Mindful Women: Exploring the effects of mindful body awareness on psychological and physical stressM. Kathleen B. Lustyk, PhD

Professor of Psychology, Seattle Pacific University

Affiliate Faculty, University of Washington

http://ww.spu.edu/LustykLab

Outline • Overview of female endocrinology and the

neurobiology of stress– Mindfulness and Premenstrual Symptoms

• What is body awareness and why might it help stress?– A brief practice– Effects of body awareness on stress responses in women– A glimpse at an intervention study

• Mindfulness-Based Relapse Prevention for women – A glimpse at a fMRI study on craving regulation

• Conclusions and Future Directions

Overview of female endocrinology

CRH

ACTH

cortisol Inhibits

LH from APE release by

ovary & causes E

resistance in target tissue

Stress & HPA Axis

Sex Steroid production

All of thesteroidsareintimatelyrelated tooneanother.

stress

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/basics/steroidogenesis.html

Vast effects of Estrogen

Recent Progress in Hormone Research 57:357-384 (2002)Estrogen Actions Throughout the BrainBruce McEwen

Estrogen

Behavior or feeling

toneEstroge

n

Behavior or feeling

tone

Estrogen Behavior or feeling

tone

Progesterone

AGE

Headache. 2006;46(3):365-386. © 2006  Blackwell Publishing

The rise and fall of Estrogen across the cycle

Hormone “drops” are associated with “withdrawals” or physical symptoms and/or affect changes that oppose the effects of the hormones.

Increased activity, cognitive clarity, positive affect,

suppressed hunger

Headache. 2006;46(3):365-386. © 2006  Blackwell Publishing

High P: Anxiolytic

effects

The rise and fall of Progesterone across the cycle

Some research findings

• Women show more physiological reactivity to laboratory stressors during the cycle phase of progesterone withdrawal (Lustyk et al., 2010).

• Women with high levels of premenstrual symptomatology report more psychological distress, life stressors, and poorer quality of life than women with low symptomatology (Lustyk et al., 2004).

Exercise Can help

I’m less stressed and have

less severe symptoms

if I exercise.

But it’s hard to get women to exercise when they feel poor.

Total Numbers by Cycle Phase

Activity Levels

N =

Very few women with intense

activity levels

First we did a survey study to see if mindfulness was associated w/ premenstrual symptomatology

Introduction• Mindfulness-Based practices are associated with:

– physical & affective symptom improvements across a broad range of conditions.

– reductions in negative anticipatory & judgmental thinking.

Developing mindfulness traits predicts improved symptomatology & well-being.

(Greeson, 2009; Carmody & Baer 2007; Baer, 2003)

Mindfulness Meditation

Mindfulness is a way of paying attention:

on purpose, in the present moment, &

non-judgmentally (adapted from Kabat-Zinn, 1990)

Attention to

immediate experienc

e

Orientation of: • Curiosity• Openness

• AcceptanceRegardless of

valence or desirability

Two-Component Model (adapted from Bishop et al., 2004)

Practicing Mindfulness

“If your attention wanders a hundred times, simply bring it back a hundred times.”

Observe wandering,begin again

Attention Wanders

Mind on chosen target

(Attention)

(Present Moment)

(Nonjudgmental)

Mindful Menses: An oxymoron, or are we on to something?

Purpose: To assess interrelationships among premenstrual symptom severity reports, menstrual attitudes, and mindfulness qualities in an effort to offer support for a role of MM practice for premenstrual symptom sufferers.

We surveyed 127 women.

Measures of symptoms

Shortened Premenstrual Assessment Form (PMSR; Allen, McBride, & Pirie, 1991)

symptom items rated from (1) “not present at all or no change from the usual level” to (6) “extreme change from usual level, perhaps noticeable even to casual acquaintances”.

Subscales: pain, affect, & water retention Modified Penn Alcohol Craving Scale (PACS; Flannery,

Volpicelli, & Pettinati, 1999)

“Considering your typical cycle, do you find that you crave a particular food, substance, or behavior the week before and/or during the first few days of your period?”

Measure of attitudes

Menstrual Attitudes Questionnaire (MAQ; Brooks-Gunn & Ruble, 1980)

indicated congruence with statements such as: “Menstruation can adversely affect my performance in

sports” “Menstruation allows women to be more aware of

their bodies.” Subscales: debilitating, bothersome, natural,

predictable (anticipate), and denial

Measures of Mindfulness Qualities

Five Facet Mindfulness Questionnaire (FFMQ; Baer et al., 2006) 39-items rated from (1) never or very rarely true to (5) very

often or always true Subscales include observing sensations and thoughts,

describing with words, acting with awareness, non-judging of inner experience, non-reactivity to experiences

Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003) single factor represented through awareness of and

attention to present moment events

Premenstrual Symptoms & Attitudes

Premenstrual Symptoms & Mindfulness Qualities

Interactions

Menses is AWFUL!

Look how different

symptoms are if

mindful!

Craving

If I don’t deny

effects of menses, look at

how different

my craving is

if I’m mindful.

• Conclusions• Poor menstrual attitudes are associated with more

premenstrual symptom severity• More mindfulness is associated with less symptom severity• Mindfulness can buffer the relationship between attitudes

and symptoms

Perhaps focusing on mindfulness/acceptance of the body (the first foundation of mindfulness) will reduce the negative effects of anticipation and denial.

Four Foundations of Mindfulness

Satipatthana sutta• Body• Feelings• Mind• Dharma“A practitioner remains established in the awareness of the body, in the body, diligent with clear understanding, mindful, abandoning all grasping and resistance, knowing the body for what it its.”

Next we did a lab study to see if body awareness was associated w/ less stress reactivity

Cardiovascular responses to a laboratory stressor in women: Assessing the role of body awarenessM. Kathleen B. Lustyk, Haley A.C. Douglas, Jacob A. Bentley,

Winslow G. Gerrish Body, Movement and Dance in Psychotherapy Vol. 7, Iss. 1, 2012

Body Awareness

• Characterized by:– A general tendency towards awareness and

recognition of normal bodily processes and physical sensations

– Considers one’s sensitivity to these sensations and one’s beliefs in how well they sense, predict, and describe their bodily functions (Shields, Mallory, & Simon, 1989)

Background

• Body-oriented psychotherapy– Goal: to integrate sensory and emotional awareness with

body awareness, which increases the capacity for healthy body connections and associations with oneself

• Young, 2006

• Evidence– Therapeutic success in the recovery from childhood

sexual abuse (Price, 2002, 2005)– Suspected mechanisms of action include stress reduction

Methods: apparatus

Hemodynamic Measures (N = 40 women) Blood pressure was assessed at timed

intervals with an automatic sphygmomanometer: Dinamap 1846

(Citikon, Inc., Tampa, FL) Heart rate was continuously measured with electrocardiography via the Powerlab 800 data

acquisition system (Adinstruments, Boulder, CO)

Methods: M

easures

Body Awareness Body Awareness Questionnaire (BAQ;

Shields et al., 1989)

State-Trait Anxiety The Spielberger State/Trait Anxiety

Inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983)

Traumatic Life Events Index of Clinical Stress (Abell, 1991):

Demographics & Health Information

Stress Protocol

0 0 0Baseline PASATRecove

ry

Self-Report Measures

Time 1:State Anxiety

Time 2:State Anxiety

Time 3: State Anxiety

Continuous ECG, BP taken at timed intervals

Paced Auditory Serial Addition Task

(Gronwall, 1977)

Baseline: 0-15 min

Stressor Recovery 1: 0-5 min

Recovery 2: 5-10 min

Recovery 3: 10-15 min

50

52

54

56

58

60

62

64

66

68

70

72

74

76

78

80

82

84

Low BAQHigh BAQ

HR

BP

M

Baseline: 0-15 min Stressor Recovery 1: 0-5 min Recovery 2: 5-10 min Recovery 3: 10-15 min

90

95

100

105

110

115

120

SBP

mm

Hg

Results: partial correlations

Results: moderation

Summary of findings

• Women with low body awareness demonstrate significantly more reactivity in HR and BP than women with high body awareness.

• Women with low body awareness are slower to recover to baseline HR following the stressor task than women with high body awareness.

• State anxiety reactivity does not differ by level of body awareness.

A glimpse at an intervention study

A CLINICAL EXAMPLE: STRESS AND ADDICTION

• Stress (psychological distress) & stressors (stressful life events)• frequently endorsed reasons for relapse (Marlatt &

Donavan, 2005; Brownell et al., 1986; Sinha, 2001)

• increase relapse risk (Sinha, 2007).

• The majority of those that attempt abstinence, relapse (McLellan et al., 2000)

• Relapse = return to problematic substance use

Mindfulness Meditation and Regulation of Craving in Female Alcoholics

Women’s Groups

vs

Images in Scanner

Feel vs Accept

How much do you

want this right now?

Effects of MBRP on Brain Function

All Subjects show greater activity in the subgenual

anterior cingulate (associated with craving)

when viewing alcohol stimuli than food stimuli.

MBRP shows no measurable activity in the subgenual anterior cingulate while

viewing alcohol images and engaging in “accept” mindset.

However dorsal regions implicated in impulse control

are activated.

Questions?

www.spu.edu/LustykLab