November 10, 2020 - A growing body of evidence supports the effectiveness of mindfulness approaches to promote positive changes in health behaviors. New neurobiologically based models of "mindful self-regulation" help to explain the how mindfulness-based interventions (MBIs) work to help people make healthy behavior changes, according to a review in the November/December issue of Harvard Review of Psychiatry. The journal is published in the Lippincott portfolio by Wolters Kluwer.
Mindfulness approaches can help patients with a wide range of physical and mental health conditions to initiate and sustain changes in health behaviors, according to the article by Zev Schuman-Olivier, MD, of Harvard Medical School and colleagues. They present an integrated model that "synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change." Dr. Schuman-Olivier is Director of the Center for Mindfulness and Compassion at the Cambridge Health Alliance.
MBIs help patients regulate attention, emotions, and thoughts
Changing unhealthy behaviors can be "exceptionally difficult" - but it's the key to prevention and treatment of many chronic medical and psychiatric illnesses. Mindfulness has been described as "the awareness that arises when paying attention to the present moment nonjudgmentally." The process for cultivating mindfulness often includes various approaches to mindfulness meditation - although the authors emphasize that "not all meditation is mindfulness and not all mindfulness is meditation."
In their comprehensive review of the field, Dr. Schuman-Olivier and colleagues seek to "describe and expand existing models of mindful self-regulation based on neurobiological mechanisms of mindfulness, motivation, and learning." Self-regulation refers to the ability to adapt one's attention, emotions, thoughts, and behavior to respond effectively to internal and external demands.
The article gives an updated account of current neuroscientific understanding of the systems involved in healthy self-regulation - including attentional and cognitive control, emotion regulation, and self-related processes - and the way these neural systems interact with those involved in motivation and learning.
In the authors' proposed model, MBIs can help patients regulate their attention, emotions, and thoughts. Mindfulness training increases the capacity for interoceptive awareness: the ability to identify, access, understand, and respond appropriately to the patterns of internal bodily signals. Patients become aware of negative and self-critical thought patterns, and better able to respond kindly to themselves when they are suffering, make mistakes, or have difficulty (self-compassion).
The authors differentiate between a traditional "cool" pathway for teaching mindfulness, focused solely on attention; and an emerging "warm" pathway that may aid in preventing adverse events and increasing accessibility to MBIs for those who have experienced trauma. The "warm" pathway encourages finding a "window of tolerance" and cultivating inner warmth and self-kindness - alongside attentional and interoceptive awareness training. This approach helps patients learn, develop, and integrate key self-regulatory capacities for "warmly being with present-moment experience."
Dr. Schuman-Olivier and colleagues highlight some key areas of research on mindfulness and behavior change, including alcohol and substance abuse disorders. In addition to general changes in self-regulation, MBIs can address disease-specific issues such as cravings for alcohol and drugs.
Research finds MBIs effective for food-related behaviors and weight loss, including reductions in binge eating and emotional eating. Studies of tobacco smoking suggest that MBIs may provide better outcomes than other accepted treatments. Mindfulness interventions have also led to improvements in self-care for patients with chronic illness and show promise in reducing aggressive behavior, suicide, and self-injury.
The authors draw attention to the need to monitor adverse events and to ensure that mindfulness programs are trauma-informed and accessible to diverse populations. Dr. Schuman-Olivier and colleagues conclude: "While evidence supports the impact of mindfulness on behavior change for key health behaviors related to psychiatric practice, more high-quality research is needed, especially with objective measures, larger samples, replication studies, active controls, and formal monitoring of adverse events."
Note: This work and effort was funded by grants through the NIH Science of Behavior Change Initiative (funded by the NIH Common Fund and National Center for Complementary and Integrative Health) and also supported by the National Center's HEAL (Helping to End Addiction Long-term) Initiative.
The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics.
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