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    Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease: A Randomized Clinical Trial. Kwok Jojo Y Y,Kwan Jackie C Y,Auyeung M,Mok Vincent C T,Lau Claire K Y,Choi K C,Chan Helen Y L JAMA neurology Importance:Clinical practice guidelines support exercise for patients with Parkinson disease (PD), but to our knowledge, no randomized clinical trials have tested whether yoga is superior to conventional physical exercises for stress and symptom management. Objective:To compare the effects of a mindfulness yoga program vs stretching and resistance training exercise (SRTE) on psychological distress, physical health, spiritual well-being, and health-related quality of life (HRQOL) in patients with mild-to-moderate PD. Design, Setting, and Participants:An assessor-masked, randomized clinical trial using the intention-to-treat principle was conducted at 4 community rehabilitation centers in Hong Kong between December 1, 2016, and May 31, 2017. A total of 187 adults (aged ≥18 years) with a clinical diagnosis of idiopathic PD who were able to stand unaided and walk with or without an assistive device were enrolled via convenience sampling. Eligible participants were randomized 1:1 to mindfulness yoga or SRTE. Interventions:Mindfulness yoga was delivered in 90-minute groups and SRTE were delivered in 60-minute groups for 8 weeks. Main Outcomes and Measures:Primary outcomes included anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale. Secondary outcomes included severity of motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale [MDS-UPDRS], Part III motor score), mobility, spiritual well-being in terms of perceived hardship and equanimity, and HRQOL. Assessments were done at baseline, 8 weeks (T1), and 20 weeks (T2). Results:The 138 participants included 65 men (47.1%) with a mean (SD) age of 63.7 (8.7) years and a mean (SD) MDS-UPDRS score of 33.3 (15.3). Generalized estimating equation analyses revealed that the yoga group had significantly better improvement in outcomes than the SRTE group, particularly for anxiety (time-by-group interaction, T1: β, -1.79 [95% CI, -2.85 to -0.69; P = .001]; T2: β, -2.05 [95% CI, -3.02 to -1.08; P < .001]), depression (T1: β, -2.75 [95% CI, -3.17 to -1.35; P < .001]); T2: β, -2.75 [95% CI, -3.71 to -1.79; P < .001]), perceived hardship (T1: β, -0.92 [95% CI, -1.25 to -0.61; P < .001]; T2: β, -0.76 [95% CI, -1.12 to -0.40; P < .001]), perceived equanimity (T1: β, 1.11 [95% CI, 0.79-1.42; P < .001]; T2: β, 1.19 [95% CI, 0.82-1.56; P < .001]), and disease-specific HRQOL (T1: β, -7.77 [95% CI, -11.61 to -4.38; P < .001]; T2: β, -7.99 [95% CI, -11.61 to -4.38; P < .001]). Conclusions and Relevance:Among patients with mild-to-moderate PD, the mindfulness yoga program was found to be as effective as SRTE in improving motor dysfunction and mobility, with the additional benefits of a reduction in anxiety and depressive symptoms and an increase in spiritual well-being and HRQOL. Trial Registration:Centre for Clinical Research and Biostatistics identifier: CUHK_CCRB00522. 10.1001/jamaneurol.2019.0534
    Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial. Farver-Vestergaard Ingeborg,O'Toole Mia S,O'Connor Maja,Løkke Anders,Bendstrup Elisabeth,Basdeo Sharee A,Cox Donal J,Dunne Pádraic J,Ruggeri Kai,Early Frances,Zachariae Robert The European respiratory journal A considerable proportion of patients with chronic obstructive pulmonary disease (COPD) entering pulmonary rehabilitation (PR) report psychological distress, which is often accompanied by poor physical health status. Mindfulness-based cognitive therapy (MBCT) has been shown to improve psychological and physical outcomes in other chronic diseases. We therefore evaluated the efficacy of MBCT as an add-on to a standard PR programme in COPD.COPD patients eligible for PR were cluster randomised to receive either an 8-week, group-based MBCT programme as an add-on to an 8-week PR programme (n=39), or PR alone (n=45). The primary outcomes of psychological distress and physical health status impairment were measured with the Hospital Anxiety and Depression Scale (HADS) and the COPD Assessment Test (CAT) before randomisation (T1), mid- (T2) and post-intervention (T3), and at 3 (T4) and 6 (T5) months' follow-up .A statistically significant time×arm effect was found for the HADS (Cohen's =0.62, 95% CIs ()=0.18-1.06, p=0.010). The treatment effect on the CAT failed to reach statistical significance (=0.42, 95% CIs ()=-0.06-0.90, p=0.061).MBCT showed a statistically significant and durable effect on psychological distress, indicating that MBCT may be an efficacious add-on to standard PR programmes in COPD. 10.1183/13993003.02082-2017
    Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial. Chambers Suzanne K,Occhipinti Stefano,Foley Elizabeth,Clutton Samantha,Legg Melissa,Berry Martin,Stockler Martin R,Frydenberg Mark,Gardiner Robert A,Lepore Stephen J,Davis Ian D,Smith David P Journal of clinical oncology : official journal of the American Society of Clinical Oncology Purpose Advanced prostate cancer (PC) is associated with substantial psychosocial morbidity. We sought to determine whether mindfulness-based cognitive therapy (MBCT) reduces distress in men with advanced PC. Methods Men with advanced PC (proven metastatic and/or castration-resistant biochemical progression) were randomly assigned to an 8-week, group-based MBCT intervention delivered by telephone (n = 94) or to minimally enhanced usual care (n = 95). Primary intervention outcomes were psychological distress, cancer-specific distress, and prostate-specific antigen anxiety. Mindfulness skills were assessed as potential mediators of effect. Participants were assessed at baseline and were followed up at 3, 6, and 9 months. Main statistical analyses were conducted on the basis of intention to treat. Results Fourteen MBCT groups were conducted in the intervention arm. Facilitator adherence ratings were high (> 93%). Using random-effects mixed-regression models, intention-to-treat analyses indicated no significant changes in intervention outcomes or in engagement with mindfulness for men in MBCT compared with those receiving minimally enhanced usual care. Per-protocol analyses also found no differences between arms in outcomes or engagement, with the exception of the mindfulness skill of observing, which increased over time for men in MBCT compared with usual care ( P = .032). Conclusion MBCT in this format was not more effective than minimally enhanced usual care in reducing distress in men with advanced PC. Future intervention research for these men should consider approaches that map more closely to masculinity. 10.1200/JCO.2016.68.8788
    Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial. Compen Félix,Bisseling Else,Schellekens Melanie,Donders Rogier,Carlson Linda,van der Lee Marije,Speckens Anne Journal of clinical oncology : official journal of the American Society of Clinical Oncology Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Because both interventions were compared with TAU, the type I error rate was set at P < .025. Results Compared with TAU, patients reported significantly less psychological distress after both MBCT (Cohen's d, .45; P < .001) and eMBCT (Cohen's d, .71; P < .001) . In addition, post-treatment prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU (all Ps < .025). Physical health-related quality of life did not improve ( P = .343). Conclusion Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer. 10.1200/JCO.2017.76.5669
    A Facilitated-Group Approach to Wellness in Surgical Residency. Mueller Claudia M,Buckle Michael,Post Lisa JAMA surgery 10.1001/jamasurg.2018.3109
    Fighting the Return of Fear: Roles of Mindfulness-Based Stress Reduction and the Hippocampus. Goldfarb Elizabeth V,Sinha Rajita Biological psychiatry 10.1016/j.biopsych.2019.08.027
    Evaluating the Feasibility of Stress-Resilience Training in Surgical Residency: A Step Toward Improving Surgeon Well-being. Riall Taylor S JAMA surgery 10.1001/jamasurg.2018.2735
    The psychological wellbeing outcomes of nonpharmacological interventions for older persons with insomnia symptoms: A systematic review and meta-analysis. Perach Rotem,Allen Courtney K,Kapantai Ioanna,Madrid-Valero Juan J,Miles Eleanor,Charlton Rebecca A,Gregory Alice M Sleep medicine reviews Nonpharmacological treatment of insomnia in older persons has been associated with reduced insomnia symptoms and increased psychological wellbeing. This systematic review and meta-analysis examined whether nonpharmacological interventions can promote wellbeing indicators in older persons who experience insomnia symptoms and investigated the components of these interventions. Twenty studies met inclusion criteria. Psychological wellbeing outcomes included symptoms of depression, anxiety, mental health-related quality of life, and fatigue. Interventions significantly reduced depression and fatigue symptoms in most of the studies that included these outcomes. Findings of our qualitative analysis suggest that mindfulness-based interventions in particular can potentially reduce depression symptoms in older persons with insomnia symptoms. Meta-analyses of studies that included psychological wellbeing outcomes showed small-medium weighted mean effects indicating reductions in symptoms of depression, anxiety, and fatigue. The results suggest that nonpharmacological interventions for older persons with insomnia symptoms can potentially reduce depression and fatigue symptoms and highlight interventions that may be particularly valuable for this purpose. 10.1016/j.smrv.2018.09.003
    Strengthened Hippocampal Circuits Underlie Enhanced Retrieval of Extinguished Fear Memories Following Mindfulness Training. Sevinc Gunes,Hölzel Britta K,Greenberg Jonathan,Gard Tim,Brunsch Vincent,Hashmi Javeria A,Vangel Mark,Orr Scott P,Milad Mohammed R,Lazar Sara W Biological psychiatry BACKGROUND:The role of hippocampus in context-dependent recall of extinction is well recognized. However, little is known about how intervention-induced changes in hippocampal networks relate to improvements in extinction learning. In this study, we hypothesized that mindfulness training creates an optimal exposure condition by heightening attention and awareness of present moment sensory experience, leading to enhanced extinction learning, improved emotion regulation, and reduced anxiety symptoms. METHODS:We tested this hypothesis in a randomized controlled longitudinal study design using a 2-day fear conditioning and extinction protocol. The mindfulness training group included 42 participants (28 women) and the control group included 25 participants (15 women). RESULTS:We show that mindfulness training is associated with differential engagement of the right supramarginal gyrus as well as hippocampal-cortical reorganization. We also report enhanced hippocampal connectivity to the primary sensory cortex during retrieval of extinguished stimuli following mindfulness training. CONCLUSIONS:These findings suggest hippocampal-dependent changes in contextual retrieval as one plausible neural mechanism through which mindfulness-based interventions enhance fear extinction and foster stress resilience. 10.1016/j.biopsych.2019.05.017
    Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a "need for care". Peters Emmanuelle,Ward Thomas,Jackson Mike,Morgan Craig,Charalambides Monica,McGuire Philip,Woodruff Peter,Jacobsen Pamela,Chadwick Paul,Garety Philippa A World psychiatry : official journal of the World Psychiatric Association (WPA) Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a "need for care", are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no "need for care" (non-clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio-demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non-clinical group experienced hallucinations in all modalities as well as first-rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non-clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self-esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well-being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well-being, may reduce the likelihood of persistent PEs leading to pathological outcomes. Future research should focus on protective factors and determinants of well-being in the context of PEs, rather than exclusively on risk factors and biomarkers of disease states. 10.1002/wps.20301
    The efficacy of different interventions to foster children's executive function skills: A series of meta-analyses. Takacs Zsofia K,Kassai Reka Psychological bulletin In the present meta-analysis all available evidence regarding the efficacy of different behavioral interventions for children's executive function skills were synthesized. After a systematic search we included experimental studies aiming to enhance children's (up to 12 years of age) executive functioning with neurodevelopmental tests as outcome measures. The results of 100 independent effect sizes in 90 studies including data of 8,925 children confirmed that it is possible to foster these skills in childhood (Diamond & Lee, 2011). We did not find convincing evidence, however, for the benefits to remain on follow-up assessment. Different approaches were effective for typically and nontypically developing samples. For nontypically developing children (including children with neurodevelopmental disorders or behavior problems) acquiring new strategies of self-regulation including biofeedback-enhanced relaxation and strategy teaching programs were the most effective. For typically developing children we found evidence for the moderate beneficial effects of mindfulness practices. Although small to moderate effects of explicit training with tasks loading on executive function skills in the form of computerized and noncomputer training were found, these effects were consistently weaker for nontypically developing children who might actually be more in need of such training. Thus, atypically developing children seem to profit more from acquiring new strategies of self-regulation as compared with practice with executive function tasks. We propose that explicit training does not seem to be meaningful as the approaches that implicitly foster executive functions are similarly or more effective, and these activities are more enjoyable and can be more easily embedded in children's everyday activities. (PsycINFO Database Record (c) 2019 APA, all rights reserved). 10.1037/bul0000195
    Randomized Trial of ConquerFear: A Novel, Theoretically Based Psychosocial Intervention for Fear of Cancer Recurrence. Butow Phyllis N,Turner Jane,Gilchrist Jemma,Sharpe Louise,Smith Allan Ben,Fardell Joanna E,Tesson Stephanie,O'Connell Rachel,Girgis Afaf,Gebski Val J,Asher Rebecca,Mihalopoulos Cathrine,Bell Melanie L,Zola Karina Grunewald,Beith Jane,Thewes Belinda Journal of clinical oncology : official journal of the American Society of Clinical Oncology Purpose Fear of cancer recurrence (FCR) is prevalent, distressing, and long lasting. This study evaluated the impact of a theoretically/empirically based intervention (ConquerFear) on FCR. Methods Eligible survivors had curable breast or colorectal cancer or melanoma, had completed treatment (not including endocrine therapy) 2 months to 5 years previously, were age > 18 years, and had scores above the clinical cutoff on the FCR Inventory (FCRI) severity subscale at screening. Participants were randomly assigned at a one-to-one ratio to either five face-to-face sessions of ConquerFear (attention training, metacognitions, acceptance/mindfulness, screening behavior, and values-based goal setting) or an attention control (Taking-it-Easy relaxation therapy). Participants completed questionnaires at baseline (T0), immediately post-therapy (T1), and 3 (T2) and 6 months (T3) later. The primary outcome was FCRI total score. Results Of 704 potentially eligible survivors from 17 sites and two online databases, 533 were contactable, of whom 222 (42%) consented; 121 were randomly assigned to intervention and 101 to control. Study arms were equivalent at baseline on all measured characteristics. ConquerFear participants had clinically and statistically greater improvements than control participants from T0 to T1 on FCRI total ( P < .001) and severity subscale scores ( P = .001), which were maintained at T2 ( P = .017 and P = .023, respectively) and, for FCRI total only, at T3 ( P = .018), and from T0 to T1 on three FCRI subscales (coping, psychological distress, and triggers) as well as in general anxiety, cancer-specific distress (total), and mental quality of life and metacognitions (total). Differences in FCRI psychological distress and cancer-specific distress (total) remained significantly different at T3. Conclusion This randomized trial demonstrated efficacy of ConquerFear compared with attention control (Taking-it-Easy) in reduction of FCRI total scores immediately post-therapy and 3 and 6 months later and in many secondary outcomes immediately post-therapy. Cancer-specific distress (total) remained more improved at 3- and 6-month follow-up. 10.1200/JCO.2017.73.1257
    Structural plasticity of the social brain: Differential change after socio-affective and cognitive mental training. Valk Sofie L,Bernhardt Boris C,Trautwein Fynn-Mathis,Böckler Anne,Kanske Philipp,Guizard Nicolas,Collins D Louis,Singer Tania Science advances Although neuroscientific research has revealed experience-dependent brain changes across the life span in sensory, motor, and cognitive domains, plasticity relating to social capacities remains largely unknown. To investigate whether the targeted mental training of different cognitive and social skills can induce specific changes in brain morphology, we collected longitudinal magnetic resonance imaging (MRI) data throughout a 9-month mental training intervention from a large sample of adults between 20 and 55 years of age. By means of various daily mental exercises and weekly instructed group sessions, training protocols specifically addressed three functional domains: (i) mindfulness-based attention and interoception, (ii) socio-affective skills (compassion, dealing with difficult emotions, and prosocial motivation), and (iii) socio-cognitive skills (cognitive perspective-taking on self and others and metacognition). MRI-based cortical thickness analyses, contrasting the different training modules against each other, indicated spatially diverging changes in cortical morphology. Training of present-moment focused attention mostly led to increases in cortical thickness in prefrontal regions, socio-affective training induced plasticity in frontoinsular regions, and socio-cognitive training included change in inferior frontal and lateral temporal cortices. Module-specific structural brain changes correlated with training-induced behavioral improvements in the same individuals in domain-specific measures of attention, compassion, and cognitive perspective-taking, respectively, and overlapped with task-relevant functional networks. Our longitudinal findings indicate structural plasticity in well-known socio-affective and socio-cognitive brain networks in healthy adults based on targeted short daily mental practices. These findings could promote the development of evidence-based mental training interventions in clinical, educational, and corporate settings aimed at cultivating social intelligence, prosocial motivation, and cooperation. 10.1126/sciadv.1700489
    Improving student mental wellbeing. Welford Paul,O'Brien Aileen BMJ (Clinical research ed.) 10.1136/bmj.l2421
    Why I . . . teach mindfulness. Jones Helen BMJ (Clinical research ed.) 10.1136/bmj.l4013
    Treat the lungs, fool the brain and appease the mind: towards holistic care of patients who suffer from chronic respiratory diseases. Similowski Thomas The European respiratory journal 10.1183/13993003.00316-2018
    Positive Psychological Well-Being and Cardiovascular Disease: JACC Health Promotion Series. Kubzansky Laura D,Huffman Jeff C,Boehm Julia K,Hernandez Rosalba,Kim Eric S,Koga Hayami K,Feig Emily H,Lloyd-Jones Donald M,Seligman Martin E P,Labarthe Darwin R Journal of the American College of Cardiology Facets of positive psychological well-being, such as optimism, have been identified as positive health assets because they are prospectively associated with the 7 metrics of cardiovascular health (CVH) and improved outcomes related to cardiovascular disease. Connections between psychological well-being and cardiovascular conditions may be mediated through biological, behavioral, and psychosocial pathways. Individual-level interventions, such as mindfulness-based programs and positive psychological interventions, have shown promise for modifying psychological well-being. Further, workplaces are using well-being-focused interventions to promote employee CVH, and these interventions represent a potential model for expanding psychological well-being programs to communities and societies. Given the relevance of psychological well-being to promoting CVH, this review outlines clinical recommendations to assess and promote well-being in encounters with patients. Finally, a research agenda is proposed. Additional prospective observational studies are needed to understand mechanisms underlying the connection between psychological well-being and cardiovascular outcomes. Moreover, rigorous intervention trials are needed to assess whether psychological well-being-promoting programs can improve cardiovascular outcomes. 10.1016/j.jacc.2018.07.042
    A Mind-Body Program for Older Adults With Chronic Low Back Pain: A Randomized Clinical Trial. Morone Natalia E,Greco Carol M,Moore Charity G,Rollman Bruce L,Lane Bridget,Morrow Lisa A,Glynn Nancy W,Weiner Debra K JAMA internal medicine IMPORTANCE:Treatment of chronic low back pain (LBP) in older adults is limited by the adverse effects of analgesics. Effective nonpharmacologic treatment options are needed. OBJECTIVE:To determine the effectiveness of a mind-body program at increasing function and reducing pain in older adults with chronic LBP. DESIGN, SETTING, AND PARTICIPANTS:This single-blind, randomized clinical trial compared a mind-body program (n = 140) with a health education program (n = 142). Community-dwelling older adults residing within the Pittsburgh metropolitan area were recruited from February 14, 2011, to June 30, 2014, with 6-month follow-up completed by April 9, 2015. Eligible participants were 65 years or older with functional limitations owing to their chronic LBP (≥11 points on the Roland and Morris Disability Questionnaire) and chronic pain (duration ≥3 months) of moderate intensity. Data were analyzed from March 1 to July 1, 2015. INTERVENTIONS:The intervention and control groups received an 8-week group program followed by 6 monthly sessions. The intervention was modeled on the Mindfulness-Based Stress Reduction program; the control program, on the "10 Keys" to Healthy Aging. MAIN OUTCOMES AND MEASURES:Follow-up occurred at program completion and 6 months later. The score on the Roland and Morris Disability Questionnaire was the primary outcome and measured functional limitations owing to LBP. Pain (current, mean, and most severe in the past week) was measured with the Numeric Pain Rating Scale. Secondary outcomes included quality of life, pain self-efficacy, and mindfulness. Intent-to-treat analyses were conducted. RESULTS:Of 1160 persons who underwent screening, 282 participants enrolled in the trial (95 men [33.7%] and 187 women [66.3%]; mean [SD] age,74.5 [6.6] years). The baseline mean (SD) Roland and Morris Disability Questionnaire scores for the intervention and control groups were 15.6 (3.0) and 15.4 (3.0), respectively. Compared with the control group, intervention participants improved an additional -1.1 (mean, 12.1 vs 13.1) points at 8 weeks and -0.04 (mean, 12.2 vs 12.6) points at 6 months (effect sizes, -0.23 and -0.08, respectively) on the Roland and Morris Disability Questionnaire. By 6 months, the intervention participants improved on the Numeric Pain Rating Scale current and most severe pain measures an additional -1.8 points (95% CI, -3.1 to -0.05 points; effect size, -0.33) and -1.0 points (95% CI, -2.1 to 0.2 points; effect size, -0.19), respectively. The changes in Numeric Pain Rating Scale mean pain measure after the intervention were not significant (-0.1 [95% CI, -1.1 to 1.0] at 8 weeks and -1.1 [95% CI, -2.2 to -0.01] at 6 months; effect size, -0.01 and -0.22, respectively). CONCLUSIONS AND RELEVANCE:A mind-body program for chronic LBP improved short-term function and long-term current and most severe pain. The functional improvement was not sustained, suggesting that future development of the intervention could focus on durability. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT01405716. 10.1001/jamainternmed.2015.8033
    Clare Gerada: Mindfulness is useful but not the only option. Gerada Clare BMJ (Clinical research ed.) 10.1136/bmj.l5698
    Behavioural medicine and gastrointestinal disorders: the promise of positive psychology. Keefer Laurie Nature reviews. Gastroenterology & hepatology Psychosocial risk factors linked to brain-gut dysregulation are prevalent across the spectrum of gastrointestinal disorders and are associated with poor patient outcomes. Robust and reproducible data in the areas of behavioural intervention science and the brain-gut axis have led to major advances in patient care, including the routine use of brain-gut psychotherapies to manage digestive symptoms and optimize coping. The logical next step for the emerging field of psychogastroenterology is to develop a scientific framework that enables the identification of those individual characteristics and coping styles that buffer patients against the negative psychological effects of chronic gastrointestinal disorders. A shift towards a strength-based, positive psychological science of gastrointestinal disorders could facilitate the integration of early, effective psychological care into gastroenterology practice. In this Perspective, I discuss the potential role of three human strengths with relevance to gastrointestinal health - resilience, optimism and self-regulation - and how these three constructs can be cultivated through existing or emerging brain-gut psychotherapies. 10.1038/s41575-018-0001-1
    Mindfulness-based cognitive therapy for relapse prophylaxis in mood disorders. Segal Zindel V,Dinh-Williams Le-Anh World psychiatry : official journal of the World Psychiatric Association (WPA) 10.1002/wps.20352
    Burnout-There's an App for That: Helping Physicians Deal With Job-Related Stress. Holoshitz Noa,Wann Samuel JAMA cardiology 10.1001/jamacardio.2017.1758
    Evidence Over Dogma: Embracing an Expanding Repertoire of PTSD Treatment Options. Aupperle Robin L The American journal of psychiatry 10.1176/appi.ajp.2018.18060675
    Mindfulness-Based Cognitive Therapy Intervention for the Treatment of Late-Life Depression and Anxiety Symptoms in Primary Care: A Randomized Controlled Trial. Torres-Platas S Gabriela,Escobar Sophia,Belliveau Claudia,Wu Joyce,Sasi Neeti,Fotso Jocelyn,Potes Angela,Thomas Zoë,Goodman Allana,Looper Karl,Segal Marilyn,Berlim Marcelo,Vasudev Akshya,Moscovitz Nona,Rej Soham Psychotherapy and psychosomatics 10.1159/000501214
    Mindfulness-Based Therapy Regulates Brain Connectivity in Major Depression. Lifshitz Michael,Sacchet Matthew D,Huntenburg Julia M,Thiery Thomas,Fan Yan,Gärtner Matti,Grimm Simone,Winnebeck Emilia,Fissler Maria,Schroeter Titus A,Margulies Daniel S,Barnhofer Thorsten Psychotherapy and psychosomatics 10.1159/000501170
    Use hand cleaning to prompt mindfulness in clinic. Gilmartin Heather M BMJ (Clinical research ed.) 10.1136/bmj.i13
    Margaret McCartney: Mindful of mindfulness. McCartney Margaret BMJ (Clinical research ed.) 10.1136/bmj.i839
    Mindfulness Interventions for Cancer Survivors: Moving Beyond Wait-List Control Groups. Bower Julienne E Journal of clinical oncology : official journal of the American Society of Clinical Oncology 10.1200/JCO.2016.68.2468
    Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. Lengacher Cecile A,Reich Richard R,Paterson Carly L,Ramesar Sophia,Park Jong Y,Alinat Carissa,Johnson-Mallard Versie,Moscoso Manolete,Budhrani-Shani Pinky,Miladinovic Branko,Jacobsen Paul B,Cox Charles E,Goodman Matthew,Kip Kevin E Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:The purpose of this randomized trial was to evaluate the efficacy of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR[BC]) program in improving psychological and physical symptoms and quality of life among breast cancer survivors (BCSs) who completed treatment. Outcomes were assessed immediately after 6 weeks of MBSR(BC) training and 6 weeks later to test efficacy over an extended timeframe. PATIENTS AND METHODS:A total of 322 BCSs were randomly assigned to either a 6-week MBSR(BC) program (n = 155) or a usual care group (n = 167). Psychological (depression, anxiety, stress, and fear of recurrence) and physical symptoms (fatigue and pain) and quality of life (as related to health) were assessed at baseline and at 6 and 12 weeks. Linear mixed models were used to assess MBSR(BC) effects over time, and participant characteristics at baseline were also tested as moderators of MBSR(BC) effects. RESULTS:Results demonstrated extended improvement for the MBSR(BC) group compared with usual care in both psychological symptoms of anxiety, fear of recurrence overall, and fear of recurrence problems and physical symptoms of fatigue severity and fatigue interference (P < .01). Overall effect sizes were largest for fear of recurrence problems (d = 0.35) and fatigue severity (d = 0.27). Moderation effects showed BCSs with the highest levels of stress at baseline experienced the greatest benefit from MBSR(BC). CONCLUSION:The MBSR(BC) program significantly improved a broad range of symptoms among BCSs up to 6 weeks after MBSR(BC) training, with generally small to moderate overall effect sizes. 10.1200/JCO.2015.65.7874
    Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. Johannsen Maja,O'Connor Maja,O'Toole Mia Skytte,Jensen Anders Bonde,Højris Inger,Zachariae Robert Journal of clinical oncology : official journal of the American Society of Clinical Oncology PURPOSE:To assess the efficacy of mindfulness-based cognitive therapy (MBCT) for late post-treatment pain in women treated for primary breast cancer. METHODS:A randomized wait list-controlled trial was conducted with 129 women treated for breast cancer reporting post-treatment pain (score ≥ 3 on pain intensity or pain burden assessed with 10-point numeric rating scales). Participants were randomly assigned to a manualized 8-week MBCT program or a wait-list control group. Pain was the primary outcome and was assessed with the Short Form McGill Pain Questionnaire 2 (SF-MPQ-2), the Present Pain Intensity subscale (the McGill Pain Questionnaire), and perceived pain intensity and pain burden (numeric rating scales). Secondary outcomes were quality of life (World Health Organization-5 Well-Being Index), psychological distress (the Hospital Depression and Anxiety Scale), and self-reported use of pain medication. All outcome measures were assessed at baseline, postintervention, and 3-month and 6-month follow-up. Treatment effects were evaluated with mixed linear models. RESULTS:Statistically significant time × group interactions were found for pain intensity (d = 0.61; P = .002), the Present Pain Intensity subscale (d = 0.26; P = .026), the SF-MPQ-2 neuropathic pain subscale (d = 0.24; P = .036), and SF-MPQ-2 total scores (d = 0.23; P = .036). Only pain intensity remained statistically significant after correction for multiple comparisons. Statistically significant effects were also observed for quality of life (d = 0.42; P = .028) and nonprescription pain medication use (d = 0.40; P = .038). None of the remaining outcomes reached statistical significance. CONCLUSION:MBCT showed a statistically significant, robust, and durable effect on pain intensity, indicating that MBCT may be an efficacious pain rehabilitation strategy for women treated for breast cancer. In addition, the effect on neuropathic pain, a pain type reported by women treated for breast cancer, further suggests the potential of MBCT but should be considered preliminary. 10.1200/JCO.2015.65.0770
    Traits and states in mindfulness meditation. Tang Yi-Yuan,Hölzel Britta K,Posner Michael I Nature reviews. Neuroscience 10.1038/nrn.2015.7
    Two-Year Follow-up of a Randomized Clinical Trial of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care for Chronic Low Back Pain. Cherkin Daniel C,Anderson Melissa L,Sherman Karen J,Balderson Benjamin H,Cook Andrea J,Hansen Kelly E,Turner Judith A JAMA 10.1001/jama.2016.17814
    Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive Relapse: An Individual Patient Data Meta-analysis From Randomized Trials. Kuyken Willem,Warren Fiona C,Taylor Rod S,Whalley Ben,Crane Catherine,Bondolfi Guido,Hayes Rachel,Huijbers Marloes,Ma Helen,Schweizer Susanne,Segal Zindel,Speckens Anne,Teasdale John D,Van Heeringen Kees,Williams Mark,Byford Sarah,Byng Richard,Dalgleish Tim JAMA psychiatry IMPORTANCE:Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development. OBJECTIVE:To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression. DATA SOURCES:English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014. STUDY SELECTION:Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care. DATA EXTRACTION AND SYNTHESIS:This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis. RESULTS:Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments. CONCLUSIONS AND RELEVANCE:Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field. 10.1001/jamapsychiatry.2016.0076
    Mindfulness-Based Attention Training Improves Cognitive and Affective Processes in Daily Life in Remitted Patients with Recurrent Depression: A Randomized Controlled Trial. Timm Christina,Rachota-Ubl Bettina,Beddig Theresa,Zamoscik Vera E,Ebner-Priemer Ulrich,Reinhard Iris,Kirsch Peter,Kuehner Christine Psychotherapy and psychosomatics 10.1159/000488862
    Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial. Wong Samuel Yeung-Shan,Zhang De-Xing,Li Carole Chi-Kwan,Yip Benjamin Hon-Kei,Chan Dicken Cheong-Chun,Ling Yuet-Man,Lo Cola Siu-Lin,Woo Doris Mei-Sum,Sun Yu-Ying,Ma Helen,Mak Winnie Wing-Sze,Gao Ting,Lee Tatia Mei-Chun,Wing Yun-Kwok Psychotherapy and psychosomatics BACKGROUND:Mindfulness-based cognitive therapy (MBCT) is a potential treatment for chronic insomnia. We evaluated the efficacy of MBCT for insomnia (MBCT-I) by comparing it with a sleep psycho-education with exercise control (PEEC) group. METHODS:Adults with chronic primary insomnia (n = 216) were randomly allocated to the MBCT-I or PEEC group. The MBCT-I included mindfulness and psycho-education with cognitive and behavioural components under cognitive behavioural therapy for insomnia. PEEC included psycho-education of sleep hygiene and stimulus control, and exercises. Any change in insomnia severity was measured by the Insomnia Severity Index (ISI). Secondary outcomes included sleep parameters measured by a sleep diary, health service utilisation, absence from work and mindfulness measured by the Five Facet Mindfulness Questionnaire. RESULTS:The ISI score significantly decreased in the MBCT-I group compared with the PEEC group at 2 months (i.e., post-intervention) (p = 0.023, effect size [95% CI] -0.360 [-0.675, -0.046]) but not at 5 or 8 months. Treatment response rates and remission rates based on the ISI cut-off scores were not significantly different between groups. Wake time after sleep onset (WASO) was less in the MBCT-I group at 2 and 5 months. At 8 months, both groups showed a reduced ISI score, sleep onset latency and WASO, and increased sleep efficiency and total sleep time; however, no group differences were seen. Other outcome measures did not significantly improve in either group. CONCLUSIONS:Long-term benefits were not seen in MBCT-I when compared with PEEC, although short-term benefits were seen. 10.1159/000470847
    A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): a pragmatic randomised controlled trial. Galante Julieta,Dufour Géraldine,Vainre Maris,Wagner Adam P,Stochl Jan,Benton Alice,Lathia Neal,Howarth Emma,Jones Peter B The Lancet. Public health BACKGROUND:The rising number of young people going to university has led to concerns about an increasing demand for student mental health services. We aimed to assess whether provision of mindfulness courses to university students would improve their resilience to stress. METHODS:We did this pragmatic randomised controlled trial at the University of Cambridge, UK. Students aged 18 years or older with no severe mental illness or crisis (self-assessed) were randomly assigned (1:1), via remote survey software using computer-generated random numbers, to receive either an 8 week mindfulness course adapted for university students (Mindfulness Skills for Students [MSS]) plus mental health support as usual, or mental health support as usual alone. Participants and the study management team were aware of group allocation, but allocation was concealed from the researchers, outcome assessors, and study statistician. The primary outcome was self-reported psychological distress during the examination period, as measured with the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), with higher scores indicating more distress. The primary analysis was by intention to treat. This trial is registered with the Australia and New Zealand Clinical Trials Registry, number ACTRN12615001160527. FINDINGS:Between Sept 28, 2015, and Jan 15, 2016, we randomly assigned 616 students to the MSS group (n=309) or the support as usual group (n=307). 453 (74%) participants completed the CORE-OM during the examination period and 182 (59%) MSS participants completed at least half of the course. MSS reduced distress scores during the examination period compared with support as usual, with mean CORE-OM scores of 0·87 (SD 0·50) in 237 MSS participants versus 1·11 (0·57) in 216 support as usual participants (adjusted mean difference -0·14, 95% CI -0·22 to -0·06; p=0·001), showing a moderate effect size (β -0·44, 95% CI -0·60 to -0·29; p<0·0001). 123 (57%) of 214 participants in the support as usual group had distress scores above an accepted clinical threshold compared with 88 (37%) of 235 participants in the MSS group. On average, six students (95% CI four to ten) needed to be offered the MSS course to prevent one from experiencing clinical levels of distress. No participants had adverse reactions related to self-harm, suicidality, or harm to others. INTERPRETATION:Our findings show that provision of mindfulness training could be an effective component of a wider student mental health strategy. Further comparative effectiveness research with inclusion of controls for non-specific effects is needed to define a range of additional, effective interventions to increase resilience to stress in university students. FUNDING:University of Cambridge and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East of England. 10.1016/S2468-2667(17)30231-1