Mechanisms of mindfulness: The dynamics of affective adaptation during open monitoring

Implementation of Mindfulness-Based Emotion Regulation Strategies: A Systematic Review and Meta-analysis

Among the strategies people can use to regulate their emotions, there is increasing interest in mindfulness. Although prior reviews support that mindful acceptance (equanimity) is an effective strategy, other components of mindfulness (monitoring/ mindful awareness) have received less attention. Further, a recent theoretical framework-the Dual-mode Model of Mindful Emotion Regulation-proposed that mindfulness has two "modes" of action in emotion regulation: (1) implementation to regulate emotions as time-limited strategies and (2) acting as a moderator that facilitates effective emotion regulation. The present systematic review and meta-analysis aimed to evaluate the implementation of mindfulness-based strategies and facilitation effects of mindfulness on emotion reactivity and strategy implementation. A total of 2037 records were screened, from which 110 studies with 767 effects (N = 8,105) were analyzed. There was a significant effect of mindfulness-based strategies (g = .28, 95% CI [.18, .38], I 2 = 83.3%). Components of monitoring (g = .17, 95% CI [.02, .32]) and equanimity (g = .3, 95% CI [.19, .41]) were also effective, although monitoring alone was significantly less effective than other strategies. The effect size was greater for within-subjects designs, text-based emotional stimuli, personally relevant stimuli, and behavioral outcomes (e.g., pain tolerance). Despite small-study effects and publication bias, the estimate was robust to sensitivity analyses (between .15 and .3). Meta-regression of facilitation supported that greater study-level equanimity was associated with reduced reactivity. As hypothesized, mindfulness-based strategies can effectively regulate emotions. Methodological considerations and directions for future study are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-024-00281-x.

Engagement and Disengagement: From the Basic Science of Emotion Regulation to an Anxiety Spectrum

Emotion regulation strategies vary in depth of processing. For instance, reappraisal requires greater engagement than distraction. This affects short-term and long-term response to stimuli. In this review, I describe how the "engagement-disengagement dimension" improves understanding of emotion regulation in normative contexts and in internalizing psychopathology. Part 1 reviews work from my laboratory and others, suggesting that relatively disengaged emotion regulation strategies (e.g., distraction), may have short-term benefits (e.g., faster implementation), but may come with long-term costs (e.g., increased processing of stimuli at subsequent encounter). Therefore, depending on the desired outcome, the adaptive selection of an emotion regulation strategy will be determined by extent of emotional engagement-disengagement. In Part 2, I describe how individuals with more comorbid internalizing psychopathology (e.g., multiple anxiety and depressive diagnoses) are characterized by disengagement from negative stimuli as measured by the late positive potential (LPP). In addition, I introduce a brain profile I have termed, HARM-A (heightened "alarm" and reduced motivated attention), which is characterized by a combination of heightened "alarm" (i.e., increased amygdala) and emotional disengagement (i.e., blunted LPPs) in response to negative stimuli. HARM-A prospectively predicts worse outcomes over 2 years in a mixed internalizing sample. As such, chronic disengagement from negative stimuli appears to contribute to more comorbid and more severe internalizing psychopathology. Overall, emotional disengagement can be beneficial in the short term but may be poorly suited to emotional coping in the longer term.

Distinct Mindfulness States Produce Dissociable Effects on Neural Markers of Emotion Processing: Evidence From the Late Positive Potential

Background

Mindfulness has long been theorized to benefit emotion regulation, but despite the ubiquity of the claim, there is little empirical evidence demonstrating how mindfulness modulates the neurophysiology of emotion processing. The current study aimed to fill this gap in knowledge by leveraging a novel research approach capable of discretizing mindfulness into distinct states of open monitoring (OM) and focused attention (FA) to distinguish their influence on multimodal subjective and objective measures of emotion processing.

Methods

Utilizing a fully within-participant picture viewing state induction protocol (N = 30), we compared the effects of OM and FA, rigorously contrasted against an active control, on the visually evoked late positive potential (LPP), a neural index of motivated attention. Bayesian mixed modeling was used to distinguish OM versus FA effects on the early and late sustained LPP while evaluating the influence of subjective arousal ratings as a within-participant moderator of the state inductions.

Results

When negative picture trials were retrospectively rated as more subjectively arousing, the OM induction reduced the late sustained LPP response, whereas the FA induction enhanced the LPP.

Conclusions

Acute manipulation of OM and FA states may reduce and enhance motivated attention to aversive stimuli during conditions of high subjective arousal, respectively. Functional distinctions between different mindfulness states on emotion processing may be most dissociable after accounting for within-participant variability in how stimuli are appraised. These results support the future potential of the state induction protocol for parsing the neural affective mechanisms that underlie mindfulness training programs and interventions.

Mindfulness enhances cognitive functioning: a meta-analysis of 111 randomized controlled trials

BACKGROUND

Currently no comprehensive meta-analysis of MBI efficacy on global and unique cognitive subdomains exist.

METHOD

Examined the effects of MBIs on global cognition and 15 cognitive subdomains. Inclusion criteria: meditation naïve participants; randomized controlled trial; outcome included one objective or subjective cognitive functioning measure; primary focus was teaching mindfulness skills. Exclusion criteria: inadequate data; one-session ; control condition contained any MBI component. Robust variance estimation and moderator analyses controlling for presence of treatment fidelity were conducted.

RESULTS

One-hundred-and-eleven RCTs (n = 9,538) met eligibility criteria. MBIs had small-to-moderate significant effects on global cognition, executive attention, working memory accuracy, inhibition accuracy, shifting accuracy, sustained attention, and subjective cognitive functioning (vs. waitlist/no-treatment, g = 0.257-0.643; vs. active controls, g = 0.192-0.394). MBIs did not impact executive functioning (EF) latency indices, verbal fluency, processing speed, episodic memory, and cognitive error. Treatment effects were stronger for those with elevated psychiatric symptoms vs. healthy controls, and medical samples, studies with complete-case (vs. intention-to-treat) analysis, face-to-face (vs. self-guided) delivery, and non-standard (vs. standard MBI).

CONCLUSION

MBIs consistently yielded small-to-moderate yet practically meaningful effect sizes on global cognition and six cognitive subdomains that captured accuracy vs. latency-based indices of EF and sustained accuracy.

Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial

BACKGROUND

Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner.

OBJECTIVE

We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD.

METHODS

We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept.

RESULTS

Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow.

CONCLUSIONS

Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/50108.

The effect of emotion regulation strategies on decision-making about the maternal pertussis vaccination among pregnant women in the Netherlands: an experimental study

OBJECTIVE

To assess whether cognitive reappraisal and acceptance are effective emotion regulation strategies to decrease the influence of negative affect on intention to accept maternal pertussis vaccination (MPV) among pregnant women in the Netherlands.

METHODS

An experimental study with baseline and two follow-up measurements was conducted. Participants selected after baseline (N = 382) were randomized into two experimental groups (cognitive reappraisal, acceptance) and a control group. The effect of the experimental manipulations on negative affect was examined with multilevel analyses. A moderation analysis was performed to examine whether the manipulations moderated the association between negative affect and intention.

RESULTS

All groups showed a decrease in negative affect (all p's < 0.001), with no differences between groups. A small decrease in the influence of negative affect on intention was found among those who used acceptance.

CONCLUSION

No additional value of the emotion regulation strategies was found compared to the control group. However, exploratory analyses showed that acceptance seemed a promising strategy to decrease the influence of negative affect on intention to accept MPV.

PRACTICE IMPLICATIONS

This study stressed the relevance for communication strategies to consider the emotions pregnant women experience during the decision-making process about the MPV.

Impact of a mindfulness-based school curriculum on emotion processing in Vietnamese pre-adolescents: An event-related potentials study

The neurocognitive mechanisms associated with mindfulness training in children are not well understood. This randomised controlled study with active and passive control groups examined the impact of an 18-week mindfulness curriculum delivered by schoolteachers on emotion processing in Vietnamese 7- to 11-year-olds. Event-related potential markers indexed emotion processing while children were completing emotional Go/No-Go tasks before and after mindfulness training, and at 6-month follow-up. In an oddball Go/No-Go task with Caucasian faces no changes in P3b and LPP components were detected, but in a Go/No-Go task with Caucasian and Japanese faces changes were observed in P3b latencies and LPP mean amplitudes. Specifically, the P3b in response to angry non-targets for Japanese faces peaked later in the mindfulness training group (TG) at 6-months follow-up in comparison to the non-intervention control group (NCG). The LPP mean amplitudes for averaged Caucasian and Japanese angry non-targets were also attenuated in the TG at 6-month follow-up. In contrast, no changes in the LPP mean amplitudes were observed for the NCG over time. Together, these findings may indicate that mindfulness training in pre-adolescents enhances emotional non-reactivity to negative distractors. A fluctuating pattern of LPP mean amplitude modulations for angry targets was observed in the active control group (ACG) receiving social-emotional learning (SEL) training. Overall, findings from this study suggest that mindfulness training in pre-adolescents enhances emotional non-reactivity to negative distractors and some of the effects are culturally sensitive.

Mindfulness-Enhanced Computerized Cognitive Training for Depression: An Integrative Review and Proposed Model Targeting the Cognitive Control and Default-Mode Networks

Depression is often associated with co-occurring neurocognitive deficits in executive function (EF), processing speed (PS) and emotion regulation (ER), which impact treatment response. Cognitive training targeting these capacities results in improved cognitive function and mood, demonstrating the relationship between cognition and affect, and shedding light on novel targets for cognitive-focused interventions. Computerized cognitive training (CCT) is one such new intervention, with evidence suggesting it may be effective as an adjunct treatment for depression. Parallel research suggests that mindfulness training improves depression via enhanced ER and augmentation of self-referential processes. CCT and mindfulness training both act on anti-correlated neural networks involved in EF and ER that are often dysregulated in depression—the cognitive control network (CCN) and default-mode network (DMN). After practicing CCT or mindfulness, downregulation of DMN activity and upregulation of CCN activity have been observed, associated with improvements in depression and cognition. As CCT is posited to improve depression via enhanced cognitive function and mindfulness via enhanced ER ability, the combination of both forms of training into mindfulness-enhanced CCT (MCCT) may act to improve depression more rapidly. MCCT is a biologically plausible adjunct intervention and theoretical model with the potential to further elucidate and target the causal mechanisms implicated in depressive symptomatology. As the combination of CCT and mindfulness has not yet been fully explored, this is an intriguing new frontier. The aims of this integrative review article are four-fold: (1) to briefly review the current evidence supporting the efficacy of CCT and mindfulness in improving depression; (2) to discuss the interrelated neural networks involved in depression, CCT and mindfulness; (3) to present a theoretical model demonstrating how MCCT may act to target these neural mechanisms; (4) to propose and discuss future directions for MCCT research for depression.

Comparing impacts of meditation training in focused attention, open monitoring, and mindfulness-based cognitive therapy on emotion reactivity and regulation: Neural and subjective evidence from a dismantling study

Commonly conducted mindfulness‐based trainings such as Mindfulness‐based Stress Reduction (MBSR) and Mindfulness‐based Cognitive Therapy (MBCT) highlight training in two key forms of meditation: focused attention (FA) and open monitoring (OM). Largely unknown is what each of these mindfulness practices contributes to emotional and other important training outcomes. This dismantling trial compared the effects of structurally equivalent trainings in MBCT, FA, and OM on neural and subjective markers of emotional reactivity and regulation among community adults, with the aim to better understand which forms of training represent active ingredients in mindfulness trainings. Participants with varying levels of depressive symptoms were randomized to one of the three trainings. Before and after each 8‐week training, N = 89 participants completed a modified version of the Emotional Reactivity and Regulation Task while electroencephalographic (EEG) and self‐reported emotional responses to negative, positive, and neutral photographic images were collected. Examination of EEG‐based frontal alpha band asymmetry during passive viewing (reactivity) and active regulation phases of the task showed that FA and MBCT trainings produced significant leftward hemispheric shifts in frontal alpha asymmetry, commonly associated with a shift toward approach‐based positive affect. Self‐reported emotional responses to negative images corroborated these results, suggesting salutary changes in both emotional reactivity and regulation. OM training had limited beneficial effects, restricted to the subjective outcomes. The findings suggest that MBCT may derive its greatest benefit from training in FA rather than OM. Discussion highlights the potential value of FA training for emotional health.

In the first report comparing emotion‐relevant impacts of focused attention meditation (FA), open awareness meditation (OM), and Mindfulness‐based Cognitive Therapy (MBCT) among those with depressive symptoms, we show that FA and MBCT produced leftward hemispheric shifts in frontal alpha asymmetry, consistent with approach‐based positive affect, during an emotion reactivity and regulation task. Self‐reported emotional responses to negative images corroborated these results. The findings highlight the potential value of FA and MBCT training for emotional health.

Investigating mindfulness influences on cognitive function: On the promise and potential of converging research strategies

Research investigating the effects and underlying mechanisms of mindfulness on cognitive functioning has accelerated exponentially over the past two decades. Despite the rapid growth of the literature and its influential role in garnering public interest in mindfulness, inconsistent methods in defining and measuring mindfulness have yielded variable findings, which contribute to the overall dearth of clear generalizable conclusions. The focus of this article is to address the lack of cohesion in the collective methodologies used in this domain by providing a new perspective grounded in classic cognitive and experimental psychology principles. We leverage the concept of converging operations to demonstrate how seemingly disparate research strategies can be integrated towards a more unified and systematic approach. An organizing taxonomic framework is described to provide useful structure in how mindfulness can be operationalized, measured, and investigated. We illustrate the rationale and core organizing principles of the framework through a selective review of studies on mindfulness and cognitive control. We then demonstrate the utility of the approach by showing how it can be applied to synthesize extant methodologies and guide the development of future research. Specific suggestions and examples pertaining to experimental design and statistical analysis are provided.

The contributions of focused attention and open monitoring in mindfulness-based cognitive therapy for affective disturbances: A 3-armed randomized dismantling trial

Objective

Mindfulness-based cognitive therapy (MBCT) includes a combination of focused attention (FA) and open monitoring (OM) meditation practices. The aim of this study was to assess both short- and long-term between- and within-group differences in affective disturbance among FA, OM and their combination (MBCT) in the context of a randomized controlled trial.

Method

One hundred and four participants with mild to severe depression and anxiety were randomized into one of three 8-week interventions: MBCT (n = 32), FA (n = 36) and OM (n = 36). Outcome measures included the Inventory of Depressive Symptomatology (IDS), and the Depression Anxiety Stress Scales (DASS). Mixed effects regression models were used to assess differential treatment effects during treatment, post-treatment (8 weeks) and long-term (20 weeks). The Reliable Change Index (RCI) was used to translate statistical findings into clinically meaningful improvements or deteriorations.

Results

All treatments demonstrated medium to large improvements (ds = 0.42–1.65) for almost all outcomes. While all treatments were largely comparable in their effects at post-treatment (week 8), the treatments showed meaningful differences in rapidity of response and pattern of deteriorations. FA showed the fastest rate of improvement and the fewest deteriorations on stress, anxiety and depression during treatment, but a loss of treatment-related gains and lasting deteriorations in depression at week 20. OM showed the slowest rate of improvement and lost treatment-related gains for anxiety, resulting in higher anxiety in OM at week 20 than MBCT (d = 0.40) and FA (d = 0.36), though these differences did not reach statistical significance after correcting for multiple comparisons (p’s = .06). MBCT and OM showed deteriorations in stress, anxiety and depression at multiple timepoints during treatment, with lasting deteriorations in stress and depression. MBCT showed the most favorable pattern for long-term treatment of depression.

Conclusions

FA, OM and MBCT show different patterns of response for different dimensions of affective disturbance.

Trial registration

This trial is registered at (v NCT01831362); www.clinicaltrials.gov.

An electrophysiological investigation on the emotion regulatory mechanisms of brief open monitoring meditation in novice non-meditators

Despite a growing literature supporting the salutary effects of mindfulness meditation on emotion regulation, the underlying mechanisms linking neural and subjective changes occurring during the actual practice of meditation with emotion regulatory effects observed after meditation remains virtually unexplored. The current study sought to address this gap in knowledge by testing the hypothesis that adoption of internally-directed focused attention, indexed by increased alpha and theta spectral power, during brief open monitoring (OM) mindfulness meditation predicts reduced emotional reactivity, as measured by the late positive potential (LPP). Results revealed that the OM meditation did not produce demonstrable differences in alpha and theta power but did increase self-reported sleepiness relative to controls. Follow-up analyses showed that sleepiness uniquely moderated the effect of meditation on the LPP, such that less sleepiness during meditation, but not the control audio, corresponded to smaller LPPs to negative images. Change in theta, but not alpha power, between meditation and rest was positively correlated with the LPP even after controlling for sleepiness. Although the primary hypothesis was unsupported, the findings demonstrate that phenomenological and neural changes occurring during OM meditation may modulate its subsequent “off-the-cushion” effects on emotional reactivity.

Toward a Refined Mindfulness Model Related to Consciousness and Based on Event-Related Potentials

Neuroimaging, behavioral, and self-report evidence suggests that there are four main cognitive mechanisms that support mindfulness: (a) self-regulation of attention, (b) improved body awareness, (c) improved emotion regulation, and (d) change in perspective on the self. In this article, we discuss these mechanisms on the basis of the event-related potential (ERP). We reviewed the ERP literature related to mindfulness and examined a data set of 29 articles. Our findings show that the neural features of mindfulness are consistently associated with the self-regulation of attention and, in most cases, reduced reactivity to emotional stimuli and improved cognitive control. On the other hand, there appear to be no studies of body awareness. We link these electrophysiological findings to models of consciousness and introduce a unified, mechanistic mindfulness model. The main idea in this refined model is that mindfulness decreases the threshold of conscious access. We end with several working hypotheses that could direct future mindfulness research and clarify our results.

Mindfulness Training, Implicit Bias, and Force Response Decision-making

OBJECTIVE

The goal of this study was to assess the preliminary efficacy of a Mindfulness-Based Training (Mindfulness-based Resilience Training; MBRT) in improving weapon identification among Law Enforcement Officers (LEOs).

METHODS

Participants (N = 61) were randomly assigned to either MBRT or a no-intervention control group (NIC). A self-report questionnaire assessing mindfulness and a computerized measure assessing implicit stereotype reliance were administered at baseline, post-training, and three months following intervention completion. We also collected information about meditation practice outside of the training for LEOs in the MBRT group.

RESULTS

Inferential analyses yielded improvements in mindfulness in the MBRT group compared to NIC. Analyses did not provide evidence for implicit stereotype reliance at baseline and therefore did not yield a significant impact of MBRT versus NIC on implicit stereotype reliance, ps > .05; however, participants across both conditions exerted more control when responding to Black male targets compared to White male targets, F(1,74) = 3.98, p = .05, 95% CI [-.05, -.01], d = .36.

CONCLUSIONS

Our results do not provide evidence for the impact of MBRT on weapon identification, but do suggest that LEOs exerted more effort when responding to images of Black males compared to White males. We discuss recommendations for future clinical trials assessing implicit stereotype reliance, viz., that researchers utilize measures more sensitive to a wider range of LEO samples and with higher ecological validity, and we discuss potential reasons why our results do not align with past research.

Treatment of Resistant Depression: A Pilot Study Assessing the Efficacy of a tDCS-Mindfulness Program Compared With a tDCS-Relaxation Program

Background: This pilot study explores a therapeutic setting combining transcranial direct current stimulation (tDCS) and mindfulness-based cognitive therapy (MBCT) for patients with drug-resistant depression. tDCS has shown efficacy for depression treatment and improvement could be maintained with the combination with mindfulness, which has shown depression relapse-prevention properties. Methods: Thirty-one treatment-resistant depressed patients have been assigned to our experimental treatment condition [tDCS combined with MBCT (n = 15)] or to a control condition [tDCS combined with relaxation (n = 16)]. Patients have completed both an intensive treatment block (eight consecutive days) and a single remind session 2 weeks after the intensive treatment. Clinical (depression, anxiety, and rumination) and cognitive (general cognitive functioning, mental flexibility, and working memory) symptoms of depression have been assessed through different questionnaires at baseline (t0), after the first block of treatment (t1), and after the remind session (t2). Results: Results seem to indicate a positive impact of both treatment conditions on clinical and cognitive symptoms of depression at t1. However, the treatment condition combining tDCS with mindfulness has been found to better maintain clinical improvements at t2 regarding some clinical [Montgomery-Åsberg Depression Rating Scale (MADRS) and Sadness and Anger Ruminative Inventory (SARI)] and cognitive variables (Digit Span-F and Digit Span-B). Conclusion: Based on the current observations, a multi-disciplinary treatment approach combining tDCS and MBCT might be effective in resistant depressed patients in the long run, even though further clinical research is necessary.

Mindfulness, acceptance, and emotion regulation: perspectives from Monitor and Acceptance Theory (MAT)

Experiential acceptance-an orientation of receptivity and noninterference with present-moment experiences-is described as central to mindfulness interventions, yet little experimental work has tested acceptance as a mechanism for mindfulness intervention effects. Guided by Monitor and Acceptance Theory (MAT), this review situates acceptance as an emotion regulation mechanism and reviews self-report mindfulness literature showing that attention monitoring skills are only associated with beneficial mental and physical health outcomes when accompanied by acceptance skills. New experimental dismantling work shows that removing acceptance training from mindfulness interventions reduces their efficacy for improving stress, positive emotion, and social relationship outcomes. Overall, converging evidence demonstrates that acceptance is a critical emotion regulation mechanism of mindfulness interventions. This work advances basic research, has translational value, and offers opportunities for future research.

Mental illness and well-being: an affect regulation perspective

Mental health crucially depends upon affective states such as emotions, stress responses, impulses and moods. These states shape how we think, feel and behave. Often, they support adaptive functioning. At other times, however, they can become detrimental to mental health via maladaptive affect generation processes and/or maladaptive affect regulation processes. Here, we present an integrative framework for considering the role of affect generation and regulation in mental illness and well-being. Our model views affect generation as an iterative cycle of attending to, appraising and responding to situations. It views affect regulation as an iterative series of decisions aimed at altering affect generation. Affect regulation decisions include identifying what, if anything, should be changed about affect, selecting where to intervene in the affect generation cycle, choosing how to implement this intervention, and monitoring the regulation attempt to decide whether to maintain, switch or stop it. Difficulties with these decisions, often arising from biased inputs to them, can contribute to manifestations of mental illness such as clinical symptoms, syndromes and disorders. The model has a number of implications for clinical assessment and treatment. Specifically, it offers a common set of concepts for characterizing different affective states; it highlights interactions between affect generation and affect regulation; it identifies assessment and treatment targets among the component processes of affect regulation; and it is applicable to prevention and treatment of mental illness as well as to promotion and restoration of psychological well-being.

Empathy and emotion regulation: An integrative account

How we understand and respond to others' emotions (i.e., empathy) may be influenced by the regulatory processes that are used to shape which emotions we and others have (i.e., emotion regulation). Empathy and emotion regulation are complex multidimensional constructs and the relationship between their component processes is not well characterized. To enable future work to examine their relationship more closely, this chapter presents an integrative framework of empathy and emotion regulation. We begin by delineating the component processes that underlie empathy and emotion regulation, and the neural underpinnings of these processes. We then present an integrative framework describing the processes of empathy and how these may be acted upon by distinct regulatory strategies. We conclude with a brief consideration of contextual influences on empathy and emotion regulation using a reward-based heuristic.

Effects of Mindfulness-Based Positive Behavior Support (MBPBS) Training Are Equally Beneficial for Mothers and Their Children With Autism Spectrum Disorder or With Intellectual Disabilities

Parenting a child with autism spectrum disorder (ASD) or intellectual disabilities (IDs) can be stressful for many parents. Mindfulness-Based Positive Behavior Support (MBPBS) is a customized mindfulness program that enables parents and other caregivers to reduce their perceived psychological stress to normative levels through mindfulness procedures and to support children with ASD or ID to self-manage their challenging behaviors through positive behavior support (PBS). In this study, we evaluated whether MBPBS would have differential effects on the stress levels of mothers of adolescents with ASD (n = 47) or with ID (n = 45) and the effects of the program on the aggressive, disruptive, and compliance behaviors of their children. Both groups of mothers participated in the 40-week study (10 weeks control and 30 weeks MBPBS program), rated their own stress levels, and collected daily observational data on the adolescents' behavior. Results showed significant reductions in the level of stress in both groups of mothers, but no differential effects on mothers of children with ASD or with ID. In addition, significant reductions in aggression and disruptive behavior and increases in compliance behaviors were observed in the adolescents in both groups. The results suggest that MBPBS is equally beneficial for mothers of adolescents with ASD or ID. In the present study, although the mothers of children with ID had slightly higher levels of stress at baseline and mothers of children with ASD had lower levels of stress following the MBPBS program, the program can be considered equally effective in reducing the stress levels of both groups of mothers. This suggests that the program may be effective regardless of baseline levels of mothers' stress.

Muscle stretching with deep and slow breathing patterns: a pilot study for therapeutic development

Background Chronic neck pain is frequently found in office workers affecting quality of life; also, stress is one participating factor. Though stretching incorporating deep-slow breathing (DSB) has benefits on health, an effective and suitable technique for office workers to perform in the workplace is a gap in need of fulfilment. Methods We explored the effective pattern of stretching with DSB to reduce neck tension and promote relaxation within the shortest time. Thirty-two female participants with neck tension were allocated into two steps totaling five patterns (n=8 for each pattern). Firstly, they performed two patterns; two other patterns were developed and compared with DSB alone. Muscle tension, pain score, and heart rate variability (HRV) were immediately measured. Results All patterns performed with the eyes closed decreased muscle tension more than those performed with the eyes open; the pain amid all stretching groups subsequently decreased. Only a bout of slow stretching, performed synchronously with the eyes closed along with a period of deep inhalation increased the parasympathetic activity of HRV; an increase in pain was reported after stretching. Conclusions A slowed and synchronized pattern between stretching with DSB and eyes closed period, performed at least four times repeatedly rendered benefits in reducing neck pain and tension, in addition to promoting relaxation within a short period; however, the DSB pattern and the feeling of the stretched muscle to promote relaxation were individual differences. Thus, future studies should come up with apposite training methods adjusted to fit individuals; self-awareness toward these aspects ought to be encouraged.

Rumination and Mindlessness Processes: Trajectories of Change in a 42-Day Mindfulness-Based Intervention

This preliminary study aimed to understand the effects of an autonomous mindfulness-based intervention (MBI) on mindlessness propensities: rumination, automatic pilot functioning, and attentional distractibility. The ecological momentary assessment was completed by community participants assigned to two nonrandomized groups: an experimental group (n = 45) that practiced 20-minute daily mindfulness meditation for 42 days and a control group (n = 44) that was on the waiting list for the MBI. All participants completed a self-assessment on rumination and mindlessness propensities twice a day. The MBI led to a favorable gradual decrease in automatic pilot functioning and attentional distractibility. Rumination evolved in three stages: a rapid decrease during the first week, a stabilization phase between the 10th and 30th days, and an additional decrease after 30 days of practice. This innovative study provides a promising perspective regarding rumination, automatic pilot functioning, and attentional distractibility dynamic trajectories over the course of an MBI.

Dismantling Mindfulness-Based Cognitive Therapy: Creation and validation of 8-week focused attention and open monitoring interventions within a 3-armed randomized controlled trial

BACKGROUND

While mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage.

METHODS

Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training).

RESULTS

The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired).

CONCLUSIONS

These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.

Cognitive reappraisal and acceptance: Effects on emotion, physiology, and perceived cognitive costs

Two emotion regulation strategies-cognitive reappraisal and acceptance-are both associated with beneficial psychological health outcomes over time. However, it remains unclear whether these 2 strategies are associated with differential consequences for emotion, physiology, or perceived cognitive costs in the short-term. The present study used a within-subjects design to examine the effects of reappraisal (reframing one's thoughts) and acceptance (accepting feelings without trying to control or judge them) on the subjective experience of negative emotions, positive emotions, and physiological responses during and following recovery from sad film clips shown in the laboratory. Participants also reported on perceived regulatory effort, difficulty, and success after deploying each emotion regulation strategy. In 2 samples of participants (N = 142), reappraisal (vs. acceptance) was associated with larger decreases in negative and larger increases in positive emotions, both during the film clips and recovery period. However, acceptance was perceived as less difficult to deploy than reappraisal, and was associated with a smaller dampening of skin conductance level (indicating more successful regulation) during the film clips in 1 sample. These results suggest that reappraisal and acceptance may exert differential short-term effects: Whereas reappraisal is more effective for changing subjective experiences in the short term, acceptance may be less difficult to deploy and be more effective at changing one's physiological response. Thus, these 2 strategies may both be considered "effective" for different reasons. (PsycINFO Database Record

Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis

OBJECTIVE

To examine the association between baseline mindfulness and response from exercise interventions in knee osteoarthritis (OA).

DESIGN

Cohort study; responder analysis of a clinical trial subset.

SETTING

Urban tertiary care academic hospital.

PARTICIPANTS

Participants with symptomatic, radiographic knee OA (N=86; mean age, 60y; 74% female; 48% white).

INTERVENTIONS

Twelve weeks (twice per week) of Tai Chi or physical therapy exercise.

MAIN OUTCOME MEASURES

Treatment response was defined using Osteoarthritis Research Society International criteria indicating meaningful improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC function, or Patient Global Assessment scores. At baseline, participants completed the Five Facet Mindfulness Questionnaire (mean total score, 142±17) and were grouped into 3 categories of total mindfulness: higher, medium, or lower. Relative risk (RR) ratios were used to compare treatment response across groups.

RESULTS

Participants with higher total mindfulness were 38% (95% confidence interval [CI], 1.05-1.83) more likely to meet responder criteria than those with lower mindfulness. We found no significant difference between medium and lower mindfulness groups (RR=1.0; 95% CI, 0.69-1.44). Among the 5 mindfulness facets, medium acting-with-awareness was 46% (95% CI, 1.09-1.96) more likely to respond than lower acting-with-awareness, and higher acting-with-awareness was 34% more likely to respond, but this did not reach significance (95% CI, 0.97-1.86).

CONCLUSIONS

In this study, higher mindfulness, primarily driven by its acting-with-awareness facet, was significantly associated with a greater likelihood of response to nonpharmacologic exercise interventions in knee OA. This suggests that mindfulness-cultivating interventions may increase the likelihood of response from exercise.