Pain regulation during mindfulness meditation: Phenomenological fingerprints in novices and experts practitioners.

BACKGROUND: The way people respond to pain is based on psychological mechanisms, beliefs and expectations. Mindfulness meditation (MM) has been shown to regulate pain and mental suffering through different mechanisms such as positive reappraisal, attentional and emotional regulation. Yet, subjective experience and meaning of pain in connection with MM are still largely unexplored. METHODS: The present mixed-methods study combined an interpretative-phenomenological qualitative approach with an experimental thermal pain paradigm to explore and compare the meaning of experiencing pain in 32 novices who received short meditation training and 30 experts in meditation practice (more than 10, 000 hr in life). We collected the qualitative data during in-depth semi-structured interviews where we probed participants' response strategies. During the pain task, we collected self-reports of intensity and unpleasantness, while after the task we collected self-reports of avoidance, openness, vividness and blissfulness. RESULTS: Five phenomenological clusters (PhC) emerged from the interviews, including three which described pain as an unpleasant sensation calling for: (1) experiential avoidance-suppression, (2) volitional agency-distanciation, or (3) a positive cognitive reappraisal and flexibility. Two additional clusters (4-5), containing mostly expert meditators, thematized pain sensation as an opportunity to gain metacognitive insights about mental processes, and to deconstruct one's suffering through these insights. PhC5 further integrates these insights with the recognition that suffering is part of the shared human experience and with the aspiration to relieve others from suffering. Each PhC was correlated to a unique profile of self-reports during the pain paradigm. CONCLUSION: These findings need to be replicated in patients and practicing MM. They also warrant the integration of this mixed-method approach with brain imaging data to refine the experiential neuroscience of pain. SIGNIFICANCE: We compared the meaning of experiencing and regulating pain in novices and expert meditators using qualitative interviews. We identified five phenomenological clusters describing relevant features implicated in pain response strategies and meditation. These clusters were organized along a pseudo-gradient, which captured meditation expertise and predicted self-reports related to a pain paradigm and psychometric scales associated with pain and its regulation. These findings advance our understanding of the metacognitive mechanisms and beliefs underlying mindfulness meditation and can inform pain treatment strategies.

Mindfulness-Based stress reduction in early palliative care for people with metastatic cancer: A mixed-method study.

OBJECTIVES: To explore the impact of a Mindfulness-Based Stress Reduction (MBSR) intervention for people with metastatic cancer integrated in Early Palliative Care (EPC). DESIGN: Mixed-method study. SETTINGS/LOCATION: EPC Service integrated with Oncology Unit, Carpi General Hospital, Italy from January to October 2017. The MBSR intervention took place inside the hospital. SUBJECTS: Study participation was offered to 25 consecutive people referred to the EPC service. INCLUSION CRITERIA: people with metastatic cancer between 18 and 75 years old; informed consent. EXCLUSION CRITERIA: Performance Status <60% according to Karnofsky scale; active psychiatric disorder. 20 patients were included in the study. INTERVENTION: The adapted program consists of 8 meetings for 2.5 h once a week, a 4.5 h session between the 6th and 7th weeks and 0.5 h home practice daily. The following mindfulness practices were included during the training: formal sitting meditation, body scan, light yoga, walking meditation, and Aikido exercises. Participants were provided with materials for home practice. A qualified MBSR instructor conducted the program. Sessions were attended by a clinical psychologist and a physician trained in meditation, together with the palliative nurse as facilitators. OUTCOME MEASURES: Feasibility and acceptability were assessed on 16 participants. In addition, pre-post measures of cancer pain and mood state were collected. Semi-structured, in-depth interviews were conducted on a subset of 8 participants at the end of the study and analysed using the Interpretative-Phenomenological approach. RESULTS: MBSR attendance to meetings and adherence to home practice were 75%. MBSR intervention helped participants to develop an accepting attitude in respect to metastatic cancer disease helping them to face anxiety and cancer pain. MBSR improves self-regulation of mood state engendering feelings of compassion MBSR program supports participants in questioning and reconnecting with their values and spiritual beliefs. CONCLUSIONS: A Mindfulness intervention integrated into EPC setting is feasible, well accepted and could help metastatic cancer patients to control cancer pain together with an opportunity of emotional and spiritual relief.

Training novice practitioners to reliably report their meditation experience using shared phenomenological dimensions.

Empirical descriptions of the phenomenology of meditation states rely on practitioners' ability to provide accurate information on their experience. We present a meditation training protocol that was designed to equip naive participants with a theoretical background and experiential knowledge that would enable them to share their experience. Subsequently, novices carried on with daily practice during several weeks before participating in experiments. Using a neurophenomenological experiment designed to explore two different meditation states (focused attention and open monitoring), we found that self-reported phenomenological ratings (i) were sensitive to meditation states, (ii) reflected meditation dose and fatigue effects, and (iii) correlated with behavioral measures (variability of response time). Each of these effects was better predicted by features of participants' daily practice than by desirable responding. Our results provide evidence that novice practitioners can reliably report their experience along phenomenological dimensions and warrant the future investigation of this training protocol with a longitudinal design.

Mindfulness-based stress reduction in patients with interstitial lung diseases: a pilot, single-centre observational study on safety and efficacy.

BACKGROUND: Chronic, progressive respiratory symptoms are associated with great psychological and emotional impact in patients suffering from interstitial lung disease (ILD). This single-centre pilot study evaluated for the first time the safety, feasibility and efficacy of a Mindfulness Based Stress Reduction Program (MBSR) in a group of patients with ILD. METHODS: Prospective observational study set in a university hospital ILD outpatient clinic. Nineteen patients with different ILDs were recruited 2 months prior to the start of the 8-week MBSR program and followed up for 12 months. Primary outcomes were program safety and feasibility, while secondary outcomes were changes in moods and stress (assessed by Profile Of Mood State (POMS) and Perceived Stress Scale (PSS) questionnaires), symptoms (Shortness Of Breath (SOB) and Cough And Sputum Assessment (CASA-Q) questionnaires), lung function and exercise tolerance at 12 months. RESULTS: Two patients (10.5%) dropped out in the observational period before the start of the MBSR intervention because of non-respiratory causes. All 17 patients who entered the 8-week MBSR program managed to complete it with an adherence average of eight sessions of nine. No adverse events related to the mindfulness training were reported. Statistically significant improvements in the POMS total score and in several individual items of POMS and PSS were observed throughout the study. However, respiratory questionnaire scores, lung function and exercise tolerance did not show a significant difference over time. CONCLUSIONS: An MBSR program appears to be safe and feasible in patients with ILD, and might affect perceived moods and stress producing a positive and lasting improvement in several stress-related negative domains. These findings pave the way to larger (possibly multicentre), randomised, controlled confirmatory trials.

The embodied transcendental: a Kantian perspective on neurophenomenology.

Neurophenomenology is a research programme aimed at bridging the explanatory gap between first-person subjective experience and neurophysiological third-person data, through an embodied and enactive approach to the biology of consciousness. The present proposal attempts to further characterize the bodily basis of the mind by adopting a naturalistic view of the phenomenological concept of intentionality as the a priori invariant character of any lived experience. Building on the Kantian definition of transcendentality as "what concerns the a priori formal structures of the subject's mind" and as a precondition for the very possibility of human knowledge, we will suggest that this transcendental core may in fact be rooted in biology and can be examined within an extension of the theory of autopoiesis. The argument will be first clarified by examining its application to previously proposed elementary autopoietic models, to the bacterium, and to the immune system; it will be then further substantiated and illustrated by examining the mirror-neuron system and the default mode network as biological instances exemplifying the enactive nature of knowledge, and by discussing the phenomenological aspects of selected neurological conditions (neglect, schizophrenia). In this context, the free-energy principle proposed recently by Karl Friston will be briefly introduced as a rigorous, neurally-plausible framework that seems to accomodate optimally these ideas. While our approach is biologically-inspired, we will maintain that lived first-person experience is still critical for a better understanding of brain function, based on our argument that the former and the latter share the same transcendental structure. Finally, the role that disciplined contemplative practices can play to this aim, and an interpretation of the cognitive processes taking place during meditation under this perspective, will be also discussed.