Relations of mindfulness facets with psychological symptoms among individuals with a diagnosis of obsessive-compulsive disorder, major depressive disorder, or borderline personality disorder

Investigating trait mindfulness in women with a history of unwanted sexual contact

Unwanted sexual contact (USC) is common in women, and may contribute to sexual dysfunction via avoidance coping techniques. Mindfulness-based treatments, which directly challenge avoidance, have been shown to be effective in treating sexual dysfunction, however, it is not yet clear whether there are differences in trait mindfulness between women with and without a history of USC. We used data from four previous studies and compared trait mindfulness on the Five Facet Mindfulness Questionnaire (FFMQ) in women with and without a history of USC. There were no significant differences between the USC and no-USC groups on total FFMQ score, nor on most individual domain scores; however, significant group differences were found on observe and acting with awareness subscales. We speculate on the possible meaning of the USC group having higher observe scores and lower acting with awareness scores compared to the no-USC group.

Promoting well-being in early adolescents through mindfulness: A cluster randomized controlled trial

OBJECTIVES

The Gaia program is a 12-week mindfulness intervention based on cultivating body, emotional, and ecological self-awareness, which has been shown to be effective in reducing children's and adolescents' internalizing problems at school. This paper presents the results of a cluster randomized controlled trial aimed at assessing the effectiveness of this program on improving psychological well-being, subjective well-being, and psychological distress in early adolescents.

METHODS

A sample of 195 early adolescent students (boys, n = 99; girls, n = 96) with a mean age of 11.49 years (standard deviation = 0.80) attending 12 middle school classes participated in the study. Seven Gaia instructors belonging to six schools led the program. Measures were administered at three time points, approximately every 3 months: 1 week before treatment, 1 week after treatment, and 3 months after treatment. We used a multilevel regression model to test whether treatment was effective in increasing psychological well-being and subjective well-being, and reducing psychological distress, as compared to a waiting-list control group.

RESULTS

The results showed that the Gaia program improved psychological well-being but not subjective well-being and psychological distress. Specifically, the Gaia program was effective in increasing personal growth and purpose in life, the key eudaimonic components of psychological well-being, in the experimental group whereas they decreased in the control group.

CONCLUSIONS

Findings from this study provide preliminary evidence that the Gaia program for early adolescents may improve the core eudaimonic components of psychological well-being from pretest to follow-up that, conversely, decrease in the control group.

Attachment and Mindfulness as Mediators in the Relationship Between Childhood Adversity and Personality Outcomes

Past research has shown that those with greater experiences of adversity (abuse and neglect) tend to exhibit insecure attachments, more borderline symptoms, higher psychopathic traits, and are lower in mindfulness. Similarly, there have been positive relationships between insecure attachment styles and borderline and psychopathic traits as well as lower mindfulness and borderline and psychopathic traits. Further, adversity can have a detrimental effect on physical and mental health, including attachment and personality, which necessitate examining this further. The purpose of this study was to examine the indirect relationships between childhood adversity and borderline traits, Factor 1, and Factor 2 of psychopathy all through lower mindfulness, anxious attachment, and avoidant attachment respectively. In this study, using youth retrospective data (N = 395, age range = 12-18, M = 14.64, SD = 1.52), 3 separate mediation models are examined. As expected, the relationship between adversity and borderline traits was indirect through anxious attachment (β = 0.075, p < .01) and lower mindfulness (β = 0.069, p < .01). For psychopathic traits, the relationship was indirect through avoidant attachment (Factor 1: β = 0.078, p < .05; Factor 2: β = 0.071, p < .05) and lower mindfulness (Factor 1: β = 0.074, p < .01: Factor 2: β = 0.076, p < .01). The results suggest that lower mindfulness and insecure attachment are important factors in the expression of disordered personality. Therefore, both mindfulness and attachment-focused interventions could mitigate the harmful effects of adversity and the subsequent expression of disordered personality symptoms.

Does trait mindfulness mediate the relationship between borderline personality symptoms and emotion dysregulation?

BACKGROUND

Emotion dysregulation is core to many biopsychosocial models of Borderline Personality Disorder (BPD) and is often targeted as part of their associated psychological therapies. Several distinct specialist psychotherapies are thought to be effective for people diagnosed with BPD but it is unclear whether they share common change mechanisms. Some evidence suggests that Mindfulness Based Interventions improve competency in emotion regulation as well as trait mindfulness, which are both plausibly associated with good treatment outcomes. It is unclear whether the association between the severity of BPD symptoms and emotion dysregulation is mediated by trait mindfulness. Would improvement in trait mindfulness mediate an association between lower severity of BPD symptoms and fewer problems of emotion dysregulation?

METHODS

One thousand and twelve participants completed online, single time-point, self-report questionnaires.

RESULTS

As predicted, the severity of BPD symptoms was significantly and positively associated with emotion dysregulation with a large effect size (r = .77). Trait mindfulness mediated this relationship as the 95% confidence interval for the indirect effect did not cross zero (size of direct effect = .48 and size of indirect effect = .29 [.25, .33].

CONCLUSIONS

The relationship between the severity of BPD symptoms and emotion dysregulation was confirmed in this dataset. As hypothesised, this relationship was mediated by trait mindfulness. Process measures of emotion dysregulation and mindfulness should be included in intervention studies for people diagnosed with BPD to understand if improvements in these factors are a universal occurrence with good response to treatment. Other process measures should also be explored to identify other factors involved in the relationship between BPD symptoms and emotion dysregulation.

A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog

BACKGROUND

Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD.

OBJECTIVE

A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps.

METHODS

Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines.

RESULTS

Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression.

CONCLUSION

BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.

Mindfulness and Depersonalization: a Nuanced Relationship

Objectives

Methods

Results

Conclusions

Supplementary Information

Dissociation and emotion regulation strategies: A meta-analytic review

OBJECTIVE

Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning.

METHODS

The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach.

RESULTS

The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (r_w = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (r_w = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (r_w = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness).

CONCLUSION

Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.

Mindfulness-based and acceptance-based programmes in the treatment of obsessive-compulsive disorder: a study protocol for a systematic review and meta-analysis

INTRODUCTION

Cognitive-behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive-compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes' effectiveness.

METHODS AND ANALYSIS

We will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence.

ETHICS AND DISSEMINATION

Ethical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.

Emotion regulation, mindfulness, and self-compassion among patients with borderline personality disorder, compared to healthy control subjects

Objectives

Emotion regulation difficulties are a major characteristic of personality disorders. Our study investigated emotion regulation difficulties that are characteristic of borderline personality disorder (BPD), compared to a healthy control group.

Methods

Patients with BPD (N = 59) and healthy participants (N = 70) filled out four self-report questionnaires (Cognitive Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Five Facet Mindfulness Questionnaire, Self-Compassion Scale) that measured the presence or lack of different emotion-regulation strategies. Differences between the BPD and the healthy control group were investigated by Multivariate Analysis of Variance (MANOVA) and univariate post-hoc F-test statistics.

Results

People suffering from BPD had statistically significantly (p<0.05) higher levels of emotional dysregulation and used more maladaptive emotion-regulation strategies, as well as lower levels of mindfulness and self-compassion compared to the HC group.

Conclusion

In comparison to a healthy control group, BPD patients show deficits in the following areas: mindfulness, self-compassion and adaptive emotion-regulation strategies. Based on these results, we suggest that teaching emotion-regulation, mindfulness, and self-compassion skills to patients can be crucial in the treatment of borderline personality disorder.

Which are the best questionnaires to longitudinally evaluate mindfulness skills in personality disorders?

BACKGROUND

Personality disorders (PDs) are severe mental illnesses, characterized by inflexible and enduring response patterns in a broad range of personal and social situations. With the aim of identifying effective and evidence-based interventions, in the last decades we observed a flourishing of the so-called "thirdwave" cognitive-behavioural therapies, where mindfulness appears as relevant factor in promoting individual well-being and treatment response. In this regard, several authors tried to develop new instruments that enable to measure mindfulness skills, such as the Kentucky Inventory of Mindfulness Skills (KIMS), the Five Facet Mindfulness Questionnaire (FFMQ) and the Philadelphia Mindfulness Scale (PHLMS). The aim of this review is to provide new insights about the mindfulness questionnaires currently used in longitudinal studies in PDs by providing a benchmark for future studies evaluating mindfulness changes associated to therapeutic interventions.

METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search in PubMed was performed. Three reviewers conducted the data extraction. Longitudinal studies on PDs evaluating mindfulness skills through a validated questionnaire were selected. Ten studies met the selection criteria.

RESULTS

The majority of the studies reviewed (N=7) detected an increase in mindfulness skills (4 rated with FFMQ, 2 KIMS, and 1 Philadelphia Mindfulness Scale). Finally, from the selected studies mindfulness changes were also associated with clinical amelioration.

LIMITATIONS

Few studies evaluate male patients and PDs other than borderline personality disorder.

CONCLUSION

Although mindfulness is a complex construct to operationalize, the considered questionnaires emerged as useful instruments for clinicians to detect changes in mindfulness abilities. In particular, currently the FFMQ appears as the most suitable measure.

Relationship Between Mindfulness, Psychopathological Symptoms, and Academic Performance in University Students

It has been shown that a mindfulness construct involving five component skills (observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience) is related to well-being and lessens depression, anxiety, and stress symptoms. This study investigates the relationship between mindfulness, academic performance, and psychopathological symptoms in a sample of Swiss university students during preparation for examinations. A total sample of 150 university students from the psychology department at the University of Geneva were invited to report their mindfulness skills and academic performance, as well as anxiety, depression, and stress symptoms, through self-report measures. Results indicated that the total mindfulness score and the nonreactivity facet of mindfulness were associated with depression scores. Furthermore, mindfulness skills were positively correlated with students' academic performance. Finally, certain demographic variables, such as gender, were linked to the presence of depression, anxiety, and stress symptoms in our sample. The clinical implications of these results are discussed.

Psychological well-being and distress in patients with generalized anxiety disorder: The roles of positive and negative functioning

Background

Whether mindfulness and emotional intelligence may counteract psychological symptoms and whether brooding and worry may be linked to decreased psychological well-being (PWB) in individuals with generalized anxiety disorder (GAD) is still an issue.

Methods

The study used a cross-sectional design on a sample of 66 consecutive individuals with a diagnosis of GAD. Two hierarchical multiple regressions were conducted to determine whether PWB and anxiety symptoms were accounted for by mindfulness and emotional intelligence skills, brooding, and worry.

Results

Worry was negatively related to PWB and showed a tendency to be positively associated with anxiety symptoms after controlling for the other variables. Brooding was uniquely and positively related to anxiety symptoms. Different mindfulness (i.e., describing and nonjudging) and emotional intelligence (i.e., attention and repair) skills were particularly important for PWB. Repair was also negatively related to anxiety symptoms.

Conclusions

Repair was the variable that played a key role in the association with both PWB and GAD symptoms. Worry was the second most important variable, although it approached significance in the relationship with anxiety symptoms. Brooding was more strongly positively associated with anxiety than worry. In sum, the results suggest that an integrated and balanced focus on both positive and negative functioning will be useful in future clinical psychology research to predict, understand, and treat anxiety as well as to examine the antecedents and characteristics of positivity in individuals with GAD and promote their PWB.

The Association of Trait Mindfulness and Self-compassion with Obsessive-Compulsive Disorder Symptoms: Results from a Large Survey with Treatment-Seeking Adults

Little is known about the role of mindfulness and self-compassion in obsessive-compulsive disorder. This cross-sectional study examined associations of mindfulness and self-compassion with obsessive-compulsive disorder symptoms and with the obsessive beliefs and low distress tolerance thought to maintain them. Samples of treatment-seeking adults (N = 1871) and non-treatment-seeking adults (N = 540) completed mindfulness, self-compassion, obsessive-compulsive disorder, anxiety, depression, obsessive beliefs and distress tolerance questionnaires. Participants with clinically significant obsessive-compulsive disorder symptoms reported lower trait mindfulness and self-compassion compared to participants with clinically significant anxiety/depression and to non-clinical controls. Among the clinical sample, there were medium-large associations between mindfulness and self-compassion and obsessive-compulsive disorder symptoms, obsessive beliefs and distress tolerance. Mindfulness and self-compassion were unique predictors of obsessive-compulsive disorder symptoms, controlling for depression severity. Once effects of obsessive beliefs and distress tolerance were controlled, a small effect remained for mindfulness (facets) on obsessing symptoms and for self-compassion on washing and checking symptoms. Directions for future research and clinical implications are considered in conclusion.