Introduction
A growing number of companies and professionals in health care settings are beginning to incorporate a more patient-centred approach in their practice, such as mindfulness centred therapies. Mindfulness is millennia’s old, rooted in Buddhist meditation practices. Many mindfulness techniques are adopted across culture and religion, yet the practices or ‘interventions’ used in healthcare settings are Buddhist in nature (Shonin & Van Gordon, 2016). The UK’s National Institute for Care Excellence (NICE) published a report in 2010 that discusses mindfulness practices in mental health care settings in detail. The report states that:
“…There is new scientific evidence that meditation, especially when associated with some other mental disciplines derived from CBT (Cognitive Behavioural Therapy), can improve our mental and physical health… This new treatment can tackle recurrent depression, but the principles have a much wider application to our lives.” (National Institute for Care Excellence, 2010).
This report calls for the institute’s implementation of CBT of individuals who are currently well but have experienced three spells of depression. The greater acceptance of mindfulness therapies in health care settings, health care institutions correlate to the growing body of literature investigating the promising force of such interventions in patient care.
Mind and Body
Shonin and Van Gordon highlight the momentous discoveries in the area of mindfulness research, such as neuroplasticity, the phenomenon of structural changes in the brain including the ‘anterior cingulate cortex, insula, default mode network structures, left hippocampus, temporo-parietal junction, and frontal-limbic network’ (Shonin & Van Gordon, 2016). Further, mindfulness practices have been found to reduce automatic arousal and increase input from the vagus nerve, which is responsible for the regulation of heartbeat, breath and praised for being the source of resilience and self-regulation where we find ourselves in stressful situations (Sullivan, 2018). Additionally, mindfulness interventions in treatments have been found to shift perception to a more positive outlook and greater sense of presence. However, it is important to note that the success of mindfulness therapy is dependent on the patient condition under investigation- the educational, spiritual, and social history of the patient, and the type of mindfulness-based therapy administered. Such mindfulness practices have therefore been found to help enhance overall quality of life and our health. Therefore, if we can make a space in our clinical practice for patient-centred care interventions, we can enhance patient wellbeing and perhaps even the efficiency of the Investigational Product (IP) in trials.
Mindfulness and Medicine
Of course, pharmaceutical drugs do work. They are commonly tested against a placebo or comparison treatment during clinical trials, and so drugs are technically tested against the power of our mind. For a drug to pass through clinical trials, it must out-perform the placebo (or comparison drug). If we empower patients to use their minds alongside their treatments, we could see greater results and a reduction in negative side effects. Ellen Langer, who conducted the famous counterclockwise study mentioned in our previous article, has argued that mindfulness is indeed instrumental in the healing process. We are taught that some illnesses are chronic, which means they are beyond our control. This can crush the hopes of many to mindfully participate in their own healing process, and consequently leads them to solely focus on external substances such as pharmaceutical treatments (Langer, 2014). However, patients could be encouraged to participate in their own healing journey by healthcare professionals and in trials through the implementation of mindfulness interventions like visualisation, meditation, nutrition and movement, alongside pharmaceutical treatments.
Movement and Mind
Emma Barton conducted a study into mindfulness, movement and mental illness. This study followed patients with severe mental illnesses and recruited them into a ‘Movement and Mindfulness’ program that featured dance movement therapy, yoga therapy-based techniques, group counselling and adopted mindfulness strategies (Barton, 2011). Barton found that this approach to treating severe mental health illnesses offered patients practical life skills more beneficial to them than their previous traditional treatments. Patients also reported improved self-esteem, confidence, self-regulation ability, greater social relationships, and better communication skills. Another study similarly illustrates that patients using mind-body therapies for the purpose of healing reported both a change in their perception and reaction to negative emotions and sensations, manifested in the growth of resilience in dealing with pain, emotional regulation and positive outlook on difficult situations (Sullivan et al., 201). Literature about mindfulness interventions in health care can teach us the importance of movement, positive perception, group support, expected changes and the patient’s wish for clinical benefits. Such conditions may help treatments, as the mind and thoughts have already been found to be a powerful force in healing, as seen in the incredible degree of variance in placebo responses. If we can harness the power of the mind through mindfulness interventions, to coincide with an active ingredient, we can improve the current success of our treatments. Taking such an approach such as our cohesion model to clinical trials and healthcare, has the potential to revolutionise medicine as we know it.
The Cohesion Model
At Caritas Neuro Solutions, we apply what we call the Cohesion Model to our clinical trials when possible. In our clinical research trials, we incorporate mindfulness practices, to promote an improved quality of life and wellbeing throughout the clinical trial process. Interestingly, in her 2014 paper, Ellen Langer concludes that mindfulness is ‘always available, and results in better health, effectiveness, and happiness, it is likely to become the preferred choice to the normative version of being mindless’ (Langer, 2014). Such matters of mindlessness can be equated to clinical trials where the power of the mind and wellness are neglected. We are open to work with our clients and tailor the level of cohesion components in trials, whether they wish to incorporate a nutritious diet, meditation, breath work and CBT or simple meditation practices. We believe that our minds’ capacity to heal our bodies can be just as powerful as pharmaceutical, surgical, or behavioural treatment. By incorporating this into clinical trials, we believe that we can increase success rates of IPs and enhance the quality of lives. In addition, we want to help other businesses in the field of healthcare and pharmaceuticals provide the best treatment possible and sell a product that embraces the mind and body connection.
Opportunities for Growth
We want to provide greater research in the field of mindfulness interventions in therapies to diminish stigma around such practices as being ‘wishy washy’ and ‘hippy nonsense.’ Bridging the gap in scientific literature and research in the field of patient-centred clinical trials, can bring us closer to more effective treatments. The UK is living through a mental health crisis, and current treatments do not suffice. Further research is required in the field of mental distress and neuro degenerative diseases specifically, and we want to accelerate this to the level of research in other fields of illness such as oncology. According to the NHS website, it is still unknown exactly how antidepressant drugs work, yet it is speculated that they work through increasing levels of neurotransmitters in the brain, such as serotonin (NHS, 2021). The NHS website about antidepressant treatment furthermore states that antidepressants may work for as little as 50-65% of those with moderate-severe depression, which is better than a placebo, but may not work for those with mild depression. Counselling or psychotherapy is recommended by the NHS for ‘mild’ cases of depression (Mental Health UK, 2021). In their study on adolescents living with depression, Hollon et al found that medication paired with CBT eased symptoms of depression (Hollon, Garber & Shelton, 2005). This indicates that when medication is paired with patient centred practices, people can feel greater benefits of their treatment. Unsurprisingly, it appears that the UK is has some catching up to do in the field of mental health treatments. In countries such as the USA and Canada, more healthcare centres are incorporating a patient centred model into their practices and choosing more alternative routes for treatment over the traditional anti-depressant drugs. The developments that have arisen in other countries show us the possibilities of how we can similarly evolve our own treatments. For example, the emerging field and treatments developed using psychedelic drugs alongside prescribed psychotherapy. In March 2021, Awakn Clinic opened the first Ketamine psychotherapy clinic in the UK in Bristol (Ketibuah-Foley, 2021), while Toronto based Field Trip has opened multiple centres throughout North America and had many competitors in the same continent, in the past few years (Field Trip Health, 2021).
Conclusion
Overall, the power of the mind and the mechanisms which generate positive responses in patients can teach us many valuable lessons. First, that there is value in harnessing the mind of individuals to encourage their active participation in healing, through mindfulness interventions. Our Caritas Cohesion Model offers a method to bridge the mind and the body in clinical trials, by introducing mindfulness interventions alongside IPs to develop therapies best aligned to the patient. It has been proven that mindfulness can help enhance quality of life as well as have an active role in healing the body, comparable to medicines. Thus, mindfulness interventions can be utilised for healing patients and naturally puts them at the centre of our trials. We want to incorporate this in our research and encourage others to consider this model. Taking an approach that combines the mind and body offers enormous potential to revolutionise current treatments of mental and neurological illnesses, which is what we need to tackle our mental health crisis in the UK.
Bibliography
Barton, E. J. (2011). Movement and Mindfulness: A Formative Evaluation of a Dance/Movement and Yoga Therapy Program with Participants Experiencing Severe Mental Illness. American Journal of Dance Therapy(33), 157-181.
Field Trip Health. (2021). About us. Retrieved from Field Trip Health: https://www.fieldtriphealth.com/
Hollon, S. D., Garber, J., & Shelton, R. C. (2005). Treatment of Depression in Adolescents With Cognitive Behavior Therapy and Medications: A Commentary on the TADS Project. Cognitive and Behavioural Practice, 12(2), 149-155.
Ketibuah-Foley, J. (2021). First Ketamine-Assisted Psychotherapy Bristol Clinic Opens. Retrieved from BBC News: https://www.bbc.co.uk/news/uk-england-bristol-56170592
Langer, E. J. (2014). Chapter 1. Mindfulness Forwards and Back. In A. Le, C. T. Ngnoumen, & E. J. Langer, The Wiley Blackwell Handbook of Mindfulness (pp. 7-20). Wiley Blackwell.
Mental Health UK. (2021, May 2021). Treatments for Depression. Retrieved from Mental Health UK: https://mentalhealth-uk.org/help-and-information/conditions/depression/treatment/
National Institute for Care Excellence. (2010). Mindfulness Report. Retrieved from MentalHealth.Org: https://www.mentalhealth.org.uk/sites/default/files/Mindfulness_report_2010.pdf
NHS. (2021). Overview of Antidepressants. Retrieved from NHS: https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/antidepressants/overview/
Shonin, E., & Van Gordon, W. (2016). The Mechanisms of Mindfulness in the Treatment of Mental Illness and Addiction. International Journal for Mental Health and Addiction(14), 844-849.
Sullivan, M. B., Erb, M., Schmalzl, L., Moonaz, S., Noggle Taylor, J. and Porges, S. W. (2018). Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience. Frontiers in Human Neuroscience (12)67.
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