A qualitative case analysis of mindfulness meditation training in an outpatient stress reduction clinic and its implications for the development of self-knowledge

Qualitative and quantitative methods were combined to examine the experience of eight adults referred for mindfulness meditation training (MMT) within the context of a group, out-patient, hospital-based, stress reduction clinic. Through interviewing, observation and document analysis, three aspects of experience were investigated: the subjective experience of learning meditation; the application of meditation-based coping skills in daily life; and the effects of the training on perception of self. Individual and cross-sectional case study methods were used to examine longitudinally, the classes and common patterns of experience of participants during and following the conclusion of the intervention. In addition, the experience of participants was examined within the theoretical framework of Self-Knowledge Development Theory (SKT) in an attempt to understand how people at differing stages of self-knowledge, as delineated by the theory, experienced and utilized MMT. Results suggest that: (1) the majority of participants showed reductions in medical symptoms (MSCL) and in clinically elevated levels of psychological distress (SCL-90R) on outcome measures; (2) common patterns of experience characteristic of mindfulness meditation practice emerged progressively during and following the intervention among patients with diverse diagnoses; (3) the interdependent nature of the formal and informal dimensions of mindfulness meditation may be particularly important in the development of positive long-term changes in health behavior in the lives of medical patients; (4) there is an interactive, learning cycle between skill development (formal meditation), application of skills in daily life (informal meditation), and perception of self that functions as a self-motivating force, fostering continued skill development following the conclusion of the intervention; and (5) there is variance in the participant\u27s use of the intervention that appears to be consistent with and further defines elements of the Situational and Pattern stages of Self-Knowledge Development Theory

What defines mindfulness-based programs? The warp and the weft

There has been an explosion of interest in mindfulness-based programs (MBPs) such as Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy. This is demonstrated in increased research, implementation of MBPs in healthcare, educational, criminal justice and workplace settings, and in mainstream interest. For the sustainable development of the field there is a need to articulate a definition of what an MBP is and what it is not. This paper provides a framework to define the essential characteristics of the family of MBPs originating from the parent program MBSR, and the processes which inform adaptations of MBPs for different populations or contexts. The framework addresses the essential characteristics of the program and of teacher. MBPs: are informed by theories and practices that draw from a confluence of contemplative traditions, science, and the major disciplines of medicine, psychology and education; underpinned by a model of human experience which addresses the causes of human distress and the pathways to relieving it; develop a new relationship with experience characterized by present moment focus, decentering and an approach orientation; catalyze the development of qualities such as joy, compassion, wisdom, equanimity and greater attentional, emotional and behavioral self-regulation, and engage participants in a sustained intensive training in mindfulness meditation practice, in an experiential inquiry-based learning process and in exercises to develop understanding. The paper\u27s aim is to support clarity, which will in turn support the systematic development of MBP research, and the integrity of the field during the process of implementation in the mainstream

Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders

OBJECTIVE: This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders. METHOD: The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists\u27 ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period. RESULTS: Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings. CONCLUSIONS: A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia

Magical Flight and Monstrous Stress: Technologies of Absorption and Mental Wellness in Azeroth

An erratum to this article can be found at http://dx.doi.org/10.1007/s11013-011-9204-4Videogame players commonly report reaching deeply ‘immersive’ states of consciousness, in some cases growing to feel like they actually are their characters and really in the game, with such fantastic characters and places potentially only loosely connected to offline selves and realities. In the current investigation, we use interview and survey data to examine the effects of such ‘dissociative’ experiences on players of the popular online videogame, World of Warcraft (WoW). Of particular interest are ways in which WoW players’ emotional identification with in-game second selves can lead either to better mental well-being, through relaxation and satisfying positive stress, or, alternatively, to risky addiction-like experiences. Combining universalizing and context-dependent perspectives, we suggest that WoW and similar games can be thought of as new ‘technologies of absorption’—contemporary practices that can induce dissociative states in which players attribute dimensions of self and experience to in-game characters, with potential psychological benefit or harm. We present our research as an empirically grounded exploration of the mental health benefits and risks associated with dissociation in common everyday contexts. We believe studies such as ours may enrich existing theories of the health dynamics of dissociation, relying as they often do on data drawn either from Western clinical contexts involving pathological disintegrated personality disorders or non-Western ethnographic contexts involving spiritual trance

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo