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Day MA, Matthews N, Mattingley JB, Ehde DM, Turner AP, Williams RM, Jensen MP. Change in Brain Oscillations as a Mechanism of Mindfulness-Meditation, Cognitive Therapy, and Mindfulness-Based Cognitive Therapy for Chronic Low Back Pain. Pain Med 2021; 22:1804-1813. [PMID: 33561289 DOI: 10.1093/pm/pnab049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Psychological treatments for chronic low back pain (CLBP) are effective. However, limited research has investigated their neurophysiological mechanisms. This study examined electroencephalography- (EEG-) assessed brain oscillation changes as potential mechanisms of cognitive therapy (CT), mindfulness-meditation (MM), and mindfulness-based cognitive therapy (MBCT) for CLBP. The a priori bandwidths of interest were changes in theta, alpha and beta power, measured at pre- and post-treatment. DESIGN A secondary analysis of a clinical trial. SETTING University of Queensland Psychology Clinic. SUBJECTS Adults (N = 57) with CLBP who completed pre- and post-treatment EEG and pain outcome assessments. METHODS EEG data were examined for five regions of interest (ROIs); the primary outcome was pain intensity. RESULTS A significant reduction in theta (P=.015) and alpha (P=.006) power in the left frontal ROI across all treatments was found, although change in theta and alpha power in this region was not differentially associated with outcome across treatments. There were significant reductions in beta power in all five ROIs across all treatments (P≤.013). Beta power reduction in the central ROI showed a significant association with reduced pain intensity in MBCT only (P=.028). Changes in other regions were not statistically significant. CONCLUSIONS These findings provide support for the capacity of psychological CLBP treatments to induce changes in brain activity. The reduced beta power in all five ROIs indicated that all three treatments engendered a state of lowered cortical arousal. The growing body of research in this area could potentially inform novel directions towards remedying central nervous system abnormalities associated with CLBP.
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Affiliation(s)
- Melissa A Day
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Natasha Matthews
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Jason B Mattingley
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.,Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Rehabilitation Care Service/Polytrauma, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rhonda M Williams
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.,Rehabilitation Care Service/Polytrauma, VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Shukla R, Gupta M, Agarwal N, Bajpai A. Mindfulness Meditation as Adjunctive Therapy to Improve the Glycemic Care and Quality of Life in Patients with Type 1 Diabetes. Med Sci (Basel) 2021; 9:33. [PMID: 34064218 PMCID: PMC8162570 DOI: 10.3390/medsci9020033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mindfulness Meditation (MM) is known to improve glycemic control and enhance the quality of life (QoL) in type 2 diabetes (T2D) patients. Unfortunately, the role of meditation in type 1 diabetes (T1D) has not been studied extensively. Therefore, we conducted this study to determine the effect of MM on the glycemic control and QoL in people living with T1D. METHODOLOGY Thirty-two adults living with T1D were equally randomized into intervention (meditation) and control groups. The glycemic control and QoL were assessed at the baseline and after six months of intervention. RESULTS A total of thirty-two adults (15 males, 46.9%; mean age 23.8 ± 6.6 years) with type 1 diabetes (mean diabetes duration 12.7 ± 6.2 years) participated in the study. At the end of six months, a statistically significant improvement was seen in the mean blood glucose level in the control group (222.4 ± 77.8 versus 182.6 ± 52.0; p = 0.007) and the intervention group (215.3 ± 50.1 versus 193.2 ± 31.8; p = 0.008). Additionally, there was a significant reduction in the total diabetes distress score in the intervention group (1.6 ± 0.3 versus 1.3 ± 0.3; p = 0.003), while no change was observed in the control group (1.6 ± 0.7 versus 1.7 ± 0.4; p = 0.762). A statistically significant improvement was noticed in the health and functioning domain in the intervention group (p = 0.023). CONCLUSIONS An improvement in the glycemic control and quality of life of the patients was observed in our study. MM certainly plays an important role in attaining peace of mind and helps patients to channel their energy in a positive direction.
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Affiliation(s)
- Rishi Shukla
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
| | - Manisha Gupta
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
| | - Neha Agarwal
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
| | - Anurag Bajpai
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
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Polaski AM, Phelps AL, Smith TJ, Helm ER, Morone NE, Szucs KA, Kostek MC, Kolber BJ. Integrated Meditation and Exercise Therapy: A Randomized Controlled Pilot of a Combined Nonpharmacological Intervention Focused on Reducing Disability and Pain in Patients with Chronic Low Back Pain. Pain Med 2021; 22:444-458. [PMID: 33621332 DOI: 10.1093/pm/pnaa403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This pilot trial examined the effects of a combined intervention of mindfulness meditation followed by aerobic walking exercise compared with a control condition in chronic low back pain patients. We hypothesized that meditation before exercise would reduce disability, pain, and anxiety by increasing mindfulness prior to physical activity compared with an audiobook control group. PARTICIPANTS Thirty-eight adults completed either meditation and exercise treatment (MedExT) (n=18) or an audiobook control condition (n=20). SETTING Duquesne University Exercise Physiology Laboratory. DESIGN A pilot, assessor-blinded, randomized controlled trial. METHODS Over a 4-week period, participants in the MedExT group performed 12-17 minutes of guided meditation followed by 30 minutes of moderate-intensity walking exercise 5 days per week. Measures of disability, pain, mindfulness, and anxiety were taken at baseline and postintervention. Pain perception measurements were taken daily. RESULTS Compared with the control group, we observed larger improvements in disability in the MedExT intervention, although the changes were modest and not statistically significant (mean between-group difference, -1.24; 95% confidence interval [CI], -3.1 to 0.6). For secondary outcome measures, MedExT increased mindfulness (within-group) from pre-intervention to postintervention (P=0.0141). Additionally, mean ratings of low back pain intensity and unpleasantness significantly improved with time for the MedExT group compared with that of the control group, respectively (intensity P=0.0008; unpleasantness P=0.0022). CONCLUSION . Overall, 4 weeks of MedExT produced suggestive between-group trends for disability, significant between-group differences for measures of pain, and significant within-group increases in mindfulness.
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Affiliation(s)
- Anna M Polaski
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA.,Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Amy L Phelps
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA.,Palumbo-Donahue School of Business, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Thomas J Smith
- Counseling and Wellbeing Center, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Eric R Helm
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Natalia E Morone
- Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Kimberly A Szucs
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA.,Department of Occupational Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Matthew C Kostek
- Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA.,Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Benedict J Kolber
- Department of Biological Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA.,Chronic Pain Research Consortium, Duquesne University, Pittsburgh, Pennsylvania, USA.,Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, Texas, USA
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Abstract
Background: Several studies have reported that mindfulness meditation has a potential effect in controlling headaches, such as migraine and tension-type headache; however, its role remains controversial. This review assessed the evidence regarding the effects of mindfulness meditation for primary headache pain. Methods: Only English databases (PubMed, Cochrane Central Register of Controlled Trials [the Cochrane Library], PsycINFO, Psychology and behavioral science collection, PsyArticles, Web of Science, and Scopus) were searched from their inception to November 2016 with the keywords (“meditation” or “mindfulness” or “vipassana” or “dzogchen” or “zen” or “integrative body-mind training” or “IBMT” or “mindfulness-based stress reduction” or “MBSR” or “mindfulness-based cognitive therapy” or “MBCT” and “Headache” or “Head pain” or “Cephalodynia” or “Cephalalgia” or “Hemicrania” or “Migraine”). Titles, abstracts, and full-text articles were screened against study inclusion criteria: controlled trials of structured meditation programs for adult patients with primary headache pain. The quality of studies included in the meta-analysis was assessed with the Yates Quality Rating Scale. The meta-analysis was conducted with Revman 5.3. Results: Ten randomized controlled trials and one controlled clinical trial with a combined study population of 315 patients were included in the study. When compared to control group data, mindfulness meditation induced significant improvement in pain intensity (standardized mean difference, −0.89; 95% confidence interval, −1.63 to −0.15; P = 0.02) and headache frequency (−0.67; −1.24 to −0.10; P = 0.02). In a subgroup analysis of different meditation forms, mindfulness-based stress reduction displayed a significant positive influence on pain intensity (P < 0.000). Moreover, 8-week intervention had a significant positive effect (P < 0.000). Conclusions: Mindfulness meditation may reduce pain intensity and is a promising treatment option for patients. Clinicians may consider mindfulness meditation as a viable complementary and alternative medical option for primary headache.
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Affiliation(s)
- Qiang Gu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang 210029, China
| | - Jin-Chao Hou
- Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 210029, China
| | - Xiang-Ming Fang
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang 210029, China
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Valls-Serrano C, Caracuel A, Verdejo-Garcia A. Goal Management Training and Mindfulness Meditation improve executive functions and transfer to ecological tasks of daily life in polysubstance users enrolled in therapeutic community treatment. Drug Alcohol Depend 2016; 165:9-14. [PMID: 27246405 DOI: 10.1016/j.drugalcdep.2016.04.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND We have previously shown that Goal Management Training+Mindfulness Meditation (GMT+MM) improves executive functions in polysubstance users enrolled in outpatient treatment. The aim of this study was to establish if GMT+MM has similar positive effects on executive functions in polysubstance users in residential treatment, and if executive functions' gains transfer to more ecologically valid goal-oriented tasks. METHODS Thirty-two polysbustance users were randomly allocated to eight weeks of GMT+MM (n=16) or control, i.e., no-intervention (n=16); both groups received treatment as usual. Outcome measures included performance in laboratory tasks of basic and complex executive functions (i.e., basic: working memory and inhibition; complex: planning and self-regulation) and in an ecological task of goal-directed behavior (the Multiple Errands Test - contextualized version, MET-CV) measured post-interventions. RESULTS Results showed that GMT+MM was superior to control in improving basic measures of working memory (Letter-number sequencing; F=4.516, p=0.049) and reflection impulsivity (Information Sampling Test; F=6.217, p=0.018), along with initial thinking times during planning (Zoo Map Test; F=8.143, p=0.008). In addition, GMT+MM was superior to control in improving performance in the MET-CV (task failures; F=8.485, p=0.007). CONCLUSION Our findings demonstrate that GMT+MM increases reflective processes and the achievement of goals in daily activities, furthermore ecological test can detects changes easily than laboratory tasks.
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Zgierska AE, Burzinski CA, Cox J, Kloke J, Stegner A, Cook DB, Singles J, Mirgain S, Coe CL, Bačkonja M. Mindfulness Meditation and Cognitive Behavioral Therapy Intervention Reduces Pain Severity and Sensitivity in Opioid-Treated Chronic Low Back Pain: Pilot Findings from a Randomized Controlled Trial. Pain Med 2016; 17:1865-1881. [PMID: 26968850 DOI: 10.1093/pm/pnw006] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess benefits of mindfulness meditation and cognitive behavioral therapy (CBT)-based intervention for opioid-treated chronic low back pain (CLBP). DESIGN 26-week parallel-arm pilot randomized controlled trial (Intervention and Usual Care versus Usual Care alone). SETTING Outpatient. SUBJECTS Adults with CLBP, prescribed ≥30 mg/day of morphine-equivalent dose (MED) for at least 3 months. METHODS The intervention comprised eight weekly group sessions (meditation and CLBP-specific CBT components) and 30 minutes/day, 6 days/week of at-home practice. Outcome measures were collected at baseline, 8, and 26 weeks: primary-pain severity (Brief Pain Inventory) and function/disability (Oswestry Disability Index); secondary-pain acceptance, opioid dose, pain sensitivity to thermal stimuli, and serum pain-sensitive biomarkers (Interferon-γ; Tumor Necrosis Factor-α; Interleukins 1ß and 6; C-reactive Protein). RESULTS Thirty-five (21 experimental, 14 control) participants were enrolled and completed the study. They were 51.8 ± 9.7 years old, 80% female, with severe CLBP-related disability (66.7 ± 11.4), moderate pain severity (5.8 ± 1.4), and taking 148.3 ± 129.2 mg/day of MED. Results of the intention-to-treat analysis showed that, compared with controls, the meditation-CBT group reduced pain severity ratings during the study (P = 0.045), with between-group difference in score change reaching 1 point at 26 weeks (95% Confidence Interval: 0.2,1.9; Cohen's d = 0.86), and decreased pain sensitivity to thermal stimuli (P < 0.05), without adverse events. Exploratory analyses suggested a relationship between the extent of meditation practice and the magnitude of intervention benefits. CONCLUSIONS Meditation-CBT intervention reduced pain severity and sensitivity to experimental thermal pain stimuli in patients with opioid-treated CLBP.
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Affiliation(s)
| | | | - Jennifer Cox
- Department of *Family Medicine and Community Health
| | - John Kloke
- Department of Biostatistics and Medical Informatics
| | - Aaron Stegner
- Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, Wisconsin
| | - Dane B Cook
- Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.,Department of Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, Wisconsin
| | | | | | - Christopher L Coe
- Department of Harlow Center for Biological Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Miroslav Bačkonja
- Department of Neurology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison,Wisconsin.,Department of **PRAHS Clinical Research Company Lifetree, Salt Lake City, Utah, USA
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Abstract
INTRODUCTION Publications claim efficacy for treatment of hypoactive sexual desire disorder (HSDD) in women with cognitive behavior therapy (CBT) and mindfulness meditation training (MMT). However, no review has evaluated the evidence for these therapies from the rigorous perspective of sexual medicine. AIMS The aim of this study was to evaluate the published controlled trials of CBT and MMT for disorders of sexual desire from the perspective of sexual medicine standards of control paradigms, risk/benefit ratios, and clinical significance. METHODS MEDLINE was reviewed from the last 10 years. Evaluated study quality via 10 metrics and efficacy as mean change, and proportion of responders and remitters. RESULTS Three controlled trials support CBT and two controlled trials support MMT. The reports of the trials each lacked several scientific requirements: a hierarchy of endpoints with a planned primary endpoint, sufficient information on the intervention to reproduce it, randomization, adequate control, accepted measures of benefits and harms, compliance data, and/or outcomes of clinical relevance. CONCLUSIONS Psychological treatments for HSDD are not yet supported by adequate clinical trials. The current scientific and regulatory standards for drug treatment trials should also be applicable to psychological treatment trials.
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Affiliation(s)
- Robert E Pyke
- Medical Department, S1 Biopharma, Inc., New Fairfield, CT, USA
| | - Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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Reiner K, Granot M, Soffer E, Lipsitz JD. A Brief Mindfulness Meditation Training Increases Pain Threshold and Accelerates Modulation of Response to Tonic Pain in an Experimental Study. Pain Med 2015; 17:628-35. [PMID: 26257209 DOI: 10.1111/pme.12883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Research shows that mindfulness meditation (MM) affects pain perception; however, studies have yet to measure patterns of change over time. We examined effects of MM on perception of experimental heat pain using multiple psychophysical indices, including pattern of change in response to tonic painful stimuli. We also tested the potential moderating role of baseline mindfulness. METHOD Forty participants were randomly assigned to a brief MM training or control group. We assessed: a) heat pain threshold (HPT), b) temperature which induces pain at a fixed, target intensity level, and c) response pattern over time to tonic heat pain. RESULTS Compared to control group, the MM group showed increased HPT and more rapid attenuation of pain intensity for tonic pain stimuli. Moderation analyses indicated that baseline mindfulness moderated effects of MM on HPT. CONCLUSIONS A brief MM intervention appears to affect perception of experimental pain both by increasing pain threshold and accelerating modulation of response. Findings may help elucidate mechanisms of MM for chronic pain.
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Affiliation(s)
- Keren Reiner
- *Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Michal Granot
- Department of Nursing, Faculty of Health and Welfare Studies, University of Haifa, Haifa, Israel Department of Neurology, Rambam Medical Center and Technion Faculty of Medicine, Haifa, Israel
| | - Eliran Soffer
- *Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Joshua Dan Lipsitz
- *Department of Psychology, Ben Gurion University of the Negev, Beer Sheva, Israel
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Hoge EA, Bui E, Goetter E, Robinaugh DJ, Ojserkis RA, Fresco DM, Simon NM. Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder. Cognit Ther Res 2014; 39:228-235. [PMID: 28316355 DOI: 10.1007/s10608-014-9646-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to examine psychological mechanisms of treatment outcomes of a mindfulness meditation intervention for Generalized Anxiety Disorder (GAD). METHODS We examined mindfulness and decentering as two potential therapeutic mechanisms of action of generalized anxiety disorder (GAD) symptom reduction in patients randomized to receive either mindfulness-based stress reduction (MBSR) or an attention control class (N=38). Multiple mediation analyses were conducted using a non-parametric cross product of the coefficients approach that employs bootstrapping. RESULTS Analyses revealed that change in decentering and change in mindfulness significantly mediated the effect of MBSR on anxiety. When both mediators were included in the model, the multiple mediation analysis revealed a significant indirect effect through increases in decentering, but not mindfulness. Furthermore, the direct effect of MBSR on decrease in anxiety was not significant, suggesting that decentering fully mediated the relationship. Results also suggested that MBSR reduces worry through an increase in mindfulness, specifically by increases in awareness and nonreactivity. CONCLUSIONS Improvements in GAD symptoms resulting from MBSR are in part explained by increased levels of decentering.
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Affiliation(s)
- Elizabeth A Hoge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Elizabeth Goetter
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | | | - David M Fresco
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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