A Brief Online Mindfulness Intervention for Women's Sexual Desire: The BROWSE Study

With growing interest in developing digital health tools for treating sexual dysfunction, this pilot study aimed to determine feasibility and gather preliminary efficacy data of a self-led online mindfulness intervention in comparison to an online psychoeducational intervention for women's low sexual desire in a community sample (N = 57). After a four-week intervention, participants showed overall improvements on sexual functioning, orgasm, sexual self-pleasure, sexual self-image, and sexual distress, in both treatment arms. Majority completed assigned homework and felt the intervention enhanced their sexual well-being. This study supports the feasibility of a self-led online mindfulness intervention that could help inform future programs.

Embodied Mindfulness Questionnaire: Scale Development and Validation

Recently developed mindfulness scales have integrated aspects of the body in measuring mindfulness unlike other established scales. However, these scales focused solely on body awareness and did not embrace all aspects of mindfulness and the body. Specifically, they did not integrate embodiment in mindfulness. The proposed Embodied Mindfulness Questionnaire (EMQ) aims to operationalize the proposed notion of "embodied mindfulness" by grounding it into five dimensions, each representing a set of skills that can be cultivated through training and practice: (a) Detachment from Automatic Thinking, (b) Attention and Awareness of Feelings and Bodily Sensations, (c) Connection with the Body, (d) Awareness of the Mind-Body Connection, and (e) Acceptance of Feelings and Bodily Sensations. The EMQ items were developed through consultations with a panel of eight graduate students and a group of 10 experts in the field. Results from a series of three studies supported the proposed five subscales of EMQ and suggested that these subscales are independent and supported by convergent and discriminant evidence. In addition, results suggested that scores of EMQ subscales are different in terms of sensitivity to mindfulness training or meditation practice and experience. Limitations, as well as theoretical and practical implications of the EMQ subscales, are thoroughly discussed.

Linking Cognitive Reappraisal and Expressive Suppression to Mindfulness: A Three-Level Meta-Analysis

Cognitive reappraisal and expressive suppression have long been considered the two most important emotion regulation strategies. Increasingly, studies have found that mindfulness has a relationship with them. However, the magnitude and direction of the relationship between them have yet to reach a consistent conclusion. To this end, a three-level meta-analysis was used to explore the relationship between mindfulness, cognitive reappraisal, and expressive suppression. Thirty-six studies were included in the meta-analysis through a literature search, including 36 samples with 83 effect sizes and a total of 12,026 subjects. The three-level random effects model showed that mindfulness was positively correlated with cognitive reappraisal to a low to moderate degree but was not correlated with expressive suppression. The moderating effect analysis showed that the relationship between mindfulness and cognitive reappraisal was slightly closer in males than in females. The study found a relatively stable positive relationship between mindfulness and cognitive reappraisal, an adaptive emotion regulation mode, while the relationship with expressive suppression was insignificant. The finding supported the affect regulation training model and also shed light on potential areas for future studies.

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

Objectives

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

Method

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

Results

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

Conclusions

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

A multi-method exploration of mindfulness as a coping tool: Perspectives from trauma-exposed, unhoused women residing at a drug treatment facility

This multi-method study examined perspectives on mindfulness and coping strategies used by trauma-exposed women experiencing homelessness (WEH), residing in a state-funded residential drug treatment site in Southern California (United States). Questionnaires and in-depth focus group interviews were utilised to examine traumatic experiences over the lifespan, probable-posttraumatic stress disorder (PTSD), and coping strategies. Mindfulness was explored as a potential way to improve coping; potential benefits and challenges associated with implementing a mindfulness-based intervention (MBI) with trauma-exposed WEH were also investigated. A Community Advisory Board (CAB) was formed to identify key issues experienced by WEH and to develop a semi structured interview guide (SSIG). Using the SSIG, women participated in one of four focus groups (total N = 28; n = 7 per group). Quantitative data on demographic indicators, probable-PTSD, and trauma exposure were collected. Almost 90% of women met criteria for probable-PTSD; trauma exposure was exceedingly high; most women had experienced multiple traumas throughout their lives. Four main themes emerged from qualitative analyses, which drew from Grounded Theory and used open, selective, and axial coding: (1) ways of coping with trauma; (2) perspectives on mindfulness; (3) prior experiences with mindfulness; and (4) challenges for conducting a mindfulness programme. Overall, WEH used a variety of coping techniques to deal with their trauma, had some familiarity with mindfulness, and were optimistic an MBI would be helpful, despite identifying several challenges to implementation. MBIs may be helpful adjuncts to traditional care for trauma-exposed, WEH, recovering from substance use disorder. Population-specific considerations may improve implementation and participation.

Mixed methods prospective findings of the initial effects of the U.S. COVID-19 pandemic on individuals in recovery from substance use disorder

The beginning of the U.S. COVID-19 pandemic interrupted integral services and supports for those in recovery from substance use disorders. The current study used qualitative and quantitative data to identify 1) pandemic-related barriers/stressors, 2) coping strategies employed, and 3) how the stressors and strategies predicted subsequent substance use frequency. Participants were 48 adults (40.5% female; 90.2% White) between 26 and 60 years old (M = 42.66, SD = 8.44) who were part of a larger, multi-year longitudinal study of individuals in recovery from substance use disorders. Individuals completed two interviews, one during the six weeks of initial stay-at-home orders in the state in which data were collected and the second within six to twelve months of their initial interview. Common barriers to recovery included cancelled support meetings, changes in job format (i.e., being fired or furloughed), and lack of social support. Common coping strategies included self-care, leisure activities/hobbies, taking caution against exposure, and strengthening personal relationships. The relationship between cravings at baseline and substance use at follow up was stronger for those who experienced worsening of their mental health (B = 21.80, p < .01) than for those who did not (B = 5.45, p = 0.09), and for those who were taking caution against exposure (B = 24.57, p < .01) than for those who were not (B = 1.87, p = 0.53). Those who engaged in self-care (B = 0.00, p>.99) had lower rates of substance use at follow-up than those who did not employ self-care as a coping mechanism (B = 16.10, p < .01). These findings inform research priorities regarding prospective effects of the pandemic on treatment endeavors, particularly emphasizing treating mental health and encouraging self-care strategies.

Development and Evaluation of a Blended Learning Mindfulness Program for High School Students During the COVID-19 Pandemic

Many adolescents worldwide suffer from stress or unhealthy emotional states such as depression. There is a trend toward limited physical contact via social distancing practices that developed during the coronavirus disease 2019 (COVID-19) pandemic. An experimental study aimed at investigating the effects of a mindfulness program on stress, concentration, self-esteem, and self-control in high school students. A 10-week mindfulness intervention was provided to the experimental group (n = 89) from September-November 2020, while the control group (n = 89) received general health education. Four weeks after the program, the experimental group showed reduced stress and improved concentration, self-esteem, and self-control compared to baseline.The blended learning mindfulness program is effective improving concentration and should be incorporated into the formal high school curriculum.

Interpersonal Mindfulness Questionnaire: Scale Development and Validation

Objectives

Previously developed mindfulness measures focused on its intrapersonal dimensions and did not measure the interpersonal aspects of mindfulness. Furthermore, recently developed interpersonal mindfulness measures were either specific to a certain context (e.g., parenting, conjugal, teaching) or omitted/minimized the role of the body in the interpersonal dynamic. The proposed Interpersonal Mindfulness Questionnaire (IMQ) aims to operationalize the theoretical notion of embodied and embedded mindfulness by grounding it into four dimensions, each representing a set of skills that can be cultivated through training and practice: (1) Detachment from the Mind, (2) Body-Anchored Presence, (3) Attention to and Awareness of the Other Person, and (4) Mindful Responding.

Methods

The IMQ subscales were developed through consultations with a panel of eight graduate students and ten experts in the field. Three studies were conducted to evaluate the construct, internal consistency, reliability, convergent validity, and utility of the IMQ.

Results

Findings from the three studies supported the proposed four subscales of IMQ and suggested that these four subscales are independent and supported by convergent evidence. In addition, results suggested that IMQ subscales’ scores are sensitive to meditation experience and are associated with better intrapersonal and interpersonal outcomes.

Conclusions

IMQ subscales are valid and are consistent with the proposed embodied and embedded conception of interpersonal mindfulness. IMQ subscales are associated with intrapersonal mindfulness, but not strongly enough to be conceived as the same phenomenon. Limitations, as well as theoretical and practical implications of IMQ subscales, are thoroughly discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01855-1.

The role of mindfulness and attachment security in facilitating resilience

Background

In recent years, there has been growing interest in exploring ways to facilitate positive psychological dispositions, including resilience. The goal of the present study was to explore the possibility that trait mindfulness facilitates attachment security and thus enhances resilience.

Methods

We conducted two studies based on cross-sectional surveys. In Study 1, data of 207 students studying in Japan was collected. In Study 2, we used a different sample of 203 participants and different measurements to replicate the findings of Study 1.

Results

The results of Study 1 revealed that mindfulness positively predicted resilience, while attachment anxiety and avoidance were mediators between mindfulness and resilience. The results of Study 2 showed that mindfulness positively predicted resilience, and the mediating effect of attachment avoidance was significant, but the mediating effect of attachment anxiety was not significant.

Conclusions

It is possible to facilitate attachment security through cultivating trait mindfulness, and in this way, resilience could be enhanced. The effect of different components of mindfulness on attachment and resilience requires further studies.

Smoking Cessation Using Wearable Sensors: Protocol for a Microrandomized Trial

BACKGROUND

Cigarette smoking has numerous health consequences and is the leading cause of morbidity and mortality in the United States. Mindfulness has the ability to enhance resilience to stressors and can strengthen an individual's ability to deal with discomfort, which may be particularly useful when managing withdrawal and craving to smoke.

OBJECTIVE

This study aims to evaluate feasibility results from an intervention that provides real-time, real-world mindfulness strategies to a sample of racially and ethnically diverse smokers making a quit attempt.

METHODS

This study uses a microrandomized trial design to deliver mindfulness-based strategies in real time to individuals attempting to quit smoking. Data will be collected via wearable sensors, a study smartphone, and questionnaires filled out during the in-person study visits.

RESULTS

Recruitment is complete, and data management is ongoing.

CONCLUSIONS

The data collected during this feasibility trial will provide preliminary findings about whether mindfulness strategies delivered in real time are a useful quit smoking aid that warrants additional investigation.

TRIAL REGISTRATION

Clinicaltrials.gov NCT03404596; https://clinicaltrials.gov/ct2/show/NCT03404596.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/22877.

Improving Mental Health and Well-Being through Informal Mindfulness Practices: An Intervention Study

BACKGROUND

Mindfulness-based programs have been shown to be effective in reducing stress, anxiety, and depression symptoms, and enhancing well-being. However, it remains unclear whether longer formal mindfulness practices are necessary to obtain such results. We therefore aimed to assess the effectiveness of a program (FOVEA, 8 weeks, 2h/week) which was only based on brief and informal practices.

METHODS

Using a switching replication design, participants (N = 139) were assigned to a FOVEA or a wait-list group, and completed the following self-report questionnaires online at three time points: perceived stress, anxiety, depression, satisfaction with life (dependent variables), and mindfulness (mediating variable). They also completed a daily practice diary.

RESULTS

Relative to the wait-list group, FOVEA participants showed significantly reduced perceived stress, anxiety, and depression, and increased satisfaction with life. These changes were completely mediated by increased mindfulness, and were maintained 2.5 months after the end of the program. The effect sizes were moderate to large.

CONCLUSIONS

These results underline the potential benefits of a mindfulness informal practices program for the general population. This type of program could constitute a first step towards more formal practices once the motivation to practice has been enhanced by the perceived benefits of brief practices.

The relationship of mindfulness and mindfulness-related practices with alcohol use among Hispanics/Latinx

Hispanics/Latinx (H/Ls) are the largest ethnic minority group in the U.S., and three of the four leading causes of death are associated with problematic alcohol use. This study examined the relationship between mindfulness and alcohol use among H/Ls and whether differences emerged by sub-ethnicity. Participants (N = 341; 49.7% female; average age=28.57) were H/Ls currently living in the U.S. Survey questions were answered online in English or Spanish. Participants primarily endorsed engaging in informal mindfulness practices (47.5%), spiritual practices (25.2%), and mindfulness meditation (24.6%). No significant differences emerged among H/L sub-ethnicities. Spiritual practices and higher mindfulness were associated with less problematic alcohol use among the entire sample. Similar results were found among drinkers-only. Findings shed light on commonly used mindfulness practices and indicate that very few differences emerge among H/L sub-ethnicities on mindfulness practices and general mindfulness. The delivery/tailoring of mindfulness-based interventions (MBIs) may not need to differ amongst H/L sub-ethnicities in the U.S. Aspects of mindfulness appear protective regarding problematic alcohol use, suggesting that future MBIs that increase mindfulness should be explored for this population.

Text message reminders as an adjunct to a substance use intervention for adolescents and young adults: Pilot feasibility and acceptability findings

OBJECTIVE

Text messaging has been proposed as a method for increasing the reach of interventions for harmful alcohol and other drug use. This paper describes the design of an automated text messaging adjunct to a substance use intervention intended to support adolescents and young adults attempting to change their alcohol and other drug use behavior. Feasibility and acceptability testing was conducted as part of this pilot study.

METHOD

Five focus groups were conducted to refine text message content and finalize pilot intervention design. Automated, daily, substance use-related reminder text messages were sent to pilot intervention participants (n = 39), who were recruited from outpatient treatment.

RESULTS

Of those who were invited, 63% enrolled in the study and 89.7% remained enrolled in the study as measured by completing at least one assessment after baseline. Participants reported a positive experience with the messages, particularly supportive/empowering messages and commitment reminder messages.

CONCLUSIONS

These findings suggest that text messaging is a feasible and acceptable method for delivery of substance use-related reminder content as an adjunct to substance use intervention.

Cognitive Fusion Mediates the Relationship between Dispositional Mindfulness and Negative Affects: A Study in a Sample of Spanish Children and Adolescent School Students

Nowadays, mindfulness-based interventions (MBI) have experienced a remarkable development of studies among childhood and adolescent interventions. For this reason, dispositional mindfulness (DM) measures for children and adolescents have been developed to determine the effectiveness of MBI at this age stage. However, little is known about how key elements of DM (for example, cognitive de/fusion or experiential avoidance that both confirm psychological inflexibility) are involved in the mechanisms of the children and adolescents' mental health outcomes. This research examined the mediating effect of cognitive fusion between DM and anxiety and other negative emotional states in a sample of 318 Spanish primary-school students (aged between 8 and 16 years, M = 11.24, SD = 2.19, 50.8% males). Participants completed the AFQ-Y (Avoidance and Fusion Questionnaire for youth), which is a measure of psychological inflexibility that encompasses cognitive defusion and experiential avoidance; CAMM (DM for children and adolescents), PANAS-N (positive and negative affect measure for children, Spanish version of PANASC), and STAIC (an anxiety measure for children). The study accomplished ethical standards. As MBI relevant literature has suggested, cognitive defusion was a significant mediator between DM and symptoms of both negative emotions and anxiety in children and adolescents. However, experiential avoidance did not show any significant mediating relationship. Probably, an improvement of the assessment of experiential avoidance is needed. MBI programs for children and adolescents may include more activities for reducing effects of the cognitive defusion on their emotional distress.

Moral Injury, Substance Use, and Posttraumatic Stress Disorder Symptoms Among Military Personnel: An Examination of Trait Mindfulness as a Moderator

Mindfulness-based approaches have been suggested as possible methods to treat moral injury in military personnel. However, empirical research has yet to evaluate if mindfulness acts as a protective factor for the possible negative effects of moral injury, such as alcohol use, drug use, or posttraumatic stress disorder (PTSD) symptoms. In this study, we investigated if five facets of mindfulness (i.e., observing, nonjudging, nonreactivity, awareness, and describing) moderated associations between moral injury and the outcomes of PTSD symptoms, alcohol misuse, and drug abuse symptoms in a sample of military personnel. Participants were 244 military personnel (the majority were former military members) who had been deployed at least once during the Iraq War, War in Afghanistan, other wars, or humanitarian missions. The study results indicated that nonjudging, β = -.22, and awareness, β = -.25, had significant attenuating effects on the association between moral injury and drug abuse symptoms. However, observing, β = .17; nonreactivity, β = .23; and describing, β = .15, had significant synergistic effects (i.e., they strengthened the association between moral injury and drug abuse symptoms). There were no significant moderation effects on the associations between moral injury and PTSD symptoms or between moral injury and alcohol misuse. Our results provide initial evidence that not all facets of mindfulness may protect against the challenges of coping with moral injury. Directions for future research and implications for practice are discussed.

Effect of Mindfulness-Based Relapse Prevention on Impulsivity Trajectories Among Young Adults in Residential Substance Use Disorder Treatment

Objectives

Impulsivity has been identified as an important construct in predicting the initiation and maintenance of substance use among at-risk populations. Interventions emphasizing mindfulness strategies appear particularly promising in reducing substance use and marking change in various aspects of impulsivity.

Methods

The current study used a rolling group mindfulness-based relapse prevention (MBRP) intervention for young adults in residential substance use disorder treatment. We examined change in impulsivity facets measured by the S-UPPS for youth randomly assigned to MBRP (n = 45) versus those assigned to treatment as usual plus 12 step/self-help (n = 34). We also examined how change in impulsivity mediated changes in substance use post-treatment.

Results

In general, results indicated that MBRP is effective at reducing facets of trait impulsivity in treatment-seeking individuals with SUDs. Only positive and negative urgency mediated the relation between treatment assignment and substance use.

Conclusions

MBRP is a viable and useful intervention for young adults in residential treatment for substance use disorders and can aid in marked change in facets of impulsivity. Both positive and negative urgency were significant mechanisms of change in reducing substance use following treatment. Results are discussed focused on the utility of MRBP as a clinical intervention for at-risk, marginalized, and young adults.

Understanding preferences for a mindfulness-based stress management program among caregivers of hematopoietic cell transplant patients

Informal caregivers of allogeneic hematopoietic cell transplant patients experience significant levels of stress throughout the caregiving process. One strategy that has been shown to aid in stress management in other populations is mindfulness. The goal of this study was to understand caregivers' experiences with mindfulness and evaluate their receptiveness to a mindfulness-based stress management program. Data were collected via in-depth phone interviews from 18 caregivers (55% female). Results indicated that about half the sample was familiar with mindfulness and/or had practiced meditation. The majority indicated that they believed a mindfulness program would have been useful for them and that they would have been willing to participate. Most indicated that a program delivered once-weekly for 60 min, during both inpatient and outpatient phases, would be preferable through a combination of in-person and mobile-based delivery. These data provide critical information for the development of future mindfulness-based interventions for this caregiving population.

Academic Stress and Self-Regulation among University Students in Malaysia: Mediator Role of Mindfulness

Academic stress is the most common emotional or mental state that students experience during their studies. Stress is a result of a wide range of issues, including test and exam burden, a demanding course, a different educational system, and thinking about future plans upon graduation. A sizeable body of literature in stress management research has found that self-regulation and being mindful will help students to cope up with the stress and dodge long-term negative consequences, such as substance abuse. The present study aims to investigate the influence of academic stress, self-regulation, and mindfulness among undergraduate students in Klang Valley, Malaysia, and to identify mindfulness as the mediator between academic stress and self-regulation. For this study, a total of 384 undergraduate students in Klang Valley, Malaysia were recruited. Using Correlational analysis, results revealed that there was a significant relationship between academic stress, self-regulation, and mindfulness. However, using SPSS mediational analysis, mindfulness did not prove the mediator role in the study.

Maintaining Treatment Fidelity of Mindfulness-Based Relapse Prevention Intervention for Alcohol Dependence: A Randomized Controlled Trial Experience

Background

Treatment fidelity is essential to methodological rigor of clinical trials evaluating behavioral interventions such as Mindfulness Meditation (MM). However, procedures for monitoring and maintenance of treatment fidelity are inconsistently applied, limiting the strength of such research.

Objective

To describe the implementation and findings related to fidelity monitoring of the Mindfulness-Based Relapse Prevention for Alcohol Dependence (MBRP-A) intervention in a 26-week randomized controlled trial.

Methods

123 alcohol dependent adults were randomly assigned to MM (MBRP-A and home practice, adjunctive to usual care; N = 64) or control (usual care alone; N = 59). Treatment fidelity assessment strategies recommended by the National Institutes of Health Behavior Change Consortium for study/intervention design, therapist training, intervention delivery, and treatment receipt and enactment were applied.

Results

Ten 8-session interventions were delivered. Therapist adherence and competence, assessed using the modified MBRP Adherence and Competence Scale, were high. Among the MM group participants, 46 attended ≥4 sessions; over 90% reported at-home MM practice at 8 weeks and 72% at 26 weeks. They also reported satisfaction with and usefulness of MM for maintaining sobriety. No adverse events were reported.

Conclusions

A systematic approach to assessment of treatment fidelity in behavioral clinical trials allows determination of the degree of consistency between intended and actual delivery and receipt of intervention.

Mindfulness in psychiatry - where are we now?

Mindfulness is an increasingly popular therapeutic approach. Mindfulness-based interventions have been tried out in a wide range of mental disorders, with the strongest evidence for use in depression and anxiety. Mindfulness operates by changing the person's relationship with unhelpful thoughts and emotions. The need for home practice is both a strength and a weakness. Some find home practice too demanding and a barrier to effective utilisation of mindfulness. Others discover a set of practical tools that, once learnt, can be applied to ongoing life difficulties; in this way mindfulness may have a place in promoting recovery beyond the acute treatment of a disorder. Additionally, mindfulness may be beneficial for clinicians to promote well-being and enhance the therapeutic relationship.

Exploratory Study

This article explores the cognitive process and awakening experience associated with natural recovery from alcohol or drug addiction in English-speaking Hong Kong residents. It is an exploratory study using qualitative research methods. Advertising and snowball sampling recruitment methods yielded two English-speaking Hong Kong residents, one White male expatriate from the United States and one female native Hong Kong resident who is half Chinese and half White American. Reported natural recovery process was evolutionary, occurring over a long period of time with intervals of cognitive appraisal and quit attempts. Awakening interpretations included having a greater insight about their cognitive process, addiction behavior, or emotional experience. The awakening experience played a role in natural recovery and may be used to enhance already existing interventions.

Improving personality/character traits in individuals with alcohol dependence: the influence of mindfulness-oriented meditation

The study of personality is critical to enhance current knowledge of the psychological characteristics of alcohol dependence. Recent evidence shows that mindfulness-oriented meditation positively influences healthy individuals' character. Here, it was assessed whether 8-week mindfulness-oriented meditation promotes similar changes in a group of alcohol-dependent individuals. A control group with alcohol dependence was also tested. Mindfulness-oriented meditation participants showed an increase in the character scores of the temperament and character inventory together with reduced risks of relapse. These longitudinal data highlight the importance of assessing personality in alcohol-dependent individuals and support the utility of therapeutic interventions for alcohol dependence aimed at enhancing individuals' character.

Mindfulness, Physical Activity and Avoidance of Secondhand Smoke: A Study of College Students in Shanghai

Introduction: To better understand the documented link between mindfulness and longevity, we examine the association between mindfulness and conscious avoidance of secondhand smoke (SHS), as well as the association between mindfulness and physical activity. Method: In Shanghai University of Finance and Economics (SUFE) we surveyed a convenience sample of 1516 college freshmen. We measured mindfulness, weekly physical activity, and conscious avoidance of secondhand smoke, along with demographic and behavioral covariates. We used a multilevel logistic regression to test the association between mindfulness and conscious avoidance of secondhand smoke, and used a Tobit regression model to test the association between mindfulness and metabolic equivalent hours per week. In both models the home province of the student respondent was used as the cluster variable, and demographic and behavioral covariates, such as age, gender, smoking history, household registration status (urban vs. rural), the perceived smog frequency in their home towns, and the asthma diagnosis. Results: The logistic regression of consciously avoiding SHS shows that a higher level of mindfulness was associated with an increase in the odds ratio of conscious SHS avoidance (logged odds: 0.22, standard error: 0.07, p < 0.01). The Tobit regression shows that a higher level of mindfulness was associated with more metabolic equivalent hours per week (Tobit coefficient: 4.09, standard error: 1.13, p < 0.001). Discussion: This study is an innovative attempt to study the behavioral issue of secondhand smoke from the perspective of the potential victim, rather than the active smoker. The observed associational patterns here are consistent with previous findings that mindfulness is associated with healthier behaviors in obesity prevention and substance use. Research designs with interventions are needed to test the causal link between mindfulness and these healthy behaviors.

Calm and smart? A selective review of meditation effects on decision making

Over the past two decades, there has been a growing interest in the use of meditation to improve cognitive performance, emotional balance, and well-being. As a consequence, research into the psychological effects and neural mechanisms of meditation has been accumulating. Whether and how meditation affects decision making is not yet clear. Here, we review evidence from behavioral and neuroimaging studies and summarize the effects of meditation on social and non-social economic decision making. Research suggests that meditation modulates brain activities associated with cognitive control, emotion regulation and empathy, and leads to improved non-social and social decision making. Accordingly, we propose an integrative model in which cognitive control, emotional regulation, and empathic concern mediate the effects of meditation on decision making. This model provides insights into the mechanisms by which meditation affects the decision making process. More evidence is needed to test our explanatory model and to explore the function of specific brain areas and their interactive effects on decision making during meditation training.

Exercise for methamphetamine dependence: rationale, design, and methodology

BACKGROUND

Effective pharmacotherapies to treat methamphetamine (MA) dependence have not been identified, and behavioral therapies are marginally effective. Based on behavioral studies demonstrating the potential efficacy of aerobic exercise for improving depressive symptoms, anxiety, cognitive deficits, and substance use outcomes, the study described here is examining exercise as a potential treatment for MA-dependent individuals.

METHODS

This study is randomizing 150 participants with MA dependence at a residential treatment facility for addictive disorders to receive either a thrice-weekly structured aerobic and resistance exercise intervention or a health education condition. Recruitment commenced in March, 2010. Enrollment and follow-up phases are ongoing, and recruitment is exceeding targeted enrollment rates.

CONCLUSIONS

Seeking evidence for a possibly effective adjunct to traditional behavioral approaches for treatment of MA dependence, this study is assessing the ability of an 8-week aerobic and resistance exercise protocol to reduce relapse to MA use during a 12-week follow-up period after discharge from residential-based treatment. The study also is evaluating improvements in health and functional outcomes during and after the protocol. This paper describes the design and methods of the study.

Affect regulation training (ART) for alcohol use disorders: development of a novel intervention for negative affect drinkers

Although negative affect is a common precipitant of alcohol relapse, there are few interventions for alcohol dependence that specifically target negative affect. In this stage 1a/1b treatment development study, several affect regulation strategies (e.g., mindfulness, prolonged exposure, distress tolerance) were combined to create a new treatment supplement called affect regulation training (ART), which could be added to enhance cognitive-behavioral therapy (CBT) for alcohol dependence. A draft therapy manual was given to therapists and treatment experts before being administered to several patients who also provided input. After two rounds of manual development (stage 1a), a pilot randomized clinical trial (N=77) of alcohol-dependent outpatients who reported drinking often in negative affect situations was conducted (stage 1b). Participants received 12-weekly, 90-minute sessions of either CBT for alcohol dependence plus ART (CBT+ART) or CBT plus a healthy lifestyles control condition (CBT+HLS). Baseline, end-of-treatment, and 3- and 6-month posttreatment interviews were conducted. For both treatment conditions, participant ratings of treatment satisfaction were high, with CBT+ART rated significantly higher. Drinking outcome results indicated greater reductions in alcohol use for CBT+ART when compared to CBT+HLS, with moderate effect sizes for percent days abstinent, drinks per day, drinks per drinking day, and percent heavy drinking days. Overall, findings support further research on affect regulation interventions for negative affect drinkers.

Emotion regulation and psychopathology: the role of gender

This review addresses three questions regarding the relationships among gender, emotion regulation, and psychopathology: (a) are there gender differences in emotion regulation strategies, (b) are emotion regulation strategies similarly related to psychopathology in men and women, and (c) do gender differences in emotion regulation strategies account for gender differences in psychopathology? Women report using most emotion regulation strategies more than men do, and emotion regulation strategies are similarly related to psychopathology in women and men. More rumination in women compared to men partially accounts for greater depression and anxiety in women compared to men, while a greater tendency to use alcohol to cope partially accounts for more alcohol misuse in men compared to women. The literature on emotion regulation is likely missing vital information on how men regulate their emotions. I discuss lessons learned and questions raised about the relationships between gender differences in emotion regulation and gender differences in psychopathology.

Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma

Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.

Mindful Attention Prevents Mindless Impulses

Three studies illustrate that mindful attention prevents impulses toward attractive food. Participants received a brief mindfulness procedure in which they observed their reactions to external stimuli as transient mental events rather than subjectively real experiences. Participants then applied this procedure to viewing pictures of highly attractive and neutral food items. Finally, reactions to food stimuli were assessed with an implicit approach-avoidance task. Across experiments, spontaneous approach reactions elicited by attractive food were fully eliminated in the mindful attention condition compared to the control condition, in which participants viewed the same items without mindful attention. These effects were maintained over a 5-minute distraction period. Our findings suggest that mindful attention to one’s own mental experiences helps to control impulsive responses and thus suggest mindfulness as a potentially powerful method for facilitating self-regulation.

Component Processes of Executive Function-Mindfulness, Self-control, and Working Memory-and Their Relationships with Mental and Behavioral Health

We examined the interrelationships between higher-order cognitive functions-mindfulness, self-control, and working memory-that appear to be component processes that underlie executive function (EF) and their association with indicators of mental and behavioral health. Data were collected from first-year medical students attending a large private university in California (N=31) via a computer-based questionnaire which was administered via email hyperlink. Results indicate that self-control schedule (SCS) scores were significantly correlated with the negative dimension of positive and negative affect schedule scores (r=-0.59, p<0.05), psychological well-being scale scores (r=0.46, p<0.05), and mindful attention awareness scale (MAAS) scores (r=0.35, p≤0.10). The planful behavior dimension of the SCS was correlated with MAAS scores (r=0.38, p<0.10), automated operation span task scores (r=0.51, p<0.05), and total SCS scores (r=0.72, p<0.01). Large and significant inverse correlations were found between current meditation practice and alcohol use (r=-0.56, p<0.05) and AUDIT scores (r=-0.48, p<0.05). Findings from this pilot study suggest that an overlap exists between some component processes of EF; however, the majority of variance in the components is not shared. Moreover, these higher-order cognitive processes appear to have protective relationships with substance use and are positively associated with self-reported meditation practice.

Mindfulness-based treatments for co-occurring depression and substance use disorders: what can we learn from the brain?

Both depression and substance use disorders represent major global public health concerns and are often co-occurring. Although there are ongoing discoveries regarding the pathophysiology and treatment of each condition, common mechanisms and effective treatments for co-occurring depression and substance abuse remain elusive. Mindfulness training has been shown recently to benefit both depression and substance use disorders, suggesting that this approach may target common behavioral and neurobiological processes. However, it remains unclear whether these pathways constitute specific shared neurobiological mechanisms or more extensive components universal to the broader human experience of psychological distress or suffering.We offer a theoretical, clinical and neurobiological perspective of the overlaps between these disorders, highlight common neural pathways that play a role in depression and substance use disorders and discuss how these commonalities may frame our conceptualization and treatment of co-occurring disorders. Finally, we discuss how advances in our understanding of potential mechanisms of mindfulness training may offer not only unique effects on depression and substance use, but also offer promise for treatment of co-occurring disorders.

Mindfulness-based acceptance and posttraumatic stress symptoms among trauma-exposed adults without axis I psychopathology

The present investigation examined the incremental predictive validity of mindfulness-based processes, indexed by the Kentucky Inventory of Mindfulness Skills, in relation to posttraumatic stress symptom severity among individuals without any axis I psychopathology. Participants included 239 adults who endorsed exposure to traumatic life events. Results indicated that the Accepting without Judgment subscale was significantly incrementally associated with posttraumatic stress symptoms; effects were above and beyond the variance accounted for by negative affectivity and number of trauma types experienced. The Acting with Awareness subscale was incrementally associated with only posttraumatic stress-relevant re-experiencing symptoms; and no other mindfulness factors were related to the dependent measures. Findings are discussed in relation to extant empirical and theoretical work relevant to mindfulness and posttraumatic stress.

Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives

AIM

The People Awakening (PA) study explored an Alaska Native (AN) understanding of the recovery process from alcohol abuse and consequent sobriety.

DESIGN

PA utilized a cross-sectional, qualitative research design and community-based participatory research methods.

SETTING AND PARTICIPANTS

The study included a state-wide convenience sample of 57 participants representing all five major AN groups: Aleut/Alutiiq, Athabascan, Inupiaq, Yup'ik/Cup'ik and Tlingit/Haida/Tsimshian. Participants were nominated and self-identified as being alcohol-abstinent at least five years following a period of problem drinking.

MEASUREMENTS

Open-ended and semistructured interviews gathered extensive personal life histories. A team of university and community co-researchers analyzed narratives using grounded theory and consensual data analysis techniques.

FINDINGS

A heuristic model of AN recovery derived from our participants' experiences describes recovery as a development process understood through five interrelated sequences: (i) the person entered into a reflective process of continually thinking over the consequences of his/her alcohol abuse; (ii) that led to periods of experimenting with sobriety, typically, but not always, followed by repeated cycling through return to drinking, thinking it over, and experimenting with sobriety; culminating in (iii) a turning point, marked by the final decision to become sober. Subsequently, participants engaged in (iv) Stage 1 sobriety, active coping with craving and urges to drink followed for some participants, but not all, by (v) Stage 2 sobriety, moving beyond coping to what one participant characterized as 'living life as it was meant to be lived.

CONCLUSIONS

The PA heuristic model points to important cultural elements in AN conceptualizations of recovery.

The assessment of present-moment awareness and acceptance: the Philadelphia Mindfulness Scale

The purpose of this project was to develop a bidimensional measure of mindfulness to assess its two key components: present-moment awareness and acceptance. The development and psychometric validation of the Philadelphia Mindfulness Scale is described, and data are reported from expert raters, two nonclinical samples (n = 204 and 559), and three clinical samples including mixed psychiatric outpatients (n = 52), eating disorder inpatients (n = 30), and student counseling center outpatients (n = 78). Exploratory and confirmatory factor analyses support a two-factor solution, corresponding to the two constituent components of the construct. Good internal consistency was demonstrated, and relationships with other constructs were largely as expected. As predicted, significant differences were found between the nonclinical and clinical samples in levels of awareness and acceptance. The awareness and acceptance subscales were not correlated, suggesting that these two constructs can be examined independently. Potential theoretical and applied uses of the measure are discussed.

Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research

OBJECTIVE

To review the impact of mindfulness-based stress reduction (MBSR) on symptoms of anxiety and depression in a range of clinical populations.

METHOD

Our review included any study that was published in a peer-reviewed journal, used a control group, and reported outcomes related to changes in depression and anxiety. We extracted the following key variables from each of the 15 studies identified: anxiety or depression outcomes after the MBSR program, measurement of compliance with MBSR instructions, type of control group included, type of clinical population studied, and length of follow-up. We also summarized modifications to the MBSR program.

RESULTS

Measures of depression and anxiety were included as outcome variables for a broad range of medical and emotional disorders. Evidence for a beneficial effect of MBSR on depression and anxiety was equivocal. When active control groups were used, MBSR did not show an effect on depression and anxiety. Adherence to the MBSR program was infrequently assessed. Where it was assessed, the relation between practising mindfulness and changes in depression and anxiety was equivocal.

CONCLUSIONS

MBSR does not have a reliable effect on depression and anxiety.

Using mindfulness-based therapeutic interventions in psychiatric nursing practice--part I: Description and empirical support for mindfulness-based interventions

Finding effective nursing interventions for the treatment of mental illness is a major concern for advanced practice psychiatric nurses (APPN). Increasingly, innovative psychotherapeutic treatment modalities are being used for the treatment of individuals with serious mental illness. One such innovative approach, mindfulness-based therapeutic interventions, has been shown to relieve distress for individuals with medical and psychiatric illnesses. In part one of this two-part article, the investigators describe principle concepts of mindfulness, review current research in the usefulness of mindfulness practice for treatment of psychiatric illnesses, and outline the theoretical basis for this treatment modality, including mindfulness-based cognitive therapy (MBCT). In Part II, the writers detail the therapy phases of MBCT and present a clinical case in which an advance practice psychiatric nurse integrates mindfulness-based psychotherapeutic approaches into her treatment. This clinical case may inform future clinical nursing research and advanced psychiatric nursing practice.