Mindfulness-Based Stress Reduction in Medical Settings

Meditation, as a psychological intervention, has become of increasing interest to psychologists who conduct clinical research with or provide clinical services to medical populations. Mindfulness-based stress reduction (MBSR) is a manualized program which teaches a variety of meditation techniques and has frequently been used in medical settings with mixed medical populations. The following is a review of the literature, which provides preliminary support for the effectiveness of MBSR in specific medical populations, including persons with chronic pain, cancer and heart disease. Despite these encouraging findings, experts agree that continued research is needed, especially controlled studies with more rigorous methodology.     

Effects of Mindfulness-Based Stress Reduction on Psychological Symptoms and Telomere Length: A Randomized Active-Controlled Trial

Much research has demonstrated the beneficial effects of mindfulness-based stress reduction (MBSR) on psychological and physical health, but it is not known whether MBSR may impact cellular aging in healthy populations. Further, little research has evaluated MBSR against an active control condition, which precludes strong conclusions regarding the unique effects of mindfulness on psychological functioning. The present study examined the effects of MBSR versus music therapy–based stress reduction (MTSR) on trait mindfulness, self-compassion, and several psychological health outcomes, as well as leukocyte telomere length (LTL). One hundred and fifty eight Singaporean Chinese adults were recruited and randomly assigned to an eight-week MBSR or MTSR course. Participants provided blood samples and completed a battery of self-report measures pre- and post-intervention. Analyses showed that participants in the MBSR condition demonstrated significantly greater improvements in depressive symptoms, trait mindfulness, and self-compassion compared to the control condition. Treatment condition did not predict changes in LTL, anxiety, stress, or happiness, though there was a trend for duration of home mindfulness practice to predict increases in LTL. Overall, the study demonstrated MBSR’s unique effects in reducing depressive symptoms. Improvements in trait mindfulness and self-compassion correspond with theorized mechanisms of change underlying mindfulness training. The lack of intervention effect with regards to LTL suggests that a more intensive intervention may be required for mindfulness to exert noticeable impact on aging at the cellular level, or that the effect may only emerge over a longer term.     

Mindfulness-Based Stress Reduction (MBSR) for Primary School Teachers

Stress within the teaching profession has a negative impact on the health and well-being of individual teachers and on retention and recruitment for the profession as a whole. There is increasing literature to suggest that Mindfulness is a useful intervention to address a variety of psychological problems, and that Mindfulness-Based Stress Reduction (MBSR) is a particularly helpful intervention for stress. We investigated the effects of teaching a MBSR course to primary school teachers to reduce stress. The MBSR course was taught to a group of primary school teachers and evaluated to establish its effects on levels of anxiety, depression, and stress, as well as movement towards a stated goal and changes in awareness. The results showed improvement for most participants for anxiety, depression, and stress, some of which were statistically significant. There were also significant improvements on two of the four dimensions of a mindfulness skills inventory. These results suggest that this approach could be a potentially cost-effective method to combat teacher stress and burnout.     

单纯糖耐量受损的冠心病患者临床及冠脉造影特点分析

入选空腹血糖正常并通过冠脉造影（CAG）确诊为冠心病（CAD）的患者104例行糖耐量试验（OGTT ）,将糖耐量正常（NGT ）者、单纯负荷后2h 血糖受损者（I-IGT ）与同期合并糖尿病（DM ）并通过 CAG 确诊为 CAD 的患者38例对照。结果,（1）DM 组甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（LDL-C）、载脂蛋白（Apo）、高敏-C 反应蛋白（hs-CRP）、尿微量白蛋白、尿酸（UA）高于 NGT 组（P＜0．05或 P＜0．01）,且 I-IGT 组体质量指数（BMI）最大,与 NGT组及 DM 组比较有统计学意义（P＜0．01）;（2）I-IGT 、DM 组冠状动脉病变支数、重度狭窄、闭塞、弥漫性病变、病变总积分、右冠状动脉病变比例均高于 NGT 组（P＜0．05或 P＜0．01）;（3）DM 组三支病变、弥漫性病变、冠状动脉病变总积分均高于 I-IGT 组（P＜0．05）。因此,空腹血糖正常的 CAD 患者均应行 OGTT 检查,以降低糖耐量异常的漏诊率;I-IGT 患者发生心血管疾病的危险性增加,且随着糖代谢异常的加重而加剧,应及早干预。     

Depressive Symptoms and Health Among Cardiovascular Disease Patients in Cardiac Rehabilitation Programs1

This study examined relations between depressive symptoms and health outcomes among 79 patients participating in cardiac rehabilitation. Results showed cross‐sectional negative associations between depressive symptoms and cardiac symptom appraisals at the beginning (Time 1) and end (Time 2) of rehabilitation. No longitudinal effects of depressive symptoms on cardiovascular functioning were found. Results also showed that improvements in depressive symptoms from Time 1 to Time 2 were related to improvements in cardiac symptom appraisals from Time 1 to Time 2. These results support the deleterious effects of depression on cardiovascular functioning. Findings such as these may help to understand the processes by which proximal health outcomes are affected by cardiac rehabilitation, thereby elucidating mechanisms linking depression to long‐term cardiovascular health.     

Heart Rate Recovery After Exercise in Outpatients with Coronary Heart Disease: Role of Depressive Symptoms and Positive Affect

Heart rate recovery after 1 min of exercise cessation (HRR-1) is an important prognostic factor in patients with cardiovascular disease (CVD). We aimed to further elucidate the association between HRR-1 and known psychosocial risk factors in patients referred for comprehensive cardiac rehabilitation. We examined 521 patients with coronary heart disease in the first week of an outpatient cardiac rehabilitation program. Depressive and anxiety symptoms were measured with the Hospital Anxiety and Depression Scale, and positive (PA) and negative affect were rated with the Global Mood Scale. Depressive symptoms showed a significant inverse relationship with HRR-1 (p?<?.05), controlling for sociodemographic and medical covariates, whereas anxiety symptoms did not show a significant association. PA made a significant contribution to HRR-1 as well (p?<?.05). Our findings suggest an independent association between HRR-1 and psychosocial risk factors of CVD.     

Mindfulness-Based Stress Reduction and Sense of Coherence Among Women with Fibromyalgia

Sense of Coherence (SOC) is conceptualized as a disposition to experience life as meaningful and manageable. Research suggests a protective effect of SOC on psychological health in stressful circumstances. This study assessed the capacity of SOC to buffer the effect of illness symptoms on psychological distress among patients with fibromyalgia. Self-reported changes in SOC after participation in a Mindfulness-Based Stress Reduction (MBSR) program were also examined. Ninety-one women with fibromyalgia provided baseline data pertaining to illness symptoms, perceived stress, and depression prior to participation in a randomized trial of MBSR. SOC and fibromyalgia symptoms were independently related to perceived stress and depression at baseline. SOC was not a statistically significant moderator of symptom effects on psychological distress. In comparison with wait-listed controls, program participants reported a significant increase in SOC after MBSR participation. These results provide the first demonstration from a randomized trial that SOC may be enhanced via intervention.     

An Open Trial of Telephone-Delivered Mindfulness-Based Cognitive Therapy: Feasibility,Acceptability, and Preliminary Efficacy for Reducing Depressive Symptoms

Mindfulness-based cognitive therapy (MBCT) is a promising intervention for reducing depressive symptoms in individuals with comorbid chronic disease, but the program’s attendance demands make it inaccessible to many who might benefit. We tested the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered adaptation of the in-person mindfulness-based cognitive therapy (MBCT-T) program in a sample of patients with depressive symptoms and hypertension.Participants (n = 14; 78.6% female, mean age = 60.6) with mild to moderate depressive symptoms and hypertension participated in the 8-week MBCT-T program. Feasibility was indexed via session attendance and home-based practice completion. Acceptability was indexed via self-reported satisfaction scores. Safety was assessed via reports of symptomatic decline or need for additional mental health treatment. Depressive symptoms (Quick Inventory of Depressive Symptomatology–Self-Report [QIDS-SR]) and anxiety (Hospital Anxiety and Depression Scale—Anxiety subscale; HADS-A) were assessed at baseline and immediately following the intervention.Sixty-four percent of participants (n = 9) attended ≥4 intervention sessions. Seventy-one percent (n = 6) of participants reported completing all assigned formal home practice and 89.2% (n = 8) reported completing all assigned informal practice. Participants were either very satisfied (75%; n = 6) or mostly satisfied (25%; n = 2) with the intervention. There were no adverse events or additional need for mental health treatment. Depressive symptom scores were 4.09 points lower postintervention (p = .004). Anxiety scores were 3.18 points lower postintervention (p = .039).Results support the feasibility, acceptability, safety, and preliminary efficacy of an abbreviated, telephone-delivered version of MBCT for reducing depressive and anxiety symptoms in individuals with co-occurring chronic disease.     

Posttraumatic Growth, Posttraumatic Stress Symptoms and Mental Health Among Coronary Heart Disease Survivors

The present study aimed to estimate posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among heart disease survivors and examine whether PTG moderates the association between PTSS and mental health. Data from 82 myocardial infarction and acute coronary artery bypass graft survivors (aged 46–82) was obtained at admission to a cardiac rehabilitation unit. Mental status was assessed by the PTSD Inventory, Posttraumatic Growth Inventory (PTGI), Mental Health Inventory and Health Related Quality of Life (HRQOL). 17.1 % of the participants suffered significantly from PTSS and most of the study sample (71.2 %) reported PTG. PTSS were positively associated with PTG and psychological distress and negatively with well-being and HRQOL. PTG moderated the association between PTSS and most mental health outcomes. We conclude that posttraumatic growth may attenuate the negative effect of posttraumatic stress symptoms on mental health.     

Making the Most of Mindfulness-Based Stress Reduction: Participant Feedback Reveals Strengths and Challenges

Mindfulness-Based Stress Reduction (MBSR) offers comprehensive instruction to clients in three forms of meditation: the body scan, sitting meditation, and gentle hatha yoga. Clinical experience suggests that participants may express a preference for one mode of practice over others. However, little research has addressed this question or explored participants’ experience of nonspecific factors such as group discussion and teacher personality. In this paper, we aimed to shed light on these open questions in two ways. First, we present quantitative and qualitative post-test data from a nonclinical sample of 181 participants who completed course evaluation forms at the end of an 8-week MBSR program. Second, we share clinical insights and lessons learned over several years teaching MBSR in a community-based program. On evaluation forms, participants reported meaningful improvements in well-being following MBSR and evaluated the nonspecific elements of the course as highly useful. Although they rated all three forms of meditation as beneficial, there was a preference for the body scan and sitting meditation over yoga, and for audio-guided over self-guided practice. Qualitative feedback reflected themes related to learning different forms of meditation, developing an independent practice, meditating with a group, adding additional sessions, and appreciation for the course. Survey findings, taken together with existing research and clinical impressions, support recommendations to address participant preconceptions about the different forms of meditation, encourage meditation practice without audio guides, pay attention to the level of individual participation, discuss how to carve out time to meditate, and promote participants’ development of an ongoing meditation practice. We illustrate these points with case examples and clinical vignettes.     

Perfectionism,Components of Stress Reactivity,and Depressive Symptoms

The current study examined the associations among dimensions of perfectionism, facets of stress reactivity, and self-reported depressive symptoms in 191 university students. Participants completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perceived Stress Reactivity Scale (PSRS), and a measure of depressive symptoms. The PSRS is a relatively new instrument that measures several distinguishable facets of stress reactivity including prolonged stress reactivity, reactivity to failure, and reactivity to social evaluation. Analyses confirmed that most of the perfectionism measures were associated with stress reactivity to failure experiences. Socially prescribed perfectionism and perfectionistic automatic thoughts were also associated with prolonged stress reactivity and reactivity to social evaluation. Moreover, all facets of stress reactivity were correlated with depressive symptoms. Finally, prolonged stress reactivity and reactivity to social evaluation mediated the links between perfectionism dimensions and depressive symptoms. The current findings provide general support for models of perfectionism and stress, and suggest that perfectionists have heightened sensitivities to stressors related to their self-definitions that are activated when threatening stressors involving these themes are experienced.     

Postpartum Daily Stress,Relationship Quality,and Depressive Symptoms

This study explored the relationships among daily stresses, specifically interpersonal conflict, the quality of supportive spousal relationships, and the experience of postpartum depressive symptoms. In our sample of 51 women nearly 30% reported symptoms consistent with postpartum depression. Using regression analysis and controlling for depression during pregnancy, results suggested that arguments with family members and the depth of the spousal relationship acted as significant predictors of the severity of reported postpartum depressive symptoms. Results of the regression were in the expected direction, but due to the small sample size, the findings should be interpreted with caution. Post-hoc analyses were conducted separating the women into three groups based on their depression scores. Therapeutic interventions to reduce postpartum depressive symptoms are considered. An erratum to this article can be found at     

Depressive Symptoms Among Delinquent Youth: Testing Models of Association with Stress and Support

The high prevalence of depression among incarcerated youth indicates a need to better understand factors that contribute to depression within this vulnerable subgroup. Previous research in general community samples has suggested that high levels of stress and low levels of parental support are associated with depression in young people, but it is unclear whether or how they might be associated with depression among incarcerated youth who are already vulnerable. Using a sample of 228 adolescents (aged 13–18 years) who were detained in the juvenile justice system, stress and support were modeled as independent main effects and as interactive risk factors in relation to depressive symptoms. More stressful life events and less caregiver support were each independently associated with depressive symptoms, but no evidence was found for the buffering hypothesis in this sample. Stressful life events were more strongly associated with depressive symptoms among boys compared to girls.     

Adolescent Responses to Depressive Parental Behaviors in Problem-Solving Interactions: Implications for Depressive Symptoms

The purpose of this study was to explore the relations between child responses to interparental depressive behavior and subsequent child depressive symptomatology. Data were collected on 156 two-parent families. Families completed questionnaire data and participated in problem-solving interactions, which were coded using a microsocial observational system. Three potential child responses to interparental depressive behavior were examined: facilitative, aggressive, and depressive. Results indicated that for female adolescents the displays of facilitative and depressive behavior as well as the suppression of aggressive behavior in response to interparental depressive behavior were related to increases in depressive symptomatology. For males, on the other hand, the display of aggressive and depressive behavior in response to interparental depressive behavior was related to increases in depression. Results provide preliminary support both for the examination of child responses to conflictual marital behavior and for expanding the conceptualization of conflictual marital behaviors to include depressive as well as the more traditionally examined aggressive behaviors, in order to better understand the link between conflictual marital behavior and child depressive symptomatology.     

Obsessive-Compulsive and Depressive Symptoms: The Role of Depressive Cognitive Styles

Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression.     

Cognitive Vulnerabilities as Predictors of Stress Generation in Early Adolescence: Pathway to Depressive Symptoms

Although individuals with depression have been found to experience a higher rate of stress in their lives, it remains unclear to what extent other personal characteristics may contribute to stress generation. The current study extended past research by examining the effects of two theoretically and empirically supported cognitive vulnerabilities to depression (negative cognitive style and rumination) as predictors of dependent interpersonal and achievement events, independent events, and relational peer victimization. In a diverse sample of 301 early adolescents (56 % female; M_age?=?12.82 years), we found that negative cognitive style prospectively predicted the experience of dependent interpersonal stress and relational victimization, and that rumination did not predict stress in any of the domains. Furthermore, the occurrence of intervening stress mediated the associations between negative cognitive style and subsequent depressive symptoms. Additionally, whereas negative cognitive style predicted relational victimization among both boys and girls, girls were particularly vulnerable to developing depressive symptoms following the occurrence of relational victimization. Thus, a negative cognitive style may contribute to the occurrence of stressful events, which in turn increases depressive symptoms. Girls may be particularly reactive to relational victimization, representing one pathway through which sex differences in depression may emerge.     

Acculturation,Stress, and Depressive Symptoms Among Korean Immigrants in the United States

Abstract

A sample of 157 Korean immigrants responded to measures of acculturation level, stress from acculturation, and depressive symptoms. The authors hypothesized that adaptive acculturation would depend on assimilation regarding social interactions and the host culture's language as well as on retention of a core identity, including values and traditions of the culture of origin. Consistent with the mediation hypothesis, acculturation, based on a factor representing language use and social relationships, was related to lower acculturative stress and, in turn, lower depression. However, there was no direct support for the integrative, or bicultural, strategy of acculturation. Stress did not mediate the effect of a 2nd acculturation factor, identity and tradition-based acculturation. Rather, this measure of acculturation was directly related to higher depression (i.e., immigrants reporting abandonment of Korean identity, traditions, and values scored higher for depression).