Workplace based mindfulness practice and inflammation: A randomized trial
Highlight
► A randomized mindfulness-based intervention performed in the workplace decreased CRP levels in overweight/obese participants.
Introduction
Current research suggests that chronic stress in our society is a contributing factor to the behaviors and physiology that have accelerated the increase in chronic disease states. Hence low-cost self-directed stress reduction programs could be of great assistance in managing this epidemic. One such candidate is mindfulness-based stress reduction (MBSR), which is a structured group program that utilizes mindfulness meditation to help manage a variety of adverse health issues (Ludwig and Kabat-Zinn, 2008).
Mindfulness is characterized by non-judgmental, moment-to-moment awareness of physical sensations, perceptions, affective states, thoughts and imagery. It involves sustained awareness of mental phenomena which arise during waking consciousness. As a form of receptive awareness, mindfulness may create an interval of time where one is able to view one’s mental landscape, including one’s behavioral options. One goal of mindfulness practice is to enable the individual to make conscious life choices, allowing for a greater appreciation of possible responses to life events. Mindfulness practice may create a resilience resource for enhancing health, and recovery from illness by exposing the self induced stress caused by the framing of internal and external events. Improvements have been noted in standardized mental health measures including quality of life scales, depression, anxiety, coping style, and other affective dimensions of disability following mindfulness training (Ludwig and Kabat-Zinn, 2008). For chronic disease, meditative practices that cultivate and enhance awareness (exposing thoughts as narratives of our thinking and not as reality) may modulate the experience of pain and/or improve the capacity to deal with pain (Morone et al., 2008, Zautra et al., 2008), enhance the management of type 2 diabetes (Hartmann et al., 2012) and improve psoriasis (Kabat-Zinn et al., 1998).
It has been suggested that mindfulness practice may engage several biological pathways, including immune and endocrine changes evidenced by an increase in antibody titers to influenza vaccine (Davidson et al., 2003), higher salivary IgA levels and lower salivary cortisol levels following an acute stressor (Tang et al., 2007). Furthermore, only 5 days of body-mind training improved regulation of the autonomic nervous system (heart rate variability and blood pressure) and it was associated with EEG activation in the frontal cortex (Tang et al., 2009).
Functional MRI imaging demonstrate that individual disposition toward mindfulness is associated with extensive prefrontal cortical activation and diminished bilateral amygdala activity (Creswell et al., 2007) indicating thoughtful response patterns rather than hyperemotional reaction to life events. Both effects are associated with more controlled regulation of inflammation via the hypothalamic-pituitary-adrenal axis, the autonomic nervous system and immune system (Cerqueira et al., 2008).
Research over the past two decades has established chronic inflammation as a pathophysiologic component of numerous disease processes including various cardiovascular disorders. Levels of the inflammatory peptide CRP, that are in the highest tertile of the normal range increase the risk two-fold for a myocardial infarction over the following three years (Ridker et al., 2000).
CRP not only predicts adverse cardiovascular events but it also appears to induce a variety of pro-inflammatory processes in the vascular endothelium (Paffen and DeMaat, 2006).Furthermore, in a longitudinal study of aging, higher CRP and IL-6 levels predicted decreased survival (Wassel et al., 2010). Psychological and behavioral factors have been shown to predict CRP levels in middle aged and older adults (Suarez, 2004), and waist circumference, latency to sleep, smoking, and perceived stress were independently associated with increased CRP levels (McDade et al., 2006).
A recent review of published clinical studies have pointed to the shortcomings of clinical MBSR investigations that we have attempted to address. These problems include small numbers of participants, lack of an active control group, the inclusion of only subjective endpoints, lack of details of participant characteristics that allow generalization of findings, insufficient details of treatment methods, inadequate documentation of protocol adherence by the participants, and infrequent use of biologic measures (Ludwig and Kabat-Zinn, 2008).
In our mindfulness intervention, we have adhered to core MBSR principles, the 8 week program duration, and inclusion of a retreat, but have reduced the time committed to meetings and formal practice, while conducting the sessions onsite during the workday (Klatt et al., 2009). This has reduced the barriers commonly mentioned for non-participation in MBSR programs. Similar modifications to weekly/daily mindfulness programs based on MBSR have emerged, for example shortened programs for oncology patients (Ott et al., 2006) and those who are at risk or have cardiovascular disease (Olivo et al., 2009). In our trial we studied university faculty and staff who were found to have an elevated CRP level, >3.0 mg/ml, and who either had or were at risk for cardiovascular disease. This study focused on working adults who could benefit from lifestyle intervention strategies. In comparing the mindfulness intervention to the lifestyle education program, we focused on three biologic measures of chronic stress and inflammation (CRP, IL-6 and cortisol).
Section snippets
Methods
PARTICIPANTS: Subjects were recruited from faculty and staff of The Ohio State University. Advertising promoted the trial as a life style intervention program and the types of interventions were not specified, with participants unaware of the intervention type until the first day of the actual intervention.
Exclusion criteria focused on conditions that enhance inflammation and included: a psychiatric disorder other than depression within the past year; pregnancy; experiencing a major life stress
Assays
CRP: High sensitivity-CRP was analyzed using chemilluminescence methodology with the Immulite 1000 (Diagnostic Products Corporation, Los Angeles, CA). Sensitivity for this assay is 0.01 mg/dl. The intra-assay coefficient of variation was 3.8% and inter-assay coefficient of variation was 7.4%.
Interleukin 6: IL-6 was measured using a electrochemiluminescence method with ultra-sensitive kits purchased from Meso Scale Discovery (Gaithersburg, MD). Plates were read using the Meso Scale Discovery
Results
PRIMARY: Fig. 1 provides a description of the number of subjects that met inclusion/exclusion criteria, consented, and were randomized. The mean CRP at screening was 6.00 with a standard deviation of 2.3. The mean CRP at baseline (approximately 3 weeks post screen) dropped to 5.5, presumably because of regression to the mean. The correlation between screen and baseline CRP levels was 0.49.
Of those who met criteria (199) almost all were randomized to the two arms (total trial n = 186). Only 13
Sensitivity and exploratory analysis
BMI: We explored whether the difference in effectiveness of the two interventions depended on BMI (BMI x intervention group interaction). A large BMI interaction effect was observed for CRP (p = 0.04). For BMI <30 (n = 59) the MBI-ld effect on CRP was a larger decrease of −2.67 (SE = 1.0, p = .009) as compared to control, while for BMI >30 (n = 127) the effect was just −0.18 (SE = .67, p = 0.79). We further broke those with BMI >30 into two groups (between 30 and 35 vs. above 35). For those between 30 and
Discussion
In this randomized controlled trial the traditional MBSR program was reduced in scope so that it could be performed at lunchtime in the workplace. The participant group was representative of the greater Columbus area. We did not select for individuals who would be more inclined to participate in a meditative practice. Individuals were told that they would receive a lifestyle intervention but mindfulness meditation was not mentioned until after they were randomized. Therefore, we cannot
Acknowledgments
The project described was supported by Award Number R21AT003670 from the National Center For Complementary & Alternative Medicine and by the National Center for Research Resources, Grant UL1RR025755 which is now at the National Center for Advancing Translational Sciences, Grant UL1TR000090.
The authors would like to thank the nursing staff at The Ohio State University Clinical Research Center, and Kemba Days Yancey for study coordination.
References (54)
- et al.
Relation of plasma leptin to C-reactive protein in older adults (from the Invecchiare nel Chianti study)
Am. J. Cardiol.
(2005) - et al.
The pittsburgh sleep quality index: a new instrument for psychiatric practice and research
Psychiatry Res.
(1989) - et al.
One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients
Brain Behav. Immun.
(2007) - et al.
The stressed prefrontal cortex. left? right! brain
Behav. Immun.
(2008) Proinflammatory cytokines in CRP baseline regulation
Adv. Clin. Chem.
(2009)- et al.
The validation of an active control intervention for mindfulness based stress reduction (MBSR)
Behav. Res. Ther.
(2012) - et al.
Cortisol as a marker for improvement in mindfulness-based stress reduction
Complement. Ther. Clin. Pract.
(2010) - et al.
Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study
Pain
(2008) - et al.
Innate immune, neuroendocrine and behavioral responses to psychosocial stress do not predict subsequent compassion meditation practice time
Psychoneuroendocrinology
(2010) - et al.
A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity
Am. J. Med.
(2004)
The effects of mindfulness-based stress reduction on sleep disturbance. a systematic review
Explore (NY).
Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer
Brain Behav. Immun.
The Culprit and the Cure: Why Lifestyle is the Culprit behind America’s Poor Health
Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression
Psychosom. Med.
How long does a mindfulness-based stress reduction program need to be? A review of class contact hours and effect sizes for psychological distress
J. Clin. Psychol.
Acute-phase response of human hepatocytes: regulation of acute-phase protein synthesis by interleukin-6
Hepatology
Perceived stress in a probability sample of the united states
Neural correlates of dispositional mindfulness during affect labeling
Psychosom. Med.
Alterations in brain and immune function produced by mindfulness meditation
Psychosom. Med.
Short-term autonomic and cardiovascular effects of mindfulness body scan meditation
Ann. Behav. Med.
Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: exploratory analysis of a randomized trial
Ann. Intern. Med.
Sustained effects of a mindfulness-based stress-reduction intervention in type 2 diabetic patients: design and first results of a randomized controlled trial (the heidelberger diabetes and stress-study)
Diab. Care
Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA)
Psychosom. Med.
Effects of low-dose mindfulness-based stress reduction (MBSR-ld) on working adults
Health Edu. Behav.
Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study
J. Clin. Endocrinol. Metab.
The toronto mindfulness scale: development and validation
J. Clin. Psychol.
Procedures for two-sample comparisons with multiple endpoints controlling the experiment-wise error rate
Biometrics
Cited by (141)
Mindfulness-based programs sustainably increase mental health: The role of cognitive fusion and mindfulness practice
2024, Revue Europeenne de Psychologie AppliqueeComparative efficacy of psychological interventions on immune biomarkers: A systematic review and network meta-analysis (NMA)
2023, Brain, Behavior, and ImmunityWorkplace mindfulness: An integrative review of antecedents, mediators, and moderators
2022, Human Resource Management ReviewMindfulness: Implications for Research Methods
2022, Journal of Pediatric Health CareA feasibility study on low-dose mindfulness-based stress reduction intervention among prediabetes and diabetes patients
2022, Complementary Therapies in Medicine