There is lots of talk about mindfulness these days: mindful eating, mindful breathing, mindfulness meditation, even mindful leadership. The benefits might all sound a little too good to be true but it turns out that there's more to mindfulness than meets the eye.
A growing body of research has found that mindfulness can help improve the quality of life of people living with HIV. Studies have found that mindfulness-based cognitive therapy (MBCT) can quickly and significantly improve people's emotional and mental health. And the kicker is that it may raise CD4 counts, too.
|What Is MBCT?|
Mindfulness-based cognitive therapy (MBCT) teaches us to become more conscious of what we're thinking and feeling in the present moment. As a result, we change our relationship with those thoughts and feelings. Dr. Evan Collins, a psychiatrist who leads MBCT groups in Toronto and has been living with HIV since the 1980s, says, "Mindfulness is like surfing: We can't always control the waves of stress, depression or anxiety that life with HIV brings, but instead of letting them drag us under water we can learn to ride above them."
MBCT involves learning various meditation practices, many of which begin with focusing your attention on your breathing. As your attention wanders, you are encouraged to acknowledge your thoughts and feelings without judging them, and to redirect your attention back to your breathing. Eventually, you can start to explore your troubling feelings and thoughts more directly.
Therapy typically involves a series of weekly sessions in which participants learn about the effects of stress and emotions on their mind and body and how to use mindfulness to handle stressful situations.
We know that stress, depression and anxiety can all affect the immune system and accelerate the progression of HIV infection. These conditions can also interfere with a person taking their HIV treatment every day. The flip side is that managing these conditions through interventions such as MBCT not only makes you feel better but may also help protect the immune system.
One large Canadian clinical trial examining the effects of mindfulness-based stress reduction on 117 men living with HIV showed that mindfulness was effective for developing a more helpful relationship to unwanted thoughts and emotions, including HIV-related worries. The men who participated in this study also reported less stress as well as increased hope, enthusiasm and life enjoyment. Another study found that mindfulness decreased the side effects of antiretroviral therapy (ART).
One of the most striking pieces of research into MBCT came out of a study of long-term survivors in Barcelona, Spain. All 40 study participants had been diagnosed with HIV prior to 1996 and had been on ART for at least five years. Half the participants attended MBCT classes for two and a half hours each week, over the course of eight weeks. These participants were also given CDs for guided mindfulness meditation, yoga and exercises. They were encouraged to practice for 45 minutes per day, six days a week. The other half (the control group) did not do mindfulness-based therapy.
The Striking Results
Depression levels dropped -- Over the course of the study, rates of depression dropped significantly among the participants who received MBCT. At the start of the study, researchers found that about four out of every five participants showed signs of depression. By week 20, only one in five participants who had received MBCT experienced symptoms of depression -- and the intensity of their depression was graded by the research team as mostly "minimal." By contrast, the rate and intensity of depression remained relatively high among the participants who did not do MBCT.
Anxiety levels diminished -- Anxiety levels fell significantly among participants who did MBCT but not among people in the control group. By week 20, symptoms of anxiety continued to be low among participants who did MBCT.
Quality of life improved -- Stress levels were generally high among participants at the start of the study. Only in the MBCT group did those levels fall significantly and remain low. The participants from the MBCT group also reported a large and significant improvement in their quality of life, whereas the control group did not report such improvements.
CD4 counts rose -- The CD4 counts of participants who received MBCT increased -- starting at 555 cells, then rising to 614 cells at week 8 and to 681 cells at week 20. By contrast, the CD4 counts of the control group remained stable.
Most of these findings are in line with those reported from earlier studies. But the change in CD4 counts among MBCT participants, though not statistically significant, was unexpected. It cannot be explained by changes in HIV treatment regimens, as none of the participants changed their meds during the study. There were also no changes in the proportion of participants whose viral load fell below the 20 copies/ml mark. Such changes, had they occurred, could have had an impact on CD4 count.
So, why the increase in CD4 cells? The researchers point to previous studies that found that mindfulness exercises are associated with decreased levels of blood proteins that are linked to inflammation (for more on inflammation, see Ask the Experts on page 26). The Spanish researchers theorize that by improving the emotional health of participants with MBCT, levels of inflammation were likely reduced, which, in turn, could have helped raise CD4 counts. But more research is needed before this theory can be confirmed.
Due to the relatively small size of the Spanish trial and the lack of long-term followup, we cannot say with certainty that mindfulness-based approaches will work for every HIV-positive person who is experiencing depression and anxiety, but a growing body of research suggests that this approach looks extremely promising.