Patients in the placebo arms of randomized controlled trials (RCT) often experience positive changes from baseline. While multiple theories concerning such “placebo effects” exist, peculiarly, none has been informed by actual interviews of patients undergoing placebo treatment. Here, we report on a qualitative study (n = 27) embedded within a RCT (n = 262) in patients with irritable bowel syndrome. Besides identical placebo acupuncture treatment in the RCT, the qualitative study patients also received an additional set of interviews at the beginning, midpoint, and end of the trial. Interviews of the 12 qualitative subjects who underwent and completed placebo treatment were transcribed. We found that patients (1) were persistently concerned with whether they were receiving placebo or genuine treatment; (2) almost never endorsed “expectation” of improvement but spoke of “hope” instead and frequently reported despair; (3) almost all reported improvement ranging from dramatic psychosocial changes to unambiguous, progressive symptom improvement to tentative impressions of benefit; and (4) often worried whether their improvement was due to normal fluctuations or placebo effects. The placebo treatment was a problematic perturbation that provided an opportunity to reconstruct the experiences of the fluctuations of their illness and how it disrupted their everyday life. Immersion in this RCT was a co-mingling of enactment, embodiment and interpretation involving ritual performance and evocative symbols, shifts in bodily sensations, symptoms, mood, daily life behaviors, and social interactions, all accompanied by self-scrutiny and re-appraisal. The placebo effect involved a spectrum of factors and any single theory of placebo—e.g. expectancy, hope, conditioning, anxiety reduction, report bias, symbolic work, narrative and embodiment—provides an inadequate model to explain its salubrious benefits.
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BACKGROUND: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.AIMS: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.
METHODS: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.
RESULTS: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.
CONCLUSIONS: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.
BACKGROUND: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.AIMS: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.
METHODS: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.
RESULTS: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.
CONCLUSIONS: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.
BACKGROUND: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.AIMS: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.
METHODS: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.
RESULTS: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.
CONCLUSIONS: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.
The effects of randomization to mindfulness training (MT) or to a waitlist-control condition on psychological and physiological indicators of teachers’ occupational stress and burnout were examined in 2 field trials. The sample included 113 elementary and secondary school teachers (89% female) from Canada and the United States. Measures were collected at baseline, post-program, and 3-month follow-up; teachers were randomly assigned to condition after baseline assessment. Results showed that 87% of teachers completed the program and found it beneficial. Teachers randomized to MT showed greater mindfulness, focused attention and working memory capacity, and occupational self-compassion, as well as lower levels of occupational stress and burnout at post-program and follow-up, than did those in the control condition. No statistically significant differences due to MT were found for physiological measures of stress. Mediational analyses showed that group differences in mindfulness and self-compassion at post-program mediated reductions in stress and burnout as well as symptoms of anxiety and depression at follow-up. Implications for teaching and learning are discussed.
The effects of randomization to mindfulness training (MT) or to a waitlist-control condition on psychological and physiological indicators of teachers’ occupational stress and burnout were examined in 2 field trials. The sample included 113 elementary and secondary school teachers (89% female) from Canada and the United States. Measures were collected at baseline, post-program, and 3-month follow-up; teachers were randomly assigned to condition after baseline assessment. Results showed that 87% of teachers completed the program and found it beneficial. Teachers randomized to MT showed greater mindfulness, focused attention and working memory capacity, and occupational self-compassion, as well as lower levels of occupational stress and burnout at post-program and follow-up, than did those in the control condition. No statistically significant differences due to MT were found for physiological measures of stress. Mediational analyses showed that group differences in mindfulness and self-compassion at post-program mediated reductions in stress and burnout as well as symptoms of anxiety and depression at follow-up. Implications for teaching and learning are discussed.
The symptoms of borderline personality disorder (BPD) have been characterized as deficits in mindfulness. Mindfulness can be defined as nonjudgmental, present-centered awareness. The present study investigates the theory that, consistent with this conceptualization, the extent to which acting with awareness predicts reduced BPD features and related dysfunction depends upon levels of nonjudgment. In a sample of 223 undergraduates, we calculated the interaction between awareness-based and nonjudging-based mindfulness skills using subscales of the Five Facet Mindfulness Questionnaire. Regression analyses demonstrated a significant effect of the interaction on several difficulties that are common in BPD: problems with relationships, emotion-related impulsivity, and anger rumination. For acting with awareness to benefit individuals with these difficulties, a less judgmental stance toward internal experiences may be necessary. These findings have significant treatment implications and demonstrate the importance of assessing mindfulness as a multifaceted, synergistic construct.
Transdiagnostic internet-delivered cognitive behavioural therapies (iCBT) are effective for treating anxiety and depression, but there is room for improvement. In this study we developed a new Mindfulness-Enhanced iCBT intervention by incorporating formal and informal mindfulness exercises within an existing transdiagnostic iCBT program for mixed depression and anxiety. We examined the acceptability, feasibility, and outcomes of this new program in a sample of 22 adults with anxiety disorders and/or major depression. Participants took part in the 7-lesson clinician-guided online intervention over 14 weeks, and completed measures of distress (K-10), anxiety (GAD-7), depression (PHQ-9), mindfulness (FFMQ) and well-being (WEMBWS) at pre-, mid-, post-treatment, and three months post-treatment. Treatment engagement, satisfaction, and side-effects were assessed. We found large, significant reductions in distress (Hedges g = 1.55), anxiety (g = 1.39), and depression (g = 1.96), and improvements in trait mindfulness (g = 0.98) and well-being (g = 1.26) between baseline and post-treatment, all of which were maintained at follow-up. Treatment satisfaction was high for treatment-completers, with minimal side-effects reported, although adherence was lower than expected (59.1% completed). These findings show that it is feasible to integrate online mindfulness training with iCBT for the treatment of anxiety and depression, but further research is needed to improve adherence. A randomised controlled trial is needed to explore the efficacy of this program.
Objective
To investigate the effect of mindfulness training on pain tolerance, psychological well-being, physiological activity, and the acquisition of mindfulness skills.
Methods
Forty-two asymptomatic University students participated in a randomized, single-blind, active control pilot study. Participants in the experimental condition were offered six (1-h) mindfulness sessions; control participants were offered two (1-h) Guided Visual Imagery sessions. Both groups were provided with practice CDs and encouraged to practice daily. Pre–post pain tolerance (cold pressor test), mood, blood pressure, pulse, and mindfulness skills were obtained.
Results
Pain tolerance significantly increased in the mindfulness condition only. There was a strong trend indicating that mindfulness skills increased in the mindfulness condition, but this was not related to improved pain tolerance. Diastolic blood pressure significantly decreased in both conditions.
Conclusion
Mindfulness training did increase pain tolerance, but this was not related to the acquisition of mindfulness skills.
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Evidence that placebo acupuncture is an effective treatment for chronic pain presents a puzzle: how do placebo needles appearing to patients to penetrate the body, but instead sitting on the skin’s surface in the manner of a tactile stimulus, evoke a healing response? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations (including warmth, tingling or flowing sensations) suggest an embodied healing mechanism. In this qualitative study, we asked a subset of patients in a singleblind randomized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament. Analysis focused on patients’ unprompted descriptions of any enhanced touch sensations (e.g., warmth, tingling) and any significance patients assigned to the sensations. We found in 5/6 cases, patients associated sensations including “warmth” and “tingling” with treatment efficacy. The conclusion offers a “neurophenomenological” account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices, possibly underlying the phenomenology of placebo acupuncture.
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Social emotional learning is what allows students control their behavior, understand how their personal behavior impacts others, and enables them to empathize and collaborate with others.
Introduction: Acupuncture is a complex holistic intervention in which patient–practitioner relationships and healing changes occur in interactive, iterative ways. Qualitative research is one way to capture such complexity. This study sought to understand better the experiences of adolescents involved in acupuncture treatment. Materials and methods: We included a qualitative substudy as part of a pilot randomized sham-controlled study of the use of Japanese acupuncture to treat chronic pelvic pain in adolescent girls. Seven (7) interviews were attained. Themes were double-coded and analyzed using qualitative analysis software. Results: Regardless of treatment arm, all subjects reported positive study-related changes, often attributed to positive qualities of the patient–practitioner relationship. Participants in both the sham and verum acupuncture treatment arms reported in the narratives that they were unsure of their study assignment. In contrast, the study's close-ended success of blinding question suggests that some participants were sure of their treatment allocation. Conclusions: As we continue to study acupuncture using sham controls, we need a better understanding of the possible affects of sham treatments on both treatment outcomes and success of blinding. Qualitative research is one-way to explore subtle emergent changes in participants' experiences.
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This is the first published qualitative assessment of a yoga program applied in a high school setting. This qualitative interview study was nested in a randomized, controlled trial studying the effects of a yoga program offered in place of a semester of physical education classes at a rural public high school. Student interviews were conducted after taking part in a semester of the yoga program. A formal passive consent with information about the qualitative study was sent home to parents/guardians of all students in the parent study before the interviews. Most students enjoyed the yoga classes and felt benefits. Negative reports of yoga practice were associated with gender as most males sensed peer pressure against practicing yoga. Despite this finding, most students wanted to continue yoga and would continue if it were offered in school. Positive reports include a greater kinesthetic awareness, which some students associated with a greater respect for the body and improved self-image. Among students reporting psychological benefits, many cited stress reduction; many used yoga to manage negative emotions; and some propagated more optimism. Most thought yoga could reduce interest in the use of drugs and alcohol and increase social cohesion with family and peers. We found that a yoga program is feasible in this sample of 9th and 10th graders, especially after benefits are perceived. We also found evidence that yoga may lead to emergent positive benefits in health behaviors not directly prescribed by the program. These results suggest that school-based yoga programs may be appropriate for promoting healthy behaviors at a societal level by focusing on the prevention of negative patterns during the adolescent transition.
When this journal entry was made I had already been working with people in prison for a number of years — something I continue to do. Back in 1995, diagnostic work was not my primary focus, nor was the prevention of self-harm and suicide, yet each of these was embedded in wider ethnographies. The reception process described above, where prison staff were concerned with identifying perceived vulnerability at a specific point in time, is one example of this. Another example from daily prison life could be a comment by a member of staff that someone appeared to be ‘looking better’ or ‘needed to be kept an eye on’. Diagnosis is still not my primary concern, but as I consider the extent and depth to which I have become familiar with the prison system and its members, it appears that aspects of diagnosis run like threads through many prison activities and practices. This is no more apparent than in prison officers’ capacity to manage prisoners’ perceived ability (or inability) to survive and cope with institutional life.
The extent to which rumination mediates the relation between mindfulness skills and depressive symptoms in nonclinical undergraduates (N = 254) was examined. Measures of mindfulness (Kentucky Inventory of Mindfulness Skills), ruminative brooding and reflective pondering (Ruminative Response Scale), and depressive symptomatology (Quick Inventory of Depressive Symptomatology) were administered. The contribution of mindfulness and rumination subscales was investigated in mediation analyses using the bootstrapping methodology. The relations among the mindfulness scales and rumination and depressive symptomatology were investigated. The results suggest that brooding partially mediated the relation from awareness to depressive symptomatology and from depressive symptomatology to awareness (higher levels of awareness result in lower levels of brooding and, as a result, lower levels of depressive symptomatology and vice versa). Brooding fully mediated the relation from accepting without judgment to depressive symptomatology (higher levels of accepting without judgment result in lower levels of brooding, which results in lower levels of depressive symptomatology). Brooding partially mediated the relation from depressive symptomatology to accepting without judgment (higher levels of depressive symptomatology result in higher levels of brooding and thus in lower levels of accepting without judgment). Reflective pondering fully mediated the relation from depressive symptomatology to observing (higher levels of depressive symptomatology result in higher levels of reflective pondering and thus in higher levels of observing). Mindful observing was negatively correlated with awareness and accepting without judgment. Mindful describing was unrelated to rumination. The current study helps clarify the relations between mindfulness and depression, as influenced by rumination. A necessary step will be to investigate these relations in a clinical population.
Mindfulness is often part of treatment for non-suicidal self-injury (NSSI); however, there has been limited research examining the role of mindfulness in NSSI. Thus, the current study sought to investigate the relationship among mindfulness, depressive symptoms, and NSSI (past year) in adolescents (N = 764; 56.8% female, M age = 14.42, SD = 0.64) with consideration of gender. Adolescents with recent NSSI (n = 74; 83.8% female, M age = 14.36, SD = 0.56) and a matched for age and gender no-NSSI group completed measures of mindfulness and depression. Findings revealed that mindfulness and depressive symptoms were negatively correlated, although significantly less so for the NSSI group. Second, the NSSI group reported greater depressive symptoms and less mindfulness. Finally, mindfulness was found to partially mediate the effect of depressive symptoms on NSSI. The present study is the first to provide empirical support for the protective role of mindfulness in NSSI.
Although several studies have examined anterior asymmetric brain electrical activity and cortisol in infants, children, and adults, the direct association between asymmetry and cortisol has not systematically been reported. In nonhuman primates, greater relative right anterior activation has been associated with higher cortisol levels. The current study examines the relation between frontal electroencephalographic (EEG) asymmetry and cortisol (basal and reactive) and withdrawal-related behaviors (fear and sadness) in 6-month-old infants. As predicted, the authors found that higher basal and reactive cortisol levels were associated with extreme right EEG asymmetry. EEG during the withdrawal-negative affect task was associated with fear and sadness behaviors. Results are interpreted in the context of the previous primate work, and some putative mechanisms are discussed.
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<p>Five studies investigated the cognitive and emotional processes by which self-compassionate people deal with unpleasant life events. In the various studies, participants reported on negative events in their daily lives, responded to hypothetical scenarios, reacted to interpersonal feedback, rated their or others' videotaped performances in an awkward situation, and reflected on negative personal experiences. Results from Study 1 showed that self-compassion predicted emotional and cognitive reactions to negative events in everyday life, and Study 2 found that self-compassion buffered people against negative self-feelings when imagining distressing social events. In Study 3, self-compassion moderated negative emotions after receiving ambivalent feedback, particularly for participants who were low in self-esteem. Study 4 found that low-self-compassionate people undervalued their videotaped performances relative to observers. Study 5 experimentally induced a self-compassionate perspective and found that self-compassion leads people to acknowledge their role in negative events without feeling overwhelmed with negative emotions. In general, these studies suggest that self-compassion attenuates people's reactions to negative events in ways that are distinct from and, in some cases, more beneficial than self-esteem.</p>
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Social-emotional (SE) skills in the early developmental years of children influence outcomes in psychological, behavioral, and learning domains. The adult ratings of a child's SE skills can be influenced by sex stereotypes. These rating differences could lead to differential conclusions about developmental progress or risk. To ensure that differences between boys and girls in SE skills are accurate, validity evidence should support that differences are not based on such issues as stereotypes influencing ratings. Differential item functioning (DIF) analysis allows for the assessment of group differences in item responses while controlling for ability. This study utilized a new multilevel Mantel-Haenszel (MMH) DIF procedure to examine sex differences in item responses for examiner ratings of children's SE skills on the Brigance Inventory of Early Development III SE scale. Of 50 items examined, 4 were identified as large DIF items. The scores do not appear to be influenced by item-level rating distortions based on sex stereotypes.
What will students need to know and be able to do in order to thrive in our fast-changing, complex, and interconnected world? For educators today, this is a driving question and one which social and emotional learning (SEL) addresses in a systematic way. SEL also provides a structure for organizing education to ensure students are equipped for the global future they will inherit. The purpose of this chapter is to explore how SEL can serve as an organizing framework to optimize education. We define social and emotional competencies and review evidence-based SEL programming in schools, including recent research on the efficacy of SEL programs and specific program design characteristics. We conclude with case examples and anecdotes of implementation of SEL in school systems.
A substantial body of evidence verifies that social-emotional learning (SEL) can be effectively taught in schools and can reduce the prevalence and impact of emotional and behavioral problems (EBP) among children and youth. Although the positive effects of SEL on individual student's emotional, behavioral, and academic outcomes have been investigated in some detail in recent years, most studies have focused on evaluating programs aimed at directly training social and emotional competencies with a focus on the individual. Far less is known about the role of interpersonal group dynamics and systems functioning at the levels of the peer group, classroom, and school community. Drawing on Bronfenbrenner's ecological systems theory and Harris's group socialization theory, this article reviews the literature on SEL and group dynamics to identify the ways in which existing SEL frameworks already encapsulate social group processes that contribute to the promotion of positive social-emotional development of children and youth. The goals of this contribution are twofold: (a) to document how EBP can be attenuated by addressing group-level processes that already exist within SEL practices and (b) to provide educators with specific SEL strategies to address group dynamics in their classrooms to optimize outcomes for all students, including students with EBP.
The scientific discovery of novel training paradigms has yielded better understanding of basic mechanisms underlying cortical plasticity, learning and development. This study is a first step in evaluating Tai Chi (TC), the Chinese slow-motion meditative exercise, as a training paradigm that, while not engaging in direct tactile stimulus training, elicits enhanced tactile acuity in long-term practitioners. The rationale for this study comes from the fact that, unlike previously studied direct-touch tactile training paradigms, TC practitioners focus specific mental attention on the body’s extremities including the fingertips and hands as they perform their slow routine. To determine whether TC is associated with enhanced tactile acuity, experienced adult TC practitioners were recruited and compared to age–gender matched controls. A blinded assessor used a validated method (Van Boven et al. in Neurology 54(12): 2230–2236, 2000) to compare TC practitioners’ and controls’ ability to discriminate between two different orientations (parallel and horizontal) across different grating widths at the fingertip. Study results showed that TC practitioners’ tactile spatial acuity was superior to that of the matched controls (P < 0.04). There was a trend showing TC may have an enhanced effect on older practitioners (P < 0.066), suggesting that TC may slow age related decline in this measure. To the best of our knowledge, this is the first study to evaluate a long-term attentional practice’s effects on a perceptual measure. Longitudinal studies are needed to examine whether TC initiates or is merely correlated with perceptual changes and whether it elicits long-term plasticity in primary sensory cortical maps. Further studies should also assess whether related somatosensory attentional practices (such as Yoga, mindfulness meditation and Qigong) achieve similar effects.
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