstered by the addition of extra sessions, with the exception of paying attention. The implications of this study are limited due to the lack of a mindfulness program-naïve control group, yet findings suggest that mindfulness training might benefit teacher-based perceptions of improved classroom behavior in a public elementary school, which has practice implications for improving the classroom learning environment for lower-income and ethnically-diverse children.

Community-Based Mindfulness Program for Disease Prevention and Health Promotion: Targeting Stress Reduction

PURPOSE

Poorly managed stress leads to detrimental physical and psychological consequences that have implications for individual and community health. Evidence indicates that U.S. adults predominantly use unhealthy strategies for stress management. This study examines the impact of a community-based mindfulness training program on stress reduction.

DESIGN

This study used a one-group pretest-posttest design.

SETTING

The study took place at the UCLA Mindful Awareness Research Center in urban Los Angeles.

SUBJECTS

A sample of N = 127 community residents (84% Caucasian, 74% female) were included in the study.

INTERVENTION

Participants received mindfulness training through the Mindful Awareness Practices (MAPs) for Daily Living I.

MEASURES

Mindfulness, self-compassion, and perceived stress were measured at baseline and postintervention.

ANALYSIS

Paired-sample t-tests were used to test for changes in outcome measures from baseline to postintervention. Hierarchical regression analysis was fit to examine whether change in self-reported mindfulness and self-compassion predicted postintervention perceived stress scores.

RESULTS

There were statistically significant improvements in self-reported mindfulness (t = -10.67, p < .001, d = .90), self-compassion (t = -8.50, p < .001, d = .62), and perceived stress (t = 9.28, p < .001, d = -.78) at postintervention. Change in self-compassion predicted postintervention perceived stress (β = -.44, t = -5.06, p < .001), but change in mindfulness did not predict postintervention perceived stress (β = -.04, t = -.41, p = .68).

CONCLUSION

These results indicate that a community-based mindfulness training program can lead to reduced levels of psychological stress. Mindfulness training programs such as MAPs may offer a promising approach for general public health promotion through improving stress management in the urban community.

Mindfulness-based intervention for prodromal sleep disturbances in older adults: design and methodology of a randomized controlled trial

Sleep problems are prevalent among older adults, often persist untreated, and are predictive of health detriments. Given the limitations of conventional treatments, non-pharmacological treatments such as mindfulness-based interventions (MBIs) are gaining popularity for sleep ailments. However, nothing is yet known about the impact of MBIs on sleep in older adults with prodromal sleep disturbances. This article details the design and methodology of a 6-week parallel-group RCT calibrated to test the treatment effect of the Mindful Awareness Practices (MAPs) program versus sleep hygiene education for improving sleep quality, as the main outcome, in older adults with prodromal sleep disturbances. Older adults with current sleep disturbances will be recruited from the urban Los Angeles community. Participants will be randomized into two standardized treatment conditions, MAPs and sleep hygiene education. Each condition will consist of weekly 2-hour group-based classes over the course of the 6-week intervention. The primary objective of this study is to determine if mindfulness meditation practice as engaged through the MAPs program leads to improved sleep quality relative to sleep hygiene education in older adults with prodromal sleep disturbances.

Mindfulness-based interventions for obesity-related eating behaviours: a literature review

Mindfulness-based interventions (MBIs) targeting eating behaviours have gained popularity in recent years. A literature review was conducted to determine the effectiveness of MBIs for treating obesity-related eating behaviours, such as binge eating, emotional eating and external eating. A search protocol was conducted using the online databases Google Scholar, PubMed, PsycINFO and Ovid Healthstar. Papers were required to meet the following criteria to be included in this review: (i) describe a MBI or the use of mindfulness exercises as part of an intervention; (ii) include at least one obesity-related eating behaviour as an outcome; (iii) include quantitative outcomes; and (iv) be published in English in a peer-reviewed journal. A total of N = 21 papers were included in this review. Interventions used a variety of approaches to implement mindfulness training, including combined mindfulness and cognitive behavioural therapies, mindfulness-based stress reduction, acceptance-based therapies, mindful eating programmes, and combinations of mindfulness exercises. Targeted eating behaviour outcomes included binge eating, emotional eating, external eating and dietary intake. Eighteen (86%) of the reviewed studies reported improvements in the targeted eating behaviours. Overall, the results of this first review on the topic support the efficacy of MBIs for changing obesity-related eating behaviours, specifically binge eating, emotional eating and external eating.

Applying neurodevelopmental theory to school-based drug misuse prevention during adolescence

Adolescence is characterized by incredible development in the prefrontal cortex of the brain, which is responsible for behavioral and emotional self-regulation, and higher order cognitive decision-making skills (that is, executive function). Typically late prefrontal cortical development and its integration with limbic areas of the brain associated with reward, pleasure, novelty seeking, and emotion can contribute to substance misuse vulnerability during adolescence. In this chapter, literature on the developmental integration of the prefrontal cortex with emotion and motivation centers of the brain is reviewed. Then this research is applied to school-based adolescent substance misuse prevention, highlighting two examples of preventive interventions incorporating neurocognitive models into comprehensive prevention approaches. Finally, innovative strategies (for example, mindfulness training) for promoting neurocognition as a mediator to substance misuse vulnerability are discussed.

Feasibility, acceptability, and preliminary outcomes of a mindfulness-based relapse prevention intervention for culturally-diverse, low-income women in substance use disorder treatment

We examined feasibility, acceptability, and benefits of a mindfulness-based relapse prevention (MBRP) intervention in a racially and ethnically diverse sample of 318 low-income women in substance use disorder treatment (2003-2006). The study used a single group, repeated measures design. Participant satisfaction was high (M = 3.4, SD = .3), but completion was modest (36%). Linear regressions examining change in addiction severity and psychological functioning by dosage showed that higher dosage was associated with reduced alcohol (β = -.07, p < .05), drug severity (β = -.04, p < .05), and perceived stress (β = -2.29, p < .05) at 12 months. Further research on MBRP efficacy for this population is warranted. The study's limitations are noted.

Mindfulness-based interventions: an antidote to suffering in the context of substance use, misuse, and addiction

The cultivation of mindfulness as an approach to human perception through the practice of meditation has become an increasingly popular treatment for medical and psychological symptoms and as a topic of scientific investigation. Substance user programs are also increasingly embracing this treatment strategy as either a stand-alone therapeutic modality or a complement to ongoing treatment. In this article, I supply an introduction to the special theme issue concerning mindfulness and substance use intervention by first providing a brief historical account of the secular Mindfulness-Based Stress Reduction program to introduce new readers to the more general topic of mindfulness-based interventions (MBIs), and to contextualize historical publishing trends observed in mindfulness research across the past four decades. I then examine the implications of MBIs for substance use, misuse, and addiction, especially in areas related to craving and suffering. To conclude, I outline the empirical and conceptual compendium of contributions offered in this special issue.

Adolescent neurocognitive development, self-regulation, and school-based drug use prevention

Adolescence is marked by several key development-related changes, including neurocognitive changes. Cognitive abilities associated with self-regulation are not fully developed until late adolescence or early adulthood whereas tendencies to take risks and seek thrilling and novel experience seem to increase significantly throughout this phase, resulting in a discrepancy between increased susceptibility to poor regulation and lower ability to exercise self-control. Increased vulnerability to drug use initiation, maintenance, and dependence during adolescence may be explained based on this imbalance in the self-regulation system. In this paper, we highlight the relevance of schools as a setting for delivering adolescent drug use prevention programs that are based on recent findings from neuroscience concerning adolescent brain development. We discuss evidence from school-based as well as laboratory research that suggests that suitable training may improve adolescents' executive brain functions that underlie self-regulation abilities and, as a result, help prevent drug use and abuse. We note that considerable further research is needed in order (1) to determine that self-regulation training has effects at the neurocognitive level and (2) to effectively incorporate self-regulation training based on neuropsychological models into school-based programming.

Spirituality in addictions treatment: wisdom to know…what it is

Spirituality has long been integrated into treatments for addiction. However, how spirituality differs from other related constructs and implications for recovery among nonspiritual persons remains a source of discussion. This article examines ways in which spirituality is delineated, identifies variables that might mediate the relations between spirituality and recovery from substance abuse disorders, describes distinctions between spiritual and nonspiritual facets of addictions treatment, and suggests means to assist in further clarification of this construct.

Use of mindful reappraisal coping among meditation practitioners

OBJECTIVE

By enhancing positive affect and cognitive flexibility, mindfulness practice may promote reappraisal of stressors. We hypothesized that coping through mindful reappraisal would be common among mindfulness practitioners from an array of traditions.

METHOD

A sample of 118 meditation practitioners completed an online survey comprising assessments of the prevalence and frequency of mindful reappraisal, as well as measures of well-being and distress.

RESULTS

Regular use of mindful reappraisal was reported by over half of the sample and was significantly correlated with years of meditation practice (r = .31, p = .01), meditation practice days per month (r = .30, p = .001), and meditation hours per week (r = .30, p = .001). Controlling for frequency of meditation practice and trait mindfulness, mindful reappraisal frequency explained significant portions of variance in well-being (P <.001) and distress (P <.001).

CONCLUSIONS

Meditation practitioners commonly employ mindful reappraisal coping as a positive emotion regulatory strategy in stressful contexts.

A comparison of stigma among patients with leprosy in rural Tanzania and urban United States: a role for public health in dermatology

BACKGROUND

  Leprosy is a chronic infection of the skin and peripheral nerves caused by the bacterium Mycobacterium leprae, which causes peripheral insensitivity and disfigurements of the skin, limbs, and digits. Social stigma is a common consequence of leprosy and may differ according to level of physical disfigurement and geographic location. The objective of this study was to assess social stigma encountered by patients with leprosy in clinical settings located in rural Tanzania and urban USA and to compare the social stigma reported in these regions.

METHODS

  A total of 56 respondents were recruited from one leprosy inpatient facility in Shirati, Tanzania (n = 28), and one outpatient clinic in Los Angeles, USA (n = 28). Cross-sectional data were obtained from face-to-face interviews, which were conducted with respondents at each clinic location. Measures of perceived stigma were assessed in family relationship, vocational, social interaction, and interpersonal contexts.

RESULTS

  Patients in Tanzania, as compared with those in the USA, reported significantly higher levels of stigma in family relationship and vocational contexts. Tanzanian patients also reported higher levels of stigma in social interaction and self-esteem contexts, but these differences were marginally significant and may reflect the small sample size.

CONCLUSIONS

  Leprosy-related social stigma is a major problem in regions of both developed and developing countries; however, patients with leprosy in developing countries reported higher levels of stigma in four social contexts. A public health role in dermatology is discussed as an agent of early diagnosis, control, and education in order to reduce social stigma and promote social rehabilitation.

Yogic meditation reverses NF-κB and IRF-related transcriptome dynamics in leukocytes of family dementia caregivers in a randomized controlled trial

BACKGROUND

Although yoga and meditation have been used for stress reduction with reported improvement in inflammation, little is known about the biological mechanisms mediating such effects. The present study examined if a yogic meditation might alter the activity of inflammatory and antiviral transcription control pathways that shape immune cell gene expression.

METHODS

Forty-five family dementia caregivers were randomized to either Kirtan Kriya Meditation (KKM) or Relaxing Music (RM) listening for 12 min daily for 8 weeks and 39 caregivers completed the study. Genome-wide transcriptional profiles were collected from peripheral blood leukocytes sampled at baseline and 8-week follow-up. Promoter-based bioinformatics analyses tested the hypothesis that observed transcriptional alterations were structured by reduced activity of the pro-inflammatory nuclear factor (NF)-κB family of transcription factors and increased activity of Interferon Response Factors (IRFs; i.e., reversal of patterns previously linked to stress).

RESULTS

In response to KKM treatment, 68 genes were found to be differentially expressed (19 up-regulated, 49 down-regulated) after adjusting for potentially confounded differences in sex, illness burden, and BMI. Up-regulated genes included immunoglobulin-related transcripts. Down-regulated transcripts included pro-inflammatory cytokines and activation-related immediate-early genes. Transcript origin analyses identified plasmacytoid dendritic cells and B lymphocytes as the primary cellular context of these transcriptional alterations (both p<.001). Promoter-based bioinformatic analysis implicated reduced NF-κB signaling and increased activity of IRF1 in structuring those effects (both p<.05).

CONCLUSION

A brief daily yogic meditation intervention may reverse the pattern of increased NF-κB-related transcription of pro-inflammatory cytokines and decreased IRF1-related transcription of innate antiviral response genes previously observed in healthy individuals confronting a significant life stressor.

Trait mindfulness helps shield decision-making from translating into health-risk behavior

PURPOSE

The cognitive tendency toward mindfulness may influence the enactment of health and risk behaviors by its bringing increased attention to and awareness of decision-making processes underlying behavior. The present study examined the moderating effect of trait mindfulness on associations between intentions to smoke (ITS)/smoking refusal self-efficacy (SRSE) and smoking frequency.

METHODS

Self-reports from Chinese adolescents (N = 5,287; mean age = 16.2 years, standard deviation = .7; 48.8% female) were collected in 24 schools. Smoking frequency was regressed on latent factor interactions Mindful Attention Awareness Scale*ITS and Mindful Attention Awareness Scale*SRSE, adjusting for school clustering effects and covariates.

RESULTS

Both interaction terms were significant in cross-sectional analyses and showed that high ITS predicted higher smoking frequency among those low, relative to high, in trait mindfulness, whereas low SRSE predicted higher smoking frequency among those low, relative to high, in trait mindfulness.

CONCLUSIONS

Findings suggest trait mindfulness possibly shields against decision-making processes that place adolescents at risk for smoking.

Testing the indirect effect of trait mindfulness on adolescent cigarette smoking through negative affect and perceived stress mediators

Mindfulness refers to an enhanced attention to and awareness of present moment experience. This study examined how trait mindfulness, as measured with six items from Mindfulness Attention Awareness Scale, might influence adolescent cigarette smoking frequency through its impact on depressive affect, anger affect and perceived stress mediators. Self-reported data from Chinese adolescents (N = 5287, mean age = 16.2 years, SD = 0.7; 48.8% females) were collected within 24 schools. The product of coefficients test was used to determine significant mediation paths. Results from baseline cross-sectional data indicated that trait mindfulness had a significant indirect effect on past 30-day smoking frequency through depressive affect, anger affect and perceived stress mediators. Results from 13-month longitudinal data indicated that these indirect effects remained significant for depressive affect and perceived stress but not for anger affect. Findings from this study may suggest that heightening mindfulness among adolescents may indirectly reduce cigarette smoking perhaps by improving affect regulation competencies.