mindful women: exploring the effects of mindful body awareness on psychological and physical stress...
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Mindful Women: Exploring the effects of mindful body awareness on psychological and physical stressM. Kathleen B. Lustyk, PhD
Professor of Psychology, Seattle Pacific University
Affiliate Faculty, University of Washington
http://ww.spu.edu/LustykLab
Outline • Overview of female endocrinology and the
neurobiology of stress– Mindfulness and Premenstrual Symptoms
• What is body awareness and why might it help stress?– A brief practice– Effects of body awareness on stress responses in women– A glimpse at an intervention study
• Mindfulness-Based Relapse Prevention for women – A glimpse at a fMRI study on craving regulation
• Conclusions and Future Directions
Overview of female endocrinology
CRH
ACTH
cortisol Inhibits
LH from APE release by
ovary & causes E
resistance in target tissue
Stress & HPA Axis
Sex Steroid production
All of thesteroidsareintimatelyrelated tooneanother.
stress
http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/basics/steroidogenesis.html
Vast effects of Estrogen
Recent Progress in Hormone Research 57:357-384 (2002)Estrogen Actions Throughout the BrainBruce McEwen
Estrogen
Behavior or feeling
toneEstroge
n
Behavior or feeling
tone
Estrogen Behavior or feeling
tone
Progesterone
AGE
Headache. 2006;46(3):365-386. © 2006 Blackwell Publishing
The rise and fall of Estrogen across the cycle
Hormone “drops” are associated with “withdrawals” or physical symptoms and/or affect changes that oppose the effects of the hormones.
Increased activity, cognitive clarity, positive affect,
suppressed hunger
Headache. 2006;46(3):365-386. © 2006 Blackwell Publishing
High P: Anxiolytic
effects
The rise and fall of Progesterone across the cycle
Some research findings
• Women show more physiological reactivity to laboratory stressors during the cycle phase of progesterone withdrawal (Lustyk et al., 2010).
• Women with high levels of premenstrual symptomatology report more psychological distress, life stressors, and poorer quality of life than women with low symptomatology (Lustyk et al., 2004).
Exercise Can help
I’m less stressed and have
less severe symptoms
if I exercise.
But it’s hard to get women to exercise when they feel poor.
Total Numbers by Cycle Phase
Activity Levels
N =
Very few women with intense
activity levels
First we did a survey study to see if mindfulness was associated w/ premenstrual symptomatology
Introduction• Mindfulness-Based practices are associated with:
– physical & affective symptom improvements across a broad range of conditions.
– reductions in negative anticipatory & judgmental thinking.
Developing mindfulness traits predicts improved symptomatology & well-being.
(Greeson, 2009; Carmody & Baer 2007; Baer, 2003)
Mindfulness Meditation
Mindfulness is a way of paying attention:
on purpose, in the present moment, &
non-judgmentally (adapted from Kabat-Zinn, 1990)
Attention to
immediate experienc
e
Orientation of: • Curiosity• Openness
• AcceptanceRegardless of
valence or desirability
Two-Component Model (adapted from Bishop et al., 2004)
Practicing Mindfulness
“If your attention wanders a hundred times, simply bring it back a hundred times.”
Observe wandering,begin again
Attention Wanders
Mind on chosen target
(Attention)
(Present Moment)
(Nonjudgmental)
Mindful Menses: An oxymoron, or are we on to something?
Purpose: To assess interrelationships among premenstrual symptom severity reports, menstrual attitudes, and mindfulness qualities in an effort to offer support for a role of MM practice for premenstrual symptom sufferers.
We surveyed 127 women.
Measures of symptoms
Shortened Premenstrual Assessment Form (PMSR; Allen, McBride, & Pirie, 1991)
symptom items rated from (1) “not present at all or no change from the usual level” to (6) “extreme change from usual level, perhaps noticeable even to casual acquaintances”.
Subscales: pain, affect, & water retention Modified Penn Alcohol Craving Scale (PACS; Flannery,
Volpicelli, & Pettinati, 1999)
“Considering your typical cycle, do you find that you crave a particular food, substance, or behavior the week before and/or during the first few days of your period?”
Measure of attitudes
Menstrual Attitudes Questionnaire (MAQ; Brooks-Gunn & Ruble, 1980)
indicated congruence with statements such as: “Menstruation can adversely affect my performance in
sports” “Menstruation allows women to be more aware of
their bodies.” Subscales: debilitating, bothersome, natural,
predictable (anticipate), and denial
Measures of Mindfulness Qualities
Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006) 39-items rated from (1) never or very rarely true to (5) very
often or always true Subscales include observing sensations and thoughts,
describing with words, acting with awareness, non-judging of inner experience, non-reactivity to experiences
Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) single factor represented through awareness of and
attention to present moment events
Premenstrual Symptoms & Attitudes
Premenstrual Symptoms & Mindfulness Qualities
Interactions
Menses is AWFUL!
Look how different
symptoms are if
mindful!
Craving
If I don’t deny
effects of menses, look at
how different
my craving is
if I’m mindful.
• Conclusions• Poor menstrual attitudes are associated with more
premenstrual symptom severity• More mindfulness is associated with less symptom severity• Mindfulness can buffer the relationship between attitudes
and symptoms
Perhaps focusing on mindfulness/acceptance of the body (the first foundation of mindfulness) will reduce the negative effects of anticipation and denial.
Four Foundations of Mindfulness
Satipatthana sutta• Body• Feelings• Mind• Dharma“A practitioner remains established in the awareness of the body, in the body, diligent with clear understanding, mindful, abandoning all grasping and resistance, knowing the body for what it its.”
Next we did a lab study to see if body awareness was associated w/ less stress reactivity
Cardiovascular responses to a laboratory stressor in women: Assessing the role of body awarenessM. Kathleen B. Lustyk, Haley A.C. Douglas, Jacob A. Bentley,
Winslow G. Gerrish Body, Movement and Dance in Psychotherapy Vol. 7, Iss. 1, 2012
Body Awareness
• Characterized by:– A general tendency towards awareness and
recognition of normal bodily processes and physical sensations
– Considers one’s sensitivity to these sensations and one’s beliefs in how well they sense, predict, and describe their bodily functions (Shields, Mallory, & Simon, 1989)
Background
• Body-oriented psychotherapy– Goal: to integrate sensory and emotional awareness with
body awareness, which increases the capacity for healthy body connections and associations with oneself
• Young, 2006
• Evidence– Therapeutic success in the recovery from childhood
sexual abuse (Price, 2002, 2005)– Suspected mechanisms of action include stress reduction
Methods: apparatus
Hemodynamic Measures (N = 40 women) Blood pressure was assessed at timed
intervals with an automatic sphygmomanometer: Dinamap 1846
(Citikon, Inc., Tampa, FL) Heart rate was continuously measured with electrocardiography via the Powerlab 800 data
acquisition system (Adinstruments, Boulder, CO)
Methods: M
easures
Body Awareness Body Awareness Questionnaire (BAQ;
Shields et al., 1989)
State-Trait Anxiety The Spielberger State/Trait Anxiety
Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)
Traumatic Life Events Index of Clinical Stress (Abell, 1991):
Demographics & Health Information
Stress Protocol
0 0 0Baseline PASATRecove
ry
Self-Report Measures
Time 1:State Anxiety
Time 2:State Anxiety
Time 3: State Anxiety
Continuous ECG, BP taken at timed intervals
Paced Auditory Serial Addition Task
(Gronwall, 1977)
Baseline: 0-15 min
Stressor Recovery 1: 0-5 min
Recovery 2: 5-10 min
Recovery 3: 10-15 min
50
52
54
56
58
60
62
64
66
68
70
72
74
76
78
80
82
84
Low BAQHigh BAQ
HR
BP
M
Baseline: 0-15 min Stressor Recovery 1: 0-5 min Recovery 2: 5-10 min Recovery 3: 10-15 min
90
95
100
105
110
115
120
SBP
mm
Hg
Results: partial correlations
Results: moderation
Summary of findings
• Women with low body awareness demonstrate significantly more reactivity in HR and BP than women with high body awareness.
• Women with low body awareness are slower to recover to baseline HR following the stressor task than women with high body awareness.
• State anxiety reactivity does not differ by level of body awareness.
A glimpse at an intervention study
A CLINICAL EXAMPLE: STRESS AND ADDICTION
• Stress (psychological distress) & stressors (stressful life events)• frequently endorsed reasons for relapse (Marlatt &
Donavan, 2005; Brownell et al., 1986; Sinha, 2001)
• increase relapse risk (Sinha, 2007).
• The majority of those that attempt abstinence, relapse (McLellan et al., 2000)
• Relapse = return to problematic substance use
Mindfulness Meditation and Regulation of Craving in Female Alcoholics
Women’s Groups
vs
Images in Scanner
Feel vs Accept
How much do you
want this right now?
Effects of MBRP on Brain Function
All Subjects show greater activity in the subgenual
anterior cingulate (associated with craving)
when viewing alcohol stimuli than food stimuli.
MBRP shows no measurable activity in the subgenual anterior cingulate while
viewing alcohol images and engaging in “accept” mindset.
However dorsal regions implicated in impulse control
are activated.