Unwanted effects: Is there a negative side of meditation? A multicentre survey

Objectives Despite the long-term use and evidence-based efficacy of meditation and mindfulness-based interventions, there is still a lack of data about the possible unwanted effects (UEs) of these practices. The aim of this study was to evaluate the occurrence of UEs among meditation practitioners, considering moderating factors such as the type, frequency, and lifetime duration of the meditation practices. Methods An online survey was developed and disseminated through several websites, such as Spanish-, English- and Portuguese-language scientific research portals related to mindfulness and meditation. After excluding people who did not answer the survey correctly or completely and those who had less than two months of meditation experience, a total of 342 people participated in the study. However, only 87 reported information about UEs. Results The majority of the practitioners were women from Spain who were married and had a University education level. Practices were more frequently informal, performed on a daily basis, and followed by focused attention (FA). Among the participants, 25.4% reported UEs, showing that severity varies considerably. The information requested indicated that most of the UEs were transitory and did not lead to discontinuing meditation practice or the need for medical assistance. They were more frequently reported in relation to individual practice, during focused attention meditation, and when practising for more than 20 minutes and alone. The practice of body awareness was associated with UEs to a lesser extent, whereas focused attention was associated more with UEs. Conclusions This is the first large-scale, multi-cultural study on the UEs of meditation. Despite its limitations, this study suggests that UEs are prevalent and transitory and should be further studied. We recommend the use of standardized questionnaires to assess the UEs of meditation practices

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Exploring the Relationship Between Subjective Ratings of Mindfulness Practices and Outcomes in Patients Participating in an MBSR Program

Objectives: The present study explored relationships between outcomes of the Mindfulness-Based Stress Reduction (MBSR) program and the importance attributed by patients to the mindfulness practices taught.Methods: Patients with chronic illnesses (46.8% breast cancer; N=126) completed questionnaires pertaining to medical symptoms, stress, and mindfulness, pre- and post-MBSR.  At program completion, each patient rated the importance of the mindfulness practices employed.  Stepwise linear regression analyses were run to investigate associations between changes in outcome variables and subjective ratings of practice importance.Results: Increases in mindfulness were associated with high ratings of importance for sitting meditation (p LT 0.02) and homework manual (p LT 0.02; Adjusted R2 = 0.10). Decreases in medical symptoms were associated with high ratings for the body scan (p LT 0.01) and small group exercises (p LT 0.01; Adjusted R2 = 0.13). High ratings for the body scan were moderately, albeit significantly, correlated with decreases in perceived stress (p LT 0.01, Adjusted R2 = 0.05). A cluster analysis performed on all 10 of the ratings of practice importance showed that greater importance was associated with better outcomes for all three dependent variables (p LT 0.01).  A qualitative examination of patients’ answers to open-ended questions revealed that incorporating mindfulness practices in daily life was a central component of the lifestyle changes experienced during the course of the program.Conclusions: Understanding the mechanisms underlying MBSR’s effectiveness is important as this program becomes recognized as an empirically-supported intervention. These results suggest that specific types of practice (concentration vs. the body scan) are related to distinct outcomes (dispositional mindfulness vs. medical symptoms, respectively). Overall, awareness of the importance of practicing is connected to actual program outcomes

Patrons de comportements en maternelle et émergence précoce de comportements antisociaux chez les garçons

Tremblay Richard E., Pihl Robert O., Vitaro Frank, Dobkin Patricia L. Patrons de comportements en maternelle et émergence précoce de comportements antisociaux chez les garçons. In: Bulletin de psychologie, tome 52 n°441, 1999. Comportements délictueux II. pp. 373-382

Practical behavioral trials to advance evidence-based behavioral medicine

There is a well-documented gap between research and practice in many areas of behavioral medicine. This gap is due in part to limitations in the capacity of the research database to address questions that are of central concern to clinicians, administrative decision makers, and policymakers. Thus, there has been a call for practical clinical trials that compare clinically viable alternative interventions and assess multiple outcomes important for clinical and policy decisions in diverse patient populations and settings. Such trials offer great potential, and they raise interesting challenges regarding optimal research design and source of funding. We discuss issues related to practical clinical trials in behavioral medicine, propose a need for practical behavioral trials (PBTs), and describe design features that will facilitate clinical and policy decision making. This type of PBT can help to close the gap between research and practice and advance the field of evidence-based behavioral medicine. We discuss potential challenges and objections to PBTs and conclude by providing recommendations for the design, conduct, reporting, and review of practical trials

Mindfulness-Based Medical Practice: Exploring the Link between Self-Compassion and Wellness

Objectives: In light of the detrimental impact of burnout upon clinicians and their patients, the identification of means through which the well-being of health care professionals can be fostered and protected is timely and important.  The present study explored outcomes associated with participation in Mindfulness-Based Medical Practice (MBMP), a program modeled after Mindfulness-Based Stress Reduction which included additional mindful communication exercises to foster the integration of mindfulness in various clinical settings.Methods: Physicians, nurses, psychologists, occupational therapists, and social workers enrolled in the 8-week MBMP program.  Participants (N = 110) between the age of 24 and 82 years (M = 46.5, SD = 11.4: 73% women) completed self-report measures prior to and following the program; the Maslach Burnout Inventory, Perceived Stress Scale-10 and the Ryff Scales of Psychological Well-Being. Two process measures designed to capture mechanisms of change were administered: the Mindful Attention Awareness Scale, and the Neff Self-Compassion Scale.Results: Results from paired-sample t-tests indicated that health care professionals enrolled in MBMP can benefit from the program. Analyses demonstrated significant decreases upon measures of perceived stress [p= .000], emotional exhaustion [p= .000], depersonalization [p= .000], and an increase in personal accomplishment [p= .000] as well as mindfulness [p=.000], self-compassion [p= .000], and well-being [p= .000].  Hierarchical regression analyses indicated that change scores on perceived stress (Beta = -1.46, p LT 0.000) and self-compassion (Beta = 9.02, p LT 0.006) predicted changes in well-being in this sample. Additionally, participants rate perceived importance of having taken part in the course using a Likert-scale from 1-10 (M=8.5, SD = 1.51).Conclusions: This study suggests that for health care professionals enrolled in MBMP may experience a variety of benefits associated with participation in the program. Further, increases in self-compassion may hold particular implications for well-being in this population