Presented at the UPHA Pre-Conference April 8, 2013 Donna Costa, DHS, OTR/L, FAOTA Professor (Clinical, University of Utah Division of Occupational

Presented at the UPHA Pre-Conference April 8, 2013

Donna Costa, DHS, OTR/L, FAOTA Professor (Clinical, University of Utah



By the end of this session participants will be able to:



Define mindfulness and mindfulness-based

interventions



Identify ways that mindfulness

can contribute to overall mental

health, and which mindfulness-

based interventions have been

shown to reduce anxiety and

depression



Know where to access resources for

further learning



What is Mindfulness?



Mindfulness Based Interventions



Mindfulness Based Stress Reduction



Mindfulness Based Cognitive Therapy



"The rush and pressure of modern life are a

form of violence. To allow oneself to be

carried away by a multitude of conflicting

concerns, to surrender to too many demands,

to commit oneself to too many projects, to

want to help everyone in everything, is to

succumb to violence. The frenzy neutralizes

our work for peace. It destroys our own inner

capacity for peace because it kills the root of

inner wisdom which makes work fruitful."



“Ever feel overwhelmed?



Do you find yourself dwelling on concerns big and

small?



It’s official: You’re human and living in the United

States.



Anxiety levels in this country are the highest they’ve

been in seven decades surveys show.



All that e-mailing, texting, and tweeting aren’t helping;

social technology has reduced actual face time (a

known stress reliever) and made us compulsively

available to everyone at all times.



Women suffer most – twice as likely as men to be

diagnosed with GAD.”



“

Mindfulness means

paying attention in a particular way,

on purpose,

in the present moment,

and non-judgmentally

.

”

(

)



“

Mindfulness is about being fully awake in

our lives. It is about perceiving the exquisite

vividness of each moment. We feel more

alive. We also gain immediate access to our

own powerful inner resources for insight,

transformation, and healing

.”



“

Mindfulness meditation is a consciousness

discipline revolving around a particular way

of paying attention in one’s life. It can be

most simply described as the intentional

cultivation of nonjudgmental

moment-to-moment awareness

”



Three axioms:



Intention, or “on purpose”



Attention, i.e., “paying attention”



Attitude, or “in a particular way”

INTENTION – focus & flexibility

ATTITUDE – open, curious, accepting ATTENTION – emotional regulation



Improves mood



Decreases stress



Improved quality of life



Effective dealing with conflict



Increases happiness with care-giving



Improves immune functioning



Increased left brain activity (+ affect)



Increased happiness in relationships



You are present here and now - without judgment



You directly experience life as it is, of yourself as

you are, and of others as they are



You are awake to life on its terms – fully alive to

each moment as it arrives, as it is, and as it ends.



“

Mindfulness is the logical extension of the

concept of reflective practice”



“The mindful practitioner is present in everyday

experience, in all of its manifestations, including

actions, thoughts, sensations, interpretations,

and emotions”



“The goals of mindful practice are to become

more aware of one’s own mental processes,

listen more attentively, become flexible,

recognize bias and judgments, and thereby act

with principles and compassion”



Attends to his/her own physical and mental

processes during everyday, ordinary tasks

without judgment



Allows us to fully be present with our

patients, listening attentively to them



Acts with compassion,

insight, presence and

technical competence



Deals with strong feelings,

making difficult decisions,

and resolving conflict



Mindfulness Based Stress Reduction (now referred to as

MBSR) is a program that was started in 1979 by Jon

Kabat Zinn at the U Mass Medical Center



It is based on Buddhist traditions, but organized into a

secular, 8 week, psycho-educational intervention

designed to give participants increased

moment-to-moment awareness of mind and body and surroundings



The MBSR course is educational, experiential, and

patient–centered.



Participants attend 2 hour sessions once a week for

eight weeks, with a full-day (7-hours) class between the

sixth and seventh sessions. Homework is assigned to

reinforce practice.



Class time each week is divided between formal

meditation practice, small and large group discussions,

and discussion into present moment experiences.



Formal practices include



body scan,



mindful Hatha yoga,



sitting meditation (moving from focus on the breath to an

expanded awareness of other objects of attention, i.e.,

body sensations, hearing, thoughts, emotions, and ending

with an open awareness of all that is arising in the present

moment),



walking meditation



eating meditation.



class discussions focus on group members’ experiences

in the formal meditation practices and the application of

mindfulness in day-to-day life.



home practice is an integral part of MBSR for 45 minutes



Designed for anyone suffering the mind-body

effects of stress, chronic disease



Studied for the following conditions



Chronic pain



Stress



Anxiety



Depression



Cancer



Heart disease



Hypertension



Traumatic Brain Injury



Diabetes



Fibromyalgia



Developed in late 1990’s by John Teasdale, Mark

Williams, and Zindel Segal



Closely modeled after MBSR – 8 week

intervention, 2 hour classes, homework



Initially designed for people with 3 or more

episodes of recurrent depression



Initial data demonstrated significant reduction in

depressive relapse – close to 40%



Now utilized with other mood disorders – bipolar

disorder, suicidal ideation



Recommended in the UK as the first-line

treatment for depression (NICE, 2009)



Incidence of depression is rising with increased cost to

society & health-care; in the U.S. and other economically

developed nations, depression is currently the

leading

cause

of disability (WHO, 2001); by the year 2020, the WHO

projects that depression will be the second leading cause of

disability

worldwide.



The rates of recurrence/relapse that increase with each

successive episode, as high as 80% risk after 3+ episodes.



There is a high rate of non-compliance with medication and

treatment.



MBCT creatively combines and integrates MBSR and CBT.



MBCT is a structured 8 week program aimed at teaching

patients skills to disengage from habitual, “automatic pilot”

types of thinking and behavior, aimed at changing one’s

relationship to thoughts.



Systematic training in mindful awareness of bodily

sensations, thoughts and feelings, and non-avoidance of

depressive thoughts.



Depression is a huge problem, afflicting about

121

million people worldwide



It has tragic consequences: it lowers mood, saps

energy, and reduces the will to live.



Sufferers often find they cannot work, reducing their

ability to earn a living for themselves and their

families.



Unlike other serious illness, depression has no

outward signs – no blisters, fever, or rash – so it is

invisible to others.



Sufferers feel ashamed, worthless, a failure – and

because they cannot understand why they feel so

bad, constantly torture themselves with questions

about what’s gone wrong.



Relationship to thoughts



Automatic Thoughts Questionnaire



Meditation experiences



Mindful movement exercises



Diagnostic criteria for depression



Relapse prevention



Three minute breathing space



Pleasant – Unpleasant Events



Early Warning Signs



Clinical practice guidelines have recommended

treatment in the UK and US (NICE, 2010)



Has been adapted for:



Children with anxiety



Adults with cancer



Bipolar disorder



Suicidal ideation and

behavior



Older adults



Insomnia



Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway,

V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of

relapse/recurrence in major depression by

mindfulness-based cognitive therapy.

Journal of Consulting and

Clinical Psychology, 68

(4), 615-23.

 This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate

relapse/recurrence.

 Recovered recurrently depressed patients (n = 145) were

randomized to continue with treatment as usual or, in addition, to receive MBCT.

 Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT

significantly reduced risk of relapse/recurrence.

 For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence.



“The ultimate aim of the MBCT program is to help

individuals make a radical shift in their relationship to

the thoughts, feelings and bodily sensations that

contribute to depressive relapse”

 (Segal, Teasdale, & Willisma, 2002)



“It also aims to ‘help participants choose the most

skillful response to any unpleasant thoughts, feelings or

situations they meet’

.

 Segal, Teasdale, & Williams, 2002



Research has shown that people who have been

clinically depressed three or more times (sometimes for

20 years or more) find that taking the programme and

learning these skills helps to considerably reduce the

chances that depression will return



“

Most MBIs are taught over an 8-week period and

there is an explicit emphasis on using all of one’s

inner and outer life as a laboratory to empirically

explore which behaviors lead to suffering and which

lead to happiness

.”



MBIs are adaptations of the original MBSR structure,

varying in focus, specific exercises, modifications to

structure based on clinical condition/symptoms, age

of participants, expectations of participants, etc.



Mindfulness teachers, regardless of the specific

intervention they deliver, must embody mindfulness,

not only in the class but also in the world.



Exponential increase in publications since 1979



Most recent search of PubMed shows



261,019 citations for mindfulness,



380 entries for Mindfulness Based Stress Reduction,



1136 for citations for Mindfulness Based Cognitive

Therapy



2427 entries for mindfulness based interventions



asthma



breast cancer



prostate cancer



solid organ transplant



bone marrow transplant



fibromyalgia



chronic pain



hypertension



HIV



myocardial ischemia



Urinary urge incontinence



type-2 diabetes,



hot flashes,



obesity,



irritable bowel

syndrome



immune response to

human papillomavirus



rheumatoid arthritis



COPD



lupus



They are also in use and investigation for a

range of psychiatric disorders, including



anxiety disorders



depression



suicidality



personality disorders



eating disorders



drug abuse and dependence



PTSD



schizophrenia



delusional disorders



Davidson, R., Kabat-Zinn, J., Schumacher, J.,

Rosenkranz, M., Muller, D., Santorelli, S., Urbanowski,

F., Harrington, A., Bonus, K., & Sheridan, J. (2003).

Alterations in brain and immune function produced by

mindfulness meditation.

Psychosomatic Medicine, 65,

564-570.

 Richard Davidson and a team from the U Wisconsin Laboratory for Affective Neuroscience measured brain electrical activity

and found that people taking an eight-week mindfulness

course showed an increase in the activity in the left side of their brains: a pattern associated with positive feelings and

responses.

 They also found a significant boost to the immune

system among the group; the magnitude of increase in left-sided activation predicted the magnitude of antibody titer rise to the vaccine.



Lazar S, et al. (2005). Meditation experience is associated

with increased cortical thickness.

Neurology Report, 16

:

1893-1897.

 MRIs were obtained from 20 experienced meditators and

compared to 20 non-meditators, examining the brain’s cortex, the outermost surface – specifically the prefrontal cortex and insula

 Some areas in the cortex were thickened in the meditators – an interesting finding since the cortex atrophies with age

 Activation of the dorsolateral prefrontal cortex (DLPFC), area of the brain associated with executive decision-making, as well as increased cortical thickness

 Increased activation in the cingulate cortex, particularly the anterior subdivision (ACC), which has a primary role in the integration of attention, motivation, and motor control

 Activation of the insula during meditation, an area which is associated with interoception, the sum of our visceral or “gut” feelings. Also

proposed as a key region involved in processing transient bodily sensations.

(Brain areas that are thicker in practitioners of insight meditation than control subjects who do not meditate. Graphs show age and cortical thickness of each individual (Red = controls, Blue = meditators.)



Hölzel, B, Carmody J, Vangel M, Congleton C, Yerramsetti S,

Gard T, Lazar S.(2011). Mindfulness practice leads to

increases in regional brain gray matter density.

Psychiatry

Research, 191

(1):36-43.

 Study investigated pre-post changes in brain gray matter

concentration attributable to participation in an MBSR program.  Anatomical magnetic resonance (MR) images from 16 healthy,

meditation-naïve participants were obtained before and after they underwent the 8-week program and compared with a waiting list control group of 17 individuals.

 Analyses in a priori regions of interest confirmed increases in gray matter concentration within the left hippocampus.

 Whole brain analyses identified increases in the posterior cingulate cortex, the temporo-parietal junction, and the cerebellum in the MBSR group compared with the controls.

 The results suggest that participation in MBSR is associated with changes in gray matter concentration in brain regions involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.



Confirmed Lazar’s research and also found

additional areas of grey matter in the brain

increased in density with meditation:



Posterior cingulate cortex and cerebellum



Temporo-parietal junction



Cerebellum and brain stem



Hippocampus



Demonstrated that the amygdala, the area of

the brain responsible for emotional reactivity,

had decreased grey matter in meditators



MBSR

– Mindfulness Based Stress Reduction



MBCT

– Mindfulness Based Cognitive Therapy (for

depression)



MBRE

- Mindfulness Based Relationship Enhancement



MBRP

– Mindfulness Based Relapse Prevention



MBSR (Ca)

– Mindfulness Based Cancer Recovery



MBCT-Ca

– Mindfulness Based Cognitive Therapy for

Cancer



MBCP

– Mindfulness Based Childbirth and Parenting



MBSR-T

– Mindfulness Based Stress reduction for

Teens



MBCT-C

– Mindfulness Based Cognitive Therapy for

Anxious Children



MB-EAT -

Mindfulness Based Eating Awareness training



MBCPM -

Mindfulness Based Chronic Pain Management



Piet J, Würtzen H, Zachariae R. (2012). The

Effect of Mindfulness-Based Therapy on

Symptoms of Anxiety and Depression in Adult

Cancer Patients and Survivors: A Systematic

Review and Meta-Analysis.

Journal of Consulting

Clinical Psychology 2012 May 7.



This systematic review and meta-analysis evaluated

the effect of mindfulness-based therapy (MBT) on

symptoms of anxiety and depression in adult cancer

patients and survivors.



Twenty-two studies with a total of 1,403 participants

were included. MBT was associated with significantly

reduced symptoms of anxiety and depression as well

as improved mindfulness skills.



Smith, J., Richardson, J., Hoffman, C., & Pilkington, K.

“Mindfulness-Based Stress Reduction as supportive

therapy in cancer care: systematic review.”

Journal of

Advanced Nursing

. 52(3):315-27, 2005.

 This paper reports a systematic review of the evidence on the effectiveness of Mindfulness-Based Stress Reduction for

cancer supportive care.

 Mindfulness-Based Stress Reduction is a therapeutic

approach that has been used with patients with a variety of conditions.

 Three randomized controlled clinical trials and seven uncontrolled clinical trials were reviewed.

 Studies report positive results, including improvements in mood, sleep quality and reductions in stress.

 The more mindfulness was practiced the greater the improved outcomes. MBSR showed potential as a clinically valuable



Chiesa A, Serretti A. (2011). Mindfulness-based

interventions for chronic pain: a systematic review

of the evidence.

Journal of Alternative &

Complementary Medicine. 17

(1): 83-93.



Ten studies were included in this review.



Mindfulness-based interventions showed nonspecific

effects for the reduction of pain symptoms and the

improvement of depressive symptoms in patients with

chronic pain.



There were also some improvements in psychological



Chiesa A, Serretti A. (2009). Mindfulness-based stress

reduction for stress management in healthy people: a

review and meta-analysis

. Journal of Alternative

Complementary Medicine 15

(5):593-600.

 Mindfulness-based stress reduction (MBSR) is a clinically

standardized meditation that has shown consistent effectiveness for many mental and physical disorders.

 Less attention has been given to the possible benefits that it may have in healthy subjects.

 The aim of the present review and meta-analysis is to better investigate current evidence about the efficacy of MBSR in

healthy subjects, with a particular focus on its benefits for stress reduction.

 Ten studies were included in this review.

 MBSR showed a nonspecific effect on stress reduction in

comparison to an inactive control, both in reducing stress and in enhancing spirituality values.



Rosenzweig, S., Greeson, J. M., Reibel, et al. (2010).

Mindfulness-Based stress reduction for chronic pain

conditions: Variation in treatment outcomes and role of

home meditation practice

. Journal of Psychosomatic

Research, 68

(1), 29-36.

 From 1997-2003, a longitudinal investigation of chronic pain patients

(n=133) participating in MBSR at a university-based Integrative Medicine center.

 Outcomes differed in significance and magnitude across common chronic pain conditions.

 Diagnostic subgroups of patients with arthritis, back/neck pain, or two or more comorbid pain conditions demonstrated a significant change in pain intensity and functional limitations due to pain following MBSR.

 Participants with arthritis showed the largest treatment effects for HRQoL and psychological distress.

 Patients with chronic headache/migraine experienced the smallest improvement in pain and HRQoL.

 Patients with fibromyalgia had the smallest improvement in psychological distress.



Bohlmeijer, E., Prenger, R., Taal, E., & Cuijpers, P.

(2010). The effects of mindfulness-based stress

reduction therapy on mental health of adults with a

chronic medical disease: A meta-analysis.

Journal of

Psychosomatic Research, 68

(6), 539-44.

 This study examined the effectiveness of mindfulness-based stress reduction (MBSR) on depression, anxiety and

psychological distress across populations with different chronic somatic diseases.

 A systematic review and meta-analysis were performed to examine the effects of MBSR on depression, anxiety, and psychological distress.

 Eight published, randomized controlled outcome studies were included.

 An overall effect size on depression of 0.26 was found,

indicating a small effect of MBSR on depression.; the effect size for anxiety was 0.47.



Carlson, L. E., Speca, M., Faris, P., & Patel, K. D. (2007). One

year pre-post intervention follow-up of psychological, immune,

endocrine and blood pressure outcomes of mindfulness-based

stress reduction (MBSR) in breast and prostate cancer

outpatients.

Brain, Behavior, and Immunity, 21

(8), 1038-49.

 49 patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. Demographic and health behaviors, QL, mood, stress

symptoms, salivary cortisol levels, immune cell counts, intracellular cytokine production, blood pressure (BP) and heart rate (HR) were assessed pre- and post-intervention, and at 6- and 12-month follow-up.

 Patients were assessed pre- and post-intervention and at 6- and 12-month follow-up, respectively, although not all participants provided data on all outcomes at each time point. Linear mixed modeling showed significant

improvements in overall symptoms of stress which were maintained over the follow-up period. Cortisol levels decreased systematically over the course of the follow-up. Immune patterns over the year supported a continued reduction in Th1 (pro-inflammatory) cytokines. Systolic blood pressure (SBP) decreased from pre- to post-intervention and HR was positively associated with self-reported

symptoms of stress.

 MBSR program participation was associated with enhanced quality of life and decreased stress symptoms, altered cortisol and immune patterns consistent with less stress and mood disturbance, and decreased blood pressure.

 Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-Based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial.

Journal of Consulting and Clinical Psychology, 78(1), 72-79.

 This study evaluated the effectiveness of mindfulness-based cognitive therapy (MBCT) for individuals with a diagnosis of cancer.

 Participants (N = 115) diagnosed with cancer, across site and stage,

were randomly allocated to either the treatment or the wait-list condition.

 Treatment was conducted at 1 site, by a single therapist, and involved participation in 8 weekly 2-hr sessions that focused on mindfulness.

 Participants meditated for up to 1 hr daily and attended an additional full-day session during the course.

 Participants were assessed before treatment and 10 weeks later; this second assessment occurred immediately after completion of the

program for the treatment condition; the treatment condition was also assessed at 3 months post-intervention.

 There were large and significant improvements in mindfulness,

depression, anxiety, and distress, as well as a trend for quality of life for MBCT participants compared to those who had not received the training.

 The wait-list group was assessed before and after receiving the intervention and demonstrated similar change.



Biegel, G., Brown, K., Shapiro, S., & Schubert, C. (2009).

Mindfulness-Based stress reduction for the treatment of

adolescent psychiatric outpatients: A randomized clinical trial

.

Journal of Consulting and Clinical Psychology, 77

(5), 855-66.

of the mindfulness-based stress reduction (MBSR) program for

adolescents age 14 to 18 years with heterogeneous diagnoses in an outpatient psychiatric facility (intent-to-treat N = 102).

 Relative to treatment-as-usual control participants, those receiving MBSR self-reported reduced symptoms of anxiety, depression, and somatic distress, and increased self-esteem and sleep quality.

 Of clinical significance, the MBSR group showed a higher percentage of diagnostic improvement over the 5-month study period and

significant increases in global assessment of functioning scores relative to controls, as rated by condition-naïve clinicians.

 These results were found in both completer and intent-to-treat samples.  The findings provide evidence that MBSR may be a beneficial adjunct



Britton, W. B., Haynes, P. L., Fridel, K. W., & Bootzin, R. R.

(2010). Polysomnographic and subjective profiles of sleep

continuity before and after mindfulness-based cognitive

therapy in partially remitted depression.

Psychosomatic

Medicine, 72

(6), 539.

 Twenty-six individuals with partially remitted depression were

randomized into an 8-week Mindfulness-Based Cognitive Therapy (MBCT) course or a waitlist control condition. Pre-post

measurements included sleep studies and subjectively reported sleep and depression symptoms.

 According to sleep studies, MM practice was associated with several indices of increased cortical arousal, including more

awakenings and stage 1 sleep and less slow-wave sleep relative to controls, in proportion to amount of MM practice.

 According to sleep diaries, subjectively reported sleep improved post MBCT but not above and beyond controls.

 Beck Depression Inventory scores decreased more in the MBCT group than controls.

 Improvements in depression were associated with increased subjective sleep continuity and increased PSG arousal.

 Bowen, S., Chawla, N., Collins, S. E., et al. (2009). Mindfulness-Based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295-305.

 First randomized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention (MBRP) program as compared to

treatment as usual (TAU).

 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment.

 Assessments were administered pre-intervention, post-intervention, and 2 and 4 months post-intervention.

 Feasibility of MBRP was demonstrated by consistent homework compliance, attendance, and participant

satisfaction. Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as

compared to those in TAU over the 4-month post-intervention period.

 Additionally, MBRP participants demonstrated greater

decreases in craving, and increases in acceptance and acting with awareness as compared to TAU.



Witkiewitz, K. & Bowen, S. (2010). Depression, craving,

and substance use following a randomized trial of

mindfulness-based relapse prevention.

Journal of

Consulting and Clinical Psychology, 78

(3), 362-74.

 Mindfulness-based relapse prevention (MBRP), uses

mindfulness-based practices to teach alternative responses to emotional discomfort and lessen the conditioned response of craving in the presence of depressive symptoms.

 Individuals with substance use disorders were recruited after intensive stabilization, then randomly assigned to either 8 weekly sessions of MBRP or a treatment-as-usual control group.; approximately 73% of the sample was retained at the final 4-month follow-up assessment.

 Results confirmed a moderated-mediation effect, whereby craving mediated the relation between depressive symptoms and substance use among the treatment-as-usual group but not among MBRP participants.

 MBRP appears to influence cognitive and behavioral responses to depressive symptoms, partially explaining reductions in post-intervention substance use among the MBRP group.



Vieten, C. & Astin, J. (2008). Effects of a mindfulness-based

intervention during pregnancy on prenatal stress and mood:

Results of a pilot study.

Archives of Women's Mental Health,

11

(1), 67-74.

 an 8 week mindfulness-based intervention directed toward reducing stress and improving mood in pregnancy and early postpartum.

 small randomized trial (n = 31) comparing women who received the intervention during the last half of their pregnancy to a wait-list

control group.

 Measures of perceived stress, positive and negative affect, depressed and anxious mood, and affect

regulation were collected prior to, immediately following, and 3 months after the intervention (postpartum).

 Mothers who received the intervention showed significantly reduced anxiety and negative affect during the third trimester in comparison to those who did not receive the intervention.

 The brief and non-pharmaceutical nature of this intervention makes it a promising candidate for use during pregnancy.

 Duncan, L. G. & Bardacke, N. (2010). Mindfulness-Based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190-202.

 Mindfulness-Based Childbirth and Parenting (MBCP) program and the results of a pilot study of n = 27 pregnant women participating in

MBCP during their third trimester of pregnancy.

 MBCP is a formal adaptation of the Mindfulness-Based Stress

Reduction program and was developed and refined over the course of 11 years of clinical practice with 59 groups of expectant couples.

 MBCP is designed to promote family health and well-being through the practice of mindfulness during pregnancy, childbirth, and early parenting.

 Quantitative results from the current study include statistically

significant increases in mindfulness and positive affect, and decreases in pregnancy anxiety, depression, and negative affect from pre- to

post-test .

 Qualitative reports from participants expand upon the quantitative findings, with the majority of participants reporting perceived benefits of using mindfulness practices during the perinatal period and early parenting.



Lee, J., Semple, R. J., Rosa, D., & Miller, L. (2008).

Mindfulness-Based cognitive therapy for children: Results

of a pilot study.

Journal of Cognitive Psychotherapy, 22

(1),

15-28.

 The purpose of this study was to evaluate the feasibility,

acceptability, and helpfulness of Mindfulness-Based Cognitive Therapy for Children (MBCT-C) for the treatment of internalizing and externalizing symptoms in a sample of non-referred children.

 Twenty-five children, ages 9 to 12, participated in the 12-week intervention.

 Assessments were conducted at baseline and post-treatment.

 Open trial analyses found preliminary support for MBCT-C as helpful in reducing internalizing and externalizing symptoms within subjects on the parent report measure.

 The high attendance rate (Intent-to-Treat sample, 78%;

Completer sample,94%), high retention rate (68%), and positive ratings on program evaluations supported treatment feasibility and acceptability.

 Semple, R., Lee, J., Rosa, D., & Miller, L. (2010). A randomized trial of mindfulness-based cognitive therapy for children:

Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family Studies, 19 (2), 218-29.

 MBCT-C is a manualized group psychotherapy for children ages 9-13 years old, developed specifically to increase social-emotional

resiliency through the enhancement of mindful attention.

 Participants were boys and girls aged 9-13 (N = 25), mostly from low-income, inner-city households

 A randomized cross-lagged design provided a wait-listed control

group, a second trial of MBCT-C, and a 3-month follow-up of children who completed the first trial.

 Participants who completed the program showed fewer attention problems than wait-listed controls and those improvements were maintained at three months following the intervention .

 Significant reductions in anxiety symptoms and behavior problems were found.



MBCPM developed over the past 10 years by

Canadian physician Dr. Jackie Gardner-Nix



Based on MBSR program but

adapted for people with chronic

pain



13 weeks long, no all-day retreat,

shorter homework and sitting

sessions



Language of meditations adapted

in response to feedback from

chronic pain patients



MBEC developed by Lucia McBee

for frail elders and caregivers



Book of same name describes

approach rather than a

manualized program



Aromatherapy and guided

imagery added



No research studies conducted

to date, but strong anecdotal

evidence for reductions in anxiety

for staff, and reductions in

aggressive behavior in nursing

home residents



Lack of active control in most studies with the

exception of McCoon study (2011)



We know these interventions work; what needs to be

examined is what works best when, with who, under

what conditions



Effect of attendance, compliance with homework, and

frequency of practice have had limited research



Some researchers are now exploring telehealth

applications and this will need to be researched further.



Issues with reimbursement and fee for service need to

be examined as variables



Long-term follow-up (more than 1-3 years) needs to be

done



Mindfulness Research Guide publishes a

Mindfulness Research Monthly

, a monthly

bulletin that aims to build awareness of and

inform the latest scientific advances in

mindfulness.



Current number of subscribers is 6,500+



To subscribe

to

Mindfulness Research Monthly

,

email FIRST and LAST name with "Subscribe

MRM" in the subject line to

mrginform@gmail.com

 Cullen, M. (2011). Mindfulness-Based Interventions: An emerging phenomena. Mindfulness, DOI 10.1007/s12671-011-0058-1

 Carlson, L. E., & Speca, M. (2010). Mindfulness-based Cancer Recovery. Oakland, CA: Harbinger.

 Carlson, L. E., Speca, M., Patel, K., & Goodey, E. (2003). Mindfulness-based stress-reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer

outpatients. Psychosomatic Medicine, 65, 571–581.

 Bartley, T. (2012). Mindfulness Based Cognitive Therapy for Cancer. New York: Wiley.

 Segal, Z. V., Williams, M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive behavior therapy for

depression: A new approach to preventing relapse. New York: Guildford.

 Rosenszweig, S., Reibel, D. K., Greeson, J., Edman, J., Jasser, S., McMerty, K., et al. (2007).

Mindfulness-based stress reduction is associated with improved glycemic control in type 2 diabetes mellitus: a pilot study. Alternative Therapies in Health and Medicine, 13, 36–38.

 Bowen, S., Witkiewitz, K., Dillworth, T. M., Chawla, N., Simpson, T. L., Ostafin, B., et al. (2006). Mindfulness meditation and substance use in an incarcerated population. Psychology of Addictive

Behaviors, 20, 343–347.

 Davidson, R., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S., Urbanowski, F., Harrington, A., Bonus, K., & Sheridan, J. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65, 564-570.

 Duncan, L. G. & Bardacke, N. (2010). Mindfulness-Based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190-202.

 Vieten, C. & Astin, J. (2008). Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: Results of a pilot study. Archives of Women's Mental Health, 11(1), 67-74.

 Witkiewitz, K. & Bowen, S. (2010). Depression, craving, and substance use following a randomized trial of mindfulness-based relapse prevention. Journal of Consulting and Clinical Psychology, 78(3), 362-74.

 Bowen, S., Chawla, N., Collins, S. E., et al. (2009). Mindfulness-Based relapse prevention for substance use disorders: A pilot efficacy trial. Substance Abuse, 30(4), 295-305.

 Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-Based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3), 211-28.

 Semple, R. J., Reid, E. F., & Miller, L. (2005). Treating anxiety with mindfulness: An open trial of mindfulness training for anxious children. Journal of Cognitive Psychotherapy, 19(4), 379-92.

 Lee, J., Semple, R. J., Rosa, D., & Miller, L. (2008). Mindfulness-Based cognitive therapy for children: Results of a pilot study. Journal of Cognitive Psychotherapy, 22(1), 15-28.

 Semple, R. J., Lee, J., Rosa, D., & Miller, L. F. (2010). A randomized trial of mindfulness-based cognitive therapy for children: Promoting mindful attention to enhance social-emotional resiliency in children. Journal of Child and Family Studies, 19(2), 218-29.

 Semple R. J., Lee J. (2011). Mindfulness-based cognitive therapy for anxious children: A manual for treating childhood anxiety. Oakland, CA: New Harbinger Publications.

 Foley, E., Baillie, A., Huxter, M., Price, M., & Sinclair, E. (2010). Mindfulness-Based cognitive therapy for individuals whose lives have been affected by cancer: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 78(1), 72-79.

 Britton, W. B., Haynes, P. L., Fridel, K. W., & Bootzin, R. R. (2010). Polysomnographic and subjective profiles of sleep continuity before and after mindfulness-based cognitive therapy in partially remitted depression. Psychosomatic Medicine, 72(6), 539.

 Bartley, T. (2011). Mindfulness Based Cognitive Therapy for Cancer. Willey-Blackwell: New York.

 Gardner-Nix, J. (2009) The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management. Oakland, CA: New Harbinger.

 Bowen, S., Chawla, N., & Marlatt, A. (2010). Mindfulness-Based Relapse Prevention for Addictive Behaviors: A Clinician’s Guide. New York: Guilford.

 McBee, L. (2008). Mindfulness-Based Elder Care: A CAM Model for Frail Elders and Their caregivers. New York: Springer.

 Bardacke, N. (2012). Mindful Birthing: Training the Mind, Body and Heart for Childbirth and Beyond. New York: Harper One.

 Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of your Mind and Body to Face Stress, Pain, and Illness. New York: Delta.

 University of Wisconsin Mindfulness Program

http://www.uwhealth.org/alternative-medicine/mindfulness-based-stress-re...

 Be Mindful Online

http://www.bemindfulonline.com/

 University of Rochester Mindfulness

http://www.urmc.rochester.edu/news/story/index.cfm?id=2623

 University of Massachusetts Center for Mindfulness http://www.umassmed.edu/content.aspx?id=41252

 University of Wisconsin Center for Investigating Healthy Minds http://www.investigatinghealthyminds.org/

 Beth Israel Continuum Center for Health and Healing http://healthandhealingny.org/

 University of California at San Diego Center for Mindfulness

http://health.ucsd.edu/specialties/mindfulness/Pages/default.aspx

 AMSA Humanistic Medicine Group

http://www.amsa.org/humed/

 University of Wisconsin Aware Medicine Curriculum (Mindfulness in Residency)

https://www.fammed.wisc.edu/aware-medicine/mindfulness

 New York/east-coast Omega Institute http://eomega.org/

 National Center for Complementary and Alternative Medicine (NCCAM) http://nccam.nih.gov/

 California/west-coast Meditation Center http://www.spiritrock.org/

 Kristen Neff

http://www.self-compassion.org/

 Christopher Germer