Effects of a brief interpersonal mindfulness program embedded in a psychiatric nursing practicum: A controlled pilot study

BACKGROUND

Nursing school is a stressful environment that demands high performance both professionally and academically. Interpersonal mindfulness training has shown promise for its stress-reducing capacity in other contexts; however, few descriptions or tests of this method in nursing training settings exist in the literature.

PURPOSE

This pilot study examined effects of a brief interpersonal mindfulness program embedded in a 4-week psychiatric nursing practicum in Thailand.

METHODS

Mixed methods were used with 31 fourth-year nursing students to measure changes in mindfulness and assess their experiences of the program's impact. The control and experimental groups received the same clinical training, but the experimental group was also trained to practice interpersonal mindfulness throughout the course.

FINDINGS

The experimental group reported statistically significantly greater increases in Observing, Describing, and Non-reacting subscale scores, and in scores for the overall Five-Facet Mindfulness questionnaire, Thai version, than the control group (p < .05, Cohen's d = 0.83-0.95, large effect sizes). Group interviews revealed themes: initial challenges to mindfulness practice, experiences of becoming more mindful, intrapersonal benefits, and consequences of mindfulness on interpersonal skills.

CONCLUSION

Overall, an interpersonal mindfulness program embedded in a psychiatric nursing practicum was effective. Further studies are required to address limitations of the present study.

Self-Regulation of Seat of Attention Into Various Attentional Stances Facilitates Access to Cognitive and Emotional Resources: An EEG Study

This study provides evidence supporting the operation of a novel cognitive process of a somatic seat of attention, or ego-center, whose somatic location is under voluntary control and that provides access to differential emotional resources. Attention has typically been studied in terms of what it is directed toward, but it can also be associated with a localized representation in the body image that is experienced as the source or seat of attention-an aspect that has previously only been studied by subjective techniques. Published studies of this phenomenon under terms such as egocenter or self-location suggest that the seat of attention can be situated in various ways within the experienced body, resulting in what are here referred to as different attentional stances. These studies also provide evidence that changes in attentional stance are associated with differences in cognitive skill, emotional temperament, self-construal, and social and moral attitudes, as well as with access to certain states of consciousness. In the present study, EEG results from multiple trials of each of 11 specific attentional stances confirmed that patterns of neural activity associated with the voluntarily control of attentional stances can be reliably measured, providing evidence for a differential neural substrate underlying the subjective location of the seat of attention. Additionally, brain activation patterns for the attentional stances showed strong correlations with EEG signatures associated with specific positive emotional states and with arousal, confirming that differential locations of the seat of attention can be objectively associated with different emotion states, as implied in previous literature. The ability to directly manage the seat of attention into various attentional stances holds substantial potential for facilitating access to specific cognitive and emotional resources in a new way.

Differentiating Third-Wave Cognitive Mindfulness From Meditative Mindfulness Using a Gurdjieffian Phenomenology of Awareness

Current literature on mindfulness offers inadequate distinction between neo-traditional mindfulness and cognitive behavioral mindfulness, to the extent that both approaches can be included within the same meta-analyses. A close examination of the mechanisms of action in several forms of mindfulness using a lens of Gurdjieffian phenomenology of awareness can point toward a clear and well defined distinction between varieties of mindfulness. The phenomenology of cognitive behavioral mindfulness suggests that it involves an enhanced attention to the cognitive contents of awareness, as in Gurdjieff’s second state, but give no evidence of attaining self-reflexive awareness in which attention attunes to its own presence as the context of cognitive processes. Neo-traditional and meditative forms of mindfulness are more likely to attend to both the contents and the context of consciousness, a change associated with a shift in state of consciousness. Using Gurdjieff’s phenomenology of awareness, neo-traditional mindfulness can be seen as similar to Gurdjieff’s self-remembering, in which awareness attends to the cognitive contents of experience as well as to its own presence. Cognitive behavioral versions of mindfulness differ from both of these in that the object of attention does not extend self-reflexively beyond cognitive contents.

Ketamine-Assisted and Culturally Attuned Trauma Informed Psychotherapy as Adjunct to Traditional Indigenous Healing: Effecting Cultural Collaboration in Canadian Mental Health Care

Ketamine therapy with culturally attuned trauma-informed psychotherapy in a collaborative cross-cultural partnership may provide a critical step in the operationalization and optimization of treatment effectiveness in diverse populations and may provide a foundation for an improved quality of life for Indigenous people. Decolonizing Indigenous health and wellbeing is long overdue, requiring an equal partnership between government and Indigenous communities, built upon an aboriginal culture holistic foundation of balance of mind, body, social and spiritual realms, and within the context of historical and lived experiences of colonialism. Culturally attuned trauma-informed psychotherapy paired with ketamine-a fast-acting antidepressant that typically takes effect within 4 hours, even in cases of acute suicidality-may be uniquely qualified to integrate into an Indigenous based health system, since ketamine's therapeutic effects engage multiple neuropsychological, physiological, biological, and behavioral systems damaged by intergenerational complex developmental trauma. Ketamine holds the potential to serve as a core treatment modality around which culturally engaged treatment approaches might be organized since its brief alteration of normal waking consciousness is already a familiar and intrinsic element of healing culture in many Indigenous societies. There is great need and desire in Indigenous communities for respectful and sacred partnership in fostering more effective mental health outcomes and improved quality of life.

An Integrative Approach to Ketamine Therapy May Enhance Multiple Dimensions of Efficacy: Improving Therapeutic Outcomes With Treatment Resistant Depression

Research over the last two decades has established ketamine as a safe, effective, fast-acting, and sustained antidepressant that significantly reduces adverse symptoms associated with depression, even in patients who are treatment resistant. Much of this research has evolved within the framework of several independent branches of scientific inquiry: in addition to the study of ketamine is a non-selective NMDAR antagonist with rapid antidepressant effects, it has also been found effective as a psychoplastogen that stimulates synaptogenesis and increases neuroplasticity, as a powerful anti-inflammatory that may improve inflammation-related depressive symptoms, as a substance that induces beneficial high entropy brain states, and as a subjectively impactful psychedelic agent. Each branch of inquiry has generated independent evidence of ketamine's efficacy but has advanced without substantive coordination or communication with other lines of inquiry. Integrative research that considers these branches of research together may lead toward a better understanding of ketamine's effects and improved treatment protocols and clinical outcomes. Such an overview can inform more comprehensive patient care through: (a) informed patient psychoeducation that encompasses all of ketamine's mechanisms of action; (b) calibration of optimal dosage to ensure induction and maintenance of high entropy brain states during each ketamine session utilizing EEG measurement; (c) Improved management of emergence side effects through proper care for set and setting; (d) inclusion of pre-selected appropriate music to enhance the emotional experience; (e) increased monitoring of ketamine effects on cortical activity, inter-hemispheric imbalance, and inflammation-related levels of cytokines to further improvements in ketamine protocols; and (f) appropriate timing of any adjunctive psychotherapy sessions to coincide with peak neurogenesis at 24-48 h post ketamine treatment.

Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention

A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.