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Origins, Growth
Meditation
Mindfulness is the conscious act of paying attention to all that is happening around us, without judgment of whether those things are good or bad. Simply being curious and paying attention to anything that the mind is registering, such as sounds or smells around us, or sensations in various parts of the body.
With some practise, we hone this skill further to being aware of the stream of thoughts in our mind. Again without judgment. And then to notice that in between discrete thoughts are blissful moments of silence, of stillness.
Meditation is finding and then remaining in that state of stillness for long periods of time.
Ian Gawler OAM introduces meditation & mindfulness
-
Not sure of the benefits? Interested in the science?
Take a look at what the recent research has to say ...
From its beginnings, first recorded in print around 5,000 BC meditation has been continuously used in all cultures around the world. While it was often used on the spiritual path, it has also been widely applied as a valuable aid to help prevent diseases, speed recovery and foster good health, vitality and general wellbeing. It has a long track record!
More recently many thousands of studies have been published in scientific journals confirming meditation’s wide range of health benefits. The evidence base supporting the therapeutic use of mindfulness and meditation is now very strong.
In the review papers below, we have brought together key research evidence that support the therapeutic application of the Allevi8 App in the management of chronic degenerative disease and the symptoms or issues people frequently experience in association with these diseases.
Evidence by disease type
Mindfulness, meditation and cancer
A literature
review
Dr Ian Gawler BVSc, MCounsHS. November
2020.
What do mindfulness and meditation-based techniques have to offer people affected by cancer and their carers?
Introduction
In 1967, Dr Ainslie Meares published a ground breaking book – Relief Without Drugs in which he advocated meditation as a therapy for a wide range of physical and psychological conditions.
In 1985, Dr Meares published an hypothesis in the Medical Journal of Australia in which he speculated intense meditation might actually reverse the progress of cancer. Fair to say there was strong opposition from his medical and scientific colleagues. However, at the time, I had been diagnosed with advanced secondary osteo-genic sarcoma (bone cancer) and had a prognosis of 3 to 6 months.
So, having agreed to test Dr Meares hypothesis and used his methods as a core element in my subsequent survival, and having taught those techniques (along with additions) to many thousands of people affected by cancer over 4 decades, I have lived long enough to see the place of meditation in cancer management go through the 19th century German philosopher Schopenhauer’s 3 stages of truth: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident. Well, almost.
It seems reasonable to contend meditation has entered the mainstream in a general sense. It enjoys widespread acceptance and uptake. It is estimated that 200–500 million people meditate worldwide.
When it comes to cancer, the evidence regarding its contribution to improving quality of life for both patients, survivors and carers is compelling. Search scholarly articles for mindfulness and meditation and cancer, and around 1.5 million results appear. However, regarding the capacity to actually increase survival, while case reports and some small studies are positive, this is an area of little good quality research.
So, what follows is a summary of key research articles supporting the use of mindfulness, meditation and related practices for people affected by cancer. This is no PhD article and makes no claim to be comprehensive, but hopefully it does highlight some of the best of recent research in the field.
Evidence of benefit - key research articles
Short on time? Need the most important and latest
findings?
Here they are, while much more detail
follows…
1. Quality of life
The evidence strongly suggests meditation and mindfulness-based programs do improve quality of life – in person and online. Two recent meta-analyses of mindfulness programs for cancer patients and survivors have both reported improvements in pain, psychological distress, anxiety, depression, fear of cancer recurrence, and sleep quality. Of note, four of the 29 studies included were online programs where the online programs recorded similar benefits to face-to-face programs.
i) This 2020 review of 28 RCTs enrolling 3053 adults with cancer was published in the prestigious Journal of the American Medical Association. The findings? Mindfulness Based Interventions (MBIs) were associated with significant reductions in the severity of short-term and medium-term anxiety but not long-term. MBIs were associated with a reduction in the severity of depression in the short term and the medium term; as well as improved health-related quality of life in patients in the short term and the medium term. The study also found MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer.
Oberoi S, et al. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8).
ii) This 2019 review of 29 independent RCTs with 3274 participants found small and statistically significant effects of MBIs on combined measures of psychological distress. Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.
Cillessen, L et al. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology, 28(12).
2. Increased survival
Perhaps surprisingly, the volume of research directly investigating the role mindfulness and meditation might play in improving survival rates is way less than that examining quality of life benefits. However, some studies do show that improvements in quality of life are associated with life extension; perhaps most notably when depression is treated survival rates extend significantly.
One good direct example of possibilities is provided by the work of Prof Dean Ornish. For over a decade he has studied prostate cancer and the effects of lifestyle interventions on the progression of the disease. These long-term studies have consistently shown intensive lifestyle changes that include the regular practice of meditation decrease Prostate Specific Antigen (PSA) readings, increase telomere length, and slow the progression of prostate cancer.
Telomeres can be compared to small protective caps of DNA and protein at the end of each chromosome. The shortening of telomeres has been associated with a broad range of disease, including cancer, stroke, obesity, vascular dementia and cardiovascular disease. Research indicates that longer telomeres are associated with fewer illnesses and longer life.
After one year in this randomised study of 92 men, PSA levels had decreased by 4% in the lifestyle group and increased by 6% in the control group. After two years, 27% of patients in the control group had required treatment for cancer progression, but only 5% of the lifestyle group needed other treatment. It seems that the programme not only down-regulated gene expression for prostate cancer, it increased telomerase activity (telomerase being enzyme that lengthens and repairs telomeres).
Follow up after five years showed a significant increase in telomere length in participants who had adhered to the meditation and lifestyle changes. The control group underwent active surveillance only, and showed a notable decrease in telomere length.
Ornish commented in 2013 “larger randomised controlled trials are warranted to confirm this finding”. Remarkably, as yet, to my knowledge no further studies testing the impact of meditation and lifestyle interventions on cancer reversal have been reported.
Ornish D. Weidner G. Fair WR. et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174(3).
Ornish et al. Journal of Urology 2005;174:1065-70..
Ornish D, Blackburn EH et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.Lancet Oncol. 2013 Sep 16.
Evidence of benefit - more details - in summary
Quality of life
1. By association
Earlier research into the general benefits of mindfulness, meditation and related practices indicated a range of physiological and psychological benefits, many of which have direct implications for cancer. As a result of this early research and independent of potential effects on survival, at the start of this century mindfulness and meditation became increasingly accepted as an evidence-based option to be offered to patients to improve their coping with cancer, to assist with symptom control and to foster a better quality of life.
A brief summary of these related benefits include
i) Improved sleep
Sephton S. Spiegel D. Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun. 2003;17(5):321-8.
ii) Elevation of melatonin levels
Mahmoud F. Sarhill N. Mazurczak MA. The therapeutic application of melatonin in supportive care and palliative medicine. Am J Hospice & Palliative Care. 2005;22(4):295-309.
iii) Improved pain control
Kabat-Zinn J et al. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163-90.
iv) Improvement of depression
Teasdale JD, Moore RG, Hayhurst H, et al. Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol. 2002;70(2):275-87.
v) Less anxiety, better coping
Tacon AM. Et al. Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Family & Comm Health. 2003;26(1):25-33.
Speca M, et al. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613-22.
vi) Improved immunity
Davidson RJ Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(4):564-70.
vii) Spiritual factors
A review of 71 research articles indicated that imagery, meditation and group support activities may address spiritual health, resulting in beneficial outcomes of enhanced physical and emotional health and decreased cancer mortality.
Hawke SR et al. Review of spiritual health: definition, role, and intervention strategies in health promotion. Am J Health Promot. 1995 May-Jun;9(5):371-8.
viii) Telomere length and survival
These studies reported on the association between meditation, telomerase activity and increased telomere length (there is no drug known currently that can accomplish this).
Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008; 9: 1048‐ 1057.
Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36: 664‐ 681.
Quinn A. et al, Insight meditation and telomere biology: The effects of intensive retreat and the moderating role of personality Brain, Behavior, and Immunity, Volume 70, 2018, Pages 233-245.
2. Cancer specific research - meta-analyses
More recently, so much specific cancer-related research has been published investigating the role of mindfulness, meditation and related practices in cancer management, that meta-analysis are now common. Here are some of the more recent ones.
i) Clinical practice guidelines
These guidelines are provided to inform clinicians and patients about safe and effective evidence-based therapies as supportive care in patients treated for breast cancer by the American Society for Integrative Oncology Guidelines Working Group. They were developed using the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. The search identified 4900 articles, of which 203 were eligible for analysis.
Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Meditation, stress management, yoga, massage, music therapy and energy conservation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B).
Greenlee, Heather et al. “Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer". Journal of the National Cancer Institute. Monographs vol. 2014,50 (2014): 346-58..
ii) Cancer related pain and meditation-based techniques
A systematic review in 2019 of 6 studies that met strict criteria was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL.
Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019;6(2):161-169.
iii) Mindfulness and breast cancer specifically
This 2019 meta-analysis investigated 14 studies involving 1505 participants. It found statistically significant benefits for physiological function, cognitive function, fatigue, emotional wellbeing, anxiety, depression, stress, distress and mindfulness. Although the effects on pain, sleep quality, and global QoL were in the expected direction, they were not statistically significant based on insufficient evidence. The authors concluded the mindfulness-based program MBSR is worthy of being recommended to breast cancer patients as a complementary treatment or adjunctive therapy.
Zhang Q, Zhao H, Zheng Y. Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis. Support Care Cancer. 2019 Mar; 27(3):771-781.
3. Cancer specific research - key papers
i) Depression and its impact on mortality
Depression affects many people diagnosed with cancer and left untreated it is associated with increased mortality. This study investigated 1790 patients within 3 months of lung cancer diagnosis. 38% had depression at baseline and an additional 14% developed new-onset depression during cancer treatment. Depression symptoms at baseline were significantly associated with a 17% higher risk of mortality and was most marked in young patients.
At 12 months of follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease and those with late-stage disease. Importantly, remission of depression symptoms is associated with a similar mortality rate as never having had depression.
Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016 Oct 3.
ii) Strong depression link with breast cancer mortality
This randomized trial on 125 women with metastatic breast cancer compared a treatment group to a control group that received educational materials. Median survival time was 53.6 months for women with decreasing depression scores over 1 year and 25.1 months for women with increasing CES-D scores. Neither demographic nor medical variables explained this association. The researchers commented : “Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with breast cancer in this sample”.
Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. J Clin Oncol. 2011 February 1; 29(4): 413–420.
iii) Cortisol levels
This study demonstrated mindfulness and meditation can reduce cortisol levels in cancer patients – high cortisol levels being a sign of a poor prognosis – and improve quality of life.
Carlson LE. Speca M. Patel KD. Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448-74.
iv) Mindfulness in a group setting
This trial compared 2 empirically supported psychosocial group interventions, mindfulness‐based cancer recovery (MBCR) and supportive‐expressive group therapy (SET), with a minimal‐intervention control condition on mood, stress symptoms, quality of life, social support, and diurnal salivary cortisol in distressed breast cancer survivors. The mindfulness-based group resulted in the most psychosocial benefit, including improvements across a range of psychosocial outcomes. Both MBCR and SET resulted in healthier cortisol profiles over time compared with the control condition.
Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013; 31: 3119‐ 3126.
v) Short term intervention effective
Each patient in this study received an individual meditation consultation (60-minute initial visit and 30 minute follow-up visits). Participants recorded significant reductions from pre- to post- meditation session in physical, psychological and symptom distress component scores. All changes reached statistically and clinically significant thresholds. Researchers concluded that “a single meditation session resulted in acute relief in multiple self-reported symptoms with the greatest reduction in anxiety, fatigue & distress".
Chaoul, A., et al. (2014). An Analysis of Meditation Consultations in an Integrative Oncology Outpatient Clinic. The Journal of Alternative and Complementary Medicine, 20(5), A86-A86.
vi) Mental state and vigour
Where cancer patients learn mindfulness in their cancer management they were found to have significantly lower scores for low mood, depression, anxiety, anger, and confusion but they also had more vigour. They also had fewer overall physical and stress symptoms. Speca M, et al. Psychosom Med. 2000;62(5):613-22.
vii) Mindfulness and immunity
Among cancer patients, the significant improvements seen in overall quality of life, symptoms of stress, and sleep quality are associated with improvements in immunity with lower levels of the inflammatory hormones that can accelerate cancer growth. Carlson LE. Speca M. Patel KD. Goodey E. Psychosomatic Medicine. 2003;65(4):571-81..
People also show better immune response to vaccinations and increases in antibodies. Davidson RJ Psychosom Med. 2003;65(4):564-70.
viii) Meditation improves quality of life for breast cancer survivors
This study reported meditation was associated with significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep. Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.
Yun MR et al : The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct;40(5):377-385.
Online programs - increasingly well proven
i) Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
ii) How do online programs compare to face to face?
Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs.
This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU.
Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.
This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist.
Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.
This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.
Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study. J Med Internet Res 2020;22(10):e17526).
Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.
Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151.
Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.
Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.
iii) Online fatigue relief
Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. This paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. The study found both web-based interventions effective for managing fatigue severity.
Bruggeman‐Everts FZ, Wolvers MD, van de Schoot R, Vollenbroek‐Hutten MM, Van der Lee ML. Effectiveness of two web‐based interventions for chronic cancer‐related fatigue compared to an active control condition: Results of the “Fitter na kanker” randomized controlled trial. J Med Internet Res. 2017;19(10):e336.
iv) Online pain management
Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. An 8-week online mindfulness-based program was evaluated via interview. Participants reported an increase in perceived relaxation and calm, less pain and improved stress management.
Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y). 2020;11(7):1666-1677.
v) Future directions for Apps
This study investigated ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.
Huberty J, Puzia M, Eckert R, Larkey L. Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study. JMIR Cancer. 2020;6(1):e16926. Published 2020 Jan 25.
Increased survival
Starting in 1976, Dr Ainslie Meares published multiple case reports of remarkable remissions following intensive meditation practice. I happened to feature in one of those reports. It strikes me as remarkable that while in recent years there has been a large body of research published that clearly attests to the many benefits to quality of life that follow from mindfulness and meditation practice amongst people affected by cancer, very few investigations have been made into the potential meditation might have to contribute to longer survival times, even cures.
It does seem highly likely that a better quality of life translates into longer survival times, and some studies do support this proposition. However, it remains for the future for serious outcome studies to be pursued. Here is a summary of what is available so far.
1. Case reports
i) Dr Ainslie Meares and intensive meditation
Meares published multiple case reports of remission from cancer following intensive meditation. Here are a few…
a) Breast cancer
Meares A. Med J of Aust. 1976, 2:184
Meares A.
Med J of Aust. 1977, 2:132-133
Meares A. Med J of
Aust. Correspondence, 10 Sept 1977
b) Osteo-genic sarcoma - Meares reported my own remission :
Meares A. Med J Aust, 1978, 2:433
ii) Books on “Spontaneous Remission”
In 1993, the Institute of Noetic Sciences published the groundbreaking Spontaneous Remission: An Annotated Bibliography. The authors, Caryle Hirshberg and Brendan O’Regan, defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor.” The book assembled the largest database of medically reported cases of spontaneous remission in the world, with more than 3,500 references from more than 800 journals in 20 different languages. All the documents in the bibliography are downloadable from here.
While the book was very well received, many who featured in it objected to being described as “spontaneous remissions” as they felt they had contributed largely to their own recoveries. In consequence, Caryle Hirschberg interviewed many of the people featured (including myself) and coined a new term as the title for her subsequent book “Remarkable Recoveries”, published in 1995 along with co-author Marc Barasch.
More recently, in 2014, Kelly Turner published Radical Remission: Surviving Cancer Against All Odds where she too interviewed many long-term cancer survivors and analysed what common measures they linked to their unexpected recoveries.
From my own work, 2 books have been published recording “Radical Remissions” or “Remarkable Recoveries” :
Inspiring People – Stories of Remarkable Recovery and Hope, Edited by Ian Gawler, 1995 in which 43 stories are recounted.
Surviving Cancer – Inspiring Stories of Hope and Healing, Edited by Paul Kraus, 2008 in which 28 stories are recounted.
Increased survival linked to related factors
i) Breast cancer survival associated with depression
levels
See the Giese-Davis study above.
ii) Psychological and behavioural variables – a meta-analysis
This meta-analysis revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475.
3. OUTCOME STUDIES
i) Prostate cancer
Revisit the work of Prof Dean Ornish at the start of this article that reported reversal of prostate cancer.
ii) The complex case of group therapy, quality of life and survival
Spiegel reported in the Lancet 1989, that attending a group based upon emotional expression weekly for one year, doubled survival time for women with secondary breast cancer and some participants survived over 10 years.
Another trial was performed by Fawzy with 68 patients with early stage malignant melanoma. At 6-year follow-up those who had usual care plus stress management showed a halving of recurrence and much lower death rate (than the group with only the usual surgical management). Both groups also had their immune function monitored which showed that after being originally comparable, the stress management group had significantly better immune function after six months.
Other studies have also yielded promising results in terms of longer survival for liver, gastrointestinal malignancies, and lymphoma but others have shown equivocal or negative results. The last of these trials was a large-scale attempt to replicate the findings of Spiegel. The results of this trial were negative despite the fact that the effects of the intervention had a positive effect on quality of life and mental health.
Of the five negative or equivocal trials mentioned above only two reported a positive effect on mental health and quality of life while all the studies that showed a positive effect on survival reported improved mental health and quality of life. Therefore, the trend seen in eight out of these 10 cancer studies seems to be similar to the findings in studies of psycho-social support in heart disease; where a psychosocial intervention improves quality of life and mental health it has the ‘side-effect’ of prolonging survival, while if there is marginal or no long-term benefit on mood or quality of life there is no corresponding improvement in survival.
References for the above
Spiegel D et al. Lancet 1989;2:888-891.
Fawzy F. et al. Malignant melanoma; Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival six years later. Arch Gen Psych 1993;50:681-89.
Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. J Clin Oncol 1990;8:356-64.
Kuchler T. Henne-Bruns D. Rappat S. et al. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology. 1999;46:322-35.
Ratcliffe MA, Dawson AA, Walker LG. Eysenck Personality Inventory L-scores in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Psycho-oncology 1995;4:39-45.
Cunningham AJ. Edmonds CV. Phillips C. et al. A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology 2000;9(4):323-39.
Edelman S. Lemon J. Bell DR. Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology. 1999;8(6):474-81.
Ilnyckyj A, Farber J, Cheang MC, Weinerman BH. A randomized controlled trial of psychotherapeutic intervention in cancer patients. Ann R Coll Physicians Surg Can 1994;27:93-6.
Linn MW, Linn BS, Harris R. Effects of counselling for late stage cancer patients. Cancer 1982;49:1048.
Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 2001;345:1719-26.
Conclusion
My sense is if Dr Meares were still alive he would be delighted with how far meditation has come since his pioneering days. There is now a solid evidence base for mindfulness and meditation being used to help people affected by cancer (including their carers) to overcome both the associated symptoms of cancer such as stress, anxiety, depression, pain management and fatigue as well as to assist in their treatment and recovery.
Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Mindfulness, meditation and dementia
A literature
review
Dr Ian Gawler OAM, BVSc, MCounsHS.
November 2020.
What do mindfulness and meditation-based techniques have to offer people affected by dementia and their carers?
The context
The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no current medical cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers.
Mindfulness training has shown to improve psychological well-being in a variety of mental health conditions. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and their caregivers. In this extensive and well documented article, we examine
- Five recent, key research papers investigating the contribution mindfulness and meditation might make to those affected by dementia.
- What might be possible? Here we briefly examine the role of lifestyle and the mind in the prevention and treatment of dementia.
- The role in dementia for a purpose-built app – Allevi8.
- What is dementia and Alzheimer’s disease? Here we provide a detailed yet accessible summary of the many conditions collectively known as dementia.
- Early signs of dementia.
- The effectiveness of online mindfulness and meditation programs – what the research says.
- Conclusions.
1. Mindfulness, meditation and dementia – The research evidence base – key recent dementia research
i) Review : Mindfulness, meditation, cognition and stress in people with Alzheimer's disease (AD), dementia, mild cognitive impairment and subjective cognitive decline – 2018.
This meta-analysis investigated how the use of meditation as a behavioural intervention can reduce stress and enhance cognition, which in turn ameliorates some dementia symptoms. Ten papers were identified and reviewed.
There was a broad use of measures across all studies, with cognitive assessment, quality of life and perceived stress being the most common. Three studies used functional magnetic resonance imaging (fMRI) to measure functional changes to brain regions during meditation.
The interventions fell into the following three categories: mindfulness, most commonly mindfulness-based stress reduction(MBSR) (six studies); Kirtan Kriya meditation (three studies); and mindfulness-based Alzheimer's stimulation (one study). Three of these studies were randomised controlled trials.
All studies reported significant findings or trends towards significance in a broad range of measures, including a reduction of cognitive decline, reduction in perceived stress, increase in quality of life, as well as increases in functional connectivity, percent volume brain change and cerebral blood flow in areas of the cortex.
Russell-Williams J, Jaroudi W, Perich T, Hoscheidt S, El Haj M, Moustafa AA. Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia. Rev Neurosci. 2018;29(7):791-804.
ii) Do adults with MCI have the capacity to learn mindfulness meditation? - 2019 High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of Mild Cognitive Impairment (MCI) and Alzheimer’s disease(AD). While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.
Chronic stress negatively impacts the hippocampus, and high levels of chronic stress are associated with an increased incidence of MCI and AD. [6–8] Adults who are prone to high levels of psychological distress are more likely to develop dementia.[9] Animal research demonstrates that high levels of cortisol (the “stress hormone”) can damage the hippocampus[10], a key structure involved in memory processing that atrophies with Alzheimer’s disease. Thus, other stress-reducing interventions, such as meditation and yoga, might be helpful for adults with MCI.
Previous studies have shown that the hippocampus is selectively activated during meditation,[15–17] and experienced meditators have larger volumes and gray matter concentration in their hippocampi compared to matched controls.[18] In addition, research has shown that an eight-week MBSR class may increase gray matter density in the hippocampi of adults.[19] MBSR is thus a stress-reducing intervention that impacts the hippocampus and could potentially interrupt the progression of MCI through these effects.
The period of time when an individual has MCI is transient and offers a rare window of opportunity prior to the development of dementia; finding an intervention that could help patients at this point of time could be invaluable. Since adults with MCI still have brain plasticity,[20] we hypothesized that adults with MCI would be able to learn and benefit from mindfulness meditation and yoga.
What did the research find? Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. So in summary, cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.
Wells RE, Kerr C, Dossett ML, et al. Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study. J Alzheimers Dis. 2019;70(3):825-842.
iii) Review of already well researched mindfulness techniques - 2018
Although there is a wide variety of interventions that include components of mindfulness (e.g., Acceptance and Commitment Therapy), this review focuses on the two programs with the largest evidence base, the mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These group-based programs have been studied in healthy populations and in those with mental or physical disorders, showing satisfactory to good efficacy (Chiesa and Serretti, 2009; Hofmann et al., 2010; Hempel et al., 2014).
Although current research supports the rationale for MBI with persons with dementia and their caregivers, only few RCTs have been conducted and more research is necessary.
What can be said is participants receiving MBSR showed greater improvement in memory, but not cognitive control. Moreover, the MBSR group improved on measures of worry, depression, and anxiety, and decreased cortisol level for those with high baseline cortisol.
Studies with persons with Mild Cognitive Impairment (MCI) or Severe Cognitive Impairment (SCD) have looked at the effect of Mindfulness Based Interventions (MBI). This is informative for dementia research, since individuals with MCI have an increased annual conversion rate of 5–17% to Alzheimer’s disease (Cheng et al., 2017), and approximately 60% over a 15-year period of persons with SCD will continue to develop Alzheimer’s disease (Reisberg et al., 2008).
Studies with persons with MCI or subjective memory complaints have looked at the effect of MBI. One pilot study found a trend toward improvement of cognition, quality of life, and well-being for people in the mindfulness condition (Wells et al., 2013). A RCT showed that the participants in the MBI group showed less memory deterioration and greater decrease in depressive symptoms compared to the control group (Larouche et al., 2016).
Although these studies demonstrate feasibility of MBSR with older adults with SCD and MCI, and preliminary evidence for memory improvement, more research is necessary to investigate whether MBI can influence cognitive decline.
Berk L, Warmenhoven F, van Os J, van Boxtel M. Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions. Front Psychol. 2018;9:982. Published 2018 Jun 13. doi:10.3389/fpsyg.2018.00982.
iv) Mindfulness practice can improve health outcomes of MCI - 2017.
Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for mild cognitive impairment (MCI). This Australian study reported long-term mindfulness practice may be associated with cognitive and functional improvements for older adults with MCI. The researchers concluded mindfulness training could be a potential efficacious non-pharmacological therapeutic intervention for MCI.
Wong WP, Coles J, Chambers R, Wu DB, Hassed C. The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment. J Alzheimers Dis Rep. 2017;1(1):181-193. Published 2017 Dec 2.
v) Support for dementia carers – a meta-analysis
Following analysis of five RCTs involving 201 carers that assessed the effectiveness of MBSR, the authors concluded low-quality evidence suggests MBSR may reduce carers' depressive symptoms and anxiety, at least in the short term. “In conclusion, MBSR has the potential to meet some important needs of the carer, but more high-quality studies in this field are needed to confirm its efficacy.”
Liu Z, Sun YY, Zhong BL. Mindfulness-based stress reduction for family carers of people with dementia. Cochrane Database Syst Rev. 2018;8(8):CD012791. Published 2018 Aug 14. Low level evidence in support of intervention with carers.
2. What might be possible?
Dementia is now well identified as another of the chronic degenerative diseases - like cancer, heart disease and MS. All these other known chronic degenerative diseases have been shown to be prevented by Lifestyle interventions. Once present, their symptoms have all been shown to be significantly lessened by Lifestyle interventions; and all have shown some signs – ranging up to major – of reversal through Lifestyle interventions. So why not dementia???
And what are Lifestyle interventions? The things you can do for yourself – like what you eat and drink, your exercise levels, relaxation, mindfulness and meditation. Many believe the mind-based interventions are key, both due to their direct effects and because the mind decides what we do with our lifestyle. Get the mind into a good state and everything else follows – we eat better, drink more wisely, are more inclined to exercise and so on.
3. Purpose built app – Allevi8
The free mindfulness and meditation-based App - Allevi8 – has been specifically designed to assist people affected by chronic degenerative disease. Allevi8 targets 5 main issues – stress and mental health, emotional health, pain management, healing and finding meaning amidst adversity.
Allevi8 is available via a simple search in your App store. There is a free, meditation session via Zoom – Allevi8@8 - that goes out live each Monday. This session is well attended and many report how helpful it is to receive practice tips and meditate in a like-minded community each week. To join, simply download Allevi8 and the link will be sent by email. All of this is free, however, you might like to consider paying it forward – there is a secure donation facility on the App under “Gift”.
4. What is dementia and Alzheimer’s disease?
A simple guide to the facts about dementia and Alzheimer’s disease
What follows is a compilation of information from sources such as dementia and Alzheimer’s websites, scientific references and Wikipedia. This information has been compiled in good faith and is intended to be accurate, succinct and easy to understand. It is not a short read as dementia represents a range of conditions, each of which are explained in turn.
i) Dementia
Dementia, also known as senility, is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and remember that is great enough to affect a person's daily functioning. Other common symptoms include problems with emotional expression, language, and a decrease in motivation.
The most common type of dementia is Alzheimer’s disease which makes up 50% to 70% of cases. Other common types include vascular dementia (25%), dementia associated with Lewy bodies (15%), alcohol related dementia (unclear), fronto-temporal dementia (rare) and mixed dementia (10%).
ii) Alzheimer's disease
First be clear, Alzheimer's disease is not a normal part of aging. Alzheimer's disease is an acquired, progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioural changes.
Alzheimer's disease is associated with 2 types of abnormal lesions - plaques and tangles.
Plaques or to be more specific, Beta-amyloid plaques, are sticky clumps of protein fragments and cellular material that form outside and around neurons.
Tangles, or neurofibrillary tangles, are insoluble twisted fibers composed largely of the protein that builds up inside nerve cells.
Although these 2 lesions are hallmarks of the disease, scientists are unclear whether they cause it or a by-product of it.
The most common symptoms are short-term memory loss and word-finding difficulties. People with Alzheimer's disease also have trouble with visual-spatial areas (for example, they may begin to get lost often), reasoning, judgment, and insight. Insight refers to whether or not the person realizes they have memory problems.
Common early symptoms include repetition, getting lost, difficulties keeping track of bills, problems with cooking, forgetting to take medication, and word-finding problems.
The part of the brain most affected by Alzheimer's is the hippocampus. Other parts of the brain that show shrinking (atrophy) include the temporal and parietal lobes. However, the brain shrinkage in Alzheimer's disease is very variable, and a brain scan cannot actually make the diagnosis (but may eliminate other causes). The relationship between undergoing anaesthesia and Alzheimer's disease is unclear.
It is often said that the seriousness of, and difference between, AD and other dementias, is seen in the response to the question: “Did you turn the computer off?”
Those with dementia respond: “I can’t remember”. Those with AD respond: “ What’s a computer?”.
iii) Vascular dementia
This type of dementia is caused by disease or injury affecting the blood supply to the brain, typically involving a series of minor strokes. Symptoms will depend upon where the strokes have occurred and whether the vessels involved are large or small. Multiple injuries can cause progressive dementia over time, while a single injury located in a critical area critical (i.e. hippocampus, thalamus) can lead to sudden cognitive decline.
On scans of the brain, a person with vascular dementia may show evidence of multiple strokes of different sizes in various locations.
So what actually is a stroke?
A stroke happens when blood supply to the brain via an artery is interrupted. This occurs most commonly when the artery is blocked (ischaemic stroke) or much less commonly bursts (haemorrhagic stroke). The resulting area of brain damage is called a cerebral infarct, or more simply, just an infarct.
A major stroke occurs when the blood flow in a large vessel in the brain is suddenly and permanently cut off. Most often this happens when the vessel has become narrower and then is blocked by a clot. Much less often it is because the vessel bursts and bleeds into the brain. Minor strokes are when the same processes occur on a smaller scale.
Types of vascular dementia
Vascular dementia can differ according to the cause of the damage, the type of stroke involved and the part of the brain that is affected. The different types of vascular dementia have some symptoms in common and some symptoms that differ. Their symptoms tend to progress in different ways.
a) Post-stroke dementia
After a major stroke, the sudden interruption in the blood supply starves the brain of oxygen and leads to the death of a large volume of brain tissue. However, not everyone who has a stroke will develop vascular dementia, but about 20% of people who have a stroke do develop post-stroke dementia within the following 6 months. A person who has one major stroke is then at increased risk of having further strokes. If this happens, the risk of developing dementia is higher.
b) Single-infarct dementia and Multi-infarct dementia
This type of vascular dementia is caused by smaller strokes that commonly cause damage to the cortex of the brain, the area associated with learning, memory and language.
These types of stroke may be so small that the person does not notice any symptoms when they occur. Alternatively, the symptoms may only be temporary - lasting perhaps a few minutes - because the blockage clears itself. If symptoms last for less than 24 hours, it is called a 'mini-stroke' or transient ischaemic attack (TIA). A TIA may mistakenly be dismissed as a 'funny turn'.
If such a stroke interrupts the blood supply for more than a few minutes, an infarct will result. Sometimes just one infarct forms in an important part of the brain and this causes dementia (known as single-infarct dementia). Much more often, a series of small strokes over a period of weeks or months lead to a number of infarcts spread around the brain. Dementia in this case (known as multi-infarct dementia) is caused by the total damage from all the infarcts together.
A person with Multi-infarct dementia is likely to have better insight in the early stages than people with Alzheimer's disease, and parts of their personality may remain relatively intact for longer. Symptoms may include severe depression, mood swings and epilepsy.
c) Subcortical dementia or Binswanger's disease
This was thought to be rare, but is now being reassessed, and may in fact be relatively common. Once considered rare, is now thought to be the most common type of vascular dementia.
Subcortical vascular dementia is caused by diseases of the very small blood vessels that causes infarcts to tissue that lies deep in the brain - the “white matter”. These small vessels develop thick walls and become stiff and twisted, meaning that blood flow through them is reduced. It is caused by high blood pressure, thickening of the arteries and inadequate blood flow.
Small vessel disease often damages the bundles of nerve fibres that carry signals around the brain, known as white matter. It can also cause small infarcts near the base of the brain. Small vessel disease develops much deeper in the brain than the damage caused by many strokes. This means many of the symptoms of subcortical vascular dementia are different from those of stroke-related dementia.
Common symptoms include slowness and lethargy, difficulty walking, emotional ups and downs and lack of bladder control early in the course of the disease.
iv) Lewy Body disease
Lewy body disease is caused by the degeneration and death of nerve cells in the brain. The name comes from the presence of abnormal spherical structures, called Lewy bodies, which develop inside nerve cells. It is thought that these may contribute to the death of the brain cells.
Lewy body disease is similar to Alzheimer's disease in many ways, and in the past it has sometimes been difficult to distinguish the two. It has only recently been accepted as a disease in its own right. It can occur by itself or together with Alzheimer's disease and/or Vascular dementia. It may be hard to distinguish Lewy body disease from Parkinson's disease, and some people with Parkinson's disease develop a dementia that is similar to that seen in Lewy body disease.
The symptoms of dementia with Lewy body disease include difficulty with concentration and attention, extreme confusion and difficulties judging distances, often resulting in falls.
There are also three cardinal symptoms, two of which must be present in order to make the diagnosis:
- - Visual hallucinations
- - Parkinsonism (tremors and stiffness similar to that seen in Parkinson's disease)
- - Fluctuation in mental state so that the person may be lucid and clear at one time and confused, disoriented and bewildered at other times. Typically this fluctuation occurs over a period of hours or even minutes and is not due to any underlying acute physical illness.
Some people who have Lewy body disease may also experience delusions and/or depression.
v) Alcohol related dementia
Alcohol related dementia can affect men and women of any age. It is currently unclear as to whether alcohol has a direct toxic effect on the brain cells (neurotoxicity hypothesis), or whether the damage is due to lack of thiamine (or vitamin B1). Nutritional problems, which often accompany consistent or episodic heavy use of alcohol, are thought to be contributing factors.
Symptoms include
- - Impaired ability to learn things
- - Personality changes
- - Problems with memory
- - Difficulty with clear and logical thinking on tasks which require planning, organising, common sense judgement and social skills
- - Problems with balance
- - Decreased initiative and spontaneity.
Generally skills learned earlier in life and old habits such as language and gestures tend to be relatively unaffected.
Who gets alcohol related dementia?
Anyone who drinks excessive amounts of alcohol over a period of years may get alcohol related dementia. Males who drink more than six standard alcoholic drinks a day, and women who drink more than four, seem to be at increased risk of developing alcohol related dementia. The risk clearly increases for people who drink high levels of alcohol on a regular basis.
The National Health & Medical Research Council of Australia recommends that for health reasons related to the prevention of brain and liver damage adult males should drink no more than four standard drinks per day and adult females should drink no more than two standard drinks per day.
NOTE : For cancer, there is no really safe limit.
Some people who drink at high levels do not develop alcohol related dementia, but it is not currently possible to understand and predict who will and who will not develop alcohol related dementia.
Some people who develop alcohol related dementia might also show some degree of recovery over time if they reduce alcohol intake to safe levels or abstain from alcohol and maintain good health.
vi) Fronto-temporal dementia or Pick’s disease
Fronto-temporal dementia (FTD) is one of the less common types of dementia. The term covers a wide range of different conditions. FTD occurs when nerve cells in the frontal and/or temporal lobes of the brain die, and the pathways that connect the lobes change. Some of the chemical messengers that transmit signals between nerve cells are also lost. Over time, as more and more nerve cells die, the brain tissue in the frontal and temporal lobes shrinks.
The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem solving, planning, speech and the control of emotions.
Symptoms of FTD include changes in personality and behaviour, and difficulties with language. These symptoms are different from the memory loss often associated with more common types of dementia, such as Alzheimer’s disease. As FTD is a less common form of dementia, many people (including some health professionals) may not have heard of it.
vii) Mixed dementia
At least 10 per cent of people with dementia are diagnosed with mixed dementia. This generally means that both Alzheimer's disease and vascular disease are thought to have caused the dementia. The symptoms of mixed dementia may be similar to those of either Alzheimer's disease or vascular dementia, or they may be a combination of the two.
5. Early signs of dementia
The early signs of dementia are very subtle and vague and may not be immediately obvious. Some common symptoms may include:
- - Progressive and frequent memory loss
- - Confusion
- - Personality change
- - Apathy and withdrawal
- - Loss of ability to perform everyday tasks.
6. The effectiveness of online mindfulness and meditation programs – increasingly well proven
i) Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
ii) How do online programs compare to face to face?
Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs…
This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU.
Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.
This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist.
Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.
This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.
Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study; J Med Internet Res 2020;22(10):e17526).
Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.
Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151.
Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.
Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.
Conclusion
There is now a solid evidence base for mindfulness and meditation being used to help people affected by dementia (including their carers) to overcome the associated symptoms of dementia such as stress, anxiety, depression and loss of cognition and memory.
Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Heart disease
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Multiple Sclerosis
A residential program for people with multiple sclerosis that teaches meditation and lifestyle changes has been shown, over a 5 year period, to lead to significant improvements in general health, including physical symptoms and mobility, many aspects of quality of life and mental health. The people on average improved in all these parameters by around 20%, whereas the general population of people with MS would be expected to deteriorate by around 10% over that same 5 year period.
References
Hadgkiss E J, Jelinek GA, Weiland TJ, et al. Neurol Sci, 25 Feb 2012
Parkinson’s disease
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Rheumatoid Arthritis
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Stroke, mindfulness and meditation
A literature
review
Dr Ian Gawler OAM, BVSc, MCounsHS.
November 2020.
The challenge
What evidence is there mindfulness and meditation can have therapeutic benefits for those affected by stroke? Are people affected by stroke capable of practicing mindfulness and meditation? Even more, what evidence is there an online program will be useful?
While this is an emerging field of research, already there is some good evidence for mindfulness and meditation – including on-line programs - facilitating improvements in both coping and recovery; and that carers can receive significant benefit.
1. Anxiety and depression
a) The scale of the problem amongst those affected by stroke
The prevalence of depression is reported to be very high among stroke survivors and has been associated with adverse clinical outcomes.
A meta-analysis published in 2005 reported a pooled estimate of 33% for the prevalence of depression in stroke survivors (i). A multi-national study of 220 patients observed that the prevalence of depression remained as high as 33% for up to 5 years post stroke (ii). In addition, a review assessing post-stroke mortality reported increased odds of mortality for a period of 2 to 5 years among patients with depressive symptoms based on findings from 13 studies including 59,598 patients with stroke (iii). Previous research has suggested that the prevalence of depression and anxiety among carers is comparable to the observed prevalence levels among stroke survivors, and directly related to the severity of stroke (iv – vi). In addition, there is also evidence that stroke survivors and their carers mutually influenced each other’s emotional state (vii – viii).
i) Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330–1340. https://pubmed.ncbi.nlm.nih.gov/15879342/
ii) Lincoln NB, Brinkmann N, Cunningham S, Dejaeger E, De Weerdt W, Jenni W, et al. Anxiety and depression after stroke: a 5 year follow-up. Disabil Rehabil. 2013;35:140–145.
iii) Bartoli F, Lillia N, Lax A, Crocamo C, Mantero V, Carrà G, et al. Depression after stroke and risk of mortality: a systematic review and meta-analysis. Stroke Res Treat. 2013;2013:862978.
iv) Berg A, Palomaki H, Lonnqvist J, Lehtihalmes M, Kaste M. Depression among caregivers of stroke survivors. Stroke [Internet] 2005;36:639–643.
v) Opara JA, Jaracz K. Quality of life of post-stroke patients and their caregivers. J Med Life. 2010;3:216–220.
vi) Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil [Internet] 2013;94:1731–1736
vii) McCarthy MJ, Lyons KS, Powers LE. Expanding poststroke depression research: movement toward a dyadic perspective. Top Stroke Rehabil [Internet] 2011;18:450–460.
viii) Godwin KM, Ostwald SK, Cron SG, Wasserman J. Long-term health-related quality of life of stroke survivors and their spousal caregivers. J Neurosci Nurs [Internet] 2013;45:147–154.
b) Mindfulness and meditation relieve anxiety and depression
Several systematic reviews and meta-analyses support the use of mindfulness-based interventions (MBIs) (largely derived from MBSR) in helping people with long-term conditions (LTCs) to cope better with improvements in symptoms of anxiety and depression.
Here are two…
i) Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of Mindfulness-Based Stress Reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68:539–544.
ii) Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.
2. Mindfulness and meditation’s specific influence on stroke outcomes
A recent systematic review of the benefits of MBIs among patients with stroke, including four studies and 160 participants in total, concluded that a range of benefits may be derived from MBIs in this population.
Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8:465–474.
Another systematic review and critical appraisal of the evidence on the effectiveness of behavioural therapies such as yoga and mindfulness practices for stroke rehabilitation examined 5 randomized controlled clinical trials and 4 single case studies. Additionally, one qualitative research study was identified. Studies reported positive results, including improvements in cognition, mood, and balance and reductions in stress. The authors concluded yoga and mindfulness could be clinically valuable self-administered intervention options for stroke rehabilitation.
Lazaridou A, Philbrook P, Tzika AA. Yoga and mindfulness as therapeutic interventions for stroke rehabilitation: a systematic review. Evid Based Complement Alternat Med. 2013;2013:357108.
3. Can people affected by stroke actually practice mindfulness and meditation?
Clinical experience says yes, however, recently a small study did examine the feasibility of an adapted 2-week mindfulness meditation protocol for chronic stroke survivors. In addition, preliminary effects of this adapted intervention on spasticity and quality of life in individuals after stroke were explored. Exploratory preliminary analyses showed statistically significant improvements in spasticity, along with improvements in quality of life measures for Energy, Personality, and Work/Productivity.
Wathugala M, Saldana D, Juliano JM, Chan J, Liew SL. Mindfulness Meditation Effects on Poststroke Spasticity: A Feasibility Study. J Evid Based Integr Med. 2019 Jan-Dec;24:2515690X19855941.
4. Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
5. Conclusion
There is a solid evidence base for mindfulness and meditation being used to help people affected by stroke (including their carers). These interventions can reduce the associated symptoms of stroke such as stress, anxiety and depression, as well as assist in recovery.
Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Type II Diabetes
Coming Soon...
Evidence by symptoms/issues
Mental health, mindfulness and meditation
A
literature review
Dr Ian Gawler OAM, BVSc, MCounsHS.
November 2020.
Summary - Mindfulness and meditation are evidence based
There is a strong body of evidence mindfulness and meditation can have therapeutic benefits for those dealing with a wide range of mental health issues - stress, anxiety, depression and more. There is also good evidence online programs are useful, and that these programs can significantly assist those caring for people affected by mental health issues.
Want key scientific articles to share with family, friends or health professionals who need convincing? Need a little reassurance yourself? Just want the facts?
Currently if one searches “mindfulness and meditation research”, Google comes up with around 17.6 million results. A bit daunting. So while what follows is no PhD, here are some of the top, recent articles (mostly meta- analyses) that highlight this rapidly expanding yet already solid evidence base.
1. Reducing stress and anxiety with online mindfulness
Spijkerman MP et al. 2016, Clin Psych review, Vol 45, 102 114.
Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials.
The authors reported online Meditation- Based Interventions have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
2. App use improves mental health
Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.
“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.
3. Stress, anxiety and depression reduction; improvements in mental and physical health
From the American Psychological Association website, 2019 Creswell JD and Khoury B. Mindfulness meditation: A research-proven way to reduce stress : Mindfulness meditation can improve both mental and physical health.
Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety and depression. Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction. Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression. What is more, mindfulness-based interventions can improve physical health too. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain. Other studies have found preliminary evidence that mindfulness might boost the immune system and help people recover more quickly from cold or flu.
4. Reducing stress and anxiety with mindfulness based therapy
Khoury B et al. Mindfulness-based therapy: A comprehensive meta-analysis; 2013 Clin Psych Review vol 33, 6, 763 - 771.
Meta-analysis (review) of studies evaluating Mindfulness Based Therapy – a specific form of mindfulness. The authors concluded “MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.”
5. Reducing (symptoms) psychological distress
Coffey, K. A., & Hartman, M. (2008). Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress. Complementary Health Practice Review, 13(2), 79–91.
The authors reported their results confirmed an inverse relationship between mindfulness and psychological distress.
6. Anxiety, mood disorders and accelerating healing
Arias et al. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006;12(8):817‐832.
While there have been few studies examining the specific question of meditation’s influence on healing in general, early studies are positive.
The authors reported the strongest evidence for efficacy was found for epilepsy, symptoms of the premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. They stated their results support the safety and potential efficacy of meditative practices for treating certain illnesses, particularly in nonpsychotic mood and anxiety disorders.
7. Reducing depression and fatigue; improving sleep
Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501.
Following this randomised clinical trial, the author’s reported Mindfulness Awareness Practices showed significant improvement relative to the Sleep Hygiene Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.
8. Reducing stress and anxiety with meditation
Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68.
This meta-analysis reviewed 18,753 citations, however, only 47 trials with 3515 participants met the stringent criteria to be included in the final analysis – having randomized clinical trials with active controls for placebo.
The authors concluded meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Specifically, there was found to be moderate evidence of improved anxiety, depression and pain, with lower evidence of improved stress/distress and mental health-related quality of life.
9. Depression and mindfulness
Research on Mindfulness Based Cognitive Therapy (MBCT) has found that these techniques more than halve the relapse rate for people who have had depression - from 78% to 36%. Meditation changes our relationship to negative thoughts and emotions giving a non-attachment to them and therefore, we are not controlled by them so much.
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects: J Consult Clin Psychol. 2004;72(1):31-40.
10. Adolescents and mindfulness
In adolescents, mindfulness reduces symptoms of anxiety, depression, and somatic distress, and increases self-esteem and sleep quality.
Biegel et al. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial: Journal of consulting and clinical psychology (2009) vol. 77 (5) pp. 855-66.
11. Burn-out in doctors and mindfulness
For professionals with high stress loads such as doctors, Mindfulness has also been found to enhance wellbeing, reduce burnout and mood disturbance with increased empathy and responsiveness to their patients.
Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians: JAMA. 2009 Sep 23;302(12):1338-40.
Conclusion
There is a solid evidence base for mindfulness and meditation being used to help people affected by mental health issues (including their carers). These interventions can reduce symptoms associated with stress, anxiety and depression, as well as assist in recovery.
Also, there is good evidence online mindfulness - based programs such as the Allevi8 App have positive benefits and these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Emotional health
Coming soon...
Pain relief
Dr Ainslie Meares and Ian Gawler have both reported on dramatic positive benefits observed when people with chronic pain learn to meditate. Mindfulness meditation has been found to be associated with a significant reduction in pain, fatigue, and sleeplessness along with improved function, mood and general health for people with chronic pain syndromes.
References
Meares, A. Relief Without Drugs. 1967; Hill of Content, Melbourne.
Gawler IJ, You Can Conquer Cancer, revised edition. 2020; Michelle Anderson Publishing, Melbourne.
Kabat-Zinn J et al. J Behav Med. 1985;8(2):163-90.
Singh BB, et al. Altern Ther Health Med. 1998;4(2):67-70.
Astin JA, et al. J Rheumatol. 2003;30(10):2257-62.
Relaxation, Mindfulness, Meditation And Sleep – The research evidence base
Clinical Experience
Before listing the research, allow me to say this. Having assisted people for over 4 decades to apply relaxation, mindfulness and meditation to manage their sleep disturbances, three things really stand out.
1. Regular relaxation-based mindfulness and meditation improve sleep patterns significantly
Over the years, many people have reported significant sleep benefits when they practice using the key practices we have included on the Allevi8 App. My sense of this is the deep physical relaxation is very important as a foundation, and then mindfulness and meditation lead to a calmer, more relaxed mind. The two together then combine so that many people, including those dealing with major illnesses like cancer and MS report it is easier to go to sleep, easier to get back to sleep if they do happen to wake, and their quality of sleep feels deeper and more refreshing.
So in fact, many of the people I have helped sleep better found regular practice was the key. The 3 practices most commonly agreed upon to be helpful have been the Deep Relaxation, the Main Practice and the Healing Light Imagery practices.
2. Specific techniques for when you need extra help
The best support to use as you are going to sleep, or to use again if you do need help to return to sleep during the night, is the simplified Deep Relaxation exercise. As guided in the Sleep section of Allevi8, this exercise has a simple introduction and at the end it fades into silence. Many people have told me they fall asleep around half way through when listening to this track in bed, and many have used it repeatedly without ever hearing how it ends!
3. Attitude is important
As we all know, worrying does not help, so do what you can to let go of dwelling on whether you are sleeping or not, how much you are sleeping, or how often you are waking. This approach is actually supported by sleep research that indicates we receive almost as much benefit from simply lying in bed relaxed, as we might from being fully asleep. Maybe this is where the Deep Relaxation exercise comes in again. This exercise does reliably lead to deep relaxation of body and mind, so do what you can to let go of any worry and simply relax into the exercises and the restful nature of simply being in bed.
WHAT DOES THE RESEARCH HAVE TO SAY?
1. The size of the problem
Sleep disturbance is widespread with significant adverse consequences on quality of life for the individual and significant economic burden for society. Approximately 6% to 20% of adults suffer from an insomnia disorder, characterized as persistent difficulty falling or staying asleep with concomitant waking dysfunction, making it the most prevalent sleep disorder.
Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn, Sleep Med Rev, 2002, vol. 6 – P97-111.
Morin CM et al. Prevalence of insomnia and its treatment in Canada, Can J Psychiatry, 2011, Vol 6- P540- 548..
Roth T et al, Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: results from the America insomnia survey,Biol Psychiatry, 2011, Vol 69, P 592 – 600.
2. What might be possible? Early research
Although meditation is about cultivating restful awareness, it can help to significantly improve sleep. Early research indicated meditation to be associated with better sleep quality, being able to go to sleep more easily, longer sleep duration and less use of sleep medications.
Cohen L et al, Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253-60.
These benefits may explain why meditation also can be responsible for reducing depression in those with chronic insomnia.
Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010 Jul;72(6):539-48.
3. Recent mindfulness and meditation sleep studies
What follows is a sample of some of the recent individual mindfulness and meditation sleep studies with links to the original articles. While not a definitive research compilation, they provide evidence to support the common clinical experience that both regular relaxation, mindfulness and meditation practice, along with the use of specific techniques, does in fact improve sleep patterns significantly.
i) Alleviating chronic insomnia
This study involving 54 people, found mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia.
Jason C. Ong, PhD, Rachel Manber, PhD, Zindel Segal, PhD, Yinglin Xia, PhD, Shauna Shapiro, PhD, James K. Wyatt, PhD, A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia, Sleep, Volume 37, Issue 9, 1 September 2014, Pages 1553–1563,
ii) Deep Relaxation alleviates anxiety and improves sleep for people affected by COVID-19
The researchers commented that through clinical observation, many COVID-19 patients developed anxiety and sleep disturbances after isolation treatment. Anxiety, as a kind of psychological stress, will trigger a series of physiological events and cause a decrease in immunity. Because the symptoms are mild in the early stage, but can suddenly worsen after a few days, the use of benzodiazepine-type sleep-promoting drugs may cause respiratory depression and delay the observation of the disease.
Therefore the Progressive Muscle Relaxation as used in the Deep Relaxation exercise on Allevi8) was trialled. Fifty one patients who entered a Hospital isolation ward were included in the study and randomly divided into experimental and control groups. The experimental group used progressive muscle relaxation (PMR) technology for 30 min per day for 5 consecutive days. During this period, the control group received only routine care and treatment.
The study concluded that using the Progressive Muscle Relaxation exercise (as guided during the Deep Relaxation exercise on Allevi8) as an auxiliary method can reduce anxiety and improve sleep quality in patients with COVID-19.
Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract. 2020;
iii) Reducing depression and fatigue; improving sleep
This randomised clinical trial showed Mindfulness Awareness Practices led to significant improvement relative to a thorough Sleep Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.
Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial.JAMA Intern Med. 2015;175(4):494–501.
iii) How does mindfulness improve sleep?
The authors of this study suggested that awareness and acceptance could be the mechanisms of mindfulness interventions in improving sleep quality, partly via reducing psychological stress.
Lau WKW, Leung MK, Wing YK, Lee TMC. Potential Mechanisms of Mindfulness in Improving Sleep and Distress. Mindfulness (N Y). 2018;9(2):547-555.
iv) Does mindfulness lead in to better sleep?
This research examined whether a brief mindfulness induction immediately prior to sleep following night training might improve athletes’ sleep. University athletes were randomly assigned into experimental group (n = 32) and control group (n = 31). Following night training and just prior to sleep, those in the experimental group received a self-administered brief 6-min mindfulness induction via a video clip, whereas the control group participants viewed a similar 6-min video devoid of mindfulness induction passively. Results showed reduced pre-sleep arousal, and improved level of rest and overall sleep quality, but not sleep duration. These findings suggest that the brief mindfulness induction may be an effective approach for decreasing pre-sleep arousal and improving sleep quality after night training among athletes.
Effect of Brief Mindfulness Induction on University Athletes’ Sleep Quality Following Night Training. Li C et al; J Front. Psychol., 12 April 2018 .
v) Sleep quality - Mindfulness meditation interventions produce significant improvements – a meta- analysis
From 3303 total records, this study examined 18 trials with a total of 1654 participants. The study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention and at follow-up.
These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
Rusch HL, Rosario M, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16.
Healing
Coming soon...
Finding meaning
Coming soon...
Evidence by disease type
Mindfulness, meditation and cancer
A
literature review
Dr Ian Gawler BVSc,
MCounsHS. November 2020.
What do mindfulness and meditation-based techniques have to offer people affected by cancer and their carers?
Introduction
In 1967, Dr Ainslie Meares published a ground breaking book – Relief Without Drugs in which he advocated meditation as a therapy for a wide range of physical and psychological conditions.
In 1985, Dr Meares published an hypothesis in the Medical Journal of Australia in which he speculated intense meditation might actually reverse the progress of cancer. Fair to say there was strong opposition from his medical and scientific colleagues. However, at the time, I had been diagnosed with advanced secondary osteo-genic sarcoma (bone cancer) and had a prognosis of 3 to 6 months.
So, having agreed to test Dr Meares hypothesis and used his methods as a core element in my subsequent survival, and having taught those techniques (along with additions) to many thousands of people affected by cancer over 4 decades, I have lived long enough to see the place of meditation in cancer management go through the 19th century German philosopher Schopenhauer’s 3 stages of truth: First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident. Well, almost.
It seems reasonable to contend meditation has entered the mainstream in a general sense. It enjoys widespread acceptance and uptake. It is estimated that 200–500 million people meditate worldwide.
When it comes to cancer, the evidence regarding its contribution to improving quality of life for both patients, survivors and carers is compelling. Search scholarly articles for mindfulness and meditation and cancer, and around 1.5 million results appear. However, regarding the capacity to actually increase survival, while case reports and some small studies are positive, this is an area of little good quality research.
So, what follows is a summary of key research articles supporting the use of mindfulness, meditation and related practices for people affected by cancer. This is no PhD article and makes no claim to be comprehensive, but hopefully it does highlight some of the best of recent research in the field.
Evidence of benefit - key research articles
Short on time? Need the most important and
latest findings?
Here they are, while
much more detail follows…
1. Quality of life
The evidence strongly suggests meditation and mindfulness-based programs do improve quality of life – in person and online. Two recent meta-analyses of mindfulness programs for cancer patients and survivors have both reported improvements in pain, psychological distress, anxiety, depression, fear of cancer recurrence, and sleep quality. Of note, four of the 29 studies included were online programs where the online programs recorded similar benefits to face-to-face programs.
i) This 2020 review of 28 RCTs enrolling 3053 adults with cancer was published in the prestigious Journal of the American Medical Association. The findings? Mindfulness Based Interventions (MBIs) were associated with significant reductions in the severity of short-term and medium-term anxiety but not long-term. MBIs were associated with a reduction in the severity of depression in the short term and the medium term; as well as improved health-related quality of life in patients in the short term and the medium term. The study also found MBIs were associated with reductions in anxiety and depression up to 6 months postintervention in adults with cancer.
Oberoi S, et al. Association of Mindfulness-Based Interventions With Anxiety Severity in Adults With Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Aug 3;3(8).
ii) This 2019 review of 29 independent RCTs with 3274 participants found small and statistically significant effects of MBIs on combined measures of psychological distress. Statistically significant effects were also found at either post‐intervention or follow‐up for a range of self‐reported secondary outcomes, including anxiety, depression, fear of cancer recurrence, fatigue, sleep disturbances, and pain. Improvements in mindfulness skills were associated with greater reductions in psychological distress at post‐intervention.
Cillessen, L et al. (2019). Mindfulness-based interventions for psychological and physical health outcomes in cancer patients and survivors: a systematic review and meta-analysis of randomized controlled trials. Psycho-Oncology, 28(12).
2. Increased survival
Perhaps surprisingly, the volume of research directly investigating the role meditation and mindfulness might play in improving survival rates is way less than that examining quality of life benefits. However, some studies do show that improvements in quality of life are associated with life extension; perhaps most notably when depression is treated survival rates extend significantly.
One good direct example of possibilities is provided by the work of Prof Dean Ornish. For over a decade he has studied prostate cancer and the effects of lifestyle interventions on the progression of the disease. These long-term studies have consistently shown intensive lifestyle changes that include the regular practice of meditation decrease Prostate Specific Antigen (PSA) readings, increase telomere length, and slow the progression of prostate cancer.
Telomeres can be compared to small protective caps of DNA and protein at the end of each chromosome. The shortening of telomeres has been associated with a broad range of disease, including cancer, stroke, obesity, vascular dementia and cardiovascular disease. Research indicates that longer telomeres are associated with fewer illnesses and longer life.
After one year in this randomised study of 92 men, PSA levels had decreased by 4% in the lifestyle group and increased by 6% in the control group. After two years, 27% of patients in the control group had required treatment for cancer progression, but only 5% of the lifestyle group needed other treatment. It seems that the programme not only down-regulated gene expression for prostate cancer, it increased telomerase activity (telomerase being enzyme that lengthens and repairs telomeres).
Follow up after five years showed a significant increase in telomere length in participants who had adhered to the meditation and lifestyle changes. The control group underwent active surveillance only, and showed a notable decrease in telomere length.
Ornish commented in 2013 “larger randomised controlled trials are warranted to confirm this finding”. Remarkably, as yet, to my knowledge no further studies testing the impact of meditation and lifestyle interventions on cancer reversal have been reported.
Ornish D. Weidner G. Fair WR. et al. Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology. 2005;174(3).
Ornish et al. Journal of Urology 2005;174:1065-70..
Ornish D, Blackburn EH et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.Lancet Oncol. 2013 Sep 16.
Evidence of benefit - more details - in summary
Quality of life
1. By association
Earlier research into the general benefits of mindfulness, meditation and related practices indicated a range of physiological and psychological benefits, many of which have direct implications for cancer. As a result of this early research and independent of potential effects on survival, at the start of this century mindfulness and meditation became increasingly accepted as an evidence-based option to be offered to patients to improve their coping with cancer, to assist with symptom control and to foster a better quality of life.
A brief summary of these related benefits include
i) Improved sleep
Sephton S. Spiegel D. Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun. 2003;17(5):321-8.
ii) Elevation of melatonin levels
Mahmoud F. Sarhill N. Mazurczak MA. The therapeutic application of melatonin in supportive care and palliative medicine. Am J Hospice & Palliative Care. 2005;22(4):295-309.
iii) Improved pain control
Kabat-Zinn J et al. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8(2):163-90.
iv) Improvement of depression
Teasdale JD, Moore RG, Hayhurst H, et al. Metacognitive awareness and prevention of relapse in depression: empirical evidence. J Consult Clin Psychol. 2002;70(2):275-87.
v) Less anxiety, better coping
Tacon AM. Et al. Mindfulness meditation, anxiety reduction, and heart disease: a pilot study. Family & Comm Health. 2003;26(1):25-33.
Speca M, et al. A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom Med. 2000;62(5):613-22.
vi) Improved immunity
Davidson RJ Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(4):564-70.
vii) Spiritual factors
A review of 71 research articles indicated that imagery, meditation and group support activities may address spiritual health, resulting in beneficial outcomes of enhanced physical and emotional health and decreased cancer mortality.
Hawke SR et al. Review of spiritual health: definition, role, and intervention strategies in health promotion. Am J Health Promot. 1995 May-Jun;9(5):371-8.
viii) Telomere length and survival
These studies reported on the association between meditation, telomerase activity and increased telomere length (there is no drug known currently that can accomplish this).
Ornish D, Lin J, Daubenmier J, et al. Increased telomerase activity and comprehensive lifestyle changes: a pilot study. Lancet Oncol. 2008; 9: 1048‐ 1057.
Jacobs TL, Epel ES, Lin J, et al. Intensive meditation training, immune cell telomerase activity, and psychological mediators. Psychoneuroendocrinology. 2011; 36: 664‐ 681.
Quinn A. et al, Insight meditation and telomere biology: The effects of intensive retreat and the moderating role of personality Brain, Behavior, and Immunity, Volume 70, 2018, Pages 233-245.
2. Cancer specific research - meta-analyses
More recently, so much specific cancer-related research has been published investigating the role of mindfulness, meditation and related practices in cancer management, that meta-analysis are now common. Here are some of the more recent ones.
i) Clinical practice guidelines
These guidelines are provided to inform clinicians and patients about safe and effective evidence-based therapies as supportive care in patients treated for breast cancer by the American Society for Integrative Oncology Guidelines Working Group. They were developed using the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. The search identified 4900 articles, of which 203 were eligible for analysis.
Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Meditation, stress management, yoga, massage, music therapy and energy conservation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B).
Greenlee, Heather et al. “Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer". Journal of the National Cancer Institute. Monographs vol. 2014,50 (2014): 346-58..
ii) Cancer related pain and meditation-based techniques
A systematic review in 2019 of 6 studies that met strict criteria was undertaken to describe the effectiveness of mindfulness interventions for pain and its underlying pathophysiologic mechanisms. These studies tested several types of intervention including mindfulness-based stress reduction, mindfulness-based cognitive therapy, meditation with massage, and mindful awareness practices. Study outcomes include improved pain severity, anxiety, stress, depression, and QoL.
Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia Pac J Oncol Nurs. 2019;6(2):161-169.
iii) Mindfulness and breast cancer specifically
This 2019 meta-analysis investigated 14 studies involving 1505 participants. It found statistically significant benefits for physiological function, cognitive function, fatigue, emotional wellbeing, anxiety, depression, stress, distress and mindfulness. Although the effects on pain, sleep quality, and global QoL were in the expected direction, they were not statistically significant based on insufficient evidence. The authors concluded the mindfulness-based program MBSR is worthy of being recommended to breast cancer patients as a complementary treatment or adjunctive therapy.
Zhang Q, Zhao H, Zheng Y. Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis. Support Care Cancer. 2019 Mar; 27(3):771-781.
3. Cancer specific research - key papers
i) Depression and its impact on mortality
Depression affects many people diagnosed with cancer and left untreated it is associated with increased mortality. This study investigated 1790 patients within 3 months of lung cancer diagnosis. 38% had depression at baseline and an additional 14% developed new-onset depression during cancer treatment. Depression symptoms at baseline were significantly associated with a 17% higher risk of mortality and was most marked in young patients.
At 12 months of follow-up, depression symptoms were associated with increased mortality among participants with early-stage disease and those with late-stage disease. Importantly, remission of depression symptoms is associated with a similar mortality rate as never having had depression.
Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016 Oct 3.
ii) Strong depression link with breast cancer mortality
This randomized trial on 125 women with metastatic breast cancer compared a treatment group to a control group that received educational materials. Median survival time was 53.6 months for women with decreasing depression scores over 1 year and 25.1 months for women with increasing CES-D scores. Neither demographic nor medical variables explained this association. The researchers commented : “Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with breast cancer in this sample”.
Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in Depression Symptoms Is Associated With Longer Survival in Patients With Metastatic Breast Cancer: A Secondary Analysis. J Clin Oncol. 2011 February 1; 29(4): 413–420.
iii) Cortisol levels
This study demonstrated mindfulness and meditation can reduce cortisol levels in cancer patients – high cortisol levels being a sign of a poor prognosis – and improve quality of life.
Carlson LE. Speca M. Patel KD. Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology. 2004;29(4):448-74.
iv) Mindfulness in a group setting
This trial compared 2 empirically supported psychosocial group interventions, mindfulness‐based cancer recovery (MBCR) and supportive‐expressive group therapy (SET), with a minimal‐intervention control condition on mood, stress symptoms, quality of life, social support, and diurnal salivary cortisol in distressed breast cancer survivors. The mindfulness-based group resulted in the most psychosocial benefit, including improvements across a range of psychosocial outcomes. Both MBCR and SET resulted in healthier cortisol profiles over time compared with the control condition.
Carlson LE, Doll R, Stephen J, et al. Randomized controlled trial of mindfulness‐based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer (MINDSET). J Clin Oncol. 2013; 31: 3119‐ 3126.
v) Short term intervention effective
Each patient in this study received an individual meditation consultation (60-minute initial visit and 30 minute follow-up visits). Participants recorded significant reductions from pre- to post- meditation session in physical, psychological and symptom distress component scores. All changes reached statistically and clinically significant thresholds. Researchers concluded that “a single meditation session resulted in acute relief in multiple self-reported symptoms with the greatest reduction in anxiety, fatigue & distress".
Chaoul, A., et al. (2014). An Analysis of Meditation Consultations in an Integrative Oncology Outpatient Clinic. The Journal of Alternative and Complementary Medicine, 20(5), A86-A86.
vi) Mental state and vigour
Where cancer patients learn mindfulness in their cancer management they were found to have significantly lower scores for low mood, depression, anxiety, anger, and confusion but they also had more vigour. They also had fewer overall physical and stress symptoms. Speca M, et al. Psychosom Med. 2000;62(5):613-22.
vii) Mindfulness and immunity
Among cancer patients, the significant improvements seen in overall quality of life, symptoms of stress, and sleep quality are associated with improvements in immunity with lower levels of the inflammatory hormones that can accelerate cancer growth. Carlson LE. Speca M. Patel KD. Goodey E. Psychosomatic Medicine. 2003;65(4):571-81..
People also show better immune response to vaccinations and increases in antibodies. Davidson RJ Psychosom Med. 2003;65(4):564-70.
viii) Meditation improves quality of life for breast cancer survivors
This study reported meditation was associated with significant decreases in depression, anxiety, perceived stress, and an increase in quality of life, satisfaction with life, post-traumatic growth and quality of sleep. Significantly, participants had a high attendance rate in the program, which speaks to the likelihood of the applicability of the meditation program on an outpatient basis.
Yun MR et al : The Effects of Mind Subtraction Meditation on Breast Cancer Survivors' Psychological and Spiritual Well-being and Sleep Quality: A Randomized Controlled Trial in South Korea. Cancer Nurs. 2017 Sep/Oct;40(5):377-385.
Online programs - increasingly well proven
i) Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
ii) How do online programs compare to face to face?
Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs.
This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU.
Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.
This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist.
Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.
This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.
Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study. J Med Internet Res 2020;22(10):e17526).
Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.
Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151.
Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.
Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.
iii) Online fatigue relief
Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. This paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. The study found both web-based interventions effective for managing fatigue severity.
Bruggeman‐Everts FZ, Wolvers MD, van de Schoot R, Vollenbroek‐Hutten MM, Van der Lee ML. Effectiveness of two web‐based interventions for chronic cancer‐related fatigue compared to an active control condition: Results of the “Fitter na kanker” randomized controlled trial. J Med Internet Res. 2017;19(10):e336.
iv) Online pain management
Chronic neuropathic pain (CNP) is a common condition cancer survivors experience. Mindfulness training may be one approach to address the psychosocial factors associated with CNP. An 8-week online mindfulness-based program was evaluated via interview. Participants reported an increase in perceived relaxation and calm, less pain and improved stress management.
Glynn BA, Khoo EL, MacLeay HML, Duong A, Cantave R, Poulin PA. Exploring Cancer Patients' Experiences of an Online Mindfulness-Based Program: A Qualitative Investigation. Mindfulness (N Y). 2020;11(7):1666-1677.
v) Future directions for Apps
This study investigated ways in which the current Calm app could be adapted to better fit cancer patients’ and survivors’ needs and preferences, including adding cancer-specific content, increasing the amount of content focusing on coping with strong emotions, developing communities for Calm users who are cancer patients and survivors, and including features that track cancer-related symptoms. Given differences in opinions about which features were desirable or would be useful, there is a clear need for future cancer-specific apps to be customizable (eg, ability to turn different features on or off). Although future research should address these topics in larger, more diverse samples, these data will serve as a starting point for the development of cancer-specific meditation apps and provide a framework for evaluating their effects.
Huberty J, Puzia M, Eckert R, Larkey L. Cancer Patients' and Survivors' Perceptions of the Calm App: Cross-Sectional Descriptive Study. JMIR Cancer. 2020;6(1):e16926. Published 2020 Jan 25.
Increased survival
Starting in 1976, Dr Ainslie Meares published multiple case reports of remarkable remissions following intensive meditation practice. I happened to feature in one of those reports. It strikes me as remarkable that while in recent years there has been a large body of research published that clearly attests to the many benefits to quality of life that follow from mindfulness and meditation practice amongst people affected by cancer, very few investigations have been made into the potential meditation might have to contribute to longer survival times, even cures.
It does seem highly likely that a better quality of life translates into longer survival times, and some studies do support this proposition. However, it remains for the future for serious outcome studies to be pursued. Here is a summary of what is available so far.
1. Case reports
i) Dr Ainslie Meares and intensive meditation
Meares published multiple case reports of remission from cancer following intensive meditation. Here are a few…
a) Breast cancer
Meares A. Med J of Aust. 1976, 2:184
Meares A. Med J of Aust. 1977,
2:132-133
Meares A. Med J of Aust.
Correspondence, 10 Sept 1977
b) Osteo-genic sarcoma - Meares reported my own remission :
Meares A. Med J Aust, 1978, 2:433
ii) Books on “Spontaneous Remission”
In 1993, the Institute of Noetic Sciences published the groundbreaking Spontaneous Remission: An Annotated Bibliography. The authors, Caryle Hirshberg and Brendan O’Regan, defined spontaneous remission as “the disappearance, complete or incomplete, of a disease or cancer without medical treatment or treatment that is considered inadequate to produce the resulting disappearance of disease symptoms or tumor.” The book assembled the largest database of medically reported cases of spontaneous remission in the world, with more than 3,500 references from more than 800 journals in 20 different languages. All the documents in the bibliography are downloadable from here.
While the book was very well received, many who featured in it objected to being described as “spontaneous remissions” as they felt they had contributed largely to their own recoveries. In consequence, Caryle Hirschberg interviewed many of the people featured (including myself) and coined a new term as the title for her subsequent book “Remarkable Recoveries”, published in 1995 along with co-author Marc Barasch.
More recently, in 2014, Kelly Turner published Radical Remission: Surviving Cancer Against All Odds where she too interviewed many long-term cancer survivors and analysed what common measures they linked to their unexpected recoveries.
From my own work, 2 books have been published recording “Radical Remissions” or “Remarkable Recoveries” :
Inspiring People – Stories of Remarkable Recovery and Hope, Edited by Ian Gawler, 1995 in which 43 stories are recounted.
Surviving Cancer – Inspiring Stories of Hope and Healing, Edited by Paul Kraus, 2008 in which 28 stories are recounted.
Increased survival linked to related factors
i) Breast cancer survival associated with
depression levels
See the Giese-Davis
study above.
ii) Psychological and behavioural variables – a meta-analysis
This meta-analysis revealed stress-related psychosocial factors to be associated with a higher cancer incidence in initially healthy people, poorer survival in patients diagnosed with cancer, and higher cancer mortality. Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychological factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5:466–475.
3. OUTCOME STUDIES
i) Prostate cancer
Revisit the work of Prof Dean Ornish at the start of this article that reported reversal of prostate cancer.
ii) The complex case of group therapy, quality of life and survival
Spiegel reported in the Lancet 1989, that attending a group based upon emotional expression weekly for one year, doubled survival time for women with secondary breast cancer and some participants survived over 10 years.
Another trial was performed by Fawzy with 68 patients with early stage malignant melanoma. At 6-year follow-up those who had usual care plus stress management showed a halving of recurrence and much lower death rate (than the group with only the usual surgical management). Both groups also had their immune function monitored which showed that after being originally comparable, the stress management group had significantly better immune function after six months.
Other studies have also yielded promising results in terms of longer survival for liver, gastrointestinal malignancies, and lymphoma but others have shown equivocal or negative results. The last of these trials was a large-scale attempt to replicate the findings of Spiegel. The results of this trial were negative despite the fact that the effects of the intervention had a positive effect on quality of life and mental health.
Of the five negative or equivocal trials mentioned above only two reported a positive effect on mental health and quality of life while all the studies that showed a positive effect on survival reported improved mental health and quality of life. Therefore, the trend seen in eight out of these 10 cancer studies seems to be similar to the findings in studies of psycho-social support in heart disease; where a psychosocial intervention improves quality of life and mental health it has the ‘side-effect’ of prolonging survival, while if there is marginal or no long-term benefit on mood or quality of life there is no corresponding improvement in survival.
References for the above
Spiegel D et al. Lancet 1989;2:888-891.
Fawzy F. et al. Malignant melanoma; Effects of an early structured psychiatric intervention, coping and affective state on recurrence and survival six years later. Arch Gen Psych 1993;50:681-89.
Richardson JL, Shelton DR, Krailo M, Levine AM. The effect of compliance with treatment on survival among patients with hematologic malignancies. J Clin Oncol 1990;8:356-64.
Kuchler T. Henne-Bruns D. Rappat S. et al. Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial. Hepatogastroenterology. 1999;46:322-35.
Ratcliffe MA, Dawson AA, Walker LG. Eysenck Personality Inventory L-scores in patients with Hodgkin's disease and non-Hodgkin's lymphoma. Psycho-oncology 1995;4:39-45.
Cunningham AJ. Edmonds CV. Phillips C. et al. A prospective, longitudinal study of the relationship of psychological work to duration of survival in patients with metastatic cancer. Psychooncology 2000;9(4):323-39.
Edelman S. Lemon J. Bell DR. Kidman AD. Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology. 1999;8(6):474-81.
Ilnyckyj A, Farber J, Cheang MC, Weinerman BH. A randomized controlled trial of psychotherapeutic intervention in cancer patients. Ann R Coll Physicians Surg Can 1994;27:93-6.
Linn MW, Linn BS, Harris R. Effects of counselling for late stage cancer patients. Cancer 1982;49:1048.
Goodwin PJ, Leszcz M, Ennis M, et al. The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 2001;345:1719-26.
Conclusion
My sense is if Dr Meares were still alive he would be delighted with how far meditation has come since his pioneering days. There is now a solid evidence base for mindfulness and meditation being used to help people affected by cancer (including their carers) to overcome both the associated symptoms of cancer such as stress, anxiety, depression, pain management and fatigue as well as to assist in their treatment and recovery.
Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Mindfulness, meditation and
dementia
A literature review
Dr
Ian Gawler OAM, BVSc, MCounsHS. November
2020.
What do mindfulness and meditation-based techniques have to offer people affected by dementia and their carers?
The context
The world population is aging and the prevalence of dementia is increasing. By 2050, those aged 60 years and older are expected to make up a quarter of the population. With that, the number of people with dementia is increasing. Unfortunately, there is no current medical cure for dementia. The progression of symptoms with no hope of improvement is difficult to cope with, both for patients and their caregivers.
Mindfulness training has shown to improve psychological well-being in a variety of mental health conditions. Research has shown preliminary but promising results for mindfulness-based interventions to benefit people with dementia and their caregivers. In this extensive and well documented article, we examine
1. Five recent, key research papers
investigating the contribution
mindfulness and meditation might make to
those affected by dementia.
2. What might be possible? Here we
briefly examine the role of lifestyle
and the mind in the prevention and
treatment of dementia.
3. The role in dementia for a
purpose-built app – Allevi8.
4. What is dementia and Alzheimer’s
disease? Here we provide a detailed yet
accessible summary of the many
conditions collectively known as
dementia.
5. Early signs of dementia.
6. The effectiveness of online
mindfulness and meditation programs –
what the research says.
7. Conclusions.
1. Mindfulness, meditation and dementia – The research evidence base – key recent dementia research
i) Review : Mindfulness, meditation, cognition and stress in people with Alzheimer's disease (AD), dementia, mild cognitive impairment and subjective cognitive decline – 2018.
This meta-analysis investigated how the use of meditation as a behavioural intervention can reduce stress and enhance cognition, which in turn ameliorates some dementia symptoms. Ten papers were identified and reviewed.
There was a broad use of measures across all studies, with cognitive assessment, quality of life and perceived stress being the most common. Three studies used functional magnetic resonance imaging (fMRI) to measure functional changes to brain regions during meditation.
The interventions fell into the following three categories: mindfulness, most commonly mindfulness-based stress reduction(MBSR) (six studies); Kirtan Kriya meditation (three studies); and mindfulness-based Alzheimer's stimulation (one study). Three of these studies were randomised controlled trials.
All studies reported significant findings or trends towards significance in a broad range of measures, including a reduction of cognitive decline, reduction in perceived stress, increase in quality of life, as well as increases in functional connectivity, percent volume brain change and cerebral blood flow in areas of the cortex.
Russell-Williams J, Jaroudi W, Perich T, Hoscheidt S, El Haj M, Moustafa AA. Mindfulness and meditation: treating cognitive impairment and reducing stress in dementia. Rev Neurosci. 2018;29(7):791-804.
ii) Do adults with MCI have the capacity to learn mindfulness meditation? - 2019 High levels of chronic stress negatively impact the hippocampus and are associated with increased incidence of Mild Cognitive Impairment (MCI) and Alzheimer’s disease(AD). While mindfulness meditation may mitigate the effects of chronic stress, it is uncertain if adults with MCI have the capacity to learn mindfulness meditation.
Chronic stress negatively impacts the hippocampus, and high levels of chronic stress are associated with an increased incidence of MCI and AD. [6–8] Adults who are prone to high levels of psychological distress are more likely to develop dementia.[9] Animal research demonstrates that high levels of cortisol (the “stress hormone”) can damage the hippocampus[10], a key structure involved in memory processing that atrophies with Alzheimer’s disease. Thus, other stress-reducing interventions, such as meditation and yoga, might be helpful for adults with MCI.
Previous studies have shown that the hippocampus is selectively activated during meditation,[15–17] and experienced meditators have larger volumes and gray matter concentration in their hippocampi compared to matched controls.[18] In addition, research has shown that an eight-week MBSR class may increase gray matter density in the hippocampi of adults.[19] MBSR is thus a stress-reducing intervention that impacts the hippocampus and could potentially interrupt the progression of MCI through these effects.
The period of time when an individual has MCI is transient and offers a rare window of opportunity prior to the development of dementia; finding an intervention that could help patients at this point of time could be invaluable. Since adults with MCI still have brain plasticity,[20] we hypothesized that adults with MCI would be able to learn and benefit from mindfulness meditation and yoga.
What did the research find? Most adults with MCI were able to learn mindfulness meditation and had improved MCI acceptance, self-efficacy, and social engagement. So in summary, cognitive reserve may be enhanced through a mindfulness meditation program even in patients with MCI.
Wells RE, Kerr C, Dossett ML, et al. Can Adults with Mild Cognitive Impairment Build Cognitive Reserve and Learn Mindfulness Meditation? Qualitative Theme Analyses from a Small Pilot Study. J Alzheimers Dis. 2019;70(3):825-842.
iii) Review of already well researched mindfulness techniques - 2018
Although there is a wide variety of interventions that include components of mindfulness (e.g., Acceptance and Commitment Therapy), this review focuses on the two programs with the largest evidence base, the mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). These group-based programs have been studied in healthy populations and in those with mental or physical disorders, showing satisfactory to good efficacy (Chiesa and Serretti, 2009; Hofmann et al., 2010; Hempel et al., 2014).
Although current research supports the rationale for MBI with persons with dementia and their caregivers, only few RCTs have been conducted and more research is necessary.
What can be said is participants receiving MBSR showed greater improvement in memory, but not cognitive control. Moreover, the MBSR group improved on measures of worry, depression, and anxiety, and decreased cortisol level for those with high baseline cortisol.
Studies with persons with Mild Cognitive Impairment (MCI) or Severe Cognitive Impairment (SCD) have looked at the effect of Mindfulness Based Interventions (MBI). This is informative for dementia research, since individuals with MCI have an increased annual conversion rate of 5–17% to Alzheimer’s disease (Cheng et al., 2017), and approximately 60% over a 15-year period of persons with SCD will continue to develop Alzheimer’s disease (Reisberg et al., 2008).
Studies with persons with MCI or subjective memory complaints have looked at the effect of MBI. One pilot study found a trend toward improvement of cognition, quality of life, and well-being for people in the mindfulness condition (Wells et al., 2013). A RCT showed that the participants in the MBI group showed less memory deterioration and greater decrease in depressive symptoms compared to the control group (Larouche et al., 2016).
Although these studies demonstrate feasibility of MBSR with older adults with SCD and MCI, and preliminary evidence for memory improvement, more research is necessary to investigate whether MBI can influence cognitive decline.
Berk L, Warmenhoven F, van Os J, van Boxtel M. Mindfulness Training for People With Dementia and Their Caregivers: Rationale, Current Research, and Future Directions. Front Psychol. 2018;9:982. Published 2018 Jun 13. doi:10.3389/fpsyg.2018.00982.
iv) Mindfulness practice can improve health outcomes of MCI - 2017.
Growing evidence has linked mindfulness to cognitive and psychological improvements that could be relevant for mild cognitive impairment (MCI). This Australian study reported long-term mindfulness practice may be associated with cognitive and functional improvements for older adults with MCI. The researchers concluded mindfulness training could be a potential efficacious non-pharmacological therapeutic intervention for MCI.
Wong WP, Coles J, Chambers R, Wu DB, Hassed C. The Effects of Mindfulness on Older Adults with Mild Cognitive Impairment. J Alzheimers Dis Rep. 2017;1(1):181-193. Published 2017 Dec 2.
v) Support for dementia carers – a meta-analysis
Following analysis of five RCTs involving 201 carers that assessed the effectiveness of MBSR, the authors concluded low-quality evidence suggests MBSR may reduce carers' depressive symptoms and anxiety, at least in the short term. “In conclusion, MBSR has the potential to meet some important needs of the carer, but more high-quality studies in this field are needed to confirm its efficacy.”
Liu Z, Sun YY, Zhong BL. Mindfulness-based stress reduction for family carers of people with dementia. Cochrane Database Syst Rev. 2018;8(8):CD012791. Published 2018 Aug 14. Low level evidence in support of intervention with carers.
2. What might be possible?
Dementia is now well identified as another of the chronic degenerative diseases - like cancer, heart disease and MS. All these other known chronic degenerative diseases have been shown to be prevented by Lifestyle interventions. Once present, their symptoms have all been shown to be significantly lessened by Lifestyle interventions; and all have shown some signs – ranging up to major – of reversal through Lifestyle interventions. So why not dementia???
And what are Lifestyle interventions? The things you can do for yourself – like what you eat and drink, your exercise levels, relaxation, mindfulness and meditation. Many believe the mind-based interventions are key, both due to their direct effects and because the mind decides what we do with our lifestyle. Get the mind into a good state and everything else follows – we eat better, drink more wisely, are more inclined to exercise and so on.
3. Purpose built app – Allevi8
The free mindfulness and meditation-based App - Allevi8 – has been specifically designed to assist people affected by chronic degenerative disease. Allevi8 targets 5 main issues – stress and mental health, emotional health, pain management, healing and finding meaning amidst adversity.
Allevi8 is available via a simple search in your App store. There is a free, meditation session via Zoom – Allevi8@8 - that goes out live each Monday. This session is well attended and many report how helpful it is to receive practice tips and meditate in a like-minded community each week. To join, simply download Allevi8 and the link will be sent by email. All of this is free, however, you might like to consider paying it forward – there is a secure donation facility on the App under “Gift”.
4. What is dementia and Alzheimer’s disease?
A simple guide to the facts about dementia and Alzheimer’s disease
What follows is a compilation of information from sources such as dementia and Alzheimer’s websites, scientific references and Wikipedia. This information has been compiled in good faith and is intended to be accurate, succinct and easy to understand. It is not a short read as dementia represents a range of conditions, each of which are explained in turn.
i) Dementia
Dementia, also known as senility, is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and remember that is great enough to affect a person's daily functioning. Other common symptoms include problems with emotional expression, language, and a decrease in motivation.
The most common type of dementia is Alzheimer’s disease which makes up 50% to 70% of cases. Other common types include vascular dementia (25%), dementia associated with Lewy bodies (15%), alcohol related dementia (unclear), fronto-temporal dementia (rare) and mixed dementia (10%).
ii) Alzheimer's disease
First be clear, Alzheimer's disease is not a normal part of aging. Alzheimer's disease is an acquired, progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioural changes.
Alzheimer's disease is associated with 2 types of abnormal lesions - plaques and tangles.
Plaques or to be more specific, Beta-amyloid plaques, are sticky clumps of protein fragments and cellular material that form outside and around neurons.
Tangles, or neurofibrillary tangles, are insoluble twisted fibers composed largely of the protein that builds up inside nerve cells.
Although these 2 lesions are hallmarks of the disease, scientists are unclear whether they cause it or a by-product of it.
The most common symptoms are short-term memory loss and word-finding difficulties. People with Alzheimer's disease also have trouble with visual-spatial areas (for example, they may begin to get lost often), reasoning, judgment, and insight. Insight refers to whether or not the person realizes they have memory problems.
Common early symptoms include repetition, getting lost, difficulties keeping track of bills, problems with cooking, forgetting to take medication, and word-finding problems.
The part of the brain most affected by Alzheimer's is the hippocampus. Other parts of the brain that show shrinking (atrophy) include the temporal and parietal lobes. However, the brain shrinkage in Alzheimer's disease is very variable, and a brain scan cannot actually make the diagnosis (but may eliminate other causes). The relationship between undergoing anaesthesia and Alzheimer's disease is unclear.
It is often said that the seriousness of, and difference between, AD and other dementias, is seen in the response to the question: “Did you turn the computer off?”
Those with dementia respond: “I can’t remember”. Those with AD respond: “ What’s a computer?”.
iii) Vascular dementia
This type of dementia is caused by disease or injury affecting the blood supply to the brain, typically involving a series of minor strokes. Symptoms will depend upon where the strokes have occurred and whether the vessels involved are large or small. Multiple injuries can cause progressive dementia over time, while a single injury located in a critical area critical (i.e. hippocampus, thalamus) can lead to sudden cognitive decline.
On scans of the brain, a person with vascular dementia may show evidence of multiple strokes of different sizes in various locations.
So what actually is a stroke?
A stroke happens when blood supply to the brain via an artery is interrupted. This occurs most commonly when the artery is blocked (ischaemic stroke) or much less commonly bursts (haemorrhagic stroke). The resulting area of brain damage is called a cerebral infarct, or more simply, just an infarct.
A major stroke occurs when the blood flow in a large vessel in the brain is suddenly and permanently cut off. Most often this happens when the vessel has become narrower and then is blocked by a clot. Much less often it is because the vessel bursts and bleeds into the brain. Minor strokes are when the same processes occur on a smaller scale.
Types of vascular dementia
Vascular dementia can differ according to the cause of the damage, the type of stroke involved and the part of the brain that is affected. The different types of vascular dementia have some symptoms in common and some symptoms that differ. Their symptoms tend to progress in different ways.
a) Post-stroke dementia
After a major stroke, the sudden interruption in the blood supply starves the brain of oxygen and leads to the death of a large volume of brain tissue. However, not everyone who has a stroke will develop vascular dementia, but about 20% of people who have a stroke do develop post-stroke dementia within the following 6 months. A person who has one major stroke is then at increased risk of having further strokes. If this happens, the risk of developing dementia is higher.
b) Single-infarct dementia and Multi-infarct dementia
This type of vascular dementia is caused by smaller strokes that commonly cause damage to the cortex of the brain, the area associated with learning, memory and language.
These types of stroke may be so small that the person does not notice any symptoms when they occur. Alternatively, the symptoms may only be temporary - lasting perhaps a few minutes - because the blockage clears itself. If symptoms last for less than 24 hours, it is called a 'mini-stroke' or transient ischaemic attack (TIA). A TIA may mistakenly be dismissed as a 'funny turn'.
If such a stroke interrupts the blood supply for more than a few minutes, an infarct will result. Sometimes just one infarct forms in an important part of the brain and this causes dementia (known as single-infarct dementia). Much more often, a series of small strokes over a period of weeks or months lead to a number of infarcts spread around the brain. Dementia in this case (known as multi-infarct dementia) is caused by the total damage from all the infarcts together.
A person with Multi-infarct dementia is likely to have better insight in the early stages than people with Alzheimer's disease, and parts of their personality may remain relatively intact for longer. Symptoms may include severe depression, mood swings and epilepsy.
c) Subcortical dementia or Binswanger's disease
This was thought to be rare, but is now being reassessed, and may in fact be relatively common. Once considered rare, is now thought to be the most common type of vascular dementia.
Subcortical vascular dementia is caused by diseases of the very small blood vessels that causes infarcts to tissue that lies deep in the brain - the “white matter”. These small vessels develop thick walls and become stiff and twisted, meaning that blood flow through them is reduced. It is caused by high blood pressure, thickening of the arteries and inadequate blood flow.
Small vessel disease often damages the bundles of nerve fibres that carry signals around the brain, known as white matter. It can also cause small infarcts near the base of the brain. Small vessel disease develops much deeper in the brain than the damage caused by many strokes. This means many of the symptoms of subcortical vascular dementia are different from those of stroke-related dementia.
Common symptoms include slowness and lethargy, difficulty walking, emotional ups and downs and lack of bladder control early in the course of the disease.
iv) Lewy Body disease
Lewy body disease is caused by the degeneration and death of nerve cells in the brain. The name comes from the presence of abnormal spherical structures, called Lewy bodies, which develop inside nerve cells. It is thought that these may contribute to the death of the brain cells.
Lewy body disease is similar to Alzheimer's disease in many ways, and in the past it has sometimes been difficult to distinguish the two. It has only recently been accepted as a disease in its own right. It can occur by itself or together with Alzheimer's disease and/or Vascular dementia. It may be hard to distinguish Lewy body disease from Parkinson's disease, and some people with Parkinson's disease develop a dementia that is similar to that seen in Lewy body disease.
The symptoms of dementia with Lewy body disease include difficulty with concentration and attention, extreme confusion and difficulties judging distances, often resulting in falls.
There are also three cardinal symptoms, two of which must be present in order to make the diagnosis:
- Visual hallucinations
- Parkinsonism (tremors and stiffness
similar to that seen in Parkinson's
disease)
- Fluctuation in mental state so that
the person may be lucid and clear at one
time and confused, disoriented and
bewildered at other times. Typically
this fluctuation occurs over a period of
hours or even
minutes
and is not due to any underlying acute
physical illness.
Some people who have Lewy body disease may also experience delusions and/or depression.
v) Alcohol related dementia
Alcohol related dementia can affect men and women of any age. It is currently unclear as to whether alcohol has a direct toxic effect on the brain cells (neurotoxicity hypothesis), or whether the damage is due to lack of thiamine (or vitamin B1). Nutritional problems, which often accompany consistent or episodic heavy use of alcohol, are thought to be contributing factors.
Symptoms include
- Impaired ability to learn things
- Personality changes
- Problems with memory
- Difficulty with clear and logical
thinking on tasks which require
planning, organising, common sense
judgement and social skills
- Problems with balance
- Decreased initiative and
spontaneity.
Generally skills learned earlier in life and old habits such as language and gestures tend to be relatively unaffected.
Who gets alcohol related dementia?
Anyone who drinks excessive amounts of alcohol over a period of years may get alcohol related dementia. Males who drink more than six standard alcoholic drinks a day, and women who drink more than four, seem to be at increased risk of developing alcohol related dementia. The risk clearly increases for people who drink high levels of alcohol on a regular basis.
The National Health & Medical Research Council of Australia recommends that for health reasons related to the prevention of brain and liver damage adult males should drink no more than four standard drinks per day and adult females should drink no more than two standard drinks per day.
NOTE : For cancer, there is no really safe limit.
Some people who drink at high levels do not develop alcohol related dementia, but it is not currently possible to understand and predict who will and who will not develop alcohol related dementia.
Some people who develop alcohol related dementia might also show some degree of recovery over time if they reduce alcohol intake to safe levels or abstain from alcohol and maintain good health.
vi) Fronto-temporal dementia or Pick’s disease
Fronto-temporal dementia (FTD) is one of the less common types of dementia. The term covers a wide range of different conditions. FTD occurs when nerve cells in the frontal and/or temporal lobes of the brain die, and the pathways that connect the lobes change. Some of the chemical messengers that transmit signals between nerve cells are also lost. Over time, as more and more nerve cells die, the brain tissue in the frontal and temporal lobes shrinks.
The frontal lobes of the brain, found behind the forehead, deal with behaviour, problem solving, planning, speech and the control of emotions.
Symptoms of FTD include changes in personality and behaviour, and difficulties with language. These symptoms are different from the memory loss often associated with more common types of dementia, such as Alzheimer’s disease. As FTD is a less common form of dementia, many people (including some health professionals) may not have heard of it.
vii) Mixed dementia
At least 10 per cent of people with dementia are diagnosed with mixed dementia. This generally means that both Alzheimer's disease and vascular disease are thought to have caused the dementia. The symptoms of mixed dementia may be similar to those of either Alzheimer's disease or vascular dementia, or they may be a combination of the two.
5. Early signs of dementia
The early signs of dementia are very subtle and vague and may not be immediately obvious. Some common symptoms may include:
- Progressive and frequent memory
loss
- Confusion
- Personality change
- Apathy and withdrawal
- Loss of ability to perform everyday
tasks.
6. The effectiveness of online mindfulness and meditation programs – increasingly well proven
i) Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
ii) How do online programs compare to face to face?
Mindfulness-based interventions are shown to be effective in reducing psychological distress in people affected by cancer. However, these interventions lack availability and flexibility, which may compromise participation in the intervention, especially for people experiencing symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. Here are 5 research reports demonstrating online programs have similar outcomes to in person programs…
This first study examined a randomised group of 245 heterogeneous patients with cancer affected by psychological distress. Compared with Treatment as Usual (TAU), MBCT and eMBCT were similarly effective in reducing that psychological distress. Also, both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU.
Compen F, Bisseling E, Schellekens M, et al. Face‐to‐face and internet‐based mindfulness‐based cognitive therapy compared with treatment as usual in reducing psychological distress in patients with cancer: A multicenter randomized controlled trial. J Clin Oncol. 2018;36(23):2413‐2421.
This second study provides further evidence for the feasibility and efficacy of an online adaptation of a mindfulness-based program as it reported usage was associated with the reduction of mood disturbance and stress symptoms, as well as an increase in spirituality and mindfully acting with awareness compared with a treatment-as-usual waitlist.
Zernicke KA, Campbell TS, Speca M, McCabe‐Ruff K, Flowers S, Carlson LE. A randomized wait‐list controlled trial of feasibility and efficacy of an online mindfulness‐based cancer recovery program: The eTherapy for cancer applying mindfulness trial. Psychosom Med. 2014;76(4):257‐267.
This third study found nonusers had more fear of cancer recurrence at baseline than users. Regular users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. The study showed that adherence was related to improved patient outcomes. The researchers recommended patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.
Cillesen L; et al. Predictors and Effects of Usage of an Online Mindfulness Intervention for Distressed Cancer Patients: Usability Study; J Med Internet Res 2020;22(10):e17526).
Fourthly, this trial compared an online 6 week program to Treatment As Usual. It concluded online mindfulness instruction represents a widely accessible intervention for reducing psychological distress and its behavioural manifestations in cancer survivors, especially those who are unable to participate in in-person training. Effect sizes were all medium to large as well.
Messer D, Horan JJ, Larkey LK, Shanholtz CE. Effects of internet training in mindfulness meditation on variables related to cancer recovery. Mindfulness. 2019;10:2143–2151.
Finally, this study focused on the long-term effects of a RCT during the nine-month follow-up period. The study compared a mindfulness-based program delivered online with the same program delivered in person. Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life in both interventions over the course of the nine-month follow-up. Furthermore, patients seemed to benefit more from the online program based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness.
Cillessen L, et al, Consolidation and prediction of long-term treatment effect of group and online mindfulness-based cognitive therapy for distressed cancer patients. Acta Oncol. 2018 Oct; 57(10):1293-1302.
Conclusion
There is now a solid evidence base for mindfulness and meditation being used to help people affected by dementia (including their carers) to overcome the associated symptoms of dementia such as stress, anxiety, depression and loss of cognition and memory.
Also, there is good evidence online mindfulness - based programs like our own Allevi8 App have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Multiple Sclerosis
A residential program for people with multiple sclerosis that teaches meditation and lifestyle changes has been shown, over a 5 year period, to lead to significant improvements in general health, including physical symptoms and mobility, many aspects of quality of life and mental health. The people on average improved in all these parameters by around 20%, whereas the general population of people with MS would be expected to deteriorate by around 10% over that same 5 year period.
References
Hadgkiss E J, Jelinek GA, Weiland TJ, et al. Neurol Sci, 25 Feb 2012
Stroke, mindfulness and meditation
A
literature review
Dr Ian Gawler OAM,
BVSc, MCounsHS. November 2020.
The challenge
What evidence is there mindfulness and meditation can have therapeutic benefits for those affected by stroke? Are people affected by stroke capable of practicing mindfulness and meditation? Even more, what evidence is there an online program will be useful?
While this is an emerging field of research, already there is some good evidence for mindfulness and meditation – including on-line programs - facilitating improvements in both coping and recovery; and that carers can receive significant benefit.
1. Anxiety and depression
a) The scale of the problem amongst those affected by stroke
The prevalence of depression is reported to be very high among stroke survivors and has been associated with adverse clinical outcomes.
A meta-analysis published in 2005 reported a pooled estimate of 33% for the prevalence of depression in stroke survivors (i). A multi-national study of 220 patients observed that the prevalence of depression remained as high as 33% for up to 5 years post stroke (ii). In addition, a review assessing post-stroke mortality reported increased odds of mortality for a period of 2 to 5 years among patients with depressive symptoms based on findings from 13 studies including 59,598 patients with stroke (iii). Previous research has suggested that the prevalence of depression and anxiety among carers is comparable to the observed prevalence levels among stroke survivors, and directly related to the severity of stroke (iv – vi). In addition, there is also evidence that stroke survivors and their carers mutually influenced each other’s emotional state (vii – viii).
i) Hackett ML, Yapa C, Parag V, Anderson CS. Frequency of depression after stroke: a systematic review of observational studies. Stroke. 2005;36:1330–1340. https://pubmed.ncbi.nlm.nih.gov/15879342/
ii) Lincoln NB, Brinkmann N, Cunningham S, Dejaeger E, De Weerdt W, Jenni W, et al. Anxiety and depression after stroke: a 5 year follow-up. Disabil Rehabil. 2013;35:140–145.
iii) Bartoli F, Lillia N, Lax A, Crocamo C, Mantero V, Carrà G, et al. Depression after stroke and risk of mortality: a systematic review and meta-analysis. Stroke Res Treat. 2013;2013:862978.
iv) Berg A, Palomaki H, Lonnqvist J, Lehtihalmes M, Kaste M. Depression among caregivers of stroke survivors. Stroke [Internet] 2005;36:639–643.
v) Opara JA, Jaracz K. Quality of life of post-stroke patients and their caregivers. J Med Life. 2010;3:216–220.
vi) Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil [Internet] 2013;94:1731–1736
vii) McCarthy MJ, Lyons KS, Powers LE. Expanding poststroke depression research: movement toward a dyadic perspective. Top Stroke Rehabil [Internet] 2011;18:450–460.
viii) Godwin KM, Ostwald SK, Cron SG, Wasserman J. Long-term health-related quality of life of stroke survivors and their spousal caregivers. J Neurosci Nurs [Internet] 2013;45:147–154.
b) Mindfulness and meditation relieve anxiety and depression
Several systematic reviews and meta-analyses support the use of mindfulness-based interventions (MBIs) (largely derived from MBSR) in helping people with long-term conditions (LTCs) to cope better with improvements in symptoms of anxiety and depression.
Here are two…
i) Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of Mindfulness-Based Stress Reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68:539–544.
ii) Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review. J Consult Clin Psychol. 2010;78:169–183.
2. Mindfulness and meditation’s specific influence on stroke outcomes
A recent systematic review of the benefits of MBIs among patients with stroke, including four studies and 160 participants in total, concluded that a range of benefits may be derived from MBIs in this population.
Lawrence M, Booth J, Mercer S, Crawford E. A systematic review of the benefits of mindfulness-based interventions following transient ischemic attack and stroke. Int J Stroke. 2013;8:465–474.
Another systematic review and critical appraisal of the evidence on the effectiveness of behavioural therapies such as yoga and mindfulness practices for stroke rehabilitation examined 5 randomized controlled clinical trials and 4 single case studies. Additionally, one qualitative research study was identified. Studies reported positive results, including improvements in cognition, mood, and balance and reductions in stress. The authors concluded yoga and mindfulness could be clinically valuable self-administered intervention options for stroke rehabilitation.
Lazaridou A, Philbrook P, Tzika AA. Yoga and mindfulness as therapeutic interventions for stroke rehabilitation: a systematic review. Evid Based Complement Alternat Med. 2013;2013:357108.
3. Can people affected by stroke actually practice mindfulness and meditation?
Clinical experience says yes, however, recently a small study did examine the feasibility of an adapted 2-week mindfulness meditation protocol for chronic stroke survivors. In addition, preliminary effects of this adapted intervention on spasticity and quality of life in individuals after stroke were explored. Exploratory preliminary analyses showed statistically significant improvements in spasticity, along with improvements in quality of life measures for Energy, Personality, and Work/Productivity.
Wathugala M, Saldana D, Juliano JM, Chan J, Liew SL. Mindfulness Meditation Effects on Poststroke Spasticity: A Feasibility Study. J Evid Based Integr Med. 2019 Jan-Dec;24:2515690X19855941.
4. Online programs and their benefits – a meta-analysis
The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions.
The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.
Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114.
5. Conclusion
There is a solid evidence base for mindfulness and meditation being used to help people affected by stroke (including their carers). These interventions can reduce the associated symptoms of stroke such as stress, anxiety and depression, as well as assist in recovery.
Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Evidence by symptoms/issues
Summary - Mindfulness and meditation are evidence based
There is a strong body of evidence mindfulness and meditation can have therapeutic benefits for those dealing with a wide range of mental health issues - stress, anxiety, depression and more. There is also good evidence online programs are useful, and that these programs can significantly assist those caring for people affected by mental health issues.
Want key scientific articles to share with family, friends or health professionals who need convincing? Need a little reassurance yourself? Just want the facts?
Currently if one searches “mindfulness and meditation research”, Google comes up with around 17.6 million results. A bit daunting. So while what follows is no PhD, here are some of the top, recent articles (mostly meta- analyses) that highlight this rapidly expanding yet already solid evidence base.
1. Reducing stress and anxiety with online mindfulness
Spijkerman MP et al. 2016, Clin Psych review, Vol 45, 102 114.
Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials.
The authors reported online Meditation- Based Interventions have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.
2. App use improves mental health
Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.
“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.
3. Stress, anxiety and depression reduction; improvements in mental and physical health
From the American Psychological Association website, 2019 Creswell JD and Khoury B. Mindfulness meditation: A research-proven way to reduce stress : Mindfulness meditation can improve both mental and physical health.
Researchers reviewed more than 200 studies of mindfulness among healthy people and found mindfulness-based therapy was especially effective for reducing stress, anxiety and depression. Mindfulness can also help treat people with specific problems including depression, pain, smoking and addiction. Some of the most promising research has looked at people with depression. Several studies have found, for example, that MBCT can significantly reduce relapse in people who have had previous episodes of major depression. What is more, mindfulness-based interventions can improve physical health too. For example, mindfulness may reduce pain, fatigue and stress in people with chronic pain. Other studies have found preliminary evidence that mindfulness might boost the immune system and help people recover more quickly from cold or flu.
4. Reducing stress and anxiety with mindfulness based therapy
Khoury B et al. Mindfulness-based therapy: A comprehensive meta-analysis; 2013 Clin Psych Review vol 33, 6, 763 - 771.
Meta-analysis (review) of studies evaluating Mindfulness Based Therapy – a specific form of mindfulness. The authors concluded “MBT is an effective treatment for a variety of psychological problems, and is especially effective for reducing anxiety, depression, and stress.”
5. Reducing (symptoms) psychological distress
Coffey, K. A., & Hartman, M. (2008). Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress. Complementary Health Practice Review, 13(2), 79–91.
The authors reported their results confirmed an inverse relationship between mindfulness and psychological distress.
6. Anxiety, mood disorders and accelerating healing
Arias et al. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006;12(8):817‐832.
While there have been few studies examining the specific question of meditation’s influence on healing in general, early studies are positive.
The authors reported the strongest evidence for efficacy was found for epilepsy, symptoms of the premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. They stated their results support the safety and potential efficacy of meditative practices for treating certain illnesses, particularly in nonpsychotic mood and anxiety disorders.
7. Reducing depression and fatigue; improving sleep
Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. 2015;175(4):494–501.
Following this randomised clinical trial, the author’s reported Mindfulness Awareness Practices showed significant improvement relative to the Sleep Hygiene Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.
8. Reducing stress and anxiety with meditation
Goyal, M et al. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Intern Med. 2014 Mar;174(3):357-68.
This meta-analysis reviewed 18,753 citations, however, only 47 trials with 3515 participants met the stringent criteria to be included in the final analysis – having randomized clinical trials with active controls for placebo.
The authors concluded meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Specifically, there was found to be moderate evidence of improved anxiety, depression and pain, with lower evidence of improved stress/distress and mental health-related quality of life.
9. Depression and mindfulness
Research on Mindfulness Based Cognitive Therapy (MBCT) has found that these techniques more than halve the relapse rate for people who have had depression - from 78% to 36%. Meditation changes our relationship to negative thoughts and emotions giving a non-attachment to them and therefore, we are not controlled by them so much.
Ma SH, Teasdale JD. Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects: J Consult Clin Psychol. 2004;72(1):31-40.
10. Adolescents and mindfulness
In adolescents, mindfulness reduces symptoms of anxiety, depression, and somatic distress, and increases self-esteem and sleep quality.
Biegel et al. Mindfulness-based stress reduction for the treatment of adolescent psychiatric outpatients: A randomized clinical trial: Journal of consulting and clinical psychology (2009) vol. 77 (5) pp. 855-66.
11. Burn-out in doctors and mindfulness
For professionals with high stress loads such as doctors, Mindfulness has also been found to enhance wellbeing, reduce burnout and mood disturbance with increased empathy and responsiveness to their patients.
Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians: JAMA. 2009 Sep 23;302(12):1338-40.
Conclusion
There is a solid evidence base for mindfulness and meditation being used to help people affected by mental health issues (including their carers). These interventions can reduce symptoms associated with stress, anxiety and depression, as well as assist in recovery.
Also, there is good evidence online mindfulness - based programs such as the Allevi8 App have positive benefits and these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.
Pain relief
Dr Ainslie Meares and Ian Gawler have both reported on dramatic positive benefits observed when people with chronic pain learn to meditate. Mindfulness meditation has been found to be associated with a significant reduction in pain, fatigue, and sleeplessness along with improved function, mood and general health for people with chronic pain syndromes.
References
Meares, A. Relief Without Drugs. 1967; Hill of Content, Melbourne.
Gawler IJ, You Can Conquer Cancer, revised edition. 2020; Michelle Anderson Publishing, Melbourne.
Kabat-Zinn J et al. J Behav Med. 1985;8(2):163-90.
Singh BB, et al. Altern Ther Health Med. 1998;4(2):67-70.
Astin JA, et al. J Rheumatol. 2003;30(10):2257-62.
Relaxation, Mindfulness, Meditation And Sleep – The research evidence base
Clinical Experience
Before listing the research, allow me to say this. Having assisted people for over 4 decades to apply relaxation, mindfulness and meditation to manage their sleep disturbances, three things really stand out.
1. Regular relaxation-based mindfulness and meditation improve sleep patterns significantly
Over the years, many people have reported significant sleep benefits when they practice using the key practices we have included on the Allevi8 App. My sense of this is the deep physical relaxation is very important as a foundation, and then mindfulness and meditation lead to a calmer, more relaxed mind. The two together then combine so that many people, including those dealing with major illnesses like cancer and MS report it is easier to go to sleep, easier to get back to sleep if they do happen to wake, and their quality of sleep feels deeper and more refreshing.
So in fact, many of the people I have helped sleep better found regular practice was the key. The 3 practices most commonly agreed upon to be helpful have been the Deep Relaxation, the Main Practice and the Healing Light Imagery practices.
2. Specific techniques for when you need extra help
The best support to use as you are going to sleep, or to use again if you do need help to return to sleep during the night, is the simplified Deep Relaxation exercise. As guided in the Sleep section of Allevi8, this exercise has a simple introduction and at the end it fades into silence. Many people have told me they fall asleep around half way through when listening to this track in bed, and many have used it repeatedly without ever hearing how it ends!
3. Attitude is important
As we all know, worrying does not help, so do what you can to let go of dwelling on whether you are sleeping or not, how much you are sleeping, or how often you are waking. This approach is actually supported by sleep research that indicates we receive almost as much benefit from simply lying in bed relaxed, as we might from being fully asleep. Maybe this is where the Deep Relaxation exercise comes in again. This exercise does reliably lead to deep relaxation of body and mind, so do what you can to let go of any worry and simply relax into the exercises and the restful nature of simply being in bed.
WHAT DOES THE RESEARCH HAVE TO SAY?
1. The size of the problem
Sleep disturbance is widespread with significant adverse consequences on quality of life for the individual and significant economic burden for society. Approximately 6% to 20% of adults suffer from an insomnia disorder, characterized as persistent difficulty falling or staying asleep with concomitant waking dysfunction, making it the most prevalent sleep disorder.
Ohayon MM. Epidemiology of insomnia: What we know and what we still need to learn, Sleep Med Rev, 2002, vol. 6 – P97-111.
Morin CM et al. Prevalence of insomnia and its treatment in Canada, Can J Psychiatry, 2011, Vol 6- P540- 548..
Roth T et al, Prevalence and perceived health associated with insomnia based on DSM-IV-TR; international statistical classification of diseases and related health problems, tenth revision; and research diagnostic criteria/international classification of sleep disorders, second edition criteria: results from the America insomnia survey,Biol Psychiatry, 2011, Vol 69, P 592 – 600.
2. What might be possible? Early research
Although meditation is about cultivating restful awareness, it can help to significantly improve sleep. Early research indicated meditation to be associated with better sleep quality, being able to go to sleep more easily, longer sleep duration and less use of sleep medications.
Cohen L et al, Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253-60.
These benefits may explain why meditation also can be responsible for reducing depression in those with chronic insomnia.
Britton WB, Haynes PL, Fridel KW, Bootzin RR. Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosom Med. 2010 Jul;72(6):539-48.
3. Recent mindfulness and meditation sleep studies
What follows is a sample of some of the recent individual mindfulness and meditation sleep studies with links to the original articles. While not a definitive research compilation, they provide evidence to support the common clinical experience that both regular relaxation, mindfulness and meditation practice, along with the use of specific techniques, does in fact improve sleep patterns significantly.
i) Alleviating chronic insomnia
This study involving 54 people, found mindfulness meditation appears to be a viable treatment option for adults with chronic insomnia and could provide an alternative to traditional treatments for insomnia.
Jason C. Ong, PhD, Rachel Manber, PhD, Zindel Segal, PhD, Yinglin Xia, PhD, Shauna Shapiro, PhD, James K. Wyatt, PhD, A Randomized Controlled Trial of Mindfulness Meditation for Chronic Insomnia, Sleep, Volume 37, Issue 9, 1 September 2014, Pages 1553–1563,
ii) Deep Relaxation alleviates anxiety and improves sleep for people affected by COVID-19
The researchers commented that through clinical observation, many COVID-19 patients developed anxiety and sleep disturbances after isolation treatment. Anxiety, as a kind of psychological stress, will trigger a series of physiological events and cause a decrease in immunity. Because the symptoms are mild in the early stage, but can suddenly worsen after a few days, the use of benzodiazepine-type sleep-promoting drugs may cause respiratory depression and delay the observation of the disease.
Therefore the Progressive Muscle Relaxation as used in the Deep Relaxation exercise on Allevi8) was trialled. Fifty one patients who entered a Hospital isolation ward were included in the study and randomly divided into experimental and control groups. The experimental group used progressive muscle relaxation (PMR) technology for 30 min per day for 5 consecutive days. During this period, the control group received only routine care and treatment.
The study concluded that using the Progressive Muscle Relaxation exercise (as guided during the Deep Relaxation exercise on Allevi8) as an auxiliary method can reduce anxiety and improve sleep quality in patients with COVID-19.
Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complement Ther Clin Pract. 2020;
iii) Reducing depression and fatigue; improving sleep
This randomised clinical trial showed Mindfulness Awareness Practices led to significant improvement relative to a thorough Sleep Education group on secondary health outcomes of insomnia symptoms, depression symptoms, fatigue interference, and fatigue severity.
Black DS et al. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial.JAMA Intern Med. 2015;175(4):494–501.
iii) How does mindfulness improve sleep?
The authors of this study suggested that awareness and acceptance could be the mechanisms of mindfulness interventions in improving sleep quality, partly via reducing psychological stress.
Lau WKW, Leung MK, Wing YK, Lee TMC. Potential Mechanisms of Mindfulness in Improving Sleep and Distress. Mindfulness (N Y). 2018;9(2):547-555.
iv) Does mindfulness lead in to better sleep?
This research examined whether a brief mindfulness induction immediately prior to sleep following night training might improve athletes’ sleep. University athletes were randomly assigned into experimental group (n = 32) and control group (n = 31). Following night training and just prior to sleep, those in the experimental group received a self-administered brief 6-min mindfulness induction via a video clip, whereas the control group participants viewed a similar 6-min video devoid of mindfulness induction passively. Results showed reduced pre-sleep arousal, and improved level of rest and overall sleep quality, but not sleep duration. These findings suggest that the brief mindfulness induction may be an effective approach for decreasing pre-sleep arousal and improving sleep quality after night training among athletes.
Effect of Brief Mindfulness Induction on University Athletes’ Sleep Quality Following Night Training. Li C et al; J Front. Psychol., 12 April 2018 .
v) Sleep quality - Mindfulness meditation interventions produce significant improvements – a meta- analysis
From 3303 total records, this study examined 18 trials with a total of 1654 participants. The study sought to evaluate the effect of mindfulness meditation interventions on sleep quality. At posttreatment and follow-up, there was low strength of evidence that mindfulness meditation interventions had no effect on sleep quality compared with specific active controls. Additionally, there was moderate strength of evidence that mindfulness meditation interventions significantly improved sleep quality compared with nonspecific active controls at postintervention and at follow-up.
These preliminary findings suggest that mindfulness meditation may be effective in treating some aspects of sleep disturbance. Further research is warranted.
Rusch HL, Rosario M, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5-16.
Sometimes we can be distracted or disappointed, but that’s ok!
Our minds are always busy, constantly surrounded by noise and movement with not a moment’s peace. Starting something new in your life can bring new challenges and learning to meditate is no different. Your Meditation App Program will help you to train your mind to deal with distractions so you can learn to deeply relax and re-energise your mind and body. These general guidelines will help you:
Dealing with thoughts and feelings
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Your mind is used to being active so there is no need to try to stop them coming into your head. What we learn in meditation is to allow the thoughts to come and go, without distracting us.
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Sometimes thoughts bring feelings to the surface. We aim to learn to let these feelings come and go too. So aim to remain calm and not to react.
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Aim to remove any judgement you have about thoughts or feelings being ‘good’ or ‘bad’.
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If you are holding on to a thought or feeling, try and imagine letting it go, a bit like a white cloud passing by on a blue sky.
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If you do find your mind becoming distracted or wandering, as soon as you notice this, bring yourself back to the present moment by focusing on your breathing.
Managing noise
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To begin with, create a quiet, peaceful space and meditate at a time when noise is less likely to intrude.
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Once you are settled, accept “this is as good as it gets”! Then, if you are in a noisy environment, aim not to physically or emotionally react to it.
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Bring your focus back to your breathing and your relaxation.
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As you practice, you will find noises become less distracting.
Feeling restless or distracted
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Make your meditation space as comfortable as you can.
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Let go of any judgment you might have about yourself.
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Focus on your relaxation technique and your breathing.
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Bring your focus back to the present moment as many times as you need.
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Be grateful for any level of relaxation you can achieve.
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Allow things to be as they are, but do persist. Be confident that with regular practice, you will experience a more relaxed and less distracted state. That after all, is one of the main reasons we choose to learn to meditate.
Your expectations
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Like anything else, each meditation session will bring a different experience.
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Allow the experience of each meditation to be the way it is.
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Remove any judgment you may have about the session being ‘good’ or ‘bad’, while it can be helpful to notice what may not have been helpful for you and to not repeat that; notice what was helpful, and do more of that.
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On any given day, you may take longer to relax or not go as deeply into your meditation, that is OK. Learning anything new is like that. Simply persevere.
Maintaining a regular routine
If you make a commitment to nurture yourself, you are half way there. Create a specific time and space for your meditation by blocking out time in your diary or calendar. If you miss a session, do not beat yourself up about it. Get back into your routine as soon as you can. Think about the short and long-term benefits you receive from meditation and write them down to remind you why you are making this commitment. As you practice regularly, you will see improvement and this will give you the incentive you need.
The great thing about the Meditation App Program is that it gradually introduces you to regular practice. You initially learn the core techniques and basic steps so you get used to relaxing and sitting quietly. You start with a 5 - 10 minute meditation and gradually build up the time. As you practise daily, you will begin to notice feelings of being more relaxed and at ease.
Specific questions are answered in the FAQs or if you feel really stuck you are welcome to email Ask the Expert.
A continuing quest to unravel our conscious and unconscious minds
One of the great strengths of meditation is its longevity. The earliest written records of meditation being practiced come from China dated around 5,000 BC. In India, written records first appeared about 1,500 BC, and in Greece, about 750 BC. Meditation has been practiced continuously in virtually all cultures. While this practice is often associated primarily with Eastern cultures and religions, it is apparent that meditation is a widespread and long-lasting phenomenon.
During the 1800s, meditation in the West was largely the domain of Christian contemplatives and a few explorers of the occult, spiritualism, mental healing and transcendental experience. This all changed when the first World Parliament of Religions was held in Chicago in 1893. For the first time major spiritual leaders from the East gathered and presented their experience and knowledge to a large gathering of influential Westerners. The Interfaith Movement began, and a serious interest in the study and practice of meditation was sparked in the Western world.
The rise of meditation in the 1960s
While the 1950s saw a few pioneers such as Alan Watts, who published his bestseller Psychotherapy East and West in 1961— meditation in the West remained largely the domain of spiritual seekers until the early 1960s. Most meditation was within the context of a Hindu Yogic, Sufi, Buddhist or Taoist framework. Then came the Age of Aquarius - the 1960s. The Beatles went to India, met the Maharishi and brought Transcendental Meditation (TM) back to the West. The Vietnam War galvanised a generation, the counterculture flourished, and people were intent on expanding their minds in different ways! Meditation was quickly popularised, and even stigmatised, as the domain of the hippies.
Meanwhile, a wave of spiritual refugees persecuted at home arrived in the West. While His Holiness the Dalai Lama is the best known of these, many other luminaries suddenly became directly available to Western audiences.
Meditation as a therapy
Beginning in the 1960s and expanding into the 70s, innovative doctors and psychologists realised that meditation had specific therapeutic applications. This coincided with the beginnings of mind-body medicine.
Until this time, the health of the mind was regarded in most medical circles to be quite unrelated to the health of the body. Likewise the capacity of the mind to influence healing was largely ignored. Very little academic research was being published up until the 1970s on mind-body medicine in general or meditation specifically. Documenting the advent of meditation as a therapy began with popular books on the subject.
Landmark publications
The first significant book came from the Australian psychiatrist, Dr Ainslie Meares. Relief Without Drugs was first published in 1967 in the United Kingdom and it rapidly created a global publishing sensation and was translated into many languages.
The psychologist Larry LeShan spent the 1960s delving into parapsychology and also became a founding pioneer in psycho-oncology, applying his training to the betterment of people affected by cancer. His book, How to Meditate was published in 1974 and became a standard reference for many years.
In 1975, another landmark book emerged. Herbert Benson, a cardiologist and convert to Transcendental Meditation (TM), published his scientifically based, runaway bestseller The Relaxation Response. Benson advocated a more secular version of TM, detailing a simple mantra-based meditation technique.
Then in 1978 Carl Simonton and Stephanie Matthews published Getting Well Again, which broke new ground. It applied Stephanie’s training as a performance psychologist to enhance Carl’s work as a radiation-oncologist. Carl and Stephanie focused on teaching their patients imagery techniques to complement and facilitate radiotherapy. They reported positive results and their research findings rapidly opened the doors to developments in the study and practice of the therapeutic use of imagery.
The 1970s and 1980s saw excellent books published on meditation. In the therapeutic arena, Pauline McKinnon, a patient of Dr Meares’ who used his methods to recover from agoraphobia in 1983, published, In Stillness Conquer Fear. Ian Gawler’s first book, You Can Conquer Cancer, with its emphasis on the therapeutic application of meditation was released in 1984, followed by his first book specifically on meditation, Peace of Mind in 1987, then Meditation - Pure and Simple in 1996, and The Creative Power of Imagery in 1997.
The next major wave in therapeutic meditation was propelled by Jon Kabat-Zinn’s first book, which detailed the use of mindfulness in the therapeutic setting. Full Catastrophe Living published in 1990, has catalysed huge interest in mindfulness among the public and the scientific research community.
In 1992 Sogyal Rinpoche published his spiritual classic The Tibetan Book of Living and Dying, which to date has sold over 3.5 million copies and has been translated into over 30 languages.
At the beginning of the 21st century, a series of breakthroughs in neurological research were summarised in Norman Doidge’s book The Brain that Changes Itself. A research psychiatrist, Doidge documented revolutionary discoveries in the new and exciting field of neuroplasticity demonstrating that our brain changes both its physical structure and function according to how we use it. This has tremendous potential for those hoping to recover from major head injuries or disease.
The year 2007 was a vintage year for mind science breakthroughs. In The Mindful Brain, Daniel Siegel, psychiatrist, educator and leader in the field of mental health, introduced recent research identifying what have been termed ‘mirror neurons’. These specialised cells form a system that has the capacity to mirror internally what we are experiencing externally.
More recent works by a new generation of young Tibetan teachers include Yongey Mingyur Rinpoche’s excellent books The Joy of Living (2007) and Joyful Wisdom (2009).
Scientific research
When TM came to the West it brought two exceptional benefits: a reliable meditation technique that was relatively easy to teach and to learn; and organizationally, a strong commitment to research. By 1990 David Orme-Johnson and colleagues at TM’s university in Iowa compiled and edited 508 scientific studies on the therapeutic benefits of TM. Of these studies about one third each came from peer-reviewed scientific journals, TM conferences and TM’s own publications. One of TM’s leading advocates, Herbert Benson, established the Mind-Body Medical Institute at Harvard and continues to have a powerful effect in catalysing research.
Another wave of groundbreaking research, was orchestrated by His Holiness the Dalai Lama. His Holiness has a long-standing interest in science and the mind in particular and was instrumental in establishing the Mind and Life Instgitute. This collaborative approach to research between modern science and Buddhist scholars has resulted in regular dialogues since 1987 between the Dalai Lama and others such as Daniel Goleman, the author of Emotional Intelligence; Matthieu Ricard; neuroscientist Richard Davidson; and Jon Kabat-Zinn. Many popular bestsellers come directly from these dialogues, such as Healing Emotions (1997) and Destructive Emotions - and how we can overcome them (2003), both edited by Daniel Goleman.
The development of academic research has been underpinned by the ongoing influences of Michael Murphy and Stephen Donovan whose famous personal development centre, the Esalen Institute was established in 1961. They have provided a wonderful contribution to this field with their work The Physical and Psychological Effects of Meditation. First released in 1988, an updated edition is now available at noetic.org. The noetic bibliography is regularly updated and includes around 7,000 scientific articles.
The body of research evidence is huge and powerfully attests to meditation’s many benefits in the prevention, management and treatment of a wide range of physical and psychological conditions. This evidence base is arguably more extensive than that relating to many well-accepted treatments carried out daily in medical practices around the world.
Meditation is for monks
It is true, monks do meditate but unless you want to be one, you do not need a robe or a monastery to start meditating.
It is also true that monks exude a contentment that many of us would like to feel too, especially in our stressed modern lives. The answers they seek about life’s meaning are vital to us all - how to be happy, how to be healthy, how to cope with life’s ups and downs. Throughout millennia, it is meditation that has been proven to be effective in answering these questions and bring true contentment to those who practice regularly.
My mind has to be totally blank to meditate
You do not have to try and tip everything out of your head before every meditation. Our active minds tend to flit like a butterfly from one thought to the next but with your Meditation App Program you can learn to slow down your thinking to develop a calm and clear mind - not necessarily an empty one!
There is one particular technique called stillness that will help you to experience the essence of meditation. When mastered it can give you inner contentment that is difficult to describe but wonderful to experience.
It is all about Gurus, Chakras and Crystals
OK, you may not be too sure about some of the lingo but meditation can be as simple as you want it to be. You do not need anything other than your body and mind, and to feel comfortable in your practice.
Some people want to enhance their experience by doing things such as burning essential oils or using particular images and symbols, but you simply need to create an atmosphere of meditation for yourself. Do what best helps you to deepen your practice.
By the way, Chakras are subtle energy centres in the body, but you do not need to know or understand them to meditate.
It takes too much time and effort
You do not have to set aside lots of time each day to reap the benefits from meditation as even a little practice each day will help. However, we all know anything that takes a bit of effort to begin with is often rewarding in the end and meditation is no different. Determine to do a little each day. Even five minutes is a good start. You will find that the time you invest in your practice will be returned to you in other ways like increased productivity at work, the ability to make decisions quickly and confidently, or spending less time worrying about things.
It's a religious practice isn't it?
Meditation is simply about you and your mind. There are no gods to worship or prayers to say. However, while contemplation on the meaning of life and the seeking of solace is a part of many world religions, it is also a part of meditation. It is a great way for you to relax, gain clarity, improve your health, and manage your day.
The Meditation App Program is about the practice of meditation and is not linked to any religious or secular group. It is open to everyone to participate in and benefit from.
I have to chant and clink bells
You do not have to do this but some people find it deepens their practice of meditation - we call them optional extras! In reality you do not need anything other than your body and your mind. Meditation is all about trying new things so you may find you can relax or concentrate better if you add them to your practice. If something you try does not feel right for you, then simply drop it and continue with what you do find helpful.
I cannot get into the lotus position
Well, being double jointed is a bonus (!) but being able to master this position is not necessary. Good posture is important but even more important is that you feel at ease using a position that you like - you do not have to sit crossed legged on a cushion! If you can, sit with your back straight and head upright. If you have a back problem, you can lie down. However, you need to make sure you do not fall asleep so create a position where you remain alert.
I have to be in a quiet place
Being in a quiet place is great but with our busy lives we know it can be hard to find. But all is not lost! In the Meditation App Program we support and encourage you to experiment in more challenging situations so you can deepen your meditation and strengthen your mind. A technique you will learn is to ‘act without reacting’ - to register and process what is happening around you, but not be drawn into it.
Once you have mastered meditation in your preferred space at your pre-designated time, we recommend that you gradually introduce increasingly challenging distractions such as noise, uncomfortable surroundings and learn to overcome them. Once you get the hang of it, you can meditate anywhere, anytime.
Meditation is for monks
It is true, monks do meditate but unless you want to be one, you do not need a robe or a monastery to start meditating.
It is also true that monks exude a contentment that many of us would like to feel too, especially in our stressed modern lives. The answers they seek about life’s meaning are vital to us all - how to be happy, how to be healthy, how to cope with life’s ups and downs. Throughout millennia, it is meditation that has been proven to be effective in answering these questions and bring true contentment to those who practice regularly.
My mind has to be totally blank to meditate
You do not have to try and tip everything out of your head before every meditation. Our active minds tend to flit like a butterfly from one thought to the next but with your Meditation App Program you can learn to slow down your thinking to develop a calm and clear mind - not necessarily an empty one!
There is one particular technique called stillness that will help you to experience the essence of meditation. When mastered it can give you inner contentment that is difficult to describe but wonderful to experience.
It is all about Gurus, Chakras and Crystals
OK, you may not be too sure about some of the lingo but meditation can be as simple as you want it to be. You do not need anything other than your body and mind, and to feel comfortable in your practice.
Some people want to enhance their experience by doing things such as burning essential oils or using particular images and symbols, but you simply need to create an atmosphere of meditation for yourself. Do what best helps you to deepen your practice.
By the way, Chakras are subtle energy centres in the body, but you do not need to know or understand them to meditate.
It takes too much time and effort
You do not have to set aside lots of time each day to reap the benefits from meditation as even a little practice each day will help. However, we all know anything that takes a bit of effort to begin with is often rewarding in the end and meditation is no different. Determine to do a little each day. Even five minutes is a good start. You will find that the time you invest in your practice will be returned to you in other ways like increased productivity at work, the ability to make decisions quickly and confidently, or spending less time worrying about things.
It's a religious practice isn't it?
Meditation is simply about you and your mind. There are no gods to worship or prayers to say. However, while contemplation on the meaning of life and the seeking of solace is a part of many world religions, it is also a part of meditation. It is a great way for you to relax, gain clarity, improve your health, and manage your day.
The Meditation App Program is about the practice of meditation and is not linked to any religious or secular group. It is open to everyone to participate in and benefit from.
I have to chant and clink bells
You do not have to do this but some people find it deepens their practice of meditation - we call them optional extras! In reality you do not need anything other than your body and your mind. Meditation is all about trying new things so you may find you can relax or concentrate better if you add them to your practice. If something you try does not feel right for you, then simply drop it and continue with what you do find helpful.
I cannot get into the lotus position
Well, being double jointed is a bonus (!) but being able to master this position is not necessary. Good posture is important but even more important is that you feel at ease using a position that you like - you do not have to sit crossed legged on a cushion! If you can, sit with your back straight and head upright. If you have a back problem, you can lie down. However, you need to make sure you do not fall asleep so create a position where you remain alert.
I have to be in a quiet place
Being in a quiet place is great but with our busy lives we know it can be hard to find. But all is not lost! In the Meditation App Program we support and encourage you to experiment in more challenging situations so you can deepen your meditation and strengthen your mind. A technique you will learn is to ‘act without reacting’ - to register and process what is happening around you, but not be drawn into it.
Once you have mastered meditation in your preferred space at your pre-designated time, we recommend that you gradually introduce increasingly challenging distractions such as noise, uncomfortable surroundings and learn to overcome them. Once you get the hang of it, you can meditate anywhere, anytime.
