Key mechanisms of action of psychosocial treatments for chronic pain include decreased catastrophizing and increased self-efficacy [cognitive-behavioral therapy (CBT)] and increased mindfulness and possibly pain acceptance [mindfulness-based stress reduction (MBSR)]. Greater understanding of overlap among these variables is important in understanding treatment-specific and shared mechanisms of action. We examined, in an RCT comparing group CBT (n=112), MBSR (n=116), and usual care (UC; n=113) for chronic back pain: (1) baseline relationships among the Pain Catastrophizing Scale (PCS), Pain Self-Efficacy Questionnaire (PSEQ), Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), and Five Facet Mindfulness Questionnaire-short form (FFMQ-SF); and (2) pre- to post-treatment changes in these measures. We hypothesized that: (1) at baseline, the PCS would be associated negatively with the CPAQ-8, PSEQ, and FFMQ-SF Non-Reactivity, Non-Judging, and Acting with Awareness scales, and the CPAQ-8 would be associated positively with the PSEQ; and (2) adjusting for baseline variables, FFMQ-SF and CPAQ-8 scores would increase more pre- to post-treatment in MBSR than in CBT and UC, and PCS scores would decrease more and PSEQ scores would increase more in CBT than in MBSR and UC. The hypothesized baseline associations were confirmed between the PCS and the CPAQ-8 (Spearman’s rho = -0.40 to -0.55), PSEQ (-0.57), and FFMQ (-0.22 to -0.30) scales (all Ps < 0.01), and between the CPAQ-8 and the PSEQ (0.46-0.65; all Ps < 0.01). Among all participants who completed baseline and post-treatment assessments (n = 290), catastrophizing decreased significantly more pre- to post-treatment in MBSR than in UC and CBT. Among those who attended >6 of the 8 group sessions, mindfulness increased more in MBSR than in CBT, but the groups did not differ significantly in pre- to post-treatment change on the other measures. The results suggest overlap in mechanisms of action of CBT and MBSR. Supported by NCCAM grant 1R01AT006226.
BACKGROUND:Depression affects as many as one in five people in their lifetime and often runs a recurrent lifetime course. Mindfulness-based cognitive therapy (MBCT) is an effective psychosocial approach that aims to help people at risk of depressive relapse to learn skills to stay well. However, there is an ‘implementation cliff’: access to those who could benefit from MBCT is variable and little is known about why that is the case, and how to promote sustainable implementation. As such, this study fills a gap in the literature about the implementation of MBCT.
BACKGROUND:Depression affects as many as one in five people in their lifetime and often runs a recurrent lifetime course. Mindfulness-based cognitive therapy (MBCT) is an effective psychosocial approach that aims to help people at risk of depressive relapse to learn skills to stay well. However, there is an ‘implementation cliff’: access to those who could benefit from MBCT is variable and little is known about why that is the case, and how to promote sustainable implementation. As such, this study fills a gap in the literature about the implementation of MBCT.
BackgroundMindfulness-based cognitive therapy (MBCT) is a cost-effective psychosocial prevention programme that helps people with recurrent depression stay well in the long term. It was singled out in the 2009 National Institute for Health and Clinical Excellence (NICE) Depression Guideline as a key priority for implementation. Despite good evidence and guideline recommendations, its roll-out and accessibility across the UK appears to be limited and inequitably distributed. The study aims to describe the current state of MBCT accessibility and implementation across the UK, develop an explanatory framework of what is hindering and facilitating its progress in different areas, and develop an Implementation Plan and related resources to promote better and more equitable availability and use of MBCT within the UK National Health Service.
Methods/Design
This project is a two-phase qualitative, exploratory and explanatory research study, using an interview survey and in-depth case studies theoretically underpinned by the Promoting Action on Implementation in Health Services (PARIHS) framework. Interviews will be conducted with stakeholders involved in commissioning, managing and implementing MBCT services in each of the four UK countries, and will include areas where MBCT services are being implemented successfully and where implementation is not working well. In-depth case studies will be undertaken on a range of MBCT services to develop a detailed understanding of the barriers and facilitators to implementation. Guided by the study’s conceptual framework, data will be synthesized across Phase 1 and Phase 2 to develop a fit for purpose implementation plan.
Discussion
Promoting the uptake of evidence-based treatments into routine practice and understanding what influences these processes has the potential to support the adoption and spread of nationally recommended interventions like MBCT. This study could inform a larger scale implementation trial and feed into future implementation of MBCT with other long-term conditions and associated co-morbidities. It could also inform the implementation of interventions that are acceptable and effective, but are not widely accessible or implemented.
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It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
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It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
It has long been theorised that there are two temporally distinct forms of self-reference: extended self-reference linking experiences across time, and momentary self-reference centred on the present. To characterise these two aspects of awareness, we used functional magnetic resonance imaging (fMRI) to examine monitoring of enduring traits (’narrative’ focus, NF) or momentary experience (’experiential’ focus, EF) in both novice participants and those having attended an 8 week course in mindfulness meditation, a program that trains individuals to develop focused attention on the present. In novices, EF yielded focal reductions in self-referential cortical midline regions (medial prefrontal cortex, mPFC) associated with NF. In trained participants, EF resulted in more marked and pervasive reductions in the mPFC, and increased engagement of a right lateralised network, comprising the lateral PFC and viscerosomatic areas such as the insula, secondary somatosensory cortex and inferior parietal lobule. Functional connectivity analyses further demonstrated a strong coupling between the right insula and the mPFC in novices that was uncoupled in the mindfulness group. These results suggest a fundamental neural dissociation between two distinct forms of self-awareness that are habitually integrated but can be dissociated through attentional training: the self across time and in the present moment.
The power of nature to both heal and inspire awe has been noted by many great thinkers. However, no study has examined how the impact of nature on well-being and stress-related symptoms is explained by experiences of awe. In the present investigation, we examine this process in studies of extraordinary and everyday nature experiences. In Study 1, awe experienced by military veterans and youth from underserved communities while whitewater rafting, above and beyond all the other positive emotions measured, predicted changes in well-being and stress-related symptoms one week later. In Study 2, the nature experiences that undergraduate students had during their everyday lives led to more awe, which mediated the effect of nature experience on improvements in well-being. We discuss how accounting for people's emotional experiences during outdoors activities can increase our understanding of how nature impacts people's well-being. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Experiential avoidance, the refusal to accept contact with unpleasant private experiences, is believed to play a role in the onset and maintenance of eating disorders. Preliminary evidence suggests that mindfulness- and acceptance-based interventions that reduce avoidance may be effective in treating disordered eating behaviors. The purpose of the current investigation was to examine whether one form of experiential avoidance (thought suppression) and the theoretically opposing construct of dispositional mindfulness are associated with bulimic symptoms. Undergraduate men (n=219) and women (n=187) completed questionnaires assessing mindful attention and awareness, chronic thought suppression, and bulimic symptoms. A series of hierarchical regression analyses revealed that thought suppression and mindfulness accounted for unique variance in bulimic symptoms among men and women after accounting for BMI. Results are discussed in terms of the role of dispositional mindfulness and thought suppression in disordered eating.
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ObjectivesThe researchers investigated the relation between mindfulness and social anxiety symptoms, and examined whether this relation is mediated by cognitive appraisals commonly associated with social anxiety.
Participants
Ninety‐eight individuals diagnosed with social phobia.
Design
Using a cross‐sectional design, ordinary least squares regression and bootstrapping mediation analyses were used to test the study hypotheses.
Results
Mindfulness was negatively related to symptoms of social anxiety. This relation was partially mediated by cognitive appraisals about the likelihood and cost of a negative social outcome.
Conclusion
Further research using a longitudinal design and other measures of mindfulness is needed to replicate these findings and further explicate the mechanism by which mindfulness might be associated with negative cognitive appraisals.
The present study examined whether pretreatment mindfulness exerts an indirect effect on outcomes following cognitive-behavioral therapy (CBT). Cognitive processes of probability and cost bias (i.e., overestimations of the likelihood that negative social events will occur, and that these events will have negative consequences when they do occur) were explored as potential mediators of the relation between mindfulness and social anxiety symptom change. People with higher levels of mindfulness may be better able to benefit from treatments that reduce biases because mindfulness may aid in regulation of attention. Sixty-seven individuals with a primary diagnosis of social phobia identifying public speaking as their greatest fear received eight sessions of one of two types of exposure-based CBT delivered according to treatment manuals. Participants completed self-report measures of mindfulness, probability bias, cost bias, and social anxiety symptoms. Mediation hypotheses were assessed by a bootstrapped regression using treatment outcome data. Pretreatment mindfulness was not related to change in social anxiety symptoms from pre- to posttreatment. However, mindfulness had an indirect effect on treatment outcome via its association with probability bias, but not cost bias, at midtreatment. These findings were consistent across three metrics of social anxiety symptoms. Mindfulness may play a role in response to CBT among individuals with social phobia through its relation with probability bias--even when the treatment does not target mindfulness.
Mount Kawa Karpo of the Menri ('Medicine Mountains' in Tibetan), in the eastern Himalayas, is one of the most sacred mountains to Tibetan Buddhists. Numerous sacred sites are found between 1900 and 4000 m, and at higher elevations the area as a whole is considered a sacred landscape. Religious beliefs may affect the ecology of these sacred areas, resulting in unique ecological characteristics of importance to conservation; recent studies have demonstrated that sacred areas can often play a major role in conservation. The goal of this study is to preliminarily analyze the vegetation of sacred areas in the Menri region using existing vegetation maps and a Geographical Information System (GIS) for remote assessment. Sacred sites are compared to random points in the landscape, in terms of: elevation, vegetation, and nearness to villages; species composition, diversity, and richness; and frequency of useful and endemic plant species. Detrended correspondence analysis (DCA) ordination reveals that sacred sites differ significantly in both useful species composition (p=0.034) and endemic species composition (p=0.045). Sacred sites are located at lower elevations, and closer to villages, than randomly selected, non-sacred sites (p< 0.0001), and have higher overall species richness (p=0.033) and diversity (p=0.042). In addition, the high-elevation (> 4000 m) areas of the mountain - a sacred landscape - are found to have significantly more endemics than low-elevation areas (p<0.0001). These findings represent an initial analysis of sacred sites and suggest that sacred sites in the Menri region may be ecologically and ethnobotanically unique.
Mount <i>Kawa Karpo</i> of the <i>Menri</i> ('Medicine Mountains' in Tibetan), in the eastern Himalayas, is one of the most sacred mountains to Tibetan Buddhists. Numerous sacred sites are found between 1900 and 4000 m, and at higher elevations the area as a whole is considered a sacred landscape. Religious beliefs may affect the ecology of these sacred areas, resulting in unique ecological characteristics of importance to conservation; recent studies have demonstrated that sacred areas can often play a major role in conservation. The goal of this study is to preliminarily analyze the vegetation of sacred areas in the <i>Menri</i> region using existing vegetation maps and a Geographical Information System (GIS) for remote assessment. Sacred sites are compared to random points in the landscape, in terms of: elevation, vegetation, and nearness to villages; species composition, diversity, and richness; and frequency of useful and endemic plant species. Detrended correspondence analysis (DCA) ordination reveals that sacred sites differ significantly in both useful species composition (<i>p</i>=0.034) and endemic species composition (<i>p</i>=0.045). Sacred sites are located at lower elevations, and closer to villages, than randomly selected, non-sacred sites (<i>p</i>< 0.0001), and have higher overall species richness (<i>p</i>=0.033) and diversity (<i>p</i>=0.042). In addition, the high-elevation (> 4000 m) areas of the mountain - a sacred landscape - are found to have significantly more endemics than low-elevation areas (<i>p</i><0.0001). These findings represent an initial analysis of sacred sites and suggest that sacred sites in the <i>Menri</i> region may be ecologically and ethnobotanically unique.
PURPOSE:Mindful eating and intuitive eating are promoted as means to circumvent potentially maladaptive dietary restraint while maintaining a healthy weight. Although theoretically related, no studies have examined the correlations between intuitive eating, mindful eating, and restraint in the same sample. This study sought to examine these constructs and their correlations with body mass index (BMI), eating-disordered behaviors, and meal consumption in a college sample.
METHODS:
Participants (N = 125) completed a laboratory taste-test meal and measures of each eating-related construct using the EDDS, IES, MEQ, and TFEQ-Restraint Subscale.
RESULTS:
Mindful eating, intuitive eating, and restraint were not strongly correlated. Hierarchical multiple regression analyses indicated that restraint and intuitive eating accounted for significant variance in disordered eating and BMI. Elevated restraint was associated with increased BMI and disordered eating; elevated intuitive eating was associated with decreased BMI and disordered eating. Mindful eating did not correlate with any outcome variables. Follow-up analyses suggested that specific intuitive eating subscales accounted for unique variance in the relation between intuitive eating and disordered eating. Intuitive eating was the only construct that was significantly associated with meal consumption.
CONCLUSIONS:
Intuitive eating and restraint appear to be only weakly correlated, and each is differentially associated with meal consumption. Mindful eating does not appear to relate to outcome variables.
ObjectiveIt is imperative that research identifies factors related to depression among individuals in substance use treatment, as depression is associated with substance use relapse. Dispositional mindfulness and spirituality may bear an important role in the relationship between depression and substance use.
Method
Using preexisting patient medical records (N = 105), the current study investigated dispositional mindfulness and spirituality in relation to depressive symptom clusters (affective, cognitive, and physiological) among men in residential substance use treatment. The mean age of the sample was 41.03 (standard deviation = 10.75).
Results
Findings demonstrated that dispositional mindfulness and spirituality were negatively associated with depressive symptoms. After controlling for age, alcohol use, and drug use, dispositional mindfulness remained negatively associated with all of the depression clusters. Spirituality only remained associated with the cognitive depression cluster.
Conclusion
Mindfulness‐based interventions may hold promise as an effective intervention for reducing substance use and concurrent depressive symptoms.
Although loving-kindness meditation (LKM) has shown some promise as a psychological intervention, little is known about the effectiveness of LKM for reducing one of the most prevalent mental health problems: anxiety. To build knowledge in this area, we conducted a randomized controlled trial, assigning non-clinical undergraduates to either a four-session, group-based LKM intervention (n = 38) or a waitlist control (n = 33). Self-reported anxiety, compassionate love, and self-compassion were assessed at pretreatment, posttreatment, and 8-week follow-up. Relative to control participants, participants in the LKM intervention reported higher compassionate love and self-compassion at posttreatment and higher self-kindness (a component of self-compassion) at follow-up. Anxiety ratings did not significantly differ between conditions at posttreatment or follow-up. Study limitations and directions for future research are discussed.
We believe that the current environmental crisis can be addressed by changing our relationship with the Earth that sustains us. This entails a reorientation of the idea of self to include an understanding that one is integrally and relationally part of everyone and everything else. Grounded on the ideologies of deep ecology and interbeing, we propose an Earth Education paradigm for art education and learning in the arts. In this article, we describe the crisis of environmental degradation and its root causes that have estranged people from the natural world. We suggest changes that may result in reconnection and address the potential role of art education in effecting these changes.
In the past 30 years, the rates of incarceration and recidivism for women in the United States have increased dramatically. Choice Theory® Connections (CTC) is a gender-tailored pre-release intervention program based on Choice Theory® (Glasser, 1999), and designed to achieve meaningful and sustainable cognitive and behavioral change. This evaluation examines CTC among 96 female participants in a California state prison enrolled in an introductory (n = 58) or advanced (n = 38) course. CTC significantly improved perceived stress, mindfulness, emotion regulation, impulsivity, and well-being on completion; effects were stronger for the introductory cohort, but significant effects also emerged for the advanced cohort. In addition, participants in the advanced cohort reported better scores at baseline, demonstrating the effects of prolonged engagement with the intervention. Results suggest that CTC can improve incarcerated women's well-being pre-release, a strong predictor of recidivism post-release. Further study and wider use of CTC are encouraged.
To assess the impact of a yoga curriculum in an elementary school on student quality of life, and to assess teacher and staff perception of potential barriers to, and benefits of, introducing yoga and mindfulness into the classroom. A randomized controlled trial was utilized to assess the impact of a brief intervention on third-grade students who screened positive for symptoms of anxiety. Students were randomized to an intervention group of 20 students receiving small-group yoga/mindfulness activities for 8 weeks between October 2016 and February 2017, and a control group of 32 students receiving care as usual. The Brief Multidimensional Students’ Life Satisfaction Scale-Peabody Treatment Progress Battery and the Pediatric Quality of Life Inventory (PedsQL) served as outcomes. Teachers were invited to participate in two professional development sessions about introducing yoga and mindfulness into the classroom, and completed a survey following each of the sessions. In generalized estimating equation models adjusted for time, the yoga-based intervention was associated with a 14.17 unit increase in student emotional PedsQL (p-value 0.001) and a 7.43 unit increase in psychosocial PedsQL (p-value 0.01). Results were not attenuated by adjustment. Teachers and staff reported using yoga more frequently in the classroom following the second of two professional development sessions (p-value <0.05). Perceived barriers to introducing yoga to the classroom were similar at two data collection time points, while perceived benefits remained high. The intervention was associated with a significant improvement in emotional and psychosocial quality of life in the intervention group when compared to the control group, suggesting that yoga/mindfulness interventions may improve symptoms of anxiety among students. Yoga/mindfulness activities may facilitate stress management among elementary school students and may be added as a complement to social and emotional learning activities.
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