Implicit or Explicit Compassion? Effects of Compassion Cultivation Training and Comparison with Mindfulness-based Stress Reduction

Mindfulness-based interventions generally include compassion implicitly, but it remains to be seen whether implicit compassion training can be effective, or if it needs to be trained explicitly through specific meditations and relational practices. This research study had two specific goals. The first was to expand the literature on the effects of compassion-based interventions (CBIs) by assessing the impact of the Compassion Cultivation Training program (CCT) on anxiety, depression, stress, life satisfaction, happiness, mindfulness, empathy, self-compassion, compassion for others, and identification with all humanity, through a waitlist randomized controlled trial in a community sample (study 1). Secondly, this research addressed the following question: Does a CBI—an explicit compassion training—have a differential impact in terms of empathy, compassion, and identification with all humanity, compared to a mindfulness-based intervention (mindfulness-based stress reduction (MBSR)) in which compassion is taught implicitly? (study 2). Groups were assessed at baseline, post-intervention, and 2-month follow-up, and analyses involved repeated-measures of analysis of variance (ANOVA) for group contrasts. Compared to the wait-list group, CCT participants showed significant improvements in psychological well-being (decreased depression and stress, increases in life satisfaction, happiness, mindfulness, and self-compassion) and compassion skills. Both MBSR and CCT were effective in generally enhancing psychological well-being and increasing mindfulness and compassion, but CCT had a greater impact on developing compassionate skills, especially empathic concern and identification with all humanity. This research highlights the potential for a complementary (rather than competitive) relationship between mindfulness- and compassion-based interventions

The mediating role of shared flow and perceived emotional synchrony on compassion for others in a mindful-dancing program

While there is a growing understanding of the relationship between mindfulness and compassion, this largely relates to the form of mindfulness employed in first-generation mindfulness-based interventions such as Mindfulness-Based Stress Reduction. Consequently, there is limited knowledge of the relationship between mindfulness and compassion in respect of the type of mindfulness employed in second-generation mindfulness-based interventions (SG-MBIs), including those that employ the principle of working harmoniously as a “secular sangha.” Understanding this relationship is important because research indicates that perceived emotional synchrony (PES) and shared flow—that often arise during participation in harmonized group contemplative activities—can enhance outcomes relating to compassion, subjective well-being, and group identity fusion. This pilot study analyzed the effects of participation in a mindful-dancing SG-MBI on compassion and investigated the mediating role of shared flow and PES. A total of 130 participants were enrolled into the study that followed a quasi-experimental design with an intervention and control group. Results confirmed the salutary effect of participating in a collective mindful-dancing program, and demonstrated that shared flow and PES fully meditated the effects of collective mindfulness on the kindness and common humanity dimensions of compassion. Further research is warranted to explore whether collective mindfulness approaches, such as mindful dancing, may be a means of enhancing compassion and subjective well-being outcomes due to the mediating role of PES and shared flow.N/

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Mindfullness-based stress reduction program: systemizing its implementation in a semirural public hospital in southern Chile

La Meditación de Atención Plena proveniente de la tradición budista ha sido aplicada como herramienta preventiva y terapéutica en hospitales y clínicas por 30 años en occidente, siendo aun prácticamente desconocida en nuestro país. Este artículo presenta el Programa de Reducción del Estrés Basado en la Atención Plena como alternativa preventiva y terapéutica para el incremento del bienestar psicológico, alivio del estrés, y disminución de síntomas depresivos y ansiosos. Se describe la implementación de un programa piloto en el Hospital de Santa Bárbara (8va Región, Chile) y se presentarán los resultados de las evaluaciones pre-post de síntomas depresivos y ansiosos de los participantes. Finalmente se discuten las potencialidades de la réplica del programa en establecimientos de salud pública del país.Originating in the Buddhist tradition, mindfulness meditation has been applied as a preventative and therapeutic tool in hospitals and clinics over the past 30 years in the western world.  Nevertheless, it is practically unknown in Chile.  This article outlines the experience of the first Mindfulness-Based Stress Reduction Program (MBSR) implemented in Chile, which has at its core the practice of mindfulness meditation, as a tool to reduce depressive and anxious symptoms in patients and workers of a hospital.  Described here is a pilot program that was implemented at the Hospital of Santa Barbara in southern Chile.  Preliminary results from the evaluations of depressive and anxious symptoms among participants are presented, finding a significant diminishing in both.  Qualitative aspects of the impact of the intervention are also included through the thematic analyses of a semi-structured interview with one of the workshops participants. Finally, the potential for reproducing this program in public health environments across the country is discussed.  

Yoga practice in the treatment of addictions. The experience of two years of Yoga practice with inpatients of Takawasi rehabilitation center

 Este artículo presenta en detalle y desde una mirada experiencial la utilización de la práctica del yoga como técnica terapéutica complementaria en el tratamiento de adic- ciones. Tomando en cuenta que, pese a la popularidad actual de esta práctica, existen pocas descripciones detalladas de su utilización en contextos clínicos, se ofrece en este artículo una descripción general de la filosofía y práctica del yoga, sus beneficios a nivel físico y psicológico, su implementación en un contexto clínico particular -el tratamiento de adicciones- y finalmente la propia perspectiva de los pacientes en tratamiento sobre el rol del yoga en su proceso de rehabilitación. This article aims to present in detail and from an experiential view the use ofyoga practice as a complementary therapeutic technique in the treatment of addictions. Considering that, despite the increasing popularity of this practice, there are few detailed descriptions of its use in clinical settings, this article provides an overview of the philosophy and practice of yoga, its physical and psychological benefits, its practice in a particular clinical context - the treatment of addictions-, and, finally, the view of the patients on the role of yoga in their rehabilitation process.  

Programa de Reducción del Estrés Basado en la Atención Plena: Un estudio exploratorio de su aplicación en un Hospital Público semi-rural del Sur de Chile

Originating in the Buddhist tradition, mindfulness meditation has been applied as a preventative and therapeutic tool in hospitals and clinics over the past 30 years in the western world.  Nevertheless, it is practically unknown in Chile.  This article outlines the experience of the first Mindfulness-Based Stress Reduction Program (MBSR) implemented in Chile, which has at its core the practice of mindfulness meditation, as a tool to reduce depressive and anxious symptoms in patients and workers of a hospital.  Described here is a pilot program that was implemented at the Hospital of Santa Barbara in southern Chile.  Preliminary results from the evaluations of depressive and anxious symptoms among participants are presented, finding a significant diminishing in both.  Qualitative aspects of the impact of the intervention are also included through the thematic analyses of a semi-structured interview with one of the workshops participants. Finally, the potential for reproducing this program in public health environments across the country is discussed.    La Meditación de Atención Plena proveniente de la tradición budista ha sido aplicada como herramienta preventiva y terapéutica en hospitales y clínicas por 30 años en occidente, siendo aun prácticamente desconocida en nuestro país. Este artículo presenta el Programa de Reducción del Estrés Basado en la Atención Plena como alternativa preventiva y terapéutica para el incremento del bienestar psicológico, alivio del estrés, y disminución de síntomas depresivos y ansiosos. Se describe la implementación de un programa piloto en el Hospital de Santa Bárbara (8va Región, Chile) y se presentarán los resultados de las evaluaciones pre-post de síntomas depresivos y ansiosos de los participantes. Finalmente se discuten las potencialidades de la réplica del programa en establecimientos de salud pública del país

Yoga en el Tratamiento de Adicciones. La experiencia de dos años de práctica de yoga con pacientes del Centro de Rehabilitación Takiwasi.

This article aims to present in detail and from an experiential view the use ofyoga practice as a complementary therapeutic technique in the treatment of addictions. Considering that, despite the increasing popularity of this practice, there are few detailed descriptions of its use in clinical settings, this article provides an overview of the philosophy and practice of yoga, its physical and psychological benefits, its practice in a particular clinical context - the treatment of addictions-, and, finally, the view of the patients on the role of yoga in their rehabilitation process.     Este artículo presenta en detalle y desde una mirada experiencial la utilización de la práctica del yoga como técnica terapéutica complementaria en el tratamiento de adic- ciones. Tomando en cuenta que, pese a la popularidad actual de esta práctica, existen pocas descripciones detalladas de su utilización en contextos clínicos, se ofrece en este artículo una descripción general de la filosofía y práctica del yoga, sus beneficios a nivel físico y psicológico, su implementación en un contexto clínico particular -el tratamiento de adicciones- y finalmente la propia perspectiva de los pacientes en tratamiento sobre el rol del yoga en su proceso de rehabilitación.