Mindfulness-based Stress Reduction Group Research Articles

223. A Quality Improvement Project Aimed At Integrating An Adapted Mindfulness Based Stress Reduction (MBSR-AH) Programme Into A Paediatric Psychology Service

This project used quality improvement methods to pilot the introduction of mindfulness-based stress reduction (MBSR) groups to a clinical psychology service for young people aged between 15 and 19. Quality improvement methods were used and three "Plan, Do, Study, Act” (PDSA) cycles were deployed, utilising both data on uptake and adherence together with qualitative feedback at each cycle to plan the next stage. Step 1: Taster sessions, designed to include didactic information about mindfulness, provide the opportunity for participants to experience some short meditations and also experience being in a group situation. Step 2: MBSR groups of 4 weeks in duration were rolled out into the service. A priori targets for uptake and adherence were set at 50% (i.e. at least 50% of people approached would take up the offer of joining the group and at least 50% should complete at least 75% of the sessions). Step 3: The development of MBSR-AH, an adapted MBSR programme specifically for adolescents. This was modelled on the traditional MBSR programme with adaptations to the session format, meditations used and an adolescent friendly manual was also developed. Step 1: Uptake was good and 18/25 (72%) of people referred attended the sessions. Qualitative feedback indicated that this was indeed an approach that could be acceptable to young people. Step 2: Uptake and treatment adherence were 65% (17/26) and 82% (14/17) respectively. This compared well against our a priori targets of 50% for both. Qualitative feedback indicated that these four week courses were too short and therefore we aimed to introduce a group programme of 8 weeks in duration, in line with the standard MBSR format, adapted for adolescents. Step 3: For practical reasons it was not possible to run 8 weeks courses and therefore courses of lasting 7 weeks took place. Uptake of the extended groups fell short of target at 35 % (8/22), although treatment adherence remained high with the majority of participants (6/8) completing at least 75% of the course. A mindfulness based stress reduction programme does appear to be faesible and acceptable to young people with chronic health problems. In this pilot the traditional MBSR programme has been adapted to be more adolescent friendly and these adaptations are described. The traditional 8 week course format posed some recruitment challenges and methods to address this are discussed.

Mindfulness-based stress reduction in patients with differentiated thyroid cancer receiving radioactive iodine therapy: a randomized controlled trial.

ObjectiveThe aim of this study was to evaluate the efficacy of mindfulness-based stress reduction (MBSR) on health-related quality of life (QoL), depression, and anxiety in patients with differentiated thyroid cancer (DTC) receiving radioactive iodine therapy (RIT).Patients and methodsA randomized controlled trial of MBSR with 120 DTC patients was performed. They were randomly assigned into the MBSR intervention group and usual care (UC) group. An 8-week MBSR program was administered to the MBSR group starting 8 weeks before RIT. Health-related QoL, depression, and anxiety were measured immediately before the start of MBSR (T1), immediately after RIT hospitalization was concluded (1 week after concluding the last MBSR session, T2), and 3 months after RIT hospitalization (T3), using the QoL Questionnaire Core 30 Items (QLQ-C30), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS).ResultsFifty-three patients in the UC group and 49 patients in the MBSR group completed the study and were analyzed. Both the UC and MBSR groups reported low QoL and high SDS and SAS scores immediately after RIT hospitalization. Patients randomly assigned to the MBSR group showed significantly greater improvements in emotional function (P=0.012, d=–0.03 for T2 and d=1.17 for T3), fatigue (P=0.037, d=1.00 for T2 and d=–0.69 for T3), global QoL (P=0.015, d=1.61 for T2 and d=1.56 for T3), depression (P=0.027, d=–1.19 for T2 and d=–0.83 for T3), and anxiety (P=0.043, d=–1.00 for T2 and d=–0.86 for T3).ConclusionAn 8-week MBSR program significantly improved a wide range of scales in health-related QoL and mitigated depression and anxiety among DTC patients receiving RIT.

Effectiveness of mindfulness-based stress reduction (MBSR) on symptom variables and health-related quality of life in breast cancer patients-a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of mindfulness-based stress reduction (MBSR) in breast cancer patients. A systematic search of Cochrane Library, Cochrane Central Register of Controlled Trials, PsycINFO database, Web of science, Medline, EMBASE, CNKI, and CBM database was carried out from February to May 2018, with no language restrictions. Trials examining the effects of MBSR versus control group on symptom variables and health-related quality of life were included. Data concerning studies, patient characteristics, and outcomes were extracted. Methodological quality of each included randomized controlled trials were assessed individually by two reviewers independently using criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. Meanwhile, Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate methodological quality of non-randomized studies. In all, 14 studies involving 1505 participants were included. Due to the effect of MBSR, statistically significant results were found on physiological function (SMD = 0.28, 95% CI [0.07, 0.049], P = 0.008), cognitive function (SMD = 1.48, 95% CI [0.34, 2.61], P = 0.01), fatigue (SMD = - 0.66, 95% CI [- 1.11, - 0.20], P = 0.004), emotional wellbeing (SMD = 1.01, 95% CI [0.35, 1.67], P = 0.003), anxiety (SMD = - 0.54, 95% CI [- 1.01, - 0.07], P = 0.02), depression (SMD = - 0.61, 95% CI [- 1.11, - 0.11], P = 0.02), stress (SMD = - 0.48, 95% CI [- 0.81, - 0.15], P = 0.004), distress (SMD = - 0.56, 95% CI [- 0.85, - 0.26], P = 0.0002) and mindfulness (SMD = 0.94, 95% CI [0.10, 1.79], P = 0.03). Although the effects on pain, sleep quality, and global QoL were in the expected direction, they were not statistically significant (P > 0.05) based on insufficient evidence. MBSR is worthy of being recommended to breast cancer patients as a complementary treatment or adjunctive therapy.

Mindfulness-based stress reduction for menopausal symptoms after risk-reducing salpingo-oophorectomy (PURSUE study): a randomised controlled trial.

ObjectiveTo assess the short‐ and long‐term effects of mindfulness‐based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk‐reducing salpingo‐oophorectomy (RRSO).DesignRandomised controlled trial.SettingA specialised family cancer clinic of the university medical center Groningen.PopulationSixty‐six women carriers of the BRCA1/2 mutation who developed at least two moderate‐to‐severe menopausal symptoms after RRSO.MethodsWomen were randomised to an 8‐week MBSR training programme or to care as usual (CAU).Main outcome measuresChange in the Menopause‐Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time.ResultsAt 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0–3.9) and 3.8 (95% CI 3.3–4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1–4.0) and 3.9 (95% CI 3.5–4.4). No significant differences were found between the MBSR and CAU groups in the other scores.ConclusionMindfulness‐based stress reduction was effective at improving quality of life in the short‐ and long‐term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress.Tweetable abstractMindfulness improves menopause‐related quality of life in women after risk‐reducing salpingo‐oophorectomy.

A Multisite Randomized Controlled Trial of Mindfulness-Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder.

Objective:Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence‐based treatment. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans.Methods:Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90‐minute group MBSR or present‐centered group therapy (PCGT) for eight weeks. Follow‐up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16.Results:Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician‐Administered PTSD Scale for DSM‐IV (CAPS‐IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self‐reported PTSD Checklist for DSM‐IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single‐blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women.Conclusions:Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self‐reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS‐IV scale.

Reduced Symptoms of Post-Traumatic Stress Disorder and Irritable Bowel Syndrome Following Mindfulness-Based Stress Reduction Among Veterans.

Objectives: Post-traumatic stress disorder (PTSD) and irritable bowel syndrome (IBS) are highly comorbid conditions associated with reduced health-related quality of life. Comorbid prevalence is especially high among veterans, ranging from 23% to 51%, but there is limited research on integrative treatments. Design: To improve treatment of comorbid PTSD and IBS, this study examined the impact of mindfulness-based stress reduction (MBSR) on symptom reduction and mindfulness skill building among veterans with this comorbidity. We hypothesized that veterans would report reduced trauma-related, gastrointestinal (GI) symptom-specific anxiety (GSA), and depression symptoms and greater mindfulness skills post-treatment. We also hypothesized that veterans who reported lower trauma-related GSA and depression symptoms, and reported greater mindfulness skills and MBSR session attendance would report lower irritable bowel symptoms post-treatment. Settings/Location: VA (Veterans Administration) Puget Sound Health Care System, Seattle, Washington. Subjects: Participants were 55 veterans with PTSD and IBS. Interventions: Veterans participated in an 8-week open trial of MBSR group. Outcome measures: This study measured the impact of MBSR on PTSD, IBS, GSA, and depression symptoms as well as mindfulness skills. Results: Veterans reported reduced trauma-related, irritable bowel, GSA, and depression symptoms and greater mindfulness skills immediately post-treatment. Trauma-related and depression symptom reduction were maintained 4 months post-treatment, but irritable bowel and GSA symptoms were nonsignificant. Lower baseline GSA predicted lower irritable bowel symptoms immediately post-treatment. At 4 months post-treatment, 77.50% met PTSD criteria and 40.38% met IBS criteria compared with 100% veteran comorbidity pretreatment. Conclusions: MBSR holds promise as a transdiagnostic intervention for individuals with comorbid trauma-related, depression, GSA, and irritable bowel symptoms, with maintenance of trauma-related and depression symptom improvement 4 months post-treatment.

A Large Randomized Trial: Effects of Mindfulness-Based Stress Reduction (MBSR) for Breast Cancer (BC) Survivors on Salivary Cortisol and IL-6.

Breast cancer survivors (BCS) often experience psychological and physiological symptoms after cancer treatment. Mindfulness-based stress reduction (MBSR), a complementary and alternative therapy, has reduced subjective measures of stress, anxiety, and fatigue among BCS. Little is known, however, about how MBSR affects objective markers of stress, specifically the stress hormone cortisol and the pro-inflammatory cytokine interleukin-6 (IL-6). In the present study, BCS ( N = 322) were randomly assigned to a 6-week MBSR program for BC or usual-care control. Measurements of cortisol, IL-6, symptoms, and quality of life were obtained at orientation and 6 weeks. Cortisol and IL-6 were also measured prior to and after the MBSR(BC) class Weeks 1 and 6. The mean age of participants was 56.6 years and 69.4% were White non-Hispanic. Most had Stage I (33.8%) or II (35.7%) BC, and 35.7% had received chemotherapy and radiation. Cortisol levels were reduced immediately following MBSR(BC) class compared to before the class Weeks 1 and 6 (Wilcoxon-signed rank test; p < .01, d = .52-.56). IL-6 was significantly reduced from pre- to postclass at Week 6 (Wilcoxon-signed rank test; p < .01, d = .21). No differences were observed between the MBSR(BC) and control groups from baseline to Week 6 using linear mixed models. Significant relationships with small effect sizes were observed between IL-6 and both symptoms and quality of life in both groups. Results support the use of MBSR(BC) to reduce salivary cortisol and IL-6 levels in the short term in BCS.

Feasibility and Acceptability of Mindfulness-based Cognitive Therapy Compared with Mindfulness-based Stress Reduction and Treatment as Usual in People with Depression and Cardiovascular Disorders: a Three-Arm Randomised Controlled Trial

Depression co-occurs in 20% of people with cardiovascular disorders, can persist for years and predicts worse physical health outcomes. While psychosocial treatments have been shown to treat acute depression effectively in those with comorbid cardiovascular disorders, to date, there has been no evaluation of approaches aiming to prevent relapse and treat residual depression symptoms in this group. Consequently, the current study aimed to examine the feasibility and acceptability of a randomised controlled trial design evaluating an adapted version of mindfulness-based cognitive therapy (MBCT) designed specifically for people with comorbid depression and cardiovascular disorders. A three-arm feasibility randomised controlled trial was conducted, comparing MBCT adapted for people with cardiovascular disorders plus treatment as usual (TAU), mindfulness-based stress reduction (MBSR) plus TAU and TAU alone. Participants completed a set of self-report measures of depression severity, anxiety, quality of life, illness perceptions, mindfulness, self-compassion and affect and had their blood pressure taken immediately before, after and 3 months following the intervention. Those in the adapted-MBCT arm additionally underwent a qualitative interview to gather their views about the adapted intervention. Three thousand four hundred potentially eligible participants were approached when attending an outpatient appointment at a cardiology clinic or via a GP letter following a case note search. Two hundred forty-two (7.1%) were interested in taking part, 59 (1.7%) were screened as being suitable and 33 (< 1%) were eventually randomised to the three groups. Of 11 participants randomised to adapted-MBCT, 7 completed the full course, levels of home mindfulness practice were high and positive qualitative feedback about the intervention was given. Twenty-nine out of 33 randomised participants completed all the assessment measures at all three time points. The means Patient Health Questionnaire (PHQ)-9 scores for the MBCT-Heart and Living Mindfully (HeLM) group were lower at post-intervention and at the 3-month follow-up compared to the MBSR and TAU groups. The sample was heterogeneous in terms of whether they reported current depression or had a history of depression and the time since the onset of cardiovascular disorders (1 to 25 years). The adapted-MBCT intervention was feasible and acceptable to participants; however, certain aspects of the trial design were not. In particular, low recruitment rates were achieved and there was a high withdrawal rate between screening and randomisation. Moreover, the heterogeneity in the sample was high, meaning the adapted intervention was unlikely to be well tailored to all the participants needs. This suggests that if the decision is made to move to a definitive trial, study recruitment procedures will need to be revised to recruit a target sample that optimally matches the adapted intervention.

Impact of mindfulness-based stress reduction for people with multiple sclerosis at 8 weeks and 12 months: A randomized clinical trial

Background: Mindfulness training is often used as a therapeutic intervention to manage stress and enhance emotional well-being, yet trials for multiple sclerosis (MS) are limited and few have used an active control. Objective: Assess the feasibility of mindfulness-based stress reduction (MBSR) for people with MS and evaluate the efficacy of MBSR compared to an education control. Methods: We conducted a single-blind, randomized trial of MBSR versus education control among 62 adults with MS. Primary outcomes were measures of feasibility. Secondary outcomes included perceived stress, anxiety, depression, fatigue, pain, resilience, and the Paced Auditory Serial Addition Test, assessed at baseline, 8 weeks, and 12 months. Mean scores for secondary outcome measures were compared between groups at each time point and within groups across time by analyses of covariance or paired t-tests, respectively. Results: Successful recruitment and retention demonstrated feasibility. Improvements in several secondary outcomes were observed among both MBSR and control groups. However, differences between the groups were not statistically significant at either 8 weeks or 12 months. Conclusion: Emotional well-being improved with both MBSR and education. Spontaneous improvement cannot be ruled out as an explanation for findings and additional studies that evaluate the impact of mindfulness training to improve emotional health are warranted.

Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial.

BackgroundPractice of meditation or exercise may enhance health to protect against acute infectious illness.ObjectiveTo assess preventive effects of meditation and exercise on acute respiratory infection (ARI) illness.DesignRandomized controlled prevention trial with three parallel groups.SettingMadison, Wisconsin, USA.ParticipantsCommunity-recruited adults who did not regularly exercise or meditate.Methods1) 8-week behavioral training in mindfulness-based stress reduction (MBSR); 2) matched 8-week training in moderate intensity sustained exercise (EX); or 3) observational waitlist control. Training classes occurred in September and October, with weekly ARI surveillance through May. Incidence, duration, and area-under-curve ARI global severity were measured using daily reports on the WURSS-24 during ARI illness. Viruses were identified multiplex PCR. Absenteeism, health care utilization, and psychosocial health self-report assessments were also employed.ResultsOf 413 participants randomized, 390 completed the trial. In the MBSR group, 74 experienced 112 ARI episodes with 1045 days of ARI illness. Among exercisers, 84 had 120 episodes totaling 1010 illness days. Eighty-two of the controls had 134 episodes with 1210 days of ARI illness. Mean global severity was 315 for MBSR (95% confidence interval 244, 386), 256 (193, 318) for EX, and 336 (268, 403) for controls. A prespecified multivariate zero-inflated regression model suggested reduced incidence for MBSR (p = 0.036) and lower global severity for EX (p = 0.042), compared to control, not quite attaining the p<0.025 prespecified cut-off for null hypothesis rejection. There were 73 ARI-related missed-work days and 22 ARI-related health care visits in the MBSR group, 82 days and 21 visits for exercisers, and 105 days and 24 visits among controls. Viruses were identified in 63 ARI episodes in the MBSR group, compared to 64 for EX and 72 for control. Statistically significant (p<0.05) improvements in general mental health, self-efficacy, mindful attention, sleep quality, perceived stress, and depressive symptoms were observed in the MBSR and/or EX groups, compared to control.ConclusionsTraining in mindfulness meditation or exercise may help protect against ARI illness.LimitationsThis trial was likely underpowered.Trial registrationClinicaltrials.gov NCT01654289

A randomized, controlled trial of mindfulness-based stress reduction in HIV infection

ObjectiveEvidence links depression and stress to more rapid progression of HIV-1 disease. We conducted a randomized controlled trial to test whether an intervention aimed at improving stress management and emotion regulation, mindfulness-based stress reduction (MBSR), would improve immunological (i.e. CD4+ T-cell counts) and psychological outcomes in persons with HIV-1 infection. MethodsWe randomly assigned participants with HIV-1 infection and CD4 T-cell counts >350 cells/μl who were not on antiretroviral therapy in a 1:1 ratio to either an MBSR group (n = 89) or an HIV disease self-management skills group (n = 88). The study was conducted at the University of California at San Francisco. We assessed immunologic (CD4, c-reactive protein, IL-6, and d-dimer) and psychological measures (Beck Depression Inventory for depression, modified Differential Emotions Scale for positive and negative affect, Perceived stress-scale, and mindfulness) at 3, 6 and 12 months after initiation of the intervention; we used multiple imputation to address missing values. ResultsWe observed statistically significant improvements from baseline to 3-months within the MBSR group in depression, positive and negative affect, perceived stress, and mindfulness; between group differences in change were significantly greater in the MBSR group only for positive affect (per item difference on DES-positive 0.25, 95% CI 0.049, 0.44, p = .015). By 12 months the between group difference in positive affect was not statistically significant, although both groups had trends toward improvements compared to baseline in several psychological outcomes that were maintained at 12-months; these improvements were only statistically significant for depression and negative affect in the MBSR group and perceived stress for the control group. The groups did not differ significantly on rates of antiretroviral therapy initiation (MBSR = 39%, control = 29%, p = .22). After 12 months, the mean decrease in CD4+ T-cell count was 49.6 cells/μl in participants in the MBSR arm, compared to 54.2 cells/μl in the control group, a difference of 4.6 cells favoring the MBSR group (95% CI, −44.6, 53.7, p = .85). The between group differences in other immunologic-related outcomes (c-reactive protein, IL-6, HIV-1 viral load, and d-dimer) were not statistically significant at any time point. ConclusionsMBSR improved positive affect more than an active control arm in the 3 months following the start of the intervention. However, this difference was not maintained over the 12-month follow-up and there were no significant differences in immunologic outcomes between intervention groups. These results emphasize the need for further carefully designed research if we are to translate evidence linking psychological states to immunological outcomes into evidence-based clinical practices.

Mindfulness-Based Stress Reduction (MBSR) or Psychoeducation for the Reduction of Menopausal Symptoms: A Randomized, Controlled Clinical Trial

Psychological and behavioural interventions may be effective in reducing menopause-related symptoms. This randomized controlled trial aimed to evaluate the effectiveness of Mindfulness-based Stress Reduction (MBSR) in reducing menopause-related symptoms by comparing with an active control group, the menopause education control (MEC). Symptomatic peri-menopausal and post-menopausal women with mild to moderate symptoms were recruited. The primary outcome was overall menopausal symptoms measured by modified Greene Climacteric Scale (GCS). Secondary outcomes include subscales of the GCS perceived stress, mindfulness and health related Quality of Life. All outcome measures were collected at baseline, 2 months (immediately post intervention), 5 and 8 months (3 and 6 months post intervention respectively). Both MBSR (n = 98) and MEC (n = 99) groups reported a reduction in total GCS score at 8 months. Between group analysis show significant symptom score reduction in MBSR group on Anxiety and Depression subscales of GCS. No differences were found between groups on other GCS subscales and majority of the secondary outcome measures. The findings show that menopausal symptoms in both MBSR and MEC significantly reduced over the study period. MBSR show a greater reduction of psychological symptoms of depression and anxiety above active controls but do not reduce other somatic, urogenital and vasomotor symptoms.

Effects of mindfulness-based stress reduction on prenatal stress, anxiety and depression

Low well-being is common among Chinese pregnant women but few effective interventions currently exist to improve prenatal stress and negative emotions. Mindfulness-based stress reduction (MBSR) has been proved to be effective in reducing stress and rarely studies were focused on Chinese pregnant women. The aim of the current paper is to investigate the effects of 8-week MBSR on prenatal stress, anxiety and depression among Chinese pregnant women. A sample of 66 pregnant women randomly allocated into either the MBSR group (n=34) or the control group (n=32). Participants in the MBSR group received a group 8-week, 90-min each time intervention. The results found a significant interaction between time and condition for prenatal stress (F=45.51, p<0.001, η2=0.427), anxiety (F=19.30, p<0.001, η2=0.240), while depression showed no time-by-group interaction (F=0.29, p=0.589, η2=0.005). As for the sub-scale of state anxiety, while there was only no time effect (F=3.68, p=0.060, η2=0.057). The findings of this study preliminary indicated effects of the MBSR intervention on self-reported prenatal stress and anxiety in comparison to a treatment-as-usual control. Effect on depression was not observed may due to the low level of depression of participants. This study provides preliminary evidence that MBSR is suitable for Chinese pregnant women and be effective in decreasing prenatal stress, anxiety.

The effectiveness of acupuncture and mindfulness-based stress reduction (MBSR) for patients with multiple sclerosis associated fatigue – A study protocol and its rationale for a randomized controlled trial

IntroductionFatigue plays an important role in the daily activity of patients with multiple sclerosis (MS) and strongly influences their quality of life. Numerous clinical trials evaluating various interventions for fatigue in MS have shown only minor benefits. The main aim of the present trial is to evaluate whether 1) acupuncture or 2) mindfulness-based stress reduction (MBSR) in addition to usual care are effective in reducing fatigue in MS patients compared to usual care alone. MethodsWithin a randomized, three-arm, controlled trial we aim to include 141 MS patients aged 18–65 years with fatigue for at least 3 months and an average score of ≥4 on the Fatigue Severity Scale (FSS). Patients will be randomized into three groups: an acupuncture group receiving 12 weeks of acupuncture in addition to usual care, a MBSR group receiving 12 weeks of MBSR in addition to usual care, and a usual care group continuing their previous treatment. Primary outcome is the Fatigue Severity Scale (FSS) after 12 weeks. To assess the trial’s characteristics regarding efficacy and effectiveness we used the pragmatic explanatory continuum summary (PRECIS-2). DiscussionThis trial addresses new therapeutic approaches for fatigue in MS. The resulting design is a compromise between scientific rigor and pragmatism. Due to difficulties with recruitment we had to scale down our trial to the groups of usual care and acupuncture. The trial's results will give first evidence whether acupuncture is effective in patients with MS associated fatigue. Trial registrationClinicalTrials.gov identifier NCT01864707, registered on 2 April 2013.

Investigating Effects and Mechanisms of a Mindfulness-Based Stress Reduction Intervention in a Sample of College Students at Risk for Social Anxiety

The aims of this study were two-fold: (1) to investigate the effectiveness of a 6-week mindfulness-based stress reduction (MBSR) program in a sample of college students at risk for social anxiety and (2) to investigate whether emotion regulation strategies and self-compassion act as mechanisms of MBSR effectiveness. Participants in this study were predominantly female college students identified as at risk for social anxiety, who were randomly assigned to either the MBSR intervention or to the wait list control group. The final sample included 22 participants in the MBSR group and 24 in the wait list control group for whom pre-intervention and post-intervention (1 week after the MBSR intervention was finalized) data were gathered on self-report measures. The results showed that MBSR participation lead to significant reductions in social anxiety and perceived stress. Also, significant post-intervention differences in favor of the MBSR group compared to the wait list control group were found for self-compassion and acceptance, but not for positive reinterpretation. Mediation analyses employing a bootstrap procedure with 95% confidence intervals were conducted to test the potential MBSR intervention mechanisms. The results revealed that acceptance and self-compassion mediated the relationship between MBSR participation and social anxiety, as well as MBSR participation and perceived stress. The current findings indicated that mindfulness-based interventions might work by: (1) reducing self-identification with successes and failures in social and stressful situations and (2) deactivating appraisals concerning anxiety provoking situations.

The Safety of Mindfulness-Based Interventions: a Systematic Review of Randomized Controlled Trials

The rapid growth of mindfulness-based interventions (MBIs) has raised questions regarding their safety. This review aimed to quantify the adverse events of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) reported in randomized control trials (RCTs) which included a statement of monitoring of adverse events. Literature was searched from the OVID databases until August 2017. A total of 36 RCTs were identified from 7931 search records, with 25 trials using MBSR and 11 trials using MBCT. A total of 19 (1%) and 19 (0.9%) adverse events were reported in the mindfulness intervention group and control group, respectively. In the MBSR group, none of them reported serious adverse event, and only three (12.0%) studies reported six (0.49%) intervention-related adverse events from among 1231 participants. No significant difference between the MBSR intervention and control groups was observed (6/1231 vs. 2/1244; risk difference (95% CI) = 0.0033 (− 0.01 to 0.01)). In the MBCT group, no intervention-related adverse events were reported, and only one trial reported ten (1.5%) cases of intervention-unrelated adverse events from 768 participants. No statistically significant difference in terms of the reported adverse events between the intervention and control groups was observed in the MBCT trials. Only a small proportion of trials reported monitoring of adverse events. Very few adverse events were reported in RCTs that used MBSR/MBCT. The MBSR/MBCT is regarded as relatively safe interventions. However, future studies are highly encouraged to report adverse events in mindfulness interventions for more affirmative conclusions.

Feasibility of Mindfulness-Based Stress Reduction for older adolescents and young adults with poorly controlled type 1 diabetes

ABSTRACTObjectiveThe purpose of the study was to assess the acceptability and feasibility of Mindfulness-Based Stress Reduction (MBSR), a group-delivered intervention, to reduce stress and improve illness management among urban, older adolescents, and young adults with poorly controlled type 1 diabetes (T1D).MethodTen older adolescents and young adults (9 females, 1 male) were recruited to participate in an MBSR group. Acceptability and feasibility were assessed based on recruitment and retention, treatment satisfaction, and changes in stress, diabetes management, and health status using a mixed-methods approach.ResultsSatisfaction with MBSR was high based on both quantitative and qualitative data. Preliminary evidence was found to suggest that MBSR reduced stress and improved blood glucose levels.ConclusionsFindings from a small feasibility study suggest that MBSR could be delivered to urban older adolescents and young adults with T1D with high rates of satisfaction. Additional testing in adequately powered controlled clinical trials appears warranted.

Impact of Mindfulness-Based Stress Reduction (MBSR) on Students' Social Anxiety: A Randomized Controlled Trial

The purpose of this study was to examine the effects of a Mindfulness-Based Stress Reduction (MBSR) program on reduced stress and perceived anxiety. 27 students with social anxiety, aged 16–40 years, from a China university were randomized to MBSR with routine care group (MBSR group, n = 14) and routine care group (non-MBSR group, n = 13). As expected, an increase in anxiety symptoms during the social situations led to more perceived anxiety in the non-MBSR group, but not in the MBSR group, due to the MBSR program. However, the MBSR group had significantly decreased anxiety and avoidance symptoms compared to the non-MBSR group. The results in this trial show that MBSR can protect students with social anxiety from an increase in perceived anxiety during the social situations.

Mindfulness-Based Stress Reduction for Residents: A Randomized Controlled Trial

BackgroundBurnout is highly prevalent in residents. No randomized controlled trials have been conducted measuring the effects of Mindfulness-Based Stress Reduction (MBSR) on burnout in residents.ObjectiveTo determine the effectiveness of MBSR in reducing burnout in residents.DesignA randomized controlled trial comparing MBSR with a waitlist control group.ParticipantsResidents from all medical, surgical and primary care disciplines were eligible to participate. Participants were self-referred.InterventionThe MBSR consisted of eight weekly 2.5-h sessions and one 6-h silent day.Main MeasuresThe primary outcome was the emotional exhaustion subscale of the Dutch version of the Maslach Burnout Inventory–Human Service Survey. Secondary outcomes included the depersonalization and reduced personal accomplishment subscales of burnout, worry, work–home interference, mindfulness skills, self-compassion, positive mental health, empathy and medical errors. Assessment took place at baseline and post-intervention approximately 3 months later.Key ResultsOf the 148 residents participating, 138 (93%) completed the post-intervention assessment. No significant difference in emotional exhaustion was found between the two groups. However, the MBSR group reported significantly greater improvements than the control group in personal accomplishment (p = 0.028, d = 0.24), worry (p = 0.036, d = 0.23), mindfulness skills (p = 0.010, d = 0.33), self-compassion (p = 0.010, d = 0.35) and perspective-taking (empathy) (p = 0.025, d = 0.33). No effects were found for the other measures. Exploratory moderation analysis showed that the intervention outcome was moderated by baseline severity of emotional exhaustion; those with greater emotional exhaustion did seem to benefit.ConclusionsThe results of our primary outcome analysis did not support the effectiveness of MBSR for reducing emotional exhaustion in residents. However, residents with high baseline levels of emotional exhaustion did appear to benefit from MBSR. Furthermore, they demonstrated modest improvements in personal accomplishment, worry, mindfulness skills, self-compassion and perspective-taking. More research is needed to confirm these results.

The effect of Mindfulness-Based Stress Reduction on wound healing: a preliminary study

Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing. Trial Registration NTR3652, http://www.trialregister.nl