Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review

Interventions based on training in mindfulness skills are becoming increasingly popular. Mindfulness involves intentionally bringing one's attention to the internal and external experiences occurring in the present moment, and is often taught through a variety of meditation exercises. This review summarizes conceptual approaches to mind-fulness and empirical research on the utility of mindfulness-based interventions. Meta-analytic techniques were incorporated to facilitate quantification of findings and comparison across studies. Although the current empirical literature includes many methodological flaws, findings suggest that mindfulness-based interventions may be helpful in the treatment of several disorders. Methodologically sound investigations are recommended in order to clarify the utility of these interventions.     

The Effect of Stress and Meditation on Salivary Protein and Bacteria: A Review and Pilot Study

Abstract

Dentally-induced stress and relaxation-induced anxiety reduction have been correlated with salivary changes in dental patients in two recent studies. In two subsequent studies, test anxiety-induced stress and relaxation-induced anxiety reduction were correlated with salivary changes in dental students. In another study using the resazurin dye indicator, increased salivary bacterial levels were correlated with an increased dental caries incidence. As a result of these findings, it was decided to reinvestigate the effects of stress and relaxation on salivary changes and in addition to examine the effects of those conditions on salivary bacteria. The hypotheses under consideration were: (1) Salivary changes from stress to relaxation will be from opaque to translucent and from high to low protein levels; and (2) salivary bacteria will increase under the condition of stress and decrease under the condition of relaxation. The subjects were twelve dental students. Stress and relaxation were evaluated before and after meditation by verbal reports and examination of saliva for opacity, translucency, protein and bacteria (resazurin dye method). There were significant anxiety-reduction changes by the end of the meditation sessions (p < 0.001) as measured by increased salivary translucency, decreased salivary protein and reduced subjective evaluation of stress. Using the resazurin dye method, bacterial levels showed a significant decrease by the end of the meditation sessions (p < 0.001). The results support hypothesis 1 and reaffirm previous findings in regard to the effectiveness of: (1) salivary changes as measures of stress and relaxation; and (2) meditation to induce deep relaxation. The finding of high bacteria levels under stress and lower bacterial levels under relaxation supports hypothesis 2 and indicates that stress may contribute to dental caries and relaxation may have an anti-caries effect.     

Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study

Background

Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges.

Objective

The present study is a qualitative investigation of participants’ experiences with MMB.

Methods

Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned.

Results

Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment.

Conclusions

These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder.     

Loving‐Kindness in the Treatment of Traumatized Refugees and Minority Groups: A Typology of Mindfulness and the Nodal Network Model of Affect and Affect Regulation

This article discusses how loving‐kindness can be used to treat traumatized refugees and minority groups, focusing on examples from our treatment, culturally adapted cognitive‐behavioral therapy (CA‐CBT). To show how we integrate loving‐kindness with other mindfulness interventions and why loving‐kindness should be an effective therapeutic technique, we present a typology of mindfulness states and the Nodal Network Model (NNM) of Affect and Affect Regulation. We argue that mindfulness techniques such as loving‐kindness are therapeutic for refugees and minority populations because of their potential for increasing emotional flexibility, decreasing rumination, serving as emotional regulation techniques, and forming part of a new adaptive processing mode centered on psychological flexibility. We present a case to illustrate the clinical use of loving‐kindness within the context of CA‐CBT.     

Effectiveness of Step-Wise Intervention Plan for Managing Nelfinavir-Associated Diarrhea: A Pilot Study

Abstract

Purpose: Pilot study to evaluate the effectiveness of a step-wise diarrhea management strategy for nelfinavir-associated diarrhea. Method: HIV-infected adults (CD4 count ≥100 cells/mm³, and no evidence of enteric pathogens) developing symptoms of diarrhea after initiation of nelfinavir for a duration of =1 month were enrolled into this 9-week prospective pilot study. Step-wise interventions, reviewed and adjusted additively at 2-week intervals, included nutritional counseling (± lactase and/or psyllium), calcium carbonate, and loperamide. Outcome measure included stool-form consistency, bowel movement frequency, and incidents of associated morbidity (urgency, incontinence) daily. Patient quality of life was also assessed. Results: Eighteen patients completed the study. Mean daily bowel movement frequency decreased by 32%, from 2.98 to 2.03 (p = .005). Mean daily stool form shifted from a rating of 4.24 to 2.37 (p = .0001), representing a shift to firmer stools. Period prevalence of incontinence (28%) and urgency (33%) decreased to 6% each, respectively. Quality of life ratings relating to gastrointestinal disturbance and overall physical/psychosocial function were improved. Conclusion: The results of this pilot study demonstrated that a step-wise intensified approach may be successful in managing nelfinavir-associated diarrhea and will need to be validated in a larger scale, randomized controlled trial.     

A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program

ABSTRACT

This study evaluated the feasibility and efficacy of integrating mindfulness training into a phone-based weight loss program to improve outcomes in those with high levels of emotional eating. Participants were 75 enrollees into an employer-sponsored weight loss program who reported high levels of overeating in response to thoughts and feelings. Seventy-five overweight and obese participants (92% female, 65% Caucasian, aged 26 to 68 years) were randomized to the new mindfulness weight loss program (n = 50) or the standard behavioral weight loss program (n = 25). Both programs consisted of 11 coaching calls with health coaches and registered dietitians with supplemental online materials. Satisfaction, engagement, and percent weight lost did not significantly differ for intervention vs. control at six months. Intervention participants had significantly better scores at six-month follow-up on mindful eating, binge eating, experiential avoidance, and one mindfulness subscale. Exploratory analyses showed that improvements on several measures predicted more weight loss in the intervention group. This pilot study found that integrating mindfulness into a brief phone-based behavioral weight loss program was feasible and acceptable to participants, but did not produce greater weight loss on average, despite hypothesized changes in mindful eating. Only one third of intervention participants reported participating in mindfulness exercises regularly. Mechanisms of change observed within the intervention group suggest that for adults with high levels of emotional eating those who embrace mindful eating and meditation may lose more weight with a mindfulness intervention.     

焦虑抑郁状态对冠心病介入治疗患者预后的影响

目的探讨焦虑抑郁与冠心病介入治疗患者预后的关系。方法入选108例冠心病并行介入治疗病人,采用汉密尔顿抑郁量表及焦虑量表评估,将入选病人分为存在焦虑抑郁状态(A组)及对照组(B组)两组,观察6个月内有无心血管事件(MACE)的发生,将影响MACE事件的因素进行对比分析,焦虑抑郁状态等与MACE事件进行多因素相关性分析。结果存在焦虑抑郁状态(A组)31例(28.7%),对照组(B组)77例(71.3%)。A组发生MACE事件(29.0%)较B组发生MACE事件(15.6%)显著增加(P<0.01),多因素回归分析提示在6个月的随访中,焦虑抑郁状态、糖尿病、高血压、吸烟是MACE事件发生的独立预测因子(焦虑抑郁,OR=0.921,95%可信区间0.845～0.963,P=0.022)。结论冠心病介入治疗术后患者焦虑抑郁普遍存在,有可能增加了冠心病介入治疗术后患者MACE事件的发生。     

心理干预对冠心病患者心身状况的影响

目的探讨心理干预对冠心病患者心身状况的影响。方法将120例冠心病患者随机等分为干预组60例,对照组60例。对照组只采用临床常规药物治疗,干预组在予以常规药物治疗的同时进行心理干预,运用自测健康评定量表(SRHM S)分别于心理干预前及结束时对两组患者进行评定。结果两组患者实施心理干预前SRHM S评分无显著差异(t=0.028,P0.05),实施心理干预后,干预组在自测健康的3个维度和总得分上的差值都明显高于对照组(t=2.772,7.779,6.403,7.035;P0.01),干预组和对照组的临床疗效有显著差异(χ2=16.536,P0.01)。结论心理干预能有效改善冠心病患者的心身状况,促进疾病的康复。     

血脂异常与老年冠心病患者冠脉病变程度的相关性研究

目的 探讨血脂异常与老年冠心病患者冠脉病变程度的相关性。方法 选取2015年5月~2017年1月本院心内科住院的明确诊断为冠状动脉粥样硬化性心脏病（CHD）的150例老年患者设为CHD组。选取同期收治的150例非CHD患者为对照组。比较两组血清中总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平,并计算N-HDL-C、LDL-C/N-HDL-C、LDL-C/HDL-C、TC/HDL-C、TG/HDL-C值。比较不同冠脉病变支数、不同病情严重程度的CHD患者的血脂及其比值。对血脂与冠脉病变支数、病情严重程度积分进行相关性分析。结果 CHD组患者LDL-C、TG、TC、N-HDL-C水平、LDL-C/HDL-C、TC/HDL-C、TG/HDL-C值均高于对照组,HDL-C水平低于对照组,差异均有统计学意义（P＜0.05）;不同冠脉病变支数各亚组间的TC、TG、N-HDL-C水平、TC/HDL-C比值差异存在统计学意义（P＜0.05）;TC、TG、N-HDL-C水平、TC/HDL-C比值均与冠脉病变支数均呈正相关（P＜0.05）;不同病情严重程度亚组间的LDL-C、TC、TG、N-HDL-C水平、LDL-C/HDL-C、TC/HDL-C、TG/HDL-C比值差异存在统计学意义（P＜0.05）;CHD患者LDL-C、TC、TG、N-HDL-C水平、LDL-C/HDL-C、TC/HDL-C、TG/HDL-C比值与冠状动脉病变积分均呈正相关（P＜0.05）。结论 可以通过对血脂指标的监测,并计算N-HDL-C、TC/HDL-C、LDL-C/HDL-C、TC/HDL-C、TG/HDL-C值,来评估CHD病情的临床进展。     

血浆脂蛋白（a）水平与冠心病相关性分析

目的观察血浆脂蛋白（a）[LP（a）]水平与冠心病的相关性。方法入选住院并行选择性冠状动脉造影检查的患者160例，其中急性冠状动脉综合征（ACS）患者60例，稳定型心绞痛（SAP）患者40例，正常对照组60例。测定各组血浆LP（a）浓度并进行比较分析。结果ACS组和SAP组LP（a）水平显著高于对照组，而ACS组LP（a）水平明显高于SAP组。脂蛋白水平与冠状动脉狭窄程度、狭窄范围呈正相关关系（r2=0．44，P〈0．01）。结论LP（a）与冠脉粥样病变的范围、程度及稳定性相关，对冠心病的诊断和预后判断具有一定意义。     

心理干预对住院冠心病患者生活质量的影响

目的探讨心理干预对住院冠心病患者生活质量的影响。方法96例患者随机分为对照组和观察组,各48例。对照组按心内科一般护理常规和系统化整体护理进行护理;观察组在此基础上调查患者的社会情况、对医院和健康问题的感知、近2个月生活事件的频度及应对能力、人格、焦虑、抑郁等,采取心理干预措施和健康教育,测评患者的生活质量和心绞痛发作的情况及住院天数。结果干预后观察组患者的生活质量评分明显高于对照组,心绞痛发作例数明显少于对照组,住院天数明显短于对照组。结论心理干预能有效提高冠心病患者的生活质量、减轻疾病的症状、缩短住院时间。     

冠脉介入治疗对冠心病急性心肌梗死患者 心肌损伤及心室重塑的影响

目的 观察冠脉介入治疗对冠心病急性心肌梗死患者心肌损伤及心室重塑的影响。方法 选取我院自2017年9月~12月收治的64例冠心病急性心肌梗死患者作为观察对象,随机分为研究组33例和对照组31例。对照组给予吸氧、镇静、对症治疗,并给予氯吡格雷+阿司匹林口服,研究组在此基础上进行冠脉介入治疗,对比两组CK、CK-MB、BNP及LVEF、LFESV、LVEDV变化情况。结果 在治疗3 d、7 d后,研究组BNP水平均低于对照组,差异有统计学意义（P＜0.05）。研究组CK峰值、CK-MB峰值与对照组比较,差异无统计学意义（P＞0.05）,但研究组CK峰值、CK-MB峰值出现时间均短于对照组,差异有统计学意义（P＜0.05）。治疗7 d后,两组患者LVEF均升高,LFESV、LVEDV均降低,且研究组LVEF高于对照组,LFESV、LVEDV低于对照组,差异均有统计学意义（P＜0.05）。结论 冠脉介入治疗冠心病急性心肌梗死患者可降低患者BNP水平,改善患者心肌损伤,促进心室重塑,具有较高的应用价值。     

A Review of the Pharmacological Mechanism of Traditional Chinese Medicine in the Intervention of Coronary Heart Disease and Stroke

In recent years, several researches have showed that Buyang Huanwu Decoction (BHD) possesses multiple target points in the intervention of diseases, and has same treatment effects on cerebrovascular diseases and cardiovascular diseases. But, there was no full report about the mechanistic and material basis in Brain-Heart concurrent treatment. The objective of the present study was to examine the pharmacological mechanism of traditional Chinese medicine in the intervention of coronary heart disease and stroke. We combined the HIT, PubChem, David Database resource and the networked pharmacology method to ultimately find out BHD''s thirty-five potential brain-heart concurrent treatment target points, and preliminarily reveal BHD''s material basis for treatment of cerebrovascular diseases and cardiovascular diseases. Finally, the study provided new information with the guidance meanings.     

DM2并发CHD患者血浆vWF和血清hs-CRP的相关性分析

目的：探讨DM2并发冠心病（CHD）患者血浆血管性白血病因子（vWF）和超敏C-反应蛋白（hs-CRP）水平的相关性。方法：应用酶联法和免疫比浊法对36例DM2并发CHD患者进行了血浆vWF和血清hs-CRP检测,并与35名正常人作比较。结果：DM2并发CHD患者血浆vWF和血清hs-CRP水平非常显著地高于正常人组（P〈0.01）,且血浆vWF水平与hs-CRP水平呈正相关（r=0.5928,P〈0.01）。结论：DM2并发CHD患者血浆vWF和血清hs-CRP水平密切相关。     

述情障碍对冠心病合并2型糖尿病患者应对方式及生活质量的影响

目的:探讨述情障碍对冠心病合并2型糖尿病患者应对方式及生活质量的影响。方法:对符合世界卫生组织冠心病、2型糖尿病诊断标准的70例患者,依据多伦多述情障碍量表(TAS-20)评分分为2组,总分60分为述情障碍组,50分为非述情障碍组,50~60分不做研究。述情障碍组41例,无述情障碍组29例。尔后分别进行医学应对问卷(MCMQ)、生活质量综合评定问卷(GQLI)测评,并进行比较分析。结果:述情障碍组MCMQ面对因子评分显著低于非述情障碍组(t=-8.23,P0.01),而回避、屈从因子评分则显著高于非述情障碍组(t=5.21,4.27;P0.01)。非述情障碍组GQLI总分及躯体健康、心理健康、社会功能因子分均显著高于述情障碍组,差异有统计学意义(t=3.66,3.82,3.66,2.37;P0.01);物质生活维度评分差异无统计学意义(P0.05)。患者TAS-20评分与MCMQ的面对因子评分呈显著负相关(r=-0.34,P0.01),而与MCMQ回避、屈从因子评分呈显著正相关(r=0.32,0.34;P0.01);与GQLI总分、躯体健康、心理健康及社会功能因子分呈显著负相关(r=-0.31,-0.33,-0.30;P0.01),与物质生活维度评分无相关性。结论 :冠心病合并2型糖尿病述情障碍患者多采用回避和屈服的消极应对方式,而较少采用积极应对方式;其生活质量较非述情障碍患者差。     

团体心理干预对老年冠心病患者焦虑情绪的影响

目的:探讨心理评估及团体心理干预在缓解老年冠心病患者焦虑情绪中的应用效果。方法:将心内科2016年2—6月收治的90例老年冠心病患者分为观察组和对照组各45例,两组治疗方法均衡,对照组采用常规心理干预,观察组心理评估后实施团体心理干预,均干预12周。比较两组患者的焦虑、抑郁情绪及社会支持度。结果:观察组干预12周后的焦虑、抑郁评分低于对照组,差异有统计学意义(t=-6.389,-9.453;P0.05)。观察组干预12周后主观支持、客观支持、支持利用度评分高于对照组,差异有统计学意义(t=5.161,7.733,11.530;P0.05)。结论:心理评估及团体心理干预能够显著缓解老年冠心病患者焦虑、抑郁情绪,提高患者的社会支持度。