Prospects for a clinical science of mindfulness-based intervention

How to design a broad mindfulness program: One approach to introducing mindfulness to a STEM community within a university setting

Mindfulness has become popular in recent decades as a tool for psychological well-being. However, mindfulness has yet to find a solid footing as a routine practice within the Science, Technology, Engineering, and Mathematics (STEM) field. Here, we discuss the design of an introductory mindfulness program that provides the STEM community with a broad overview of various mindfulness methods. We also discuss delivery implementation methods and other considerations when designing mindfulness programming. This article provides resources for those interested in incorporating mindfulness into the STEM field, especially within the university setting.

Volitional mental absorption in meditation: Toward a scientific understanding of advanced concentrative absorption meditation and the case of jhana

Meditation has been integral to human culture for millennia, deeply rooted in various spiritual and contemplative traditions. While the field of contemplative science has made significant steps toward understanding the effects of meditation on health and well-being, there has been little study of advanced meditative states, including those achieved through intense concentration and absorption. We refer to these types of states as advanced concentrative absorption meditation (ACAM), characterized by absorption with the meditation object leading to states of heightened attention, clarity, energy, effortlessness, and bliss. This review focuses on a type of ACAM known as jhana (ACAM-J) due to its well-documented history, systematic practice approach, recurring phenomenological themes, and growing popularity among contemplative scientists and more generally in media and society. ACAM-J encompasses eight layers of deep concentration, awareness, and internal experiences. Here, we describe the phenomenology of ACAM-J and present evidence from phenomenological and neuroscientific studies that highlight their potential applications in contemplative practices, psychological sciences, and therapeutics. We additionally propose theoretical ACAM-J frameworks grounded in current cognitive neuroscientific understanding of meditation and ancient contemplative traditions. We aim to stimulate further research on ACAM more broadly, encompassing advanced meditation including meditative development and meditative endpoints. Studying advanced meditation including ACAM, and specific practices such as ACAM-J, can potentially revolutionize our understanding of consciousness and applications for mental health.

Mindfulness-based interventions for body image dissatisfaction among clinical population: A systematic review and meta-analysis

PURPOSE

Mindfulness-based interventions (MBIs) are well-validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice.

METHODS

A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist.

RESULTS

Random effects meta-analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = -.59 and 95% CI = -1.03 to -.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = -1.29, 95% CI = -2.06 to -.52, p = .001) and My Changed Body (MyCB) (SMD = -.24, 95% CI = -.46 to -.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = -.24, 95% CI = -.46 to -.01, p = .04) showed a significant effect size.

CONCLUSIONS

MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.

Mindfulness Teacher Trainees' Experiences (MTTE): An investigation of intense experiences in mindfulness-based interventions

With the increasing interest in mindfulness practices within clinical as well as non-clinical settings and the increasing body of research on the positive effects of mindfulness, concerns have been raised that mindfulness might also produce adverse effects including intense experiences and psychosis. The aim of this study was to investigate if intense experiences occur as a natural part of mindfulness practice, and if so to examine the characteristics of such experiences. We conducted a qualitative analysis based on fortnightly meditation reports from 13 mindfulness teacher trainees for 4 months. Intense experiences in meditation were frequently expressed in the reports of most of the practitioners and in some individuals these experiences were similar to psychotic-like experiences. This study presents suggestive evidence that mindfulness practices can produce intense experiences and that for some individuals these intense experiences may resemble psychotic-like experiences.

Daily micropractice can augment single-session interventions: A randomized controlled trial of self-compassionate touch and examining their associations with habit formation in US college students

In this pre-registered study, we evaluated the effects of a single-session, self-guided intervention, leveraging daily micropractice (≤20 seconds/day practice) of self-compassionate touch to enhance self-compassion. We randomly assigned undergraduates (N = 135) to one of two conditions: a single-session intervention in which they were taught self-compassionate touch or a finger-tapping active control. Then, we instructed them to practice for 20 seconds/day for one month. At baseline (T1) and one-month follow-up (T2), participants completed assessments of self-compassion, growth mindset, positive affect, stress, psychopathology, habit formation, and more. In confirmatory, intention-to-treat analyses (N = 135), we found no significant effects on these outcomes. However, in confirmatory, per-protocol analyses (comparing the subsets from each condition who practiced>28 times, N = 45), self-compassionate touch, relative to active control, predicted T1-to-T2 increases in self-compassion (β = 0.71, p = .025), and reductions in stress (β = -0.62, p = .047) and psychopathology (β = -0.61, p = .046). In exploratory intention-to-treat analyses (N = 135), we found the same pattern of effects as in the per-protocol analyses among those who practiced self-compassionate touch more frequently relative to active control. We discuss factors associated with habit formation of daily practice. Daily micropractices have the potential for augmenting single-session interventions and for offering help when more time-intensive approaches may be less accessible. CLINICAL TRIAL REGISTRATION NUMBER: NCT05199779.

Intensive whole-brain 7T MRI case study of volitional control of brain activity in deep absorptive meditation states

Jhanas are profound states of mind achieved through advanced meditation, offering valuable insights into the nature of consciousness and tools to enhance well-being. Yet, its neurophenomenology remains limited due to methodological difficulties and the rarity of advanced meditation practitioners. We conducted a highly exploratory study to investigate the neurophenomenology of jhanas in an intensively sampled adept meditator case study (4 hr 7T fMRI collected in 27 sessions) who performed jhana meditation and rated specific aspects of experience immediately thereafter. Linear mixed models and correlations were used to examine relations among brain activity and jhana phenomenology. We identified distinctive patterns of brain activity in specific cortical, subcortical, brainstem, and cerebellar regions associated with jhana. Furthermore, we observed correlations between brain activity and phenomenological qualities of attention, jhanic qualities, and narrative processing, highlighting the distinct nature of jhanas compared to non-meditative states. Our study presents the most rigorous evidence yet that jhana practice deconstructs consciousness, offering unique insights into consciousness and significant implications for mental health and well-being.

Mindful Eco-Wellness: Steps Toward Personal and Planetary Health

Rising greenhouse gas levels heat the earth's surface and alter climate patterns, posing unprecedented threats to planetary ecology and human health. At the same time, obesity, diabetes, and cardiovascular disease have reached epidemic proportions across the globe, caused in part by decreases in physical activity and by over-consumption of carbon-intensive foods. Thus, interventions that support active transportation (walking or cycling rather than driving) and healthier food choices (eating plant-based rather than meat-based diets) would yield health and sustainability "co-benefits." Emerging research suggests that mindfulness-based practices might be effective means toward these ends. At the University of Wisconsin-Madison, we have developed a mindfulness-based group program, Mindful Eco-Wellness: Steps Toward Healthier Living. Loosely based on the Mindfulness-Based Stress Reduction course, our curriculum teaches mindfulness practices in tandem with sustainability principles, following weekly themes of Air, Water, Food, Energy, Transportation, Consumption, Nature Experience, and Ethics. For example, the "Air" class offers participants practice in guided breath meditations while they learn about the benefits of clean air. The theme of "Food" is presented through mindful eating, accompanied by educational videos highlighting the consequences of food production and consumption. "Transportation" includes walking/movement meditations and highlights the health benefits of physical activity and detriments of fossil-fueled transportation. Pedagogical lessons on energy, ecological sustainability, and the ethics of planetary health are intertwined with mindful nature experience and metta (loving-kindness) meditation. Curricular materials, including teaching videos, are freely available online. Pilot testing in community settings (n = 30) and in group medical visits (n = 34) has demonstrated feasibility; pilot data suggests potential effectiveness. Rigorous evaluation and testing are needed.

Investigating the protective effects of mindfulness-based attention training on mind wandering in applied settings

Introduction

Mind wandering, a phenomenon in which attention drifts away from the task-at-hand, is associated with deleterious effects on performance and well-being. As such, efforts to curb mind wandering are warranted. Recently, mindfulness training (MT) has been found to protect against mind wandering. Yet, many MT programs are at risk of falling off the implementation cliff due to challenges implementing these programs in applied settings. To mitigate against this, early-stage research in small convenience samples may be necessary to spur stakeholder engagement and collaboration. Herein, the effects of MT on mind wandering were examined via an internal meta-analysis of early-stage studies of a manualized, context-adaptable short-form MT program, referred to as Mindfulness-Based Attention Training (MBAT).

Methods

Five longitudinal studies (N = 304) were conducted in a variety of organizational cohorts. Self-reported mind wandering and meta-awareness, as well as accuracy (A') and response time variability (intra-individual coefficient of variation, ICV) during performance of the sustained attention to response task (SART) were assessed at baseline (T1) and 4 weeks later (T2) in MBAT and no-training participants.

Results

Standardized mean change (SMC) from T1 to T2 significantly differed between MBAT and no-training groups for mind wandering (ΔSMC = -0.387, p < 0.001), meta-awareness (ΔSMC = -0.374, p < 0.001), and ICV (ΔSMC = -0.376, p = 0.043), suggesting potential protective effects in self-reported and performance-based metrics of mind wandering.

Discussion

These results serve as preliminary proof-of-concept support for MBAT's protective effects on mind wandering. Further, they suggest that MBAT is amenable to implementation across a variety of applied and organizational settings and warrants additional research employing larger sample sizes in randomized controlled designs.

The Effects of a Mindfulness-Based Intervention on Mental Health Outcomes in Pregnant Woman: A Systematic Review and Meta-Analysis

BACKGROUND

Pregnancy stress, anxiety, and depression increase the risk of short-term and long-term health problems for the mother and fetus. Mindfulness-based intervention (MBI) is one of the most popular, nonpharmacological interventions used to treat mental health problems. The results of prior research indicate MBI has a less consistent effect on mental health problems in pregnant women.

PURPOSE

The purpose of this systematic review and meta-analysis was to clarify and determine the effect of MBI on mental health outcomes in pregnant women.

METHODS

Six databases, including Embase, Ovid MEDLINE, CINAHL, EBSCOhost, Cochrane Library, and ScienceDirect, were searched from their dates of inception to November 2021. Google Scholar was also used for the literature inquiry. The inclusion criteria followed the PICO (Patient/Problem, Intervention, Comparison, and Outcome) model in terms of only including studies that used mindfulness therapy, reported mental health outcomes, and applied randomized controlled trial and quasi-experimental approaches. The Cochrane risk of bias tool was applied to evaluate the quality of the studies. Review Manager 5 software with random effect with a standardized mean difference (SMD) was used to analyze level of effect.

RESULTS

Thirteen studies (10 randomized controlled trials and three quasi-experimental studies) were included. MBI was found to have a small effect on mental health outcomes in pregnant women (p < .0001, SMDs = -0.48, 95% CI [-0.74, -0.22], I2 = 87%). Specifically, MBI had moderate effects on stress and anxiety (SMDs = -0.59, 95% CI [-1.09, -0.09], and SMDs = -0.55, 95% CI [-1.00, -0.10], respectively) and no significant effect on depression (SMDs = -0.33, 95% CI [-0.74, 0.08]).

CONCLUSIONS

MBIs have a small but notable effect on mental health in pregnant women. The high heterogeneity found in this review may reflect the different types and durations of interventions used. Notably, none of the studies in the review examined intervention effects by trimester. Future research should use larger sample sizes and assess the effects of therapy for each trimester of pregnancy.

How do mindfulness and compassion programs improve mental health and well-being? The role of attentional processing of emotional information

BACKGROUND AND OBJECTIVES

Although the benefits of Meditation-Based Programs are well documented, the mechanisms underlying these benefits have not been fully elucidated. Therefore, we examined whether: (1) formal training in mindfulness and compassion meditation modifies the distribution of attentional resources towards emotional information; and (2) whether changes in attentional processing of emotional information after the meditation programs mediate the improvements in psychological distress, emotion regulation, and well-being.

METHODS

A sample of 103 participants enrolled in the study: 36 in the mindfulness program (MBSR), 30 in the compassion program (CCT), and 37 in the no-intervention comparison group (CG). The assessment before and after the programs included the completion of an emotional Attentional Blink task (AB) together with self-report measures of psychological distress, emotion regulation, and well-being.

RESULTS

MBSR and CCT reduced similarly the AB deficit, whereas no changes occurred in the CG. This AB reduction was found for the different emotional and non-emotional stimuli (i.e., negative, positive, and neutral), showing a significant disengagement from first-target emotions and significant accessibility of second-target emotions to consciousness. The effects of both meditation programs on the psychological measures were mediated by changes in the AB and emotion regulation skills.

LIMITATIONS

Due to our naturalistic design in a real-world community setting, random assignment of participants was not feasible.

CONCLUSIONS

Meditation may promote more flexible and balanced attention to emotional information, which may be a key transdiagnostic mechanism underlying its benefits on emotional distress and well-being.

The effect of ten versus twenty minutes of mindfulness meditation on state mindfulness and affect

We aimed to elucidate the effects of "dose" of a single-session of mindfulness meditation on state mindfulness and affect as well as moderators of effects. 372 adults recruited remotely via Amazon's MTurk platform were randomly assigned to either a: 10-min mindfulness meditation, 20-min mindfulness meditation, 10-min control, or 20-min control. Control conditions were recordings of a National Geographic article. Primary outcomes were changes in state mindfulness, anxiety, and negative and positive affect. Moderator variables included neuroticism, trait mindfulness, and prior meditation experience. Collapsing across doses, participants in mindfulness conditions reported greater increases in state mindfulness than in control conditions. There was a greater increase in state mindfulness in the 10-min mindfulness condition versus 10-min control condition. There were no differences between 10- and 20-min mindfulness conditions. Exploratory moderation analyses indicated that meditation (10 or 20) versus control (10 or 20) predicted increased state mindfulness among participants with lower trait mindfulness. Additionally, 20-min versus 10-min meditation predicted greater decreases in state anxiety among individuals with high trait mindfulness. Dose-response relationships were minimal, suggesting that 10 and 20 min of meditation may improve state mindfulness comparably. Findings support the benefits of brief mindfulness meditation and suggest that trait mindfulness moderates certain outcomes.

Mindfulness-based Practices in Workers to Address Mental Health Conditions: A Systematic Review

The effectiveness of mindfulness techniques in addressing mental health conditions in workers is uncertain. However, it could represent a therapeutic tool for workers presenting with such conditions. Our objective was to assess the effects of mindfulness-based practices for workers diagnosed with mental health conditions. We conducted a systematic review of randomized controlled trials. Participants included were workers with a mental health condition. Interventions included any mindfulness technique, compared to any nonmindfulness interventions. Outcomes were scores on validated psychiatric rating scales. A total of 4,407 records were screened; 202 were included for full-text analysis; 2 studies were included. The first study (Finnes et al., 2017) used Acceptance and Commitment Therapy (ACT) associated or not with Workplace Dialogue Intervention (WDI), compared to treatment as usual. At 9 months follow-up, for the ACT group, depression scores improved marginally (standardized mean difference [SMD]: -0.06, p = 0.021), but anxiety scores were worse (SMD: 0.15, p = 0.036). Changes in mental health outcomes were not statistically significant for the ACT + WDI group. In the second study (Grensman et al., 2018), no statistically significant change in mental health scales has been observed after completion of mindfulness-based cognitive therapy compared to cognitive behavioral therapy. Substantial heterogeneity precluded meta-analysis. This systematic review did not find evidence that mindfulness-based practices provide a durable and substantial improvement of mental health outcomes in workers diagnosed with mental health conditions.

The State- and Trait-Level Effects and Candidate Mechanisms of Four Mindfulness-Based Cognitive Therapy (MBCT) Practices: Two Exploratory Studies

Objectives

The primary aim was to explore state- and trait-level effects and candidate mechanisms of four Mindfulness-Based Cognitive Therapy (MBCT) practices.

Method

One hundred sixty adults self-selected from the general population were randomized to one of four mindfulness practices: body scan, mindful movement, breath and body, and befriending. Study 1 explored state-level self-compassion, mindfulness, decentering (mechanisms), and pleasantness of thoughts, emotions, and body sensations at multiple time points using two single mindfulness sessions. Study 2 explored trait-level self-compassion, mindfulness, decentering, interoceptive awareness, attentional control (mechanisms), anxiety, depression, and psychological quality of life pre-post 2 weeks of daily practice.

Results

In study 1, state-level effects were demonstrated in all candidate mechanisms and outcomes within the whole sample across time points (d = 0.27 to 0.86), except for state decentering. After controlling for pre-scores and additional covariates, no between-group effects were found (p = 0.050 to 0.973). In study 2, trait-level effects were demonstrated in psychological quality of life and most candidate mechanisms within the whole sample (d = 0.26 to 0.64) but no between-group effects were found (p = 0.080 to 0.805). Within the whole sample, after controlling for pre-scores, changes in mindfulness, self-compassion, decentering, and interoceptive awareness (i.e. body listening) were associated with improvements in psychological quality of life (r = 0.23 to 0.40) and self-led mindfulness practice (r = 0.18 to 0.23).

Conclusions

Future research should test the generated hypotheses using well-designed, adequately powered, and theory-driven studies that address universal and specific mechanisms in different populations and contexts.

Pre-registration

This study is not pre-registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-023-02193-6.

Effects of Induced Mindfulness at Night on Repetitive Negative Thinking: Ecological Momentary Assessment Study

BACKGROUND

Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown.

OBJECTIVE

We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress.

METHODS

A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping.

RESULTS

The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], d_GMA=-0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (d_GMA=-0.78; P<.001) and follow-up (d_GMA=-0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms.

CONCLUSIONS

A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT.

Altered self-reported resting state mediates the effects of Mindfulness-Based Stress Reduction on mental health: a longitudinal path model analysis within a community-based randomized trial with 6-months follow-up

Background

A large body of randomized controlled trials (RCTs) has shown that mindfulness-based interventions are effective for improving mental health, but research is lacking in regards to the mechanisms of change. We aimed to investigate the mediating effects of self-reported altered resting state of Mindfulness-Based Stress Reduction (MBSR) on mental health, when provided as a universal intervention in a real-life context.

Methods

Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in an RCT. The RCT took place in all five geographical regions of Denmark and included 110 schools and 191 schoolteachers. The schools were randomized 1:1 in each geographical region to intervention or a wait-list control group. The intervention was the standardized MBSR. Data were collected at baseline and after 3 and 6  months. The outcomes were perceived stress, measured by Cohen's Perceived Stress Scale (PSS), symptoms of anxiety and depression, measured by Hopkins Symptom Check List-5 (SCL-5), and well-being measured by WHO-5 Well-being Index (WHO-5). The mediator was resting state measured by the Amsterdam Resting State Questionnaire (ARSQ).

Results

Statistically significant mediated effects of altered ARSQ-subscales scores for Discontinuity of Mind, Planning, and Comfort were found for the MBSR effect on all outcomes; PSS, SCL-5 and WHO-5. Furthermore, statistically significant mediated effects of altered sleepiness subscale score of the effects on PSS and SCL-5 of MBSR were found. No statistically significant mediating effects of the subscales Theory of Mind, Self and Somatic Awareness for the MBSR intervention effect were found.

Conclusion

The results support that the MBSR program can alter self-reported resting state, towards less mind wandering and more comfort, measured by the ARSQ, and that this may explain some of the mechanisms regarding the effectiveness of MBSR on mental health at 6 months, when provided as a universal intervention. The study provides insight into an active ingredient of how MBSR may improve mental health and well-being. It supports the suggestions that mindfulness meditation may be a sustainable way of training the mental health.Clinical trial registration:ClinicalTrials.gov, identifier NCT03886363.

Feasibility and Acceptability of an Online Mindfulness-Based Intervention for Stress Reduction and Psychological Wellbeing of University Students in Pakistan: A Pilot Randomized Controlled Trial

The rise in mental health concerns of university students is causing a serious hinderance to their wellbeing, impeding their functioning. The socio-economic and political friction in low- and middle-income countries adds to their vulnerability and calls for a cost-effective indigenous intervention. Consequently, this study aimed to inform a large definitive trial by assessing the feasibility and acceptability of a randomized controlled trial (RCT) design evaluating a culturally adapted online Mindfulness Training Course (MTC) used to improve stress and wellbeing among Pakistani university students. A two-arm pilot randomized controlled trial was conducted. University students (n = 156) were randomly assigned to either the MTC group (n = 80) or Wait-list (WL) control group (n = 76) and completed baseline and post-intervention self-report measures for mindfulness, stress and psychological wellbeing. Additionally, semi-structured interviews were conducted with consenting MTC group participants (n = 18) to explore their views about MTC, employing reflexive thematic analysis. Of 80 participants randomized to the MTC group, 32 completed the course, whereas, from the 156 randomized participants, 102 completed assessment surveys. Feasibility and acceptability indicators showed high recruitment, compliance, and adherence to MTC, with practical steps for randomization and online data collection. Further results showed higher levels of mindfulness and psychological wellbeing and lowered stress levels in the MTC group compared to the control group. The attrition and dropout rates were high; however, the feedback from participants who completed the MTC was highly positive and encouraging. In conclusion, if the trial proceeds with increased outreach in a large-scale RCT, the recruitment might be revised to reduce attrition rates. Further recommendations are discussed.

Validation of online mindfulness-enhanced course for stress reduction in teachers

Background

Mindfulness-based interventions have gained popularity as a means of reducing stress and increasing resilience among the preclinical population. The present study aimed to investigate the effects of an online mindfulness-enhanced course on stress reduction in teachers, especially since online learning and teaching have been frequently applied to respond to emergencies such as COVID-19-relevant school suspension.

Methods

The study consisted of two phases. Phase 1 aimed to explore the relationship between teachers' perceived stress and mindfulness traits. In total of 6,252 teachers completed assessments of stress symptoms using the Chinese Perceived Stress Scale (CPSS) and occupational stress sources, as well as mindfulness using the Five Factor Mindfulness Questionnaire (FFMQ). Phase 2 aimed to examine the effectiveness of the online mindfulness-enhanced course. In total of 132 teachers were randomly assigned to either receive a 3-week online mindfulness course specifically designed for stress reduction and emotion regulation (N = 66) or a matched active control group (N = 66) and their pre-training and post-training self-reported states (e.g., perceived stress, mindfulness level, practice time) were measured.

Results

The detection rate of Health Risk Stress (≥26 scores) was as high as 61.72%, and a negative association between the score of FFMQ and perceived stress level was found. Importantly, compared to the control group, the mindfulness training group showed a significant decrease in perceived stress and negative emotion, as well as an increase in understanding of the core mechanisms of mindfulness after training. Additionally, individual improvement in FFMQ scores was predicted by practice time.

Conclusions

The study showed a high percentage of teachers experiencing stress, and the data supported the reliability and validity of the brief online mindfulness-enhanced course designed to reduce stress and regulate emotion for frontline teachers.

Mindfulness-Based Teaching Competency Assessment: Comparing Self-Assessment With Expert Evaluation in the Veterans Administration - Compassionate Awareness Learning Module Program

Background

Meditation, including Mindfulness-Based Interventions (MBI), is a required Complementary and Integrative Health intervention at the US Department of Veterans Affairs (VA). Training VA clinicians to provide MBI at scale must address fidelity concerns and the assessment of clinician competency.

Objective

The psychometric properties of the Mindfulness-Based Intervention: Teaching Assessment Criteria (MBI:TAC), a widely used tool for assessing facilitator competence, continue to be explored. To support the dissemination of MBI, the utility of using the MBI:TAC for self-assessment for clinicians in a national training program was evaluated.

Methods

In a training cohort of VA clinicians (n = 39), participant self evaluations on 2 domains of the MBI:TAC are compared to the competency scores of 2 expert evaluators as based on the observations of a 10-minute exercise. Additionally, the inter-rater reliability between the 2 experts was explored.

Results

Intraclass Correlation for the 2 expert evaluators for Guiding Practice was significant (ρ = .83, P = .003), but was not significant for Embodiment of Mindfulness (ρ = .34, P = .186). Self-evaluation scores were not significantly correlated to expert rater scores such that participants rate their level of competence higher than expert scores.

Conclusion

The MBI:TAC, while an essential tool in teacher training, may not produce accurate scores when used for self-assessment. Instruction from a senior teacher is needed for accurate scoring. Interrater reliability may be improved with enhanced domain operationalization and training. Implications for MBI training are explored.

Intervention Fidelity in Mindfulness-Based Research and Practice: Developing Criteria to Acknowledge New Training Programs

The field of mindfulness-based research and practice is expanding fast. This development calls for a careful evaluation of the merits and scientific underpinnings of newly developed mindfulness-based programs (MBP's). In this viewpoint, we describe a process initiated by two professional mindfulness teacher training organisations (the Dutch Vereniging Mindfulness-based Trainers Nederland, VMBN, and the British Association of Mindfulness-based Approaches, BAMBA) to develop a framework for evaluating the integrity of newly developed MBP's. The framework aims to articulate criteria describing the elements and processes required to ensure that a new MBP meets good practice, adheres to evidenced-based practice, and is attending to the challenge of implementation and scalability. The development and implementation of the criteria are still a 'work in progress'. We hope that this initiative offers a foundation for supporting the MBP field to balance innovation and grassroot community development with aligning to the principles of evidence-based practice.

The psychometric properties of the Vietnamese Version of the Five Facet Mindfulness Questionnaire

BACKGROUND

Although recent decades have witnessed a growing interest in mindfulness with the development of many mindfulness scales and their adaptation to different cultures, there has been no attempt at developing or adapting a mindfulness scale for Vietnamese people. To fill this gap and encourage the study of mindfulness in Vietnam, we adapted a 20-item short-form of the Five Facet Mindfulness Questionnaire (FFMQ-20) into Vietnamese, which we called the FFMQ-V, and examined its psychometric properties in a series of three independent studies.

METHODS

In Study 1, using a college sample (N = 412) we conducted several exploratory factor analyses to elucidate the factor structure of the FFMQ-V. In Study 2, using an independent college sample (N = 344) we performed a confirmatory factor analysis (CFA) to test the goodness-of-fit for all obtained factor models from Study 1. In this study, we also examined the discriminant validities of the FFMQ-V by correlating mindfulness and other related psychological constructs, including acceptance, nonattachment, depression, anxiety, and stress. In Study 3, we replicated all data analyses in Study 2 using a community sample of young adults (N = 574).

RESULTS

Across all Studies, our results indicated that the hierarchical five-factor model with method factors best captured the latent structure of the FFMQ-V. Our results also showed that the mindfulness facets met our expectations as they correlated positively with the acceptance and nonattachment and negatively with the depression, anxiety, and stress.

CONCLUSIONS

In aggregate, our EFA and CFA results provided strong evidence for the hierarchical five-factor model with method factors in both community and college samples, suggesting that the FFMQ-V can be used to measure trait mindfulness of the Vietnamese young adults.

Social-Ecological Measurement of Daily Life: How Relationally Focused Ambulatory Assessment can Advance Clinical Intervention Science

Individuals’ daily behaviors and social interactions play a central role in the diagnosis and treatment of psychological disorders. Despite this, observational ambulatory assessment methods—research methods that allow for direct and passive assessment of individuals’ momentary activities and interactions—have a remarkably scant history in the clinical science field. Prior discussions of ambulatory assessment methods in clinical science have focused on subjective methods (e.g., ecological momentary assessment) and physiological methods (e.g., wearable heart rate monitoring). Comparatively less attention has been dedicated to ambulatory assessment methods that collect objective, relational data about individuals’ social behaviors and their interactions with their momentary environmental contexts. Drawing on extant social-ecological measurement frameworks, this article first provides a conceptual and psychometric rationale for the integration of daily relational data into clinical science research. Next, the nascent research applying such methods to clinical science is reviewed, and priorities for further research organized by the NIH Stage Model for Clinical Science Research are recommended. These data can provide unique information about the social contexts of diverse patient populations; identify social-ecological targets for transdiagnostic, precision, and culturally responsive interventions; and contribute novel data about the effectiveness of established interventions at creating behavioral and relational change.

A common factors perspective on mindfulness-based interventions

Mindfulness-based interventions (MBIs) have entered mainstream Western culture in the past four decades. There are now dozens of MBIs with varying degrees of empirical support and a variety of mindfulness-specific psychological mechanisms have been proposed to account for the beneficial effects of MBIs. Although it has long been acknowledged that non-specific or common factors might contribute to MBI efficacy, relatively little empirical work has directly investigated these aspects. In this Perspective, I suggest that situating MBIs within the broader psychotherapy research literature and emphasizing the commonalities rather than differences between MBIs and other treatments might help guide future MBI research. To that end, I summarize the evidence for MBI efficacy and several MBI-specific psychological mechanisms, contextualize MBI findings within the broader psychotherapy literature from a common factors perspective, and propose suggestions for future research based on innovations and challenges occurring within psychotherapy research.

Dose–response Relationship of Reported Lifetime Meditation Practice with Mental Health and Wellbeing: a Cross-sectional Study

Objectives

Meta-analyses of meditation studies have revealed mixed modest evidence of benefits across a range of outcomes. However, because this evidence-base is predominantly from brief interventions, it is unclear whether it accurately reflects how contemporary meditators practice or the dose–response relationship between amount of practice and outcome. This study sought to characterize how contemporary meditators practice, examine any possible dose–response relationships between historical practice and measures of psychological wellbeing, and explore which characteristics of practice most strongly predict favorable psychological outcomes.

Methods

One thousand six hundred and sixty-eight meditators (M = 1095 h practice, SD = 2365) responded to advertisements in meditation practice communities and social media. We explored associations between demographics, meditation practice characteristics, and outcomes including positive and negative affect, psychological distress, and life satisfaction in a cross-sectional study design.

Results

Historical meditation practice (accumulated lifetime hours) was significantly associated with favorable psychological outcomes (|r| ranging from .18 to .28). Model fit was optimized with a generalized additive model (average increase in R² = 2.22), indicating non-linear effects. The strength of association between practice time and outcomes was generally strongest for approximately the first 500 h, before plateauing. Several practice types including Vipassana (as taught by S.N. Goenka) and cultivating practices (e.g. compassion, lovingkindness) were more strongly predictive of favorable psychological outcomes.

Conclusions

Benefits of meditation accrue over time in a non-linear manner, and show variation based on practice context. These results highlight the importance of understanding how the benefits of meditation accrue over longer time durations than typical standardized programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01977-6.

Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training

OBJECTIVE

Sleep disturbance is experienced by nearly 20% of Americans and is highly comorbid with anxiety. Sleep disturbances may predict the development of anxiety disorders. Mindfulness training (MT) has shown efficacy for anxiety yet remains limited by in-person-based delivery. Digitally delivered MT may target habitual worry processes, yet its effects on sleep have not been studied. This study tested if app-based MT for anxiety could reduce worry and improve sleep and examined the underlying mechanisms.

METHODS

Individuals reporting worry interfering with sleep were randomized to treatment as usual (TAU; n = 40) or TAU + app-based MT (n = 40). Treatment-related changes in worry-related sleep disturbances (WRSDs), worry, nonreactivity, and anxiety were evaluated via self-report questionnaires at 1 and 2 months after treatment initiation. Fitbit devices were used to record total sleep time and estimate sleep efficiency. At 2 months, TAU received access to app-based MT, and both groups were reassessed at 4 months.

RESULTS

In a modified intent-to-treat analysis, WRSD scores decreased by 27% in TAU + MT (n = 36) and 6% in TAU (n = 35) at 2 months (median [IQR] change = 11 [4.3] versus 15 [5.0], p = .001). These WRSD reductions were mediated by decreased worry, particularly improved nonreactivity (p values < .001). At 4 months, TAU reported a significant 29% reduction after beginning app-based MT at 2 months and TAU + MT maintained its gains. No significant between-group differences in average estimated total sleep time or sleep efficiency were found after 2 months of using the app.

CONCLUSIONS

Few mindfulness-related apps have been evaluated for clinical efficacy and/or mechanism. Results from this study demonstrate a mechanistic link between MT and increased emotional nonreactivity, decreased worry, and reduction in reported sleep disturbances, suggesting that app-based MT may be a viable option to help individuals who report that worry interferes with their sleep.Trial Registration: ClinicalTrials.gov identifier: NCT03684057.

The impact of session-introducing mindfulness and relaxation interventions in individual psychotherapy for children and adolescents: a randomized controlled trial (MARS-CA)

Background

The investigation of mindfulness-based interventions (MBIs) in cognitive-behavioral therapy has greatly increased over the past years. However, most MBI research with youth focuses on structured, manualized group programs, conducted in school settings. Knowledge about the implementation and effects of MBIs in individual psychotherapy with children and adolescents is scarce. To fill this research gap, the “Mindfulness and Relaxation Study – Children and Adolescents” (MARS-CA) is designed. It aims to assess the effects of short session-introducing interventions with mindfulness elements on juvenile patients’ symptomatic outcome and therapeutic alliance in individual child and adolescent psychotherapy.

Methods

MARS-CA is conducted at a university outpatient training center for cognitive-behavior therapy. Short session-introducing interventions with mindfulness elements will be compared to short session-introducing relaxation interventions and no session-introducing intervention to explore their effects on symptomatic outcome and therapeutic alliance. The session-introducing interventions will take place at the beginning of 24 subsequent therapy sessions. We hypothesize that patients’ symptomatic outcome and therapeutic alliance improve more strongly in the mindfulness condition than in the other two conditions and that the mindfulness condition moderates the relationship between therapeutic alliance and symptomatic outcome. Patients and their trainee therapists will be randomized to one of the three treatment arms. Participants aged between 11 and 19 years and having a primary diagnosis of either a depressive disorder, an anxiety disorder, or a hyperkinetic disorder will be included. Therapeutic alliance will be assessed after every therapy session (therapy session 1 to therapy session 24), symptomatic outcome will be assessed before the start of treatment (pre), after the 3rd, the 10th, and the 17th therapy sessions, at the end of treatment (24th therapy session, post), and at a 6-month follow-up. Additionally, mindfulness and mindfulness-related measures as well as demographic data, adherence, allegiance, and therapeutic techniques will be assessed. It is our aim to assess a sample of 135 patients. We will conduct multilevel modeling to address the nested data structure.

Discussion

The study can provide information about how add-on MBIs, conducted by trainee therapists, influence therapeutic alliance and symptomatic outcome in individual psychotherapy in children and adolescents.

Trial registration

ClinicalTrials.gov NCT04034576. Registered on July 17, 2019

Building a More Diverse and Inclusive Science: Mindfulness-Based Approaches for Latinx Individuals

Objectives

This article represents a call to action for the mindfulness field to be more diverse and inclusive of Latinx individuals. Building a diverse and inclusive science around mindfulness-based approaches (MBAs) that considers important group-level cultural and contextual information is an important public health challenge in need of innovative solutions.

Methods

We describe ways that the Latinx population is poised to benefit from MBAs. We further elucidate challenges, describe potential solutions, and outline a research agenda that may hold promise for building a more inclusive mindfulness movement.

Results

Our recommendations center around developing nuanced cultural adaptations to MBAs, engaging Latinx individuals in research, increasing the rigor of scientific studies pertaining to Latinx individuals, relying on implementation science to develop innovative methods for disseminating MBAs to Latinx individuals, developing training and certification mechanisms to increase diversity and representation of Latinx mindfulness teachers, and creating mechanisms for the oversight of MBAs within this group.

Conclusions

There has been a lack of inclusivity of Latinx individuals in the field of MBAs with regards to research studies, barriers to access for economically disadvantaged groups, and lack of diversity in its workforce. Considering the recognition of adverse social drivers of health that generate chronic stress and health disparities, the Latinx population is especially poised to benefit greatly from MBAs. A diverse and inclusive mindfulness science holds promise to enhance the effectiveness, acceptability, feasibility, and wide-scale dissemination and implementation of MBAs.

Differentiating Third-Wave Cognitive Mindfulness From Meditative Mindfulness Using a Gurdjieffian Phenomenology of Awareness

Current literature on mindfulness offers inadequate distinction between neo-traditional mindfulness and cognitive behavioral mindfulness, to the extent that both approaches can be included within the same meta-analyses. A close examination of the mechanisms of action in several forms of mindfulness using a lens of Gurdjieffian phenomenology of awareness can point toward a clear and well defined distinction between varieties of mindfulness. The phenomenology of cognitive behavioral mindfulness suggests that it involves an enhanced attention to the cognitive contents of awareness, as in Gurdjieff’s second state, but give no evidence of attaining self-reflexive awareness in which attention attunes to its own presence as the context of cognitive processes. Neo-traditional and meditative forms of mindfulness are more likely to attend to both the contents and the context of consciousness, a change associated with a shift in state of consciousness. Using Gurdjieff’s phenomenology of awareness, neo-traditional mindfulness can be seen as similar to Gurdjieff’s self-remembering, in which awareness attends to the cognitive contents of experience as well as to its own presence. Cognitive behavioral versions of mindfulness differ from both of these in that the object of attention does not extend self-reflexively beyond cognitive contents.

Mindfulness-Based Programs: Why, When, and How to Adapt?

This paper provides a framework for understanding why, when and how to adapt mindfulness-based programs (MBPs) to specific populations and contexts, based on research that developed and adapted multiple MBPs. In doing so, we hope to support teachers, researchers and innovators who are considering adapting an MBP to ensure that changes made are necessary, acceptable, effective, cost-effective, and implementable. Specific questions for reflection are provided such as (1) Why is an adaptation needed? (2) Does the theoretical premise underpinning mainstream MBPs extend to the population you are considering? (3) Do the benefits of the proposed adaptation outweigh the time and costs involved to all in research and implementation? (4) Is there already an evidenced-based approach to address this issue in the population or context? Fundamental knowledge that is important for the adaptation team to have includes the following: (1) essential ingredients of MBPs, (2) etiology of the target health outcome, (3) existing interventions that work for the health outcome, population, and context, (4) delivery systems and settings, and (5) culture, values, and communication patterns of the target population. A series of steps to follow for adaptations is provided, as are case examples. Adapting MBPs happens not only by researchers, but also by MBP teachers and developers, who endeavor to best serve the populations and contexts they work within. We hope that these recommendations for best practice provide a practical framework for skilfully understanding why, when, and how to adapt MBPs; and that this careful approach to adaptation maximizes MBP safety and efficacy.

Exploring Fidelity in School-Based Mindfulness Programs

A small but growing body of research on school-based mindfulness programs (SBMPs) has demonstrated benefits for students' cognitive and affective functioning and overall wellbeing. Yet, lack of fidelity in SBMP implementation may diminish these programs' purported benefits. This commentary presents 4 current challenges that need to be addressed so that questions of whether and how mindfulness improves student functioning can be clarified and implementation of programs can be strengthened and sustained. These challenges include coming to consensus on the definition and intention of mindfulness training, balancing adherence with flexibility in SBMP delivery, determining the role SBMP teachers' mindfulness experience plays in program fidelity, and delineating distinctive features of mindful pedagogy. Some suggestions for addressing each of these challenges are provided.

Headspace for parents: qualitative report investigating the use of a mindfulness-based app for managing parents' stress during COVID-19

BACKGROUND

Stress can compromise parental well-being and may contribute to harsh and critical parenting styles, which are in turn associated with children's conduct problems. Coronavirus disease 2019 (COVID-19)-related restrictions are likely to have exacerbated parental stress as, for many, UK-based family life was altered considerably. Mindfulness has been demonstrated to improve stress management and emotion regulation when delivered to parents in person, however, more accessible online interventions are under-researched.

AIMS

To provide preliminary data on family well-being and parent-child relationships as well as the acceptability and usability of the Headspace app - a self-delivered mindfulness-based intervention - for parents in low-risk families during the early days of the COVID-19 pandemic.

METHOD

We provided 12 parents with access to Headspace, and collected qualitative data (semi-structured interviews and 5 minute speech samples) immediately following the initial COVID-19 lockdown in the UK. The resulting transcripts were thematically analysed.

RESULTS

Most parents reported Headspace to be acceptable and useful - improvements in parents' own sleep were particularly noted - and there was high adherence to the intervention. However, difficulties related to family well-being and parent-child relationships following the lockdown were also reported.

CONCLUSIONS

As a result of the confounding impact of COVID-19 restrictions, and varied access to app content, we were unable to determine any outcomes to be a result of practising mindfulness specifically. However, COVID-19 has had a profound impact on many UK-based families, including those previously at low risk, and our results demonstrate that Headspace may have beneficial effects for parents. There is a need to more rigorously test this tool with a broader range of families.

The Effects of a Mindfulness Program on Mental Health in Students at an Undergraduate Program for Teacher Education: A Randomized Controlled Trial in Real-Life

Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction (MBSR) on the mental health of student teachers when offered at their educational institution in a real-life context.

Methods: A parallel randomized controlled trial (RCT) was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of (1) clinical depression or a diagnosis of psychosis or schizophrenia, (2) abuse of alcohol, drugs, and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling.

Results: The study group included 67 student teachers with 34 allocated to the intervention group (median age: 25 years; women: n = 24, 71%); and 33 students (median age: 25 years; women: n = 25, 76%) allocated to a waiting list control group. At baseline, mean Perceived Stress Scale (PSS) scores were 18.88 (SD: 5.75) in the intervention group and 17.91 (SD: 6.36) in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up (28 in both the intervention- and the control group). Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found.

Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts.

Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099].

The Implementation of Mindfulness-Based Programs in the Swedish Healthcare System-A Qualitative Study

Background:

As the provision of Mindfulness-Based Programs (MBPs) in health care settings progresses, more research is needed to develop guidelines and structures for implementation in various contexts. This study is part of a larger project were MBP provision in Sweden is explored.

Objective:

The objective is to provide knowledge for the next steps of MBP implementation both in Sweden and internationally. The specific aim of the study is to explore how MBP teachers and other relevant stakeholders experience the implementation of MBP.

Methods:

Qualitative in-depth interviews were conducted with 15 MBP providers and 2 other stakeholders from a range of health care settings in Sweden.

Results:

The results, presented in 3 themes, provide insights into the factors that are crucial for facilitating or hindering MBP implementation; (1) MBP teachers and their training, including the importance of champion individuals and the benefit and shortcomings of various forms of MBP; (2) Patients and patient referrals, including patient characteristics and referral pathways; (3) Organizational prerequisites to successful implementation, highlighting the importance of financial factors and managers’ and colleagues’ knowledge and acceptance of MBP; and (4) the need for structural changes, including future recommendations on quality assessment and guidelines.

Conclusion:

This study highlights the need for national guidelines for MBP provision and teacher training pathways, as well as improved availability of teacher training. Also, the benefit of a stepped-care model of MBP provision is indicated by the findings. Finally, increasing awareness of MBPs among referrers, managers, and the public may enable successful implementation.

The protective effect of mindfulness and compassion meditation practices on ageing: Hypotheses, models and experimental implementation

Alzheimer's disease (AD) represents a major health and societal issue; there is no treatment to date and the pathophysiological mechanisms underlying this disease are not well understood. Yet, there is hope that AD risk factors and thus the number of AD cases can be significantly reduced by prevention measures based on lifestyle modifications as targeted by non-pharmacological preventive interventions. So far, these interventions have rarely targeted the psycho-affective risk factors related to depression, stress, anxiety, and feeling of loneliness, which are all prevalent in ageing. This paper presents the hypothesis that the regular practice of mindfulness meditation (MM) and loving-kindness and compassion meditation (LKCM) in the ageing population constitutes a lifestyle that is protective against AD. In this model, these practices can promote cognition, mental health, and well-being by strengthening attention control, metacognitive monitoring, emotion regulation and pro-social capacities. Training these capacities could reduce the risk of AD by upregulating beneficial age-related factors such as cognitive reserve, and down-regulating detrimental age-related factors, such as stress, or depression. As an illustration, we present the Medit-Ageing study (public name Silver Santé Study), an on-going European project that assesses the impact and mechanisms of non-pharmacological interventions including meditation, in the ageing population.

The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance

Objectives

Evidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants' characteristics on symptom improvement.

Methods

Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment.

Results

Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement.

Conclusions

According to our results, MBCT can be effectively and safely delivered in primary care.

The Implementation of Mindfulness-Based Programs in the Swedish Healthcare System - A Survey Study of Service Providers

Background

The burden of depression and anxiety is on the rise globally. Mindfulness-Based Programs (MBPs) are a particular group of psychosocial programs targeting depression and anxiety. There is growing research and practice interest in MBPs internationally, and they are becoming more commonly implemented in a number of countries’ healthcare services.

Objective

To systematically map the existing provision of MBPs in the Swedish healthcare sector, in order to understand facilitators and barriers to uptake, and so inform future implementation efforts.

Methods

We assessed the experiences of MBP implementation among relevant stakeholders in Swedish healthcare settings through an online survey. The survey was designed to gather data on (1) the evidence-base of practice being implemented; (2) the context in which implementation was taking place and (3) the process of facilitation. Respondents were identified through snowball sampling of key stakeholders.

Results

In total, 129 individuals from 20 of the 21 healthcare regions in Sweden responded to the survey. Our findings showed that there is variation in the types of MBP models being implemented, and that the delivery structure of evidence-based programs were often being modified for implementation. We found some divergence from international guidance on good practice standards for the training of MBP teachers within Swedish implementation processes. The main service context for implementation is primary care; the most important facilitating factors for successful MBP implementation were the presence of a championing individual and support from leadership. The most influential hindering factors for implementation were lack of time, and lack of funding.

Conclusion

To support integrity and fidelity of MBP implementation in Sweden, a strategic plan and good practice guidelines seem necessary. Also, an evidence-based stepped care model for implementation may work to ensure intervention fidelity in cases where time and funding constraints permit.

Investigating differential effects of socio-emotional and mindfulness-based online interventions on mental health, resilience and social capacities during the COVID-19 pandemic: The study protocol

BACKGROUND

The SARS-CoV-2 pandemic has led to a mental health crisis on a global scale. Epidemiological studies have reported a drastic increase in mental health problems, such as depression and anxiety, increased loneliness and feelings of disconnectedness from others, while resilience levels have been negatively affected, indicating an urgent need for intervention. The current study is embedded within the larger CovSocial project which sought to evaluate longitudinal changes in vulnerability, resilience and social cohesion during the pandemic. The current second phase will investigate the efficacy of brief online mental training interventions in reducing mental health problems, and enhancing psychological resilience and social capacities. It further provides a unique opportunity for the prediction of intervention effects by individual biopsychosocial characteristics and preceding longitudinal change patterns during the pandemic in 2020/21.

METHODS

We will examine the differential effects of a socio-emotional (including 'Affect Dyad') and a mindfulness-based (including 'Breathing Meditation') intervention, delivered through a web- and cellphone application. Participants will undergo 10 weeks of intervention, and will be compared to a retest control group. The effectiveness of the interventions will be evaluated in a community sample (N = 300), which is recruited from the original longitudinal CovSocial sample. The pre- to post-intervention changes, potential underlying mechanisms, and prediction thereof, will be assessed on a wide range of outcomes: levels of stress, loneliness, depression and anxiety, resilience, prosocial behavior, empathy, compassion, and the impact on neuroendocrine, immunological and epigenetic markers. The multi-method nature of the study will incorporate self-report questionnaires, behavioral tasks, ecological momentary assessment (EMA) approaches, and biological, hormonal and epigenetic markers assessed in saliva.

DISCUSSION

Results will reveal the differential effectiveness of two brief online interventions in improving mental health outcomes, as well as enhancing social capacities and resilience. The present study will serve as a first step for future application of scalable, low-cost interventions at a broader level to reduce stress and loneliness, improve mental health and build resilience and social capacities in the face of global stressors.

TRIAL REGISTRATION

This trial has been registered on May 17, 2020 with the ClinicalTrials.gov NCT04889508 registration number (clinicaltrials.gov/ct2/show/NCT04889508).

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

What do people mean when they talk about mindfulness?

Psychological theories cast mindfulness as a form of awareness in which accepting the presence of stressful thoughts and feelings facilitates engaged exploration and identification of adaptive responses. Critics of mindfulness' popularization suggest that lay people misconstrue acceptance as a passive endorsement of experience, undermining engaged problem-solving. To evaluate this criticism, we traced the contemporary semantic meaning of mindfulness in three of the most extensive linguistic corpora of English language and found that general public's depictions of mindfulness highlight engagement-related processes. We further analyzed the nomological network of mindfulness. While mindfulness theories suggest a general convergence of facets representing awareness and acceptance, in a meta-analysis (k = 145; N = 41,966) of the Five Facet Mindfulness Questionnaire only expert- and clinical samples reported convergence, whereas lay people showed absent or even antagonistic associations. Further, contrary to the synergistic model of awareness and acceptance contributing to greater engagement, empirical probes of two lay samples (N_total = 406) show that acceptance is either unrelated or inversely related to markers of engagement. To overcome resulting conceptual and methodological challenges, we highlight the need for a contextualized mindfulness framework whereby acceptance enables the process of engaging with life's challenges rather than avoiding them.

Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention?

BACKGROUND

Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice.

METHODS

Data were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning.

RESULTS

Adherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37-0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect.

CONCLUSIONS

After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.

Mindfulness interventions for offsetting health risk following early life stress: Promising directions

Early life stress (ELS), common to childhood maltreatment, socioeconomic disadvantage, and racial discrimination, is thought to create a proinflammatory phenotype that increases risk for poor health in adulthood. Systemic change is needed to address the root causes of ELS, but a substantial number of adults are already at increased health risk by virtue of ELS exposure. Interventions that target stress pathways have the potential to interrupt the trajectory from ELS to inflammatory disease risk in adulthood. Mindfulness-based interventions (MBIs), which train acceptance toward present-moment experience, have shown promise for reducing stress and improving a variety of stress-sensitive health outcomes. Although MBIs have primarily been conducted in more advantaged populations, evidence suggests that they may be uniquely effective for improving mental health and health-related quality of life among those with a history of ELS. Whether these effects extend to physical health remains unknown. To shed light on this question, I review evidence that MBIs influence inflammatory markers in at-risk samples, explore the promise of MBIs for improving stress-related health outcomes in diverse at-risk populations, and describe adaptations to MBIs that may increase their acceptability and efficacy in populations exposed to ELS. This prior work sets the stage for well-controlled RCTs to evaluate whether MBIs influence stress and inflammatory pathways among those exposed to ELS and for pragmatic and implementation trials focused on disseminating MBIs to reach these at-risk populations. Overall, the evidence assembled here shows the potential of MBIs for offsetting physical health risk related to ELS.

Examining the Moderating Effect of Mindfulness on the Relationship between Soldiers’ Perceived Stress and Hopelessness

Mindfulness is a type of meditation in which one consciously pays attention to being fully present in the moment. Research has shown that mindfulness can lower anxiety, stress, and hopelessness. This fact may also apply to people in special circumstances, such as those in the military. Therefore, we examined the relationship between perceived stress, mindfulness, and hopelessness among military soldiers. Specifically, we verified the moderating effect of mindfulness on the relationship between perceived stress and mindfulness. We surveyed 309 Korean military soldiers and a total of 257 data were analyzed through descriptive statistical analysis, correlation analysis, and regression analysis. Our results showed that perceived stress, mindfulness, and hopelessness are interrelated, and that mindfulness moderated the influence of perceived stress on hopelessness. In other words, the lower the level of mindfulness, the greater the hopelessness when the perceived stress increased. This study suggests that conducting mindfulness training for soldiers can benefit soldiers’ adaptation to military life.

First, do no harm: An intensive experience sampling study of adverse effects to mindfulness training

OBJECTIVE

The study of safety and adverse effects of mindfulness-based interventions (MBIs) is limited. We propose a novel reliable change index (RCI) approach to experience sampling (ES) data to begin to understand the common domains, frequency, severity, risk for, and context of adverse responding to mindfulness meditation practice and brief MBI.

METHODS

Over the course of a 21-day MBI among 82 meditation-naïve participants, we estimated (i) momentary adverse effects during mindfulness meditation practice and (ii) sustained adverse effects in daily living following the intervention.

RESULTS

First, RCI analyses of experience sampling of mindfulness meditation document that 87% of participants demonstrated at least one momentary adverse effect during meditation, most commonly anxiety; and subject-level temporal variability or instability in experience samples of daily living did not account for momentary adverse effects attributed to mindfulness meditation sessions. Second, 25% of participants experienced a sustained adverse effect in daily living at post-intervention. Yet, neither momentary adverse effects to meditation nor vulnerability factors at pre-intervention predicted adverse effects at post-intervention.

CONCLUSIONS

Findings illustrate that mindfulness meditation may be transiently anxiogenic for many participants, yet, these experiences are unlikely to constitute objective harm per se. Furthermore, observed deterioration in daily living post-intervention cannot be attributed to momentary adverse effects in response to mindfulness meditation. We speculate that observed deterioration in daily living post-intervention may thus be better explained by increased awareness to internal states following mindfulness training. Findings highlight the potential utility of applying a RCI approach to intensive ES measurement to quantify adverse effects of mindfulness training specifically and mental health interventions broadly.

The Daily Dose-Response Hypothesis of Mindfulness Meditation Practice: An Experience Sampling Study

OBJECTIVE

Because of fast-growing interest in the applications of mindfulness to promote well-being and mental health, there are field-wide efforts to better understand how mindfulness training works and thereby to optimize its delivery. Key to these efforts is the role of home practice in mindfulness-based intervention (MBI) outcomes. Despite its centrality in MBIs, recent reviews have documented limited and mixed effects of home practice on MBI outcomes. However, methodological issues regarding monitoring and quantifying home practice and focus on cumulative or additive effects may limit our understanding of it. Temporally proximate, more transient, and contextually circumscribed effects of mindfulness mediation practice have not been examined.

METHODS

We applied intensive experience sampling to measure daily practice and levels of targeted proximal outcomes (state mindfulness, decentering, emotional valance, and arousal) of training over the course of a 21-day MBI among a community-based sample of 82 meditation-naive adults.

RESULTS

Despite intensive experience sampling, we found no evidence of cumulative or additive effects of total mindfulness meditation practice on outcomes at postintervention for mindfulness, decentering, emotional valence, or emotional arousal. However, we found that that daily dose of mindfulness meditation home practice significantly predicted same-day levels of state mindfulness (B = 0.004, SE = 0.001, t = 3.17, p = .000, f2 = 0.24), decentering (B = 0.004, SE = 0.001, t = 2.757, p = .006, f2 = 0.05), and emotional valence (B = 0.006, SE = 0.003, t = 2.015, p = .044, f2 = 0.01) but not daily levels of emotional arousal. Daily dose-response practice effects did not carry over to next-day levels of monitored outcomes.

CONCLUSIONS

Findings show that effects of daily home mindfulness meditation practice dose on state mindfulness, decentering, and positive emotion are reliable but transient and time-limited. Findings are discussed with respect to the proposed daily dose-response hypothesis of mindfulness meditation practice.

Harnessing Life's Slings and Arrows: The Science and Opportunities for Mindfulness Meditation During a Global Pandemic and Beyond

ABSTRACT

We are at a difficult time in history with societal increases in stress, loneliness, and psychopathology, along with high rates of obesity, sedentary lifestyles, and chronic pain. Mindfulness interventions offer promise to address these societal issues. However, in order to make best use of the opportunities revealed by our current challenges, we must: (1) tackle these issues head-on with inclusive, innovative, and creative experimental designs and interventions, and (2) collectively adhere to rigorous, high quality methods so as to provide an evidence-based integration of mindfulness interventions into mainstream medicine and public health.We find there are several areas for which important advances are happening, including sampling socially diverse populations, examining mechanisms of action, pain management, and health behaviors. Furthermore, rigorous methods, including measurement, causal inference from control groups, delivery and scalability of mindfulness interventions, and effect modifiers to determine who mindfulness programs work best for are also gaining traction. This special issue on Mindfulness: Biobehavioral Mechanisms and Health Outcomes attends to many of these issues, several of which are highlighted in this editorial perspective.

The Effects of Mindfulness and Meditation on Vagally Mediated Heart Rate Variability: A Meta-Analysis

OBJECTIVE

Heart rate variability (HRV) is a marker of autonomic nervous system function associated with both physical and mental health. Many studies have suggested that mindfulness and meditation-based interventions (MBIs) are associated with improvements in HRV, but findings are mixed, and to date, no comprehensive meta-analysis has synthesized results.

METHODS

Systematic literature searches were conducted using PsycINFO, Embase, Medline, CINAHL, ERIC, and Scopus to identify randomized controlled trials (RCTs) investigating the effects of predominantly seated MBIs on resting-state vagally mediated HRV. Risk of bias was judged using the Cochrane Risk of Bias tool.

RESULTS

Nineteen RCTs met the criteria for inclusion in the meta-analysis. Random-effects meta-analysis found that MBIs were not efficacious in increasing vagally mediated resting-state HRV relative to control conditions (Hedges g = 0.38, 95% confidence interval [CI] = -0.014 to 0.77). When removing an outlier (g = 3.22), the effect size was reduced, CI narrowed, and findings remained nonsignificant (g = 0.19, 95% CI = -0.02 to 0.39). High heterogeneity in results (I2 = 89.12%) could not be explained by a priori-determined moderators including intervention duration, study setting, and control type.

CONCLUSIONS

There is currently insufficient evidence to indicate that MBIs lead to improvements in vagally mediated HRV over control conditions. Future large, well-designed RCTs with low risk of methodological bias could help add to the current evidence to elucidate any role MBIs might play in impacting HRV.

Mindfulness practice for protecting mental health during the COVID-19 pandemic

Emerging evidence shows that the coronavirus disease 2019 (COVID-19) pandemic is negatively affecting mental health around the globe. Interventions to alleviate the psychological impact of the pandemic are urgently needed. Whether mindfulness practice may protect against the harmful emotional effects of a pandemic crisis remains hitherto unknown. We investigated the influence of mindfulness training on mental health during the COVID-19 outbreak in China. We hypothesized that mindfulness practitioners might manifest less pandemic-related distress, depression, anxiety, and stress than non-practitioners and that more frequent practice would be associated with an improvement in mental health during the pandemic. Therefore, we assessed pandemic-related distress and symptoms of depression, anxiety, and stress, as well as the frequency of meditation practice at the peak of new infections (Feb 4-5; N = 673) and three weeks later (Feb 29-30; N = 521) in mindfulness practitioners via online questionnaires. Self-reported symptoms were also collected from non-practitioners at peak time only (N = 1550). We found lower scores of pandemic-related distress in mindfulness practitioners compared to non-practitioners. In general, older participants showed fewer symptoms of depression and anxiety. In younger practitioners, pandemic-related distress decreased from peak to follow-up. Importantly, increased mindfulness training during the preceding two weeks was associated with lower scores of depression and anxiety at both assessments. Likewise, practice frequency predicted individual improvement in scores of depression, anxiety, and stress at follow-up. Our results indicate that mindfulness meditation might be a viable low-cost intervention to mitigate the psychological impact of the COVID-19 crisis and future pandemics.