07 April 2021

Paradigms change. Centres change. People change. Life is change.

How many stories of remarkable cancer recoveries do you hear these days? 

You know, the ones where people were expected by their doctors to live for a short while and ended up living for a long while or fully recovering? 

My sense is not so many.

This feels to be at the heart of the tragedy unfolding at the Foundation I helped establish. That work goes way back to the 16th September 1981 with the meeting of our first cancer support group. 

On Thursday, 1st April 2021 Ruth and I completed the last residential program at the Foundation’s Yarra Valley Living Centre, then joined in a wake/celebration with the last of the staff, closed the doors and walked away. 

Now… where will people go who are seeking help to accomplish something quite difficult and so important? 

And, maybe some would rather I did not ask this question – but has the slowing down in stories of remarkable recovery over the years played more than a coincidental role in the Foundation’s demise?

So this week, some reflections on a glorious history, some speculation on what happened, and a look to the future, but first, and in the spirit of Easter, transformation and resurrection…


Thought for the day

Contemplation is the only ultimate answer 

To the unreal and insane world 

That our financial systems, 

Our advertising culture, 

And our chaotic and unexamined emotions 

Encourage us to inhabit. 

To learn contemplative practice 

Is to learn what we need 

So as to live truthfully and honestly and lovingly. 

It is a deeply revolutionary matter. 

                                  Rev Dr Rowan Williams, former Archbishop of Canterbury 


The Foundation began as the Melbourne Cancer Support Group. 

We met in rented premises in Hawthorn, a leafy suburb of Melbourne. 

The offering was a 12 week, non-residential program that had the stated intention of helping those attending with their quality of life but was really focused on teaching people how they could best become actively engaged with their own recovery.

In those early days, the basis of the program – meditation, therapeutic nutrition and positive thinking was far from mainstream and so we tended to attract a lot of people who had tried all the other options. 

We began as a place of last resort.

But also, in those days cancer medicine was pretty blunt. 

People were often told by their doctors quite literally, “There is nothing more we can do for you. Go home, put your affairs in order, make the most of your time left, and when things get really tough come back for Palliative Care”. It was often that blunt. Apart from anything else, the lack of compassion and consideration in the communication was often staggering; as well as very damaging.

What did happen, however, is that people were presented with a stark choice. Do nothing and probably fulfill the expectations of dying; or try to help yourself.

So the people who did find their way to our groups, came highly fearful, and highly motivated. And yes, my own story of recovery inspired them and offered hope; but once they heard the rationale around reactivating and utilising their own inherent healing potential, that hope became genuine hope. They really understood what was possible.

In those early days there were many stories of remarkable recoveries. 

We published two books featuring the stories. 

Disappointingly, and rather surprisingly, those recoveries were commonly dismissed rather quickly by the medical profession as so called “Spontaneous Remissions” and despite our best efforts, no significant research followed. 

Yet our participants felt there was nothing “spontaneous” about these remissions! They worked hard; meditating regularly, changing their diets, juicing, working on changing mental and emotional habits, training their minds in Mind-Body Medicine.

And yes, of course many also died, but they had “good deaths” and they and their families rarely expressed regrets. 

Their families often felt they became much closer and learnt of life in profound ways courtesy of the illness and the program.

So the groups grew rapidly and we expanded into prevention work and the wellness domain. The Foundation became a legal entity in 1983, I left my veterinary practice around the same time and the work attracted great support from new staff, many volunteers, donors and the media. 

However, there was a strong undercurrent of opposition from the medical profession, in large part due to the fact we were helping to change a paradigm. 

Up until the ‘80s, and as a generalisation, medicine was based on the notion that people got sick, they went to their doctors who were revered almost like Gods, they were diagnosed and told what to do and they did it. 

Very few questions. 

The doctor took care of things; our health was in their hands. 

They were responsible.

As the new kids, we encouraged people to ask questions. Lots of questions. We encouraged people to take an active part in their own health; particularly when diagnosed with a major illness like cancer. We respected the doctors a great deal – after all I had worked in an allied field for many years as a veterinarian - but we did not go along unquestioning with whatever was said. We encouraged patient empowerment and we were active at a time when the doctor/patient paradigm was indeed changing.

But it was also the time when the whole notion of self-help techniques was coming into play. We based our program on the notion of reviving and stimulating the individual’s own immune system through a fairly intense self-help, lifestyle-based program. Significantly, this focus on the immune system became the basis of much of the medical criticism of our program as in those days the medical consensus was there was no way the human immune system could contribute to recovery from cancer.

Similarly, prior to the ‘80s, the notion that nutrition could play an active role in any therapeutic situation was pretty well unheard of. 

In cancer medicine, using nutrition therapeutically was laughed at by the authorities. 

This always staggered me. As a veterinarian, nutrition was one of the first things we always investigated when considering the cause of illness and how best to effect a recovery. In agriculture, the soil is essential to healthy plants. By contrast, Medicine carried on in those older times as if what people ate was completely irrelevant, and the fact we strongly advocated what people ate matters a great deal led to some interesting interactions… 

Then too, we were advocating the therapeutic application of meditation and other mind techniques. In those early day there was nothing like the huge body of supportive research that currently exists. It was also a time when the practice of meditation was heavily overlaid by its associations with exotic, and in the public’s eyes, probably mischievous eastern gurus. So quite a few more interesting interactions with cautious or full-on reactionary authorities…

More context. Some decades back the cancer world went through another seismic shift. 

Mainstream cancer medicine transformed Palliative Care into Palliative Treatment. 

Instead of palliation being about accepting people would die and helping them to make the best for the time available and to be as comfortable as possible, it became a fertile ground for new drugs that while not curing might extend life. 

These new drugs frequently came with a high price tag – so the public valued them – and often were accompanied by significant side-effects – which the public seems to have accepted. 


As a consequence, cancer very much became a chronic illness to be managed in its entirety by the medical profession and its allied health workers. 

No longer the “go home a die” message; now a new emphasis on treatments that while they may not cure, will prolong life. Those palliative treatments have become increasingly expensive – some are now over $200,000 per person per year, and the public seems very pleased to have them available; many being provided virtually freely courtesy of the PBS.

And another paradigm shift. 

Cancer medicine has largely moved on from the old stalwarts of surgery followed by radiation and chemotherapy. 

There is now much less chemo and far more immunotherapy. 

Yes - Immunotherapy that was once dismissed, now seems to be the great new hope. 

Yet curiously, all the research goes into new immunological drugs and hardly any – if any at all – into investigating the real therapeutic potential of a program like ours based upon self-help techniques.

So the observation? 

In the early days we helped many with medically incurable disease. As our work became better known, we also attracted many with medically manageable cancers who wanted to learn how to give themselves the best chance of recovery, as well as learn through their illness. 

For this is what cancer does. 

It is such a tough and demanding illness, that for those who look into its meaning in their own lives and the lives of those they care for; it causes them to examine everything. 

It may sound strange, but without doubt, cancer is one of the best personal growth opportunities around. (Hope the growth reference is not too much like a bad pun!) 

And in my view, the very best way to explore this aspect of a cancer diagnosis is with your partner in a residential program designed to facilitate that process.

So back in the ‘80s and ‘90s we heard many personal “anecdotes” of people transforming their illness and their lives – both physically, emotionally, mentally and spiritually. That was what that program did. It was genuinely holistic. The program evolved over the years, courtesy of the expertise and insight of great staff. This was complemented by the learnings gained from so many incredible participants and it was supported by incredible volunteers, Boards and donors. The Foundation was very busy.

So what happened? 

Really want to know? Hard to be sure. It is complex, but my own sense is as cancer medicine changed, as these paradigms changed, the Foundation did not adapt all that well.

In the new millennium, patient empowerment became a thing. Communication training in oncology began to improve doctor/patient relationships. Mindfulness was branded as an acceptable, secular word for meditation. Research exploded and gave the evidence base required for mainstream authorities to advocate it. Nutrition was increasingly recognised to be relevant. Attention to emotional and mental health became strong domains in new cancer centres where an “Integrated approach” was touted as a major marketing focus.

Now, and for some time past, many hospitals run their versions of support groups, their offerings of mindfulness and meditation programs. 

Many individual components of the Foundation’s program are offered locally by groups and individuals and as a consequence potential clients actively question the need to travel to a residential centre. 

Then too of course, so much is available on the internet. 

In the early days, people came to our programs to gather information. Information was hard to find, and we accumulated and shared it. These days, people come to the groups to debate and to filter information. But VERY significantly, they have real trouble working out who is telling the truth. “Is soy OK? My naturopath who I see weekly says it is dangerous, yet you who I have come to for this program and have been working and researching in this field for nearly 40 years say it is OK. How do I deal with that?”

So for the Foundation, in recent years there has been a shift from where we were one of very few centres in Australia, even the world, that could offer this information let alone run a genuine integrated program to help people learn and implement it; to now being one of a large number of such groups and individuals – all of varying content and quality.

And the paradigms have changed. These days not so many people with cancer feel there is nothing that can be done for them medically; they are fully engaged with Palliative Treatment. So they tend to regard the self-help options as somewhat soft add-ons; not like the crucial, life-saving major focus of people in earlier days.

This then may be the tough bit. 

In cancer medicine, remarkable recoveries do not come easily. 

In sporting terms, they represent fairly elite achievement. 

Clearly if recovery from difficult cancer was easy, when it happened it would not be regarded as remarkable.

In the earliest days of the groups, and faced with no other options, people were highly motivated and worked at their health in the manner elite athletes might. They were committed, single-minded. They did their very best, and many did accomplish remarkable outcomes.

Now I need to be clear. 

Many of those early people did a lot and died of cancer anyway. And why some experienced remarkable recoveries and lived while others did very similar things and died often seemed a mystery to me. But what I can say is those who applied themselves fully never expressed regret to me. On the contrary, they rejoiced in having given it their best, and while naturally disappointed, if cancer did still end their lives, they were content and invariably experienced what those around them described as a good death.

So in current time, my experience is there seem to be few who have that same high level of commitment. Many want to benefit from dietary change, from training their minds, becoming more mindful, meditating and so on, yet there is not the same edge to it. Often there is a half-heartedness. Often too, there is a background of uncertainty that is hard to shift. “Am I doing the right thing? Am I doing enough? Who do I trust? What do I make of all the options coming my way through the medical profession, the internet, family and friends?” There is not the same thoroughness. The nature of the groups has changed, the conversations have changed; the work has changed, what people do has changed. 

This approach has become less like an elite sport, to more like a weekend run around the park. Useful, but not quite the same.

Actually, having said all of this, in my view, the Foundation’s current cancer programs seem to be doing really well in adapting to the changes. 

In my view the basic cancer residential program remains the Gold Standard. 

I know of no other program so complete or so well presented anywhere in the world. 

Big claim? I believe it to be true.

So why is the centre closing? 

Who knows really, but where they may well have fallen behind is in helping the public to value the program. To value it enough to come; to value it enough to support it financially and in other ways. But then what would I know? Having not been on staff or on the board for 12 years, I really can only celebrate the fact of all the good work done over the 40 years of the Foundation’s history; these last 12 without me.

What comes next? 

My guess is something will arise like a phoenix. 

In the interim, there is every possibility the cancer programs will continue to be presented by the current group of therapists – either at the YVLC under someone else’s management or elsewhere. 

Regarding the other spheres of activity the Foundation has been involved in, many people present meditation programs and retreats and the Overcoming MS people are presenting the MS program and providing great support for people affected by MS. All of that work is well catered for. 

And the fact so many hospitals and community centres, schools, prisons and work places have these techniques embedded in their way of functioning, is heartening indeed.

People are asking about what next for me? 

There are 3 major projects

1. In all probability I will be on the advisory boards to help develop and support the Centre for Contemplative Studies at University of Melbourne, and the Centre for Consciousness and Contemplative Studies at Monash. With the Centres now funded for 5 years, these projects are in full swing.

2. Development of the Agape project to provide ready access to a residential meditation and Perennial Wisdom-based program designed for young people, This project has been developing over the last 3 years and will likely ramp up in the second half of 2021.

3. Development of the Allevi8 app and its mentor program. Allevi8 has been available for around 9 months now. It provides relaxation, mindfulness and meditation practices for people affected by significant physical or mental challenges. We are about to release a mentor program that will provide a 12 week on line, one on one meditation program where participants will be taught personally and supported to establish and develop their meditation practice.

So all in all?

There is an air of tragedy in the closure. 

But so much to celebrate. 

All the lives transformed – both in participants, staff and volunteers! 

So much good work done. 

So much to delight in. 

Maybe even a contribution in changing a paradigm or two…



A big thank you to all who contributed. 


Many supported me in a very direct way; many more supported the work and all the other extra-ordinary people I was so fortunate, so blessed to engage with...

Life is change…


RELATED BLOG

Yarra Valley Living Centre is closing




15 March 2021

Emotions, mindfulness and meditation – a research review says the more you practice, the better your emotional life

Is practicing mindfulness likely to make you happier? Feel more contentment? More inner peace? Is meditation likely to improve your emotional life? Make you more comfortable with your own emotions and the emotions of others? Improve your relationships?

Intuitively, we probably all would say yes, but what about the research? This week, a review of the literature around emotions, relaxation, mindfulness and meditation, but first

       Thought for the day



I am always inclined to believe that the best way 

Of knowing [the divine] is to love a great deal. 

Love that friend, that person, that thing, whatever you like, 

You will be on the right path; 

That is what I say to myself. 

But you must love with a high, serious intimate sympathy, 

With a will, with intelligence, and you must always seek 

To know more thoroughly, better and more.


                          Vincent van Gogh


Most people these days take up meditation having been inspired by friends or colleagues. They notice them changing; becoming calmer, kinder, more capable, healing faster, seeming happier, more joyful and vibrant. They see all this with their own eyes, and upon enquiry, find out the changes coincided with taking up relaxation, mindfulness and meditation. We all want an easier, more fulfilling emotional life. Meditation makes good sense!

Yet others need the research evidence to be convinced of meditation’s benefits.

 Fair enough. 

While this is an emerging field, and not such an easy one to study, a good deal of published research is building to confirm the direct experience. 

There is a growing body of evidence to validate regular relaxation, mindfulness and meditation practice does lead to healthier, happier emotional states, and that these practices do enhance wellbeing.


So in this literature review of the impact of relaxation, mindfulness and meditation on emotional health and emotional states, key studies are brought together and grouped under major headings. Direct links to the research articles cited are provided. While not exhaustive, this review provides solid evidence that the practices of relaxation, mindfulness and meditation do improve emotional health.


Mindfulness boosts healthy emotions

While there is a growing consensus about mindfulness meditation as an effective treatment for a wide range of somatic illnesses and psychological disorders, little research attention has been paid to promoting healthy and positive outcomes, rather than just to reduce negative outcomes. 

This despite existing research indicating mindfulness is positively related to vitality, life satisfaction, and interpersonal relationship quality. 

This recent, controlled trial amongst staff in a large hospital examined mindfulness training’s effect upon positive outcomes. 

The researcher’s analysis found the intervention program was successful in boosting the existing levels of work engagement, happiness and work performance. 

Coo, C., Salanova, M. 2018. Mindfulness Can Make You Happy-and-Productive: A Mindfulness Controlled Trial and Its Effects on Happiness, Work Engagement and Performance. J Happiness Stud 19, 1691–1711.

Mindfulness Boosts Relationship Satisfaction

Several studies have found a person's ability to be mindful can help predict relationship satisfaction — the ability to respond well to relationship stress and the skill in communicating one's emotions to a partner. Empirical evidence suggests mindfulness protects against the emotionally stressful effects of relationship conflict, is positively associated with the ability to express oneself in various social situations and predicts relationship satisfaction.

Barnes et al., The role of mindfulness in romantic relationship satisfaction and responses to relationship stress. 2007, JMFT Vol33 - 4, 482-500

Brief Mindfulness Intervention Improves Processing of Emotion

Mindfulness-based interventions have previously been shown to have positive effects on psychological well-being. However, the time commitment, teacher shortage, and high cost of classic mindfulness interventions may have hindered efforts to spread the associated benefits to individuals in developing countries. Brief mindfulness meditation (BMM) has recently received attention as a way to disseminate the benefits of mindfulness-based interventions. 

This study compared BMM intervention with ERE (Emotional Regulation Education). It demonstrated that BMM may improve aspects of emotion processing such as emotion intensity, emotional memory, and emotional attention bias. Negative effects on mood state were found in the ERE group but not in the BMM group.

Wu Ran et al. Brief Mindfulness Meditation Improves Emotion Processing; Frontiers in Neuroscience, 2019, Vol 13 – 1074.

Mindfulness makes it easier to be kind to ourselves

This study investigated the role of self-compassion in relation to mindfulness. Two components of mindfulness — nonjudging and nonreacting — were strongly correlated with self-compassion, as were two dimensions of empathy — taking on others' perspectives (i.e., perspective taking) and reacting to others' affective experiences with discomfort. Self-compassion fully mediated the relationship between perspective taking and mindfulness.

Kingsbury, E. (2009). The relationship between empathy and mindfulness: Understanding the role of self-compassion. Dissertation Abstracts International: Section B: The Sciences and Engineering, 70(5-B), 3175.

Mindfulness improves empathy and emotional expression

In this study, researchers found all elements of mindfulness were positively associated with expressing oneself in various social situations. A greater tendency for mindful observation was associated with more engagement in empathy. Mindful description, acting with awareness, and non-judgemental acceptance were associated with better identification and description of feelings, more body satisfaction, less social anxiety, and less distress contagion.

Dekeyser, M et al, 2008. Mindfulness skills and interpersonal behaviour. Personality and Individual Differences, 44(5), 1235–1245.

Do short term interventions work? A meta-analysis

Over the last 10 years, there has been a dramatic increase in published randomized controlled trials (RCTs) of brief mindfulness training (from single-session inductions to multisession interventions lasting up to 2 weeks), with some preliminary indications that these training programs may improve mental health outcomes, such as negative affectivity. This meta-analysis involving 65 RCTs and 5,489 participants aimed to evaluate whether brief mindfulness training reliably reduces negative affectivity. The researchers concluded brief mindfulness training does modestly reduce negative affectivity. 

Schumer MC et al. Brief mindfulness training for negative affectivity: A systematic review and meta-analysis. J Consult Clin Psychol. 2018 Jul;86(7):569-583.

How Mindfulness and Meditation Impact on Romantic Relationships

There is increasing scientific interest in the potential association between mindfulness and romantic relationship wellbeing. This study examined the effect of either guided mindfulness exercises, or guided relaxation exercises. 

The mindfulness intervention significantly promoted relationship wellbeing, for both participants and their partners. However, these findings did not significantly differ from changes in relationship wellbeing in the relaxation condition. 

Karremans JC et al. Comparing the effects of a mindfulness versus relaxation intervention on romantic relationship wellbeing. Sci Rep. 2020 Dec 10;10(1):21696. 

Mindfulness builds gratitude

This PhD dissertation indicated just ten days of mindfulness training increased gratitude, psychological flexibility, and wellbeing. The relation between mindfulness and psychological wellbeing was fully mediated by gratitude and psychological flexibility, both before and after participants underwent training. Results suggest that mindfulness training can increase individuals’ quality of life and psychological flexibility, in part by increasing their ability to appreciate positive aspects of their lives.

Schultz, D, "Effect of Mindfulness on Gratitude and Psychological Wellbeing" (2019). Dissertations. 1704.

Mindfulness Meditation Reduces Emotional Reactivity

In this study of people who had anywhere from one month to 29 years of mindfulness meditation practice, researchers found that mindfulness meditation practice helped people disengage from emotionally upsetting pictures and enabled them to focus better on a cognitive task as compared with people who saw the pictures but did not meditate.

Ortner, C et al. (2007). Mindfulness meditation and reduced emotional interference on a cognitive task. Motivation and Emotion. 31. 271-283.

Mindfulness increases intimate relationship satisfaction

This research studied married couples and examined measures of mindful awareness, emotion skills, and marital quality. Findings suggested that emotion skills and mindfulness are both related to marital adjustment, and that skilled emotion repertoires, specifically those associated with identifying and communicating emotions, as well as the regulation of anger expression, fully mediate the association between mindfulness and marital quality. 

Wachs, K., & Cordova, J. V. (2007). Mindful relating: Exploring mindfulness and emotion repertoires in intimate relationships. Journal of Marital and Family Therapy, 33(4), 464–481.

Mindfulness builds compassion in health professionals

Mindfulness-based stress reduction training has been found to enhance self-compassion among health-care professionals. The literature is replete with evidence that the stress inherent in health care negatively impacts health care professionals, leading to increased depression, decreased job satisfaction, and psychological distress. 

In an attempt to address this, the current study examined the effects of a short-term stress management program, mindfulness-based stress reduction (MBSR), on health care professionals. Results from this prospective randomized controlled pilot study suggest that an 8-week MBSR intervention may be effective for reducing stress and increasing quality of life and self-compassion in health care professionals. 

Shapiro, S. L et al. 2005, Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial. International Journal of Stress Management, 12(2), 164–176.

The rationale for mindfulness-based anger management

In this paper, the literature in relation to the theory and treatment of problematic anger is reviewed, with the aim of determining whether a rationale exists for the use of mindfulness with angry individuals. It is concluded that anger as an emotion seems particularly appropriate for the application of mindfulness-based interventions, and the potential mechanisms for its proposed effects in alleviating the cognitive, affective and behavioral manifestations of anger are discussed.

Wright, S et al (2009). Mindfulness and the treatment of anger Problems. Aggression and Violent Behavior. 14. 396-401. 10.1016

Meditation improves creativity

One form of meditation - integrative body-mind training (IBMT) - has been shown to improve attention, reduce stress and change self-reports of mood. This study found short-term (30 min per day for 7 days) IBMT improved creativity performance and yielded better emotional regulation compared to Relaxation Training (RT), suggesting that emotion-related creativity-promoting mechanism may be attributed to short-term meditation.

X. Ding et al. Improving creativity performance by short-term meditation. Behav. Brain Funct., 10 (2014), p. 9

Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

CONCLUSION

There is a growing evidence base for relaxation, mindfulness and meditation being used to help people affected by emotional health issues to become less reactive, more expressive and to build better relationships.

Also, there is good evidence online mindfulness - based programs such as the Allevi8 App have positive benefits and these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.


09 March 2021

Australia to have 2 University-based Centres for Contemplative Studies

Here is news that has been quietly developing these past 6 months, but is now public. The Universities of Melbourne and Monash are each being funded to establish Australia’s first Centres for Contemplative Studies.

It has been my privilege to work with the philanthropists Martin and Loreto Hosking alongside the Universities to help bring this all about. What a delight to have worked with such exceptional people at both institutions. How wonderful to have lived long enough to witness meditation move from the fringes in the 70s to be embraced by two world ranked Universities here in my own home town. Just wonder full. That is – full of wonder!

So this week, seems the best way to convey the import of all this is to directly share the University’s Press Releases, but first

   Thought for the day


     Knowing others is intelligence;

     Knowing yourself is true wisdom.

     Mastering others is strength; 

     Mastering yourself is true power.

     If you realize you have enough,

    You are truly rich.

                               Tao Te Ching


                                             

                                           PHOTO : Professor Jakob Hohwy with students at Monash

FROM MONASH

Generous donation helps Monash open world-first Centre for Consciousness and Contemplative Studies

Professor Jakob Hohwy will lead a new, world-first Centre for Consciousness and Contemplative Studies at Monash University from early 2022.

Monash University has announced it will develop a first-of-its-kind centre for unprecedented collaboration between philosophy, neuroscience, medicine, education and interfaith dialogue research and studies.

The world-first Monash Centre for Consciousness and Contemplative Studies will bring together humanities and science researchers and be housed in the Faculty of Arts’ School of Philosophical, Historical and International Studies from early 2022, following a transformational donation of $12million from Redbubble co-founder, Martin Hosking and his wife Loreto Hosking.

The Hoskings’ charitable organisation Three Springs Foundation is behind the gift.

By combining consciousness research and contemplative studies, it will be the first of its kind in the world with a broad, interdisciplinary remit covering three interrelated domains:

Research: enabling multidisciplinary humanities and neuroscience research at the forefront of consciousness science and contemplative studies;

Education: making philosophical wisdom and contemplative practices relevant and accessible to the broadest possible audience both nationally and globally; and

Community engagement: fostering understanding  through cross-cultural and interfaith dialogue around contemplative practice traditions

Dean of the Faculty of Arts, Professor Sharon Pickering, said the Centre would enable Monash to set an international benchmark for pre-eminent research, dialogue and outreach for consciousness and contemplative studies.

“Understanding consciousness is one of the great scientific questions of our time, its connection to contemplation and contemplative studies will build our sense of common humanity, so I am thrilled that this new Centre will be based within the Faculty of Arts,” she said.

Centre Director Professor Jakob Hohwy, from Monash’s Cognition & Philosophy Lab, will lead the research stream and said: “We are excited about this unique opportunity to apply philosophical and scientific rigour to provide profound answers about the very essence of consciousness and contemplation.

“Thanks to the Hoskings, we believe we can open doors to greater reflection, curiosity, resilience, wellbeing and meaningful connections. The benefit of the Centre will be significant, across many research areas, for the community, and with future generations firmly in mind.”

Renowned mindfulness expert from Monash’s Faculty of Medicine, Nursing and Health Sciences,
Associate Professor Craig Hassed OAM, will lead the education offering, with contemplative practices - mindfulness, meditation and contemplation - developed as core curriculum subjects and in-depth electives.

“Monash already has a reputation as a world leader in integrating contemplative practices, particularly mindfulness, into staff development and student education,” he said.


PHOTO Myself along with Assoc Prof Craig Hassed and Prof George Jelinek - both very well known and much loved contributors to programs at the Foundation

“Education will be a crucial platform to equip new generations of mindful leaders and contemplative practitioners. We want to provide public-facing educational opportunities for students, staff and industry partners that will allow for broad engagement with contemplative practice.”

Professor Rebecca Margolis from Monash’s Australian Centre for Jewish Civilisation will lead community engagement to actively foster dialogue between the university and the general public and across cultures and religious traditions in meaningful ways, including in-person and online workshops and webinars, international visiting scholars, conferences, guided practice sessions and more.

“This Centre offers a groundbreaking model for a dynamic meeting place around consciousness and contemplative studies that will bring together researchers, educators, students, practitioners of diverse wisdom traditions as well as the general public,” Professor Margolis said.

Mr Hosking said the COVID-19 pandemic highlighted the need for connection and reflection, which led him to consider supporting such a centre.

“I have been interested in unlocking the benefits of meditation and contemplative studies for a number of years. I know the personal benefits of meditation and believe the introduction of study in this area in universities will have a profound impact on our future leaders, professionals and educators. With this centre, Monash has shown a commitment to making research and education in this area a core part of their offerings,” he said.

Monash University President and Vice-Chancellor Professor Margaret Gardner AC said: “This wouldn’t be possible without the generosity and commitment of Three Springs Foundation and the Hoskings. We are deeply grateful for their contribution, and humbled by their passion and enthusiasm for bringing consciousness research and contemplative studies into the public domain.”

From left : Assoc Prof Craig Hassed, Prof Rivke Margolies, Ian Gawler, Martin Hosking, The Dean of Arts Prof Sharon Pickering, the new centre Director Prof Jacob Howhy 

Three Springs Foundation and the Hoskings have also donated funds to the University of Melbourne for a Contemplative Studies Centre, to be established within the Melbourne School of Psychological Sciences. Together these two centres are positioning Victoria, and indeed Australia, as world leaders in this space.

The transformational gift from the Three Springs Foundation contributes to the Change It. For Good. campaign, which is the largest public fundraising initiative in Monash’s history.


FROM MELBOURNE

The University of Melbourne is establishing a Contemplative Studies Centre, which will be the first point of entry into the world of mindfulness, meditation and contemplative practice at the University.

The centre has been made possible by a generous philanthropic gift of $10 million from Redbubble co-founder Martin Hosking and his wife Loreto.

Contemplative studies focus on the variety of religious, spiritual, and secular practices – such as meditation, mindfulness, and prayer – and is at the very heart of what it is to be connected to ourselves, one another, and the world. These practices help people from all walks of life to facilitate wellbeing, and to aid in the development of a meaningful, balanced life.

The Contemplative Studies Centre will be led by Dr Nicholas Van Dam, a recently appointed fellow of the Mind and Life Institute and hosted within the Melbourne School of Psychological Sciences in the Faculty of Medicine, Dentistry and Health Sciences. 

It will have offerings for all audiences, including the general public, students, staff, faith leaders and practitioners.

Dr Van Dam said the last 30 years has seen a boom in contemplative practices. 

However, despite increased popularity, enthusiasm for the practices has outpaced the evidence for how best to use them and commercialisation has jeopardised the potential of these ancient practices in the modern world, excluding those most knowledgeable about how to implement and optimise them.

“In Australia, like the rest of the world, we’ve seen massive growth in meditation and mindfulness practices in schools, workplaces and in just about every aspect of life,” Dr Van Dam said. “The foundations of the practices have often been left behind; platitudes and optimistic thinking have replaced authentic self-exploration and opportunities for people to find balance.

“While there’s no doubt these practices can be transformational, helping people and society to thrive, we need evidence-based research and guidelines to determine how they are best used and when.”

The internationally focused centre will bring together experts from around the world to critically assess contemplative practices to help people discern between the plethora of offerings to ensure connection to authentic practices and optimal outcomes for all.

It will draw on knowledge and expertise from across the University including the Faculty of Arts and the Melbourne School of Graduate Education, to deliver ground-breaking research, innovative educational offerings and a world-class engagement series. It will also offer an opportunity for authentic practice, guided sessions and a place for inter-faith and wisdom discussion.

Vice-Chancellor Duncan Maskell said the University is extremely grateful to Martin and Loreto Hosking for the incredibly generous donation to establish the Contemplative Studies Centre. He said the new centre represents a breakthrough to develop contemplative study, research and practice in the Asia-Pacific region and create purposeful change for our communities.

“Considering the quite extraordinary year that we have all experienced, there is a real need for greater focus on mindfulness and wellbeing in our society. Through the new centre we hope to assist many people who would most benefit from mindfulness and meditative practice,” Professor Maskell said.

Mr Hosking said he has been interested in unlocking the benefits of meditation and contemplative studies for a number of years.  “I know the personal benefits of meditation and believe the introduction of study in this area will have a profound impact on our future leaders, professionals and educators.”

Professor Sarah Wilson, Head of the Melbourne School of Psychological Sciences said the University is committed to achieving exceptional research quality and impact that translates to benefits for people’s everyday lives.

“The research of Dr Van Dam in mindfulness and meditation is world-leading and his interdisciplinary approach will equip the future generation of thought-leaders with the necessary skills to navigate the complexities our society currently faces,” Professor Wilson said.

              PHOTO : Prof Sarah Wilson

“The long lockdown during the pandemic has shown us that now, more than ever, we need skills to help us engage in contemplative practices that enhance our wellbeing and mental health.

“This exciting new centre is a timely gift to our whole community, as it brings the latest research evidence and an interdisciplinary approach to guide us on the most effective ways to contemplate and navigate the complexities of our lives.”

The centre will be located within Melbourne Connect, a newly completed, purpose-built innovation
precinct at the University of Melbourne, ensuring industry collaborations and community engagement is at the heart of its research partnerships.

Melbourne Connect is delivered in partnership with a consortium led by Lendlease, bringing together world-class researchers, start-ups, government, industry, artists, and Science Gallery Melbourne, right in the heart of Carlton and next to the Parkville precinct.


Three Springs Foundation and the Hoskings have also donated funds to Monash University for a Centre for Consciousness and Contemplative Studies, to be established within the School of Philosophical, Historical and International Studies in the Faculty of Arts. Together these two centres are positioning Victoria, and indeed Australia, as world leaders in this space.


01 March 2021

Heart disease, mindfulness and meditation - a literature review

Research has confirmed Dr Dean Ornish’s lifestyle and meditation based program can reverse coronary heart disease cheaply and reliably when compared to ordinary medical care. Yet while endorsed in America for Medicare rebates, in Australia few seem to know of this option, let alone have it offered. 

But what of mindfulness and meditation on their own? This week we examine what they have to offer according to recent research. But first

    Thought for the day

Silence is not empty

It is full of answers

So I encourage you - bow eagerly to love. 

Follow its humble stirrings in your heart. 

Let it guide you in this life 

And it will bring you safely to eternal bliss in the next. 

Love is the essence of all goodness. 

Without it, no kind work is ever begun or finished. 

Simply put, love is a good will, in harmony with God.


                                 The Cloud of Unknowing 


THE BACKGROUND of TRAGEDY

Heart disease remains the leading non-communicable lifestyle related illness in Australia and the US Heart disease, leading to 1 in 4 deaths in both countries. 

Consider how many lives this directly and indirectly affects. 

Tragic. 

Yet heart disease is highly preventable, and much can be done for people diagnosed with heart disease. 


THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to bring together the research evidence around heart disease, mindfulness and meditation. And given the times we are in, it also examines the evidence base for online programs.

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes) that investigates the efficacy of mindfulness and meditation for people affected by heart disease. 

This review includes direct hyper-links to the original articles as published. The review is in three parts –the role of mindfulness and meditation in the prevention of heart disease, in the management of heart disease and evidence for online programs. On prevention, just the one major review of recent research is quoted.


CONTEXT – THE ORNISH STUDIES

For more than 35 years, Dr. Ornish has championed lifestyle modification as a proven approach for reversing heart disease in patients with pre-existing coronary artery disease. 

Based on in-depth scientific research, Dr. Ornish’s approach actually reverses the progression of cardiovascular disease and reduces the need for interventional revascularizations and costly medications for patients with one of several risk indicators, including a prior acute myocardial infarction, CABG surgery, a PCI procedure or stable angina. 

Recognizing the extraordinary results that Dr. Ornish achieved in reversing heart disease, Congress and the Centers for Medicare and Medicaid Services (CMS) in 2010 provided for Medicare reimbursement for individuals enrolled in The Ornish Program for Reversing Heart Disease. Dr. Ornish and Healthways are now deploying a scalable solution that is unmatched in its impact on outcomes and costs. 

The Ornish program uses the following four core elements equally 

1. A very low-fat, whole foods diet

2.  Moderate aerobic exercise

3. Stress management techniques

4. Support groups

The program has proven results documented in peer-reviewed research journals. In these published studies, CHD patients showed greater changes in diet and lifestyle and better clinical outcomes than have ever before been reported for various lifestyle change interventions. These studies showed, for the first time, that the progression of coronary atherosclerosis could be stopped or reversed by making comprehensive lifestyle changes. 

Specifically, these studies demonstrated the following benefits of the lifestyle modification program


• Regression of coronary artery stenosis using quantitative coronary arteriography

• Decreased size and severity of ischemic myocardial perfusion abnormalities (blood flow to the heart) using cardiac positron emission tomography (PET), exercise thallium scintigraphy, and exercise radionuclide ventriculography

• Safe avoidance of revascularization procedures such as coronary bypass surgery, angioplasty, and intracoronary stents in almost 80% of those who were eligible for these procedures, with comparable clinical outcomes

• Significantly greater exercise capacity

• Substantial cardiac risk factor improvements, e.g., reductions in LDL-cholesterol comparable to what can be achieved with statin drugs without the costs and potential side-effects as well as significant reductions in weight, BMI, blood pressure and fasting blood glucose

• Marked, rapid, and often dramatic decreases in the frequency and severity of angina

• Substantial improvements in quality of life by a variety of measures (including decreased emotional stress and depression and increased vitality, physical function, and well-being)

• 2.5 times fewer cardiac events. In addition, we measured significant improvements in other chronic diseases prevalent in the population, including obesity, diabetes, hypertension, hypercholesterolemia, depression, arthritis, prostate cancer, and related illnesses. 

Follow-up analyses revealed even more reversal after five years than after one year. In contrast, patients in the usual-care randomized control group showed worsening (progression) of coronary atherosclerosis after one year and even more worsening after five years. Also, there was a direct correlation between degree of adherence to this lifestyle 5 modification program and changes in coronary atherosclerosis after one year and also after five years. 

So again, given the Ornish program has stress management based upon meditation and yoga as a key element, what does the research have to say regarding heart disease, mindfulness and meditation on their own?


PART 1  -  MINDFULNESS AND MEDITATION IN THE PREVENTION OF HEART DISEASE

The American Heart Association’s major review from 2017

This review was compiled by a large group of leading researchers under the auspices of the AMA. It systematically reviewed the data on the potential benefits of meditation on cardiovascular risk.

Neurophysiological and neuroanatomical studies demonstrate that meditation can have long‐standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. 

Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease.

Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline‐directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. 

Levine GN et al. Meditation and Cardiovascular Risk Reduction. A Scientific Statement From the American Heart Association; 2017 Journal of the American Heart Association; Vol6: Issue 10.


PART 2  -  MINDFULNESS AND MEDITATION IN THE MANAGEMENT AND TREATMENT OF HEART DISEASE

1. Meditation cuts death risk in half 

From 2012 this 5 year, randomised controlled study of 201 people with coronary disease found those who practiced meditation were 48% less likely to have a heart attack, stroke or die from all causes, compared to a group of study participants who merely attended a health education class over more than five years.

The authors hypothesised reducing stress by managing the mind-body connection would help improve rates of this epidemic disease. They also found the meditators were able to lower their blood pressure and decrease their overall stress and anger.

Schneider RH et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes. 2012 Nov;5(6):750-8. 

2. 2019 Major review recommends meditation

In this highly objective paper, the authors screened 3,540 research papers, reducing that number to 45 final papers that met their strict criteria for inclusion in their actual analysis. They point out the quality and quantity of published research in this field is limited and complicated by the different methods taught and studied.

Even so they concluded available data suggest a potential influence of meditation interventions on various factors of cardiovascular disease. The authors state that in clinical practice, meditation as an intervention may be suggested to patients at cardiovascular risk in addition to conservative treatment protocols because of its non-invasive and cost-effective nature. In particular, as recommended by the European Society of Cardiology, treating psychosocial factors can counteract stress, depression and anxiety, and therefore facilitate behaviour change and improve general quality of life. 

The authors reported the quintessence of this expert opinion

Heterogenous data suggest a link between meditation interventions and cardiovascular disease.

Meditation can be suggested to patients in addition to conservative treatment or prophylactic protocols.

In particular, meditation can help to reduce stress, depression and anxiety.

Schnaubelt S et al. Meditation and Cardiovascular Health: What is the Link? European Cardiology Review 2019;14(3):161–4

3. Mindfulness reduces depression and anxiety, improves Quality of life

This review from 2020 searched 7 English and 2 Chinese electronic databases for experimental studies that examined mindfulness-based interventions in adults with heart failure. Five studies involving 467 patients with heart failure met the inclusion criteria. They had weak to moderate quality. 

There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. 

Zou H et al.  Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review. European Journal of Cardiovascular Nursing. 2020;19(1):44-54.


PART 3  -  ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH HEART DISEASE

1. Early follow up of online program shows benefits

This study, based upon 12 week follow-up was a pragmatic, randomized, controlled single-blind trial involving 324 patients with heart disease assigned to a 12-week online mindfulness training in addition to usual care (UC) compared to UC alone.

The authors reported mindfulness training showed positive effects on the physiological parameters, exercise capacity and heart rate and concluded it might therefore be a useful adjunct to current clinical therapy in patients with heart disease. Physiological parameters included heart rate, blood pressure, respiratory rate, and NT-proBNP.

Younge JO et al. Web-Based Mindfulness Intervention in Heart Disease: A Randomized Controlled Trial. PLoS One December 7, 2015 : https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143843

2. Online Mindfulness Based Stress Reduction improves outcomes over 12 months

This 2017 paper, evaluated the effect at 12-month follow-up of 324 patients randomized in a 2:1 ratio to additional 3-month online mindfulness training or to usual care alone. Online delivery of the training was chosen for pragmatic reasons: the training was designed to be self-directed, easily accessible and engaging to a wide audience by keeping practice sessions and lessons short, usually ten to fifteen minutes per exercise. 


Online mindfulness training shows favorable albeit small long-term effects on exercise capacity, systolic blood pressure, mental functioning, and depressive symptomatology in patients with heart disease and might therefore be a beneficial addition to current clinical care.

Gotink RA et al. Online mindfulness as a promising method to improve exercise capacity in heart disease: 12-month follow-up of a randomized controlled trial. PLoS One. 2017;12(5):e0175923. Published 2017 May 9. doi:10.1371/journal.pone.0175923

3. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  


PART 4 - CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by heart disease. These interventions can play a part in prevention and they can reduce the associated symptoms of heart disease such as stress, anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.


15 February 2021

Multiple Sclerosis, Relaxation, Mindfulness and Meditation - what do they offer? A Literature Review with links to the original articles

In 1978 Neil Sambell wrote me a heartfelt letter of anguish. The half page letter took him 30 minutes to type with the one functional finger he could use; yet that letter changed his life and the lives of many others.

Neil explained he was severely immobilised by MS and wondered if the lifestyle-based, self-help program I had used to overcome my own cancer might help him. This week, what happened to Neil, how his story led to my own involvement helping those with MS and results from a good deal research that has followed, but first


  Thought for the day

      The problem with patience and discipline 

       Is that it requires both of them 

        To develop each of them.

                      Thomas Sterner





My initial reply to Neil was I did not know if what had helped me might help him, and I had no experience at the time with MS. However, I added that my approach involved doing all possible to build a healthy immune system and to gain the best from my capacity to contribute to my own healing. Knowing MS to be an auto-immune-based, chronic degenerative disease, I suggested the same program might be well worth trying. Neil did.

Over 40 years later, Neil is alive and well, writes fluently, has good mobility, a slight, almost imperceptible limp and a big smile. Neil’s outcome inspired me to agree to help others with MS who asked about our program; and then came George Jelinek.

Professor George Jelinek was Head of Emergency Medicine at Sir Charles Gairdner Hospital in Perth when diagnosed with MS in 1999. Being a research based academic clinician, George scoured the literature and discovered there was a lot of support for nutritional intervention along with other lifestyle factors. George gathered the research, added his own experience and published a book for which he asked me to write the Forward. 

From there it seemed a natural fit; George had the MS specific knowledge and personal experience, the MS program that he put together in his book was very similar to the one we used for people with cancer, and we had the experience with running intensive Residential programs. 

George accepted the offer to help establish MS specific programs in 2003 with myself and my wife, Dr Ruth Gawler who has expertise in Mind-Body Medicine. 

A research evaluation of the new program was instigated from day one.


            Prof George Jelinek (R) with myself and Assoc-Prof Craig Hassed at Yarra Junction

All of this is mentioned as it portrays a normal progression. Clinical observations of exceptional results need first to be noticed, and then tested. That is what research does. If we had waited for research to completely validate the MS program before we started, in all likelihood we would still be waiting. In fact, the research George set up provided remarkable results.


THE PURPOSE OF THIS REVIEW

What follows is intended to bring together key research papers investigating the potential role for the practices of relaxation, mindfulness and meditation amongst people with MS. This is not intended as an exhaustive review, rather a good, representative sample of the published research in this field. We start with results of research into the program I helped to establish with Prof Jelinek and my wife, Dr Ruth Gawler.


MS program including meditation shows strong benefits after 2.5 years

Here is the basic issue. According to most measures for people affected by MS, quality of life usually deteriorates around 10% over 5 years. However, George’s investigations found attending the residential retreat promoting lifestyle modification and featuring deep relaxation, mindfulness and meditation had a significant short-medium term positive effect on quality of life for people with MS. 

Participants showed significant improvement in HRQOL at one year and 2.5 year follow-up with significant gains in overall quality of life, physical health composite and mental health composite. 

Li MP, Jelinek GA, Weiland TJ, Mackinlay CA, Dye S, Gawler I. Effect of a residential retreat promoting lifestyle modifications on health-related quality of life in people with multiple sclerosis. Qual Prim Care. 2010;18(6):379-89. PMID: 21294980.

MS program benefits continue to improve after 5 years

After 5 years the gains were even better. By then data had been collected on nearly 300 participants. Each completed a standard, well-validated 54-item questionnaire, the MSQOL-54; at 1 and 5 year follow up. The only intervention provided was the 5 day retreat, although each group had group support via regular email after the retreat. 

The results were remarkable! Not only had this group of people with MS stopped deteriorating, they rapidly began to get better as shown by the first data published, and that improvement continued to the five year mark. There was highly significant (p<0.001) improvements at one year in mental health of about 12%, physical health 19%, and quality of life 11%. At five years the benefit continued to accrue, with highly significant (p<0.001) improvements in mental health of about 23%, physical health 18%, and quality of life 20%.

Hadgkiss EJ, Jelinek GA, Weiland TJ, Rumbold G, Mackinlay CA, Gutbrod S, Gawler I. Health-related quality of life outcomes at 1 and 5 years after a residential retreat promoting lifestyle modification for people with multiple sclerosis. Neurol Sci. 2013 Feb;34(2):187-95.


WHERE DOES MEDITATION FIT?   

HOW MIGHT IT HELP THOSE WITH MS?        A LITERATURE SEARCH

In this 2014 paper, the author’s observe MS is known to be adversely affected by several factors including stress. A proposed mechanism for decreasing stress and therefore decreasing MS morbidity and improving quality of life is meditation. 

Therefore, a literature search of meditation being used in MS was conducted. Twelve pieces of primary literature fitting the selection criteria were selected: two were randomised controlled studies, four were cohort studies, and six were surveys. The review observed current literature (2014) varies in quality; however common positive effects of meditation include improved quality of life (QOL) and improved coping skills. 

The authors concluded all studies suggest possible benefit to the use of meditation as an adjunct to the management of multiple sclerosis. They suggested additional rigorous clinical trials are required to validate the existing findings and determine if meditation has an impact on disease course over time.

Levin AB, Hadgkiss EJ, Weiland TJ, Jelinek GA. Meditation as an adjunct to the management of multiple sclerosis. Neurol Res Int. 2014;2014:704691. 

The dramatic benefits from using available resources – huge decreases in depression and fatigue

More recent findings from the ongoing HOLISM study compare health outcomes of people with MS coming to the YVLC retreat programs, with those who did not engage with self-help resources. 

This 2015 study of 2233 participants recruited online compared health-related quality of life, fatigue and depression risk between people who had, or had not, attended a Yarra Valley Living Centre week-long retreat, read the book ‘Overcoming Multiple Sclerosis’ or visited the Overcoming MS website (www. overcomingmultiplesclerosis.org).

The results were remarkable, showing people who attended a retreat program had physical-health quality of life scores 18 per cent higher (on a scale of 0 to 100), and mental-health quality of life scores 14 per cent higher, than those who did not attend.

Even more so, people who attended a retreat program, read the book and accessed the website had 19.5 and 15.6 better physical-health and mental-health quality of life scores, respectively, than those who did not attend.

The research team noted that there had been a “paradigm shift” in the management of chronic diseases, towards a patient-centred approach of self-management and prevention.

“People who are proactive in their health may achieve better outcomes than those more passive,” they said in the paper.

Indeed, the study’s depression outcomes were particularly striking, showing that depression risk among retreat program attendees (8.6 per cent) was around half that of the whole sample. Further analysis showed that no engagement with the retreat program, book or website was associated with tenfold higher odds of depression risk. 

Dr Jelinek said the findings, that people using the three resources had one-tenth the risk of depression, were “astonishing”. “Roughly every second person with MS will have depression and to have such a dramatic fall in incidence of depression is really quite startling.” “No anti-depressant ever achieves that.”

Lack of engagement also found nearly threefold higher odds of clinically significant fatigue. This is a crucial issue for people with MS as 85 per cent report significant fatigue, and for most, it is the most disabling symptom they have. Professor Jelinek said the findings showed that people were one third less likely to suffer fatigue, a significant problem not successfully treated with medication, if they engaged in the three educational resources compared to those who did not.

In the study discussion, researchers noted the role of patient empowerment in dealing with MS. “Rather than the effect of lifestyle modification itself, or perhaps additional to that effect, perceived benefits for health-related quality of life, depression and fatigue may arise from participants’ level of empowerment or self-efficacy,” they said.

“Empowerment is both a process and an outcome—‘‘a process to increase one’s ability to think critically and act autonomously…an outcome when an enhanced sense of self-efficacy occurs as a result of the process’’. “This is distinguished from a patient simply becoming more compliant.”

They added that actively engaged patients may also have a greater understanding of their condition, a better relationship with their doctor, be more likely to attend appointments and stick to their treatments – leading to better outcomes.

“In general, in medicine we significantly underestimate and underutilise people’s own resources in dealing with their illness,” Professor Jelinek said. “We expect people to become compliant.” 

Retreat programs such as those run by the Yarra Valley Living Centre also gave people connectedness by providing a supportive environment, the benefits of which can be profound. “The whole basis of the retreat program is that people become the captain of their own health ship,’’ he said.

Hadgkiss, E.J., Jelinek, G.A., Taylor, K.L. et al. Engagement in a program promoting lifestyle modification is associated with better patient-reported outcomes for people with MS. Neurol Sci 36, 845–852 (2015).



LITERATURE REVIEWS AND META-ANALYSES

1. Mindfulness and its relevance for MS – a 2014 review

Three studies (n = 183 participants) were included in the final analysis. Statistically significant beneficial effects relating to quality of life, mental health, and selected physical health measures were sustained at 3 and 6 month follow up.

The authors concluded from the limited data available, MBIs may benefit some MS patients in terms of QOL, mental health, and some physical health measures. They added further studies are needed to clarify how MBIs might best serve the MS population.

Simpson, R, Booth J et al. (2014). Mindfulness based interventions in multiple sclerosis - a systematic review. BMC neurology. 14. 15. 10.1186/1471-2377-14-15.

2. Mental wellbeing, mindfulness and MS – a 2019 meta-analysis

Twelve RCTs including 744 PwMS were eligible for inclusion in this systematic review, eight had data extractable for meta-analysis; n=635. Ethnicity, socioeconomic status, comorbidity and disability were inconsistently reported. MBIs varied from manualised to tailored versions, lasting 6–9 weeks, delivered individually and via groups, both in person and online. Only three adverse events were reported.

The authors concluded MBIs are effective at improving mental well-being for people with MS. More research is needed regarding optimal delivery method, cost-effectiveness and comparative-effectiveness.

Simpson R, Simpson S, Ramparsad N, et al. Mindfulness-based interventions for mental well-being among people with multiple sclerosis: a systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery &Psychiatry 2019;90:1051-1058.

IN PERSON PROGRAMS

1. MS quality of life, depression, and fatigue improve after mindfulness training – a randomized trial

150 adults with relapsing-remitting or secondary progressive MS were randomly assigned to the intervention - a structured 8-week program of mindfulness training.  

This trial provides Class III evidence that MBI compared with UC improved HRQOL, fatigue, and depression up to 6 months postintervention. In addition, the findings demonstrate broad feasibility and acceptance of, as well as satisfaction and adherence with, a program of mindfulness training for patients with MS. The results may also have treatment implications for other chronic disorders that diminish HRQOL.

Grossman P, Kappos L, Gensicke H, et al. MS quality of life, depression, and fatigue improve after mindfulness training: a randomized trial. Neurology. 2010;75(13):1141-1149. 

2. Progressive Muscle Relaxation effective in MS 

The results of this 2009 study revealed that compared with the control group, patients with multiple sclerosis in the experimental group who practiced the progressive muscle relaxation over eight weeks, experienced higher quality of life in physical and mental dimensions.

Gafari S et al. Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis. J Clin Nursing 2009, Vol 8, 2171-2179

EDITOR’S NOTE. The Progressive Muscle Relaxation practice referred to here is the basis for the Deep Relaxation practice on the Allevi8 App. 

3. Progressive Muscle Relaxation and dose dependent benefits in MS

The authors of this 2014 study point out there is a well-established adverse reciprocal relationship between stress and multiple sclerosis (MS). However, stress management in these patients has been parsimoniously studied. In this parallel randomized controlled trial, relapsing-remitting MS patients were randomly assigned to undergo either an 8-week stress management program (n = 31; relaxation breathing and progressive muscle relaxation, twice a day) or not (n = 30). 

In patients in the intervention group, perceived stress and symptoms of depression were significantly decreased after 8 weeks of relaxation. Repeated measures analyses showed significant group-by-time interactions for both the number of weekly symptoms and the mean intensity per symptom. 

Artemios K et al, Stress Management and Multiple Sclerosis: A Randomized Controlled Trial, Archives of Clinical Neuropsychology, Volume 27, Issue 4, June 2012, Pages 406–416,

4. MS, psychological distress, cognitive dysfunctioning and mindfulness - a pilot

Twenty-five MS patients completed the MBSR training and psychological measures, of which 16 patients completed the cognitive tests. Significant improvements were found in depressive symptoms, quality of life, fatigue, mindfulness skills, and self-compassion. Of the cognitive tests, performance on a visual spatial processing test significantly improved after the intervention. Overall, this pilot study showed promising results of the effects of MBSR on reducing psychological distress, and it suggests MBSR might improve cognitive functioning in MS patients. 

Blankespoor, R.J., Schellekens, M.P., et al. The Effectiveness of Mindfulness-Based Stress Reduction on Psychological Distress and Cognitive Functioning in Patients with Multiple Sclerosis: a Pilot Study. Mindfulness 8, 1251–1258 (2017).

5. MS and pain – a cross-sectional survey

Chronic pain is a common symptom in people with multiple sclerosis (MS) and often requires a multimodal approach to care. The practice of mindfulness has been shown to decrease the experience of pain in other conditions, yet little is known about the relationship between mindfulness and pain in people with MS. The objective of this cross-sectional survey of 132 people with any type of MS was to evaluate the association between pain interference and trait mindfulness in people with MS.

The relationship between pain and mindfulness was found to be clinically meaningful and highly significant. These results suggest a clinically significant association between mindfulness and pain interference in MS and support further exploration of mindfulness-based interventions in the management of MS-related pain.These results support further exploration of mindfulness-based interventions in the management of MS-related pain.

Senders A et al. Association Between Pain and Mindfulness in Multiple Sclerosis: A Cross-sectional Survey. Int J MS Care. 2018;20(1):28-34. doi:10.7224/1537-2073.2016-076

6. Level of interest and engagement with meditation

This study aimed to describe website traffic and qualitatively analyse an e-health community discussion forum for people affected by multiple sclerosis visiting the Overcoming Multiple Sclerosis (OMS) website.

This mixed methods study combined descriptive analysis of website traffic over 7 years and 1 month, and qualitative analysis of 1 week of posts in the meditation topic, coded into theme groups using qualitative thematic analysis.

There were 166 meditation topics posted with 21,530 initial views of primary post and 785 sub-post responses. Meditation posts and sub-posts received 368,713 replies. Number of views increased from 4,684 in 2011 to over 80,000 in 2017, a considerably greater rate of increase than overall traffic.

Qualitative analysis of posts on the meditation forum identified themes of barriers and enablers to utilization of meditation resources. Enablement themes dominated, observed across six of the seven theme groups with various forms of positive social and emotional support to learn and practice meditation. One theme, negative emotion, was identified as a barrier.

The OMS peer-to-peer patient online discussion forum serves important functions in encouraging, educating and enabling its growing online community. Our analysis may help improve and innovate online support for lifestyle management in many chronic diseases.

O’Donnell JM, Jelinek GA et al. (2020) Therapeutic utilization of meditation resources by people with multiple sclerosis: insights from an online patient discussion forum, Informatics for Health and Social Care, 45:4, 374-384, 

7. Guided imagery for use in MS

This exploratory efficacy study examined the effects of Healing Light Guided Imagery (HLGI), a novel variant of guided imagery, compared with a wait-list control in patients with relapsing-remitting multiple sclerosis. 

Patients who completed HLGI (N = 9) showed significant reductions in depressed mood and fatigue and showed significant gains in physical and mental quality of life compared with journaling (N = 8). Our results suggest that HLGI can improve self-reported physical and mental well-being in patients with relapsing-remitting multiple sclerosis. 

Case LK et al. Guided Imagery Improves Mood, Fatigue, and Quality of Life in Individuals With Multiple Sclerosis: An Exploratory Efficacy Trial of Healing Light Guided Imagery. J Evid Based Integr Med. 2018 Jan-Dec;23:25 

EDITOR’S NOTE. This Guided Imagery practice is very similar to the Healing Light practice on the Allevi8 App. 


ONLINE MINDFULNESS and MEDITATION PROGRAMS for PEOPLE with MS

1. MS, distress levels, service costs, Skype and mindfulness

This randomised trial assessed the potential effectiveness and cost-effectiveness of a specially adapted Skype distant-delivered mindfulness intervention, designed to reduce distress for people affected by primary and secondary progressive MS.

Forty participants were randomly assigned to the 8-week intervention. Distress scores were lower in the intervention group compared with the control group at postintervention and follow-up. Mean scores for pain, fatigue, anxiety, depression, impact of MS were reduced for the mindfulness group compared with control group at posttherapy and follow-up. There were no differences in quality-adjusted life years, but an 87.4% probability that the intervention saves on service costs and improves outcome. 

Bogosian A, et al. Distress improves after mindfulness training for progressive MS: A pilot randomised trial. Mult Scler. 2015 Aug;21(9):1184-94.

2. MS and online mindfulness – the need for follow-up

139 participants were randomly assigned to an MS-specific online mindfulness meditation intervention or to a psychoeducational (active control) group. Participants were assessed for QOL, depression, anxiety, sleep problems, and fatigue, at three different times: at recruitment, after 2 months, and after 6 months.

In comparison to the control group, the experimental subjects reported higher QOL and lower depression, anxiety, and sleep problems at the end of intervention. However, after 6 months these group differences were no longer significant.

An online MBI could be an effective psychological treatment for the promotion of well-being in MS in short-term. However, the lack of lasting effects requires the development of new strategies to support long-term changes.

Cavalera C, et al. Online meditation training for people with multiple sclerosis: A randomized controlled trial. Mult Scler. 2019 Apr;25(4):610-617. 

3. Online mindfulness leads to significant gains – a 2016 study 

Thirty people with various forms of MS were 2:1 randomized to either active training (one hourly phone session per week) or a control condition of initial instruction only (with no further training) for six weeks. 

Those in the mindfulness training group  showed significant improvement in cognitive measures of information processing, along with greater reduction in fatigue, depressive symptoms and improved sleep quality after the mindfulness training. Fidelity to daily meditation practice was greatest for those who were initially seeking stress reduction training. 

The authors concluded providing instruction and practice through a telemedicine platform greatly improves access and lowers the cost of this symptomatic treatment approach.

Frontario a et al Telehealth Mindfulness Meditation Improves Cognitive Performance in Adults with Multiple Sclerosis (MS); Neurology Apr 2016, 86 (16 Supplement) P3.092;

4. Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size. 

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

5. App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.

LINK HERE TO THE ARTICLE


CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by Multiple Sclerosis (including their carers). These interventions can reduce the associated symptoms of MS such as fatigue and mobility issues, along with reducing stress, anxiety and depression, as well as assisting in actual recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes increasing the number of guided sessions increases the measured benefits.