Mindfulness and Behavior Change

Timing theory integrated nursing combined behavior change integrated theory of nursing on primiparous influence

BACKGROUND

The comprehension and utilization of timing theory and behavior change can offer a more extensive and individualized provision of support and treatment alternatives for primipara. This has the potential to enhance the psychological well-being and overall quality of life for primipara, while also furnishing healthcare providers with efficacious interventions to tackle the psychological and physiological obstacles encountered during the stages of pregnancy and postpartum.

AIM

To explore the effect of timing theory combined with behavior change on self-efficacy, negative emotions and quality of life in patients with primipara.

METHODS

A total of 80 primipara cases were selected and admitted to our hospital between August 2020 and May 2022. These cases were divided into two groups, namely the observation group and the control group, with 40 cases in each group. The nursing interventions differed between the two groups, with the control group receiving routine nursing and the observation group receiving integrated nursing based on the timing theory and behavior change. The study aimed to compare the pre- and post-nursing scores of Chinese Perceived Stress Scale (CPSS), Edinburgh Postpartum Depression Scale (EPDS), Self-rating Anxiety Scale (SAS), breast milk knowledge, self-efficacy, and SF-36 quality of life in both groups.

RESULTS

After nursing, the CPSS, EPDS, and SAS scores of the two groups was significantly lower than that before nursing, and the CPSS, EPDS, and SAS scores of the observation group was significantly lower than that of the control group (P = 0.002, P = 0.011, and P = 0.001 respectively). After nursing, the breastfeeding knowledge mastery, self-efficacy, and SF-36 quality of life scores was significantly higher than that before nursing, and the breastfeeding knowledge mastery (P = 0.013), self-efficacy (P = 0.008), and SF-36 quality of life (P = 0.011) scores of the observation group was significantly higher than that of the control group.

CONCLUSION

The integration of timing theory and behavior change integrated theory has been found to be an effective approach in alleviating negative mood and stress experienced by primipara individuals, while also enhancing their self-efficacy and overall quality of life. This study focuses on the key concepts of timing theory, behavior change, primipara individuals, negative mood, and quality of life.

The Evolution of Mindfulness-Based Stress Reduction Teacher Training Programs for People Who Serve Historically Underrepresented Racial and Ethnic Groups

Background

There is a lack of mindfulness instructors from underserved/underrepresented communities who have completed systematic mindfulness teacher-training programs to meet the growing demand for culturally responsive mindfulness training in those communities.

Objectives

To investigate strategies for increasing the representation of Mindfulness-Based Stress Reduction (MBSR) teachers who serve historically underrepresented racial and ethnic groups.

Methods

Conducted through 4 one-hour Zoom focus groups (n = 54; women = 74%), this study queried individuals with experience serving underrepresented racial and ethnic communities, and had mindfulness experience, on how to increase participation from underrepresented communities in mindfulness. Thematic analysis of transcripts of participant responses involved double-coding by three team members, supporting rigorous evaluation of the data. All respondents who expressed interest in participating enrolled (no dropout from study enrollment to participation in focus groups).

Results

The study identified four key themes that illuminate challenges and essential adaptations for MBSR teacher training aimed at individuals serving historically underrepresented racial and ethnic groups. These themes include: (1) Cost and time commitment; (2) Trauma sensitivity; (3) Cultural Awareness; and (4) Diversity in teachers.

Conclusion

Participants provided actionable recommendations poised to facilitate the expansion of MBSR into more diverse communities, emphasizing optimal benefits and effective communication of inherent healing strengths within these communities. The findings underscore the compelling interest among leaders in marginalized communities to extend the reach of MBSR through culturally responsive approaches. This involves guiding pertinent adjustments and encouraging greater involvement of underserved communities in MBSR teacher training programs.

Interactive effects of mindfulness and negative urgency on intimate partner aggression perpetration

Intimate partner aggression (IPA) is a costly and incompletely understood phenomenon. Negative urgency, the tendency to act impulsively in response to negative affect, is predictive of IPA perpetration. Mindfulness, by virtue of its emphasis on nonreactivity to negative affect, is an opposing force to urgent tendencies that may mitigate the negative urgency-IPA link. Yet, no research to date investigates the interactive effects of negative urgency and mindfulness on IPA perpetration. Two studies were conducted that measured and manipulated multiple facets of mindfulness alongside measures of negative urgency and tendencies of IPA perpetration (combined N = 508 undergraduate students in monogamous intimate relationships). Counter to our preregistered predictions, we found that negative urgency's association with greater IPA perpetration increased at higher levels of mindfulness. These findings suggest that mindfulness may not be a protective factor against IPA perpetration for individuals higher in negative urgency, but rather may serve as a risk factor.

Inside the mindful moment: The effects of brief mindfulness practice on large-scale network organization and intimate partner aggression

Mindfulness can produce neuroplastic changes that support adaptive cognitive and emotional functioning. Recently interest in single-exercise mindfulness instruction has grown considerably because of the advent of mobile health technology. Accordingly, the current study sought to extend neural models of mindfulness by investigating transient states of mindfulness during single-dose exposure to focused attention meditation. Specifically, we examined the ability of a brief mindfulness induction to attenuate intimate partner aggression via adaptive changes to intrinsic functional brain networks. We employed a dual-regression approach to examine a large-scale functional network organization in 50 intimate partner dyads (total n = 100) while they received either mindfulness (n = 50) or relaxation (n = 50) instruction. Mindfulness instruction reduced coherence within the Default Mode Network and increased functional connectivity within the Frontoparietal Control and Salience Networks. Additionally, mindfulness decoupled primary visual and attention-linked networks. Yet, this induction was unable to elicit changes in subsequent intimate partner aggression, and such aggression was broadly unassociated with any of our network indices. These findings suggest that minimal doses of focused attention-based mindfulness can promote transient changes in large-scale brain networks that have uncertain implications for aggressive behavior.

Adapted Mindfulness Training for Interoception and Adherence to the DASH Diet: A Phase 2 Randomized Clinical Trial

Importance

Hypertension is a major cause of cardiovascular disease, and although the Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP), adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption.

Objective

To evaluate the effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness and DASH adherence.

Design, Setting, and Participants

Parallel-group, phase 2, sequentially preregistered randomized clinical trials were conducted from June 1, 2017, to November 30, 2020. Follow-up was 6 months. Participants with elevated unattended office BP (≥120/80 mm Hg) were recruited from the population near Providence, Rhode Island. Of 348 participants assessed for eligibility, 67 did not meet inclusion criteria, 17 declined, and 63 did not enroll prior to study end date. In total, 201 participants were randomly assigned, 101 to the MB-BP program and 100 to the enhanced usual care control group, with 24 (11.9%) unavailable for follow-up. Outcome assessors and the data analyst were blinded to group allocation. Analyses were performed using intention-to-treat principles from June 1, 2022, to August 30, 2023.

Interventions

The 8-week MB-BP program was adapted for elevated BP, including personalized feedback, education, and mindfulness training directed to hypertension risk factors. Both MB-BP and control groups received home BP monitoring devices with instructions and options for referral to primary care physicians. The control group also received educational brochures on controlling high BP.

Main Outcomes and Measures

The primary outcome was Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire scores (range 0-5, with higher scores indicating greater interoceptive awareness), and the secondary outcome was DASH adherence scores assessed via a 163-item Food Frequency Questionnaire (range 0-11, with higher scores indicating improved DASH adherence), all compared using regression analyses.

Results

Among 201 participants, 118 (58.7%) were female, 163 (81.1%) were non-Hispanic White, and the mean (SD) age was 60.0 (12.2) years. The MB-BP program increased the MAIA score by 0.54 points (95% CI, 0.35-0.74 points; P < .001; Cohen d = 0.45) at 6 months vs control. In participants with poor baseline DASH adherence, the MB-BP program also significantly increased the DASH score by 0.62 points (95% CI, 0.13-1.11 points; P = .01; Cohen d = 0.71) at 6 months vs controls. The intervention was also associated with a 0.34-point improvement in the DASH diet score in all MB-BP participants from baseline (95% CI, 0.09-0.59 points; P = .01; Cohen d = 0.27), while the control group showed a -0.04 point change in DASH diet score from baseline to 6 months (95% CI, -0.31 to 0.24 points; P = .78; Cohen d = -0.03).

Conclusions and Relevance

A mindfulness program adapted to improving health behaviors to lower BP improved interoceptive awareness and DASH adherence. The MB-BP program could support DASH dietary adherence in adults with elevated BP.

Clinical Trial Registration

ClinicalTrials.gov Identifiers: NCT03859076 and NCT03256890.

Be more mindful: Targeting addictive responses by integrating mindfulness with cognitive bias modification or cue exposure interventions

This review provides an overview of the most prominent neurocognitive effects of cognitive bias modification (CBM), cue-exposure therapy and mindfulness interventions for targeting addictive responses. It highlights the key insights that have stemmed from cognitive neuroscience and brain imaging research and combines these with insights from behavioural science in building a conceptual model integrating mindfulness with response-focused CBM or cue-exposure interventions. This furthers our understanding of whether and how mindfulness strategies may i) facilitate or add to the induced response-focused effects decreasing cue-induced craving, and ii) further weaken the link between craving and addictive responses. Specifically, awareness/monitoring may facilitate, and decentering may add to, response-focused effects. Combined awareness acceptance strategies may also diminish the craving-addiction link. The conceptual model presented in this review provides a specific theoretical framework to deepen our understanding of how mindfulness strategies and CBM or cue-exposure interventions can be combined to greatest effect. This is important in both suggesting a roadmap for future research, and for the further development of clinical interventions.

Features of Self-Organization during the Process of Mindfulness-Based Stress Reduction: A Single Case Study

Compared to the extensive evidence of the effectiveness of mindfulness-based interventions, there is only a limited understanding of their mechanisms of change. The three aims of this study are (1) to identify features of self-organization during the process (e.g., pattern transitions), (2) to obtain an impression of the effects of continuous self-assessments and feedback sessions on mindfulness-related stress reduction, and (3) to test the feasibility of high-frequency process monitoring and process feedback. Concerning aim (1), the specific hypothesis is that change will occur as a cascade of discontinuous pattern transitions emerging spontaneously in the sense of not being a reaction to external input. This single case study describes changing patterns of multiple time series that were produced by app-based daily self-assessments during and after an 8-week mindfulness-based stress reduction program. After this MBSR program, the participant (a female nurse) continued the self-assessment and the mindfulness practice for a further 10 months. The results confirm findings on the positive effects of mindfulness programs for healthcare professionals, especially on coping with work-related stress. The analysis of the time series data supports the hypothesis of self-organization as a possible mechanism of change manifesting as a cascade of phase transitions in the dynamics of a biopsychosocial system. At the end of the year, the participant reported a beneficial impact of daily monitoring and systematic feedback on the change process. The results underline the feasibility and usefulness of continuous high-frequency monitoring during and after mindfulness interventions.

Survivors Overcoming and Achieving Resiliency (SOAR): Mindful Eating Practice for Breast Cancer Survivors in a Virtual Teaching Kitchen

The practice of mindful eating brings awareness to food choices, brings attention to the eating experience, and encourages selecting and preparing food that is both satisfying and nourishing. We examined mindful eating in breast cancer survivors following a 9-week, multidisciplinary virtual teaching kitchen intervention called Survivors Overcoming and Achieving Resiliency (SOAR). SOAR engaged participants through weekly cooking classes that also taught multiple domains of mindfulness. Participants (n = 102) were breast cancer survivors and completed the Mindful Eating Questionnaire (MEQ) prior to and after completion of the intervention. Linear regression analyses examined relationships between the aspects of mindful eating and body mass index (BMI). Wilcoxon (paired) rank sum tests evaluated the significance of the change in the MEQ total sum and subscales scores. A total of 102 participants completed both the pre- and post-intervention surveys. The mean change between the pre- and post-SOAR MEQ summary scores was 0.12 (sd = 0.30; Wilcoxon p-value = 0.0003). All MEQ subscale scores significantly increased with the exception of the distraction subscale. The MEQ summary scores increased for participants across both BMI stratifications. The SOAR teaching kitchen represents one of the first interventions that is tailored for breast cancer survivors and combines behavioral strategies from mindful eating training to nutritional knowledge and culinary medicine pedagogy in a virtual teaching kitchen. Further research is needed to examine whether mindful eating practices among cancer survivors result in sustainable healthy eating behaviors and food choices consistent with the cancer risk reduction guidelines.

Non-pharmaceutical interventions to optimize cancer immunotherapy

The traditional picture of cancer patients as weak individuals requiring maximum rest and protection is beginning to dissolve. Too much focus on the medical side and one's own vulnerability and mortality might be counterproductive and not doing justice to the complexity of human nature. Unlike cytotoxic and lympho-depleting treatments, immune-engaging therapies strengthen the immune system and are typically less harmful for patients. Thus, cancer patients receiving checkpoint inhibitors are not viewed as being vulnerable per se, at least not in immunological and physical terms. This perspective article advocates a holistic approach to cancer immunotherapy, with an empowered patient in the center, focusing on personal resources and receiving domain-specific support from healthcare professionals. It summarizes recent evidence on non-pharmaceutical interventions to enhance the efficacy of immune checkpoint blockade and improve quality of life. These interventions target behavioral factors such as diet, physical activity, stress management, circadian timing of checkpoint inhibitor infusion, and waiving unnecessary co-medication curtailing immunotherapy efficacy. Non-pharmaceutical interventions are universally accessible, broadly applicable, instantly actionable, scalable, and economically sustainable, creating value for all stakeholders involved. Most importantly, this holistic framework re-emphasizes the patient as a whole and harnesses the full potential of anticancer immunity and checkpoint blockade, potentially leading to survival benefits. Digital therapeutics are proposed to accompany the patients on their mission toward change in lifestyle-related behaviors for creating optimal conditions for treatment efficacy and personal growth.

Psychosocial-spiritual well-being is related to resilience and mindfulness in patients with severe and/or life-limiting medical illness

BACKGROUND

Improvement of psychosocial-spiritual well-being in patients with life-threatening or life-limiting illness is desirable. Resilience and mindfulness are considered to be helpful for enhancing psychosocial-spiritual well-being. Mindfulness-based interventions have been shown to promote resilience to stress and enhance well-being. However, in medical patients, evidence for the associations between mindfulness and resilience is lacking. We hypothesize patients with higher levels of psychosocial-spiritual well-being demonstrate greater resilience and mindfulness.

METHODS

200 patients (mean age = 50.2, SD = 15.5) with serious and or life-limiting illnesses were recruited from the NIH Clinical Center. Patients completed a demographic questionnaire, the NIH-HEALS measure of psychosocial-spiritual well-being, the Connor-Davidson Resilience Scale (CD-RISC-10), and the Mindful Attention Awareness Scale (MAAS). The demographic questionnaire also included a question on current stress level.

RESULTS

The NIH-HEALS was positively correlated to CD-RISC-10 (rs=0.44, p < 0.001) and MAAS (rs=0.32, p < 0.001). These findings were consistent across all three NIH-HEALS factors. Additionally, CD-RISC-10 and MAAS demonstrated a meaningful relationship to each other (rs=0.46, p < 0.001). All three constructs were inversely related to current stress level.

CONCLUSIONS

Findings suggest that there is a meaningful relationship between psychosocial-spiritual well-being, mindfulness, and resilience. Mindfulness and resilience are positively correlated in a medical population. Clinical interventions aimed at enhancing psychosocial-spiritual well-being through mindfulness and resilience can be highly promising for patients with severe and or life limiting illness.

Psychometric Testing of the Caregiver Attitudes on Substance Use in Pregnancy Instrument

OBJECTIVE

To modify an existing instrument used to measure the attitudes of perinatal nursing caregivers about pregnant women with substance use disorder (SUD) and to psychometrically test the new instrument: Caregiver Attitudes on Substance Use in Pregnancy (CASUD-OB).

DESIGN

Instrument modification and psychometric testing of results from a modified instrument.

SETTING

Multi-hospital health care system in the midwestern United States.

PARTICIPANTS

A total of 147 perinatal nursing caregivers (perinatal nurses: n = 131; unlicensed assistive personnel: n = 16) who worked on obstetric and neonatal nursing units.

METHODS

We modified the existing instrument, and 12 experts in perinatal nursing (1 who also had expertise in SUD in the perinatal period) evaluated the items for content validity. We administered the CASUD-OB via online survey between November 2019 and December 2019. We used item reduction, calculated item-total correlations, and conducted exploratory factor analysis to modify the instrument and assessed its internal consistency.

RESULTS

After psychometric testing, we reduced the number of items from 26 to 16. Through item reduction and exploratory factor analysis, we identified three subscales (Caregiver Bias, Caregiver Self-Awareness, and Caregiver Perception of Parental Fitness). The Cronbach's alpha for the overall instrument was .92.

CONCLUSION

This study provides preliminary evidence to suggest that the CASUD-OB may be a valid and reliable instrument for measuring nurses' attitudes toward pregnant women with SUD. Through additional testing, this instrument has the potential to become a valuable resource to evaluate quality improvement initiatives, staff education programs, and other interventions designed to transform the attitudes of nursing caregivers toward pregnant women with SUD.

Can mindfulness-based interventions improve outcomes in cognitive-behavioural therapy for chronic insomnia disorder in the general population? Systematic review and meta-analysis

Cognitive-behavioural therapy for insomnia (CBT-I) is the recommended first-line therapy for adults with chronic insomnia disorder (ID), which is characterized by hyperarousal. Mindfulness-based interventions (MBIs) are protocols aimed at stress reduction based on non-judgmental attention control in the present moment. However, MBIs have been increasingly used without a clear scientific basis. The objective of this analysis was to examine if MBIs could be useful as a component of the CBT-I therapeutic system through a systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies (NRS) searched in PubMed, PsycINFO, Cochrane and WoS. The Insomnia Severity Index (ISI) was the primary outcome, while the Pittsburgh Sleep Quality Index (PSQI) and a composite sleep variable (CSV) were secondary outcomes. Thirteen articles corresponding to nine studies (three pragmatic RCTs, three explanatory RCTs and three NRS) were included. The omnibus test found that MBIs had a small to medium effect size on ISI nearing signification when comparing active control groups in the pretest-posttest period [Δ = 0.44, p = 0.07], a medium, non-significant, effect size on PSQI [Δ = 0.52, p = 0.18], and a significant though small effect size on CSV [Δ = 0.05, p < 0.01]. No heterogeneity was found. The analysis could not demonstrate that MBIs, combined with CBT-I components in some studies, positively affected ID in the general adult population. This was probably due to the lack of pragmatic designs and suitable measuring instruments. Recommendations are made for designing further studies to address these issues.

Perspective on salutogenic approaches to persistent pain with a focus on mindfulness interventions

In this article, we provide a unique perspective on the use of mindfulness interventions in a whole health framework embedded within the theory of salutogenesis and the concept of painogenic environments. We argue that mindfulness is a valuable tool to bridge exploration of inner experiences of bodily pain with socio-ecological influences on thoughts and emotions. We outline research from neuroimaging studies that mindfulness techniques mediate neural processing and neuroplastic changes that alleviate pain and related symptoms. We also review evidence examining behavioural changes associated with mindfulness meditation providing evidence that it promotes self-regulatory activity, including the regulation and control of emotion and catalysation of health behaviour changes; both of which are important in chronic illness. Our viewpoint is that mindfulness could be a core element of salutogenic approaches to promote health and well-being for people living with pain because it rebuilds a fractured sense of cohesion. Mindfulness empowers people in pain to embrace their existence; shifting the focus away from pain and giving their lives meaning. We propose that integrating mindfulness into activities of daily living and individual or community-based activities will promote living well in the modern world, with or without pain; thus, promoting individual potential for fulfilment. Future research should consider the effects of mindfulness on people with pain in real-life settings, considering social, environmental, and economic factors using a broader set of outcomes, including self-efficacy, sense of coherence and quality of life.

Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction

OBJECTIVES

Transitions from middle adolescence into merging adulthood, a life stage between age 15-25, has a high prevalence of sleep problems. Mindfulness is a trait defined as being attentive to the present moment which positively relates to sleep quality. In this study, we aimed to investigate how resilience and emotional dysfunction may influence the relationship between trait mindfulness and sleep quality.

METHODS

The Five Facet Mindfulness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scales were used to measure the key variables through an online survey of 497 participants between middle adolescence and emerging adults (317 females, mean age 18.27 ± 0.76 years). A process model was built to investigate the mediating roles of resilience and emotional dysfunction in the impact of trait mindfulness on sleep quality, together with the relationships between their specific components.

RESULTS

We found a positive association between mindfulness and sleep quality through resilience and through emotional dysfunction, and through the sequential pathway from resilience to emotional dysfunction. Of note, acting with awareness (mindfulness facet) showed significant indirect effects on sleep quality, mediated by resilience and emotional dysfunction.

CONCLUSIONS

Our findings may unveil the underlying mechanisms of how low mindfulness induces poor sleep quality. The findings indicate that conceiving mindfulness as a multifaceted construct facilitates comprehension of its components, relationships with other variables, and underscores its potential clinical significance given its critical implications for mental health.

Assessing the benefits of the "Intergalactic World" social emotional learning program for 8-12-year-old children in Portugal: perspectives from teachers and caregivers

Introduction

"Intergalactic World" is a new social-emotional program designed to reduce psychopathological symptoms and improve social and emotional skills in children aged 8-12. This study aims to evaluate the program's benefits from teachers' and caregivers' perspectives, focusing on internalizing and externalizing behaviors.

Methods

The findings were obtained through self-reported measures using a pretest-posttest design with a follow-up period, but with no control group. One hundred fifty-four children (M age = 9.66, SD = 0.78) participated in this intervention study. Eleven teachers completed the Teacher's Report Form (TRF) for these children, and 133 caregivers completed the Child Behavior Checklist (CBCL). Participants without caregivers' reports were excluded from the analysis. Data were collected at three-time points: before the intervention (T1), immediately after (T2), and 6 months after the implementation of the program (T3).

Results

Results (n = 133) showed an effect of time on the Internalization scores (at T3 for teachers and T2 and T3 for caregivers) with no gender effect and a decrease in the perception of externalizing behaviors with a gender effect: Boys were perceived as exhibiting more externalizing behaviors than girls. However, these behaviors significantly decrease at T3 for teachers and at T2 and T3 for caregivers.

Discussion

Despite its limitations, this study highlights the benefits of employing social-emotional programs to help reduce children's internalizing and externalizing behaviors. A multi-informant approach enables a comprehensive analysis and provides insights into the child's significant contexts and interactions with adults.

The Impact of Psychological Interventions with Elements of Mindfulness on Burnout and Well-Being in Healthcare Professionals: A Systematic Review

Background

Healthcare professionals are highly likely to experience various causes of work-related stress, which often leads to burnout. This became even more obvious during the Covid-19 pandemic. This systematic review aimed to analyze articles where psychological interventions with elements of mindfulness (PIM) were used to support healthcare professionals to foster well-being and reduce burnout levels. Compared to other recently published reviews, it is unique, due to its focus on a wide group of healthcare professionals, a broader selection of psychological interventions, and the evaluation of any sustained effects.

Methods

Systematic searches were carried out in February 2021 with different combinations of Boolean operators within six electronic databases: PubMed, EBSCOhost, MEDLINE, PsycArticles, Cochrane Library, JSTOR and Cobiss. We included articles that had been published in the last ten years (2011 to 2021) and which reported on original research focused on evaluating the influence of PIM on healthcare professionals. MERSQI was used to assess the quality of the included studies.

Results

Of 1315 identified studies, 15 were included in this systematic review. Regardless of the specific type, duration and setting (individual vs group) of PIM applied, the results demonstrated a positive impact on well-being and burnout in participating healthcare professionals. The most studied interventions involved MBSR (mindfulness-based stress reduction) and other mindfulness training programmes, in online as well as in-person versions.

Conclusion

Given the new reality with the presence of the SARS-Cov-2 virus, it is of the utmost importance to offer feasible, effective interventions for burnout reduction to vulnerable groups of healthcare professionals. By focusing on their needs, several key aspects of burnout and mindfulness could be efficiently improved; this review demonstrates that short, online interventions could be as effective as longer, in-person ones.

Effects of Adapted Mindfulness Training on Interoception and Adherence to the Dietary Approaches to Stop Hypertension (DASH) Diet: The MB-BP Randomized Clinical Trial

Background

Hypertension is a major cause of cardiovascular disease. The Dietary Approaches to Stop Hypertension (DASH) diet lowers blood pressure (BP). However, adherence is typically low. Mindfulness training adapted to improving health behaviors that lower BP could improve DASH adherence, in part through improved interoceptive awareness relevant to dietary consumption. The primary objective of the MB-BP trial was to evaluate effects of the Mindfulness-Based Blood Pressure Reduction (MB-BP) program on interoceptive awareness. Secondary objectives assessed whether MB-BP impacts DASH adherence, and explored whether interoceptive awareness mediates DASH dietary changes.

Methods

Parallel-group phase 2 randomized clinical trial conducted from June 2017-November 2020 with 6 months follow-up. Data analyst was blinded to group allocation. Participants had elevated unattended office BP (≥120/80 mmHg). We randomized 201 participants to MB-BP (n=101) or enhanced usual care control (n=100). Loss-to-follow-up was 11.9%. Outcomes were the Multidimensional Assessment of Interoceptive Awareness (MAIA; range 0-5) score, and the DASH adherence score (range 0-11) assessed via a 163-item Food Frequency Questionnaire.

Results

Participants were 58.7% female, 81.1% non-Hispanic white, with mean age 59.5 years. Regression analyses demonstrated that MB-BP increased the MAIA score by 0.54 (95% CI: 0.35,0.74; p<.0001) at 6 months follow-up vs. control. MB-BP increased the DASH score by 0.62 (95% CI: 0.13,1.11; p=0.01) at 6 months vs. control, in participants with poor DASH adherence at baseline.

Conclusions

A mindfulness training program adapted to improving health behaviors that lower BP improved interoceptive awareness and DASH adherence. MB-BP could support DASH dietary adherence in adults with elevated BP.

Clinical Trial Registration

Clinicaltrials.gov identifier NCT03859076 (https://clinicaltrials.gov/ct2/show/NCT03859076; MAIA) and NCT03256890 (https://clinicaltrials.gov/ct2/show/NCT03256890; DASH diet adherence).

Effects of a trauma-informed mindful recovery program on comorbid pain, anxiety, and substance use during primary care buprenorphine treatment: A proof-of-concept study

BACKGROUND

A mindfulness-based intervention that reduces comorbid pain, anxiety, and substance use during office-based opioid treatment (OBOT) could enhance retention and prevent overdose. We conducted a pilot study of the Mindful Recovery OUD Care Continuum (M-ROCC), a 24-week trauma-informed program with a motivationally-sensitive curriculum.

METHODS

Patients prescribed buprenorphine (N = 18) enrolled in M-ROCC. We collected urine toxicology biweekly. At 0, 4, and 24 weeks, participants completed PROMIS-Pain, PROMIS-Anxiety, Mindfulness (FFMQ), Experiential Avoidance (BEAQ), Interoceptive Awareness (MAIA), and Self-Compassion (SCS-SF) scales. We estimated changes over time using mixed models. Participants completed qualitative interviews at 4 and 24 weeks.

RESULTS

Positive urine toxicology decreased over time for cocaine (β = -.266, p = .008) and benzodiazepines (β = -.208, p = .028). M-ROCC reduced PROMIS-Pain (Z = -2.29; p = .022), BEAQ (Z = -2.83; p = .0005), and increased FFMQ (Z = 3.51; p < .001), MAIA (Z = 3.40; p = .001), and SCS-SF (Z = 2.29; p = .022). Participants with co-morbid anxiety had decreased PROMIS-Anxiety (Z = -2.53; p = .012). Interviewed participants commonly used mindfulness practices for stress and anxiety (12/12, 100%), and to reduce pain catastrophizing and rumination (7/12, 58%).

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

This is the first study to report the effects of a 24-week mindfulness program during buprenorphine treatment on common comorbidities, including pain interference, anxiety, cocaine, and benzodiazepine use. The findings that M-ROCC is associated with reduced experiential avoidance, as well as increased interoceptive awareness and self-compassion, align with proposed mechanisms that are now extended to OUD treatment. Future larger randomized controlled trials are needed before effectiveness can be established and the role of these mechanisms can be confirmed.

Emotional Regulation Interventions on Developmental Course for Preterm Children: A Systematic Review of Randomized Control Trials

Children born preterm (<37 weeks of gestation) are at increased risk of socio-emotional difficulties. This study aims to determine the effects of rehabilitation intervention on the emotional regulation of children born preterm through a systematic review. We conducted a systematic review according to PRISMA guidelines. The literature screening was carried out on PUBMED, SCOPUS and WEB OF SCIENCE in August 2022. An author identified eligible studies based on predefined inclusion criteria and extracted the data. RCT quality was assessed using the JADAD and PEDro scales. We selected five RCTs for qualitative synthesis, having the common objective of evaluating the changes in emotional regulation after a rehabilitation intervention. Evidence of benefits was found after parent training intervention (PCIT; p < 0.05). Moreover, there was an improvement in day-to-day executive life and fewer behavioral problems after mindfulness intervention. Clinical, but not statistical, efficacy was found for the group-based physiotherapy intervention. In conclusion, parent training and mindfulness interventions can be helpful rehabilitation techniques, but the relatively small sample limited statistical power, so the discovery needs to be interpreted cautiously. Further research on these aspects is recommended.

Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement

CONTEXT

The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury.

OBJECTIVE

Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps.

DESIGN

Consensus process.

SETTING

Virtual video conference calls and online voting.

PATIENTS OR OTHER PARTICIPANTS

The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds.

MAIN OUTCOME MEASURE(S)

The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation.

RESULTS

The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models.

CONCLUSIONS

This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.

Mechanisms of mindfulness in patients with migraine: Results of a qualitative study

OBJECTIVE

To understand the mechanisms of mindfulness' impact on migraine.

BACKGROUND

Promising mindfulness research demonstrates potential benefit in migraine, but no data-driven model exists from the lived experiences of patients that explains the mechanisms of mindfulness in migraine.

METHODS

Semi-structured qualitative interviews were conducted with adults with migraine who participated in two mindfulness-based stress reduction (MBSR) clinical trials (n = 43). Interviews were audio-recorded, transcribed, and summarized into a framework matrix with development of a master codebook. Constructivist grounded theory approach was used to identify themes/subthemes.

RESULTS

Participants who learned mindfulness techniques through MBSR experienced altered pain perception, altered response to migraine attacks and disease, increased awareness of external and internal experiences, improved overall well-being, and group benefits. Mindfulness resulted in earlier stress-body awareness and increased interoceptive awareness resulting in earlier attack recognition, leading to earlier and more effective management. Interictal factors of self-blame, guilt, and stigma decreased while migraine acceptance, hope, empowerment, self-efficacy, and self-compassion increased. Improved emotion regulation resulted in decreased fear of migraine, pain catastrophizing, anticipatory anxiety, and pain reactivity. Although taught as prevention, mindfulness was used both acutely and prophylactically. We created a conceptual model hypothesizing that MBSR skills led to an infusion of mindfulness in daily life, resulting in altered pain perception and experience, ultimately leading to improvement in overall well-being, which may positively feed back to the infusion of mindfulness in daily life. The therapeutic benefit of learning mindfulness in a group setting may moderate these effects.

CONCLUSIONS

This study identified several new potential mechanisms of mindfulness' effect on migraine. After learning MBSR skills, participants reported altered pain and migraine perception and experiences. Increased stress-body and interoceptive awareness resulted in earlier migraine awareness and treatment. Mindfulness may target important interictal factors that affect disease burden such as fear of migraine, pain catastrophizing, and anticipatory anxiety. This is the first data-driven study to help elucidate the mechanisms of mindfulness on migraine from patient voices and can help direct future research endeavors.

Service-user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in improving access to psychological therapies services: A qualitative investigation into mechanisms of change in quitting smoking

INTRODUCTION

High smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique-based intervention for smoking cessation and depression/anxiety.

METHODS

This study was embedded within an ongoing randomized-controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open-ended questions about their quitting experience and perception of how the intervention aided their behaviour change.

RESULTS

Five themes were identified. Acquiring an increased awareness of smoking patterns: participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies: participants described acquiring 'a couple of tricks up your sleeve' that were helpful in making smoking cessation feel more 'manageable'. Practitioner style as 'supportive but not lecture-y': participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions: participants expressed the importance of 'having someone that's checking in on you'. Having the opportunity to access the intervention at 'the right time': participants described the intervention as the 'push' that they 'needed'.

CONCLUSIONS

Participants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants' mental health, and the opportunity to be offered smoking cessation treatment in a 'non-judgemental', 'supportive' environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety.

PATIENT OR PUBLIC CONTRIBUTION

Persons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.

Brief structured respiration practices enhance mood and reduce physiological arousal

Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.

The effect of mindfulness on social media addiction among Chinese college students: A serial mediation model

Introduction

The COVID-19 pandemic has exacerbated social media addiction (SMA), making it urgent to find effective interventions for social media addiction. Evidence has shown that mindfulness might be an effective intervention for social media addiction. However, psychological mechanisms by which mindfulness reduce social media use remain unclear. Here, we further addressed this issue to examine whether attentional control and fear of missing out (FOMO) mediate the relationship between mindfulness and SMA.

Methods

We recruited 446 college students from two universities in China and analyzed the data.

Results

The results suggest that there are mediation effects of attentional control and FOMO between mindfulness and SMA through 3 paths: path 1, mindfulness → attention control → SMA (-0.04); path 2, mindfulness → FOMO → SMA (-0.22); and path 3, mindfulness → attention control → FOMO → SMA (-0.05).

Discussion

Therefore, mindfulness-based interventions may be an effective way to alleviate social media addiction, especially mindfulness-based interventions targeting FOMO. At the end of the article, we also discussed the limitations of this study.

A Web-Based Mind-Body Intervention (Mindful Steps) for Promoting Walking in Chronic Cardiopulmonary Disease: Insights From a Qualitative Study

Background

Given the deleterious effects of physical inactivity in persons with chronic obstructive pulmonary disease (COPD) and/or heart failure (HF), interventions that promote long-term daily physical activity are needed. Mindful Steps, designed to promote walking behaviors in COPD and HF, is a multicomponent intervention that integrates mind-body content with other self-regulatory components. The aim of the current qualitative study was to characterize participants' experiences with Mindful Steps and understand the perceived influence of the intervention on walking and health.

Method

In the context of a pilot randomized controlled feasibility trial comparing the year-long Mindful Steps program to usual care among individuals with COPD and HF, semi-structured qualitative interviews were administered at 6- and 12-months. Interviews were audio recorded and transcribed. The constant comparative method was used to code transcripts, identify categories, and develop interrelated themes.

Results

Nineteen participants (63% female; Mage = 70.2 years, SD = 6.95) who were randomized to the intervention group completed the 6-month interview and 17 completed the 12-month interview. The pedometer with feedback, live group classes, and mind-body videos were described as the most helpful intervention components. Participants learned several strategies that helped their walking (e.g., breathing regulation and awareness, body awareness, mind-body techniques, pacing), described walking as enjoyable, and identified internal reasons for walking (e.g., to feel good). They also reported several physical and mental health benefits of the intervention. Some participants reported limited influence of the intervention on walking or health. Many participants continued to use the strategies they learned in the first half of the intervention at 12-months.

Conclusions

The mind-body content of Mindful Steps appeared to positively influence walking behaviors. Participants' experiences with the intervention helped to identify areas for future intervention refinement. Future quantitative work is needed to corroborate these qualitative findings and assess the efficacy of the intervention on long-term physical activity engagement.

Trial Registration

This trial is registered in Clinical Trials.gov, ID number NCT01551953.

Remotely Delivered Psychologically Informed Mindful Movement Physical Therapy for Pain Care: A Framework for Operationalization

Background

While there is recognition by the greater medical community and physical therapists to address the biopsychosocial needs of people with chronic, persistent pain, there are challenges in implementation and delivery including wide variability in interventions, lack of clear rationale, and absence of clinical models that are feasible and acceptable on a large scale. Important components for psychologically informed physical therapy (PiPT) for pain care include behavioral approaches (e.g., Acceptance and Commitment Therapy), mindfulness, pain neuroscience education, motivational interviewing (MI), and interoceptive skills-building. The Empower Veterans Program (EVP) Mindful Movement framework blends these components and emphasizes a mindfulness and self-compassion approach with MI and body-based experiential learning. This program was offered in-person at the Atlanta and Maryland VA Health Care Centers with published positive Patient Reported Outcomes (PRO) pre-COVID 19 crisis and shifted to entirely remote delivery in March 2020.

Objective

This paper offers an evidence-based and theory driven framework to operationalize a remotely delivered group-based psychologically informed mindful movement physical therapy intervention as part of an interdisciplinary pain care program.

Methods

Since 2021 PRO and demographics are collected using a survey administered through Qualtrics over a 12-month period at baseline, immediately post TelePain EVP, at 6 months, and at 12 months, with findings forthcoming.

Discussion/Results

Tele-pain EVP offers 6-9 groups a week with 7-9 veterans from Atlanta based team and 3-4 groups a week with 5-9 veterans from Maryland based team. Adaptations for remote delivery optimized mindfulness and active learning strategies including interoceptive skills-building and use of MI to support self-efficacy to trust, restore a sense of safety in the body, and explore adaptations for safe movement.

Conclusion

TelePain-EVP Mindful Movement provides a framework for other programs to translate for their populations and systems to further develop best practices in PiPT for pain care and integration into interdisciplinary care.

Mindfulness and psychological distress in men during the COVID-19 pandemic: The mediating role of environmental mastery and purpose in life

Men's mental health has been severely affected during the COVID-19 pandemic, with many studies focussing on the determinants of men's psychological distress. This study aimed at examining the relationships between mindfulness, environmental mastery (EM), purpose in life (PL) and indicators of psychological distress (i.e., common mental disorders and perceived stress). This was a cross-sectional online study in which participants were 1,006 men aged between 29 and 39 years (45.1%), residing in Brazil during the first wave of the COVID-19 pandemic. A parallel multiple mediator model was used to test the study variables' relationships, using mindfulness as the independent variable and indicators of psychological distress as the dependent variables. Results indicated that EM and PL significantly mediated the effects of mindfulness on men's psychological distress, lowering its levels and accounting for 31% of common mental disorders and 51% of perceived stress. Implications for public health policies and clinical practice are discussed.

An experimental approach to training interoceptive sensitivity: study protocol for a pilot randomized controlled trial

BACKGROUND

Eating in absence of hunger is quite common and often associated with an increased energy intake co-existent with a poorer food choice. Intuitive eating (IE), i.e., eating in accordance with internal hunger and satiety cues, may protect from overeating. IE, however, requires accurate perception and processing of one's own bodily signals, also referred to as interoceptive sensitivity. Training interoceptive sensitivity might therefore be an effective method to promote IE and prevent overeating. As most studies on eating behavior are conducted in younger adults and close social relationships influence health-related behavior, this study focuses on middle-aged and older couples.

METHODS

The present pilot randomized intervention study aims at investigating the feasibility and effectiveness of a 21-day mindfulness-based training program designed to increase interoceptive sensitivity. A total of N = 60 couples participating in the NutriAct Family Study, aged 50-80 years, will be recruited. This randomized-controlled intervention study comprises three measurement points (pre-intervention, post-intervention, 4-week follow-up) and a 21-day training that consists of daily mindfulness-based guided audio exercises (e.g., body scan). A three-arm intervention study design is applied to compare two intervention groups (training together as a couple vs. training alone) with a control group (no training). Each measurement point includes the assessment of self-reported and objective indicators of interoceptive sensitivity (primary outcome), self-reported indicators of intuitive and maladaptive eating (secondary outcomes), and additional variables. A training evaluation applying focus group discussions will be conducted to assess participants' overall acceptance of the training and its feasibility.

DISCUSSION

By investigating the feasibility and effectiveness of a mindfulness-based training program to increase interoceptive sensitivity, the present study will contribute to a deeper understanding of how to promote healthy eating in older age.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS), no. DRKS00024903. Retrospectively registered on April 21, 2021.

Dispositional mindfulness and its relationship to exercise motivation and experience

Mindfulness is the psychological state of staying attuned to the present moment, without ruminating on past or future events, and allowing thoughts, feelings, or sensations to arise without judgment or attachment. Previous work has shown that heightened dispositional mindfulness is associated with the awareness of the importance of exercise, exercise self-efficacy, exercise motivation, and self-reported exercise level. However, more methodologically rigorous studies are needed to understand the relationship between mindfulness and the psychological mechanisms related to exercise motivation, including the identification of why individuals are motivated to engage in exercise, the subjective experience of exercise, and the propensity for exercise dependence and addiction. In this cross-sectional investigation, we utilized the framework of the Self-Determination Theory to examine the hypothesis that heightened dispositional mindfulness (as measured by the Mindful Attention Awareness Scale) would be associated with increased levels of exercise motivation that were derived by higher levels of autonomous self-regulation. Individuals were recruited from urban areas who self-reported either low (exercising 2 or fewer times per week for 20 min or less; n = 78) or moderate (exercising 1 or 2 times per week for 20 min or more; n = 127) levels of exercise engagement. As hypothesized, heightened dispositional mindfulness was significantly associated with heightened levels of exercise self-determination as measured by the Behavioral Regulations in Exercise Questionnaire, with this effect being driven by negative associations with amotivation, external regulation, and introjected regulation. Additionally, we found that heightened dispositional mindfulness was associated with lower levels of psychological distress upon exercise and decreased exercise dependence/addiction. Overall, increased dispositional mindfulness may support a healthy relationship with exercise. These findings have implications for the utility of mindfulness interventions to support the regulation of exercise behaviors in service of enhancing exercise motivation and engagement.

Effect of an Online Mindfulness Course for Hospital Doctors During COVID-19 Pandemic on Resilience and Coping

INTRODUCTION

Physicians' wellbeing is a priority to prevent increasing rates of poor mental health and burnout, exacerbated by caregiving during the COVID-19 pandemic. Structured mindfulness courses have been shown to be beneficial, but face-to-face delivery is not always feasible in the context of busy health services. Remotely delivered structured mindfulness courses could enable wider participation, particularly at time when social distancing to prevent infection transmission is necessary. Our objective was to test the feasibility of a remotely delivered structured mindfulness course for hospital doctors during the COVID-19 pandemic.

METHODS

This was a feasibility study run at one English hospital between January and March 2021, when COVID-19 admissions were at a high. Interested doctors participated in a 6-session remotely delivered mindfulness course. Sessions lasted 90 min and could be attended on-line or the recording watched at later time. Main outcome measures were data on interest, course attendance and engagement, together with validated psychological outcome measures at baseline and follow-up after course completion.

RESULTS

20 doctors expressed interest to participate and 16 started the course. Of these, 12 completed at least 3 sessions (median = 4); difficulty attending resulted from conflicting clinical commitments and rosters. Twelve participants completed the follow-up survey. They rated the course highly and all perceived it to have been useful, with statistically significant (P < .01) improvements in wellbeing and mindfulness scores. They all stated that they would recommend this course to their colleagues and most (10/12) were interested in follow-up mindfulness sessions.

CONCLUSION

Remotely delivered structured mindfulness training for hospital doctors was feasible, but there is a need to address the difficulties that affected attendance in order to optimize accessibility and completion of such programs.

Facilitating Mindfulness-Based Interventions for Anxiety in Older People: History, Effectiveness, and Future Possibilities

The origins of mindfulness go back some 25 centuries to Eastern teachings, including Buddhism and Hinduism. Mindfulness-based interventions gained credence in Western mental health settings in the late 1970s through the work of medical researcher Kabat-Zinn, whose interest in Eastern meditation led him to develop a program for stress reduction. Since then, mindfulness-based interventions have been utilized for various populations, including older people with anxiety. Group mindfulness-based interventions have demonstrated benefits for older people with anxiety living in residential aged care and the community. In primary care settings, innovative delivery models for group mindfulness-based interventions could be facilitated by nurses to support older people with anxiety to age in place with dignity. The benefits of mindfulness-based interventions suggest the value of integrating ancient Eastern techniques with modern Western strategies to achieve better health outcomes for older people with mental health concerns.

Effectiveness of Mindfulness - Based Therapy and Counseling programs (MBTC) on relapses to methamphetamine dependence at a substance dependency treatment center

This non-concurrent controlled intervention study aimed to examine the effectiveness of the Mindfulness - Based Therapy and Counseling programs (MBTC) on the treatment of methamphetamine use disorder among 70 individuals (37 females) receiving methamphetamine dependency treatment. Participants were divided into a control group undergoing the usual program and an experimental group using MBTC plus the usual program at a treatment center in Thailand. The study was conducted using the Methamphetamine Craving Questionnaire, urine Color Immunochromatographic Assay and the Mini-International Neuropsychiatric Interview. Stress, depression, and mindfulness were also assessed. MBTC comprised of practicing mindfulness for 90-120 min weekly for eight weeks. Participants were assessed before and after the treatment(s) and at follow-ups visits at 2, 4, 8, 12, and 24 weeks. Mean age (30.3 ± 5.8 years), age of first methamphetamine use (18.2 ± 4.5 years) and other demographics did not differ between groups. At six-month follow-up, the experimental group had significantly lower craving (-7.89, 95%CI = -15.47, -0.32), stress (-7.44, 95%CI = -12.21, -2.67), and depression (-2.95, 95%CI = -5.31, -0.6) and statistically significant higher mindfulness scores (12.86, 95%CI = 9.37, 16.35) than the control group. In addition, methamphetamine relapse in the MBTC group (5/35, 14.3%) was significantly lower than the control group (16/35, 45.7%).

Evaluation of an Intervention to Promote Self-Management Regarding Cardiovascular Disease: The Social Engagement Framework for Addressing the Chronic-Disease-Challenge (SEFAC)

BACKGROUND

Cardiovascular diseases (CVD) are predominantly lifestyle related. Mental health issues also influence CVD progression and quality of life. Self-management of lifestyle behaviors and mental well-being may play a significant role in reducing the CVD burden. Previous studies have shown that mindfulness practices are associated with psychological well-being, but their effects on CVD self-management are mainly unknown.

METHODS

The study had a before-after design and included adults over 50 years with CVD and/or one or more risk factors from three European countries. Follow-up was six months. The intervention was a 7-week mindfulness-based intervention (MBI) in a group setting focusing on chronic disease self-management. Outcomes were measured with validated self-report questionnaires at baseline and follow-up: self-efficacy, physical activity, nutrition, smoking, alcohol use, sleep and fatigue, social support, stress, depression, medication adherence, and self-rated health.

RESULTS

Among 352 participants, 324 (92%) attended ≥4 of the 7 group sessions and completed follow-up. During follow-up, self-efficacy, stress, social support, depressive symptoms, and self-rated health significantly improved. No significant changes were detected for other outcomes.

CONCLUSIONS

A 7-week MBI focusing on chronic disease self-management was conducive to improved self-efficacy, emotional well-being, social support, and self-rated overall health during six months. These findings support the use of MBIs for improving self-management in cardiovascular care. ISRCTN registry-number ISRCTN11248135.

Implementing a novel self-care clock strategy as part of a trauma awareness intervention in a university setting

PURPOSE

This study compared post- and preintervention trauma-informed care attitudes, explored relationships among outcomes, and identified self-care behavior changes participants are willing to make.

DESIGN AND METHODS

A quasi-experimental study with content analysis was conducted with 96 adults that took part in a Trauma Awareness Intervention including a novel self-care clock.

CONCLUSIONS

Participants' trauma-informed care attitudes improved (p ≤ 0.05) compared to baseline and were positively related to their post-intervention compassion scores (p < 0.05). Qualitative analyses revealed self-awareness, self-care, empathy, applying a trauma lens, changing the narrative, and student-centeredness as the main themes in participants' responses.

PRACTICAL IMPLICATIONS

This university-based initiative had a positive impact on attitudes toward trauma and should be explored in other settings, as there is an unmet need for trauma-informed care strategies at the community level.

What Happens When You Smoke a Cigarette Mindfully? A Deductive Qualitative Study

Objectives

The mindful smoking exercise instructs participants to pay attention to a range of experiences while smoking a cigarette with the expectation that it will modify the often automatic process of smoking. Given its theoretical value, mindfulness- and acceptance and commitment therapy-based smoking cessation interventions have usually included a mindful smoking exercise. However, its utility has not been empirically examined. Through qualitative analyses, the current study examined smokers' lived experience with mindful smoking during an 8-week telehealth group-based smoking cessation and alcohol modification trial.

Method

Participants were smokers who were present in group during the mindful smoking exercise. The recordings of sessions and follow-up interviews in which discussion on mindful smoking took place were transcribed and hand-coded for qualitative analysis. A thematic content analytic approach was used to identify themes.

Results

Participants (N=20) were 75% female (mean age=49.75, average cigarettes per day=16.35). Identified themes mapped onto both the theoretical rationale for mindful smoking (e.g., attention/awareness, decentering, similarity/difference between mindful versus automatic smoking) and cognitive-affective-behavioral responses (e.g., unpleasant/pleasant experience, shifts in desire to smoke, cognitive reappraisal). The most prominent themes were attention/awareness, similarity/difference between mindful versus automatic smoking, and unpleasant/pleasant experience; Dynamic interplay between themes was also observed and representative quotes are included.

Conclusions

Our findings indicate that intentionally paying attention to smoking led to the reporting of a heightened awareness of automatic behavior accompanied by noticing unpleasant aspects of smoking, potentially facilitating change in one's relationship to smoking. Theoretical implications of mindful smoking in the context of addiction are discussed.

Understanding the Pathways from Mindfulness to COVID-19 Vaccination Intention via Positive Psychology Attributes among Health Care Workers in China

OBJECTIVE

The present study aims to examine the association between mindfulness and COVID-19 vaccination intention, and the mediating role of presence of meaning in life and moral elevation in such association.

METHOD

In a cross-sectional study design, a total of 1733 health care workers (81.1% females, M_age = 34.16 ± 9.03) from four cities in China were recruited and completed an online survey that measured mindfulness, moral elevation, presence of meaning in life and COVID-19 vaccination intention.

RESULTS

It has been found that 73.1% of the participants reported an intention to receive COVID-19 vaccination. Mindfulness was positively associated with COVID-19 vaccination intention; Mediation analyses using structural equation modeling showed a significant indirect effect of mindfulness on COVID-19 vaccination intention, accounting for 42.4% of the total effect. Mindfulness was positively associated with COVID-19 vaccination intention directly via presence of meaning in life, and indirectly via moral elevation and presence of meaning in life.

CONCLUSIONS

The findings add knowledge of how mindfulness may increase COVID-19 vaccination intention, and underscore the potential need for mindfulness training, positive emotion promotion, presence of meaning in life interventions to improve acceptance of COVID-19 vaccination among health care workers.

Underlying mechanisms of mindfulness meditation: Genomics, circuits, and networks

Understanding neuropsychological mechanisms of mindfulness meditation (MM) has been a hot topic in recent years. This review was conducted with the goal of synthesizing empirical relationships via the genomics, circuits and networks between MM and mental disorders. We describe progress made in assessing the effects of MM on gene expression in immune cells, with particular focus on stress-related inflammatory markers and associated biological pathways. We then focus on key brain circuits associated with mindfulness practices and effects on symptoms of mental disorders, and expand our discussion to identify three key brain networks associated with mindfulness practices including default mode network, central executive network, and salience network. More research efforts need to be devoted into identifying underlying neuropsychological mechanisms of MM on how it alleviates the symptoms of mental disorders.

The Effects of Combined Respiratory-Gated Auricular Vagal Afferent Nerve Stimulation and Mindfulness Meditation for Chronic Low Back Pain: A Pilot Study

OBJECTIVE

Respiratory-gated Auricular Vagal Afferent Nerve stimulation (RAVANS) is a safe nonpharmacological approach to managing chronic pain. The purpose of the current study was to examine (1) the feasibility and acceptability of RAVANS, combined with mindful meditation (MM) for chronic low back pain (CLBP), (2) the potential synergy of MM+RAVANS on improving pain, and (3) possible moderators of the influence of MM+RAVANS on pain.

DESIGN

Pilot feasibility and acceptability study.

SETTING

Pain management center at large academic medical center.

SUBJECTS

Nineteen adults with CLBP and previous MM training.

METHODS

Participants attended two sessions during which they completed quantitative sensory testing (QST), rated pain severity, and completed a MM+stimulation session. Participants received RAVANS during one visit and sham stimulation during the other, randomized in order. Following intervention, participants repeated QST.

RESULTS

MM+RAVANS was well tolerated, acceptable, and feasible to provide relief for CLBP. Both MM+stimulation sessions resulted in improved back pain severity, punctate pain ratings, and pressure pain threshold. Individuals with greater negative affect showed greater back pain improvement from MM+RAVANS while those with greater mindfulness showed greater back pain improvement from MM+sham.

CONCLUSIONS

Results suggest that for CLBP patients with prior MM training, the analgesic effects of MM may have overshadowed effects of RAVANS given the brief single session MM+RAVANS intervention. However, those with greater negative affect may benefit from combined MM+RAVANS.

The Value of Contemplative Practices: A Mixed Methods Approach Exploring Associations between Resilience and Experiences of the COVID-19 Pandemic among Older Adults

The aim of this study was to explore the association between resilience and experiences of the COVID-19 pandemic among older adults. We used a sequential explanatory mixed methods study design to recruit older adults who spoke English and were 60 and above during the pandemic. Survey data investigated older adults' resilience, post-traumatic growth, well-being, and demographics. Extreme case purposeful sampling of their resilience score was used to select interviewees. Qualitative data sought to understand the relationship between resilience and how older adults responded to the COVID-19 pandemic. Exploring the relationship between resilience (well-being in the face of challenge) and one's experience of the COVID-19 pandemic revealed that participants categorized as having high resilience had long held behaviors of contemplative practices that helped them effectively adapt to the COVID-19 pandemic. As we continue to face global challenges, we must redefine care, guide interventions, and promote healthy aging by incorporating contemplative practices into the lives of older adults.

Comparative effectiveness of mindfulness and mindful eating programmes among low-income overweight women in primary health care: A randomised controlled pragmatic study with psychological, biochemical, and anthropometric outcomes

Obesity is a chronic and multifactorial disease, with growing rates in the last 50 years worldwide, reaching pandemic levels. It is a major public health problem and is difficult to treat. Different approaches have been used to improve this scenario, including mindfulness-based interventions to enhance dietary behaviour and nutritional status. We compared the effectiveness of a 10-week mindful eating programme with that of a 10-week mindfulness programme and of a no-treatment control group. The sample was composed of adult, low-income women with a body mass index (BMI) ≥ 25 to < 40 receiving primary health care in São Paulo, Brazil. The participants (n = 284) were randomised into 3 groups: the control, mindfulness, and mindful eating. We took anthropometric and body composition measurements, applied psychometric measures, and performed biochemical tests at pre-intervention, post-intervention, and after 3 months. We estimated the regression coefficients among the analysis of adherent participants (per protocol: PP) and among those of all participants randomised to treatment (intention-to-treat: ITT) in addition to multiple imputation (MI). Both groups showed improvement in eating behaviour and reduction of binge eating both in the post-intervention and follow-up periods, but without significant changes in weight or most of the biological tests. Those in the mindful eating programme performed slightly better than those in the mindfulness and control groups in terms of improving eating behaviour and reducing binge eating among low-income overweight women.

"Today I Can Look in the Mirror and Like Myself": Effects of a Trauma-Informed Mindful Recovery Program on Self-Compassion

Background

Opioid-related deaths continue to rise. Psychological trauma is commonly comorbid with Opioid Use Disorder (OUD). Adverse childhood experiences can disrupt the development of emotion regulation, increasing risk of substance use. Self-compassion may reduce OUD risk and outcomes by facilitating emotion regulation, decreasing the toxicity of shame, and reducing internalized stigma that can hinder recovery. Mindfulness practice enhances self-compassion.

Methods

This study is part of a pilot (N = 18) of the Mindful Recovery OUD Care Continuum (M-ROCC) during buprenorphine office-based opioid treatment (OBOT). The present study was conducted to gain a deeper understanding of the intervention’s effects on self-compassion development, and to explore differential changes in self-compassion during the intervention among participants with varying intensity of trauma exposure measured by high levels of childhood adversity (defined by 4+ adverse childhood experiences (ACEs) at baseline). We conducted secondary analyses of a subset of qualitative interview data (N = 11 unique participants) collected for the pilot study (weeks 4 and 24, 14 total interviews) to elaborate upon changes in Self-Compassion Scale (SCS-SF) scores.

Results

In the primary pilot study, participants’ mean SCS-SF scores shifted significantly from baseline to week 24, β = 0.22, p = 0.028. This change is elaborated upon through interviews. Despite pervasive challenges to becoming more self-compassionate (e.g., trauma histories and substance use), participants reported increased compassionate self-responding and decreased uncompassionate self-responding. Mindfulness training was identified as the primary mechanism underlying the shift. Kindness to self and others and—to a lesser extent an increased sense of common humanity—were also identified as key to overall self-compassion. Compared to those in the lower ACEs group, participants in the higher ACEs group tended to have lower baseline self-compassion scores (d = 1.09, p = 0.055).

Conclusion

M-ROCC may increase self-compassion among patients with OUD during OBOT by increasing compassionate, and decreasing uncompassionate, self-responding. Patients with OUD with greater childhood adversity tended to have lower levels of self-compassion, which improved with M-ROCC. Future trials with larger samples are needed to confirm these potential outcomes, mechanisms, and differential impacts between ACEs subgroups.

The Relationship of Breathing and COVID-19 Anxiety When Using Smart Watches for Guided Respiration Practice: A Cross-Sectional Study

COVID-19 mortality rates are increasing worldwide, which has led to many highly restrictive precautionary measures and a strong sense of anxiety about the outbreak for many people around the world. There is thus an increasing concern about COVID-19 anxiety, resulting in recommending approaches for effective self-care. From a positive psychology perspective, it is also important for people to have positive affect when dealing with this pandemic. According to previous literature, respiration is considered to be an effective way to enhance people's mental health. Among all the wearable devices, Apple Watch has the largest market share, so this study recruited Chinese users that use respiration exercise function on Apple Watch; a total of 316 valid data were retrieved. Meanwhile, to understand one approach related to using Apple Watch to practice respiration to reduce COVID-19 anxiety about being infected during the COVID-19 outbreak, this study used a web-based cross-sectional survey to examine anxiety about being infected by COVID-19 among Chinese people who had been using the Apple Watch to practice respiration during the period of the COVID-19 outbreak. The study was based on the Health Theoretical Model, and the model was developed with four dimensions and was validated with structural equation modeling. The results of this study showed that practicing few minutes had a positive relationship on positive attitude, and positive attitude had a negative relationship on pandemic anxiety and a positive relationship on continuance use intention. Anxiety about the pandemic had a negative relationship on the intention to continue using the function. This showed that respiration practice can help to suppress the increase in anxiety levels regarding this pandemic.

Neurobiological and epigenetic perspectives on hedonism, altruism and conscience

This article examines notions of hedonism, altruism and conscience in relation to the activity of four neurotransmitter pathways: the dopamine reward, noradrenaline fight or flight, serotonin calming and glutamine learning pathways. Associated brain areas that modulate behaviour are highlighted: the prefrontal cortex (activity planning, risk mitigation), the hippocampus (memory retrieval) and the insular cortex (integration of information to decide on action). Putative epigenetic changes influencing adult behaviours after childhood privation are discussed. Pharmacological and psychological means of mitigating harmful behaviours are summarised, alongside the ethics of epigenetic screening to predict future addictive and violent tendencies.

Sustainable Consumption Research and the Role of Marketing: A Review of the Literature (1976–2021)

There is a causal relationship between existential dangers to our biosphere and our unsustainable consumption practices. For more than three decades, academics and researchers have explored ideas to make consumption practices sustainable. Still, a practical and widely accepted solution to the problem is missing. This review aims for a theoretical and structural understanding of the literature to identify future avenues for marketing, to explore and increase its contribution to consumption sustainability research. The review used bibliometric and integrative review methods to synthesize knowledge. The review found that sustainable consumption research has proliferated since 2015, indicating a heightened interest in the field. There are four major schools of thought in sustainable consumption research, employing three interdependent micro, meso, and macro levels of analysis to understand consumption practices. By focusing on individual consumption behaviors, this review recommends that consumption sustainability be repositioned as a means of attaining a better quality of life for consumers. It involves reforming the consumer mindset toward progress based on pro-social and pro-ecological choices, training consumers in mindful consumption practices, and providing them with an infrastructure for consuming with a mindful mindset. It is recommended that marketing should refine itself as a pro-social discipline, with consumer well-being as its primary goal, and to become a leader in reshaping quality of life in terms of non-financial standards.

Mindfulness and Acceptance-Based Interventions in Physical Therapist Practice: The Time Is Now

One in 5 adults in the United States lives with a mental illness, and many more struggle with stress-related chronic illnesses. Physical therapists often see the physical effects that stress has on the body, but there is an underutilization of evidence-based stress management strategies with patients and clients. Mindfulness and acceptance-based interventions (MABIs) constitute a family of methods that emphasize present-moment awareness, nonjudgment, and values-based living. They operate by teaching patients to cope with stressful thoughts, emotions, and physical sensations. MABIs are associated with improved health outcomes in areas commonly seen in physical therapist practice, including health promotion, physical function, injury prevention, pain management, immune function, and noncommunicable diseases. The purpose of this Perspective article is to (1) describe MABIs; (2) discuss the relevance of MABIs to physical therapist practice; (3) discuss the positive impact of MABIs for pain, sports, immune function, physical and mental health promotion, and wellness; and (4) identify MABI outcome measures related to health behavior change. It is time.

IMPACT

Contemporary practice requires that physical therapists manage patient care by addressing both the mind and body. Given the existing research on MABIs, it is time to translate the evidence into minimum accreditable standards for health promotion and prevention of chronic, noncommunicable disease. This approach would have far-reaching benefits for individuals, family units, communities, and society as a whole.

LAY SUMMARY

Mindfulness instruction delivered by a physical therapist can help improve physical and mental well-being.

Mining the Gems of a Web-Based Mindfulness Intervention: Qualitative Analysis of Factors Aiding Completion and Implementation (Preprint)

Background

Digital health interventions provide a cost effective and accessible means for positive behavior change. However, high participant attrition is common and facilitators for implementation of behaviors are not well understood.

Objective

The goal of the research was to identify elements of a digital mindfulness course that aided in course completion and implementation of teachings.

Methods

Inductive thematic analysis was used to assess participant comments regarding positive aspects of the online mindfulness course Mindfulness for Well-being and Peak Performance. Participants were aged 18 years and older who had self-selected to register and voluntarily completed at least 90% the course. The course comprised educator-guided lessons and discussion forums for participant reflection and feedback. Participant comments from the final discussion forum were analyzed to identify common themes pertaining to elements of the course that aided in course completion and implementation of teachings.

Results

Of 3355 course completers, 283 participants provided comments related to the research question. Key themes were (1) benefits from the virtual community, (2) appeal of content, (3) enablers to participation and implementation, and (4) benefits noted in oneself. Of subthemes identified, some, such as community support, variety of easily implementable content, and free content access, align with that reported previously in the literature, while other subthemes, including growing together, repeating the course, evidence-based teaching, and immediate benefits on physical and mental well-being, were novel findings.

Conclusions

Themes identified as key elements for aiding participant completion of a mindfulness digital health intervention and the implementation of teachings may inform the effective design of future digital health interventions to drive positive health behaviors. Future research should focus on understanding motivations for participation, identification of effective methods for participant retention, and behavior change techniques to motivate long-term adherence to healthy behaviors.

Mindfulness-Based Interventions and Body Awareness

Body awareness (BA) has long been proposed as a working mechanism of mindfulness-based interventions (MBIs), yet research on the mediating role of BA is scarce. Hence, the present study assesses the impact of an 8-week MBI on self-reported and indirect measures of BA, investigates the potential mediating role of BA in the relationship between an MBI and symptomatology, evaluates the impact of an MBI on important psychological processes (i.e., experiential avoidance, rumination, self-efficacy, and self-discrepancy), and explores whether these variables act alongside BA in mediating the relationship between an MBI and symptomatology. A non-randomized controlled trial was conducted with 148 participants (n = 89 in the MBI group; n = 59 in the control group) who completed questionnaires assessing BA and the above-mentioned psychological processes before and after an MBI. A sub-sample of participants (n = 86) completed a task that evaluates BA indirectly. Results showed a significant effect of MBI on the self-reported BA but not on the indirect measure of BA. The MBI significantly reduced symptomatology, and this effect was mediated by regulatory and belief-related dimensions of BA. Multiple mediator models showed a significant mediation via various pathways involving improved BA and various transdiagnostic psychological processes.