session 11, TherouxLeonardo Da Vinci 1452–1519 The “average” human looks without seeing, listens without hearing, touches without feeling, eats without tasting, moves without

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Mindfulness:A Path to Health and Healing

Sharon M Theroux, Ph.D., ABPP

Disclosures

Sharon M. Theroux, PhD

Licensed Psychologist

Board Certified Clinical Neuropsychologist

Certified MBSR instructor

Founder, South Florida Center for Mindfulness

Co-founder & Program Director,

International Seminars Group (ISG)

CP

Learning Objectives

1. Define Mindfulness

2. Practice an awareness of breathing meditation

3. Review the effectiveness of mindfulness-

based interventions for individuals with

depression and addictive behaviors.

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Leonardo Da Vinci1452–1519

The “average” human

looks without seeing, listens without hearing, touches without feeling,

eats without tasting, moves without physical

awareness,

inhales without awareness of odour or fragrance,

and talks without thinking.

William James1842-1910

“The faculty of voluntarily bringing back a wandering

attention, over and over again,

is the very root of judgment, character, and will.

An education to improve this faculty would be THE

education, par excellence. But it is easier to define this

idea, then to teach it.”

CP

Jon Kabat-Zinn, PhD1944-

Mindfulness:

Paying attention:

� on purpose,

� in the present moment,

� and non-judgmentally.

CP

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Practice # 1, Awareness of Breathing

What did you notice?

Neuroplasticity

The brain’s ability to adapt and change in response to

thoughts, emotions, behaviors, and our

environment

SMT

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A Brief History of Mindfulness-Based Interventions in the

United States

1979

Mindfulness-Based Stress Reduction

(MBSR)

1990

A Brief History of Mindfulness-Based Interventions in the United States

Mindfulness-Based Cognitive Therapy

for Depression Relapse

(MBCT)

2000

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Effect Size

� ‘small' effect size

� < 0.2

� ‘medium' effect size

� 0.2 - 0.5

� ‘large' effect size

� > 0.5

Mindfulness unequivocally helps those with

� Chronic Pain

� Depression

� Anxiety

� Quality of Life

• 38 Randomized Control Trials

• 3536 Participants

• Medical conditions• Fibromyalgia• Back pain• Osteoarthritis• Migraine• IBS

Mindfulness Meditation for Chronic Pain:

Systematic Review and Meta-analysisHilton et al, 2017

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Treatment groups:8-week MBSR (21)

8-week MBCT (6)Modified mindfulness programs (11)

Controls:

Waitlist/TAU (21)Educ/Support Group w/ TAU (7)

Other (nutrition/stretching) (12)

Length of Interventions3 to 12 weeks

Majority were 8 weeks

Type of treatment:Monotherapy (no drugs) (13)

Adjunctive therapy (18)Unclear (7)

Measures:Pain

McGill Pain questionnaire (MPQ)Pain subscale of the Short Form

Health Survey-36Average of general pain measures

Depression

BDIBrief Symptom Inventory-18

Patient Health Questionnaire

QOLQuality of Life Questionnaire

SF-36 Global health composite



� Depression

� (0.15 over 12 RCTs)

� Pain

� (0.32 over 30 RCTs)

� Quality of Life

� (0.49 over 16 RCTs)



� Meditation Programs for

� Psychological Stress and Well-being:

� a Systematic Review and metanalysis

� (Goyal et al, 2014)

47 Randomized Control Trials

Length of treatment time matched to controls

3515 Participants with

Medical condition

Psychiatric condition

Stress

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8-week MBCT (6)Modified mindfulness programs (13)

TM (8)

Controls:Non-specific Active Control (23)

(education/attention control group)similar to placebo

Drug (3)CBGT/CBT (6)

Exercise/yoga (4)Biofeedback/relaxation (3)

Length of Interventions> 4 hours of instruction

Majority were 8 weeks

MeasuresNot specified

Looked at difference scores with all

Meditation Programs for Psychological Stress and Well-being: a Systematic Review and metanalysis

(Goyal et al, 2014)

� Anxiety

� 0.38 at 8 weeks and

� 0.22 at 3-6 months

� Depression

� 0.30 at 8 weeks and

� 0.23 at 3-6 months

� Pain

� 0.33

Meditation Programs for Psychological Stress and Well-being: a Systematic Review and metanalysis

(Goyal et al, 2014)

� Mild to mod Depression

� (HRSD < 18)

� d=0.11

� Severe Depression

� (HRSD 19-22)

� d=0.17

� Very severe

� (HRSD > 27)

� d=0.81

Antidepressant Drug effects and Depression Severity: A Patient-Level Meta-Analysis

Fournier et al, 2010

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� How effective are mindfulness-based

interventions for reducing stress among healthcare professionals

� (Burton et al, 2017)

9 Studies

284 Healthcare professionals

Nurses

Mental Health Professionals

Midwives

MD

Occupational Therapists


Modified mindfulness programs (6)

Length of Interventions1 day (1) to 10 weeks (1)

Majority were between 4-8 weeks (6)

Study DesignPre-post testing (6)

Quasi-experimental (1)RCT (2)

Measures:Perceived Stress Scale (PSS)

Mental Health Provider Perceived Stress scale (MHPSS)

Depression Anxiety Stress Scale (DSS)Survey of Recent Life Experience

Mindfulness Measures:

Mindful Attention Awareness ScaleToronto Mindfulness Scale

Five Facet Mindfulness Questionnaire

How effective are mindfulness-based interventions for reducing stress among healthcare professionals

(Burton et al, 2017)

� Reported level of Stress

� 0.34 (CI 0.2 to 0.4)

How effective are mindfulness-based

interventions for reducing stress among healthcare professionals

(Burton et al, 2017)

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� How effective are mindfulness-based

interventions for reducing

� addictive behaviors?

� (Li et al, 2017)

42 Studies

4858 Subjects

College Students

Low income adults

Chronic pain patients

Incarcerated adults (7)

Treatment groups:8-week MBSR, MBRP, MORE

Modified mindfulness programsMindful-based therapeutic communities

Mindful-based mind-body training

Study DesignRCT (36)

Quasi-experimental (8)

Substances MisusedAlcohol and drugs

DrugsTobacco

Opioids

Comparison GroupsTAU (17)

Active Controls (17)Inactive Controls (2)

Brief mm vs other (6)

Measures:# days of relapse episodes

Short Inventory of Problem Alcohol/Drug use

Penn Alcohol/Drug Craving ScalePerceived Stress Scale (PSS)

Mindfulness Measures:

Five Facet Mindfulness Questionnaire

How effective are mindfulness-based interventions for reducing addictive behaviors

(Li et al, 2017)

� Substance abuse @ post-tx

� -0.33 (CI -0.49—0.17)

� Abstinence from tobacco@ post-tx

� 1.76 (CI .098-3.15)

� Craving

� -0.68 (CI -1.11—0.25)


interventions for reducing addictive behaviors (Li et al, 2017)

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� Stress at post-tx

� -1.12 (CI = -2.24—0.01)

� Mindfulness at post-tx

� 0.62 (CI = 0.02-1.26)


interventions for reducing addictive behaviors (Li et al, 2017)

Thank you!

BibliographyBurton, A., Burgess, C., Koutsopoulu, G.Z., & Hugh-Jones, S. (2017). How effective are mindfulness-based interventions for reducing stress among healthcare professionals? A

systematic review and meta-analysis. Stress and Health, 33, 3-13/

Goyal, M., Singh, S., Sibinga, E., Gould, N., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D., Shihab, H., Ranasinghe, P., Linn, S., Saha, S., Bass, E.,

Haythornwaite, J. (2014). Meditation Programs for Psychological Stress and Well-Being: A systematic Review and Meta-analysis. JAMA Internal Medicine. doi10.1001/jamainternmed.2013.13018

Hilton,. Ll., Hemple, S., Ewing, B. A., Apaydin, E., Xenakis, L., Newberry, S., Colaiaco, B., Ruelaz Maher, A., Shanman, R. M., Sorbero, M. E., & Maglione, M. (2017). Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis,

Annals of Behavioral Medicine, 51, 199-213. Doi 10.1007/s12160-016-9844-2.

Kabat-Zinn, Jon. (2013). Full Catastrophe Living: using the wisdom of your body and mind to face stress, pain, and illness. New York : Bantam Books trade paperback.

Li, W., Howard, M. O., Garland, E. L., McGovern, P., Lazar, M. (2017) Mindfulness treatment for substance misuse: A systematic Review and meta-analysis. Journal of Substance Abuse Treatment, 75, 62-96.

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session 11, TherouxLeonardo Da Vinci 1452–1519 The “average” human looks without seeing, listens without hearing, touches without feeling, eats without tasting, moves without