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  • Julianne McGillJulianne McGill
  • Francesca Adler-BaederFrancesca Adler-Baeder
  • Leah BurkeLeah Burke
Objective The factor structure, reliability, and concurrent, convergent, and incremental validity were tested for a new theoretically informed measure of couple relationship mindfulness, the Mindfulness in Couple Relationships Scale (MCRS). Methods The analytic (training) sample included 408 (independent) adult men and women, and the cross-validation (test) sample included 368 adults who responded to 52 survey items as part of a measurement development study conducted within the context of a relationship education evaluation. Both samples were racially, economically, and relationally diverse. Results Confirmatory factor analyses of individual measurement models in the training sample informed the refinement of a 31-item, eight-factor measure. The full measurement model had good fit and reliability. Cross-validation in the test sample provided further evidence of validity and reliability. Support for concurrent validity was evidenced by significant associations between the MCRS and couple quality, relationship positivity, relationship negativity, and sexual satisfaction. Support for convergent validity was evidenced by significant associations between the MCRS and the abbreviated Five Facet Mindfulness Questionnaire (FFMQ). Finally, regression models indicated support for incremental validity over and above the influence of the abbreviated FFMQ (i.e., a measure of individual mindfulness) in predicting relationship well-being. Conclusions This measure provides an efficient and multi-dimensional assessment of mindfulness in the context of couple relationships and may prove useful, whether using the total scale or subscales of the measure, in future research and in practice.
Participant flow
Objectives College is an exhilarating but stressful time often associated with mental distress. The StudiCare project offers Internet- and mobile-based interventions (IMI) for college student mental health promotion. Within this framework, we evaluated the IMI StudiCare Mindfulness , and examined potential moderators and mediators of effectiveness. Methods In this randomized controlled trial, 150 college students with low to moderate mindfulness were randomly assigned to StudiCare Mindfulness or a waitlist control group (WL). StudiCare Mindfulness comprises 5 weekly online modules based on Acceptance Commitment Therapy and stress management. Assessments took place before (t0) and 6 weeks after (t1) randomization. Primary outcome was mindfulness. Secondary outcomes were stress, depression, anxiety, quality of life, intervention satisfaction, and adherence. Sociodemographic variables, pre-intervention symptomatology, personality traits, and attitudes towards IMI were examined as potential moderators. Results Intention-to-treat analyses ( N = 149) showed a large effect of StudiCare Mindfulness on mindfulness ( d = 1.37; 95% CI: 1.01–1.73) compared to WL at t1 ( β = 1.18; 95% CI: 0.96–1.40). Effects on secondary outcomes were significant in favor of the intervention group except for physical quality of life. Mindfulness was found to mediate intervention effectiveness on depression, anxiety, and stress. Moderation analysis was non-significant except for baseline openness to experience, with lower openness associated with larger intervention effects on mindfulness. Conclusions This trial suggests that StudiCare Mindfulness may enhance mindfulness and reduce mental health problems. Its potential applicability as low-threshold prevention and treatment option on a population level should be subject to future trials. Trial Registration German Clinical Studies Trial Register TRN: DRKS00012559.
Multilevel structural equation model showing a 1–1-1 multilevel mediation model (A) between daily self-compassion (SC) and affective well-being (AW; i.e. either negative or positive affect) with the three mediators perceived stress (PS), engagement coping (EC), disengagement coping (DC)., c′w, c′b = direct effect; cw, cb = total effect; figures are based on Preacher et al. (2011)
Objectives While the positive effects of trait self-compassion on affective well-being are widely known, within-person effects of state self-compassion and underlying mechanisms between state self-compassion and affective well-being have rarely been investigated. The current study aimed at examining whether perceived stress and healthier coping responses are mediators in the relation between momentary self-compassion and affective well-being. Methods A total of 213 participants completed measures of momentary self-compassion, momentary perceived stress, and engagement and disengagement coping responses, as well as affective well-being (i.e., presence of positive and absence of negative affect) via their smartphones. The ambulatory assessment design included three measurements per day (morning, afternoon, evening) for 7 days. Results Multilevel modeling revealed that within-persons, momentary levels of self-compassion were related to momentary levels of stress, coping responses, and affective well-being components. 1–1-1 multilevel mediation analyses were conducted and demonstrated that, at the within-person level, momentary self-compassion was related to more positive and less negative affect via perceived stress and facilitating healthy coping responses. The within-person relations of the original 1–1-1 multilevel mediation could partially be replicated in an alternative model with momentary self-compassion one occasion prior and positive affect. However, the link between self-compassion one occasion prior and negative affect was only mediated by perceived stress. Conclusions This work helps to understand the processes underlying the adaptive effects of momentary self-compassion on momentary affective well-being on a given occasion. Theoretical and practical implications of these findings are discussed.
Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Flowchart of the Literature Search and Article Selection (Page et al., 2021)
Objectives Growing research indicates that self-compassion is associated with key physical health outcomes in non-clinical adult populations. This systematic review was designed to characterize the mediators linking self-compassion to physical health outcomes, evaluate study quality and theoretical evidence, compare findings to the mental health literature, and provide directions for future research. Methods We searched Embase , Medline , APA PsycInfo , Scopus , AMED , and Web of Science for relevant articles (including the inclusion of formal statistical mediation tests) from 2003 to February 2022. Study quality was assessed with Downs and Black Checklist for Measuring Quality and Mediation Quality Checklist tools. Results We screened 6439 articles for title and abstracts, assessed 101 full texts for eligibility, and included 20 relevant articles. A range of mediators were categorized as testing psychological or behavioral factors. Perceived stress ( n = 5), emotion regulation ( n = 5), negative affect ( n = 3), and coping strategies ( n = 3) were the most frequently assessed mediators. In general, self-compassion had a significant indirect effect on physical health via negative affect and perceived stress (in the absence of overlapping affective mediators). Findings for emotion regulation and coping strategies were mixed. Conclusions The mediational evidence linking self-compassion to physical health via psychological and behavioral factors remains underdeveloped and focused on the measures of affect and emotion regulation. Future studies need to broaden the scope of mediators to include other self-regulatory factors indicated by theory (e.g., motivational and physiological indices) and implement designs other than cross-sectional/correlational. Protocol Registration PROSPERO CRD42021241915.
Depiction of the three-class profiles defined by pattern of standardized means, confidence intervals, and raw data on five facets of mindfulness
Scatterplots of mindfulness facets separating each latent profile for the 3-profile solution pre-MBSR
Objectives The Five Facet Mindfulness Questionnaire (FFMQ) is one of the most common self-report instruments used in scientific literature to assess mindfulness. However, mixed evidence has been provided regarding its psychometric properties. Among them, the FFMQ seems to present latent classes or profiles with specific patterns in its facets, which might explain said mixed evidence. This study explores mindfulness profiles in the Spanish population using the short form of the FFMQ (FFMQ-SF) and its relations with relevant constructs (i.e., decentering, self-compassion, psychological well-being, psychopathology, positive and negative states). Methods A general population sample of 826 participants completed instruments measuring mindfulness and related constructs. Latent profile analyses were applied to the FFMQ-SF facets, and profile membership of participants was estimated for relations with related constructs. Results Three latent profiles were found: General Mindfulness, Judgmentally Observing, and Non-judgmentally Aware. General Mindfulness showed expected relations with other constructs, but the other two profiles showed some relations opposite to prior literature: The Judgmentally Observing profile displayed functional behaviors while the Non-judgmentally Aware profile showed an inverse mitigated pattern. Results could not be explained by gender, age, level of studies, or minimum experience with meditation. Conclusions Most people (68%) fall into mindfulness profiles that can be regarded as a continuum (e.g., an overall mindfulness factor). However, the FFMQ-SF shows heterogeneities in its facets due to two unique latent profiles, namely “Judgmentally Observing” (7.4%) and “Non-judgmentally Aware” (24.8%). While the structure of these profiles was replicated, relations with relevant psychological constructs contradicted previous literature. Implications and recommendations for future studies are discussed.
Moderating effect of self-judgment on the relationship between experiences of racial discrimination and symptoms of anxiety
Moderating effect of self-judgment on the relationship between experiences of racial discrimination and somatic symptoms
Objectives Racial discrimination can have deleterious effects on the mental health of Black, Indigenous, and People of Color (BIPOC) individuals. Understanding mechanisms that contribute to the development of mental health symptoms in BIPOC populations in the context of discrimination is an essential component in treating such concerns within these groups. This study examined whether elements of self-compassion (i.e., self-kindness, mindfulness, common humanity, self-judgment, over-identification, and isolation) buffered against, or exacerbated, negative mental health outcomes in BIPOC college students experiencing racial discrimination. Methods Participants were 100 BIPOC college students (Mage = 22.07, SD = 5.57, 69.2% female) from diverse racial and ethnic backgrounds (1.0% Native American, 32.0% Asian, 37.0% Black, 24.0% Latinx, 4.0% Middle Eastern/North African, 3.0% Multiracial/Multiethnic). A cross-sectional survey was utilized to examine elements of self-compassion as a moderator of the relationship between racial discrimination and symptoms of anxiety and depression and somatic symptoms. Results Some, but not all, elements of self-compassion were associated with mental health outcomes. Self-judgment emerged as the only moderator. Specifically, the relationship between the experience of discrimination with both somatic and anxiety symptoms was stronger for individuals who endorsed higher self-judgment. Conclusions Findings suggest that self-judgment may play a unique role in the experience of mental health symptoms among BIPOC individuals who face discrimination.
Objectives In recent years, mindfulness has gone mainstream, reaching many adolescents through school programs and smartphone applications. Yet there is little empirical understanding of what mindfulness practice is like for adolescents. This mixed-methods study sought to capture adolescents’ lived experiences as they embarked on a period of intensive mindfulness practice. Methods Twenty-three self-selected youth (Mage = 16.68 years, SD = 1.55; 57% girls, 43% boys; 52% White, 13% African American, 4% Latino, 4% East Asian, and 26% Multiracial) participated in a 6-day residential mindfulness retreat. Participants completed self-report surveys, open-ended daily diaries, and discussed their experiences in focus groups. Qualitative data were analyzed using a two-cycle coding process to categorize common patterns of adolescents’ experiences during mindfulness practice and quantitative data were examined for demographic subgroup differences. Results Adolescents reported an array of experiences of distress from cognitive (83% of adolescents; e.g., self-loathing and rumination), to emotional (87% of adolescents; e.g., sadness), and to physical distress (44% of adolescents; e.g., physical pain) during mindfulness practice. They also described a range of well-being experiences from cognitive (87% of adolescents; e.g., self-inquiry and discovery), to emotional (65% of adolescents; e.g., acceptance), and to social well-being (39% of adolescents; e.g., loving-kindness and connection). The frequency of experiences of distress and well-being reported were relatively balanced overall, yet girls and experienced meditators reported greater distress. Conclusions This study paints a descriptive picture of adolescents’ experiences during mindfulness practice and suggested that their experiences might reflect core developmental concerns. Implications for adolescent development and contemplative science are discussed.
Consort diagram
Objectives The effectiveness of mindfulness-based programs (MBPs) has been established in many randomized controlled trials. However, effect sizes are often modest, and there remains ample scope to improve their effectiveness. One approach to this challenge is to offer a “follow-on” course to people who have completed an MBP and are interested in further skill development. We developed and tested a new 8-week course for this purpose based on awareness of feeling tone (vedanā), an understudied aspect of mindfulness in many current MBPs, incorporating new developments in neuroscience and trauma sensitivity. We examined its effectiveness and the frequency and severity of unpleasant experience and harm. Methods In an open trial, 83 participants, 78 of whom had previously taken part in an MBP (majority MBSR or MBCT), completed the program in nine groups. Participants completed questionnaires before and after and gave qualitative written feedback at completion. Results Participants reported significantly reduced depression (d = 0.56), stress (d = 0.36), and anxiety (d = 0.53) and increased well-being (d = 0.54) and mindfulness (d = 0.65) with 38% meeting criteria for reliable change on anxiety and depression. As expected, about three-quarters of participants reported some unpleasant experiences associated with mindfulness practice during the course, but none reported harm. Five participants showed “reliable deterioration” (an increase) in either depression or anxiety, but four of these five also gave anonymous qualitative feedback describing benefits of the course. Conclusions Findings support the added value of a follow-on course based on the exploration of feeling tone for participants who have a range of previous mindfulness experience.
Objectives Based on the current literature, mindfulness seems to have positive effects on mental and physical health not only in adults but also in children and adolescents. Research should further investigate these findings and needs properly validated measures. Therefore, the aim of the present study is to validate a German version of the Child and Adolescent Mindfulness Measure (CAMM). Methods A sample of 248 children and adolescents (10–19 years, M = 14.85, SD = 2.55, 58.87% females) filled in the CAMM, measures of self-compassion, internalizing (depression and anxiety) and externalizing (destructiveness and boundary violations) symptoms, and quality of life. A confirmatory factor analysis was conducted to test the original factor structure. Also, internal consistency, convergent validity, and possible gender and age group differences were examined. Results Results did not support the original one-factor structure of the CAMM with ten items but indicated a one-factor structure with seven items for the German version of the CAMM. Internal consistency was good with Cronbach’s α = .83 and McDonald’s ω = .85. Convergent validity of the seven-item scale was indicated by moderate correlations in expected directions with self-compassion, internalizing and externalizing symptoms, and quality of life. Conclusions The German seven-item version of the CAMM seems to be a promising tool to measure mindfulness in German-speaking children and adolescents.
Flowchart of the trials per Ultimatum Game round for study 1 and study 2
Graphical depiction of the effect of the fairness of offer (from very unfair — 1 out of 20 — through fair — 10 out of 20) and trait mindfulness (standardized) on the probability of acceptance of offers for study 1 (a) and study 2 (b), and the interaction effect of offers x trait mindfulness on emotional reactions to offers in study 2 (c)
Objectives The current study assessed whether trait mindfulness relates to social decision making as increased acceptance rates towards offers in the Ultimatum Game. Mindfulness has been associated to a reduction in emotional reactivity and an increase in emotion regulation once intense emotions do occur. Therefore, we reasoned that trait mindfulness would predict acceptance in the Ultimatum Game, perhaps even in case of unfair offers. Methods In two online studies we assessed whether trait mindfulness positively predicts acceptance of offers in the Ultimatum Game among community samples (study 1 N = 107; study 2 N = 118). In study 2, we also assessed participants’ emotional reactions to offers prior to their decision to accept or reject. Results Whereas study 1 indeed showed a significant positive relation between trait mindfulness and acceptance of offers (OR = 2.01, p = .05), study 2 did not show this relation (OR = .91, p = .81). Also, the results of study 2 showed that trait mindfulness may moderate emotional responses to offers (β = − .06, p = .03). Yet, analyses of the pooled data indicated no relation between trait mindfulness and acceptance of offers (p < .15). Conclusions Our research provides mixed support regarding the association between trait mindfulness and behavioral acceptance of offers in the Ultimatum Game. We discuss the need for more fine-grained examinations of when and why mindfulness should lead to acceptance of unfairness, and if and when mindfulness would lead to wise responding in social exchange situations.
Path model of the relationship linking trait mindfulness facets, perceived stress, and physical symptoms of stress. Standardized beta (β) path coefficients are shown. Solid arrows indicate statistically significant paths. Dashed arrows indicate non-significant paths. R² values for perceived stress and physical symptoms of stress denote percent variance explained. Perceived stress significantly mediated the effect of four mindfulness facets (describing, non-judging, non-reactivity, and acting with awareness) on physical symptoms of stress. Covariates of perceived stress and physical symptoms of stress included gender, race, and prior meditation experience (paths not shown for simplicity)
Objectives The mindfulness stress buffering account posits mindfulness may benefit physical health by reducing stress. Previous research supports this account and suggests the non-judging facet of mindfulness may be most strongly associated with physical symptoms of stress, via lower perceived stress. The current replication study used structural equation modeling to analyze relationships between multiple facets of mindfulness, perceived stress, and physical symptoms of stress. Methods Undergraduate students (n = 534, 68% White, 65% female) completed surveys measuring trait mindfulness (Five Facet Mindfulness Questionnaire—Short Form), perceived stress (Perceived Stress Scale), and physical symptoms of stress (Cohen-Hoberman Inventory of Physical Symptoms). Results As hypothesized, results showed the negative relationship between four facets of mindfulness (describing, non-judging, non-reactivity, and acting with awareness) and physical symptoms of stress was partially mediated by lower perceived stress. Observing, however, was associated with more physical symptoms of stress. Conclusions The current findings successfully replicated the results of two previous studies in an independent sample, using a more parsimonious analytic strategy that included all variables in a single path model. Results confirm the stress-buffering effect of trait mindfulness, particularly non-judging. Future research may test whether changes in trait mindfulness, particularly non-judging, explain individual differences in objective measures of stress and physical health.
Mindful parenting model among parents of children with ASD. Standardized beta coefficients are shown. Demographic factors were included as control variables. *p < 0.05; **p < 0.01; ***p < 0.001
Objectives The present study examined the longitudinal impact of mindful parenting on child internalizing and externalizing symptoms in families of children with autism spectrum disorder (ASD) and explored the potential mechanisms underlying this impact. We hypothesized that mindful parenting would be longitudinally associated with decrements in child internalizing and externalizing symptoms and these associations would be mediated by increased parent–child closeness and reduced parent–child conflict. Methods Data were collected from 441 parents of children with ASD in three waves (W1, W2, W3) over 2 years. Measures included mindful parenting, parent–child closeness and conflict, and child internalizing and externalizing symptoms. Results Path analyses showed that, when demographic factors and autoregressive effects were controlled, mindful parenting at W1 had significant direct effects on parent–child closeness and conflict at W2. While parent–child closeness at W2 had non-significant direct effects on child internalizing and externalizing symptoms at W3, parent–child conflict at W2 had significant direct effects on child internalizing and externalizing symptoms at W3. Bootstrap analyses further showed that mindful parenting at W1 had significant indirect effects on child internalizing and externalizing symptoms at W3 through parent–child conflict at W2. Conclusions Our findings reveal the longitudinal impact of mindful parenting on child psychopathology. In particular, our findings indicate that mindful parenting is associated with lower levels of child internalizing and externalizing symptoms through lower levels of maladaptive parent–child interactions.
Flow chart of the included studies
Assessments using RoB 2 for the included studies
Forest plots of the meta-analysis of MBIs for negative symptoms
Objectives Mindfulness-based interventions (MBIs) can effectively relieve negative symptoms in patients with schizophrenia. However, the effect size of MBIs and their potential influencing factors remain unclear. Methods We searched different databases and performed a meta-analysis to determine the efficacy of MBIs for the treatment of negative symptoms in schizophrenia. Standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess effect sizes of MBIs for negative symptoms. Subgroup analysis and meta-regression analysis were used to explore the potential influencing factors of the pooled SMD of MBIs for negative symptoms. Results We identified 26 randomized controlled trials including 1725 individuals with schizophrenia. We observed a small-to-large effect size of MBIs for negative symptoms. The pooled SMD of MBIs for negative symptoms was − 0.59 (95% CI: − 0.87 to − 0.32), with a heterogeneity (I²) of 83.6% (95% CI: 76.9 to 88.4%; p < 0.01) based on a random effects model. In the subgroup analysis, significant differences were found with “Different Geographical Location of Treatment Study” (p < 0.01) and “Different Lengths of MBIs treatment” (p = 0.02). Meta-regression analysis showed that publication year was a significant predictor of the effect size of MBIs for negative symptoms (p < 0.001). Conclusions We identified a small-to-large effect size of MBIs to relieve negative symptoms in patients with schizophrenia. The number of sessions and different cultures were associated with the efficacy of MBT for negative symptoms.
Objectives The Interpersonal Mindfulness Scale (IMS) was recently developed to assess the qualities of mindfulness relevant to interpersonal interactions. The objective of the current study was to create a valid and reliable short-form version from the existing 27-item IMS. Methods Rasch modeling methods were used to evaluate a 17-item version and 13-item version of the IMS-short form (IMS-SF) in a sample of 584 participants (sample A). Items from the IMS were deleted with the goals to maintain the theoretical representation of the construct and to retain at least three items from each subscale. An independent sample of 503 participants (sample B) was used to examine the robustness of each IMS-SF. Results In both samples, the 17-item and 13-item versions of the IMS-SF met the expectations of the unidimensional Rasch model, were invariant across demographic factors, and had acceptable reliability (PSI = 0.74–0.81). The 17-item version demonstrated better reliability and coverage of the construct in both samples compared to the 13-item version. Nevertheless, the 13-item IMS-SF maintained satisfactory psychometric properties to be recommended as a briefer alternative for most research uses. Zero-order correlations and partial correlations, controlling for trait mindfulness, supported the construct validity of each IMS-SF. The accuracy of measurement of the IMS-SF can be enhanced by transforming ordinal responses into interval-level data using the included ordinal-to-interval conversion tables. Conclusions Both the 17-item and 13-item IMS-SF can be used to efficiently measure overall levels of interpersonal mindfulness.
The averaged P300 amplitude distribution and its relationship with the FFMQ attentional awareness score prior to the intervention tasks. Left panel: showing the topographic map of the somatosensory P300 component, that is the mean amplitude in the 250–500-ms time window after onset of tactile oddballs; right panel: showing a scatterplot of the mean P300 amplitude at electrode CPz and the attentional awareness score of the FFMQ for each participant (grey circles), also including a trendline representing the strength of the correlation
Somatosensory ERPs averaged across midline electrodes elicited by tactile oddballs before the intervention (solid lines) and after the intervention (dotted lines) separate for the control (left panel) and mindfulness meditation group (right panel)
Objectives Mindfulness training has been theorised to have beneficial effects on mental health through initially changes in attention mechanisms. The aim of the present study was to assess the impact of a short mindfulness meditation on the P300 event-related potential (ERP), a neural marker of attention, in meditation-naïve participants. Methods As mindfulness practice is based on monitoring bodily sensations and breathing, we applied somatosensory stimuli to investigate attention changes. We employed an oddball paradigm with frequent tactile stimuli delivered to the tip of the index finger and infrequent stimuli to the base of the index and the little finger of the right hand to elicit the somatosensory P300. Forty-six participants counted the infrequent stimuli in two separate sessions before and after a 10-min guided meditation, or a control audio clip. We also measured participants’ trait mindfulness (FFMQ) and anxiety (STAI-T) to ensure similar levels in the meditation and control group prior to the intervention. Results In line with previous research, we show decreased somatosensory P300 amplitudes to infrequent tactile target stimuli after compared to before the audio clip in the control group. Such a decrease in P300 amplitudes was not present in the mindfulness meditation group as confirmed in a significant group by time interaction. Conclusions Even a short mindfulness meditation leads to preservation of attention resources in meditation-naïve participants. The preservation (or lack of habituation) of the amplitude of the somatosensory P300 across repeated presentations may reflect the underlying, early neural mechanism by which mindfulness meditation training modulates executive attention. Trial Registration Open Science Framework: https://osf.io/pkxm3.
The mediation model of dispositional mindfulness (FFMQ), difficulties with emotion regulation, and depression. Note: In the mediation model, the coefficient in brackets is the influencing coefficient of the independent variable on the dependent variable. ***p < .001
Objectives Bereavement is a significant and stressful event that has a profound impact and can cause physical and psychological illness for the bereaved. To clarify the mechanisms underlying recovery from bereavement grief, the present study examines the relationship between dispositional mindfulness, difficulties with emotion regulation, and depressive, complicated grief. Methods Five hundred and nine bereaved Taiwanese participants completed the measures of dispositional mindfulness, grief, depression, and difficulties with emotion regulation scales, as well as the inventory of complicated grief. Mediation analyses were performed to explain the relationships between the variables. Two models were performed to test the hypotheses; one explored difficulties with emotion regulation as a mediator between dispositional mindfulness and depression, and the other explored the same mediator but employed complicated grief instead of depression as the dependent variable. Results The results showed that dispositional mindfulness was negatively related to depression, difficulties with emotion regulation, and complicated grief among the bereaved population. Emotion regulation fully mediated the relationship between dispositional mindfulness and depression but only partially mediated that between dispositional mindfulness and complicated grief. Conclusions This study provides information regarding the possible mechanisms whereby implementing mindfulness-based interventions with bereaved individuals who are suffering difficulties with emotion regulation might be useful. Given the limitations of the research design and participant recruitment, more studies are needed to explore the mechanisms of mindfulness underlying recovery from bereavement grief.
Network analysis with multidimensional scaling method. Note. The size and density of the edges between the nodes represent the strength of connectedness. A blue edge indicates a positive relation between nodes, and a red edge indicates a negative relation between nodes. Multidimensional scaling method plots high related ones close together, whereas weakly related ones are far apart. SCmp, self-compassion; PA, personal accomplishment; Ob, observing; NREACT, nonreacting; NJUG, nonjudging; Inti, initiatory self-control; Inhib, inhibitory self-control; Des, describing; aSCld, reversed scores on self-coldness; aEE, reversed scores on emotional exhaustion; aDP, reversed scores on depersonalization; Act, acting with awareness
Centrality indices. Note. SCmp, self-compassion; PA, personal accomplishment; Ob, observing; NREACT, nonreacting; NJUG, nonjudging; Inti, initiatory self-control; Inhib, inhibitory self-control; Des, describing; aSCld, reversed scores on self-coldness; aEE, reversed scores on emotional exhaustion; aDP, reversed scores on depersonalization; Act, acting with awareness
Participants’ flow chart
Objectives Previous studies have supported the idea that mindfulness-based interventions (MBIs) could reduce burnout but lack theory-based explorations of the underlying mechanisms. The integrative view of job demands-resources theory and self-regulation suggests that self-regulation is crucial for coping with job burnout. Based on this theoretical point of view, the present research investigated the effect of MBIs on burnout and the potential mediation between burnout and specific self-regulation traits, including mindfulness, self-compassion, and self-control. Methods Study 1 (N = 342; 19.9% managers and 19.9% technologists) collected cross-sectional data utilizing network analysis to explore the complex relations between self-regulation and burnout. Study 2 (N = 156; 30.8% teachers) conducted a randomized controlled trial to investigate the effect of mindfulness-based positive psychology (MBPP) on burnout and the mediating role of the three self-regulation components. Results (1) Self-compassion was more related to initiatory than inhibitory self-control; (2) acting with awareness, self-compassion, and inhibitory and initiatory self-control played important roles in the self-regulation and burnout network; (3) MBPP could significantly improve mindfulness, self-control, and self-compassion while protecting against burnout; and (4) acting with awareness mediated the effect of inhibitory self-control on depersonalization. Conclusions MBPP has the potential to protect against burnout. Self-regulation mediated the intervention effect on burnout, which supported the integrative view on burnout in MBIs. The findings also supported the necessity to differentiate subcomponents of self-compassion and self-control and suggested a new mechanism by which self-control could benefit the application of mindfulness.
Category probability curves for item 5 before rescoring illustrating disordered thresholds (above) and after rescoring showing perfectly ordered thresholds (below)
Person-item threshold distribution of sample A
Objectives People conceptualize their identities, in part, by their social roles. We defined the construct of “selfing” as excessive identification with a social role. This over-identification may influence feelings of psychological stress; research to understand this theorized association requires reliable and valid measurement of the selfing construct. Method The Selfing Scale was developed and validated using both classical and Rasch methodology with a large sample (N = 1882) including undergraduate students and MTurk workers. Two randomized samples (n = 400 each) were extracted and subjected to Rasch analysis to ensure replicability of the results. Additional independent samples were used to establish test–retest reliability and validity by examining relationships with other measures relevant to the self. Results An exploratory factor analysis on the initial 27 items yielded a 25-item solution with acceptable psychometric properties that supported a single overarching selfing factor. To achieve the best Rasch model fit, we uniformly rescored disordered thresholds, removed 7 misfitting items, and used testlet models to address local dependency resulting in a more robust 18-item scale. Conversion algorithms were also developed to transform ordinal scores into the interval-level metric to enhance accuracy of the scale. Selfing was negatively related to trait and interpersonal mindfulness and frequency of meditation among mindfulness practitioners, and positively related to psychological stress among non-practitioners. Conclusions This study developed a reliable and valid Selfing Scale to measure over-identification with the self that is useful to investigate the impact of selfing on an individual’s health and well-being.
PRISMA 2009 flow diagram of screened and selected studies
Functional connectivity (FC) differences from pre- to post-intervention. Regions are color coded in relation to the network categorization of Spreng et al. (2013). The size of the circles increases with the number of studies reporting the given brain region. Regions that only have been reported by one study are represented by black circles. A Group-by-time interaction effects. B Effects within the mindfulness-intervention group. ACC = anterior cingulate cortex; IPS = intraparietal sulcus; ITG = inferior temporal gyrus; MCC = medial cingulate cortex; MFC = medial frontal cortex; MTC = medial temporal cortex; OFC = orbitofrontal cortex; PCC = posterior cingulate cortex; SFC = superior frontal cortex; SMG = supramarginal gyrus; SPL = superior parietal lobule; vmPFC = ventromedial prefrontal cortex
Functional connectivity (FC) differences from pre- to post-intervention that correlated significantly with self-report questionnaires. Regions are color coded in relation to the network categorization of Spreng et al. (2013). The size of the circles does not reflect the number of times it has been reported in various studies. A Group-by-time interaction effects. B Effects within the mindfulness-intervention group. ACC = anterior cingulate cortex; IPS = intraparietal sulcus; MFC = medial frontal cortex; MTC = medial temporal cortex; PCC = posterior cingulate cortex; SPL = superior parietal lobule; vmPFC = ventromedial prefrontal cortex
Risk of bias of (quasi-)randomized and non-randomized controlled trials
Objectives Despite the growing popularity of mindfulness-based interventions (MBIs), little is known about the neural connectivity changes that underlie the effects of MBI. The aim of this systematic review was to summarize the effects of MBI on functional brain connectivity. Methods We summarized findings of longitudinal controlled studies investigating the impact of standardized and manualized 6- to 8-week MBIs on functional connectivity in healthy and clinical populations as measured with functional MRI. Web of Science, PubMed, and Scopus were searched to identify articles published up to August 2021. Quality was assessed using the Cochrane risk-of-bias tools. Fourteen studies, investigating 681 participants, were eligible for a qualitative synthesis. Results Our summary of results shows altered functional connectivity between networks involved in attention, executive function, emotional reactivity, and mind wandering. More specifically, three studies reported increased amygdala-frontoparietal network connectivity after MBI compared to a control group. Two other studies reported altered connectivity between salience- and dorsal attention/frontoparietal network regions. Increased connectivity between a default mode network seed and areas in the prefrontal cortex was reported in two studies. Conclusions We speculate that increased amygdala-frontoparietal network connectivity might translate as improved emotion regulation after MBI. Furthermore, the capacity to be aware of unfolding experiences may be expressed in enhanced connectivity between attentional control- and salience-related brain areas. An increased focus after MBI might be reflected in enhanced default mode network-prefrontal cortex connectivity. However, studies investigating whole-brain connectivity or similar seed regions are needed to generalize conclusions.
PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers, and other sources
Objectives Studies that use meditation-interventions (MIs) and mind–body practices (MBPs) typically highlight health-enhancing benefits whereas health-inhibiting adverse effects (AEs) have been largely underreported. The primary aim of this review was to identify articles outlining health-inhibiting AEs and synthesize the findings narratively. Randomized control trials were excluded because this design often underreports AEs or does not include measures for monitoring them. Methods We conducted our search using four different databases (PubMed, PsychInfo, Psychology and Behavioral Sciences Collection, and Web of Science) from inception to March 2021. We used cited reference searching and conducted a gray literature search. Results A total of 1,826 articles were identified through search strategies. Sixty-one studies met all inclusion criteria, and were separated by intervention/practice, with MIs being used most frequently (n = 41). The total sample size was 8,620. AEs were separated into two categories: somatic and mental distress. Nearly all studies (n = 57) mentioned some form of mental distress such as anxiety, while fewer studies (n = 21) reported somatic distress such as sleep disturbance. Individuals primarily engaged with MIs and MBPs face-to-face (n = 59). Conclusions This review suggests that AEs appear more frequently in research using MIs, and that mental distress is more common than somatic. These effects were primarily identified in studies delivering MIs and MBPs face-to-face, suggesting that future studies should aim to evaluate emerging technologies (i.e., apps). Easy access to apps disseminating MIs and/or MBPs could be problematic for users, considering the lack of supervision associated with technology. Systematic review registration: PROSPERO ID#CRD42020167263
Monitoring and acceptance have been identified as key dimensions in mindfulness-based programs, with acceptance in particular being central to their beneficial potential. From an early Buddhist perspective, the notion of such acceptance could be enhanced by adding the qualification “wise.” In other words, it is a wise form of acceptance that is indeed a key dimension of the type of cultivation of mindfulness which can be expected to lead to a diminishing of suffering and distress.
Theory of change: Art and Science of Human Flourishing course on student outcomes. Note: Experiential learning opportunities are predicted to lead to attention and social-emotional skills learning. Academic learning opportunities are predicted to lead to effects on knowledge of and perspectives on flourishing. Both experiential and academic learning outcomes are predicted to impact distal outcomes through students’ application of these skills and perspectives
Art and Science of Human Flourishing curriculum: dimensions and quality of flourishing. Note: Dimensions represent the five overarching domains of flourishing in the course. Qualities represent the specific knowledge, perspectives, and skills of flourishing taught during the course. Each quality reflects 1 week of course content (15 weeks total)
Love plot of balance following propensity-score matching. Note: All variables are T1 scores. Standardized mean difference is between the ASHF and control group. Gray triangles: difference between the ASHF and control groups prior to matching. Black circles: difference between ASHF and the PSM control group (i.e., after matching) based on the 50 complete multiply imputed datasets. Black error bars represent the spread of imputed values across the 50 imputed datasets. Standardized mean differences between − 0.10 and 0.10 indicate adequate balance
Model-based post-test standardized mean group differences on all outcomes. Note: SMD, standardized mean difference between ASHF and PSM controls at post-test (T2). * p < .05 false discovery rate corrected (FDR). ns, not statistically significant (p > .05 FDR). Error bars: 95% confidence interval
Objectives Significant concerns have been raised about the “mental health crisis” on college campuses, with attention turning to what colleges can do beyond counseling services to address students’ mental health and well-being. We examined whether primarily first-year (89.1%) undergraduate students (n = 651) who enrolled in the Art and Science of Human Flourishing (ASHF), a novel academic and experiential for-credit elective course on human flourishing, would demonstrate improved mental health and strengthen skills, perspectives, and behaviors associated with flourishing relative to students who did not enroll in this course. Methods In a two-wave, multi-site, propensity-score matched controlled trial (ASHF n = 217, control n = 434; N = 651), we used hierarchal linear models and false discovery rate corrected doubly robust estimates to evaluate the impact of the ASHF on attention and social-emotional skill development, flourishing perspectives, mental health, health, and risk behavior outcomes. Results ASHF participants reported significantly improved mental health (i.e., reduced depression) and flourishing, improvements on multiple attention and social-emotional skills (e.g., attention function, self-compassion), and increases in prosocial attitudes (empathic concern, shared humanity; Cohen’s ds = 0.18–0.46) compared to controls. There was no evidence for ASHF course impacts on health or risk behaviors, raising the possibility that these outcomes take more time to change. Conclusions This research provides initial evidence that the ASHF course may be a promising curricular approach to reduce and potentially prevent poor mental health while promoting flourishing in college students. Continued research is needed to confirm these conclusions.
Objectives Evaluating comprehensive reliability of the Vietnamese Self-Compassion Scale (VSCS) and its ability to distinguish between trait (stable) vs state (dynamic) aspects of self-compassion using Generalisability Theory (G-Theory) is necessary. This investigation contributes to both reliability and validity of research that uses the VSCS to measure self-compassion in Vietnamese adults. Methods In a sample of 155 Vietnamese adults who completed the VSCS at three occasions that were each 2 weeks apart, a G-study was conducted to measure reliability and trait vs state aspects of each VSCS subscale and the short-form VSCS, and a D-study was conducted to examine the effects of removing subscales on overall scale reliability as well as evaluate trait vs state aspects of each item. Results With G-coefficients of 0.93-0.98, both the complete and short-form VSCS (VSCS-SF) demonstrated excellent reliability in measuring trait self-compassion. Three of the six subscales-self-judgement, mindfulness, and kindness-also demonstrated excellent reliability, with G-coefficients of 0.82-0.85. Eighteen of the 26 items measured trait more than state. The remaining eight items reflected a mixture of trait and state, but this did not affect overall reliability. Conclusions This study indicated that the VSCS, VSCS-SF, and three VSCS subscales reliably measured trait self-compassion , with scores generalisable across the Vietnamese population and occasions. Thus, overall self-compassion levels remained stable over time, which is useful for evaluating the effectiveness of an intervention because significant changes of self-compassion are likely to be long-lasting.
Scree plots and parallel analysis for Mindful Attention Awareness Scale (MAAS) scores, Five Facet Mindfulness Questionnaire (FFMQ) item scores, and Five Facet Mindfulness Questionnaire (FFMQ) subscale scores
Confirmatory factor analysis standardized parameter estimates for the Mindful Attention Awareness Scale (MAAS)
Confirmatory factor analysis standardized parameter estimates for the Five Facet Mindfulness Questionnaire (FFMQ)
Item response theory standard error of estimate for the Five Facet Mindfulness Questionnaire (FFMQ) and Mindful Attention Awareness Scale (MAAS)
Objectives Mindfulness is increasingly relevant to posttraumatic stress disorder (PTSD) in veterans as a treatment component. The Mindful Attention Awareness Scale (MAAS) and Five Facet Mindfulness Questionnaire (FFMQ) are measures commonly used to assess mindfulness, but it is unclear if these scales measure distinct constructs, and their applicability to veterans has not been studied. We compare the psychometric properties of the MAAS and FFMQ in data collected from clinical trials. Methods Across three trials involving veterans with PTSD (n = 487), analyses of factor structure, reliability, and validity were conducted for the MAAS and FFMQ. Validity analyses examined correlations between scales, demographic associations, treatment effects, and correlations with the PTSD Checklist 4 (PCL-4) and the World Health Organization Quality of Life scale (WHOQOL). Results The MAAS was consistent with a single-factor measurement model, and the FFMQ was consistent with a five-factor model. The FFMQ did not have a clear higher-order factor. Scores for both the MAAS and FFMQ demonstrated good reliability. Treatment had positive association with both MAAS and FFMQ Nonreactivity scores, and follow-up PCL-4 scores were strongly negatively associated with baseline MAAS scores and FFMQ Acting with Awareness and Nonreactivity scores. Also, WHOQOL scores were associated with MAAS and FFMQ baseline and change scores indicating good validity in this population. Conclusion The MAAS and FFMQ are reliable and valid measures of mindfulness in veterans with PTSD, though they measure different aspects of mindfulness, suggesting clinical trials should not use the MAAS or FFMQ as outcomes by themselves.
Frequency histogram of obsessive compulsive symptom severity as assessed by clinical interview using the Yale-Brown Obsessive Compulsive Scale (YBOCS)
Anxiety levels following OC symptom provocation behavioral tasks (Contamination vs Harm tasks) across the two training conditions (Control vs Mindful Attention condition)
Urge to ritualize following OC symptom provocation behavioral tasks (Contamination vs Harm tasks) across the two training conditions (Control vs Mindful Attention condition)
Objectives Despite growing research on mindfulness-based interventions for obsessive compulsive disorder (OCD), it remains unknown which aspects of mindfulness are most beneficial and whether the effects vary for different OCD symptom domains. Methods To clarify these relationships, we examined the links between dispositional mindfulness, experimentally induced mindfulness, and obsessive compulsive (OC) symptoms in a sample of young adults selected for elevated OC symptoms (N = 97). First, we investigated the association between dispositional mindfulness on the Five Facet Mindfulness Questionnaire (FFMQ) and clinical interview-assessed OC symptoms, as well as anxiety and urge to ritualize in response to two OC symptom provocation tasks. Second, we examined the effects of a brief, computerized Mindful Attention (MA) training relative to a Control training on responses to two different OC symptom provocation tasks (harm- or contamination-related). Results FFMQ-nonjudgment negatively predicted obsession and compulsion severity, as well as post-task urge intensity. None of the other FFMQ indices was predictive of any OC symptom measures. The effect of MA training, relative to Control training, was moderated by the type of OC symptom (harm-related vs. contamination-related concerns) such that it appeared to have a beneficial effect for the former, but not the latter. Conclusions Our findings indicate that the nonjudgment facet of mindfulness may be especially important for individuals with OCD, and that MA training may be more helpful for harm-related unacceptable thoughts than for contamination concerns. Future research and clinical interventions would benefit from further examination of the relationship between specific facets of mindfulness and OC symptoms.
Mediation model of treatment being associated with drug use outcomes via an indirect effect of self-efficacy at post-treatment (intercept) and change in self-efficacy (slope) over time. Note. Paths related to the mediation analysis highlighted in bold. Treatment contrast 1, RP and MBRP vs. TAU; treatment contrast 2, MBRP vs. RP. Drug use model is shown, and the same model was estimated for heavy drinking outcomes
Descriptive statistics for self-efficacy and outcomes by treatment group
Latent growth mediation model results with unstandardized (B) and standardized (β) path coefficients of treatment in predicting drug use via self-efficacy (N=281)
Objectives Self-efficacy, the belief in one’s ability to moderate or abstain from heavy drinking and drug use, predicts outcomes following substance use disorder (SUD) treatment. The current study examined whether self-efficacy was associated with treatment outcomes in a trial of mindfulness-based relapse prevention (MBRP), cognitive-behavioral relapse prevention (RP), and treatment as usual (TAU). We hypothesized self-efficacy would mediate the effects of treatment on substance use outcomes. Methods Secondary analyses of a randomized clinical trial of MBRP, RP, versus TAU among individuals with SUD in an aftercare setting (n = 286; 71.5% male; 42.1% non-White) were performed. Change in self-efficacy, measured via the Drug Taking Confidence Questionnaire at baseline, post-treatment, 6-month follow-up, and 12-month follow-up, was examined using latent growth mediation models on 12-month heavy drinking and drug use. Results Greater self-efficacy at post-treatment and increases in self-efficacy over time predicted a significantly higher probability of no drug use and no heavy drinking at 12-month follow-up. Greater self-efficacy at post-treatment was also associated with significantly fewer days of heavy drinking among those who drank, and mediated the association between treatment condition and probability of no drug use and fewer heavy drinking days at 12-month follow-up. Those who received MBRP had the highest self-efficacy at post-treatment, which was associated with greater probability of no drug use and fewer heavy drinking days. Conclusions Self-efficacy is an important treatment target for individuals with SUD. These results highlight the potential utility of MBRP in improving self-efficacy and suggest self-efficacy may be one mechanism by which MBRP is effective. Parent Trial Registration https://ClinicalTrials.gov; registration number: NCT01159535.
The conditional ALT model of mindfulness and positive affect. Note. Regression paths are presented with arrows; dashed arrows indicate non-significant paths. Correlations are represented by double-headed arrows. For the sake of clarity, only significant correlations are displayed, and error terms and non-significant parameter estimates are not shown. *p < .05; **p < .001
The conditional ALT model of mindfulness and negative affect. Note. Regression paths are presented with arrows; dashed arrows indicate non-significant paths. Correlations are represented by double-headed arrows. For the sake of clarity, only significant correlations are displayed, and error terms and non-significant parameter estimates are not shown. *p < .05; **p < .001
Objectives While efficacy research on mindfulness-based interventions in cancer patients is available, research on possible mechanisms of change is lacking. The current study investigated general and week-to-week changes and interrelations in mindfulness and positive and negative affect in Mindfulness-Based Cognitive Therapy (MBCT) for cancer patients. Methods In total, 163 cancer patients completed face-to-face or online MBCT. Mindfulness and positive and negative affect were measured weekly during the intervention. Autoregressive latent trajectory models were used to evaluate general and week-to-week effects. Results Overall, mindfulness and positive affect increased, and negative affect decreased during MBCT. Higher general levels of mindfulness were associated with higher general levels of positive affect. Regarding week-to-week effects, positive affect in weeks 3, 7, and 8 predicted an increase in mindfulness in the following week. Various general relations were observed between mindfulness and negative affect, showing that higher mindfulness was related to less negative affect. To the contrary, week-to-week effects showed higher mindfulness consistently predicted increased negative affect in the subsequent week. Conclusions In cancer patients, mindfulness appeared to be more robustly related to negative than to positive affect. Furthermore, mindfulness in one week was related to an increase of negative affect in the following week, possibly due to turning towards previously suppressed negative emotions. However, when focusing on the whole course from start to end, the increase of mindfulness was related to a decrease of negative affect, possibly due to acceptance of and exposure to negative emotions. Our findings reveal the complexity of mechanisms of MBCT and illustrate the necessity of sophisticated models with longitudinal measurements to truly elucidate these mechanisms. Trial Registration Clinical Trials.gov: NCT02138513.
Changes over time in study outcomes
Objectives As the demand for Mindfulness-Based Interventions (MBIs) expands, there is a growing need for training healthcare professionals to deliver these interventions. To meet this demand, VA CALM (Veterans Affairs – Compassionate Awareness Learning Module) was developed and evaluated. Methods Participants (n = 74, female = 73%) were a national sample of VA clinicians including psychologists (48%), social workers (33%), physicians (10%), nurses (5%), and other clinicians (4%) who joined the year-long training program delivered via hybrid learning platforms including live video and in-person instruction. The evaluation was a single-arm, repeated measures design comparing outcomes at baseline, at the halfway point of training, and immediately post-training. Outcomes from standardized measures included burnout, competence, mindfulness, self-compassion, and stress. Participant self-efficacy was also assessed. Results Random intercept regressions were performed examining linear and quadratic time contrasts as predictors of study outcome change trajectories. The pattern of change was largely linear, where there were statistically significant and large magnitude (r > .50) increases at each observation period for burnout (r = − 0.52), competence with one-on-one interventions (r = 0.68) and groups (r = 0.76), mindfulness (r = 0.61), perceived stress (r = − 0.51), self-compassion (r = 0.58), and self-efficacy (r = 0.83). The linear model indicates changes in study outcomes were cumulative over the course of the training. Conclusions VA CALM is an effective training program for mindfulness facilitators and appears to confer additional participant benefits, even when participants have significant experience with mindfulness.
Objectives The 14-item Freiburg Mindfulness Inventory-short form assesses mindfulness, and enhanced mindfulness is beneficial for reducing anxiety and depressive symptoms. This study aims to develop a Japanese version of the measure (J-FMI) and examine its reliability and validity in a clinical population. Methods Patients (N = 340) with mainly depression and/or anxiety completed the J-FMI and a set of questionnaires to measure the five facets of trait mindfulness, anxiety, and depressive symptoms after attending a 2.5-h mindfulness training program. Results The exploratory factor analysis revealed that the J-FMI had two factors, with five items in the presence factor and nine in the acceptance factor. Internal consistency and reliability were high for the overall scale (α = .90, ω = .92), J-FMI presence (α = .80, ω = .80), and acceptance (α = .89, ω = .90) factors. In the correlation analyses, each J-FMI factor was significantly correlated with the five facets of trait mindfulness (r = .11 to .65) and anxiety and depressive symptoms (r = − .22 to − .61). There were no significant correlations between J-FMI presence and anxiety and depressive symptoms after acceptance was controlled (r = − .04 to − .05) in the partial correlation analyses. Conversely, significant correlations were noted between J-FMI acceptance and anxiety and depressive symptoms after presence was controlled (r = − .27 to − .53). Conclusions These findings demonstrate the J-FMI’s high internal consistency, reliability, and factorial validity and support its criterion, convergent, and discriminant validity in a clinical sample, thus confirming its high reliability and validity.
Tested moderated mediation model. Note. Black paths are significant; gray paths are not significant. Standardized path estimates and standard errors are displayed. Child age, child sex, and parent sex were controlled
Moderation by child clinical status in the association between parental attributions and negative parenting
Objectives Research interest in mindfulness, the capacity for present-oriented, nonjudgmental attention and awareness, and its relation to parenting has been growing in recent years. However, factors facilitating the association between mindfulness and parenting are not yet well understood. In the present study, we examined whether parents’ biased causal thinking about children’s misbehaviors, i.e., parental attributions, may mediate the link between parents’ dispositional mindfulness and parenting. Given that parents of children with clinically elevated mental health difficulties tend to report more biased parental attributions, we further examined whether the proposed mediation may differ across parents of children with and without clinical diagnoses or referrals for mental health difficulties. Methods Parents (59.8% mothers) of 8- to 12-year-old children with (n = 157) and without (n = 99) clinical diagnoses or referrals for mental health difficulties participated in online surveys assessing their mindfulness, parental attributions, and negative parenting behaviors. Results More mindful parents reported less negative parenting, with the link significantly mediated by less biased parent-directed attributions, but not child-directed attributions. The mediating effect via parent-directed attributions was significantly moderated by the child’s clinical status: the effect was retained only for parents of children with clinical diagnoses or referrals for mental health difficulties. No significant moderation effect emerged for child-directed attributions. Conclusions The results provide initial support for the links among parents’ mindfulness, parental attributions, and parenting. The present findings suggest that parental mindfulness may be important for less biased parental attributions, with implications for parenting behaviors at least in the context of children’s mental health disorders.
Objectives Although mindfulness-based interventions have been shown to be helpful in reducing psychological distress in autistic adults, limited research has explored virtual delivery in the autism community. We designed an adapted virtual group–based mindfulness intervention, based on input from autistic adults, and evaluated its feasibility in terms of demand, acceptability, implementation, practicality, adaptation, and limited efficacy testing. Methods Informed by an online needs assessment survey of 77 autistic adults, 37 individuals completed a six-week autism informed manualized course delivered virtually. Participants completed pre, post, and 12-week follow up, and also provided qualitative feedback. Results There was a demand for the course, adaptations were successful, and participants indicated good acceptability of the intervention. Open-ended feedback highlighted advantages and challenges with the technology, the benefits of connecting with other autistic adults, and unique aspects of the mindfulness instruction. Participants reported reduced levels of distress which were maintained at three-month follow-up, and increased mindfulness, and self-compassion. Conclusions Autism-informed adaptations to standard mindfulness-based interventions can lead to self-reported improvements in mindfulness, self-compassion, and distress by autistic adults. Continued research with outcome measures tailored toward autistic adults will be important, during and post-pandemic.
Cross plots of marginal reliabilities for the total score, two subscale scores, and six subscale scores
Objectives The aim of this study was to conduct a multi-faceted assessment of the psychometric properties of the Self-Compassion Scale (SCS). In addition to the goodness-of-fit, we aimed to assess the strength and replicability of three factorial solutions, and the quality and effectiveness of the three scoring schemes of the scale (i.e., total scale score, two subscale scores, and six subscale scores). Methods Participants were 1508 Spanish-speaking community-dwelling adults ( M = 34.94 years, SD = 15.02). Data were examined by means of a conjoint strategy using Rasch modeling, non-linear factor analysis, exploratory bifactor analysis, and parallel analysis. A procedure for selecting the optimal set of items that must be used to compute individual’s scores was used. Results The unidimensional solution showed a marginal model fit (RMSR = .089), and both the bifactor two-group and bifactor six-group solutions showed a good fit (RMSR = .043 and .019, respectively). However, only the unidimensional and the bifactor two-factor solutions showed interpretable and replicable factor structures, and high-quality and effective scores to be used for measurement purposes. Subscale scores derived from the six primary factors did not show adequate psychometric properties. It was observed that the information provided by 10 items was redundant and had already been provided by the other 16 items. Conclusions Good model fit is neither sufficient nor necessary to justify the use of a scoring scheme. Goodness-of-fit statistics should be complemented by an assessment of the metric properties of the resulting scores when proposing SCS scoring schemes.
Plots of the interactions between experienced discrimination and nonattachment in predicting self-stigma content, self-stigma process, parenting stress, and depressive symptoms
Plots of the interactions between anticipated discrimination and nonattachment in predicting self-stigma content, self-stigma process, parenting stress, and depressive symptoms
Objectives Research shows that stigma has an adverse psychological impact on parents of children with autism spectrum disorder (ASD). However, there are very few studies examining the potential protective factors that may buffer the adverse impact. The present study investigated the longitudinal associations of experienced discrimination and anticipated discrimination with detrimental cognitive consequences (i.e., self-stigma content and self-stigma process) and affective consequences (i.e., parenting stress and depressive symptoms) for parents of children with ASD and tested whether these associations would be moderated by nonattachment. Methods At two time points separated by 24 months, 381 Hong Kong parents of children with ASD completed standardized questionnaires to provide data on experienced discrimination, anticipated discrimination, nonattachment, self-stigma content, self-stigma process, parenting stress, and depressive symptoms. Results Hierarchical regressions showed that experienced discrimination and anticipated discrimination had significant interactions with nonattachment at baseline in predicting adverse psychological consequences (i.e., self-stigma content, self-stigma process, parenting stress, and depressive symptoms) at follow-up. In addition, simple slope analyses showed that the associations of experienced discrimination and anticipated discrimination with the adverse psychological consequences were weaker in parents with high nonattachment than in parents with low nonattachment. Conclusions Our findings indicate the longitudinal associations of experienced discrimination and anticipated discrimination with detrimental cognitive consequences and affective consequences for parents of children with ASD, and highlight the protective effects of nonattachment against such associations. These findings suggest the importance of supporting parents of children with ASD to increase nonattachment in order to cope with discrimination and improve psychological well-being.
Change in perceived stress by condition. Note: CC, control condition; MC, meditation condition; PMC, priming + meditation condition. Error bars: ± 2 standard error
Post-exposure SART accuracy scores by condition for a mean (standard error) total correct responses by condition, b mean (standard error) error of omission, and c mean (standard error) error of commission. Note: CC, control condition; MC, meditation condition; PMC, priming + meditation condition. Mean total correct response = greater score indicates better performance; error of omission = lower score indicates greater error; error of commission = higher score in indicates greater error. Error bars: ± 2 standard error
Objectives: The objective of the current study was to investigate the effect of a brief mindfulness practice on perceived stress and sustained attention, and to determine whether priming the benefits of mindfulness meditation enhances this effect. Methods: Two hundred and twenty undergraduate students were randomly assigned to a control condition (CC), a meditation condition (MC), or a priming + meditation condition (PMC). Baseline and post-treatment measures included subjective stress ratings on a visual analog scale (VAS) and performance on a Sustained Attention to Response Task (SART), determined by reaction time coefficient of variability (RTCV) and three measures of accuracy: correct responses, errors of commission, and errors of omission. Results: Repeated measures analyses revealed that both the MC and the PMC displayed a decline in perceived stress relative to the CC. Analyses further revelated that the MC and PMC displayed fewer errors of omission relative to the CC. However, only the PMC displayed better performance relative to the CC with respect to total correct response and errors of commission. There were no significant between-group differences for RTCV. Conclusions: These findings are novel and provide a foundation to further investigate the effect of priming on mindfulness engagement and its potential benefits. Supplementary information: The online version contains supplementary material available at 10.1007/s12671-022-01913-8.
The interaction between the themes and subthemes of thematic analysis
The intervention modules along with their themes (including reflection and homework) and example of experiential exercises
Objectives Patients with Hashimoto thyroiditis (HT) experience mental health complaints due to the immune system dysregulation. Preliminary evidence suggests that psychological interventions could improve patients’ quality of life. Compassionate mind training (CMT) is part of compassion-focused therapy (CFT) and can be used to help individuals address physical and mental health difculties. The present study sought to assess the acceptability and preliminary efcacy of Reset Your Immune System, a 6-week CMT-based online intervention, in patients with HT. Methods Nine women were randomly selected from a wider sample that undertook the online intervention. Upon completion, they were interviewed with nine standard open-ended questions. Additionally, pre- and post-intervention questionnaires were flled out. Results Qualitative analysis indicated that participants observed improvements in symptoms, sleep quality, self-awareness, stress-management, and self-regulation skills. Participants did experience some difculties in undertaking compassion-related exercises. Quantitative analyses showed that negative afect, social/role limitations, and HT symptoms indicated a reliable change from pre- to post intervention. Conclusions Overall, Reset Your Immune System showed benefcial efects on patients with HT, suggesting that including psychological care as part of the standard treatment of HT might have added value. It is important to assess long-term efects in a larger sample through a randomized control trial.
Sample selection
Mean CCIT in the final sample and in the total sample
Objectives Buddha’s Four Noble Truths state that (1) life is full of suffering, (2) there is a cause of suffering, (3) it is possible to stop suffering, and (4) there is a path leading to the cessation of suffering. The current study aimed to explore how trauma-related suffering and mindfulness dispositions are experienced among survivors of childhood cumulative interpersonal trauma (i.e., CCIT, an accumulation of physical, psychological, and sexual trauma before the age of 18) through the lens of Buddha’s Four Noble Truths. Methods Semi-structured in-depth interviews were conducted with 23 adult survivors of CCIT (12 men, 11 women). A directed content analysis was performed. Results Findings revealed that survivors of CCT experience paths of suffering and healing echoing the Four Noble Truths. First, being a survivor of CCIT is a major source of suffering. Second, most participants engage in experiential avoidance (aversion, cravings, illusion, and amnesia) as adaptive strategies to pain and suffering. Third, some participants search for inner and outer resources to reduce the suffering caused by experiential avoidance. Fourth, a few participants engage in a path of liberation characterized by a new approach to trauma and to life. Conclusions Findings suggest that the integration of Western and Buddhist frameworks might foster a better understanding of mindfulness dispositions and suffering in survivors of CCT.
Schematic of the dot-probe task
P1-Cue ERPs and scalp distributions for the full sample (N = 50). Left: Pre- and post-MBCT grand average ERP waveforms time-locked to the presentation of angry and happy face pair cues at electrode P8 (indicated with black circles on scalp distribution figures). Right: Mean P1 amplitudes as a function of time and emotion (error bars represent standard error of the mean) and scalp distribution figures for each condition at the approximate peak time point (92 ms)
P1-Probe ERPs and scalp distributions for the full sample (N = 50). Left: Pre- and post-MBCT grand average ERP waveforms time-locked to the onset of angry congruent and angry incongruent probes (top) and happy congruent and happy incongruent probes (bottom) at electrode P8 (indicated with black circles on scalp distribution figures). Right: Mean P1-Probe amplitudes as a function of time, emotion, and congruency (error bars represent standard error of the mean) and scalp distribution figures for each condition at the approximate peak time point (132 ms)
Mean reaction times to probes as a function of time, emotion, and congruency in the full sample (N = 50). Error bars represent standard error of the mean
Objectives Mindfulness-based cognitive therapy (MBCT) can reduce anxiety and depression symptoms in adults with anxiety disorders, and changes in threat-related attentional bias may be a key mechanism driving the intervention’s effects on anxiety symptoms. Event-related potentials (ERPs) can illuminate the physiological mechanism through which MBCT targets threat bias and reduces symptoms of anxiety. This preliminary study examined whether P1 ERP threat–related attentional bias markers in anxious adults change from pre- to post-MBCT delivered in-person or virtually (via Zoom) and investigated the relationship between P1 threat–related attentional bias markers and treatment response. Methods Pre- and post-MBCT, participants with moderate to high levels of anxiety (N = 50) completed a dot-probe task with simultaneous EEG recording. Analyses focused on pre- and post-MBCT P1 amplitudes elicited by angry-neutral and happy-neutral face pair cues, probes, and reaction times in the dot-probe task and anxiety and depression symptoms. Results Pre- to post-MBCT, there was a significant reduction in P1-Probe amplitudes (d = .23), anxiety (d = .41) and depression (d = .80) symptoms, and reaction times (d = .10). Larger P1-Angry Cue amplitudes, indexing hypervigilance to angry faces, were associated with higher levels of anxiety both pre- and post-MBCT (d = .20). Post-MBCT, anxiety symptoms were lower in the in-person versus virtual group (d = .80). Conclusions MBCT may increase processing efficiency and decreases anxiety and depression symptoms in anxious adults. However, changes in threat bias specifically were generally not supported. Replication with a comparison group is needed to clarify whether changes were MBCT-specific. Clinical Trials Registration NCT03571386, June 18, 2018.
Mediation models when controlling for age, anxiety and depression scores. IE, indirect effect
Objectives Self-compassion, defined as the ability to be accepting and loving towards oneself, has been identified as a potential protective factor against the development of body dissatisfaction and eating disorders (ED). In contrast, compulsive exercise is a core feature in the development and progression of EDs and is often employed as a maladaptive coping strategy for negative emotions and body image concerns. However, the relationships between self-compassion and compulsive exercise attitudes and behaviours are as yet unexplored. Methods A total of 539 Spanish female university students (Mage = 20.03, SD = 2.22) completed measures of compulsive exercise, frequency of compensatory exercise, self-compassion, eating disorder symptoms, and anxiety and depression. Results Hierarchical multiple regressions showed that lower levels of self-compassion significantly predicted some compulsive exercise elements (namely, weight control exercise and lack of exercise enjoyment) after controlling for ED symptoms, anxiety, depression and age. However, frequency of compensatory exercise was unrelated to self-compassion elements. Findings from the mediation models suggest an indirect effect of self-compassion on the association between compulsive exercise and ED symptoms. Conclusions The findings suggest a significant link between low self-compassion and greater harmful exercise attitudes and behaviours towards exercise. Further research is needed to clarify whether self-compassion may be a core feature in the development and maintenance of harmful attitudes and behaviours towards exercise.
Treatment-by-time interaction for the total problems scale
Treatment-by-time interaction for the internalizing scale
Treatment-by-time interaction for the externalizing scale
Objectives. The Gaia Program is a 12-week mindfulness intervention based on cultivating body, emotional, and ecological self-awareness, which has been shown so far to be effective in reducing children’s Internalizing and Externalizing Problems at school. This paper presents the results of a CRCT aimed at investigating the effectiveness of this program on improving Internalizing, Externalizing, and Total Problems in a different population group (i.e., high-school adolescents). Methods. The study compared outcomes for adolescents assigned to the experimental group, who received the intervention delivered by instructors within the school curriculum, with those of the control group using a multilevel regression model. Emotional/behavioral problems were assessed with the Achenbach Youth Self Report. Two hundred thirty-four participants (mean age 14 years) were recruited from seven schools. Results. The experimental group showed a significant decrease in Internalizing and Total Problems scales, as well as a stable pattern of Externalizing Problems over time, whereas the control group showed an increasing trend in Internalizing, Externalizing, and Total Problems. Moreover, the treatment group showed a decreasing trend in Social and Thought Problems as compared to the control group. Finally, adolescents in the control group who scored below the clinical cut-off score at pre-test, at the end of the study scored above the clinical cut-off score in Total and Externalizing Problems. Conclusions. Findings from this study provide evidence that the GAIA program for adolescents may significantly decrease internalizing problems and maintain similar levels of externalizing problems from pre-test to post-test that, conversely, increase in the control group.
Objectives Despite the increasing interest in mindfulness, there are few multifaceted mindfulness measures for children, mainly in Portuguese. Thus, this study developed the Portuguese version of the Comprehensive Inventory of Mindfulness Experiences (CHIME). Because this scale was initially created for adolescents, we also aimed to adapt it to children. Methods After translating the original CHIME to Portuguese and adapting the wording for children, the instrument was administered to 223 9–10-year-olds, along with self-report measures of affect and quality of life, teacher-rated measures of inhibition, inattention, and emotional lability, and a performance-based attentional measure. We examined CHIME’s factorial validity, inspected facets’ reliability, and tested convergent, discriminant, and predictive validity. Results Confirmatory factor analyses (CFA) supported a 7-factor structure of the scale, after removing the accepting and non-judgmental attitude facet. Factor loadings (> .34) and reliability indices (> .54) were acceptable, though the average variance extracted was less than desirable. Correlations with external correlates provided support to CHIME’s convergent and divergent validity (rs range .13–.55, ps < .05). Finally, evidence of predictive validity was found with a regression analysis showing that external awareness (b = − .16) and openness to experience (b = − .17) predicted academic achievement. Conclusions This study provided preliminary validity and reliability evidence on the Portuguese CHIME. This instrument can provide relevant insights about the mindfulness facets and offer useful indications for the development of evidence-based interventions in childhood.
Article screening, inclusion, and design
Breakdown of studies for each outcome by quality. Note: Acceptability outcomes were not included in the breakdown as few studies examined this outcome
Results and evidence grades from MBSI studies
Objectives The purpose of this systematic review was to assess the current literature on mindfulness-based school interventions (MBSIs) by evaluating evidence across specific outcomes for youth. Methods We evaluated 77 studies with a total sample of 12,358 students across five continents, assessing the quality of each study through a robust coding system for evidence-based guidelines. Coders rated each study numerically per study design as 1 + + (RCT with a very low risk of bias) to 4 (expert opinion) and across studies for the corresponding evidence letter grade, from highest quality (“A Grade”) to lowest quality (“D Grade”) evidence. Results The highest quality evidence (“A Grade”) across outcomes indicated that MBSIs increased prosocial behavior, resilience, executive function, attention, and mindfulness, and decreased anxiety, attention problems/ADHD behaviors, and conduct behaviors. The highest quality evidence for well-being was split, with some studies showing increased well-being and some showing no improvements. The highest quality evidence suggests MBSIs have a null effect on depression symptoms. Conclusions This review demonstrates the promise of incorporating mindfulness interventions in school settings for improving certain youth outcomes. We urge researchers interested in MBSIs to study their effectiveness using more rigorous designs (e.g., RCTs with active control groups, multi-method outcome assessment, and follow-up evaluation), to minimize bias and promote higher quality—not just increased quantity—evidence that can be relied upon to guide school-based practice.
The PRISMA flow diagram illustrating the procedure of selection of the studies
Objectives Autobiographical memory (AM) is linked to the construct of self, which is influenced by mindfulness training. Furthermore, both self-reference and AM can be affected by psychopathological conditions, such as depression. This article offers a critical review with a systematic search of the studies using different paradigms to investigate the effects of mindfulness training on AM, as well as the relationships between trait mindfulness and AM. Methods The review includes studies with behavioral, self-report, and neuroimaging methods by considering both non-clinical and clinical investigations in an integrative perspective. Fifty articles were reviewed. The review addressed the following main fields: mindfulness and autobiographical memory specificity; mindfulness and emotional autobiographical recall; and self-inquiry into negative autobiographical narratives and mindfulness. An additional section analyzed 18 studies that addressed the effects of mindfulness training on memory flashbacks. Results In line with the hypotheses, grounded on theories of AM, self, conscious processing, memory reconsolidation, and Buddhist psychology, the review results suggest that the influences of mindfulness training and trait mindfulness on AM can be related to enhanced cognitive, emotional, and self-referential flexibility. This influence is also associated with improved meta-awareness, acceptance, and the flexibility to shift from a first- to a third-person self-perspective in AM recall. In particular, the review highlights increased self-referential flexibility related to mindfulness, which during AM recall would enable a more balanced retrieval of episodic, semantic, and emotional contents, as well as increased AM specificity and reduced emotional reactivity. A mindfulness-related reconsolidation of the links between AM traces and the self might play a crucial role. The mindfulness-related changes of the experiences during AM recall may be translated into long-term reconsolidation-related changes in the AM traces, with a potential interactive effect on the self, thus becoming more flexible. The review also highlights brain mechanisms underlying these influences, given by changes in activity and functional connectivity of core regions in the default mode network (medial prefrontal cortex and posterior cingulate cortex), salience network (anterior cingulate cortex and anterior insula), and central executive network (dorsolateral prefrontal cortex). Finally, we suggest new research developments from the review and the related theoretical perspective. Conclusion The review results, together with the proposed theoretical accounts, bridge a set of investigations on several autobiographical memory phenomena and mindfulness, and might usefully lead to further studies, also with relevant clinical and cognitive neuroscience implications.
The Hertzsprung-Russell diagram which shows temperatures of stars plotted against their luminosities. Credit: European Southern Observatory, https://www.eso.org/public/images/eso0728c/ licensed under CC by 4.0
An example bifactor model with the global latent factor (self-compassion) and the specific factors each causing observed responses (I1 to I12)
The within-person association between yearly changes in self-compassion and yearly changes in self-judgment
Two process-based, case conceptualizations of self-compassion
Frequency of youth falling into different tertiles of self-kind- ness and self-judgment
Objectives Although research in self-compassion has been rapidly growing, there is still substantial controversy about its meaning and measurement. The controversy centers on Neff’s popular Self- Compassion Scale (SCS) and the argument that compassionate self-responding (CSR) and uncompassionate self-responding (UCS) are a single dimension versus the argument that they are two semi-independent, unipolar dimensions, with UCS not reflective of “true” self-compassion. Methods We review the evidence for both positions and conclude that the data cannot yet resolve the debate. Results Neither position is proven to be right or wrong. We recommend the way forward is to let go of traditional factor analytic approaches and examine self-compassionate behavior as a dynamic network of interacting processes that are influenced by context. This leads us to three classes of testable hypotheses. The link between CS and UCS will depend on the timeframe of measurement, current circumstances, and individual differences. Conclusions We propose a middle ground to the SCS debate; rather than supporting the single total score, 2-factor score (CSR and UCS) or the 6-factor score (the six subscales of the SCS), we argue these constructs interact dynamically, and the decision of which scoring method to use should depend on the three testable contextual hypotheses.
The cultivation of mindfulness in early Buddhist soteriology can comprise awareness of an absence. Such absence can be specific, in the sense of the absence of a particular mental condition. It can also take on a general sense, in that certain meditation practices that involve mindfulness can take as their object the notion that there is nothing at all. Besides being the standard approach for cultivating one of the immaterial spheres, a pre-Buddhist form of practice, the same notion that there is nothing can also be related to insight. Such insight could be retrospectively applied to the attainment of the immaterial sphere of nothingness, or else insight could be cultivated in conjunction with tranquility in a way that involves the same notion of nothingness, testifying to the interrelatedness of these two modalities of meditation in early Buddhism. In addition, the term nothingness can also serve as an epithet for the final goal of Nirvana, a usage that can also be related to mindfulness.
Top-cited authors
Jennifer L Frank
  • Pennsylvania State University
Susan Bögels
  • University of Amsterdam
Oleg N. Medvedev
  • The University of Waikato
William Van Gordon
  • University of Derby
Christine Burke
  • NSW Department of Education and Communities