A Randomized Study of the Effects of Mindfulness Training on Psychological Well-being and Symptoms of Stress in Patients Treated for Cancer at 6-month Follow-up

Background

There is increasing evidence showing beneficial effects of mindfulness and mindfulness training on various indicators of mental and physical health.

Purpose

This paper reports the 6-month follow-up effects of a mindfulness stress reduction training program among patients treated for cancer on perceived stress, depression, anxiety, post-traumatic stress symptoms, positive states of mind, coping self-efficacy, and mindfulness.

Methods

Patients with a previous cancer diagnosis were recruited and randomized into an intervention group or a waiting list control group. The intervention consisted of an 8-week mindfulness training course.

Results

Compared to participants in the control group, the intervention group showed a larger increase in mindfulness at 6-month follow-up. However, there were no differences on any of the other outcomes between the intervention and control groups. Continued meditation practice was associated with a significant reduction in post-traumatic stress symptoms of avoidance.

Conclusions

The study draws attention to the need to better understand the mechanisms behind the effect of mindfulness training and to potential modification of mindfulness interventions to promote sustained benefits over time.     

正念注意觉知量表(MAAS)的修订及信效度检验

目的:修订正念注意觉知量表(Mindful Attention Awareness Scale,MAAS)中文版,考察其在中国大学生样本中的信度和效度。方法:在华北、西北、东南、东北等地区4所高校收集有效数据718份,并在两周后对其中的125人进行重测。结果:探索性因素分析表明,抽取1个因素最为合适,特征根为6.39,累积方差贡献率为45.46%。验证性因素分析显示,单因素模型具有良好的结构效度,TLI=0.904,IFI=0.918,CFI=0.917,RMR=0.067,RMSEA=0.077;Cron-bach’sα系数为0.890,重测信度为0.870;正念注意觉知与焦虑特质负相关、与抑郁情绪负相关、与自尊水平正相关;MAAS得分没有性别差异,有过冥想经验的和没有冥想经验的在MAAS得分上无显著差异。结论:中文版MAAS具有良好的心理测量学指标,适宜在中国大陆使用。     

The mindful attention and awareness scale is associated with lower levels of high-frequency heart rate variability in a laboratory context

Trait mindfulness has been associated with well-being. A key component of trait mindfulness is intentional attention and awareness which is most commonly measured by the Mindful Attention and Awareness Scale (MAAS). This study investigated the relationship between the MAAS and cardiovascular (HF-HRV, heart rate) reactivity to two laboratory stressors that evoked different patterns of change in heart rate (HR). One stressor (viewing a video of a surgery) evoked HR deceleration while the other stressor (mental arithmetic) evoked HR acceleration. Undergraduate students completed the MAAS and were then exposed to the two stressors while ECG (electrocardiography) was recorded. Findings support the reliability of the stressors to induce expected differential cardiovascular responses and explicate the role of parasympathetic activation. Further, a main effect for MAAS was observed indicating that across laboratory conditions, persons scoring higher on the MAAS had lower HF-HRV relative to persons scoring lower on the MAAS. These findings suggest that higher levels of intentional attention and awareness in a laboratory context might promote parasympathetic withdrawal because these participants were more vigilant, experienced higher cognitive load, and detected more threat cues. Implications for the MAAS and cardiovascular responses to stress are discussed.     

Mindfulness‐based approaches: are they all the same?

Mindfulness-based approaches are increasingly employed as interventions for treating a variety of psychological, psychiatric and physical problems. Such approaches include ancient Buddhist mindfulness meditations such as Vipassana and Zen meditations, modern group-based standardized meditations, such as mindfulness-based stress reduction and mindfulness-based cognitive therapy, and further psychological interventions, such as dialectical behavioral therapy and acceptance and commitment therapy. We review commonalities and differences of these interventions regarding philosophical background, main techniques, aims, outcomes, neurobiology and psychological mechanisms. In sum, the currently applied mindfulness-based interventions show large differences in the way mindfulness is conceptualized and practiced. The decision to consider such practices as unitary or as distinct phenomena will probably influence the direction of future research.     

Positive prenatal well-being: conceptualising and measuring mindfulness and gratitude in pregnancy

Little research has examined the usefulness of positive well-being factors during pregnancy. Recent mindfulness research demonstrates that inconsistencies and the suitability of extant measures have yet to be examined in pregnancy. Effects of gratitude during pregnancy have yet to be examined despite consistently reported benefits in non-pregnant groups. The aims of this paper were to develop the Gratitude during Pregnancy (GDP) scale, validate the Mindfulness Awareness Attention Scale (MAAS) and examine the importance of gratitude and mindfulness during pregnancy. In study 1, 375 pregnant women completed gratitude and mindfulness measures. The one-factor structure of the MAAS was retained and demonstrated good reliability α?=?0.88. Using exploratory factor analysis, an 18-item GDP scale was developed, demonstrating good reliability α?=?0.89. The four GDP factors are as follows: general gratitude, physical changes, antenatal care and social support. In study 2, 87 pregnant women completed well-being questionnaires, including the GDP and MAAS. Gratitude correlated with positive affect, life satisfaction and pregnancy uplifts (p?<?.001); mindfulness correlated negatively with negative affect and pregnancy hassles (p?<?.001) and positively correlated with positive affect and pregnancy uplifts (p?<?.05). These findings highlight the importance of mindfulness and gratitude and provide a reliable means to measure both constructs during pregnancy.     

Enhancing Web-Based Mindfulness Training for Mental Health Promotion With the Health Action Process Approach: Randomized Controlled Trial

Background

With increasing evidence demonstrating the effectiveness of Web-based interventions and mindfulness-based training in improving health, delivering mindfulness training online is an attractive proposition.

Objective

The aim of this study was to evaluate the efficacy of two Internet-based interventions (basic mindfulness and Health Action Process Approach enhanced mindfulness) with waitlist control. Health Action Process Approach (HAPA) principles were used to enhance participants’ efficacy and planning.

Methods

Participants were recruited online and offline among local universities; 321 university students and staff were randomly assigned to three conditions. The basic and HAPA-enhanced groups completed the 8-week fully automated mindfulness training online. All participants (including control) were asked to complete an online questionnaire pre-program, post-program, and at 3-month follow-up.

Results

Significant group by time interaction effect was found. The HAPA-enhanced group showed significantly higher levels of mindfulness from pre-intervention to post-intervention, and such improvement was sustained at follow-up. Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre-intervention to post-intervention, and improvement was sustained at 3-month follow-up.

Conclusions

Online mindfulness training can improve mental health. An online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12002954; http://www.chictr.org/en/proj/show.aspx?proj=3904 (Archived by WebCite at http://www.webcitation.org/6VCdG09pA).     

A self-help, positive goal-focused intervention to increase well-being in people with depression

Self-help interventions are an accessible, first-step treatment for depression. Well-being interventions focus on increasing people's resources and bringing about positive feelings and behaviours and could enhance self-help interventions for depression by increasing well-being as well as reducing depression. The present study tested the effectiveness of a self-help, well-being intervention (Goal-setting and Planning, GAP) in both increasing well-being and reducing depression within a sample from a depression self-help organization. We used a cross-over design, with half of the participants allocated to GAP (n = 26) and half to a wait-list control group (n = 29). After 5 weeks, the wait-list control group also received GAP. Compared with wait-list controls, those allocated to GAP showed an overall positive change, with individual significant decreases in negative affect and trends towards significant decreases in depression and increases in positive affect and life satisfaction post-intervention. Within a cross-over design, the wait-list controls also received GAP. In the whole sample that received GAP, there were significant increases in positive affect and life satisfaction and significant decreases in negative affect and depression, post-intervention and at 5-week follow-up, relative to baseline. These findings demonstrate that GAP is a useful intervention for people with symptoms of depression, influencing both levels of well-being and depressive symptoms.     

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.     

The effect of hyperandrogenism and obesity on mindfulness and metacognition in adolescents with polycystic ovary syndrome

The aim of this study was to determine whether serum androgen levels have an effect on mindfulness and metacognition in adolescents with polycystic ovary syndrome (PCOS). Adolescents diagnosed with PCOS were asked to answer a questionnaire that included socio-demographic information and two scales: the Mindful Attention Awareness Scale (MAAS) and the Metacognition Scale Child and Adolescent form (MCQ-C). The patients were divided into two groups, the hyperandrogenism group and the non-hyperandrogenism group, according to serum androgen levels. The scores of MAAS and MCQ-C were compared between the groups. The study sample consisted of 70 adolescents. Of these, 44 had hyperandrogenism according to a blood test. No statistically significant difference was found in MAAS scores between the hyperandrogenism and the non-hyperandrogenism groups (p = 0.79). However, the level of mindfulness was found to be lower in participants with a higher modified Ferriman-Gallwey score (mFGS) (r = 0.26, p = 0.02). Mindfulness levels were also lower for obese patients with PCOS compared to non-obese patients with PCOS (p = 0.02). Cognitive monitoring (MCQ-C-CM), one of the MCQ-C sub-scales, was significantly higher in the non-hyperandrogenism group (p = 0.03), and similarly, a positive correlation was detected between higher androgen levels and the positive meta-worry (MCQ-C-PM) sub-scale of the MCQ-C (for total testosterone; r = 0.348, p = 0.03, and for androstenedione; r = 0.35, p = 0.03). High serum androgen levels in PCOS had no effect on mindfulness, but as the modified Ferriman Gallwey score increased, mindfulness levels decreased. For the sub-scales of MCQ-C,MCQ-C-CM, and MCQ-C-PM, the scores increased as androgen levels increased. In line with the results of the present study, evaluating mindfulness in PCOS patients with increased hair growth and metacognition in PCOS patients with serum hyperandrogenism may contribute well-being in adulthood by reducing the psychological burden caused by the disease.

     

An Exploratory Study of a Meditation-based Intervention for Binge Eating Disorder

The efficacy of a 6-week meditation-based group intervention for Binge Eating Disorder (BED) was evaluated in 18 obese women, using standard and eating-specific mindfulness meditation exercises. A single-group extended baseline design assessed all variables at 3 weeks pre-and post-, and at 1, 3, and 6 weeks; briefer assessment occurred weekly.Binges decreased in frequency, from 4.02/week to 1.57/week (p < .001), and in severity. Scores on the Binge Eating Scale (BES) and on the Beck Depression and Anxiety Inventories decreased significantly; sense of control increased. Time using eatingrelated meditations predicted decreases on the BES (r 5 .66, p < .01). Results suggest that meditation training may be an effective component in treating BED.     

初一学生正念与主观幸福感:自尊的中介作用

目的考察自尊在初中一年级学生的正念水平与主观幸福感之间的中介作用。方法采用五因素正念量表(FFMQ)、幸福感指数量表(IWB)和自尊量表(SES)对409名北京市初一年级学生进行调查。结果 1皮尔逊积差相关分析显示,正念水平与主观幸福感呈显著正相关(r=0.308)、与自尊呈显著正相关(r=0.496)、自尊与主观幸福感呈显著正相关(r=0.500);2多元线性回归分析对中介作用的检验表明,自尊在正念水平与主观幸福感之间起完全中介作用。结论初一年级学生的正念与主观幸福感之间的相关关系是通过自尊来中介的。     

Effects of Mindfulness-Based Stress Reduction on Medical and Premedical Students

The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level. The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design. Findings indicate that participation in the intervention can effectively (1) reduce self-reported state and trait anxiety, (2) reduce reports of overall psychological distress including depression, (3) increase scores on overall empathy levels, and (4) increase scores on a measure of spiritual experiences assessed at termination of intervention. These results (5) replicated in the wait-list control group, (6) held across different experiments, and (7) were observed during the exam period. Future research should address potential long-term effects of mindfulness training for medical and premedical students.     

大学生童年期虐待与特质抑郁和正念的关系

目的:探讨大学生童年期虐待、特质抑郁和正念之间的关系。方法:选取大学生415名,采用童年期创伤问卷(CTQ)、状态-特质抑郁量表中特质抑郁分量表(T-DEP)和正念注意知觉量表(MAAS),分别测量大学生童年期虐待、特质抑郁和正念。结果:童年期虐待得分与特质抑郁得分呈正相关(r=0.4,P<0.01),与正念得分呈负相关(r=-0.37,P<0.01);正念在童年期虐待与特质抑郁得分关系中的调节作用有统计学意义(β_高=0.60、β_低=0.33,均P<0.001),与特质抑郁中快感缺失维度得分关系中的调节作用有统计学意义(β_高=0.75、β_低=0.31,均P<0.001)。结论:有童年期虐待经历的大学生表现出更高水平的特质抑郁,其特质抑郁受到正念的调节。     

Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial

Objectives

This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies.

Design

A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL).

Methods

N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes.

Results

CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44–.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects.

Conclusions

In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors’ emotional functioning and general well-being.     

Sustained resiliency building and burnout reduction for healthcare professionals via organizational sponsored mindfulness programming

PurposeTo measure healthcare professional (HCP) result sustainability following implementation of an organizationally sponsored Mindfulness Based Intervention (MBI), Mindfulness in Motion (MIM), in areas of burnout, perceived stress, resilience, and work engagement.MethodsA follow-up survey was sent via email to healthcare professionals (n = 220) who previously participated in the 8-week MIM intervention. Survey assessed burnout, perceived stress, resilience, work engagement, and included open-ended questions pertaining to barriers, facilitators, and sustained impact of practicing mindfulness after program end.ResultsAnalysis included 66 healthcare professionals with sustainability time frames ranging from 3 to 28 months from initial program finish. Average time since intervention end was 12.2 months. Based on 12.2 months sustained results post MIM, there were significant differences from pre-MIM to sustainability follow-up in burnout (*p = 0.0047), perceived stress (*p = 0.00001), and resilience (*p = 0.0004). Work engagement benefits were non-significant from pre-test to follow-up (p = 0.4008). There were no significant differences in results when comparing the length of time since participant was enrolled in the initial study. Additionally, analysis of the qualitative data revealed multiple subthemes relating to facilitators of sustained mindfulness, barriers to practicing mindfulness, and lasting impacts of the MIM intervention.ConclusionsFor Healthcare Professionals, the organizationally sponsored mindfulness intervention outcomes were sustained beyond the 8-weeks of the initial MIM intervention for all but one outcome variable. Post 8–week intervention end, participants were given the option of receiving weekly “Mindful Moment” emails and attending monthly mindfulness booster sessions. Organizational support may be a pivotal factor in sustaining positive results achieved via mindfulness programming.     

A randomized controlled trial of mindfulness-based stress reduction to manage affective symptoms and improve quality of life in gay men living with HIV

To determine whether MBSR groups would help gay men living with HIV improve psychosocial functioning and increase mindfulness compared to treatment-as-usual (TAU). Methods: 117 participants were randomized 2:1 to MBSR or TAU. No new psychosocial or psychopharmacological interventions were initiated within 2 months of baseline. Standardized questionnaires were administered pre-, postintervention and at 6 months. An intent-to-treat analysis found significant benefits of MBSR: at post-intervention and 6 months follow up, MBSR participants had significantly lower avoidance in IES and higher positive affect compared to controls. MBSR participants developed more mindfulness as measured by the Toronto Mindfulness Scale (TMS) including both TMS subscales, curiosity and decentering, at 8-week and 6 months. For the sample as a whole, increase in mindfulness was significantly correlated with reduction in avoidance, higher positive affect and improvement in depression at 6 months. MBSR has specific and clinically meaningful effects in this population.     

Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.     

Relationships between mindfulness practice and levels of mindfulness,medical and psychological symptoms and well-being in a mindfulness-based stress reduction program

Relationships were investigated between home practice of mindfulness meditation exercises and levels of mindfulness, medical and psychological symptoms, perceived stress, and psychological well-being in a sample of 174 adults in a clinical Mindfulness-Based Stress Reduction (MBSR) program. This is an 8- session group program for individuals dealing with stress-related problems, illness, anxiety, and chronic pain. Participants completed measures of mindfulness, perceived stress, symptoms, and well-being at pre- and post-MBSR, and monitored their home practice time throughout the intervention. Results showed increases in mindfulness and well-being, and decreases in stress and symptoms, from pre- to post-MBSR. Time spent engaging in home practice of formal meditation exercises (body scan, yoga, sitting meditation) was significantly related to extent of improvement in most facets of mindfulness and several measures of symptoms and well-being. Increases in mindfulness were found to mediate the relationships between formal mindfulness practice and improvements in psychological functioning, suggesting that the practice of mindfulness meditation leads to increases in mindfulness, which in turn leads to symptom reduction and improved well-being.     

A Randomized Pilot Study of a Phone-Based Mindfulness and Weight Loss Program

ABSTRACT

This study evaluated the feasibility and efficacy of integrating mindfulness training into a phone-based weight loss program to improve outcomes in those with high levels of emotional eating. Participants were 75 enrollees into an employer-sponsored weight loss program who reported high levels of overeating in response to thoughts and feelings. Seventy-five overweight and obese participants (92% female, 65% Caucasian, aged 26 to 68 years) were randomized to the new mindfulness weight loss program (n = 50) or the standard behavioral weight loss program (n = 25). Both programs consisted of 11 coaching calls with health coaches and registered dietitians with supplemental online materials. Satisfaction, engagement, and percent weight lost did not significantly differ for intervention vs. control at six months. Intervention participants had significantly better scores at six-month follow-up on mindful eating, binge eating, experiential avoidance, and one mindfulness subscale. Exploratory analyses showed that improvements on several measures predicted more weight loss in the intervention group. This pilot study found that integrating mindfulness into a brief phone-based behavioral weight loss program was feasible and acceptable to participants, but did not produce greater weight loss on average, despite hypothesized changes in mindful eating. Only one third of intervention participants reported participating in mindfulness exercises regularly. Mechanisms of change observed within the intervention group suggest that for adults with high levels of emotional eating those who embrace mindful eating and meditation may lose more weight with a mindfulness intervention.     

Impact of mindfulness-based cognitive therapy on counseling self-efficacy: A randomized controlled crossover trial

ObjectiveTo investigate the impact of a structured eight-week mindfulness-based cognitive therapy (MBCT) program on counseling self-efficacy among counseling trainees.MethodsUndergraduate counseling trainees were randomized to an MBCT group (n = 25) or a waitlist control group (n = 25) with a crossover trial design. Psychological measurements regarding mindfulness, empathy, self-compassion, psychological distress, counseling self-efficacy as well as neuro-physiological measures including frontal midline theta activity, respiration rate, and skin conductance were taken at baseline (T1), after intervention (T2), and six-month follow-up (T3).ResultsMindfulness training could make significant positive changes in empathy, self-compassion, stress reduction, and counseling self-efficacy with this being backed up by both psychological and neuro-physiological evidence at T2. However, such differences between the two groups had greatly subsided after crossover in which carry-over effect and marked improvement were noted in the study and control group, respectively, at T3. In addition, mindfulness was the most significant determinant that contributed to counseling self-efficacy, followed by psychological distress reduction and self-compassion according to the regression models.ConclusionIntegrating mindfulness into counseling training is beneficial for helping profession trainees.Practice implicationIncorporating mindfulness into counseling training can enhance the necessary “being mode” qualities in counseling and address self-care issues during training.