Mindfulness-based Stress Reduction Therapy Research Articles

Hvad er gode forudsætninger for at undervise i mindfulness?

Mindfulness-based clinical interventions have become popular and broadly implemented within several university clinics and hospitals. The efficacy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) is supported by evidence from numerous clinical trials and meta-analyses. However, with the increase inpopularity and greater demand, the central risk is that the quality and integrity of MBSR and MBCT could be lost, in particular if these evidence-based interventions are not delivered as intended. In this article, an overall model of quality and integrity is presented with an emphasis on professional training, standards of good practice, teaching competencies,ethics, and insights of contemplative traditions. It is suggested that professional training requires a longer time frame in order to develop, integrate, implement, and evaluate the basic competencies needed to effectively teach MBSR and MBCT. It is also argued that teachers of MBSR and MBCT need to be engage in the personal work ofintegrating mindfulness into their own lives.

Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain

Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain

Salute to the sun: a new dawn in yoga therapy for breast cancer.

IntroductionInterest in the application of yoga for health benefits in western medicine is growing rapidly, with a significant rise in publications. The purpose of this systematic review is to determine whether the inclusion of yoga therapy to the treatment of breast cancer can improve the patient's physical and psychosocial quality of life (QoL).MethodsA search of peer reviewed journal articles published between January 2009 and July 2014 was conducted. Studies were included if they had more than 15 study participants, included interventions such as mindfulness‐based stress reduction (MBSR) or yoga therapy with or without comparison groups and had stated physical or psychological outcomes.ResultsScreening identified 38 appropriate articles. The most reported psychosocial benefits of yoga therapy were anxiety, emotional and social functioning, stress, depression and global QoL. The most reported physical benefits of yoga therapy were improved salivary cortisol readings, sleep quality and lymphocyte apoptosis. Benefits in these areas were linked strongly with the yoga interventions, in addition to significant improvement in overall QoL.ConclusionThe evidence supports the use of yoga therapy to improve the physical and psychosocial QoL for breast cancer patients with a range of benefits relevant to radiation therapy. Future studies are recommended to confirm these benefits. Evidence‐based recommendations for implementation of a yoga therapy programme have been derived and included within this review. Long‐term follow‐up is necessary with these programmes to assess the efficacy of the yoga intervention in terms of sustainability and patient outcomes.

Impact of Mindfulness Based Stress Reduction Therapy on Myocardial Function and Endothelial Dysfunction in Female Patients with Microvascular Angina.

BackgroundMindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. In this study, we investigate the impact of MBSR on left ventricular (LV) and endothelial function in female patients with microvascular angina.MethodsA total of 34 female patients (mean age 52.2 ± 13.8 years) diagnosed with microvascular angina underwent a MBSR program with anti-anginal medication for 8 weeks. The global longitudinal strain (GLS) of the LV was used as a parameter to assess myocardial function and reactive brachial flow-mediated dilatation (FMD) was used to assess endothelial function. Symptoms were analyzed by the Symptom Checklist 90 Revised to determine emotional stress. Changes in GLS and FMD between baseline and post-MBSR were analyzed.ResultsAfter 8 weeks of programmed MBSR treatment, stress parameters were significantly decreased. In addition, GLS (−19.5 ± 2.1% vs. −16.6 ± 2.5%, p < 0.001) and reactive FMD significantly improved (8.9 ± 3.0% vs. 6.9 ± 2.6%, p = 0.005) after MBSR compared to baseline. The changes in GLS correlated to changes in FMD (r = 0.120, p = 0.340) and with the changes in most stress parameters.ConclusionMBSR has beneficial impacts on myocardial and endothelial function in female patients with microvascular angina.

Effectiveness of mindfulness-based stress reduction on emotion regulation and test anxiety in female high school students.

BACKGROUND:Test anxiety is one of the most disabling disorders and annual school academic performance will affect millions of students. Hence, it needs attention and treatment. Therefore, this research aimed to examine the effectiveness of a mindfulness-based stress reduction (MBSR) therapy on emotion regulation and test anxiety of students and test the remaining effect of this treatment after 3 month.METHODS:Sample size of fifty participants randomly divided into experimental (MBSR) and control groups. The MBSR training interventions were implemented to the experimental group, in eight weekly sessions using MBSR manual by John Kabat-Zinn (2013). Participants in both groups were evaluated using the Test Anxiety Scale and the Cognitive Emotion Regulation Questionnaire. The study findings were analyzed using analysis of variance with repeated measures.RESULTS:The result shows that the MBSR program has had continuous significant effects on test anxiety (P < 000) and emotion regulation (P < 000) but was not significant only for the self-blame subscale (P = 0.126).CONCLUSIONS:The study results indicated that the effects of MBSR lasted through the follow-up, for both of these variables. Using the results of this study may be proposed school counselors use mindfulness to reduce the anxiety of their pupils.

What Is Wrong with Us?: What Is Wrong with the World? A Buddhist Perspective

What Is Wrong with Us?What Is Wrong with the World? A Buddhist Perspective Hsiao-Lan Hu When being asked to join the Society of Buddhist-Christian Studies panel "What Is Wrong with Us? What Is Wrong with the World?," I felt honored and acquiesced with some sense of dread. As soon as I actually had a chance to ponder about this topic, I regretted having agreed to the engagement. For one thing, this topic seems to be the broadest topic conceivable: given the extremely large amount of news of destruction and injustice around the world, where do I even begin? For another, what can I possibly say that is beyond, or simply different from, what has already been said in the long traditions of Buddhism and Christianity? As I thought about what I could write, I noticed that my attention at each moment is always gravitated toward the experiences I recently had with my colleagues and my students, as well as the articles I recently read. Perhaps, then, the only thing I can adequately assess is "what is wrong with me." Or perhaps I can talk about "what is wrong with other people around me." As it quickly became painfully obvious that I would much prefer discussing "what is wrong with other people around me" to discussing "what is wrong with me," it also became clear to me that all of the teachings I have studied and all of the thoughts I have had on the topic can actually be presented from this angle: self and others. While the only topic I can address with any sense of adequacy is perhaps "what is wrong with me," it seems much easier, and much more satisfying, to talk about "what is wrong with other people around me." The others who have given me grief. The others who insulted me or looked down on me. The others who angered me or frustrated me. The others who refused to listen to me. Surely that accounts for what is wrong with me: the others. "What is wrong with me" is caused by what others did to me. But that is not what Buddhist teachings say and not what Buddhist practices would imply, and from what little I know, that is not what Christian teachings say, either. By Buddhist standards, this line of thinking is a display of egocentric consideration that we call "ignorance" or "delusion" (Pāli: avijjā; Skt.: avidyā), one of the fundamental propellers of samsāra. And doesn't the Bible speak of casting out the beam in one's own eye before doing something about the mote in someone else's eye (Matt. 7:5)? Shirking the responsibility by counting the wrongs of others rather than confronting the wrongs of oneself is perhaps the most fundamental wrong. [End Page 17] So does this mean I should retreat to the discussion on "what is wrong with me"? But shifting the focus of discussion from "what is wrong with the world" to "what is wrong with me" seems every bit as egocentric as judging the wrongs of the world. Besides, cognitive psychologists told us that we are often inaccurate in evaluating ourselves or our situations. For example, one of the reasons that mindfulness-based stress reduction (MBSR) or mindfulness-based cognitive therapy (MBCT) has become a trend is that studies have found basic mindfulness training effective in reducing anxiety and fear because, on the one hand, mindfulness prevents perception "from going astray to conceptual proliferation (papañca)," and on the other hand it "prevents feelings from developing into emotional disturbances."1 That is, prior to basic mindfulness training, the subjects in those studies would experience anxiety and fear because they would ruminate excessively about how others may perceive or react to the self (which very often is not true at all) and have emotional reactions to their own ruminations about the reality as they perceive it.2 Also, some studies find that people do not even accurately perceive their friendship with others: only about a half of the people that they consider to be good friends would consider them to be good friends in return.3 If the subjects of these studies are...

Women, Stress and Heart Health: Mindfulness-Based Stress Reduction and Cardiovascular Disease

Psychological stress including depression and anxiety are independent risk factors for cardiovascular disease morbidity and mortality, especially in women. Emotional regulation plays a mediating role in the development of depression and physical illness, and can alter resting physiologic responses associated with the stress response. Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic, and psychiatric disorders. MBSR was originally developed for the management of chronic pain, which is now used widely to reduce psychological morbidity associated with chronic illnesses and to treat emotional and behavioral disorders. In cardiovascular disease, MBSR may be helpful for controlling several risk factors for coronary heart disease such as hypertension, type 2 diabetes mellitus, dyslipidemia, oxidative and psychosocial stress, obesity, and smoking, and improvements in submaximal exercise responses and heart rate variability. Although the most effective mode of stress reduction therapy is yet to be established, increasing recognition is being given to MBSR therapy.

Male Representation in Randomized Clinical Trials of Mindfulness-Based Therapies

Mindfulness-based treatments for health issues and psychological disorders have increased in popularity and use. A large amount of empirical evidence indicates that these treatments are effective. However, it is possible that these scientific investigations of mindfulness-based treatments have not been conducted with representative samples. In particular, it seems like most participants in these studies are female. In order to explore this, we conducted a systematic review and examined the sample demographics of 117 articles that investigated the effectiveness of mindfulness-based stress reduction or mindfulness-based cognitive therapy via randomized controlled trials. Male participants accounted for less than 29% of the 9820 total participants. These findings suggest that the evidence supporting the effectiveness of mindfulness-based treatments is based on non-representative samples, and future research should work to correct this.

Les interventions basées sur la pleine conscience dans le trouble obsessionnel compulsif : mécanismes d’action et présentation d’une étude pilote

Obsessive-compulsive disorder (OCD) is a frequent and severe disease, potentially inducing a major impairment for the patient and burden for their family. Recent research in psychiatry and neuroscience have led to better comprehension of the disease's mechanisms and helped to improve its treatment. However, a large proportion of patients have refractory symptoms, including for traditional cognitive and behavioral therapy by exposure and response prevention (ERP), leading clinicians to look for new treatments. Mindfulness-based interventions (MBI) are a new type of approach, initially based on Buddhist meditation, which aims to provide better consciousness of the present moment. It has been successfully developed in some psychiatric diseases and other general medical conditions such as chronic pain. The two main programs using mindfulness meditation, Mindfulness-based stress reduction (MBSR) and Mindfulness-based cognitive therapy (MBCT), have shown effectiveness for the reduction of depressive and anxiety symptoms and relapses of depressive episodes in unipolar depression. It has no side effects and is well tolerated by patients. Its action relies on the specific correction of cognitive deficits in attention, emotion regulation and executive functions which are shared by OCD, GAD and depression. For OCD, we make the hypothesis that Mindfulness-Based Interventions could reduce the cognitive bias specifically existing in this pathology, such as dysfunctional beliefs, and therefore improve the symptoms. This article first reviews the existing literature on clinical trials involving Mindfulness-Based Interventions in OCD which comprises a small number of clinical studies based on very different types of protocols. At this time, and due to the lack of gold-standard studies with a large number of patients, no proof of the efficiency of mindfulness-based interventions in OCD has been shown. In a second section, following our hypothesis on the mechanisms of specific and non-specific action of this therapy in OCD, we propose a cognitive model of mindfulness-based therapy action in OCD involving the correction of OCD's cognitive bias. In this model, mindfulness-based therapy is supposed to treat specifically the cognitive aspects of the disease, while ERP is focused on its behavioral part. Then we present a clinical study aiming to prove the feasibility and the interest of the use of mindfulness in OCD, carried out in two different clinical centers. One of them used MBCT while the second used MBSR. Its results show the feasibility of mindfulness-based therapy in OCD patients and tend to prove that it could be more effective in young patients suffering from less severe forms of OCD. In parallel, attention tests and fMRI scans were done at the beginning and at the end of the therapy. Their results will be published separately. We also discuss the putative role of a specific form of MBCT adapted for OCD, specifically for its benefits in psychoeducation, which could reduce the dysfunctional beliefs present in OCD patients. Finally, we propose a therapeutic strategy in which the MBCT could complement the classical ERP therapy, as a “maintenance” treatment, aiming to extend the relapse of OCD symptoms. This article is a step further in the use of mindfulness-based therapy for OCD which could be added to the existing treatments reducing the patient's symptoms and improving their quality of life.

Effects of mindfulness-based stress reduction combined with progressive muscle relaxation training on cancer-related fatigue in patients with breast cancer chemotherapy

Objective To explore the effect of mindfulness-based stress reduction (MBSR) combined with progressive muscle relaxation (PMR) training on cancer-related fatigue in patients with breast cancer chemotherapy. Methods Totally 98 patients with breast cancer chemotherapy were randomly divided into the control group and the intervention group. Patients in the intervention group received MBSR therapy combined with PMR training, while the control group received routine nursing care. Cancer-related fatigue, and the level of anxiety and depression in two groups before and after intervention were compared. Results After intervention, the cases of patients in the intervention group without fatigue, and with mild, moderate, severe fatigue were respectively 27, 10, 10 and 3; in the control group, the cases of patients without fatigue, and with mild, moderate, severe fatigue were respectively 7, 12, 23 and 6 (Z=-3.994, P<0.05). The level of anxiety and depression in the intervention group was significantly improved compared with the control group (t=29.399, 17.960; P<0.05). Conclusions MBSR therapy combined with PMR training can effectively improve the cancer-related fatigue in patients with breast cancer chemotherapy, and improve anxiety and depression status of patients. Key words: Breast neoplasms; Cancer-related fatigue; Mindfulness-based stress reduction; Progressive muscle relaxation training

Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial.

Cognitive behavioral therapy (CBT) is believed to improve chronic pain problems by decreasing patient catastrophizing and increasing patient self-efficacy for managing pain. Mindfulness-based stress reduction (MBSR) is believed to benefit patients with chronic pain by increasing mindfulness and pain acceptance. However, little is known about how these therapeutic mechanism variables relate to each other or whether they are differentially impacted by MBSR vs CBT. In a randomized controlled trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with chronic low back pain (N = 342), we examined (1) baseline relationships among measures of catastrophizing, self-efficacy, acceptance, and mindfulness and (2) changes on these measures in the 3 treatment groups. At baseline, catastrophizing was associated negatively with self-efficacy, acceptance, and 3 aspects of mindfulness (nonreactivity, nonjudging, and acting with awareness; all P values <0.01). Acceptance was associated positively with self-efficacy (P < 0.01) and mindfulness (P values <0.05) measures. Catastrophizing decreased slightly more posttreatment with MBSR than with CBT or UC (omnibus P = 0.002). Both treatments were effective compared with UC in decreasing catastrophizing at 52 weeks (omnibus P = 0.001). In both the entire randomized sample and the subsample of participants who attended ≥6 of the 8 MBSR or CBT sessions, differences between MBSR and CBT at up to 52 weeks were few, small in size, and of questionable clinical meaningfulness. The results indicate overlap across measures of catastrophizing, self-efficacy, acceptance, and mindfulness and similar effects of MBSR and CBT on these measures among individuals with chronic low back pain.

Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain

Mindfulness-based stress reduction (MBSR) has not been rigorously evaluated for young and middle-aged adults with chronic low back pain. To evaluate the effectiveness for chronic low back pain of MBSR vs cognitive behavioral therapy (CBT) or usual care. Randomized, interviewer-blind, clinical trial in an integrated health care system in Washington State of 342 adults aged 20 to 70 years with chronic low back pain enrolled between September 2012 and April 2014 and randomly assigned to receive MBSR (n = 116), CBT (n = 113), or usual care (n = 113). CBT (training to change pain-related thoughts and behaviors) and MBSR (training in mindfulness meditation and yoga) were delivered in 8 weekly 2-hour groups. Usual care included whatever care participants received. Coprimary outcomes were the percentages of participants with clinically meaningful (≥30%) improvement from baseline in functional limitations (modified Roland Disability Questionnaire [RDQ]; range, 0-23) and in self-reported back pain bothersomeness (scale, 0-10) at 26 weeks. Outcomes were also assessed at 4, 8, and 52 weeks. There were 342 randomized participants, the mean (SD) [range] age was 49.3 (12.3) [20-70] years, 224 (65.7%) were women, mean duration of back pain was 7.3 years (range, 3 months-50 years), 123 (53.7%) attended 6 or more of the 8 sessions, 294 (86.0%) completed the study at 26 weeks, and 290 (84.8%) completed the study at 52 weeks. In intent-to-treat analyses at 26 weeks, the percentage of participants with clinically meaningful improvement on the RDQ was higher for those who received MBSR (60.5%) and CBT (57.7%) than for usual care (44.1%) (overall P = .04; relative risk [RR] for MBSR vs usual care, 1.37 [95% CI, 1.06-1.77]; RR for MBSR vs CBT, 0.95 [95% CI, 0.77-1.18]; and RR for CBT vs usual care, 1.31 [95% CI, 1.01-1.69]). The percentage of participants with clinically meaningful improvement in pain bothersomeness at 26 weeks was 43.6% in the MBSR group and 44.9% in the CBT group, vs 26.6% in the usual care group (overall P = .01; RR for MBSR vs usual care, 1.64 [95% CI, 1.15-2.34]; RR for MBSR vs CBT, 1.03 [95% CI, 0.78-1.36]; and RR for CBT vs usual care, 1.69 [95% CI, 1.18-2.41]). Findings for MBSR persisted with little change at 52 weeks for both primary outcomes. Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain. clinicaltrials.gov Identifier: NCT01467843.

Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer: A Meta-analysis.

Anxiety and depression are common among patients with cancer, and are often treated with psychological interventions including mindfulness-based therapy.The aim of the study was to perform a meta-analysis of the effectiveness of mindfulness-based interventions for improving anxiety and depression in patients with cancer.Medline, the Cochrane Library, EMBASE, and Google Scholar were searched. The randomized controlled trials designed for patients diagnosed with cancer were included. Mindfulness-based interventions were provided.The outcomes assessed were the changes in anxiety and depression scores from before to after the intervention. The treatment response was determined by calculating the standardized mean difference (SMD) for individual studies and for pooled study results. Subgroup analyses by cancer type, type of therapy, and length of follow-up were performed.Seven studies, involving 469 participants who received mindfulness-based interventions and 419 participants in a control group, were included in the meta-analysis. Mindfulness-based stress reduction and art therapy were the most common interventions (5/7 studies). All studies reported anxiety and depression scores. The pooled SMD of the change in anxiety significantly favored mindfulness-based therapy over control treatment (-0.75, 95% confidence interval -1.28, -0.22, P = 0.005). Likewise, the pooled SMD of the change in depression also significantly favored mindfulness-based therapy over control (-0.90, 95% confidence interval -1.53, -0.26, P = 0.006). During the length of follow-ups less than 12 weeks, mindfulness-based therapy significantly improved anxiety for follow-up ≤12 weeks after the start of therapy, but not >12 weeks after the start of therapy.There was a lack of consistency between the studies in the type of mindfulness-based/control intervention implemented. Patients had different forms of cancer. Subgroup analyses included a relatively small number of studies and did not account for factors such as the severity of anxiety and/or depression, the time since diagnosis, and cancer stage.Mindfulness-based interventions effectively relieved anxiety and depression among patients with cancer. However, additional research is still warranted to determine how long the beneficial effects of mindfulness-based therapy persist.

The value of mindfulness meditation in the treatment of insomnia.

Insomnia is the most common reported sleep disorder with limited treatment options including pharmacotherapy and cognitive behavioral therapy for insomnia. Pharmacotherapy can be complicated by tolerance and significant side-effects and cognitive behavioral therapy for insomnia providers are limited in number. This article reviews mindfulness meditation as an additional therapy for insomnia. Both mindfulness-based stress reduction (MBSR) and mindfulness-based therapy for insomnia (MBTI) have been studied in the treatment of insomnia. Randomized controlled studies of MBSR and MBTI have shown overall reduction in sleep latency and total wake time and increase in total sleep time after mindfulness therapy using both patient reported outcome and quantitative measures of sleep. Mindfulness techniques have been shown to be well accepted by patients with long-lasting effects. A three-arm randomized study with MBSR, MBTI, and self-monitoring showed similar improvement in insomnia between the MBSR and MBTI groups, with possibly longer duration of efficacy in the MBTI group. Recent data show that MBTI is also an effective and accepted treatment for insomnia in older patients. Increasing evidence shows that mindfulness meditation, delivered either via MBSR or MBTI, can be successfully used for the treatment of insomnia with good patient acceptance and durable results.

Effect of mindfulness-based stress reduction (MBSR) on depression symptoms and emotional schema inwomen with major depressive disorder

Background: mindfulness has an important role in depression. The present study investigatedthe impact of Mindfulness-Based Stress Reduction (MBSR) on emotional schema and depression symptoms in women with major depressive disorder. Method: In this experimental pretest-posttest study, twenty four patients with Major Depressive Disorder (MDD) were selected by convenience sampling and randomly assigned to experimental and control groups. The experimental group received MBSR therapy over two months. Beck Depression Questionnaire and Leahy Emotional Schema Scale (LESS) were used to collect the data in the pre-test, post-test and two-month follow-up. Data were analyzed by mixed analysis of variance. Results: MBSR significantly reduced the symptoms of depression (P<0.01) and maladaptive emotional schemas (p<0.01), and increased adaptive emotional schemas (P<0.01) in experimental group in the post-test and follow-up. Conclusion: The results of this study revealed the effectiveness of mindfulness-based stress reduction in reducing the severity of depression and maladaptive emotional schema in depressed patients.

Mindfulness-Based Stress Reduction for Posttraumatic Stress Disorder Among Veterans: A Randomized Clinical Trial.

Mindfulness-based interventions may be acceptable to veterans who have poor adherence to existing evidence-based treatments for posttraumatic stress disorder (PTSD). To compare mindfulness-based stress reduction with present-centered group therapy for treatment of PTSD. Randomized clinical trial of 116 veterans with PTSD recruited at the Minneapolis Veterans Affairs Medical Center from March 2012 to December 2013. Outcomes were assessed before, during, and after treatment and at 2-month follow-up. Data collection was completed on April 22, 2014. Participants were randomly assigned to receive mindfulness-based stress reduction therapy (n = 58), consisting of 9 sessions (8 weekly 2.5-hour group sessions and a daylong retreat) focused on teaching patients to attend to the present moment in a nonjudgmental, accepting manner; or present-centered group therapy (n = 58), an active-control condition consisting of 9 weekly 1.5-hour group sessions focused on current life problems. The primary outcome, change in PTSD symptom severity over time, was assessed using the PTSD Checklist (range, 17-85; higher scores indicate greater severity; reduction of 10 or more considered a minimal clinically important difference) at baseline and weeks 3, 6, 9, and 17. Secondary outcomes included PTSD diagnosis and symptom severity assessed by independent evaluators using the Clinician-Administered PTSD Scale along with improvements in depressive symptoms, quality of life, and mindfulness. Participants in the mindfulness-based stress reduction group demonstrated greater improvement in self-reported PTSD symptom severity during treatment (change in mean PTSD Checklist scores from 63.6 to 55.7 vs 58.8 to 55.8 with present-centered group therapy; between-group difference, 4.95; 95% CI, 1.92-7.99; P=.002) and at 2-month follow-up (change in mean scores from 63.6 to 54.4 vs 58.8 to 56.0, respectively; difference, 6.44; 95% CI, 3.34-9.53, P < .001). Although participants in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (48.9% vs 28.1% with present-centered group therapy; difference, 20.9%; 95% CI, 2.2%-39.5%; P = .03) at 2-month follow-up, they were no more likely to have loss of PTSD diagnosis (53.3% vs 47.3%, respectively; difference, 6.0%; 95% CI, -14.1% to 26.2%; P = .55). Among veterans with PTSD, mindfulness-based stress reduction therapy, compared with present-centered group therapy, resulted in a greater decrease in PTSD symptom severity. However, the magnitude of the average improvement suggests a modest effect. clinicaltrials.gov Identifier: NCT01548742.

The Process-Outcome Mindfulness Effects in Trainees (PrOMET) study: protocol of a pragmatic randomized controlled trial.

BackgroundMindfulness has its origins in an Eastern Buddhist tradition that is over 2500 years old and can be defined as a specific form of attention that is non-judgmental, purposeful, and focused on the present moment. It has been well established in cognitive-behavior therapy in the last decades, while it has been investigated in manualized group settings such as mindfulness-based stress reduction and mindfulness-based cognitive therapy. However, there is scarce research evidence on the effects of mindfulness as a treatment element in individual therapy. Consequently, the demand to investigate mindfulness under effectiveness conditions in trainee therapists has been highlighted.Methods/DesignTo fill in this research gap, we designed the PrOMET Study. In our study, we will investigate the effects of brief, audiotape-presented, session-introducing interventions with mindfulness elements conducted by trainee therapists and their patients at the beginning of individual therapy sessions in a prospective, randomized, controlled design under naturalistic conditions with a total of 30 trainee therapists and 150 patients with depression and anxiety disorders in a large outpatient training center. We hypothesize that the primary outcomes of the session-introducing intervention with mindfulness elements will be positive effects on therapeutic alliance (Working Alliance Inventory) and general clinical symptomatology (Brief Symptom Checklist) in contrast to the session-introducing progressive muscle relaxation and treatment-as-usual control conditions. Treatment duration is 25 therapy sessions. Therapeutic alliance will be assessed on a session-to-session basis. Clinical symptomatology will be assessed at baseline, session 5, 15 and 25. We will conduct multilevel modeling to address the nested data structure. The secondary outcome measures include depression, anxiety, interpersonal functioning, mindful awareness, and mindfulness during the sessions.DiscussionThe study results could provide important practical implications because they could inform ideas on how to improve the clinical training of psychotherapists that could be implemented very easily; this is because there is no need for complex infrastructures or additional time concerning these brief session-introducing interventions with mindfulness elements that are directly implemented in the treatment sessions.Trial registrationFrom ClinicalTrials.gov, Identifier: NCT02270073 (registered October 6, 2014)

Effects of mindfulness based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus.

To evaluate the impact of a Mindfulness Based Stress Reduction (MBSR) program in patients with chronic bothersome tinnitus on the (1) severity of symptoms of tinnitus and (2) functional connectivity in neural attention networks. Open-label interventional pilot study. Outpatient academic medical center. A total of 13 adult participants with a median age of 55 years, suffering from bothersome tinnitus. An 8-week MBSR program was conducted by a trained MBSR instructor. The primary outcome measure was the difference in patient-reported tinnitus symptoms using the Tinnitus Handicap Index (THI) and Tinnitus Functional Index (TFI) between pre-intervention, post-MBSR, and 4-week post-MBSR assessments. Secondary outcomes included change in measurements of depression, anxiety, mindfulness, and cognitive abilities. Functional connectivity magnetic resonance imaging (MRI) was performed at pre- and post-MBSR intervention time points to serve as a neuroimaging biomarker of critical cortical networks. Scores on the THI and TFI showed statistically significant and clinically meaningful improvement over the course of the study with a median ΔTHI of -16 and median ΔTFI of -14.8 between baseline and 4-week follow-up scores. Except for depression, there was no significant change in any of the secondary outcome measures. Analysis of the resting state functional connectivity MRI (rs-fcMRI) data showed increased connectivity in the post-MBSR group in attention networks but not the default network. Participation in an MBSR program is associated with decreased severity in tinnitus symptoms and depression and connectivity changes in neural attention networks. MBSR is a promising treatment option for chronic bothersome tinnitus that is both noninvasive and inexpensive.

Mindfulness equity and Western Buddhism: reaching people of low socioeconomic status and people of color

This study presents the findings of the first pilot series of the Mindfulness Allies Project (MAP), and focuses on the intersection of mindfulness, Western Buddhism, socioeconomic status (SES), and race. While much has been published about the efficacy of mindfulness meditation with various clinical and non-clinical populations, understudied populations still include people of low SES and people of color. Additionally, while care is often, and appropriately, taken to differentiate mindfulness from Buddhism, the fact remains that Buddhism directly influenced the creation of leading clinical uses of mindfulness, including Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. MAP proposes a model for Western Buddhist centers and teachers, as well as professional mindfulness providers, to offer annual secular mindfulness series in partnership with local organizations serving marginalized populations—those not benefitting from privileged identity factors—particularly in relation to race and class. MAP is founded on a vision of mindfulness equity—or equal access to mindfulness teachings. This MAP pilot series consisted of five weekly mindfulness classes. Classes were provided free of charge at a community center serving low-income residents, with childcare during and dinners after classes also provided free of charge. Participants largely consisted of people of color earning less than $15,000 per year. Quantitative and qualitative surveys administered at the conclusion of the final class revealed highly positive feedback, and suggest that the MAP model could benefit both marginalized communities as well as Buddhist centers’ and teachers’ desire to diversify those benefitting from their teachings in the West.

Disciplined Improvisation: Characteristics of Inquiry in Mindfulness-Based Teaching.

Evidence for the effectiveness of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) is rapidly growing as interest in this field expands. By contrast, there are few empirical analyses of the pedagogy of MBSR and MBCT. Development of the evidence base concerning the teaching of MBCT or MBSR would support the integrity of the approach in the context of rapid expansion. This paper describes an applied conversation analysis (CA) of the characteristics of inquiry in the MBSR and MBCT teaching process. Audio-recordings of three 8-week MBCT and MBSR classes, with 24, 12, and 6 participants, were transcribed and systematically examined. The study focused on the teacher-led interactive inquiry which takes place in each session after a guided meditation practice. The study describes and analyzes three practices within the inquiry process that can be identified in sequences of talk: turn-taking talk involving questions and reformulations; the development of participant skills in a particular way of describing experience; and talk that constructs intersubjective connection and affiliation within the group. CA enables fine-grained analysis of the interactional work of mindfulness-based inquiry. Inquiry is a process of disciplined improvisation which is both highly specific to the conditions of the moment it took place in and uses repeated and recognizable patterns of interaction.