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

Transcription

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

2 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 mindfulnessbased interventions have been shown to reduce anxiety and depression Know where to access resources further learning for

3 What is Mindfulness? Mindfulness Based Interventions Mindfulness Based Stress Reduction Mindfulness Based Cognitive Therapy Evidence for Mindfulness Based Interventions

4 "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." Thomas Merton

5 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 ing, 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. CNN, 9/26/12

6 Mindfulness means paying attention in a particular way, on purpose, in the present moment, and non-judgmentally. (Jon Kabat-Zinn, 1990)

7 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. (Jon Kabat-Zinn, 1990)

8 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-tomoment awareness (Kabat-Zinn, 1996).

9 Three axioms: Intention, or on purpose Attention, i.e., paying attention Attitude, or in a particular way INTENTION focus & flexibility ATTENTION emotional regulation ATTITUDE open, curious, accepting (Shapiro, Carlson, Astin, & Freedman, 2006)

10 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 Increased self-awareness, balance in life

11 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. (Sanderson, 2004)

12 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 (Epstein, 1999)

13 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 (Epstein, 1999)

14 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-tomoment 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.

15 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 a day, six days per week.

16 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 Urinary urge incontinence

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19 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)

20 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.

21 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.

22 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 Using Activities to change mood

23 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 Generalized anxiety disorder

24 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 mindfulnessbased cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoriaactivated 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.

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26 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 (National Collaborating Centre for Mental Health, 2009).

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29 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. (Cullen, 2011) 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.

30 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 (4/5/12)

31 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 (Clinical Trials, 2008);

32 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 (Clinical Trials, 2008).

33 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, 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 leftsided activation predicted the magnitude of antibody titer rise to the vaccine.

34 Lazar S, et al. (2005). Meditation experience is associated with increased cortical thickness. Neurology Report, 16: 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.

35 (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.)

36 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): 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.

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38 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

39 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 MBEC Mindfulness Based Elder Care

40 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.

41 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, 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 tool for self-care for patients living with cancer.

42 Chiesa A, Serretti A. (2011). Mindfulness-based interventions for chronic pain: a systematic review of the evidence. Journal of Alternative & Complementary Medicine. 17(1): 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 measures related to chronic pain including pain coping.

43 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): 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.

44 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), From , 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.

45 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), 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.

46 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), patients with breast cancer and 10 with prostate cancer enrolled in an eightweek 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 preto 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.

47 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), 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 fullday 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.

48 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), The present randomized clinical trial was designed to assess the effect 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 to outpatient mental health treatment for adolescents.

49 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.

50 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), 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, postintervention, 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.

51 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), 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 postintervention substance use among the MBRP group.

52 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), 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.

53 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), 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.

54 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), 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.

55 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), 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 lowincome, 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.

56 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 Adapted for telehealth application

57 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

58 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

59 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, FIRST and LAST name with "Subscribe MRM" in the subject line to mrginform@gmail.com

60 Cullen, M. (2011). Mindfulness-Based Interventions: An emerging phenomena. Mindfulness, DOI /s 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, 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, 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, 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, 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), 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), 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), 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), Witkiewitz, K., Marlatt, G. A., & Walker, D. (2005). Mindfulness-Based relapse prevention for alcohol and substance use disorders. Journal of Cognitive Psychotherapy, 19(3),

61 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), 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), 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), 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), 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.

62 University of Wisconsin Mindfulness Program Be Mindful Online University of Rochester Mindfulness University of Massachusetts Center for Mindfulness University of Wisconsin Center for Investigating Healthy Minds Beth Israel Continuum Center for Health and Healing University of California at San Diego Center for Mindfulness AMSA Humanistic Medicine Group University of Wisconsin Aware Medicine Curriculum (Mindfulness in Residency) New York/east-coast Omega Institute National Center for Complementary and Alternative Medicine (NCCAM) California/west-coast Meditation Center Kristen Neff Christopher Germer