The effect of mindful attention training for pain modulation capacity: Exploring the mindfulness-pain link.

OBJECTIVE: Mindfulness has been shown to be beneficial for chronic pain. The underlying mechanisms of the mindfulness-pain link, however, are yet to be established. Particularly, the effects of mindfulness on pain modulation, which is shown to be dysfunctional among chronic pain patients, barely has been tested. This study investigated whether a short mindful attention training based on Langerian mindfulness mitigates reductions in pain modulation. METHOD: Systemic quantitative-somatosensory testing of conditioned pain modulation (CPM) was conducted in 60 undergraduates, who were randomly assigned to one of three groups: (1) Pain-specific mindful attention training; (2) nonspecific mindful attention training; and (3) no mindful attention training. CPM was tested before and after the intervention. RESULTS: As hypothesized, a reduction in CPM magnitude was observed only in the control group, whereas this reduction was abolished in the two mindfulness groups. CONCLUSIONS: Langerian mindfulness may mitigate pain modulation reduction as observed in chronic pain, thus shedding light on its potential advantages.

Reducing Delirium and Improving Patient Satisfaction With a Perioperative Mindfulness Intervention: A Mixed-Methods Pilot Study.

Postoperative delirium (incidence estimated up to 82%) can be ameliorated with nonpharmacologic methods. Mindfulness has not yet been incorporated into these methods, although mindfulness has been demonstrated to help patients adapt to illness and hospitalization. To reduce postoperative delirium incidence and increase patient satisfaction, this study employs a program of thought exercises based on Langerian mindfulness. Preoperatively, cardiac surgical patients listened to a mindfulness or informational audio; mindfulness subjects were also guided by the principal investigator through mindfulness exercises. Postoperatively, mindfulness subjects were visited twice daily for mindfulness exercises. For all patients, delirium screening was performed twice daily. Before discharge, affective status and satisfaction with hospital stay were assessed. No patients who completed the study screened positive for delirium. Trends include (1) lower (improved) median anxiety and depression scores postoperatively when considering both study groups together; (2) both groups rated the hospital more favorably on global satisfaction measures; (3) both groups shared generally positive comments regarding the audio files (qualitative data). Audio files and mindfulness exercises are associated with patient satisfaction among cardiothoracic surgery patients. The absence of delirium precludes determination of the effectiveness of the intervention in reducing delirium incidence.

Mindful creativity matters: trajectories of reported functioning after severe traumatic brain injury as a function of mindful creativity in patients' relatives: a multilevel analysis.

OBJECTIVE: The objective of the present investigation was to examine the association of mindful creativity with the trajectory of recovery (emotional, interpersonal, cognitive, and total functioning) of patients with severe TBI. METHODS: This was drawn from a subsample of an adult prospective cohort study on severe TBI in Switzerland; patients and their relatives were assessed at 3, 6, and 12 months (patients N = 176, relatives N = 176). Predictor measures were assessed using Mindful Creativity Scale-short form and time (trajectory of functioning of the patient over time). Outcome measures were assessed using Patient Competency Rating Scale for Neuro-rehabilitation (PCRS-NR; measuring emotional, interpersonal, cognitive, and total functioning post-injury). All measures were assessed at each time point. Mixed linear models were run separately for ages >50 and ≤50 (i.e., bimodal distribution). RESULTS: Patients' mindful creativity showed no significant association with patients' functioning across time in any of the models. In all age groups, interpersonal functioning decreased across time (slope>50 = -4.66, p = .037; slope≤50 = -7.19, p = .007). Interestingly, in age group ≤50, interpersonal functioning increased when looking at relative mindful creativity by time (slope = 1.69, p = .005). Additionally, relatives mindful creativity was significantly associated with patients' functioning in age group ≤50: (a) patients' total functioning (slope = 0.18, p = .03) and (b) cognitive functioning (slope = 0.72, p = .020). CONCLUSIONS: Relatives' mindful creativity was significantly associated with patients' functioning after severe TBI. Implications for treatment and future research are discussed.

Presenting a sham treatment as personalised increases the placebo effect in a randomised controlled trial.

Background: Tailoring interventions to patient subgroups can improve intervention outcomes for various conditions. However, it is unclear how much of this improvement is due to the pharmacological personalisation versus the non-specific effects of the contextual factors involved in the tailoring process, such as the therapeutic interaction. Here, we tested whether presenting a (placebo) analgesia machine as personalised would improve its effectiveness. Methods: We recruited 102 adults in two samples (N1=17, N2=85) to receive painful heat stimulations on their forearm. During half of the stimulations, a machine purportedly delivered an electric current to reduce their pain. The participants were either told that the machine was personalised to their genetics and physiology, or that it was effective in reducing pain generally. Results: Participants told that the machine was personalised reported more relief in pain intensity than the control group in both the feasibility study (standardised ß=-0.50 [-1.08, 0.08]) and the pre-registered double-blind confirmatory study (ß=-0.20 [-0.36, -0.04]). We found similar effects on pain unpleasantness, and several personality traits moderated the results. Conclusions: We present some of the first evidence that framing a sham treatment as personalised increases its effectiveness. Our findings could potentially improve the methodology of precision medicine research and inform practice. Funding: This study was funded by the Social Science and Humanities Research Council (93188) and Genome Québec (95747).

Precision treatments are therapies that are tailored to a patient's individual biology with the aim of making them more effective. Some cancer drugs, for example, work better for people with specific genes, leading to improved outcomes when compared to their 'generic' versions. However, it is unclear how much of this increased effectiveness is due to tailoring the drug's chemical components versus the contextual factors involved in the personalisation process. Contextual factors like patient beliefs can boost a treatment's outcomes via the 'placebo effect' ­ making the intervention work better simply because the patient believes it to. Personalised treatments typically combine more of these factors by being more expensive, elaborate, and invasive ­ potentially boosting the placebo effect. Sandra et al. tested whether simply describing a placebo machine ­ which has no therapeutic value ­ as personalised would increase its effectiveness at reducing pain for healthy volunteers. Study participants completed several sham physiological and genetic tests. Those in the experimental group were told that their test results helped tailor the machine to increase its effectiveness at reducing pain whereas those in the control group were told that the tests screened for study eligibility. All volunteers were then exposed to a series of painful stimuli and used the machine to reduce the pain for half of the exposures. Participants that believed the machine was personalised reported greater pain relief. Those with a stronger desire to be seen as different from others ­ based on the results of a personality questionnaire ­ experienced the largest benefits, but only when told that the machine was personalised. This is the first study to show that simply believing a sham treatment is personalised can increase its effectiveness in healthy volunteers. If these results are also seen in clinical settings, it would suggest that at least some of the benefit of personalised medicine could be due to the contextual factors surrounding the tailoring process. Future work could inform doctors of how to harness the placebo effect to benefit patients undergoing precision treatments.

Manipulating sleep duration perception changes cognitive performance - An exploratory analysis.

OBJECTIVES: To test the effect of perceived sleep duration on cognitive performance. METHODS: Sixteen healthy individuals [8F; mean age (± SD): 24.2 ± 3.0 years)] received an 8-h sleep opportunity followed by a 5-h opportunity on two consecutive nights. Upon waking, they were randomized to being informed that they received either an 8-h or 5-h sleep opportunity, via a clock that ran either fast, slow or normally. Cognitive performance was assessed using 10-min auditory psychomotor vigilance tests and subjective sleepiness ratings. Homeostatic and circadian sleep drive was assessed using waking electroencephalography (EEG). RESULTS: Reaction time was significantly quicker when individuals thought that they had slept for 8 h but given a 5-h sleep opportunity. Conversely, reaction times were significantly slower when individuals thought they had 5 h of sleep but given an 8-h sleep opportunity. EEG delta power (1.0-4.5 Hz) during wake increased significantly when sleep was restricted to 5 h, and individuals thought they slept for 5 h, but this increase was attenuated with a perceived sleep duration of 8 h following a 5-h opportunity. EEG delta power did not increase, however, with perceived sleep restriction. EEG high-alpha activity (10.5-11.5 Hz) was consistently higher when participants thought that they had an 8-h sleep opportunity, regardless of the actual duration. CONCLUSIONS: These results suggest that perceived sleep duration may modulate psychosomatic responses. Additional studies with predefined outcomes and analyses are necessary to confirm these findings, which may have important implications for understanding how sleep affects cognition and psychosomatic responses.

Forecasting the onset and course of mental illness with Twitter data.

We developed computational models to predict the emergence of depression and Post-Traumatic Stress Disorder in Twitter users. Twitter data and details of depression history were collected from 204 individuals (105 depressed, 99 healthy). We extracted predictive features measuring affect, linguistic style, and context from participant tweets (N = 279,951) and built models using these features with supervised learning algorithms. Resulting models successfully discriminated between depressed and healthy content, and compared favorably to general practitioners' average success rates in diagnosing depression, albeit in a separate population. Results held even when the analysis was restricted to content posted before first depression diagnosis. State-space temporal analysis suggests that onset of depression may be detectable from Twitter data several months prior to diagnosis. Predictive results were replicated with a separate sample of individuals diagnosed with PTSD (Nusers = 174, Ntweets = 243,775). A state-space time series model revealed indicators of PTSD almost immediately post-trauma, often many months prior to clinical diagnosis. These methods suggest a data-driven, predictive approach for early screening and detection of mental illness.

The DSM: mindful science or mindless power? A critical review.

In this paper we review the Diagnostic and Statistical Manual of mental health (DSM), its scientific bases and utility. The concepts of "normality," "pathology," and boundaries between them are critically reviewed. We further use the concepts of mindfulness and mindlessness, and evidence from cognitive and social sciences to investigate the DSM clinical and social impact and we argue against its assigned overpower. We recommend including alternative perspectives to the DSM, such as mindfulness and positive psychology. We also argue for including mindfulness training in psychiatric residency and clinical psychology programs.

The Influence of Age-Related Cues on Health and Longevity.

Environmental cues that signal aging may directly and indirectly prime diminished capacity. Similarly, the absence of these cues may prime improved health. The authors investigated the effects of age cues on health and longevity in five very different settings. The findings include the following: First, women who think they look younger after having their hair colored/cut show a decrease in blood pressure and appear younger in photographs (in which their hair is cropped out) to independent raters. Second, clothing is an age-related cue. Uniforms eliminate these age-related cues: Those who wear work uniforms have lower morbidity than do those who earn the same amount of money and do not wear work uniforms. Third, baldness cues old age. Men who bald prematurely see an older self and therefore age faster: Prematurely bald men have an excess risk of getting prostate cancer and coronary heart disease than do men who do not prematurely bald. Fourth, women who bear children later in life are surrounded by younger age-related cues: Older mothers have a longer life expectancy than do women who bear children earlier in life. Last, large spousal age differences result in age-incongruent cues: Younger spouses live shorter lives and older spouses live longer lives than do controls.

Mind-set matters: exercise and the placebo effect.

In a study testing whether the relationship between exercise and health is moderated by one's mind-set, 84 female room attendants working in seven different hotels were measured on physiological health variables affected by exercise. Those in the informed condition were told that the work they do (cleaning hotel rooms) is good exercise and satisfies the Surgeon General's recommendations for an active lifestyle. Examples of how their work was exercise were provided. Subjects in the control group were not given this information. Although actual behavior did not change, 4 weeks after the intervention, the informed group perceived themselves to be getting significantly more exercise than before. As a result, compared with the control group, they showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. These results support the hypothesis that exercise affects health in part or in whole via the placebo effect.