Trial Of Mindfulness-based Stress Reduction Research Articles

Advances in Mind/Body Therapies: Concept, Data and Delivery

Mind/body therapies, such as yoga, mindfulness, and guided imagery, are often touted in media reports as ways to slow cognitive decline, improve brain health, and ameliorate negative psychological symptoms such as stress and depression. However, the clinical and neurobiological evidence base for these uses in older adults is limited. Moreover, many older adults, particularly during the COVID-19 pandemic, have difficulty accessing these therapies due to the in-person, group formats in which they are often delivered. A major difficulty in understanding the objective benefits of mind/body therapies for subjective cognitive and psychological symptoms is infrequent measurement during clinical trials using retrospective questionnaires. Thus, increased clinical efficacy research, neurobiological research, and methodological research to identify new ways to deliver and measure the effects of mind/body therapies is urgently needed.In this general session, three presenters will discuss recent advances in mind/body therapies, including new evidence from large-scale trials, and methodological innovations enabling remote therapy delivery and the assessment of behavioral outcomes.First, Dr. Felipe Jain will discuss smartphone delivery of mind/body therapies and new technologies that use passive smartphone sensors to enable continuous measurement of behavior. The development of digital phenotypes of psychological symptoms from these fine-grained behavioral assessments will be discussed. Dr. Jain's presentation will describe a smartphone application which delivers mind/body tools, mentalizing imagery therapy (MIT), and caregiver skills, to older adult family caregivers of persons living with dementia. His talk will elucidate simultaneous capture of usage data and passive smartphone sensor data in a subset of participants in a clinical trial using the application. Statistical methods to derive individual behavioral phenotypes for symptom tracking of psychological stress and sleep will be presented.Second, Dr. Eric Lenze will share clinical and neuroimaging results of a large trial of mindfulness-based stress reduction (MBSR) with and without exercise aimed at improving cognitive function and brain health in older adults. His talk will include clinical effects of intervention on episodic memory and executive function, and structural brain markers including hippocampal volume and dorsolateral prefrontal cortex thickness and surface area. Finally, he will focus on sensitive analyses of functional brain connectivity from before to after treatment.Finally, Dr. Helen Lavretsky will discuss the recent trends in the methodology of conducting mind-body efficacy and effectiveness trials. She will also discuss the results of a recently completed trial of Kundalini yoga for prevention of cognitive decline in women with subjective memory complaints and at risk for AD. This will also cover clinical outcomes and the role of neural and peripheral biomarkers of response.The panel discussion will outline future research directions in mind-body therapies for treatment and prevention in older adults, with a focus on diversity and inclusion of underrepresented populations.

Moderators and Nonspecific Predictors of Treatment Benefits in a Randomized Trial of Mindfulness-Based Stress Reduction vs Cognitive-Behavioral Therapy vs Usual Care for Chronic Low Back Pain

Both mindfulness-based stress reduction (MBSR) and cognitive-behavioral therapy (CBT) are effective for chronic low back pain (CLBP), but little is known regarding who might benefit more from one than the other. Using data from a randomized trial comparing MBSR, CBT, and usual care (UC) for adults aged 20 to 70 years with CLBP (N = 297), we examined baseline characteristics that moderated treatment effects or were associated with improvement regardless of treatment. Outcomes included 8-week function (modified Roland Disability Questionnaire), pain bothersomeness (0–10 numerical rating scale), and depression (Patient Health Questionnaire-8). There were differences in the effects of CBT versus MBSR on pain based on participant gender (P = .03) and baseline depressive symptoms (P = .01), but the only statistically significant moderator after Bonferroni correction was the nonjudging dimension of mindfulness. Scores on this measure moderated the effects of CBT versus MBSR on both function (P = .001) and pain (P = .04). Pain control beliefs (P <.001) and lower anxiety (P < .001) predicted improvement regardless of treatment. Replication of these findings is needed to guide treatment decision-making for CLBP. Trial RegistrationThe trial and analysis plan were preregistered in ClinicalTrials.gov (Identifier: NCT01467843). PerspectiveAlthough few potential moderators and nonspecific predictors of benefits from CBT or MBSR for CLBP were statistically significant after adjustment for multiple comparisons, these findings suggest potentially fruitful directions for confirmatory research while providing reassurance that patients could reasonably expect to benefit from either treatment.

Protocol for a randomized controlled trial of mindfulness-based stress reduction to improve attentional control in older adults (HealthyAgers trial)

BackgroundMindfulness meditation is a form of mind–body intervention that has increasing scientific support for its ability to reduce age-related declines in cognitive functioning, improve affective health, and strengthen the neural circuitry supporting improved cognitive and affective health. However, the majority of existent studies have been pilot investigations with small sample sizes, limited follow-up data, and a lack of attention to expectancy effects. Here, we present the study design of a Phase I/II, efficacy trial—HealthyAgers trial—that examines the benefits of a manualized mindfulness-based stress reduction program in improving attentional control and reducing mind-wandering in older adults.MethodsOne hundred fifty older adults (ages 65–85 years) will be randomized into one of two groups: an eight-week mindfulness program or an eight-week, placebo-controlled, lifestyle education program. Behavioral and neuroimaging assessments are conducted before and after the training. Participants are then invited to booster sessions once every three months for a period of 12 months with post-intervention follow-up assessments conducted at 6-months and 12-months. The primary outcomes for the study are behavioral measures of attentional control and mind-wandering. Additional, secondary outcomes include network strength in an a priori defined neuromarker of attentional control, fluid and everyday cognition, emotion regulation strategy use, and markers of inflammation.DiscussionThis study will establish the efficacy of a group-based, low-cost mind–body intervention for the inter-related facets of attentional control and mind-wandering in older adults. Strengths of this study include a well-designed, placebo-controlled comparison group, use of web/mobile application to track study adherence, and longitudinal follow-up.Trial registrationClinicaltrials.gov (#NCT03626532). Registered August 4, 2018.

Neural Signatures of Pain Modulation in Short-Term and Long-Term Mindfulness Training: A Randomized Active-Control Trial.

Mindfulness-based interventions are widely used to target pain, yet their neural mechanisms of action are insufficiently understood. The authors studied neural and subjective pain response in a randomized active-control trial of mindfulness-based stress reduction (MBSR) alongside long-term meditation practitioners. Healthy participants (N=115) underwent functional neuroimaging during a thermal acute pain task before and after random assignment to MBSR (N=28), an active control condition (health enhancement program [HEP]) (N=32), or a waiting list control condition (N=31). Long-term meditators (N=30) completed the same neuroimaging paradigm. Pain response was measured via self-reported intensity and unpleasantness, and neurally via two multivoxel machine-learning-derived signatures: the neurologic pain signature (NPS), emphasizing nociceptive pain processing, and the stimulus intensity independent pain signature-1 (SIIPS1), emphasizing stimulus-independent neuromodulatory processes. The MBSR group showed a significant decrease in NPS response relative to the HEP group (Cohen's d=-0.43) and from pre- to postintervention assessment (d=-0.47). The MBSR group showed small, marginal decreases in NPS relative to the waiting list group (d=-0.36), and in SIIPS1 relative to both groups (HEP group, d=-0.37; waiting list group, d=-0.37). In subjective unpleasantness, the MBSR and HEP groups also showed modest significant reductions compared with the waiting list group (d=-0.45 and d=-0.55). Long-term meditators reported significantly lower pain than nonmeditators but did not differ in neural response. Within the long-term meditator group, cumulative practice during intensive retreat was significantly associated with reduced SIIPS1 (r=-0.65), whereas daily practice was not. Mindfulness training showed associations with pain reduction that implicate differing neural pathways depending on extent and context of practice. Use of neural pain signatures in randomized trials offers promise for guiding the application of mindfulness interventions to pain treatment.

Covariance and Correlation Analysis of Resting State Functional Magnetic Resonance Imaging Data Acquired in a Clinical Trial of Mindfulness-Based Stress Reduction and Exercise in Older Individuals.

We describe and apply novel methodology for whole-brain analysis of resting state fMRI functional connectivity data, combining conventional multi-channel Pearson correlation with covariance analysis. Unlike correlation, covariance analysis preserves signal amplitude information, which feature of fMRI time series may carry physiological significance. Additionally, we demonstrate that dimensionality reduction of the fMRI data offers several computational advantages including projection onto a space of manageable dimension, enabling linear operations on functional connectivity measures and exclusion of variance unrelated to resting state network structure. We show that group-averaged, dimensionality reduced, covariance and correlation matrices are related, to reasonable approximation, by a single scalar factor. We apply this methodology to the analysis of a large, resting state fMRI data set acquired in a prospective, controlled study of mindfulness training and exercise in older, sedentary participants at risk for developing cognitive decline. Results show marginally significant effects of both mindfulness training and exercise in both covariance and correlation measures of functional connectivity.

A randomized controlled trial of mindfulness-based stress reduction on academic resilience and performance in college students

Objective The transition into college can pose barriers for student success. We examined the impact of mindfulness-based stress reduction (MBSR) compared to an active and no treatment control group, respectively, on stressor appraisals, academic persistence, and performance in unversity students. Participants Students were randomly assigned to receive MBSR (n = 29), study skills active control (n = 27), or no treatment (n = 29). Method Participants reported stressor appraisals and academic persistence pre- and post-intervention. Semester grade point average (GPA) and enrollment was also obtained. Results Academic stressor appraisals did not vary by group. MBSR was protective against depleted academic persistence, whereas academic persistence decreased in the control groups. Enrollment rates remained unchanged in the MBSR group, but increased in the active control relative to no treatment. Finally, GPA improved in the MBSR group, but not controls. Conclusions Findings suggest that MBSR confers some benefits for resilience in university students.

Enhancing Cognition in Older Persons: A Pilot Clinical Trial of Mindfulness-Based Stress Reduction (MBSR) and Transcranial Direct Current Stimulation (tDCS)

Low-burden, accessible interventions are needed to prevent cognitive decline in individuals at high-risk for decline. Mindfulness-Based Stress Reduction (MBSR) and transcranial direct current stimulation (tDCS) are two interventions which can be delivered remotely, improving their reach and scalability. This study aimed to assess the feasibility, safety and tolerability of combining MBSR with tDCS, and the preliminary efficacy on improving cognition, mood symptoms, social functioning and mindfulness.

Enhancing Cognition in Older Persons: A Pilot Clinical Trial of Mindfulness-Based Stress Reduction (MBSR) and transcranial Direct Current Stimulation (tDCS)

<h3>Introduction</h3> Low-burden and accessible interventions are needed to prevent cognitive decline in individuals at high-risk for decline. Mindfulness-Based Stress Reduction (MBSR) and transcranial direct current stimulation (tDCS) are two interventions which can be delivered remotely, improving their reach and scalability. This aim of this study is to assess the feasibility, safety and tolerability of combining MBSR with tDCS, and the preliminary efficacy on improving cognition, mood symptoms, social functioning and mindfulness. <h3>Methods</h3> We randomized 26 individuals aged 60 years or older with cognitive complaints and mood symptoms (Active: 12, mean age=68.34, SD=5.88; Sham: 14, mean age=69.04, SD=4.99). All participants completed an 8-week course of MBSR with active or sham tDCS. Participants attended weekly MBSR sessions, and completed daily at-home MBSR with tDCS. Cognition, depression, anxiety, social functioning and everyday mindfulness were assessed before and after treatment. <h3>Results</h3> MBSR+tDCS was safe and well-tolerated, though adherence to the interventions was mediocre. Both groups improved in cognition(<i>F(</i>1,20)=17.05, <i>p</i>=0.001) and anxiety(<i>F(</i>1,21)=7.05, <i>p</i>=0.02), with no effect of tDCS (cognition: <i>F</i>(1,20)=1.81, <i>p</i>=0.19); anxiety: <i>F(</i>1,20)=0.04, <i>p</i>=0.84). There was no change in depression or social functioning (<i>p</i> > 0.5). Interestingly, while there was no significant difference between the two groups on everyday mindfulness (<i>F(</i>1,21)=3.68, <i>p</i>=0.07), the effect size of difference between the groups was 0.55, favoring active tDCS. <h3>Conclusions</h3> Our findings suggest it is feasible and safe to combine tDCS with MBSR in older depressed and anxious adults, including during remote, at-home use. Active tDCS may facilitate the learning of mindfulness. Future research should focus on improving adherence to MBSR with tDCS and then determining efficacy using larger samples. <h3>Funding</h3> This study was supported primarily by the National Institute of Mental Health (R25 MH112473 to Washington University) and the Canadian Institutes of Health Research (Canada Research Chair Grant #: 950-230879 to the University of Toronto). Magstim/Newronika loaned equipment for the project. Additional funding was provided by the Paula J. Clayton MD Hawthorne Foundation Research Award, the Taylor Family Institute for Innovative Psychiatric Research, and the Center for Brain Research in Mood Disorders.

Recruitment, retention, and adherence in a randomized feasibility trial of mindfulness-based stress reduction for patients with migraine

ObjectivesIncreasing evidence demonstrates effectiveness of Mindfulness-Based Stress Reduction (MBSR) for pain-related and functional disorders. In order to conduct successful and efficient trials of MBSR, evidence regarding the relative performance of strategies to improve recruitment, retention, and adherence is required, but few studies have examined these issues specifically. DesignIn preparation for a fully powered trial, we conducted a 2-arm, parallel comparison randomized controlled feasibility trial of MBSR vs. usual-care for 60 patients with migraine headache. SettingTwo large U.S. health systems in Northern California. InterventionMBSR is an 8-week classroom-based intervention that combines mindfulness meditation and yoga, with didactic presentations about stress psychology and group process/experiential education. Participants received the intervention at their choice of one of several existing, vetted community-based classes. Main outcome measuresSuccessful recruitment was defined a priori as 18 participants within any 9-week period or 60 participants enrolled within a 36-week period. We considered participants adherent to the intervention if they attended at least 5 of the 8 weekly classes and the day-long retreat. ResultsWe successfully enrolled 18 participants within a 7-week period, however, we did not attain our second goal of recruiting 60 participants within a 36-week period. Sixty-eight percent of our participants were adherent to the intervention. ConclusionsWe found that close monitoring of recruitment activities, flexibility in protocol modifications, and integration within the delivery system were crucial factors for successful participant recruitment, retention, and adherence in mindfulness research.

Participant experiences of change in mindfulness-based stress reduction for anxiety disorders

ABSTRACT Aim To explore experiences of change among participants in a randomized clinical trial of mindfulness-based stress reduction (MBSR) for anxiety disorders. Method Semi-structured interviews were conducted to explore the subjective experiences of change for individuals with anxiety disorders after a course in MBSR. Interviews were analysed employing hermeneutic-phenomenological thematic analysis. Results Five main themes were identified: 1) Something useful to do when anxiety appears, 2) Feeling more at ease, 3) Doing things my anxiety wouldn’t let me, 4) Meeting what is there, and 5) Better—but not there yet. Most participants used what they had learned for instrumental purposes, and described relief from anxiety and an increased sense of personal agency. A few reported more radical acceptance of anxiety, as well as increased self-compassion. Conclusion Participants of MBSR both describe mindfulness as a tool to “fix” anxiety and as bringing about more fundamental change towards acceptance of their anxiety. The complexity of reported change corresponds with better handling of areas representing known transdiagnostic features of anxiety disorder, such as dysfunctional cognitive processes (including attentional biases), emotional dysregulation, avoidance behaviours, and maladaptive self-relatedness. This supports MBSR as a transdiagnostic approach to the treatment of anxiety disorders.

Randomized Trial of Mindfulness-Based Stress Reduction in Cardiac Patients Eligible for Cardiac Rehabilitation

Currently, exercise-based cardiac rehabilitation (CR) is the only recommended secondary prevention strategy for cardiac patients that attempts to tackle stress and psychosocial wellbeing, but it is under-utilized and lacks a comprehensive curriculum for this purpose; hence there is a critical gap to address psychosocial needs of cardiac patients after an event. Mindfulness-based stress reduction (MBSR) has shown benefits in the general population but its role in cardiac patients is not clear. We conducted a pilot randomized controlled trial (RCT) of MBSR in CR-eligible cardiac patients during their initial year of recovery. Patients were allocated 2:1 (intervention:control) to an 8-week MBSR group intervention or usual care. Standard measures of depression, anxiety, perceived stress, health related quality of life (HRQOL), blood pressure, biomarkers (lipids, HbA1c, CRP) and 24-hour Holter monitoring were obtained at baseline, 3- and 9-months post-randomization. Sub-group analyses were performed for participants with at least mild depression (PHQ-9 ≥ 5). 47 patients [mean age 58.6 years; 38% female; 77% white] were enrolled in 2 cohorts. 87% of MBSR patients completed the intervention; study retention was >95% at each follow-up visit. At 3 months, compared to controls, MBSR patients showed improvements in depression [p = 0.01] and anxiety [p = 0.04] with a similar trend in HRQOL [p = 0.06]. The MBSR group showed greater improvement or less worsening of most CV risk factors, with an attenuation of treatment effects at 9 months. Participants with at PHQ-9 scores ≥5 at baseline showed greater improvement in psychosocial and CV outcomes, that persisted at 9 months. MBSR is a safe and well received secondary prevention strategy. This pilot RCT provides preliminary evidence of MBSR’s potential to improve short term psychosocial well-being in cardiac patients during their first year of recovery.

A randomized controlled efficacy trial of mindfulness-based stress reduction compared with an active control group and usual care for fibromyalgia: the EUDAIMON study.

Fibromyalgia (FM) syndrome represents a great challenge for clinicians and researchers because the efficacy of currently available treatments is limited. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for reducing functional impairment as well as the role of mindfulness-related constructs as mediators of treatment outcomes for people with FM. Two hundred twenty-five participants with FM were randomized into 3 study arms: MBSR plus treatment-as-usual (TAU), FibroQoL (multicomponent intervention for FM) plus TAU, and TAU alone. The primary endpoint was functional impact (measured with the Fibromyalgia Impact Questionnaire Revised), and secondary outcomes included "fibromyalginess," anxiety and depression, pain catastrophising, perceived stress, and cognitive dysfunction. The differences in outcomes between groups at post-treatment assessment (primary endpoint) and 12-month follow-up were analyzed using linear mixed-effects models and mediational models through path analyses. Mindfulness-based stress reduction was superior to TAU both at post-treatment (large effect sizes) and at follow-up (medium to large effect sizes), and MBSR was also superior to FibroQoL post-treatment (medium to large effect sizes), but in the long term, it was only modestly better (significant differences only in pain catastrophising and fibromyalginess). Immediately post-treatment, the number needed to treat for 20% improvement in MBSR vs TAU and FibroQoL was 4.0 (95% confidence interval [CI] = 2.1-6.5) and 5.0 (95% CI = 2.7-37.3). An unreliable number needed to treat value of 9 (not computable 95% CI) was found for FibroQoL vs TAU. Changes produced by MBSR in functional impact were mediated by psychological inflexibility and the mindfulness facet acting with awareness. These findings are discussed in relation to previous studies of psychological treatments for FM.

A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects

AimTo evaluate the efficacy of mindfulness-based stress reduction on objective and subjective sleep parameters and hypnotic medication use of patients with insomnia secondary to cervical cancer. MethodsThis was a randomized controlled trial enrolled insomnia patient who were caused or worsened by cervical cancer. Seventy patients with insomnia caused or aggravated by cervical cancer were at random divided into either a usual care group or an 8-week mindfulness-based stress reduction group. Subjective sleep parameters, objective sleep parameters and hypnotic medication consumption were assessed at baseline, after the program, 6- and 12-month after finishing the interventions. ResultsThe results showed that mindfulness-based stress reduction had a positive effect on subjective sleep parameters (Total wake time: ∆ = 45.32, P < 0.05; Sleep efficacy: ∆ = 6.87, P < 0.05; Total sleep time: ∆ = 22.22, P < 0.01). Compared with control group, polysomnography data in mindfulness-based stress reduction group were not improved significantly. There were no associations between subjective sleep parameters and objective sleep parameters. ConclusionMindfulness-based stress reduction had a definite impact on patients with insomnia that was secondary to cervical cancer just after the intervention, but no long-term influences. Trial registrationChiCTR1800018571; 9/25/2018; retrospectively registered.

Retracted: A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Effects on sleep.

Retraction: 'A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Effects on sleep' DOI https://doi.org/10.1002/cnr2.1190 by Huashuang Zhang, Yang Li, Mingming Li, Xiaowen Chen. The above article, published online on 29 May 2019 in Wiley Online Library (http://onlinelibrary.wiley.com), has been retracted by agreement between the authors, Huashuang Zhang, Yang Li, Mingming Li, Xiaowen Chen, the journal Editor in Chief Nidhi Bansal, and John Wiley and Sons Ltd. The retraction has been agreed because of an honest error discovered by the authors in the data presented in Table 4 that impacts the overall conclusions of the article.

Feasibility Randomized Control Trial of Mindfulness-Based Stress Reduction (MBSR) With Older Adults Living With Cognitive Impairment in Primary Care.

Feasibility Randomized Control Trial of Mindfulness-Based Stress Reduction (MBSR) With Older Adults Living With Cognitive Impairment in Primary Care.

Increased high-frequency NREM EEG power associated with mindfulness-based interventions for chronic insomnia: Preliminary findings from spectral analysis

ObjectiveMindfulness-based interventions (MBI) have been shown to reduce subjective symptoms of insomnia but the effects on objective measures remain unclear. The purpose of this study was to examine sleep EEG microarchitecture patterns from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Therapy for Insomnia (MBTI). MethodsSleep EEG spectral analysis was conducted on 36 participants with chronic insomnia (>6 months) randomized to 8-week MBSR, MBTI, or self-monitoring control (SM). Overnight polysomnography with 6-channel EEG was conducted at baseline, post-treatment, and 6-month follow-up. Spectral power averaged from channels C3/C4 across NREM epochs (excluding N1) was examined for within-group changes and relationships with self-report measures. ResultsIncreases in absolute NREM beta (16–25 Hz) power were observed from baseline to post-treatment (p = .02, d = 0.53) and maintained at 6-month follow-up (p = .01, d = 0.57) in the combined MBI groups, and additionally in the gamma (25–40 Hz) range at follow-up for the MBTI group only. No significant changes in these frequency bands were observed for SM. Following mindfulness intervention, NREM beta was positively associated with Five-Facet Mindfulness (FFM) score (rho = 0.37, p = .091) and negatively associated with Insomnia Severity Index (rho = −0.43, p = .047). ConclusionThese results in people with insomnia corroborate prior reports of increased high-frequency sleep EEG power associated with mindfulness training. This change in beta EEG pattern merits further evaluation as a potential marker of the effects of mindfulness meditation on sleep, especially given the paradoxical findings in the context of insomnia. Clinical Trial Registrationclinicaltrials.gov, NCT00768781.

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.

A pilot randomised controlled trial investigating a mindfulness-based stress reduction (MBSR) intervention in individuals with pulmonary arterial hypertension (PAH): the PATHWAYS study

BackgroundPulmonary arterial hypertension (PAH) is an uncommon condition with progressive heart failure and premature death. Treatment costs up to £120,000 per patient per year, and the psychological burden of PAH is substantial. Mindfulness-based stress reduction (MBSR) is an intervention with the potential to reduce this burden, but to date, it has not been applied to people with pulmonary hypertension. We wished to determine whether a trial of MBSR for people with PAH would be feasible.MethodsA customised gentle MBSR programme of eight sessions was developed for people with physical disability due to PAH, and they were randomised to group-based MBSR or treatment as usual. The completeness of outcome measures including Beck Anxiety Index, Beck Depression Inventory and standard physical assessment at 3 months after randomisation were recorded. Health care utilisation was measured. Attendance at the sessions and the costs involved in delivering the intervention were assessed. Semi-structured interviews were conducted to explore the acceptability of the MBSR intervention and when appropriate the reasons for trial non-participation.ResultsFifty-two patients were recruited, but only 34 were randomised due to patients finding it difficult to travel to sessions. Twenty-two completed all questionnaires and attended all clinics, both routine and additional in order to collect outcomes measures. The MSBR sessions were delivered in Bristol, Cardiff and London, costing, on average, between £2234 (Cardiff) and £4128 (London) per patient to deliver. Attendance at each session averaged between two patients in Bristol and Cardiff and three in London. For those receiving treatment as usual, clinician blinding was achievable. Interviews revealed that people who attended MBSR found it interesting and helpful in managing their symptoms and minimising the psychological component of their disease.ConclusionsWe found that attendance at group MBSR was poor in people with chronic PAH within the context of a trial. Achieving better MBSR intervention attendance or use of an Internet-based programme might maximise the benefit of MBSR.

A Systematic Review of the Demographic Characteristics of Participants in US-Based Randomized Controlled Trials of Mindfulness-Based Interventions

This systematic review examines the socio-economic and demographic characteristics of adults enrolled in US-based randomized controlled trials of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). We conducted a literature search using Medline, PsycINFO, and CINAHL electronic databases from the earliest available until March 2017. We found 69 randomized controlled trials that met inclusion criteria. Only one study specifically aimed to test the mindfulness interventions in racial/ethnic minority or lower socio-economic status populations and none reported their effectiveness in these populations. For the 56 articles that reported the proportion of Caucasians in their samples, 79% of all individuals were identified as Caucasian. Out of the 45 studies that reported data on other races and ethnicities, 76% of the individuals were Caucasian, 11% were African-American, 4% were Asian-American, 4% were Hispanic/Latinx, < 1% were American Indian/Native American, and 5% were reported as “other” or multi-ethnic. The three most commonly reported socio-economic characteristics were educational attainment (n = 48), employment/professional status (n = 29), and income (n = 27). The proportion of college graduates in the study samples was higher than the national average in all but one of the studies that reported this data. Most of the studies that reported employment rates had more than half of their participants employed. Of the studies that reported average income, most had more than 50% of their participants making over $40,000 a year. This review highlights the need for increased diversity in randomized controlled trials of mindfulness-based interventions as these interventions have great promise to alleviate mental and physical health problems in underserved populations.

Associations of mindfulness with depressive symptoms and well-being in older adults: the moderating role of neuroticism

ABSTRACTObjective: To investigate whether observed interactions of mindfulness with the personality trait neuroticism extend to older adults and to aspects of psychological functioning other than depressive symptoms, and whether effects of mindfulness training in this population depend on levels of neuroticism.Method: We performed a secondary analysis of data from a randomized controlled trial of Mindfulness-Based Stress Reduction (MBSR) for community-dwelling older adults. We investigated whether neuroticism moderates associations of dispositional mindfulness with various aspects of psychological and physical functioning at baseline, as well as effects of MBSR on these outcomes.Results: Significant two-way interactions showed that greater mindfulness was associated with fewer depressive symptoms and less negative affect at baseline in individuals with average or higher levels of neuroticism. In contrast, mindfulness was associated with greater positive affect and vitality and fewer physical symptoms regardless of the level of neuroticism. There were no effects of MBSR on these outcomes at any level of neuroticism.Conclusion: Mindfulness may be more protective against psychological ill-being in older adults with higher levels of neuroticism, but conducive to positive psychological and physical well-being regardless of this personality trait. The potential moderating role of neuroticism should be further evaluated in studies of mindfulness-based interventions in older adults.