A Perspective on the Similarities and Differences Between Mindfulness and Relaxation

A Pilot Randomized Controlled Trial Among People Recovering from Mental Illness: A Tailored Mindfulness-Based Intervention versus Relaxation Training

BACKGROUND

This study assessed the potential effectiveness, acceptability and feasibility of a tailored mindfulness-based intervention (MBI, REMIND 2.0) for personal recovery among people with mental illness during the COVID-19 pandemic.

METHODS

In this pilot mixed methods randomized controlled trial, participants were assigned to either the MBI (n = 14) or the relaxation training (RT) (n = 14). Quantitative measures were used to assess primary outcomes, including personal recovery, mindfulness, self-compassion, resilience, and secondary outcomes, including depression, stress, anxiety, positive and negative moods, quality of life and general health at baseline (T0), post-intervention (T1) and one-month follow-up (T2). Quantitative interviews were conducted to explore the experiences and perceptions toward the MBI.

RESULTS

Results indicated significant group and time interactions for all outcomes except anxiety and stress. MBI participants showed significant improvements in all outcomes at T1, which were maintained at T2, except for positive mood. RT participants showed a significant decline in resilience but significant improvements in all secondary outcomes at T1, but all outcomes significantly declined at T2, except for anxiety and stress. MBI participants were receptive toward the programme in all aspects of personal recovery.

CONCLUSIONS

The tailored MBI is a potentially effective, feasible and acceptable approach to facilitate personal recovery among people with mental illness. Differences between MBI and RT are discussed.

Enhancing Chronic Non-Cancer Pain Management: A Systematic Review of Mindfulness Therapies and Guided Imagery Interventions

Background and Objectives: There has been an increasing interest in the use of non-pharmacological approaches for the multidimensional treatment of chronic pain. The aim of this systematic review was to assess the effectiveness of mindfulness-based therapies and Guided Imagery (GI) interventions in managing chronic non-cancer pain and related outcomes. Materials and Methods: Searching three electronic databases (Web of Science, PubMed, and Scopus) and following the PRISMA guidelines, a systematic review was performed on Randomized Controlled Trials (RCTs) and pilot RCTs investigating mindfulness or GI interventions in adult patients with chronic non-cancer pain. The Cochrane Risk of Bias Tool was utilized to assess the quality of the evidence, with outcomes encompassing pain intensity, opioid consumption, and non-sensorial dimensions of pain. Results: Twenty-six trials met the inclusion criteria, with most of them exhibiting a moderate to high risk of bias. A wide diversity of chronic pain types were under analysis. Amongst the mindfulness interventions, and besides the classical programs, Mindfulness-Oriented Recovery Enhancement (MORE) emerges as an approach that improves interoception. Six trials demonstrated that mindfulness techniques resulted in a significant reduction in pain intensity, and three trials also reported significant outcomes with GI. Evidence supports a significant improvement in non-sensory dimensions of pain in ten trials using mindfulness and in two trials involving GI. Significant effects on opioid consumption were reported in four mindfulness-based trials, whereas one study involving GI found a small effect with that variable. Conclusions: This study supports the evidence of benefits of both mindfulness techniques and GI interventions in the management of chronic non-cancer pain. Regarding the various mindfulness interventions, a specific emphasis on the positive results of MORE should be highlighted. Future studies should focus on specific pain types, explore different durations of the mindfulness and GI interventions, and evaluate emotion-related outcomes.

Spiritual interventions: Improving the lives of colorectal cancer survivors-A systematic literature review

AIM

To systematically review the types of spiritual interventions available for colorectal cancer survivors and determine if they improve their lives.

DESIGN

Systematic review.

DATA SOURCE

A thorough literature search was conducted in July 2023 using PRIMO, PubMed/Medline, Cochrane, CINAHL, Scopus, and EMBASE.

REVIEW METHODS

As an extension of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist, the Synthesis Without Meta-Analysis reporting guideline was employed. A narrative synthesis was used to analyse the data.

RESULTS

Thirty-five articles were analysed for this study. The findings suggest that psychoeducational intervention, cognitive behavioural therapy intervention, mindfulness intervention, social intervention, and spiritual counselling improved CRC survivor's coping skills, boosted self-esteem, lessened anxiety, instilled hope, enhanced daily functioning, improved survival rates, improved neurological functional status and quality of life (QoL).

CONCLUSION

There is proof that spiritual interventions help CRC patients and improve their QoL. It has been discovered that spiritual intervention is helpful in the diagnosis, management, and treatment of CRC conditions.

IMPACT

CRC survivors may have impairments in their physical ability and daily functioning as a result of many symptoms, such as pain, bowel dysfunction, and exhaustion. Furthermore, individuals may encounter difficulties in several aspects of their psychological, emotional, social, and role functioning due to the presence of dread symptoms. Therefore, these study will help CRC survivors To implement spiritual interventions in the management of their long-term care. To cultivate problem-solving abilities, foster self-assurance, and enhance self-awareness. To alleviate symptoms, enhance everyday functioning, and improve QoL.

NO INDUCEMENT

No financial incentives were used to compensate patients or members of the public for this review.

The effects of progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy on dyspnea, pain and sleep quality: A randomized controlled trial

PURPOSE

The aim of the present study is the analysis of how progressive muscle relaxation exercise affects dyspnea, pain and sleep quality in patients with lung cancer receiving chemotherapy.

METHODS

Seventy-four patients diagnosed with lung cancer were included in this randomized controlled study. A total of 16 sessions of progressive muscle relaxation exercises were applied to the patients in the intervention group for a duration of 30 min, 2 days a week for 8 weeks. Patient Information Form, Medical Research Council Dyspnea Scale (MRC dyspnea scale), Pitssburg Sleep Quality Index (PSQI), Visual Analog Scale- Pain (VAS-P) were used to collect data.

RESULTS

Socio-demographic and disease characteristics were found to be similar in control and intervention groups. Final scores indicated significant differences between the experimental and control groups in all variables. The experimental group showed significantly more favorable results in dyspnea (p < 0.001), pain (p < 0.003) and sleep (p < 0.001) symptoms. When the effect size values (Cohen's d) of these findings were analyzed, PMR exercise was found to have a moderate effect on mean VAS-P scores (0.548) and a large effect on mean MRC dyspnea scale (1.073) and PSQI (0.970) scores. These results indicated significant differences in pre and post intervention mean scores.

CONCLUSION

Progressive muscle relaxation exercise applied to lung cancer patients receiving chemotherapy was found to be effective in reducing dyspnea and pain severity and improving sleep quality. Clinical trial registration at ClinicalTrials.gov. NCT04978805.

Mindfulness, coping, and optimism as mechanisms of change in the 3RP-NF intervention

INTRODUCTION

Neurofibromatosis (NF) is chronic neurogenetic condition that increases risk for poor quality of life, depression, and anxiety. Given the lack of biomedical treatments, we developed the "Relaxation Response Resiliency for NF" (3RP-NF) program to improve psychosocial outcomes among adults with NF.

OBJECTIVE

To move toward effectiveness testing, we must understand mechanisms that explained treatment effects. We tested whether our hypothesized mechanisms of change-mindfulness, coping, and optimism-mediated improvements in quality of life, depression, and anxiety among adults in the 3RP-NF program (N = 114; ages 18-70; 72.80% female; 81.58% White).

METHODS

We conducted mixed-effects models to assess whether these mechanisms uniquely mediated outcomes.

RESULTS

Improvements in quality of life were most explained by coping, (b = 0.97, SE = 0.28, CI [0.45, 1.56]), followed by mindfulness (b = 0.46, SE = 0.17, CI [0.15, 0.82]) and optimism (b = 0.39, SE = 0.12, CI [0.17, 0.65]). Improvements in depression and anxiety were most explained by mindfulness (b = -1.52, SE = 0.38, CI [-2.32, -0.85], CSIE = -0.26; b = -1.29, SE = 0.35, CI [-2.04, -0.67], CSIE = -0.23), followed by optimism (b = 0.39, SE = 0.12, CI [0.17, 0.65]; b = -0.49, SE = 0.20, CI [-0.91, -0.13]), but were not explained by coping (b = 0.22, SE = 0.43, CI [-0.62, 1.07]; b = 0.06, SE = 0.46, CI [-0.84, 0.97]), respectively.

CONCLUSIONS

Targeting mindfulness, coping, and optimism in psychosocial interventions may be a promising way to improve the lives of adults with NF.

A Narrative Review of the Effects of Mindfulness on Sleep and Hypertension

PURPOSE OF REVIEW

The prevalence of both insomnia and hypertension in the general population is vast and the health implications to individuals and society are costly. The current pharmacological treatment options for insomnia and hypertension are limited and patients are becoming increasingly interested in non-pharmacological treatment options. Mindfulness, a disciplined mental training practice rooted in Eastern traditions, has become a widely popular treatment method for multiple chronic health problems. The aim of this paper was to review research on mindfulness-based intervention effects on sleep, insomnia, and hypertension from the past 3 years. Theoretical foundations of mindfulness are discussed. Empirical evidence and potential mechanisms of how mindfulness impacts sleep and hypertension are provided.

RECENT FINDINGS

Our findings suggest that mindfulness-based interventions are safe and effective for people with insomnia and hypertension. We saw consistent, albeit small to moderate, effects of mindfulness-based interventions on reducing insomnia symptoms, improving sleep quality, and lowering systolic and diastolic blood pressure readings. While mindfulness interventions have shown to be effective for improving sleep and lowering hypertension, future research is needed to further evaluate their efficacy on larger samples of patient populations with long-term follow-up measures. These high-quality studies could help researchers and clinicians identify treatment response tendencies in patient populations which can lead to better tailoring of mindfulness-based interventions for specific health concerns.

Greater Discrimination Frequency and Lower Distress Tolerance Are Associated with Mental Health Problems Among Racially Privileged and Minoritized Adults Accessing an Urban Day Shelter

INTRODUCTION

Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness.

METHODS

Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems.

RESULTS

Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models.

CONCLUSION

Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.

Development and feasibility of a virtual, synchronous mind-body resiliency intervention for fathers of children and youth with special healthcare needs

Background

Fathers of children and youth with special healthcare needs (FCYSHCN) are an overlooked population at risk for chronic stress. Mind-body practices offer a patient-centered approach to foster coping and resiliency, yet low engagement from fathers in existing programs suggests adaptation is needed. This multiphase study examines the feasibility of a synchronous, virtual mind-body intervention adapted for FCYSHCN.

Methods

31 FCYSHCN were recruited online via community partners and recruitment portals in an academic medical center in Boston, MA. Phase 1 consisted of individual interviews (N = 17) to determine fathers' stressors, coping strategies, program needs, and suggested adaptations to the intervention protocol. The Phase 2 single arm pilot feasibility trial (N = 14) consisted of eight weekly 60-minute group sessions delivered virtually. Primary feasibility metrics were attendance (benchmark: mean=6 sessions) and electronic survey completion at baseline and post-intervention. Acceptability was assessed using post-session ratings of program satisfaction (4-point Likert scale; scores ≥3 coded as helpful) and helpfulness (e.g., group structure). Exploratory outcomes included validated measures of stress coping, resiliency, parental stress, depression, anxiety, which were analyzed using paired-samples t-tests (alpha=.05) to generate effect sizes (η2).

Results

In Phase 1, FCYSHCN discussed primary stressors (e.g., perceived inadequacy as a father) and multifaceted impacts of these stressors on physical, cognitive, emotional, and social wellbeing. Fathers also described coping strategies deemed helpful (e.g., humor) and unhelpful (e.g., "shutting down" from others). Qualitative findings informed intervention modifications. In Phase 2, most FCYSHCN (79%) attended ≥ 6 intervention sessions (mean=7). Follow-up survey completion was high (86%). Session satisfaction was high, with 7/8 sessions rated as helpful by most fathers. Program components deemed most helpful were the group structure, virtual delivery, exposure to a variety of relaxation and meditation skills, and the length of sessions. Although we were not powered to observe pre-post change, stress coping improved (p = .02, η2 = 0.42) and confidence increased in applying relaxation (p = .04, η2 = 0.34) and assertiveness techniques (p = .05, η2 = 0.31).

Conclusions

The first mind-body resiliency program for FCYSHCN is feasible and acceptable. Further testing is warranted in randomized trials with diverse samples of fathers, an appropriate comparison arm, and longitudinal assessments of psychosocial and biobehavioral outcomes.

A pilot randomized study of a telephone-based cognitive-behavioral stress-management intervention to reduce distress in phase 1 oncology trial caregivers

OBJECTIVES

Caregivers of adult phase 1 oncology trial patients experience high levels of distress and face barriers to in-person supportive care. The Phase 1 Caregiver LifeLine (P1CaLL) pilot study assessed the feasibility, acceptability, and general impact of an individual telephone-based cognitive behavioral stress-management (CBSM) intervention for caregivers of phase I oncology trial patients.

METHODS

The pilot study involved 4 weekly adapted CBSM sessions followed by participant randomization to 4 weekly cognitive behavioral therapy sessions or metta-meditation sessions. A mixed-methods design used quantitative data from 23 caregivers and qualitative data from 5 caregivers to examine the feasibility and acceptability outcomes. Feasibility was determined using recruitment, retention, and assessment completion rates. Acceptability was assessed with self-reported satisfaction with program content and participation barriers. Baseline to post-intervention changes in caregiver distress and other psychosocial outcomes were assessed for the 8-session intervention.

RESULTS

The enrollment rate was 45.3%, which demonstrated limited feasibility based on an a priori criterion enrollment rate of 50%. Participants completed an average of 4.9 sessions, with 9/25 (36%) completing all sessions and an 84% assessment completion rate. Intervention acceptability was high, and participants found the sessions helpful in managing stress related to the phase 1 oncology trial patient experience. Participants showed reductions in worry and isolation and stress.

SIGNIFICANCE OF RESULTS

The P1CaLL study demonstrated adequate acceptability and limited feasibility and provided data on the general impact of the intervention on caregiver distress and other psychosocial outcomes. Caregivers of phase 1 oncology trial patients would benefit from supportive care services; a telephone-based intervention may have more utilization and thus make a larger impact.

Systematic review with meta-analysis: Stress-management interventions for patients with irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder of unknown pathological origin that is associated with psychological distress and reduced health-related quality of life (HRQoL). We investigated the effects of stress-management for adults with IBS on typical symptoms, HRQoL and mental health. With predefined criteria (patients: adults with IBS; intervention: stress-management; control: care as usual or waitlist; outcome: patient-relevant; study-type: controlled trials), we registered the study with PROSPERO (168030) and searched the main medical databases. Two researchers independently reviewed the publications and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network checklist. We performed meta-analysis with homogeneous trials of acceptable quality. After screening 6656 publications, ten suitable randomized trials of acceptable (n = 5) or low methodological quality (n = 5) involving 587 patients were identified. Our meta-analysis showed no effect of stress-management on IBS severity 1-2 months after the intervention (Hedges' g = -0.23, 95%-CI = -0.84 to -0.38, I2  = 86.1%), and after 3-12 months (Hedges' g = -0.77, 95%-CI = -1.77 to -0.23, I2  = 93.3%). One trial found a short-term reduction of symptoms, and one trial found symptom relief in the long-term (at 6 months). One of two studies that examined HRQoL found an improvement (after 2 months). One of two studies that examined depression and anxiety found a reduction of these symptoms (after 3 weeks). Stress-management may be beneficial for patients with IBS regarding the short-term reduction of bowel and mental health symptoms, whereas long-term benefits are unclear. Good quality RCTs with more than 6 months follow-up are needed.

The Future of Stress Management: Integration of Smartwatches and HRV Technology

In the modern world, stress has become a pervasive concern that affects individuals' physical and mental well-being. To address this issue, many wearable devices have emerged as potential tools for stress detection and management by measuring heart rate, heart rate variability (HRV), and various metrics related to it. This literature review aims to provide a comprehensive analysis of existing research on HRV tracking and biofeedback using smartwatches pairing with reliable 3rd party mobile apps like Elite HRV, Welltory, and HRV4Training specifically designed for stress detection and management. We apply various algorithms and methodologies employed for HRV analysis and stress detection including time-domain, frequency-domain, and non-linear analysis techniques. Prominent smartwatches, such as Apple Watch, Garmin, Fitbit, Polar, and Samsung Galaxy Watch, are evaluated based on their HRV measurement accuracy, data quality, sensor technology, and integration with stress management features. We describe the efficacy of smartwatches in providing real-time stress feedback, personalized stress management interventions, and promoting overall well-being. To assist researchers, doctors, and developers with using smartwatch technology to address stress and promote holistic well-being, we discuss the data's advantages and limitations, future developments, and the significance of user-centered design and personalized interventions.

Comparing the effect of internet-delivered short-term progressive muscle relaxation and psychoeducation on mindful ability, visceral hypersensitivity and symptoms of patients with irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) is a functional bowel disorder that psychological interventions are effective on it. The present study aimed to compare the effect of internet-delivered short-term PMR (iPMR) and psychoeducation on mindful ability (MA), visceral hypersensitivity (VH), and symptoms of patients with IBS.

MATERIALS AND METHODS

This randomized clinical trial was performed on individuals with IBS in 2020, recruiting a total of 60 patients fulfilling the inclusion criteria. Prior to the intervention, the Freiburg Questionnaire- Short Form (FMI-SF), the Visceral Sensitivity Questionnaire (VSI), and the Gastrointestinal Symptoms Rating Scale (GSRS) were filled out for the patients. Patients were divided into iPMR and psychoeducation groups randomly. All training in both groups was accomplished via WhatsApp social network. FMI-SF, VSI, and GSRS questionnaires for patients were completed 1 month (post-test) and 2 months later (follow-up). The data was analyzed by SPSS-23 software and one-way analysis of variance (ANOVA).

RESULTS

Compared to the psychoeducation group, the MA of the iPMR group increased significantly in post-test and follow-up (43.06 ± 7.12 and 42.88 ± 6.28 vs 51.23 ± 11.7 and 56.74 ± 12.36 and P < 0.001) and their VH decreased significantly (37.85 ± 11.6 and 38.03 ± 11.8 vs 26.9 ± 6.45 and 22.46 ± 5.32 and P < 0.001). Also, their GSRS had significant decreases (43.27 ± 10.73 and 41.18 ± 9.31 vs 32.33 ± 8.21 and 25.79 ± 6.30 and P < 0.001).

CONCLUSION

The findings showed iPMR in patients with IBS, in spite of a few sessions and internet-delivered approach, increased MA and decreased VH and gastrointestinal symptoms of them.

Effect of brief mindfulness and relaxation inductions on anxiety, affect and brain activation in athletes

The mindfulness-based intervention and psychological skills training are often used for maintaining the mental health or reducing undesirable mental states in athletes. However, their differences in acute effects on mental health and underlying neural mechanism are not well understood. Therefore, the purpose of the current study was to examine the differential effects of brief mindfulness induction (MI) and relaxation induction (RI) on state anxiety, affect and brain activation. Thirty-five track and field athletes were recruited for this study. Using a within-subjects crossover design, participants underwent three conditions that incorporated two 30-min experimental conditions (i.e., MI or RI) and a control condition. State anxiety and affect were assessed before and after intervention, and brain activation (i.e., theta, alpha bands) were recorded by electroencephalography (EEG) during each 30-min condition. Repeated measures analysis of variance revealed that MI and RI similarly reduced state anxiety and negative affect from pre-test to post-test compared to the control condition. In terms of positive affect, there were no significant differences among the three conditions across times. Furthermore, participants exhibited higher frontal theta power during the MI and RI than control condition, whereas no differences in alpha power were observed among conditions. The current study provides initial evidence from an electrophysiological perspective that brief MI and RI both improve the negative psychological states in individual sport athletes through similar neural mechanisms. Nevertheless, the moderating effects of training experiences and long-term interventions on mental state and EEG activity in athletes need further investigation in future studies.

Differing associations of depersonalization with physiological response during rest and breath-focused mindfulness in a trauma-exposed female population

BACKGROUND

Dissociative and posttraumatic stress disorder (PTSD) symptoms are commonly co-occurring responses to psychological trauma. Yet, these two groups of symptoms appear to be related to diverging patterns of physiological response. To date, few studies have examined how specific dissociative symptoms, namely, depersonalization and derealization, relate to skin conductance response (SCR), a marker of autonomic function, within the context of PTSD symptoms. We examined associations among depersonalization, derealization, and SCR during two conditions - resting control and breath-focused mindfulness - in the context of current PTSD symptoms.

METHODS

Sixty-eight trauma-exposed women (82.4% Black; Mage = 42.5, SDage = 12.1) were recruited from the community for a breath-focused mindfulness study. SCR data were collected during alternating resting control and breath-focused mindfulness conditions. Moderation analyses were conducted to examine relations among dissociative symptoms, SCR, and PTSD for these different conditions.

RESULTS

Moderation analyses revealed that depersonalization was linked to lower SCR during resting control, B = 0.0005, SE = 0.0002, p = .006, in participants low-to-moderate PTSD symptoms; however, depersonalization was associated with higher SCR during breath-focused mindfulness, B = -0.0006, SE = 0.0003, p = .029, in individuals with similar levels of PTSD symptoms. No significant interaction between derealization and PTSD symptoms on SCR was observed.

CONCLUSIONS

Depersonalization symptoms may associate with physiological withdrawal during rest, but greater physiological arousal during effortful emotion regulation in individuals with low-to moderate levels of PTSD, which has significant implications for barriers to treatment engagement as well as treatment selection in this population.

Case report: Co-occurring autism spectrum disorder (Level One) and obsessive-compulsive disorder in a gender-diverse adolescent

This fictionalized case report captures the common themes and considerations during the diagnostic assessment and behavioral treatment of adolescents demonstrating symptoms of autism spectrum disorder (ASD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD), as well as gender-diversity concerns. Our patient was a white, non-Hispanic 17-year-old individual who identified as gender-neutral but had been assigned female at birth. Symptoms presented were social withdrawal, rigid rule-following behavior, unusual repetitive behavior, impairments in social communication skills, sensory sensitivity, body dissatisfaction, self-injury, and anxiety related to contamination, perfectionism, and social interactions. These symptoms contributed to functional impairment with school attendance, school achievement, family relationships, and the activities of daily living. This case report summarizes instruments employed for differential diagnosis concerning cognitive functioning, ASD, OCD, ADHD, depression, anxiety, and commonly co-occurring repetitive behavior. This patient was ultimately diagnosed with ASD, level one for both social communication and restricted, repetitive behaviors, without accompanying intellectual or language impairment; OCD with panic attacks; gender dysphoria; major depressive disorder (single episode and moderate); and ADHD. The subsequent 40-session course of cognitive-behavioral therapy with exposure and response prevention (CBT/ERP) to treat OCD tailored to an individual with ASD and gender diversity concerns is described in detail. Components of family involvement are highlighted. As a result, significant improvements in school attendance, OCD symptoms, depression, social relationships, and adaptive functioning were measured. Lastly, recommendations for clinicians are summarized.

Investigating the role of auditory and visual sensory inputs for inducing relaxation during virtual reality stimulation

Stress is a part of everyday life which can be counteracted by evoking the relaxation response via nature scenes presented using immersive virtual reality (VR). The aim of this study was to determine which sensory aspect of immersive VR intervention is responsible for the greatest relaxation response. We compared four conditions: auditory and visual combined (audiovisual), auditory only, visual only, and no artificial sensory input. Physiological changes in heart rate, respiration rate, and blood pressure were recorded, while participants reported their preferred condition and awareness of people, noise, and light in the real-world. Over the duration of the stimulation, participants had the lowest heart rate during the audiovisual and visual only conditions. They had the steadiest decrease in respiration rate and the lowest blood pressure during the audiovisual condition, compared to the other conditions, indicating the greatest relaxation. Moreover, ratings of awareness indicated that participants reported being less aware of their surroundings (i.e., people, noise, light, real environment) during the audiovisual condition versus the other conditions (p < 0.001), with a preference for audiovisual inputs. Overall, the use of audiovisual VR stimulation is more effective at inducing a relaxation response compared to no artificial sensory inputs, or the independent inputs.

Effectiveness of mindfulness-based intervention in the improvement of maternal role adaptation among first time mothers: A randomized controlled trial

BACKGROUND AND PURPOSE

Mindfulness-based intervention (MBI) has been suggested as a method to alleviate mental health difficulties during the perinatal period. However, few studies have examined its use in improving maternal role adaptation. This study aimed to investigate the effectiveness of mindfulness in maternal role adaptation among first-time mothers.

MATERIALS AND METHODS

This randomized controlled trial study was performed on 40 first-time mothers who were randomly assigned into experimental (n = 20) and control (n = 20) groups. Research instruments included a demographic questionnaire and a validated Maternal Role Adaptation Questionnaire (MRAQ). In addition to receiving routine care, mothers in the experimental group attended eight 90-min sessions of mindfulness-based intervention. The control group, however, received only routine care. Both groups completed MRAQ before intervention, and immediately, one month, and two months after it.

RESULTS

After intervention, there was a significant increase in the mean scores of MRAQ and its seven domains in the experimental group at all three follow-up intervals (P < 0.001). These domains included "support and strengthening of the couples' relationships", "hardship and dissatisfaction", "mother-infant attachment", "stress and anxiety", "emotional growth", "functionality" and "social adaptation development".

CONCLUSION

The intervention implemented in this study could be effective in promoting maternal role adaptation.

PE augmented mindfulness: A neurocognitive framework for research and future healthcare

Various well-controlled studies have suggested that practitioners in mindfulness can be prone to patient drop-out (e.g., due to chronic stress, pathology, cognitive reactivity), despite researchers having identified the underlying mechanisms that link mindfulness to mental health. In this article, a framework for physical exercise (PE) augmented mindfulness is proposed, which posits that consistently practiced PE before meditation can support (early-stage) mindfulness. Neurocognitive research shows PE (aerobic exercises or yoga) and mindfulness to impact similar pathways of stress regulation that involve cognitive control and stress regulation, thereby supporting the proposed synergistic potential of PE augmented mindfulness. Research focused on the psychophysiological impact of PE, showed its practice to promote short-term neurocognitive changes that can promote both cognitive control and the attainment of mindful awareness (MA). In order to chart dose responses required for protocol development, further research will be presented. Together these findings are discussed in light of future research on this multidisciplinary topic, protocol development, mindful walking, and further application in healthcare and beyond.

Mindfulness and Relaxation-Based Interventions to Reduce Parental Stress, Anxiety and/or Depressive Symptoms in the Neonatal Intensive Care Unit: A Systematic Review

Parents with infants in the neonatal intensive care unit (NICU) experience high levels of stress, anxiety, and depression. Mindfulness and relaxation-based interventions are effective in reducing distress in the general postpartum population. The aim of this systematic review was to evaluate whether mindfulness and/or relaxation-based interventions reduce stress, anxiety, and depression in NICU parents. A total of five studies met the inclusion criteria and were assessed for quality using the Downs & Black Checklist. The most consistent results in this review suggest that mindfulness and/or relaxation-based interventions may be effective at reducing anxiety symptoms in NICU parents, with moderate to large effect sizes, and show promise in reducing depressive symptoms. The findings show limited potential benefits on parental stress. Methodological weaknesses, heterogeneous intervention factors (including format and length), and varying participant adherence hinder the ability to make strong conclusions. Directions for future research are discussed.

Short Mindfulness Meditation Increases Help-Giving Intention Towards a Stranger in Distress

Objectives

Mindfulness practice increases personal well-being, yet its effect on prosocial behaviors is not well-established. Initial studies suggest that an 8-week mindfulness program has a positive effect on help-giving towards a stranger in distress and that a short meditation promotes care towards an ostracized member. This research aims at examining whether a short mindfulness intervention promotes help-giving intention towards a stranger in distress and to understand the role of empathy in this effect.

Methods

A total of 210 undergraduate students were randomly assigned to two sessions of mindfulness practice, music, or lecture control conditions. Participants then listened to a sham interview with a student dealing with a chronic illness and were surveyed on their willingness to volunteer in an organization helping such students. Baseline dispositional empathy and consequent empathic care scales were completed to determine their effect.

Results

A significantly higher percentage of participants were willing to provide help in the mindfulness condition (50.8%), as compared to the music (31.2%) and the lecture (31%) conditions, χ2 (2, N = 189) = 9.51, p = .009. A significantly positive effect of dispositional empathy on empathic care was found in the mindfulness group (b = 1.40, SE = .31, p < .001), but not in the control groups.

Conclusions

This study showed that short mindfulness practice increases help-giving intention as compared to active control groups and moderates the association between dispositional empathy and empathic care. Future research including long-term follow-up will strengthen these findings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-022-01963-y.

Spiritual Interventions Used by Jewish Women to Facilitate the Family Continuum: A Qualitative Study

Introduction: Spiritual interventions (SI) are used by patients and their families as a means to promote health. The family continuum (FC), which includes finding a partner/spouse, getting married, becoming pregnant, and having a safe pregnancy/birth, is an important concept for the Jewish culture as well as other cultures that have a traditional family-centered approach. There is a dearth of professional literature pertaining to SI to promote the FC. Although patients may use SI, this information is not routinely collected in a health history. The purpose of the study was to describe the experience of Jewish women's use of SI to promote the FC. Methods: This ethnographic study included interviews of Jewish women pertaining to FC, a text review, and field study. Coding of the text, site visits, and interviews were performed and reviewed to identify categories and themes and were refined until saturation was achieved. Results: Fifty-three observant and non-observant Jewish women participated in the study. Women expressed that SI were the means for them playing an active role in fulfilling the FC, and included intermediaries to God, self-improvement, and folk/spiritual remedies. The examples of SI included: visits to holy sites and spiritual leaders for blessings and advice, prayers, psalms, doing good deeds, eating special foods, wearing amulets, and performing certain SI with predesignated repetitions. Women attributed these SI to attaining an FC. Women who achieved each FC milestone without difficulty tended to use less SI, whereas women's SI usage increased the longer a milestone was not achieved. Conclusions: Jewish women are using many SI to promote the FC. Health care should be delivered in a culturally competent manner, which includes the incorporation of safe cultural practices. Obtaining a cultural assessment as part of the medical history could assist the health care professional in integrating safe SI into patient care.

“Practice Makes Perfect”? Associations Between Home Practice and Physical and Emotional Function Outcomes Among Patients with Chronic Pain Enrolled in a Mind–Body Program

Objectives: To summarize the characteristics of home practice adherence in patients with chronic pain randomized to a 10-week group mind-body activity program with (GetActive-Fitbit) and without (GetActive) a digital monitoring device, and test the association between home practice adherence and improvement in physical and emotional treatment outcomes. Methods: Data were collected in a pilot randomized controlled trial (RCT) of the GetActive (n = 41) and GetActive-Fitbit (n = 41) programs. Participants submitted weekly home practice logs depicting their daily physical activity and practice of relaxation and gratitude skills. Participants completed assessments of physical (patient-reported, performance-based, and accelerometer-measured) and emotional function outcomes both before and after the programs. Participants in both programs were combined due to the identical session and home practice content. Results: Participants reported engaging in physical activity on average 30.62 days (SD = 20.28, 48.6% of intervention days), relaxation skill practice on average 29.87 days (SD = 21.16, 47.4% of intervention days), and gratitude practice on average 32.10 days (SD = 22.12, 51.0% of intervention days). The average duration of physical activity and relaxation skill practice were 44.40 min a day (SD = 59.44) and 11.15 min a day (SD = 12.00), respectively. The duration of physical activity was significantly associated with decrease depression symptoms (p = 0.049, η² = 0.056). No other association was found between home practice and change in outcomes. Conclusions: Patients with chronic pain are generally able and willing to engage in home practice during a mind-body activity intervention. Emphasizing longer duration of physical activity practice may contribute to an improvement in depression. Future fully powered RCTs with rigorous assessment of home practice adherence and dose-response designs may further elucidate the role of home practice in improvements in treatment outcomes. ClinicalTrials.gov identifier: NCT03412916.

Comparing the Effectiveness of Multicomponent Sleep-Promoting Interventions on the Sleep Quality of Menopausal Women: A Quasi-Experimental Study

Sleep disturbance is considered one of the hallmarks of the common symptoms experienced by women during and after menopause. This study aimed to compare the effectiveness of two different multiple-component, sleep-promoting interventions on the sleep quality of menopausal women. A quasi-experimental study and repeated measured design, with a four-week sleep-promoting intervention, was conducted. A total of 123 eligible participants were recruited from a health center in northern Taiwan and divided into the progressive muscle relaxation plus sleep hygiene (PMRS), the meditative movement relaxation plus sleep hygiene (MMRS), or control group at a 1:1:1 ratio. The Chinese version of Pittsburgh sleep quality index and actigraphy were used to assess the sleep disturbances of menopausal women. The subjective sleep data was collected before, immediately after the intervention, 8 weeks, and 12 weeks after the intervention. The results showed that the global score of subjective sleep quality and its components were significantly improved after both interventions. Additionally, the MMRS was superior to the PMRS for subjective sleep quality. Moreover, the objective sleep indices indicated that sleep latency was reduced after both the interventions. These findings can serve as a reference for nurses when caring for menopausal women with sleep disturbance.

Exploring Fidelity in School-Based Mindfulness Programs

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

East Meets West in Therapeutic Approaches to the Management of Chronic Pain

Yoga as a holistic principle, not only practice of asanas or poses, integrates all aspects of the self, with biological, mental, intellectual, and spiritual elements. Yoga encompasses the biopsychosocial medical perspective, which regards pain as a dynamic interaction between physiological, psychological, and social factors. The purpose of this perspective article is to compare and contrast psychological practices such as mindfulness meditation, relaxation response (RR), and cognitive behavioral therapy (CBT) with Yoga in their management of chronic pain. The use of these practices is explored through history, literature, and research studies. Results from scientific studies on Yoga show changes in health-related pain outcomes for patients with chronic pain. The key aspects of Yoga, notably relaxation, positive thinking, and mindfulness, are discussed in relation to mindfulness meditation, RR, and CBT.

El efecto de la relajación muscular progresiva en la reducción del síndrome de las piernas inquietas entre los pacientes sometidos a hemodiálisis en una unidad periférica en Indonesia

Introducción: La relajación muscular se considera una terapia alternativa para el síndrome de las piernas inquietas (SPI). Objetivo: Determinar el efecto de la relajación muscular progresiva (RMP) sobre el síndrome de piernasinquietas en pacientes sometidos a hemodiálisis. Metodología: Se llevó a cabo un estudio con diseño cuasi-experimental en la unidad de hemodiálisis. Lamuestra reclutada fue de 12 encuestados tanto en el grupo de intervención como en el de control, siendo elmuestreo de conveniencia. El instrumento de investigación utilizado fue la Escala Internacional del Grupo de Estudio del SPI. Resultados: En el grupo de intervención, las puntuaciones medias del SPI antes y después fueron de22,92 y 17,42, respectivamente. En el grupo de control, las puntuaciones medias del SPI antes y despuésde la intervención fueron de 24,33 y 23,50, respectivamente. La RPM fue eficaz para mejorar el SPI (p<0,005). Conclusión: La RMP podría ser una alternativa para reducir el SPI en pacientes sometidos a hemodiálisis. Se necesitan estudios futuros para aclarar los hallazgos utilizando métodos más robustos y un tamaño de muestra mayor.

Mindfulness-Informed Guided Imagery to Target Physical Activity: A Mixed Method Feasibility and Acceptability Pilot Study

Physical activity offers substantial mind-body health benefits and reduced mortality, yet many individuals are chronically underactive. Physical activity interventions may benefit from integrative approaches that join components of mindfulness and neurobiological models of behavior. Mindfulness increases one’s awareness of cognitions and physical sensations to potentially facilitate self-regulation, while neurobiological models such as the dual system model of health behavior offer guidance on improving physical activity intervention targets. This 2-phase study includes an initial development process to create brief (∼4 min) mindfulness informed guided imagery audio files that target distinct cognitive and affective processes to promote physical activity. In the second phase, participants completed a 2-week pilot intervention study to gather qualitative and quantitative data on intervention feasibility and acceptability. Participants endorsed the mindfulness informed guided imagery as easy to use, enjoyable and helpful. Over a 2-week intervention period participants reported positive shifts in behavior change, physical activity enjoyment, increased mindfulness during physical activity, and increased physical exercise self-efficacy and satisfaction. Interview data revealed that participants increased their frequency of physical activity and tended to experience positive affect during physical activity, engaged in future oriented thinking and were able to view physical activity in a more positive light. Findings support the feasibility and acceptability of an integrative online mindfulness informed guided imagery intervention to promote physical activity enjoyment and engagement. This study extends health behavior change intervention research and provides supporting evidence for a flexible and tailorable online mindfulness-based intervention.

The role of mindfulness and relaxation in improved sleep quality following a mind-body and activity program for chronic pain

Objectives

Poor sleep quality is prevalent among individuals with chronic pain and contributes to increased physical and emotional dysfunction. However, treatments that improve sleep quality among individuals with chronic pain are scant. A previously developed mind-body activity program for chronic pain has been shown to be feasible and associated with improvements in pain and physical and emotional function. Using secondary data-analysis, the purpose of this study was to understand whether participants also experienced significant and sustained improvements in sleep quality over time and whether these improvements were explained by change in two core treatment targets, relaxation and mindfulness.

Methods

Participants with heterogenous chronic pain (N = 82) were randomized to a mind-body activity intervention with (GetActive-Fitbit; n=41) or without (GetActive; n=41) a Fitbit device. Sleep quality was measured with the PSQI, mindfulness with the CAMS-R, and relaxation with the relaxation subscale of the MOCS-A. Mediation was tested via mixed-models analysis.

Results

Both intervention groups experienced significant and comparable improvements in sleep quality from baseline to post-treatment, which were sustained through a 3-month follow-up. Mindfulness and relaxation also improved significantly over time and these improvements were associated with improved sleep quality. Mindfulness and relaxation fully mediated improvement in sleep quality (medium to large effect sizes).

Conclusions

Results suggest that, despite not targeting sleep explicitly, the two mind-body activity programs hold promise for sustainably improving sleep quality among patients with chronic pain. Targeting mindfulness and relaxation may facilitate these improvements.

Self-Healing: A Concept for Musculoskeletal Body Pain Management - Scientific Evidence and Mode of Action

Traditionally, musculoskeletal pain management has focused on the use of conventional treatments to relieve pain. However, multi-modal integrative medicine including alternative/complementary treatments is becoming more widely used and integrated into treatment guidelines around the world. The uptake of this approach varies according to country, with generally a higher uptake in developed countries and in females aged more than 40 years. Integral to the concept described here, is that the body has an innate ability to self-heal, which can be optimized by the use of integrative medical strategies. Stress triggers for acute or recurring musculoskeletal pain are diverse and can range from physical to psychological. The mechanism by which the body responds to triggers and initiates the self-healing processes is complex, but five body networks or processes are thought to be integral: the nervous system, microcirculation/vasodilation, immune modulation, muscular relaxation/contraction and psychological balance. Multi-modal integrative medicine approaches include nutritional/dietary modification, postural/muscular training exercises, and cognitive behavioral mind/body techniques. This article will review the self-healing concept and provide plausible scientific evidence where available.

Promoting Third Graders' Executive Functions and Literacy: A Pilot Study Examining the Benefits of Mindfulness vs. Relaxation Training

Research suggested that developing mindfulness skills in children improves proximal outcomes, such as attention and executive functions, as well as distal outcomes, such as academic achievement. Despite empirical evidence supporting this claim, research on the benefits of mindfulness training in child populations is scarce, with some mixed findings in the field. Here, we aimed to fill in this gap, by examining the effects of a mindfulness training on third graders' proximal and distal outcomes, namely, attention and executive functions (viz., inhibitory control, working memory, and cognitive flexibility) as well as literacy-related achievement (viz., handwriting fluency, text quality, Portuguese grades). These outcomes were measured with behavioral tasks and teacher ratings. Sixty-six Portuguese children were randomly allocated to an experimental group receiving mindfulness training (n = 29) or an active control group receiving relaxation training (n = 37). Both training programs were implemented by psychologists in two 30-min weekly sessions for 8 weeks. All students were assessed before and after the interventions. Three main findings are noteworthy: (a) mindfulness training enhanced teacher-rated cognitive flexibility and a performance-based composite score of executive functions among children with higher pretest scores; (b) relaxation training improved performance-based cognitive flexibility and the composite score of executive functions among children with lower pretest scores; (c) children receiving mindfulness training had higher handwriting fluency and better grades in Portuguese than those receiving relaxation training. These findings provide preliminary evidence on the benefits of mindfulness training in educational settings and highlight the moderating role of baseline performance on those benefits.

A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity

Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.