A new Penn State study finds that for some population groups, mindfulness-based stress reduction (MBSR) appears to be a better method to relieve stress than traditional health education.
Researchers performed a clinical trial on eighty-six women age ≥ 18 years, with BMI ≥ 25 kg/m2. Women were randomized to eight weeks of MBSR, or health education, and followed for 16 weeks.
Investigators discovered the MBSR group displayed increased mindfulness and decreased stress compared with health education. In addition, fasting blood sugar levels decreased within the MBSR group, but not within the health education group.
“Our study suggests that MBSR lowers perceived stress and blood sugar in women with overweight or obesity. This research has wider implications regarding the potential role of MBSR in the prevention and treatment of diabetes in patients with obesity,” said Dr. Nazia Raja-Khan, lead author. The study appears in the journal Obesity.
As a background to the study, investigators explain that more than two-thirds of US adults are overweight or obesity, which increases their risk for diabetes and cardiovascular disease.
Stress could exacerbate obesity and its cardiometabolic conditions by impeding the adoption of healthy behaviors, and altering body chemistry. Researchers observed, however, that there is a lack of effective interventions targeting stress in obesity.
As such, mindfulness-based stress reduction (MBSR), the most researched mindfulness-based intervention, may be beneficial for reducing stress and cardiometabolic risk among overweight or obese individuals.
Potential mechanisms by which MBSR could improve cardiometabolic outcomes include physiological changes in cortisol and catecholamines, psychological changes in depressive and anxiety symptoms, self-regulation, resilience, and coping, and behavioral changes in diet and physical activity.
Mindfulness-based interventions, including MBSR, have been shown to decrease stress in various patient populations. Mindfulness-based eating awareness training, developed for binge eating disorder, reduces binge eating episodes, improves self-control, and may promote weight loss.
Mindfulness-based interventions have also been preliminarily shown to improve glucose and blood pressure in patients with diabetes.
In the study, participants randomized to MBSR received the standard MBSR program consisting of instructor-led weekly 2.5-hour sessions for eight weeks and a six hour retreat session. One adaptation to standard MBSR was that participants were asked to do only 25 to 30 minutes of daily home practice instead of the standard 45 minutes.
There were no other changes to the standard MBSR curriculum, including no changes to the type or content of meditation practice. The instructor who led the MBSR intervention was well qualified, having completed professional MBSR training and with nine years of experience training others in mindfulness.
During the study, the MBSR instructor received regular guidance from a supervisor highly experienced in teaching MBSR. The MBSR intervention lasted eight weeks. Between eight and 16 weeks, participants were encouraged to continue with the daily home practice, but there was no contact from intervention staff.
All participants in the MBSR and health education groups were given the same written guidelines on diet and exercise, which consisted of the American Academy of Nutrition and Dietetics’ “General, Healthful Nutrition” handout and the Centers for Disease Control and Prevention’s “Physical Activity and Health” webpage.
These guidelines were the only information that was the same across both groups. The MBSR group did not receive any additional health education other than these guidelines.
The health education group was taught by a registered dietitian who delivered additional diet and exercise information. To control for instructor attention and group support, the health education group also received instructor-led, weekly, 2.5-hour sessions for eight weeks and a six hour retreat.
During sessions, the health education group received lectures and participated in learning activities about diet, exercise, general stress management, and the diagnosis, symptoms, complications, and treatments for obesity.
Participants practiced exercising with cans, resistance bands, balls, and chairs and created their own exercise plan. They reviewed their own food logs and identified foods high in sodium and fat and low in fiber, as well as foods that were good protein choices.
They created meal plans for themselves. During the stress management session, they wrote down what caused them to be stressed and what they did when they were stressed (e.g., ate more, cried). This was followed by a discussion on how to relieve stress.
General stress management was included in the health education group to minimize the bias of subject expectations. The health education group did not receive any mindfulness. The MBSR group received a more extensive discussion on stress and practiced using mindfulness to respond to stress, which is a key component of the MBSR curriculum.
Because weight loss is not a part of the MBSR curriculum, all subjects were informed at enrollment that the primary focus of the study was stress reduction, not weight reduction. They were informed that the study was being done to determine the effects of stress reduction on glucose, blood pressure, and overall health.
To limit subject expectation bias, subjects were not told that one program was hypothesized to be more effective than the other. They were told that the study was being done to test two different stress reduction programs, one of which is combined with health education.
Future studies are needed to determine whether a sustained increase in mindfulness with a longer mindfulness-based intervention would result in even greater and more long-term benefits.
Source: Penn State/Wiley
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