Complementary Alternative Cardiovascular Medicine

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130 Alternative Cardiovascular Medicine decreasing stress, anxiety, and depressive symptoms in the general population (55–57). Astin (55) compared university undergraduates engaged in an 8-wk MBSR program with peer controls not engaged in MM on a well-validated measure of general, physical, and psychological well-being. The MBSR group demonstrated statistically significant lower postintervention scores on the Global Severity Index (GSI) of the SCL-90, with a 65% average reduction in scores. Scores on the subscales for depression, anxiety, obsessive-compulsive symptoms, interpersonal sensitivity, psychoticism, and paranoid ideation were also significantly lower postintervention when compared with controls. Shapiro and colleagues (56) used the same measure of general psychological well-being in their controlled study that compared premedical and medical students engaged in the 8-wk MSBR program with a gender-matched waiting-list control group. Findings were similar to previous studies, with the MBSR group exhibiting significantly lower postintervention scores on the GSI and on the depression and state anxiety subscales than on waiting-list controls. In addition, the MBSR participants also demonstrated significantly greater scores on the empathy subscale. Change in scores from preintervention to postintervention for the waiting-list controls who subsequently received the MM training also supported these findings. These participants demonstrated significant reductions in GSI and the depression subscale, as well as lower state anxiety and greater empathy after the MBSR program (56). Williams et al. (57) conducted a randomized controlled trial of an MBSR program offered to self-identified “stressed” volunteers from the local West Virginia community. The MBSR group received the 8-wk standard MBSR intervention, and the control group received educational materials and community referrals. Intervention subjects reported significant decreases from baseline on measures of the effect of daily hassles, psychological distress as measured by the SCL-90, and medical symptoms, as compared to control subjects. These results were maintained at the 3-mo follow-up assessment (57). In clinical samples, two randomized, controlled studies have been conducted (58,59). Speca et al. (58) studied the impact of an MSBR program with a mixed group of patients with cancer. Findings showed the significant reductions in total mood disturbance and stress symptoms of 65% and 35%, respectively. In addition, amount of time spent meditating was significantly correlated with reduction in mood disturbance (58). Teasdale et al. (59) conducted a randomized controlled trial of an MBSR-based treatment for recently recovered depressed patients after medication therapy. The intervention in this study was a combined
Chapter 8 / Meditation and CVD 131 modality using cognitive therapy and MBSR called mindfulness-based cognitive therapy (MBCT). MBCT patients who had three or more previous depressive episodes showed a much lower relapse rate (37%) than the treatment as usual (TAU) group (66%) during the 1-yr study period. Relapse rates for the MBCT and TAU groups did not differ for patients who had only one or two previous depressive episodes (59). There have been numerous uncontrolled studies of the impact of meditation on psychological symptoms. Kabat-Zinn (60–62) reports findings from several studies of his MBSR program with patients with chronic pain that indicate reductions on self-report measures of presentmoment pain, negative body image, inhibition of activity by pain symptoms, mood disturbance, and psychological symptomatology, including depression and anxiety (60–62). These results were maintained for up to 4 yr after the meditation training, with the exception of the measure of present-moment pain (62). The subjects in this study had received previous treatment for their chronic pain, with little or no results, making the positive findings even more impressive in this treatment-resistant group (60–62). Kabat-Zinn’s research studying the impact of MBSR programs on anxiety and panic disorder (63,64) has demonstrated significant reductions in the severity of symptoms from baseline to postintervention. Subjects were rigorously assessed using Diagnostic and Statistical Manual (DSM)-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Clinically and statistically significant posttreatment reductions were found in both subjective and objective symptoms of anxiety and depression, and these results were maintained at the 3-yr follow-up. Unfortunately, 50% of the patients in the study were also being treated with psychotropic medications during the MBSR program and approx 50% received additional treatment for their anxiety disorder after the MBSR treatment, making it difficult to establish the relative therapeutic contribution of each intervention (63,64). Despite the methodological flaws, the preponderance of evidence regarding the impact of MBSR programs on psychological symptoms does suggest that it may be a useful intervention. However, what is clear from this research is the need for additional, more rigorous research investigating this promising clinical tool. Adverse Impact of Meditation Although the clinical use of meditation strategies has shown several positive effects in decreasing autonomic arousal and mediating psychological and stress symptoms, there is a small body of literature that suggests there may be some potential adverse meditation effects (65–69).
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Complementary and Alternative Cardi
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CONTEMPORARY CARDIOLOGY CHRISTOPHER
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© 2004 Humana Press Inc. 999 River
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vi Preface physician or other healt
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viii Contents 10 Massage Therapy an
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x Contributors ERIN L. OLIVO, PhD
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Chapter 1 / CAM and CVD 1 1 Complem
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Chapter 1 / CAM and CVD 3 patients
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Chapter 1 / CAM and CVD 5 The crite
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Chapter 1 / CAM and CVD 7 disease c
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Chapter 1 / CAM and CVD 9 analyses,
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12 Alternative Cardiovascular Medic
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Chapter 3 / Botanical Medicine and
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Index 279 INDEX A N-Acetylcysteine
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Index 281 taurine studies, 106 Conj
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Index 283 Homeopathic medicine, see
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Index 285 funding of studies, 148 g
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Contemporary Cardiology COMPLEMENTA
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