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Oliva F, Malandrone F, di Girolamo G, Mirabella S, Colombi N, Carletto S, Ostacoli L. The efficacy of mindfulness-based interventions in attention-deficit/hyperactivity disorder beyond core symptoms: A systematic review, meta-analysis, and meta-regression. J Affect Disord 2021; 292:475-486. [PMID: 34146899 DOI: 10.1016/j.jad.2021.05.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/09/2021] [Accepted: 05/30/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mindfulness-Based Interventions (MBIs) have been increasingly proposed as treatment in patients with Attention-Deficit/Hyperactivity Disorder (ADHD), showing promising results on different proposed outcomes, in both children and adults. OBJECTIVES To systematically review and meta-analyse studies concerning the effects of MBIs on either ADHD and associated features, associated clinical conditions, neurocognitive impairments, mindfulness skills, global functioning and quality of life. METHODS Searches were conducted on five databases, including controlled and observational studies on both adults and children populations. The review process was compliant to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Meta-analyses and meta-regression models were conducted. RESULTS Thirty-one full-texts were included. In both adults and children, MBIs showed to be more effective than waiting lists in improving ADHD symptoms and some other outcomes. In adults, a medium pooled effect size was shown by meta-analysis for ADHD symptoms but in some cases a publication bias was detected. Subgroup analysis and meta-regression confirmed the gap detected by our systematic review between the medium/large effect size of inactive-controlled studies and the low/negligible one of active-controlled studies. In children, no active-controlled studies have been conducted. Mindfulness Awareness Practice (MAP) and Mindfulness Based Cognitive Therapy (MBCT) were the most used protocols in adult studies, whereas a combination of MBCT and Mindfulness Based Stress Reduction (MBSR) was more preferred for children and adolescent patients. CONCLUSIONS Even if further studies with a better methodology are needed, we can suggest the MBIs may be useful as complementation and not as replacement of other active interventions.
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Affiliation(s)
- Francesco Oliva
- Department of Clinical and Biological Sciences, University of Turin, Italy.
| | | | - Giulia di Girolamo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Santina Mirabella
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Nicoletta Colombi
- Biblioteca Federata di Medicina "Ferdinando Rossi", University of Turin, Italy
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Italy
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Italy
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Hartstone JM, Medvedev ON. The Role of Mindfulness and Life Satisfaction in Psychological Distress During the COVID-19 Lockdown in New Zealand: a Quasi-experimental Study. Mindfulness (N Y) 2021; 12:2693-2706. [PMID: 34462646 PMCID: PMC8387552 DOI: 10.1007/s12671-021-01731-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 01/07/2023]
Abstract
Objectives Quantitative research on the psychological effects of lockdown conditions during the COVID-19 pandemic is needed to inform mental health interventions which aim to alleviate potential adverse effects. The goal of this study was to investigate psychological distress during the lockdown in New Zealand. Methods We implemented a longitudinal quasi-experimental research design using a sample (n = 81) who completed surveys on mindfulness, satisfaction with life, and mental health indicators at three time-points, separated by at least 2-week intervals. The sample was divided into two parts, the baseline group (n = 44) and the lockdown group (n = 37). The baseline group completed the surveys the first time prior to lockdown, and mostly completed the second and third surveys during lockdown. The lockdown group mostly completed the survey for the first time during lockdown and the second and third surveys during or after lockdown. Results Mindfulness and satisfaction with life at baseline significantly predicted lower levels of depression, anxiety, and stress during uncertain and emergency conditions before and during lockdown. The baseline group experienced significantly less anxiety and stress during lockdown compared to just prior to the lockdown (baseline condition). Conclusions Individuals who have higher levels of mindfulness and those with greater life satisfaction experience significantly less depression, anxiety, and stress over time, during both uncertain and emergency conditions such as during the threat of COVID-19. The finding of anxiety and stress reduction during lockdown may be specific to New Zealand, as conditions differ in many ways from those in other countries. Preventative measures which increase mindfulness and satisfaction with life could help alleviate depression, anxiety, and stress during uncertain and emergency conditions. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-021-01731-4.
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Affiliation(s)
- Jayne M Hartstone
- School of Psychology, University of Waikato, Rm K 1.23, Hillcrest, Private Bag 3105, Hamilton, 3240 New Zealand
| | - Oleg N Medvedev
- School of Psychology, University of Waikato, Rm K 1.23, Hillcrest, Private Bag 3105, Hamilton, 3240 New Zealand
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53
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A network approach to the five-facet model of mindfulness. Sci Rep 2021; 11:15094. [PMID: 34301994 PMCID: PMC8302557 DOI: 10.1038/s41598-021-94151-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/01/2021] [Indexed: 12/20/2022] Open
Abstract
Despite the large-scale dissemination of mindfulness-based interventions, debates persist about the very nature of mindfulness. To date, one of the dominant views is the five-facet approach, which suggests that mindfulness includes five facets (i.e., Observing, Describing, Nonjudging, Nonreactivity, and Acting with Awareness). However, uncertainty remains regarding the potential interplay between these facets. In this study, we investigated the five-facet model via network analysis in an unselected sample (n = 1704). We used two distinct computational network approaches: a Gaussian graphical model (i.e., undirected) and a directed acyclic graph, with each model determining the relations between the facets and their relative importance in the network. Both computational approaches pointed to the facet denoting Acting with Awareness as playing an especially potent role in the network system. Altogether, our findings offer novel data-driven clues for the field's larger quest to ascertain the very foundations of mindfulness.
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54
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Ma Y, Kraemer KM, Lyu J, Yeh GY. Randomized Controlled Trials of Mindfulness and Acceptance-Based Interventions Over the Past Two Decades: A Bibliometric Analysis. J Altern Complement Med 2021; 27:930-939. [PMID: 34252294 DOI: 10.1089/acm.2020.0548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: The past several years have witnessed a significant increase in interest among the public in mindfulness with an unmistakable growth in the scientific literature investigating mindfulness-based therapies. A myriad of therapeutic uses of mindfulness have been studied. Given this burgeoning interest, the authors' objective was to conduct a broad-sweeping bibliometric analysis over the past two decades to describe overarching trends in the publications of randomized controlled trials (RCTs) investigating mindfulness to broadly identify both strengths and gaps in this field and inform a strategic plan for further advancing this research area. Materials and Methods: The authors retrieved mindfulness-focused RCTs available on PubMed in the past two decades (2000-2019). They synthesized the literature with respect to publication numbers, countries of publication, journal type, areas of research focus, characteristics of study designs, sample size, and trends in remote intervention delivery. Results: The resulting 1389 publications represent a near exponential growth trend over the past 20 years. Publications from the top three countries (the United States, the United Kingdom, and the Netherlands) with the highest productivity accounted for 60% of total number of publications. The most published modalities include acceptance-based therapy (n = 260), mindfulness-based stress reduction (n = 238), mindfulness-based cognitive therapy (n = 174), and dialectical behavior therapy (n = 82). Stress, depression, anxiety, pain, cancer, diet/healthy eating, and sleep were the most common major areas of focus. Studies included active (46%) or inactive controls (44%), and increasingly more studies with both types of controls (10%). The top 10 journals that published the most mindfulness RCTs were from behavioral sciences and psychiatry or psychology. There were 187 RCTs utilizing remote delivery, with 146 (87.1%) in the most recent 5 years. Conclusion: Publications of mindfulness-focused RCTs show a continuous increasing trend. Mindfulness research from non-Western countries and studies published in biomedical journals were less prevalent and potentially represent future opportunities. Trends of studies with both inactive and active controls support an overall advancement in research methodology. There has been a significant expansion of studies of remotely delivered mindfulness interventions. Future research might consider evaluation of a broader range of modalities and further examine optimal delivery formats.
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Affiliation(s)
- Yan Ma
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristen M Kraemer
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jiaxuan Lyu
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Gloria Y Yeh
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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55
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Esbensen AJ, Hoffman EK, Shaffer RC, Patel LR, Jacola LM. Relationship Between Parent and Teacher Reported Executive Functioning and Maladaptive Behaviors in Children With Down Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 126:307-323. [PMID: 34161563 PMCID: PMC8244734 DOI: 10.1352/1944-7558-126.4.307] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/19/2020] [Indexed: 05/30/2023]
Abstract
The current study evaluates the concurrent relationship between parent ratings of executive functioning and maladaptive behavior among children and adolescents with Down syndrome and then repeats this evaluation using teacher reports. Parents and teachers of 63 school-age children with Down syndrome rated the child's executive functioning (Behavior Rating Inventory of Executive Function) and behaviors (Achenbach Child Behavior Checklist). For parent and teacher ratings, elevated behavior dysregulation predicted higher levels of rule-breaking, aggressive, and externalizing behavior. For teacher ratings, elevated behavior dysregulation also predicted higher levels of inattention problems. Among both parent and teacher ratings, greater metacognitive difficulties predicted challenges with attention. Understanding the relationship between these constructs has important implications for targets of intervention and developing preventative strategies.
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Affiliation(s)
- Anna J. Esbensen
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Emily K. Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Rebecca C. Shaffer
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children’s Hospital Medical Center
| | - Lina R. Patel
- Sie Center for Down Syndrome, Children’s Hospital Colorado
| | - Lisa M. Jacola
- Department of Psychology, St Jude Children’s Research Hospital
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56
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Liu X, Yi P, Ma L, Liu W, Deng W, Yang X, Liang M, Luo J, Li N, Li X. Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis. Psychiatry Res 2021; 300:113935. [PMID: 33895444 DOI: 10.1016/j.psychres.2021.113935] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
Various psychiatric disorders are treated with mindfulness-based interventions (MBIs), although the efficacy of MBIs in patients with social anxiety disorder (SAD) is unclear. In this meta-analysis, we investigated the efficacy of MBIs on SAD symptoms. Systematic searches were performed in various databases, and 11 eligible randomized controlled trials (RCTs) and 5 single-arm trials were identified. The between-groups analysis of the 11 RCTs showed that Hedges' g = 0.00, while the within-group analysis showed a large pre-post effect size (g = 1.20).MBIs were superior to the no-treatment comparator (g = 0.89), equivalent to specific active treatment (g = -0.19), and less effective than evidence-based treatment (i.e., cognitive behavioral therapies) (g = -0.29).MBIs significantly alleviated depressive symptoms and improved mindfulness, quality of life, and self-compassion. Meta-regression analysis showed a dose-response relationship between the alleviation of SAD symptoms and the duration of the MBIs (β = 0.659). Follow-up analysis showed that the effects of MBIs on SAD persisted for 12 months (g = 0.231). An analysis of the 5 single-arm trials found that MBIs had a medium effect in alleviating SAD symptoms (g = 0.48). Future research is needed regarding the design of large RCTs of MBIs on SAD patients.
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Affiliation(s)
- Xiaoyu Liu
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Pengcheng Yi
- Department of Clinical Psychology, The Third People's Hospital of Xiangshan County, Zhejiang, China
| | - Lijun Ma
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China; Department of Psychology, School of Education, Anqing Normal University, Anqing, China
| | - Wen Liu
- Affiliated Psychological Hospital of Anhui Medical University,Anhui, China; Hefei Fourth People's Hospital, Anhui, China; Anhui Mental Health Center, Anhui, China.
| | - Wenrui Deng
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Xinxin Yang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Meng Liang
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Jingyi Luo
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Ni Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China
| | - Xiaoming Li
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, China.
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57
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Young JH, Arterberry ME, Martin JP. Contrasting Electroencephalography-Derived Entropy and Neural Oscillations With Highly Skilled Meditators. Front Hum Neurosci 2021; 15:628417. [PMID: 33994976 PMCID: PMC8119624 DOI: 10.3389/fnhum.2021.628417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Meditation is an umbrella term for a number of mental training practices designed to improve the monitoring and regulation of attention and emotion. Some forms of meditation are now being used for clinical intervention. To accompany the increased clinical interest in meditation, research investigating the neural basis of these practices is needed. A central hypothesis of contemplative neuroscience is that meditative states, which are unique on a phenomenological level, differ on a neurophysiological level. To identify the electrophysiological correlates of meditation practice, the electrical brain activity of highly skilled meditators engaging in one of six meditation styles (shamatha, vipassana, zazen, dzogchen, tonglen, and visualization) was recorded. A mind-wandering task served as a control. Lempel-Ziv complexity showed differences in nonlinear brain dynamics (entropy) during meditation compared with mind wandering, suggesting that meditation, regardless of practice, affects neural complexity. In contrast, there were no differences in power spectra at six different frequency bands, likely due to the fact that participants engaged in different meditation practices. Finally, exploratory analyses suggest neurological differences among meditation practices. These findings highlight the importance of studying the electroencephalography (EEG) correlates of different meditative practices.
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Affiliation(s)
- Jacob H. Young
- Department of Biology, Colby College, Waterville, ME, United States
- Department of Psychology, Colby College, Waterville, ME, United States
| | | | - Joshua P. Martin
- Department of Biology, Colby College, Waterville, ME, United States
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58
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Manwaring J, Blalock DV, Le Grange D, Duffy A, McClanahan SF, Johnson C, Mehler PS, Plotkin M, Rienecke RD. Motivation to recover for adolescent and adult eating disorder patients in residential treatment. EUROPEAN EATING DISORDERS REVIEW 2021; 29:622-633. [PMID: 33851492 DOI: 10.1002/erv.2828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/22/2021] [Accepted: 02/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess how baseline motivation to recover impacts eating disorder (ED) and comorbid symptoms at end-of-treatment (EOT) for adolescents and adults in inpatient/residential treatment. METHOD Two hundred and three adolescent (M = 15.90) and 395 adult (M = 25.45) patients with a Diagnostic Statistical Manual, 5th edition ED diagnosis completed the Decisional Balance Scale (DBS) at baseline, and psychosocial measures (ED symptoms, anxiety, depression, obsessive-compulsive disorder symptoms), and %body mass index (kg/m2 ; BMI) or median %BMI (for adolescents) at baseline and EOT. RESULTS The DBS Avoidance Coping and Burdens subscales at baseline were significantly lower for adolescents than adults (p < 0.001), whereas the DBS Benefits subscale at baseline did not significantly differ between subsamples (p = 0.06). Motivation to recover via DBS subscales was a more reliable predictor of EOT outcomes for both ED and comorbid psychopathology in adults (significant predictor in 19 of 54 total analyses, and 4 significant associations post-Bonferroni correction) than adolescents (significant predictor in 5 of 54 total analyses, and 1 significant association post-Bonferroni correction). CONCLUSIONS Baseline motivation to recover may be an important predictor of outcome for adult patients in inpatient/residential treatment but does not appear associated with outcomes for adolescent patients.
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Affiliation(s)
- Jamie Manwaring
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.,Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Susan F McClanahan
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry, Rush University Medical Center, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Craig Johnson
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Philip S Mehler
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,ACUTE, Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Millie Plotkin
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Behavioural Health Centers, Denver, Colorado, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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59
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Santarnecchi E, Egiziano E, D'Arista S, Gardi C, Romanella SM, Mencarelli L, Rossi S, Reda M, Rossi A. Mindfulness-based stress reduction training modulates striatal and cerebellar connectivity. J Neurosci Res 2021; 99:1236-1252. [PMID: 33634892 DOI: 10.1002/jnr.24798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/05/2023]
Abstract
Mindfulness is a meditation practice frequently associated with changes in subjective evaluation of cognitive and sensorial experience, as well as with modifications of brain activity and morphometry. Aside from the anatomical localization of functional changes induced by mindfulness practice, little is known about changes in functional and effective functional magnetic resonance imaging (fMRI) connectivity. Here we performed a connectivity fMRI analysis in a group of healthy individuals participating in an 8-week mindfulness-based stress reduction (MBSR) training program. Data from both a "mind-wandering" and a "meditation" state were acquired before and after the MBSR course. Results highlighted decreased local connectivity after training in the right anterior putamen and insula during spontaneous mind-wandering and the right cerebellum during the meditative state. A further effective connectivity analysis revealed (a) decreased modulation by the anterior cingulate cortex over the anterior portion of the putamen, and (b) a change in left and right posterior putamen excitatory input and inhibitory output with the cerebellum, respectively. Results suggest a rearrangement of dorsal striatum functional and effective connectivity in response to mindfulness practice, with changes in cortico-subcortical-cerebellar modulatory dynamics. Findings might be relevant for the understanding of widely documented mindfulness behavioral effects, especially those related to pain perception.
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Affiliation(s)
- Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eutizio Egiziano
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Sicilia D'Arista
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Concetta Gardi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Sara M Romanella
- Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - Lucia Mencarelli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - Simone Rossi
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.,Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy.,Department of Medicine, Surgery and Neuroscience, Human Physiology Section, Siena Medical School, Siena, Italy
| | - Mario Reda
- Department of Neurological, Neurosurgical and Behavioral Sciences, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Siena Brain Investigation and Neuromodulation Laboratory (SiBIN-Lab), Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
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60
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Gál É, Ștefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users' well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord 2021; 279:131-142. [PMID: 33049431 DOI: 10.1016/j.jad.2020.09.134] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/30/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness applications are popular tools for improving well-being, but their effectiveness is unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) that employed a mindfulness meditation app as the main intervention to improve users' well-being and mental-health related outcomes. METHODS A systematic search was conducted in PsycINFO, PubMed, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Library, Open Grey and ResearchGate through June, 2020. Effects were calculated as standardized mean difference (Hedges' g) between app-delivered mindfulness interventions and control conditions at post-test and pooled with a random-effects model. RESULTS From 2637 records, we selected 34 trials (N = 7566). Significant effect sizes were found at post-test for perceived stress (n = 15; g = 0.46, 95% CI [0.24, .68], I2= 68%), anxiety (n = 15; g = 0.28, 95% CI [0.16, .40], I2= 35%), depression (n = 15; g = 0.33, 95% CI [0.24, .43], I2= 0%), and psychological well-being (n = 5; g = 0.29, 95% CI [0.14, .45], I2= 0%). No significant effects were found for distress at post-test (n = 6; g = 0.10, 95% CI [-0.02, .22], I2= 11%) and general well-being (n = 5; g = 0.14, 95% CI [-0.02, 0.29], I2 = 14%). CONCLUSION AND LIMITATIONS Mindfulness apps seem promising in improving well-being and mental-health, though results should be interpreted carefully due to the small number of included studies, overall uncertain risk of bias and heterogeneity.
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Affiliation(s)
- Éva Gál
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș- Bolyai University, Cluj-Napoca, Romania.
| | - Simona Ștefan
- Department of Clinical Psychology and Psychotherapy, Babeș- Bolyai University, Cluj-Napoca, Romania; The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș- Bolyai University, Cluj- Napoca, Romania
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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61
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Ritvo P, Ahmad F, El Morr C, Pirbaglou M, Moineddin R. A Mindfulness-Based Intervention for Student Depression, Anxiety, and Stress: Randomized Controlled Trial. JMIR Ment Health 2021; 8:e23491. [PMID: 33264098 PMCID: PMC7833974 DOI: 10.2196/23491] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/19/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND University students are experiencing higher levels of distress and mental health disorders than before. In addressing mental health needs, web-based interventions have shown increasing promise in overcoming geographic distances and high student-to-counselor ratios, leading to the potential for wider implementation. The Mindfulness Virtual Community (MVC) program, a web-based program, guided by mindfulness and cognitive behavioral therapy principles, is among efforts aimed at effectively and efficiently reducing symptoms of depression, anxiety, and perceived stress in students. OBJECTIVE This study's aim was to evaluate the efficacy of an 8-week MVC program in reducing depression, anxiety, and perceived stress (primary outcomes), and improving mindfulness (secondary outcome) in undergraduate students at a large Canadian university. Guided by two prior randomized controlled trials (RCTs) that each demonstrated efficacy when conducted during regular university operations, this study coincided with a university-wide labor strike. Nonetheless, the students' response to an online mental health program on a disrupted campus can provide useful information for anticipating the impact of other disruptions, including those related to the COVID-19 pandemic as well as future disruptions. METHODS In this parallel-arm RCT, 154 students were randomly allocated to an 8-week MVC intervention (n=76) or a wait-list control (WLC) condition (n=78). The MVC intervention included the following: (1) educational and mindfulness video modules, (2) anonymous peer-to-peer discussions, and (3) anonymous, group-based, professionally guided, 20-minute videoconferences. Study outcomes were evaluated at baseline and at 8-week follow-up using the following: Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), the Perceived Stress Scale (PSS), and the Five Facets Mindfulness Questionnaire Short Form (FFMQ-SF). Generalized estimation equations with an AR (1) covariance structure were used to evaluate the impact of the intervention, with outcome evaluations performed on both an intention-to-treat (ITT) and per-protocol (PP) basis. RESULTS Participants (n=154) included 35 males and 117 females with a mean age of 23.1 years. There were no statistically significant differences at baseline between the MVC and WLC groups on demographics and psychological characteristics, indicating similar demographic and psychological characteristics across the two groups. Results under both ITT and PP approaches indicated that there were no statistically significant between-group differences in PHQ-9 (ITT: β=-0.44, P=.64; PP: β=-0.62, P=.053), BAI (ITT: β=-2.06, P=.31; PP: β=-2.32, P=.27), and FFMQ-SF (ITT: β=1.33, P=.43; PP: β=1.44, P=.41) compared to WLC. There was a significant difference for the PSS (ITT: β=-2.31, P=.03; PP: β=-2.38, P=.03). CONCLUSIONS During a university labor strike, the MVC program led to statistically significant reductions in PSS compared to the WLC group, but there were no other significant between-group differences. Comparisons with previous cycles of intervention testing, undertaken during nondisrupted university operations, when efficacy was demonstrated, are discussed. TRIAL REGISTRATION ISRCTN Registry ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.
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Affiliation(s)
- Paul Ritvo
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Christo El Morr
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Meysam Pirbaglou
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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- York University, Toronto, ON, Canada
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Kraemer KM, Luberto CM, Hall DL, Ngo LH, Yeh GY. A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity. Behav Res Ther 2020; 135:103746. [PMID: 33011486 PMCID: PMC7943058 DOI: 10.1016/j.brat.2020.103746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022]
Abstract
Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.
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Affiliation(s)
- Kristen M Kraemer
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
| | - Christina M Luberto
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Daniel L Hall
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02108, USA.
| | - Long H Ngo
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Gloria Y Yeh
- Division of General Medicine, Harvard Medical School/Beth Israel Deaconess Medical Center, 330 Brookline Avenue, CO-1309, 2nd Floor, Boston, MA, 02215, USA.
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Stapleton P, Dispenza J, McGill S, Sabot D, Peach M, Raynor D. Large effects of brief meditation intervention on EEG spectra in meditation novices. IBRO Rep 2020; 9:290-301. [PMID: 33204893 PMCID: PMC7649620 DOI: 10.1016/j.ibror.2020.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
This study investigated the impact of a brief meditation workshop on a sample of 223 novice meditators. Participants attended a three-day workshop comprising daily guided seated meditation sessions using music without vocals that focused on various emotional states and intentions (open focus). Based on the theory of integrative consciousness, it was hypothesized that altered states of consciousness would be experienced by participants during the meditation intervention as assessed using electroencephalogram (EEG). Brainwave power bands patterns were measured throughout the meditation training workshop, producing a total of 5616 EEG scans. Changes in conscious states were analysed using pre-meditation and post-meditation session measures of delta through to gamma oscillations. Results suggested the meditation intervention had large varying effects on EEG spectra (up to 50 % increase and 24 % decrease), and the speed of change from pre-meditation to post-meditation state of the EEG co-spectra was significant (with 0.76 probability of entering end-meditation state within the first minute). There was a main 5 % decrease in delta power (95 % HDI = [-0.07, -0.03]); a global increase in theta power of 29 % (95 % HDI = [0.27, 0.33]); a global increase of 16 % (95 % HDI = [0.13, 0.19]) in alpha power; a main effect of condition, with global beta power increasing by 17 % (95 % HDI = [0.15, 0.19]); and an 11 % increase (95 % HDI = [0.08, 0.14]) in gamma power from pre-meditation to end-meditation. Findings provided preliminary support for brief meditation in altering states of consciousness in novice meditators. Future clinical examination of meditation was recommended as an intervention for mental health conditions particularly associated with hippocampal impairments.
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Affiliation(s)
- P. Stapleton
- School of Psychology, Bond University, Gold Coast, Queensland, 4229, Australia
| | | | - S. McGill
- School of Psychology, University of Auckland, New Zealand
| | - D. Sabot
- School of Psychology, Bond University, Gold Coast, Queensland, 4229, Australia
| | - M. Peach
- School of Psychology, Evexia Pty Ltd, Brisbane, Australia
| | - D. Raynor
- School of Psychology, Bond University, Gold Coast, Queensland, 4229, Australia
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Denk-Florea CB, Gancz B, Gomoiu A, Ingram M, Moreton R, Pollick F. Understanding and supporting law enforcement professionals working with distressing material: Findings from a qualitative study. PLoS One 2020; 15:e0242808. [PMID: 33237979 PMCID: PMC7688122 DOI: 10.1371/journal.pone.0242808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/09/2020] [Indexed: 01/13/2023] Open
Abstract
This study aimed to extend previous research on the experiences and factors that impact law enforcement personnel when working with distressing materials such as child sexual abuse content. A sample of 22 law enforcement personnel working within one law enforcement organisation in England, United Kingdom participated in anonymous semi-structured interviews. Results were explored thematically and organised in the following headings: "Responses to the material", "Impact of working with distressing evidence", "Personal coping strategies" and "Risks and mitigating factors". Law enforcement professionals experienced heightened affective responses to personally relevant material, depictions of violence, victims' displays of emotions, norm violations and to various mediums. These responses dampened over time due to desensitisation. The stress experienced from exposure to the material sometimes led to psychological symptoms associated with Secondary Traumatic Stress. Job satisfaction, self-care activities, the coping strategies used when viewing evidence, detachment from work outside working hours, social support and reducing exposure to the material were found to mediate law enforcement professionals' resilience. Exposure to distressing material and the risks associated with this exposure were also influenced by specific organisational procedures implemented as a function of the funding available and workload. Recommendations for individual and organisational practices to foster resilience emerged from this research. These recommendations are relevant to all organisations where employees are required to view distressing content.
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Affiliation(s)
| | | | - Amalia Gomoiu
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
| | - Martin Ingram
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
| | - Reuben Moreton
- Qumodo, London, United Kingdom
- Department of Psychology, The Open University, Milton Keynes, United Kingdom
| | - Frank Pollick
- Institute of Neuroscience and Psychology, The University of Glasgow, Glasgow, United Kingdom
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Kubota R, Nixon RDV. The effect of mindfulness training on rumination and intrusions after analogue trauma. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rie Kubota
- Flinders University, Adelaide, South Australia, Australia,
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66
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Moir S, Skues J, Theiler S. Exploring the Perspectives of Psychologists Who Use Mindfulness in Therapeutic Practice. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Susan Moir
- Faculty of Health, Arts and Design, Swinburne University of Technology
| | - Jason Skues
- Faculty of Health, Arts and Design, Swinburne University of Technology
| | - Stephen Theiler
- Faculty of Health, Arts and Design, Swinburne University of Technology
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67
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Woods BK, Sauer-Zavala S, Farchione TJ, Barlow DH. Isolating the Effects of Mindfulness Training Across Anxiety Disorder Diagnoses in the Unified Protocol. Behav Ther 2020; 51:972-983. [PMID: 33051038 PMCID: PMC8791357 DOI: 10.1016/j.beth.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/01/2020] [Accepted: 01/05/2020] [Indexed: 12/22/2022]
Abstract
The Unified Protocol for Transdiagnostic Treatment (UP; Barlow et al., 2011) has recently demonstrated statistically equivalent therapeutic effects compared to leading cognitive behavioral therapy (CBT) protocols for anxiety disorders designed to address disorder-specific symptoms (i.e., single-disorder protocols [SDP]); Barlow et al., 2017). Although all treatment protocols included similar evidence-based CBT elements, investigation of those related to symptom improvement in the UP is warranted. Because the UP is unique from the SDPs for its inclusion of mindfulness, the present study evaluated mindfulness as a primary treatment element. We explored whether UP participants, compared to SDP, demonstrated greater improvements in mindfulness from pre- to posttreatment, and whether these improvements predicted posttreatment severity across anxiety disorder diagnoses. Participants were individuals with a principle anxiety disorder (N = 179) randomized to receive either the UP or SDP. Results indicated significant improvements pre- to posttreatment in mindfulness for participants receiving either the UP or SDP. However, at posttreatment, mindfulness scores were significantly greater for the UP condition. At the diagnosis level, posttreatment scores in mindfulness were significantly greater in the UP condition than the respective SDP conditions for principal Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SOC). Moreover, results suggest that change in mindfulness is related to posttreatment severity, when moderated by treatment condition, but only for participants with principal GAD. Taken together, the UP is effective in improving mindfulness in a sample with heterogeneous anxiety disorders, but this change seems particularly relevant for reduction in symptom severity for individuals with principal GAD.
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68
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Lenhart L, Steiger R, Waibel M, Mangesius S, Grams AE, Singewald N, Gizewski ER. Cortical reorganization processes in meditation naïve participants induced by 7 weeks focused attention meditation training. Behav Brain Res 2020; 395:112828. [PMID: 32745662 DOI: 10.1016/j.bbr.2020.112828] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Based on the evidence that meditation is associated with numerous beneficial effects on well-being and reduced stress-related symptoms, mindfulness-based techniques were increasingly implemented into psychotherapeutic programs. However, different meditation styles and the cross-sectional nature of most previous analyses resulted in a great variety of morphometric findings. The present study aims to elucidate cortical reorganization processes and altered axonal integrity caused by short-term meditation training, and benefits from solely using focused attention meditation (FAM). METHODS 3 T MRI, including T1-MPRAGE and diffusion-weighted sequences, was performed in 27 healthy, meditation naïve participants (age: 43 ± 12.4 years) pre and post FAM meditation training (duration: 7.3 ± 0.4 weeks). Voxel-based morphometry was applied to assess brain changes in gray and white matter. Questionnaires were filled out by the individuals at both time-points to evaluate quality of life and self-awareness deficits. RESULTS The major findings comprised (i) gray matter increases in the insula, the caudate nucleus and frontal cortices, (ii) decreases in extended parietotemporal regions, the right medial prefrontal cortex and the parahippocampal gyrus, as well as (iii) fractional anisotropy increases of the right hippocampus, the basal ganglia and adjacent regions. Regression analysis revealed an association of specific alterations with reduced levels of state anxiety. CONCLUSIONS FAM training induced a broad range of dynamic brain alterations even within few weeks of training. Interestingly, this cohort revealed more, and partially different patterns of structural gray matter change compared to prior studies. The broad impact on neuronal organization processes may reflect more general outcomes related to health and well-being.
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Affiliation(s)
- Lukas Lenhart
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid E Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy and CMBI, Leopold Franzens University, Innsbruck, Austria
| | - Elke R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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A Brief Report on an 8-Week Course of Mindfulness-based Care for Chronic Pain in the Treatment of Veterans With Back Pain: Barriers Encountered to Treatment Engagement and Lessons Learned. Med Care 2020; 58 Suppl 2 9S:S94-S100. [PMID: 32826778 DOI: 10.1097/mlr.0000000000001377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic pain and associated symptoms are debilitating for veterans. Medical costs of treatments are high and current treatment options, most notably with opioid medications, have been associated with significant risk. Mindfulness-based interventions appear promising for chronic pain, but require additional testing in veteran care settings. OBJECTIVE This project was designed to test the feasibility of engaging and retaining veterans with chronic lower back pain in a new mindfulness protocol tailored for veterans, mindfulness-based care for chronic pain (MBCP). Clinical outcomes were also assessed. DESIGN An open pilot trial of an 8-week MBCP course that included meditation, gentle yoga, and psychoeducation. SUBJECTS Twenty-two veterans (mean age=49.77; 18% women) were recruited from a VA Medical Center in the Northeastern US. After screening for inclusion/exclusion criteria, 20 were eligible at baseline. MEASURES Veterans were assessed at baseline and postintervention for functional impairment, pain intensity and bothersomeness, depression, and mindfulness. RESULTS The average number of sessions completed was 5; only 4 (20%) attended all sessions. Eleven of the 20 participants (55%) attended 5 or more sessions and had complete preintervention and postintervention visits. Five of the 11 had a clinically meaningful decrease in pain intensity and in depressive symptoms, while 6 of 11 had a meaningful decrease in pain bothersomeness and functional impairment. CONCLUSIONS It was challenging to enroll and retain participants in this study, even with our intervention designed for veterans. We discuss possible adaptations and refinements in MBCP for veterans with chronic pain to enhance feasibility and improve upon these interventions.
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Abbott DJ, Lack CW. Conventional versus Mindfulness-based Interventions for Anxiety and Worry: A Review and Recommendations. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082216666200220121648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Anxiety disorders are among the most prevalent and most functionally impairing psychiatric
problems experienced by the population. Both pharmacological and psychological evidencebased
treatments exist for a number of specific disorders, but may fail to fully relieve symptoms,
pointing to the need for additional treatment options. Often considered to be part of the “third wave”
of cognitive-behavioral therapies, treatments incorporating mindfulness have emerged in the past
two decades as increasingly popular with clinicians and frequently sought out by consumers. The
present article reviews the extant literature regarding the efficacy and effectiveness of mindfulnessbased
treatments for anxiety, worry, and related problems. Although they have not attained the solid
empirical status of CBT or certain pharmacological treatments, the extant research shows mindfulness-
based interventions appear to be a promising and useful treatment for people suffering from
anxiety and worry. Further work should be done, levels 3-5 of the NIH stage model to determine
whether or not they should be further implemented.
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Affiliation(s)
- Deah Jo Abbott
- Department of Psychology, Georgia State University, Atlanta, GA 30302, United States
| | - Caleb Wayne Lack
- Department of Psychology, University of Central Oklahoma, Edmond, OK 73034, United States
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Gaitzsch H, Benard J, Hugon-Rodin J, Benzakour L, Streuli I. The effect of mind-body interventions on psychological and pregnancy outcomes in infertile women: a systematic review. Arch Womens Ment Health 2020; 23:479-491. [PMID: 31897607 DOI: 10.1007/s00737-019-01009-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
Preliminary evidence suggests that mind-body interventions, including mindfulness-based interventions and yoga, may be effective in reducing mental health difficulties and psychological distress in infertile patients undergoing fertility treatments. We systematically reviewed and synthesized current medical literature of the effectiveness of mind-body interventions in reducing the severity of psychological distress and improving marital function and pregnancy outcomes in infertile women/couple. Databases including PsychINFO, PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Manual searches were conducted in relevant articles. We included 12 studies that met the inclusion criteria. Four studies were randomized controlled trials (RCT), 4 non-randomized controlled trial (NRCT), and 4 uncontrolled studies (UCT). Participation in a mind-body intervention was associated with reduced anxiety trait and depression scores. The reduction was of low or moderate amplitude in most studies. Our review offers evidence for the effectiveness of mind-body interventions in reducing anxiety state and depression in infertile women and a possible improvement in pregnancy rate. Further RCTs with a precise timing of intervention are needed.
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Affiliation(s)
- Hélène Gaitzsch
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Julie Benard
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | | | - Lamyae Benzakour
- Division for Liaison Psychiatry and Crisis Intervention, Department of Mental Health, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland
| | - Isabelle Streuli
- Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva and the Faculty of Medicine of the University of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
- Hélène Gaitzsch Medical Resident Unit for Reproductive Medicine and Gynecological Endocrinology, Department for Gynecology and Obstetrics, University Hospitals of Geneva, 30 boulevard de la Cluse, 1205, Geneva, Switzerland.
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El Morr C, Ritvo P, Ahmad F, Moineddin R. Effectiveness of an 8-Week Web-Based Mindfulness Virtual Community Intervention for University Students on Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e18595. [PMID: 32554380 PMCID: PMC7395254 DOI: 10.2196/18595] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A student mental health crisis is increasingly acknowledged and will only intensify with the COVID-19 crisis. Given accessibility of methods with demonstrated efficacy in reducing depression and anxiety (eg, mindfulness meditation and cognitive behavioral therapy [CBT]) and limitations imposed by geographic obstructions and localized expertise, web-based alternatives have become vehicles for scaled-up delivery of benefits at modest cost. Mindfulness Virtual Community (MVC), a web-based program informed by CBT constructs and featuring online videos, discussion forums, and videoconferencing, was developed to target depression, anxiety, and experiences of excess stress among university students. OBJECTIVE The aim of this study was to assess the effectiveness of an 8-week web-based mindfulness and CBT program in reducing symptoms of depression, anxiety, and stress (primary outcomes) and increasing mindfulness (secondary outcome) within a randomized controlled trial (RCT) with undergraduate students at a large Canadian university. METHODS An RCT was designed to assess undergraduate students (n=160) who were randomly allocated to a web-based guided mindfulness-CBT condition (n=80) or to a waitlist control (WLC) condition (n=80). The 8-week intervention consisted of a web-based platform comprising (1) 12 video-based modules with psychoeducation on students' preidentified life challenges and applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided 20-minute live videoconferences. The outcomes (depression, anxiety, stress, and mindfulness) were measured via an online survey at baseline and at 8 weeks postintervention using the Patient Health Questionnaire-9 (PHQ9), the Beck Anxiety Inventory (BAI), the Perceived Stress Scale (PSS), and the Five Facets Mindfulness Questionnaire Short Form (FFMQ-SF). Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible covariates (gender, age, country of birth, ethnicity, English as first language, paid work, unpaid work, relationship status, physical exercise, self-rated health, and access to private mental health counseling). RESULTS Of the 159 students who provided T1 data, 32 were males and 125 were females with a mean age of 22.55 years. Participants in the MVC (n=79) and WLC (n=80) groups were similar in sociodemographic characteristics at T1 with the exception of gender and weekly hours of unpaid volunteer work. At postintervention follow-up, according to the adjusted comparisons, there were statistically significant between-group reductions in depression scores (β=-2.21, P=.01) and anxiety scores (β=-4.82, P=.006), and a significant increase in mindfulness scores (β=4.84, P=.02) compared with the WLC group. There were no statistically significant differences in perceived stress for MVC (β=.64, P=.48) compared with WLC. CONCLUSIONS With the MVC intervention, there were significantly reduced depression and anxiety symptoms but no significant effect on perceived stress. Online mindfulness interventions can be effective in addressing common mental health conditions among postsecondary populations on a large scale, simultaneously reducing the current burden on traditional counseling services. TRIAL REGISTRATION ISRCTN Registry ISRCTN12249616; http://www.isrctn.com/ISRCTN12249616.
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Affiliation(s)
- Christo El Morr
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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- School of Health Policy and Management, York University, Toronto, ON, Canada
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Fumero A, Peñate W, Oyanadel C, Porter B. The Effectiveness of Mindfulness-Based Interventions on Anxiety Disorders. A Systematic Meta-Review. Eur J Investig Health Psychol Educ 2020; 10:704-719. [PMID: 34542506 PMCID: PMC8314302 DOI: 10.3390/ejihpe10030052] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE There has been a growing interest in the study of the effectiveness of mindfulness-based interventions (MBIs). Many clinical trials and experimental designs have been implemented, with different samples and diverse MBI procedures. Reviews have shown unclear results, apart from a tendency to identify low-to-moderate effectiveness. The purpose of this review is to examine the effectiveness of MBIs on anxiety complaints, analyzing available systematic reviews and meta-analyses. METHOD The literature search was done in MEDLINE (PubMed) and PsycINFO, from the first available review in 2003 until March 2020. From 82 initial references, 12 reviews were selected. RESULTS Reviews confirmed a moderate effect size of MBIs in improving anxiety symptoms. This efficacy was similar to that of well-established therapies for reducing anxiety symptoms, such as cognitive behavioral therapies. A large effect size was found when well-developed MBI protocols were applied. DISCUSSION More refined clinical trials are needed to establish clear conditions of MBI effectiveness (protocols, samples, psychological mechanisms, etc.). In addition, considering mindfulness processes, new outcome measures are needed (such as acceptance, self-awareness, or well-being) to test the incremental value of MBIs.
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Affiliation(s)
- Ascensión Fumero
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
| | - Wenceslao Peñate
- Departamento de Psicología Clínica, Psicobiología y Metodología, Facultad de Psicología, Campus de Guajara, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain;
| | - Cristián Oyanadel
- Facultad de Ciencias Sociales, Universidad de Concepción, 4030000 Concepción, Chile; (C.O.); (B.P.)
| | - Bárbara Porter
- Facultad de Ciencias Sociales, Universidad de Concepción, 4030000 Concepción, Chile; (C.O.); (B.P.)
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Humer E, Pieh C, Probst T. Metabolomic Biomarkers in Anxiety Disorders. Int J Mol Sci 2020; 21:E4784. [PMID: 32640734 PMCID: PMC7369790 DOI: 10.3390/ijms21134784] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 12/24/2022] Open
Abstract
Anxiety disorders range among the most prevalent psychiatric disorders and belong to the leading disorders in the study of the total global burden of disease. Anxiety disorders are complex conditions, with not fully understood etiological mechanisms. Numerous factors, including psychological, genetic, biological, and chemical factors, are thought to be involved in their etiology. Although the diagnosis of anxiety disorders is constantly evolving, diagnostic manuals rely on symptom lists, not on objective biomarkers and treatment effects are small to moderate. The underlying biological factors that drive anxiety disorders may be better suited to serve as biomarkers for guiding personalized medicine, as they are objective and can be measured externally. Therefore, the incorporation of novel biomarkers into current clinical methods might help to generate a classification system for anxiety disorders that can be linked to the underlying dysfunctional pathways. The study of metabolites (metabolomics) in a large-scale manner shows potential for disease diagnosis, for stratification of patients in a heterogeneous patient population, for monitoring therapeutic efficacy and disease progression, and for defining therapeutic targets. All of these are important properties for anxiety disorders, which is a multifactorial condition not involving a single-gene mutation. This review summarizes recent investigations on metabolomics studies in anxiety disorders.
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Affiliation(s)
- Elke Humer
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, 3500 Krems, Austria; (C.P.); (T.P.)
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75
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Can Acceptance, Mindfulness, and Self-Compassion Be Learned by Smartphone Apps? A Systematic and Meta-Analytic Review of Randomized Controlled Trials. Behav Ther 2020; 51:646-658. [PMID: 32586436 DOI: 10.1016/j.beth.2019.10.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022]
Abstract
The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could help overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learned through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = -0.32; 95% CI = -0.48, -0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learned through cheap, easily accessible, and low-intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.
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76
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Marshall JM, Dunstan DA, Bartik W. Apps With Maps-Anxiety and Depression Mobile Apps With Evidence-Based Frameworks: Systematic Search of Major App Stores. JMIR Ment Health 2020; 7:e16525. [PMID: 32579127 PMCID: PMC7381031 DOI: 10.2196/16525] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/27/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mobile mental health apps have become ubiquitous tools to assist people in managing symptoms of anxiety and depression. However, due to the lack of research and expert input that has accompanied the development of most apps, concerns have been raised by clinicians, researchers, and government authorities about their efficacy. OBJECTIVE This review aimed to estimate the proportion of mental health apps offering comprehensive therapeutic treatments for anxiety and/or depression available in the app stores that have been developed using evidence-based frameworks. It also aimed to estimate the proportions of specific frameworks being used in an effort to understand which frameworks are having the most influence on app developers in this area. METHODS A systematic review of the Apple App Store and Google Play store was performed to identify apps offering comprehensive therapeutic interventions that targeted anxiety and/or depression. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was adapted to guide this approach. RESULTS Of the 293 apps shortlisted as offering a therapeutic treatment for anxiety and/or depression, 162 (55.3%) mentioned an evidence-based framework in their app store descriptions. Of the 293 apps, 88 (30.0%) claimed to use cognitive behavioral therapy techniques, 46 (15.7%) claimed to use mindfulness, 27 (9.2%) claimed to use positive psychology, 10 (3.4%) claimed to use dialectical behavior therapy, 5 (1.7%) claimed to use acceptance and commitment therapy, and 20 (6.8%) claimed to use other techniques. Of the 162 apps that claimed to use a theoretical framework, only 10 (6.2%) had published evidence for their efficacy. CONCLUSIONS The current proportion of apps developed using evidence-based frameworks is unacceptably low, and those without tested frameworks may be ineffective, or worse, pose a risk of harm to users. Future research should establish what other factors work in conjunction with evidence-based frameworks to produce efficacious mental health apps.
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Affiliation(s)
- Jamie M Marshall
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Debra A Dunstan
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
| | - Warren Bartik
- School of Psychology, Faculty of Medicine and Health, University of New England, Armidale, Australia
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77
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Lee SA, Mathis AA, Jobe MC. How are worriers particularly sensitive to grief? Tonic immobility as a mediating factor. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2020. [DOI: 10.1080/03069885.2020.1772462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sherman A. Lee
- Department of Psychology, Christopher Newport University, Newport News, VA, USA
| | - Amanda A. Mathis
- Department of Psychology, Christopher Newport University, Newport News, VA, USA
| | - Mary C. Jobe
- Department of Psychology, Christopher Newport University, Newport News, VA, USA
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Quach JL, Deery B, Kern M, Clinton J, Gold L, Orsini F, Sciberras E. Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial. BMJ Open 2020; 10:e036523. [PMID: 32393614 PMCID: PMC7223282 DOI: 10.1136/bmjopen-2019-036523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes. METHODS AND ANALYSIS This cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen's d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted. ETHICS AND DISSEMINATION Ethics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families. PRE-RESULTS TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12619000326190).
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Affiliation(s)
- Jon L Quach
- Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Ben Deery
- Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
| | - Margaret Kern
- Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
| | - Janet Clinton
- Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia
| | - Lisa Gold
- Deakin Health Economics, Deakin University, Burwood, Victoria, Australia
| | - Francesca Orsini
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Emma Sciberras
- Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- School of Psychology, Deakin University, Burwood, Victoria, Australia
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Effects of Mindfulness-Based Interventions on Biomarkers and Low-Grade Inflammation in Patients with Psychiatric Disorders: A Meta-Analytic Review. Int J Mol Sci 2020; 21:ijms21072484. [PMID: 32260096 PMCID: PMC7177919 DOI: 10.3390/ijms21072484] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022] Open
Abstract
Mindfulness-Based Interventions (MBIs) present positive effects on mental health in diverse populations. However, the detailed associations between MBIs and biomarkers in patients with psychiatric disorders remain poorly understood. The aim of this study was to examine the effects of MBIs on biomarkers in psychiatric illness used to summarise the effects of low-grade inflammation. A systematic review of PubMed, EMBASE, PsycINFO, and the Cochrane Library was conducted. Effect sizes (ESs) were determined by Hedges' g and the number needed to treat (NNT). Heterogeneity was evaluated. A total of 10 trials with 998 participants were included. MBIs showed significant improvements in the event-related potential amplitudes in attention-deficit hyperactivity disorder, the methylation of serotonin transporter genes in post-traumatic stress disorder, the salivary levels of interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) in depression, and the blood levels of adrenocorticotropic hormone (ACTH), IL-6, and TNF-α in generalised anxiety disorder. MBIs showed low but significant effects on health status related to biomarkers of low-grade inflammation (g = -0.21; 95% confidence interval (CI) -0.41 to -0.01; NNT = 8.47), with no heterogeneity (I2 = 0; 95% CI 0 to 79). More trials are needed to establish the impact of MBIs on biomarkers in psychiatric illness.
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80
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Ahmad F, El Morr C, Ritvo P, Othman N, Moineddin R. An Eight-Week, Web-Based Mindfulness Virtual Community Intervention for Students' Mental Health: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e15520. [PMID: 32074061 PMCID: PMC7055779 DOI: 10.2196/15520] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/08/2019] [Accepted: 12/16/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Innovative interventions are needed to address the increasing mental health needs of university students. Given the demonstrated anxiolytic and antidepressant benefits of mindfulness training, we developed an 8-week, Web-based Mindfulness Virtual Community (MVC) intervention informed by cognitive behavioral therapy (CBT) constructs. OBJECTIVE This study investigated the efficacy of the MVC intervention in reducing symptoms of depression, anxiety, and stress among undergraduate students in Toronto, Canada. The secondary outcomes included quality of life, life satisfaction, and mindfulness. METHODS The first 4 weeks of the full MVC intervention (F-MVC) comprised: (1) 12 video-based modules with psycho-education on students' preidentified stressful topics and topically applied mindfulness practice; (2) anonymous peer-to-peer discussion forums; and (3) anonymous, group-based, professionally guided, 20-min live videoconferences. The second 4 weeks of F-MVC involved access only to video-based modules. The 8-week partial MVC (P-MVC) comprised 12 video-based modules. A randomized controlled trial was conducted with 4 parallel arms: F-MVC, P-MVC, waitlist control (WLC), and group-based face-to-face CBT; results for the latter group are presented elsewhere. Students recruited through multiple strategies consented and were randomized: WLC=40; F-MVC=40, P-MVC=39; all learned about allocation after consenting. The online surveys at baseline (T1), 4 weeks (T2), and 8 weeks (T3) included the Patient Health Questionnaire-9 item, Beck Anxiety Inventory, Perceived Stress Scale, Quality of Life Scale, Brief Multi-Dimensional Students Life Satisfaction Scale, and Five-Facet Mindfulness Questionnaire. Analyses employed generalized estimation equation methods with AR(1) covariance structures and were adjusted for possible confounders (gender, age, birth country, paid work, unpaid work, physical activities, self-rated health, and mental health counseling access). RESULTS Of the 113 students who provided T1 data, 28 were males and 85 were females with a mean age of 24.8 years. Participants in F-MVC (n=39), P-MVC (n=35), and WLC (n=39) groups were similar in sociodemographic characteristics at T1. At T3 follow-up, per adjusted comparisons, there were statistically significant reductions in depression scores for F-MVC (score change -4.03; P<.001) and P-MVC (score change -4.82; P<.001) when compared with WLC. At T3, there was a statistically significant reduction in anxiety scores only for P-MVC (score change -7.35; P=.01) when compared with WLC. There was a statistically significant reduction in scores for perceived stress for both F-MVC (score change -5.32; P<.001) and P-MVC (score change -5.61; P=.005) compared with WLC. There were statistically significant changes at T3 for quality of life and mindfulness for F-MVC and P-MVC vs WLC but not for life satisfaction. CONCLUSIONS Internet-based mindfulness CBT-based interventions, such as F-MVC and P-MVC, can result in significant reductions in symptoms of depression, anxiety, and stress in a student population. Future research with a larger sample from multiple universities would more precisely test generalizability. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number ISRCTN92827275; https://www.isrctn.com/ISRCTN92827275.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Christo El Morr
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Paul Ritvo
- Kinesiology & Health Science, York University, Toronto, ON, Canada
| | - Nasih Othman
- School of Health Policy and Management, York University, Toronto, ON, Canada
| | - Rahim Moineddin
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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- See Authors' Contributions,
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81
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Aguilar-Raab C. Mindfulness- and Compassion-Based Interventions in Relational Contexts. SYSTEMIC RESEARCH IN INDIVIDUAL, COUPLE, AND FAMILY THERAPY AND COUNSELING 2020. [DOI: 10.1007/978-3-030-36560-8_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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82
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Trkulja V, Barić H. Current Research on Complementary and Alternative Medicine (CAM) in the Treatment of Anxiety Disorders: An Evidence-Based Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:415-449. [PMID: 32002940 DOI: 10.1007/978-981-32-9705-0_22] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complementary and alternative medicine (CAM) encompasses a wide range of different nonmainstream therapies that have been increasingly used for treatment or adjunctive treatment of various ailments with anxiety/anxiety disorders being one of the commonly CAM (self)-medicated conditions. Thousands of published papers refer to use of CAM in various psychiatric disorders or in healthy or medically ill patients with mood or anxiety difficulties. In this chapter we focus specifically on clinically diagnosed (in line with the standard criteria) anxiety disorders and overview evidence of efficacy/safety of a range of CAM modalities: biologically based therapies (typically herbal preparations and less so nutraceuticals); manipulative and body-based therapies (acupuncture, aerobic exercise, massage, therapeutic touch, repetitive transcranial magnetic stimulation, balneotherapy, and others); mind-body therapies (yoga, Morita therapy, Tai Chi, reiki, Chinese cognitive therapy, religious and spiritual interventions, relaxation, mediation, and mindfulness-based interventions); and alternative medical systems (Ayurveda, homeopathy). We focus exclusively on randomized controlled trials and attempt to evaluate the existing body of evidence in the same manner that is applied to mainstream treatments.
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Affiliation(s)
- Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia.
| | - Hrvoje Barić
- Department of Neurosurgery, University Hospital Center Zagreb, Zagreb, Croatia
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83
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Apolinário-Hagen J, Drüge M, Fritsche L. Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:291-329. [DOI: 10.1007/978-981-32-9705-0_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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84
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Asensio-Martínez Á, Oliván-Blázquez B, Montero-Marín J, Masluk B, Fueyo-Díaz R, Gascón-Santos S, Gudé F, Gónzalez-Quintela A, García-Campayo J, Magallón-Botaya R. Relation of the Psychological Constructs of Resilience, Mindfulness, and Self-Compassion on the Perception of Physical and Mental Health. Psychol Res Behav Manag 2019; 12:1155-1166. [PMID: 31920412 PMCID: PMC6939394 DOI: 10.2147/prbm.s225169] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/13/2019] [Indexed: 12/17/2022] Open
Abstract
Purpose Health factors that enhance an individual’s ability to perceive and maintain health and well-being are referred to as “health assets”. Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population. Patients and methods A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables. Results The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense. Conclusion The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.
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Affiliation(s)
- Ángela Asensio-Martínez
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Bárbara Oliván-Blázquez
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Jesús Montero-Marín
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain
| | - Bárbara Masluk
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Ricardo Fueyo-Díaz
- Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Santiago Gascón-Santos
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Psychology and Sociology, University of Zaragoza, Zaragoza 50005, Spain
| | - Francisco Gudé
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Clinical Epidemiology Unit, Santiago de Compostela Hospital, Santiago de Compostela 15706, Spain
| | - Arturo Gónzalez-Quintela
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Departamento de Medicina Interna, Santiago de Compostela Hospital, Santiago de Compostela 15706, Spain
| | - Javier García-Campayo
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza 50009, Spain
| | - Rosa Magallón-Botaya
- Research Network on Preventive Activities and Health Promotion (RedIAPP), Zaragoza 50009, Spain.,Health Research Institute of Aragon, Zaragoza 50009, Spain.,Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza 50009, Spain
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Kang D, Fairbairn CE, Ariss TA. A meta-analysis of the effect of substance use interventions on emotion outcomes. J Consult Clin Psychol 2019; 87:1106-1123. [PMID: 31724427 PMCID: PMC6859954 DOI: 10.1037/ccp0000450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Emotional distress has been posited as a key underlying mechanism in the development and maintenance of substance use disorder (SUD), and patients seeking SUD treatment are often experiencing high levels of negative emotion and/or low levels of positive emotion. But the extent to which SUD interventions impact emotional outcomes among general SUD populations is yet unquantified. The current meta-analysis aims to fill this gap. METHOD A total of 11,754 records were screened for randomized, controlled trials examining the effect of behavioral SUD interventions on emotion outcomes. Our search yielded a total of 138 effect sizes calculated based on data from 5,146 individuals enrolled in 30 independent clinical trials. Random-effects meta-analysis was used to calculate pooled effect sizes, and metaregression analyses examined study-level moderators (e.g., intervention type). RESULTS Findings indicated a small but significant effect of SUD interventions on emotion outcomes, d = 0.157, 95% CI [0.052, 0.262] (k = 30). The effect size for negative emotion was nominally bigger, d = 0.162, 95% CI [0.056, 0.269] (k = 30), whereas the effect for positive emotion did not reach statistical significance, d = 0.062, 95% CI [-0.089, 0.213] (k = 7). Studies featuring SUD interventions designed to specifically target emotions (i.e., affect-regulation, mindfulness-based treatments) produced larger reductions in negative emotion compared with studies featuring interventions that did not contain specific emotion modules (e.g., contingency management). CONCLUSIONS Findings suggest that SUD interventions-especially mindfulness-based and affect-regulation treatments-indeed significantly reduce negative emotion, although relatively small effect sizes indicate potential room for improvement. Conclusions regarding positive emotion should be considered preliminary because of the limited numbers of samples assessing these outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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El Morr C, Maule C, Ashfaq I, Ritvo P, Ahmad F. Design of a Mindfulness Virtual Community: A focus-group analysis. Health Informatics J 2019; 26:1560-1576. [PMID: 31709878 DOI: 10.1177/1460458219884840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mental illnesses are on the rise on campuses worldwide. There is a need for a scalable and economically sound innovation to address these mental health challenges. The aim of this study was to explore university students' needs and concerns in relation to an online mental health virtual community. Eight focus groups (N = 72, 55.6% female) were conducted with university students aged 18-47 (mean = 23.38, SD = 5.82) years. Participants were asked about their views in relation to online mental health platform. Three major themes and subthemes emerged: (1) perceived concerns: potential loss of personal encounter and relationships, fear of cyber bullying, engagement challenge, and privacy and distraction; (2) perceived advantages: anonymity and privacy, convenience and flexibility, filling a gap, and togetherness; and (3) desired features: user-centered design, practical trustworthy support, and online moderation. The analysis informed design features for a mindfulness virtual community.
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Mehrsafar AH, Strahler J, Gazerani P, Khabiri M, Sánchez JCJ, Moosakhani A, Zadeh AM. The effects of mindfulness training on competition-induced anxiety and salivary stress markers in elite Wushu athletes: A pilot study. Physiol Behav 2019; 210:112655. [PMID: 31437476 DOI: 10.1016/j.physbeh.2019.112655] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Due to the impact of stress and related psychophysiological responses on competitive performance, psychological interventions that reduce stress and may thus increase athletic performance need to be evaluated. In this pilot study, the effects of a mindfulness-based intervention (MBI) on competitive anxiety, self-confidence and mindfulness, and autonomic and endocrine stress responses to a competition in elite athletes were explored. METHODS Twenty-six male elite Wushu athletes (N = 26) were randomly assigned to either MBI (8 weeks) or a wait-list control group. Both groups participated in three competitions at baseline, immediately post intervention, and at a 2-month follow-up. Athletes completed the Competitive State Anxiety Inventory-2 prior to the competitions. Saliva, from which the stress markers cortisol (sCort) and alpha-amylase (sAA) were determined, was collected prior to and after competitions as well as after awakening and in the evening of competition days. RESULTS Repeated measures ANOVAs showed that the MBI group, but not the wait-list control group, demonstrated an increase in self-confidence and mindfulness and a decrease in competitive anxiety from baseline to post intervention (all p < .001, all ɳp2 > 0.39). The MBI group exhibited lower sCort daily levels (p = .001, ɳp2 = 0.332) and lower sCort (p = .013, ɳp2 = 0.121) and sAA responses (p = .022, ɳp2 = 0.119) to the competition after the intervention. Daily sAA was unaffected by the intervention (p = .742, ɳp2 = 0.011). These changes remained stable up to the 2-month follow-up. CONCLUSIONS The present pilot study suggested that mindfulness-based intervention might be associated with a diminished physiological and psychological stress responses to competition. Whether this in turn translates to change in performance needs to be examined in future studies with larger samples. Moreover, different sport activities need to be considered before findings can be generalized.
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Affiliation(s)
- Amir Hossien Mehrsafar
- Department of Sport Psychology, Faculty of Sports Sciences, University of Tehran, Tehran, Iran.
| | - Jana Strahler
- Department of Psychotherapy and Systems Neuroscience, Faculty of Psychology and Sport Science, University of Giessen, Giessen, Germany.
| | - Parisa Gazerani
- Department of Health Science and Technology, School of Medicine and Health, Aalborg University, Aalborg, Denmark.
| | - Mohammad Khabiri
- Department of Sport Psychology, Faculty of Sports Sciences, University of Tehran, Tehran, Iran.
| | - José Carlos Jaenes Sánchez
- Department of Social Anthropology, Basic Psychology and Health, Universidad Pablo de Olavide, Seville, Spain.
| | - Alireza Moosakhani
- Department of Exercise Physiology, Faculty of Sports Sciences, University of Tehran, Tehran, Iran.
| | - Ali Moghadam Zadeh
- Department of Psychology, Faculty of Psychology and Education, University of Tehran, Tehran, Iran.
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88
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Adult colouring: the effect of app-based
vs. pen-and-paper colouring on mindfulness
and anxiety. HEALTH PSYCHOLOGY REPORT 2019. [DOI: 10.5114/hpr.2019.87312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BackgroundThe rise in popularity of “mindfulness colouring books” has led to the development of colouring applications as an alternative to the traditional pen-and-paper versions. There have been no investigations exploring these applications in regards to mindfulness.Participants and procedureIn two randomised experiments, this study examined whether there were any differences in state mindfulness and anxiety between (a) paper-and-pen and a colouring application (i.e., Experiment 1; n = 100), and (b) two different methods of colouring within an application (i.e., tapping or swiping; i.e., Experiment 1; n = 100).ResultsExperiments 1 and 2 showed a significant decrease in anxiety symptoms following a single colouring session, irrespective of different conditions. Also, Experiment 1, but not Experiment 2, revealed that colouring through the application significantly aided the increase in mindfulness.ConclusionsApp-based colouring may be a contemporary time- and cost-effective intervention in reducing anxiety. However, the non-significant increase in mindfulness appears challenging when attempting to justify the results. The effectiveness of colouring apart from mindfulness is seen through potential constructs such as flow, and display a limitation that requires further reflections on guidance to enhance mindfulness through colouring. Future directions are discussed.
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89
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Sundquist J, Palmér K, Memon AA, Wang X, Johansson LM, Sundquist K. Long-term improvements after mindfulness-based group therapy of depression, anxiety and stress and adjustment disorders: A randomized controlled trial. Early Interv Psychiatry 2019; 13:943-952. [PMID: 29968371 DOI: 10.1111/eip.12715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although mindfulness-based group therapies (MGTs) for depressive, anxiety or stress and adjustment disorders are promising, there is a substantial lack of knowledge regarding the long-term improvements after such therapies in these common psychiatric disorders. METHODS Two hundred and fifteen patients were randomized in a randomized clinical trial (RCT) (ClinicalTrials.gov ID: NCT01476371) conducted in 2012 at 16 primary healthcare centres in southern Sweden. The patients were randomized to MGT or treatment as usual (TAU) and completed four psychometric self-rated scales after 8 weeks of treatment. Approximately 12 months after the completion of the 8-week treatment, the same scales were repeated. Ordinal and generalized linear-mixed models, adjusted for cluster effects, were used for the analysis. RESULTS For all four psychometric scales (MADRS-S [Montgomery-Åsberg Depression Rating Scale-S], HADS-D, HADS-A [Hospital Anxiety and Depression Scale A and D] and PHQ-9 [Patient Health Questionnaire-9]) the scores at the 1-year follow-up were significantly improved (all P values <0.001) in both groups. Furthermore, there were no significant differences between the MGT and TAU in the psychometric scores at the 1-year follow-up. CONCLUSIONS To the best of our knowledge, this is the first RCT comparing the long-term improvements after MGT with TAU. Although it cannot be excluded that our findings are a result of the natural course of common psychiatric disorders or other factors, they suggest a long-term positive improvement after both MGT and TAU.
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Affiliation(s)
- Jan Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Karolina Palmér
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Ashfaque A Memon
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Xiao Wang
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Leena M Johansson
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Clinical Research Centre (CRC), Malmö, Sweden
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90
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The effects of cognitive behavioral and mindfulness-based therapies on psychological distress in patients with multiple sclerosis, Parkinson's disease and Huntington's disease: Two meta-analyses. J Psychosom Res 2019; 122:43-51. [PMID: 31126411 DOI: 10.1016/j.jpsychores.2019.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Psychological distress has a high impact on quality of life in patients with multiple sclerosis (MS), Parkinson's disease (PD), and Huntington's disease (HD). Studies have shown that cognitive behavioral therapy (CBT) and mindfulness-based therapies (MBTs) are successful in reducing psychological distress in patients with anxiety, depressive, and chronic somatic disorders. We aimed to investigate the effectiveness of these therapies in MS, PD, and HD patients. METHODS We performed a comprehensive literature search in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials up to March 2018. Randomized controlled trials (RCTs) investigating a CBT or MBT and reporting psychological outcome measures were included. Two separate meta-analyses were performed; one on studies comparing psychological therapy with a treatment as usual or waitlist condition and one on studies with active treatment control conditions. RESULTS The first meta-analysis (N = 12 studies, 8 in MS and 4 in PD populations) showed a significant effect size of g = 0.51 in reducing psychological distress. The second meta-analysis (N = 7 studies, in MS populations) showed a mean effect size of g = 0.36. No RCTs were found in HD populations. The overall quality of the included studies was low and considerable heterogeneity was found. No evidence was found for publication bias. CONCLUSION CBT and MBTs have a small to moderate effect on reducing psychological distress in patients with PD and MS. However, more research with better methodological quality and larger study samples is warranted, especially in HD patient populations.
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91
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Acceptance- and Mindfulness-Based Interventions for Health Behavior Change: Systematic Reviews and Meta-Analyses. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019; 13:74-93. [PMID: 32832377 DOI: 10.1016/j.jcbs.2019.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Behavioral health issues such as smoking and overweight are risk factors for a variety of adverse health outcomes, including mortality. Over the past decade, a growing number of randomized controlled trials have examined the efficacy of acceptance- and mindfulness-based interventions for smoking cessation and weight loss. The purpose of the current meta-analytic reviews was to quantitatively synthesize the existing literature comparing these interventions to controls for a) smoking cessation and b) weight loss outcomes. Searches identified 17 smoking cessation studies and 31 weight loss studies eligible for inclusion. Meta-analytic results indicated a non-significant effect favoring acceptance- and mindfulness-based interventions over controls for smoking cessation (OR = 1.13) and a small, significant effect favoring these interventions over controls for weight loss outcomes (Hedge's g = 0.30). Statistical heterogeneity and risk of bias were assessed. Subgroup and meta-regression analyses were conducted to examine moderating variables (e.g., sample and intervention characteristics). The findings indicated that acceptance- and mindfulness-based interventions were at least as efficacious as active control conditions. Given the significant health risks associated with smoking and overweight, these findings have important clinical and public health implications. Limitations (e.g., relative infancy of the literature; lack of diversity in sample demographics) and future directions (e.g., further exploration of mediators and moderators of change) are discussed.
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Burgdorf V, Szabó M, Abbott MJ. The Effect of Mindfulness Interventions for Parents on Parenting Stress and Youth Psychological Outcomes: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:1336. [PMID: 31244732 PMCID: PMC6562566 DOI: 10.3389/fpsyg.2019.01336] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The psychological well-being of parents and children is compromised in families characterized by greater parenting stress. As parental mindfulness is associated with lower parenting stress, a growing number of studies have investigated whether mindfulness interventions can improve outcomes for families. This systematic review and meta-analysis evaluates the effectiveness of mindfulness interventions for parents, in reducing parenting stress and improving youth psychological outcomes. Methods: A literature search for peer-reviewed articles and dissertations was conducted in accordance with PRISMA guidelines in the PsycInfo, Medline, PubMed, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses databases. Studies were included if they reported on a mindfulness-based intervention delivered in person to parents with the primary aim of reducing parenting stress or improving youth psychological outcomes. Results: Twenty-five independent studies were included in the review. Eighteen studies used a single group design and six were randomized controlled trials. Within-groups, meta-analysis indicated a small, post-intervention reduction in parenting stress (g = 0.34), growing to a moderate reduction at 2 month follow-up (g = 0.53). Overall, there was a small improvement in youth outcomes (g = 0.27). Neither youth age or clinical status, nor time in mindfulness training, moderated parenting stress or overall youth outcome effects. Youth outcomes were not moderated by intervention group attendees. Change in parenting stress predicted change in youth externalizing and cognitive effects, but not internalizing effects. In controlled studies, parenting stress reduced more in mindfulness groups than control groups (g = 0.44). Overall, risk of bias was assessed as serious. Conclusions: Mindfulness interventions for parents may reduce parenting stress and improve youth psychological functioning. While improvements in youth externalizing and cognitive outcomes may be explained by reductions in parenting stress, it appears that other parenting factors may contribute to improvements in youth internalizing outcomes. Methodological weaknesses in the reviewed literature prevent firm conclusions from being drawn regarding effectiveness. Future research should address these methodological issues before mindfulness interventions for parents are recommended as an effective treatment option for parents or their children.
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Affiliation(s)
- Virginia Burgdorf
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
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93
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Duarte R, Lloyd A, Kotas E, Andronis L, White R. Are acceptance and mindfulness-based interventions 'value for money'? Evidence from a systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 58:187-210. [PMID: 30499217 PMCID: PMC6588093 DOI: 10.1111/bjc.12208] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/26/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Acceptance and mindfulness-based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions. METHODS Eight electronic bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines. RESULTS Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost-effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost-effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made. CONCLUSION This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost-effectiveness of A/MBIs for mental health conditions. PRACTITIONER POINTS The findings of the review provide information that may be relevant to mental health service commissioners and decision-makers as all economic evidence available on acceptance and mindfulness-based interventions for mental health conditions is summarized. Evidence relating to the cost-effectiveness and cost-saving potential of acceptance and mindfulness-based interventions is focused mainly on depression and emotional unstable personality disorder to date. Heterogeneity in the specific forms of acceptance and mindfulness-based interventions may limit generalizability of the findings. The number of health economic evaluations relating to acceptance and mindfulness-based interventions remains relatively small. Further research in this area is required.
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Affiliation(s)
- Rui Duarte
- Liverpool Reviews and Implementation GroupUniversity of LiverpoolUK
| | | | - Eleanor Kotas
- Liverpool Reviews and Implementation GroupUniversity of LiverpoolUK
| | - Lazaros Andronis
- Populations, Evidence and Technologies GroupDivision of Health SciencesUniversity of WarwickCoventryUK
- Division of Clinical TrialsUniversity of WarwickCoventryUK
| | - Ross White
- School of PsychologyUniversity of LiverpoolUK
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Mathersul DC, Tang JS, Schulz-Heik RJ, Avery TJ, Seppälä EM, Bayley PJ. Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans. BMJ Open 2019; 9:e027150. [PMID: 30948610 PMCID: PMC6500221 DOI: 10.1136/bmjopen-2018-027150] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a debilitating, highly prevalent condition. Current clinical practice guidelines recommend trauma-focused psychotherapy (eg, cognitive processing therapy; CPT) as the first-line treatment for PTSD. However, while these treatments show clinically meaningful symptom improvement, the majority of those who begin treatment retain a diagnosis of PTSD post-treatment. Perhaps for this reason, many individuals with PTSD have sought more holistic, mind-body, complementary and integrative health (CIH) interventions. However, there remains a paucity of high-quality, active controlled efficacy studies of CIH interventions for PTSD, which precludes their formal recommendation. METHODS AND ANALYSES We present the protocol for an ongoing non-inferiority parallel group randomised controlled trial (RCT) comparing the efficacy of a breathing meditation intervention (Sudarshan Kriya Yoga [SKY]) to a recommended evidence-based psychotherapy (CPT) for PTSD among veterans. Assessors are blinded to treatment group. The primary outcome measure is the PTSD Checklist-Civilian Version and a combination of clinical, self-report, experimental and physiological outcome measures assess treatment-related changes across each of the four PTSD symptom clusters (re-experiencing, avoidance, negative cognitions or mood and hyperarousal/reactivity). Once the RCT is completed, analyses will use both an intent-to-treat (using the 'last observation carried forward' for missing data) and a per-protocol or 'treatment completers' procedure, which is the most rigorous approach to non-inferiority designs. ETHICS AND DISSEMINATION To the best of our knowledge, this is this first non-inferiority RCT of SKY versus CPT for PTSD among veterans. The protocol is approved by the Stanford University Institutional Review Board. All participants provided written informed consent prior to participation. Results from this RCT will inform future studies including larger multi-site efficacy RCTs of SKY for PTSD and other mental health conditions, as well as exploration of cost-effectiveness and evaluation of implementation issues. Results will also inform evidence-based formal recommendations regarding CIH interventions for PTSD. TRIAL REGISTRATION NUMBER NCT02366403; Pre-results.
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Affiliation(s)
- Danielle C Mathersul
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Julia S Tang
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Timothy J Avery
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Emma M Seppälä
- Center for Compassion and Altruism Research and Education, Stanford University School of Medicine, Stanford, California, USA
- Yale Center for Emotional Intelligence, Yale University, New Haven, Connecticut, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
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Tubbs JD, Savage JE, Adkins AE, Amstadter AB, Dick DM. Mindfulness moderates the relation between trauma and anxiety symptoms in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:235-245. [PMID: 29979916 PMCID: PMC6330246 DOI: 10.1080/07448481.2018.1477782] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/02/2018] [Accepted: 05/09/2018] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To explore the relations between trauma exposure and anxiety and depression among college students, and to determine whether trait mindfulness may moderate these relations. PARTICIPANTS Self-report survey data from 2,336 college sophomores were drawn from a larger university-wide study ("Spit for Science"). METHODS We constructed multiple linear regression models using past-year trauma exposure, trait mindfulness, and their multiplicative interaction to predict current anxiety and depressive symptom severity, while controlling for covariates. RESULTS Mindfulness was associated with lower levels of depression and anxiety symptom severity. Trauma was a significant predictor of anxiety, but not depression, and high levels of mindfulness attenuated the association between trauma exposure and higher anxiety symptom severity. CONCLUSIONS These results have implications for the treatment and prevention of anxiety among trauma-exposed college students and provide a basis for further research into the mechanisms through which mindfulness may facilitate positive mental health.
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Affiliation(s)
- Justin D. Tubbs
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- Department of Biology, Virginia Commonwealth University, Richmond, Virginia
| | - Jeanne E. Savage
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Amy E. Adkins
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- College Behavioral and Emotional Health Institute, Virginia Commonwealth University, Richmond, Virginia
| | - Ananda B. Amstadter
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle M. Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
- College Behavioral and Emotional Health Institute, Virginia Commonwealth University, Richmond, Virginia
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Emotion Regulation Intensive Outpatient Programming: Development, Feasibility, and Acceptability. J Autism Dev Disord 2019; 49:495-508. [PMID: 30143951 DOI: 10.1007/s10803-018-3727-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Individuals with Autism Spectrum Disorder (ASD) and/or intellectual and developmental disabilities (DD) often struggle with behavior management and emotion-regulation (ER). In this manuscript, we describe the results of a chart review examining a group treatment program designed to address ER deficits in youth with ASD and/or DD. The intensive 5 week program utilizes cognitive behavior, applied behavior analysis, and mindfulness techniques and includes biweekly child and parent groups. Results indicate that this program is feasible and associated with high caregiver satisfaction. Pre-and-post outcome results indicate statistically significant improvement on behavioral measures, but did not demonstrate significant improvment on the Pediatric Quality of Life Family Impact Module. Based on overall positive outcomes, a randomized controlled trial of the program is indicated.
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97
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Carpena MX, Tavares PDS, Menezes CB. The effect of a six-week focused meditation training on depression and anxiety symptoms in Brazilian university students with 6 and 12 months of follow-up. J Affect Disord 2019; 246:401-407. [PMID: 30597302 DOI: 10.1016/j.jad.2018.12.126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/15/2018] [Accepted: 12/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Evidence shows high prevalence of depression and anxiety symptoms among university students. This study investigated whether a meditation-based program would help reducing these symptoms in this population. METHODS Non-randomized controlled trial investigating the effects of a six-week focused meditation training on depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) outcomes among university students. Participants were allocated into a meditation or waiting list control group. Assessment occurred pre and post intervention and only for the meditation group at 6 and 12 months follow-up. General linear model for repeated measures evaluated the intervention effect considering group and time factors, controlling for minor psychiatric disorders, gender and absence at meetings. RESULTS The meditation group presented a reduction in depression and anxiety symptoms after intervention compared to controls. Among the meditation group, depression (at 6 months follow-up) and anxiety (at 6 and 12 months follow-up) scores were lower for those who continued practicing. LIMITATIONS Non-randomization and absence of daily practice record (precluding dose-response gradient evaluation). CONCLUSION The meditation training was effective in reducing depression and anxiety symptoms, but the maintanance of these reductions only occurred for those who continued meditating. Permanent meditation programs may be an alternative for promoting mental health for university students.
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Affiliation(s)
- Marina Xavier Carpena
- Post Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil.
| | - Patrice de Souza Tavares
- Post Graduate Program in Epidemiology, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Carolina Baptista Menezes
- Post Graduate Program in Psychology, Universidade Federal de Santa Catarina, Florianopolis, Santa Catarina, Brazil
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Didonna F, Rossi R, Ferrari C, Iani L, Pedrini L, Rossi N, Xodo E, Lanfredi M. Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder. Psychol Psychother 2019; 92:112-130. [PMID: 29575447 DOI: 10.1111/papt.12180] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/26/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore differences in mindfulness facets among patients with a diagnosis of either obsessive-compulsive disorder (OCD), major depressive disorder (MDD), or borderline personality disorder (BPD), and healthy controls (HC), and their associations with clinical features. DESIGN AND METHOD One hundred and fifty-three patients and 50 HC underwent a clinical assessment including measures of mindfulness (Five Facets Mindfulness Questionnaire - FFMQ), psychopathological symptoms (Symptom Check List-90-R), dissociation (Dissociative Experience Scale), alexithymia (Alexithymia Scale 20), and depression (Beck Depression Inventory-II). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) were performed to assess differences in mindfulness scores and their associations with clinical features. RESULTS The three diagnostic groups scored lower on all mindfulness facets (apart from FFMQobserving) compared to the HC group. OCD group had a significant higher FFMQ total score (FFMQ-TS) and FFMQacting with awareness compared to the BPD group, and scored higher on FFMQdescribing compared to BPD and MDD groups. The scores in non-judging facet were significantly lower in all the three diagnostic groups compared to the HC group. Interestingly, higher FFMQ-TS was inversely related to all psychological measures, regardless of diagnostic group. CONCLUSIONS Deficits in mindfulness skills were present in all diagnostic groups. Furthermore, we found disease-specific relationships between some mindfulness facets and specific psychological variables. Clinical implications are discussed. PRACTITIONER POINTS The study showed deficits in mindfulness scores in all diagnostic groups compared to a healthy control group. Overall, mindfulness construct has a significantly negative association with indexes of global distress, dissociative symptoms, alexithymia, and depression. Mindfulness-based interventions in clinical settings should take into account different patterns of mindfulness skills and their impact on disease-specific maladaptive cognitive strategies or symptomatology.
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Affiliation(s)
- Fabrizio Didonna
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy.,Italian Institute for Mindfulness, Vicenza, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luca Iani
- Department of Human Sciences, European University of Rome, Italy
| | - Laura Pedrini
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicoletta Rossi
- Unit for OCD, Department of Psychiatry, Villa Margherita Private Hospital, Vicenza, Italy
| | - Erica Xodo
- Italian Institute for Mindfulness, Vicenza, Italy
| | - Mariangela Lanfredi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Galhardo A, Cunha M, Pinto-Gouveia J. A 7-year follow-up study of the Mindfulness-Based Program for Infertility: Are there long-term effects? Clin Psychol Psychother 2019; 26:409-417. [PMID: 30812065 DOI: 10.1002/cpp.2362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 11/06/2022]
Abstract
The Mindfulness-Based Program for Infertility (MBPI) was developed for people facing infertility and proved effective in cultivating mindfulness skills, improving infertility self-efficacy, and decreasing depression, shame, entrapment, and defeat feelings. Fifty-five women attended the MBPI sessions and completed self-report measures of depression, anxiety, mindfulness, and experiential avoidance at post-MBPI (T1), 6-month follow-up (T2), and 7-year follow-up (T3). There were significant direct time effects regarding experiential avoidance (F = 3.81; p < 0.033; ηp 2 = 0.08), the mindfulness facets describing (F = 3.54; p = 0.037; ηp 2 = 0.13), acting with awareness (F = 6.87; p = 0.002; ηp 2 = 0.22), nonjudging of inner experience (F = 10.66; p < 0.001; ηp 2 = 0.31), and depressive symptoms (F = 4.85; p = 0.020; ηp 2 = 0.10). There was an increase in the describing facet from T1 to T3 (p = 0.036). The act with awareness facet increased from T1 to T2 (p = 0.010) and from T1 to T3 (p = 0.007), as well as the nonjudging of inner experience facet (T1 to T2 [p = 0.030] and T1 to T3 [p = 0.002]). Experiential avoidance decreased from T1 to T3 (p = 0.022) and depressive symptoms from T1 to T2 (p = 0.019). Post-MBPI scores were maintained at T2 and T3 concerning anxiety symptoms and the observing and no-reactivity mindfulness facets. There were long-term effects of MBPI on mindfulness and experiential avoidance. Moreover, therapeutic gains were maintained regarding depression and anxiety symptoms, independently of the reproductive outcome.
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Affiliation(s)
- Ana Galhardo
- Department of Psychology, Instituto Superior Miguel Torga, Coimbra, Portugal.,CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- Department of Psychology, Instituto Superior Miguel Torga, Coimbra, Portugal.,CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - José Pinto-Gouveia
- CINEICC - Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Nguyen MC, Gabbe SG, Kemper KJ, Mahan JD, Cheavens JS, Moffatt-Bruce SD. Training on mind-body skills: Feasibility and effects on physician mindfulness, compassion, and associated effects on stress, burnout, and clinical outcomes. JOURNAL OF POSITIVE PSYCHOLOGY 2019. [DOI: 10.1080/17439760.2019.1578892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Michelle C. Nguyen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven G. Gabbe
- Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center
| | - Kathi J. Kemper
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D. Mahan
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Susan D. Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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