Diabetes, relaxation, mindfulness and meditation – what the research says

Diabetes is a major global healthcare problem and its prevalence is increasing rapidly. Like other chronic, degenerative diseases, diabetes is closely related to lifestyle. So what does mindfulness and meditation have to offer those affected by diabetes? What does the research say? 

In short, the answer is Yes; the evidence demonstrates these practises improve both quality of life and disease progression for both type 1 and type 2 diabetes. So this week we review and summarise that evidence, but first

       Thought for the day

What am I in the eyes of most people—a nonentity, an eccentric or an unpleasant person—somebody who has no position in society and will never have; in short, the lowest of the low. 

All right, then—even if that were absolutely true, then I should one day like to show by my work what such an eccentric, such a nobody, has in his heart. That is my ambition, based less on resentment than on love in spite of everything, based more on a feeling of serenity than on passion. 

Though I am often in the depths of misery, there is still calmness, pure harmony and music inside me. I see paintings or drawings in the poorest cottages, in the dirtiest corners. And my mind is driven towards these things with an irresistible momentum.


                           Vincent van Gogh

Diabetes is a chronic, metabolic, multifaceted health problem and is a common cause of death and disability. It has significant effects not only on the body but also on the mind and social functioning of those affected. Peoples' quality of life, wellbeing, and social relationship can be profoundly affected by diabetes and its side effects.

Diabetes is a complex medical condition whose management requires a diversified approach. This can include drug therapy, diabetes education programs, adherence to medical treatment and active participation in a therapeutic lifestyle program featuring dietary change, exercise and stress management.

THE SCOPE OF THIS LITERATURE REVIEW

This literature review aims to bring together research investigating what mindfulness and meditation can offer to those affected by diabetes. Then, given the times we are in, it also examines the evidence base for online mindfulness and meditation programs. 

Diabetes is a generic word used to describe different conditions, so the review includes definitions of the different types of diabetes. However, this review does focus on diabetes mellitus type 1 and 2.

Quite a large body of research has been published in this field, but not surprisingly, it varies in quality. Therefore, while not exhaustive, this review aims to reproduce key research (using many direct quotes from that research) that investigates the efficacy of mindfulness and meditation for people affected by diabetes. 

This review includes direct hyper-links to the original scholarly articles as published. 

PART A  :  DIABETES – MELLITUS OR INSIPIDUS? TYPE 1 OR 2? THE DEFINITIONS…

1. DIABETES INSIPIDUS

Diabetes Insipidus (DI) is quite distinct from Diabetes Mellitus. In brief, Diabetes Insipidus is a condition characterized by large amounts of urine (up to 20 litres per day) and increased thirst. Extreme urination continues throughout the day and the night. In children, DI can interfere with appetite, eating, weight gain and growth. Adults with untreated DI may remain healthy for decades as long as enough water is consumed to offset the urinary losses. However, there is a continuous risk of dehydration and loss of potassium. 

This condition is not specifically addressed in this review.

2. DIABETES MELLITUS (DM), commonly known as just diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time.

Symptoms often include frequent urination, increased thirst, and increased appetite. Left untreated, DM can cause many health complications and result in an early death – see below.

There are 3 main types of Diabetes Mellitus, plus some uncommon ones

i) Type 1 Diabetes (T1D)

T1D results from the failure of the pancreas to produce enough insulin (the hormone that  regulates blood sugar) due to loss of beta cells. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The loss of beta cells is caused by an autoimmune response whose cause is unknown. T1D management requires the use of insulin injections, although there is growing evidence lifestyle factors can reduce the dosage needed.

ii) Type 2 Diabetes (T2D)

T2D begins with insulin resistance, a condition in which cells in the body fail to respond to insulin properly. As the disease progresses, a lack of insulin may also develop. This form was previously referred to as "non-insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". 

The most common cause of T2D is a combination of excess body weight and lack of exercise.

Prevention and treatment of type 2 diabetes involves adopting a healthy lifestyle based upon maintaining a healthy diet, exercising regularly, avoiding the use of tobacco and utilizing stress management techniques. Care needs to be taken to control blood pressure, along with maintaining proper foot and eye care. Medications such as insulin sensitizers and injections of insulin may be required. Weight loss surgery can sometimes provide an effective measure for those dealing with obesity.

       Pre-Type 2 Diabetes

Pre-diabetes describes a condition in which blood glucose levels are higher than normal, although not high enough to be diagnosed with type 2 diabetes. Pre-diabetes has no signs or symptoms. People with pre-diabetes have a higher risk of developing T2D and cardiovascular (heart and circulation) disease. Two million Australians have pre-diabetes and are at high-risk of developing T2D. Risk factors for pre-diabetes are similar to those for T2D.

Treatment of pre-diabetes involves the same lifestyle changes that are recommended for people diagnosed with T2D. For most, this will include regular physical activity, healthy eating and if necessary losing weight. People with pre-diabetes are also at increased risk of heart disease, so controlling blood pressure and blood cholesterol and triglycerides is also important.

Without sustained lifestyle changes, including healthy eating, increased activity and losing weight, approximately one in three people with pre-diabetes will go on to develop T2D.

iii) Gestational diabetes occurs when pregnant women without a previous history of diabetes develop high blood sugar levels. The majority of women with gestational diabetes have a healthy pregnancy, normal delivery and a healthy baby. 

The cause? The need for insulin in pregnancy is 2 to 3 times higher than normal. For women with underlying insulin resistance, the body may not be able to cope with the extra demand for insulin production and the blood glucose levels will be higher resulting in gestational diabetes being diagnosed.

When the pregnancy is over, blood glucose levels usually return to normal and the gestational diabetes disappears. However, this insulin resistance increases the risk of developing T2D in later life for both the mother and the child, so monitoring may well be advised and maintaining a healthy lifestyle is a logical choice.

The treatment is a healthy eating plan, regular physical activity and monitoring and maintaining blood glucose levels

iv) Uncommon Causes of Diabetes

There are some rare forms of diabetes such as the genetic condition Maturity Onset Diabetes of the Young (MODY), while some diseases such as cystic fibrosis and chronic pancreatitis can lead to diabetes.

PART B  :  THE CONTEXT - WHAT IS THE IMPACT OF DIABETES?

1. HOW MANY PEOPLE ARE AFFECTED?

Diabetes is the 7th leading cause of death globally. In 2019, diabetes resulted in approximately 4.2 million deaths. As of 2019, an estimated 463 million people had diabetes worldwide (8.8% of the adult population). In Australia, around 1.8 million people are diagnosed with diabetes. T2D makes up about 85% of the cases and T1D around 10%. Rates for T1D and T2D are similar in women and men. 

The data suggests rates are rising rapidly and will continue to rise.  Large numbers of people are affected by silent, undiagnosed T2D which may be damaging their bodies. An estimated 2 million Australians are at high risk of developing T2D and are already showing early signs of the condition.

2. WHAT ARE THE RISKS?

Many seem to regard diabetes as a mere inconvenience; something you can live with easily enough. However, the facts are stark. 

While diabetes can be managed well, the potential for very unwelcome complications are high and they are the same for type 1 and type 2 diabetes. 

According to Diabetes Australia, diabetes mellitus:

• Is the leading cause of blindness in working age adults

• Is a leading cause of kidney failure and dialysis

• Increases the risk of heart attacks and stroke by up to four times

• Is a major cause of limb amputations

• Affects mental health as well as physical health. Depression, anxiety and distress occur in more than 30% of all people with diabetes. Cognitive impairment is a serious risk.

• Overall, DM more than doubles the risk of an early death

Early diagnosis, optimal treatment and effective ongoing support and management reduce the risk of diabetes-related complications.

3. WHAT ARE THE FINANCIAL COSTS?

The global economic cost of diabetes-related health expenditure in 2017 was estimated at US$727 billion. In the United States, diabetes cost nearly US$327 billion in 2017. Medical expenditures among people with diabetes are about 2.3 times higher than average. 

4. WHAT CAUSES DIABETES?

Type 2 diabetes is a chronic degenerative disease closely related to lifestyle factors. Happily, its successful management is significantly affected by lifestyle changes. According to Diabetes Australia, T2D is one of the major consequences of the obesity epidemic. The combination of massive changes to diet and the food supply, combined with massive changes to physical activity with more sedentary work and less activity, means most populations are seeing more T2D. 

PART C  :  WHAT DOES MEDITATION AND MINDFULNESS HAVE TO OFFER DIABETES?

What the science says - a research based summary

Mindfulness-based Interventions (MBIs) can be seen as preventive and complementary interventions in DM, particularly for the relief of symptoms related to depression and anxiety in diabetic patients and also in the management of other factors, including mindful eating, physical exercises and treatment adherence. Mindfulness seems to have beneficial effects on all aspects of diabetes, including incidence, control and complications. 

Medina WL et al. Effects of Mindfulness on Diabetes Mellitus: Rationale and Overview. Curr Diabetes Rev. 2017;13(2):141-147. 

What common sense says

The mind controls what we eat and drink, along with how much we exercise. If we want to take charge of what we eat and drink, we will benefit from taking charge of what – and how – we think. This is the beauty of mindfulness and meditation; these 2 practices help us to take more control over our own thoughts, our habits and our way of living. Of necessity, they must form the basis of any therapeutic lifestyle program. And they are easy to learn, easy to practice, can be done anywhere – and once they are learnt, are entirely free – we can do them for ourselves! And as a side effect, mindfulness and meditation reliably lead to inner peace and contentment…

1. META-ANALYSES and REVIEWS – DIABETES, MINDFULNESS AND MEDITATION

i) Meditation and mindfulness lead to wide-ranging benefits 

This study analysed 154 articles examining the potential contribution of mindfulness and meditation to those affected by diabetes. The articles spanned from 1984 to 2017. The review concluded the practice of meditation is associated with reduction in stress and negative emotions and improvements in patient attitude, health-related behaviour and coping skills. There is increased parasympathetic activity with reduction in sympathetic vascular tone, stress hormones and inflammatory markers. Additionally, several studies evaluated the role of mindfulness-based stress reduction in diabetic individuals and demonstrated modest improvements in body weight, glycaemic control and blood pressure. 

The summary?

Mindfulness meditation-based intervention can lead to improvements across all domains of holistic care – biological, psychological and social. 

Meditation strategies can be useful adjunctive techniques to lifestyle modification and pharmacological management of diabetes and help improve patient wellbeing.

Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. Eur Endocrinol. 2018;14(1):35-41. doi:10.17925/EE.2018.14.1.35

ii) Mindfulness-based interventions reduce diabetes distress

This meta-analysis examined the evidence and determined the factors influencing the effect of mindfulness-based interventions (MBI) on diabetes distress. A systematic search of nine databases was conducted and randomized controlled trials of MBIs for adults with diabetes that evaluated the effect of the interventions on diabetes distress were retrieved. A total of 10 articles, consisting of eight studies with 649 participants, were included. 

The summary? MBIs improve outcomes in adults with diabetes who have elevated diabetes distress at baseline, using mindfulness-based stress reduction therapy, using a group format to deliver the intervention, and assigning home practice. MBIs improve diabetes distress significantly more at long-term follow-up compared with short-term follow-up. MBIs could be considered as an adjunct treatment in adults with diabetes to reduce diabetes distress.

Guo J et al. Factors influencing the effect of mindfulness-based interventions on diabetes distress: a meta-analysis. BMJ Open Diabetes Res Care. 2019 Dec 11;7(1)

iii) Mindfulness reduces physiological and psychological symptoms in T1D and T2D

This systematic review examined research published in 5 databases. Eleven studies satisfied the inclusion criteria and they demonstrated Mindfulness-based intervention effectiveness for physiological outcomes (glycaemic control and blood pressure) was mixed. Mindfulness-based interventions appear to have psychological benefits reducing depression, anxiety and distress symptoms across several studies. Some studies’ short-term follow-up periods may not have allowed sufficient time to observe physiological changes or illustrate Mindfulness-based interventions’ potential long-term efficacy. More long-term studies that include a consistent, standardised set of outcome measures are required.

Noordali F., Cumming J., Thompson J. L. Effectiveness of mindfulness-based interventions on physiological and psychological complications in adults with diabetes: a systematic review. Journal of Health Psychology. 2017;22(8):965–983. doi: 10.1177/1359105315620293. [PubMed] 

2. INDIVIDUAL RESEARCH PAPERS

i) Mindfulness meditation improves glycemic control and mental health 

Stress and mental illnesses adversely affect glycemic control. In most patients, a multidisciplinary approach including physical activity, healthy diet, and stress management is required for glycemic control. Mindfulness-based stress reduction (MBSR) is a structured group program that reduces emotional distress through self-awareness and assuming the responsibility for individual choices, and results in increased effective health behaviours. This randomized clinical trial study involved 108 patients with T2D randomised into a 12 weeks MBSR program or routine care. 

The means of haemoglobin A1C (HbA1C), fasting blood sugar (FBS), and depression, anxiety, and stress scores improved significantly after intervention in the MBSR group. Except FBS levels, all outcome variable scores' mean change was significant between the two groups.

Conclusions? In general, this study revealed that mindfulness meditation could be helpful in improving the quality of mental health and lowering glycemic control indices in patients with T2D.

Nikkhah Ravari O, Mousavi SZ, Babak A. Evaluation of the Effects of 12 Weeks Mindfulness-Based Stress Reduction on Glycemic Control and Mental Health Indices in Women with Diabetes Mellitus Type 2. Adv Biomed Res. 2020 Oct 30;9:61.

ii) MBSR demonstrates a remarkable improvement on emotional wellbeing and glycemic control 

Sixty patients with T2D were recruited for this outpatient-based randomized controlled trial. The intervention group participated in 8 sessions of MBSR, and the control group continued treatment as usual. All the assessments were performed at baseline and after 8 weeks and 3 months as follow-up.

In comparison with the control group, the MBSR intervention group showed a significant reduction on all outcome measures including FBS, HbA1C, Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) scores.

The researchers concluded MBSR had a remarkable improvement on emotional wellbeing and glycemic control of patients with T2D.

Armani Kian A et al. The Impact of Mindfulness-Based Stress Reduction on Emotional Wellbeing and Glycemic Control of Patients with Type 2 Diabetes Mellitus. J Diabetes Res. 2018;2018:1986820. 

iii) Innate mindfulness associated with less obesity, less diabetes

Dispositional mindfulness, or trait mindfulness refers to an individual’s innate capacity to pay and maintain attention to present-moment experiences with an open and nonjudgmental attitude. (Brown & Ryan, 2003).

This study examined 399 people with median age 47 years from the New England Family Study, a prospective birth cohort. Dispositional mindfulness was assessed using the Mindful Attention Awareness Scale (MAAS).

The conclusions? People with high versus low MAAS scores were significantly more likely to have normal plasma glucose levels and were not significantly associated with T2D when adjusted for age, sex, race/ethnicity, family history of diabetes and childhood socioeconomic status. 

Mediation analyses provided evidence of mediation via obesity and sense of control, where indirect effects were prevalence ratios.

The authors concluded dispositional mindfulness may be associated with better glucose regulation, in part because of a lower likelihood of obesity and greater sense of control among participants with higher levels of mindfulness. They suggest findings need to be replicated by prospective studies to establish causality and to evaluate potential implications for mindfulness-based interventions to reduce risk of T2D.

Loucks EB et al. Associations of Mindfulness with Glucose Regulation and Diabetes. Am J Health Behav. 2016;40(2):258-267. doi:10.5993/AJHB.40.2.11

iv) Mindfulness and yoga improve quality of life

Many studies reveal the incidence of depression and anxiety is higher among patients with T2D. This study examined an 8 session group mindfulness-based stress reduction program that included conscious yoga. The data demonstrated a significant difference between experimental and control groups in terms of the quality of life level. The mindfulness-based stress reduction program was associated with a significantly increase in the quality of life in the participants of the experimental group. 

The authors concluded the result of this study suggests mindfulness-based stress reduction program can be an appropriate therapeutic method for improving quality of life in patients with T2D.

Rahmani Set al. Examining the effectiveness of mindfulness-based stress reduction program and conscious yoga on quality of life in patients with diabetes type 2. Iranian Journal of Diabetes and Obesity. 2014;6(4):168–175. 

v) More mindfulness, less stress and depression, better quality of life

Twenty to forty percent of outpatients with diabetes are affected by emotional distress. This study of 139 outpatients examined the effectiveness of group therapy with Mindfulness-Based Cognitive Therapy (MBCT), relative to usual care with regard to reducing emotional distress and improving health-related quality of life and glycemic control.

The results? Compared with control, MBCT was more effective in reducing stress, depressive symptoms, and anxiety and more effective in improving quality of life. No significant effect was detected on HbA(1c) or diabetes-specific distress, although patients with elevated diabetes distress in the MBCT group tended to show a decrease in diabetes distress  compared with the control group.

van Son J et al. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA1c in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36(4):823–830. doi: 10.2337/dc12-1477.

vi) More meditation, less worry

This pilot tested a six-week meditation and mindfulness intervention in people (n = 40) with diabetes mellitus and coronary heart disease. The intervention was highly acceptable, with 90% completing ≥5 sessions. Meditation and mindfulness skills led to improved sleep, greater relaxation, and more-accepting approaches to illness and illness experience. At the end of the six-week meditation course, worry, and thought suppression were significantly reduced. 

Keyworth C et al. A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behav Med. 2014;40(2):53-64. 

vii) Mindfulness in adolescents – well accepted; reduces depression and insulin resistance

This study explored a brief mindfulness-based intervention (MBI) on clinical outcomes in adolescents at-risk for T2D. Participants were 12–17yo girls with overweight/obesity, elevated depression symptoms, and T2D family history participating in a randomized, controlled pilot trial of a six-session MBI vs. cognitive-behavioural therapy (CBT) group. 

The results? One-year retention was 71% in MBI; 81% in CBT. At 1-year, depression decreased and IR decreased in adolescents randomized to MBI compared to those in CBT. There were no significant between-condition differences in mindfulness, adiposity, or BMI.

The authors concluded One-year outcomes from this randomized, controlled pilot trial suggest that brief MBI may reduce depression and insulin resistance in at-risk adolescents. They suggested replication and exploration of mechanisms within the context of a larger clinical trial are necessary.

Shomaker LB et al. One-Year Follow-Up of a Randomized Controlled Trial Piloting a Mindfulness-Based Group Intervention for Adolescent Insulin Resistance. Front. Psychol., 08 May 2019 

viii)  Mindfulness meditation shows even greater diabetes related pain reduction than Progressive Relaxation (PR)

Chronic pain, the most common complication of diabetes, is treated with medication often to no avail. This study compared the use of mindfulness meditation (MM) and PR to reduce chronic pain in 109 older females with diabetes. 

Groups MM and PM experienced significant reduction in average daily pain compared to baseline (28.7% and 39.7%, respectively). Group MM had more significant reduction of pain compared to control. Groups MM and PM showed significant improvement in patients’ impression at study end. In Group MM, patient satisfaction scores increased significantly by week 12. 

The authors concluded Integrative therapies such as mindfulness meditation can be part of a comprehensive pain management plan. Benefits include reduction of pain-related medication consumption, better treatment outcomes, improvement in comorbid conditions such as anxiety and depression as well as no risk of addiction or abuse.

Hussain N, Said ASA. Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy. Journal of Evidence-Based Integrative Medicine. January 2019. doi:10.1177/2515690X19876599

ix) Mindfulness Meditation improves glycaemic control and quality of life in T1D

While Mindfulness Meditation (MM) is known to improve glycemic control and enhance the quality of life (QoL) in T2D patients, to date the role of meditation in T1D has not been studied extensively. Therefore, this randomised study of 32 people examined the effect of MM on the glycemic control and QoL in people living with T1D. 

The results? Significant improvement was recorded in the glycemic control and quality of life of the patients practicing MM. Also, the authors concluded MM certainly plays an important role in attaining peace of mind and helps patients to channel their energy in a positive direction. 

Shukla R, et al. Mindfulness Meditation as Adjunctive Therapy to Improve the Glycemic Care and Quality of Life in Patients with Type 1 Diabetes. Medical Sciences. 2021; 9(2):33. 

x) Mindfulness offers help to T1D in adolescents

This small study examined the acceptability and feasibility of Mindfulness-Based Stress Reduction (MBSR) to reduce stress and improve illness management among urban, older adolescents, and young adults with poorly controlled T1D.

The results? Satisfaction with MBSR was high based on both quantitative and qualitative data. Preliminary evidence was found to suggest that MBSR reduced stress and improved blood glucose levels. The authors suggested additional testing in adequately powered controlled clinical trials appears warranted.

Deborah A. Ellis, et al. (2018) Feasibility of Mindfulness-Based Stress Reduction for older adolescents and young adults with poorly controlled type 1 diabetes, Health Psychology and Behavioral Medicine, 6:1, 1-14.

3. ONLINE MINDFULNESS AND MEDITATION PROGRAMS FOR PEOPLE WITH DIABETES

i) Online programs and their benefits – a meta-analysis

The aim of this meta-analysis of 15 randomised controlled studies was to estimate the overall effects of online MBIs on mental health. Results showed that online MBIs have a small but significant beneficial impact on depression, anxiety, well-being and mindfulness. The largest effect was found for stress, with a moderate effect size.

For stress and mindfulness, analysis demonstrated significantly higher effect sizes for guided online MBIs than for unguided online MBIs. In addition, effect sizes for stress were significantly moderated by the number of intervention sessions. 

The researchers concluded their findings indicate online MBIs have potential to contribute to improving mental health outcomes.

Spijkerman MPJ et al. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clinical Psychology Review Vol 45, 2016, 102-114  

ii) App use improves mental health

Previous research has shown one in five Australians (21%) have taken time off work in the past 12 months due to feeling stressed, anxious, depressed or mentally unhealthy. Workers who took part in this 30 day app trial were assessed over 12 months and reported fewer depressive symptoms while scores for workplace performance, resilience and wellbeing had improved.

“This is the first time researchers have ever been able to achieve reductions in depression incidence using an app alone,” claimed the lead author Dr Mark Deady.

PART D  :   CONCLUSION

There is a solid evidence base for mindfulness and meditation being used to help people affected by diabetes. Both the cause and management of diabetes are directly related to lifestyle factors and the evidence is clear that regular mindfulness and meditation is associated with a healthier lifestyle. These same interventions can play a part in prevention and they can reduce the associated symptoms of diabetes such as stress, anxiety and depression, as well as assist in recovery. 

Also, there is good evidence online mindfulness - based programs have positive benefits and that these benefits are increased with the support of an on-line guide or mentor. Further, the evidence concludes that increasing the number of guided sessions increases the measured benefits.

MORRESEARCH SUMMARIES

This review summary of the research evidence for the use of mindfulness and meditation with diabetes, will appear on the Allevi8 website where similar reviews can be found for cancer, MS, Stroke, heart disease, dementia, pain management, sleep disorders, mental health and emotional health. 

Go to Allevi8.net

Around Australia in 2 months by road and rail – a photographic essay

 It is big. Very big. But gone are the days when you could travel Australia’s backroads for a day and not see another car. Plenty are out there getting to know their “back yard”. And for Ruth and myself, it was time to complete the missing link – the trip down the far West Coast.

So this week, while still in self-quarantine having returned via Sydney’s red zone hotspot – no not King’s Cross as it might have been in those older days, just these more complex times of COVID – a photographic essay from a wonderful trip – with maybe an insight or 2; but first

         Thought for the day

              A meditation practice 

              Deepened in silence 

              Yields an intimacy with oneself, 

              And over time, 

              A greater intimacy with others 

              And with all of life.

                                         Beth Roth

It is the silence that seems to draw me back time after time. 

Once one leaves the cities and towns there is the chance to enter into, engage with the bulk of Australia – its deserts. Here it is the silence that welcomes and holds you; like a tender mother holding a fragile child. You relax into it. It is that easy.

We talk of “letting go” as a point of entry to meditation; Australia’s outback takes you there – almost whether you want to or not. It simply drops you into it. Deep, natural peace. Something that nature provides quite effortlessly. You can simply let go, and drop into it.

So in May we hired a motorhome, 

meandered down the Murray for a few days

And joined 2 dear friends from Sydney in the Flinders Ranges. 

Having shared accommodation on several retreats we were fairly confident, yet 7 weeks on the road together actually proved to be a delight! 

Our friends travel and sleep in a Prado and love it. 

Yes, they slept for 2 months in the back of their car by choice! 

We consider this to be a major yogic accomplishment!

The Flinders Ranges are just superb; one of my favourite places to be in, and one of my favourite places to paint.

Around the corner and up into the desert 

- what a landscape! 

Where the blue sky mind quickly goes beyond being 

just a metaphor...

Then on to Coober Pedy where most live underground as if living out here is not already far enough away from the gaze of others.

And a visit to the rabbit proof fence – or the dog fence depending upon your point of view. 

The longest fence in the world designed to keep dingos away from the Eastern States' sheep

Joyfully we return to Uluru; finally with climbing prohibited .

And yet the sun still lights it up in the evenings 

Next Alice Springs and time with son Peter and his family. 

Exploring the beauty of the McDonnell Ranges water holes... Trephina Gorge...

Another favourite - Simpson's gap.

Maybe this place that is so close to Alice Springs still has as much if not more presence than any other...

Meditation in the Desert was conducted for many years on the Northern side of this extra ordinary place

And Ellery Big Hole 

- a place of reflection outer and inner; 

and again, deep natural peace...

Yet so sad to have direct experience of the difficulties the young aboriginals face, and are creating in this iconic town and others we visited along the way. 

Such a complex issue and not for me to make comment other than to observe there seems in recent times to be a deepening disconnect amongst many young people from their traditions of origin, without anything to fill that cavernous void. This loss of meaning and the stability that comes with a sense of belonging is what the new Centres for Contemplative Studies at the university of Melbourne and Monash will be addressing and hopefully will make a contribution.

Anyway, on to the Devil’s Marbles where touching the rocks is like touching a living being; they feel powerfully alive - like any large animal you might place your hand upon - albeit with a rough, cool skin.

Then the hot springs at Mataranka.

This country is full of paradox 

- hot springs in the middle of a desert :)

Unbelievably clear water...

Next Darwin, daughter Alice and her family. 

Finally the T-shirts come out in response 

to some real warmth 

- and some fun on the water

Then down to Litchfield and a natural spa 

under a magical waterfall.

Katherine Gorge strikes me as a bit underwhelming.

But then the trip across the Kimberly 

with its amazing landscape.

And the Bungle Bungles 

– designed for the accurate use 

of the adjective “awesome”!

Fitzroy Crossing and Hall’s Creek – watch out for rocks thrown from the bushes. 

Happily the one that hit us bounced off with no damage done…

Wyndham, Derby and Dampier

- a glimpse of Australia’s natural wealth 

– as it exits via boat to China and other parts unknown ...

What is Broome without the mandatory 

evening camel tour :)

And travelling North once again, 

more remote, less well known, 

but truly delightful Cape Leveque...

Then on down West and South around the far North West Coast. While the coast itself feels seriously remote and desolate, here we travel through the Pilbara that has great beauty and warrants more time than we have available. So we scamper on to Exmouth and make day trips to the Ningaloo Reef where no photos document a tough but enjoyable day in a kayak :)

Monkey Mia 

Here back in the mid 80s with 4 young children 

and a campervan, 2 holidays were spent camped 

on the beach amidst the freedom to mingle 

with the dolphins that regularly came inshore. 

These days, the connection is far more regulated,

but still wonder full and despite the masses, 

highly recommended.

Last sunset before leaving the motorhome in Perth, 

then resting a few days while catching up with 

the Allvi8 allstars in Perth – Nanne and Cathy

 – before boarding the India-Pacific. 

The landscapes across the Nullabor are amazing, 

the staff trying hard, the food good.

Even some humour along the way – here the remote 

stop at Cook appealing for support for 

its floundering – now floundered – hospital!

Included are some excellent side trips off the train 

including time to visit the same organic market stall 

in Adelaide where I was buying organic veggies 

back in the 70s while recovering from cancer. 




Downside? The train’s ride often is like being in a washing machine. Nothing like the smooth ride of European or Japanese trains and way past a gentle rocking motion.

Brief sojourn in Sydney before COVID flared leading to a hasty retreat home and 14 days self-quarantine – a great way to settle and integrate a fabulous trip. 

We drove 12,000Ks and covered another 4,000 by train. 

What a blessing.

Any message? 

In other circumstance, at least another month could have been easily filled - or a year...

If you think of going, so are many others. We needed to book campsites well ahead and again, unless we planned well ahead, often could not join the tours we might have preferred due to them being fully booked when we arrived.

Avoiding plane travel feels good for the environment and COVID. 

Australia is an endless travel destination – so much to experience…

Travelling in close proximity is great for relationships – both with Ruth and good friends. 

The Australian outback is a natural meditative environment – spacious, both deeply grounding and elevating. There is so much beauty…  And beauty is Truth as Mr Keates would say...

Allevi8 online meditation mentoring program now available

We probably all know someone who is dealing with a major physical or mental illness. Maybe you are facing such challenges yourself? Our hearts go out to anyone in that situation, but what to do? How to be helpful in a meaningful way?

Mindfulness and meditation provide many answers, but how to be sure you are using the best techniques?

How to gain easy access to a good teacher? 

The Alleviate Mentor Program has been developed to provide personalised, face-to-face, 1:1 online support. 

The program has been designed so you can speak in real time to an experienced and qualified meditation teacher who will assist you to sort out what specific meditation-based techniques will help best, to deepen your experience, and to be supported to develop a regular practice. 

The program employs trained and experienced meditation teachers registered with the peak body Meditation Australia. These are all people I know well, have worked with and trust highly. They are a great team. Bookings are taken online via this link. (allevi8.net).

So this week, more news of this exciting new development that I hope will be of real service and help many, and results of evaluation of the Allevi8 App’s benefits – that are quite remarkable – it does seem the App is helping many people; but first

        Thought for the day

            The body needs movement to be healthy

                The mind needs stillness to be healthy

                    Ian Gawler

ORIGINS OF THE ALLEVI8 APP

This new one-to-one meditation mentor service is something I have been working on for some time with the team at Allevi8. We all hope it will be of real benefit to those in need. The mentor program has developed from very positive feedback from the Allevi8 App and a recognition of the need to provide personalised teaching and support for those in need.

The Allevi8 App is a mindfulness and meditation-based App designed for people affected by significant physical and mental health challenges. 

It was released in 2020 and features the voices of my wife Dr Ruth Gawler and myself leading a range of techniques we have developed over decades that address mental and emotional health, pain management, sleep difficulties, healing and the urge to find meaning in difficult times. 

More details on the website allevi8.net.

The Allevi8 App and its attendant Monday group meetings on Zoom are offered freely with a pay-it-forward option. 

HOW THE MENTOR PROGRAM WORKS

The Allevi8 Meditation Mentor Program provides 5 personal 1:1 sessions, each for one hour over a 12 week period. During the first session, the mentor and client get to know each other and the mentor helps evaluate their client’s needs, helping them to decide which of the Allevi8 techniques fits those needs best. 

Then, based upon the client’s existing experience, personalised instruction is offered. Beginners will be provided with a solid foundation; those more experienced meditators will be helped to both deepen and ensure their practice well suits their situation. All are supported  to become confident they are on the right track and know how to practice with the support of the App in their own time.

Over ensuing weeks, the client and mentor continue to meet, address any questions arising from the practice and continue to develop and deepen that practice. The mentor leads a personalised meditation session each time the two meet.

After the 12 week program, people may feel content and able to continue on their own, however, there is the option to meet regularly, or from time to time with your mentor.

Initial feedback has been very strong. Participants really appreciate the ease of connection provided by this online service (using Zoom); emphasising the benefit of the one-to-one opportunity to learn, ask questions and be supported. Currently, of those being mentored, around 95% report meditating daily.

While the Allevi8 App is offered freely, as are our regular group meditation sessions over Zoom every Monday (we do encourage the pay-it-forward option), this new service needs to be costed and the details are on the website where you can book at allevi8.net.

RESULTS FROM USAGE OF THE ALLEVI8 APP AND THE MENTOR PROGRAM

The Allevi8 mentor program was piloted in 2020/21 by Cathy Brown with a small group of people affected by significant health issues. The program received excellent feedback. 

Major reductions in anxiety and depression levels were recorded via a self-reporting questionnaire; along with significant gains in wellbeing and reductions in pain and fatigue levels. Daily meditation rates of 95% were also reported and the connection with a personal mentor was highly valued by participants. 

People likened the service to having a personal gym trainer for the mind.

We have also gathered statistics from hundreds of early users of the Allevi8 App along with the small group who have piloted the mentor program and chart those results below. Another major development is that a major hospital is well into developing a research study to evaluate the App and probably the use of the mentors in their Oncology Department.

So maybe this mentor program is for you. 

Maybe it is something you would recommend or gift to someone you know who is in need. 

More details are on our website allevi8.net and that is the place to register for the program. 

May this new development be of real benefit to many.  

Please do share with your family, friends and colleagues ...

Paradigms change. Centres change. People change. Life is change.

How many stories of remarkable cancer recoveries do you hear these days? 

You know, the ones where people were expected by their doctors to live for a short while and ended up living for a long while or fully recovering? 

My sense is not so many.

This feels to be at the heart of the tragedy unfolding at the Foundation I helped establish. That work goes way back to the 16th September 1981 with the meeting of our first cancer support group. 

On Thursday, 1st April 2021 Ruth and I completed the last residential program at the Foundation’s Yarra Valley Living Centre, then joined in a wake/celebration with the last of the staff, closed the doors and walked away. 

Now… where will people go who are seeking help to accomplish something quite difficult and so important? 

And, maybe some would rather I did not ask this question – but has the slowing down in stories of remarkable recovery over the years played more than a coincidental role in the Foundation’s demise?

So this week, some reflections on a glorious history, some speculation on what happened, and a look to the future, but first, and in the spirit of Easter, transformation and resurrection…

Thought for the day

Contemplation is the only ultimate answer 

To the unreal and insane world 

That our financial systems, 

Our advertising culture, 

And our chaotic and unexamined emotions 

Encourage us to inhabit. 

To learn contemplative practice 

Is to learn what we need 

So as to live truthfully and honestly and lovingly. 

It is a deeply revolutionary matter. 

                                  Rev Dr Rowan Williams, former Archbishop of Canterbury 

The Foundation began as the Melbourne Cancer Support Group. 

We met in rented premises in Hawthorn, a leafy suburb of Melbourne. 

The offering was a 12 week, non-residential program that had the stated intention of helping those attending with their quality of life but was really focused on teaching people how they could best become actively engaged with their own recovery.

In those early days, the basis of the program – meditation, therapeutic nutrition and positive thinking was far from mainstream and so we tended to attract a lot of people who had tried all the other options. 

We began as a place of last resort.

But also, in those days cancer medicine was pretty blunt. 

People were often told by their doctors quite literally, “There is nothing more we can do for you. Go home, put your affairs in order, make the most of your time left, and when things get really tough come back for Palliative Care”. It was often that blunt. Apart from anything else, the lack of compassion and consideration in the communication was often staggering; as well as very damaging.

What did happen, however, is that people were presented with a stark choice. Do nothing and probably fulfill the expectations of dying; or try to help yourself.

So the people who did find their way to our groups, came highly fearful, and highly motivated. And yes, my own story of recovery inspired them and offered hope; but once they heard the rationale around reactivating and utilising their own inherent healing potential, that hope became genuine hope. They really understood what was possible.

In those early days there were many stories of remarkable recoveries. 

We published two books featuring the stories. 

Disappointingly, and rather surprisingly, those recoveries were commonly dismissed rather quickly by the medical profession as so called “Spontaneous Remissions” and despite our best efforts, no significant research followed. 

Yet our participants felt there was nothing “spontaneous” about these remissions! They worked hard; meditating regularly, changing their diets, juicing, working on changing mental and emotional habits, training their minds in Mind-Body Medicine.

And yes, of course many also died, but they had “good deaths” and they and their families rarely expressed regrets. 

Their families often felt they became much closer and learnt of life in profound ways courtesy of the illness and the program.

So the groups grew rapidly and we expanded into prevention work and the wellness domain. The Foundation became a legal entity in 1983, I left my veterinary practice around the same time and the work attracted great support from new staff, many volunteers, donors and the media. 

However, there was a strong undercurrent of opposition from the medical profession, in large part due to the fact we were helping to change a paradigm. 

Up until the ‘80s, and as a generalisation, medicine was based on the notion that people got sick, they went to their doctors who were revered almost like Gods, they were diagnosed and told what to do and they did it. 

Very few questions. 

The doctor took care of things; our health was in their hands. 

They were responsible.

As the new kids, we encouraged people to ask questions. Lots of questions. We encouraged people to take an active part in their own health; particularly when diagnosed with a major illness like cancer. We respected the doctors a great deal – after all I had worked in an allied field for many years as a veterinarian - but we did not go along unquestioning with whatever was said. We encouraged patient empowerment and we were active at a time when the doctor/patient paradigm was indeed changing.

But it was also the time when the whole notion of self-help techniques was coming into play. We based our program on the notion of reviving and stimulating the individual’s own immune system through a fairly intense self-help, lifestyle-based program. Significantly, this focus on the immune system became the basis of much of the medical criticism of our program as in those days the medical consensus was there was no way the human immune system could contribute to recovery from cancer.

Similarly, prior to the ‘80s, the notion that nutrition could play an active role in any therapeutic situation was pretty well unheard of. 

In cancer medicine, using nutrition therapeutically was laughed at by the authorities. 

This always staggered me. As a veterinarian, nutrition was one of the first things we always investigated when considering the cause of illness and how best to effect a recovery. In agriculture, the soil is essential to healthy plants. By contrast, Medicine carried on in those older times as if what people ate was completely irrelevant, and the fact we strongly advocated what people ate matters a great deal led to some interesting interactions… 

Then too, we were advocating the therapeutic application of meditation and other mind techniques. In those early day there was nothing like the huge body of supportive research that currently exists. It was also a time when the practice of meditation was heavily overlaid by its associations with exotic, and in the public’s eyes, probably mischievous eastern gurus. So quite a few more interesting interactions with cautious or full-on reactionary authorities…

More context. Some decades back the cancer world went through another seismic shift. 

Mainstream cancer medicine transformed Palliative Care into Palliative Treatment. 

Instead of palliation being about accepting people would die and helping them to make the best for the time available and to be as comfortable as possible, it became a fertile ground for new drugs that while not curing might extend life. 

These new drugs frequently came with a high price tag – so the public valued them – and often were accompanied by significant side-effects – which the public seems to have accepted. 

As a consequence, cancer very much became a chronic illness to be managed in its entirety by the medical profession and its allied health workers. 

No longer the “go home a die” message; now a new emphasis on treatments that while they may not cure, will prolong life. Those palliative treatments have become increasingly expensive – some are now over $200,000 per person per year, and the public seems very pleased to have them available; many being provided virtually freely courtesy of the PBS.

And another paradigm shift. 

Cancer medicine has largely moved on from the old stalwarts of surgery followed by radiation and chemotherapy. 

There is now much less chemo and far more immunotherapy. 

Yes - Immunotherapy that was once dismissed, now seems to be the great new hope. 

Yet curiously, all the research goes into new immunological drugs and hardly any – if any at all – into investigating the real therapeutic potential of a program like ours based upon self-help techniques.

So the observation? 

In the early days we helped many with medically incurable disease. As our work became better known, we also attracted many with medically manageable cancers who wanted to learn how to give themselves the best chance of recovery, as well as learn through their illness. 

For this is what cancer does. 

It is such a tough and demanding illness, that for those who look into its meaning in their own lives and the lives of those they care for; it causes them to examine everything. 

It may sound strange, but without doubt, cancer is one of the best personal growth opportunities around. (Hope the growth reference is not too much like a bad pun!) 

And in my view, the very best way to explore this aspect of a cancer diagnosis is with your partner in a residential program designed to facilitate that process.

So back in the ‘80s and ‘90s we heard many personal “anecdotes” of people transforming their illness and their lives – both physically, emotionally, mentally and spiritually. That was what that program did. It was genuinely holistic. The program evolved over the years, courtesy of the expertise and insight of great staff. This was complemented by the learnings gained from so many incredible participants and it was supported by incredible volunteers, Boards and donors. The Foundation was very busy.

So what happened? 

Really want to know? Hard to be sure. It is complex, but my own sense is as cancer medicine changed, as these paradigms changed, the Foundation did not adapt all that well.

In the new millennium, patient empowerment became a thing. Communication training in oncology began to improve doctor/patient relationships. Mindfulness was branded as an acceptable, secular word for meditation. Research exploded and gave the evidence base required for mainstream authorities to advocate it. Nutrition was increasingly recognised to be relevant. Attention to emotional and mental health became strong domains in new cancer centres where an “Integrated approach” was touted as a major marketing focus.

Now, and for some time past, many hospitals run their versions of support groups, their offerings of mindfulness and meditation programs. 

Many individual components of the Foundation’s program are offered locally by groups and individuals and as a consequence potential clients actively question the need to travel to a residential centre. 

Then too of course, so much is available on the internet. 

In the early days, people came to our programs to gather information. Information was hard to find, and we accumulated and shared it. These days, people come to the groups to debate and to filter information. But VERY significantly, they have real trouble working out who is telling the truth. “Is soy OK? My naturopath who I see weekly says it is dangerous, yet you who I have come to for this program and have been working and researching in this field for nearly 40 years say it is OK. How do I deal with that?”

So for the Foundation, in recent years there has been a shift from where we were one of very few centres in Australia, even the world, that could offer this information let alone run a genuine integrated program to help people learn and implement it; to now being one of a large number of such groups and individuals – all of varying content and quality.

And the paradigms have changed. These days not so many people with cancer feel there is nothing that can be done for them medically; they are fully engaged with Palliative Treatment. So they tend to regard the self-help options as somewhat soft add-ons; not like the crucial, life-saving major focus of people in earlier days.

This then may be the tough bit. 

In cancer medicine, remarkable recoveries do not come easily. 

In sporting terms, they represent fairly elite achievement. 

Clearly if recovery from difficult cancer was easy, when it happened it would not be regarded as remarkable.

In the earliest days of the groups, and faced with no other options, people were highly motivated and worked at their health in the manner elite athletes might. They were committed, single-minded. They did their very best, and many did accomplish remarkable outcomes.

Now I need to be clear. 

Many of those early people did a lot and died of cancer anyway. And why some experienced remarkable recoveries and lived while others did very similar things and died often seemed a mystery to me. But what I can say is those who applied themselves fully never expressed regret to me. On the contrary, they rejoiced in having given it their best, and while naturally disappointed, if cancer did still end their lives, they were content and invariably experienced what those around them described as a good death.

So in current time, my experience is there seem to be few who have that same high level of commitment. Many want to benefit from dietary change, from training their minds, becoming more mindful, meditating and so on, yet there is not the same edge to it. Often there is a half-heartedness. Often too, there is a background of uncertainty that is hard to shift. “Am I doing the right thing? Am I doing enough? Who do I trust? What do I make of all the options coming my way through the medical profession, the internet, family and friends?” There is not the same thoroughness. The nature of the groups has changed, the conversations have changed; the work has changed, what people do has changed. 

This approach has become less like an elite sport, to more like a weekend run around the park. Useful, but not quite the same.

Actually, having said all of this, in my view, the Foundation’s current cancer programs seem to be doing really well in adapting to the changes. 

In my view the basic cancer residential program remains the Gold Standard. 

I know of no other program so complete or so well presented anywhere in the world. 

Big claim? I believe it to be true.

So why is the centre closing? 

Who knows really, but where they may well have fallen behind is in helping the public to value the program. To value it enough to come; to value it enough to support it financially and in other ways. But then what would I know? Having not been on staff or on the board for 12 years, I really can only celebrate the fact of all the good work done over the 40 years of the Foundation’s history; these last 12 without me.

What comes next? 

My guess is something will arise like a phoenix. 

In the interim, there is every possibility the cancer programs will continue to be presented by the current group of therapists – either at the YVLC under someone else’s management or elsewhere. 

Regarding the other spheres of activity the Foundation has been involved in, many people present meditation programs and retreats and the Overcoming MS people are presenting the MS program and providing great support for people affected by MS. All of that work is well catered for. 

And the fact so many hospitals and community centres, schools, prisons and work places have these techniques embedded in their way of functioning, is heartening indeed.

People are asking about what next for me? 

There are 3 major projects

1. In all probability I will be on the advisory boards to help develop and support the Centre for Contemplative Studies at University of Melbourne, and the Centre for Consciousness and Contemplative Studies at Monash. With the Centres now funded for 5 years, these projects are in full swing.

2. Development of the Agape project to provide ready access to a residential meditation and Perennial Wisdom-based program designed for young people, This project has been developing over the last 3 years and will likely ramp up in the second half of 2021.

3. Development of the Allevi8 app and its mentor program. Allevi8 has been available for around 9 months now. It provides relaxation, mindfulness and meditation practices for people affected by significant physical or mental challenges. We are about to release a mentor program that will provide a 12 week on line, one on one meditation program where participants will be taught personally and supported to establish and develop their meditation practice.

So all in all?

There is an air of tragedy in the closure. 

But so much to celebrate. 

All the lives transformed – both in participants, staff and volunteers! 

So much good work done. 

So much to delight in. 

Maybe even a contribution in changing a paradigm or two…



A big thank you to all who contributed. 

Many supported me in a very direct way; many more supported the work and all the other extra-ordinary people I was so fortunate, so blessed to engage with...

Life is change…

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Yarra Valley Living Centre is closing