Research Articles

Original research and reliable science journalism about research. Note: be a little careful about science reporting in the mainstream media, it can be less than accurate.

  • 04 Jan 2017 10:50 AM | Tim Burnett (Administrator)

    These and other sources indicate that physicians report high levels of distress, which is linked to burnout, attrition, and poorer quality of care. Several studies show that mindfulness interventions have been helpful in dealing with these problems. Article #1, a review of studies on MBSR, reports: “Empirical evidence indicates that participation in MBSR yields benefits for clinicians in the domains of physical and mental health.”

    Although much of the research on mindfulness interventions focuses on the 8-week MBSR class, a pilot study, #7, states that “an abbreviated mindfulness training course adapted for primary care clinicians was associated with reductions in indicators of job burnout, depression, anxiety, and stress.”

    Krasner et al, Article #2, studied primary care physicians who took the 8-week MBSR class +  a 10-month maintenance phase of 2.5 hours/month.

    The authors reported, 9 months’ post-intervention, “increased mindfulness and less burnout (less emotional exhaustion and greater personal accomplishment, greater empathy, conscientiousness, and emotional stability).” They concluded: “Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care.”

    In Article #4, a study of these same primary care physicians 3 years after they participated in the course, the authors conclude: “Participants reported three main themes: (1) sharing personal experiences from medical practice with colleagues reduced professional isolation, (2) mindfulness skills improved the participants' ability to be attentive and listen deeply to patients' concerns, respond to patients more effectively, and develop adaptive reserve, and (3) developing greater self-awareness was positive and transformative, yet participants struggled to give themselves permission to attend to their own personal growth.”

    Article #5 adds that not only are the physicians who’ve taken MBSR experiencing less stress and higher levels of self care, but also their participation in the course “resulted in improved patient care.” Article #6 gives greater detail about the relationship between clinicians and patients: “In adjusted analyses comparing clinicians with highest and lowest tertile mindfulness scores, patient visits with high-mindfulness clinicians were more likely to be characterized by a patient-centered pattern of communication (adjusted odds ratio of a patient-centered visit was 4.14; 95% CI, 1.58-10.86), in which both patients and clinicians engaged in more rapport building and discussion of psychosocial issues. Clinicians with high-mindfulness scores also displayed more positive emotional tone with patients (adjusted β = 1.17; 95% CI, 0.46-1.9). Patients were more likely to give high ratings on clinician communication (adjusted prevalence ratio [APR] = 1.48; 95% CI, 1.17-1.86) and to report high overall satisfaction (APR = 1.45; 95 CI, 1.15-1.84) with high-mindfulness clinicians.

    Selected Articles on Mindfulness Interventions with Physicians

    1. Irving JA1, Dobkin PL, Park J. (2009) Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR). Complement Ther Clin Pract. 2009 May;15(2):61-6. doi: 10.1016/j.ctcp.2009.01.002.

    2. Krasner et all (2009) Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009 Sep 23;302(12):1284-93.

    3. Goodman MJ1, Schorling JB. (2012) A mindfulness course decreases burnout and improves well-being among healthcare providers.  Acad Med. 2012 Jun;87(6):815-9.

    4. Beckman et al (2012) The impact of a program in mindful communication on primary care physicians. Acad Med. 2012 Jun;87(6):815-9.

    5. Brady S1, O'Connor N, Burgermeister D, Hanson P. (2012) The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit., Perspect Psychiatr Care. 2012 Jul;48(3):129-37

    6. Beach et al (2013) A multicenter study of physician mindfulness and health care quality. Ann Fam Med. 2013 Sep-Oct;11(5):421-8.

    7. Fortney et al (2013) Abbreviated mindfulness intervention for job satisfaction, quality of life, and compassion in primary care clinicians: a pilot study. Ann Fam Med. 2013 Sep-Oct;11(5):412-20. doi: 10.1370/afm.1511.

  • 25 Mar 2016 6:15 AM | Tim Burnett (Administrator)

    Tim and our local colleague Carolyn McManus were both involved in this study. It's notable for it's larger sample sized, being a random controlled trial, and being published in a very prestigious journal.

    Mind-Based Therapies May Ease Lower Back Pain

    By RONI CARYN RABIN MARCH 22, 2016 3:47 PM

    Sixty-five million Americans suffer from chronic lower back pain, and many feel they have tried it all: physical therapy, painkillers, shots. Now a new study reports many people may find relief with a form of meditation that harnesses the power of the mind to manage pain.

    The technique, called mindfulness-based stress reduction, involves a combination of meditation, body awareness and yoga, and focuses on increasing awareness and acceptance of one’s experiences, whether they involve physical discomfort or emotional pain. People with lower back pain who learned the meditation technique showed greater improvements in function compared to those who had cognitive behavioral therapy, which has been shown to help ease pain, or standard back care.

    Participants assigned to meditation or cognitive behavior therapy received eight weekly two-hour sessions of group training in the techniques. After six months, those learning meditation had an easier time doing things like getting up out of a chair, going up the stairs and putting on their socks, and were less irritable and less likely to stay at home or in bed because of pain. They were still doing better a year later.

    The findings come amid growing concerns about opioid painkillers and a surge of overdose deaths involving the drugs. At the beginning of the trial, 11 percent of the participants said they had used an opioid within the last week to treat their pain, and they were allowed to continue with their usual care throughout the trial.

    “This new study is exciting, because here’s a technique that doesn’t involve taking any pharmaceutical agents, and doesn’t involve the side effects of pharmaceutical agents,” said Dr. Madhav Goyal of Johns Hopkins University School of Medicine, who co-wrote an editorial accompanying the paper.

    Dr. Goyal said he sees many patients with chronic lower back pain who become frustrated when they run out of treatments. “It may not be for everybody,” he said, noting that some people with back pain find yoga painful. “But for people who want to do something where they’re using their own mind to help themselves, it can feel very empowering.”

    One of the strengths of the study, published in JAMA on Tuesday, was its sheer size. It included 342 participants ranging in age from 20 to 70. They were randomly assigned in equal numbers to either mindfulness-based stress reduction, cognitive behavioral therapy, or to continue doing what they were already doing.

    Sixty-one percent of participants who received meditation training experienced meaningful improvement in functioning six months after the program started, slightly more than the 58 percent who improved with cognitive behavioral treatment but far exceeding the 44 percent who improved with their usual care.

    Those who got cognitive behavioral therapy had greater improvement when it came to a measure called “pain bothersomeness,” with 45 percent gaining meaningful improvement compared with 44 percent in the meditation group. But both these treatments were more effective than the usual treatment, which led to improvement in only 27 percent of people.

    The benefits were limited, but that’s not really surprising, said the study’s lead author, Daniel Cherkin of Group Health Research Institute in Seattle. “There are no panaceas here. No treatment for nonspecific back pain has been found to make a whole lot of difference for many people.” While some treatments may help some people, he said, they don’t work well for others, which is why it’s important to be able to offer lots of options.

    Mindfulness-based stress reduction was developed in the 1970s by Jon Kabat-Zinn, a scientist in Massachusetts who adapted Buddhist meditation practices for an American audience. The goal is for meditators to increase their awareness of their experience and of “how it’s affecting them and how they’re responding to it,” said Dr. Cherkin, adding that the idea is for participants “to change their mind-set and, in a way, almost befriend the pain, and not feel it’s oppressing them.”

    The new study is the second showing that meditation may help people manage chronic lower back pain. Earlier this month, researchers at the University of Pittsburgh School of Medicinereported in JAMA Internal Medicine that mindfulness meditation helped older adults manage their pain for up to six months, though the improvements in function did not persist.

    Access to mindfulness-based stress reduction can be problematic, however. Training by certified instructors is not available everywhere, and may not be covered by health insurance.

    But the need is tremendous. Back pain is a leading cause of disability worldwide and the second most common cause of disability for American adults.

    One in four adults in the United States has had a bout of back pain within the past month, according to national health figures, and back pain that has no clear underlying cause can be tough to treat, often improving only to flare up again weeks to months later.

    Dr. Cherkin said mindfulness-based stress reduction may be particularly helpful for people because even if their use lapses, they develop a skill they can draw on later when they need it.

    “That suggests that training the mind has potential to change people on a more lasting basis than doing a manipulation of the spine or massage of the back,” techniques that may be “effective in the short term but lose effects over time,” Dr. Cherkin said. “You can practice it by waiting at the bus stop and just breathing.”


    Actual journal article: Effects of MBSR vs TAU on Back Pain - Cherkin, Sherman et al 2016.pdf

  • 04 Mar 2015 3:42 PM | Tim Burnett (Administrator)

    This just in from the American Mindfulness Research Association which offers a monthly summary of recent mindfulness research:

    Can mindfulness training increase real-life
    compassionate behavior? To address this question,
    Lem[PLOS One] randomly assigned 69
    college undergraduates to either a mindfulness
    meditation (MM) or cognitive skills (CS) program.
    Both programs were delivered over self-guided web-
    based smartphone apps. A total of 56 participants
    completed the three week long interventions. The
    MM participants engaged in 14 mindfulness
    meditation sessions lasting an average of 12 minutes
    each. The sessions did not include loving-kindness
    or compassion content. The CS participants engaged
    in 14 game-playing sessions designed to enhance
    memory, attention, speed, and problem solving.

    After completing the intervention, participants were
    asked to visit a waiting area that contained three
    chairs, two of which were already occupied by
    alleged “participants,” who were actually researcher
    confederates (actors who played participants), and
    the third of which was to be occupied by the
    participant. As they sat waiting, another confederate
    entered with crutches and a walking boot, acting as
    if in pain. The seated confederates showed
    indifference to the newcomer. Researchers then
    observed whether or not the participants yielded
    their seats to the newcomer.

    MM participants were more than twice as likely to
    yield their chairs than were CS participants (37 vs.
    14 ). This increase in compassionate behavior was
    not accompanied by an increased ability to judge
    other’s emotions; MM and CS participants did not
    differ on that variable.

    The results support the ability of mindfulness
    training to help a person to act compassionately to
    others. Smartphone apps can potentially extend the
    benefits of mindfulness training to those who would
    otherwise lack access to and the time for more
    immersive programs. Future research can
    determine whether more immersive programs
    might result in larger benefits and help clarify the
    underlying mechanisms for enhancement of
    compassion through mindfulness training.

  • 25 Oct 2014 12:59 PM | Tim Burnett (Administrator)

    This fascinating article from Dr. Susan Fiske at Princeton examines how the brain seems to rapidly categorize people we perceive into 4 categories. A kind neural baseline for empathy vs. prejudice. She even shows that some people are seem as non-human by the mind, but happily we can rehumanize people again. Worth a bit of a careful science paper read. Dense but not unreadable and just 4 pages long.

    week 6 - Fiske2009NeuroimaingStudiesonEmpathy.pdf  [earlier broken link fixed - 10/28/2014]

  • 19 Jul 2014 2:42 PM | Tim Burnett (Administrator)

    We often cite this fascinating (and very readable) experience sample study out of Harvard Psychology.

    Killingsworth & Gilbert (2010) A Wandering Mind is an Unhappy Mind.pdf

    Matthew Killingsworth collected a lot of data and makes two really interesting and important assertions:

    1) People's minds wander about half the time

    2) We are generally happier if we are paying attention to the task we're doing, regardless of what that task might be. Doing a desirable task does affect our happiness, but paying attention matters more.

  • 19 Jul 2014 2:39 PM | Tim Burnett (Administrator)

    People would rather be electrically shocked than left alone with their thoughts

    Nadia is a news intern at Science.

    At some point today you will disengage from the rest of the world and just think. It could happen any number of ways: if your mind wanders from work, while you're sitting in traffic, or if you just take a quiet moment to reflect. But as frequently as we drift into our own thoughts, a new study suggests that many of us don't like it. In fact, some people even prefer an electric shock to being left alone with their minds.

    “I'm really excited to see this paper,” says Matthew Killingsworth, a psychologist at the University of California (UC), San Francisco, who says his own work has turned up a similar result. “When people are spending time inside their heads, they're markedly less happy.”

    To conduct the study, Timothy Wilson, a social psychologist at the University of Virginia in Charlottesville and colleagues recruited hundreds of undergraduate student volunteers and community members to take part in “thinking periods.” Individuals were placed in sparsely furnished rooms and asked to put away their belongings, such as cellphones and pens. They then were given one of two tests that lasted between 6 and 15 minutes. While some were told to think about whatever they wanted, others chose from several prompts, such as going out to eat or playing a sport, and planned out how they would think about it during the period.

    Afterward, the team asked the volunteers to rate their experience on a nine-point scale, where the higher the number, the more enjoyable their time was. In both the free-thinking and planned-prompt scenarios, about 50% of people did not like the experience, reporting an enjoyment level at or below the midpoint of the scale. Participants generally gave high ratings of boredom, too, according to Wilson.

    To see if a change of scenery would help, the team let participants do the studies in their own homes, but still found similar results. Overall, the subjects said they enjoyed activities like reading and listening to music about twice as much as just thinking.

    The researchers then decided to take the experiment a step further. For 15 minutes, the team left participants alone in a lab room in which they could push a button and shock themselves if they wanted to. The results were startling: Even though all participants had previously stated that they would pay money to avoid being shocked with electricity, 67% of men and 25% of women chose to inflict it on themselves rather than just sit there quietly and think, the team reports online today in Science.

    “We went into this thinking it wouldn’t be that hard for people to entertain themselves,” Wilson says. “We have this huge brain and it’s stuffed full of pleasant memories, and we have the ability to construct fantasies and stories. We really thought this [thinking time] was something people would like.”

    He suggests that the results may be mixed signs of boredom and the trouble that we have controlling our thoughts. “I think [our] mind is built to engage in the world,” he says. “So when we don’t give it anything to focus on, it’s kind of hard to know what to do.”

    Although daydreaming is spontaneous and can be enjoyable, Wilson says the pressure to think on commandundefinedwhether it’s being demanded by researchers, or while you’re waiting in line with nothing else to doundefinedmay be what’s difficult and unpleasant for so many.

    “I found it quite surprising and a bit disheartening that people seem to be so uncomfortable when left to their own devices; that they can be so bored that even being shocked seemed more entertaining,” says Jonathan Schooler, a psychology professor at UC Santa Barbara who studies consciousness. “But I can't help but feel that there has to be more to the story. I'm confident that there are conditions in which at least a subsample of the population enjoys this quiet opportunity for self-reflection.”

    Some people seem to enjoy thinking more than others. For instance, the study found that people who are more agreeable or cooperative were more likely to enjoy themselves when they were told to think about anything. Individuals who admitted that their daydreams normally leave them happy fared better, too.

    Because people so often find themselves intentionally or unintentionally wrapped up in their thoughts, the research team suggests that meditation or other techniques to relax and learn how to gain control of the mind could be helpful. If we knew how to steer our thoughts in a pleasant direction and enjoy the experience, maybe we wouldn’t hate to be alone with ourselves.

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