1. The effects of mindfulness meditation training on Type D personality Center of Research on Psychology in Somatic diseases Dr. Nina Kupper Dr. Sietze Graafsma Kirsten Cuppens Dr. Ivan Nyklicek

2. Acknowledgment & disclosure Co authors –Dr. Sietze Graafsma, internist and biologist @ TweeSteden hospital, trainer @ Zen.nl Tilburg (not involved in intervention) –Dr. Ivan Nyklicek, associate professor @ Tilburg University –Kirsten Cuppens, BCh student @ Tilburg University Funding: –Wetenschapsfonds TweeSteden hospital (vouchers for participation) No conflicts of interest to disclose

3. Meditation Improving attention Learn to control attention Mental fitness Benson H, Beary JF, Carol MP. The relaxation response. Psychiatry. 1974;37(1):37–46. Smith JC. Meditation, biofeedback, and the relaxation controversy. A cognitive-behavioral perspective. American Psychologist. 1986;41(9):1007–1009. Increasing awareness of how thoughts and emotions arise in response to various environmental events Reduces stress by … –Reducing somatic-arousal [Benson et al. 1974] –Altering cognitive appraisal & perceived self-efficacy [Smith, 1986]

4. Meditation - effects on mood & personality Reduces depression, anxiety, perceived stress & work stress [Manocha et al. 2011] Reduces distractive and ruminative thoughts and behaviors [Jain et al. 2007] Meditation practice has been associated with higher levels of openness and extraversion and lower levels of neuroticism and conscientiousness [van den Hurk et al. 2011] Manocha Ret al. Evid Based Complement Alternat Med. 2011;2011:960583. Jain S, et al. Ann Behav Med. 2007;33(1):11-21. van den Hurk et al. Mindfulness (N Y). 2011;2(3):194-200 Does meditation have an effect on the Distressed personality??

5. What is Type D (Distressed) personality –Negative affectivity (NA) Tendency to experience negative emotions (Watson & Pennebaker 1989) –Social inhibition (SI) Tendency to inhibit emotions and behaviors in social interaction (Asendorpf, 1993) Denollet. Psychosom Med 2005; 67:89-97 NA ≥10 <10 SI ≥10 <10 Other, non-Type D Type D personality

6. Methods 30 participants following the introductory meditation course at Zen.nl 21 age- and gender matched controls that did not follow any meditation course Zen meditation, directed at improving attention for optimal personal development in harmony with the envirnoment (same aim as mindfulness meditation) Chi square tests, paired t-tests,RM ANOVA and McNemar test for proportions in dependent samples 5 intervention participants dropped out at t1  final sample 25:21 Participants Intervention Analysis

7. Results: baseline characteristics CasesControls Type D personality39%19% Anxiety score (HADS)10.98.7 Depression score (HADS) 5.54.6 Perceived stress score17.012.4 Individuals that subscribed to the meditation training were significantly more emotionally distressed than the invited controls p=.04 p=.001 p=.051 p=.002 Intervention and control group were of equal age and had equal distributions of gender, educational level and marital status Total group was on average 44 years of age, predominantly female (76%), in a relationship (75%) and highly educated (54% Higher education)

8. Results: Intervention successful? YES: Participants in the intervention showed a significant improvement in mindfulness elements compared to controls FFMQ Δ MeanCasesControlsRM analysis Observe2.2 (5.1)**-0.51 (2.2)Within s. effect of time X condition; p=.03 Describe2.8 (3.4)**0.59 (3.1)Within s. effect of time X condition; p=.03 Act aware2.8 (3.4)**0.36 (2.8)Within s. effect of time X condition; p=.002 No judgment3.1 (5.0)**0.95 (3.4)NS (p=.10) Non reactivity3.8 (4.3)**0.70 (3.0)Within s. effect of time X condition; p=.01

9. Effect of meditation training on Type D personality characteristics The intervention significantly reduced levels of social inhibition in comparison with controls (p=.02) This reduction was much larger in Type Ds than in non-Type Ds (p=.01 vs. NS) Multivariate repeated measures ANOVA Levels of negative affectivity were also reduced (Δ = 1.8 vs. -0.2), without reaching significance in this analysis 0.4 SD 0.3 SD 0.5 SD change was used as a proxy for clinically relevant change

10. Type D personality and the change in level of mindfulness FFMQ Δ MeanCasesControls ObserveNS DescribeSystematically lower level in Type Ds (p=.002), equal improvement (p=.86) NS Act awareSystematically lower level in Type Ds (p=.003), equal improvement (p=.30) NS No judgmentSystematically lower level in Type Ds (p=.003), equal improvement (p=.86) NS Non reactivityStronger effect intervention in Type Ds (p=.06)NS Type D cases had significantly lower levels of mindfulness than the non Type Ds Type D cases only improved better on non reactivity P<.10 considered significant due to the small N of the Type D group

11. Type D personality and the change in emotional distress Type D individuals showed a larger reduction in anxiety over the intervention period than non Type Ds (p=.03) Systematic higher reports of anxiety in Type Ds compared to non-Type Ds (both in intervention and control group; p=.02) No significant findings for change in depression (nonsignificant reduction in Type Ds) Multivariate repeated measures ANOVA

12. Conclusions ZEN meditation improves mindfulness Preliminary evidence that individuals with a Type D personality seem to benefit from meditation training –Lower SI and NA scores SI improvement predominantly in Type Ds –Improved mindfulness elements (but improvement was equal to that of nonType Ds) –Reduced anxiety (but reduction was equal to that of nonType Ds)

13. Limitations Small sample size Small numer of Type Ds Relatively large drop out

14. Take home message

15. RESERVE SLIDES

16. No effect on Type D classification When excluding drop outs (mostly Type Ds) McNemar test for proportions in dependent samples

17. Effect of the intervention on Type D classification 5 intervention participants were no longer Type D after the intervention But there were also 5 intervention patients that became classified as Type D Type D > no Type DNo Type D > Type D 1 due to reduction in SI (11 pts)2 due to increase in SI (3-7 pts) 2 due to reduction in NA (3-4 pts)2 due to an increase in NA (2-4 pts) 2 due to reduction in NA & SI (4-9 pts)2 due to increase in NA & SI (1-2 pts)