Mindfulness-based Stress Management Research Articles

A Qualitative Analysis of a Mindfulness-Based Stress Management Program to Reduce Stress and Burnout for Health Care Staff.

Occupational stress in the work setting can lead to burnout. Health care workers are at a higher risk of experiencing stress and burnout. Mindfulness has gained momentum as a coping mechanism for stress and feelings of burnout, although it is unknown which mindfulness practices are the most effective for reducing feelings of occupational stress. The purpose of the qualitative portion of this mixed-methods study was to explore health care staff's perceptions of the characteristics of mindfulness interventions that were effective in reducing their stress and feelings of burnout. Health care staff consisting of nurses, State Tested Nursing Aides, housekeeping staff, culinary staff, activities staff, social workers, and chaplain staff ( N =48) in a senior care and rehabilitation setting in a Midwestern city were invited to attend a semi-structured focus group, post-intervention. Thematic analysis was used to identify 3 main themes: ease of use promotes effective implementation, positive impact of mindfulness on self and others, and home- and work-related factors affect implementation. Overall, participants perceived benefit from various mindfulness practices for reducing their feelings of stress and burnout in the workplace. Guidance, ease of use of the mindfulness practice, and addressing barriers such as time and location can help with implementation.

Protocol of the HARMONY study: A culturally relevant, randomized-controlled, stress management intervention to reduce cardiometabolic risk in African American women

BackgroundAfrican American Women (AAW) are at high risk for stress-related cardiometabolic (CM) conditions including obesity, heart disease, and diabetes. Prior interventions lack attention to culturally-nuanced stress phenomena (Superwoman Schema [SWS], contextualized stress, and network stress), which are positively and significantly associated with unhealthy eating and sedentary behavior. PurposeThe HARMONY Study is designed to test a culturally tailored mindfulness-based stress management intervention to address SWS, contextualized stress, and network stress as potential barriers to adherence to healthy exercise and eating goals. The study will help AAW build on their strengths to promote cardiometabolic health by enhancing positive reappraisal, self-regulation, and self-efficacy as protective factors against chronic stress-inducing biobehavioral morbidity and mortality risk. MethodsThis two-arm, randomized-controlled trial will test the effects of two group-based, online interventions. HARMONY 1 includes culturally-tailored exercise and nutrition education. HARMONY 2 includes mindfulness-based stress reduction, exercise, and nutrition education. We aim to recruit 200 AAW ≥ 18 years old with CM risk. ResultsPrimary outcomes (actigraphy and carotenoid levels) and secondary outcomes (body composition, inflammatory markers, glucose metabolism, and stress) are being collected at baseline and 4-, 8-, and 12-months post-intervention. Intent-to-treat, data analytic approaches will be used to test group differences for the primary outcomes. DiscussionThis study is the first to address culturally-nuanced stress phenomena in AAW (SWS, network stress, and contextualized stress) using culturally-tailored stress management, exercise, and nutrition educational approaches to reduce biobehavioral CM risk among AAW. Quantitative and qualitative results will inform the development of scalable and sustainable CM risk-reduction programming for AAW. Trial registrationThe Multiple PIs registered the clinical trial (Identifier: NCT04705779) and reporting of summary results in ClinicalTrials.gov in accordance with the NIH Policy on the Dissemination of NIH-Funded Clinical Trial Information, within the required timelines.

TIP24-196: Efficacy of a Mindfulness-Based Stress Management Program for Allogeneic HCT Caregivers: Trial in Progress.

TIP24-196: Efficacy of a Mindfulness-Based Stress Management Program for Allogeneic HCT Caregivers: Trial in Progress.

Nörodejeneratif Hastalıklarda Rehabilitasyonun Psikososyal Yönleri ve Yaklaşım Alanları

Psychosocial health is a concept included in definition of health by World Health Organization and corresponds to state of emotional and social well-being. In the context of neurological disorder, psychosocial health refers to social reintegration and psychological adjustment. Studies reporting that neurological diseases are associated with negative psychosocial health outcomes such as a decrease in the quality of life, a decrease in ability to establish and maintain social relationships, and an increase in high levels of depression, stress and anxiety have increased in recent years. Therefore, it is important to consider programs and interventions that can improve the psychosocial health of people with neurodegenerative diseases. Currently, it is not clear which psychosocial approaches can produce definitively positive results. The aim of this study is to examine how being an individual with Multiple Sclerosis and Parkinson's, which are the most common neurodegenerative diseases in the clinic, affects psychosocial health in the rehabilitation process and the existing evidence-based psychosocial approaches. For this purpose, a descriptive review was prepared by scanning English and Turkish articles with keywords on psychotherapeutic, psychosocial and mindfulness-based interventions and stress management, published in the determined databases in the last 10 years. Studies have shown that psychosocial approaches such as interventions for acquisition of social integration and adaptive coping strategies, cognitive and social behavioral therapy methods, concentration and movement-based mind-body exercises are effective in rehabilitation of neurodegenerative diseases. These approaches were reported to have benefits in reducing anxiety, depression and fatigue, improving sleep quality and quality of life, relationships, employment, level of participation, motivation and self-efficacy in exercise and physical activity, improving physical functions, facilitating difficult and personal experiences and adaptation to new life in rehabilitation processes and more evidence-based studies are needed.

Digital Cognitive Behavioral- and Mindfulness-Based Stress-Management Interventions for Survivors of Breast Cancer: Development Study.

Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework. This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI). The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations. For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements. This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer. RR2-10.2196/47195.

The efficacy of Persian Version of Mindfulness-Based Stress Management app (Aramgar) for college’s mindfulness skills and perceived stress

Functional mobile applications are regarded as one of the brand-new approaches to psychological interventions in different areas, including stress. The study aims to analyze a mobile application for Persian users on perceived stress and improve mindful skills. This study was a one-group pretest-posttest design with a quasi-experimental research design. Three instruments were used in this study: the Five Factor Mindfulness Questionnaire (FFMQ), the Perceived Stress Scale (PSS-10), and the Mobile App Rating Scale (MARS). Eighty-five students participated in an 8-week mindfulness mobile app (Aramgar) for at least 10 minutes per day intervention. They responded to validated outcome measures of stress and mindfulness at baseline after the 8-week continued access period. The mobile application, Aramgar, was designed based on Mindfulness-based stress reduction. Paired t-tests showed significant differences in general perceived stress (P = 0.03) and total score of mindfulness (P = 0.002) before and after Aramgar. The results of analyzing the quality of Aramgar in terms of engagement, functionality, aesthetics, and information quality showed that specialists assessed the quality of the application appropriately. Using functional mobile apps provides ease of use for mental health services. Therefore, to strengthen and develop the mentioned services, it is recommended that the necessary information technology infrastructures be provided and the existing limitations for designing and running mental health mobile apps be removed.

Coping After Breast Cancer: Protocol for a Randomized Controlled Trial of Stress Management eHealth Interventions.

One-third or more of breast cancer survivors report stress and other psychological and physical complaints that can negatively impact their quality of life. Psychosocial stress management interventions, shown to mitigate the negative impact of these complaints, can now be delivered as accessible and convenient (for the patient and provider) eHealth interventions. In this randomized controlled trial (RCT), Coping After Breast Cancer (CABC), 2 modified versions of the stress management eHealth intervention program StressProffen were created: one with predominantly cognitive behavioral stress management content (StressProffen-cognitive behavioral therapy intervention [StressProffen-CBI]) and another with predominantly mindfulness-based stress management content (StressProffen-mindfulness-based intervention [StressProffen-MBI]). This study aims to investigate the effects in breast cancer survivors of using StressProffen-CBI and StressProffen-MBI compared with a control group (treatment as usual). Women diagnosed with breast cancer (stage I-III, unequivocally human epidermal growth factor receptor 2-positive or estrogen receptor-negative tumors) or ductal carcinoma in situ (DCIS) aged 21-69 years who completed the Cancer Registry of Norway-initiated health survey on quality of life are invited to the CABC trial about 7 months after diagnosis. Women who give consent to participate are randomized (1:1:1) to either the StressProffen-CBI, StressProffen-MBI, or control group. Both StressProffen interventions consist of 10 modules of stress management content delivered through text, sound, video, and images. The primary outcome is between-group changes in perceived stress at 6 months, assessed with Cohen 10-item Perceived Stress Scale. The secondary outcomes comprise changes in quality of life, anxiety, depression, fatigue, sleep, neuropathy, coping, mindfulness, and work-related outcomes approximately 1, 2, and 3 years after diagnosis. Long-term effects of the interventions on work participation, comorbidities, relapse or new cancers, and mortality will be assessed using data from national health registries. Recruitment is scheduled from January 2021 to May 2023. The goal is to recruit 430 participants (100 in each group). As of April 14 2023, 428 participants have been enrolled. The CABC trial is possibly the largest ongoing psychosocial eHealth RCT in patients with breast cancer. If 1 or both interventions prove to be effective in reducing stress and improving psychosocial and physical complains, the StressProffen eHealth interventions could be beneficial, inexpensive, and easily implementable tools for breast cancer survivors when coping with late effects after cancer and cancer treatments. Clinicaltrials.gov NCT04480203; https://clinicaltrials.gov/ct2/show/NCT04480203. DERR1-10.2196/47195.

The Effects of Mindfulness-Based Stress Reduction and Stress Management Education on Arterial Stiffness, Trait Anxiety, and Sympathetic Regulation

Mindfulness-based stress reduction (MBSR) has been shown to reduce blood pressure and anxiety in several studies, but the effects of MBSR on arterial stiffness and muscle sympathetic nerve activity (MSNA) have not been studied. We hypothesized that MBSR would lower arterial stiffness and MSNA. The present study randomized 22 adults (17 male; 5 female; age 25±1 years; BMI 26±1 kg/m2) with elevated blood pressure (i.e., ≥120/80 mmHg) into 8 weeks of MBSR or stress management education (SME). We examined resting blood pressure, heart rate, trait anxiety, arterial stiffness, and MSNA within 10 days before and after each of the 8-week interventions. Ten participants were randomized into the MBSR group, and 12 into the SME group. Resting blood pressure and heart rate were recorded as the average of three readings from an automated cuff in the seated position. Arterial stiffness was estimated as the average of two carotid-femoral pulse wave velocity (cfPWV) recordings in the supine position, and MSNA was recorded as burst frequency via direct post-ganglionic recordings from the peroneal nerve in a subset of participants. Mean arterial blood pressure was unchanged from pre- to post in either group, but heart rate was reduced from pre- to post in the MBSR participants (77±4 vs. 69±3 beats/min; p=0.01). There was a significant time-effect for trait anxiety, with raw scores reduced from pre- to post (38±3 vs. 34±2 a.u.; p=0.02). cfPWV was unchanged from pre to post (5.6±0.2 vs. 5.4±0.2 m/s; p=0.25), and MSNA was also unchanged (time-effect p=0.51) by MBSR (14±2 vs. 12±3 bursts/min; n=5) or SME (16±1 vs. 15±2 bursts/min; n=5). Results of the present study confirm that MBSR can have beneficial effects such as reducing HR and trait anxiety. Our results suggest that MBSR and SME do not change arterial stiffness or resting MSNA, but this may deserve further investigation in other at-risk populations. NIH (1R15HL140596-01) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Online, low-volume meditation does not alter immune-related biomarkers

ObjectivesPrior studies of mindfulness meditation have demonstrated anti-inflammatory and immunoregulatory effects but whether meditation courses delivered online can exert similar effects is poorly understood. Barriers to large scale implementation of traditional mindfulness meditation programs has created an increased interest in the effect of less time- and resource-intensive online meditation courses. The purpose of this study was to determine whether a 6-week online mindfulness program with low time demands on nurses would lead to changes in gene expression, cytokine profiles, telomerase activity, and cortisol profiles. MethodsThis was a randomized, parallel pilot study comparing an online mindfulness-based stress management program to an active control group from December 2018 to May 2019. Healthy nurses with above average levels of perceived stress were randomized to receive a 6-week online mindfulness-based stress management program including ≥5 min daily meditation practice or listen to relaxing music for ≥5 min daily as the control arm. Blood samples were collected at baseline and after 6 weeks, and various self-reported measures of stress, physical and emotional health were collected at baseline, after 6 weeks, and after 12 weeks. Whole transcriptome mRNA sequencing of whole blood at baseline and after 6 weeks was performed along with measurement of plasma IL-6, IL-8, IL-10, TNF-α, and IFN-γ. Peripheral blood mononuclear cells were isolated, and telomerase activity was measured. Diurnal salivary cortisol profiles were assessed at baseline and after 6 weeks. The primary outcome was change over time in a pre-determined set of 53 genes representative of the immune-related changes seen with stress, which was analyzed using a mixed linear model. Secondary outcomes included all other self-reported measures and biomarkers mentioned above. ResultsA total of 61 nurses were randomized, with 52 having sufficient data to include in the final analysis. After 6 weeks, nurses in the control group reported significant reductions in stress as measured by the Perceived Stress Scale while those in the mindfulness group did not. However, after 12 weeks, the mindfulness group also showed a significant reduction in stress. When compared to the control group, no significant changes in RNA gene expression or any other biomarkers were observed in the nurses who participated in the mindfulness program. ConclusionsOur study found that this brief online mindfulness-based intervention was effective in reducing stress in nurses, albeit with a delayed effect compared to listening to relaxing music. Regarding immunoregulatory effects, there were no significant differences between treatment and control groups in transcriptomic or other tested biomarkers of immune function. This study provides evidence for a floor effect of mindfulness on transcriptional and circulating biomarkers of immune function.

Potential benefits of a virtual, home-based combined exercise and mindfulness training program for HSC transplant survivors: a single-arm pilot study

PurposeImpaired quality of life (QOL) including reduced physical fitness is a recognized late effect of hemopoietic cell transplantation (HCT). Guided exercise and mindfulness-based stress management (MBSM) programs have shown promise, mainly in the inpatient setting. We aimed to examine the feasibility of a virtual, home-based, combined exercise and MBSM program.MethodsPatients attending post-HCT clinic were invited to participate in this single-arm pre-post study. Eligibility criteria included age 18–75 years, > 6 months post allogeneic HCT. Consented participants attended an in-person session, followed by weekly exercise and MBSM training for 6 weeks via videoconferencing. Assessments were performed pre-training, and at 3-, 6- and 12-months and compared using a linear mixed effects model.Results21 of 24 patients consenting to the study completed the program (median age 56 years [IQR 46–62], median time post-HCT 37 months [IQR 26–46]). Six-minute walk test scores were significantly higher at 3 (mean difference 79.6, 95%CI 28–131, ES 0.55) and 12 months (mean difference 48.4, 95%CI 13–84, ES 0.33) compared to baseline. Sit-to-stand test was significantly higher at 3 (mean difference 4.4, 95%CI 1.4–7.4, ES 0.68) and 12 months (mean difference 3.9, 95%CI 0.24–7.6, ES 0.61). Dominant hand grip was significantly stronger at 3 (mean difference 0.16, 95%CI 0.04–0.28, ES 0.45), and 12 months (mean difference 0.21, 95%CI 0.08–0.24, ES 0.62). Significantly higher FACT-BMT total (mean difference 6.9, 95%CI 1.5–12.4, ES 0.49) and FACT-G scores (mean difference 5.2, 95%CI 1.4–9.1, ES 0.48) were found at 3 months. Over 80% of participants rated the virtual combined modal program highly and no adverse events were reported.ConclusionA 6-week virtual, home-based exercise and MBSM program was an acceptable, and potentially effective intervention for sustained improvement of some physical capacity and QOL outcomes in HCT survivors. Virtual-based healthcare service is highly relevant particularly during pandemics. To our knowledge, this study has the longest follow-up observation period for Internet based combined modality training program reported to date and warrants additional investigation.Trial Registration Research protocol approved by St Vincent’s Hospital Ethics Committee (HREC 12/SVH/175), approved 27/09/2012, trial commenced 24/05/13 and the first participant 07/06/13. Retrospectively registered with ANZCTR (ACTRN12613001054707) 23/09/2013.

Impact of Mindfulness-Based Stress Management Treatment on the Psychological Disorders of Individuals with Chronic Medical Problems

Aim: The goal of this research would have been to look at the impact of mindfulness-based stress decrease on despair, stress, in addition emotional stress in individuals having various chronic medical conditions. Methods: To investigate the benefits of MBSR on depression, anxiety, and emotional stress, a review and meta-analysis were conducted. The impact of study quality on possessions of MBSR remained investigated. Results: Ten researches randomized control trials have been included. The total impact size on sadness was 0.28, showing that MBSR had little effect on mental health. Anxiety had an effective dose of 0.48. The validity of the research, however, was shown to reduce this impact magnitude. When low-quality research was eliminated, an effect size of 0.26 on stress was discovered. Emotional trauma also had a minor impact size (0.35). Conclusion: It is possible to infer that MBSR has only a minor impact on despair, concern, also psychological discomfort in individuals through chronic somatic conditions. The use of MBSR in behavioral treatment can increase effectiveness of mindfulness-grounded therapies. Keywords: Mindfulness-Based Stress Management Treatment, Anxiety, emotional trauma, medical disease.

The effectiveness of adapted group mindfulness-based stress management program on perceived stress and emotion regulation in midwives: a randomized clinical trial

BackgroundMidwives' stress can have negative consequences on their emotional state, burnout, and poor quality of midwifery care. This study aimed to determine the effectiveness of an adapted mindfulness-based stress management program on perceived stress and the emotional regulation of midwives.MethodsThe study was a parallel randomized clinical trial on the midwives working in general hospitals of Zanjan, Iran. In this study, 121 midwives registered to participate based on the census sampling method were screened using a cut point of ≥ 28 in the Perceived Stress Scale (PSS). From the initial sample, 42 subjects had inclusion criteria assigned to two groups of control (n = 21) and intervention (n = 21) using online random allocation. The intervention group received an 8-week adapted mindfulness-based stress management program. This program emanates from the Kabat-Zinn's MBSR program, which has been adjusted according to the Iranian culture. The ANCOVA and repeated measure analysis of variance test were used to compare groups over time.ResultsThe results showed that the group intervention effectively affected perceived stress (P = 0.001) and difficulty in emotion regulation during the post-intervention period (P = 0.001). Moreover, the interventions were effective in emotion regulation (P = 0.003), but it was not effective on perceived stress (P = 0.125) at the 3-month follow-up.ConclusionsThis adapted mindfulness-based program successfully reduced stress and increased emotion regulation strategies in midwives; however, the long-term outcomes of this treatment program need further consideration.

Pandemic Deployment of a Smarthealth Technology to Improve Stress in Dementia Family Caregivers

Caregiving stress from repetitive and heavy caregiving workloads can trigger poor emotional health, such as stress, anxiety, and depression, leading to higher caregiver mortality rates. Interest in technology-based interventions for this population has increased among researchers due to availability, acceptability, and flexibility compared to in-person services, especially now, during an unprecedented pandemic. Our study focuses on in-home SmartHealth technologies for caregivers of persons with Alzheimer’s Disease and related dementias, delivered using Ecological Momentary Assessment and a novel acoustic monitoring, mood recognition, and self-learning recommendation system. The system provides mindfulness-based stress management in response to interpersonal conflict in real-time. We will report challenges and solutions of creating and deploying a SmartHealth system for older adults in their home during the COVID-19 pandemic. Potential effects of this system on caregivers' emotional health are also examined. Findings suggest SmartHealth technologies may assist caregiving populations adapt and thrive in a new, more isolated normal.

Potential Benefits of a 6-Week Exercise and Mindfulness-Based Telehealth Training for HCT Survivors to Meet the Challenges of the COVID-19 Pandemic - a Feasibility Study

Background: Impairment of quality of life (QOL) such as reduced physical fitness and psycho-social dysfunction, is a recognized late effect of HCT, a life-saving procedure. Guided exercise and mindfulness-based stress management (MBSM) programs, delivered alone or in combination, have shown promise in improving patient's QOL mainly in the inpatient setting. Delivery of equitable and effective interventions in outpatient settings is challenging but may be addressed via telecommunication technology, reducing clinic visits and infection transmission. The aim of this study is to examine the feasibility and efficacy of a virtual and home-based program of combined exercise and MBSM via videoconference.Methods: Patients attending our post-HCT outpatient clinic were invited to participate (SVH HREC approval 12/175). Eligibility criteria included aged 18-75 years, >6 months post allogeneic HCT and the basic skills to access the online training and assessment packages. Patients with severe medical and psychological problems were excluded by their clinicians. Consented participants attended an initial in-person introductory session and were provided materials including booklet and audio recordings for skill practice. This was followed by once weekly exercise and MBSM training for 6 weeks via videoconferencing. Assessments were performed pre, and then virtually post training, and at 3, 6 and 12 months. Assessment session included: 6-minute walk test (6-MWT), Modified Bruce Test (MBT), sit-to-stand (STS), hand grip strength (HGS). Subjective measures were Goal Attainment Scale, Karnofsky Score, FACT-BMT, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, and Godin-Shephard Leisure Time Index. Linear mixed-effects model was used for outcome comparisons. This maximum likelihood approach utilizes all acquired data points and manages missing data points by missing at random (MAR) assumption. P values were adjusted using Holm-Sidak method for multiple comparisons.Results: Twenty-four eligible patients responded to the invitation and completed the program (54% male, median age 53 years (33 - 73), median time post-HCT of 37 months (13 - 68), 38% rural/remote). Based on participant feedback surveys at 6 months, this combined modality telehealth program was found to be well-accepted and safe.The 6-MWT scores were significantly higher at 3 and 12 months (M=646.5m, SD=53.34 and M=615.33m, SD= 94.95, respectively; both p < 0.01) compared to baseline (M=566.94, SD=145.22). The MBT, the only test that required participants to attend the clinic was ceased after 3 months as changes in 6-MWT paralleled changes in MBT. STS Test was significantly higher at 3 and 12 months (M=19.53, SD=6.93, p<0.01 and M=19.07 SD= 8.0; both p < 0.05) compared to baseline (M=15.14, SD=6.44). For the upper limb assessment, dominant hand grip was significantly stronger at 3, and 12 months (M=35.09, SD=9.83; p< 0.01) compared to baseline (M=29.07, SD=9.79). A significantly higher FACT-BMT total and FACT-G scores were found at 3 months (M=123.37, SD=15.12 and M=91.23, SD=11.76; p< 0.01) compared to baseline (M=116.44, SD=14.16 and M=88.25, SD=12.52 respectively), and a trend non-significant at 12 months.Conclusion: A 6-week internet and home-based exercise and MBSM programme was an acceptable, safe, and potentially effective intervention for sustained improvement of some QOL outcomes in HCT survivors. The positive findings of this feasibility study provided valuable data for the design of a multicentre RCT that is underway . DisclosuresNo relevant conflicts of interest to declare.

A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder

BackgroundRecently, mindfulness-based therapies have emerged as a treatment modality for OCD, but there is sparse controlled data. We report the efficacy of mindfulness-based cognitive therapy (MBCT) in treating OCD in comparison with stress management training (SMT). Methods60 outpatients with DSM-IV-TR OCD attending a specialty OCD clinic were randomly assigned in 1:1 ratio to either MBCT (n=30) or SMT (n= 30). Both the groups received 12 weekly sessions of assigned intervention. An independent blind rater assessed the primary outcome measure at baseline and at the end of 12 weeks. ResultsSignificantly greater proportion of patients responded to MBCT than to SMT (80% vs. 27%, P <0.001). In the linear mixed-effects modelling for intent-to-treat analysis, there was a significant reduction in the illness severity measured using the Yale-Brown Obsessive-Compulsive Scale, obsessive beliefs of ‘responsibility/threat estimation’ and ‘perfectionism/intolerance of uncertainty’ measured using the Obsessive Beliefs Questionnaire and anxiety. LimitationsSmall sample size with a relatively high attrition in the control group. Lack of a cognitive behaviour therapy (CBT) control group. ConclusionsMindfulness-based cognitive therapy is efficacious in the treatment of OCD. Future studies should compare MBCT with CBT in larger representative samples and also examine the sustainability of change in longitudinal studies.

Teaching mindfulness-based stress management techniques to medical learners through simulation.

Implication StatementAcutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers. The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.

Acceptability and perceived effectiveness of a single-session mindfulness intervention for medical residents

Introduction: Medical residents report high levels of stress, with many work-related demands contributing to their experience of heightened stress. Mindfulness training has been suggested as a beneficial strategy for stress management with residents; however, many mindfulness programs are time-consuming, and compliance with conventional mindfulness training programs becomes challenging given the intense, competing time commitments of residency. The present study sought to evaluate the acceptability and perceived effectiveness of a single-session, mindfulness-based stress management workshop for medical residents.Methods: Residents (n = 142) from family medicine, internal medicine and general surgical residency programs participated in a 1.5-hour mindfulness workshop in 2016 and completed: a measure of workshop satisfaction immediately post-workshop; a measure of adherence to suggested strategies 4–6 weeks post-workshop; and measures of stress, mindfulness and positive and negative affect immediately post-workshop and 4–6 weeks post-workshop.Results: Results revealed high levels of satisfaction with the workshop. Participants who used the recommended strategies over the 4 to 6-week post-workshop period reported significant increases in mindfulness and significant decreases in stress at follow-up.Conclusions: Results suggest single-session mindfulness training can be beneficial for residents who use the strategies effectively; however, ensuring strategy use following training is challenging. Future research is needed to investigate facilitators and barriers to strategy use.

Enhanced mindfulness-based stress reduction in episodic migraine: a randomized clinical trial with magnetic resonance imaging outcomes.

We aimed to evaluate the efficacy of an enhanced mindfulness-based stress reduction (MBSR+) vs stress management for headache (SMH). We performed a randomized, assessor-blind, clinical trial of 98 adults with episodic migraine recruited at a single academic center comparing MBSR+ (n = 50) with SMH (n = 48). MBSR+ and SMH were delivered weekly by group for 8 weeks, then biweekly for another 8 weeks. The primary clinical outcome was reduction in headache days from baseline to 20 weeks. Magnetic resonance imaging (MRI) outcomes included activity of left dorsolateral prefrontal cortex (DLPFC) and cognitive task network during cognitive challenge, resting state connectivity of right dorsal anterior insula to DLPFC and cognitive task network, and gray matter volume of DLPFC, dorsal anterior insula, and anterior midcingulate. Secondary outcomes were headache-related disability, pain severity, response to treatment, migraine days, and MRI whole-brain analyses. Reduction in headache days from baseline to 20 weeks was greater for MBSR+ (7.8 [95% CI, 6.9-8.8] to 4.6 [95% CI, 3.7-5.6]) than for SMH (7.7 [95% CI 6.7-8.7] to 6.0 [95% CI, 4.9-7.0]) (P = 0.04). Fifty-two percent of the MBSR+ group showed a response to treatment (50% reduction in headache days) compared with 23% in the SMH group (P = 0.004). Reduction in headache-related disability was greater for MBSR+ (59.6 [95% CI, 57.9-61.3] to 54.6 [95% CI, 52.9-56.4]) than SMH (59.6 [95% CI, 57.7-61.5] to 57.5 [95% CI, 55.5-59.4]) (P = 0.02). There were no differences in clinical outcomes at 52 weeks or MRI outcomes at 20 weeks, although changes related to cognitive networks with MBSR+ were observed. Enhanced mindfulness-based stress reduction is an effective treatment option for episodic migraine.

Mindfulness' effects on stress, coping, and mood: A daily diary goodness-of-fit study.

Dispositional mindfulness is often linked to higher positive affect and lower negative affect, and coping with stress has been hypothesized to mediate these links. However, few studies have explicitly tested the ways in which stress appraisals, coping strategies, or coping flexibility (i.e., fit of coping to controllability appraisals) uniquely relate to mindfulness and well-being. Drawing on a stress and coping framework, the present study tested the degree to which (a) lower stress appraisals mediate mindfulness' effects on daily positive and negative affect; (b) daily coping mediates mindfulness' impact on daily positive and negative affect, above and beyond the effects of stress appraisals; and (c) coping flexibility mediates mindfulness' impact on positive and negative affect, above and beyond the effects of stress appraisals and average daily coping. Participants were 157 undergraduate students (mean age = 17.81; 79% women), completing daily diary questionnaires regarding stress appraisals, coping, and affect for 1 week. Results demonstrate that lower average stress appraisals mediated 19% of mindfulness' effects on negative affect; further, average use of some "mindful" emotion-focused coping strategies (i.e., non-self-blame and acceptance) independently mediated 3%-13% of mindfulness' effects on positive and negative affect. Although mindfulness was associated with greater "fit" of problem-focused versus acceptance coping to high controllability appraisals, coping flexibility did not appear to mediate mindfulness' effects on either positive or negative affect. Thus, mindfulness-based stress management interventions may be most effective by promoting mindful coping to complement, rather than replace, problem-focused coping. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes.

African Americans have disproportionately high rates of stress-related conditions, including diabetes and diabetes-related morbidity. Psychological stress may negatively influence engagement in risk-reducing lifestyle changes (physical activity and healthy eating) and stress-related physiology that increase diabetes risk. This study examined the feasibility of conducting a randomized trial comparing a novel mindfulness-based stress management program combined with diabetes risk-reduction education versus a conventional diabetes risk-reduction education program among African American adults with prediabetes and self-reported life stress. Participants were recruited in collaboration with community partners and randomized to the mindfulness-based diabetes risk-reduction education program for prediabetes (MPD; n = 38) or the conventional diabetes risk-reduction education program for prediabetes (CPD; n = 30). The mindfulness components were adapted from the Mindfulness-based Stress Reduction Program. The diabetes risk-reduction components were adapted from the Power to Prevent Program and the Diabetes Prevention Program. Groups met for eight weeks for 2.5 hours, with a half-day retreat and six-monthly boosters. Mixed-methods strategies were used to assess feasibility. Psychological, behavioral, and metabolic data were collected before the intervention and at three and six months postintervention to examine within-group change and feasibility of collecting such data in future clinical efficacy research. Participants reported acceptability, credibility, and cultural relevance of the intervention components. Enrollment of eligible participants (79%), intervention session attendance (76.5%), retention (90%), and postintervention data collection attendance (83%, 82%, and 78%, respectively) demonstrated feasibility, and qualitative data provided information to further enhance feasibility in future studies. Both groups exhibited an A1C reduction. MPD participants had reductions in perceived stress, BMI, calorie, carbohydrate and fat intake, and increases in spiritual well-being. Considering the high prevalence of diabetes and diabetes-related complications in African Americans, these novel findings provide promising guidance to develop a larger trial powered to examine efficacy of a mindfulness-based stress management and diabetes risk-reduction education program for African Americans with prediabetes.