Mindfulness-based stress reduction (MBSR) and distress in a community-based sample

Background: Numerous studies have found Mindfulness‐based stress reduction (MBSR) to be useful for a wide range of problems including anxiety, pain and coping with a medical illness. The primary goal of this study was to evaluate the effectiveness of an 8‐week MBSR programme in relieving distress in a community based sample. Methods: Subjects (n = 14) were participants in the MBSR programme at a major academic medical center and completed the Profile of Mood States (POMS) and the Mindful Attention Awareness Scale (MAAS) prior to starting the class and at the end of the 8‐week course. Means and standard deviations were computed for the pre‐and post‐POMS total and subscale measures and the MAAS. Wilcoxon Signed Ranks Test was conducted. Results: There were significant reductions on multiple dimensions of distress on the POMS as well as a significant increase in mindful awareness as measured by the MAAS. Conclusion: These results suggest that MBSR appears to be associated with a reduction of distress and increased awareness of everyday life experiences in a sample of residents living in a large urban community. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? Mindfulness‐based stress reduction (MBSR) appears to be an acceptable modality for mild to moderate psychological distress in a community sample. ? Mindfulness training is associated with reduction in psychological distress. ? Mindful Attention Awareness scale scores improved following an 8‐week MBSR course.     

Mindfulness-based stress reduction for GPs: results of a controlled mixed methods pilot study in Dutch primary care

Background

Burnout is highly prevalent in GPs and can have a negative influence on their wellbeing, performance, and patient care. Mindfulness-based stress reduction (MBSR) may be an effective intervention to decrease burnout symptoms and increase wellbeing.

Aim

To gain insight into the feasibility and effectiveness of MBSR on burnout, empathy, and (work-related) wellbeing in GPs.

Design and setting

A mixed methods pilot study, including a waiting list-controlled pre-/post-study and a qualitative study of the experiences of participating GPs in the Netherlands.

Method

Participants were sent questionnaires assessing burnout, work engagement, empathy, and mindfulness skills, before and at the end of the MBSR training/waiting period. Qualitative data on how GPs experienced the training were collected during a plenary session and with evaluation forms at the end of the course.

Results

Fifty Dutch GPs participated in this study. The MBSR group reported a greater decrease in depersonalisation than the control group (adjusted difference −1.42, 95% confidence interval [CI] = −2.72 to −0.21, P = 0.03). Dedication increased more significantly in the MBSR group than in the control group (adjusted difference 2.17, 95% CI = 0.51 to 3.83, P = 0.01). Mindfulness skills increased significantly in the MBSR group compared with the control group (adjusted difference 6.90, 95% CI = 1.42 to 12.37, P = 0.01). There was no significant change in empathy. The qualitative data indicated that the MBSR course increased their wellbeing and compassion towards themselves and others, including their patients.

Conclusion

The study shows that MBSR for GPs is feasible and might result in fewer burnout symptoms and increased work engagement and wellbeing. However, an adequately powered randomised controlled trial is needed to confirm the study’s findings.     

Mindfulness groups for early psychosis: A qualitative study

Objectives . The aim of the study was to explore experiences of practising mindfulness in participants within an early intervention for psychosis (EIP) service. Design. A qualitative research methodology was used – that of grounded theory. This was chosen as it enabled examination of clients’ experiences of mindfulness practice. Methods . The experience of mindfulness among nine people within an EIP service who had been practising mindfulness for at least 20 weeks was investigated. Semi‐structured interviews exploring how mindfulness practice related to psychosis and day‐to‐day life were recorded verbatim, transcribed, and analysed. Results . Four main categories emerged: being able to use mindfulness, making sense of mindfulness and coping, relating to people differently, and increased self‐understanding and acceptance. Conclusions. All participants reported subjective benefits and challenges of mindfulness practice, and gave insights into processes of change. These preliminary data suggest mindfulness can be of use to individuals experiencing their first episode of psychosis.     

Mindfulness-based stress reduction as an adjunct to outpatient psychotherapy

BACKGROUND: Research on Mindfulness-Based Stress Reduction (MBSR) has supported the utility of the technique in a number of clinical settings. This study explored whether MBSR, used as an adjunct to individual psychotherapy, would result in more rapid alleviation of symptoms, increased achievement of therapeutic goals, and a decrease in number of therapy sessions sought by clients. METHODS: A group undergoing psychotherapy coupled with training in MBSR was compared with a group undergoing psychotherapy alone. RESULTS: At the conclusion of MBSR training, the groups showed a comparable significant decrease in psychological distress. However, the MBSR group's gains on a novel measure of goal achievement were significantly greater than those of the comparison group. In addition, the MBSR group terminated therapy at a significantly greater rate than the comparison group. CONCLUSION: The effects of introducing MBSR early in psychotherapy, as well as its effect on self-directed goal attainment in non-psychotherapy contexts, deserve further attention.     

Hepatitis C: A Socio-cultural Perspective on the Effects of a New Virus on a Community's Health

Since the emergence of diagnostic medical tests in Australia in 1990, hepatitis C (HCV) has been shown to account for over 90 percent of all non-A non-B hepatitis, revealing it to be a widespread and major public health problem. The diagnosis of HCV involves a diverse range of issues for affected persons, introducing identity and lifestyle changes, which are commonly articulated through psychological concepts. In this article we argue that it is important to examine the broader social and cultural contexts that contribute to the experiences of persons affected by HCV. The thematic analysis of qualitative data from six individuals diagnosed with HCV is included to exemplify some of the processes that are involved in the changing identity of a person following a positive diagnosis. The theoretical framework for the interpretation of these processes is interpretive interactionism. In this research, we are attempting to extend the understanding of the effects of HCV diagnoses beyond internal, psychological processes by examining how these diagnoses transform some of the processes of self-formation and expression. The participants' experiences indicate that there are at least four dimensions of self that were significant to their changing sense of self: relationship of self to others; the emotional self; self-stories and identity; and self-scrutiny and relationships. We conclude that a socio-cultural perspective contributes to the explanation of the transition period following a HCV-positive diagnosis and the redefinition of self towards a HCV status.     

From pain to self-awareness--a qualitative analysis of the significance of group participation for persons with chronic musculoskeletal pain

The experiences of persons with chronic musculoskeletal pain who participated in a twelve-session process and experience-oriented learning programme were analysed with qualitative methods. The programme was based on a phenomenological frame of understanding where the individual's experience of her/his situation was essential. The educational approach was inspired by personal construct theory that calls attention to the human being's capacity to redefine and reconstruct the meanings of any situation and symptom. Certain qualities and values were embedded in the group programme: A context that emphasised an understanding of the body 'as a talking subject' rather than focusing on pain and diagnoses; the wholeness of participants' situation rather than viewing chronic muscular pain as either physical or psychological: activity, participation and operating within the participants' everyday language and ways of expressing themselves; respecting, seeing, listening and trusting the group participants; focusing on each participant's and the whole group's resources, potentials and possibilities; challenging the participants to evoke their inner authority and internal validation instead of surrendering authority on their pain to the health personnel. Self-reports shortly after, and a year after, participation indicated that participants in the groups had reconstructed some patterns in their lives, both in relation to self and others. They had an increased awareness of self, less pain and more constructive ways of handling pain and life situation.     

A bitter pill: a discursive analysis of women's medicalized accounts of depression

Taking a discourse analytic approach, this article explores how a biomedical understanding is drawn on and mobilized in women's accounts of their depressive experiences. Through talk of diagnosis, and by drawing comparisons between depression and physical illnesses, participants constructed depression as a medical condition with the effect of validating their pain and legitimizing their identities. However, participants' accounts also indicated an uneasy fit between the objective discipline of biomedicine and their subjective experiences of depression. Without tangible evidence to validate the 'reality' of their condition, speakers were on precarious ground for talking of themselves and their distress within a biomedical frame. The social construction of biomedicine and stigma for marginalized forms of distress are discussed.     

Informal caregiving experiences in posttraumatic stress disorder: A content analysis of an online community

This study explored the experiences of individuals who self‐identify as providing support to a friend, family member, or significant other with posttraumatic stress disorder (PTSD). We analyzed and coded a total of 345 posts from an online support forum, with reference to 13 categories (finances, life interference, venting/emotional expression, maltreatment, sexual behavior, distress, prevented expression, physical health, communication, no personal space, isolation, and compassion fatigue). Categories for coding were established a priori and based on previous literature about caregiving and supporting. Results suggested that informal PTSD caregivers experience concerns involving interpersonal relations, emotional turmoil, and barriers to care for themselves and the individual they are caring for. This study provides a preliminary examination of the experiences and concerns of PTSD caregivers. Implications and suggestions for future research are discussed.     

The moderation of Mindfulness-based stress reduction effects by trait mindfulness: results from a randomized controlled trial

Mindfulness-based stress reduction (MBSR) has shown effectiveness for a variety of mental health conditions. However, it is not known for whom the intervention is most effective. In a randomized controlled trial (N = 30), we explored whether individuals with higher levels of pretreatment trait mindfulness would benefit more from MBSR intervention. Results demonstrated that relative to a control condition (n = 15), MBSR treatment (n = 15) had significant effects on several outcomes, including increased trait mindfulness, subjective well-being, and empathy measured at 2 and 12 months after treatment. However, relative to controls, MBSR participants with higher levels of pretreatment mindfulness showed a larger increase in mindfulness, subjective well-being, empathy, and hope, and larger declines in perceived stress up to 1 year after treatment.     

Effects of mindfulness-based stress reduction on emotional experience and expression: a randomized controlled trial

Objectives: Mindfulness‐based stress reduction (MBSR) has been found to reduce psychological distress and improve psychological adjustment in medical, psychiatric, and nonclinical samples. We examined its effects on several processes, attitudes, and behavior patterns related to emotion regulation. Design: Fifty‐six adults were randomly assigned to MBSR or to a waiting list (WL). Results: Compared with WL completers (n = 21), MBSR completers (n = 20) reported significantly greater increases in trait mindfulness and decreases in absent‐mindedness, greater increases in self‐compassion, and decreases in fear of emotions, suppression of anger, aggressive anger expression, worry, and difficulties regulating emotions. The WL group subsequently received MBSR, and the two groups combined showed significant changes on all of these variables from pre‐MBSR to post‐MBSR, and on all except the 2 anger variables from pre‐test to 2‐month follow‐up, as well as significant reductions in rumination. Conclusion: An 8‐week mindfulness training program might increase mindful awareness in daily life and have beneficial impact on clinically relevant emotion regulation processes. © 2011 Wiley Periodicals, Inc. J Clin Psychol 68:1–15, 2011.     

Mindfulness for healthcare providers fosters professional quality of life and mindful attention among emergency medical technicians

ObjectiveEmergency medical service (EMS) providers are systematically subjected to intense stimuli in their work that may result in distress and emotional suffering. While it is known that mindfulness-based stress reduction (MBSR) helps to foster well-being in healthcare workers, the effectiveness of MBSR among EMS providers is less understood. We explored the impact of a modified version of MBSR for healthcare workers called Mindfulness for Healthcare Providers (MHP) on reducing distress and promoting wellbeing in EMS providers.MethodsA one-arm pilot study was conducted. We implemented eight two-and-a-half hour sessions of Mindfulness for Healthcare Providers with an additional day-long retreat at the end. Feasibility, perceived stress, professional quality of life, and trait mindfulness were assessed prior to and after the intervention. The professional quality of life scale includes measures of compassion satisfaction, burnout, and secondary trauma.ResultsFifteen veteran EMS providers enrolled in the course; four participants dropped out. Prior to initiation of the study, no significant differences were revealed between those who did not participate (n = 48) and those who did (n = 11). After the intervention EMS providers endorsed statistically significant increases in compassion satisfaction, trait mindfulness, and decreases in burnout compared to the beginning of the program. These changes were sustained at six months post-completion. No significant changes over time were found for secondary trauma or perceived stress.ConclusionsTo our knowledge, this study is the first to employ Mindfulness for Healthcare Providers in an EMS population and to demonstrate a positive impact on self-reported compassion, trait mindfulness, and burnout in this population. Additional research regarding mindfulness training within EMS populations should be conducted to further understand the relationship between mindfulness and perceived stress over time.     

Corrective Experiences of Psychotherapists in Training

Although the concept of corrective experiences (CEs) is usually linked to the process of change in psychotherapy patients, we investigated them in the professional development of therapists‐in‐training. Inasmuch as psychotherapy is a relational process, it is important to look closely at how therapists reach the position of a competent partner in corrective experiencing. In this study, we interviewed 10 therapists‐in‐training undergoing their own training therapy. Responses to these semistructured interviews were analyzed using a computer‐assisted grounded theory method. The 499 first‐level categories were grouped into 5 main themes: therapist characteristics, therapist technical interventions, therapist relational interventions, relationship experience, and outcome experience. Two core categories representing corrective experiencing were (a) unexpected unconditional support from and trust in their own therapist and (b) unexpected confrontation and limitation with their therapist as well as awareness of self–other boundaries. Results are discussed in the broader context of the CE literature, relational theory, and relational practice.     

'I can actually exercise if I want to; it isn't as hard as I thought': a qualitative study of the experiences and views of obese adolescents participating in an exercise therapy intervention

A qualitative study nested within a randomized controlled trial explored obese adolescents' experiences of participation in an exercise therapy intervention. Semi-structured interviews were conducted with participants assigned to exercise therapy. Participants' reported feeling more energetic during and after exercise, than before. Many participants reported feeling happy/happier and expressed feeling better about themselves as individuals after the intervention. Most participants felt more confident in their ability to exercise regularly. Greater emphasis needs to be placed upon educating obese adolescents about the wide range of health benefits that exercise can provide, and that weight loss, while important, is only one such benefit.     

Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being

BACKGROUND: Mindfulness-based stress reduction (MBSR) proposes a systematic program for reduction of suffering associated with a wide range of medical conditions. Studies suggest improvements in general aspects of well-being, including quality of life (QoL), coping and positive affect, as well as decreased anxiety and depression. METHODS: A quasi-experimental study examined effects of an 8-week MBSR intervention among 58 female patients with fibromyalgia (mean, 52 +/- 8 years) who underwent MBSR or an active social support procedure. Participants were assigned to groups by date of entry, and 6 subjects dropped out during the study. Self-report measures were validated German inventories and included the following scales: visual analog pain, pain perception, coping with pain, a symptom checklist and QoL. Pre- and postintervention measurements were made. Additionally, a 3-year follow-up was carried out on a subgroup of 26 participants. RESULTS: Pre- to postintervention analyses indicated MBSR to provide significantly greater benefits than the control intervention on most dimensions, including visual analog pain, QoL subscales, coping with pain, anxiety, depression and somatic complaints (Cohen d effect size, 0.40-1.10). Three-year follow-up analyses of MBSR participants indicated sustained benefits for these same measures (effect size, 0.50-0.65). CONCLUSIONS: Based upon a quasi-randomized trial and long-term observational follow-up, results indicate mindfulness intervention to be of potential long-term benefit for female fibromyalgia patients.     

Young women's accounts of intimate partner violence during adolescence and subsequent recovery processes: An interpretative phenomenological analysis

Objective. Previous qualitative research into the experience of intimate partner violence (IPV) has largely focused upon mature women's accounts. The objectives of this interpretative phenomenological analysis (IPA) were to explore three young women's understandings of why they had been vulnerable to IPV in mid-to-late adolescence, their experiences of IPV, and their recovery processes. Design. This study followed guidelines for IPA, largely focusing upon shared aspects of the experience of IPV as narrated by three young women who considered that they had since recovered from the experience. Method. Semi-structured interviews explored participants' retrospective understandings of how they had become entrapped in a long-term abusive relationship in adolescence, how IPV had affected them at the time, and the processes that they had found helpful to recover well-being. Findings. Participants largely attributed their vulnerability to IPV to feeling confused about feelings and relationships, disconnected, and powerless in early adolescence. IPV was described as escalating insidiously, rendering participants confined, anxious and powerless, ensnaring them in their partner's family, marginalized in their own families, and undermining their identities. Recovery processes began with pivotal moments. Participants described repairing identity through engaging in age-appropriate activities, extricating self from the partner's family, and rebuilding family relationships. Conclusions. Participants described experiences of IPV and recovery in adolescence that differed in some ways from those previously identified in adult women and were interpreted using theories of adolescent identity development and attachment.     

Preliminary Evidence of a Missing Self Bias in Face Perception for Individuals with Dissociative Identity Disorder

Failing to recognize one’s mirror image can signal an abnormality in one’s sense of self. In dissociative identity disorder (DID), individuals often report that their mirror image can feel unfamiliar or distorted. They also experience some of their own thoughts, emotions, and bodily sensations as if they are nonautobiographical and sometimes as if instead, they belong to someone else. To assess these experiences, we designed a novel backwards masking paradigm in which participants were covertly shown their own face, masked by a stranger’s face. Participants rated feelings of familiarity associated with the strangers’ faces. 21 control participants without trauma-generated dissociation rated masks, which were covertly preceded by their own face, as more familiar compared to masks preceded by a stranger’s face. In contrast, across two samples, 28 individuals with DID and similar clinical presentations (DSM-IV Dissociative Disorder Not Otherwise Specified type 1) did not show increased familiarity ratings to their own masked face. However, their familiarity ratings interacted with self-reported identity state integration. Individuals with higher levels of identity state integration had response patterns similar to control participants. These data provide empirical evidence of aberrant self-referential processing in DID/DDNOS and suggest this is restored with identity state integration.