Mindfulness associated with better health
A new study that measured “dispositional mindfulness” along with seven indicators of cardiovascular health found that persons reporting higher degrees of awareness of their present feelings and experiences had better health. The research suggests that interventions to improve mindfulness could benefit cardiovascular health, an idea researchers can test.
PROVIDENCE, R.I. [Brown University] — Pay attention to the implication of these new research results: People who pay more attention to their feelings and experiences tend to have better cardiovascular health.
As noted more precisely in a new study in the International Journal of Behavioral Medicine, researchers at Brown University found a significant association between self-reported “dispositional mindfulness” and better scores on four of seven cardiovascular health indicators, as well as a composite overall health score. Dispositional mindfulness is defined as someone’s awareness and attention to what they are thinking and feeling in the moment.
The study is the first to quantify such an association between mindfulness and better cardiovascular health, said study lead author Eric Loucks, assistant professor of epidemiology in the School of Public Health. It’s an encouraging link for health promotion, because mindfulness can be enhanced with training.
“Mindfulness is changeable, and standardized mindfulness interventions are available,” Loucks said. “Mostly they’ve been looked at for mental health and pain management, but increasingly they are being looked at for cardiovascular risk factors such as obesity, smoking, and blood pressure.”
The connection may come about because people who are attuned to their present feelings may be better at minding and managing the various cravings — for salty or sugary foods or cigarettes or even a spell on the couch — that undermine health, Loucks said. Mindfulness interventions, for example, have already shown efficacy in helping people to quit smoking.
Measuring mindfulness and health
In the study, Loucks and his colleagues asked 382 participants in the broader New England Family Study to answer the 15 questions of the Mindful Attention Awareness Scale (MAAS).
MAAS questions, rated on a six-point scale from “almost always” to “almost never” include “I find it difficult to stay focused on what’s happening in the present” and “I tend not to notice feelings of physical tension or discomfort until they really grab my attention.”
The participants also underwent tests to determine ratings on seven indicators of cardiovascular health, as suggested by the American Heart Association: smoking avoidance, physical activity, body mass index, fruit and vegetable consumption, cholesterol, blood pressure, and fasting blood glucose. The researchers also noted the participants’ age, race, sex, education and scores on standardized scales of depression, and sense of control in their lives.
In their analysis of the data, Loucks and his team examined the association between the degree of self-reported mindfulness and the scores on each of the seven cardiovascular health indicators, accounting for age, sex, and race. They also calculated a composite score of the health indicators.
Participants with high MAAS scores had an 83 percent greater prevalence of good cardiovascular health (as measured by the composite score) compared to those with relatively low MAAS scores. High vs. low MAAS scores were associated with significantly higher cardiovascular health on four of the seven individual indicators: BMI, physical activity, fasting glucose, and avoiding smoking.
That higher mindfulness did not also associate with higher scores for blood pressure or cholesterol may be because neither of those health indicators directly affect how someone feels in a typical moment, whereas smoking, obesity (and closely related fasting glucose), and physical activity are all much more explicitly evident experiences for the self.
Meanwhile, fruit and vegetable consumption, an indicator of diet quality, showed a positive association with higher MAAS scores, but with too wide a range of uncertainty to be considered statistically significant.
Loucks said the next step in his research is to begin testing whether improving mindfulness can increase cardiovascular health indicators. He said he hopes to launch randomized controlled trials with long-term follow-up (because behavioral interventions often look good in the short term but then don’t last).
In addition to Loucks, the paper’s other authors are Willoughby Britton, Chanelle Howe, Dr. Charles Eaton and Stephen Buka, all of Brown University.
The National Institutes of Health provided support for the study (grant: 1RC2AG036666).
Mindfulness meditation may relieve chronic inflammation
People suffering from chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease and asthma—in which psychological stress plays a major role—may benefit from mindfulness meditation techniques, according to a study by University of Wisconsin-Madison neuroscientists with the Center for Investigating Healthy Minds at the Waisman Center.
Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations and mental content while seated, walking or practicing yoga.
While interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.
A class in stress reduction can be beneficial in many ways, some of which have little to do with mindfulness, according to Melissa Rosenkranz, assistant scientist at the center and lead author on the paper, which was published recently in the journal Brain, Behavior and Immunity. For example, learning to manage stress by engaging in regular physical activity may be therapeutic.
"We wanted to develop an intervention that was meant to produce positive change and compare the mindfulness approach to an intervention that was structurally equivalent," Rosenkranz says.
The study compared two methods of reducing stress: a mindfulness meditation-based approach, and a program designed to enhance health in ways unrelated to mindfulness.
The comparison group participated in the Health Enhancement Program, which consisted of nutritional education; physical activity, such as walking; balance, agility and core strengthening; and music therapy. The content of the program was meant to match aspects of the mindfulness instruction in some way.
For example, physical exercise was meant to match walking meditation, without the mindfulness component.
Both groups had the same amount of training, the same level of expertise in the instructors, and the same amount of home practice required by participants. "In this setting, we could see if there were changes that we could detect that were specific to mindfulness," Rosenkranz explains.
Using a tool called the Trier Social Stress Test to induce psychological stress, and a capsaicin cream to produce inflammation on the skin, immune and endocrine measures were collected before and after training in the two methods. While both techniques were proven effective in reducing stress, the mindfulness-based stress reduction approach was more effective at reducing stress-induced inflammation.
The results show that behavioral interventions designed to reduce emotional reactivity are beneficial to people suffering from chronic inflammatory conditions. The study also suggests that mindfulness techniques may be more effective in relieving inflammatory symptoms than other activities that promote well-being.
Rosenkranz emphasizes that the mindfulness-based approach is not a magic bullet. "This is not a cure-all, but our study does show that there are specific ways that mindfulness can be beneficial, and that there are specific people who may be more likely to benefit from this approach than other interventions."
Significant portions of the population do not benefit from available pharmaceutical treatment options, for example. Some of these patients suffer from negative side effects of the drugs, or simply do not respond to the standard-of-care for treatment of the disorder.
"The mindfulness-based approach to stress reduction may offer a lower-cost alternative or complement to standard treatment, and it can be practiced easily by patients in their own homes, whenever they need," Rosenkranz says.
If you haven't discovered the work of Jud Brewer yet, let me be the first to introduce you. Dr. Brewer is a psychiatrist, specializing in addiction medicine, and teaches mindfulness and MBSR through the Center for Mindfulness at University of Massachusetts Medical School. He has developed mindfulness based intervention apps for smoking cessation (Craving to Quit) and emotional/addictive eating (Eat Right Now). His new book, The Craving Mind, is a fascinating and illuminating read which I would bet everyone will see a part of themselves in the pages. Here is one of the numerous talks by Dr. Brewer, all of which are accessible on YouTube.
A great article by Kristen Neff, PhD from Mindful Magzine
Striving for self-esteem is about trying hard to feel special, above average. It’s absurd. We don’t need to feel extra-special or over the top. We need to touch who we really are in any given moment.
The great angst of modern life is this: No matter how hard we try, no matter how successful we are, no matter how good a parent, worker, or spouse we are—it’s never enough. There is always someone richer, thinner, smarter, or more powerful than we are, someone who makes us feel like a failure in comparison. And failure of any kind is unacceptable. What to do?One response has come in the form of the self-esteem movement. Over the years there have been thousands of books and magazine articles promoting self-esteem—how to get it, how to raise it, and how to keep it. It has almost become a truism in our culture that we need to have high self-esteem in order to be happy and healthy. We are told to think positively of ourselves at all costs, like Al Franken’s Saturday Night Live character Stuart Smalley who proclaims, “I’m good enough, I’m smart enough, and doggone it, people like me!”
But the need to continually evaluate ourselves positively comes at a high price. For instance, high self-esteem usually requires feeling special and above average. To be called average is considered an insult. (“How did you like my performance last night?” “It was average.” Ouch!) Of course, it’s logically impossible for every human being on the planet to be above average at the same time, putting us in a bit of a bind. One way we try to deal with this is through a process of social comparison in which we continually try to puff ourselves up and put others down (just think of the film Mean Girls and you’ll know what I’m talking about).
The quest to raise one’s esteem at the expense of others is a phenomenon that underlies many societal problems, such as prejudice, social inequality, and bullying. Bullies generally have high self-esteem, since picking on people weaker than themselves is an easy way to boost their sense of self-worth.
Even when you have high self-esteem, it will likely fly out the window the next time you blow a big work assignment, can’t zip up your pants anymore, or don’t get invited to that big party.
One of the most insidious consequences of the self-esteem movement over the last couple of decades is the narcissism epidemic. Jean Twenge, author of Generation Me, examined the narcissism levels of over 15,000 U.S. college students between 1987 and 2006. During that 20-year period narcissism scores went through the roof, with 65% of modern-day students scoring higher in narcissism than previous generations. Not coincidentally, students’ average self-esteem levels rose by an even greater margin over the same period.
Even when you have high self-esteem, however, you can’t necessarily keep it. Your self-esteem is likely to fly out the window the next time you blow a big work assignment, can’t zip up your pants anymore, or don’t get invited to that big party. Self-esteem is an emotional roller-coaster ride: Our sense of self-worth rises and falls in step with our latest success or failure. Yet we don’t want to suffer from low self-esteem either. What’s the alternative?
There is another way to feel good about ourselves that does not involve evaluating how good or worthy we are: self-compassion. Self-compassion is not based on positive evaluations of ourselves. Rather, it is a way of relating to ourselves. It involves being caring and supportive to ourselves when we fail, feel inadequate, or struggle in life—extending the same feelings of compassion to ourselves that we typically extend to others. People are compassionate to themselves because they’re human beings who suffer, not because they’re special and above average. Unlike self-esteem, therefore, self-compassion emphasizes interconnection rather than separateness. It also offers more emotional stability, because it is always there for you—when you’re on top of the world and when you fall flat on your face.
A huge body of research now supports the mental health benefits of self-compassion, and programs—such as Mindful Self-Compassion, which my colleague from Harvard, Chris Germer, and I developed—are now being taught all over the world.
But what is self-compassion exactly?
As I define it, it involves three key components—being kind to ourselves when we suffer, framing our experience of imperfection in light of the shared human experience, and being mindfully aware of our negative thoughts and emotions.
Three Components of Self-Compassion
1. Self-KindnessWhen we are self-compassionate we’re kind to ourselves rather than harshly self-critical, or to put it more simply, we treat ourselves in the same way we would treat a good friend. The golden rule tells us “do unto others as you would have them do unto you.” That’s all well and good, but hopefully we won’t treat others even half as badly as we treat ourselves. Listen to our self-talk: “You’re such an idiot! You’re disgusting!” Would you talk this way to a friend?
It’s natural for us to try to be kind to the people we care about in our lives. We let them know it’s okay to be human when they fail. We reassure them of our respect and support when they’re feeling bad about themselves. We comfort them when they’re going through hard times. In other words, most of us are very good at being kind and understanding toward others, but not toward ourselves. Think of all the generous, caring people you know who constantly beat themselves up (this may even be you). For some strange reason our culture tells us that’s the way we should be—women especially—or we’ll become self-centered and selfish. But is it true?
All harsh self-criticism does is make us feel depressed, insecure, and afraid to take on new challenges because we’re afraid of the self-flagellation that will come if we fail. When our inner voice continually criticizes and berates us for not being good enough, we often end up in negative cycles of self-sabotage and self-harm—and these are incredibly self-focused states of mind.
Self-kindness helps us take the perspective of an “other” toward ourselves. It lets in a breath of fresh air, so we see our pain from a different—more detached—vantage point.
When we are self-compassionate, however, we are kind, nurturing, and understanding toward ourselves when we fail. Self-kindness is expressed in internal dialogues that are benevolent and encouraging rather than cruel or disparaging. Instead of attacking and berating ourselves for being inadequate, we offer ourselves warmth and unconditional acceptance. Similarly, when external life circumstances are challenging and difficult to bear, self-compassion involves active self-soothing and support. This means that when our emotional cup is full, we have more resources available to give to others.
Self-kindness helps us take the perspective of an “other” toward ourselves, so we see our pain from a different point of view. It lets in a breath of fresh air, so the toxicity of our pain is not so all-consuming. When we adopt the role of a kind friend to a person in need (i.e., ourselves), we’re no longer totally identified with the role of the one who is suffering. Yes, I hurt. But I also feel care and concern. I am both the comforter and the one in need of comfort. There is more to me than the pain I’m feeling right now, I am also the heartfelt response to that pain. And holding our suffering with love allows us to bear our struggles in life with greater ease.
2. Common HumanityThe second essential element of self-compassion is recognition of our common humanity. Compassion means “to suffer with,” indicating a basic mutuality in the experience of suffering. It honors the fact that everyone experiences pain, no matter who they are. This is what distinguishes self-compassion from self-pity. While self-pity says “poor me,” self-compassion recognizes suffering is part of the shared human experience. The pain I feel in difficult times is the same pain that you feel in difficult times. The triggers are different, the circumstances are different, the degree of pain is different, but the basic experience is the same.
Sadly, however, most of us don’t focus on what we have in common with others, especially when we feel ashamed or inadequate. Rather than framing our imperfection in light of the shared human experience, we’re more likely to feel isolated and disconnected from others when we fail. Our perspective narrows, and we become absorbed by feelings of insufficiency and insecurity. When we’re confined in the space of self-loathing, it’s as if the rest of humanity doesn’t exist. This isn’t a logical thought process, but a type of emotional tunnel vision. Somehow it feels like I’m the only one who has failed or made a mistake, while everyone else is getting it right.
And even when we’re facing a hardship that’s outside our control—let’s say we develop a genetically determined illness, for instance—we tend to feel like this is an abnormal state that “shouldn’t” be happening. (Like the dying 84-year-old man whose final words were “why me?”)
Once we fall into the trap of believing things are “supposed” to go well, we think something has gone terribly amiss when they don’t. If we were to take a completely logical approach to the issue, of course, we’d consider the fact that there are thousands of things that can go wrong in life at any one time, so it’s highly likely—in fact inevitable—that we’ll make mistakes and experience hardships on a regular basis. But we don’t tend to be rational about these matters. Instead, we suffer, and we feel all alone in our suffering. When we remember that pain is part of the shared human experience, however, every moment of suffering has the potential to be transformed into a moment of connection with others.
3. MindfulnessTo be self-compassionate, we need to be mindful, which entails being aware of present-moment experience in a clear and balanced way. It involves being open to the reality of what’s happening: allowing whatever thoughts, emotions, and sensations that arise to enter awareness without resistance.
Why is mindfulness an essential component of self-compassion?
First, it’s necessary to recognize you’re suffering in order to give yourself compassion. Although you may think suffering is pretty obvious, it isn’t always. When you look in the mirror and decide you’re overweight, or that your nose is too big, do you immediately tell yourself these feelings of inadequacy are painful, and therefore deserving of a kind, caring response? When your boss calls you into your office and tells you your job performance is below par, is your first instinct to comfort yourself? Probably not. We certainly feel the pain of falling short of our ideals, but our minds tend to focus on the failure itself, rather than the pain caused by failure. There isn’t much mental space left over to recognize the emotional suffering caused by feelings of inadequacy, let alone try to soothe and comfort ourselves in the midst of our suffering.
One of the reasons we engage in this pattern of responding is that we are programmed to avoid pain. Pain signals that something is wrong, triggering our fight or flight response. Because of our innate tendency to move away from pain, it can be difficult to turn toward it, to hold it, to be with it as it is.
Mindfulness counters the tendency to avoid painful thoughts and emotions, allowing us to hold the truth of our experience even when it’s unpleasant. At the same time, being mindful means we don’t “overidentify” with negative thoughts or feelings and get caught up and swept away by our aversive reactions. This type of rumination exaggerates our assessments of our self-worth. Not only did I fail, “I AM A FAILURE.” Not only was I disappointed, “MY LIFE IS DISAPPOINTING.”
When we observe our pain mindfully, however, we acknowledge our suffering without exaggerating it, allowing ourselves to adopt a more balanced perspective toward ourselves. We can then open our hearts and let our self-compassion flow freely.
Three doorways in
The beauty of self-compassion is that it has three distinct doorways in. Whenever you notice you are suffering, you have three potential courses of action.
1. You can give yourself kindness and understanding.
2. You can remind yourself that suffering is part of the shared human experience.
3. Or you can be mindful of your thoughts and emotions so that you find greater peace and balance.
Enhancing any one of the three components of self-compassion will make it easier to engage the other components. Sometimes you’ll find it easier to enter one doorway than another depending on your mood and the current situation, but once you’re in, you’re in. You’ll be in a state of loving, connected presence (another way of describing the three components of self-compassion) no matter what the circumstances of your life are in the moment. You will have discovered the power of self-compassion, and it could change your life for good.
The self-compassion break
The self-compassion break involves using a set of memorized phrases to soothe and comfort yourself when you’re in pain.
1. Put both hands on your heart, pause, and feel their warmth. You can also put your hands on any other place on your body that feels soothing and comforting, such as your belly or your face.
2. Breathe deeply in and out.
3. Speak these words to yourself (out loud or silently) in a warm and caring tone:
This is a moment of suffering
Suffering is part of life
May I be kind to myself
May I give myself the compassion I need
The first phrase, “This is a moment of suffering” is designed to bring mindfulness to the fact that you’re in pain. Other possible wordings for this phrase are “I’m having a really tough time right now,” or “This hurts,” and so forth.
The second phrase, “Suffering is part of life” is designed to remind you that imperfection is part of the shared human experience. Other possible wordings are “Everyone feels this way sometimes,” “This is part of being human,” and so on.
The third phrase, “May I be kind to myself in this moment” is designed to help bring a sense of caring concern to your present moment experience. Other possible wordings are “May I love and support myself right now” or “May I accept myself as I am,” and so on.
The final phrase, “May I give myself the compassion I need,” firmly sets your intention to be self-compassionate. You might use other words such as “May I remember that I am worthy of compassion,” or “May I give myself the same compassion I would give to a good friend,” and so on.
Find the four phrases that seem most comfortable for you, and memorize them. Then, the next time you judge yourself or have a difficult experience you can use these phrases as a way of reminding yourself to be self-compassionate. It’s a handy tool to help soothe and calm troubled states of mind.