Psychological Mechanisms of Mindfulness-Based Interventions: What Do We Know?

The role of experiential avoidance in the early stages of an online mindfulness-based intervention: Two mediation studies

Objectives There is evidence to suggest that only 2-4 weeks of mindfulness-based interventions (MBIs) can already alleviate emotional stress. The current studies sought to examine whether experiential avoidance mediated the effects of MBIs on emotional distress during an early stage of the intervention. Methods: Chinese participants with high emotional distress were recruited. Study 1 included 324 participants, randomly assigned to an online MBI (N = 171) or a control group (N = 153). Experiential avoidance and general emotional distress were measured at baseline and after the 3rd week of the intervention. Study 2 included 158 participants, randomly assigned to an online MBI (N = 79) or a control group (N = 79). Experiential avoidance and emotional distress were measured at baseline and weekly in the first three weeks. Results: Compared to the control group, experiential avoidance and emotional distress were significantly improved in the MBI group during the first three weeks of the intervention (Cohen's d = 0.22-0.63). Moreover, changes in experiential avoidance mediated the effects of MBI on emotional distress in the early stage in both contemporary and lagged mediation models. Discussion: Experiential avoidance is an important mediator during the early-stage of MBIs for alleviating emotional distress.

10-Week Trajectories of Candidate Psychological Processes Differentially Predict Mental Health Gains from Online Dyadic versus Mindfulness Interventions: A Randomized Clinical Trial

Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health.

Identifying modifiable factors associated with psychological health in women experiencing infertility

This study assessed the relationship between modifiable psychological variables and depression, anxiety, and posttraumatic growth in women experiencing infertility. U.S. women (N = 457) who identified as experiencing infertility completed standardized self-report measures of mindfulness, self-compassion, positive affect, intolerance of uncertainty, relationship satisfaction, experiential avoidance, depression, anxiety, and posttraumatic growth. Clinical and demographic characteristics (age, duration trying to conceive, miscarriage, and childlessness) did not predict depression or anxiety. Lower positive affect and higher experiential avoidance were associated with depression and anxiety. Lower self-compassion was associated with depression; higher intolerance of uncertainty was associated with anxiety. There were indirect effects of mindfulness on anxiety and depression via these variables. Future research should explore whether intervening on these factors reduces depressive and anxiety symptoms. Promoting mindfulness may have beneficial effects on symptoms via its downstream effects on multiple coping variables. Counterintuitively, posttraumatic growth was associated with higher intolerance of uncertainty and experiential avoidance.

Virtually-Delivered Emotion Focused Mindfulness Therapy (EFMT) Group vs. Wait-List Control for Late-Life Anxiety: A Randomized Controlled Trial

BACKGROUND

The worldwide annual prevalence of anxiety in older adults is estimated to be between 6% and 10%. Emotion Focused Mindfulness Therapy (EFMT) is a mindfulness-based group intervention that has been demonstrated to reduce symptoms of anxiety in community dwelling adults. No study has yet assessed EFMT for older adults with late-life anxiety. The aim of this study was to determine the feasibility of video-delivered group EFMT for older adults living in community settings, a novel and potentially scalable intervention.

METHODS

This was a feasibility randomized controlled trial (RCT) of 48 older adults (≥55 years old), recruited through primary care, community organizations and snowball methods. Participants were randomized to group EFMT delivered by Zoom vs. a wait-list control. Data were collected at baseline (T1), 9 weeks following baseline (T2, primary study endpoint) and 17 weeks following baseline (T3). Random allocation was conducted immediately after each group of 12 participants had been enrolled into the trial, with groups beginning on a rolling basis each time a block of 12 participants had been enrolled. The main efficacy outcome examined changes over time to anxiety.

RESULTS

Recruitment was successfully completed in 32 weeks. Enrollment was calculated at 62.3% (48 of 77 people screened). Retention (80.0%) and adherence (100.0% for intervention group participants) were excellent. The EFMT group had significant improvements in anxiety at T2 compared to the wait-list control group (-3.47 [4.12] vs.-1.22 [3.25] points, p = 0.05).

CONCLUSIONS

Virtually-delivered EFMT appears to be a feasible, acceptable, and efficacious group treatment to improve late-life anxiety.

Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Background

The pain-fatigue-sleep disturbance symptom cluster is commonly experienced by breast cancer patients, and a variety of nonpharmacological interventions are used to treat this symptom cluster.

Objective

To compare the efficacy of nonpharmacological interventions in improving the symptoms of the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients.

Methods

A comprehensive literature search was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, and Wanfang databases to identify randomized controlled studies from database inception to May 2022. Two reviewers independently performed data retrieval and risk of bias assessments. The consistency model was used to conduct network meta-analyses (NMA) based on the frequentist framework to assess the interventions, which were ranked by the surface under the cumulative ranking curve (SUCRA). Finally, the CINeMA application was used to evaluate the results of the NMA and the evidence of quality. The results Twenty-three eligible studies assessing 14 interventions were included. According to SUCRA values, among the management effects of the three symptoms, the effect of progressive muscle relaxation (PMR) ranked first, followed by mindfulness-based stress reduction (MBSR). The overall evidence quality of our study ranges from very low to moderate.

Conclusion

PMR and MBSR were effective interventions for the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Clinical recommendations prioritize PMR for symptom management, followed by MBSR. However, this should be interpreted cautiously, as the confidence in the evidence was not high.

Using connectome-based models of working memory to predict emotion regulation in older adults

Older adulthood is characterized by enhanced emotional well-being potentially resulting from greater reliance on adaptive emotion regulation strategies. However, not all older adults demonstrate an increase in emotional well-being and instead rely on maladaptive emotion regulation strategies. An important moderator of age-related shifts in strategy preferences is working memory (WM) and its underlying neural circuitry. As such, individual differences in the neural integrity underlying WM may predict older adults' emotion regulation strategy preferences. Our study used whole-brain WM networks-derived from young adults using connectome-based predictive modeling-to predict WM performance and acceptance strategy use in healthy older adults. Older adults (N = 110) completed baseline assessments as part of a randomized controlled trial examining the impact of mind-body interventions on healthy aging. Our results revealed that the WM networks predicted WM accuracy but not acceptance use or difficulties in emotion regulation in older adults. Individual differences in WM performance, but not WM networks, moderated relationships between image intensity and acceptance use. These findings highlight that robust neural markers of WM generalize to an independent sample of healthy older adults but may not generalize beyond cognitive domains to predict emotion-based behaviors.

Religious and Existential Determinants of Affective Response to a Brief Mindfulness Intervention

Mindfulness-based interventions (MBIs) are often promoted in the Western world as being "secular" in nature, despite the religious/spiritual (R/S) roots of mindfulness itself. Relevant individual characteristics such as R/S, however, have yet to be examined thoroughly in relation to treatment response. Using pre-post experimental designs, we examined the interaction of participant religiosity and different religious framings (Buddhist, secular, spiritual) of a brief MBI as determinants of affective responses to the MBI using regression in two online samples (Study 1: N=677; Study 2: N= 157). Aspects of religiosity (existential quest, scriptural literalism) had differential effects on affective responses to MBIs dependent on the framing of the condition. Participants' R/S, as well as the R/S attributes of an MBI, may impact affective responses to MBIs. Further research is needed to ascertain how, and to what extent, MBIs might be optimized in order to maximize benefits for participants with diverse religious and existential commitments.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00139-0.

The role of emotion regulation in the relationship between mindfulness and risk factors for disordered eating: A longitudinal mediation analysis

OBJECTIVE

Evidence suggests mindfulness may reduce risk factors for disordered eating. However, mechanisms of change in this relationship are unclear. This longitudinal study tested whether emotion regulation mediates the prospective associations between mindfulness and two proximal risk factors for disordered eating: weight and shape concerns, and negative affect.

METHOD

This study is a secondary analysis of data collected within an eating disorder prevention trial. Adolescent girls (N = 374, M_age  = 15.70, SD = 0.77) completed self-report measures of mindfulness, emotion regulation, weight and shape concerns, and negative affect at baseline, 2 months following baseline, and 7 months following baseline. Path analyses were computed to test hypothesized indirect effects using confidence intervals based on 5000 bootstrap samples.

RESULTS

Higher baseline mindfulness predicted lower weight and shape concerns and negative affect at 7 months via a mediator of better emotion regulation at 2 months. This effect remained while controlling for earlier measurements of the mediator and outcome in the model of negative affect but not weight and shape concerns.

DISCUSSION

Emotion regulation may be an important mechanism explaining how mindfulness influences negative affect. Efforts should be made to intervene on mindfulness and emotion regulation in prevention and early intervention programmes for eating disorders and other psychiatric conditions.

PUBLIC SIGNIFICANCE

Research has shown that mindfulness can help to reduce some of the risk of developing an eating disorder. This study explored whether mindfulness reduces some of this risk by helping people to better manage their emotions. Understanding this process can help us to develop better mindfulness-based strategies to support people who are at risk of developing an eating disorder.

Trauma-Integrated Mindfulness-Based Relapse Prevention for Women with Comorbid Post-Traumatic Stress Disorder and Substance Use Disorder: A Cluster Randomized Controlled Feasibility and Acceptability Trial

Background: Comorbid post-traumatic stress disorder and substance use disorder (PTSD-SUD) among women receiving substance use treatment are common. Few evidence-based interventions target PTSD-SUD, however, fewer are gender responsive. Mindfulness-based relapse prevention (MBRP) has shown effectiveness for women with SUD, although it does not explicitly target PTSD. Integration of trauma-focused and gender-responsive treatments into MBRP may address the limited availability of PTSD-SUD interventions for women. This study assessed feasibility and acceptability of trauma-integrated MBRP (TI-MBRP). Methods: A single-blind computer-generated cluster-randomized design was employed in which women with PTSD-SUD (N = 83) received either TI-MBRP (k = 5) or MBRP (k = 5). Measures of PTSD symptom severity and craving were administered at pre-, post-, 1-, 3-, 6-, 9-, and 12-month follow-up and assessed at the individual level. Results: TI-MBRP demonstrated acceptability among participants; however, attrition was high (64%) at 12-month follow-up. Reductions in PTSD were greater in the MBRP than in the TI-MBRP group at postcourse and 1-month follow-up, and there were significant reductions in PTSD severity and craving over the 12-month period in both conditions. Conclusions: Integrating trauma- and gender-focused interventions into MBRP was feasible and acceptable. MBRP alone may be effective in reducing both PTSD and SUD symptoms in women with PTSD-SUD; however, confirmatory studies are warranted. Clinical Trial Registration Number: NCT03505749.

Effect of mindfulness-based interventions on mental health of perinatal women with or without current mental health issues: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The effectiveness of mindfulness-based interventions (MBIs) on the mental health of perinatal women with or without current mental health issues remains unclear.

METHODS

Four electronic databases were searched from inception to October 1, 2021. Data synthesis, sensitivity analysis, subgroup analysis, and quality assessment were performed on the included studies. I² and Q tests were applied to evaluate heterogeneity across studies. The risk of publication bias was assessed and visualized using a funnel plot.

RESULTS

A total of 21 RCTs with 1765 perinatal women were enrolled in the meta-analysis. We found MBIs were effective in reducing depression, anxiety, and stress, as well as increasing mindfulness in perinatal women with current mental health issues. However, MBIs were not prior to controls in reducing depression and stress, and increasing mindfulness in perinatal women without current mental health issues. The effectiveness of MBIs on reducing anxiety in perinatal women without current mental health issues was unclear.

LIMITATIONS

Considerable heterogeneity was found in the pooled analyses of the RCTs in depression and anxiety in perinatal women with mental health issues and stress in perinatal women without mental health issues.

CONCLUSION

MBIs could serve as a useful addition to existing support for perinatal women with current mental health issues. However, further studies were needed to explore and prove the effectiveness of MBIs on the mental health of perinatal women without current mental health.

Development of the Applied Mindfulness Process Scale as a Process Evaluation Measure for Mindfulness Practice in a Chinese Context

With the rising popularity of mindfulness practice, it is necessary and crucial to evaluate mindfulness using comprehensive and objective measures. The instruments to assess mindfulness in China mainly evaluate mindfulness as a state or trait mode. Few process measures have been developed to clarify effective therapy benefits of the alterations obtained using mindfulness practice. Therefore, this study aims to adapt the Applied Mindfulness Process Scale (AMPS) into Mandarin and explore in detail the reliability and validity of this novel-translated measure. Following cross-cultural modification for original AMPS into Mandarin as per established guidelines, psychometric evaluation was performed on a cohort of 234 Chinese adults. Construct validity was analyzed through exploratory factor analysis (n = 115), together with confirmatory factor analysis (n = 119). Reliability was assessed by internal consistency together with test-retest reliability. Findings indicated that the internal consistency was high, with Cronbach's alpha being 0.936. The principal component analysis led to a three-factor structure that explained 67.374% of all variations. The three-factor model was consistent with the original scale model. Based upon confirmatory factor analyses, all fitting indices satisfied the standard, which showed a close fit to the data. Therefore, the newly multi-culturally modified AMPS has sufficient validity, test-retest reliability, together with internal consistency. Chinese AMPS may offer researchers and clinicians a psychometrically optimized tool for evaluating the application of mindfulness and change process within mindfulness-based interventions (MBIs) in Mainland China.

Ayahuasca may help to improve self-compassion and self-criticism capacities

OBJECTIVE

Ayahuasca is a psychedelic brew that originated in the Amazon basin. The psychological effects of this drug are becoming better understood due to the growing research interest in identifying new potential therapeutic agents for the treatment of emotion dysregulation and other disorders. Previous studies suggest that ayahuasca enhances mindfulness-related capacities (decentering, non-judging, non-reacting and acceptance) and emotion regulation. The aim of the present exploratory study was to determine the effects of ayahuasca on self-compassion in a community sample.

METHODS

We administered validated questionnaires (the Self-Compassion Scale-Short Form and Forms of Self-Criticism and Self-Reassurance) to evaluate pre-post changes in self-compassion and self-criticism/self-reassurance in 45 volunteers (27 women; 60%) before and after (≤24 h) an ayahuasca ceremony. Most participants (n = 29; 67.4%) had previously used ayahuasca.

RESULTS

Ayahuasca resulted in significant improvements, with medium to large effect sizes (η²  = 0.184-0.276), in measures of self-compassion (p < 0.05), self-criticism (p < 0.01) and self-reassurance (p < 0.01).

CONCLUSIONS

The findings of this study suggest that ayahuasca promotes well-being and self-compassion, which could have a therapeutic effect on individuals with negative affect and other psychopathological conditions. Large, controlled studies are needed to confirm these findings.

The Effect of Mindfulness Breathing Meditation on Psychological Well-being: A Quasi-Experimental Study Among Nurses Working for COVID-19 Patients

The study aims to test the effect of mindfulness breathing meditation on psychological well-being among nurses working for COVID-19 patients. A total of 50 nurses (25 each in the intervention and control groups) were included in the study. We found significant differences between the preintervention and postintervention mean scores of both groups, based on the Warwick-Edinburgh Mental Well-being Scale Indonesian version.

Feasibility, Effectiveness, and Mechanisms of a Brief Mindfulness- and Compassion-Based Program to Reduce Stress in University Students: A Pilot Randomized Controlled Trial

The mental health of university students is a public health concern, as psychopathology has significantly risen among this population. Mindfulness-based programs may support their mental health, though more research is needed. We used a two-armed pilot randomized controlled trial to study the feasibility, preliminary effectiveness, and potential mechanisms of a brief 6-week instructor-led mindfulness- and compassion-based program (MCBP for University Life) on perceived stress and psychological distress. Thirty undergraduate psychology students participated (15 in the intervention group, and 15 as wait-list controls). Those in the intervention arm engaged well with the course and formal at-home practice, attending at least five sessions and meditating between 4-6 days per week. Significant improvements in perceived stress, psychological distress, mindfulness skills, decentering, self-compassion, and experiential avoidance were found at the end of the intervention, while the wait-list group remained unchanged. There were significant differences between the two groups in those variables at post-test, favoring the intervention arm with major effects. Reductions in stress were mediated by improvements in mindfulness skills, decentering, and self-compassion; meanwhile reductions in psychological distress were mediated by improvements in decentering. These results suggest that this intervention might be feasible and effective for university students, but more high-quality research is needed.

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.

A Systematic Review of Mindfulness-Based Interventions for Patients with Mild Cognitive Impairment or Dementia and Caregivers

The aim of this article was to systematically review the quality and efficacy of the current evidence for mindfulness-based interventions (MBIs) in patients with mild cognitive impairment (MCI), patients with dementia (PwD), and their caregivers. We identified 20 randomized controlled trials (RCTs) (11 for patients, 9 for caregivers) published in the last 15 years. Evidence suggested that MBIs are highly acceptable and credible treatments for patients with MCI, PwD and caregivers. Specifically, for PwD, the results indicated that the magnitude of post-treatment effects of MBIs are in the medium to large range for psychosocial outcomes, and in the small to medium range for cognitive functioning; however, treatment effects on dementia biomarkers were mixed, ranging from small to large, depending on the outcome measure. Findings also evidenced salutary effects of MBIs for caregivers of PwD, with post-treatment effects ranging from medium to large for caregiver stress and burden and large effects for quality of life, and mixed outcomes for cognitive functioning, with effects in the small to large range. However, confidence in these findings is relatively limited due to methodological limitations, especially in terms of poor consistency in intervention strategies, outcome measures, and other key criteria across studies. To better assess the value of MBIs for these populations and optimize treatment outcomes, we recommend further research with improved study methodology (e.g., multi-method assessment, universal criterion and outcome measures, use of active control groups, larger sample sizes, long-term follow-up) to replicate current findings and enhance our understanding of underlying treatment mechanisms of MBIs.

Initial Efficacy of a Community-Derived Mindfulness-Based Intervention for Latinx Parents and their Children

Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10-16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B =  - 2.94, 95% CI [- 5.58, - 0.39], p = 0.029), while their children reported greater increases in perceived social support from family (B = 2.32, 95% CI [0.26, 4.38], p = 0.027). Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children.

Examining Individual Differences in Wellbeing, Anxiety and Depression in Psoriasis Using a Clinically Modified Buddhist Psychological Model

Psoriasis patients can experience a range of psychosocial difficulties, which can lead to issues with wellbeing, anxiety and depression. Mindfulness-based interventions have positive impacts on these outcomes; however, there is a need to identify the mechanisms of action of such interventions. This study attempts to do so by examining individual differences in psoriasis patients' wellbeing, anxiety and depression using a clinically modified Buddhist psychological model (CBPM). Psoriasis patients (N = 285) and (N = 209) completed measures of each CBPM component at time 1 and 2. SEM analyses found that a direct and mediated effect of CBPM model was a good fit to the participant's data. This study suggests that non-attachment, aversion, acceptance and self-compassion could have a direct effect on the wellbeing, anxiety and depression of psoriasis patients and an indirect effect through reduced worry and rumination. This study provided preliminary evidence for the CBPM as being a useful explanatory framework of psoriasis patients' anxiety, depression and wellbeing.

A Brief Online Mindfulness-Based Group Intervention for Psychological Distress Among Chinese Residents During COVID-19: a Pilot Randomized Controlled Trial

Objectives

The coronavirus (COVID-19) global pandemic has increased psychological distress among the general population. The objective of this study is to evaluate a mindfulness-based intervention for psychological distress among Chinese residents during COVID-19.

Methods

This study used a switching replications design to test the feasibility and efficacy of a brief online mindfulness-based intervention for Chinese residents’ psychological distress. Fifty-one residents in the Hubei province were randomly allocated to two groups (experimental group and waitlist control group) with three waves of measurement at time 1, time 2, and time 3 for changes in mindfulness and psychological distress.

Results

In addition to significant within-group improvements over time for both groups, OLS linear regression with full information likelihood estimation revealed statistically significant between-group treatment effects across outcome domains, including mindfulness awareness, b = 2.84, p < 0.001, g = 6.92, psychological distress, b = −21.33, p < 0.001, g = 6.62, somatic symptoms, b = −6.22, p < 0.001, g = 4.42, depressive symptoms, b = −7.16, p < 0.001, g = 5.07, and anxiety symptoms, b = −8.09, p < 0.001, g = 6.84.

Conclusions

Results suggest that a brief online mindfulness-based intervention can be a feasible and promising intervention for improving mindfulness and decreasing psychological distress among Chinese residents staying at home during the COVID-19 outbreak. The study used a small convenience sample which led to a concern of external generalizability and with limited evaluation of long-term change.

The Effect of Baseline Patient and Caregiver Mindfulness on Dementia Outcomes

BACKGROUND

Mindfulness is the practice of awareness and living in the present moment without judgment. Mindfulness-based interventions may improve dementia-related outcomes. Before initiating interventions, it would be beneficial to measure baseline mindfulness to understand targets for therapy and its influence on dementia outcomes.

OBJECTIVE

This cross-sectional study examined patient and caregiver mindfulness with patient and caregiver rating scales and patient cognitive performance and determined whether dyadic pairing of mindfulness influences patient outcomes.

METHODS

Individuals (N = 291) underwent comprehensive evaluations, with baseline mindfulness assessed using the 15-item Applied Mindfulness Process Scale (AMPS). Correlation, regression, and mediation models tested relationships between patient and caregiver mindfulness and outcomes.

RESULTS

Patients had a mean AMPS score of 38.0±11.9 and caregivers had a mean AMPS score of 38.9±11.5. Patient mindfulness correlated with activities of daily living, behavior and mood, health-related quality of life, subjective cognitive complaints, and performance on episodic memory and attention tasks. Caregiver mindfulness correlated with preparedness, care confidence, depression, and better patient cognitive performance. Patients in dyads with higher mindfulness had better cognitive performance, less subjective complaints, and higher health-related quality of life (all p-values<0.001). Mindfulness effects on cognition were mediated by physical activity, social engagement, frailty, and vascular risk factors.

CONCLUSION

Higher baseline mindfulness was associated with better patient and caregiver outcomes, particularly when both patients and caregivers had high baseline mindfulness. Understanding the baseline influence of mindfulness on the completion of rating scales and neuropsychological test performance can help develop targeted interventions to improve well-being in patients and their caregivers.

Compassion-focused therapy for trauma in people with intellectual disabilities: A conceptual review

Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.

Seeking refuge in the present moment: A qualitatively refined model of dispositional mindfulness, minority stress, and psychosocial health among Latino/a sexual minorities and their families

Racial/ethnic and sexual minorities may experience excess stress from social prejudice and structural disadvantage, which is associated with family relationship problems and poorer psychosocial health. There is increasing evidence that certain positive psychological processes can attenuate these negative outcomes at the individual and interpersonal levels; however, the mechanisms of these effects remain poorly understood. Based on previous research and two extant conceptual frameworks, we constructed a preliminary model of how dispositional mindfulness operated in the context of minority stress among Latino/a sexual minority young adults and their families. We then conducted semi-structured interviews in a life history format with 21 Latino/a sexual minority young adults and 15 family members to test our preliminary model and refine it. We mixed content analysis and grounded theory techniques, whereby we initially used deductive coding with pre-established codes based on our preliminary model, and subsequently used inductive coding to account for novel categories in the interview data that could not be explained by the preliminary model. The refined model revealed pathways by which five constructs of dispositional mindfulness (act with awareness, observe, describe, non-judge, non-react) buffered negative effects of minority stress on psychosocial health in young adults, and were qualitatively associated with compassion, acceptance of sexual minorities, and closeness among family members. Young adults reporting deficiencies in mindfulness reported greater suffering and negative coping related to minority stress. Our model provides a framework to explore modes of resilience and adaptation to minority stress, and offers a basis for further refinement in other affected populations.

Promoting mental health and wellbeing in schools: examining Mindfulness, Relaxation and Strategies for Safety and Wellbeing in English primary and secondary schools: study protocol for a multi-school, cluster randomised controlled trial (INSPIRE)

BACKGROUND

There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based, universal prevention programmes are thought to be one way of helping tackle such difficulties. This protocol describes a four-arm cluster randomised controlled trial, investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. The primary outcome for Mindfulness and Relaxation interventions is a measure of internalising difficulties, while Strategies for Safety and Wellbeing will be examined in relation to intended help-seeking. In addition to the effectiveness analysis, a process and implementation evaluation and a cost-effectiveness evaluation will be undertaken.

METHODS AND ANALYSIS

Overall, 160 primary schools and 64 secondary schools will be recruited across England. This corresponds to 17,600 participants. Measures will be collected online at baseline, 3-6 months later, and 9-12 months after the commencement of the intervention. An economic evaluation will assess the cost-effectiveness of the interventions. Moreover, a process and implementation evaluation (including a qualitative research component) will explore several aspects of implementation (fidelity, quality, dosage, reach, participant responsiveness, adaptations), social validity (acceptability, appropriateness and feasibility), and their moderating effects on the outcomes of interest, and perceived impact.

DISCUSSION

This trial aims to address important questions about whether schools' practices around the promotion of mental wellbeing and the prevention of mental health problems can: (1) be formalised into feasible and effective models of school-based support and (2) whether these practices and their effects can be sustained over time. Given the focus of these interventions on mirroring popular practice in schools and on prioritising approaches that present low-burden, high-acceptability to schools, if proved effective, and cost-effective, the findings will indicate models that are not only empirically tested but also offer high potential for widespread use and, therefore, potentially widespread benefits beyond the life of the trial.

TRIAL REGISTRATION

ISRCTN16386254. Registered on 30 August 2018.

Effects of mindfulness-based interventions on health-related outcomes for patients with heart failure: a systematic review

BACKGROUND

Mindfulness-based interventions may offer a promising approach for promoting psychological and physical health and wellbeing for patients with heart failure. However, the effects of mindfulness-based interventions for this population have not been systematically reviewed.

AIMS

This review aimed to synthesise available evidence to assess the effects of mindfulness-based interventions on psychological and physical outcomes and health-related quality of life in patients with heart failure.

METHODS

Seven English and two Chinese electronic databases were searched with keywords from inception to May 2019. Experimental studies that examined mindfulness-based interventions in adults with heart failure were eligible for inclusion. Two reviewers independently performed study selection, data extraction and study quality assessment. The results were then narratively synthesised.

RESULTS

This review identified five studies involving 467 patients with heart failure. The reviewed studies had weak to moderate quality. There were consistent findings that mindfulness-based interventions could significantly reduce depression (three studies) and anxiety (two studies) and improve health-related quality of life (two studies) after intervention. However, the effects on physical symptoms were inconsistent in three studies. The effects on physical function were only measured in one study, with non-significant changes being reported.

CONCLUSIONS

This review provides preliminary evidence that mindfulness-based interventions are beneficial for patients with heart failure in reducing depression and anxiety and enhancing health-related quality of life in the short term. These findings should be carefully generalised considering the methodological limitations across studies. More rigorous studies are required to examine further the effects of mindfulness-based interventions in patients with heart failure.

A Systematic Review and Meta-Analysis of the Impact of Mindfulness Based Interventions on Heart Rate Variability and Inflammatory Markers

Mindfulness Based Interventions (MBIs) have recently been increasingly used in clinical settings, and research regarding their effects on health has grown rapidly. However, with regard to the physiological effects of mindfulness practices, studies have reported associations that vary in strength and direction. Therefore, in this systematic review and meta-analysis, we aimed to systematically identify, appraise, and summarize the existing data from randomized and non-randomized controlled trials that examine physiological effects of the standardized MBIs by focusing on pro-inflammatory cytokines and C-reactive protein, and commonly used heart rate variability parameters. The following electronic databases were searched: MEDLINE (via Ovid), PsychINFO (via Ovid), PubMed, Web of Science, EMBASE, CINAHL, ProQuest (Dissertations and Theses), and ClinicalTrails.gov. The systematic review identified 10 studies to be included in the meta-analysis, comprising in total 607 participants. The meta-analysis ended up with mixed and inconclusive results. This was assumedly due to the small number of the original studies and, in particular, to the lack of large, rigorously conducted RCTs. Therefore, the current meta-analysis highlights the necessity of larger, more rigorously conducted RCTs on physiological outcomes with standardized MBIs being compared to various forms of active controls, and with more long-term follow-ups.

A Comparison of Self-Reported Emotional Regulation Skills in Adults With Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder

Objective: Emotion dysregulation has been described as a central feature of both borderline personality disorder (BPD) and attention-deficit/hyperactivity disorder (ADHD). The current study aims to compare emotion regulation among ADHD, BPD, and healthy controls (HC). Method: Eighty adults with ADHD, 55 with BPD, and 55 HC completed self-report assessments of ADHD and BPD symptoms, psychosocial functioning, and emotion regulation skills. Principal components analysis (PCA) was conducted on the emotion regulation items, followed by multivariate analyses of group differences in emotion regulation. Results: PCA yielded four components: "Being Aware of Emotions," "Making Sense of Emotions," "Modifying and Accepting Emotions," and "Confronting Emotions With Self-Encouragement." The last component best distinguished the two patient groups from the HC. No differences were found between adults with ADHD and BPD. Conclusion: Adults with ADHD and BPD report comparable difficulties in encouraging oneself to attend inner aversive experiences, without engaging in impulsive behavior.

Nonacceptance of negative emotions in women with borderline personality disorder: association with neuroactivity of the dorsal striatum

BACKGROUND

Emotion dysfunction is a key symptom in patients with borderline personality disorder (BPD) and is considered a consequence of dysfunctional emotion regulation (e.g., reduced emotion acceptance). In the present functional MRI (fMRI) study, we investigated the neural correlates of habitual emotion acceptance in individuals with BPD.

METHODS

Female patients with BPD and female healthy controls passively viewed negative and neutral movie clips of faces during fMRI. We assessed emotion acceptance using the Emotion Acceptance Questionnaire (EAQ). To examine brain activation associated with habitual emotional acceptance of negative stimuli, the EAQ score was included as a regressor of interest in brain data analyses of activation intensity during negative compared with neutral movies.

RESULTS

We included 20 women with BPD and 20 heatlhy controls in our analysis. Compared with healthy controls, patients with BPD showed significantly more activation in frontostriatal brain regions (i.e., left superior frontal gyrus, right caudate) as well as in the left precuneus, left precentral gyrus, left posterior cingulate cortex and left hippocampus when confronted with negative (v. neutral) stimuli. Patients with BPD reported decreased emotion acceptance compared with healthy controls, and habitual emotion acceptance was inversely associated with activation of striatal areas (i.e., left putamen, left caudate) in patients with BPD.

LIMITATIONS

Causal conclusions are not possible. Comorbid diagnoses were not excluded, and only female participants were investigated. Stimuli were not rated immediately and may not be generalizable to all negative emotions. We cannot make any statements about other emotion-regulation strategies that may have been applied here.

CONCLUSION

Data indicate that striatal hyperactivation during the processing of negative stimuli in women with BPD is related to their decreased disposition to accept unpleasant emotional states. Thus, individuals with BPD may benefit from therapy approaches that focus on emotion acceptance in order to normalize emotional reactions.

Internet Mindfulness Meditation Intervention (IMMI) Improves Depression Symptoms in Older Adults

Background: Older adults have fewer physiological reserves and are more likely to be affected by stress. Mindfulness meditation has the potential to be an effective treatment for depression, but little research has been conducted on older adults. The primary objective of this study was to evaluate depression symptom changes in older adults (55–80 years old) taking an Internet Mindfulness Meditation Intervention (IMMI) compared to a waitlist control. The secondary aims were to collect data on pain, perceived stress, resilience, mindfulness, sleep quality, and spirituality. Methods: Fifty older adults were randomized to either the Internet Mindfulness Meditation Intervention, a six-week online intervention with daily home practice, or a waitlist control. Measures were collected at baseline, after the six-week intervention period, and again six weeks later after the waitlist participants completed IMMI. Adherence to home practice was objectively measured with iMINDr. Changes in outcomes for the IMMI and waitlist participants were compared. All participants who completed IMMI were then combined for a within-participant analysis. Results: Adherence to the intervention was low, likely due to a traumatic event in the local area of the participants. Compared to the waitlist participants, those in IMMI had improved depression symptoms (p < 0.00005), perceived stress (p = 0.0007), insomnia symptoms ((p = 0.0009), and pain severity (p = 0.05). In the within-participant analysis of all data before and after IMMI (i.e., those initially randomized to IMMI and waitlist participants who took it), we found improvements in depression symptoms (p = 0.0001), perceived stress (p = 0.0001), insomnia symptoms (p < 0.00005), pain interference (p = 0.003), and spirituality (p = 0.018). A seven-week follow-up after the original six-week IMMI program showed sustained improvements in the IMMI participants. Conclusions: IMMI improved depression and related symptoms compared to controls despite minimal support from study staff. IMMI offers a low-dose, low-cost, easily accessible mindfulness meditation intervention for older adults with depression symptoms.

A Mindfulness-Based Intervention: Differential Effects on Affective and Processual Evolution

OBJECTIVES

A 20-minutes-a-day, self-help, mindfulness-based intervention was conducted for 6 weeks with a French community sample. First, the intervention effects on affective and functioning variables were evaluated. Then, a differential approach was used to examine improvement potentiality and the perceived benefits of mindfulness according to the participants' baseline mindfulness competencies.

METHOD

Participants were non-randomly assigned to a control group on the waiting list (n = 44) or a mindfulness group (n = 47). Self-report measures assessed anxiety, depression, psychological distress, mindfulness, negative self-oriented cognition, and experiential avoidance.

RESULTS

Improvements in the variables were observed for the mindfulness group but not for the control group, with effect sizes ranging between .53 and .88. Low baseline levels of mindfulness predicted greater improvement in mindfulness (r = -0.55, p < .001) than high baseline levels.

CONCLUSIONS

Mindfulness practice elicited several positive outcomes regarding affective variables, highlighting emotional functioning changes.

Breath Versus Emotions: The Impact of Different Foci of Attention During Mindfulness Meditation on the Experience of Negative and Positive Emotions

Mindfulness meditation yields beneficial effects on the processing of emotions. However, it is still unclear whether the focus of attention during meditation influences these effects. In the present study we aimed at comparing the effects of breathing meditation and emotion-focused meditation on the immediate and delayed processing of negative and positive emotions. The study included 65 adult novice meditators who were exposed to positively and negatively valenced film clips. Participants were randomly assigned to three conditions. While watching the films at t1, they were asked to mindfully focus on their breath (condition 1), on emotions (condition 2), or on nothing in particular (condition 3). Ten minutes later at t2, comparable film clips were shown but all participants watched them without taking up a mindful attitude. Dependent measures were emotional states at t1 and t2. Participants of both meditation conditions particularly showed a more preferable delayed emotional reaction to negative stimuli than participants of the control condition. Breathing meditation and emotion-focused meditation may constitute effective emotion regulation strategies to deal with negatively valenced emotional states.

Rumination and Mindlessness Processes: Trajectories of Change in a 42-Day Mindfulness-Based Intervention

This preliminary study aimed to understand the effects of an autonomous mindfulness-based intervention (MBI) on mindlessness propensities: rumination, automatic pilot functioning, and attentional distractibility. The ecological momentary assessment was completed by community participants assigned to two nonrandomized groups: an experimental group (n = 45) that practiced 20-minute daily mindfulness meditation for 42 days and a control group (n = 44) that was on the waiting list for the MBI. All participants completed a self-assessment on rumination and mindlessness propensities twice a day. The MBI led to a favorable gradual decrease in automatic pilot functioning and attentional distractibility. Rumination evolved in three stages: a rapid decrease during the first week, a stabilization phase between the 10th and 30th days, and an additional decrease after 30 days of practice. This innovative study provides a promising perspective regarding rumination, automatic pilot functioning, and attentional distractibility dynamic trajectories over the course of an MBI.

Feasibility of an online mindfulness-based program for patients with melanoma: study protocol for a randomised controlled trial

BACKGROUND

People with a melanoma diagnosis are at risk of recurrence, developing a new primary or experiencing disease progression. Previous studies have suggested that fear of a cancer recurrence is clinically relevant in this group of patients and, if not addressed, can lead to distress. Mindfulness-based interventions have been shown to alleviate symptoms of anxiety and depression among various groups of cancer patients. Online mindfulness-based interventions have the potential to reach people unable to attend face-to-face interventions due to limitations such as cancer-related illness, transportation or time constraints. This study aims to (1) examine whether individuals with a melanoma diagnosis are willing to participate and adhere to a 6-week online mindfulness-based intervention and (2) explore potential benefits of the program on fear of cancer recurrence, worries, rumination, perceived stress and trait mindfulness to inform the design of a clinical trial.

METHODS/DESIGN

This is a single-site randomised controlled trial of a feasibility study. Seventy-five participants with stage 2c or 3 melanoma will be recruited from a melanoma outpatient clinic and randomised (2:1) either to an online mindfulness-based program (intervention) or to usual care (control). The intervention is a 6-week program specifically developed for this study. It consists of videos describing the concept of mindfulness, short daily guided meditation practices (5-10 min), automated meditation reminders and instructions for applying mindfulness in daily life to enhance wellbeing. All participants will complete questionnaires at baseline and at 6-week post-randomisation. Participants in the control group will be given access to the online program at the end of the study. Primary outcomes are overall recruitment; retention; extent of questionnaire completion; and usability and acceptability of, and adherence to, the program. The secondary outcomes are fear of cancer recurrence, worries, rumination, perceived stress and trait mindfulness measured using validated instruments.

DISCUSSION

This feasibility study will evaluate participants' satisfaction with the program and identify barriers to recruitment and adherence. The recruitment and data collection process will highlight methodological aspects to address in the planning of a larger scale study assessing the impact of an online mindfulness-based intervention on fear of cancer recurrence and wellbeing.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12617000081314 . Registered on 16 January 2017.

Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial

Objectives

The purpose of this randomized controlled trial was to evaluate the effects of a specialized yoga program for individuals with a spinal cord injury (SCI) on pain, psychological, and mindfulness variables.

Materials and methods

Participants with SCI (n=23) were outpatients or community members affiliated with a rehabilitation hospital. Participants were randomized to an Iyengar yoga (IY; n=11) group or to a 6-week wait-list control (WLC; n=12) group. The IY group participated in a twice-weekly 6-week seated IY program; the WLC group participated in the same yoga program, after the IY group’s yoga program had ended. Pain, psychological, and mindfulness measures were collected at two time points for both groups (within 1–2 weeks before and after program 1 and at a third time point for the WLC group (within 1 week after program 2).

Results

Linear mixed-effect growth models were conducted to evaluate the main effects of group at T2 (postintervention), controlling for T1 (preintervention) scores. T2 depression scores were lower (F_1,18=6.1, P<0.05) and T2 self-compassion scores higher (F_1,18=6.57, P< 0.05) in the IY group compared to the WLC group. To increase sample size and power, the two groups were combined and analyzed across time by comparing pre- and postintervention scores. Main effects of time were found for depression scores, (F_1,14.83=6.62, P<0.05), self-compassion, (F_1,16.6=4.49, P<0.05), mindfulness (F_1,16.79=5.42, P<0.05), mindful observing (F_1,19.82=5.06, P<0.05), and mindful nonreactivity, (F_1,16.53=4.92, P<0.05), all showing improvement after the intervention.

Discussion

The results indicated that a specialized 6-week yoga intervention reduced depressive symptoms and increased self-compassion in individuals with SCI, and may also have fostered greater mindfulness.

Citation patterns and trends of systematic reviews about mindfulness

OBJECTIVES

We performed a citation analysis of the literature about mindfulness aimed at describing the most significant topics and the impact of more relevant papers.

METHODS

We classified 128 systematic reviews about mindfulness-based intervention retrieved in Scopus according to their object, the population included and the type of mindfulness proposed. The citation counting was reported. The cumulative citation numbers per chronological years and article life were analyzed thorough a linear regression model.

RESULTS

1) We observed a general increase in the number of reviews published from 2003 to 2016; 2) two reviews collected the 33% of the overall citations; 3) citation counting for clinical and mixed population collected the 90% of total citations; 4) clinical reviews had higher cumulative citation per publication/year growth.

CONCLUSIONS

As mindfulness research advances, higher attention should be given to the mechanisms by which mindfulness interventions work so as to provide fruitful insights for future research.

Processes of change in a school-based mindfulness programme: cognitive reactivity and self-coldness as mediators

The underlying mechanisms of the effectiveness of mindfulness-based interventions for emotional well-being remain poorly understood. Here, we examined the potential mediating effects of cognitive reactivity and self-compassion on symptoms of depression, anxiety and stress using data from an earlier randomised controlled school trial. A moderated time-lagged mediation model based on multilevel modelling was used to analyse the data. The findings showed that post-treatment changes in cognitive reactivity and self-coldness, an aspect of self-compassion, mediated subsequent changes in symptoms of depression, anxiety and stress. These results suggest that cognitive reactivity and self-coldness may be considered as transdiagnostic mechanisms of change of a mindfulness-based intervention programme for youth.

Contextualising family microaggressions and strategies of resilience among young gay and bisexual men of Latino heritage

Young Latino gay and bisexual men experience discrimination due to heterosexism and racism from within and beyond their communities. Although most research has emphasised overt forms of discrimination, a growing body of research is examining the effects of microaggressions, or indirect forms of discrimination, on racial and sexual minorities. The purpose of this study was to explore the contexts of various types of microaggressions, as well as describe the resilience strategies used by young adult Latino gay and bisexual men living in Los Angeles, California. A sample of 21 young Latino gay and bisexual men aged 18 to 29 years were recruited to complete qualitative, in-depth, semi-structured interviews following a phenomenological approach. Three contextual themes relevant to microaggressions emerged: (1) microassaults, (2) microinsults and (3) microinvalidations. Three themes emerged around the resilience strategies to overcome these experiences: (1) self-discovery, (2) adaptive socialisation and (3) self-advocacy. Family and community-based efforts to reinforce and expand resilience repertoires are needed to help young Latino gay and bisexual men.

'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder

Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.

Shared health characteristics in Hispanic colorectal cancer patients and their primary social support person following primary diagnosis

PURPOSE

The aim of this paper was to determine individual and shared levels of psychosocial, behavioral, and symptomological health characteristics among Hispanics with recent history of cancer and their primary social support person (PSSP) in the years following diagnosis.

PATIENTS AND METHODS

Recruited from a population-based cohort study were 409 Hispanic patients with a previous diagnosis of colorectal cancer. Forty-seven patients identified a PSSP, who assists with medical decision-making and health-related matters, who also participated in the study. Current behavioral (smoking, alcohol use, physical activity, and complementary and alternative medicine use), psychosocial (stress and mindfulness), and physical symptom (fatigue) data were obtained using validated instruments. Analyses tested the individual and shared (between patients and PSSPs) variance in these health measures.

RESULTS

The sample was diagnosed on average 3.1 years (standard deviation = 1.7) prior to assessment. PSSPs were mainly spouses/partners (63%) or children (28%) of patients. Among patients, stress was positively associated with being a current smoker (p < 0.01) and with fatigue (r = 0.45, p < 0.001); stress was negatively correlated with mindfulness (r = -0.41, p < 0.001); mindfulness was negatively associated with smoking (odds ratio (OR) = 0.72, p < 0.01) and alcohol consumption (OR = 0.83, p < 0.05); the inverse relationship between mindfulness and fatigue was partially mediated through lower levels of stress (β = -0.17, p < 0.001). Similar patterns were observed among PSSPs. Patient mindfulness was negatively correlated with PSSP stress (r = -0.45, p < 0.01). Complementary and alternative medicine use showed interdependence between patients and PSSPs for use of herbal remedies (OR = 6.2; p < 0.01) and bodywork (OR = 8.3, p < 0.05).

CONCLUSION

Hispanic colorectal cancer patients and their PSSP share a common health milieu in the years following a cancer diagnosis, offering opportunities for advancing interpersonal intervention approaches in cancer care. Copyright © 2015 John Wiley & Sons, Ltd.

How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms

BACKGROUND

Acceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention.

METHODS

Data from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms.

RESULTS

The treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up.

CONCLUSIONS

The findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations.

TRIAL REGISTRATION

Netherlands Trial Register NTR2736 . Registered 6 February 2011.

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

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

Mechanistic Pathways of Mindfulness Meditation in Combat Veterans With Posttraumatic Stress Disorder

OBJECTIVE

This study's objective was to evaluate the effect of two common components of meditation (mindfulness and slow breathing) on potential mechanistic pathways.

METHODS

A total of 102 combat veterans with posttraumatic stress disorder (PTSD) were randomized to (a) the body scan mindfulness meditation (MM), (b) slow breathing (SB) with a biofeedback device, (c) mindful awareness of the breath with an intention to slow the breath (MM+SB), or (d) sitting quietly (SQ). Participants had 6 weekly one-on-one sessions with 20 minutes of daily home practice. The mechanistic pathways and measures were as follows: (a) autonomic nervous system (hyperarousal symptoms, heart rate [HR], and heart rate variability [HRV]); (b) frontal cortex activity (attentional network task [ANT] conflict effect and event-related negativity and intrusive thoughts); and (c) hypothalamic-pituitary-adrenal axis (awakening cortisol). PTSD measures were also evaluated.

RESULTS

Meditation participants had significant but modest within-group improvement in PTSD and related symptoms, although there were no effects between groups. Perceived impression of PTSD symptom improvement was greater in the meditation arms compared with controls. Resting respiration decreased in the meditation arms compared with SQ. For the mechanistic pathways, (a) subjective hyperarousal symptoms improved within-group (but not between groups) for MM, MM+SB, and SQ, while HR and HRV did not; (b) intrusive thoughts decreased in MM compared with MM+SB and SB, while the ANT measures did not change; and (c) MM had lower awakening cortisol within-group (but not between groups).

CONCLUSION

Treatment effects were mostly specific to self-report rather than physiological measures. Continued research is needed to further evaluate mindfulness meditation's mechanism in people with PTSD.

The Applied Mindfulness Process Scale (AMPS): A process measure for evaluating mindfulness-based interventions

OBJECTIVE

Mindfulness-based interventions (MBIs) include the application of meditation and mind-body practices used to promote mindful awareness in daily life. Operationalizing the construct of mindfulness is important in order to determine mechanisms of therapeutic change elicited by mindfulness practice. In addition to existing state and trait measures of mindfulness, process measures are needed to assess the ways in which individuals apply mindfulness in the context of their practice.

METHOD

This report details three independent studies (qualitative interview, N = 8; scale validation, N = 134; and replication study, N = 180) and the mixed qualitative-quantitative methodology used to develop and validate the Applied Mindfulness Process Scale (AMPS), a 15-item process measure designed to quantify how mindfulness practitioners actively use mindfulness to remediate psychological suffering in their daily lives.

RESULTS

In Study 1, cognitive interviewing yielded a readily comprehensible and accessible scale of 15 items. In Study 2, exploratory factor analysis derived a potential three-factor solution: decentering, positive emotion regulation, and negative emotion regulation. In Study 3, confirmatory factor analysis verified better model fit with the three-factor structure over the one-factor structure.

CONCLUSIONS

AMPS functions as a measure to quantify the application of mindfulness and processes of change in the context of MBIs and general mindfulness practice.

Group CBT versus MBSR for social anxiety disorder: A randomized controlled trial

OBJECTIVE

The goal of this study was to investigate treatment outcome and mediators of cognitive-behavioral group therapy (CBGT) versus mindfulness-based stress reduction (MBSR) versus waitlist (WL) in patients with generalized social anxiety disorder (SAD).

METHOD

One hundred eight unmedicated patients (55.6% female; mean age = 32.7 years, SD = 8.0; 43.5% Caucasian, 39% Asian, 9.3% Hispanic, 8.3% other) were randomized to CBGT versus MBSR versus WL and completed assessments at baseline, posttreatment/WL, and at 1-year follow-up, including the Liebowitz Social Anxiety Scale-Self-Report (primary outcome; Liebowitz, 1987) as well as measures of treatment-related processes.

RESULTS

Linear mixed model analysis showed that CBGT and MBSR both produced greater improvements on most measures compared with WL. Both treatments yielded similar improvements in social anxiety symptoms, cognitive reappraisal frequency and self-efficacy, cognitive distortions, mindfulness skills, attention focusing, and rumination. There were greater decreases in subtle avoidance behaviors following CBGT than MBSR. Mediation analyses revealed that increases in reappraisal frequency, mindfulness skills, attention focusing, and attention shifting, and decreases in subtle avoidance behaviors and cognitive distortions, mediated the impact of both CBGT and MBSR on social anxiety symptoms. However, increases in reappraisal self-efficacy and decreases in avoidance behaviors mediated the impact of CBGT (vs. MBSR) on social anxiety symptoms.

CONCLUSIONS

CBGT and MBSR both appear to be efficacious for SAD. However, their effects may be a result of both shared and unique changes in underlying psychological processes.