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      Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence

      1 , 2 , *

      ISRN Psychiatry

      International Scholarly Research Network

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          Abstract

          Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.

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          Most cited references 214

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          Acceptance and commitment therapy: model, processes and outcomes.

          The present article presents and reviews the model of psychopathology and treatment underlying Acceptance and Commitment Therapy (ACT). ACT is unusual in that it is linked to a comprehensive active basic research program on the nature of human language and cognition (Relational Frame Theory), echoing back to an earlier era of behavior therapy in which clinical treatments were consciously based on basic behavioral principles. The evidence from correlational, component, process of change, and outcome comparisons relevant to the model are broadly supportive, but the literature is not mature and many questions have not yet been examined. What evidence is available suggests that ACT works through different processes than active treatment comparisons, including traditional Cognitive-Behavior Therapy (CBT). There are not enough well-controlled studies to conclude that ACT is generally more effective than other active treatments across the range of problems examined, but so far the data are promising.
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            An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results.

            The practice of mindfulness meditation was used in a 10-week Stress Reduction and Relaxation Program to train chronic pain patients in self-regulation. The meditation facilitates an attentional stance towards proprioception known as detached observation. This appears to cause an "uncoupling " of the sensory dimension of the pain experience from the affective/evaluative alarm reaction and reduce the experience of suffering via cognitive reappraisal. Data are presented on 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, and headache. Facial pain, angina pectoris, noncoronary chest pain, and GI pain were also represented. At 10 weeks, 65% of the patients showed a reduction of greater than or equal to 33% in the mean total Pain Rating Index (Melzack) and 50% showed a reduction of greater than or equal to 50%. Similar decreases were recorded on other pain indices and in the number of medical symptoms reported. Large and significant reductions in mood disturbance and psychiatric symptomatology accompanied these changes and were relatively stable on follow-up. These improvements were independent of the pain category. We conclude that this form of meditation can be used as the basis for an effective behavioral program in self-regulation for chronic pain patients. Key features of the program structure, and the limitations of the present uncontrolled study are discussed.
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              The clinical use of mindfulness meditation for the self-regulation of chronic pain.

              Ninety chronic pain patients were trained in mindfulness meditation in a 10-week Stress Reduction and Relaxation Program. Statistically significant reductions were observed in measures of present-moment pain, negative body image, inhibition of activity by pain, symptoms, mood disturbance, and psychological symptomatology, including anxiety and depression. Pain-related drug utilization decreased and activity levels and feelings of self-esteem increased. Improvement appeared to be independent of gender, source of referral, and type of pain. A comparison group of pain patients did not show significant improvement on these measures after traditional treatment protocols. At follow-up, the improvements observed during the meditation training were maintained up to 15 months post-meditation training for all measures except present-moment pain. The majority of subjects reported continued high compliance with the meditation practice as part of their daily lives. The relationship of mindfulness meditation to other psychological methods for chronic pain control is discussed.
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                Author and article information

                Journal
                ISRN Psychiatry
                ISRN Psychiatry
                ISRN.PSYCHIATRY
                ISRN Psychiatry
                International Scholarly Research Network
                2090-7966
                2012
                14 November 2012
                : 2012
                Affiliations
                1Division of Psychosocial Oncology, Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada T2N 4N2
                2Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services Cancer Care, Calgary, AB, Canada T2S 3C1
                Author notes
                *Linda E. Carlson: lcarlso@ 123456ucalgary.ca

                Academic Editors: B. Camarena and S. M. Hyman

                Article
                10.5402/2012/651583
                3671698
                23762768
                Copyright © 2012 Linda E. Carlson.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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