Mindfulness and rumination as predictors of persistence with a distress tolerance task

Comparing the effectiveness of transdiagnostic treatment with acceptance and commitment therapy on emotional disorders, rumination, and life satisfaction in patients with irritable bowel syndrome: a randomized clinical trial

OBJECTIVE

The present study was conducted to compare the effectiveness of transdiagnostic treatment (UP) with the acceptance and commitment therapy (ACT) on the emotional disorders, rumination, and life satisfaction in the patients with irritable bowel syndrome (IBS).

METHOD

The present study was a randomized clinical trial with a pre-test and post-test design. Between the winter of 2021 and the end of spring 2022, Taleghani Hospital in Tehran received referrals from the statistical population of IBS patients. Of them, 30 individuals (15 in each group) were chosen by convenience sampling and then randomly allocated to groups. UP (It is emotion-based and intervenes in comorbid symptoms), and ACT treatments were provided to the participants online. The participants in the UP and ACT groups received the desired treatments in eight weekly sessions of 45-60 min.

RESULTS

There was no significant difference between UP pre-test and ACT regarding depression, anxiety, rumination, and life satisfaction (P > 0.05). There was no significant difference between UP and ACT post-test in terms of depression, rumination, and life satisfaction (P > 0.05), but due to anxiety, their difference was significant (P < 0.05). Besides, there was a significant difference between pre-test and post-test phases of UP and ACT regarding depression, anxiety, and rumination (P < 0.05). Still, they had no significant difference regarding life satisfaction (P > 0.05).

CONCLUSION

Therefore, it is suggested that specialists use UP and ACT as effective psychological treatments for the emotional symptoms of IBS patients to improve psychological symptoms.

The Cognitive Cost of Repetitive Thinking: A Study on the Effects of Shifting and Updating on Rumination of Emotional Experiences

The present study aimed to investigate the consequence of resource competition between post-emotional processing and concurrent cognitive tasks. Previous studies have shown that such a resource competition engenders both short-term (e.g., defeats in the execution of the working memory task) and long-term effects (e.g., procrastination or rumination following an emotional experience). We expected these effects to vary as a function of the different WM components involved (shifting, Study 1; updating, Study 2). In two studies, participants (Study 1: N = 48; Study 2: N = 42) were administered one out of two variants of a visuospatial task (Study 1: shifting; Study 2: updating) adopted by Curci and colleagues before and after a negative or neutral manipulation. Rumination was assessed immediately after the second WM task performance and 24 h later. In Study 1, results showed that the exposure to negative content impaired the subsequent executive performance compared with exposure to neutral material, while no difference was found in Study 2. Rumination for emotional material was higher and more persistent over time as a function of shifting resources but not for updating ones. These findings provide information on the possible role of individuals' cognitive resources on rumination for emotional experiences.

Aversive Reactivity: A Transdiagnostic Functional Bridge Between Neuroticism and Avoidant Behavioral Coping

Aversive reactivity to negative affect has been described as a transdiagnostic mechanism that links distal temperamental vulnerabilities to clinically relevant behaviors. However, the abundance of constructs reflecting aversive reactivity has resulted in a proliferation of models that may ultimately be redundant. We performed a circumscribed review of studies measuring associations between six constructs - anxiety sensitivity, experiential avoidance, distress intolerance, intolerance of uncertainty, thought-action fusion, and negative urgency - and ten relevant coping behaviors. Results suggested that most constructs were measured in relation to a limited number of coping behaviors. Additionally, constructs were most often measured in isolation, rather than with similar constructs. Implications and suggestions for future research and treatment are discussed.

Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis

BACKGROUND

There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users' understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling.

OBJECTIVE

This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data.

RESULTS

A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app's content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t₃₃=-2.16) and the increase in the well-being measures (t₃₃=2.87) were statistically significant. No adverse events were reported during the follow-up period.

CONCLUSIONS

The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app.

Variations in mindfulness associated with the COVID-19 outbreak: Differential effects on cognitive failures, intrusive thoughts and rumination

The lockdown due to the coronavirus outbreak in 2019 (COVID-19) has caused psychological distress and cognitive discomfort for emerging adults, who have experienced increased rumination, intrusive thoughts and cognitive failures. States of mindfulness and being in the moment can prevent anxiety and fear associated with the lockdown and alleviate ruminative and automatic negative thinking. This longitudinal study investigated the role of mindfulness before and during the COVID-19 lockdown in protecting a sample of emerging adults from experiencing cognitive failures, intrusive thoughts and rumination and examined how lockdown-related variables-emotions, socio-economic status and housing conditions-influenced this mindfulness profile. The results showed overall more cognitive failures and rumination during lockdown, especially in participants whose mindfulness status diminished. However, these signs of cognitive distress remained stable or decreased among participants who reported improved changes in mindfulness. Financial difficulties and a reduced sense of privacy associated with the lockdown predicted lower stability in mindfulness profiles. The state of being fully aware of what is happening in the present moment may be helpful in reducing cognitive discomfort and psychological maladjustment, especially during stressful times such as lockdowns.

A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery

BACKGROUND AND OBJECTIVES

Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change.

METHODS

Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15-20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up.

PROJECTED OUTCOMES

This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery.

A longitudinal investigation of the association between rumination, hostility, and PTSD symptoms among trauma-exposed individuals

BACKGROUND

Rumination, defined as perseverative thinking regarding the causes and consequences of psychological symptoms, is a risk and maintaining factor for PTSD. Existing work has largely focused on the extent to which rumination functions as a coping strategy used to avoid traumatic memories and associated emotions. However, rumination may also maintain negative thinking patterns, such as hostility, which has been positively associated with both rumination and PTSD symptoms. The current study therefore investigated the extent to which hostility was a significant mediator of the prospective association between rumination and PTSD symptoms.

METHODS

The sample consisted of 119 trauma-exposed individuals (48.7% female), who completed self-report questionnaires at three time points during a clinical trial.

RESULTS

When controlling for treatment condition and baseline depressive disorder diagnosis, hostility temporally mediated the effects of rumination on PTSD symptoms. Specificity analyses provided further support for the direction and specific variables examined in this model, such that rumination was positively and uniquely associated with later hostility.

LIMITATIONS

Our findings are limited by the use of a sample in which only 30% of participants met diagnostic criteria for a trauma-related disorder, as well as the administration of the rumination measure at only one time point.

CONCLUSIONS

Results suggest that rumination and hostility may be promising treatment and prevention targets for PTSD symptoms.

Bullying, Discrimination, Sexual Harassment, and Physical Violence: Common and Associated With Burnout in Pediatric Residents

BACKGROUND

Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout.

METHODS

We analyzed data from the Spring, 2019 Pediatric Resident Burnout and Resilience Study Consortium's 72-item online survey. Surveys included screening questions about burnout; residents' characteristics and experiences, and attitudes about their learning environment.

RESULTS

Nineteen hundred fifty-six residents (66% of those eligible) from 46 programs participated; most (70%) were women and most (66%) were Caucasian. Overall 45% reported weekly or more frequent burnout symptoms; 33% reported 1 or more of these experiences ("mistreatment") during the past year: 19% reported experiencing bullying; 18% reported discrimination; 5% reported sexual harassment; and 1% reported physical violence. The most frequent sources of mistreatment were clinical staff (60%), patients' families (54%), and faculty (43%). Women were more likely than men to report mistreatment (36% vs 25%, P < .01) Residents who reported experiencing mistreatment were more likely than those who did not to report symptoms of burnout (adjusted odds ratio 1.98; 95% confidence interval, CI 1.62-2.42); they also reported higher stress levels, lower quality of life, and were less likely to agree that their program prioritized collaboration, education, or mentoring (P < .001 for all).

CONCLUSIONS

Mistreatment occurs frequently among pediatric residents, especially women; mistreatment is associated with burnout, stress, lower quality of life, and worse attitudes about the learning environment. Future studies could explore whether institutional efforts to improve workplace civility improves resident well-being and attitudes about training.

Mindfulness-based skills training group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention

BACKGROUND AND PURPOSE

Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects.

MATERIALS AND METHODS

Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected.

RESULTS

In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction.

CONCLUSION

Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03212703.

Targeting cognitive and emotional regulatory skills for smoking prevention in low-SES youth: A randomized trial of mindfulness and working memory interventions

Research to date provides striking evidence that youth from low socio-economic status (SES) households are at an increased risk for smoking. Converging evidence from developmental studies, psychopathology studies, intervention studies, and basic research on self-control abilities have identified working memory and distress tolerance as potential crucial modifiable risk factors to prevent smoking onset in this cohort. To confirm the value of these mechanistic targets, this randomized trial was designed to evaluate the influence of working memory and distress tolerance interventions on risk of smoking initiation. Recruiting primarily from low-income community afternoon programs, we randomized 93 adolescents to one of three intervention conditions, all of which were a prelude to a smoking-prevention informational intervention: (1) a working memory intervention, (2) a mindfulness training intervention to target distress tolerance, and (3) a wellness-focused control condition. Despite a number of adherence efforts, engagement in treatment was limited, and under these conditions no significant evidence was found either for differential efficacy for smoking prevention or for intervention effects on mechanistic targets. However, working memory capacity and distress tolerance were found to be negatively related to smoking propensity. As such, our mechanistic targets-working memory and distress tolerance--may well be processes undergirding smoking, despite the fact that our interventions did not adequately engage these targets.

Ultra-brief breath counting (mindfulness) training promotes recovery from stress-induced alcohol-seeking in student drinkers

The therapeutic effect of mindfulness interventions on problematic drinking is thought to be driven by increased resilience to the impact of stress on negative mood and alcohol-seeking behaviour, but this claim needs empirical support. To address this hypothesis, the current study tested whether brief training of one component of mindfulness - breath counting - would reduce drinkers' sensitivity to the effect of noise stress on subjective mood and alcohol-seeking behaviour. Baseline alcohol-seeking was measured by choice to view alcohol versus food thumbnail pictures in 192 student drinkers. Participants then received a 6-minute audio file which either trained breath counting or recited a popular science extract, in separate groups. All participants were then stressed by a loud industrial noise and alcohol-seeking was measured again simultaneously to quantify the change from baseline. Subjective mood was measured after all three stages (baseline, post intervention, post stress test). The breath counting group were instructed to deploy this technique during the stress test. Results showed that the breath counting versus control intervention improved subjective mood relative to baseline, attenuated the worsening of subjective mood produced by stress induction, and accelerated recovery from a stress induced increase in alcohol-seeking behaviour. Exploratory moderation analysis showed that this accelerated recovery from stress induced alcohol-seeking by breath counting was weaker in more alcohol dependent participants. Mindfulness therapies may improve problematic drinking by increasing resilience to stress induced negative mood and alcohol-seeking, as observed in this study. The weaker therapeutic effect of breath counting in more dependent drinkers may reveal limitations to this intervention strategy.

Human-Centered Leadership in Health Care: An Idea That's Time Has Come

The Human-Centered Leadership model, which is relevant for leaders at all levels in a complex health care system, embraces change from the inside out. The Human-Centered Leader (HCL) is embedded in the organization, rather than positioned above it, and recognizes the expertise and value of those who serve at the point of care. The HCL starts with a focus on self-awareness, self-compassion, self-care, and mindfulness while focusing on others through demonstration of the characteristics of an Awakener, a Connector, and an Upholder. As an Awakener, the HCL grows and cultivates the team through the development of individual growth plans and staff empowerment in decision making. The result is a professionally prepared workforce that delivers market-leading patient outcomes. The HCL, as a Connector, builds the community in the microsystem by creating a healthy work environment. Finally, as an Upholder, the HCL recognizes the humanity in others and brings out the best in them. Demonstration of sincere care for those who care for patients results in improved staff satisfaction and, in turn, exceptional patient experience. The sustainable changes resulting from Human-Centered Leadership are realized through development of Cultures of Excellence, Trust, and Caring.

Burnout in Pediatric Residents: Three Years of National Survey Data

BACKGROUND

We aimed to describe the national epidemiology of burnout in pediatric residents.

METHODS

We conducted surveys of residents at 34 programs in 2016, 43 programs in 2017, and 49 programs in 2018. Survey items included the Maslach Burnout Inventory, demographics, program characteristics, personal qualities, experiences, and satisfaction with support, work-life balance, and learning environment. Analyses included cross-sectional comparisons and cross-sectional and longitudinal regression.

RESULTS

More than 60% of eligible residents participated; burnout rates were >50% in all years and not consistently associated with any demographic or residency characteristics. Cross-sectional associations were significant between burnout and stress, sleepiness, quality of life, mindfulness, self-compassion, empathy, confidence in providing compassionate care (CCC), being on a high-acuity rotation, recent major medical error, recent time off, satisfaction with support and career choice, and attitudes about residency. In cross-sectional logistic regression analyses, 4 factors were associated with an increased risk of burnout: stress, sleepiness, dissatisfaction with work-life balance, and recent medical error; 4 factors were associated with lower risk: empathy, self-compassion, quality of life, and CCC. Longitudinally, after controlling for 2017 burnout and 2018 risk factors (eg, recent error, sleepiness, rotation, and time off), 2017 quality of life was associated with 2018 burnout; 2017 self-compassion was associated with lower 2018 stress; and 2017 mindfulness, empathy, and satisfaction with learning environment and career choice were associated with 2018 CCC.

CONCLUSIONS

A majority of residents met burnout criteria. Several identified factors (eg, stress, sleepiness, medical errors, empathy, CCC, and self-compassion) suggest targets for interventions to reduce burnout in future studies.

Relationships Among Dispositional Mindfulness, Distress Tolerance, and Women's Dating Violence Perpetration: A Path Analysis

Scant research examined mechanisms underlying the relationship between dispositional mindfulness and dating violence (DV) perpetration. Using a cross-sectional design with 203 college women, we examined whether distress tolerance mediated the relationship between dispositional mindfulness and DV perpetration (i.e., psychological aggression and physical assault). Path analyses results revealed indirect effects of mindfulness facets nonjudging of inner experiences and nonreactivity to inner experiences on both psychological aggression and physical assault through distress tolerance. Mindfulness facets observing, describing, and acting with awareness were not linked to DV perpetration through distress tolerance. Results suggest that women who allow internal experiences to come and go without assigning criticism or avoidance are better able to tolerate transient distress and less likely to abuse a dating partner. Future research may examine distress tolerance and dispositional mindfulness facets as potential intervention targets for women who abuse dating partners.

Evaluating the Indirect Effects of Trait Mindfulness Facets on State Tripartite Components Through State Rumination and State Experiential Avoidance

The present study investigated whether specific trait mindfulness facets indirectly influenced state negative affect (NA), positive affect (PA), and physiological hyperarousal (PH) through state rumination and state experiential avoidance. Participants (n = 360, 68% female) rated trait mindfulness facets, then completed an interview task about life experiences intended to elicit state NA, PA, and PH. After the interview task, participants completed measures of state NA, PA, and PH, and state measures of rumination and experiential avoidance. Indirect effect results indicated that the relationships between Nonjudge, Nonreact, and Describe, and each of the state tripartite components indirectly flowed through state rumination. Further, there was a significant indirect effect of Nonjudge and Actaware on each of the three state tripartite components through experiential avoidance. Overall, strengthening the mindfulness skills of Nonjudge, Nonreact, Describe, and Actaware may have positive downstream effects via reducing reliance on maladaptive emotion regulation strategies, such as rumination or experiential avoidance.

The Effect of a Brief Mindfulness Training on Distress Tolerance and Stress Reactivity

Poor distress tolerance (DT) is considered an underlying facet of anxiety, depression, and a number of other psychological disorders. Mindfulness may help to increase DT by fostering an attitude of acceptance or nonjudgment toward distressing experiences. Accordingly, the present study examined the effects of a brief mindfulness training on tolerance of different types of distress, and tested whether trait mindfulness moderates the effect of such training. Undergraduates (n = 107) naïve to mindfulness completed a measure of trait mindfulness and underwent a series of stress tasks (cold pressor, hyperventilation challenge, neutralization task) before and after completing a 15-minute mindfulness training or a no-instruction control in which participants listened to relaxing music. Participants in the mindfulness condition demonstrated greater task persistence on the hyperventilation task compared to the control group, as well as a decreased urge to neutralize the effects of writing an upsetting sentence. No effect on distress ratings during the tasks were found. Overall trait mindfulness did not significantly moderate task persistence, but those with lower scores on the act with awareness facet of mindfulness demonstrated greater relative benefit of mindfulness training on the hyperventilation challenge. Mediation analyses revealed significant indirect effects of mindfulness training on cold pressor task persistence and urges to neutralize through the use of the nonjudge and nonreact facets of mindfulness. These results suggest that a brief mindfulness training can increase DT without affecting the subjective experience of distress.

An examination of mindfulness skills in terms of affect tolerance among individuals with elevated levels of health anxiety

BACKGROUND AND OBJECTIVES

Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.

METHODS

Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit.

RESULTS

Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.

CONCLUSIONS

These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.

A Psychometric Examination of the Anagram Persistence Task: More Than Two Unsolvable Anagrams May Not Be Better

The purpose of this investigation was to examine a single-anagram, a double-anagram, and multi-anagram versions of the Anagram Persistence Task (APT) for factorial validity, reliability, and convergent validity. Additionally, a battery of intelligence tests was administered to examine convergent validity. Based on an unrestricted factor analysis, two factors were uncovered from the 14 anagram (seven very difficult and seven very easy) response times: test-taking persistence and verbal processing speed. The internal consistency reliabilities for the single-anagram, double-anagram, and multi-anagram (seven difficult anagrams) measures were .42, .85, and .86, respectively. Furthermore, all three versions of the APT correlated positively with intelligence test performance (r ≈ .22). However, the double-anagram and multi-anagram versions also evidenced negative, nonlinear effects with intelligence test performance (r ≈ -.15), which suggested the possibility of testee adaptation. Taking psychometrics and administration time into consideration, simultaneously, the double-anagram version of the APT may be regarded as preferred.

The Role of Technology-Based Interventions for Substance Use Disorders in Primary Care: A Review of the Literature

The burden of alcohol and drug use disorders (substance use disorders [SUDs]) has intensified efforts to expand access to cost-effective psychosocial interventions and pharmacotherapies. This article provides an overview of technology-based interventions (eg, computer-based and Web-based interventions, text messaging, interactive voice recognition, smartphone apps, and emerging technologies) that are extending the reach of effective addiction treatments both in substance use treatment and primary care settings. It discusses the efficacy of existing technology-based interventions for SUDs, prospects for emerging technologies, and special considerations when integrating technologies in primary care (eg, privacy and regulatory protocols) to enhance the management of SUDs.

The role of mindfulness skills in terms of anxiety-related cognitive risk factors among college students with problematic alcohol use

BACKGROUND

The aim of the current study was to examine the associations between the specific mindfulness skills of observing, describing, awareness, nonjudgment, and nonreactivity in terms of anxiety sensitivity (AS), distress tolerance (DT), and intolerance of uncertainty (IU) among college students with problematic alcohol use.

METHODS

Participants were 202 (69.3% male; M_age = 18.96, SD = 2.24, range = 18-45 years) undergraduate college students with problematic alcohol use who completed self-report measures for course credit.

RESULTS

Results indicated that after controlling for the effects of gender, smoking status, marijuana use status, and negative affectivity, greater use of the mindfulness skill of observing was associated with higher AS, greater describing was associated with lower AS and higher DT, greater nonjudgment was associated with lower AS and IU and higher DT, and greater nonreactivity was associated with increased DT. Awareness did not significantly predict any of the examined risk factors.

CONCLUSIONS

These results suggest that specific mindfulness skills are associated with a greater tolerance of physiological, emotional, and uncertain states. An important next step will be to examine whether mindfulness skills are associated with decreased problematic alcohol use due to improvements in these anxiety-related risk factors.

Exploring resilience and mindfulness as preventative factors for psychological distress burnout and secondary traumatic stress among human service professionals

BACKGROUND

Human service professionals are concerned with the intervention and empowerment of vulnerable social populations. The human service industry is laden with employment-related stressors and emotionally demanding interactions, which can lead to deleterious effects, such as burnout and secondary traumatic stress. Little attention has been given to developing knowledge of what might enable human service workers to persist and thrive. Cultivating and sustaining resilience can buffer the impact of occupational stressors on human service professionals. One of the psychological factors associated with cultivating resilience is mindfulness.

OBJECTIVE

The aim of this current research is to improve our understanding of the relationship between resilience, mindfulness, burnout, secondary traumatic stress, and psychological distress among human service professionals.

METHODS

The current study surveyed 133 human service professionals working in the fields of psychology, social work, counseling, youth and foster care work to explore the predictive relationship between resilience, mindfulness, and psychological distress.

RESULTS

The results showed that higher levels of resilience were a significant predictor of lower levels of psychological distress, burnout and secondary traumatic stress. In addition, higher levels of mindfulness were a significant predictor of lower levels of psychological distress and burnout.

CONCLUSIONS

The findings suggest that cultivating resilience and mindfulness in human service professionals may assist in preventing psychological distress burnout and secondary traumatic stress. Limitations of this study are discussed together with implications for future research.

Online Training in Mind-Body Therapies: Different Doses, Long-term Outcomes

Background.

There is a high rate of burnout among health professionals, driving diverse attempts to promote resilience and well-being to counter this trend. The purpose of this project was to assess the dose-response relationship between the number of hours of online mind-body skills training for health professionals and relevant outcomes a year later.

Methods.

Among 1438 registrants for online training (including up to 12 hours of training on mind-body practices) between December 2013 and November 2015, we analyzed responses from the first 10% who responded to an anonymous online survey between December 1, 2015 and February 1, 2016. Questions included the type and frequency of mind-body practice in the past 30 days and whether the online training had any impact on personal life or professional practice. Standardized measures were used to assess stress, mindfulness, confidence in providing compassionate care, and burnout.

Results.

The 149 respondents represented a variety of ages and health professions; 55% completed one or more mind-body training modules an average of 14 months previously. Most (78%) engaged in one or more mind-body practices in the 30 days before the survey; 79% reported changes in self-care and 71% reported changes in the care of others as a result of participating. Increasing number of hours of training were significantly associated with practicing mind-body skills more frequently; increasing practice frequency was associated with less stress and burnout, which were associated with missing less work. Greater practice frequency was also associated with improvements in stress, mindfulness, and resilience, which were associated with increased confidence in providing compassionate care.

Conclusion.

Online training in mind-body therapies is associated with changes in self-reported behavior one year later; increasing doses of training are associated with more frequent practice which is associated with less stress, burnout, and missing work, and higher levels of mindfulness, resilience, and confidence in providing compassionate care. Additional studies are needed to compare mind-body skills training with other interventions designed to improve resilience and compassion while decreasing burnout in health professionals.

Behavioral Assessment of the Negative Emotion Aspect of Distress Tolerance: Tolerance to Emotional Images

The current behavioral tasks assessing distress tolerance measure tolerance to frustration and tolerance to physical discomfort, but do not explicitly assess tolerance to negative emotion. We closely evaluated the conceptual distinctions between current behavioral tasks and self-report tasks assessing distress tolerance, and then developed a new behavioral distress tolerance task called the Emotional Image Tolerance (EIT) task. The EIT task retains elements of existing behavioral tasks (e.g., indices of persistence) while augmenting the reliability and content sufficiency of existing measures by including multiple trials, including a variety of negative affect stimuli, and separating overall task persistence from task persistence after onset of distress. In a series of three studies, we found that the EIT correlated with extant behavioral measures of distress tolerance, the computerized mirror-tracing task and a physical cold pressor task. Across all of the studies, we also evaluated whether the EIT correlated with self-report measures of distress tolerance and measures of psychopathology (e.g., depression, anxiety, and binge eating). Implications for the refinement of the distress tolerance construct are discussed.

Measuring the Effects of Self-Awareness: Construction of the Self-Awareness Outcomes Questionnaire

Dispositional self-awareness is conceptualized in several different ways, including insight, reflection, rumination and mindfulness, with the latter in particular attracting extensive attention in recent research. While self-awareness is generally associated with positive psychological well-being, these different conceptualizations are also each associated with a range of unique outcomes. This two part, mixed methods study aimed to advance understanding of dispositional self-awareness by developing a questionnaire to measure its outcomes. In Study 1, expert focus groups categorized and extended an initial pool of potential items from previous research. In Study 2, these items were reduced to a 38 item self-report questionnaire with four factors representing three beneficial outcomes (reflective self-development, acceptance and proactivity) and one negative outcome (costs). Regression of these outcomes against self-awareness measures revealed that self-reflection and insight predicted beneficial outcomes, rumination predicted reduced benefits and increased costs, and mindfulness predicted both increased proactivity and costs. These studies help to refine the self-awareness concept by identifying the unique outcomes associated with the concepts of self-reflection, insight, reflection, rumination and mindfulness. It can be used in future studies to evaluate and develop awareness-raising techniques to maximize self-awareness benefits while minimizing related costs.

Reviewing Mindfulness-Based Interventions for Suicidal Behavior

This article describes the rationale for using mindfulness-based interventions (MBIs) to prevent suicidal behavior in high suicide-risk individuals. A narrative review of studies testing the feasibility of MBIs with individuals at risk for suicidal behavior and the effectiveness of MBIs for reducing suicidality was conducted. Studies testing the effectiveness of MBIs for reducing deficits specific to suicide attempters among depressed individuals were also reviewed as were studies examining moderators of MBI treatment adherence and effectiveness to the extent that these might suggest possible limitations to using MBIs with high suicide-risk individuals. Findings from the handful of available studies support targeting suicidal ideation with MBI. Additional studies show deficits associated with suicide attempt, namely attentional dyscontrol, problem solving deficits, and abnormal stress response, are improved by MBI and thus strengthen the rationale for using MBIs with high suicide-risk individuals.

Dispositional Mindfulness Uncouples Physiological and Emotional Reactivity to a Laboratory Stressor and Emotional Reactivity to Executive Functioning Lapses in Daily Life

Both dispositional mindfulness and mindfulness training may help to uncouple the degree to which distress is experienced in response to aversive internal experience and external events. Because emotional reactivity is a transdiagnostic process implicated in numerous psychological disorders, dispositional mindfulness and mindfulness training could exert mental health benefits, in part, by buffering emotional reactivity. The present studies examine whether dispositional mindfulness moderates two understudied processes in stress reactivity research: the degree of concordance between subjective and physiological reactivity to a laboratory stressor (Study 1); and the degree of dysphoric mood reactivity to lapses in executive functioning in daily life (Study 2). In both studies, lower emotional reactivity to aversive experiences was observed among individuals scoring higher in mindfulness, particularly non-judging, relative to those scoring lower in mindfulness. These findings support the hypothesis that higher dispositional mindfulness fosters lower emotional reactivity. Results are discussed in terms of implications for applying mindfulness-based interventions to a range of psychological disorders in which people have difficulty regulating emotional reactions to stress.