Mechanisms of mindfulness training: Monitor and Acceptance Theory (MAT)

Psychological mechanisms underpinning change in intolerance of uncertainty across anxiety-related disorders: New insights for translational research

Intolerance of uncertainty (IU), the tendency to find uncertainty negative, is a fundamental transdiagnostic dimension across anxiety-related disorders. Over the past two decades, there has been an increase in both clinical and experimental research on the role of IU in the maintenance and treatment of anxiety-related disorders. However, there has been a lack of integration of research findings from a mechanistic perspective, which has slowed progress in translational research. This review seeks to fill this gap by synthesising the clinical (e.g. randomised controlled trials) and experimental (e.g. lab-based) literature on the psychological mechanisms that drive change in IU across anxiety-related disorders. The review highlighted that: (1) cognitive restructuring, supported by mechanisms such as cognitive appraisal, modify IU-related cognitions, (2) behavioural exposures, supported by mechanisms such as inhibitory learning, alter IU-related cognitions and physiological arousal, and (3) mindfulness techniques underpinned by mechanisms such as attentional monitoring, decentering, and acceptance, change IU-related cognitions. Across the different therapeutic techniques reviewed, there was a lack of evidence for how different mechanisms change IU-related emotions and behaviours. Directions for further research include directly comparing the effectiveness of different mechanisms that produce change in IU across anxiety disorders and other mental health disorders, and examining the specificity of change in IU over other anxious traits. Overall, the findings provide a foundation for future translational research efforts to build upon maximising existing treatment interventions and/or to develop novel treatment interventions to target dispositional IU and situational uncertainty-related distress in anxiety-related disorders and beyond.

Emotion regulation and psychopathology: Investigating differential associations between emotion regulation skills and psychological symptoms using a network approach

OBJECTIVES

Emotion regulation plays an important role in the development and maintenance of psychopathology. However, the question whether specific ER skills are related to specific psychological symptoms has rarely been studied, but has important implications for targeted interventions. This analysis aims to explore potential differential associations between various ER skills and psychological symptoms using a network analysis approach.

METHODS

Routine data from a transdiagnostic clinical sample of 716 patients (460 females, 256 males) from an outpatient clinic for psychotherapy were analysed. Nine ER skills were assessed with the Emotion Regulation Skills Questionnaire, and nine symptom dimension scores were obtained using the Brief Symptom Inventory. A regularized partial correlation network models including ER skills and individual symptom domains were calculated. Bridge expected influence was calculated to estimate the strength of association of each ER skill with psychological symptoms.

RESULTS

Only the following ER skills were most strongly related to psychological symptoms (bridge expected influence): Tolerance, Confrontation and Modification. All other ER skills were indirectly connected to symptom severity through these four skills. The strongest direct edges between ER skills and symptoms were Modification-Depression, Confrontation-Obsession-Compulsion and Tolerance-Interpersonal Sensitivity, which were significantly stronger than the vast majority of other associations between ER skills and psychological symptoms.

CONCLUSIONS

These exploratory findings provide valuable targets for future studies to investigate specific associations between ER skills and psychological symptoms which could help to improve outcome monitoring and efficacy of interventions targeting ER.

Using Mindfulness to Manage Moral Injury in Veterans: Feasibility and Satisfaction of a Pilot Randomized Controlled Trial

OBJECTIVE

The present study assessed program feasibility and satisfaction among recent-era veterans who participated in Mindfulness to Manage Moral Injury (MMMI), a live facilitated web-based 7-week mindfulness-based program targeting moral injury among veterans.

METHOD

In total, 56 post-9/11 veterans were recruited with 28 randomized to the MMMI condition and 28 to the Education and Support (ES) condition. Most participants identified as being White (71.4%), male (66.1%), and had a reported mean age of 41.50 years (Median = 39.50, SD = 9.26).

RESULTS

Among the 56 participants, 82.1% attended at least one treatment session and 44.6% completed all seven sessions. There were no significant differences in the average number of sessions attended between the MMMI (M = 4.79, SD = 2.70) and the ES (M = 4.68, SD = 2.84) conditions, t(54) = 0.145, p = 0.87. Regarding randomization, there were no statistically significant differences on almost all demographic (i.e., years in military, gender, ethnicity) characteristics and baseline scores on all outcomes across treatment conditions, thus ensuring randomization was adequately met. Of the 56 who consented, 41 (73.21%) completed most study components (i.e., completed baseline and follow-up surveys, at least 1 weekly survey, and attended at least one treatment session). Regarding treatment satisfaction, individuals in the MMMI condition reported higher treatment satisfaction (Cohen's d = 0.66).

CONCLUSIONS

Preliminary findings suggest MMMI is feasible and acceptable and may be able to reach veterans who may not seek traditional Veterans Affairs Medical Center care or who prefer a web-based program. Given its promise for the treatment of moral injury among veterans, MMMI warrants additional large-scale clinical-trial testing.

Limited Validity of Breath-Counting as a Measure of Mindfulness in Ruminative Adolescents

Objective measurement of mindfulness could help us understand the mechanisms of meditation interventions and how individuals vary in their disposition to be mindful. One proposed measure is the breath-counting task (BCT), which measures how accurately one can count cycles of their breath. Breath counting, which involves sustained attention, meta-awareness, and an internal locus of attention, has been shown in adults to be related to measures of mindfulness even when controlling for established attentional measures. In this study, we test the psychometrics of the BCT in a convenience sample of 78 adolescents with elevated rumination. In preregistered analyses, we related breath-counting measures, including novel objective respiration measures, to a suite of self-report measures as well as the sustained attention to response task (SART). While breath-counting performance showed fair split-half reliability and similar distributions to studies in adults, it did not show the expected positive associations with self-reported mindfulness measures (neither trait nor EMA). Surprisingly, breath-counting accuracy showed negative correlations with a subscale measuring observing of emotions and body sensations, negative correlations with nonreactivity, and performance decrements were larger for individuals scoring more highly on mindfulness in general. The SART showed a small negative correlation with breath-counting resets (an index of mind-wandering). Finally, breath-counting performance was not related to other theoretically relevant clinical, personality, and executive functioning criteria. Our results suggest that, at least in ruminative adolescents, breath-counting may measure a very narrow, contextual form of sustained attention, may not capture other qualities of mindfulness, and may lack predictive validity.

Maternal interpretation of infant emotions related to mothers' mindfulness and mother-infant stress

We aimed to identify maternal characteristics predicting interpretation of infant emotions, as well as relations between such interpretations and mother-infant stress. Specifically, we investigated (1) prospective associations between maternal dispositional mindfulness and interpretation of infant emotions, and (2) concurrent associations between maternal interpretation of infant emotions and mothers' and infants' cortisol during a dyadic stressor in a non-clinical community sample (n = 78) of mother-infant dyads. Mothers completed the Five Facet Mindfulness Questionnaire at 3 months postnatal, and the IFEEL Picture infant emotion interpretation task at 6 months postnatal. At 6-months, mother-infant dyads completed the Face-to-Face Still Face paradigm, and physiological stress was assessed via salivary cortisol. Regression analyses revealed significant links between aspects of maternal mindfulness - specifically, Observing, Describing, and Acting with Awareness facets - and infant emotion interpretation; more mindful mothers' emotion ratings were less negatively biased and covered the full spectrum of infant emotions, congruent with the range of responses given by a low-risk reference sample. In turn, less negativity bias and greater interpretive congruence predicted lower infant and mother cortisol during the stress session, with effects small-medium in size. Findings highlight the potential role of maternal interpretation of infant emotions in mindful parenting.

The impact of academic anxiety on smartphone addiction among college students: the mediating role of self-regulatory fatigue and the moderating role of mindfulness

BACKGROUND

Academic anxiety is recognized as a risk factor of smartphone addiction among college students. However, the underlying mechanisms and moderating factors remain insufficiently explored.

METHOD

This study examines the impact of academic anxiety on smartphone addiction, focusing on the mediating role of self-regulatory fatigue and the moderating role of mindfulness. Using convenience sampling strategy, a cross-sectional survey was implemented. Data were collected from a survey of 685 college students by using the Academic Anxiety Scale, Smartphone Addiction Scale, Self-Regulatory Fatigue Scale, and Mindfulness Scale. The hypothesized moderated mediation model was analyzed using Hayes' (2017) PROCESS macro (Model 59).

RESULTS

Moderated mediation analysis finds that academic anxiety significantly positively predicts smartphone addiction (β = 0.30, t = 7.24, 95%CI=[0.22, 0.38], p<0.001) in college students. Academic anxiety also indirectly predicts smartphone addiction through self-regulatory fatigue (β = 0.09, t = 2.43, 95%CI=[0.02, 0.16], p<0.05), with the mediation effect accounting for 11.76%. The mediation pathways are moderated by mindfulness. Compared with students with low mindfulness, the influence of academic anxiety on self-regulatory fatigue is stronger in students with high mindfulness(β = 0.10, t = 3.85, 95%CI=[0.05, 0.16], p<0.001). However, compared with students with low mindfulness, the influence of self-regulatory fatigue on smartphone addiction is weaker in students with high mindfulness(β=-0.08, t= -2.53, 95%CI=[-0.15, -0.02], p<0.05). That is, among individuals with a high level of mindfulness, mindfulness enhances the positive relationship between academic anxiety and self-regulatory fatigue while weakening the positive association between self-regulatory fatigue and smartphone addiction.

CONCLUSION

These findings elucidate the internal mechanisms linking academic anxiety to smartphone addiction and underscoring the dual role of mindfulness. The results offer valuable insights for developing strategies to prevent and manage smartphone addiction among college students.

The associations and effects of mindfulness on anger and aggression: A meta-analytic review

Dispositional mindfulness and mindfulness-based interventions have been linked to emotion regulation and may reduce anger and aggression. The present set of four meta-analyses examined and quantified correlational relationships between trait mindfulness, trait anger, and trait aggression, as well as the effects of experimental mindfulness-based interventions on anger and aggression. These meta-analyses contained data from 118 correlational (dispositional mindfulness) and experimental (mindfulness-based intervention) studies. For the subset of self-report correlational studies (kanger = 243, kaggression = 286), we found small-to-medium inverse relationships between dispositional mindfulness and both anger (r = -0.23, p < .001) and aggression (r = -0.19, p < .001). For experimental studies (kanger = 95, kaggression = 38), we found medium effects. Specifically, mindfulness-based interventions produced lower anger (d = -0.48, p < .001) and aggression (d = -0.61, p < .001) relative to the control groups. In sum, results suggest that mindfulness can curb angry and aggressive responses. Effect sizes for the interventions were largest in Asia. Studies with passive versus active control groups showed larger effect sizes. Effect sizes were largely equivalent for all populations studied (e.g., clinical, forensic, healthy adults, medical, students). Our meta-analytic findings suggest that mindfulness training may aid the effective regulation of anger and aggression for diverse populations. They also highlight the need for more rigorous control groups in future research.

The Effects of Mindfulness on Shame: Exploring Mediation by Cognitive Flexibility and Self-Compassion in a Chinese Adult Population

To examine the effects of mindfulness on shame and the mechanisms mediated by cognitive flexibility and self-compassion in a Chinese adult population in daily life, we conducted two studies. Study 1 was a cross-sectional study using the Five-Factor Mindfulness Questionnaire, the Cognitive Flexibility Inventory, the Self-Compassion Scale, and the Self-Conscious Affect-3, which were administered to 481 adults in Beijing and Chengdu. For Study 2, an 8-month follow-up study was conducted on 128 of the adults. The results of Study 1 showed that (1) the awareness of action and nonjudgment dimensions, and the total score of mindfulness were significantly correlated with shame; (2) cognitive flexibility and self-compassion could fully mediate the prediction of mindfulness on shame. The Study 2 showed that (1) mindfulness and shame were significantly negatively correlated in both phases of measurement; (2) controlling for T1 shame, T1 mindfulness was able to negatively predict T2 shame; controlling for T1 mindfulness, T1 shame was not able to predict T2 mindfulness. There is a longitudinal association between mindfulness and shame, and only mindfulness scores are predictive of the shame and not vice-versa; both cognitive flexibility and self-compassion can provide explanations for the prediction of shame by mindfulness. Enhancing levels of mindfulness can help alleviate individuals' shame levels.

Longitudinal Relationship Between Mindful Awareness, Acceptance and Mental Health Problems: A Mediation Model

Mental health problems among college students are increasingly prominent. The negative effects of emotional distress on college students' mental health have been supported empirically. It is important to understand the psychological processes underlying this relationship. Using a longitudinal design, the present study aimed to reveal the explanatory mechanism of the association between dimensions of dispositional mindfulness and mental health problems among Chinese college students by testing the mediating effects of experiential avoidance and intolerance of uncertainty. A total of 907 Chinese college students (57% male; Mage = 20.33 years) were invited to complete self-report questionnaires at two time points. Mindful awareness, acceptance and mental health problems (depression, anxiety and stress) were assessed at baseline (T0). Experiential avoidance, intolerance of uncertainty and mental health problems were assessed at the 6 month follow-up (T1). Following structural equation modeling (SEM) analyses, the results show that high levels of mindful awareness and acceptance may diminish mental health problems by decreasing the levels of experiential avoidance among college students. However, only mindful acceptance diminished mental health problems through decreased intolerance of uncertainty. In addition, our study found that mindful awareness and acceptance may have different functions when working alone. Specifically, these two constructs may have different relationships with mental health. Identifying these mechanisms by which dispositional mindfulness is associated with college students' mental health over time has potential value for the prevention of potential mental health issues and timely interventions.

The association between trait mindfulness and sleep problems: A three-level meta-analysis

Trait mindfulness has shown potential in relieving the symptoms related to sleep problems, but the relationship between trait mindfulness and sleep problems varies across studies. To explore this association and obtain reliable estimates, a three-level meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. A comprehensive literature search identified 86 studies involving 87 independent samples and 35,521 participants. A total of 441 effect sizes were analyzed. The study indicated a negative association between trait mindfulness and sleep problems. Furthermore, the meta-analysis revealed significant moderating effects of study design, mindfulness facets, and measurement for trait mindfulness on this relationship. This study suggests that trait mindfulness is closely related to the alleviation of sleep problems. Furthermore, trait mindfulness is vital important in strengthening prevention and intervention measures targeting individuals' sleep problems.

Enhancing Equanimity With Noninvasive Brain Stimulation: A Novel Framework for Mindfulness Interventions

Mindfulness has gained widespread recognition for its benefits for mental health, cognitive performance, and well-being. However, the multifaceted nature of mindfulness, which encompasses elements such as attentional focus, emotional regulation, and present-moment awareness, complicates its definition and measurement. A key component that may underlie its broad benefits is equanimity-the ability to maintain an open and nonreactive attitude toward all sensory experiences. Empirical research suggests that mindfulness works through a combination of top-down attentional control and bottom-up sensory and emotional processes and that equanimity's role in regulating those bottom-up processes drives the psychological and physiological benefits, making it a promising target for both theoretical and practical exploration. Given these findings, the development of interventions that specifically augment equanimity could improve the impact of mindfulness practices. Research into noninvasive brain stimulation (NIBS) suggests that it is a potential tool for altering neural circuits involved in mindfulness. However, most NIBS studies reported to date have focused on improving cognitive control systems and have left equanimity relatively unexplored. Preliminary findings from focused ultrasound interventions targeting the posterior cingulate cortex suggest that NIBS can directly facilitate equanimity by inhibiting self-referential processing in the default mode network to promote a more present-centered state of awareness. Future research should prioritize the integration of NIBS with well-defined mindfulness training protocols, focusing on equanimity as a core target. This approach could provide a novel framework for advancing both contemplative neuroscience and clinical applications, offering new insights into the mechanisms of mindfulness and refining NIBS methodologies to support individualized, precision wellness interventions.

School-based mindfulness: Application of the PARiHS framework to contextualize implementation

Although school-based mindfulness programs are increasing, contextual issues that facilitate or hinder program implementation are poorly understood. Utilizing an implementation science framework (i.e., Promoting Action on Research in Health Services [PARiHS]) as a heuristic for data collection and analysis, we used an exploratory sequential mixed methods design to investigate implementation barriers and facilitators of the Peace of Mind (PoM) program from the perspective of educators (n = 27) in eight schools and PoM staff (n = 4) using diverse implementation approaches. The integration of qualitative interview data and mixed methods survey data suggests that a combination of personal and structural factors is critical for successful program implementation, with these factors operating synergistically. The most salient factors related to facilitation of PoM implementation included robust buy-in supported by strong champions who were also in leadership positions. The most salient factors indicated for context related to time and implementation process. First-hand, informal evidence impacted buy-in more than distal research studies. The implications for SBMP implementation and implementation research are discussed.

Development of a Brief Online Mindfulness-Based Intervention to Reduce Patient Anxiety Before a First-Time Screening Colonoscopy

To describe the development of an online mindfulness-based intervention (MBI) to reduce anxiety before a first-time screening colonoscopy among average-risk patients. A qualitative study used an iterative process guided by health behavior and mindfulness theories and feedback from a convenience sample of patients, endoscopy medical staff, and community members. Patient and medical staff (n = 18) were included in formative interviews (30-45 min), eight helped during intervention development sessions (15-90 min), and four community members reviewed the MBI in individual sessions (60 min). Interviews and sessions were recorded, transcribed verbatim, and analyzed using NVivo qualitative data software. Two themes emerged from the study: (1) both patients and medical staff reported that average-risk patients have pre-procedural anxiety before a first-time screening colonoscopy, and (2) using stakeholder-engaged strategies in an iterative process with both patients and medical staff is important so the developed intervention is acceptable to the priority population and to ensure medical accuracy and avoid disruption of workflow. Using an iterative process with key stakeholders is essential to develop interventions that are feasible and acceptable. The MBI developed through this process is being compared to usual care in a pilot randomized controlled trial to determine intervention feasibility and patient acceptability and to collect preliminary efficacy data. If efficacious, the developed MBI has the potential to reduce pre-procedural anxiety which may improve patient behaviors (e.g., bowel prep adherence and quality), patient satisfaction, and clinic workflow by reducing cancellation/no-shows, the amount of sedation required, and procedural time.

Development and Training of Mindfulness and Its Relationship with Executive Function in Chinese Rural Upper-Grade Elementary School Students

The purpose of this study was to explore the development and relationship between mindfulness and executive function (EF) in students in grades 4-5 and investigate mindfulness training's impact on mindfulness and EF in grade 4 students in rural China. Study 1 measured mindfulness and EF in Chinese students in grades 4-5. Differences in the level of mindfulness among children in grade 4 (n = 159) and grade 5 (n = 187) in rural China were analyzed by multi-factor analysis of variance. Correlation and hierarchical multiple regression analyses were used to explore the relationship between mindfulness and EF in grade 4 (n = 103) and grade 5 (n = 124). Study 2 included 45 4th graders with a general mindfulness level, with 21 children in the experimental group receiving 12 mindfulness training lessons. The mindfulness and EF scores of individuals in the mindfulness and control groups were tested before and after the intervention. Study 1 showed that 4th graders had significantly lower mindfulness scores than 5th graders. EFs in grades 4-5 were significantly correlated with mindfulness. Study 2 revealed that mindfulness training significantly improved the experimental group's mindfulness and working memory. A non-significant improvement in inhibitory control and cognitive flexibility was observed. There was a significant difference in mindfulness in grades 4 and 5 of Chinese rural upper-grade elementary school. Children who perform well in mindfulness also perform well in EFs. Mindfulness training improved the mindfulness and working memory of 4th graders in rural China with a general mindfulness level.

'It was a fair fight' v. 'let the body do the work.' How squash players mentalizing abilities affect their experiences of playing squash: An Interpretative Phenomenological Analysis

The use of metacognitive process and skills has been the subject of considerable research in the sport performance literature over the past decade. However, there has been little qualitative research on athletes' experiences of using metacognitive processes and skills. A related but different area theoretically and practically, is mentalizing, which refers to the imaginative ability to perceive and interpret the feelings, thoughts, wishes and beliefs that explain human behaviour. This study sought to understand how mentalizing abilities affect the playing experiences of amateur squash players, who regularly played competitive squash. Semi-structured interviews were conducted with ten amateur adult squash players. Data were analysed using Interpretative Phenomenological Analysis. This was developed into three group experiential themes (GETs): a) balanced minds, b) no-man's land, and c) an interpersonal battle. Findings indicate that mentalizing abilities of participants helped them focus, self-regulate, and enjoy playing. Conversely, participants temporary loss of mentalizing significantly affected their enjoyment, relationships with opponents and their capacity to focus and concentrate when under pressure which for some led to poorer performances. The study is novel in its application to sport, adding an important holistic dimension to the applied sport psychology literature. It is suggested that mentalizing plays a critical role in influencing competitive sport situations and further research is required to elucidate these abilities in greater depth.

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.

Effectiveness of an Internet-Based, Self-Guided, Short-Term Mindfulness Training (ISSMT) Program for Relieving Depressive Symptoms in the Adult Population in China: Single-Blind, Randomized Controlled Trial

BACKGROUND

Depression is a significant global public health issue, and in China, access to mental health services remains limited despite high demand. Research has shown that mindfulness can effectively alleviate depressive symptoms and that telehealth solutions offer a promising avenue for addressing this service gap. Despite this potential, there are currently few studies in China focusing on short-term online mindfulness training. Most existing online mindfulness studies relied on traditional 8-week programs, which can be challenging for participant adherence due to limited accessibility and high dropout rates. Additionally, limited research exists on short-term online mindfulness interventions, and findings remain inconsistent.

OBJECTIVE

This study aimed to develop and evaluate an internet-based, self-guided, short-term mindfulness training (ISSMT) program based on the Monitor and Acceptance Theory (MAT) to reduce depression symptoms.

METHODS

The ISSMT program was delivered via an online platform, "Hi Emotion," and was accessible to the general public. Interested individuals aged 18 years and older were randomized into either the ISSMT group or a wait-list control group. Participants in the ISSMT group received daily reminders to participate in a 15- to 20-minute session over a 14-day training period. Measurements, including mindfulness and depressive symptoms, were collected at baseline and weekly for the subsequent 3 weeks.

RESULTS

A total of 205 adults participated in the 14-day online intervention. Linear mixed models were used to analyze both per-protocol (PP) and intention-to-treat (ITT) samples. Compared with the wait-list control group, participants in the ISSMT group showed significant improvements in mindfulness (Cohen d=0.44 for ITT; Cohen d=0.55 for PP) and reductions in depressive symptoms (Cohen d=0.50 for ITT; Cohen d=0.53 for PP). Furthermore, participants expressed high acceptance of this training format with a relatively low dropout rate (<40%).

CONCLUSIONS

The ISSMT program based on the MAT effectively enhanced mindfulness and alleviated depressive symptoms. This intervention could be considered for integration into psychosocial service systems to improve mental health outcomes and help bridge the gap between limited resources and the high demand for services in China. Future research should focus on personalizing these programs and incorporating advanced technologies to enhance their effectiveness and user engagement.

TRIAL REGISTRATION

Open Science Framework; https://doi.org/10.17605/OSF.IO/8P4V6.

Effect of perceived stress on psychological distress in hepatocellular carcinoma patients undergoing TACE: the mediating role of experiential avoidance and the moderating role of trait mindfulness

OBJECTIVE

The aim of this study was to explore the moderated mediation mechanism of the relationships among perceived stress, psychological distress, experiential avoidance and trait mindfulness of hepatocellular carcinoma (HCC) patients after transarterial chemoembolization (TACE) in China.

METHODS

This study utilized a cross-sectional approach to gather data from 458 HCC patients undergoing TACE. Participants completed self-report measures assessing psychological distress, perceived stress, experiential avoidance and trait mindfulness. Mediation and moderation analyses are carried out in SPSS macro PROCESS.

RESULTS

Perceived stress could affect psychological distress and experiential avoidance could mediate this relationship (mediation effect = 0.041, [95%CI=(0.027, 0.056)]). Trait mindfulness played a role as a moderator in the direct and indirect effect of perceived stress on psychological distress.

CONCLUSION

Our findings underscore the vital role of experiential avoidance and trait mindfulness to relieve psychological distress, and provide practical implications for mental health intervention programs of HCC patients undergoing TACE.

Can psychedelic use benefit meditation practice? Examining individual, psychedelic, and meditation-related factors

INTRODUCTION

Meditation practice and psychedelic use have attracted increasing attention in the public sphere and scientific research. Both methods induce non-ordinary states of consciousness that may have significant therapeutic benefits. Thus, there is growing scientific interest in potential synergies between psychedelic use and meditation practice with some research suggesting that psychedelics may benefit meditation practice. The present study examined individual, psychedelic-related, and meditation-related factors to determine under what conditions meditators perceive psychedelic use as beneficial for their meditation practice.

METHOD

Participants (N = 863) who had reported psychedelic use and a regular meditation practice (at least 3 times per week during the last 12 months) were included in the study. To accommodate a large number of variables, machine learning (i.e., elastic net, random forest) was used to analyze the data.

RESULTS

Most participants (n = 634, 73.5%) found psychedelic use to have a positive influence on their quality of meditation. Twenty-eight variables showed significant zero-order associations with perceived benefits even following a correction. Elastic net had the best performance (R2 = .266) and was used to identify the most important features. Across 53 variables, the model found that greater use of psychedelics, intention setting during psychedelic use, agreeableness, and exposure to N,N-Dimethyltryptamine (N,N-DMT) were most likely to be associated with the perception that psychedelics benefit meditation practice. The results were consistent across several different approaches used to identify the most important variables (i.e., Shapley values, feature ablation).

DISCUSSION

Results suggest that most meditators found psychedelic use to have a positive influence on their meditation practice, with: 1) regularity of psychedelic use, 2) the setting of intentions for psychedelic use, 3) having an agreeable personality, and 4) reported use of N,N-DMT being the most likely predictors of perceiving psychedelic use as beneficial. Longitudinal designs and randomized trials manipulating psychedelic use are needed to establish causality.

Treatment mechanism and outcome decoupling effects in cognitive therapy, mindfulness-based stress reduction, and behavior therapy for chronic pain

ABSTRACT

Findings suggest that cognitive therapy (CT), mindfulness-based stress reduction (MBSR), and behavior therapy (BT) for chronic pain produce improvements through changes in putative mechanisms. Evidence supporting this notion is largely based on findings showing significant associations between treatment mechanism variables and outcomes. An alternative view is that treatments may work by reducing or decoupling the impact of changes in mechanism variables on changes in outcomes. We examined the degree to which relationships between previous changes in potential treatment mechanisms and subsequent changes in outcomes changed as treatment progressed and vice versa. Cognitive therapy, MBSR, BT, and treatment as usual (TAU) were compared in people with chronic low back pain (N = 521). Eight individual sessions were administered with weekly assessments of putative treatment mechanisms and outcomes. Lagged analyses revealed mechanism × session number interactions and outcome × session number interactions, such that associations between mechanism and outcome variables were strong and significant in the first third of treatment, but weakened over time and became nonsignificant by the last third of treatment. These effects were similar across treatment conditions but did not emerge among people undergoing TAU. Results suggest that during the course of CT, MBSR, and BT, the links between changes in treatment mechanism variables became decoupled from subsequent changes in outcomes and vice versa. Thus, starting by midtreatment and continuing into late treatment, participants may have learned through participation in the treatments that episodes of maladaptive pain-related thoughts and/or spikes in pain need not have detrimental consequences on their subsequent experience.

The influence of family resilience on non-suicidal self-injury among Chinese adolescents: The mediating roles of mindfulness and individual resilience

Previous research has documented that family-related supportive factors (e.g., family resilience) can protect adolescents from risky behaviors. However, the data regarding the potential psychological mechanism linking family resilience and non-suicidal self-injury (NSSI) remain scarce. This study aimed to explore the possible serial mediational roles of mindfulness and individual resilience in the relationship between family resilience and NSSI. A sample including 548 Chinese adolescents (Mage = 16.10, SD = 1.61; 50.9 % male) with a six-month interval and two waves (Time 1, T1 - September 25, 2023 - October 13, 2023; Time 2, T2 - March 9, 2024 - March 22, 2024) of follow-up was used in the present study. Results showed that, within the examined model, mindfulness at T2 mediated the relation between family resilience at T1 and NSSI at T2; individual resilience at T2 mediated the association between family resilience at T1 and NSSI at T2; and the relationship between family resilience at T1 and NSSI at T2 was fully serially mediated by mindfulness and individual resilience at T2. The findings suggest that family resilience may reduce the likelihood of NSSI by enhancing adolescents' mindfulness and individual resilience. Future interventions aimed at reducing NSSI may benefit from incorporating strategies to strengthen family resilience, promote mindfulness practices, and enhance individual resilience in adolescents.

Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach

BACKGROUND

Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules.

OBJECTIVE

This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians.

METHODS

Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up.

RESULTS

Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001).

CONCLUSIONS

To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425.

How trait mindfulness protects late adolescents from stress-induced sleep problems: the unique role of mindfulness facets and gender differences

BACKGROUND

Understanding sleep problems in late adolescents caused by daily stress is essential due to their increased vulnerability to stress-related sleep issues. While previous research has demonstrated the potential protective effect of trait mindfulness, facets of mindfulness were found to have unique functions against the negative impact of stress, and the unique impact of each facet of mindfulness on the sleep problems caused by the negative impact of stress remains unclear. Thus, this longitudinal study aimed to assess the impact of stressful life events on sleep problems a year later among late adolescents and to explore the moderating effects of the five trait mindfulness facets. Gender differences have been observed in mindfulness's protective effects, yet how gender influences each mindfulness facet remains unclear. This study also examines how gender moderates the effects of individual mindfulness facets.

METHODS

The study tracked 1,926 Chinese vocational high school students (Mage = 18.49) over a year, assessing them for their sleep problems, perceived impact of stressful life events, and mindfulness facets through self-reported questionnaires. Multivariate analysis was used to investigate the moderating effects of each mindfulness facet on the relationship between stressful life events and sleep problems one year later. Then, gender differences were examined through multi-group comparison.

RESULTS

A higher impact from stressful life events predicted more sleep problems a year later. Notably, among all five facets of mindfulness, only Observing significantly buffered the negative impact of stressful life events on sleep problems, in females but not in males, thus gender moderated the impact of Observing.

CONCLUSIONS

This study suggested that Observing uniquely protected young females from the negative impact of stressful life events on their sleep problems a year later. Since the measurement tool for the Observing facet only had 1 question tested on observing inner feelings, and other questions are all about observing bodily sensations and outer environments, this study implies that insomnia therapies focus on enhancing the ability to anchor attention in the present moment, especially towards bodily sensations and the outer environment, may be particularly effective in buffering the long-term impact of daily stressors on sleep for young females.

TRIAL REGISTRATION

Not applicable.

The relationship between psychological resilience, perceived social support, acceptance of illness and mindfulness in patients with hepatolenticular degeneration

To investigates the current status of mindfulness in patients with Wilson's disease (WD) and to explore the effects of psychological resilience, perceived social support, and acceptance of illness on their mindfulness. By using the convenient sampling method, 136 patients with WD were selected from May 2019 to January 2023 in 12 tertiary hospitals in Chengdu. General information questionnaire, five facet mindfulness scale, resilience scale, acceptance of illness and perceived social support scale were used to conduct the investigation. Structural equation model was used to analyze the data. The score of mindfulness of patients with WD was (128.63 ± 22.62), and there were statistically significant differences in different courses of disease, clinical classification, and hospitalization times (P < 0.05). Perceived social support (β = 0.18, P < 0.01) and psychological resilience (β = 0.36, P < 0.05) directly affected mindfulness, perceived social support (β = 0.21, P < 0.01), and acceptance of illness (β = 0.11, P < 0.05) indirectly affected mindfulness through psychological resilience. Patients with WD have moderate levels of mindfulness, psychological resilience, perceived social support and acceptance of illness directly or indirectly affect their mindfulness. Nursing staff can help patients improve their mental defense ability, actively seek more social support, dialectical view, and accept the disease to improve their level of mindfulness to promote physical and mental health.

App-based mindfulness meditation reduces stress in novice meditators: a randomized controlled trial of headspace using ecological momentary assessment

BACKGROUND

App-based mindfulness meditation programs have shown mixed effects in reducing stress levels. These studies have typically relied on limited assessments of dimensions of stress and on pre-post designs to detect effects.

PURPOSE

This randomized controlled trial examined the effect of the mindfulness meditation app Headspace on reducing subjective stress, stressor appraisals, perceived coping, and perseverative cognitions. It tested stress-reducing effects in everyday life throughout an eight-week intervention period.

METHOD

Non-faculty employees (n = 138; age M = 38.19; 75.36% female; 54.5% White, 27.54% Hispanic; 51.45% with a professional degree) from a university in California's Central Valley were randomized into either the Headspace condition (instructed to complete 10 minutes of meditation daily) or wait-list (inactive) control group. Participants completed ecological momentary assessments of stress five times a day for four consecutive days at baseline, at two and five weeks after randomization (mid-intervention), and at eight weeks post-randomization (post-intervention), resulting in 6260 observations of stress dimensions.

RESULTS

Hierarchical linear models were used to test the interaction of condition by time, revealing significant effects for subjective stress, perceived coping, and perseverative cognitions. By week 2, compared to the baseline, participants in the Headspace condition reported less subjective stress and perseverative cognitions, and by week 5 reported more perceived coping. These effects persisted through week 8. No changes were observed for stressor appraisal. Participants in the control condition reported increases in subjective stress and perseverative cognitions, and decreases in coping, throughout the intervention period.

DISCUSSION

Headspace was effective at reducing stress in a high-stress environment. Findings suggest the potential for relatively quick and sustained gains in stress benefits from meditation practice that may help practitioners develop their future programs.

Psychological Mediators of Reduced Distress: Preregistered Analyses from a Randomized Controlled Trial of a Smartphone-Based Well-Being Training

Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a four-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion and purpose) were assessed five times during the intervention period and at three-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators which in turn significantly mediated follow-up distress (21.9%-62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.

A Meta-Regression of psychosocial factors associated with sleep outcomes in mindfulness-based intervention trials

OBJECTIVES

In this meta-regression, we aimed to explore associations between changes in psychosocial factors and changes in sleep disturbance during mindfulness-based interventions (MBIs). We also investigated participant-specific and methodological factors associated with sleep disturbance during MBIs.

METHOD

We utilized data from a published meta-analysis of 40 randomized controlled trials of MBIs (published from inception to 2020) with a sleep disturbance outcome measure in healthy and clinical adult populations. We conducted meta-regressions to test associations between sleep improvements following MBIs and psychosocial factors, as well as demographic and methodological factors.

RESULTS

MBIs were associated with significant reductions in sleep disturbance (SMD = -0.523; 95% CI = -0.678 to -0.368) and psychosocial factors (SMD = -0.213 - -0.894). Reductions in sleep disturbance were associated with reductions in stress (r = 0.74, p = .02) and depression (r = 0.90, p < .001).

CONCLUSIONS

MBIs improve sleep disturbance across a wide range of healthy and clinical populations. Stress and depression may be important psychosocial factors associated with sleep disturbance. Future RCTs should include measures of additional factors and should investigate longitudinal associations between psychosocial, demographic, and methodological factors with changes in sleep disturbance to test mechanisms and to identify "active ingredients" of MBIs.

The chain mediating effect of mindfulness and self-esteem in the relationship between leisure-time physical activity and academic burnout among college students

This study aimed to investigate the relationship between leisure-time physical activity and academic burnout among college students, and the mediating roles of mindfulness and self-esteem in the relationship, so as to provide a reference for alleviating academic burnout among college students. The study used the Physical Activity Rating Scale, the Mindful Attention Awareness Scale, the Self-Esteem Scale, and the Academic Burnout Scale to conduct a questionnaire survey to 629 college students (M = 19.6) through a convenience sampling method. The constructed chained mediation model was tested for path analysis, and mediation effects using SPSS 29.0. The results showed that leisure-time physical activity, mindfulness, self-esteem and academic burnout were significantly correlated with each other. The direct effect of leisure-time physical activity on college students' academic burnout was not significant, but the indirect effect was significant. Mindfulness and self-esteem had significant mediating effects between leisure-time physical activity and academic burnout among college students, and the mediating effects consisted of the independent mediation of mindfulness and self-esteem and the chain mediating effect between them. Thus, enhancing leisure-time physical activity as an intervention to alleviate academic burnout among college students should focus on the effects on mindfulness perception and self-esteem. By enhancing the levels of mindfulness perception and self-esteem, leisure-time physical activity may play an important role in alleviating the growing academic burnout among college students.

Mindfulness and CBT: a conceptual integration bridging ancient wisdom and modern cognitive theories of psychopathology

With the rapid expansion of mindfulness and its incorporation into the "third wave" of Cognitive Behavioral Therapy (CBT), there has been evident confusion about what mindfulness is and how it relates to this broader category of interventions. In this article, I define mindfulness and CBT, and differentiate them while highlighting their substantial overlap. Specifically, I discuss the Buddhist Psychological Model and how it relates to the foundational cognitive model, demonstrating the common threads that run across these seemingly disparate philosophies. I use depression throughout as the exemplar disorder through which these connections are highlighted. This is all in the hope of helping clinicians and scientists see the common ground across these modalities and comprehend how and why mindfulness has come to be associated with the "third wave" of CBT. Ultimately, the aim of this brief article is to showcase the breadth of CBT, its concordance with ancient philosophical thought and wisdom, and to demonstrate why mindfulness has been and continues to be effectively integrated into CBT to address a wide range of mental health concerns and fortify efforts toward wellbeing.

Mindfulness acting with awareness and emotional eating among polycystic ovary syndrome women with infertility: the mediating role of depression

Emotional eating, characterized by the tendency to increase food intake in response to negative emotional states, is often linked to poor emotion regulation. While mindfulness-based interventions have been studied for their benefits in reducing emotional eating, less is known about how inherent mindfulness traits, relate to emotional regulation particularly among individuals with polycystic ovary syndrome (PCOS), a population known for high rates of psychological distress and disordered eating behaviors. This study investigates the associations between different facets of mindfulness, depressive symptoms, and emotional eating among individuals with PCOS and infertility who had not received any formal mindfulness intervention. A cross-sectional study was conducted involving 334 individuals. Participants completed the Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF), the Patient Health Questionnaire (PHQ-9) to assess depressive symptoms, and the Dutch Eating Behavior Questionnaire (DEBQ) to measure emotional eating. Structural Equation Modeling (SEM) was employed to examine the relationships between inherent mindfulness traits (i.e., observation, describing, acting with awareness, non-reactivity, and non-judgment), depressive symptoms, anxiety, and emotional eating. The findings indicated that the trait of acting with awareness may reduce emotional eating through its influence on depressive symptoms, while observational mindfulness was found to be associated with increased emotional eating without prior external mindfulness training. In conclusion, Mindfulness is a multidimensional construct, with its facets contributing differently to emotional regulation and eating behaviors in individuals with PCOS and infertility. Future research should explore these nuances to develop more targeted interventions.

Why Do People with High Mindfulness Experience Greater Eudaimonic Well-Being? Integrating Self-Determination Theory and the Mindfulness Reperceiving Model

Although previous studies have found that mindfulness positively predicts eudaimonic well-being, the underlying mechanism remains to be explored and verified from a theoretical perspective. By integrating self-determination theory and the mindfulness reperceiving model, this study explored the mediating roles of decentering, intrinsic goals, and autonomous motivation in the relationship between mindfulness and eudaimonic well-being among 497 undergraduate students aged 17 to 30 (359 females and 138 males). Structural equation modeling analyses showed that decentering, intrinsic goals, and autonomous motivation mediated the relationship between mindfulness and eudaimonic well-being. Moreover, mindfulness was linked to eudaimonic well-being through the sequential pathways of "decentering → intrinsic goals" and "decentering → autonomous motivation." These findings deepen our insights into how mindfulness is linked to eudaimonic well-being from a self-regulation perspective and provide a reference for the targeted application of mindfulness training to enhance eudaimonic well-being.

Are We Sailing in the Right Direction for Deeper Insights Into Acceptance? Evidence From a Systematic Review of Research in Laboratory Settings

This systematic review aims to review and update the current state of research on the acceptance strategy for a healthy population in a laboratory setting. Using a previously defined search strategy, the PsycInfo, PubMed, and Web of Science databases were searched from 1961 to May 2020 for articles on this topic. Twenty-five high-quality articles, involving a total of 2265 participants, met inclusion criteria. According to these results, acceptance is a strategy with promising outcomes for handling pain in healthy populations, although its superiority over other strategies to reduce negative affect, anger, and other pain variables is unclear. The instructions and outcome variables vary widely between studies, and few studies compare acceptance with mindfulness. We discuss these findings and provide information to guide future researchers for designing fine-grained investigations that can address the gaps in this area.

Mindfulness-based training effect on attention, impulsivity, and emotional regulation among children with ADHD: The role of family engagement in randomized controlled trials

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is among the most common psychiatric conditions affecting school-aged children, marked by diverse levels of inattention, hyperactivity, and impulsivity. Mindfulness-based training intervention throughout childhood enhances those symptoms, improving emotional regulation and well-being, hence improving their quality of life.

AIM

To investigate the effects of mindfulness-based training on attention, impulsivity, and emotional regulation among children diagnosed with ADHD.

DESIGN

A randomized controlled trial (RCT) was used to carry out this study.

SETTING

This study was conducted at the outpatient Medical National Institute in Damanhur. The subjects were 60 children and their parents for the control and study groups (30 in each group).

TOOLS

Researchers used three tools to collect the necessary data: Tool I, A Socio-demographic and Academic Data Questionnaire; Tool II, the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); and Tool III, The Emotion Regulation Questionnaire.

RESULTS

The difference in the level of attention, impulsivity, and emotional regulation between the study and control groups after the mindfulness-based training intervention was statistically significant.

CONCLUSION

Mindfulness-based interventions are effective in improving inattention, impulsivity, and emotional regulation among children with ADHD and increasing their performance in all activities.

RECOMMENDATIONS

Health care professionals should consider incorporating mindfulness-based techniques into standard treatment protocols for children with ADHD. Families should be educated about the benefits of mindfulness as family involvement appears to strengthen the effectiveness of these interventions. These programs should be accessible in schools, community centers, and therapeutic settings to guarantee general distribution. RCT: NCT06131190, Date: 11-9-2023.

An integrated approach to the treatment of Rheumatic diseases: the role of psychological interventions

Rheumatic diseases are chronic conditions that often result in significant physical and psychological challenges, reducing patients' quality of life and increasing the economic burden on healthcare systems. This study examines the vital role of psychological interventions in the comprehensive treatment of rheumatic diseases. The findings reveal a high prevalence of psycho-emotional disorders such as depression, anxiety, and stress among these patients, which can worsen disease progression and hinder treatment adherence. The review highlights the bidirectional relationship between the central nervous and immune systems, showing how psychological stress influences the pathophysiology of inflammatory diseases. Various psychological interventions are explored, including mind-body therapies, cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based practices such as meditation, yoga, and tai chi. These approaches improve emotional well-being, help reduce pain, and enhance overall quality of life. The article emphasizes a holistic treatment model incorporating pharmacological care, physical rehabilitation, and psychological support. This integrated approach fosters more effective management of rheumatic diseases by addressing their complex nature and promoting better functional outcomes. The study advocates for the seamless incorporation of psychological support into routine clinical practice tailored to the biopsychosocial profile of each patient. Future research should focus on identifying the most effective psychological interventions for different patient groups to enhance the quality of life for individuals with rheumatic diseases.

Effectiveness of Acceptance and Commitment Therapy on Psychotic Severity Among Inpatients With Primary Psychoses: A Randomized Controlled Trial

This study investigated the effectiveness of acceptance and commitment therapy (ACT) compared to treatment as usual in managing psychotic symptoms, emotional dysregulation, recovery and psychological flexibility in inpatients with primary psychoses. The Primary outcome assessed the positive and negative syndrome scale, while the secondary outcomes were to assess difficulties in the emotion regulation scale, recovery assessment scale and acceptance and action questionnaire. An open-label, two-arm parallel randomized controlled trial was conducted. Participants diagnosed with primary psychoses were randomly assigned to either the ACT (n = 33) or treatment-as-usual (n = 32) group. The intervention included six structured sessions of ACT. ACT significantly reduced psychotic symptoms from 128 to 104 (Z = 5.01) compared to treatment as usual from 130 to 117 (Z = 4.88). Emotional regulation improved significantly in the ACT group from 73 to 55 (Z = 4.835) compared to treatment as usual from 73 to 70 (Z = 2.406). Recovery increased in the ACT group from 50 to 88 (Z = 5.01) compared to treatment as usual from 51 to 61 (Z = 4.93). Psychological flexibility improved in the ACT group from 33 to 25 (Z = 4.98) compared to treatment as usual from 33 to 31 (Z = 4.75). Between-group differences after intervention were significant for psychotic symptoms, emotional regulation, recovery and psychological flexibility (Z = 2.356, 4.652, 3.881 and 4.453, respectively). Accordingly, the current study demonstrates the effectiveness of ACT in reducing psychotic symptoms and improving emotional regulation, recovery and psychological flexibility in patients with primary psychoses. Integrating ACT into standard care protocols can enhance treatment outcomes, offering a comprehensive approach to managing complex mental health conditions. Trial Registration: ClinicalTrials.gov identifier: NCT06160869.

The acute effect of mindfulness-based regulation on neural indices of cue-induced craving in smokers

Mindfulness has garnered attention for its potential in alleviating cigarette cravings; however, the neural mechanisms underlying its efficacy remain inadequately understood. This study (N=46, all men) aims to examine the impact of a mindfulness strategy on regulating cue-induced craving and associated brain activity. Twenty-three smokers, consuming over 10 cigarettes daily for at least 2 years， were compared to twenty-three non-smokers. During a regulation of craving task, participants were asked to practice mindfulness during smoking cue-exposure or passively view smoking cues while fMRI scans were completed. A 2 (condition: mindfulness-cigarette and look-cigarette) × 2 (phase: early, late of whole smoking cue-exposure period) repeated measures ANOVA showed a significant interaction of the craving scores between condition and phase, indicating that the mindfulness strategy dampened late-phase craving. Additionally, within the smoker group, the fMRI analyses revealed a significant main effect of mindfulness condition and its interaction with time in several brain networks involving reward, emotion, and interoception. Specifically, the bilateral insula, ventral striatum, and amygdala showed lower activation in the mindfulness condition, whereas the activation of right orbitofrontal cortex mirrored the strategy-time interaction effect of the craving change. This study illuminates the dynamic interplay between mindfulness, smoking cue-induced craving, and neural activity, offering insights into how mindfulness may effectively regulate cigarette cravings.

The benefits of mindfulness training for momentary mindfulness and emotion regulation: A randomized controlled trial for adolescents exposed to chronic stressors

OBJECTIVE

The goal of this study was to test if a mindfulness-based intervention (MBI) compared to an active control ameliorates the impacts of life stressors on momentary mindfulness and emotion regulation difficulties among adolescents exposed to chronic stressors.

METHOD

Adolescents exposed to chronic stressors (N = 81, Mage = 13.75 years; 56% boys; 24% Hispanic/Latino, 57% White) were randomized to receive MBI within the context of a community-based mentoring program (MBI + mentoring) or mentoring-alone. Participants completed ecological momentary assessments (EMAs) three times each day for 7 days at three intervals/bursts (preintervention, midintervention, and postintervention), contributing to a total of 3,178 EMA reports. EMA assessed momentary exposure to life stressors, mindfulness (vs. mindlessness), and emotion regulation difficulties.

RESULTS

Linear mixed-effects models revealed that the interaction between intervention arm (MBI + mentoring vs. mentoring-alone) and burst was significantly associated with the random slopes of life stressor exposure predicting mindful attention (b = -.05, SE = .01, p < .001), mindful nonjudgment (b = -.03, SE = .01, p < .001), and emotion regulation difficulties (b = -.04, SE = .01, p < .001). Estimated marginal means revealed that MBI + mentoring, compared to mentoring-alone, produced small but significant attenuation in the association of life stressors with mindful attention, mindful nonjudgment, and emotion regulation difficulties at postintervention.

CONCLUSION

Mindfulness training may buffer adolescents exposed to chronic stressors against the negative impacts of life stressors on mindfulness and emotion regulation in daily life. Going forward, it will be important to investigate these relationships in the context of mental/physical health outcomes and to include longer periods of follow-up to determine the sustainable benefits of MBI for adolescent health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Virtual reality vs. imagery: comparing approaches in guided meditation

Introduction

This study compared the influence of virtual reality (VR)-based and traditional (e.g., imagery-based) guided meditation on stress and concentration levels among South Korean adults. In addition, we examined whether concentration levels differed between individuals who are new to meditation and those who are experienced.

Methods

Seventy participants were randomly assigned to either the VR or imagery condition, where they engaged in breathing and waterfall concentration meditation. Pretest and posttest measures of heart rate (HR), galvanic skin response (GSR), negative affect, and concentration during meditation were recorded.

Results

Both VR- and imagery-based guided meditation significantly reduced HR, GSR, and negative affect. However, no significant differences in outcomes were observed between the two groups. Still, participants in the VR condition reported higher concentration levels during meditation, particularly novice meditators. In addition, qualitative feedback indicated that VR-based meditation was more effective in inducing positive emotions, such as calmness and enjoyment.

Discussions

While both VR- and imagery-based guided meditation effectively reduce stress and negative affect, VR-guided meditation shows promise for enhancing concentration, particularly for novice meditators.

Psychometric assessment of a Chinese version of a mindfulness practice quality measurement tool

BACKGROUND

Mindfulness training is increasingly popular in China. The challenge of evaluating mindfulness practice objectively and accurately has attracted research attention. However, previous studies in China focused primarily on the quantity rather than the quality of mindfulness training. The Practice Quality - Mindfulness (PQ-M) can provide a solution. Consequently, the present study aimed to validate and assess the internal consistency and construct validity of the Chinese version of the Practice Quality - Mindfulness (Ch-PQ-M) in a non-clinical sample.

METHODS

One hundred and sixty participants (female:81) were recruited to practice 20 min of mindfulness training daily for four consecutive days and to complete the Ch-PQ-M, the State Anxiety Inventory, and the Peace of Mind Scale immediately after each mindfulness practice. The Five Facet Mindfulness Questionnaire, the Trait Anxiety Inventory, and the Positive and Negative Affect Scale were administered pre- and post- 4-day treatment. Construct validity (confirmatory factor analysis), internal consistency, test-retest reliability, predictive validity and construct validity were examined.

RESULTS

Ch-PQ-M demonstrated acceptable internal consistency and test-retest reliability. Confirmatory factor analysis supported the established two-factor model (perseverance and receptivity). The Ch-PQ-M attention score was significantly associated with changes of trait anxiety. It improved with short-term mindfulness practice. The perseverance score consistently correlates with scores on peace of mind, state anxiety, trait anxiety, and observe and nonreactivity. The receptivity score remains consistently correlated with the nonjudging. These findings suggest that Ch-PQ-M is a valid instrument for evaluating individual mindfulness quality for a single-session practice.

CONCLUSIONS

Our findings suggest that Ch-PQ-M (especially for the Ch-PQ-M perseverance score) has acceptable psychometric properties and is a reliable and valid instrument for assessing mindfulness practice quality in the Chinese cultural context.

How Are Physical Activity and Mindfulness Associated with Psychological Symptoms Among Chinese University Students: The Independent and Joint Role

Prevalence of psychological symptoms among Chinese university students is relatively high globally, and most students cannot receive timely treatment. Therefore, exploring protective factors for these symptoms is crucial. In this study, the aim was to examine the independent and joint associations of physical activity (PA) and mindfulness with symptoms of depression, anxiety, and internet addiction. Due to the simplicity of implementation in a university context, a cross-sectional survey was conducted in China in 2022. Participants were recruited through online advertisements, in which 710 Chinese university students met the eligibility criteria and were included in the analysis. Participants were then classified into four groups according to their PA and mindfulness levels. Adjusted nominal logistic regression models controlled for age and sex were fitted to examine the independent and joint associations of PA and mindfulness with symptoms of depression, anxiety, and internet addiction. When examined independently, high PA was associated with lower odds of depressive, anxiety, and internet addiction symptoms, while high mindfulness was associated with lower odds of depressive symptoms. When examining the joint effect, compared to students with low PA and low mindfulness, those with high PA and low mindfulness had a lower risk of depressive and internet addiction symptoms, while students with high PA and high mindfulness reported the lowest odds of depressive, anxiety, and internet addiction symptoms. The current study found that a combination of PA and mindfulness was associated with a lower risk of psychological symptoms. Future studies are suggested to confirm the joint effects of PA and mindfulness on mental health using experiment design.

Understanding the Relationship Between Trait Mindfulness and Perceived Stress: The Serial Multiple Mediating Roles of Basic Psychological Needs Satisfaction and Psychological Flexibility

Although research suggests that trait mindfulness has been negatively associated with perceived stress, an integrative examination of the underlying mechanisms is lacking. Consequently, the purpose of this study was to establish an integrative model within Monitor and Acceptance Theory (MAT). This model examined the relationship between trait mindfulness and perceived stress by assessing two important psychological resources: basic psychological needs satisfaction (BPNS) and psychological flexibility. A total of 679 young adults (Mage = 19.27 years, SD = 1.06) participated in this research. They completed a set of standardized instruments that assessed trait mindfulness, BPNS, psychological flexibility, and perceived stress. Serial multiple mediation analyses showed that trait mindfulness was associated with higher levels of BPNS and psychological flexibility, which in turn were associated with less perceived stress. Furthermore, the path coefficient of the serial multiple mediation was higher than other pathways. These findings demonstrate that BPNS and psychological flexibility are important mechanisms that underlie the relationship between trait mindfulness and perceived stress, particularly when they are synergistic.

The use of mindfulness-based stress reduction (MBSR) for breast cancer patients-meta-analysis

BACKGROUND

Mindfulness-based stress reduction (MBSR) intervention has been widely used to reduce the burden of symptoms in cancer patients, and its effectiveness has been proven. However, the effectiveness of MBSR on depression, anxiety, fatigue, quality of life (QOL), posttraumatic growth (PTG), fear of cancer recurrence (FCR), pain, and sleep in breast cancer patients has not yet been determined. This study aims to determine the role of mindfulness-based stress reduction therapy in patients with breast cancer.

OBJECTIVES

The objective was to systematically review the literature to explore the effect of MBSR on anxiety, depression, QOL, PTG, fatigue, FCR, pain, stress and sleep in breast cancer patients. To explore the effect of 8-week versus 6-week MBSR on the 9 indicators. Data were extracted from the original RCT study at the end of the intervention and three months after baseline to explore whether the effects of the intervention were sustained.

METHODS

We conducted searches on PubMed, Web of Science, Embase, and China National Knowledge Infrastructure from inception to November 2023. Eligible studies included randomized controlled trials of breast cancer patients who received mindfulness stress reduction intervention, reporting outcomes for anxiety, depression, fatigue, QOL, PTG, FCR, pain, stress, and sleep. Two researchers conducted separate reviews of the abstract and full text, extracted data, and independently evaluated the risk of bias using the Cochrane 'Bias Risk Assessment tool'. The meta-analysis utilized Review Manager 5.4 to conduct the study, and the effect size was determined using the standardized mean difference and its corresponding 95% confidence interval.

RESULTS

The final analysis included 15 studies with a total of 1937 patients. At the end of the intervention, the interventions with a duration of eight weeks led to a significant reduction in anxiety [SMD=-0.60, 95% CI (-0.78, -0.43), P < 0.00001, I2 = 31%], depression [SMD=-0.39, 95% CI (-0.59, -0.19), P = 0.0001, I2 = 55%], and QOL [542 participants, SMD = 0.54, 95% CI (0.30, 0.79), P < 0.0001, I2 = 49%], whereas no statistically significant effects were found in the intervention with a duration of six weeks. Similarly, in 3 months after baseline, the interventions with a duration of eight weeks led to a significant reduction in depression and QOL, however, no statistically significant effects were found at the 6-week intervention. MBSR led to a significant improvement in PTG at end of intervention [MD = 6.25, 95% CI (4.26, 8.25), P < 0.00001, I2 = 0%] and PTG 3 months after baseline. We found that MBSR reduced the fatigue status at end of intervention, but had no significant effect on fatigue status 3 months after baseline. There was no significant difference in improving pain, stress, and FCR compared to usual care.

CONCLUSIONS

In terms of effects on QOL, anxiety, depression, and fatigue, the 8-week MBSR intervention showed better results than the 6-week MBSR intervention. The intervention of MBSR on PTG was effective, and the effect lasted until 3 months after baseline. Future studies could further identify the most effective intervention components in MBSR.

TRIAL REGISTRATION

PROSPERO registration number: CRD42023483980.

Feasibility and effects of mindfulness-based stress reduction (MBSR) for improving resilience, posttraumatic stress disorder symptoms and posttraumatic growth among military medical college students

BACKGROUND

Increased stress among medical students in military college has been a challenge in the field of education. One approach to addressing stress reduction is mindfulness training. MBSR has been verified to improve the health status of different individuals. The aim of this study was to examine whether MBSR improves the psychological resilience, posttraumatic stress and posttraumatic growth of medical students in military college.

METHODS

MBSR was performed with students from a military medical university. A total of 372 students were surveyed by questionnaires, including the 10-item of Connor-Davidson Resilience Scale, Posttraumatic Growth Inventory, PTSD Checklist for DSM-5, Satisfaction with Life Scale, and Mindful Attention Awareness Scale, before the intervention, after the intervention and one month later. A control group of students also answered the questionnaires at the three time points but did not participate in the MBSR intervention. Statistical analyses were performed using repeated-measures ANOVA.

RESULTS

The results suggest that the MBSR group experienced significant improvements in resilience, posttraumatic growth, life satisfaction, and mindful attention awareness scores, as well as significant reductions in depression, anxiety, and PTSD intrusive symptoms scores after the intervention. These results were not found in the control group. One month after the intervention, all of these variables showed varying degrees of maintenance effects in the MBSR group.

CONCLUSION

The MBSR intervention was effective, as the medical students in military college in the MBSR group exhibited improvements in psychological resilience, posttraumatic growth, satisfaction with life and mindful attention awareness, depression, anxiety and intrusive symptoms.

The mindful resiliency in recovery model: empowering the transcendence of stigma

Introduction

Mindfulness-based interventions show unique promise in treating substance use disorders among marginalized populations who face heightened stigma. The Mindful Resiliency in Recovery Model is introduced as a novel theoretical framework articulating how mindfulness training can mitigate the adverse effects of stigma, enhance psychological resilience, and facilitate sustained recovery from addiction.

Methods

The current manuscript synthesizes various models of mindfulness processes, stigma, and substance use disorder recovery to propose an integrated theoretical framework on the promise of mindfulness-based interventions in supporting recovery. Further, the current manuscript draws upon empirical literature to establish preliminary support for the premises and hypotheses of the Mindful Resiliency in Recovery Model concerning the mechanisms influencing the efficacy of mindfulness-based interventions among marginalized individuals.

Results

Preliminary evidence supports the premises of the proposed model. There is evidence to suggest that specific processes like increased present-moment awareness, acceptance, decentering, reappraisal, and savoring may be especially salient in mitigating internalized stigma and fostering resiliency in recovery. There is a need for additional research on these processes, and contextual factors that may moderate their efficacy.

Discussion

The Mindful Resiliency in Recovery Model has significant implications for optimizing mindfulness-based interventions to empower marginalized individuals to transcend stigma and actualize their capacity for wellbeing in substance use disorder recovery. It provides a roadmap for future research on the mechanisms and contextual factors affecting the efficacy of mindfulness-based interventions for marginalized and stigmatized communities. It further offers guidance to clinicians utilizing mindfulness-based interventions to support individuals experiencing stigma.

Practicing mindfulness can foster monitoring and acceptance after experiencing negative affect

Although being mindful, that is, monitoring and accepting one's present feelings, has been shown to be associated with less current negative affect than distraction, acceptance is less endorsed after experiencing negative affect. Thus, acceptance, although effective, may not be endorsed when it is most needed, leading people to endorse other strategies such as distraction instead. In the present study, we examined whether a monitoring and acceptance induction in a laboratory setting (N = 258) and a monitoring and acceptance training in daily life (N = 125) increased acceptance (Study 1) and monitoring (Study 2) after experiencing negative affect. We found this to be the case: While participants in the control condition showed a significant negative association between prior negative affect and subsequent monitoring and acceptance, participants in the monitor and acceptance condition did not. Thus, even brief monitor and acceptance training is well suited to increasing the likelihood that individuals can monitor and accept their thoughts and feelings when confronted with strong emotions.

Mindfulness-based group intervention for adolescents with type 1 diabetes: initial findings from a pilot and feasibility randomized controlled trial

OBJECTIVE

To evaluate feasibility/acceptability of a virtual, group mindfulness-based intervention (MBI) adapted for pediatric type 1 diabetes (T1D).

METHODS

This two-way controlled trial randomized adolescents 1:1 to MBI (n = 20) or health education (HE; n = 22) groups lasting 6-7 weeks. Eligibility included 12-17 years, T1D ≥ 1 year, and elevated scores on PROMIS depression or anxiety measures. Recruitment, retention, and session attendance were tracked to measure feasibility. Acceptability was measured via youth-reported post-session surveys. Adolescents completed depression, anxiety, and diabetes-specific surveys at baseline, immediately post-program, and 3 months post-program completion. HbA1c values approximating these timeframes were obtained from chart review.

RESULTS

55% of screened participants were eligible to participate, and 100% of eligible youth enrolled. There was 93% study retention and 96% session attendance rates. Survey data were 100% complete at baseline, and 93% complete at post-program and 3-month follow-ups; 83% and 78% of MBI participants rated sessions as at least somewhat enjoyable and helpful, respectively, and 91% and 82% of HE participants rated sessions as at least somewhat enjoyable and helpful, respectively. Mean scores showed declines in depression, anxiety, disordered eating, diabetes distress, and HbA1c in both groups across time, with trends toward potential greater reductions in depression and HbA1c in MBI.

CONCLUSIONS

This pilot provides preliminary evidence that virtual MBI and HE groups adapted for adolescents with T1D are feasible to deliver and acceptable, with potential improvement in psychosocial, behavioral, and diabetes-specific outcomes. Whether MBI is more effective for targeting negative affect and glycemic control in the context of adolescent T1D requires testing in a full-scale efficacy trial.

Are Mindfulness and Mind-Wandering Opposite Constructs? It Depends on How Mindfulness is Conceptualised

This study investigated if trait mindfulness and its components, mindful attention, acceptance, and non-judging correlate negatively with self-reported and indirect markers of mind-wandering. The 552 participants of the study completed an anonymous online questionnaire consisting of trait mindfulness and mind-wandering scales. They also completed the computer-based Sustained Attention to Response Task (SART), an objective measure of mind-wandering. The total mindfulness score and acceptance and non-judging subscale scores were strongly negatively correlated with both self-reported trait mind-wandering (TMW) and SART indices of mind-wandering. In contrast, attention was significantly positively correlated with both. These findings suggest that trait mindfulness conceptualised as a multi-component construct, but not a uni-component one, is probably an opposing construct to trait mind-wandering. Furthermore, mindfulness and its components, acceptance and non-judging, are associated with a reduction in the more common form of SART errors. However, only the acceptance component made a unique contribution to the variance in TMW and SART performance. Therefore, it is advisable for researchers to specify whether they investigated mindfulness as a uni-component or multi-component construct. Furthermore, it would be beneficial if future research investigates the relationship of mindfulness and its components with mind-wandering further by also incorporating a measure of state mindfulness.

When and how is depression associated with ostracism among college students? The mediating role of interpretation bias and the moderating role of awareness rather than acceptance

Depression is closely related to individual social functions. The current study aimed to examine whether depression is associated with ostracism, whether interpretation bias mediates this relationship, and whether trait mindfulness moderates direct and indirect relationships between depression and ostracism. Overall, 389 Chinese college students completed the Center for Epidemiological Survey, Depression Scale, Interpretation Bias Questionnaire, Philadelphia mindfulness scale, and perceived ostracism scale at two-time points. Latent Profile analysis and moderated mediation analysis were performed. After controlling for sex and age, depression (t1) was positively correlated to perceived ostracism, with this relationship being partially mediated by negative interpretation bias (IBN, t2). The effect of IBN on perceived ostracism was weak when awareness was high at time 2. Acceptance had a non-significant moderating role in the relationship between IBN and perceived ostracism at time 2. LPA delineated three profiles: high awareness, high acceptance, and medium mindfulness. The moderating role of the different profiles in the relationship between IBN (t2) and perceived ostracism (t2) was significant. Depressed individuals appear to experience more ostracism because of IBN. Awareness might alleviate the effect of IBN on perceived ostracism.

Work-related resilience, engagement and wellbeing among music industry workers during the Covid-19 pandemic: A multiwave model of mindfulness and hope

We surveyed workers in the performing arts sector to explore the role of positive mindsets in facilitating work-related resilience, engagement and reduced stress using retrospective reporting surveys during the Covid-19 work shut down period. Integrating conservation of resources theory with research on metacognitive self-regulation, we controlled for the severity of the Covid-19 impact and negative affect and found that hope (but not mindfulness) predicted professional engagement, resiliency and reduced tension and distress over time. Further, the relationships between hope and outcomes were mediated by positive affect (PA). Mindfulness was not indirectly (via PA) related to outcomes (i.e., engagement, resiliency, job tension, distress) but was directly and negatively related to job tension and distress. These findings suggest that in times of intense stress or adversity, future-oriented thinking such as hope may be more effective than mindfulness in sustaining positive mindsets and action-oriented outcomes such as engagement. Implications for practice and future research are discussed.

Psychological mechanisms and neural correlates of trait mindfulness in emotion regulation: Testing a novel approach to the monitor and acceptance theory

Background

The ongoing mental health crisis warrants investigations to understand why trait mindfulness is associated with beneficial mental health outcomes. This study examined attention monitoring and acceptance as psychological mechanisms underlying the relationship between trait mindfulness and emotion regulation and connectivity between the dorsolateral prefrontal cortex (dlPFC) and posterior cingulate cortex (PCC) as a potential neural mechanism.

Methods

A cross-sectional study was conducted with 501 adult participants (age range: 17-79, M = 31, SD = 11.3) representing the general population. To assess emotion regulation and trait mindfulness, participants completed the Difficulties in Emotion Regulation Scale (DERS) and Five Facets Mindfulness Questionnaire (FFMQ). Resting-state functional MRI was acquired in a subsample of 20 participants to explore the role of dlPFC-PCC functional connectivity.

Results

Higher levels of acceptance, as measured using the Non-judging and Non-reactivity subscales of the FFMQ, were significantly associated with fewer overall emotion regulation difficulties and predicted all emotion regulation subscales. In contrast, higher levels of attention monitoring, measured using the Observe subscale, predicted only three DERS subscales and with mixed effects: higher emotional awareness and clarity, but greater difficulties in goal-directed behaviour. The interaction between monitoring and acceptance was not significant, and no correlation was found between these variables and dlPFC-PCC functional connectivity.

Conclusions

These findings challenge previous theories that argue that attention monitoring is crucial for effective emotion regulation. Instead, we conclude that acceptance is the key psychological mechanism, indicating that the traditional focus on attention monitoring in mindfulness training may be less effective than a primary emphasis on acceptance. This study provides a critical review of past research, highlighting issues with operationalising acceptance, and offers recommendations for future studies and practical implications for developing mindfulness interventions.