• Mindful Yoga Research

     

    Thus far, five research studies have demonstrated important benefits of Mindful Yoga in medical populations in the form of an 8-week course (“Yoga of Awareness”). The first two studies involved breast cancer patients at Duke University Medical Center, and the three more recent trials focused on fibromyalgia patients at Oregon Health & Science University.

    Following are brief summaries of the five studies thus completed:

     

    Mindful Yoga for Metastatic Breast Cancer Patients

    Metastatic breast cancer remains a terminal illness for which major treatment advances are slow to appear. Hence it is crucial that effective supportive interventions be developed to reduce the cancer-related symptoms of women with this condition during the remaining years of their lives. This small pilot study examined the effects of the Mindful Yoga approach in a sample of women with metastatic breast cancer. The 8-week protocol included gentle yoga postures, breathing exercises, meditation, didactic presentations, and group interchange. Outcome was assessed before the program and at the end of the program using daily measures of pain, fatigue, distress, vigor, acceptance, and relaxation. Thirteen women completed the intervention (mean age = 59; mean time since diagnosis = 7 years; 2 African American, 11 Caucasian). During the study 4 participants had cancer recurrences, and several others’ physical condition deteriorated noticeably, yet none of the women experienced yoga-related adverse events . Analyses of before-to-after changes showed significant increases in vigor and acceptance. Analyses examining length of home yoga practice showed that on days when women practiced more, on the next day they experienced significantly lower levels of pain and fatigue, and higher levels of vigor, acceptance, and relaxation. These findings support the need for further investigation of the effects of the Mindful Yoga program in women with metastatic breast cancer.

    This study was published in Journal of Pain and Symptom Management, 2007.

     

    Mindful Yoga for Breast Cancer Patients Experiencing Hot Flashes

    Breast cancer survivors have limited options for the treatment of hot flashes and related symptoms. Further, therapies widely used to prevent recurrence of cancer in survivors, such as tamoxifen, tend to induce or exacerbate menopausal symptoms. Although one study has shown yoga to be helpful for menopausal-related quality of life among normal healthy women, the effects of yoga on cancer survivors who are experiencing hot flashes has yet to be tested. The aim of this preliminary, randomized controlled trial was to evaluate the effects of Mindful Yoga on hot flashes and other menopausal symptoms in a sample of survivors of early stage breast cancer (Stages IA-IIB). Thirty-seven disease-free women experiencing hot flashes were randomized to the 8-week yoga program or to a wait-list control group who would receive the program 6 months later. Mindful Yoga was specifically tailored in this study to address patients’ hot flashes and other menopausal symptoms. Each 120-minute session included gentle physical stretching postures (e.g., seated forward folds, supine lateral twists), breathing exercises (e.g., extended exhalation), meditation techniques (e.g., noticing thoughts, noticing the witness of thoughts/"simple being"), study of yogic topics (e.g., the value of observing oneself in daily life with the intention to understand rather than judge), and group discussions (e.g., effects of home yoga practice). The primary outcome was daily reports of hot flashes collected before the program, after the program and 3 months later via an interactive telephone system. Data were analyzed using the standard approach for medical studies (intention to treat). Attendance in the yoga sessions was good, and on average participants practiced yoga techniques at home for about 30 min per day. Prior to the beginning of the yoga program, a comparison showed no significant differences existed between the yoga and control groups. However, after the program, women who had undergone yoga training showed significantly greater improvements relative to the control condition in hot flash frequency, severity, and total scores, and in levels of fatigue, joint pain, sleep disturbance, emotional distress, and vigor. After an additional 3 months, further significant gains were evident in the yoga group relative to the control group. This pilot study supports the efficacy of the Mindful Yoga program for hot flashes and related symptoms in early stage breast cancer survivors.

    This study was presented at the 2008 Symposium on Yoga Therapy and Research (SYTAR) in Los Angeles, which is the annual conference sponsored by the International Association of Yoga Therapists. The study was also published in Supportive Care in Cancer, 2009...

     

    Mindful Yoga for Fibromyalgia

    Fibromyalgia is a debilitating condition affecting 11-15 million persons in the U.S. Most fibromyalgia patients use health services extensively; this illness carries an annual direct cost for care of >$20 billion. FDA indicated drug therapies are generally only 30% effective in relieving symptoms and 20% effective in improving function. A mounting body of literature recommends that treatment for fibromyalgia encompass medications, exercise and improvement of coping skills. However, there is a significant gap in determining an effective counterpart to pharmacotherapy that incorporates both exercise and coping. The aim of this randomized controlled trial was to evaluate the effects of a comprehensive yoga intervention on fibromyalgia symptoms and coping. A sample of 53 female fibromyalgia patients were randomized to the 8-week Mindful Yoga program (gentle poses, meditation, breathing exercises, yoga-based coping instructions, group discussions) or to wait-listed standard care. Data were analyzed by intention to treat. At post-treatment, findings provided evidence, based on various types of measures (standardized questionnaires, physical tests, daily diaries) that the intervention was helpful for improving a wide range of fibromyalgia symptoms and functional deficits, including pain, fatigue, stiffness, poor sleep, depression, poor memory, anxiety, tenderness, poor balance, environment sensitivity, vigor, and limited strength. In addition, the results suggested the yoga intervention led to a beneficial shift in how patients cope with pain, including greater use of adaptive pain coping strategies (e.g. problem solving, positive reappraisal, use of religion, activity engagement despite pain, acceptance, relaxation) and less use of maladaptive strategies (e.g. catastrophizing, self-isolation, disengagement, confrontation). These changes may seem surprising, given that the coping strategies employed in the intervention were drawn from the yoga tradition and differed markedly from standard cognitive-behavioral coping skills. Moreover, attendance in the yoga sessions was good, and on average participants practiced yoga techniques at home for about 40 min per day. The results of this study provide promising support for the beneficial effects of yoga in patients with fibromyalgia.

    This study was published in Pain, 2010.

     

    Follow-up of Mindful Yoga for Fibromyalgia: Results at 3 months and replication in the wait-list group

    The primary aims of this study were 1) to evaluate the post-treatment effects of Yoga of Awareness among participants originally assigned to the wait-list group in an earlier fibromyalgia trial, and 2) to test the program’s effects at 3 month follow-up in the earlier trial’s immediate treatment group. Unpaired t-tests were used to compare data from a per protocol sample of 18 women in the wait-list group who had completed treatment, and 21 women in the immediate treatment group. Within-group paired t-tests were performed to compare post-treatment data to 3 month follow-up data in the immediate treatment group. The primary outcome measure was the Fibromyalgia Impact Questionnaire Revised (FIQR). Multilevel random effects models were also used to examine associations between yoga practice rates and outcomes. Findings showed that post-treatment results in the wait-list group largely mirrored results seen at post-treatment in the immediate treatment group, with the FIQR Total Score improving 31.9% across the two groups. Follow-up results showed that patients sustained most of their post-treatment gains, with the FIQR Total Score remaining 21.9% improved at 3 months. Yoga practice rates were good, and more practice was associated with more benefit for a variety of outcomes. These results indicate that the benefits of Yoga of Awareness in fibromyalgia are replicable and can be maintained.

    This study was published in Clinical Journal of Pain, 2012.

     

    Mindful Yoga alters pressure pain thresholds and other pain processing variables in fibromyalgia patients

    Published findings from a randomized controlled trial have shown that Mindful Yoga training improves symptoms, functional deficits, and coping abilities in individuals with fibromyalgia and that these benefits are replicable and can be maintained 3 months post-treatment. The aim of this study was to collect pilot data in female fibromyalgia patients (n = 7) to determine if initial evidence indicates that Mindful Yoga also modulates the abnormal pain processing that characterizes fibromyalgia. Pre- and post-treatment data were obtained on quantitative sensory tests and measures of symptoms, functional deficits, and coping abilities. Separation test analyses indicated significant improvements in heat pain tolerance, pressure pain threshold, and heat pain after-sensations at post-treatment. Fibromyalgia symptoms and functional deficits also improved significantly, including physical tests of strength and balance, and pain coping strategies. These findings indicate that further investigation is warranted into the effect of Mindful Yoga on neurobiological pain processing.

    This study was published in International Journal of Yoga Therapy, 2016.

     

    Additional Ground-Breaking Research by the Carsons

    Jim and Kimberly Carson together developed the first mindfulness program for couples, Mindfulness-Based Relationship Enhancement (Behavioral Therapy, 2004);  (Journal of Marriage and Family Therapy, 2007). Along with colleagues at Duke, the Carsons also developed the first Loving-kindness Meditation program for medical patients (Journal of Wholistic Nursing, 2005).