1
|
Sharp M, Ward LG, Pomerantz M, Bourjeily G, Guthrie KM, Salmoirago-Blotcher E, Desmarattes A, Bublitz MH. Prenatal Mindfulness Training and Interoceptive Awareness in Pregnant People at Risk for Hypertensive Disorders. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 38976481 DOI: 10.1089/jicm.2024.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Aim: In this secondary analysis of a pilot randomized controlled trial (RCT), we sought to examine whether mindfulness training (MT) is associated with change in interoceptive awareness in pregnant people at risk for hypertension using quantitative and qualitative methods. Interoceptive awareness is the perception, regulation, and integration of bodily sensations. Interoceptive awareness increases following MT and has been proposed as a psychosomatic process underlying hypertension outside of pregnancy. Methods: Twenty-nine participants (mean age 32 ± 4 years; 67% White) with a history of hypertensive disorders of pregnancy (HDP) were enrolled at 16 weeks' gestation (SD = 3) for a RCT assessing the feasibility and acceptability of an 8-week phone-delivered MT intervention. Fifteen participants were randomized to MT, whereas 14 were randomized to usual prenatal care. Before and after the intervention, all participants completed the Multidimensional Assessment of Interoceptive Awareness (MAIA) measure and participated an individual interview, which queried for mind-body changes noticed across the study period. Results: Adjusting for baseline interoceptive awareness and gestational age, participants randomized to MT reported less worry about physical sensations on the MAIA after the intervention compared to those randomized to usual care. Qualitative data corroborated these results; MT participants described improved awareness of body and breath sensations, ability to notice blood pressure changes, non-judgmental observation of thoughts, and improved responses to interpersonal challenges. Conclusions: MT may improve the ability to notice body sensations that arise in pregnancy in a way that promotes healthy responding rather than worry. Results provide support for interoceptive awareness as a potential mechanism through which mindfulness may modulate blood pressure and potentially reduce the prevalence of HDP. Clinical Trial Registration: ClinicalTrials.gov (NCT03679117).
Collapse
Affiliation(s)
- Meghan Sharp
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - L G Ward
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Madison Pomerantz
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ghada Bourjeily
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, USA
| | - Elena Salmoirago-Blotcher
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Lifespan Cardiovascular Institute, The Miriam Hospital, Providence, Rhode Island, USA
| | - Amanda Desmarattes
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
| | - Margaret H Bublitz
- Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| |
Collapse
|
2
|
Huynh T, Kerr ML, Kim CN, Fourianalistyawati E, Chang VYR, Duncan LG. Parental Reflective Capacities: A Scoping Review of Mindful Parenting and Parental Reflective Functioning. Mindfulness (N Y) 2024; 15:1531-1602. [PMID: 39328292 PMCID: PMC11426413 DOI: 10.1007/s12671-024-02379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 09/28/2024]
Abstract
Objectives Two key parental reflective capacities-mindful parenting (MP) and parental reflective functioning (PRF) - have been shown to promote healthy parent-child relationships through parents' increased sensitivity and responsiveness to their children's needs in spite of parenting stressors. Despite the theoretical overlap between these two constructs, researchers have continued to examine them independently. Therefore, the purpose of this scoping review was to review the overlapping and distinctive outcomes and correlates in the empirical MP and PRF literatures. Method A comprehensive literature search across the MP and PRF literature for studies published from 2005 through early 2020 (pre-COVID-19 pandemic) was conducted. Results A review of 301 articles (n = 180 MP and n = 121 PRF) revealed overlapping study outcomes and correlates, including improvement in parent and child well-being, parenting behaviors, and attachment. Both MP and PRF literatures suggest MP and PRF are amenable to intervention-induced changes, although mostly documented in White mothers, which results may not be generalizable to diverse populations. Conclusions Researchers should consider the impact MP and PRF have on positive family relationships. Results suggest that scholars should consider investigating and intervening on MP and PRF simultaneously. Specifically, results identified MP and PRF convergent associations and perhaps synergistic impacts on positive parenting behaviors. Limitations and future directions are discussed. Preregistration This review was not preregistered.
Collapse
Affiliation(s)
- Tuyen Huynh
- Department of Psychology, University of South Carolina, Barnwell College Room 517, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Margaret L Kerr
- Human Development and Family Studies, University of Wisconsin-Madison, 4109 Nancy Nicholas Hall, 1300 Linden Drive, Madison, Wisconsin 53706, USA
| | - Christina N Kim
- Department of Population Health, NYU Grossman School of Medicine, New York, USA
| | - Endang Fourianalistyawati
- Faculty of Psychology, Universitas YARSI, Menara YARSI, Kav. 13, Jl. Letjend. Suprapto. Cempaka Putih, Jakarta Pusat, DKI, Jakarta 10510, Indonesia
| | | | - Larissa G Duncan
- Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, Wisconsin 53706, USA
| |
Collapse
|
3
|
Lengua LJ, Thompson SF, Calhoun R, Long RB, Price C, Kantrowitz-Gordon I, Shimomaeda L, Nurius PS, Katz LF, Sommerville J, Booth-LaForce C, Treadway A, Metje A, Whiley DJ, Moini N. Preliminary Evaluation of the Effectiveness of Perinatal Mindfulness-Based Well-Being and Parenting Programs for Low-Income New Mothers. Mindfulness (N Y) 2023; 14:933-952. [PMID: 37090851 PMCID: PMC9990962 DOI: 10.1007/s12671-023-02096-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Objectives This study examined specificity in the effects of three perinatal mindfulness-based prevention programs that differed in their timing (prenatal, postpartum) and target (maternal well-being, parenting). Effects on maternal mental health (depression, anxiety, resilience), mindfulness, and observed parenting, as well as observed, physiological, and mother-report indicators of infant self-regulation, were examined. Methods The programs were evaluated in a racially and ethnically diverse sample of first-time mothers (n = 188) living in low-income contexts using intention-to-treat analysis. Mothers were assigned to a prenatal well-being, postpartum well-being, parenting, or book control group. Multi-method assessments that included questionnaire, observational, and physiological measures were conducted at four time points: during pregnancy (T1) and when infants were 2–4 months (T2), 4–6 months (T3), and 10–12 months. Results Compared to the postpartum intervention and control groups, the 6-week prenatal well-being intervention was related to decreases in depressive symptoms during pregnancy but not postpartum, higher maternal baseline respiratory sinus arrhythmia (RSA), fewer intrusive control behaviors, and lower infant cortisol levels in the early postpartum period. Compared to all other groups, the postpartum parenting intervention was related to decreases in maternal anxiety and increases in responsive parenting. Some differential effects across programs might be due to differences in attendance rates in the prenatal (62%) vs. postpartum (35%) groups. Conclusions The findings suggest that brief mindfulness-based well-being and parenting preventive interventions can promote maternal and infant mental health in families living in low-income, high-stress settings, particularly if accessibility can be enhanced. Preregistration This study is not preregistered.
Collapse
Affiliation(s)
- Liliana J. Lengua
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Rebecca Calhoun
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Robyn B. Long
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Cynthia Price
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Lisa Shimomaeda
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Paula S. Nurius
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | | | | | - Anna Treadway
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | - Alina Metje
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| | | | - Natasha Moini
- University of Washington, Psychology Box 351525, Seattle, WA 98195-1525 USA
| |
Collapse
|
4
|
Ramdas DL, Sbrilli MD, Laurent HK. Impact of maternal trauma-related psychopathology and life stress on HPA axis stress response. Arch Womens Ment Health 2022; 25:121-128. [PMID: 34365527 DOI: 10.1007/s00737-021-01169-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
To understand and curb intergenerational transmission of stress-related disorder, it is important to identify how trauma-related psychopathology in mothers impacts their psychophysiological stress regulation, particularly in the context of parenting their infants. In this study we investigated associations between mothers' trauma-related psychopathology and life stress and HPA axis response to a personally relevant stressor (infant separation stress) in a non-clinical sample followed longitudinally postpartum. A community sample of low-income mothers (n = 73) and their infants completed laboratory sessions at 3, 6, 12, and 18 months postnatal, and salivary cortisol samples collected before and after dyadic stress tasks at the latter three sessions. These tasks were used to assess HPA function. A three-level hierarchical linear model of repeated cortisol measures nested within sessions within mother-infant dyads did not reveal significant main effects of trauma-related psychopathology on maternal cortisol response, but there was evidence that both a clinical interviewer-rated diagnosis of PTSD and ongoing self-reported trauma symptoms blunted effects of life events on cortisol reactivity. Region of significance analyses indicated that current life stress predicted more pronounced cortisol reactivity only among mothers without trauma-related psychopathology; for those with trauma-related psychopathology, life stress did not relate to cortisol response. Effects held when controlling for childhood trauma and previous (prenatal) maternal distress symptoms, suggesting they did not reflect ongoing impacts of past trauma exposure and/or psychopathology. Blunting effects of trauma-related psychopathology on maternal life stress responsiveness may help clarify how stress sensitivities and mental health are transmitted from parent to child.
Collapse
Affiliation(s)
- Dawn L Ramdas
- Psychiatry Department, Carle Illinois College of Medicine, Urbana, IL, USA.
| | - Marissa D Sbrilli
- Department of Psychology, University of Illinois At Urbana-Champaign, Champaign, IL, USA
| | - Heidemarie K Laurent
- Department of Psychology, University of Oregon, Eugene, OR, USA.,Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
5
|
Kantrowitz-Gordon I, McCurry SM, Landis CA, Lee R, Wi D. Online prenatal trial in mindfulness sleep management (OPTIMISM): protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2020; 6:128. [PMID: 32944276 PMCID: PMC7488736 DOI: 10.1186/s40814-020-00675-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Sleep deficiency affects a majority of pregnant women with significant impact on daily function, mood, and pregnancy and birth outcomes. This ongoing study combines two evidence-based strategies for improving sleep and mood, mindfulness meditation and cognitive-behavioral therapy for insomnia (CBT-I), in a unique online format to address the particular needs of pregnant women. The purpose of this study is to test the feasibility and estimate the efficacy of this novel 6-week online mindfulness meditation intervention to help pregnant women in remission from depression self-manage insomnia. Methods This is a two-arm, parallel group randomized controlled trial. A total of 50 pregnant women between 12 and 28 weeks gestation will be recruited from the community and randomly assigned to a mindfulness or education-only control group in a 1:1 ratio. During the study, all participants will complete six weekly online modules, daily sleep diaries, and optional participation in a treatment-specific online discussion forum. Feasibility outcome measures will include study recruitment, retention, intervention adherence (number of online modules completed, number of meditation days per week), and intervention acceptability (8-item questionnaire). The primary clinical outcome measure will be sleep quality measured with the Pittsburgh Sleep Quality Index. Secondary outcome measures will include sleep measured with actigraphy and diaries (sleep efficiency, total sleep time, total wake time), Patient-Reported Outcomes Measurement Information System (PROMIS) measures (fatigue, sleep-related impairment, sleep disturbance); mood (depression, anxiety, positive affect, quality of life); and self-management and behavior change (potential self-efficacy, self-regulation, sleep problem acceptance, and trait mindfulness). Assessments will occur at baseline and post-intervention; an additional acceptability survey will be completed 4 weeks postpartum. Analyses will examine within-group differences in outcome change scores from baseline to post-intervention. Open-ended feedback will be analyzed using qualitative content analysis. Discussion This research is innovative in addressing sleep in pregnancy using a self-management research design and methods that can be accessible and cost-effective for large numbers of pregnant women. The results from this study will inform intervention refinement and efficacy testing of the intervention in a larger randomized controlled trial. Trial registration ClinicalTrials.gov, NCT04016428. Registered on 11 July 2019. Updated version registered on 26 July 2019.
Collapse
Affiliation(s)
- Ira Kantrowitz-Gordon
- Child, Family, and Population Health Nursing, University of Washington, Box 357262, Seattle, WA 98195 USA
| | - Susan M McCurry
- Child, Family, and Population Health Nursing, University of Washington, Box 357262, Seattle, WA 98195 USA
| | - Carol A Landis
- Biobehavioral Nursing and Health Informatics, University of Washington, Box 357266, Seattle, WA 98195 USA
| | - Rachel Lee
- Child, Family, and Population Health Nursing, University of Washington, Box 357262, Seattle, WA 98195 USA
| | - Dahee Wi
- Child, Family, and Population Health Nursing, University of Washington, Box 357262, Seattle, WA 98195 USA
| |
Collapse
|