The benefits of meditation and mindfulness practices during times of crisis such as COVID-19

Cross-cultural validity of the five items Mindful Attention Awareness Scale (MAAS-5) in Peru and Mexico during the COVID-19 pandemic

The Spanish version of the 5-item Mindful Attention Awareness Scale (MAAS-5) is a brief measure of the general tendency to be attentive and aware of experiences in the present moment during daily life. The MAAS-5 has been used in different countries; however, an assessment of its cross-cultural measurement invariance (MI) has not been conducted. Therefore, the study aimed to evaluate the cross-cultural measurement invariance of the MAAS-5 in university students from two countries: Peru and Mexico. A total of 1144 university students from Peru (N = 822) and Mexico (N = 322) responded online to the Spanish version of the 5-item Mindful Attention Awareness Scale (MAAS-5). A multigroup confirmatory factor analysis was performed. Measurement invariance tests the hypothesis that the model behind a set of scores is comparable between groups. The results showed that the unidimensional structure of the MAAS-5 is the same between Peruvian and Mexican university students. Therefore, it is suggested that university students from both countries conceptualize the mindfulness in a similar way. As a result, the MAAS-5 can be used to compare differences between countries. No significant differences were observed in the MAAS-5 score between Peruvian and Mexican university students. The present study contributes to a better understanding of the psychometric properties of the MAAS-5 by presenting MI results in two Latin American countries. Implications of the findings are discussed, which will facilitate a more solid and reliable use of the MAAS-5 in future cross-cultural studies.

How Does Buddhist Contemplative Space Facilitate the Practice of Mindfulness?

This paper examines the spaces where Buddhist spiritual activity—specifically mindfulness practice—takes place, exploring how contemporary urban Buddhist contemplative places may benefit people’s mindful experience. Historical Buddhist contemplative places are examined through a literature review of Buddhist philosophy and Buddhist architecture and landscape. A case study of Kagyu Samye Dzong London, UK (KSDL) in the contemporary western context is then presented, drawing upon mixed methods (qualitative spatial analysis, questionnaires with mindfulness practitioners, and an in-depth interview with the director of the Buddhist center). This study investigates the relationship between the Buddhist spiritual activity of mindfulness practice and one specific physical space, exploring how the KSDL has been designed and is used to facilitate such mindfulness awareness and insight. Results suggest that quiet, solitude, and the presence of nature are three tangible spatial qualities that can facilitate mindful practice to some extent. However, additional relational or intangible qualities, namely the presence of The Three Jewels and blessings, are equally if not more important when sustaining mindfulness for Buddhist practitioners, and these contemplative qualities are more than “spatial”. Both the physical tangible qualities and intangible qualities are indispensable in the contemplative space and in influencing one’s practice. Findings evidence the importance of physical design and space for supporting contemporary mindfulness practitioners, whilst acknowledging that mindfulness emanates from—and can ultimately be discovered from—within.

At the Peak of the Second Wave of COVID-19, Did Millennials Show Different Emotional Responses from Older Adults?

The COVID-19 pandemic disturbs mental health. Indeed, higher levels of negative emotions and anxiety, along with lower levels of positive emotions and well-being, have been highlighted. As a result, individuals need to regulate these psychological states in a context of uncertainty and daily restrictions (e.g., access to leisure activities, social contacts) or modifications of livelihood (e.g., working modalities). Overall, psychological reactions to the pandemic have been shown to differ based on one's age. The purpose of this research is to compare psychological reactions to the pandemic between Millennials (born between 1981 and 1996) and Older Adults. The generation's prism seems relevant as members of specific generations are shaped (e.g., views of the world, the future) by their similar experiences. Ninety-four Millennials and 129 Older Adults, recruited in the general population, participated to an online survey assessing emotions, emotion regulation strategies, environmental satisfaction, and intolerance of uncertainty. Results show that Millennials experience higher levels of negative emotions along with higher levels of worry and rumination than Older Adults. Millennials also report a higher level of joy. Nonetheless, more Older Adults engage themselves in novel activities. Overall, findings confirm previous ones and indicate the need to offer effective clinicals tool to prevent mental health worsening.

Exploring experiences and impact of the COVID-19 pandemic on young racially minoritised people in the United Kingdom: A qualitative study

Within high-income-countries, the COVID-19 pandemic has disproportionately impacted people from racially minoritised backgrounds. There has been significant research interrogating the disparate impact of the virus, and recently, interest in the long-term implications of the global crisis on young people’s mental health and wellbeing. However, less work explores the experiences of young people from racialised backgrounds as they navigate the pandemic, and the specific consequences this has for their mental health. Forty young people (age 16–25) from Black, mixed and other minority backgrounds and living in London, participated in consecutive focus group discussions over a two-month period, to explore the impact of the pandemic on their lives and emotional wellbeing. Thematic analysis identified seven thematic categories describing the impact of the pandemic, indicating: deepening of existing socioeconomic and emotional challenges; efforts to navigate racism and difference within the response; and survival strategies drawing on communal and individual resources. Young people also articulated visions for a future public health response which addressed gaps in current strategies. Findings point to the need to contextualize public health responses to the pandemic in line with the lived experiences of racialised young people. We specifically note the importance of long-term culturally and socio-politically relevant support interventions. Implications for policy and practice are discussed.

"I'm making a positive change in my life": a mixed method evaluation of a well-being tertiary education unit

ISSUE ADDRESSED

Mental health disorders (MHDs) are prevalent among university students with detrimental impacts for individual students, universities and the wider community. There is urgent need for proactive and preventative strategies to address the mental health crisis in the university population. This study evaluated the efficacy of a 13-week unit developed to directly educate university students about ways to improve and maintain well-being.

METHODS

Fifty-eight university students from five disciplines participated in a 13-week elective undergraduate unit "Well-Being Fundamentals for Success" as part of their degree. The Act Belong Commit mental health promotion campaign framework formed the basis of teaching materials. Outcome well-being measures were self-assessed at weeks 1, 6 and 12 using four scales: 1) Warwick-Edinburgh Mental Well-being Scale (WEMWBS); 2) Perceived Stress Scale (PSS); 3) Brief Resilience Scale (BRS); and 4) Mindful Attention Awareness Scale (MAAS). Post-unit group interviews (n = 11) were analysed for key themes.

RESULTS

Linear mixed models demonstrated a significant improvement in BRS over the semester; well-being (WEMBS) and mindful attention (MAAS) did increase but not significantly. There was a significant increase in stress (PSS) over the semester. Key themes that emerged from the group interviews were that 1) University life contributes to well-being; 2) University life contributes to stress; 3) The well-being unit helped students see and do things differently; 4) An overall endorsement of the unit.

CONCLUSION

University students' resilience increased over the semester following participation in curriculum focused on well-being which featured a combination of theoretical content and experiential workshops.

Chronicle of an Indian psychiatrist's mindfulness journey retold

This article describes the author's discovery of mindfulness and its method and describes the bias against mindfulness even at the beginning of the 21st century. The short essay also throws light on recent developments in mindfulness training and practice in the world and in the state of Kerala in South India.

Did Mindful People Do Better during the COVID-19 Pandemic? Mindfulness Is Associated with Well-Being and Compliance with Prophylactic Measures

This paper investigates the relationship between mindfulness and well-being within the context of compliance with prophylactic measures in the time of COVID-19. We conducted a large-scale survey among a representative sample of the French population. We measured mindfulness, using the Mindful Attention Awareness Scale, and the extent to which respondents were impacted by COVID-19 in terms of their mood and quality of sleep, as well as how they complied with prophylactic measures. Our results suggest that more mindful individuals were less negatively impacted by COVID-19 with regard to their sleep and mood. Concerning the prophylactic measures, we obtained mixed results: more mindful participants were more likely to respect lockdowns, physical distancing and to cough in their sleeves, but did not wash their hands, wear masks or avoid touching their face more often than less mindful individuals.

Being Hopeful and Mindful During Adversity: A Longitudinal Study on College Students’ Adjustment During COVID-19

Objectives

The current study examined whether hope and mindfulness were associated with changes in two maladjustment measures, internalizing and externalizing behaviors, during the COVID-19 pandemic and tested sense of coherence as a mediator. The salutogenic theory of health, which posits that sense of coherence is central to individuals’ well-being in stressful situations and that individuals derive their sense of coherence from their generalized resistance resources (GRRs), was used to guide the analyses.

Methods

On two occasions separated by about 6 months, 253 Hong Kong college students (mean age = 21.0 years at time 1; 86% of them were women) filled in online questionnaires during the COVID-19 outbreaks. Path analysis was conducted to examine the interrelationships among hope and mindfulness, sense of coherence, and internalizing and externalizing behaviors.

Results

Results indicated that hope and mindfulness at time 1 were associated with internalizing and externalizing behaviors at time 2, even after controlling for confounding variables and prior levels of internalizing and externalizing behaviors. Moreover, sense of coherence at time 1 significantly mediated these associations.

Conclusions

Findings pointed to the potential roles of hope, mindfulness, and sense of coherence in understanding Chinese college students’ adjustment during the COVID-19 pandemic. Future research is needed to test whether sense of coherence and behavioral adjustment can be promoted through hope- and mindfulness-based intervention programs. Future research is also needed to examine the interrelationships among health-promoting assets, sense of coherence, and individual adjustment in samples of diverse cultural backgrounds.

Health and Mindfulness during the Syndemic of SARS-CoV-2: An Ethnographic Study

SARS-CoV-2 (COVID-19) has caused physical and mental health problems for a large part of the population. In this context, the practice of mindfulness has become relevant due to its usefulness in channeling and mitigating these problems. The objective of this article is to know the implications of the practice of mindfulness in physical and mental health in this syndemic period throh the perception of its practitioners. To achieve this purpose, we conducted an ethnographic study with fieldwork in three mindfulness training and practice groups. The techniques used were participant observation, open interview and survey. Participant observation was carried out from October 2019 to November 2021. A total of 22 open interviews were conducted. In addition, 44 surveys were carried out on a total population of 54. From the first sessions, 45.5% stated that they had felt beneficial effects on their health, and 100% perceived benefits in different aspects of their mental and physical health. The techniques perceived as most effective were those that focused on the body and emotions. The usefulness of mindfulness in managing the problems derived from the syndemic was unquestionable for 95.4%. In addition, a strong correlation is observed between the time spent practicing mindfulness and the reduction in the impact of the syndemic on the health of the practitioners.

Debate on mandatory COVID-19 vaccination

BACKGROUND

Since January 2020, worldwide public health has been threatened by COVID-19, for which vaccines have been adopted from December 2020.

DISCUSSION

Although vaccines demonstrate effectiveness against this disease, vaccine hesitancy reveals concerns towards short-term and long-term side effects or adverse reactions such as post-inoculation death. Mandatory vaccination is used to provide herd immunity, but is refutable due to infringement of human rights and autonomy. Furthermore, the evidence testifies that vaccination cannot guarantee prevention of infection or re-infection, resulting in public resentment against this coercive measure, whilst post-inoculation anxiety continues.

PERSPECTIVE

This discussion suggests a holistic approach, involving the collective efforts of governments, medical experts and individuals, through basic preventive measures and alternative therapy to live with COVID-19 in a healthy and resourceful manner.

Comparative assessment of factors affecting anxiety levels among adults attending online meditation sessions during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

The ongoing coronavirus disease 2019 (COVID-19) pandemic induced the governments around the world to impose harsher preventive measures like stay at home order, lock down etc., to contain the spread of infection. This measure increased the stress of the general population through isolation of masses, loss of employment, and loss of recreation. There is a dearth of quality data showing anxiety levels among the population and association of novel nonpharmaceutical measures such as online meditation with it.

MATERIALS AND METHODS

The study is a cross-sectional comparative study based on an online survey. The study population included 74 adult participants, out of which 30, included in the study group were attending structured online meditation sessions and 44 of the participants as a comparison group after matching age, gender, location of residence, and socioeconomic status. The data was collected using self-administered questionnaire. Multiple logistic regression was applied to ascertain factors contributing to the anxiety levels of the participants.

RESULTS

Both the groups of participants were comparable in terms of their demographic characteristics. The mean generalized anxiety disorder (GAD 7) score among the participants of online meditation program was significantly lower as compared to those not attending any online meditation. 6.7% of the participants of online meditation had GAD 7 score more than 10 as compared to 13.6% among the comparison group (P value 0.7).

CONCLUSION

"At home" mental health promotion measures such as structured online meditation can serve an important role in mitigating the mental health impact of COVID-19 pandemic on the community. Further researches are needed to assess the feasibility and effectiveness of such measures.

COVID-19 Adaptive Interventions: Implications for Wellbeing and Quality-of-Life

Social bonds may assist in cultivating a more positive attitude to life through commonly shared meanings about the COVID-19 pandemic. The key challenge, however, is how to foster social bonds meeting the changing demands in a post pandemic world. Yet, it is in the middle of a crisis that the conversation needs to start about how to strategically plan for the recovery. This is important not only in the current pandemic, but also in a post pandemic world. Reinforcing or fostering new social bonds is likely to bring positive experiences. The latter is central to human health and wellbeing, and has potential to contribute greatly in enhancing people's quality of life. In an attempt to foster place social bonding in the COVID-19 pandemic and beyond to subsequently contribute to wellbeing, this paper develops and proposes a new conceptual framework suggesting the need for adaptive social bonding interventions in the SARS-CoV-2 pandemic. This is an essential measure to manage the significant impacts on our global health services due to a decline in people's mental health in addition to COVID-19 physical impacts. The paper discusses how promoting adaptive social bonding interventions (psycho-socio, digital and nature social bonding) can make people more resilient. It further discusses how they can be empowered psychologically, socially, and emotionally in the current challenging times. The conceptual framework posits that social bonding interventions can assist in maintaining better mental, physical, emotional, and spiritual wellbeing and discusses how these wellbeing outcomes may also be experienced post the pandemic. This has important benefits and is of relevance to governments, policy makers and healthcare professionals in delivering better health care and equipping people with coping mechanisms both throughout the pandemic and in the long run.

Does Servant Leadership Control Psychological Distress in Crisis? Moderation and Mediation Mechanism

Purpose

This study aims to investigate the impact of servant leadership on the psychological distress of healthcare staff during the Covid-19 crisis. The authors propose that work engagement mediates and mindfulness moderates the direct relationship between servant leadership and psychological distress.

Methods

Time-lagged data were collected from 277 healthcare staff working at different hospitals in Pakistan. Process Macro version 3.1 on SPSS 23 was used for statistical analysis. For model fitness, we used AMOS V 22.

Results

The results show that servant leadership is negatively related to psychological distress. Furthermore, work engagement mediates the relationship between servant leadership and psychological distress. Moreover, mindfulness is anticipated to moderate the direct relationship between servant leadership and psychological distress, drawing on the social exchange and conservation of resources theory.

Discussion

This study finds that servant leadership is vital for the mental health of healthcare staff. Thus, it extends the utility of the concept of servant leadership to the psychology and crisis management literature.

Couple Conflict and Intimate Partner Violence during the Early Lockdown of the Pandemic: The Good, the Bad, or Is It Just the Same in a North Carolina, Low-Resource Population?

The COVID-19 pandemic has forced couples to navigate illness-related stressors and unique public health responses, including extended lockdowns. This study focused on under-resourced North Carolina residents (n = 107) who self-reported changes in relationship conflict (Increased, Decreased, Stayed the Same) and intimate partner violence (IPV) during the pandemic. We expected high rates of increased conflict and IPV since the start of the pandemic. We then sought to determine the associations between dyadic changes in conflict and reports of IPV and pandemic-related experiences and responses. Participants completed a brief online survey assessing their demographics, COVID-19 exposure/stressors, and pandemic responses. As expected, reports of increased couple conflict were related to difficulties getting needed social support, loss of health insurance, more fear and worry, stress, pain, and greater use of alcohol and/or illicit drugs, related to the coronavirus. Participants reporting increased conflict were also more likely to be unemployed. Conversely, reports of decreased conflict were associated with being ill from the virus (48.9%), having health insurance, and working part time. Substantial amounts of IPV were reported (62.2% of the sample); however, increased conflict and IPV were unrelated. Those reporting No IPV were less likely to be receiving public assistance but more likely to have home responsibilities due to the virus. They also reported increased social interactions and less use of alcohol than those reporting IPV perpetration. Findings highlight key associations among pandemic experiences and responses, IPV, and couple functioning in an under-resourced sample. Efforts to facilitate coping, resilience, and tolerating uncertainty may facilitate cooperative and safe couple functioning throughout the pandemic.

COVID-19 Pandemic Lockdown and Wellbeing: Experiences from Aotearoa New Zealand in 2020

In 2020, in the first COVID-19 pandemic lockdown, Aotearoa New Zealand consistently maintained stringent public health measures including stay-at-home lockdowns and distancing responses. Considering the widespread disruption to social functioning caused by the pandemic, this paper aimed to explore environmental and social factors that influenced the wellbeing of individuals during the first lockdown in Aotearoa New Zealand. Our mixed-methods study involved a survey (n = 1010) and semi-structured interviews of a subset of surveyed individuals undertaken at the tail end of the first 2020 lockdown. Survey participants were recruited through social media-driven snowball sampling, less than 50% were aged under 45 years and 85% identified as female. Of those interviewed, 63% identified as female. Qualitative interview findings and open-ended survey results were analysed thematically. Participants described a variety of factors influencing wellbeing, largely related to the community and household; physical, behavioural, and lifestyle factors; access to health services; and social and economic foundations. While much of the focus of COVID-19 recovery was on reversing the economic and physical toll of the pandemic, our findings emphasise the need to empower individuals, families, and communities to mitigate the pandemic’s negative implications on wellbeing.

The effects of yoga and mindful meditation on elderly care worker's burnout: a CONSORT-compliant randomized controlled trial

Objectives: This study aims to investigate the effects of mindful meditation and yoga on reducing burnout and stress in care workers who assist elderly individuals. Knowing how to reduce burnout is important because that of care workers is associated with the quality of client care, worker productivity, and job turnover.

Patients and Methods: The participants included 44 care workers who worked for elderly care facilities in rural Fukuoka. They were randomly assigned to one of three intervention groups: control, yoga, or mindfulness. In the yoga intervention group, a certified yoga instructor taught a 60-minute yoga session each week for six weeks. In the mindfulness group, an experienced medical doctor instructed a mindful meditation program for the same length. Participants were asked to complete the Japanese Burnout Scale (JBS), and the research team collected the level of α-amylase in saliva using NIPRO: T-110-N pre- and post-interventions.

Results: MANOVA was performed with each intervention (control, yoga, mindfulness) as the independent variable on the three subscales of the JBS (emotional exhaustion, depersonalization, and personal achievement) and a biomarker of stress level (α-amylase). The results indicated a significant main effect of interventions, and a follow-up ANOVA showed a significant effect of interventions on emotional exhaustion and personal achievement.

Conclusion: The results indicate that practicing mindful meditation or yoga for 60 minutes once a week for six weeks can reduce care workers’ burnout. This study was notable because the biomarker of stress also improved. It is strongly recommended and encouraged that institutions caring for the elderly population provide mindful meditation or yoga intervention to reduce burnout, which benefits not only care workers but also their clients.

COVID-19 and Its Lockdown in Belgium: How Limited Access to Environmental Satisfaction Impacts Emotions?

The COVID-19 pandemic has been shown to induce several psychological consequences (e.g., increases in anxiety and stress). Accordingly, it seems relevant to investigate how individuals cope with their emotions. Indeed, when facing negative emotions, individuals need to rely on adaptive emotion regulation strategies to alleviate their negative impacts (e.g., decrease in quality of life, increase in sleep disturbances). Moreover, lockdown’s measures led to a restriction of the access to activities which, in turn, might have decreased the “environmental satisfaction”. Then, this research investigates the pandemic’s psychological impacts on emotions and regulation strategies, intolerance of uncertainty, and environmental satisfaction. Our approach’s originality relies on comparing one’s actual psychological functioning (i.e., since the pandemic) to one’s general psychological functioning (i.e., before the pandemic). This study also assesses the relationships between both negative and positive emotions and (1) emotion regulation strategies, (2) intolerance of uncertainty and, (3) environmental satisfaction since the pandemic and its lockdown. The total sample comprised 948 adults from the general population. Results show that, since the pandemic, individuals experience higher levels of negative emotions, lower levels of positive emotions and environmental satisfaction. They also tend to worry less and to resort to acceptance more often. Also, environmental satisfaction is the most important predictor of both negative emotions and positive ones. Overall, findings confirm previous ones and seem to indicate that environmental satisfaction should be addressed more thoroughly.

5-min mindfulness audio induction alleviates psychological distress and sleep disorders in patients with COVID-19

BACKGROUND

Mindfulness meditation is beneficial to mitigate the negative effects of the coronavirus disease 2019 (COVID-19) pandemic in the general population, but no study examined such meditation in the COVID-19 patients themselves.

AIM

To explore the short-term efficacy of mindfulness meditation in alleviating psychological distress and sleep disorders in patients with COVID-19.

METHODS

This prospective study enrolled patients with mild COVID-19 treated at Wuhan Fangcang Hospital in February 2020. The patients were voluntarily divided into either a mindfulness or a conventional intervention group. The patients were evaluated before/after the intervention using the Short Inventory of Mindfulness Capability (SMI-C), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Seventy-five participants were enrolled in this study, with 43 and 32 in the mindfulness and conventional groups, respectively. Before the intervention, there were no differences in SMI-C, HADS, or PSQI scores between the two groups. After the 2-wk intervention, the mindfulness level (from 30.16 ± 5.58 to 35.23 ± 5.95, P < 0.001) and sleep quality (from 12.85 ± 3.06 to 9.44 ± 3.86, P < 0.001) were significantly increased in the mindfulness group. There were no differences in the conventional group. After the intervention, the mindfulness level (35.23 ± 5.95 vs 31.17 ± 6.50, P = 0.006) and sleep quality (9.44 ± 3.86 vs 11.87 ± 4.06, P = 0.011) were significantly higher in the mindfulness group than in the conventional group. Depression decreased in the mindfulness group (from 14.15 ± 3.21 to 12.50 ± 4.01, P = 0.038), but there was no difference between the two groups.

CONCLUSION

Short-term mindfulness meditation can increase the mindfulness level, improve the sleep quality, and decrease the depression of patients with COVID-19.

Efficacy and cost-effectiveness of an online mindfulness program (MindOnLine) to reduce fear of recurrence among people with cancer: study protocol for a randomised controlled trial

INTRODUCTION

Fear of cancer recurrence (FCR) is a common condition among cancer survivors that can lead to significant levels of distress, anxiety and depression. Online mindfulness programmes may provide the mechanism to support cancer survivors manage FCR and distress, and improve people's well-being over the short, medium and long term. The primary aim of this study is to determine the potential efficacy of MindOnLine, a 9 session mindfulness-based programme for survivors of breast, prostate and colorectal cancer. A formal economic programme will also be conducted.

METHODS AND ANALYSIS

A single-blind randomised controlled trial to determine the efficacy and cost-efficacy of a MindOnLine programme for cancer survivors. A total of 400 people living with cancer will be recruited via online advertisements on social media platforms, peak consumer advocacy groups or through outpatient services at healthcare providers across Victoria, Australia. People will be randomly allocated to either the MindOnLine programme (n=200) or waitlist control (n=200). Participant assessments will occur at baseline, at 9 weeks and 9-month follow-up. The primary outcome is change in Fear of Recurrence Index Score total score between baseline and 9 weeks; secondary outcomes are changes in depression and anxiety, quality of life and mindfulness. The economic analysis comprises a cost-consequences analysis where all outcomes will be compared with costs.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Peter MacCallum Cancer Centre (20-53) and Deakin University (2020-284). All participants will be required to provide written informed consent. Findings will be disseminated in peer reviewed journals and among key stakeholder organisations including hospitals, cancer and community organisations and Government. If successful the project will be rolled out nationally with a formal implementation plan.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (12620000645954); Pre-results. Registered 6 June 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379520&isReview=true.

ON WAR, UNCERTAINTY, AND FUTURE: LESSONS LEARNED FROM THE EASTERN PHILOSOPHY

OBJECTIVE

The aim: The paper aims to examine the relationship between uncertainty and plans for the future in traumatic situations such as war, as well as the role of the Eastern philosophy and its practical implications in managing uncertainty.

PATIENTS AND METHODS

Materials and methods: The authors used integrative anthropological approach, interpretive research paradigm, hermeneutical approach along with narrative approach. The data collection was carried out using PubMed, Scopus, Web of Science, Google Scholar databases. Research papers were identified according to search terms "uncertainty", "mental health", "health", "refugee", "anxiety", "depression", "war", "future", "Eastern philosophy", "mindfulness".

CONCLUSION

Conclusions: Bearing a set of negative beliefs about uncertainty and reacting negatively to uncertain and unpredictable situations, individuals fall into a vicious cycle of uncertainty fueled by their fear of uncertainty. Uncertainty takes us to the future that seems threatening or returns us to the world of primordial chaos. In both cases, we are not in the present moment, "here and now". As far as we have no control over the past and future, we feel helpless and experience fear, anxiety, depression. Returning to the present gives us back control over the situation. By expanding the range of possible visions of the future, we stop focusing on the worst-case scenario. By accepting the situation and realizing what is subject to our control and what is not, we learn to comfort uncertainty by elaborating possible futures taking into account both our desires and the current situation. Our thoughts and actions today determine our tomorrow. We cannot overcome uncertainty since it is ontologically predetermined. But we can manage our responses to uncertainty turning to the Eastern philosophy thereby maintaining our mental and physical health and expanding the functional field of human capabilities to achieve freedom and self-realization.

Fear of COVID-19 and Mental Health: The Role of Mindfulness in During Times of Crisis

The novel coronavirus disease (COVID-19) has had a significant impact on all aspects of individuals' lives, particularly their mental health due to the fear associated with the pandemic. Thus, the current study explored the relationship between the fear of COVID-19 and aspects of mental health, namely anxiety and depression, and will consider whether this relationship can be mediated by mindfulness. Data were collected from a student sample of 355 participants (71.5% female and 28.5% male) ranging between 18 and 41 years of age (M = 22.41 ± 3.27), with participants completing a fear of COVID-19 scale (FCV-19S), Mindfulness Attention and Awareness Scale (MAAS), and the anxiety and depression subscale of the Symptom Checklist-90-Revised (SCL-90-R). In terms of the results, correlational analyses indicated that fear of COVID-19 is inversely associated with mindfulness, while positive correlations were found with anxiety and depression. Structural equation modeling analyses demonstrated that mindfulness mediated the relationship between fear of COVID-19 and depression and anxiety. Associated implications are further discussed.

Insights and Future Directions on the Combined Effects of Mind-Body Therapies with Transcranial Direct Current Stimulation: An Evidence-based Review

Mind-body therapies (MBTs) use mental abilities to modify electrical neural activity across brain networks. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates neuronal membrane potentials to enhance neuroplasticity. A combination of these treatment strategies may generate synergistic or additive effects, and thus has been more commonly tested in clinical trials, fostering a novel yet promising field of research. We conducted a literature search in four different databases including only randomized clinical trials (RCTs) that tested the combination of MBTs with tDCS. Ten studies (n=461) were included. Combined protocols included meditation/mindfulness (8/10), biofeedback (1/10), and hypnosis (1/10). The RCTs were heterogeneous with regards to population, design, and types of outcomes. Based on the findings of this search, we provide here a content description, methodological and practical insights, and future directions for the field. We hope this review will provide future authors with information to facilitate the development of trials with improved protocols.

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η² = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η² = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η² = 0.071-F (2.79) = 2.874; p = 0.049; η² = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs.

Efficacy of video-based psychotherapy in reducing psychological distress of COVID-19 patients treated in isolation ward

BACKGROUND Hospitalized patients with COVID-19 experience isolation during treatment, which may cause psychological distress. Thus, alternative ways to deliver psychological support are needed when face-to-face therapy is not possible. This study aimed to investigate the efficacy of video-based psychotherapy in reducing distress in COVID-19 patients treated in an isolation ward. METHODS This quasi-experimental trial without a control group included 42 COVID-19 patients aged 20–59 years. Participants were recruited conveniently in the COVID-19 isolation ward in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. They watched three brief psychotherapy videos including relaxation, managing thoughts and emotions, and mindfulness for approximately 30 min. The videos were created by the Department of Psychiatry, Faculty of Medicine, Universitas Indonesia. Subjective units of distress scale (SUDS) was measured before and after watching all videos. Data were analyzed using the Wilcoxon-signed rank test. RESULTS All 42 subjects finished watching the videos. 31 subjects experienced a significant median decrease in SUDS score after the intervention. The effect size of the psychotherapy videos for the SUDS score was 0.485 (95% CI 0.302 to 0.634). CONCLUSIONS Watching psychotherapy videos is effective in reducing the SUDS score for COVID-19 patients in an isolation ward. Our brief video-based psychotherapy intervention has reduced psychological distress in hospitalized COVID-19 patients with limited access to face-to-face consultations due to the risk of disease transmission.

Mindfulness-Based Stress Reduction Increases Mental Wellbeing and Emotion Regulation During the First Wave of the COVID-19 Pandemic: A Synchronous Online Intervention Study

The COVID-19 pandemic imposed extreme living conditions of social distancing, which triggered negative mental health problems and created challenges in seeking mental health support. Mindfulness-based interventions (MBIs) have been found to enhance wellbeing and mental health by reducing stress and anxiety and improving emotion regulation. Preliminary evidence suggests that online, synchronous MBIs may produce beneficial effects similar to face-to-face programs. However, the effectiveness of such online-MBIs to support mental health in highly stressful times, such as a global pandemic, requires further study. To this end, we investigated the effect of an online 8-week Mindfulness-Based Stress Reduction (MBSR) program on aspects of mental health during the first wave of the COVID-19 pandemic. Participants (N=92) who expressed interest in discounted online-MBSR programs were recruited for the study. The division into experimental and control groups was based on actual enrollment to the courses. Those who enrolled in a program were assigned to the experimental condition and those who decided not to enroll served as controls. Participants were assessed pre-intervention, post-intervention, and 1-month post-intervention for levels of mindfulness, perceived stress, anxiety, emotion regulation, and intolerance of uncertainty. Differences between the groups were tested using the general linear mixed effects model (GLMM) and Individual Growth Curve Models (IGCM) in intent to treat analysis. The findings indicated that, relative to the control group, MBSR improved mindfulness abilities (p <0.001), decreased anxiety (p <0.001), and stress (p <0.001) and increased emotion regulation (p <0.001). These effects were found to persist 1 month after the end of the program, despite the increased governmental public-health restrictions due to COVID-19 at that time. The ability to tolerate uncertainty, a central characteristic of the pandemic, was not found to be affected by the program. A mediation analysis revealed that the effect of the intervention on mental health improvement was partially mediated by the improvement in emotion regulation. Overall, the findings provide positive evidence for the feasibility of an online-MBSR program to support the mental health of individuals from the general population through the mediation of emotion regulation in challenging times, such as a global pandemic.

Mental health interventions following COVID-19 and other coronavirus infections: a systematic review of current recommendations and meta-analysis of randomized controlled trials

OBJECTIVE

To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics.

METHODS

We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analysis was performed with data from randomized controlled trials (RCTs). For non-RCT studies, a critical description of recommendations was performed.

RESULTS

From a total of 2,825 articles, 125 were included. Of those, three RCTs were included in the meta-analysis. The meta-analysis revealed that the interventions promoted better overall mental health outcomes as compared to control groups (standardized mean difference [SMD] = 0.87 [95%CI 0.33-1.41], p < 0.001, I2 = 69.2%), but did not specifically improve anxiety (SMD = 0.98 [95%CI -0.17 to 2.13], p > 0.05; I2 = 36.8%). Concerning the systematic review, we found a large body of scientific literature proposing recommendations involving psychological/psychiatric interventions, self-care, education, governmental programs, and the use of technology and media.

CONCLUSIONS

We found a large body of expert recommendations that may help health practitioners, institutional and governmental leaders, and the general population cope with mental health issues during a pandemic or a crisis period. However, most articles had a low level of evidence, stressing the need for more studies with better design (especially RCTs) investigating potential mental health interventions during COVID-19.

PROSPERO REGISTRATION

CRD42020190212.

Quality of Life and a Surveillant Endocannabinoid System

The endocannabinoid system (ECS) is an important brain modulatory network. ECS regulates brain homeostasis throughout development, from progenitor fate decision to neuro- and gliogenesis, synaptogenesis, brain plasticity and circuit repair, up to learning, memory, fear, protection, and death. It is a major player in the hypothalamic-peripheral system-adipose tissue in the regulation of food intake, energy storage, nutritional status, and adipose tissue mass, consequently affecting obesity. Loss of ECS control might affect mood disorders (anxiety, hyperactivity, psychosis, and depression), lead to drug abuse, and impact neurodegenerative (Alzheimer's, Parkinson, Huntington, Multiple, and Amyotrophic Lateral Sclerosis) and neurodevelopmental (autism spectrum) disorders. Practice of regular physical and/or mind-body mindfulness and meditative activities have been shown to modulate endocannabinoid (eCB) levels, in addition to other players as brain-derived neurotrophic factor (BDNF). ECS is involved in pain, inflammation, metabolic and cardiovascular dysfunctions, general immune responses (asthma, allergy, and arthritis) and tumor expansion, both/either in the brain and/or in the periphery. The reason for such a vast impact is the fact that arachidonic acid, a precursor of eCBs, is present in every membrane cell of the body and on demand eCBs synthesis is regulated by electrical activity and calcium shifts. Novel lipid (lipoxins and resolvins) or peptide (hemopressin) players of the ECS also operate as regulators of physiological allostasis. Indeed, the presence of cannabinoid receptors in intracellular organelles as mitochondria or lysosomes, or in nuclear targets as PPARγ might impact energy consumption, metabolism and cell death. To live a better life implies in a vigilant ECS, through healthy diet selection (based on a balanced omega-3 and -6 polyunsaturated fatty acids), weekly exercises and meditation therapy, all of which regulating eCBs levels, surrounded by a constructive social network. Cannabidiol, a diet supplement has been a major player with anti-inflammatory, anxiolytic, antidepressant, and antioxidant activities. Cognitive challenges and emotional intelligence might strengthen the ECS, which is built on a variety of synapses that modify human behavior. As therapeutically concerned, the ECS is essential for maintaining homeostasis and cannabinoids are promising tools to control innumerous targets.

Efficacy of a brief online mindfulness-based intervention on the psychological well-being of health care professionals and trainees during the COVID-19 pandemic: A mixed method design

Background

During the coronavirus disease 2019 (COVID-19) pandemic, health professionals were pushed to the front line of a global health crisis unprepared and resource constrained, which affected their mental well-being.

Aim

This study aimed to investigate the effectiveness of a brief online mindfulness-based intervention (MBI) on stress and burnout for health professionals training and working in South Africa during the COVID-19 crisis.

Setting

The context of the study is the overburdened, under-resourced health care system in South Africa during a global pandemic.

Methods

A mixed method framework was adopted for this study. The quantitative data was analysed using descriptive analysis and the participants’ qualitative experiences were interpreted using interpretative phenomenological analysis.

Results

Forty-seven participants took part in this study. The study found a statistically significant (p < 0.05) reduction in stress levels and emotional exhaustion as well as an increase in mindful awareness and feelings of personal accomplishment after the intervention. The participants’ shared experiences were analysed in two parts. The pre-intervention analysis presented with central themes of loss of control and a sense of powerlessness because of COVID-19. The post-intervention analysis comprised themes of a sense of acquired control and empowerment through increased mindfulness.

Conclusions

The study found that a brief online MBI can be associated with reduced levels of stress and burnout as well as an increased sense of control and empowerment, felt both personally and professionally, during a global crisis.

Contribution

The impact of an online MBI for health care professionals amidst a pandemic has not been previously documented.

A Protocol for a Systematic Review and Meta-Analysis of Mind-Body Modalities to Manage the Mental Health of Healthcare Workers during the COVID-19 Era

The coronavirus disease 2019 (COVID-19) pandemic has become an unprecedented threat to humanity worldwide, including healthcare workers (HCWs). Mind–body modalities have been used to improve the mental health, well-being, quality of life, and physical health of clinical and general populations, and may also be used to improve the mental health of HCWs during COVID-19. The objective of this review is to analyze the effectiveness of mind–body modalities for the mental health of HCWs in the COVID-19 era. Six electronic bibliographic databases were comprehensively searched to find intervention studies using mind–body modalities, including meditation, mindfulness-based intervention, autogenic training, yoga, tai chi, qigong, breathing exercise, music therapy, guided imagery, biofeedback, prayer, and faith-based techniques for HCWs. All intervention studies conducted from December 2019 to August 2021 will be included. Quality assessment will be performed according to study type, and Cochrane Collaboration’s Risk of Bias tool will be used for randomized controlled clinical trials (RCTs). If sufficient homogeneous data from RCTs exist, a meta-analysis will be performed. Dichotomous data and continuous data are presented as risk ratios and mean differences with their 95% confidence intervals, respectively. The results of this systematic review will be disseminated through the publication of a manuscript in a peer-reviewed journal or by presentation at a conference.

Anxiety, anger, and mindfulness as predictors of general health in the general population during COVID-19 outbreak: A survey in southeast Iran

Communities have been exposed to the complications and problems caused by COVID‐19 disease, which has had various and complex effects on general health. The aim of this study was to investigate the relationship between anxiety, anger, mindfulness, and general health in the general population during the COVID‐19 outbreak in Iran. This cross‐sectional study was performed on 456 participants from September 2020 to April 2021. For data collection, Demographic Characteristics Form, General Health Questionnaire, Freiburg Mindfulness Inventory‐Short Form, The trait anxiety section of the State‐Trait Anxiety Inventory, The State‐Trait Anger Expression Inventory‐2 were used. General health was positively correlated with anxiety and anger and negatively correlated with mindfulness. Anxiety was positively correlated with anger and negatively correlated with mindfulness. No significant correlation was found between anger and mindfulness. Based on the multiple regression model, anxiety, anger and a family member infected with COVID‐19 were the predictors of general health (p < 0.001). Given that anxiety, anger, and family members infected with COVID‐19 are all predictors of public health, it is suggested that psychological programs and interventions be designed to reduce anxiety and anger, as well as to support family members infected with COVID‐19, to promote general health.

Non-Pharmacological Measures in the Prevention and Treatment of COVID-19 Infection

BACKGROUND

Previous pandemic and catastrophic events significantly changed the life of every human being, bringing him/her into a state of stress and the need to quickly adapt to new ways of daily activity. COVID-19 has a negative impact on all elements of health: social, physical and mental. Pharmacotherapy, as well as protective measures (isolation, wearing masks and maintaining physical distance) did not give the expected results. Vaccination has not yet led to herd immunity, so it is still jeopardizing every aspect of human health (1, 2). Non-pharmacological methods, such as stress and sleep control, physical activity and contact with nature are of great importance since they can significantly contribute to staying healthy during a pandemic.

OBJECTIVES

The aim of this paper is to evaluate the impact of non-pharmacological measures such as stress and sleep control (with different measures against the negative effects of anxiety and depression on mental state) and the possible positive impact of "forest bathing" on improving the immune response to the virus and its consequences.

METHODS

Available evidence-based studies on ways to com- bat stress and the effect of the proposed measures on human mental health and the im- mune system were analyzed. From the mentioned studies, recommended measures have been registered, which refer to stress and sleep control, diet and eating habits, contact with nature ("forest bathing", gardening), virtual communication and meditation (mindfulness practice).

RESULTS AND DISCUSSION

The combined results of these studies indicate that COVID-19 has a chronic course and complications that significantly affect the physical, mental and emotional state of the patient. Proven positive effects of non-pharmacological measures can be applied in the daily practice of primary health care in the comprehensive fight against the COVID-19 pandemic.

CONCLUSION

Non-pharmacological measures such as stress and sleep control, spending time in nature, healthy diet, and physical activity may improve the immune response to COVID-19. These measures, with their positive effects on all aspects of health, can make a major contribution to controlling and improving the quality of life during the COVID-19 pandemic.

Mindfulness and psychological distress among hemodialysis patients

The current study identifies the unique role of trait mindfulness in improving the psychological health of patients under hemodialysis. A correlational research design was employed with a sample of 221 patients under hemodialysis. Participants completed a survey about the basic demographics, psychological distress, and mindfulness. The mean age of the study participants was 51.87 years (SD = 14.00). Participants had a moderate level of psychological distress. Psychological distress was associated with various demographic and clinical variables. Mindfulness accounted for 2.6% additional variance above and beyond the 18% accounted by demographic and clinical variables. This study suggests that mindfulness may enhance the psychological health of patients under hemodialysis. Future research may want to develop an intervention that employs a mindfulness-based approach and assess its effectiveness in supporting patients under hemodialysis.

Anxiety, OCD, delusions, and religiosity among the general public during the COVID-19 pandemic

The COVID-19 outbreak has not only affected the physical health of the public but also resulted in severe psychological outcomes. This study aims to investigate the psychological effects of the COVID-19 outbreak on Pakistan's general public. In order to identify the main psychological factors that have emerged due to the current pandemic, extensive literature and opinion pieces of psychologists were reviewed. After a thorough study of the existing scholarship, four main psychological factors were investigated: stress and anxiety, obsessive compulsive disorder (OCD), delusions of getting infected from the disease, and religiosity. A research survey was circulated among the sample population online. A total 356 valid responses were received in the period of two to three weeks. Findings showed that the respondents reported a moderate level of anxiety, occasional symptoms of OCD, and delusions. However, respondents showed a high inclination toward religion during the current pandemic situation. Furthermore, respondents highlighted a few other psychological factors, such as financial strain and loneliness, in the survey. The primary sources of COVID-19-related information were social media and television among the general public of Pakistan. Finally, guidelines and tips from the reviewed psychologists and psychiatrists on overcoming the highlighted psychological problems that have arisen due to the COVID-19 outbreak were summarised.

Presentation and management of anxiety in individuals with acute symptomatic or asymptomatic COVID-19 infection, and in the post-COVID-19 recovery phase

COVID-19 is associated with neuropsychiatric complications, the most frequent one being anxiety. Multiple biological and psychosocial factors contribute to anxiety in COVID-19. Among the biological factors, stress, genetics, gender, immune system, resilience, anosmia, hypogeusia, and central nervous system infection with SARS-CoV-2 are key. Anxiety is a complication of COVID-19 that may exacerbate the infection course, and the infection may exacerbate anxiety. We present the mechanisms of anxiety in symptomatic or asymptomatic COVID-19. We discuss the presentation of anxiety in patients without or with prior psychiatric illness, and with co-morbidities. Timely diagnosis and management of anxiety in COVID-19 patients is important. Given the frequent complication of COVID-19 with Acute Respiratory Distress Syndrome and Intensive Care Unit stay, anxiety may be a long-term complication. We review the diagnostic tools for anxiety in COVID-19, and summarise pharmacologic and non-pharmacologic treatments. We provide recommendations for diagnosis, treatment, prevention and follow up of anxiety in COVID-19.Key pointsPatients with COVID-19 (symptomatic or asymptomatic) exhibit a high frequency of neuropsychiatric complications with highest percentage attributed to anxiety.Multiple biological and psychosocial risk factors for anxiety exist in COVID-19-ill individuals. Biological risk factors include stress, resilience, genetics, gender, age, immune system, direct infection of the central nervous system (CNS) with SARS-CoV-2, comorbid psychiatric and general medical illnesses, ARDS and ICU stay. Anosmia and hypogeusia are COVID-19-specific anxiety risk factors. Knowledge of the anxiety risk factors is essential to focus on timely interventions, because anxiety may be a complication of and exacerbate the COVID-19 course.An inverse correlation exists between resilience and anxiety because of COVID-19, and therefore efforts should be made to increase resilience in COVID-19 patients.In COVID-19, important anxiety mechanism is neuroinflammation resulting from activation of the immune system and an ensuing cytokine storm.The general approach to management of anxiety in COVID-19 should be compassionate, similar to that during trauma or disaster, with efforts focussed on instilling a sense of hope and resilience.In selecting pharmacological treatment of anxiety, the stress response and immune system effects should be key. Medications with cardio-respiratory adverse effects should be avoided in patients with respiratory problems.Anxiety is a disorder that will require for long-term follow up at least one month after COVID-19.

Mental Health Status of Late-Middle-Aged Adults in China During the Coronavirus Disease 2019 Pandemic

Background: The novel coronavirus 2019 (COVID-19) pandemic and related compulsory measures have triggered a wide range of psychological issues. However, the effect of COVID-19 on mental health in late-middle-aged adults remains unclear. Methods: This cross-sectional, web-based survey recruited 3,730 participants (≥ 50 years old) between February 28 and March 11 of 2020. The Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale were used to evaluate depression, anxiety, insomnia, and acute stress symptoms. Multivariate logistic regression analysis was fitted to explore risk factors that were associated with the selected outcomes. Results: The mean age of the participants was 54.44 ± 5.99 years, and 2,026 (54.3%) of the participants were female. The prevalence of depression, anxiety, insomnia, and acute stress symptoms among late-middle-aged adults in China during the COVID-19 pandemic was 20.4, 27.1, 27.5, and 21.2%, respectively. Multivariable logistic regression analyses showed that participants who were quarantined had increased odds ratios for the four mental health symptoms, and those with a good understanding of the COVID-19 pandemic displayed a decreased risk for all mental health symptoms among late-middle-aged adults. In addition, participants with a low income and with a risk of COVID-19 exposure at work had a remarkably high risk of depression, anxiety, and acute stress symptoms. Conclusions: Mental health symptoms in late-middle-aged adults in China during the COVID-19 pandemic are prevalent. Population-specific mental health interventions should be developed to improve mental health outcomes in late-middle-aged adults during this public health emergency.

The Relationship between Coronavirus Anxiety, Mindfulness and Spiritual Health in Patients with Cancer: A Survey in Southeast Iran

OBJECTIVE

The sudden outbreak of COVID-19 has caused major health problems, including anxiety in cancer patients worldwide. Spiritual health and mindfulness are considered as factors affecting anxiety. This study addressed the relationship between COVID-19 anxiety, spiritual health and mindfulness in patients with cancer.

METHODS

One hundred and eighty-four cancer patients participated in this cross-sectional study. The data were collected with convenience sampling method from two oncology centers from 15 June to 15 July 2020 in the southeast Iran. Patients completed the Demographic and Clinical Characteristics Form, Corona Disease Anxiety Scale (CDAS), The Freiburg Mindfulness inventory-Short Form (FMI-SF) and Spiritual Health Scale.

RESULTS

According to the psychological symptom subscale (CDAS), 61.4% of the participants had moderate to severe anxiety. According to the physical symptom subscale, 38% of the participants had moderate to severe anxiety. No significant association was found between corona disease anxiety and mindfulness/spiritual health (p>0.05).

CONCLUSION

The results of this study showed high levels of mental and physical anxiety and worries about COVID-19 disease in cancer patients, which led to challenges in their lives. It is necessary to review and implement effective interventions in future studies to prevent anxiety and its consequences in cancer patients.

Fear of COVID-19 and Mental Health: The Role of Mindfulness in During Times of Crisis

The novel coronavirus disease (COVID-19) has had a significant impact on all aspects of individuals' lives, particularly their mental health due to the fear associated with the pandemic. Thus, the current study explored the relationship between the fear of COVID-19 and aspects of mental health, namely anxiety and depression, and will consider whether this relationship can be mediated by mindfulness. Data were collected from a student sample of 355 participants (71.5% female and 28.5% male) ranging between 18 and 41 years of age (M = 22.41 ± 3.27), with participants completing a fear of COVID-19 scale (FCV-19S), Mindfulness Attention and Awareness Scale (MAAS), and the anxiety and depression subscale of the Symptom Checklist-90-Revised (SCL-90-R). In terms of the results, correlational analyses indicated that fear of COVID-19 is inversely associated with mindfulness, while positive correlations were found with anxiety and depression. Structural equation modeling analyses demonstrated that mindfulness mediated the relationship between fear of COVID-19 and depression and anxiety. Associated implications are further discussed.

Improvements in Health Might Contradict Adherence to Mobile Health Interventions: Findings from a Self-Care Cancer App Study

Background: Cancer patients often suffer from high levels of distress. Mobile health (mHealth) applications might be an innovative way to deliver mindfulness and relaxation interventions for cancer patients. However, data about the implementation of apps in health care are lacking. Adherence to mHealth interventions is an important indicator for a successful implementation and might be needed to maximize treatment effects. However, the decrease in distress might reduce the motivation of patients to engage in such self-care tools in the long run. Therefore, the aim of this analysis was to investigate the association between the course of distress over time and the adherence to a relaxation self-care app in cancer patients. Methods: We developed an app for cancer patients (CanRelax) and 83 patients who participated in the prospective observational study used the app at least once. The evaluation was guided by the RE-AIM framework, and this analysis focused on the implementation of the app. Patients were grouped into five subgroups according to their course of distress over 10 weeks (Distress Thermometer). These subgroups of patients were compared with each other to identify different user groups. Findings: About half of the patients were adherent over 10 weeks. However, a decrease in distress was associated with lower adherence to the app intervention, whereas patients with moderate distress or an increase in distress showed more adherence. Conclusion: Adherence to an app intervention might be also driven by patients' distress level. A decrease in distress might reduce patients' motivation to continue with a self-care intervention. The interplay between adherence and treatment outcomes should be explored in upcoming mHealth trials to get a better understanding for the implementation of such interventions. Encouraging patients to continue self-care interventions is a major challenge in integrative medicine if they are delivered digitally. The Clinical Trial Registration number: DRKS00010481.

Comparison of the Effectiveness of an Abbreviated Program versus a Standard Program in Mindfulness, Self-Compassion and Self-Perceived Empathy in Tutors and Resident Intern Specialists of Family and Community Medicine and Nursing in Spain

Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271; p = 0.042; η2 = 0.067) and self-compassion (F(2,91) = 6.046; p = 0.003; η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880; p = 0.025; η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.

The Effect of Meditation and Physical Activity on the Mental Health Impact of COVID-19-Related Stress and Attention to News Among Mobile App Users in the United States: Cross-sectional Survey

BACKGROUND

The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people's mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19.

OBJECTIVE

The objectives of this study were to (1) examine the regional differences in mental health and COVID-19-related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19-related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19-related worry, attention to news, and stress.

METHODS

A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19-related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19-related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19-related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects.

RESULTS

The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19-related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity (P<.001), strength of meditation habit (P<.001), and stopping meditation (P=.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity (P<.001) and strength of meditation habit (P<.001).

CONCLUSIONS

Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.

Latent profile analysis of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience

The purpose of the current study was to identify latent profiles of COVID-19 fear, depression, anxiety, stress, mindfulness, and resilience among university students. A total of 506 university undergraduate and graduate students from various universities were recruited through online platforms in Turkey. Data were collected utilizing self-report scales and were analyzed utilizing latent profile analysis. Results indicated significant relationships among COVID-19 fear, depression, anxiety, stress, resilience, and mindfulness. A three-class solution was adapted to fit the current data. Findings revealed that 46% of the participants were classified into the high COVID-19 fear and medium psychological symptoms profile. Also, 38% of the participants were identified as low psychological symptoms and high mindfulness and resilience. Additionally, 16% of the participants were classified as high COVID-19 fear, psychological symptoms and low mindfulness and resilience. Female gender was positively associated with COVID-19 fear, depression, anxiety, and stress. Life satisfaction and social support were positively associated with the mindfulness and resilience, and were negatively related to COVID-19 fear, depression, anxiety, and stress.

Neurological involvement of COVID-19: from neuroinvasion and neuroimmune crosstalk to long-term consequences

As the coronavirus disease 2019 (COVID-19) pandemic continues to be a multidimensional threat to humanity, more evidence of neurological involvement associated with it has emerged. Neuroimmune interaction may prove to be important not only in the pathogenesis of neurological manifestations but also to prevent systemic hyperinflammation. In this review, we summarize reports of COVID-19 cases with neurological involvement, followed by discussion of possible routes of entry, immune responses against coronavirus infection in the central nervous system and mechanisms of nerve degeneration due to viral infection and immune responses. Possible mechanisms for neuroprotection and virus-associated neurological consequences are also discussed.

COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons

BACKGROUND

To better understand how the COVID-19 pandemic has affected surgical trainees' and early-career surgeons' professional and personal experiences, a survey of the membership of the American College of Surgeons (ACS) Resident and Associate Society (RAS) and Young Fellows Association (YFA) was performed.

STUDY DESIGN

An anonymous online survey was disseminated to members of RAS and YFA. Descriptive analyses were performed and factors associated with depression and burnout were examined with univariate and multivariable stepwise logistic regression.

RESULTS

Of the RAS/YFA membership of 21,385, there were 1,160 respondents. The majority of respondents (96%) reported the COVID-19 pandemic having a negative impact on their clinical experience, with 84% of residents reporting a > 50% reduction in operative volume and inability to meet minimum case requirements. Respondents also reported negative impacts on personal wellness. Nearly one-third reported inadequate access to personal protective equipment, and depression and burnout were pervasive (≥21% of respondents reported yes to every screening symptom). On multivariable analysis, female sex (odds ratio [OR] 1.54 for depression, OR 1.47 for burnout) and lack of wellness resources (OR 1.55 for depression, OR 1.44 for burnout) predicted depression and burnout. Access to adequate personal protective equipment was protective against burnout (OR 0.52).

CONCLUSIONS

These data demonstrate a significant impact of the COVID-19 pandemic on the lives of residents and early-career surgeons. Actionable items from these data include mitigation of burnout and depression through increasing personal protective equipment access and provision of wellness programs, with a particular focus on high-risk groups.

Understanding wellbeing and death obsession of young adults in the context of Coronavirus experiences: Mitigating the effect of mindful awareness

The present study investigated the mediating effect of mindfulness on the association of coronavirus-related suffering and stress with death obsession and subjective wellbeing in young adults during the COVID-19 pandemic. The sample of this study was 583 Turkish young adults from a public university in Turkey. They ranged in age between 18 and 40 years (M = 20.97; SD = 2.38). The results showed that coronavirus stress mediated the impact of coronavirus suffering on mindfulness and death obsession. Moreover, greater mindfulness mediated the adverse impacts of coronavirus suffering and stress on young adults' subjective wellbeing.

Influence on Forgiveness, Character Strengths and Satisfaction with Life of a Short Mindfulness Intervention via a Spanish Smartphone Application

Mindfulness-based interventions (MBI) are a recognized effective psychological practice characterized by attention control, awareness, acceptance, non-reactivity, and non-judgmental thinking obtained through the practice of meditation. They have been shown to be useful in reducing stress and enhancing well-being in different contexts. In this research, the effectiveness of an MBI was evaluated on variables that can promote successful job performance such as mindfulness trait, positive and negative affect, forgiveness, personality strengths and satisfaction with life. The intervention was carried out through a smartphone application called "Aire Fresco" (Fresh Air) during 14 days in the middle of the quarantine produced by the Covid-19 pandemic. The study sample was composed of 164 Spanish people who were distributed in two groups: control group and experimental group, which were evaluated before and after the intervention. The MANCOVA performed showed an overall positive effect of the intervention on the variables evaluated. The different ANCOVAs carried out showed that the intervention was beneficial in increasing mindfulness trait, reducing negative affect or increasing life satisfaction, among others. Our study is, as far as we know, the first to demonstrate the effectiveness of a brief intervention in mindfulness conducted using a smartphone application in Spanish.

Evaluation of the E-Mental Health Mindfulness-Based and Skills-Based "CoPE It" Intervention to Reduce Psychological Distress in Times of COVID-19: Results of a Bicentre Longitudinal Study

Background: The SARS-CoV-2 pandemic poses immense challenges for health care systems and population-wide mental health. The e-mental health intervention "CoPE It" has been developed to offer standardized and manualized support to overcome psychological distress caused by the pandemic. The aim of this study was to assess the effectiveness of "CoPE It" in terms of reducing distress (primary outcome), depression and anxiety symptoms, and improving self-efficacy, and mindfulness (secondary outcomes). Furthermore, the intervention's usability, feasibility, and participants' satisfaction with "CoPE It" was evaluated (tertiary outcome). The study protocol has been published previously. Methods: A bicentre longitudinal study was conducted from April 27th 2020 to May 3rd 2021. N = 110 participants were included in the analyses. The intervention consisted of four modules featuring different media promoting evidence-based methods of cognitive behavioral therapy and mindfulness-based stress reduction. Difference in psychological distress between baseline (T0) and post-intervention (T1) were analyzed by repeated measure analysis of covariance. Mixed linear models were applied to assess moderating effects. Depressive symptoms, generalized anxiety symptoms, self-efficacy, and mindfulness were compared between baseline (T0) and post-intervention (T1) via t-tests. Usability of the "CoPE It" intervention and participants' satisfaction was evaluated by calculation means and frequencies. Results: Primary outcome: A significant effect of time on psychological distress at post-intervention (T1) after controlling for age, gender, education, mental illness and attitudes toward online interventions was found. Depressive and anxiety symptoms, and mindfulness were a significant moderators of the relationship between time and psychological distress for consistent wording. Secondary outcomes: There was a significant decrease in depressive symptoms and generalized anxiety, and a significant increase in self-efficacy and mindfulness between baseline (T0) and post-intervention (T1). Tertiary outcomes: 95.83% of the participants thought the "CoPE It" intervention was easy to use and 87.50% were satisfied with the "CoPE It" intervention in an overall, general sense. Conclusion: The e-mental health "CoPE It" intervention seems to be an effective approach in reducing psychological distress, anxiety and depressive symptoms, and in enhancing self-efficacy and mindfulness during the COVID-19 pandemic. Participants' satisfaction and the program's feasibility, and usability were proven to be high. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: DRKS00021301.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

OBJECTIVES

Work related stress is a major occupational health problem that is associated with adverse effects on physical and mental health. Healthcare workers are particularly vulnerable in the era of COVID-19. Physical methods of stress relief such as yoga and massage therapy may reduce occupational stress. The objective of this systematic review and network meta-analysis is to determine the effects of yoga, massage therapy, progressive muscle relaxation, and stretching on alleviating stress and improving physical and mental health in healthcare workers.

METHODS

Databases were searched for randomized controlled trials on the use of physical relaxation methods for occupational stress in healthcare workers with any duration of follow-up. Meta-analysis was performed for standard mean differences in stress measures from baseline between subjects undergoing relaxation vs non-intervention controls. Network meta-analysis was conducted to determine the best relaxation method.

RESULTS

Fifteen trials representing 688 healthcare workers were identified. Random-effects meta-analysis shows that physical relaxation methods overall reduced measures of occupational stress at the longest duration of follow-up vs baseline compared to non-intervention controls (SMD -0.53; 95% CI [-0.74 to -0.33]; p < .00001). On network meta-analysis, only yoga alone (SMD -0.71; 95% CI [-1.01 to -0.41]) and massage therapy alone (SMD -0.43; 95% CI [-0.72 to -0.14]) were more effective than control, with yoga identified as the best method (p-score = .89).

CONCLUSION

Physical relaxation may help reduce occupational stress in healthcare workers. Yoga is particularly effective and offers the convenience of online delivery. Employers should consider implementing these methods into workplace wellness programs.

Relationship Between Problematic Social Media Usage and Employee Depression: A Moderated Mediation Model of Mindfulness and Fear of COVID-19

Social media plays a significant role in modern life, but excessive use of it during the COVID-19 pandemic has become a source of concern. Supported by the conservation of resources theory, the current study extends the literature on problematic social media usage during COVID-19 by investigating its association with emotional and mental health outcomes. In a moderated mediation model, this study proposes that problematic social media use by workers during COVID-19 is linked to fear of COVID-19, which is further associated with depression. The current study tested trait mindfulness as an important personal resource that may be associated with reduced fear of COVID-19 despite problematic social media use. The study collected temporally separate data to avoid common method bias. Pakistani employees (N = 267) working in different organizations completed a series of survey questionnaires. The results supported the moderated mediation model, showing that problematic social media use during the current pandemic is linked to fear of COVID-19 and depression among employees. Furthermore, trait mindfulness was found to be an important buffer, reducing the negative indirect association between problematic social media use and depression through fear of COVID-19. These results offer implications for practitioners. The limitations of this study and future research directions are also discussed.