A mindfulness-based intervention adapted to dementia caregivers: A study protocol for a randomized clinical control trial.

Dementia caregiving, besides encompassing various challenges in tandem to the diagnosis of the care recipient, is associated with decreased psychological well-being and mental health. Accordingly, caregivers' wellbeing has an impact on the quality of care they provide and on the relationship quality with the person in their care. The aim of the present study is to examine the effectiveness of a mindfulness-based intervention on relational and psychological wellbeing, tailored to the needs of dementia caregivers. This clinical trial (NCT04977245) will apply a randomized controlled mixed method design. Caregivers will be randomly allocated to either the mindfulness intervention or the active control group. The intervention arm is based on experiential learning and is targeted to promote caregivers' well-being and empowerment. Assessments will include, standardized self-report questionnaires, task performance measures, and qualitative measures. All assessments will be held at three time points (baseline; t0, 0 months, post-intervention; t1, 2 months, and after maintenance; t2, 3 months) focused on three core domains (1. relational well-being, 2. psychological well-being, and 3. dementia patient's lifestyle/activities). The primary outcome will be relational well-being, and data will be analyzed using linear mixed modelling.

Stress and Illness: A Role for Specific Emotions.

Research on stress and disease has often afforded an important role to emotion, typically conceptualized in broad categories (e.g., negative emotions), viewed as playing a causal role (e.g., anger contributing to pathophysiology of cardiovascular disease), and measured using self-report inventories. In this article, I argue for the value of evaluating specific emotions, considering bidirectional causal influences, and assessing actual emotional responding when considering the role that emotions play in the stress-disease relationship. In terms of specificity, specific emotions (e.g., anger, sadness, and embarrassment) can be linked with particular health outcomes (e.g., cardiovascular disease and musculoskeletal disease). In terms of bidirectionality, the influences of emotions on disease as well as the influences of disease on emotional functioning can be considered. In terms of assessing actual emotional responding, emotions can be studied in vivo under controlled conditions that allow behavioral, physiological, and subjective responses to be measured during different kinds of emotional functioning (e.g., responding to emotional stimuli, interacting with relationship partners, and downregulating emotional responses). With these considerations in mind, I review early theories and empirical studies in psychosomatic medicine that considered the role of specific emotions and emotion-related behaviors. Studies from our laboratory are presented that illustrate a) differences in patterns of autonomic nervous system responding associated with specific emotions, b) relationships between specific emotions and particular health outcomes in the context of social relationships, c) age as a moderator of the relationship between specific emotions and well-being, d) bidirectional influences (emotions influencing disease and disease influencing emotional functioning), and e) impact of changes in emotional functioning in individuals with neurodegenerative diseases on the health of familial caregivers.

Meditation and the startle response: a case study.

The effects of two kinds of meditation (open presence and focused) on the facial and physiological aspects of the defensive response to an aversive startle stimulus were studied in a Buddhist monk with approximately 40 years of meditation experience. The participant was exposed to a 115-db, 100-ms acoustic startle stimulus under the 2 meditation conditions, a distraction condition (to control for cognitive and attentional load) and an unanticipated condition (startle presented without warning or instruction). A completely counterbalanced 24-trial, single-subject design was used, with each condition repeated 6 times. Most aspects of the participant's responses in the unanticipated condition did not differ from those of a comparison group of 12 age-matched male controls. Both kinds of meditation produced physiological and facial responses to the startle that were smaller than in the distraction condition. Within meditation conditions, open presence meditation produced smaller physiological and facial responses than focused meditation. These results from a single highly expert meditator indicate that these 2 kinds of meditation can differentially alter the magnitude of a primitive defensive response.

Coherence between emotional experience and physiology: does body awareness training have an impact?

Two fundamental issues in emotion theory and research concern: (a) the role of emotion in promoting response coherence across different emotion systems; and (b) the role of awareness of bodily sensations in the experience of emotion. The present study poses a question bridging the two domains; namely, whether training in Vipassana meditation or dance, both of which promote attention to certain kinds of bodily sensations, is associated with greater coherence between the subjective and physiological aspects of emotion. We used lag correlations to examine second-by-second coherence between subjective emotional experience and heart period within individuals across four different films. Participants were either: (a) experienced Vipassana meditators (attention to visceral sensations), (b) experienced dancers (attention to somatic sensations), and (c) controls with no meditation or dance experience. Results indicated a linear relationship in coherence, with meditators having highest levels, dancers having intermediary levels, and controls having lowest levels. We conclude that the coherence between subjective and cardiac aspects of emotion is greater in those who have specialized training that promotes greater body awareness.

Expressive suppression during an acoustic startle.

Previous studies have shown that inhibiting negative or positive emotion-expressive behavior leads to increased sympathetic activation. Inhibiting facial behavior while in an affectively neutral state has no such physiological consequences. This suggests that there may be something special about inhibiting emotion-expressive behavior. To test the boundary conditions of the suppression effect, acoustic startles were delivered to 252 participants in three experimental groups. Participants in one group received unanticipated startles. Participants in the other two groups were told that after a 20-s countdown a loud noise would occur; participants in one of these groups were further told to inhibit their expressive behavior. Results indicated that startle suppression increased sympathetic activation. These findings extend prior work on emotion suppression, and suggest that inhibiting other biologically based responses also may be physiologically taxing.

The impact of orbital prefrontal cortex damage on emotional activation to unanticipated and anticipated acoustic startle stimuli.

Damage to the orbital prefrontal cortex has been implicated in selectively diminishing electrodermal autonomic nervous system responses to anticipated punishing stimuli (e.g., losing money; Bechara, Damasio, & Damasio, 2000), but not to unanticipated punishing stimuli (e.g., loud noises; Damasio, Tranel, & Damasio, 1990). We extended this research by examining the effects of orbitofrontal damage on emotional responses to unanticipated and anticipated acoustic startles and collecting a more extensive set of physiological measures, emotional facial behavior, and self-reported emotional experience. Consistent with previous research, patients showed intact physiology to an unanticipated startle but failed to show appropriate anticipatory cardiovascular responses (patients' heart rates decreased, controls' increased). In addition, patients displayed more surprise facial behavior and reported marginally more fear than did controls in response to the unanticipated startle. Thus, orbitofrontal damage may compromise the ability to anticipate physiologically the onset of aversive stimuli, despite intact or enhanced emotional responses when such stimuli occur unexpectedly.