Assignment #3: My Intervention

                                    Assignment #3: My Intervention

Unfortunately, I have had to change the subject of my study, as my previous subject, Mary, became an unreliable and uninterested participant in it.  Given that she was the only viable fieldwork client I had for this project, I decided to use myself as a subject.  The behavior I would like to target is the covert one of stress and the element of this “behavior” I would like to monitor is a physical condition that appears to have at least largely a psychosomatic component.  I have a condition called “restless legs syndrome.”  It is a syndrome that causes its sufferers legs to feel uncomfortable when they are still.  In my case, I get cramping, originally in one or both of my upper legs and eventually the central ankle area of one leg, right above the foot area.  It began a few years ago, only occurring at night after I got into bed for the evening, usually commencing within the hour before I actually switched off the light to go to sleep.  (I tend to read and/or watch t.v. for a while before actually attempting to go asleep).  Soon after I started having this problem, I went to doctor for the condition and he prescribed a non-addictive drug called Neurontin to be taken as needed before bedtime.  Traditionally, I have taken it anywhere from biweekly, to weekly, to nightly.  Around seven months ago, I decided to stop taking the medication.  I had a bit of discomfort in the beginning, but it soon passed.  In the past month, I have started to need to take it again.  In the first couple of those weeks, and now, in the past two weeks, I am taking it nightly. 

Though my doctor never told me that there is a direct correlation between stress and my restless legs syndrome, he did not provide any medical reason for it either and I have seen a pattern where the amount of stress I am under is directly proportional to the amount I suffer from the condition.  The most dramatic example of this is that this past summer was an unusually low-stress period for me, yet in the past two months, I have been under more stress than usual.  Therefore, I have chosen two interventions to deal with my stress.  As a marker to be used of their efficacy, I am using not just the frequency of my restless leg syndrome, but the frequency of my Neurontin-taking.

Originally, the pair of interventions I was going to work with was a combination of mindfulness meditation and Dialectical Behavior Therapy (DBT).  Yet, it would turn out that latter would be problematic for two reasons.  One was that scholarly literature focused mainly on the therapy’s validity for such conditions borderline personality disorder, and not anxiety that occurred outside of the realm of that illness.  The other is that studies have shown that it has not yet met the criteria of evidence-based therapy except for suicidal gestures and self-injury.  (Ost, 2007; Dr. M. Goldman, personal communication, March, 2011).  Therefore I decided to replace that planned intervention with another one I will later discuss.

    There are many forms of meditation.  One form is called “mindful meditation.”  Interestingly DBT utilizes mindful meditation in its therapy. (Ost, 2007)  Mindfulness meditation involves focusing your mind on the present through specific breathing exercises that require you to be very aware of how your mind and body are experiencing certain prescribed breaths. (I will be mores specific in my next assignment as to what these prescribed breathing exercises are.)  To be “mindful” is to non-judgmentally be aware of your thoughts and actions.   (Wong, 2007).  I chose this form of meditation because I was able to find scholarly journal articles that supported its efficacy for stress reduction.   

A 1997 study examined the effects of an 8-week stress reduction program based on training in mindfulness meditation.  The study used twenty-eight volunteers who were then separated randomly into an experimental group or a non-intervention control group.  Following their participation, experimental subjects, in comparison to those in the control group, experienced greater gains in terms of reducing their overall psychological symptomology, improving their overall sense of feeling they had control in their lives, and scored higher on a measure done within the study of spiritual experiences.  The conclusion of the study was that mindful meditation, due to its emphasis on developing detached observation and awareness of the contents for consciousness, may represent a powerful cognitive behavioral coping strategy for transforming the ways in which we deal with life events and might also might aid preventing those with affective disorders from relapsing.  (Astin, 1997).

In 1990, another study was done on stress reduction through mindful meditation that was performed by a group that included MDs, Ph.Ds, and a doctor of education.  The study’s goal was to assess the efficacy of a mindful mediation-based group stress reduction program for anxiety disorder-sufferers.  The study used 22 people who met the DSM-II-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia.  Assessments, including self and therapist ratings, were gotten weekly before and after the participants engaged in the stress-reduction group and monthly for a three-month period after they finished it.  It turned out that 20 of the subjects had significant reductions in their scores for depression and anxiety-level tests they took.  This was true both right after their involvement in the group as well as during the follow-up period.  (Kabat-Zinn, Massion, et al., 1992).             

In 2000, a study was done in Canada by a group that included PhDs, an MSW and a PsyD.  Its goal was to discover whether mindfulness meditation could reduce mood disturbances and symptoms of stress in cancer patients.  A randomized-wait-list controlled design was used and a convenience sample of eligible cancer patients enrolled after giving informed consent.  They then were randomly assigned to either an immediate treatment condition or a wait-list control condition.  The subjects subsequently had to complete two assessments: one called the Profile of Mood States, the other called the Symptoms of Stress Inventory.  They then were required to participate in weekly mindfulness meditation group lasting 90 minutes for seven weeks plus home meditation practice.  A group of ninety people averaging 51 years old completed the study.  They were heterogeneous in type and stage of cancer.  After this meditation-based intervention, patients in the treatment group had significantly lower scored on Total Mood Disturbance tests and subscales measuring their anxiety, depression, anger, and confusion than the control subjects.  The group conducting the study concluded that the meditation program has been effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, illness stages and ages. (Speca, Carlson, et al).

The second type of intervention I have planned for myself is one of exercise.  Normally I exercise four times a week, but in the last month or so, I have been exercising less, approximately one to two times a week.  I was planning to return to my normal schedule anyway, and soon came to realize it might help my stress levels, which in turn, might help my restless legs syndrome.   Exercise has always had a reputation as a stress reducer, and I found a scholarly article that this reputation is a deserved one.  In 2000, a English study was done that showed that there is a “pattern of evidence [that] suggests the theory that exercise training recruits a process which confers enduring resilience to stress.” (Salmon, 2001, p.1). 

            Now that I have chosen my interventions, I am giving myself the following prescription.  I will begin to work out four times a week and engage in daily five- minute sessions of mindful meditation sessions.  After the first week, I will attempt to raise that number it seven minutes a day.  I know from my past experience with meditation that five minutes is quite difficult to achieve as it is and feels more like fifteen.  This is why am I only committing to small amounts of mediation per day.  I want to create a realistic goal regarding the practice.

            I will write about some of my experience with this pair of interventions in my next assignment. 

                                   

Reference List

Astin, J.A.. (1997).  Stress Reduction through Mindfulness Meditation: Effects on

Psychological Symptomology, Sense of Control, and Spiritual Experiences.

Psychotherapy and Psychosomatics. 66,97-106. (DOI: 10.1159/000289116).

Kabat-Zinn, J., Massion, A.O., Kristeller, J., Peterson, L.G., Fletcher, K.E., Pbert, L.,

Lenderking, W.R., Santorelli, S.F.. (July, 1992).  Effectiveness of a Meditation-Based Stress Reduction Program in the Treatment of Anxiety Disorders.  Am J Psychiatry.  149, (7), 936-943.

Ost, L-G.. (March, 2008).  Efficacy of third-wave behavioral therapies: A systematic

review and meta-analysis. Behaviour and Therapy.46 (3), 296-321.

Salmon, P.  February 2001.  Effects of physical exercise on anxiety, depression, and

sensitivity to stress: A unifying theory.  Clinical Psychology Review. 21(1), 33-61.

Speca, M., Carlson, L.E., Goodey, E, Angen, W.. (2000).  A Randomized, Wait-List

Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients. Psychosomatic Medicine.  62, 613-622. 

Wong, C.  (0ctober 25, 2007).  Mindfulness Meditation. About.com.  Retrieved on

March 5, 2011 from http://altmedicine.about.com/cs/mindbody.a.meditation.htm.

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