Final summary for everything
Lecture and literature 5
Consciousness: wakefulness and awareness
Coma: no awake, no aware
VS: awake but not aware
MSC: awake, fluctuating signs of awareness (producible non-reflective behaviours but unable to communicate)
Active neuroimaging paradigms:
identify non-reflexive brain activation patterns in response to commands
positive response: presence of consciousness
Tennis imagery paradigm (fMRI paradigm)
motor imagery (i.e., playing tennis) or spatial navigation mental imagery (i.e., walking in your house)
fMRI data are analyzed by detecting task-specific motor or spatial navigation neural activation
investigators used an increase in brain activation during attention to the words “yes”(imagine playing tennis) or “no”(imagine walking through your house) presented in a stream of numbers as a patient’s response to a command
task very specific: a positive effect can be safely considered as reflecting the presence of consciousness
task not very sensitive: a negative result can be due to many non-relevant factors (task performance requires many residual functions that are not directly related to consciousness, e.g. attention, memory, language)
Schankers (2008) EEG paradigm
sequences of names containing the patient’s own name are presented, in both passive and active conditions.
active condition: the patients instructed to count her or his own name or to count another target name (vs passive: no counting)
Cruse (2011) EEG paradigm
detecting oscillatory changes after the instruction to imagine squeezing one’s hand or moving one’s feet.
Limitation of active paradigms:
Negative findings are uninterpretable
only a minority, about 20%, of DOC patients can positively respond to this approach
negative results obtained with command-following approaches could be due NOT to patient unconsciousness, but to other reasons such as aphasia, apraxia, fluctuating vigilance, or simply the patient’s unwillingness to collaborate
Thus, negative findings in the active paradigm can never exclude the possibility that the patient has retained awareness!
Passive paradigms:
general measures of brain function
procedures without any specific instruction where the subject does not do anything in particular
PET measures paradigm
measures brain metabolism
decreased metabolism in frontoparietal cortices in VS/UWS patients resuming to normal after recovery of consciousness
In MCS patients, lateral frontoparietal area metabolism is preserved
MCS+ patients show preserved metabolism in language and sensorimotor areas
reduced metabolism may indicate a significant impairment or dysfunction of these brain areas, which are associated with higher-order cognitive functions and awareness.
EEG passive paradigm
higher delta power in VS/UWS and more frequent high delta power microstates in VS/UWS
VS/UWS patients do not present with preserved EEG sleep-wake patterns
the amplitude of low-frequency fluctuations of resting-state fMRI signal higher in MCS as compared with VS/UWS
VS/UWS patients showing more prominent and frequent delta wave activity, which is often associated with a deeper level of unconsciousness or reduced awareness
Response to stimuli paradigm
VS/UWS patients:
in response to stimuli, only primary sensory cortices activation
weak DMN activation in response to self-referential stimuli
DMN deactivation absent
MSC patients:
preserved higher-order areas of activation, including frontoparietal cortices, in response to sensory stimuli.
more widespread set of associative sensory cortices in response to sensory stimuli.
stronger DMN activation
DMN deactivation preserved
Mismatch Negativity (MMN)
early negative waveform that occurs in response to a deviant tone within a repetitive series of auditory stimuli.
presence of MMN may indicate a higher level of cognitive processing and responsiveness to changes in the auditory environment.
MMN is more frequently observed in individual MCS patients (compared to VS/UWS patients)
P3 component
long-latency positive waveform that is often observed in cognitive and sensory processing tasks
found more consistently in MCS patients, although it can be detected in some VS/UWS patients.
amplitude is generally higher in MCS patients, indicating a more robust brain response to cognitive tasks and sensory stimuli in this group.
So, MCS patients exhibit more robust and frequent MMN and P3 components in response to sensory and cognitive tasks when compared to VS/UWS patients.
→ their presence and higher amplitudes in MCS patients indicate a higher level of preserved cognitive function and responsiveness.
Preservation of Cerebral Connection
MCS patients, there may be better preserved neural pathways and connections involved in higher-order cognitive processing and sensory integration.
Functional Connectivity Studies
how different brain areas interact and communicate with each other
conducted during resting states or sensory stimulation and are based on the assumption that if brain areas causally interact, the time course of their activity should be correlated.
PET functional studies
impaired frontoparietal cortico-cortical and thalamo-cortical connectivity in VS/UWS patients
preserved PET functional connectivity in frontoparietal cortices, indicating a higher level of preserved functional interactions in MSC patients
Resting-state fMRI connectivity studies
preserved connectivity in both lateral and medial frontoparietal areas in MCS patients compared to VS/UWS patients. → MCS patients maintain stronger functional connectivity in these brain regions even during a resting state.
EEG functional connectivity studies
stronger frontoparietal connectivity in MCS patients compared to VS/UWS patients.
the organization of oscillatory brain connectivity in interacting modules, particularly within the Default Mode Network (DMN), is also preserved in MCS patients
Conclusion:
there is a link between preserved cerebral functional interactions and a higher level of consciousness in MCS patients
MCS patients exhibit more robust and widespread functional connectivity in various brain regions, particularly in frontoparietal areas, as well as within the DMN.
functional connectivity patterns are indicative of a higher level of consciousness in MCS patients, as they maintain better communication and interaction among different brain regions, even in the absence of external stimuli or tasks
MCS patients exhibit more intact and widespread brain interactions, suggesting a higher level of consciousness, including both arousal and cognitive functions
Limitations of neuroimaging techniques: +example
variability in PET findings (among those with preserved metabolism, only 1 may show a positive response to fMRI or EEG active paradigms)
challenges in interpretation (during epileptic seizures, PET metabolism can be normal, or even increased, even though subjects are unconscious)
lack of definitive markers: neuroimaging techniques not sufficient to diagnose consciousness
Integrated Information Theory (IIT)
consciousness is related to a system's capacity for information integration.
consciousness-supporting networks should exhibit an optimal balance between functional integration and differentiation.
Testing ITT with TMS-EEG
the technique showed clear differences in TMS-EEG responses between conscious and unconscious subjects in all tested conditions.
unconscious state: TMS typically triggers a stereotypical slow wave that stays local → breakdown of effective connectivity, indicating a lack of complex, widespread, and differentiated brain activation patterns.
conscious state: brain activation patterns in response to TMS are consistently complex, reflecting widespread and differentiated brain activity
so, conscious states show more complex and widespread responses, and unconscious states display stereotypical and local responses.
→ information integration, as assessed through effective connectivity, is linked to the presence of consciousness.
Clinical diagnosis of consciousness limitation:
subjective assessment:
behaviours such as smiling and crying are typically reflexive and automatic, but in certain contexts they may be the only means of communication available to a patient and therefore reflect a willful, volitional act of intention.
behaviours such as smiling and crying are typically reflexive and automatic, but in certain contexts they may be the only means of communication available to a patient and therefore reflect a willful, volitional act of intention.
Lecture and literature 6
Coronary heart diseases CHD: all disease that involve problems with the coronary heart muscle and the supply of blood from the coronary arteries.
stages of CVD:
the gradual subclinical disease progression
vulnerable disease stage
the presentation of acute coronary syndromes.
Coronary Atherosclerosis
the inside of an artery narrows due to the buildup of plaque.
as we get older, there will be gradual build-up of atherosclerotic plaque.
has a gradual disease progression (when 50% blocked - ischemia; 100% - MI/sudden death)
treatment: revascularization (opening up blocked arteries)
Percutaneous coronary intervention (PCI): used to re-open narrowed coronary arteries.
Coronary artery bypass graft (CABG) surgery: used to bypass narrow segments in the arteries.
Thrombolysis: used to re-open (nearly) completely blocked coronary arteries.
Risk factors for CHD:
modifable:
hypertension
diabetes mellitus
elevated lipid levels (like cholesterol)
smoking
overweight
psychosocial factors:
acute: anger, mental arousal
episodic: depression, exhaustion
chronic: trait anxiety, hostility, negative affectivity, lol SES
non-modifable:
age
sex (male)
genetic factors
Interplay of risk factors and disease stages
Acute risk factors: have critical important as a potential trigger of acute coronary syndromes in vulnerable individuals.
Chronic risk factors: are associated with increased reactivity to acute stressors and promote the risk of the development of episodic risk factors.
Episodic risk factors: are associated with an increased emotional and biological response to acute stressors.
Risk factors may have direct physiologic and biologic effects relevant to CAD progression.
Anger as a trigger of acute MI
The relative risk of onset of MI was biggest when the anger was experienced in the hour or 2 hours before the MI.
Hostility as a trigger of MI
Studies report associations between hostility and severity of underlying coronary disease as well as longitudinal association with incident MI. This latter association is stronger in younger than older men.
Myocardial Ischemia: imbalance between demand and supply
a condition that develops when cardiac demands exceed coronary blood supply to the heart muscle.
decreased cardiac supply (narrowing coronary arteries)
increased cardiac demand (hemodynamic reactivity: blood pressure, heart rate, contractility)
A drop in HRV (parasympathetic activity) is seen prior to ischemia.
30-70% of patients with CAD will develop ischemia in response to mental stress.
severe and sustained ischemia causes infarctions, but temporary stress-induced ischemia can be used to investigate the effects of acute emotional states on cardiac function.
in the laboratory, acute challenges (exercise and psychologic distress) can induce temporary ischemia by increasing cardiac demand.
Ischemia, emotions and activity
increased risk of ischemia was associated with negative emotions
as the day progresses, ischemia becomes less.
both physical and mental activity can result in ischemia during daily life, although physical activity shows more ischemia
INTERHEART: distress and MI
MI was associated with higher prevalence of all 4 stress factors (distress at at work, at home, financial distress and major life events in the past year, lower locus of control, and more depression.
Depression in patients with CVD:
prevalence 15-40%
associated with biological risk factors like inflammation
associated with adverse health behaviours like physical inactivity, poor diet, smoking, alcohol overconsumption, medication non-adherence
somatic depressive symptoms like fatigue, sleep problems and irritability are more common than depressed mood and anhedonia
Depression and inflammation
Depression is consistently related to elevated C-reactive protein (CRP) levels and other inflammatory markers such as IL-6 (this could partly explain the link between depression and CVD)
Neurohormonal and ANS dysregulation during distress
psychological distress is associated with:
sympathetic adrenomedullary (SAM) activation (including HPA hormones)
increased sympathetic nervous system activity
decreased parasympathetic activity.
These neurohormonal and ANS dysregulations contribute to a disruption of homeostasis and CVD progression either directly (increase in micro-organism antibodies), or via other biologic processes (increase of pro-inflammatory cytokines)
Depression and CNS
depression affects the CNS and, thus, CNS outcomes,
these biological changes result in changes in the immune system
changes in immune can result in plaque activation and pro- thrombotic (blood clot) state.
Finally, acute coronary syndrome can be the result.
Leukocytes and plaque
in atherosclerotic plaque, leukocytes (from the immune system) were found to be present. → immune system plays an essential role in the early stages of the atherosclerotic disease process.
C-reactive protein (CRP) is a global measure of inflammation, and it was shown that higher levels of CRP are indicative of elevated risk of cardiovascular events.
Lecture and literature 7
Lecture and literature 8
6 function of medical communication:
fostering the relationships: cooperation
gathering information: adequate diagnosis and interpretation of symptoms
providing information: well informed patient
decision making: reaching effective and preferred decision
enabling disease and treatment related behaviour: adequate and feasible disease and treatment-related patient behaviour
responding to emotions: support for patient, referral if needed
Trust and its dimensions
= trust in physicians is the optimistic acceptance of a vulnerable situation in which the patient believes the physician to care for his interests. It's hard to form a treatment relationship if there is no primary healthcare provider, or if there's no trust / interpersonal connection
Dimensions of trust:
competence: avoiding mistakes and producing best achievable results
honesty: telling the truth and avoiding intentional falsehoods
fidelity: putting patients’ interests first
caring: the time, attention and sympathy devoted to the patient
What’s determines trust?
research 1: uncertainty and gender
manipulations:
non-verbally expressed uncertainty,
verbally expressed uncertainty
gender
procedure and analysis:
2x2x2 design (8 different videos)
results:
Non-verbal communication of high uncertainty by the oncologist led to reduced trust
Neither verbal uncertainty nor oncologists' gender influenced trust
research 2: eye gaze
results:
The rate of clinician eye gaze towards the patient was highly variable : 15-80% of the consultation time
More face gaze towards patients associated with lower trust
Patients varied in treating the gaze shift as an indication to continue their turn or not.
conclusion:
Eye contact is not necessarily always related to stronger trust – further research is needed
Providing information
positive effects:
better relationship
Participation in decision making
Treatment adherence
Emotions (sense of control, reduces uncertainty, correctsdysfunctional cognitions)
when effective: giving an information in such a way, that the patient can hear, understand, recall and use this information
cognitive restrictions can impair this process:
selective attention (remembering things that are important to you)
limited memory capacity (forgetting things easily)
age (older people)
emotions (impaired performance because of strong anxiety)
Prognostic awareness and information preferences RESEARCH
prevalence and predictors of advanced cancer patients’ preference not to know prognosis.
prevalence and predictors of patients’ inaccurate perceptions of prognosis.
Methods: survey (prognostic information preferences and prognostic perceptions; + personal characteristics)
Results:
Around 1/3rd of patients don't want to know their prognosis
Agreement between physicians’ perceived and patients’ actual prognostic information preference was poor (kappa 0.066)
Agreement between physicians’ perceived and patients’ actual prognostic awareness was poor (kappa 0.186).
While a substantial group of advanced cancer patients prefer not to know prognosis and perceive prognosis discordantly from their physicians, physicians seem unaware
→ Physicians should explicitly ask whether patients want to know prognosis!
How physicians discuss uncertainty with patients RESEARCH
Method: Audio recording between physicians and parents differentiation between implicit and explicit uncertainty, the parent's reaction is also analysed
Results 1 :
Large variety of topics: Uncertain diagnosis, process of dying
Wide array of communication strategies
Mostly implicit uncertainty
3 Different stages, where the physician also changes their method of communication:
Phase 1: Unstable condition, additional diagnostic testing and care planning
Communication: Uncertainty related to diagnosis and diagnostic procedures, physicians providing short-term action plans and explanations
Phase 2: Deteriorating condition, limited treatment options
Communication: Uncertainties related to short-term prognosis, choice of treatment efficacy and risks, emphasizing uncertainties and sketching scenarios (providing reassurance)
Phase 3: Imminent death, treatments become futile
Communication: Eliminating uncertainties, except the process of dying
How did parents respond to discussed uncertainties?
Parents hardly responded to the discussed uncertainty
They did respond to some rarely observed communication strategies:
Checking their perspective on uncertainty
Providing emotional support
Acknowledging psychological impact of uncertainties.
Conclusions:
Providing the right amount of information in an adequate way is highly challenging for clinicians
Patients vary strongly in their information needs and also over time
Knowledge can enhance physicians' awareness and enhance their skills in discussing uncertainties
Improving shared decision making RESEARCH
incurable cancer patients (less than 1 year to live)
Hypothesis: oncologist training will improve shared decision making, especially when including all 4 steps of involving the patients in decision making (setting SDM agenda, informing, exploring values, making a decision) and patient communication aid (list of questions that they can potentially ask the clinician)
Outcome: to what extend the oncologist involved the patients (measured in simulated consultation with actor and actual consultation with patients)
Results:
simulated consultation: oncologists in the training group received higher score after training → the training had an effect on SDM
real consultations: the training did have an effect but there we no difference between training group and control in patient aid→ there were no added value of having both the training and patient aid
Conclusion:
Training oncologists in shared decision making has an effect on their performance in standardized and real consultations
Patient aid has no effect
Physical Health Status
the presence of pain and other symptoms,
objective disease markers (e.g., hemoglobin A1C, blood pressure, weight, prostate-specific antigen),
functional capacity (e.g., the ability to walk),
subjective self-ratings of health.
Regimens for improved physical health:
chemical (e.g., medication),
mechanical (e.g., surgery),
behavioral (e.g., lifestyle changes such as smoking cessation and dietary improvements),
psychological (e.g., placebo effects and cognitive therapy).
Role of Communication in enhancing Physical Health:
help identify the correct diagnosis and formulate an appropriate treatment plan, ensuring that the patient receives the most suitable care.
motivate patients to adhere to treatment or self-care regimens, improving their overall health.
impact patients' health beliefs, influencing their perceptions of treatment effectiveness and fostering a positive mindset.
Psychosocial health
psychological well-being, vitality, self-efficacy, and social functioning
influenced by the presence of positive beliefs and feelings, the absence of negative beliefs and feelings (e.g., worry, anger, anxiety, fear, despair), and the quality of one's social network.
measured through self-report assessments by patients (and sometimes family members
Impact of communication on health
direct:
validation: help a patient experience improved psychological well-being—fewer negative emotions (e.g., fear, anxiety) and more positive ones (e.g., hope, optimism, and self-worth)
physical symptoms: empathic communication lowered physiological arousal and pain in patients with irritable bowel symptoms
lessening anxiety/giving comfort: nonverbal behaviors, such as touch or tone of voice lessen anxiety and provide comfort
indirect:
satisfaction with care,
motivation to adhere,
trust in the clinician and system,
self-efficacy in self-care,
clinician–patient agreement,
shared understanding
→ can affect health or can contribute to the intermediate outcomes adherence, self-management skills, social support that lead to better health
7 pathways through which communication can lead to better health
increased access to care
communicating the need for a test or treatment,
providing information about where to get specific health services
facilitating collaboration among health professionals
advocating on behalf of the patient for needed clinical and community services
greater patient knowledge and shared understanding,
patients must have an understanding of illness, risks, and benefits of various treatment options in order to make informed decisions about medical care
clinicians need to understand a patient’s values, preferences, and beliefs about health
when successful, it can increase:
satisfaction
participation in the consultation,
the patient’s ability to cope with illness
greater trust in their clinicians
the patient’s commitment to treatment
higher quality medical decisions
reach decisions that are based on the best clinical evidence, are consistent with patient values, are mutually agreed upon, and are feasible to implement
medical decision-making proceeds through information exchange (clinician and patient perspectives), deliberation (finding common ground), making the decision
enhanced therapeutic alliances
mutual trust among all parties, coordinated and continuous health care, and the patient’s perception of feeling respected and cared for
can affect health outcomes in two respects:
a patient’s perception that he or she has good care, will not be abandoned, and is understood can promote emotional well-being, especially when facing serious and life-threatening illness
a patient’s trust in his or her clinicians and the health care system can have an indirect effect through better continuity of care, patient satisfaction with decisions, and patient commitment to treatment plan
enhanced when:
clinicians optimally informative and show empathy with the patient’s circumstances,
when patients have an opportunity to express their concerns
when the patient receives consistent messages and coordinated care from the clinical team
increased social support,
the perception of having social support → lowering arousal and reversing the effects of over-activation of hypothalamic-pituitary axis
providing a sense of connectedness with others and opportunities to discuss difficult situations
social support networks → instrumental help (e.g., transportation), financial resources, encouragement, and advocacy in gaining access to needed health services
the clinician’s communication itself → offer encouragement, praise, reassurance, advice, and advocacy
talk with patients about ways to strengthen existing social networks to provide tangible help, emotional support
suggest new sources of support such as online support networks
counter, or at least help address the effects of ‘negative’ social support (e.g., peer pressure to engage in unhealthy behaviors; well-intentioned nagging)
patient agency and empowerment
helping patients actively seek information, clarify treatment goals and express concerns and feelings
discussing topics with focus on autonomy, self- efficacy, specific skills in managing one’s health, and where to get access to self-care resources → lead to greater ability and motivation to solve health related problems, cope with complications, and follow-through with treatment
better management of emotions
providing clear and thorough explanations about health and treatment options → greater sense of control, be more hopeful, and manage uncertainty
eliciting, exploring, and validating patients’ emotions → reduce patient anxiety and depression
challenges in achieving high quality decisions:
many decisions are complicated by the lack of clinical evidence or evidence that is ambiguous or inconsistent
many patients have difficulty in understanding clinical information
clinicians and patients often understand risk differently. (analytically vs based on personal experience)
Shared decision-making SDM
patients work together with their clinicians to make informed choices about their medical care, taking into consideration their personal values, preferences, and the best available evidence regarding treatment options
SDM ensures that both the patient and the physician agree on the final treatment decision, even if it may not align with the physician's initial preference.
Essentials elements:
defining or explaining the problem,
presenting options,
discussing the pros and cons of each option,
assessing patient values or preferences,
discussing patient ability or self-efficacy,
providing doctor knowledge or recommendations,
checking or clarifying understanding,
making or explicitly deferring decisions.
4 steps:
Informing the patient that a decision is to be made and their opinion is important.
Explaining the options and their pros and cons.
Discussing the patient's preferences and supporting them in deliberation.
Discussing the patient's decisional role preference, making or deferring the decision, and discussing possible follow-up.
Challenges with SDM:
Lack of evidence on SDM outcomes
challenges in assessing SDM → there is little agreement between patient, professional, and observer reports on the occurrence of SDM.
The non-occurrence of professional-related aspects of SDM → the necessary professional behaviors for SDM were often not observed, and when observed, they were performed perfunctorily
Limited implementation of SDM in practice → the steps of SDM are seen to a limited extent in daily clinical practice.
Recommendations for risk communication:
percentages of natural frequencies (rather than chance words)
absolute rather than relative risk
avoiding Numbers Needed to Treat
using visual aids
Pitfalls in communicating benefits and harms of treatment:
implicit normativity
presenting the information in such a way that the patient is implicitly steered towards one specific option
the professional may, consciously or unconsciously, present one option as the logical one to choose, by for example the framing of the outcomes and the probabilities
“salesman” techniques
presenting treatment as an authorized ‘we’ decision,
selectively emphasizing the benefits or harms of treatment
downplaying the negative impact of treatment.
Lecture and literature 9
Effect of mindfulness interventions:
physical health
improve chronic pain management relative to TAU, with some initial evidence that mindfulness interventions may be superior to some active treatments (support groups, health education programs) but not to other treatments (CBT)
may reduce immune markers of pro-inflammation among stressed individuals and buffer declines in CD4+ T lymphocytes in HIV-infected adults
may reduce symptoms and improve quality of life across a broad range of stress-related conditions (e.g., fibromyalgia, IBS, breast cancer, psoriasis) and has positive impact on reducing the frequency and duration of illness
some initial RCT evidence that mindfulness interventions can
reduce smoking among heavy smokers
alter dietary behaviors such as eating sweets
improve self-reported and polysomnographic markers of sleep
Mental health
reduces the risk of depression relapse during follow-up periods among at-risk individuals
reduce depressive symptoms among individuals who are acutely depressed
MBRP (compared to standard relapse prevention programs) improves substance abuse outcomes and reduce drug use days and legal problems
significant reductions in drug relapse and relapse to heavy drinking.
reduce anxiety and PTSD symptomatology
cognitive outcomes
improve attention-related outcomes (e.g., sustained attention, working memory) and affective outcomes (e.g., reducing rumination).
reduce self-reported measures of negative affect and improve measures of positive affect in healthy populations.
interpersonal outcomes
improve basic processes associated with better interpersonal functioning, such as stress reductionand increased perspective-taking
positive effects on social functioning outcomes.
reduce loneliness among older adults and improving relationship satisfaction in adult couples.
Participants more likely to exhibit compassionate behaviors, such as giving up their chair to someone in need.
Psychological mechanism of mindfulness
self-reported mindfulness
increases in self-reported mindfulness have been associated with improvements in self-reported outcomes, such as reductions in perceived stress or anxiety symptoms
but half of the studies fail to show a significant increase in self-reported mindfulness
decentering
a mechanism of change involving observing internal experiences from a more objective third-person perspective which may help individuals respond more effectively to thoughts, emotions, and behaviors
self-reported increases in decentering have been found to mediate the effects of mindfulness interventions on outcomes like anxiety reduction and decreases in depressive symptoms.
acceptance and emotion regulation skills
home practice
Neurobiological mechanism of mindfulness
brain regions:
activation of the insula, putamen, somatosensory cortex, anterior cingulate cortex, and prefrontal cortex.
structural brain changes:
increase in gray matter density in brain regions like the hippocampus.
stress regulation:
increase in resting-state functional connectivity between the default mode network and the dorsolateral prefrontal cortex
decrease in stress-related resting-state functional connectivity between the amygdala and the subgenual anterior cingulate cortex.
educed stress biomarkers (cortisol, interleukin 6) at a 4-month follow-up.
affective activation:
increase in ventrolateral prefrontal cortex activity and amygdala-prefrontal connectivity associated with reductions in anxiety symptoms.
potential adverse reactions and cognitive effects of mindfulness interventions:
unpleasant reactions
experience of adverse events (resurfacing traumatic memories)
cognitive costs (cognitive effort required to adopt new mindfulness strategies could temporarily deplete self-regulatory strength)
disruption of cognitive processing (increased false memory recall)
Reduced stress and inflammatory responsiveness in experienced meditators compared to a matched healthy control group RESEARCH
results:
experienced meditators have lower TSST-evoked cortisol and perceived stress, as well as a smaller neurogenic inflammatory response compared to the control group.
Moreover, experienced meditators reported higher levels of psychological factors associated with wellbeing and resilience.
conclusion: These results suggest that the long-term practice of meditation may reduce stress reactivity and could be of therapeutic benefit in chronic inflammatory conditions characterized by neurogenic inflammation.