Self-Regulatory Deficits Associated with Unpracticed Mindfulness Strategies for Coping with Acute Pain

Child Emotion Regulation Capacity Moderates the Association Between Parent Behaviors and Child Distress During Pediatric Venipuncture

OBJECTIVES

Medical needle procedures are a common source of pain, distress, and fear for children, which can worsen over time and lead to needle noncompliance and avoidance, if unaddressed. Children's pain experience is multiply determined by external (e.g., parent behaviors) and internal (e.g., cognitive and affective) factors. Some parent behaviors (e.g., reassurance, giving control to child, empathy, apologies, criticism) have related to poor child pain experiences. No research has examined how children's internal emotion regulation, commonly measured via heart rate variability (HRV), may buffer, or strengthen this association. This study is the first to examine child HRV in relation to pain experiences, and as a moderator between a constellation of parent behaviors (reassurance, giving control, empathy) and child pain, fear, and distress.

METHODS

Sixty-one children aged 7-12 years undergoing venipuncture and a parent participated. Child HRV was measured before the procedure. After venipuncture, children rated their pain and fear. Parent and child behaviors during venipuncture were coded using the "distress promoting" and "distress" composites of the Child-Adult Medical Procedure Interaction Scale-Revised.

RESULTS

Children with lower HRV displayed greater distress. Child HRV moderated the positive association between parent behaviors (reassurance, giving control, empathy) and child distress such that the association was strongest among children with low HRV.

CONCLUSIONS

Findings suggest children with lower HRV, indicative of lower emotion regulation capacity, may be at risk of experiencing higher levels of distress and may be more vulnerable to distress when facing parent reassurance, giving control, and empathy verbalizations during venipuncture.

A Brief Mindfulness Intervention for Parents and Children before Pediatric Venipuncture: A Randomized Controlled Trial

BACKGROUND

Routine needle procedures can be distressing for parents and children. Mindfulness interventions may be helpful for parents and children but have not been examined for pediatric needle procedures despite showing benefits in the context of pediatric chronic pain and in lab-based pain tasks.

METHODS

This preregistered (NCT03941717) two-arm, parallel-group randomized controlled trial examined the effects of a 5 min mindfulness intervention before pediatric venipuncture for parents and children (aged 7-12) compared to a control group on primary outcomes of child pain and fear, secondary outcomes of parent distress, and tertiary outcomes of parent ratings of child pain and fear. Moderators of parent and children's responses to the intervention were examined: state catastrophizing, trait mindfulness, and experiential avoidance.

RESULTS

Sixty-one parent-child dyads were randomized (31 mindfulness; 30 control). Parents and children completed measures, listened to a 5 min audio recording (mindfulness or control), and parents accompanied their child during routine venipuncture. The mindfulness intervention involved breathing and encouraging nonjudgmental attention to one's experiences, while the control condition involved an unfocused attention task. Three between-subject MANCOVAs assessed for group differences. Child pain and fear rated by children and their parents did not differ between groups. Parents in the mindfulness group were less distressed during the venipuncture than the controls. Parent state catastrophizing may have moderated the intervention effects, such that parents with moderate and high catastrophizing levels had lower distress following the mindfulness intervention versus control.

CONCLUSIONS

The intervention did not reduce child pain or fear but reduced parent distress. It appeared most helpful for parents catastrophizing about their child's pain, which is noteworthy as these children are prone to worse outcomes.

Effects of Brief Mindfulness Interventions on the Interference Induced by Experimental Heat Pain on Cognition in Healthy Individuals

Background: Pain captures attention and interferes with competing tasks demanding cognitive effort. Brief mindfulness interventions involving both conceptual learning and meditation exercises have been shown to improve attention and reduce pain sensitivity, and could potentially reduce pain interference. This study assesses the effect of a 5-day mindfulness intervention (20 min/day) on the interference produced by thermal pain on working memory performance using a 2-back task.

Methods: Healthy participants were randomized into three groups exposed to mindfulness meditation training (n = 15), an active educational control intervention comprising only conceptual information on mindfulness (n = 15), or no intervention (n = 15). The two active interventions were administered in a dual-blind fashion and outcomes were assessed by research personnel blind to this allocation. Evaluation sessions were conducted before and after the interventions to assess the effect of pain on 2-back performance (pain interference). Importantly, both pain stimuli and the 2-back task were calibrated individually and in each session before assessing pain interference, thereby controlling for possible changes in baseline pain sensitivity and cognitive performance. Secondary outcomes included heat pain sensitivity, cold pain tolerance, cognitive inhibition, cognitive flexibility, and divided attention.

Results: Manipulation checks confirmed that heat pain interferes with the performance of the working-memory task. Compared to the no-intervention control group, pain interference was significantly reduced following the conceptual intervention but not the meditation intervention, although a corollary analysis suggests the effect might be due to regression toward the mean caused by baseline imbalance in pain interference. Secondary outcomes also suggested an increase in pain tolerance in the conceptual learning group only.

Discussion: A short mindfulness meditation intervention was insufficient to reduce pain interference but conceptual learning about mindfulness produced some unexpected benefits. Although the generalization of experimental findings to clinical pain conditions may be premature, these results highlight the importance of distinguishing the contribution of mindfulness education and meditation training in future studies. Understanding the effects of mindfulness training on pain regulation and management must take into consideration the multiple factors underlying this complex intervention.

When Mindfulness Becomes a Mental Health Risk: The Relevance of Emotion Regulation Difficulties and Need Frustration

Although a great deal of research has shown the positive effects of mindfulness on mental health, some studies have provided evidence that mindfulness can have negative consequences. However, not much is known about the conditions that can account for such negative effects. We examined the moderating roles of difficulties in emotion regulation and basic psychological need frustration in the relationship between mindfulness and psychological ill-being. Longitudinal data were collected at three points in time during a 6-month period from two adult samples in Turkey and Germany. Self-report measures were used to measure ill-being, mindfulness, emotion regulation difficulties, and need frustration. In the German sample, difficulties in emotion regulation and need frustration were related to ill-being, but there were no significant interactions. In the Turkish sample, need frustration predicted ill-being, and the interaction between mindfulness and difficulties in emotion regulation also predicted ill-being. Mindfulness was a protective factor among people with no major difficulties in emotion regulation, whereas it was a risk factor among those with emotion regulation difficulties. The findings suggest that the relationship between mindfulness and ill-being may be more complex than previously thought.

Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Slow deep breathing (SDB) may help patients with acute pain. The primary aim of this systematic review and meta-analysis is to investigate the effects of SDB on acute pain. Secondary aims include investigating the effects of SDB on acute pain-related physical and emotional functioning. An a priori protocol was registered and a database search was conducted by a reference librarian. Randomized controlled trials (RCT) were eligible for inclusion and exclusion criteria included studies of SDB for non-pain indications and studies that applied SDB as a component of an encompassing intervention. The risk or bias was assessed using the Cochrane Collaboration's revised tool for assessing risk of bias in randomized trials. Meta-analysis was conducted using the random effects model. A total of 11 968 studies were screened and seven RCTs met inclusion criteria; five were judged to have low risk of bias. Meta-analysis of post-intervention pain scores demonstrated that SDB was associated with significantly lower pain scores compared with a control group, but with high levels of heterogeneity. Subgroup analyzes demonstrated that trials of burn pain were associated with a larger reduction in pain which partially explains the heterogeneity. Very low certainty evidence suggests that SDB may reduce acute pain intensity. Further research is needed to identify patients who are candidates for SDB and determine the best approach to deliver this therapy.

Heart Rate Variability and Pain: A Systematic Review

Background and Objective: Heart rate variability (HRV) as an index of the autonomic nervous system appears to be related to reactivity to experimental pain stimuli. HRV could better explain the contributions of sympathetic and parasympathetic activity response to nociceptive stimulation. The aim of this study was to systematically review and synthesize the current evidence on HRV in relation to the experience of pain in experimental tasks. Databases and Data Treatment: Studies indexed in the PubMed, PsycINFO, MEDLINE, WebOfScience, and Scopus databases were reviewed for eligibility. Studies on the autonomic response (i.e., HRV) to experimentally induced pain in healthy adults were included. Different methods of pain induction were considered (e.g., thermal, pressure, and electrical). Data were synthesized considering the association between HRV and both pain induction and subjective measures of pain. Results: Seventy-one studies were included. The results underline significant change in both the sympathetic and parasympathetic autonomic nervous systems during the painful stimulation independent of the pain induction method. The autonomic reaction to pain could be affected by several factors, such as sex, age, body mass index, breathing patterns, the intensity of the stimulation, and the affective state. Moreover, an association between the autonomic nervous system and the subjective experience of pain was found. Higher parasympathetic activity was associated with better self-regulation capacities and, accordingly, a higher pain inhibition capacity. Conclusions: HRV appears to be a helpful marker to evaluate nociceptive response in experimentally induced pain. Future studies are also needed in clinical samples to understand better the interindividual changes of autonomic response due to pain stimuli.

Cognitive reappraisal is not always successful during pain anticipation: Stimulus-focused and goal-based reappraisal effects on self-reports and peripheral psychophysiology

The present study aims at comparing the effects of two subtypes of cognitive reappraisal (i.e., stimulus-focused vs. goal-based reappraisal) to reduce anticipatory anxiety of pain. Affective ratings, startle reflex, and autonomic measures (electrodermal and heart rate changes) were used as a measure of emotion regulation success. A total of 86 undergraduate students completed an anticipatory task in which they had to regulate their negative emotions or react naturally when faced with the possibility of receiving a painful thermal stimulus. Participants were randomly assigned to two experimental groups to compare the stimulus-focused and goal-based strategies explored here. Our results revealed enhanced self-reported anxiety, electrodermal activity and eyeblink response when participants tried to voluntarily down-regulate their negative emotions, compared to the control instruction. Differences between both cognitive reappraisal groups were not found. These unexpected findings suggest that brief reappraisal instructions may not necessarily be favorable for regulating emotions during anticipation of aversive events. Moreover, these results are further explained in terms of the pain expectation, the painful stimuli modality, and emotion regulation instructions.

A balanced view of mindfulness at work

Mindfulness has grown from an obscure subject to an immensely popular topic that is associated with numerous performance, health, and well-being benefits in organizations. However, this growth in popularity has generated a number of criticisms of mindfulness and a rather piecemeal approach to organizational research and practice on the subject. To advance both investigation and application, the present paper applies The Balance Framework to serve as an integrative scaffolding for considering mindfulness in organizations, helping to address some of the criticisms leveled against it. The Balance Framework specifies five forms of balance: 1) balance as tempered view, 2) balance as mid-range, 3) balance as complementarity, 4) balance as contextual sensitivity, and 5) balance among different levels of consciousness. Each form is applied to mindfulness at work with a discussion of relevant conceptual issues in addition to implications for research and practice.

Plain Language Summary

In order to appreciate the value of mindfulness at work researchers and practitioners might want to consider both the benefits and potential drawbacks of mindfulness. This paper presents a discussion of both the advantages and possible disadvantages of mindfulness at work organized in terms of the five dimensions of an organizing structure called The Balance Framework.

Emotion regulation and peripheral psychophysiological correlates in the management of induced pain: A systematic review

Cognitive reappraisal and acceptance strategies have been shown to be effective in reducing pain experience and increasing pain tolerance. However, no systematic reviews have focused on the relationship between the use of these two strategies and peripheral physiological correlates when pain is experimentally induced. This systematic review aims to summarize the existing literature that explores the relationship between emotion regulation strategies (i.e., cognitive reappraisal and acceptance) and peripheral correlates of the autonomic nervous system and facial electromyography, such as affect-modulated responses and corrugator activity, on laboratory tasks where pain is induced. The systematic review identifies nine experimental studies that meet our inclusion criteria, none of which compare these strategies. Although cognitive reappraisal and acceptance strategies appear to be associated with decreased psychological responses, mixed results were found for the effects of the use of both strategies on all the physiological correlates. These inconsistencies between the studies might be explained by the high methodological heterogeneity in the task designs, as well as a lack of consistency between the instructions used in the different studies for cognitive reappraisal, acceptance, and the control conditions.

Mindfulness and intergroup bias: A systematic review

People’s proclivity for favoring their ingroups over outgroups has negative consequences for individuals, groups, and societies. Social psychologists have explored a variety of techniques to reduce these intergroup biases. Emerging research suggests that mindfulness may be effective for this purpose. Mindfulness is defined as present-moment attention and awareness with an accepting attitude, and it is often cultivated through meditation. Our systematic review of the mindfulness-intergroup literature suggests that, across the heterogeneity of paradigms, mindfulness attenuates intergroup bias. Supporting this supposition, for all studies in the current review, regardless of operationalization of mindfulness (i.e., mindfulness-based intervention, brief mindfulness induction, expert meditators, dispositional mindfulness), the overall effect size was g = +.29 ( k-number of studies = 36; 95% CI [0.20, 0.39]; Z = 5.94, p < .0001), suggesting a small but significant effect of mindfulness on improved levels of intergroup bias. In the current work, we review the eligible studies and their findings in detail and conclude by discussing critical issues and implications for future research.

Meaning-Making Activity in the Emotional Experience of Borderline Personalities

This article describes the mereological constitution of contents in the intentional acts of people affected by borderline personality disorder (BPD) or emotionally unstable personality disorder (EUPD) in order to shed light on the origin of the emotional instability characterizing this disorder. The article will first discuss the emotional cycle of people affected by this disorder; second, it will focus on the mereological aspect of the meaning-making<A51_FootRef>1</A51_FootRef> experience in the intentional act; third, it will show how this meaning-making experience usually interacts with axiological<A51_FootRef>2</A51_FootRef> qualities that affect the continuity of their sense of reality. From the investigation, it emerges that the mereological constitution of contents occurs in a way that is disruptive of the continuity of BPD/EUPDs' interaffective lifeworld as it generates intersubjective disturbances on the axiological, logical, and ontological levels. On this basis, as a concluding suggestion, the paper will propose an alternative way to approach the problem, soothe the disturbance, and encourage integration.

Acute Effects of Brief Mindfulness Intervention Coupled with Carbohydrate Ingestion to Re-Energize Soccer Players: A Randomized Crossover Trial

Background: This field experiment investigated the acute effects of brief mindfulness-based intervention (MBI) coupled with carbohydrate (CHO) intake on players' recovery from half-time break in a simulated soccer competition. Methods: In a single-blinded randomized crossover experiment, 14 male players received 3 treatments (Control: non-carbohydrate solution + travelling introduction audio; CHO: CHO-electrolyte solution + travelling introduction audio; and CHO_M: CHO-electrolyte solution + MBI) during simulated half-time breaks. Vertical jump, sprint performance, mindfulness level, rate of perceived exertion, muscle pain, mental fatigue, blood glucose, and lactate were measured immediately before, during, and after the exercise. Results: (1) MBI significantly increased participants' mindfulness level (Control vs. CHO_M, p < 0.01; CHO vs. CHO_M, p < 0.01) and decreased mental fatigue for CHO_M condition (pre vs. post, p < 0.01); (2) participants in the CHO_M condition performed better in the repeated sprint tests than in the Control and CHO condition (Control vs. CHO_M, p = 0.02; CHO vs. CHO_M, p = 0.02). Conclusion: Findings of this study provide preliminary evidence of the positive effect of MBI coupled with CHO ingestion on athletes' recovery from fatigue in the early stage of the second half of a game.

Acceptance-Based Emotion Regulation Reduces Subjective and Physiological Pain Responses

Acceptance-based regulation of pain, which focuses on the allowing of pain and pain related thoughts and emotions, was found to modulate pain. However, results so far are inconsistent regarding different pain modalities and indices. Moreover, studies so far often lack a suitable control condition, focus on behavioral pain measures rather than physiological correlates, and often use between-subject designs, which potentially impede the evaluation of the effectiveness of the strategies. Therefore, we investigated whether acceptance-based strategies can reduce subjective and physiological markers of acute pain in comparison to a control condition in a within-subject design. To this end, participants (N = 30) completed 24 trials comprising 10 s of heat pain stimulation. Each trial started with a cue instructing participants to welcome and experience pain (acceptance trials) or to react to the pain as it is without employing any regulation strategies (control trials). In addition to pain intensity and unpleasantness ratings, heart rate (HR) and skin conductance (SC) were recorded. Results showed significantly decreased pain intensity and unpleasantness ratings for acceptance compared to control trials. Additionally, HR was significantly lower during acceptance compared to control trials, whereas SC revealed no significant differences. These results demonstrate the effectiveness of acceptance-based strategies in reducing subjective and physiological pain responses relative to a control condition, even after short training. Therefore, the systematic investigation of acceptance in different pain modalities in healthy and chronic pain patients is warranted.

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

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

Self-regulatory ability, fatigue, and the experience of pain: Mechanistic insights from pain-free undergraduates

Self-regulatory (SR) ability is an important resource for managing pain, but chronic pain patients experience chronic self-regulatory fatigue even when they are not in pain. Pressure pain thresholds (PPT) and pain inhibition are two mechanisms that differentiate people with and without chronic pain. It was hypothesized that trait SR ability would be associated with higher PPT and better pain inhibition and that PPT and pain inhibition would be lower following high versus low SR fatigue. Three studies tested these hypotheses. Study 1 had 240 pain-free undergraduates complete measures of trait SR ability and PPT; 122 also provided data on pain inhibition. Study 2 had 38 of Study 1's participants return for two additional sessions in which they underwent PPT testing under conditions of high or low SR fatigue (within-person, counterbalanced). Study 3 repeated these procedures with pain inhibition as the outcome (n = 39). Results revealed that individual differences in SR ability were not associated with PPT or pain inhibition (all ps > 0.05). Within people, neither PPT (F(1, 36) = 1.57, p = 0.22) nor pain inhibition (F(1, 37) = 1.79, p = 0.19) were significantly different under conditions of low versus high SR fatigue. Results do not support the hypotheses that PPT or pain inhibition associate with individual differences in trait SR ability or transient changes in state SR fatigue in the absence of pain. Instead, the SR deficits in chronic pain patients may arise from the experience of chronic pain.

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

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

Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review

OBJECTIVES

Nonpharmacologic approaches have been characterized as the preferred means to treat chronic noncancer pain by the Centers for Disease Control and Prevention. There is evidence that mindfulness-based interventions (MBIs) are effective for pain management, yet the typical MBI may not be feasible across many clinical settings due to resource and time constraints. Brief MBIs (BMBIs) could prove to be more feasible and pragmatic for safe treatment of pain. The aim of the present article is to systematically review evidence of BMBI's effects on acute and chronic pain outcomes in humans.

METHODS

A literature search was conducted using PubMed, PsycINFO, and Google Scholar and by examining the references of retrieved articles. Articles written in English, published up to August 16, 2017, and reporting on the effects of a BMBI (i.e., total contact time <1.5 h, with mindfulness as the primary therapeutic technique) on a pain-related outcome (i.e., pain outcome, pain affect, pain-related function/quality of life, or medication-related outcome) were eligible for inclusion. Two authors independently extracted the data and assessed risk of bias.

RESULTS

Twenty studies meeting eligibility criteria were identified. Studies used qualitative (n = 1), within-group (n = 3), or randomized controlled trial (n = 16) designs and were conducted with clinical (n = 6) or nonclinical (i.e., experimentally-induced pain; n = 14) samples. Of the 25 BMBIs tested across the 20 studies, 13 were delivered with audio/video recording only, and 12 were delivered by a provider (participant-provider contact ranged from 3 to 80 min). Existing evidence was limited and inconclusive overall. Nevertheless, BMBIs delivered in a particular format-by a provider and lasting more than 5 min-showed some promise in the management of acute pain.

CONCLUSIONS

More rigorous large scale studies conducted with pain populations are needed before unequivocally recommending BMBI as a first-line treatment for acute or chronic pain.

Can mindfulness be too much of a good thing? The value of a middle way

Previous research has found that very few, if any, psychological or physiological processes are universally beneficial. Instead, positive phenomena tend to follow a non-monotonic or inverted U-shaped trajectory where their typically positive effects eventually turn negative. This review investigates mindfulness-related processes for signs of non-monotonicity. A number of mindfulness-related processes-including, mindful attention (observing awareness, interoception), mindfulness qualities, mindful emotion regulation (prefrontal control, decentering, exposure, acceptance), and meditation practice-show signs of non-monotonicity, boundary conditions, or negative effects under certain conditions. A research agenda that investigates the possibility of mindfulness as non-monotonic may be able to provide an explanatory framework for the mix of positive, null, and negative effects that could maximize the efficacy of mindfulness-based interventions.

Acceptance lowers stress reactivity: Dismantling mindfulness training in a randomized controlled trial

OBJECTIVE

Mindfulness interventions, which train practitioners to monitor their present-moment experience with a lens of acceptance, are known to buffer stress reactivity. Little is known about the active mechanisms driving these effects. We theorize that acceptance is a critical emotion regulation mechanism underlying mindfulness stress reduction effects.

METHOD

In this three-arm parallel trial, mindfulness components were dismantled into three structurally equivalent 15-lesson smartphone-based interventions: (1) training in both monitoring and acceptance (Monitor+Accept), (2) training in monitoring only (Monitor Only), or (3) active control training (Coping control). 153 stressed adults (mean age=32years; 67% female; 53% white, 21.5% black, 21.5% Asian, 4% other race) were randomly assigned to complete one of three interventions. After the intervention, cortisol, blood pressure, and subjective stress reactivity were assessed using a modified Trier Social Stress Test.

RESULTS

As predicted, Monitor+Accept training reduced cortisol and systolic blood pressure reactivity compared to Monitor Only and control trainings. Participants in all three conditions reported moderate levels of subjective stress.

CONCLUSIONS

This study provides the first experimental evidence that brief smartphone mindfulness training can impact stress biology, and that acceptance training drives these effects. We discuss implications for basic and applied research in contemplative science, emotion regulation, stress and coping, health, and clinical interventions.

A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain

Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13-17 years. Measures of pain intensity, functional disability, depression and parent worry about their child's pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents' worry about child's pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy.

Emotional Processes in Borderline Personality Disorder: An Update for Clinical Practice

Despite prior assumptions about poor prognosis, the surge in research on borderline personality disorder (BPD) over the past several decades shows that it is treatable and can have a good prognosis. Prominent theories of BPD highlight the importance of emotional dysfunction as core to this disorder. However, recent empirical research suggests a more nuanced view of emotional dysfunction in BPD. This research is reviewed in the present article, with a view towards how these laboratory-based findings can influence clinical work with individuals suffering from BPD.

Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT)

Despite evidence linking trait mindfulness and mindfulness training with a broad range of effects, still little is known about its underlying active mechanisms. Mindfulness is commonly defined as (1) the ongoing monitoring of present-moment experience (2) with an orientation of acceptance. Building on conceptual, clinical, and empirical work, we describe a testable theoretical account to help explain mindfulness effects on cognition, affect, stress, and health outcomes. Specifically, Monitor and Acceptance Theory (MAT) posits that (1), by enhancing awareness of one's experiences, the skill of attention monitoring explains how mindfulness improves cognitive functioning outcomes, yet this same skill can increase affective reactivity. Second (2), by modifying one's relation to monitored experience, acceptance is necessary for reducing affective reactivity, such that attention monitoring and acceptance skills together explain how mindfulness improves negative affectivity, stress, and stress-related health outcomes. We discuss how MAT contributes to mindfulness science, suggest plausible alternatives to the account, and offer specific predictions for future research.

Mindfulness Interventions

Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.

Examination of trait impulsivity on the response to a brief mindfulness intervention among college student drinkers

Mindfulness-based strategies show promise for targeting the construct of impulsivity and associated variables among problematic alcohol users. This study examined the moderating role of intervention (mindfulness vs relaxation vs control) on trait impulsivity and three outcomes examined post-intervention (negative affect, positive affect, and urge to drink) among 207 college students with levels of at-risk drinking. Moderation analyses revealed that the relationship between baseline impulsivity and the primary outcomes significantly differed for participants who underwent the mindfulness versus relaxation interventions. Notably, simple slope analyses revealed that negative urgency was positively associated with urge to drink following the mindfulness intervention. Among participants who underwent the relaxation intervention, analysis of simple slopes revealed that negative urgency was negatively associated with urge to drink, while positive urgency was positively associated with positive affect following the relaxation intervention. Findings suggest that level (low vs high) and subscale of impulsivity matter with regard to how a participant will respond to a mindfulness versus relaxation intervention.

Brief mindfulness meditation training alters psychological and neuroendocrine responses to social evaluative stress

OBJECTIVE

To test whether a brief mindfulness meditation training intervention buffers self-reported psychological and neuroendocrine responses to the Trier Social Stress Test (TSST) in young adult volunteers. A second objective evaluates whether pre-existing levels of dispositional mindfulness moderate the effects of brief mindfulness meditation training on stress reactivity.

METHODS

Sixty-six (N=66) participants were randomly assigned to either a brief 3-day (25-min per day) mindfulness meditation training or an analytic cognitive training control program. All participants completed a standardized laboratory social-evaluative stress challenge task (the TSST) following the third mindfulness meditation or cognitive training session. Measures of psychological (stress perceptions) and biological (salivary cortisol, blood pressure) stress reactivity were collected during the social evaluative stress-challenge session.

RESULTS

Brief mindfulness meditation training reduced self-reported psychological stress reactivity but increased salivary cortisol reactivity to the TSST, relative to the cognitive training comparison program. Participants who were low in pre-existing levels of dispositional mindfulness and then received mindfulness meditation training had the greatest cortisol reactivity to the TSST. No significant main or interactive effects were observed for systolic or diastolic blood pressure reactivity to the TSST.

CONCLUSIONS

The present study provides an initial indication that brief mindfulness meditation training buffers self-reported psychological stress reactivity, but also increases cortisol reactivity to social evaluative stress. This pattern may indicate that initially brief mindfulness meditation training fosters greater active coping efforts, resulting in reduced psychological stress appraisals and greater cortisol reactivity during social evaluative stressors.