Evaluation of the Feasibility of a Yoga and Mindfulness-Based Mental Health Intervention for Latina Immigrant Mothers

Thesis (Master's)--University of Washington, 2016-06

Mindfulness practice moderates the relationship between craving and substance use in a clinical sample

Thesis (Master's)--University of Washington, 2016-05

Utility of cotyledon and detached leaf assays for assessing root reactions of lucerne to Phytophthora root rot caused by Phytophthora medicaginis

Phytophthora root rot, caused by Phytophthora medicaginis, is a major limitation to lucerne production but it can be managed through the use of resistant cultivars. Current resistance screening methods, using mature plants or post-emergence seedling assays, are costly and time consuming. The use of zoospore inoculum on detached leaves and intact cotyledons as an assay for plant resistance was assessed using genetically defined segregating populations. The detached leaf assay was a reproducible test, but this test could not be used for accurately predicting root ratings. The cotyledon tests using zoospores gave results at the population level that were indicative of the root responses of 19 cultivars and lines tested. The cotyledon reaction of individual plants also showed a strong association with root response. The cotyledon test, while not completely predictive of mature root responses, allowed the selection of Phytophthora resistant plants at a higher frequency than could be achieved by random selection.

The Observing Self : Diminishing Egocentrism Through Brief Mindfulness Meditation

Peer reviewed

The Role of Home Practice Engagement in a Mindfulness-Based Intervention

Over the last three decades, there has been a precipitous rise in curiosity regarding the clinical use of mindfulness meditation for the self-management of a broad range of chronic health conditions. Despite the ever-growing body of evidence supporting the use of mindfulness-based therapies for both medical and psychological concerns, data on the active ingredients of these mind-body interventions are relatively scarce. Regular engagement in formal mindfulness practice is considered by many to be requisite for generating therapeutic change; however, previous investigations of at-home practice in MBIs have produced mixed results. The equivocal nature of these findings has been attributed to significant methodological limitations, including the lack of standardized, systematic practice monitoring tools, and a singular focus on practice time, with little attention paid to the nature and quality of one’s practice. The present study used a prospective, observational design to assess the effects of home-based practice on dispositional mindfulness, self-compassion, and psychological functioning in twenty-eight people enrolled in an MBSR or MBCT program. To address some of the aforementioned limitations, the present study collected detailed weekly accounts of participants’ home-based practice engagement, including information about practice time (i.e., frequency and duration), exercise type, perceived effort and barriers to participation, and practice quality. Hierarchical multiple regression was used to examine the relative contribution of practice time and practice quality on treatment outcomes, and to explore possible predictors of adherence to at-home practice recommendations. As anticipated, practice quality and perceived effort improved with time; however, rather unexpectedly, practice quality was not a significant predictor of treatment-related improvements in psychological health. Home practice engagement, however, was predictive of change in dispositional mindfulness, in the expected direction. Results of our secondary analyses demonstrated that employment status was predictive of home practice engagement, with those who were unemployed completing more at-home practice on average. Mindfulness self-efficacy at baseline and previous experience with meditation or other contemplative practices were independently predictive of mean practice quality. The results of this study suggest that home practice helps generate meaningful change in dispositional mindfulness, which is purportedly a key mechanism of action in mindfulness-based interventions.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

Mindfulness and Spirituality as determinants of Existential Loneliness in the Dutch

Existential loneliness is a concept that is largely ignored in the psychological research tradition, although from a philosophical perspective it is deeply connected to inherent human longings of connection and meaning. This research investigated the relationship between existential loneliness and two variables that are theoretically closely related to the concepts of connection and meaning, namely mindfulness (connection to oneself and others) and spiritual well-being (connection to a larger whole). This was done in a sample of n = 180 individuals (61.7% female; mean age 41.72, SD = 12.16) of the Dutch population. A multiple regression analysis was conducted. It can be concluded that there is a negative relationship between mindfulness and existential loneliness, as well as between spiritual well-being and existential loneliness. This means that people with a higher level of mindfulness and/or a higher level of spiritual well-being experience a lower level of existential loneliness. At the same time, people with a lower level of mindfulness and/or spiritual well-being experience a lower level of existential loneliness. There are some limitations to this study, for example the use of a non-random sampling method, a limited sample group, a scale that has not been widely tested, and a potential bias towards the higher educated. However, these limitations are inherent to exploratory research and does not diminish the main strength of this thesis, namely that it has provided more insight into an important and prevalent societal phenomenon, that had not been extensively researched previously, that has so far only been addressed in more philosophical instead of scientific debates, and linked almost exclusively to negative concepts, such as terminal illness. This research provides a first understanding of two positive determinants of existential loneliness, which could potentially be used to help make sense of this inherently humane condition, as well as to actively cope with the potential (adverse) effects of it.

De Relatie tussen Hechting en Welbevinden bij Ouderen: De mediërende Invloed van Mindfulness en Zingeving

Empirische studies hebben aangetoond dat bij ouderen een veilige hechting positief samenhangt met het niveau van welbevinden. Hechting is een relatief stabiel en moeilijk te beïnvloeden persoonlijk kenmerk en daarom is het belangrijk om mediatoren van het verband tussen hechting en psychologische uitkomstmaten te vinden die met interventies te beïnvloeden zijn. De vraagstelling van de studie luidde: ‘Welk verband bestaat er tussen hechting en welbevinden bij ouderen en wordt dit verband gemedieerd door mindfulness en zingeving?’. De huidige studie was een survey met één meetmoment. De 210 respondenten waren 65 jaar of ouder (M = 71.25, SD = 5.42) en thuiswonend. Daarnaast mochten ze geen ernstige geheugenproblemen of een psychiatrische stoornis hebben. Via de sneeuwbalmethode werden de respondenten mondeling of schriftelijk door de onderzoeker benaderd. De vragenlijst kon anoniem online of op papier worden ingevuld. Hechting werd gemeten met de Experiences in Close Relationships-Revised (ECR-R), mindfulness met de Five Facet Mindfulness Questionnaire (FFMQ), zingeving met de Meaning in Life Questionnaire, subschaal ‘Presence of meaning in life’ (MLQ-P) en welbevinden met de Positive Affect Negative Affect Scale (PANAS) en de Satisfaction With Life Scale (SWLS). Zowel hechtingsgerelateerde angst (‘angst’) als hechtingsgerelateerde vermijding (‘vermijding’) bleek in correlatieanalyses negatief samen te hangen met mindfulness, zingeving en welbevinden. Tussen mindfulness, zingeving en welbevinden werden positieve verbanden gevonden. De (seriële) mediatieanalyse werd uitgevoerd met behulp van de macro PROCESS 2.13. Zowel het verband tussen ‘angst’ en welbevinden als tussen ‘vermijding’ en welbevinden werd volledig (serieel) gemedieerd door mindfulness en zingeving.

De Relatie tussen Angst- en Stemmingsklachten en Self-disclosure: het Effect van Emotie-inhibitie en Mindfulness

Angst- en stemmingsklachten worden geassocieerd met verminderde self-disclosure. Met self-disclosure wordt zelfonthulling van ervaren emoties bedoeld. Dit speelt een rol bij zelfacceptatie en zelfinzicht, en is belangrijk bij gesprekstherapie. Deze studie onderzocht of emotie-inhibitie de negatieve relatie tussen angst- en stemmingsklachten en self-diclosure verklaart, en of de relatie gunstig te beïnvloeden is door mindfulness. Het effect van mindfulness op deze relatie was nog niet eerder onderzocht. Deelnemers waren 99 vrouwen van 24 t/m 74 jaar (M = 44.60, SD = 10.55) en 26 mannen van 26 t/m 77 jaar (M = 48.27, SD = 12.68), afkomstig uit de normale Nederlands populatie. Het onderzoeksontwerp betrof een cross-sectioneel online vragenlijstonderzoek, waarbij gebruik gemaakt werd van de Symptom Checklist (Arrindel & Ettema, 1986), Emotional Self-Disclosure Scale (Snell, Miller, & Belk, 1988), Emotion Regulation Questionnaire (Gross & John, 2003) en Five Factor Mindfulness Questionnaire – Short Form (Bohlmeijer, Ten Klooster, Fledderus, Veehof, & Baer, 2011). Resultaten tonen, conform bestaande literatuur, dat angst- en stemmingsklachten negatief samenhangen met self-disclosure. Emotie-inhibitie heeft echter géén mediatie-effect en mindfulness heeft géén moderatie-effect op de negatieve relatie tussen angst- en stemmingsklachten en self-disclosure. Mindfulness heeft wel mediatie-effect op deze relatie. Mindfulness hangt hierbij positief samen met self-disclosure. De relevantie van de bevindingen is vooral praktisch: om mensen met angst- en stemmingsklachten te stimuleren over hun emoties te praten zou mindfulness aangewend kunnen worden.

Mindfulness: Why (Not)? Explaining Variations in Mindfulness Levels

Despite the apparent benefits of being mindful, people are often not very mindful. There seem to be forces that drive people toward as well as away from mindfulness. These forces are conceptualised in terms of a competition for scarce attentional capacity. To explore these forces and to test this framework, an experience sampling study among people with an explicit intention to be mindful and an ongoing practice to that end (29 participants, 1012 measurements) was done to examine the antecedents of mindfulness in their daily lives. The results generally support the framework. People tend to be more mindful if the intention to be mindful is salient, and if they feel good. They tend to be less mindful when they are in a hurry, experiencing threat, tired, or very busy. A conscious intention to be mindful seems to be very important, and its development may be a key ingredient in the development of mindfulness.

A Relação entre Mindfulness, Auto-Compaixão, Vergonha e Psicopatologia em Praticantes e Não Praticantes de Meditação/Yoga

O estudo do mindfulness tem sido alvo de um crescente interesse no domínio da Psicologia, pela sua importância no aumento de bem-estar e redução de sintomatologia psicopatológica. Os estudos realizados acerca da forma como o mindfulness assume um papel preponderante no bem-estar psicológico dos indivíduos, tendo por base um conjunto de competências ou aptidões que podem ser aprendidas e praticadas, favorece uma melhoria da saúde e do bem-estar dos indivíduos. Deste modo, com o objectivo de contribuir para o conhecimento da relação entre mindfulness, auto-compaixão, vergonha e psicopatologia em praticantes e não praticantes de meditação/yoga, realizou-se um conjunto de estudos numa amostra constituída por 121 sujeitos, em que 53 integram uma população praticante de meditação/yoga e 68 pertencem à população geral não praticante de meditação/yoga. Os resultados revelam que indivíduos praticantes de meditação/yoga registam valores significativamente mais elevados nas facetas observar e não reagir da escala de mindfulness. Por sua vez, sujeitos com maiores índices de traço de mindfulness apresentam níveis mais baixos de vergonha externa e interna. Para além disto, indivíduos com elevado traço de mindfulness distinguem-se significativamente dos indivíduos com baixo traço de mindfulness ao apresentarem níveis mais elevados de auto-compaixão e níveis mais baixos de depressão, ansiedade e stress. / The study of mindfulness has been the target of a growing interest in the field of psychology because of its importance in increasing welfare and lessening of psychopathological symptoms. Studies on how mindfulness plays a central role in psychological well-being of individuals, based on a set of competencies or skills that can be learned and practiced, promotes improved health and well-being of individuals. Thus, in order to contribute to the knowledge of the relationship between mindfulness, self-pity, shame and psychopathology in non-practitioners and practitioners of meditation / yoga, it was held a series of studies on a sample of 121 subjects, in which 53 were part of a population practicing meditation / yoga and 68 belong to the general population not practicing meditation / yoga. The results show that individuals who practice meditation / yoga recorded significantly higher values in the watch and not react aspects of mindfulness scale. In turn, subjects with higher trait mindfulness have lower levels of external and internal shame. In addition, individuals with higher trait mindfulness differ significantly from individuals with low trait mindfulness of the present higher levels of self-pity and lower levels of depression, anxiety and stress.

A Influência de um Curso de Meditação nos Níveis de Mindfulness, Satisfação com a Vida e Optimismo

O mindfulness tem sido alvo de um crescente interesse no domínio da Psicologia e a sua importância ao nível do funcionamento psicológico tem vindo a ser empiricamente verificada. Os estudos sobre mindfulness têm demonstrado que este constructo está positivamente relacionado com a saúde psicológica e negativamente com a psicopatologia. Deste modo, a presente investigação teve como objectivo compreender a relação entre mindfulness, satisfação com a vida e optimismo, bem como explicar a influência de um curso de meditação nestas variáveis. Neste sentido, os participantes completaram uma bateria de questionários de auto-resposta avaliando o mindfulness, satisfação com a vida e optimismo num primeiro momento de avaliação, antes do curso de meditação (N = 104), num segundo momento, depois do curso de meditação (N = 30). Os resultados revelam um aumento significativo nos níveis de mindfulness, satisfação com a vida e optimismo após a frequência do curso de meditação e indicam que a prática do curso de meditação fortalece a relação entre estes constructos. Apesar de algumas limitações metodológicas que futura investigação deverá tentar colmatar, este estudo reforça a importância da prática de meditação para um funcionamento psicológico positivo e adaptativo. / Mindfulness has been target of a growing interest to Psychology in terms of the verified importance to psychological function. Studies show that mindfulness has demonstrated an important correlation with psychological health and negatively to psychopathology. The objective of the present research is to understand the relation between mindfulness, satisfaction with life and optimism as well as to explain the influence of a course of meditation in the study of these variables. The participants of this research completed several different types of auto-response questionnaires regarding mindfulness, satisfaction with life, and optimism; prior to the meditation course (N = 104), and then, after the meditation course (N = 30). Therefore, the results of the research demonstrated that the level of mindfulness, satisfaction with life and optimism significantly increased as the participants undergone in the meditation course as well as indicated that the practice such course strengthens the relation between the variables. Despite some methodological limitations that a future research should relieve, this study reinforces the practice of meditation for a positive and adaptive psychological function.

Ansiedade a Exames no Contexto do Ensino Secundário: o papel da ansiedade social, auto-criticismo e competências de mindfulness e aceitação

No presente trabalho, estudamos a Ansiedade aos Testes, entre a população estudantil adolescente. Queremos estudá-la enquanto traço comum da Perturbação de Ansiedade Social; simultaneamente, desejamos captar o papel desempenhado por outras variáveis psicológicas, como o auto-criticismo, e as competências de aceitação e consciência de si (minfulness). A amostra do estudo consiste em 449 estudantes de uma escola secundária de Coimbra, que responderam a um conjunto de 5 questionários. Adoptámos como medidas da ansiedade aos testes a versão portuguesa do Test Anxiety Inventory (TAI) (Ponciano, 1980) e a Escala de Cognições e Comportamentos na Ansiedade aos Exames (ECCAE) (Pinto-Gouveia, Melo e Pereira, 2005); da Ansiedade Social a EAESSA (Escala de Ansiedade e Evitamento de Situações Sociais para Adolescentes – Cunha, Pinto-Gouveia e Salvador, 2002); como medida da auto-complacência e consciência de si a versão portuguesa ad hoc da CAMM (Child Acceptance and Mindfulness Measure - Greco, Smith & Baer, 2008); do auto-criticismo a adaptação portuguesa do FRSC (Forms of Self-Criticizing/Attacking and Self-Reassuring Scale, Gilbert et al., 2004, Castilho e Pinto-Gouveia, 2005). De maneira geral, os resultados desta investigação coadunam-se com a literatura, no que diz respeito ao efeito de género e da preponderância do componente cognitivo na ansiedade face aos exames (frequência de cognições ansiosas); por outro lado, indicam que determinados construtos psicológicos, como o auto-criticismo (selfcriticism) e as competências de aceitação e consciência de si (acceptance e mindfulness), se encontram associadas à ansiedade aos exames. Os estudos futuros devem esclarecer a arquitectura funcional desta relação.

Os Benefícios de Estar no Presente. o papel do mindfulness na saúde física e mental: uma revisão empírica

A Terapia Cognitiva pode ser dividida em três gerações: terapias comportamentais, terapia cognitivo-comportamental e, a mais recente, “a terceira geração” onde se incluem uma variedade de terapias que, não obstante as diferenças entre si, têm o Mindfulness como componente central da terapia (Hayes, 2004). Estas últimas estão a tornar-se cada vez mais populares, pois a sua eficácia clínica tem sido demonstrada através de numerosos estudos. O Mindfulness envolve o foco da atenção de forma consciente para as experiências internas e externas que ocorrem no momento presente, através de uma variedade de exercícios de meditação. Uma das intervenções baseadas no Mindfulness é o programa clínico de Redução de Stresse (MBSR), desenvolvido por Jon Kabat-Zinn de forma a facilitar a adaptação e aliviar o sofrimento associado a perturbações psiquiátricas, físicas e psicossomáticas. A outra intervenção, a Terapia Cognitiva baseada no Mindfulness (MBCT) é largamente baseada no programa anterior, tendo como objectivo prevenir a reincidência de episódios depressivos, através da observação dos pensamentos e sentimentos sem os julgar, vendo-os apenas como eventos mentais e não como aspectos pessoais ou reflexo directo da realidade. O nosso objectivo neste estudo foi realizar uma revisão compreensiva de 14 estudos onde foram administradas uma das intervenções baseadas no Mindfulness (MBSR ou MBCT), de forma a avaliar os benefícios na saúde física e/ou mental. Como técnica metaanalítica foi utilizada o cálculo do tamanho do efeito de d de Cohan’s, de forma a facilitar a quantificação dos resultados e a comparação entre os estudos. Esta análise demonstrou um tamanho do efeito médio/alto (d=0,74), manifestando que os programas baseados no Mindfulness têm resultados terapêuticos significativos num largo leque de perturbações mentais e doenças físicas.