Reporting of Positive Results in Randomized Controlled Trials of Mindfulness-Based Mental Health Interventions

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.

DESIGN

Systematic review and network meta-analysis.

METHODS

Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool.

DATA SOURCES

Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression.

RESULTS

218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

CONCLUSIONS

Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018118040.

Statistical significance and publication reporting bias in abstracts of reproductive medicine studies

STUDY QUESTION

What were the frequency and temporal trends of reporting P-values and effect measures in the abstracts of reproductive medicine studies in 1990-2022, how were reported P-values distributed, and what proportion of articles that present with statistical inference reported statistically significant results, i.e. 'positive' results?

SUMMARY ANSWER

Around one in six abstracts reported P-values alone without effect measures, while the prevalence of effect measures, whether reported alone or accompanied by P-values, has been increasing, especially in meta-analyses and randomized controlled trials (RCTs); the reported P-values were frequently observed around certain cut-off values, notably at 0.001, 0.01, or 0.05, and among abstracts present with statistical inference (i.e. P-value, CIs, or significant terms), a large majority (77%) reported at least one statistically significant finding.

WHAT IS KNOWN ALREADY

Publishing or reporting only results that show a 'positive' finding causes bias in evaluating interventions and risk factors and may incur adverse health outcomes for patients.

Despite efforts to minimize publication reporting bias in medical research, it remains unclear whether the magnitude and patterns of the bias have changed over time.

STUDY DESIGN, SIZE, DURATION

We studied abstracts of reproductive medicine studies from 1990 to 2022. The reproductive medicine studies were published in 23 first-quartile journals under the category of Obstetrics and Gynaecology and Reproductive Biology in Journal Citation Reports and 5 high-impact general medical journals (The Journal of the American Medical Association, The Lancet, The BMJ, The New England Journal of Medicine, and PLoS Medicine). Articles without abstracts, animal studies, and non-research articles, such as case reports or guidelines, were excluded.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Automated text-mining was used to extract three types of statistical significance reporting, including P-values, CIs, and text description. Meanwhile, abstracts were text-mined for the presence of effect size metrics and Bayes factors. Five hundred abstracts were randomly selected and manually checked for the accuracy of automatic text extraction. The extracted statistical significance information was then analysed for temporal trends and distribution in general as well as in subgroups of study designs and journals.

MAIN RESULTS AND THE ROLE OF CHANCE

A total of 24 907 eligible reproductive medicine articles were identified from 170 739 screened articles published in 28 journals. The proportion of abstracts not reporting any statistical significance inference halved from 81% (95% CI, 76-84%) in 1990 to 40% (95% CI, 38-44%) in 2021, while reporting P-values alone remained relatively stable, at 15% (95% CI, 12-18%) in 1990 and 19% (95% CI, 16-22%) in 2021. By contrast, the proportion of abstracts reporting effect measures alone increased considerably from 4.1% (95% CI, 2.6-6.3%) in 1990 to 26% (95% CI, 23-29%) in 2021. Similarly, the proportion of abstracts reporting effect measures together with P-values showed substantial growth from 0.8% (95% CI, 0.3-2.2%) to 14% (95% CI, 12-17%) during the same timeframe. Of 30 182 statistical significance inferences, 56% (n = 17 077) conveyed statistical inferences via P-values alone, 30% (n = 8945) via text description alone such as significant or non-significant, 9.3% (n = 2820) via CIs alone, and 4.7% (n = 1340) via both CI and P-values. The reported P-values (n = 18 417), including both a continuum of P-values and dichotomized P-values, were frequently observed around common cut-off values such as 0.001 (20%), 0.05 (16%), and 0.01 (10%). Of the 13 200 reproductive medicine abstracts containing at least one statistical inference, 77% of abstracts made at least one statistically significant statement. Among articles that reported statistical inference, a decline in the proportion of making at least one statistically significant inference was only seen in RCTs, dropping from 71% (95% CI, 48-88%) in 1990 to 59% (95% CI, 42-73%) in 2021, whereas the proportion in the rest of study types remained almost constant over the years. Of abstracts that reported P-value, 87% (95% CI, 86-88%) reported at least one statistically significant P-value; it was 92% (95% CI, 82-97%) in 1990 and reached its peak at 97% (95% CI, 93-99%) in 2001 before declining to 81% (95% CI, 76-85%) in 2021.

LIMITATIONS, REASONS FOR CAUTION

First, our analysis focused solely on reporting patterns in abstracts but not full-text papers; however, in principle, abstracts should include condensed impartial information and avoid selective reporting. Second, while we attempted to identify all types of statistical significance reporting, our text mining was not flawless. However, the manual assessment showed that inaccuracies were not frequent.

WIDER IMPLICATIONS OF THE FINDINGS

There is a welcome trend that effect measures are increasingly reported in the abstracts of reproductive medicine studies, specifically in RCTs and meta-analyses. Publication reporting bias remains a major concern. Inflated estimates of interventions and risk factors could harm decisions built upon biased evidence, including clinical recommendations and planning of future research.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was received for this study. B.W.M. is supported by an NHMRC Investigator grant (GNT1176437); B.W.M. reports research grants and travel support from Merck and consultancy from Merch and ObsEva. W.L. is supported by an NHMRC Investigator Grant (GNT2016729). Q.F. reports receiving a PhD scholarship from Merck. The other author has no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study

BACKGROUND

Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body's physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization.

METHODS

This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed.

RESULTS

The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (β = -.31, p = .01; β = -.28, p = .02; β = -.31, p = .00, respectively). Increased Body Listening (β = .37, p = .00), Not-Worrying (β = .26, p = .02), and diminished Attention Regulation (β = -.32, p = .01) predicted higher mental fatigue.

CONCLUSIONS

Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.

Mindfulness for the self-management of negative coping, rumination and fears of compassion in people with cancer: An exploratory study

BACKGROUND

Cancer and its treatments have the potential to significantly impact mental health, provoking feelings of anxiety, depression, and distress, which can last long after treatment is over. One of the most rapidly emerging influences in the healthcare field is mindfulness-based interventions (MBIs), which are designed to cultivate present moment awareness, attentional flexibility, compassion and acceptance, to reduce physical and psychological distress. However, there is limited research into the efficacy of MBIs or disease specific MBIs in shifting negative coping, ruminative thinking and fears of compassion as primary outcomes in individuals with cancer.

AIMS

This exploratory study was designed to evaluate inter- and intra-individual change in the management of negative coping, rumination and fears of compassion, following a cancer-specific mindfulness-based intervention.

METHODS AND RESULTS

A single group, non-experimental, repeated measures study of 22 participants across six cancer care centres explored the efficacy of an 8-week Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca) course. The Reliable Change Index (RCI) examined reliable clinical improvement, deterioration, or no change in individuals on the Mental Adjustment to Cancer Scale (MACS), the Ruminative Responses Scale (RRS) and the Fears of Compassion Scale (FCS). About 82% of participants (n = 18) saw an improvement in at least one measure. A significant decrease in primary outcome scores was observed in negative coping, ruminating and fears of self-compassion. There were significant correlations between the fear of self-compassion and depressive ruminating, fear of accepting compassion from others and showing it to others pre and post intervention.

CONCLUSION

Our findings indicate that the MBCT-Ca programme may significantly reduce negative coping, ruminating and fears of self-compassion improving psychological health and wellbeing in cancer survivors.

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

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

Supplementary Information

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

Designing Mobile Health Applications to Support Walking for Older Adults

Physical activity is extremely important at an older age and has major benefits. There is a range of applications that help maintain physical activity. However, their adoption among older adults is still limited. The purpose of the study is to explore the key aspects of the design of mobile applications that support walking for older adults. We conducted a field study with older adults, aged 69-79 years, using a technology probe (a mobile application developed as an early prototype) with the purpose of eliciting requirements for mobile health applications. We interviewed the participants during and after the study period, asking them about their motivation for walking, usage of the application, and overall preferences when using such technologies. The findings suggest that mobile applications that support walking should address a range of walking variables, support a long-term learning process, and enable the user to take control and responsibility for the walk. In addition, we provide design guidelines concerning the motivation for walking and the data visualization that would make technology adoption easier. The findings from this study can be used to inform the design of more usable products for older users.

Meditative-based diaphragmatic breathing vs. vagus nerve stimulation in the treatment of fibromyalgia-A randomized controlled trial: Body vs. machine

IMPORTANCE

Vagus nerve innervation via electrical stimulation and meditative-based diaphragmatic breathing may be promising treatment avenues for fibromyalgia.

OBJECTIVE

Explore and compare the treatment effectiveness of active and sham transcutaneous vagus nerve stimulation (tVNS) and meditative-based diaphragmatic breathing (MDB) for fibromyalgia.

DESIGN

Participants enrolled from March 2019-October 2020 and randomly assigned to active tVNS (n = 28), sham tVNS (n = 29), active MDB (n = 29), or sham MDB (n = 30). Treatments were self-delivered at home for 15 min/morning and 15 min/evening for 14 days. Follow-up was at 2 weeks.

SETTING

Outpatient pain clinic in Oslo, Norway.

PARTICIPANTS

116 adults aged 18-65 years with severe fibromyalgia were consecutively enrolled and randomized. 86 participants (74%) had an 80% treatment adherence and 107 (92%) completed the study at 2 weeks; 1 participant dropped out due to adverse effects from active tVNS.

INTERVENTIONS

Active tVNS is placed on the cymba conchae of the left ear; sham tVNS is placed on the left earlobe. Active MDB trains users in nondirective meditation with deep breathing; sham MDB trains users in open-awareness meditation with paced breathing.

MAIN OUTCOMES AND MEASURES

Primary outcome was change from baseline in ultra short-term photoplethysmography-measured cardiac-vagal heart rate variability at 2 weeks. Prior to trial launch, we hypothesized that (1) those randomized to active MDB or active tVNS would display greater increases in heart rate variability compared to those randomized to sham MDB or sham tVNS after 2-weeks; (2) a change in heart rate variability would be correlated with a change in self-reported average pain intensity; and (3) active treatments would outperform sham treatments on all pain-related secondary outcome measures.

RESULTS

No significant across-group changes in heart rate variability were found. Furthermore, no significant correlations were found between changes in heart rate variability and average pain intensity during treatment. Significant across group differences were found for overall FM severity yet were not found for average pain intensity.

CONCLUSIONS AND RELEVANCE

These findings suggest that changes in cardiac-vagal heart rate variability when recorded with ultra short-term photoplethysmography in those with fibromyalgia may not be associated with treatment-specific changes in pain intensity. Further research should be conducted to evaluate potential changes in long-term cardiac-vagal heart rate variability in response to noninvasive vagus nerve innervation in those with fibromyalgia.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03180554, Identifier: NCT03180554.

Mindfulness-Based Stress Reduction in Breast Cancer Survivors with Chronic Neuropathic Pain: A Randomized Controlled Trial

Objectives

The purpose of this study was to compare the effects of group-delivered mindfulness-based stress reduction as compared to a waitlist control group among breast cancer survivors living with CNP.

Methods

A randomized controlled trial design was applied, and outcomes collected included pain, emotional function, quality of life, and global impression of change.

Results

A total of 98 women were randomized and included in analyses. The sample included 49 women in the mindfulness-based stress reduction group, and 49 women in the waitlist control group. The intervention group participants (mean age 51.3 years, standard deviation = 11.4) and waitlist participants (mean age 55.1 years, standard deviation = 9.6) reported an average pain duration of approximately three years. No significant differences were found on the primary outcome of the proportions of women with reduced pain interference scores from the time of randomization to 3 months after the intervention was received. No significant changes were found among secondary outcomes.

Conclusion

Our randomized clinical trial did not find significant benefits of group-based mindfulness-based stress reduction for the management of CNP. The current study findings should be replicated and are important to consider given ongoing concerns that nonsignificant results of mindfulness-based stress reduction are often unpublished.

Absence of structural brain changes from mindfulness-based stress reduction: Two combined randomized controlled trials

Studies purporting to show changes in brain structure following the popular, 8-week mindfulness-based stress reduction (MBSR) course are widely referenced despite major methodological limitations. Here, we present findings from a large, combined dataset of two, three-arm randomized controlled trials with active and waitlist (WL) control groups. Meditation-naïve participants (n = 218) completed structural magnetic resonance imaging scans during two visits: baseline and postintervention period. After baseline, participants were randomly assigned to WL (n = 70), an 8-week MBSR program (n = 75), or a validated, matched active control (n = 73). We assessed changes in gray matter volume, gray matter density, and cortical thickness. In the largest and most rigorously controlled study to date, we failed to replicate prior findings and found no evidence that MBSR produced neuroplastic changes compared to either control group, either at the whole-brain level or in regions of interest drawn from prior MBSR studies.

Méditation de pleine conscience pour les patients en oncologie : adapter la pratique en temps de pandémie

Des ateliers de méditation ont été proposés aux patients, nous en avons étudié la faisabilité pendant les soins oncologiques. Ils ont été adaptés du fait de la Covid-19 : une session a eu lieu en présentiel, la suivante en distanciel. Les données ont été analysées de manière rétrospective. Une analyse mixte a été menée : le volet quantitatif a évalué la participation aux ateliers, les caractéristiques des patients et l’impact des ateliers, le volet qualitatif s’est concentré sur l’appropriation de cet outil par les patients. Concernant la faisabilité, 66,7 % des patients ont terminé le programme, il n’y avait pas de différence dans la participation en présentiel et en distanciel. Nous retrouvons une amélioration des compétences de pleine conscience, une diminution de l’anxiété et des douleurs physiques, une aggravation des nausées. La méditation semble être un outil intéressant pour les patients pendant leurs soins en oncologie, en présentiel et en distanciel.

Mindfulness-based interventions for medication adherence: A systematic review and narrative synthesis

OBJECTIVE

Inadequate medication adherence is a significant limitation for achieving optimal health outcomes across chronic health conditions. Mindfulness-based interventions (MBIs) have been increasingly applied to promote medical regimen adherence as MBIs have been shown to improve patient-level barriers to adherence (i.e., depressive symptoms, cognitive impairment, stress). The purpose of this review is to investigate the state of research regarding MBIs targeting medication adherence in chronic illnesses and to identify evidence gaps to inform future studies.

METHODS

The search reviewed 5 databases (e.g., PubMed, PsycINFO, Embase, CINAHL, Proquest Thesis/Dissertations) to identify trials that quantitatively evaluated the effect of MBIs on medication adherence. Study abstracts and full texts were screened identifying eligible studies, and findings were summarized using a narrative synthesis.

RESULTS

A total of 497 studies were reviewed; 41 were eligible for full text review and 9 were included in narrative synthesis: seven were RCTs and two were pre-post designs. Study quality varied, with five rated moderate or high risk for bias. Clinical populations tested included living with HIV (k = 3), cardiovascular disease (k = 3), psychological disorders (k = 2), and men who underwent a radical prostatectomy (k = 1). Four studies found significant improvements in medication adherence, however only two of these studies had low risk of bias.

CONCLUSIONS

Research on MBI's for medication adherence is developing, but the effectiveness of MBIs remains unclear due to the nascent stage of evidence and methodological limitations of existing studies. Researchers should prioritize rigorous experimental designs, theory-driven investigations of behavioral mechanisms, and the use of objective measurements of adherence.

Validation of the Multidimensional Assessment of Interoceptive Awareness (MAIA-2) questionnaire in hospitalized patients with major depressive disorder

OBJECTIVES

Interoception refers to the sensation, interpretation, and integration of internal somatic signals. Abnormalities in self-reported interoception are prevalent features of major depressive disorder (MDD) and may affect treatment outcomes. In the present study, we investigated the psychometric properties of the revised eight-dimensional and 37-item Multidimensional Assessment of Interoceptive Awareness questionnaire (the MAIA-2) in a severely depressed sample, after translating two updated scales (Not-Distracting, Not-Worrying) into German. Specifically, we examined the measure's internal consistency reliability, sensitivity to change, and minimal important differences (MID) with a focus on patient's antidepressive responses to treatment.

METHODS

The study enrolled 110 participants (age: M = 46.85, SD = 11.23; female: 55.45%) undergoing hospital treatment, of whom 87 were included in the pre-post analysis. Participants completed a German translation of MAIA-2 and the Beck Depression Inventory-II (pre-/post-treatment). Internal consistency reliability was determined by Cronbach's α/McDonalds's ω, sensitivity to change was determined by effect sizes, and MIDs were determined by distribution- (0.5*SD) and anchor-based approaches (mean change method; ROC curve cut-points).

RESULTS

Depression severity reduced over the course of treatment (Median = -65.22%), and 34.48% of patients achieved remission. Reliability was appropriate for post-treatment (range of ω: .70-.90), but questionable for two pre-treatment scales (Noticing: ω = .64; Not-Distracting: ω = .66). The eight dimensions of MAIA-2 were sensitive to change (standardized response mean: .32-.81; Cohen's effect size: .30-.92). Distribution-based MIDs (.38-.61) and anchor-based mean change MIDs (remission vs. partial response: .00-.85; partial response vs. nonresponse: .08-.88) were established on the group level. For six scales, ROC cut-points (remission: .00-1.33; response: -.20-1.00) demonstrated accurate classification to treatment response groups on the individual level.

CONCLUSIONS

This study demonstrated the applicability of the MAIA-2 questionnaire in MDD. The updated version may have led to reliability improvements regarding the revised scales, but subthreshold reliability was evident prior to treatment. The measure's dimensions were sensitive to change. MIDs were established that corresponded with antidepressive treatment outcomes. Our findings are consistent with a growing area of research which considers somatic feelings as key contributors to mental health.

Mindfulness-based interventions for social anxiety disorder: A systematic review and meta-analysis

Various psychiatric disorders are treated with mindfulness-based interventions (MBIs), although the efficacy of MBIs in patients with social anxiety disorder (SAD) is unclear. In this meta-analysis, we investigated the efficacy of MBIs on SAD symptoms. Systematic searches were performed in various databases, and 11 eligible randomized controlled trials (RCTs) and 5 single-arm trials were identified. The between-groups analysis of the 11 RCTs showed that Hedges' g = 0.00, while the within-group analysis showed a large pre-post effect size (g = 1.20).MBIs were superior to the no-treatment comparator (g = 0.89), equivalent to specific active treatment (g = -0.19), and less effective than evidence-based treatment (i.e., cognitive behavioral therapies) (g = -0.29).MBIs significantly alleviated depressive symptoms and improved mindfulness, quality of life, and self-compassion. Meta-regression analysis showed a dose-response relationship between the alleviation of SAD symptoms and the duration of the MBIs (β = 0.659). Follow-up analysis showed that the effects of MBIs on SAD persisted for 12 months (g = 0.231). An analysis of the 5 single-arm trials found that MBIs had a medium effect in alleviating SAD symptoms (g = 0.48). Future research is needed regarding the design of large RCTs of MBIs on SAD patients.

A treatment in search of a disease? Challenges in mindfulness research and practice

'Mindfulness' has become a mainstream component of American culture and a successful business worth more than 1 billion dollars. Born out of Buddhist contemplative traditions that reached the West in the mid-1960s, secular mindfulness programs have spread both geographically (to the US and Europe) and socially (to healthcare, academia, politics, the military, and finance). The diffusion of mindfulness practice to domains that are culturally and socially so different from its original Buddhist context has had important consequences. This manuscript will examine some of these consequences as well as some challenges generated by the encounter between the American culture and Eastern millennial contemplative traditions. With the purpose of increasing awareness about these issues and to generate a debate within the mindfulness community, some suggestions on how to face such challenges are then offered to mindfulness researchers, instructors, and health care providers interested in alleviating the suffering of their patients using mindfulness meditation.

The effects of app-based mindfulness practice on the well-being of university students and staff

Mental health problems like anxiety, depression, and stress have been increasing in many countries and the 2020 COVID-19 pandemic has further exacerbated their toll. Mindfulness-based interventions have been shown to provide evidence-based treatments for anxiety and depression, and accumulating evidence is emerging in support of using mindfulness apps yielding small-to-moderate treatment effects. The study was a 4-week randomized controlled trial with 561 university students and staff as participants, divided into a treatment group (mindfulness app) and an active control group (psychoeducational online content). Depression, anxiety, and stress were evaluated as primary study outcomes. Saliva cortisol samples were also collected from a subgroup of the treatment arm (n = 29). Using the mindfulness app for four weeks resulted in small reductions in stress (d = .16), and depression (d = .16). Attrition was 28.0%. Subjects who practiced more did not experience additional improvement in wellbeing. Mindfulness apps offer modest but clear benefits to users in terms of improved mental health. They present a promising supplement to traditional mental health services.

Contemplative sciences: A future beyond mindfulness

Mindfulness is a psychological technique based on Eastern meditative practices that was developed in the late 1970s by Kabat-Zinn at the University of Massachusetts. Initially, there was a debate over whether it should be considered a scientific technique or labelled as part of the "new wave" practices. Today, mindfulness is omnipresent in modern societies but has suffered from merchandising and banalization, which has been strongly criticized. Despite some limitations regarding methodological aspects of mindfulness research, it is considered effective for treating many physical and psychological disorders, and even it is recommended in clinical guidelines such the British National Institute for Health and Care Excellence. During the last 2500 years, mindfulness practices have moved from Northern India across most of Asia, but their mixing with Western science and culture at the end of the 20th century is considered a key event in recent history. For the first time in human history, due to globalization, the wisdom of all contemplative traditions can be shared with all human beings and assessed by science. Mindfulness practices, yoga included, are giving birth to a new field of knowledge, contemplative sciences, which go beyond mindfulness and is devoted to helping humanity to reach higher levels of happiness and mental peace.

The Empirical Status of Mindfulness-Based Interventions: A Systematic Review of 44 Meta-Analyses of Randomized Controlled Trials

In response to questions regarding the scientific basis for mindfulness-based interventions (MBIs), we evaluated their empirical status by systematically reviewing meta-analyses of randomized controlled trials (RCTs). We searched six databases for effect sizes based on four or more trials that did not combine passive and active controls. Heterogeneity, moderators, tests of publication bias, risk of bias, and adverse effects were also extracted. Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses (k = 336 RCTs, N = 30,483 participants). MBIs showed superiority to passive controls across most PICOS (ds = 0.10-0.89). Effects were typically smaller and less often statistically significant compared with active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. Heterogeneity was typically moderate. Few consistent moderators were found. Results were generally robust to publication bias, although other important sources of bias were identified. Reporting of adverse effects was inconsistent. Statistical power may be lacking in meta-analyses, particularly for comparisons with active controls. Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.

Mindfulness-based programmes for mental health promotion in adults in nonclinical settings: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

There is an urgent need for mental health promotion in nonclinical settings. Mindfulness-based programmes (MBPs) are being widely implemented to reduce stress, but a comprehensive evidence synthesis is lacking. We reviewed trials to assess whether MBPs promote mental health relative to no intervention or comparator interventions.

METHODS AND FINDINGS

Following a detailed preregistered protocol (PROSPERO CRD42018105213) developed with public and professional stakeholders, 13 databases were searched to August 2020 for randomised controlled trials (RCTs) examining in-person, expert-defined MBPs in nonclinical settings. Two researchers independently selected, extracted, and appraised trials using the Cochrane Risk-of-Bias Tool 2.0. Primary outcomes were psychometrically validated anxiety, depression, psychological distress, and mental well-being questionnaires at 1 to 6 months after programme completion. Multiple testing was performed using p < 0.0125 (Bonferroni) for statistical significance. Secondary outcomes, meta-regression and sensitivity analyses were prespecified. Pairwise random-effects multivariate meta-analyses and prediction intervals (PIs) were calculated. A total of 11,605 participants in 136 trials were included (29 countries, 77% women, age range 18 to 73 years). Compared with no intervention, in most but not all scenarios MBPs improved average anxiety (8 trials; standardised mean difference (SMD) = -0.56; 95% confidence interval (CI) -0.80 to -0.33; p-value < 0.001; 95% PI -1.19 to 0.06), depression (14 trials; SMD = -0.53; 95% CI -0.72 to -0.34; p-value < 0.001; 95% PI -1.14 to 0.07), distress (27 trials; SMD = -0.45; 95% CI -0.58 to -0.31; p-value < 0.001; 95% PI -1.04 to 0.14), and well-being (9 trials; SMD = 0.33; 95% CI 0.11 to 0.54; p-value = 0.003; 95% PI -0.29 to 0.94). Compared with nonspecific active control conditions, in most but not all scenarios MBPs improved average depression (6 trials; SMD = -0.46; 95% CI -0.81 to -0.10; p-value = 0.012, 95% PI -1.57 to 0.66), with no statistically significant evidence for improving anxiety or distress and no reliable data on well-being. Compared with specific active control conditions, there is no statistically significant evidence of MBPs' superiority. Only effects on distress remained when higher-risk trials were excluded. USA-based trials reported smaller effects. MBPs targeted at higher-risk populations had larger effects than universal MBPs. The main limitation of this review is that confidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach is moderate to very low, mainly due to inconsistency and high risk of bias in many trials.

CONCLUSIONS

Compared with taking no action, MBPs of the included studies promote mental health in nonclinical settings, but given the heterogeneity between studies, the findings do not support generalisation of MBP effects across every setting. MBPs may have specific effects on some common mental health symptoms. Other preventative interventions may be equally effective. Implementation of MBPs in nonclinical settings should be partnered with thorough research to confirm findings and learn which settings are most likely to benefit.

Motivational nondirective resonance breathing versus transcutaneous vagus nerve stimulation in the treatment of fibromyalgia: study protocol for a randomized controlled trial

BACKGROUND

Chronic widespread pain (CWP), including fibromyalgia (FM), affects one in every ten adults and is one of the leading causes of sick leave and emotional distress. Due to an unclear etiology and a complex pathophysiology, FM is a condition with few, if any, effective and safe treatments. However, current research within the field of vagal nerve innervation suggests psychophysiological and electrical means by which FM may be treated. This study will investigate the efficacy of two different noninvasive vagal nerve stimulation techniques for the treatment of FM.

METHODS

The study will use a randomized, single-blind, sham-controlled design to investigate the treatment efficacy of motivational nondirective resonance breathing (MNRB™) and transcutaneous vagus nerve stimulation (Nemos® tVNS) on patients diagnosed with FM. Consenting FM patients (N = 112) who are referred to the Department of Pain Management and Research at Oslo University Hospital, in Oslo, Norway, will be randomized into one of four independent groups. Half of these participants (N = 56) will be randomized to either an experimental tVNS group or a sham tVNS group. The other half (N = 56) will be randomized to either an experimental MNRB group or a sham MNRB group. Both active and sham treatment interventions will be delivered twice per day at home, 15 min/morning and 15 min/evening, for a total duration of 2 weeks (14 days). Participants are invited to the clinic twice, once for pre- and once for post-intervention data collection. The primary outcome is changes in photoplethysmography-measured heart rate variability. Secondary outcomes include self-reported pain intensity on a numeric rating scale, changes in pain detection threshold, pain tolerance threshold, and pressure pain limit determined by computerized pressure cuff algometry, blood pressure, and health-related quality of life.

DISCUSSION

The described randomized controlled trial aims to compare the efficacy of two vagal nerve innervation interventions, MNRB and tVNS, on heart rate variability and pain intensity in patients suffering from FM. This project tests a new and potentially effective means of treating a major public and global health concern where prevalence is high, disability is severe, and treatment options are limited.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03180554 . Registered on August 06, 2017.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

No panacea? Tai Chi enhances motoric but not executive functioning in a normal aging population

Tai Chi Chuan (TCC) is a promising intervention against age-related decline. Though previous studies have shown benefits in motoric and cognitive domains, it is unclear how these effects are functionally related. Therefore, a randomized controlled trial was conducted in an aging population (53-85). Two measures of motor functioning - motor speed and functional balance - and three cognitive control measures - shifting, updating and inhibition - were included. The TCC condition consisted of an online 10 week 20 lessons video program of increasing level and control condition of educational videos of similar length and frequency. All analyses were done with Bayesian statistics. Counter to expectation no differences were found in cognition between TCC and control pre-to-posttest. However, there was extreme evidence for TCC benefits on functional balance and moderate evidence for increased motoric speed. After weighing the evidence and limitations of the intervention we conclude that TCC does not enhance cognitive control.

Can a teacher-led mindfulness intervention for new school entrants improve child outcomes? Protocol for a school cluster randomised controlled trial

INTRODUCTION

The first years of school are critical in establishing a foundation for positive long-term academic, social and well-being outcomes. Mindfulness-based interventions may help students transition well into school, but few robust studies have been conducted in this age group. We aim to determine whether compared with controls, children who receive a mindfulness intervention within the first years of primary school have better: (1) immediate attention/short-term memory at 18 months post-randomisation (primary outcome); (2) inhibition, working memory and cognitive flexibility at 18 months post-randomisation; (3) socio-emotional well-being, emotion-regulation and mental health-related behaviours at 6 and 18 months post-randomisation; (4) sustained changes in teacher practice and classroom interactions at 18 months post-randomisation. Furthermore, we aim to determine whether the implementation predicts the efficacy of the intervention, and the cost effectiveness relative to outcomes.

METHODS AND ANALYSIS

This cluster randomised controlled trial will be conducted in 22 primary schools in disadvantaged areas of Melbourne, Australia. 826 students in the first year of primary school will be recruited to detect between groups differences of Cohen's d=0.25 at the 18-month follow-up. Parent, teacher and child-assessment measures of child attention, emotion-regulation, executive functioning, socio-emotional well-being, mental health-related behaviour and learning, parent mental well-being, teacher well-being will be collected 6 and 18 months post-randomisation. Implementation factors will be measured throughout the study. Intention-to-treat analyses, accounting for clustering within schools and classes, will adopt a two-level random effects linear regression model to examine outcomes for the intervention versus control students. Unadjusted and analyses adjusted for baseline scores, baseline age, gender and family socioeconomic status will be conducted.

ETHICS AND DISSEMINATION

Ethics approval has been received by the Human Research Ethics Committee at the University of Melbourne. Findings will be reported in peer-review publications, national and international conference presentations and research snapshots directly provided to participating schools and families.

PRE-RESULTS TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12619000326190).

Systematic Review and Meta-Analysis of Correlates of FFMQ Mindfulness Facets

Background: A number of meta-analyses of mindfulness have been performed, but few distinguished between different facets of mindfulness, despite it being known that facets of mindfulness behave differently in different populations; and most studied the outcome of interventions, which tend to involve additional ingredients besides mindfulness. Furthermore, there has recently been some concern regarding possible publication bias in mindfulness research. Objective: Systematic review and meta-analysis of the relationship of different facets of mindfulness with various outcomes, taking into account possible moderators, and controlling for publication bias using a method appropriate given the substantial heterogeneity present. Methods: Random effects meta-analysis with a number of robustness checks and estimation of the possible impact of publication bias on the results. Included are all studies that report correlations of outcomes with all five FFMQ facets, in English, French, German, or Spanish. Study Registration: PROSPERO International prospective register of systematic reviews http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016041863. Results: For the designated primary measure (SWLS) estimated correlations were: 0.15 [0.07, 0.22] for the Observing facet, 0.31 [0.27, 0.36] for Describing, 0.35 [0.31, 0.38] for Acting-with-Awareness, 0.30 [0.10, 0.47] for Non-judging and 0.28 [0.18, 0.37] for Non-reacting. Grouping all desirable outcomes together, Describing has the highest zero-order (though not partial) correlation; Non-judging the highest effect on avoiding undesirable outcomes. Results seem to be reasonably robust even to severe publication bias.

The next generation of mindfulness-based intervention research: what have we learned and where are we headed?

The previous two decades have seen an exponential increase in the number of published scientific investigations on the efficacy of mindfulness-based stress reduction (MBSR) training to improve function in a wide range of physical and psychological processes. The resulting body of work provides strong evidence that MBSR has salubrious effects. Yet, when compared directly to groups with training that matches MBSR in factors common to most legitimate interventions, such as learning new skills, expectation of benefit, social engagement and support, and attention from expert instructors, both groups tend to improve to a similar extent. This raises the question of whether there are benefits that are specific to training in mindfulness and if so, why are we not detecting them? Here, we discuss the factors that contribute to the general lack of differentiation between MBSR and active control groups, including the specificity of outcome measures and experimental design, random assignment, inclusion/exclusion criteria, and the time course and trajectory of change. In addition, we offer recommendations to address these factors in future research.

Contemplative interventions and employee distress: A meta-analysis

Mindfulness, meditation, and other practices that form contemplative interventions are increasingly offered in workplaces to support employee mental health. Studies have reported benefits across various populations, yet researchers have expressed concerns that adoption of such interventions has outpaced scientific evidence. We reappraise the extant literature by meta-analytically testing the efficacy of contemplative interventions in reducing psychological distress in employees (meta-analysed set: k = 119; N = 6,044). Complementing other reviews, we also examine a range of moderators and the impact of biases that could artificially inflate effect sizes. Results suggested interventions were generally effective in reducing employee distress, yielding small to moderate effects that were sustained at last follow-up. Effects were moderated by the type of contemplative intervention offered and the type of control group utilized. We also found evidence of publication bias, which is likely inflating estimated effects. Uncontrolled single-sample studies were more affected by bias than were large or randomized controlled trial studies. Adjustments for publication bias lowered overall effects. Overall, our review supports the effectiveness of contemplative interventions in reducing employee distress, but there is a need for proactive strategies to mitigate artificially inflated effect sizes to avoid the misapplication of contemplative interventions in work settings.

Does mindfulness change the mind? A novel psychonectome perspective based on Network Analysis

If the brain is a complex network of functionally specialized areas, it might be expected that mental representations could also behave in a similar way. We propose the concept of ‘psychonectome’ to formalize the idea of psychological constructs forming a dynamic network of mutually dependent elements. As a proof-of-concept of the psychonectome, networks analysis (NA) was used to explore structural changes in the network of constructs resulting from a psychological intervention. NA was applied to explore the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program in healthy participants (N = 182). Psychological functioning was measured by questionnaires assessing five key domains related to MBSR: mindfulness, compassion, psychological well-being, psychological distress and emotional-cognitive control. A total of 25 variables, covering the five constructs, were considered as nodes in the NA. Participants significantly improved in most of the psychological questionnaires. More interesting from a network perspective, there were also significant changes in the topological relationships among the elements. Expected influence and strength centrality indexes revealed that mindfulness and well-being measures were the most central nodes in the networks. The nodes with highest topological change after the MBSR were attentional control, compassion measures, depression and thought suppression. Also, cognitive appraisal, an adaptive emotion regulation strategy, was associated to rumination before the MBSR program but became related to mindfulness and well-being measures after the program. Community analysis revealed a strong topological association between mindfulness, compassion, and emotional regulation, which supports the key role of compassion in mindfulness training. These results highlight the importance of exploring psychological changes from a network perspective and support the conceptual advantage of considering the interconnectedness of psychological constructs in terms of a ‘psychonectome’ as it may reveal ways of functioning that cannot be analyzed through conventional analytic methods.

Motivational Non-directive Resonance Breathing as a Treatment for Chronic Widespread Pain

Chronic widespread pain (CWP) is one of the most difficult pain conditions to treat due to an unknown etiology and a lack of innovative treatment design and effectiveness. Based upon preliminary findings within the fields of motivational psychology, integrative neuroscience, diaphragmatic breathing, and vagal nerve stimulation, we propose a new treatment intervention, motivational non-directive (ND) resonance breathing, as a means of reducing pain and suffering in patients with CWP. Motivational ND resonance breathing provides patients with a noninvasive means of potentially modulating five psychophysiological mechanisms imperative for endogenously treating pain and increasing overall quality of life.

An Examination of Whether Mindfulness Can Predict the Relationship Between Objective and Subjective Attitudinal Ambivalence

Ambivalence is a mixed reaction toward an attitudinal object. Ambivalence is often viewed as aversive and people are motivated to reduce it. However, the presence of both strong positive and negative attitudes toward an object (objective ambivalence; OA) does not always lead to consciously experienced conflicted and torn feelings (subjective ambivalence; SA) or psychological discomfort. We hypothesized that the way people think about their inner experience can affect whether ambivalent attitudes lead to increased conflicted feelings. In five studies, we examined whether mindfulness predicts the relationship between objective and subjective ambivalence. We predicted that the acceptance aspect of mindfulness would attenuate the relationship between OA and SA, based on the idea that acceptance makes people more tolerant and less judgmental toward their inner states in general (and OA in particular). Although some findings across five studies were consistent with the prediction showing that acceptance attenuated the OA–SA relationship, other findings were not and even showed that acceptance strengthened the OA–SA relationship. A meta-analysis of the interaction effect across all studies failed to find support for predictions (r = -0.036 and 95% CI [-0.087; 0.022]). We discuss possible reasons for these mixed findings, and the implications of these studies.

The Role of One's Motive in Meditation Practices and Prosociality

No individual exists without exhibiting prosociality in one or another situation during their lifetime. The argument however, is to what extent? Does it arise spontaneously, out of true empathy and compassion for others, or it is goal-oriented with some hidden motive? Here, our primary intention is to convey that, though various meditation-based interventions can be utilized for different purposes like cultivating prosocial behaviors such as compassion, empathy etc., one's underlying motive and intent seems to play a crucial role in an individual's development. Most of the studies exploring prosociality, in the context of meditation, usually do not consider the role of hidden or underlying motivation in one's prosocial expression. By considering an example of how mindfulness may sometimes lead to the wrong consequences, we try to analyze why it is important to include the aspect of inner motivation in future studies exploring the effects of meditation on prosociality. We also propose that while practicing meditation one may need traditional assistance and ethical/moral teachings in addition to those merely isolated techniques.

Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: a meta-analysis

Mindfulness-based cognitive therapy (MBCT) appears to be a promising intervention for the prevention of relapse in major depressive disorder, but its efficacy in patients with current depressive symptoms is less clear. Randomized clinical trials of MBCT for adult patients with current depressive symptoms were included (k = 13, N = 1046). Comparison conditions were coded based on whether they were intended to be therapeutic (specific active controls) or not (non-specific controls). MBCT was superior to non-specific controls at post-treatment (k = 10, d = 0.71, 95% confidence interval [CI] [0.47, 0.96]), although not at longest follow-up (k = 2, d = 1.47, [-0.71, 3.65], mean follow-up = 5.70 months across all studies with follow-up). MBCT did not differ from other active therapies at post-treatment (k = 6, d = 0.002, [-0.43, 0.44]) and longest follow-up (k = 4, d = 0.26, [-0.24, 0.75]). There was some evidence that studies with higher methodological quality showed smaller effects at post-treatment, but no evidence that effects varied by inclusion criterion. The impact of publication bias appeared minimal. MBCT seems to be efficacious for samples with current depressive symptoms at post-treatment, although a limited number of studies tested the long-term effects of this therapy.

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.

Mindfulness Meditation and Psychopathology

Mindfulness meditation is increasingly incorporated into mental health interventions, and theoretical concepts associated with it have influenced basic research on psychopathology. Here, we review the current understanding of mindfulness meditation through the lens of clinical neuroscience, outlining the core capacities targeted by mindfulness meditation and mapping them onto cognitive and affective constructs of the Research Domain Criteria matrix proposed by the National Institute of Mental Health. We review efficacious applications of mindfulness meditation to specific domains of psychopathology including depression, anxiety, chronic pain, and substance abuse, as well as emerging efforts related to attention disorders, traumatic stress, dysregulated eating, and serious mental illness. Priorities for future research include pinpointing mechanisms, refining methodology, and improving implementation. Mindfulness meditation is a promising basis for interventions, with particular potential relevance to psychiatric comorbidity. The successes and challenges of mindfulness meditation research are instructive for broader interactions between contemplative traditions and clinical psychological science.

Mindfulness in severe and persistent mental illness: a systematic review

OBJECTIVE

This systematic review summarises the current state of research on mindfulness in SPMI, given the pressing need to provide alternative, scalable and cost-effective treatment modalities for patients with severe and persistent mental illness (SPMI).

METHODS

Articles included mindfulness-based interventions for SPMI. Excluded articles included qualitative studies, acceptance and compassion therapies, case reports and reviews. Studies were identified by searching the databases Medline, Embase and PsycINFO.

RESULTS

Six randomised controlled trials, seven prospective studies and one retrospective study were identified. Clinical improvements were observed on psychotic symptoms, and on improvements of depression symptoms, cognition, mindfulness, psycho-social and vocational factors.

CONCLUSIONS

Findings suggest that mindfulness is feasible for individuals with SPMI, and displays potential benefits in outcomes aside from psychotic symptoms. The effects of mindfulness in psychotic symptoms needs further investigation in larger definitive studies using methodological rigor and thorough assessments of other psychiatric populations who are also representative of SPMI.

Into the Moment: Does Mindfulness Affect Biological Pathways in Multiple Sclerosis?

Mindfulness was introduced in the Western world by Jon Kabat-Zinn in 1979. He defined it as "awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally." Since then, research on mindfulness-based interventions (MBIs) has increased exponentially both in health and disease, including in patients with neurodegenerative diseases such as dementia and Parkinson's disease. Research on the effect of mindfulness and multiple sclerosis (MS) only recently gained interest. Several studies completed since 2010 provided evidence that mindfulness improves quality of life (QoL), depression and fatigue in MS patients. In addition to patient-reported outcome measures, potential effects on cognitive function have been investigated only to a very limited extent. However, research on laboratory biomarkers and neuroimaging, capable to deliver proof-of-concept of this behavioral treatment in MS, is mainly lacking. In this perspective, we illustrate possible neurobiological mechanisms, including the tripartite interaction between the brain, the immune system and neuroendocrine regulation, through which this treatment might affect multiple sclerosis symptoms. We propose to (1) include immunological and/or neuroimaging biomarkers as standard outcome measures in future research dedicated to mindfulness and MS to help explain the clinical improvements seen in fatigue and depression; (2) to investigate effects on enhancing cognitive reserve and cognitive function; and (3) to investigate the effects of mindfulness on the disease course in MS.

A systematic review of randomized trials of mind-body interventions for PTSD

OBJECTIVE

To systematically review outcomes from randomized controlled trials (RCTs) of mind-body treatments for PTSD.

METHODS

Inclusion criteria based on guidelines for assessing risk of bias were used to evaluate articles identified through electronic literature searches.

RESULTS

Twenty-two RCTs met inclusion standards. In most of the nine mindfulness and six yoga studies, significant between-group effects were found indicating moderate to large effect size advantages for these treatments. In all seven relaxation RCT's, relaxation was used as a control condition and five studies reported significant between-group differences on relevant PTSD outcomes in favor of the target treatments. However, there were large within-group symptom improvements in the relaxation condition for the majority of studies.

CONCLUSIONS

Although many studies are limited by methodologic weaknesses, recent studies have increased rigor and, in aggregate, the results for mindfulness, yoga, and relaxation are promising. Recommendations for design of future mind-body trials are offered.

Effects of Mindfulness-Based Stress Reduction on employees' mental health: A systematic review

OBJECTIVES

The purpose of this exploratory study was to obtain greater insight into the effects of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) on the mental health of employees.

METHODS

Using PsycINFO, PubMed, and CINAHL, we performed a systematic review in October 2015 of studies investigating the effects of MBSR and MBCT on various aspects of employees' mental health. Studies with a pre-post design (i.e. without a control group) were excluded.

RESULTS

24 articles were identified, describing 23 studies: 22 on the effects of MBSR and 1 on the effects of MBSR in combination with some aspects of MBCT. Since no study focused exclusively on MBCT, its effects are not described in this systematic review. Of the 23 studies, 2 were of high methodological quality, 15 were of medium quality and 6 were of low quality. A meta-analysis was not performed due to the emergent and relatively uncharted nature of the topic of investigation, the exploratory character of this study, and the diversity of outcomes in the studies reviewed. Based on our analysis, the strongest outcomes were reduced levels of emotional exhaustion (a dimension of burnout), stress, psychological distress, depression, anxiety, and occupational stress. Improvements were found in terms of mindfulness, personal accomplishment (a dimension of burnout), (occupational) self-compassion, quality of sleep, and relaxation.

CONCLUSION

The results of this systematic review suggest that MBSR may help to improve psychological functioning in employees.

Mind the Hype: A Critical Evaluation and Prescriptive Agenda for Research on Mindfulness and Meditation

During the past two decades, mindfulness meditation has gone from being a fringe topic of scientific investigation to being an occasional replacement for psychotherapy, tool of corporate well-being, widely implemented educational practice, and "key to building more resilient soldiers." Yet the mindfulness movement and empirical evidence supporting it have not gone without criticism. Misinformation and poor methodology associated with past studies of mindfulness may lead public consumers to be harmed, misled, and disappointed. Addressing such concerns, the present article discusses the difficulties of defining mindfulness, delineates the proper scope of research into mindfulness practices, and explicates crucial methodological issues for interpreting results from investigations of mindfulness. For doing so, the authors draw on their diverse areas of expertise to review the present state of mindfulness research, comprehensively summarizing what we do and do not know, while providing a prescriptive agenda for contemplative science, with a particular focus on assessment, mindfulness training, possible adverse effects, and intersection with brain imaging. Our goals are to inform interested scientists, the news media, and the public, to minimize harm, curb poor research practices, and staunch the flow of misinformation about the benefits, costs, and future prospects of mindfulness meditation.

Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis

Despite widespread scientific and popular interest in mindfulness-based interventions, questions regarding the empirical status of these treatments remain. We sought to examine the efficacy of mindfulness-based interventions for clinical populations on disorder-specific symptoms. To address the question of relative efficacy, we coded the strength of the comparison group into five categories: no treatment, minimal treatment, non-specific active control, specific active control, and evidence-based treatment. A total of 142 non-overlapping samples and 12,005 participants were included. At post-treatment, mindfulness-based interventions were superior to no treatment (d=0.55), minimal treatment (d=0.37), non-specific active controls (d=0.35), and specific active controls (d=0.23). Mindfulness conditions did not differ from evidence-based treatments (d=-0.004). At follow-up, mindfulness-based interventions were superior to no treatment conditions (d=0.50), non-specific active controls (d=0.52), and specific active controls (d=0.29). Mindfulness conditions did not differ from minimal treatment conditions (d=0.38) and evidence-based treatments (d=0.09). Effects on specific disorder subgroups showed the most consistent evidence in support of mindfulness for depression, pain conditions, smoking, and addictive disorders. Results support the notion that mindfulness-based interventions hold promise as evidence-based treatments.

Is mindfulness research methodology improving over time? A systematic review

Background

Despite an exponential growth in research on mindfulness-based interventions, the body of scientific evidence supporting these treatments has been criticized for being of poor methodological quality.

Objectives

The current systematic review examined the extent to which mindfulness research demonstrated increased rigor over the past 16 years regarding six methodological features that have been highlighted as areas for improvement. These feature included using active control conditions, larger sample sizes, longer follow-up assessment, treatment fidelity assessment, and reporting of instructor training and intent-to-treat (ITT) analyses.

Data sources

We searched PubMed, PsychInfo, Scopus, and Web of Science in addition to a publically available repository of mindfulness studies.

Study eligibility criteria

Randomized clinical trials of mindfulness-based interventions for samples with a clinical disorder or elevated symptoms of a clinical disorder listed on the American Psychological Association’s list of disorders with recognized evidence-based treatment.

Study appraisal and synthesis methods

Independent raters screened 9,067 titles and abstracts, with 303 full text reviews. Of these, 171 were included, representing 142 non-overlapping samples.

Results

Across the 142 studies published between 2000 and 2016, there was no evidence for increases in any study quality indicator, although changes were generally in the direction of improved quality. When restricting the sample to those conducted in Europe and North America (continents with the longest history of scientific research in this area), an increase in reporting of ITT analyses was found. When excluding an early, high-quality study, improvements were seen in sample size, treatment fidelity assessment, and reporting of ITT analyses.

Conclusions and implications of key findings

Taken together, the findings suggest modest adoption of the recommendations for methodological improvement voiced repeatedly in the literature. Possible explanations for this and implications for interpreting this body of research and conducting future studies are discussed.

Brain-Gut-Microbiota Axis and Mental Health

OBJECTIVE

The brain-gut-microbiota axis has been put forward as a new paradigm in neuroscience, which may be of relevance to mental illness. The mechanisms of signal transmission in the brain-gut-microbiota axis are complex and involve bidirectional communications that enable gut microbes to communicate with the brain and the brain to communicate with the microbes. This review assesses the potential usefulness and limitations of the paradigm.

METHODS

A selective literature review was conducted to evaluate the current knowledge in clinical and preclinical brain-gut-microbiota interactions as related to psychiatric disorders.

RESULTS

Most published studies in the field are preclinical, and there is so far a lack of clinical studies. Preliminary studies in psychiatric populations support the view of a dysbiosis in some conditions, but studies are often small scale and marred by potential confounding variables. Preclinical studies support the view that psychobiotics ("bacteria which when ingested in adequate amounts have a positive mental health benefit") might be of use in treating some patients with mental health difficulties. To date, we have no well-conducted studies in clinical populations, although there are some studies in healthy volunteers. A cocktail of probiotics has been shown to alter brain activity as monitored by functional magnetic resonance imaging, and Bifidobacterium longum was reported to alter brain electrical activity.

CONCLUSIONS

It has yet to be convincingly demonstrated that the exciting findings of psychobiotic efficacy demonstrated in preclinical models of psychiatric illness will translate to patients.