Tobias Esch

Effects of mindfulness-based stress reduction on quality of life in nursing home residents: a feasibility study.

Background: With demographic change, the number of elderly people is increasing. The aging process and associated stress diminishes their quality of life. Mindfulness-based stress reduction (MBSR) has been claimed to reduce stress and alleviate suffering. It might be a useful approach to improve the condition in the elderly. Patients and Methods: To examine feasibility and potential effects of MBSR on nursing home residents in Germany, a non-randomized feasibility study was conducted including 22 participants; 15 of them participated in an 8-week MBSR course, 7 served as untreated comparison group. Health-related quality of life (SF-12), depressive symptoms (GDS-12R), cognitive impairment (MMST), activities of daily living (Barthel Index), satisfaction with life, physical pain and major complaints were assessed pre- and post-intervention. Results: 9 out of 15 course participants completed the course (60%). They showed a significant increase in the SF-12 physical health score (p = 0.017). Depressive symptoms (GDS-12R) significantly declined within the meditation group (p = 0.04) and as compared to the untreated group (p = 0.011). In the comparison group, a significant decrease in major complaints (p = 0.011) and an increase in the SF-12 mental health score were found. The meditation group yielded positive changes in the SF-12 mental health score, in satisfaction with life and in pain intensity. Conclusions: In view of the setting, the completion rate of 60% appears to be acceptable. Significant results suggest that MBSR may help improve health-related quality of life and reduce symptoms of depression. Yet, as participants did not meet the requirement to practice independently, feasibility of conducting MBSR with elderly who live in a nursing home has to be questioned.

Evaluation of a Seven-Week Web-Based Happiness Training to Improve Psychological Well-Being, Reduce Stress, and Enhance Mindfulness and Flourishing: A Randomized Controlled Occupational Health Study

Background. As distress in society increases, including work environments, individual capacities to compete with stress have to be strengthened. Objective. We examined the impact of a web-based happiness training on psychological and physiological parameters, by self-report and objective means, in an occupational health setting. Methods. Randomized controlled trial with 147 employees. Participants were divided into intervention (happiness training) and control groups (waiting list). The intervention consisted of a seven-week online training. Questionnaires were administered before, after, and four weeks after training. The following scales were included: VAS (happiness and satisfaction), WHO-5 Well-being Index, Stress Warning Signals, Freiburg Mindfulness Inventory, Recovery Experience Questionnaire, and Flourishing Scale. Subgroup samples for saliva cortisol and alpha-amylase determinations were taken, indicating stress, and Attention Network Testing for effects on attention regulation. Results. Happiness (P = 0.000; d = 0.93), satisfaction (P = 0.000; d = 1.17), and quality of life (P = 0.000; d = 1.06) improved; perceived stress was reduced (P = 0.003; d = 0.64); mindfulness (P = 0.006; d = 0.62), flourishing (P = 0.002; d = 0.63), and recovery experience (P = 0.030; d = 0.42) also increased significantly. No significant differences in the Attention Network Tests and saliva results occurred (intergroup), except for one saliva value. Conclusions. The web-based training can be a useful tool for stabilizing health/psychological well-being and work/life balance.

Engaging patients through open notes: an evaluation using mixed methods

Objectives (A) To gain insights into the experiences of patients invited to view their doctors’ visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes. Design Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks. Setting Greater Boston, USA. Participants Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23–88 years). In addition, 13 patients (9 female, 4 male; 58–87 years) were interviewed. Results Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits. Conclusions As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physicians office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.

Effect of leeches therapy (Hirudo medicinalis) in painful osteoarthritis of the knee: a pilot study

Leeches therapy was a mainstay in conventional treatment of pain and inflammatory diseases throughout antiquity until the 20th century.1-3 There is now renewed interest in leeches therapy in the field of complementary medicine. Sales of the four principal German traders have increased continuously throughout the past few years and led to an estimated 70 000 treatments (350 000 leeches sold/year, four to five used for each single treatment) yearly in Germany (Roth M, unpublished data). The majority of these treatments aim at pain reduction in regional pain syndromes, mostly for knee osteoarthritis.2 With the exception of its application in plastic surgery to maintain blood flow in congested skin flaps,4 5 treatment with leeches has, however, never been evaluated in clinical studies. We conducted a non-randomised controlled pilot study to assess the onset of action and the impact of leeches …

Endogenous morphine/nitric oxide-coupled regulation of cellular physiology and gene expression : Implications for cancer biology

Cancer is a simplistic, yet complicated, process that promotes uncontrolled growth. In this regard, this unconstrained proliferation may represent primitive phenomena whereby cellular regulation is suspended or compromised. Given the new empirical evidence for a morphinergic presence and its profound modulatory actions on several cellular processes it is not an overstatement to hypothesize that morphine may represent a key chemical messenger in the process of modulating proliferation of diverse cells. This has been recently demonstrated by the finding of a novel opiate-alkaloid selective receptor subtype in human multilineage progenitor cells (MLPC). Adding to the significance of morphinergic signaling are the findings of its presence in plant, invertebrate and vertebrate cells, which also have been shown to synthesize this messenger as well. Interestingly, we and others have shown that some cancerous tissues contain morphine. Furthermore, in medullary histolytic reticulosis, which is exemplified by cells having hyperactivity, the mu3 (mu3) opiate select receptor was not present. Thus, it would appear that morphinergic signaling has inserted itself in many processes taking a long time to evolve, including those regulating the proliferation of cells across diverse phyla.

Endogenous reward mechanisms and their importance in stress reduction, exercise and the brain

Stress can facilitate disease processes and causes strain on the health care budgets. It is responsible or involved in many human ailments of our time, such as cardiovascular illnesses, particularly related to the psychosocial stressors of daily life, including work. Besides pharmacological or clinical medical treatment options, behavioral stress reduction is much-needed. These latter approaches rely on an endogenous healing potential via life-style modification. Hence, research has suggested different ways and approaches to self-treat stress or buffer against stressors and their impacts. These self-care-centred approaches are sometimes referred to as mind-body medicine or multi-factorial stress management strategies. They consist of various cognitive behavioral techniques, as well as relaxation exercises and nutritional counselling. However, a critical and consistent element of modern effective stress reduction strategies are exercise practices. With regard to underlying neurobiological mechanisms of stress relief, reward and motivation circuitries that are imbedded in the limbic regions of the brain are responsible for the autoregulatory and endogenous processing of stress. Exercise techniques clearly have an impact upon these systems. Thereby, physical activities have a potential to increase mood, i.e., decrease psychological distress by pleasure induction. For doing so, neurobiological signalling molecules such as endogenous morphine and coupled nitric oxide pathways get activated and finely tuned. Evolutionarily, the various activities and autoregulatory pathways are linked together, which can also be demonstrated by the fact that dopamine is endogenously converted into morphine which itself leads to enhanced nitric oxide release by activation of constitutive nitric oxide synthase enzymes. These molecules and mechanisms are clearly stress-reducing.

Role of amygdala in mediating sexual and emotional behavior via coupled nitric oxide release

AbstractAlthough the anatomical configuration of the amygdala has been studied a great deal, very little research has been conducted on understanding the precise mechanism by which this emotional regulatory center exerts its control on emotional and sexual behavior. By applying research methodology from the Neuroscience Research Institute, State University of New York, College at Old Westbury, we intended to demonstrate that much of the mediated effects of the amygdala, specifically the regulation of the male and female sexual response cycles, as well as related emotional considerations, exert their effects coupled to nitric oxide (NO) release. Furthermore, by using current anatomical and histological data, we demonstrated that amygdalar tissue rich in endocannabinoid and opiate, as well as catecholamine, receptors could exert its neurochemical effects within an NO-mediated paradigm. This paradigm, together with the existence of estrogen and androgen signaling within the amygdala, further lends credence to our theoretical framework. We begin with a brief anatomical and functional review of amygdalar function, and then proceed to demonstrate its relationship with NO.

Stress, Anpassung und Selbstorganisation: Gleichgewichtsprozesse sichern Gesundheit und Überleben

Stress, Adaptation, and Self-Organization: Balancing Processes Facilitate Health and Survival Background: Stress is of growing significance not only in established industrial countries. Preventive medical aspects are becoming important in association with the stress phenomenon. Objective: Discussing the correlation between stress and health (or disease). Does a state of dynamic balance play a role in the context of stress, allostasis, adaptation, and self-organization? What kind of influence do balancing processes have on health and survival? Results: Stress itself is neither harmful nor healthy. Instead, it represents a fundamental biological principle that is associated with vivacity and that facilitates adaptation, dynamic balance, self-organization, and survival within a constantly changing environment. Stress may also be of significance for biological evolution. A crucial part of the physiological concept is the autoregulatory stress response. Thereby, stress may enhance biological creativity and health, but may also lead to allostatic load and disease. Not only exogenous stressors, but also the subject itself decide upon the individual stress outcome. Conclusions: Dynamic balances characterize life and survival. Further, they are crucial for health processes. Stress may facilitate a ‘healthy’ balance or enhance disease processes likewise. Hence, the subjective inner structure or self-organization of an organism determines – in addition to exogenous factors – individual consequences of stress. Therefore, prevention should strengthen the subject and amplify self-capacity and responsibility. Professional stress-management strategies or integrative/mind-body medical programs may be helpful.

A Bio-Psycho-Socio-Molecular Approach to Pain and Stress Management

Stress and trauma are interconnected with the experience of pain. This connection is due to a physiological coupling of underlying molecular autoregulatory mechanisms, as well as phenomenological similarities. Nonpharmaceutical therapeutic approaches such as the relaxation response, a process that supports physiological stress reduction and decreases the negative mental and physical effects of stress, also facilitate pain relief, again demonstrating physiological commonalties. These behavioral approaches have a critical impact on molecular patterns of autoregulation, leading to the assumption of a bio-psycho-socio-molecular model of autoregulation, including stress and pain. Thus, molecules and behavior may be seen as two sides of the same problem in pain and stress relief.

The Neurobiology of Meditation and Mindfulness

Neurobiological effects of meditation and mindfulness can be detected in the brain as functional and also structural alterations in grey and white matter, particularly in areas related to attention and memory, interoception and sensory processing, or self- and auto-regulation (including control of stress and emotions). On the molecular level, dopamine and melatonin are found to increase, serotonin activity is modulated, and cortisol as well as norepinephrine have been proven to decrease. These findings are reflected in functional and structural changes documented by imaging techniques such as fMRI or EEG. They may be relevant for medicine and health care, especially with reference to therapeutic strategies for behavior change and life-style modification, or in association with stress regulation and the treatment of addiction. Neuronal mechanisms of mindfulness can be divided into four areas: attention regulation, body awareness, emotion regulation and self-perception.