A Pilot Randomized Controlled Trial Investigating MBSR for Parkinson’s Disease Patients and Their Caregiving Partners: Effects on Distress, Social support, Cortisol, and Inflammation

“Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder characterized by neurodegeneration of dopamine-producing neurons in the substantia nigra, an area in the brain involved in controlled movement and coordination (Hughes et al., 1992) and other non-motor pathways.”

“It is plausible mindfulness training increased introspective awareness and approach toward internal experience (Kabat‐Zinn, 2003) leading patients to become more aware of internal experience, which may have involved distress and intrusive thoughts about their disease.”

“Disease-Specific Distress: The Impact of Events Scale (IES) is a 15-item self-report measure assessing the impact of events perceived as distressing (Horowitz et al., 1979).”

“…dyads in the management of non-motor, stress-related changes associated with PD. MBSR is a widely known clinical stress reduction program established by Kabat-Zinn (1982) that teaches mindfulness principles and practices through awareness exercises, body scan, sitting meditation, and hatha yoga.”

“Inclusion criteria for patient participants consisted of (1) a diagnosis of idiopathic PD within 3 years based on the UK PD Brain Bank criteria (Gibb & Lees, 1988); (2) stage II or III according to the Hoehn and Yahr Parkinson’s Disease Severity Scale (Hoehn & Yahr, 1998); (3) adequate cognitive…”

“Yet these biomarkers have not been examined among caregiving partners of individuals with PD. Exploration into these markers of health could elucidate caregivers’ reports of a decline in health (Schrag et al., 2006) as well as caregiving as a risk factor for mortality (Schulz & Beach, 1999).”

“…number of non-motor changes that accompany PD, including disease-related distress, depression, anxiety, sleep disruption, including rapid eye movement (REM) sleep behavior disorder, and pain, which can lead to poorer disease outcomes and quality of life (Broen et al., 2016; Chaudhuri et al., 2006).”

“The Interpersonal Support Evaluation List (ISEL) is a 40-item self-report measure designed to assess the perceived availability of social report and overall functional support (Cohen & Hoberman, 1983).”

“It is well documented that chronic stress is linked to poorer hypothalamic–pituitary–adrenal (HPA) function, meaning higher diurnal mean cortisol and flatter diurnal cortisol slope (Miller et al., 2007) as well as poorer immune function (Dhabhar, 2014).”

“…or III according to the Hoehn and Yahr Parkinson’s Disease Severity Scale (Hoehn & Yahr, 1998); (3) adequate cognitive functioning defined as a score ≥ 25 on the Mini-Mental Status Examination (MMSE; Folstein et al. (1983); (4) ≥ 40 years of age; and (5) proficiency in written and spoken English.”

“It is well documented that chronic stress is linked to poorer hypothalamic–pituitary–adrenal (HPA) function, meaning higher diurnal mean cortisol and flatter diurnal cortisol slope (Miller et al., 2007) as well as poorer immune function (Dhabhar, 2014).”

“MBSR was designed for chronically ill patients and has since demonstrated both psychological and physiological benefits across many clinical populations (Bohlmeijer et al., 2010; Ledesma & Kumano, 2009), making it a promising approach for those afflicted by PD.”

“Patients completed two physical movement tests, the Berg Balance Scale (Qutubuddin et al., 2005) and the Get up and Go Test (Morris et al., 2001), to ensure their ability to participate in the yoga portion of MBSR. Partners completed a brief interview on their caregiving experience.”

“…neurodegeneration, a symptom of PD, or a result of dopaminergic treatment, because circadian dysregulation promotes neuroinflammation and neurodegeneration (Leng et al., 2019), non-pharmacologic interventions, such as MBSR, that evidence healthy shifts in these neurobiological systems is promising.”

“In one study, caregiver burden correlated with patients’ depression and quality of life (Schrag et al., 2006), and patients’ non-motor symptoms have demonstrated a greater contribution to caregiving burden than motor symptoms (Mosley et al., 2017).”

“In addition to the neurologic changes that are characteristic of PD, a growing number of studies have evidenced poorer physiological and immune function among patients with PD, including elevated mean cortisol levels (Breen et al., 2014), flattened diurnal cortisol slopes (Hartmann et al., 1997), and elevated proinfla…”

“MBSR was designed for chronically ill patients and has since demonstrated both psychological and physiological benefits across many clinical populations (Bohlmeijer et al., 2010; Ledesma & Kumano, 2009), making it a promising approach for those afflicted by PD.”

“…number of non-motor changes that accompany PD, including disease-related distress, depression, anxiety, sleep disruption, including rapid eye movement (REM) sleep behavior disorder, and pain, which can lead to poorer disease outcomes and quality of life (Broen et al., 2016; Chaudhuri et al., 2006).”

“…findings are particularly noteworthy given the growing evidence demonstrating significant alterations to the circadian system (Bordet et al., 2003; Breen et al., 2014) and increased inflammation (Alam et al., 2016) with the development and progression of PD. Circadian dysregulation, which…”

“…and immune function among patients with PD, including elevated mean cortisol levels (Breen et al., 2014), flattened diurnal cortisol slopes (Hartmann et al., 1997), and elevated proinflammatory cytokines, including IL-6, IL-1beta, TNF-alpha, and CRP (Reale et al., 2009; Song et al., 2009).”

“Although PD is most commonly recognized by motor symptoms, defined as bradykinesia plus resting tremor or rigidity (Postuma et al., 2018), there are a number of non-motor changes that accompany PD, including disease-related distress, depression, anxiety, sleep disruption, including rapid eye…”

“While these results contradict initial hypotheses, Baer et al. (2019) have noted that participation in mindfulness-based programs involves experiencing discomfort; unwanted thoughts, emotions, and sensations are expected to arise during practice.”

“Patients completed two physical movement tests, the Berg Balance Scale (Qutubuddin et al., 2005) and the Get up and Go Test (Morris et al., 2001), to ensure their ability to participate in the yoga portion of MBSR. Partners completed a brief interview on their caregiving experience.”

“Defined in terms of emotional, instrumental, and/or informational assistance (Finfgeld-Connett, 2005), an individual’s spouse, partner, children, family, friends, colleagues, neighbors, and/or community members can provide social support.”

“In one study, caregiver burden correlated with patients’ depression and quality of life (Schrag et al., 2006), and patients’ non-motor symptoms have demonstrated a greater contribution to caregiving burden than motor symptoms (Mosley et al., 2017).”

“Similarly, elevated levels of proinflammatory markers have been linked to more severe instances of non-motor symptoms, including depression (Lindqvist et al., 2013), and higher proinflammatory/lower anti-inflammatory markers have been shown to predict more rapid progression of motor symptoms…”

“…growing evidence demonstrating significant alterations to the circadian system (Bordet et al., 2003; Breen et al., 2014) and increased inflammation (Alam et al., 2016) with the development and progression of PD. Circadian dysregulation, which promotes neuroinflammation, has been proposed as a risk…”

“These findings are particularly noteworthy given the growing evidence demonstrating significant alterations to the circadian system (Bordet et al., 2003; Breen et al., 2014) and increased inflammation (Alam et al., 2016) with the development and progression of PD. Circadian dysregulation, which…”

“Given the well-established beneficial effects of social support in the context of medical illness (Wang et al., 2003), it is no surprise that social support has been shown to ameliorate the effects of disease among individuals with PD as well (Simpson et al., 2006).”

“Alternatively, MBSR could have improved sleep and/or autonomic regulation (Brand et al., 2012) leading to observed improvements in biomarkers of circadian and immune function.”

“Diurnal cortisol slope was calculated excluding post-waking samples using the unstandardized beta of natural log-transformed cortisol regressed on collection time (Kraemer et al., 2006).”

“…processes that promote health and protect against disease, and dysregulated circadian function has been associated with a number of disease states (Gibson et al., 2009), an intervention that evidences healthy biological shifts in both PD patients and their caregiving partners who are at risk for…”

“Half of these caregivers demonstrated increases in depression and two-thirds indicated a decline in social activities, which is noteworthy given that perceived social support is protective against caregiver burden (Edwards & Scheetz, 2002).”

“Lastly, we acknowledge the limitations associated with the use of TAU as a control condition (Kazdin, 2015), but remain encouraged by the promising results of the current investigation.”

“It is also possible that potential benefits did not emerge until beyond the conclusion of the intervention and our assessment time point (Dobkin & Zhao, 2011).”

“A pilot study conducted by Cash et al. (2016) demonstrated an increase in mindfulness and language-functioning and a decrease in symptoms of depression following MBSR among PD patients and their caregivers/family members.”

“Given the well-established beneficial effects of social support in the context of medical illness (Wang et al., 2003), it is no surprise that social support has been shown to ameliorate the effects of disease among individuals with PD as well (Simpson et al., 2006).”

“In a recent study conducted by Baer et al. (2021), two-thirds of a non-medically ill sample (N = 158) reported unpleasant experiences associated with mindfulness practice during an 8-week mindfulness course, but the majority (85–92”

“Evidence of improved social support is notable given that caregiving spouses of patients with PD have reported a progressive loss of social contacts as the disease worsens (Roland et al., 2010).”

“Patients with PD have reported mental and psychosocial symptoms to be more severe and distressing than problems related to motor-related difficulties (Abudi et al., 1997; Backer, 2000; Habermann, 1996).”

“Emerging evidence suggests disrupted circadian rhythmicity may not only be linked to non-motor symptoms of PD, such as poor sleep (Breen et al., 2014), but may be integral to the pathology of the disease and may even accelerate the disease (Willison et al., 2013).”

“Patients with PD have reported mental and psychosocial symptoms to be more severe and distressing than problems related to motor-related difficulties (Abudi et al., 1997; Backer, 2000; Habermann, 1996).”

“…and immune function among patients with PD, including elevated mean cortisol levels (Breen et al., 2014), flattened diurnal cortisol slopes (Hartmann et al., 1997), and elevated proinflammatory cytokines, including IL-6, IL-1beta, TNF-alpha, and CRP (Reale et al., 2009; Song et al., 2009).”

“Patients with PD have reported mental and psychosocial symptoms to be more severe and distressing than problems related to motor-related difficulties (Abudi et al., 1997; Backer, 2000; Habermann, 1996).”

“These stressors can translate to caregiving burden (Karlstedt et al., 2020), fatigue, and difficulty with adjustment (Martinez-Martin et al., 2005), potentially leading to a decline in the caregiver’s health.”

“…dispositional mindfulness demonstrate less stress and depressive symptoms and greater social support, sleep quality, and health-related quality of life (Hicks et al., 2019), further evidencing mindfulness as an appropriate intervention for coping with stress-related symptoms among this population.”

“The largest effectiveness trial found a significant reduction in Hospital Anxiety and Depression Scale (HADS) following Mindfulness Yoga ( n = 71) compared to an active control ( n = 67) (Kwok et al., 2019); an effectiveness trial with a smaller sample size ( n = 33 in each arm) reported a greater reduction in the Ger…”