Mindfulness-based Group Intervention Research Articles

A Qualitative Study of a Compassion, Presence, and Resilience Training for Oncology Interprofessional Teams.

The well-being of health care providers may be challenged by their work, with evidence that oncology health care providers are a high-risk group for burnout. The present qualitative pilot study evaluated a mindfulness-based group intervention, referred to as Compassion, Presence, and Resilience Training (CPR-T), for oncology interprofessional teams. The purpose of this study was to elucidate the subjective experience of oncology health care providers receiving CPR-T and their perceptions of its benefits, risks, or challenges. The CPR-T was delivered to providers from two oncology teams in a large cancer center in Canada. Ten of these providers participated in semistructured interviews 1 to 5 months after completing the CPR-T. The interview transcripts were coded using a thematic analysis strategy. Five benefits of the CPR-T were identified: learning to pause, acquiring a working definition of stress and self-care, becoming fully present, building self-compassion, and receiving organizational acknowledgment and recognition of stress. In addition, two participant-identified challenges were recognized: sharing vulnerability within interprofessional teams and committing to a sitting meditation practice. These findings demonstrate positive transformations as a result of the CPR-T, as well as important challenges, and have important implications for holistic health care practice in oncology. Further research is necessary to validate the findings of this explorative study.

Impact of Depression and Psychosocial Treatment on Heart Rate Variability in Patients with Type 2 Diabetes Mellitus: An Exploratory Analysis Based on the HEIDIS Trial.

To explore the impact of depression on heart rate (HR) and heart rate variability (HRV) as a marker of autonomic nervous system (ANS) impairment in depressed and non-depressed patients with advanced type 2 diabetes mellitus (T2DM) and to explore possible effects of an acceptance- and mindfulness-based group intervention (MBSR) on HR and HRV. Alongside a prospective clinical trial, we collected demographic, psychosocial and clinical data from 113 chronic T2DM patients in a standardized setting. At baseline and after one year, depressive mood was assessed with the Patient Health Questionnaire (PHQ-9), and autonomic function was determined by measuring HR and HRV markers. A subsample was randomly assigned to take part in eight MBSR sessions. Of the 113 T2DM patients (77.9% men; mean age=58.8±7.0 years; diabetes duration 11.5±7.0 years), 33 showed clinically relevant depressive symptoms at baseline. In cross-sectional analysis, we found no association between depression and HR/HRV (all comparisons p>0.05). In prospective regression analysis depression did not predict follow-up scores of HRV. The patients who participated in the MBSR intervention showed a tendency toward improved parasympathetic control (RMSSD, CV, E-I-Ratio) with small-to-moderate effect sizes (d≤0.38). Depression was not directly associated with cardiac autonomic control in this sample, but MBSR training may have positively influenced HR and HRV. In advanced diabetes, somatic and behavioral parameters seem to be more predictive than depression for the course of autonomic functioning, but the pathways remain unclear.

Feasibility of a mindfulness-based cognitive therapy group intervention as an adjunctive treatment for postpartum depression and anxiety

BackgroundMany women experience moderate-to-severe depression and anxiety in the postpartum period for which pharmacotherapy is often the first-line treatment. Many breastfeeding mothers are reticent to increase their dose or consider additional medication, despite incomplete response, due to potential adverse effects on their newborn. These mothers are amenable to non-pharmacological intervention for complete symptom remission. The current study evaluated the feasibility of an eight-week mindfulness-based cognitive therapy (MBCT) intervention as an adjunctive treatment for postpartum depression and anxiety. MethodsWomen were recruited at an outpatient reproductive mental health clinic based at a maternity hospital. Participants had a diagnosis of postpartum depression/anxiety within the first year following childbirth. They were enrolled in either the MBCT intervention group (n = 14) or the treatment-as-usual control group (n = 16), and completed the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the Mindful Attention Awareness Scale (MAAS) at baseline and at 4 weeks, 8 weeks, and 3 months following baseline. ResultsMultivariate analyses demonstrated that depression and anxiety levels decreased, and mindfulness levels increased, in the MBCT group, but not in the control group. Many of the between-group and over time comparisons displayed trends towards significance, although these differences were not always statistically significant. Additionally, the effect sizes for anxiety, depression, and mindfulness were frequently large, indicating that the MBCT intervention may have had a clinically significant effect on participants. LimitationsLimitations include small sample size and the non-equivalent control group design. ConclusionsWe demonstrated that MBCT has potential as an adjunctive, non-pharmacological treatment for postpartum depression/anxiety that does not wholly remit with pharmacotherapy. (249 words)

Effects of a Brief Mindfulness Based Group Intervention On College Students

ABSTRACTIncreases in the number of college students seeking mental health services require counseling centers to explore innovative strategies to provide effective and efficient treatments. Group interventions offer an alternative to traditional individual counseling, allowing centers to serve more students with fewer clinical staff (Burlingame et al., 2016). Of current group modalities, mindfulness-based interventions (MBIs) have been growing in popularity as an effective approach for addressing college students’ increasingly complex needs. This study describes the evaluation of a three-session mindfulness-based intervention on students’ mindfulness, symptoms, and stress. Compared to a comparison group of 109 students not seeking counseling center services, 78 students who received the intervention reported increased mindfulness, and decreased symptoms of depression, anxiety, and stress at the end of the group. Furthermore, improvements in mindfulness mediated intervention effects on symptoms of depression and anxiety. These gains were generally maintained 3 weeks later. These findings support the benefits of brief group interventions for college students. Suggestions for modifications to the intervention and for future research are discussed.

Pilot randomized controlled trial of a mindfulness-based group intervention in adolescent girls at risk for type 2 diabetes with depressive symptoms

Objective(1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. Design and settingParallel-group, randomized controlled pilot trial conducted at a university. ParticipantsThirty-three girls 12–17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). InterventionsBoth interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. Main outcome measuresAdolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. ResultsMost adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). ConclusionsA mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance.ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov

Supporting emotional well-being in schools: a pilot study into the efficacy of a mindfulness-based group intervention on anxious and depressive symptoms in children

ABSTRACTObjective: This study examines the efficacy of a six week child mindfulness program (TRIPLE R) in teaching mindfulness skills and reducing negative emotional symptoms in a school setting.Method: Using a correlational within-subjects repeated measures design, the relationships between child self-reported mindfulness skills and negative emotional symptoms were explored. Mindfulness skills were measured using the Child and Adolescent Mindfulness Measure, and emotional symptoms were measured using the Revised Children’s Anxiety and Depression Scale. A sample of 57 Australian grade 5 children in three primary schools completed the measures pre and post intervention.Results: There was a small to moderate increase in mindfulness skills post intervention (Cohen’s d = 0.32), however negative emotional symptoms did not significantly improve. Increased mindfulness skills were significantly associated with decreased emotional symptoms, most notably for symptoms related to social phobia (R = −.61), separation anxiety (R = −.42) and generalised anxiety (R = −.32).Discussion: This study provides preliminary support for the TRIPLE R program and the potential benefits of school-based mindfulness interventions in improving children’s well-being. The limited improvement in negative emotional symptoms is likely related to the non-clinical sampling. The relationship between increased mindfulness skills and decreased emotional symptoms is discussed, and recommendations for further research are presented.

Internet Mindfulness Meditation Intervention for the General Public: Pilot Randomized Controlled Trial.

BackgroundMindfulness meditation interventions improve a variety of health conditions and quality of life, are inexpensive, easy to implement, have minimal if any side effects, and engage patients to take an active role in their treatment. However, the group format can be an obstacle for many to take structured meditation programs. Internet Mindfulness Meditation Intervention (IMMI) is a program that could make mindfulness meditation accessible to all people who want and need to receive it. However, the feasibility, acceptability, and ability of IMMI to increase meditation practice have yet to be evaluated.ObjectivesThe primary objectives of this pilot randomized controlled study were to (1) evaluate the feasibility and acceptability of IMMIs in the general population and (2) to evaluate IMMI’s ability to change meditation practice behavior. The secondary objective was to collect preliminary data on health outcomes.MethodsPotential participants were recruited from online and offline sources. In a randomized controlled trial, participants were allocated to IMMI or Access to Guided Meditation arm. IMMI included a 1-hour Web-based training session weekly for 6 weeks along with daily home practice guided meditations between sessions. The Access to Guided Meditation arm included a handout on mindfulness meditation and access to the same guided meditation practices that the IMMI participants received, but not the 1-hour Web-based training sessions. The study activities occurred through the participants’ own computer and Internet connection and with research-assistant telephone and email contact. Feasibility and acceptability were measured with enrollment and completion rates and participant satisfaction. The ability of IMMI to modify behavior and increase meditation practice was measured by objective adherence of daily meditation practice via Web-based forms. Self-report questionnaires of quality of life, self-efficacy, depression symptoms, sleep disturbance, perceived stress, and mindfulness were completed before and after the intervention period via Web-based surveys.ResultsWe enrolled 44 adults were enrolled and 31 adults completed all study activities. There were no group differences on demographics or important variables at baseline. Participants rated the IMMI arm higher than the Access to Guided Meditation arm on Client Satisfaction Questionnaire. IMMI was able to increase home practice behavior significantly compared to the Access to Guided Meditation arm: days practiced (P=.05), total minutes (P=.01), and average minutes (P=.05). As expected, there were no significant differences on health outcomes.ConclusionsIn conclusion, IMMI was found to be feasible and acceptable. The IMMI arm had increased daily meditation practice compared with the Access to Guided Meditation control group. More interaction through staff and/or through built-in email or text reminders may increase daily practice even more. Future studies will examine IMMI’s efficacy at improving health outcomes in the general population and also compare it directly to the well-studied mindfulness-based group interventions to evaluate relative efficacy.Trial RegistrationClinicaltrials.gov NCT02655835; http://clinicaltrials.gov/ct2/show/NCT02655835 (Archived by WebCite at http://www.webcitation/ 6jUDuQsG2)

A Mindfulness-Based Group Intervention for Enhancing Self-Regulation of Emotion in Late Childhood and Adolescence: A Pilot Study

Emotion dysregulation is strongly implicated in the development of psychological problems during adolescence. The purpose of this study was to examine the feasibility and acceptability of an intervention for enhancing self-regulation of emotion in adolescents, adapted from Mindfulness-based Cognitive Therapy. We studied the impact of the intervention on depressive symptoms, as well as on transdiagnostic psychological processes related to emotional regulation, namely impulsivity and ruminative thinking. Twenty-one participants aged between 11 and 19 years were offered a nine-session group intervention. Adolescents completed standardized questionnaires before and after the training. This intervention was found to increase self-reported mindfulness and was well-accepted by adolescents, as estimated by the low dropout rate. As expected, a decrease was observed in depressive symptoms, in specific impulsivity facets (urgency and lack of perseverance), and in internal-dysfunctional strategies of emotion regulation (especially in unconstructive repetitive thoughts). The present findings provide preliminary support for a group intervention for adolescents characterized by emotion regulation difficulties, targeting transdiagnostic psychological processes (impulsivity and ruminative thinking). Furthermore, by potentially enhancing self-regulation skills, this intervention might constitute an effective method for general prevention of psychological disorders in late childhood and adolescence.

Both sides of the story: Exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder

Objective: What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD. Methods: A two-staged mixed methods design was used to identify the participants who reported the highest (n = 7) and lowest (n = 7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology. Results: We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life. Conclusions: MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.

Pilot Study of a Mindfulness-Based Group Intervention for Individuals with Parkinson’s Disease and Their Caregivers

This pilot study assessed the feasibility and impact of an 8-week mindfulness-based group intervention on cognitive and emotional functioning for individuals with Parkinson’s disease (PD) and their caregivers. Twenty-five percent of those initially recruited dropped out before completing the study. The final sample (N = 39; 29 patients/10 caregivers) was 53.8 % male, 89.7 % Caucasian, with a mean level of education of 16.77 years (SD = 2.51), and ranged in age from 50 to 82 (M = 65.64, SD = 7.62). Mindfulness levels significantly increased for all participants from pre- to immediate-post. A significant improvement was seen for self-reported symptoms of depression and self-reported language functioning. Patient participants uniquely showed significant improvement on mental flexibility and complex attention tasks and reported significantly fewer emotional and cognitive symptoms associated with PD. Participant compliance with assigned home mindfulness practice was measured with homework tracking logs, and participants reported an average of 20 min/day, 6 days/week. Participants attended an average of six classes. Homework compliance significantly correlated with improvement in mindfulness levels, apathy and anxiety symptoms, and on working memory and mental flexibility tasks. Better class attendance was also associated with increased mindfulness and reduced apathy symptoms. Increased mindfulness was related to fewer symptoms of apathy and anxiety and better PD-related quality of life. These results show promise for the use of mindfulness-based interventions to improve emotional and cognitive functioning in individuals with PD and their caregivers and suggest that efforts to increase participant retention and encourage homework compliance and class attendance are important for optimizing outcomes in future trials.

Taming the adolescent mind: a randomised controlled trial examining clinical efficacy of an adolescent mindfulness-based group programme.

Mindfulness interventions with adolescents are in the early stages of development. This study sought to establish efficacy of a mindfulness-based group intervention for adolescents with mixed mental health disorders. One hundred and eight adolescents (ages 13-18) were recruited from community mental health clinics and randomised into two groups (control vs. treatment). All participants received treatment-as-usual (TAU) from clinic-based therapists independent of the study. Adolescents in the treatment condition received TAU plus a 5-week mindfulness-training programme (TAU+Mi); adolescents in the control group received only TAU. Assessments including parent/carer reports were conducted at baseline, postintervention and 3-month follow-up. At postintervention, adolescents in the mindfulness condition experienced significant decrease in mental distress (measured with the DASS-21) compared to the control group (Cohen's d=0.43), and these gains were enhanced at 3-month follow-up (Cohen's d=0.78). Overall outcomes at 3months showed significant improvement for adolescents in the mindfulness condition; in self-esteem, mindfulness, psychological inflexibility and mental health, but not resilience. Parents/carers also reported significant improvement in their adolescent's psychological functioning (using the CBCL). Mediation analyses concluded mindfulness mediated mental health outcomes. Increase in mindful awareness after training leads to improvement in mental health and this is consistent with mindfulness theory. The mindfulness group programme appears to be a promising adjunctive therapeutic approach for clinic-based adolescents with mental health problems.

Addressing Student Attrition: The Role of College Counselors

According to Aud et al. (2012), between 2000 and 2010, the enrollment at degree-granting institutions increased by 37%, from 15.3 million to 21.0 million. Despite the growing number of students appearing on campuses nationwide, the reality is that most of them will not persist through graduation. Among those who enrolled in 4-year institutions during the 2004 fall semester, only 58% completed a bachelor's degree within 6 years. Student attrition is by no means a recent phenomenon. In fact, student retention is a long-standing challenge that colleges and universities continue to address (Braxton, Bray, & Berger, 2000). Although the reasons why students choose not to persist vary by individual, two variables that have become important to institutional retention efforts are academic adjustment and social integration (Tinto, 1993). As Ishitani (2003, 2006) has noted, adjustment to college has both short-term and long-term benefits for students that include, but are not limited to, their overall success. To address the retention issue, college and university administrators are committing significant resources to ensure student success. One vital resource that has shown promise in helping students persist in their academic pursuit is counseling. Several researchers have demonstrated the important role counselors can play in the retention process (Archer & Cooper, 1999; Coll & Stewart, 2008; Sharkin, 2004). The articles included in this issue of the Journal of College Counseling expand the knowledge base on effective student retention strategies. It is my hope that the information presented in the following six articles assist college counselors in their work with students at risk for attrition in order to promote degree persistence on their individual campuses. In this issue's Research section, Marybeth Rigali-Oiler and Sharon Robinson Kurpius examine how college counselors might best promote academic persistence among freshman and sophomore students. Given the body of research that demonstrates that students are most at risk for attrition during their first 2 years, their research is timely. In their study, Rigali-Oiler and Robinson Kurpius compare European American and racial/ethnic minority students by examining the impact of racial/ethnic identity, self-beliefs, and perceptions of the university environment on academic persistence decisions. Their findings suggest ways counselors might best work with students who are showing signs that they may be at risk for attrition. The second article in this section examines the efficacy of a mindfulness-based counseling intervention with college students. In this article, Ciara Byrne, Lynne Bond, and Miv London compare mindfulness-based and interpersonal process group interventions with no-treatment groups to determine which method is most effective in reducing psychological stress. Their results suggest that as students' stress levels are reduced, they are more likely to adjust more easily to college and perform better. The third article, authored by Wendi Williams and Y. Barry Chung, explores the role of cultural orientation on academic self-concept among Black/African American college students. Analyzing data collected from 119 college students, the authors found that there was a significant relationship between cultural orientation and academic self-concept. Suggested activities for counselors to use to improve issues related to a poor academic self-concept are noted. In addition to the aforementioned Research articles, this issue also includes the third installment of our special section highlighting current research being produced by the Center for Collegiate Mental Health (CCMH). CCMH is a collaborative research network composed of more than 150 college and university counseling centers across the United States. Through their access to a database from tens of thousands students, CCMH researchers are able to advance the college counseling knowledge base in several important areas. …

Two to five repeated measurements per patient reduced the required sample size considerably in a randomized clinical trial for patients with inflammatory rheumatic diseases

BackgroundPatient reported outcomes are accepted as important outcome measures in rheumatology. The fluctuating symptoms in patients with rheumatic diseases have serious implications for sample size in clinical trials. We estimated the effects of measuring the outcome 1-5 times on the sample size required in a two-armed trial.FindingsIn a randomized controlled trial that evaluated the effects of a mindfulness-based group intervention for patients with inflammatory arthritis (n=71), the outcome variables Numerical Rating Scales (NRS) (pain, fatigue, disease activity, self-care ability, and emotional wellbeing) and General Health Questionnaire (GHQ-20) were measured five times before and after the intervention. For each variable we calculated the necessary sample sizes for obtaining 80% power (α=.05) for one up to five measurements.Two, three, and four measures reduced the required sample sizes by 15%, 21%, and 24%, respectively. With three (and five) measures, the required sample size per group was reduced from 56 to 39 (32) for the GHQ-20, from 71 to 60 (55) for pain, 96 to 71 (73) for fatigue, 57 to 51 (48) for disease activity, 59 to 44 (45) for self-care, and 47 to 37 (33) for emotional wellbeing.ConclusionsMeasuring the outcomes five times rather than once reduced the necessary sample size by an average of 27%. When planning a study, researchers should carefully compare the advantages and disadvantages of increasing sample size versus employing three to five repeated measurements in order to obtain the required statistical power.

A mindfulness-based group intervention to reduce psychological distress and fatigue in patients with inflammatory rheumatic joint diseases: a randomised controlled trial

ObjectiveTo evaluate the effects of a mindfulness-based group intervention, the Vitality Training Programme (VTP), in adults with inflammatory rheumatic joint diseases.MethodsIn a randomised controlled trial, the VTP—a 10-session mindfulness-based group...

Mindfulness groups for men with advanced prostate cancer: a pilot study to assess feasibility and effectiveness and the role of peer support

Men diagnosed with advanced prostate cancer experience higher psychological distress and greater unmet supportive care needs than men with localized disease. A mindfulness-based cognitive therapy group intervention was pilot tested for acceptability and effectiveness in this patient group. Nineteen men were initially recruited to three groups and 12 completed final assessments. Outcomes assessed included anxiety, depression, cancer-related distress, prostate cancer-specific quality of life, and mindfulness skills at baseline, immediately, and 3 months post-intervention. Satisfaction measures and in-depth interviews were undertaken post-intervention to describe men's personal experiences of the groups. Significant improvements were observed for anxiety (p = 0.027), avoidance (p = 0.032), and mindfulness skills (p = 0.019), with a trend for a reduction in fear of cancer recurrence (p = 0.062). Effect sizes were moderate to large. A shared group identity, acceptance of, and learning from other group members were key aspects of the group context that contributed to acceptance of progressive disease. Mindfulness-based group interventions appear to have utility in this patient group and show promise for reducing anxiety, avoidance, and fear of cancer recurrence. Peer learning appeared to be helpful in generating acceptance of advancing disease.

Akzeptanz- und achtsamkeitsbasiertes Gruppenkonzept für Patienten mit fortgeschrittenem Diabetes Typ 2: Konzept und praktische Erfahrungen

Patients with type 2 diabetes mellitus and early diabetic nephropathy have a poor disease-related prognosis; furthermore these patients are often also mentally stressed. We investigated an acceptance- and mindfulness-based group intervention for these patients in addition to regular medical therapy. Both intervention program and descriptive outcomes of patients' evaluation are presented. A total of 51 patients attended the groups. Patients reported developing a mindfulness attitude towards life during the group process as well as an improvement in pain, sleep and worrying.

The effects of mindfulness‐based group intervention on the mental health of middle‐aged Korean women in community

AbstractThis study was conducted to develop a mindfulness and self‐compassion enhancement intervention for middle‐aged women who complained of emotional distress and to ascertain whether participation in the mindfulness‐based programme was associated with an increase in psychological well‐being and the improvement of psychological symptoms. The results showed that time by group interactions were significant in improving psychological well‐being, depression, anxiety, hostility, somatization, positive affect (PA) and negative affect (NA). These results suggest that participants in the mindfulness and self‐compassion group programme appeared to have enhanced psychological well‐being and improved psychological distress. The study findings also suggest that mindfulness and self‐compassion enhancement programme may be an intervention with potential for helping many individuals to learn to deal with emotional distress. Copyright © 2010 John Wiley &amp; Sons, Ltd.

The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical Distress

To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress. Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention. The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction. Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment. Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests. Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety. Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy.

A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This report describes the development and implementation of a 10-week cognitive-behavioral mindfulness-based group intervention designed to reduce binge eating and address the specific needs of bariatric surgery patients. Posttreatment data showed improvement in binge eating symptoms, depressive symptomatology, and emotion regulation skills and increased motivation to change maladaptive eating behavior.

Myopathy of hypothyroidism.

<h3>Introduction</h3> People with fibromyalgia (FM) suffer from symptoms such as widespread pain, non-refreshing sleep, fatigue and reduced quality of life. Effects of pharmacological treatment are questionable and non-pharmacological treatments are recommended as first-line therapy. To date the majority of patients with FM in Norway are not offered any targeted treatment. The aim of this randomised controlled trial is to investigate the effects of a community-based multicomponent rehabilitation programme comprising an acceptance-based and mindfulness-based group intervention, the Vitality Training Programme (VTP), followed by tailored physical activity counselling. <h3>Materials and methods</h3> General practitioners refer potential participants to a rheumatologist in specialist healthcare for diagnostic clarification and assessment of comorbidities. Inclusion criteria are widespread pain/FM ≥3 months, age 20–50 and work participation (minimum part-time) within the last 2 years. The intervention group attends the VTP comprising 10 weekly 4 hour group sessions plus a booster session after 6 months. Thereafter, they receive 12 weeks of individually tailored physical exercise counselled by physiotherapists at community-based Healthy Life Centers. The control group follows treatment as usual. The primary outcome is Patient Global Impression of Change. Secondary outcomes include self-reported pain, fatigue and sleep quality, psychological distress, mindfulness, health-related quality of life, physical activity, work ability and exercise beliefs and habits. To achieve a power of 80% and allow for 10% dropout, 70 participants are needed in each arm. All analyses will be conducted on intention-to-treat bases and measured as differences between groups at 12 months follow-up. <h3>Ethics and dissemination</h3> The study is approved and granted by the Norwegian South-Eastern Regional Health Authority (reference 2016015). Ethics approval was obtained from Regional Committee for Medical and Health Research Ethics (reference 2015/2447/REK sør-øst A). Results will be submitted to appropriate journals and presented in relevant conferences and social media. <h3>Trial registration</h3> ISRCTN96836577.