Reference
Carmody JF, Crawford S, Salmoirago-Blotcher E, et al. Mindfulness training for coping with hot flashes: results of a randomized trial. Menopause. 2011;18(6):611-20.
Design
Randomized, non-blinded clinical trial
Participants
110 women aged 47–69 years experiencing an average of 5 or more moderate or severe hot flashes (including night sweats)/day
Study Intervention and Frequency
Subjects were randomized to 8 weekly 2.5-hour Mindfulness-Based Stress Reduction (MBSR) classes, plus an all-day class on a weekend day during the 6th week and received 2 CDs of guided instruction to be practiced at home on days they did not have class. Alternately, they were assigned to a wait-list control (WLC) group.
Main Outcome Measures
Bothersomeness and intensity of hot flashes and night sweats, and their impact on quality of life, sleep quality, anxiety, and perceived stress.
Key Findings
Reported intensity of hot flashes in the women who participated in the MBSR training was lower but did not reach statistical significance. The degree of ‘bother’ reported in the participants was also lower and reached significance 5 weeks into the training program. The total decrease in bother from hot flashes for the MSBR group was 21.62% (P<0.0001) versus 10.50% (P= 0.016) for the WLC group. The MSBR group also reported clinical but not statistically significant improvements in quality of life (P=0.022), sleep quality (P=0.009), anxiety (P=0.005) and perceived stress (P=0.001). The results were sustained for at least 3 months after the completion of the study.
Practice Implications
For women in menopause, hot flashes remain an irksome problem and may be recalcitrant to many treatments. As humans, we are conditioned to react according to habit patterns that develop within the mind based upon stimulus from the body. It is these reactions that further intensify our experience of suffering. This is frequently seen in menopause: Negative emotions and psychological distress are reported in conjunction with hot flashes.
Yoga has in some reports improved menopausal symptoms. So have trials with various meditation techniques.
In this particular study, participants were trained in Mindfulness-Based Stress Reduction (MSBR). This is a program developed by Jon Kabat-Zinn at the Center for Mindfulness at the University of Massachusetts Medical Center in 1979. MSBR has become a central feature in many hospital-based 'integrative' medical clinics. Because the MBSR program is systematized and widely used in hospital settings, it has also been widely studied. The program consists of 8 classes, during which meditation instruction is provided. The teaching includes various types of meditation in the form of a body scan meditation, Hatha yoga postures, and sitting meditation.
A similar but smaller pilot study on MBSR and menopausal symptoms was conducted by the same research group and published in 2006. This earlier trial reported much better results. In particular, hot flash severity had decreased by 40%.
Proponents claim that MBSR training offers a tool to increase the capacity to maintain equanimity to experiences such as thoughts, feelings, and sensations. In essence, mindfulness and MBSR training teaches participants to sit with pain or discomfort in a non-reactive way.
Proponents claim that MBSR training offers a tool to increase the capacity to maintain equanimity to experiences such as thoughts, feelings, and sensations.
In this current paper, MBSR failed to significantly decrease the intensity or frequency of hot flashes. It did affect the perception of stress and capacity to deal with symptoms arising in the body during a hot flash. The degree of bother reported from hot flashes and night sweats in the mindfulness group decreased over time, indicating time and persistence using mindfulness techniques may be key to obtaining beneficial results. At 20 weeks from baseline, reported bother in course participants was reduced by almost 25% from their initial scores. The control group, who did not receive training, reported an approximately 12% decrease in bother at week 16.
