Mindfulness-based stress reduction and mindfulness-based cognitive therapy: a systematic review of randomized controlled trials

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

OBJECTIVES

To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility.

METHODS

Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders.

RESULTS

The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care.

CONCLUSIONS

The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus.

MOOD DISORDERS COMMITTEE

Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh.

INTERNATIONAL EXPERT ADVISORS

Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham.

AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS

Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.

Integrative oncology: an overview

Integrative oncology, the diagnosis-specific field of integrative medicine, addresses symptom control with nonpharmacologic therapies. Known commonly as "complementary therapies" these are evidence-based adjuncts to mainstream care that effectively control physical and emotional symptoms, enhance physical and emotional strength, and provide patients with skills enabling them to help themselves throughout and following mainstream cancer treatment. Integrative or complementary therapies are rational and noninvasive. They have been subjected to study to determine their value, to document the problems they ameliorate, and to define the circumstances under which such therapies are beneficial. Conversely, "alternative" therapies typically are promoted literally as such; as actual antitumor treatments. They lack biologic plausibility and scientific evidence of safety and efficacy. Many are outright fraudulent. Conflating these two very different categories by use of the convenient acronym "CAM," for "complementary and alternative therapies," confuses the issue and does a substantial disservice to patients and medical professionals. Complementary and integrative modalities have demonstrated safety value and benefits. If the same were true for "alternatives," they would not be "alternatives." Rather, they would become part of mainstream cancer care. This manuscript explores the medical and sociocultural context of interest in integrative oncology as well as in "alternative" therapies, reviews commonly-asked patient questions, summarizes research results in both categories, and offers recommendations to help guide patients and family members through what is often a difficult maze. Combining complementary therapies with mainstream oncology care to address patients' physical, psychologic and spiritual needs constitutes the practice of integrative oncology. By recommending nonpharmacologic modalities that reduce symptom burden and improve quality of life, physicians also enable patients to play a role in their care. Critical for most patients, this also improves the physician-patient relationship, the quality of cancer care, and the well-being of patients and their families.

Staying Well: A Follow Up of a 5-Week Mindfulness Based Stress Reduction Programme for a Range of Psychological Issues

112 women and 37 men, with an average age of 50 years were referred for MBSR training with a range of chronic psychological issues. All participants completed the Warwick-Edinburgh Mental Wellbeing Scale (Tennant et al. in Health and Quality of Life Outcomes 5:63, 2007) before and after the mindfulness training programme. A significant overall effect of pre/post training was found and this difference was not related to a specific disorder. The results suggest that a 'brief' dose of MBSR can have a positive impact on measures of well-being in a manner that is not related to patient characteristics. A follow-up of 28 participants confirms that participation in the 5-week Living Mindfully MBSR programme significantly enhances psychological well-being immediately after training, and this benefit is maintained up to 4 years after training. Continued practice in mindfulness meditation showed an insignificant relationship to well-being scores at follow up. Qualitative data suggest that the 5 week MBSR is an effective means of developing emotion regulation and psychological well-being.

Integrative Medicine in a Preventive Medicine Residency: A Program for the Urban Underserved

The Preventive Medicine Residency Program collaborated with the Department of Family Medicine's Program for Integrative Medicine and Health Disparities at Boston Medical Center to create a new rotation for preventive medicine residents starting in autumn 2012. Residents participated in integrative medicine group visits and consults, completed an online curriculum in dietary supplements, and participated in seminars all in the context of an urban safety net hospital. This collaboration was made possible by a federal Health Resources and Services Administration grant for integrative medicine in preventive medicine residencies and helped meet a need of the program to increase residents' exposure to clinical preventive medicine and integrative health clinical skills and principles. The collaboration has resulted in a required rotation for all residents that continues after the grant period and has fostered additional collaborations related to integrative medicine across the programs.

eMindfulness Therapy-A Study on Efficacy of Blood Pressure and Stress Control Using Mindful Meditation and Eating Apps among People with High Blood Pressure

Background: With the increasing availability of Smartphones and wearable tracking devices, it is now feasible and affordable to apply such mobile devices to delivering mindfulness-based stress reduction (MBSR) and intermittent fasting (IF) to lower blood pressure, as traditional MBSR and IF incur the burden of commuting to the intervention sites for the patients. Our study will develop and scientifically evaluate an MBSR app, an IF app and an MBSR + IF app in terms of their effectiveness for lowering blood pressure. We will further explore the possible interaction effect (synergistic effect) between MBSR and IF intervention: will improved mindfulness enhance patients' adherence to the IF protocol? Methods: We will develop an MBSR app, an IF app, and an MBSR+IF app. We will then conduct an 8-week randomized controlled trial with a factorial design to evaluate the efficacy of these new apps, especially the interaction effect between MBSR and IF. Eligible individuals will be randomly assigned to Group 1 (MBSR app), Group 2 (IF app), Group 3 (MBSR + IF app) or Group 4 (usual care). Discussion: This will be the first attempt to explore the impact of mindfulness intervention on the adherence of a behavioral intervention. Nevertheless, our protocol is limited in that the effectiveness of intermittent fasting on lowering blood pressure has not been supported by large-sample randomized controlled trials. Thus if there is no significant effectiveness we cannot determine whether it is due to the intermittent fasting intervention itself or it is due to the limit of smartphone as a vehicle.

Mindfulness of the kindness of others: The contemplative practice of Naikan in cultural context

Mindfulness in the Buddhist tradition involves a variety of practices, and contemporary secular forms of mindfulness practices, therapies, and interventions can similarly be broadened to include more of these forms. The Japanese practice of Naikan takes one mindfulness practice from the Buddhist tradition--that of recollecting the kindness of others--and asks clients to engage in this practice for 1 solid week, 15 hours per day. Difficult interpersonal relationships and a perceived lack of social support are chief sources of stress, and Japanese selfhood in particular has been described as interdependent and highly social in nature. It is unsurprising therefore that Japanese would be drawn to relational forms of practice like Naikan, and that they would find particular benefit from such practices. Recent ethnographic and survey work I have conducted at 2 Naikan centers suggests that Naikan significantly improves positive mental health, perceived connection with others, and perceived meaning in life, even up to 6 months later, thereby potentially undercutting factors contributing to depression and suicide. Naikan practice is not entirely limited to Japan, however, and its use in Europe and North America prompts us to ask about the culturally specific and universal aspects of mindfulness practices, and how we may construct mindfulness interventions that are best suited for addressing the mental health problems that face our communities.

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

Introduction

Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy.

Methods

A sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253).

Results

No changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses).

Discussion/conclusion

The study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.

Psychological resources are associated with reduced incidence of coronary heart disease. An 8-year follow-up of a community-based Swedish sample

BACKGROUND

A large number of studies have provided clear evidence for a link between the risk of coronary heart disease and psychological risk factors. Much less attention has been given to the potential protective effect of psychological resources.

PURPOSE

The major aim of this study was to investigate the independent association between psychological resources and incidence of coronary heart disease (CHD) in an 8-year follow-up study of a Swedish community-based cohort.

METHODS

The cohort consisted of 484 men and 497 women, aged 45-69 years at baseline. The incidence of first-time major event of CHD was analysed in relation to baseline levels of psychological resources, including mastery, self-esteem, and sense of coherence as well as psychological risk factors including cynicism and hostile affect, vital exhaustion, hopelessness, and depressive symptoms. In Cox proportional hazard models, adjustments were made for age, sex, eight traditional cardiovascular risk factors, and depressive symptoms.

RESULTS

A total of 56 CHD events had occurred after the 8-year follow-up. After adjustment for age, sex, and eight traditional risk factors, a significantly decreased risk of CHD was found for mastery (HR 0.62 per SD, p = 0.003), self-esteem (HR 0.64, p = 0.004), and sense of coherence (HR 0.70, p = 0.031). An increased risk of CHD was found for vital exhaustion (HR 1.46, p = 0.014), hopelessness (HR 1.59, p = 0.003), and depressive symptoms (HR 1.45, p = 0.009). After further adjustment for depressive symptoms, significant associations remained for mastery (HR 0.67, p = 0.034), self-esteem (HR 0.69, p = 0.048), and hopelessness (HR 1.48, p = 0.023).

CONCLUSIONS

The psychological resources, mastery and self-esteem, showed robust protective effects on CHD, also after adjustment for established risk factors as well as depressive symptoms. In parallel, hopelessness was an independent risk factor for CHD. The results may have implications for novel approaches in preventive efforts.

An Exploratory Study of the Effects of Mind-Body Interventions Targeting Sleep on Salivary Oxytocin Levels in Cancer Survivors

Cancer survivors experience high levels of distress, associated with a host of negative psychological states, including anxiety, depression, and fear of recurrence, which often lead to sleep problems and reduction in quality of life (QOL) and well-being. As a neuropeptide hormone associated with affiliation, calmness, and well-being, oxytocin may be a useful biological measure of changes in health outcomes in cancer survivors. In this exploratory study, which comprised a subset of participants from a larger study, we evaluated (a) the feasibility and reliability of salivary oxytocin (sOT) levels in cancer survivors and (b) the effects of 2 sleep-focused mind-body interventions, mind-body bridging (MBB) and mindfulness meditation (MM), compared with a sleep hygiene education (SHE) control, on changes in sOT levels in 30 cancer survivors with self-reported sleep disturbance. Interventions were conducted in 3 sessions, once per week for 3 weeks. Saliva samples were collected at baseline, postintervention (~1 week after the last session), and at the 2-month follow-up. In this cancer survivor group, we found that intra-individual sOT levels were fairly stable across the 3 time points, of about 3 months' duration, and mean baseline sOT levels did not differ between females and males and were not correlated with age. Correlations between baseline sOT and self-report measures were weak; however, several of these relationships were in the predicted direction, in which sOT levels were negatively associated with sleep problems and depression and positively associated with cancer-related QOL and well-being. Regarding intervention effects on sOT, baseline-subtracted sOT levels were significantly larger at postintervention in the MBB group as compared with those in SHE. In this sample of cancer survivors assessed for sOT, at postintervention, greater reductions in sleep problems were noted for MBB and MM compared with that of SHE, and increases in mindfulness and self-compassion were observed in the MBB group compared with those in SHE. The findings in this exploratory study suggest that sOT may be a reliable biological measure over time that may provide insight into the effects of mind-body interventions on health outcomes in cancer survivors.

Mindfulness-Based Stress Reduction: pilot study of a treatment group for patients with chronic pain in a primary care setting

AIM

The study objective was to evaluate an eight-week Mindfulness-Based Stress Reduction (MBSR) treatment group for chronic pain in terms of effects on pain disability, subjective ratings of pain and psychological distress related to pain, and activity level and willingness to experience pain. This pilot study evaluated the impact of two eight-week MBSR treatment groups that were delivered in a clinic in Winnipeg, Manitoba.

BACKGROUND

Chronic pain is one of the most common presenting problems in primary care settings.

METHODS

Adult patients with chronic pain were recruited from 20 clinics that are part of a collaborative care programme and outcome measures were administered at baseline and programme completion.

FINDINGS

Despite a modest attendance rate and the short length of programme, a pre-post evaluation involving 17 patients revealed significant and/or clinically relevant improvements in level of pain disability, psychological distress, engagement in life activities, willingness to experience pain, and subjective rating of current pain.

A Neurophysiological and Neuropsychological Consideration of Mindful Movement: Clinical and Research Implications

In this article, we present ideas related to three key aspects of mindfulness training: the regulation of attention via noradrenaline, the importance of working memory and its various components (particularly the central executive and episodic buffer), and the relationship of both of these to mind-wandering. These same aspects of mindfulness training are also involved in the preparation and execution of movement and implicated in the pathophysiology of psychosis. We argue that by moving in a mindful way, there may be an additive effect of training as the two elements of the practice (mindfulness and movement) independently, and perhaps synergistically, engage common underlying systems (the default mode network). We discuss how working with mindful movement may be one route to mindfulness training for individuals who would struggle to sit still to complete the more commonly taught mindfulness practices. Drawing on our clinical experience working with individuals with severe and enduring mental health conditions, we show the real world application of these ideas and how they can be used to help those who are suffering and for whom current treatments are still far from adequate.

Mindfulness Meditation Training for Attention-Deficit/Hyperactivity Disorder in Adulthood: Current Empirical Support, Treatment Overview, and Future Directions

Research examining nonpharmacological interventions for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) has expanded in recent years and provides patients with more treatment options. Mindfulness-based training is an example of an intervention that is gaining promising preliminary empirical support and is increasingly administered in clinical settings. The aim of this review is to provide a rationale for the application of mindfulness to individuals diagnosed with ADHD, describe the current state of the empirical basis for mindfulness training in ADHD, and summarize a treatment approach specific to adults diagnosed with ADHD: the Mindful Awareness Practices (MAPs) for ADHD Program. Two case study examples are provided to demonstrate relevant clinical issues for practitioners interested in this approach. Directions for future research, including mindfulness meditation as a standalone treatment and as a complementary approach to cognitive-behavioral therapy, are provided.

Mindfulness-based stress reduction to enhance psychological functioning and improve inflammatory biomarkers in trauma-exposed women: A pilot study

This study examined the effects of a mindfulness-based stress reduction (MBSR) program on psychological functioning and inflammatory biomarkers in women with histories of interpersonal trauma. The 8-week MBSR program was conducted at a community-based health center and participants (N = 50) completed several measures of psychological functioning at study entry as well as 4 weeks, 8 weeks, and 12 weeks later. Inflammatory biomarkers were assayed from blood collected at each assessment. A series of linear mixed-model analyses were conducted to measure the effect of attendance and time on the dependent variables. Time was associated with significant decreases in perceived stress, depression, trait and state anxiety, emotion dysregulation, and posttraumatic stress symptoms, as well as increases in mindfulness. Session attendance was associated with significant decreases in interleukin (IL)-6 levels. This pilot study demonstrated the potential beneficial effects of MBSR on psychological functioning and the inflammatory biomarker IL-6 among trauma-exposed and primarily low-income women. Decreases in inflammation have implications for this population, as interpersonal trauma can instigate chronic physiological dysregulation, heightened morbidity, and premature death. This study's preliminary results support efforts to investigate biological remediation with behavioral interventions in vulnerable populations.

Self-evaluative and emotion processes linked with brooding rumination among adolescents

Rumination has been linked with a number of deleterious outcomes, though relatively little is known about self-evaluative and emotion processes by which it develops. The current investigation uses a prospective, longitudinal design and self-report measures to examine the role of contingent self-worth, perfectionism, negative emotion beliefs, and suppression of negative emotion in predicting the development of brooding and reflective forms of rumination among 168 adolescents (98 girls, 79.6% European-American) undergoing the transition to high school (Mage = 13.58). Results of structural equation modeling indicate that self-evaluative vulnerability (i.e., self-worth contingencies, perfectionism) and negative emotion beliefs, but not the suppression of negative emotion, predict brooding (but not reflective) rumination. The current study demonstrates how brooding is intertwined with views of self and core assumptions about emotion.

A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder

BACKGROUND

The investigation of treatment mechanisms in randomized controlled trials has considerable clinical and theoretical relevance. Despite the empirical support for the effect of mindfulness-based cognitive therapy (MBCT) in the treatment of recurrent major depressive disorder (MDD), the specific mechanisms by which MBCT leads to therapeutic change remain unclear.

OBJECTIVE

By means of a systematic review we evaluate how the field is progressing in its empirical investigation of mechanisms of change in MBCT for recurrent MDD.

METHOD

To identify relevant studies, a systematic search was conducted. Studies were coded and ranked for quality.

RESULTS

The search produced 476 articles, of which 23 were included. In line with the theoretical premise, 12 studies found that alterations in mindfulness, rumination, worry, compassion, or meta-awareness were associated with, predicted or mediated MBCT's effect on treatment outcome. In addition, preliminary studies indicated that alterations in attention, memory specificity, self-discrepancy, emotional reactivity and momentary positive and negative affect might play a role in how MBCT exerts its clinical effects.

CONCLUSION

The results suggest that MBCT could work through some of the MBCT model's theoretically predicted mechanisms. However, there is a need for more rigorous designs that can assess greater levels of causal specificity.

Mindfulness-based stress reduction in patients with interstitial lung diseases: a pilot, single-centre observational study on safety and efficacy

Background

Chronic, progressive respiratory symptoms are associated with great psychological and emotional impact in patients suffering from interstitial lung disease (ILD). This single-centre pilot study evaluated for the first time the safety, feasibility and efficacy of a Mindfulness Based Stress Reduction Program (MBSR) in a group of patients with ILD.

Methods

Prospective observational study set in a university hospital ILD outpatient clinic. Nineteen patients with different ILDs were recruited 2 months prior to the start of the 8-week MBSR program and followed up for 12 months. Primary outcomes were program safety and feasibility, while secondary outcomes were changes in moods and stress (assessed by Profile Of Mood State (POMS) and Perceived Stress Scale (PSS) questionnaires), symptoms (Shortness Of Breath (SOB) and Cough And Sputum Assessment (CASA-Q) questionnaires), lung function and exercise tolerance at 12 months.

Results

Two patients (10.5%) dropped out in the observational period before the start of the MBSR intervention because of non-respiratory causes. All 17 patients who entered the 8-week MBSR program managed to complete it with an adherence average of eight sessions of nine. No adverse events related to the mindfulness training were reported. Statistically significant improvements in the POMS total score and in several individual items of POMS and PSS were observed throughout the study. However, respiratory questionnaire scores, lung function and exercise tolerance did not show a significant difference over time.

Conclusions

An MBSR program appears to be safe and feasible in patients with ILD, and might affect perceived moods and stress producing a positive and lasting improvement in several stress-related negative domains. These findings pave the way to larger (possibly multicentre), randomised, controlled confirmatory trials.

"Like walking into an empty room": effects of eurythmy therapy on stress perception in comparison with a sports intervention from the subjects' perspective-a qualitative study

Background. Stress and health-related quality of life are important constructs used in treatment evaluation today. This study is based on a randomised controlled trial examining the stress-reducing effect of eurythmy therapy in comparison with step aerobics in 106 healthy but stressed subjects. The aim of the analysis was to characterise changes in the subjective perceptions of the participants. Methods. Interviews were conducted with 76 healthy adults, 36 (f = 31/m = 5) from the eurythmy group and 40 (f = 28/m = 12) from the step aerobics group both analysed by content analysis and phenomenologically. Results. The following categories were identified for the eurythmy therapy group: enabling a productive therapeutic response, emergence of a new perceptual space, reevaluation of the accustomed perception, and emergence of new options for action. Step aerobics places increased physical and intellectual demands. These are perceived differently as pleasant and relaxing, insufficiently challenging and/or boring, and too challenging and thus experienced as stress-enhancing. Conclusion. The qualitative results provided revealing insights into the profound effects of and subjective assignments of meaning to external and internal stress factors. Processes of mental reinterpretation leading to stress reduction can be stimulated by physical procedures such as eurythmy therapy.

Mindfulness training for medical students in their clinical clerkships: two cross-sectional studies exploring interest and participation

BACKGROUND

So far, studies investigating Mindfulness Based Stress Reduction (MBSR) training in medical students are conducted in self-selected, pre-clinical samples, with modest response rates without collecting data on non-participants. This study first examines interest and participation rates of students starting their clinical clerkships. Second, it compares students interested in a mindfulness training with non-interested students and students participating in a trial on the effect of MBSR with non-participating students on levels of psychological distress, personality traits, cognitive styles and mindfulness skills.

METHODS

We examined two student samples from the Radboud University Medical Center, Nijmegen: Study 1 From March to December 2010 we performed a cross-sectional pilot-study among 4th year medical students starting their clinical clerkships, assessing interest in a MBSR training. We compared scores on the Brief Symptom Inventory, the Neo Five Factor Inventory and the Five Facet Mindfulness Questionnaire of interested students with those of non-interested students using t-tests with Bonferroni correction. Study 2 From February 2011 to August 2012 we invited 4th year medical students starting their clinical clerkships to participate in a randomized controlled trial (RCT) on the effectiveness of MBSR. We compared scores on the Brief Symptom Inventory, the Irrational Beliefs Inventory and the Five Facet Mindfulness Questionnaire of participating students with those of non-participants using t-tests with Bonferroni correction.

RESULTS

Study 1: Ninety-five out of 179 participating students (53%) were interested in a MBSR training. Interested students scored significantly higher on psychological distress (p = .004) and neuroticism (p < .001), than 84 non-interested students. Study 2: Of 232 eligible students, 167 (72%) participated in our RCT. Participants scored significantly higher on psychological distress (p = .001), worrying (p = .002), problem avoidance (p = .005) and lower on mindfulness skills (p = .002) than 41 non-participants.

CONCLUSIONS

Interest in mindfulness training and response rates in a RCT on the effectiveness of MBSR among clinical clerkship students are equal to (study 1) or higher (study 2) than in studies on pre-clinical students. Interested students and participants in a RCT reported more psychological distress and psychopathology related character traits. Participants scored lower on mindfulness skills.

Toward a theoretical model for mindfulness-based pain management

Mindfulness, as both a process and a practice, has received substantial research attention across a range of health conditions, including chronic pain. Previously proposed mechanisms underlying the potential health-related benefits of mindfulness and mindfulness-based interventions (MBIs) are based on a strong theoretical background. However, to date, an empirically grounded, integrated theoretical model of the mechanisms of MBIs within the context of chronic pain has yet to be proposed. This is a surprising gap in the literature given the exponential growth of studies reporting on the benefits of MBIs for heterogeneous chronic pain conditions. Moreover, given the importance of determining how, and for whom, psychological interventions for pain management are effective, it is imperative that this gap in the literature be addressed. The overarching aim of the current theoretical paper was to propose an initial integrated, theoretically driven, and empirically based model of the mechanisms of MBIs for chronic pain management. Theoretical and research implications of the model are discussed. The theoretical considerations proposed herein can be used to help organize and guide future research that will identify the mechanisms underlying the benefits of mindfulness-based treatments, and perhaps psychosocial treatments more broadly, for chronic pain management.

PERSPECTIVE

This focus article presents an initial framework for an empirically based, theoretical model of the mechanisms of MBIs for chronic pain management. Implications of the framework for refining theory and for future research are addressed.

Mindfulness-based stress reduction teachers, practice characteristics, cancer incidence, and health: a nationwide ecological description

BACKGROUND

Studies have demonstrated the potential of the Mindfulness-Based Stress Reduction (MBSR) program to improve the condition of individuals with health outcomes such as hypertension, diabetes, and chronic pain; improve psychological well-being; reduce stress levels; and increase survival among cancer patients. To date, only one study has focused on the effect of long-term meditation on stress, showing a positive protective relationship. However, the relationship between meditation and cancer incidence remains unexplored. The objective of this study was to describe the state-level relationship between MBSR instructors and their practices and county-level health outcomes, including cancer incidence, in the United States.

METHODS

This ecologic study was performed using geospatial mapping and descriptive epidemiology of statewide MBSR characteristics and overall health, mental health state rankings, and age-adjusted cancer incidence rates.

RESULTS

Weak to moderate state-level correlations between meditation characteristics and colorectal and cervical cancer incidence were detected, with states with more meditation (e.g., more MBSR teachers per population) correlated with a decreased cancer incidence. A negative correlation was detected between lung & bronchus cancer and years teaching MBSR only. Moderate positive correlations were detected between Hodgkin's Lymphoma and female breast cancer in relation to all meditation characteristics. Statistically significant correlations with moderate coefficients were detected for overall health ranks and all meditation characteristics, most strongly for total number of years teaching MBSR and total number of years of general meditation practice.

CONCLUSIONS

Our analyses might suggest that a relationship exists between the total number of MBSR teachers per state and the total number of years of general meditation practice per state, and colorectal and cervical cancer incidence. Positive correlations were observed with overall health rankings. Despite this study's limitations, its findings could serve to generate hypotheses and to inform and motivate a new focus on meditation and stress reduction in relation to cancer incidence, with specific relevance to colorectal and cervical cancer.

Mindfulness-based relationship education for couples expecting their first child--part 1: a randomized mixed-methods program evaluation

This article is Part 1 of a two-part series, in which we report on our evaluation of a mindfulness-based relationship enhancement program for couples who are expecting their first child. In this mixed-methods randomized clinical trial, we assigned 33 couples to the 4-week Mindful Transition to Parenthood Program treatment group (n = 16 couples) or to a waitlist control condition (n = 17 couples). Men in the treatment group significantly improved in relationship satisfaction, mindfulness, and negative affect; women had no significant treatment effects. Small to large effect sizes were present for treatment group men and women in multiple areas. Mixed-methods analyses demonstrated that this intervention may be especially helpful for men because of differences in social support needs, effects of program enrollment, and relational processes in the prenatal period.

Searching for existential security: a prospective qualitative study on the influence of mindfulness therapy on experienced stress and coping strategies among patients with somatoform disorders

OBJECTIVE

The aim was to explore how mindfulness group therapy for somatoform disorders influenced the patients' stress experiences, coping strategies and contextual psychosocial processes.

METHODS

A longitudinal pre- and post-treatment design, using 22 semi-structured individual pre- and post-treatment interviews. Data-analysis was based on a thematic methodology.

RESULTS

Pre-treatment patients were struggling in an existential crisis, feeling existentially insecure about their social identity, the causes, consequences and management of their illness; experiencing difficulties identifying and expressing stress-related cognitions, emotions and feelings, and low bodily and emotional self-contact; often leading to avoidant coping, making these individuals highly stress-vulnerable. Post-treatment, the overall change was conceptualized as increased existential security, defined by patients being more self-confident; more clarified with their social identity, the nature, management and future prospects of their illness; generally using more flexible coping strategies to reduce their daily stress experiences. Four related subthemes were identified contributing to increased existential security: 1) more secure illness perceptions - feeling existentially recognized as "really" ill, 2) enhanced relaxation ability - using mindfulness techniques, 3) increased awareness - connecting differently to mind and body 4) improved ability to identify and express needs and feelings of distress - more active communicating. Patients suggested that mindfulness therapy could be expanded with more time for group-discussions followed by additional individual therapy.

CONCLUSION

Generally, treatment positively influenced the patients' illness perceptions, stress-experiences, body- and self-awareness, coping strategies, self-image, social identity and social functioning. However, patients identified potentials for treatment improvements, and they needed further treatment to fully recover.

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.

Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial

BACKGROUND

Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges.

METHODS/DESIGN

This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task.

DISCUSSION

The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00004525 . Registered 19 March 2013.

Toxic Stress: Effects, Prevention and Treatment

Children who experience early life toxic stress are at risk of long-term adverse health effects that may not manifest until adulthood. This article briefly summarizes the findings in recent studies on toxic stress and childhood adversity following the publication of the American Academy of Pediatrics (AAP) Policy Report on the effects of toxic stress. A review of toxic stress and its effects is described, including factors of vulnerability, resilience, and the relaxation response. An integrative approach to the prevention and treatment of toxic stress necessitates individual, community and national focus.

Effects of mindfulness-based cognitive therapy on self-reported suicidal ideation: results from a randomised controlled trial in patients with residual depressive symptoms

INTRODUCTION

The aim of the present study was to investigate the effects of mindfulness-based cognitive therapy (MBCT) on suicidal ideation in an open-label randomised controlled trial of patients with residual depressive symptoms. Furthermore, this study aimed at examining whether an effect of MBCT on suicidal ideation was dependent on a reduction in depression severity, worry and rumination, or an increase in mindfulness.

METHODS

One hundred and thirty participants were randomised to a treatment arm (treatment as usual plus MBCT) or a wait list arm. Change in depression, change in worry, change in rumination and change in mindfulness were entered as covariates in a repeated measures ANOVA in order to assess to what degree MBCT-induced changes in suicidal ideation were independent from changes in these parameters.

RESULTS

There was a significant group×time (pre vs. post) interaction on suicidal ideation indicating a significant reduction of suicidal ideation in the MBCT group, but not in the control group. The interaction remained significant after addition of the above covariates. Change in worry was the only covariate associated with change in suicidal ideation, causing a moderate reduction in the interaction effect size.

CONCLUSIONS

The results suggest that MBCT may affect suicidal ideation in patients with residual depressive symptoms and that this effect may be mediated, in part, by participants' enhanced capacity to distance themselves from worrying thoughts.

Rehabilitation of individuals on long-term sick leave due to sustained stress-related symptoms: a comparative follow-up study

AIMS

Nature-assisted therapy for mental health problems receives increased attention. However, quantitative evaluations are rare. This study evaluates the effects of an all-outdoors vocational rehabilitation program for individuals on long-term sick leave due to sustained stress-related symptoms.

METHODS

In a comparative pre-post intervention design the intervention group contained 48 participants from Mariendal Gardens (MG), while 45 participants at Stress- & Jobmanagement (SJ) formed the comparison group. At MG all activities took place outdoors, while activities at SJ were mainly indoors. Questionnaires were completed at baseline, 3- and 6-month follow-up. Outcomes included Perceived Stress Scale (PSS-10) and measures of sleep, mindfulness, self-efficacy, daily functioning, and work ability. Data were analyzed using mixed model repeated measures analysis of variance.

RESULTS

At baseline the MG-group PSS-10 mean score was 25.15 points (SD=7.20), while the SJ-group mean score was 23.91 (SD=7.48). At 3-months the MG within-group score dropped 4.61 [2.71; 6.52] points (p<0.01), corresponding to at standardized mean difference (Cohen's d) of d=0.64 [0.38; 0.91], while the SJ within-group score dropped 4.16 [1.73; 6.59] points (p<0.01), corresponding to d=0.56 [0.23; 0.88]. The between-group mean difference was not significant (p=0.77). Similarly, results for sleep, mindfulness, self-efficacy, daily functioning, and work ability demonstrated significant within-group effects and minimal between-group differences.

CONCLUSIONS

Both interventions demonstrated small to large pre-post effect sizes. Negligible differences were observed between the effects of the two interventions, indicating no added effect of the all-outdoors setting. Results should be interpreted with caution as unequal lost to follow-up rates threatens the comparability of changes in the two groups.

CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety

Many women experience anxiety during pregnancy with potential negative effects on maternal, birth, and child outcomes. Because of potential risks of fetal exposure to psychotropic medications, efficacious non-pharmacologic approaches are urgently needed. However, no published studies of psychotherapeutic treatments for anxiety in pregnancy exist. Mindfulness-based cognitive therapy (MBCT) may substantially reduce anxiety and co-morbid symptoms in people with anxiety disorders. Coping with Anxiety through Living Mindfully (CALM) Pregnancy is an adaptation of MBCT designed to address anxiety in pregnant women. This study examined the feasibility, acceptability, and clinical outcomes of the CALM Pregnancy intervention in pregnant women anxiety. Twenty-four pregnant women with generalized anxiety disorder (GAD) or prominent symptoms of generalized anxiety participated in an open treatment trial of the CALM Pregnancy group intervention. Psychiatric diagnoses were determined by structured clinical interview, and self-report measures of anxiety, worry, depression, self-compassion, and mindfulness were completed at baseline and post-intervention. Qualitative feedback was elicited via questionnaire. Twenty-three participants completed the intervention with high attendance and good compliance with home practice. Completers showed statistically and clinically significant improvements in anxiety, worry, and depression, and significant increases in self-compassion and mindfulness. Of the 17 participants who met GAD criteria at baseline, only one continued to meet criteria post-intervention. Participants regarded their experience in the intervention to be overwhelmingly positive. MBCT in the form of the CALM Pregnancy intervention holds potential to provide effective, non-pharmacological treatment for pregnant women with anxiety. These promising findings warrant further testing of the intervention with a randomized controlled trial.

Mindfulness-based cognitive therapy for seasonal affective disorder: a pilot study

BACKGROUND

The best available treatment for seasonal affective disorder (SAD) is light therapy. Yet, this treatment does not prevent recurrence of depression in subsequent seasons. The aim of the study is to gain preliminary insight in the efficacy of Mindfulness Based Cognitive Therapy (MBCT) in the prevention of SAD recurrence.

METHODS

This is a randomized controlled pilot study, in which SAD patients in remission were randomly allocated to an individual format of MBCT or a control condition (i.e. treatment as usual). MBCT was given between May and June 2011, when there was no presence of depressive symptoms. The Inventory for Depressive Symptomatology Self-Report (IDS-SR), which patients received on a weekly basis from September 2011 to April 2012, was used to assess moment of recurrence (≥20) and severity at moment of recurrence.

RESULTS

23 SAD patients were randomized to MBCT and 23 to the control condition. Kaplan-Meier survival curve showed that the groups did not differ in moment of recurrence (χ²(1).41, p=.52). T-tests showed no group difference in mean IDS-SR scores at moment of recurrence (t(31)=-.52, p=.61).

LIMITATIONS

The results are limited by small sample size (n=46) and missing data of weekly IDS-SR assessments.

CONCLUSION

The findings of this pilot RCT suggest that individual MBCT is not effective in preventing a SAD recurrence when offered in a symptom free period (i.e. spring).

Potential therapeutic effects of meditation for treating affective dysregulation

Affective dysregulation is at the root of many psychopathologies, including stress induced disorders, anxiety disorders, and depression. The root of these disorders appears to be an attenuated, top-down cognitive control from the prefrontal cortices over the maladaptive subcortical emotional processing. A form of mental training, long-term meditation practice can trigger meditation-specific neuroplastic changes in the brain regions underlying cognitive control and affective regulation, suggesting that meditation can act as a kind of mental exercise to foster affective regulation and possibly a cost-effective intervention in mood disorders. Increasing research has suggested that the cultivation of awareness and acceptance along with a nonjudgmental attitude via meditation promotes adaptive affective regulation. This review examined the concepts of affective regulation and meditation and discussed behavioral and neural evidence of the potential clinical application of meditation. Lately, there has been a growing trend toward incorporating the "mindfulness" component into existing psychotherapeutic treatment. Promising results have been observed thus far. Future studies may consider exploring the possibility of integrating the element of "compassion" into current psychotherapeutic approaches.

Medical group visits: a feasibility study to manage patients with chronic pain in an underserved urban clinic

BACKGROUND

Chronic pain affects millions of racially diverse Americans. Evidence suggests that group medical visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain.

OBJECTIVES

The primary goal of this study is to evaluate the feasibility of the integrative medical group visit (IMGV) care model in an inner-city racially diverse outpatient clinic. IMGV combines patient-centered, non-pharmacologic strategies and principles of mindfulness-based stress-reduction with a group medical visit to reduce pain and associated symptoms.

METHODS

We surveyed patients pre and post an 8-session IMGV program to evaluate changes in pain in the last week (0-10 point scale) and comorbid symptoms including depression (Patient Health Questionaire-8 [PHQ-8]), perceived stress, and sleep quality. We also recorded referrals to the program, patients screened for eligibility, total enrollment, loss to follow-up, and attendance.

RESULTS

Seventy patients joined IMGV, and of these, 65 (93%) enrolled in the study. Over the course of 12 months, 7 groups met (median 9 patients/group; range 8-13 participants). Mean difference in pain level for all patients between baseline and 8 weeks was 0.7 (SD=2.0, P=.005). Mean difference in PHQ-8 depression score for patients with baseline score ≥5 was 2.6 (SD=4.6, P<.001). Statistically significant improvements were also seen in sleep quality and perceived stress.

CONCLUSION

A group visits program combining conventional and integrative medicine for predominantly racially diverse patients is feasible.

Classical hallucinogens as antidepressants? A review of pharmacodynamics and putative clinical roles

Hallucinogens have been part of spiritual practice for millennia, but controversy surrounding their mind-manifesting effects led to their proscription by the mid-20th century, largely without evidence of harm or toxicity and despite nascent data suggesting therapeutic utility in treating depressive illnesses. This review explores their pharmacodynamic actions and the current limited data on their clinic effectiveness. These drugs appear to exert their psychedelic effects through their agonist or partial agonist activity at the serotonergic 5-HT2A receptor, though they also have affinity for other metabotropic serotonin receptors. Hallucinogen binding affects a wide range of intracellular signalling pathways, the precise nature of which remains incompletely understood. They alter the serotonergic tone of brainstem raphe nuclei that project through the brain; they interact with receptors in the prefrontal cortex altering connectivity patterns and intracellular functioning; and they disrupt inhibitory control of sensory input via the thalamus to the cortex. The serotonergic system has long been implicated in anxiety and depressive disorders, and is a major target of most existing antidepressants. Classical hallucinogens alter the functioning of this system, but not in the same way current medications do: whilst there are identified receptors and neurotransmitter pathways through which hallucinogens could therein produce therapeutic effects, the neurobiology of this remains speculative at this time. There is currently an extremely limited but growing literature on hallucinogen safety and clinical application. The drugs appear well tolerated by healthy controls and clinical populations, and the rapid tolerance to repeated administration might reduce the possibility of dependency. Clinical trials reported over the past decade have generally shown positive therapeutic potential, but they are notably few in number. Legislative policy has had a freezing effect on evaluation of these compounds, a better understanding of which might improve our knowledge of the processes involved in consciousness, the neuropathology of depression, and potentially open up new pharmacological therapies.

[Review of the effects of mindfulness meditation on mental and physical health and its mechanisms of action]

Interventions based on mindfulness have become increasingly popular. This article reviews the empirical literature on its effects on mental and physical health, discusses presumed mechanisms of action as well as its proposed neurobiological underpinning. Mindfulness is associated with increased well-being as well as reduced cognitive reactivity and behavioral avoidance. It seems to contribute to enhance immune functions, diminish inflammation, diminish the reactivity of the autonomic nervous system, increase telomerase activity, lead to higher levels of plasmatic melatonin and serotonin. It enhances the quality of life for patients suffering from chronic pain, fibromylagia and HIV infection. It facilitates adaptation to the diagnosis of cancer and diabetes. It seems to lead to symptomatic improvement in irritable bowel syndrome, chronic fatigue syndrome, hot flashes, insomnia, stress related hyperphagia. It diminishes craving in substance abuse. The proposed mechanism of action are enhanced metacognitive conscience, interoceptive exposure, experiential acceptance, self-management, attention control, memory, relaxation. Six mechanism of actions for which neurological underpinnings have been published are: attention regulation (anterior cingulate cortex), body awareness (insula, temporoparietal junction), emotion regulation (modulation of the amygdala by the lateral prefrontal cortex), cognitive re-evaluation (activation of the dorsal medial prefrontal cortex or diminished activity in prefrontal regions), exposure/extinction/reconsolidation (ventromedial prefrontal cortex, hippocampus, amygdala) and flexible self-concept (prefrontal median cortex, posterior cingulated cortex, insula, temporoparietal junction). The neurobiological effects of meditation are described. These are: (1) the deactivation of the default mode network that generates spontaneous thoughts, contributes to the maintenance of the autobiographical self and is associated with anxiety and depression; (2) the anterior cingulate cortex that underpins attention functions; (3) the anterior insula associated with the perception of visceral sensation, the detection of heartbeat and respiratory rate, and the affective response to pain; (4) the posterior cingulate cortex which helps to understand the context from which a stimulus emerges; (5) the temporoparietal junction which assumes a central role in empathy and compassion; (6) the amygdala implicated in fear responses. The article ends with a short review of the empirical basis supporting the efficacy for mindfulness based intervention and suggested directions for future research.

Mindfulness-based interventions in schools-a systematic review and meta-analysis

Mindfulness programs for schools are popular. We systematically reviewed the evidence regarding the effects of school-based mindfulness interventions on psychological outcomes, using a comprehensive search strategy designed to locate both published and unpublished studies. Systematic searches in 12 databases were performed in August 2012. Further studies were identified via hand search and contact with experts. Two reviewers independently extracted the data, also selecting information about intervention programs (elements, structure etc.), feasibility, and acceptance. Twenty-four studies were identified, of which 13 were published. Nineteen studies used a controlled design. In total, 1348 students were instructed in mindfulness, with 876 serving as controls, ranging from grade 1 to 12. Overall effect sizes were Hedge's g = 0.40 between groups and g = 0.41 within groups (p < 0.0001). Between group effect sizes for domains were: cognitive performance g = 0.80, stress g = 0.39, resilience g = 0.36, (all p < 0.05), emotional problems g = 0.19 third person ratings g = 0.25 (both n.s.). All in all, mindfulness-based interventions in children and youths hold promise, particularly in relation to improving cognitive performance and resilience to stress. However, the diversity of study samples, variety in implementation and exercises, and wide range of instruments used require a careful and differentiated examination of data. There is great heterogeneity, many studies are underpowered, and measuring effects of Mindfulness in this setting is challenging. The field is nascent and recommendations will be provided as to how interventions and research of these interventions may proceed.

Comparison of complementary and alternative medicine with conventional mind-body therapies for chronic back pain: protocol for the Mind-body Approaches to Pain (MAP) randomized controlled trial

BACKGROUND

The self-reported health and functional status of persons with back pain in the United States have declined in recent years, despite greatly increased medical expenditures due to this problem. Although patient psychosocial factors such as pain-related beliefs, thoughts and coping behaviors have been demonstrated to affect how well patients respond to treatments for back pain, few patients receive treatments that address these factors. Cognitive-behavioral therapy (CBT), which addresses psychosocial factors, has been found to be effective for back pain, but access to qualified therapists is limited. Another treatment option with potential for addressing psychosocial issues, mindfulness-based stress reduction (MBSR), is increasingly available. MBSR has been found to be helpful for various mental and physical conditions, but it has not been well-studied for application with chronic back pain patients. In this trial, we will seek to determine whether MBSR is an effective and cost-effective treatment option for persons with chronic back pain, compare its effectiveness and cost-effectiveness compared with CBT and explore the psychosocial variables that may mediate the effects of MBSR and CBT on patient outcomes.

METHODS/DESIGN

In this trial, we will randomize 397 adults with nonspecific chronic back pain to CBT, MBSR or usual care arms (99 per group). Both interventions will consist of eight weekly 2-hour group sessions supplemented by home practice. The MBSR protocol also includes an optional 6-hour retreat. Interviewers masked to treatment assignments will assess outcomes 5, 10, 26 and 52 weeks postrandomization. The primary outcomes will be pain-related functional limitations (based on the Roland Disability Questionnaire) and symptom bothersomeness (rated on a 0 to 10 numerical rating scale) at 26 weeks.

DISCUSSION

If MBSR is found to be an effective and cost-effective treatment option for patients with chronic back pain, it will become a valuable addition to the limited treatment options available to patients with significant psychosocial contributors to their pain.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT01467843.

Mindfulness-Based Stress Reduction for Posttraumatic Stress Symptoms

Mindfulness-based psychotherapies are associated with reductions in depression and anxiety. However, few studies address whether mindfulness-based approaches may benefit individuals with posttraumatic stress symptoms. The current pilot study explored whether group mindfulness-based stress reduction therapy reduced posttraumatic stress symptoms, depression, and negative trauma-related appraisals in 9 adult participants who reported trauma exposure and posttraumatic stress or depression. Participants completed 8 sessions of mindfulness-based stress reduction treatment, as well as pretreatment, midtreatment, and posttreatment assessments of psychological symptoms, acceptance of emotional experiences, and trauma appraisals. Posttraumatic stress symptoms, depression, and shame-based trauma appraisals were reduced over the 8-week period, whereas acceptance of emotional experiences increased. Participants’ self-reported amount of weekly mindfulness practice was related to increased acceptance of emotional experiences from pretreatment to posttreatment. Results support the utility of mindfulness-based therapies for posttraumatic stress symptoms and reinforce studies that highlight reducing shame and increasing acceptance as important elements of recovery from trauma.