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People who suffer from bipolar disorder are prone to episodes of depression and mania and often show heightened psychological and physiological responses to emotion-provoking stimuli. Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for people with affective disorders that is designed to improve emotional regulation and decease dysfunctional beliefs. Dysfunctional beliefs include the beliefs that one must always be perfect or that one must be loved by everyone.
Docteur at al. [Journal of Clinical Psychology] tested the association between participation in the MBCT program and physiological response to emotional stimuli among adults diagnosed with bipolar disorder who are in remission.
The researchers assigned 67 adults diagnosed with bipolar disorder in remission (age = 47 years; 64% female) to an 8-week MBCT program. The program met weekly in 2-hour group sessions. Participants were assessed at three time points: 2 months prior to treatment (baseline), immediately before treatment, and immediately after treatment.
Participants served as their own controls, allowing researchers to compare changes occurring between baseline and pre-MBCT with changes occurring between pre-MBCT and post-MBCT.
At each assessment point, participants completed a self-report measure of dysfunctional beliefs and had their skin conductance captured in response to a set of 36 positive (e.g., puppies), negative (e.g., accidents) and neutral (e.g., landscapes) images.
The skin conductance response (SCR) is a measure of changes in the skin’s ability to conduct an electrical current due to changes in sweat gland activity. When people are emotionally aroused, sweat gland activity increases thereby increasing skin electrical conductance.
The results showed that dysfunctional attitudes did not change in the interval between baseline and pre-MBCT, but they did decrease significantly from pre- to post-MBCT.
Analyses of SCR changes were only performed on that one-third of the sample that showed SCR changes greater than 0.04 μSv. In that subsample, there was no change in average SCR to negative images from baseline to pre-MBCT, but a significant decrease in average SCR to negative images from pre- to post-MBCT (Cohen’s d=0.73). Changes in dysfunctional beliefs were correlated with changes in SCR, but did not mediate that change.
The study shows that participation in MBCT is associated with reduced dysfunctional beliefs and physiological responses to negatively emotionally charged images in people with bipolar disorder in remission. It is possible that such changes, if in fact due to the intervention, may help prevent the recurrence of bipolar episodes. SCR potentially offers an objective marker of response to behavioral intervention.
The study is limited by the absence of a randomized comparison condition and the small size of the subset of participants included in the SCR analyses that limited the power of the mediation analyses.
Docteur, A., Gorwood, P., Mirabel-Sarron, C., Kaya Lefèvre, H., Sala, L., & Duriez, P. (n.d.). Mindfulness-based cognitive therapy efficacy in reducing physiological response to emotional stimuli in patients with bipolar I disorder and the intermediate role of cognitive reactivity. Journal of Clinical Psychology.
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The military veteran population has an increased risk for suicide when compared to non-vets. Almost 18 veterans are lost to suicide each day. The Veterans Health Administration has prioritized investigating ways to lower suicide risk, and mindfulness interventions might be protective against mental health disruptions that are linked with suicide.
Interian et al. [Journal of Clinical Psychiatry] tested the effects of Mindfulness-Based Cognitive Therapy for Suicide (MBCT-S) on suicide-related events when added to the Veterans Health Administration enhanced standard treatment in a cohort of veterans at high risk for suicide.
The researchers randomly assigned 140 veterans at high risk for suicide (average age = 47; 88% male; 45% White, 28% Black, 21% Latino, 6% other) to enhanced treatment-as-usual alone, or enhanced treatment-as-usual with adjunctive MBCT-S. Eighty-four percent of the participants had histories of a prior suicide attempt, and 79% had made multiple attempts.
Most of the participants began the study as inpatients when hospitalized for suicidal behavior or ideation and then continued the study as outpatients while under psychiatric monitoring.
MBCT-S consisted of two individual treatment sessions during inpatient care, 8 weekly group sessions after transition to outpatient care, and optional monthly after-care booster sessions. The curriculum modeled MBCT for recurrent depression with added emphasis on accepting and disengaging from suicide related thoughts, feelings, and behaviors.
Enhanced treatment-as-usual included suicide safety planning while still an inpatient and 6 post-hospitalization mental health visits to monitor suicidal status and bolster safety planning. These specific enhancements are above and beyond the usual care offered for low-suicide risk psychiatric disorders.
Participants received routine standard health services in the veterans system including outpatient psychotherapy, medication, and residential support.
Participants were assessed on measures of depression, hopelessness, suicidal ideation and distress tolerance at baseline, mid-treatment, post-treatment, and 6-and 12-month follow-up. Medical records were assessed for suicide-related events (attempts, preparations for suicide, and hospitalizations for suicidal thinking).
Over the course of the 12 months, 148 suicide-related events occurred with 19% of the cohort attempting suicide. The results showed a significantly fewer number of suicide-related events in the MBCT-S group (56 vs. 92) with a significantly smaller proportion of the MBCT-S group making suicide attempts (13% vs. 26%) or being hospitalized for suicidal thinking (30% vs 46%).
Participants improved significantly, and to an equivalent degree, on measures of depression, hopelessness, suicidal ideation, and distress tolerance.
The study shows MBCT-S added to enhanced standard psychiatric care can reduce the proportion of high-risk veterans who make suicide attempts or require hospitalization for suicidal thoughts when compared to enhanced standard psychiatric care alone. This was an impressive finding given the intensity of services received by the standard care group.
Interian, A., Chesin, M. S., Stanley, B., Latorre, M., Hill, L. M. S., Miller, R. B., King, A. R., Boschulte, D. R., Rodriguez, K. M., & Kline, A. (2021). Mindfulness-Based Cognitive Therapy for Preventing Suicide in Military Veterans: A Randomized Clinical Trial. The Journal of Clinical Psychiatry.
Schizophrenia is a persistent mental illness with positive (hallucinations and delusions), negative (lack of motivation, social withdrawal, flat affect) and cognitive (impaired executive functioning) symptoms. While medications can often reduce positive symptoms, negative and cognitive symptoms often persist. Psychiatrists are interested in psychosocial treatments that can reduce these residual symptoms.
Mindfulness training targets emotion regulation and executive functioning and may serve as an adjunctive treatment for schizophrenia. Shen et al. [Psychological Medicine] conducted a randomized controlled trial to test the effect of mindfulness training on residual negative and cognitive symptoms beyond the combined effects of routine medication and psychosocial rehabilitation among patient with schizophrenia.
The researchers randomly assigned 100 Han Chinese patients with non-acute schizophrenia and residual symptoms (68% male; average age = 60 years) to a 6-week general rehabilitation control or a 6-week general rehabilitation plus mindfulness group.
Controls attended 90-minute general rehabilitation group workshops on weekdays, while the mindfulness group attended daily general rehabilitation (45 minutes) and mindfulness training (45 minutes) group workshops.
General rehabilitation included health education, reading, painting, gardening, manual work, and daily life skill training. Mindfulness training included didactic material on mindfulness and rumination, focusing on sensations and thoughts, identifying emotions, self-acceptance, and relapse prevention.
All participants continued their prior psychotropic medications throughout the study as usual. Participants were assessed on clinical positive and negative symptoms and neuropsychological functioning at baseline and immediately following the intervention period.
After treatment, the mindfulness group showed moderate-sized improvements in total symptoms (Cohen’s d=0.51), depression (d=0.41), and anxiety (d=0.42) relative to controls and had significantly fewer negative symptoms.
The mindfulness group also showed small-sized relative improvements in general cognitive functioning (d=0.26), especially with regard to being able to remember verbal and visual information immediately after hearing or seeing it (d=0.31) and after a time delay (d=0.29).
The study shows adjunctive mindfulness training in a psychiatric treatment setting can reduce affective and cognitive symptoms in patients with non-acute schizophrenia above and beyond general rehabilitation and medication alone.
These findings are important because negative symptoms are often treatment-resistant, and mindfulness training can be an important new add-on modality to the treatment of schizophrenia. The study is limited by the absence of long-term follow-up.
Shen, H., Zhang, L., Li, Y., Zheng, D., Du, L., Xu, F., Xu, C., Liu, Y., Shen, J., Li, Z., & Cui, D. (2021). Mindfulness-based intervention improves residual negative symptoms and cognitive impairment in schizophrenia: A randomized controlled follow-up study. Psychological Medicine.
The goal of psychological and behavioral intervention is to help people live better lives. It is possible, however, that such interventions can also cause harm for select individuals. This is as true of mindfulness meditation as it is of other cognitive-behavioral and therapeutic interventions. Researchers want to learn who might be most vulnerable to adverse effects and under what circumstances. Examples of adverse effects include anxiety, depression, flashbacks, psychotic symptoms, and alterations in identity.
There is anecdotal evidence that adverse effects may be more common in intensive meditation retreats than in standard mindfulness-based interventions (MBIs). Aizik-Reebs et. Al [Behaviour Research and Therapy] used experience sampling (checking in on how participants felt at random moments) to evaluate the frequency of momentary and persistent adverse effects associated with participation in a MBI.
The researchers recruited 82 meditation-naïve Israelis (52% female; average age = 25 years) seeking stress-reduction. Prior to starting the MBI, participants were assessed on measures of mindfulness, anxiety, depression, worry, rumination, and distress tolerance.
The 21-day MBI included 3 group-based session held once per week for 90 minutes each, and 3 web-based 30-minute individual sessions. Session content included focused-attention, open monitoring, and movement meditations with encouragement for daily home practice.
Participant experience sampling was conducted several times a day over a 28-day period beginning 3.5 days before and ending 3.5 days after the MBI. During sampling, participants rated the extent of their negative emotions and cognitions. Experience samples were taken immediately after three mindfulness meditation sessions, and at random times throughout the day.
Momentary adverse effects were defined as significant (>1.96 standard deviations) deteriorations in mood during meditation compared to participant mood during normal daily activities. Sustained adverse effects were defined as significant deteriorations in mood during the 3.5 days after the MBI relative to the 3.5 days prior to the MBI.
The results showed 87% of participants experienced at least one momentary adverse effect during the three sampled meditation sessions, with 42% having them during two and 28% in all three sessions. The most common adverse events were momentary increases in anxiety (70% of adverse events), rumination (29%), sadness (22%), and depressed mood (17%).
Twenty-five percent of the participants showed a sustained adverse effect (poorer mood after the MBI than before). The most common sustained adverse effects were increases in worry (9%), decreases in happiness (7%), and increases in rumination (6%). Momentary adverse effects and measures of pre-intervention emotional vulnerability were uncorrelated with sustained adverse effects.
The study shows moments of anxiety, worry, and negative mood are commonplace in novice meditators during early stages of a meditation program, but these momentary experiences are not predictive of sustained adverse effects. About a quarter of meditation-naïve participants experienced poorer mood after completing the MBI program than before.
It is possible that increases in negative mood are due to facing previously avoided problems, transitioning to new coping strategies, increased awareness of feelings, or a genuine deterioration in functioning. The study is limited by a brief follow-up period and the absence of a control group.
Aizik-Reebs, A., Shoham, A., & Bernstein, A. (2021). First, do no harm: An intensive experience sampling study of adverse effects to mindfulness training. Behaviour Research and Therapy.
Social anxiety disorder is a diagnosis of unreasonable fear of embarrassment in social situations. People with social anxiety disorder often avoid social situations, thereby limiting the quality of their lives. Cognitive-Behavioral Therapy (CBT) uses cognitive reappraisal to reduce social anxiety through questioning irrational beliefs about feared outcomes. Mindfulness-Based Stress Reduction (MBSR) stresses the acceptance of thoughts, rather than altering them.
While CBT and MBSR are both effective in treating social anxiety disorder, it is not clear whether their benefits are due to unique or shared therapeutic elements. Goldin et al. [JAMA Psychiatry] conducted a randomized controlled trial of CBT and MBSR to test the efficacy of each program on anxiety among people with social anxiety disorder, and tested the neural activity associated with each program.
The researchers randomly assigned 108 unmedicated generalized social anxiety disorder patients (56% female; average age=33 years; 44% White; 39% Asian-American, 9% Latino, 9% Other) to CBT, MBSR, or a waitlist control. Patients completed self-report measures of anxiety symptoms at baseline, posttreatment, and one year follow-up, and an fMRI task at baseline and posttreatment.
CBT and MBSR were delivered in 12 weekly 2.5-hour group sessions. CBT included cognitive restructuring, exposure, and relapse prevention. MBSR used a standard 8-week protocol with four additional weekly sessions substituting for the all-day retreat.
Before undergoing functional brain imaging, participants wrote down scenarios for the social situations that personally caused them anxiety along with the negative self-beliefs associated with those scenarios. Participants then imagined the feared social situations and associated self-beliefs, and either reacted to, reappraised, or accepted them while undergoing imaging.
Brain regions selected for analysis were previously associated with cognitive restructuring and attentional regulation (e.g., prefrontal and anterior cingulate cortices).
Previously published results from this study showed CBT and MBSR both reduced social anxiety symptoms significantly more than waitlist controls at post-treatment and one-year follow-up. The effects of CBT and MBSR were equivalent in size.
CBT and MBSR groups showed similar significant reductions in negative emotions during reacting, reappraising, and accepting trials from pre- to post-testing (partial η2 range=0.38-0.53). These changes were significantly greater than changes in the control group.
Both treatment groups showed increased brain activation in regions of interest compared to controls, and these changes were similar across CBT and MBSR groups.
The study shows CBT and MBSR are similarly effective in reducing social anxiety compared to a wait-list control, and that improvement is maintained at one-year follow-up. It suggests that, despite contrasting models of therapeutic change, CBT and MBSR have overlapping effects on brain activity. Despite their application of differing strategies, they both refine awareness, weaken avoidant behavior, and decrease the influence of negative self-beliefs. Acceptance and reappraisal strategies may involve brain regions that share substantial overlap.
The study is limited by excluding other brain regions previously associated with MBSR that may differ from CBT.
Goldin, P. R., Thurston, M., Allende, S., Moodie, C., Dixon, M. L., Heimberg, R. G., & Gross, J. J. (2021). Evaluation of Cognitive Behavioral Therapy vs Mindfulness Meditation in Brain Changes During Reappraisal and Acceptance Among Patients With Social Anxiety Disorder: A Randomized Clinical Trial. JAMA Psychiatry.
An epidemic of obesity has been reported in the United States. Over 40% of Americans are classified as overweight and at elevated risk for diabetes, heart disease, and stroke. Obesity-associated medical costs are estimated at $147 billion yearly. Cognitive-behavioral programs are used in an attempt to support weight loss, but often fail because cognitive control over emotionally rewarding eating is difficult to sustain.
Mindful attention to eating, however, may reduce binge eating by lowering our expectations of just how rewarding eating a craved food will be. Taylor et al. [Journal of Behavioral Addictions] conducted two studies to test if mindfulness alters expectations of the reward of eating, and whether such changes result in decreased binge eating behavior.
In the first study, 64 overweight women (average age=53 years; 92% Caucasian; average BMI=33) participated in an 8-week app-based mindful eating program. The mindful eating app contained 28 self-paced sequential modules introducing mindfulness in brief video format. Modules were designed to help participants become mindful of eating triggers and learn mindful eating skills.
The app included a tool that participants used when they experienced cravings to binge eat. The tool had them rate their craving intensity, then imagine themselves eating the desired food and how that would make them feel, then rate their subsequent craving intensity, and finally decide whether or not to yield to the craving. If participants decided to go ahead and binge eat, they then rated how much food they ate and the level of contentment they felt after mindfully attending to their body, thoughts, and emotions.
The tool intended to help participants become aware of discrepancies between how they expected to feel and how they actually felt after yielding to cravings, and to ultimately update their expectancies in accordance with this realization.
Participants completed several eating-related self-report measures before and after the 8-week intervention. Results showed significant reductions in food craving (Cohen’s d=1.25) and stress-based (d=1.35) and reward-based (d=1.19) eating after the intervention. Decreases in the expected reward value of food were significantly associated with increased use of the app-based craving tool. The more frequently the participants used the tool, the less they binge ate.
The authors conducted a second naturalistic community-based study examining data from a pool of 1,119 mindfulness app users. The pool was subdivided into a “low use” group of 1,044 participants who used the craving tool <10 times (females=78%; average age=45 years) and a “high use” group of 75 participants who used the craving tool ≥10 times (females=79%; average age=49 years).
Results from the second study showed the more participants used the craving tool, the smaller their anticipated rewards from eating craved foods. Unlike the first study, binge eating did not decrease with increased tool use. A post-hoc analysis of the low use group showed binge eating increased for participants who used the craving tool 1-3 times and decreased for those using it 5 or more times.
These two studies showed a mindful eating app reduced the frequency and amount of binge eating in an experimental setting, but not in a naturalistic community setting. More use of the mindful craving tool resulted in lower reward expectancies about the benefit of eating, and to less binge eating for participants who used the tool at least five times. The study is limited by the absence of a control group.
Taylor, V. A., Moseley, I., Sun, S., Smith, R., Roy, A., Ludwig, V. U., & Brewer, J. A. (2021). Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating. Journal of Behavioral Addictions.
How does mindfulness reduce the experience of pain? One theory has it that focusing mindfully on present-moment sensory experience reduces the influence of held beliefs. For example, past experiences with pain shape expectations about what pain will be like in the future.
Using a pain conditioning experiment, Vencatachellum et al. [European Journal of Pain] tested the effect of inducing mindfulness compared to pain-suppression strategies on pain expectations.
The researchers enrolled 68 healthy meditation-naive participants (50% female; average age=27 years) from three European countries in a laboratory study. All participants first underwent sensory conditioning that paired a computer-presented visual cue with a heat stimulus delivered a few seconds later to their forearm. The heat stimulus was calibrated to each participant to induce low, moderate, or high levels of heat-induced pain.
Color cues were consistently paired with subsequent pain stimuli so that the colors became associated with an expected degree of pain. As such, participants now learned what to expect. Participants rated their anxiety and pain intensity and unpleasantness on each trial.
After the cue conditioning, participants were randomly assigned to receive 10 minutes of audio training in either mindfully attending to pain or suppressing pain. Participants were then exposed to the previously conditioned color cues along with a novel color cue, each followed by a moderate pain stimulus. The novel color was added because it was not conditioned with pain and so served as comparison to the conditioned colors. Participants again rated their anxiety and pain.
The researchers then assessed whether the moderate pain stimulus was rated as more painful following the high-pain color cue, or less painful following the low-pain color cue than after the unconditioned color cue.
Results showed that after the low-pain cue, the suppression group judged the moderate pain stimulus as less-than-moderate. The mindfulness group judged it, accurately, as moderate. No group difference was found for judgements about the high-pain cue.
The study findings offered partial support for a theory proposing that mindfulness reduces the influence of learned expectancies on future pain judgments, but only when expectancies signal a lower level of pain. The study is limited by the brevity of its mindfulness induction and the absence of a control group instructed merely to rest during the pain task.
Vencatachellum, S., Meulen, M. van der, Ryckeghem, D. M. L. V., Damme, S. V., & Vögele, C. (2021). Brief mindfulness training can mitigate the influence of prior expectations on pain perception. European Journal of Pain.
Many psychotherapeutic interventions are available to treat pain. Mindfulness-Based Stress Reduction, Cognitive Therapy, and Behavior Therapy are shown to be effective in improving pain-related outcomes among patients with chronic pain. However, little is known about whether one of these treatments is superior.
Burns et al. [Pain] conducted a randomized controlled trial to compare the effect of these three interventions relative to each other as well as to a treatment-as-usual control group on pain-related outcomes. Relative efficacy, rate of benefit gained, and persistence of effect at follow up were compared across groups.
The researchers randomly assigned 521 participants (51% Black; 58% female; average age = 53 years; average duration of pain = 12 years) with chronic lower back pain to Mindfulness-Based Stress Reduction (MBSR), Cognitive Therapy, Behavioral Therapy, or a treatment-as-usual control. Participants had significant daily back pain and related impairments in activities of daily living for at least six-months.
All treatments were manualized and delivered in eight weekly 90-minute individual therapy sessions by clinical psychologists with prior experience in psychosocial interventions for pain. Participants were assessed on pain interference and intensity and pain-related outcomes of mood, sleep disturbance, and physical functioning at study baseline, weekly during the treatment period, and at 6-month follow-up.
MBSR participants engaged in body scan, sitting, and gentle movement meditations, and focused on cultivating mindfulness in activities of daily life. Cognitive Therapy participants learned to identify, evaluate, and correct automatic pain-related thoughts. Behavior Therapy participants learned how to set and track realistic daily activity goals aimed at graded increases in activities such as walking and standing, as well as increased engagement in pleasure-generating activities.
Treatment-as-usual was whatever standard care participants received before the start of the study, usually pain medication and social support from a medical team.
The results showed that all three therapy groups were superior to the control group. The range of effect sizes for treatment groups compared to the control group were of small size for pain interference and physical functioning (Cohen’s d=0.21-0.26) and up to medium size for pain intensity (d=0.30-0.48), mood (d=0.26-0.53), and sleep disturbance (d=0.26-0.61). This superiority over the control group was statistically equivalent across the therapy groups, and no one therapy (MBSR, CT, BT) showed superiority over any other therapy group.
All three therapy groups diverged from the control group by week six of therapy on all measures, thus shedding light on an important time signal of change. All therapy group gains over the control group were maintained at six-month follow-up. Again, no single treatment group was significantly superior to any other treatment group at follow-up.
The study shows that three different psychotherapeutic interventions lend benefit on pain-related outcomes beyond that of standard care practices for patients with long-term pain. Findings uncover that multiple therapies can aid in improving pain outcomes, giving patients the option to select a therapy they prefer.
The study is limited given that the MBSR group did not receive the full curriculum, and there was no indication of whether therapists delivering MBSR had adequate training in the program and a personal meditation practice.
Burns, J. W., Jensen, M. P., Thorn, B. E., Lillis, T. A., Carmody, J., Newman, A. K., & Keefe, F. (2021). Cognitive therapy, mindfulness-based stress reduction, and behavior therapy for the treatment of chronic pain: A single-blind randomized controlled trial. Pain.
Perimenopause, the multiyear transition from regular menses to their complete cessation, places women at increased risk for depression, with 45-68% of perimenopausal women reporting depressive symptoms.
Erratic levels of the reproductive hormone estradiol play a role in this increased vulnerability for depression, but not all women have moods that fluctuate with estradiol levels. Women with wider hormonal-related mood fluctuations are more vulnerable to stress and more likely to experience depressive symptoms.
Gordon et al. [Psychoneuroendocrinology] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on women’s perimenopausal depressive symptoms, and then explored whether the program might prove especially helpful for women with elevated hormonal-related mood fluctuations.
The researchers randomly assigned 104 mediation-naïve Canadian healthy perimenopausal women (average age = 49 years; 89% Caucasian; early menopause = 69%, late menopause = 31%) to MBSR or a wait-list control. MBSR was taught by experienced MBSR teachers and delivered in 2.5-hour group sessions over an 8-week period, with a 7-hour silent retreat in the sixth week.
Baseline urine estradiol levels and daily moods were assessed over a period of 30-50 days prior to randomization, and the researchers calculated a standardized mood sensitivity to estradial changes based on these data. Self-report measures, histories of trauma, and recent stressful events were also assessed at baseline.
Depressive symptoms were assessed at baseline, immediately after intervention, and every two weeks during a 6-month follow-up. Perceived stress, anxiety, mindfulness, resilience, and sleep quality were assessed at baseline, immediately after intervention, and at 2-, 4-, and 6-month follow-up. Participants with high levels of self-reported depressive symptoms were assessed for major depression in structured clinical interviews.
The results showed that the MBSR group showed significantly greater reductions in depressive symptoms (d = -0.34), perceived stress (d = -0.55), and anxiety (d = -0.53), and greater increases in mindfulness (d = -0.46) and resilience (d = -0.30) than controls at postintervention and throughout follow-up.
The subgroup of participants displaying elevated mood sensitivity to estradiol benefited most from MBSR. Women in early perimenopause benefitted more than those in late perimenopause from MBSR, and decreases in depressive symptoms were dose-dependent on home meditation practice.
The study shows MBSR is more effective in reducing depressive symptoms in perimenopausal women than a wait-list control. Women early in menopause and women sensitive to hormonal-related mood changes appear to gain the most benefit from MBSR practices.
The study is limited by the absence of an active comparison group, support group, or clinical monitoring program that might improve depressive symptoms in a similar fashion.
Gordon, J. L., Halleran, M., Beshai, S., Eisenlohr-Moul, T. A., Frederick, J., & Campbell, T. S. (2021). Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial. Psychoneuroendocrinology.
College can be demanding, and up to one-third of college students report feeling highly stressed. High stress levels can be a significant problem since a third of all college students report current or past mood, anxiety, or substance use disorders which can be retriggered or worsened by stress.
Mindfulness training can effectively reduce stress, but many students who enroll in mindfulness programs drop out before completion. Virtual reality (VR) technology has shown promise to improve learning, and may perhaps increase treatment adherence.
Mondrego-Alarcón et al. [Behaviour Research and Therapy] compared the relative efficacy of mindfulness versus relaxation training in reducing college student stress, and explored whether VR added to the mindfulness program reduces attrition.
The researchers randomly assigned 280 Spanish college students (79% female; average age = 22 years) to a standard mindfulness program, a VR-enhanced mindfulness program, or an active relaxation control. All groups met in person once weekly for six weeks. The mindfulness programs emphasized mindfulness and self-compassion using the body scan, and sitting, walking, movement, and self-compassion meditations.
The standard mindfulness condition met in 90-minute group sessions, while the VR-enhanced mindfulness condition met in 75-minute group sessions coupled with brief individual VR-guided meditations.
The body scan VR-meditation included a visual simulation of the human body which successively highlighted body parts as participants attended to those parts. Another VR meditation involved a virtual nature walk with participants mindfully observing their thoughts.
The relaxation control group utilized progressive muscle relaxation and visual imagery but did not use VR. All participants were assessed at baseline, post-treatment, and 6-month follow-up on the primary self-report measure of perceived stress as well as on the secondary outcomes.
The results show that, relative to the relaxation group, mindfulness (d=-0.72) and VR-enhanced mindfulness (d=-0.59) groups showed less perceived stress after intervention. This superiority remained at 6-month follow-up. The effect was dose dependent for mindfulness—the more sessions participants attended, the less their stress—but not for relaxation. Increases in mindfulness and self-compassion both contributed to decreased stress.
At post-treatment, the standard mindfulness group also showed significantly greater improvements on the secondary outcome measures of trait anxiety (d = -.90), emotional suppression (d = -0.71), mindfulness (d = 1.01), and self-compassion (d = .1.10) than the relaxation group.
These relative improvements persisted at 6-month follow-up and were joined by additional improvements in state anxiety (d = -1.37), affect balance (d = 1.02), academic engagement (d = 1.14) and burnout (d = -1.60). The VR-enhanced mindfulness group performed similarly on these measures but did not outperform the standard mindfulness group.
VR-enhanced participants had significantly better attendance than standard mindfulness participants, who in turn had significantly better attendance than relaxation participants. Ninety-six percent of the VR-enhanced group attended at least half of all sessions, compared with 83% of the standard mindfulness and 70% of the relaxation group.
The study shows mindfulness training to be superior to relaxation training in reducing stress in college students. Adding VR correlates with improved attendance in this younger sample, but did not yield superior efficacy on stress reduction.
The study is limited by its reliance on self-report measures, and inability to determine whether any novel activity for young adults like VR would increase motivation to attend a behavioral intervention.
Modrego-Alarcón, M., López-del-Hoyo, Y., García-Campayo, J., Pérez-Aranda, A., Navarro-Gil, M., Beltrán-Ruiz, M., Morillo, H., Delgado-Suarez, I., Oliván-Arévalo, R., & Montero-Marin, J. (2021). Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behaviour Research and Therapy.
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