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 people living with HIV/AIDS: preliminary review of intervention trial methodologies and findings

In the context of successful antiretroviral therapy (ART) for the management of HIV infection, the harmful effects of stress remain a significant threat. Stress may increase viral replication, suppress immune response, and impede adherence to ART. Stressful living conditions of poverty, facing a chronic life-threatening illness and stigma all exacerbate chronic stress in HIV-affected populations. Stress-reduction interventions are urgently needed for the comprehensive care of people living with HIV. Mindfulness-based stress reduction (MBSR) is one approach that has shown promise as an intervention for patients facing other medical conditions for reducing disease progression, psychological distress and maladaptive behaviours. In this systematic review, we identified 11 studies that have examined MBSR as an intervention for HIV-positive populations. Of the studies, six were randomised designs, one was a quasi-experimental design, and the remaining four were pre- and post-test designs. The preliminary outcomes support MBSR to decrease emotional distress with mixed evidence for impact on disease progression. Effect sizes were generally small to moderate in magnitude. The early findings from this emerging literature must be considered preliminary and support moving forward with more rigorous controlled trials, evaluated with objective assessments in longer-term follow-ups to determine the efficacy of MBSR for people living with HIV.     

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-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.     

正念训练提升自愿者幸福感的6周随机对照试验

目的:探索正念训练提升普通个体主观幸福感的效果.方法:采用随机对照设计,将招募的72名被试分至正念训练组或对照组(每组36人),训练组进入每周1次,共6次的正念训练,对照组等待6周,直到训练组结束训练后1周进入训练.在训练前、后采用五因素正念度量表(FFMQ)、幸福感指数(IWB)量表和情感平衡量表(ABS)进行网络心理测评,用后测减前测的差值来评估干预效果.结果:训练组有效样本17人,对照组有效样本21人.6周正念训练后,训练组FFMQ[(15.1±9.9) vs.(-0.3±6.8),P＜0.001]、IWB差值[(0.9±1.6)vs.(-0.3±2.6),P=0.050]均高于对照组,而负性情感的差值低于对照组[(-0.4±1.4)vs.(0.5±1.6),P=0.041].结论:本研究提示,正念训练能有效提升参与者的主观幸福感.     

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, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients

OBJECTIVE: The objective of this study was to assess the effects of participation in a mindfulness meditation-based stress reduction program on mood disturbance and symptoms of stress in cancer outpatients. METHODS: A randomized, wait-list controlled design was used. A convenience sample of eligible cancer patients enrolled after giving informed consent and were randomly assigned to either an immediate treatment condition or a wait-list control condition. Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention. The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice. RESULTS: Ninety patients (mean age, 51 years) completed the study. The group was heterogeneous in type and stage of cancer. Patients' mean preintervention scores on dependent measures were equivalent between groups. After the intervention, patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression, Anxiety, Anger, and Confusion and more Vigor than control subjects. The treatment group also had fewer overall Symptoms of Stress; fewer Cardiopulmonary and Gastrointestinal symptoms; less Emotional Irritability, Depression, and Cognitive Disorganization; and fewer Habitual Patterns of stress. Overall reduction in Total Mood Disturbance was 65%, with a 31% reduction in Symptoms of Stress. CONCLUSIONS: This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses, stages of illness, and ages. cancer, stress, mood, intervention, mindfulness.     

Engaging women with an embodied conversational agent to deliver mindfulness and lifestyle recommendations: A feasibility randomized control trial

ObjectiveThis randomized controlled trial evaluates the feasibility of using an Embodied Conversational Agent (ECA) to teach lifestyle modifications to urban women.MethodsWomen were randomized to either 1) an ECA (content included: mindfulness, stress management, physical activity, and healthy eating) or 2) patient education sheets mirroring same content plus a meditation CD/MP3 once a day for one month. General outcome measures included: number of stress management techniques used, physical activity levels, and eating patterns.ResultsSixty-one women ages 18 to 50 were enrolled. On average, 51% identified as white, 26% as black, 23% as other races; and 20% as Hispanic. The major stress management techniques reported at baseline were: exercise (69%), listening to music (70%), and social support (66%). After one month, women randomized to the ECA significantly decreased alcohol consumption to reduce stress (p = 0.03) and increased daily fruit consumption by an average of 2 servings compared to the control (p = 0.04).ConclusionIt is feasible to use an ECA to promote health behaviors on stress management and healthy eating among diverse urban women.Practice implicationsCompared to patient information sheets, ECAs provide promise as a way to teach healthy lifestyle behaviors to diverse urban women.     

Effective and viable mind-body stress reduction in the workplace: a randomized controlled trial

Highly stressed employees are subject to greater health risks, increased cost, and productivity losses than those with normal stress levels. To address this issue in an evidence-based manner, worksite stress management programs must be able to engage individuals as well as capture data on stress, health indices, work productivity, and health care costs. In this randomized controlled pilot, our primary objective was to evaluate the viability and proof of concept for two mind-body workplace stress reduction programs (one therapeutic yoga-based and the other mindfulness-based), in order to set the stage for larger cost-effectiveness trials. A second objective was to evaluate 2 delivery venues of the mindfulness-based intervention (online vs. in-person). Intention-to-treat principles and 2 (pre and post) × 3 (group) repeated-measures analysis of covariance procedures examined group differences over time on perceived stress and secondary measures to clarify which variables to include in future studies: sleep quality, mood, pain levels, work productivity, mindfulness, blood pressure, breathing rate, and heart rate variability (a measure of autonomic balance). Two hundred and thirty-nine employee volunteers were randomized into a therapeutic yoga worksite stress reduction program, 1 of 2 mindfulness-based programs, or a control group that participated only in assessment. Compared with the control group, the mind-body interventions showed significantly greater improvements on perceived stress, sleep quality, and the heart rhythm coherence ratio of heart rate variability. The two delivery venues for the mindfulness program produced basically equivalent results. Both the mindfulness-based and therapeutic yoga programs may provide viable and effective interventions to target high stress levels, sleep quality, and autonomic balance in employees.     

Social support moderates the effects of stress on sleep in adolescents

Academic expectations and demands become primary sources of stress during adolescence, negatively affecting sleep. To cope with stress, adolescents may turn to social support figures. The present study tested the extent of main and moderating effects of various sources of social support on the association between stress and sleep. Adolescents (n = 202, mean_age 14.6 years, standard deviation = 0.71) reported on academic stress, sleep, and support using questionnaires during a low‐ and high‐stress period, defined by the absence or presence of examinations, respectively. Inquiries were made regarding social support from parents, friends, and class supervisor. During both stress periods, academic stress was associated negatively with sleep quality and positively with sleep reduction. Social support increased sleep quality and lowered sleep reduction. In addition, social support moderated the effects of academic stress on sleep, thus improving sleep quality and lowering sleep reduction. Moderating effects were stronger during a period of high stress. The present study showed that adolescents can benefit from stress moderation through social support by improvements of sleep quality and sleep reduction. Such moderating effects should be taken into account when studying stress and sleep. Implications and recommendations based on these findings are discussed.     

Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial

BACKGROUND: Depression is a highly prevalent, often recurring or persistent disorder. The majority of patients are initially seen and treated in primary care. Effective treatments are available, but possibilities for providing adequate follow-up care are often limited in this setting. This study assesses the effectiveness of primary-care-based enhanced treatment modalities on short-term patient outcomes. METHOD: In a randomized controlled trial we evaluated a psycho-educational self-management intervention. We included 267 adult patients meeting criteria for a DSM-IV diagnosis of major depressive disorder, assessed by a structured psychiatric interview. Patients were randomly assigned to: the Depression Recurrence Prevention (DRP) program (n=112); a combination of the DRP program with psychiatric consultation (PC+DRP, n=39); a combination with brief cognitive behavior therapy (CBT+DRP, n=44); and care as usual (CAU, n=72). Follow-up assessments were made at 3 months (response 90%) and 6 months (85%). RESULTS: Patient acceptance of enhanced care was good. The mean duration of the index episode was 11 weeks (S.D.=9.78) and similar in CAU and enhanced care. Recovery rate after 6 months was 67% overall; 17% of all participants remained depressed for the entire 6-month period. CONCLUSION: Enhanced care did not result in better short-term outcomes. We found no evidence that the DRP program was more effective than CAU and no indications for added beneficial effects of either the psychiatric evaluation or the CBT treatment to the basic format of the DRP program. Observed depression treatment rates in CAU were high.     

A randomized controlled trial of mindfulness-based cognitive therapy for treating tinnitus

We conducted a randomized clinical trial to examine the relative effectiveness of two psychological interventions for treating tinnitus. People with tinnitus were initially offered a single session of psychoeducation about tinnitus, followed 2 months later by six weekly sessions of either mindfulness or relaxation training. Results indicated benefits from psychoeducation in reducing negative emotions, rumination and psychological difficulties of living with tinnitus. These effects were maintained or enhanced by mindfulness training that also emphasized acceptance, although they were eroded in the relaxation condition over the follow-up. Mediating processes are discussed, and suggestions for refining clinical interventions for this population are offered. KEY PRACTITIONER MESSAGE: The present results suggest that mindfulness training might constitute a useful addition to psychoeducation for interventions targeting the psychological consequences of tinnitus.     

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.     

Internet‐based treatment for social phobia: a randomized controlled trial

In this study conducted in the French‐speaking part of Switzerland, 52 individuals with social phobia were randomly assigned either to an Internet‐based cognitive–behavioral treatment with minimal contact with therapists via e‐mail or to a waiting‐list control group. Significant differences between the two groups were found at posttreatment on all primary outcome measures (social anxiety measures) and on two of the secondary outcome measures (general symptomatology, therapy goal attainment). On average, within‐groups effect sizes were large for the primary outcomes (Cohen's d=0.82) and for secondary outcomes (Cohen's d=1.04). Moreover, subjects in the treatment group fulfilled the criteria of clinically significant improvement significantly more often than subjects in the control group on all measured dimensions (58% vs. 20%). Users' acceptance of the program was high. The results from the present study lend further support to the hypothesis that Internet‐delivered interventions with minimal therapist contact are a promising treatment approach to social phobia. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65:1–15, 2009.