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					 Medical Applications
                of
Mindfulness Meditation

   Thanh V. Huynh, M.D.
      JAB School of Medicine
        University of Hawaii
   Cultivating the body
   Cultivating the Mind: Meditation
    (Bhavana)
Concentration and
Mindfulness
   Concentration: One-pointedness
    of mind which is absorbed in a
    chosen physical object (the breath,
    light, sounds…) or mental object
    (Mantra or prayers).
   Mindfulness: Dynamic moment to
    moment choiceless awareness of
    the most obvious object (real life
    experience).
         What is Mindfulness?

Mindfulness is the non-judging attention to observe
  present time life experiences as they really are. It is
  associated with patience and acceptance, without
  expectation of outcome, without clinging to the
  pleasant experience or rejecting the unpleasant one.
   Mindfulness is a beautiful or wholesome
    mental factor that coexists only with other
    beautiful mental qualities in the particular
    moment that it is present.
Metaphore
   Mindfulness is like a torch in a dark
    night clarifying the path we are
    following
Four Aspects of
Mindfulness:
   Body: the breath, postures,
    movements and physical
    sensations.
   Feeling tone (pleasant,
    unpleasant, neutral).
   Mind (consciousness): thoughts,
    mental states, emotions.
   Mental contents
           CONCEPT AND REALITY

   Concept: the apparent form; what we
    conventionally name or perceive through
    our preconceived ideas which is colored by
    our past experience or misconception.
   Reality: How things really are at the
    “cellular/microscopic” level of perception
    through mindful awareness: the four
    physical elements, the true characteristics of
    life which is a stream of continuously
    changing mind/body process.
Benefits of Mindfulness
By embracing all life experiences, whether
  pleasant or unpleasant, one develops
  insights into the true nature of life
  (changing, unsatisfactory and
  impersonal), having more patience and
  acceptance. One therefore acts with
  clarity of mind rather than reacts and
  encounters less stress, more joy and
  inner peace.
             Medical Applications
   Results of your search: mindfulness.m_titl.
   Viewing 1-25 of 131 Results
   Go to #:
   1.
   Chatzisarantis NL. Hagger MS. Mindfulness and the intention-behavior relationship within the theory of planned behavior. [Journal Article] Personality & Social Psychology Bulletin. 33(5):663-76,
    UI: 17440208 Authors Full Name
    Chatzisarantis, Nikos L D. Hagger, Martin S.
   |
   2.
   Berking M. von Kanel M. [Mindfulness training as a psychotherapeutic tool. Clarification of concept, clinical application and current state of empirical research]. [Review] [71 refs] [German] [Englis
    Review] Psychotherapie, Psychosomatik, Medizinische Psychologie. 57(3-4):170-7, 2007 Mar-Apr.
    At HML online--see E-Journals web pages
    UI: 17427100 Authors Full Name
    Berking, Matthias. von Kanel, Miriam.
   |
   3.
   Horton-Deutsch S. O'Haver Day P. Haight R. Babin-Nelson M. Enhancing mental health services to bone marrow transplant recipients through a mindfulness-based therapeutic intervention. [Jou
    Non-U.S. Gov't] Complementary Therapies in Clinical Practice. 13(2):110-5, 2007 May.
    UI: 17400146 Authors Full Name
    Horton-Deutsch, Sara. O'Haver Day, Pamela. Haight, Regina. Babin-Nelson, Michele.
   |
   4.
   Gregg JA. Callaghan GM. Hayes SC. Glenn-Lawson JL. Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. [Journal Article. Rando
    Journal of Consulting & Clinical Psychology. 75(2):336-43, 2007 Apr.
    UI: 17469891 Authors Full Name
    Gregg, Jennifer A. Callaghan, Glenn M. Hayes, Steven C. Glenn-Lawson, June L.
   |
   5.
   Santorelli SF. Mindfulness and medicine. Interview by Bonnie J. Horrigan. [Interview] Explore-The Journal of Science & Healing. 3(2):136-44, 2007 Mar-Apr.
    UI: 17362849 Authors Full Name
    Santorelli, Saki F.
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   6.
   Kingston J. Chadwick P. Meron D. Skinner TC. A pilot randomized control trial investigating the effect of mindfulness practice on pain tolerance, psychological well-being, and physiological activi
    Article. Randomized Controlled Trial] Journal of Psychosomatic Research. 62(3):297-300, 2007 Mar.
    At HML online--see E-Journals web pages
    UI: 17324679 Authors Full Name
    Kingston, Jessica. Chadwick, Paul. Meron, Daniel. Skinner, T Chas.
   |
   7.
Serious research on TM (Transcendental
Meditation) first appeared in the scientific
literature about three decades ago, and
inspired, as listed on PsycINFO, 147 articles
from 1973 to 1982 (during this time, 88
studies focused on Zen and mindfulness). In
the present decade (1993-2002), mindfulness
research has been on the rise, with over 140
articles to date (75 for TM).
Mindfulness-based stress reduction and health benefits
A meta-analysis
Paul Grossman, a, , , Ludger Niemannb, Stefan Schmidtc and Harald Walachc, d
J Psychosom Res. 2004 Jul;57(1):35-43.
Table 2. Mean effect size, d, 95% confidence intervals (CIs) and P
values (two-tailed) calculated for the difference between
mindfulness meditation and control group on mental health and
physical health variables for all controlled studies
Table 3. Effect of mindfulness training based on a pre–post
comparison for mental and physical health variables (k, number of
studies; N, number of subjects; d, mean effect size; P value, two-
tailed)
             Case Presentation
   Nine-year-old Victoria had been struggling with nausea and
    epigastric pain caused by gastroesophageal reflux (GER) for
    many months. When initial medical treatment failed and her
    symptoms worsened, an endoscopy was performed. As a
    result of the biopsy and pathology findings, different
    medications were prescribed. The new medications offered
    little relief from the nausea and vomiting, and Victoria was
    experiencing anxiety about her condition that was manifested
    in sleep disturbance.
   Her gastroenterologist and primary nurse felt she could benefit
    from complementary care intervention. Victoria, accompanied
    by her mother, was referred for a nonpharmacological
    intervention. Mindfulness meditation played an important role
    in the treatment of Victoria's plan for pain and symptom
    management.
   Over time, Victoria was surprised to learn, through self-
    observation and being mindful of her experience, that there
    were physical changes that she experienced before feeling
    sick. With continued practice, she became more aware of her
    bodily sensations and developed keen observational skills.
    Victoria found mindfulness meditation and the body scan
    effective interventions for the distress she experienced.
    She was able to decrease the amount of medication she
    required and at the same time experienced a decrease in
    physical symptoms. Once again she was able to sleep
    peacefully and wake well rested. She also discovered that
    when she took a couple minutes to breathe before taking
    tests in school, it helped her to calm down and think
    better - an unexpected benefit.
   A randomized controlled trial of
    mindfulness meditation versus
    relaxation training: effects on
    distress, positive states of mind,
    rumination, and distraction. Jain
    S, Shapiro SL, Swanick S,
    Roesch SC, Mills PJ, Bell I,
    Schwartz GE. Ann Behav Med.
    2007 Feb;33(1):11-21
   Compared with a no-treatment control,
    brief training in mindfulness meditation or
    somatic relaxation reduces distress and
    improves positive mood states.
   However, mindfulness meditation may
    be specific in its ability to reduce
    distractive and ruminative thoughts and
    behaviors, and this ability may provide a
    unique mechanism by which mindfulness
    meditation reduces distress.
   Mindfulness-based stress
    reduction as an adjunct to
    outpatient psychotherapy.
   Weiss M, Nordlie JW, Siegel EP
   Psychother Psychosom.
    2005;74(2):108-12.
   The MBSR group's gains on a
    novel measure of goal
    achievement were significantly
    greater than those of the
    comparison group.
    In addition, the MBSR group
    terminated therapy at a
    significantly greater rate than the
    comparison group
                 Chronic Pain
   Kabat-Zinn, J., Lipworth, L., Burney, R. and Sellers,
    W. Four year follow-up of a meditation-based program for
    the self-regulation of chronic pain: Treatment outcomes
    and compliance. Clin. J. Pain (1986) 2:159-173.
   Abstract: 225 chronic pain patients were studied
    following training in mindfulness meditation. Large and
    significant overall improvements were recorded post-
    intervention in physical and psychological status. These
    gains were maintained at follow-up in the majority of
    subjects. Follow-up times ranged from 2.5 to 48 months
 The impact of a meditation-based stress
 reduction program on fibromyalgia.
 Kaplan KH, Goldenberg DL, Galvin-Nadeau M.
 Arthritis-Fibromyalgia Center, Newton Wellesley Hospital, Massachusetts.


77 patients meeting the 1990 criteria of the American College of
Rheumatology for fibromyalgia took part in a 10-week group
outpatient program.
Outcome measures included visual analog scales to measure global
well-being, pain, sleep, fatigue, and feeling refreshed in the morning
51% showed moderate to marked improvement
                                Psoriasis
   Kabat-Zinn, J., Wheeler, E., Light, T., Skillings, A.,
    Scharf, M.S., Cropley, T.G., Hosmer, D. and Bernhard, J.
    Influence of a mindfulness-based stress reduction
    intervention on rates of skin clearing in patients with
    moderate to severe psoriasis undergoing phototherapy
    (UVB) and photochemotherapy (PUVA). Psychosomat Med
    (1998) 60:625-632.
   Thirty-seven patients were randomly assigned to one of two conditions: a mindfulness
    meditation-based stress reduction intervention guided by audiotaped instructions during
    light treatments, or a control condition consisting of the light treatments alone

   Conclusions: A brief mindfulness meditation-based stress
    reduction intervention delivered by audiotape during
    ultraviolet light therapy can increase the rate of resolution
    of psoriatic lesions (the meditators cleared at approximately four times the
    rate of controlled subjects) .
Mindfulness meditation to reduce
symptoms after organ transplant: a
pilot study.
Gross CR, Kreitzer MJ, Russas V, Treesak C, Frazier PA, Hertz MI.
College of Pharmacy and School of Nursing, University of Minnesota, USA.


RESULTS: Nineteen participants completed the course.

Findings suggest improvement from baseline symptom scores for
depression (P = .006) and sleep (P = .011) at the completion of the
MBSR program.
At 3 months, improvement in sleep continued (P = .002), and a
significant improvement in anxiety scores was seen (P = .043);
                     Mindfulness-Based Stress Reduction in
                     Relation to Quality of Life, Mood, Symptoms
                     of Stress, and Immune Parameters in Breast
                     and Prostate Cancer Outpatients
                     Carlson, Linda E. PhD; Speca, Michael PsyD; Patel, Kamala D. PhD;
                     Goodey, Eileen MSW


Forty-nine (49) patients with breast cancer and 10 with prostate
cancer participated in an 8-week MBSR program. Demographic and
health behavior variables, quality of life (EORTC QLQ C-30), mood
(POMS), stress (SOSI), and counts of NK, NKT, B, T total, T helper,
and T cytotoxic cells, as well as NK and T cell production of TNF, IFN-
[gamma], IL-4, and IL-10 were assessed pre- and post-intervention
Results: Significant improvements were seen in overall quality of life,
symptoms of stress, and sleep quality.
T cell production of IL-4 increased and IFN-[gamma] decreased,
whereas NK cell production of IL-10 decreased.
These results are consistent with a shift in immune profile
from one associated with depressive symptoms to a more normal profile.
    Alterations in Brain and Immune Function Produced by
    Mindfulness Meditation.
    Davidson, Richard J. PhD; Kabat-Zinn, Jon PhD; Schumacher, Jessica MS; Rosenkranz,
    Melissa BA; Muller, Daniel MD, PhD; Santorelli, Saki F. EdD; Urbanowski, Ferris MA;
    Harrington, Anne PhD; Bonus, Katherine MA; Sheridan, John F. PhD




Brain electrical activity was measured before and immediately
after, and then 4 months after an 8-week training program in
mindfulness meditation.
Twenty-five subjects were tested in the meditation group. A
wait-list control group (N = 16) was tested at the same points
in time as the meditators.
At the end of the 8-week period, subjects in both groups were
vaccinated with influenza vaccine.

.
The mindfulness group (compared with the wait-list control group)
displayed significant increases in left-sided anterior activation
(previously associated with positive affect) and increases in
antibody titers to influenza vaccine
Mean trait anxiety
from the Spielberger State-Trait Anxiety Inventory
Means ± SE antibody rise
from the 3- to 5-week to the 8- to 9-week
Scatter plot for the meditation group only showing the relation
between the change in asymmetric anterior activation at baseline
from Time 1 to Time 2 in C3/C4 and the magnitude of rise in
antibody titers to the influenza vaccine from the week 3 to 5 to the
week 8 to 9
   Neural Correlates of
    Dispositional Mindfulness
    During Affect Labeling
   From the Department of Psychology
    (J.D.C., B.M.W., M.D.L.) and Cousins
    Center for Psychoneuroimmunology
    (N.I.E.), University of California, Los
    Angeles, Los Angeles, California.
   Results:
    Dispositional mindfulness was
    associated with greater widespread
    prefrontal cortical activation, and
    reduced bilateral amygdala activity
    during affect labeling, compared with the
    gender labeling control task.
   Strong dissociations were found between
    areas of prefrontal cortex and right
    amygdala responses in participants high
    in mindfulness but not in participants low
    in mindfulness.
                           Mindfulness in Medicine and Law
                           and Sports
   Medicine
    In the medical field, the University of Massachusetts Medical Center has used
    mindfulness practice for over twenty-five years. Founded by Dr. Jon Kabat-Zinn, the
    Center for Mindfulness in Medicine, Health Care and Society, has been instructing
    patients, doctors, medical students and a host of others in mindfulness practice to
    reduce suffering and enhance the quality of their lives. The program's success has lead
    to its replication in over 240 medical institutions around the world.
   Law
    The legal profession has also found great use for mindfulness practice. Harvard Law
    School's Program on Negotiation sponsored the seminar "Mindfulness in the Law and
    Alternative Dispute Resolution" in 2002 in response to Professor Leonard Riskin's
    influential paper "The Contemplative Lawyer"
   (link: www.law.missouri.edu/csdr/contempl_lawyer.htm) published in the Harvard
    Negotiation Law Review. Mindfulness programs have been taught to students,
    professors of Harvard, Yale, Stanford and Columbia Law Schools, Boalt Hall of UC
    Berkeley, the University of Missouri-Columbia
    (www.law.missouri.edu/csdr/mindfulness.htm) and Pepperdine University as well as
    practicing lawyers and judges from around the nation.
   Professional Sports
    Mindfulness practice has also been used to great success in professional sports. Former
    Chicago Bulls Coach Phil Jackson, now of the Los Angeles Lakers, (see his book:
    Sacred Hoops) has used mindfulness practice in basketball training for many years.
    Olympic athletes like US Gold Medalist Speed skater Apolo Ohno and golf star Tiger
    Woods have also employed mindfulness practice as part of their training.
Effects of mindfulness-based stress
reduction on medical and premedical
students.
Shapiro SL, Schwartz GE, Bonner G.
Department of Psychology, University of Arizona, Tucson 85719, USA.

The inability to cope successfully with the enormous stress of medical
education may lead to a cascade of consequences at both a personal and
professional level.
A short-term effects of an 8-week meditation-based stress reduction
intervention on premedical and medical students using a well-
controlled statistical design.

Findings indicate that participation in the intervention can effectively (1)
reduce self-reported state and trait anxiety, (2) reduce reports of
overall psychological distress including depression, (3) increase
scores on overall empathy levels, and (4) increase scores on a measure
of spiritual experiences assessed at termination of intervention      .
Feedback from a Hawaiian intermediate
 school student after a brief introduction to
 Mindfulness:
“…I really enjoyed the message that you sent to us.
   It taught me a lot about how to take life as it
   comes. It was a great way to be mindful of
   myself. It really is starting to help me because
   I’m becoming less stressed about everything.
I also really enjoyed the “Breathe in Breathe out”
   song. The food activity with the pretzel helped
   me to understand that once you eat the food it
   will soon become a part of me. I always
   mindfully enjoy what I do daily…
 Love,“
     Kahala.
      Study Title: A Feasibility Study of Online Mindfulness Meditation For
      Newly Diagnosed Cancer Patients
      Study Coordinator: Carolyn Gotay, PhD (psychology), Professor, University of Hawaii Cancer
      Research Center of Hawaii
      Study Team: Brian Issell, MD (medical oncology), Thanh Huynh, MD (radiation oncology)
   Supported by: Developmental Funds, Cancer
    Research Center of Hawaii
   Primary Study Objective: To examine the feasibility of
    a web-based mindfulness intervention for patients
    beginning chemotherapy or radiation therapy
   Study Summary:
       The target sample size of 15 was achieved. To date,
    exit interviews have been completed with the 11 patients
    who have completed the intervention (four are currently in
    the midst of the program). . Ten of 11 patients reported
    many positive benefits due to participation, including
    stress reduction, relaxation, easing pain, and
    counteracting negative feelings. Ten said that they
    would recommend it to other cancer survivors, and nine
    said they would continue MM practice after the study
    conclusion.
Attitude of Practicing
Mindfulness
   Preparing the soil: Non Harming
    commitments.
   Non-expectation.
   Relaxed, persisting joyous interest.
   Formal and informal practice in
    daily life.

				
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