***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND This study examined the effects of an 8-week stress reduction program based on training in mindfulness meditation . Previous research efforts suggesting this program may be beneficial in terms of reducing stress-related symptomatology and helping patients cope with chronic pain have been limited by a lack of adequate comparison control group . METHODS Twenty-eight individuals who volunteered to participate in the present study were r and omized into either an experimental group or a nonintervention control group . RESULTS Following participation , experimental subjects , when compared with controls , evidence d significantly greater changes in terms of : ( 1 ) reductions in overall psychological symptomatology ; ( 2 ) increase in overall domain-specific sense of control and utilization of an accepting or yielding mode of control in their lives , and ( 3 ) higher scores on a measure of spiritual experiences . CONCLUSIONS The techniques of mindfulness meditation , with their emphasis on developing detached observation and awareness of the contents of consciousness , may represent a powerful cognitive behavioral coping strategy for transforming the ways in which we respond to life events . They may also have potential for relapse prevention in affective disorders Fibromyalgia is a chronic illness characterized by widespread pain , fatigue , sleep disturbance , and resistance to treatment . The purpose of this study was to evaluate the effectiveness of a meditation-based stress reduction program on fibromyalgia . Seventy-seven patients meeting the 1990 criteria of the American College of Rheumatology for fibromyalgia took part in a 10-week group outpatient program . Therapists followed a carefully defined treatment approach and met weekly to further promote uniformity . Patients were evaluated before and after the program . Initial evaluation included a psychiatric structured clinical interview ( SCID ) . Outcome measures included visual analog scales to measure global well-being , pain , sleep , fatigue , and feeling refreshed in the morning . Patients also completed a medical symptom checklist , SCL-90-R , Coping Strategies Question naire , Fibromyalgia Impact Question naire , and the Fibromyalgia Attitude Index . Although the mean scores of all the patients completing the program showed improvement , 51 % showed moderate to marked improvement and only they were counted as " responders . " These preliminary findings suggest that a meditation-based stress reduction program  is effective for patients with fibromyalgia Generalized anxiety disorder ( GAD ) is a chronic anxiety disorder , associated with comorbidity and impairment in quality of life , for which improved psychosocial treatments are needed . GAD is also associated with reactivity to and avoidance of internal experiences . The current study examined the efficacy of an acceptance-based behavioral therapy aim ed at increasing acceptance of internal experiences and encouraging action in valued domains for GAD . Clients were r and omly assigned to immediate ( n = 15 ) or delayed ( n = 16 ) treatment .  Acceptance-based behavior therapy led to statistically significant reductions in clinician-rated and self-reported GAD symptoms that were maintained at 3- and 9-month follow-up assessment s ; significant reductions in depressive symptoms were also observed . At posttreatment assessment 78 % of treated participants no longer met criteria for GAD and 77 % achieved high end-state functioning ; these proportions stayed constant or increased over time . As predicted , treatment was associated with decreases in experiential avoidance and increases in mindfulness Background : Mindfulness-based stress reduction ( MBSR ) proposes a systematic program for reduction of suffering associated with a wide range of medical conditions . Studies suggest improvements in general aspects of well-being , including quality of life ( QoL ) , coping and positive affect , as well as decreased anxiety and depression . Methods : A quasi-experimental study examined effects of an 8-week MBSR intervention among 58 female patients with fibromyalgia ( mean , 52 ± 8 years ) who underwent MBSR or an active social support procedure .  Participants were assigned to groups by date of entry , and 6 subjects dropped out during the study . Self-report measures were vali date d German inventories and included the following scales : visual analog pain , pain perception , coping with pain , a symptom checklist and QoL. Pre- and postintervention measurements were made . Additionally , a 3-year follow-up was carried out on a subgroup of 26 participants . Results : Pre- to postintervention analyses indicated MBSR to provide significantly greater benefits than the control intervention on most dimensions , including visual analog pain , QoL subscales , coping with pain , anxiety , depression and somatic complaints ( Cohen d effect size , 0.40–1.10 ) . Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures ( effect size , 0.50–0.65 ) . Conclusions : Based upon a quasi-r and omized trial and long-term observational follow-up , results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients & NA ; Acceptance of chronic pain  is emerging as an important concept in underst and ing ways that chronic pain sufferers can remain engaged with valued aspects of life . Recent studies have relied heavily on cross‐sectional investigations at a single time point . The present study sought to prospect ively investigate relations between acceptance of chronic pain and patient functioning .  A sample of adults referred for interdisciplinary treatment of severe and disabling chronic pain was assessed twice , an average of 3.9 months apart . Results showed that pain and acceptance were largely unrelated . Pain at Time 2 was weakly related to measures of functioning at Time 2 . On the other h and , acceptance at Time 1 was consistently related to patient functioning at Time 2 . Those patients who reported greater acceptance at Time 1 reported better emotional , social , and physical functioning , less medication consumption , and better work status at Time 2 . These data suggest that willingness to have pain , and to engage in activity regardless of pain , can lead to healthy functioning for patients with chronic pain . Treatment outcome and process studies may demonstrate the potential for acceptance‐based clinical methods for chronic pain management OBJECTIVE The effectiveness of an attention distracting and an attention focusing guided imagery as well as the effect of amitriptyline on fibromyalgic pain was studied prospect ively . METHODS Fifty-five women with previously diagnosed fibromyalgia were monitored for daily pain ( VAS ) in a r and omized , controlled clinical trial . One group received relaxation training and guided instruction in " pleasant imagery " ( PI ) in order to distract from the pain experience ( n=17 ) . Another group received relaxation training and attention imagery upon the " active workings of the internal pain control systems " , " attention imagery " ( AI ) ( n=21 ) . The control group ( CG ) received treatment as usual ( n=17 ) . Patients were also r and omly assigned to 50-mg amitriptyline/day or placebo . Some psychological and socio-demographic variables were also measured initially . The slopes of diary pain ratings over a 4-week period were used as the outcome measures . RESULTS We found significant differences of the pain-slopes between the three psychological conditions ( P=0.0001 ) . The pleasant imagery ( P<0.005 ) , but not the attention imagery group 's slope , declined significantly when compared with the control group ( P>0.05 ) . There was neither a difference between the amitriptyline and placebo slopes ( main effects , P=0.98 ) nor a significant amitriptyline x psychological interaction ( P=0.76 ) . CONCLUSION Pleasant imagery ( PI ) was an effective intervention in reducing fibromyalgic pain during the 28-day study period . Amitriptyline had no significant advantage over placebo during the study period Through empirical methods we now characterize patients with chronic pain as either dysfunctional , interpersonally distressed , or adaptive copers . Study ing factors that differentiate these groups may reveal the behavioral processes that determine adjustment to pain . Subjects for this study were 190 patients referred for treatment of chronic pain . They were classified as dysfunctional ( n = 41 ) , interpersonally distressed ( n = 28 ) or adaptive copers ( n = 59 ) based on the Multidimensional Pain Inventory ( Kerns , R.D. , Turk , D.C. and Rudy , T.E. , The West Haven-Yale Multidimensional Pain Inventory ( WHYMPI ) , Pain , 23 ( 1985 ) 345 - 356 ) and compared on measures of  pain-related anxiety and pain acceptance .  Our analyses showed that the dysfunctional group reported greater pain-related anxiety and less acceptance of pain than the other groups . Additional analyses , statistically controlling for pain severity and depression , showed that the patient subtypes continued to differ on pain-related anxiety and acceptance . Discriminant function analyses including pain-related anxiety and acceptance correctly classified 72.5 % of dysfunctional and 90.9 % of adaptive copers . Again , anxiety and acceptance contributed uniquely to classification independent of depression and pain intensity . Pain-related anxiety and acceptance of pain appear to be unique behavioral dimensions of adjustment to chronic pain . Decreasing anxiety and increasing acceptance may ' move ' patients with chronic pain from the dysfunctional to the adaptive coper category OBJECTIVE The aim of this study was to compare the effect of a short-term intensive residential yoga program with physical exercise ( control ) on pain and spinal flexibility in subjects with chronic low-back pain ( CLBP ) . DESIGN This was a wait-list , r and omized controlled study . SETTING The study was conducted at a residential integrative health center in Bangalore , South India . SUBJECTS Eighty ( 80 ) subjects ( females , n = 37 ) with CLBP , who consented were r and omly assigned to receive yoga or physical exercise  if they satisfied the selection criteria . INTERVENTION The intervention consisted of a 1-week intensive residential yoga program comprised of asanas ( physical postures ) design ed for back pain , pranayamas ( breathing practice s ) , meditation , and didactic and interactive sessions on philosophical concepts of yoga . The control group practice d physical exercises under a trained physiatrist and also had didactic and interactive sessions on lifestyle change . Both of the groups were matched for time on intervention and attention . OUTCOME MEASURES Pain-related outcomes were assessed by the Oswestry Disability Index ( ODI ) and by spinal flexibility , which was assessed using goniometer at pre and post intervention . Data were analyzed using repeated measures analysis of variance ( RMANOVA ) . RESULTS Data conformed to a Gaussian distribution . There was a significant reduction in ODI scores in the yoga group compared to the control group ( p = 0.01 ; effect size 1.264 ) . Spinal flexibility measures improved significantly in both groups but the yoga group had greater improvement as compared to controls on spinal flexion ( p = 0.008 ; effect size 0.146 ) , spinal extension ( p = 0.002 ; effect size 0.251 ) , right lateral flexion ( p = 0.059 ; effect size 0.006 ) ; and left lateral flexion ( p = 0.006 ; effect size 0.171 ) . CONCLUSIONS Seven ( 7 ) days of a residential intensive yoga-based lifestyle program reduced pain-related disability and improved spinal flexibility in patients with CLBP better than a physical exercise regimen OBJECTIVE To assess the effect of a meditation training program , Mindfulness-Based Stress Reduction ( MBSR ) , on depressive symptoms , psychological status , and disease activity in patients with rheumatoid arthritis ( RA ) through a r and omized , waitlist-controlled pilot study . METHODS Participants were r and omized to either an MBSR group , where they attended an 8-week course and 4-month maintenance program , or to a waitlist control group , where they attended all assessment visits and received MBSR free of charge after study end . Participants received usual care from their rheumatologists throughout the trial . Self-report question naires were used to evaluate depressive symptoms , psychological distress , well-being , and mindfulness . Evaluation of RA disease activity ( by Disease Activity Score in 28 joints ) included examination by a physician masked to treatment status . Adjusted means and mean changes in outcomes were estimated in mixed model repeated measures analyses . RESULTS Sixty-three participants were r and omized : 31 to MBSR and 32 to control . At 2 months , there were no statistically significant differences between groups in any outcomes . At 6 months , there was significant improvement in psychological distress and well-being ( P = 0.04 and P = 0.03 , respectively ) , and marginally significant improvement in depressive symptoms and mindfulness ( P = 0.08 and P = 0.09 , respectively ) . There was a 35 % reduction in psychological distress among those treated . The intervention had no impact on RA disease activity . CONCLUSION An 8-week MBSR class was not associated with change in depressive symptoms or other outcomes at 2-month followup . Significant improvements in psychological distress and well-being were observed following MBSR plus a 4-month program of continued reinforcement . Mindfulness meditation may complement medical disease management by improving psychological distress and strengthening well-being in patients with RA CONTEXT Patients suffering from chronic low back pain ( cLBP ) are often unsatisfied with conventional medical care and seek alternative therapies . Many mind-body techniques are said to help patients with low back pain by enhancing body awareness , which includes proprioception deficit in cLBP , but have not been rigorously studied in cLBP . Breath therapy is a western mind-body therapy integrating body awareness , breathing , meditation , and movement . Preliminary data suggest benefits from breath therapy for proprioception and low back pain . OBJECTIVE To assess the effect of breath therapy on cLBP . DESIGN R and omized , controlled trial . SETTING Academic medical center . PARTICIPANTS Thirty- 
    Output:
    
The quality of the studies was not found to moderate the effects of acceptance-based interventions .
The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives .
Acceptance-based therapies have small to medium effects on physical and mental health in chronic pain patients .
These effects are comparable to those of cognitive behavioral therapy