A Qualitative Study of Use of Mindfulness to Reduce Long-Term Use of Habit-Forming Prescription Drugs.

Objective: The aim of this study was to study how participants used a mindfulness-based program-Mindfulness Based Relapse Prevention to reduce use of habit-forming prescription drugs after long-term use. We explored participants' descriptions of their post-intervention strategies for controlling medication intake. Method: Eighteen participants provided semi-structured qualitative interviews shortly after completion of the program and 13 participants were also interviewed 1 year after completion. Participants were asked about the conditions that originally led to use of medication, how they had attempted prior to the course to cope with problems associated with these conditions and their prescription drug-use, and whether and how their coping strategies had changed after participation in the program. Thematic analysis was performed within the framework of a realist epistemology, with an emphasis on researcher reflexivity. Results: The following themes were identified in the material: Increased present-moment sensory awareness, Observing without controlling, Self-acceptance, Making conscious choices, Non-judgmental self-guidance, Sense of control, and Challenges of learning and using mindfulness. Although these findings are closely related to the specific needs of our sample-mainly coping with tapering use of prescription drugs-they are largely in line with existing research on mindfulness interventions. An exception is the theme "Non-judgmental self-guidance," which encompasses change in individuals' inner dialogue and practical self-care. Conclusions: Analyses suggested that mindfulness might increase individuals' control over medication intake by shifting individuals' attention toward present-moment sensory awareness of concrete stimuli, thereby facilitating other kinds of control, such as non-judgmental inner self-guidance and more adaptive ways of reducing distress. We suggest that it is the moment-to-moment sensory awareness and non-controlling observation of distress, together with inner self-guidance, that differentiates mindful control from dysfunctional attempts at direct, top down control of medication-use.

The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse - a randomized wait-list controlled trial.

BACKGROUND: The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness-Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. METHODS: Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). RESULTS: Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. CONCLUSIONS: Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants' ability to be less self-judgmental and more self-compassionate. TRIAL REGISTRATION: ISRCTN, ISRCTN18001392. Registered 29 June 2018.

Participant experiences of change in mindfulness-based stress reduction for anxiety disorders.

AIM: To explore experiences of change among participants in a randomized clinical trial of mindfulness-based stress reduction (MBSR) for anxiety disorders. METHOD: Semi-structured interviews were conducted to explore the subjective experiences of change for individuals with anxiety disorders after a course in MBSR. Interviews were analysed employing hermeneutic-phenomenological thematic analysis. RESULTS: Five main themes were identified: 1) Something useful to do when anxiety appears, 2) Feeling more at ease, 3) Doing things my anxiety wouldn't let me, 4) Meeting what is there, and 5) Better-but not there yet. Most participants used what they had learned for instrumental purposes, and described relief from anxiety and an increased sense of personal agency. A few reported more radical acceptance of anxiety, as well as increased self-compassion. CONCLUSION: Participants of MBSR both describe mindfulness as a tool to "fix" anxiety and as bringing about more fundamental change towards acceptance of their anxiety. The complexity of reported change corresponds with better handling of areas representing known transdiagnostic features of anxiety disorder, such as dysfunctional cognitive processes (including attentional biases), emotional dysregulation, avoidance behaviours, and maladaptive self-relatedness. This supports MBSR as a transdiagnostic approach to the treatment of anxiety disorders.

Is Dispositional Self-Compassion Associated With Psychophysiological Flexibility Beyond Mindfulness? An Exploratory Pilot Study.

BACKGROUND: Dispositional mindfulness and self-compassion are shown to associate with less self-reported emotional distress. However, previous studies have indicated that dispositional self-compassion may be an even more important buffer against such distress than dispositional mindfulness. To our knowledge, no study has yet disentangled the relationship between dispositional self-compassion and mindfulness and level of psychophysiological flexibility as measured with vagally mediated heart rate variability (vmHRV). The aim was thus to provide a first exploratory effort to expand previous research relying on self-report measures by including a psychophysiological measure indicative of emotional stress reactivity. METHODS: Fifty-three university students filled out the "Five Facet Mindfulness Questionnaire" (FFMQ) and the "Self-Compassion Scale" (SCS), and their heart rate was measured during a 5 min resting electrocardiogram. Linear hierarchical regression analyses were conducted to examine the common and unique variance explained by the total scores of the FFMQ and the SCS on level of resting vmHRV. RESULTS: Higher SCS total scores associated significantly with higher levels of vmHRV also when controlling for the FFMQ total scores. The SCS uniquely explained 7% of the vmHRV. The FFMQ total scores did not associate with level of vmHRV. CONCLUSION: These results offer preliminary support that dispositional self-compassion associates with better psychophysiological regulation of emotional arousal above and beyond mindfulness.

Mentalization-Based Treatment From the Patients' Perspective - What Ingredients Do They Emphasize?

Objective: The aim of this study was to explore how patients with personality disorder (PD) and substance use disorder (SUD) experience mentalization-based treatment (MBT), in particular what they consider useful and less useful elements of the therapy. Method: Semi-structured qualitative interviews with 13 participants were conducted. Participants were interviewed on their experience of the different elements of MBT, their experience of working in the transference, and their view on MBT as a whole. Thematic analyses were performed within a hermeneutical-phenomenological epistemology, with an emphasis on researcher reflexivity. Results: The following themes were found in the material: "I am not alone," "Taking blinders off," "Just say it," "The paradox of trust," and "Follow me closely." Three of these themes concerned therapist interventions; these involved addressing the relationship with the patients, addressing negative or unspoken feelings in the sessions, and validating and tolerating patients' affect. Two themes concerned group therapy experiences; these were the experience of sameness with co-patients in group and the experience of discovering different perspectives in group. Conclusions: Patients' experiences of useful elements in MBT resonate with theoretical tenets of (borderline) personality pathology, in particular attachment disturbances and emotional dysregulation. Patients highlight what we would label working in the therapeutic relationship, addressing transferential and counter-transferential processes explicitly, emotional validation, and enhancing mentalizing in its own right.

Juggling thoughts and feelings: How do female patients with borderline symptomology and substance use disorder experience change in mentalization-based treatment?

OBJECTIVE: The aim of this study was to explore the experience of central psychological change processes for female patients with borderline symptomology and substance use disorder in mentalization-based treatment. METHOD: Semi-structured qualitative interviews on experiences from mentalization-based treatment with 13 participants were conducted. The interview material was analysed within a hermeneutical-phenomenological epistemology, with emphasis on researcher reflexivity. RESULTS: The following themes regarding central psychological change processes were found: "by feeling the feeling," "by thinking things through," "by walking in your shoes to see myself" and "by stepping outside of own bad feelings in seeing you." Two of these themes dealt with intra-psychic modes of how to relate to own mind-states. First, they had a shift from avoiding emotions into tolerating emotions. Second, they discovered the ability to think mental states through. Two themes dealt with mental stances for dealing with interpersonal situations, where one mode included a self-reflective stance in difficult encounters, and the other mode entailed an empathic reflective stance by exploring others' intentionality. CONCLUSIONS: The findings are in line with theoretical assumptions that increasing mentalizing capacity is a central change process for these patients. Furthermore, the findings demonstrate the complex interaction between different modes of mentalizing. Clinical or methodological significance of this article: The article explores change processes in manualized psychotherapy for patients with comorbid borderline personality disorder and substance use disorder, a focus which is not researched in the clinical literature. We claim that putting attention to this patient group and investigating their potential in psychotherapy is of clinical significance. Methodologically, this article utilizes thematic analyses within an epistemology following a specific procedure that is step based and transparent, thus it is of interest for qualitative researchers who also utilize thematic analyses.

Dispositional Mindfulness and Attentional Control: The Specific Association Between the Mindfulness Facets of Non-judgment and Describing With Flexibility of Early Operating Orienting in Conflict Detection.

Background: A state of mindfulness refers to a present-centered attentional awareness without judging. Being mindful seems to increase the ability to be flexible and adaptive in attention focus according to situational contingencies. The way mindfulness affects such attentional control is often measured with three different but interacting attentional networks of alerting (preparedness), orienting (selection of stimulus), and conflict detection (suppression of irrelevant stimuli). In the current study, the aim was to study the effects of dispositional mindfulness on these attention networks, and specifically the effects on the interactions between these attention networks. Methods: Fifty participants between 19 and 29 years old filled out the questionnaire Five Facet Mindfulness Questionnaire (FFMQ) and performed the revised version of the Attention Network Test (ANT-R). The five FFMQ facets of Describing, Non-Judgment, Orienting, Non-Reactivity, and Acting with Awareness were included as predictors in multiple linear regression analyses with the ANT-R scores of alerting, orienting, conflict detection, and the interaction scores of alerting by conflict detection and orienting by conflict detection as outcome variables, respectively. Results: Higher dispositional mindfulness as measured with the five FFMQ facets predicted interaction scores (faster reaction times) of orienting by conflict detection, but none of the other ANT-R scores. It was specifically the FFMQ facets of Describing and non-judgment that predicted this lower interaction score of orienting by conflict detection. Conclusion: Our findings indicate that being mindful is associated with a more flexible and efficient orienting attention. It is associated with a higher ability to disengage from salient stimuli that is irrelevant to pursue goal-directed behavior (conflict detection).

This is what I need a clinical feedback system to do for me: A qualitative inquiry into therapists' and patients' perspectives.

Routine outcome monitoring and clinical feedback systems (ROM/CFSs) are promising methods of providing naturalistic research data and enhancing mental health care. However, implementation in routine care is challenging, and we need more knowledge about clinicians' and patients' needs from such systems. OBJECTIVE: We aimed to study perspectives of clinicians and patients to explore how ROM/CFS can be helpful and acceptable to them. METHOD: We interviewed 55 participants in focus groups and individual interviews and analyzed the data through rigorous team-based qualitative analyses. RESULTS: We report 3 overarching domains: (a) Shared needs, (b) Specific patient needs, and (c) Specific therapist needs. Shared needs, in which perspectives of different stakeholders converge, was the dominant domain in the material. Under each domain, we report 3 specific themes: (a1) Degree of trust in therapy, (a2) Allowing for openness, (a3) Monitoring joint objectives; (b1) Life functioning, (b2) Canary in the coal mine, (b3) Holistic report; and (c1) Emotional presence and style, (c2) Monitoring risk and symptoms, and (c3) Agency and ownership of process. CONCLUSIONS: In what should increase our confidence toward core aspects of ROM, we suggest that an integration of relational feedback concepts and stringent clinical dimension tracking into the ROM/CFS can be beneficial.

Both sides of the story: Exploring how improved and less-improved participants experience mindfulness-based stress reduction for social anxiety disorder.

OBJECTIVE: What works for whom in mindfulness-based group interventions for social anxiety disorder (SAD)? The present article compared the experiences of 14 participants in a clinical study of mindfulness-based stress reduction (MBSR) for young adults with SAD. METHODS: A two-staged mixed methods design was used to identify the participants who reported the highest (n = 7) and lowest (n = 7) levels of symptomatic change on outcome measures after treatment, and analyze qualitative in-depth interviews to explore what they experienced as helpful and unhelpful during the MBSR program. The qualitative interviews were analyzed using a thematic analysis methodology. RESULTS: We identified the global theme of (i) Discovering agency to change or not feeling empowered through the MBSR program, and four sub-themes: (ii) Forming an active commitment or feeling ambivalence toward learning mindfulness, (iii) Engaging with others or avoiding contact with the group, (iv) Using the mindfulness exercises to approach or resigning when facing unpleasant experiences, and (v) Using the course to break interpersonal patterns or remaining stuck in everyday life. CONCLUSIONS: MBSR may be helpful for young adults with SAD, although it may be important to match clients to their preferred form of treatment.

Does a short self-compassion intervention for students increase healthy self-regulation? A randomized control trial.

The primary aim of this study was to examine the effects of a two-week self-compassion course on healthy self-regulation (personal growth self-efficacy and healthy impulse control) and unhealthy self-regulation (self-judgment and habitual negative self-directed thinking) in university students. We also examined the effects on self-compassion, anxiety and depression. Students (N = 158, 85% women, mean age = 25 years) were randomized to an intervention group and a waiting-list control group in a multi-baseline randomized control trial. Healthy self-control was measured by the Personal Growth Initiative Scale (PGIS) and the Self-Control Scale; unhealthy self-control was measured by the Non-judgement subscale from the Five-Facet Mindfulness Questionnaire (reversed) and the Habit Index of Negative Thinking (HINT). Secondary outcomes were measured by the State-Trait Anxiety Inventory (STAI-trait), the Major Depression Inventory (MDI), and the Self-Compassion Scale (SCS). A 2 × 3 repeated measures analysis of variance (ANOVA) showed gains for the intervention-group in personal growth self-efficacy and healthy impulse-control and reductions in self-judgment and habitual negative self-directed thinking, as well as increases in self-compassion and reductions in anxiety and depression. After all participants had completed the course, the groups were combined and repeated measures ANOVAs showed that changes remained at six-month follow-up for personal growth self-efficacy, self-judgment and habitual negative self-directed thinking; as well as for self-compassion, anxiety and depression. Concluding, a short self-compassion course seems an effective method of increasing self-compassion and perceived control over one's life for university students, as well as increasing mental health.

Is restlessness best understood as a process? Reflecting on four boys' restlessness during music therapy in kindergarten.

ADHD can be considered an internationally recognized framework for understanding children's restlessness. In this context, children's restlessness is understood as a symptom of neurodevelopmental disorder. However, there are other possible understandings of children's restlessness. In this article, we explore four boys' collaborative and creative process as it is described and understood by three adults. The process is framed by a community music therapy project in a Norwegian kindergarten, and we describe four interrelated phases of this process: Exploring musical vitality and cooperation, Consolidating positions, Performing together, and Discovering ripple effects. We discuss these results in relation to seven qualities central to a community music therapy approach: participation, resource orientation, ecology, performance, activism, reflexivity and ethics. We argue that in contrast to a diagnostic approach that entails a focus on individual problems, a community music therapy approach can shed light on adult and systemic contributions to children's restlessness.

An open trial of mindfulness-based stress reduction for young adults with social anxiety disorder.

The present study investigated mindfulness-based stress reduction (MBSR) for young adults with a social anxiety disorder (SAD) in an open trial. Fifty-three young adults in a higher education setting underwent a standard eight-week MBSR program. Eight participants (15%) did not complete the program. Participants reported significant reductions in SAD symptoms and global psychological distress, as well as increases in mindfulness, self-compassion, and self-esteem. Using intention-to-treat (ITT) analyses, effect sizes ranged from large to moderate for SAD symptoms (Cohen's d = 0.80) and global psychological distress (d = 0.61). Completer analyses yielded large effect sizes for SAD symptoms (d = 0.96) and global psychological distress (d = 0.81). The largest effect sizes were found for self-compassion (d = 1.49) and mindfulness (d = 1.35). Two thirds of the participants who were in the clinical range at pretreatment reported either clinically significant change (37%) or reliable improvement (31%) on SAD symptoms after completing the MBSR program, and almost two thirds reported either clinically significant change (37%) or reliable improvement (26%) on global psychological distress. MBSR may be a beneficial intervention for young adults in higher education with SAD, and there is a need for more research on mindfulness and acceptance-based interventions for SAD.

Mindfulness Based Stress Reduction for Academic Evaluation Anxiety: A Naturalistic Longitudinal Study.

Mindfulness based stress reduction (MBSR) for academic evaluation anxiety and self-confidence in 70 help-seeking bachelor's and master's students was examined. A repeated measures analysis of covariance on the 46 students who completed pretreatment and posttreatment measures (median age = 24 years, 83% women) showed that evaluation anxiety and self-confidence improved. A growth curve analysis with all 70 original participants showed reductions in both cognitive and emotional components of evaluation anxiety, and that reduction continued postintervention. Although more research is needed, this study indicates that MBSR may reduce evaluation anxiety.

Facing the fear of failure: An explorative qualitative study of client experiences in a mindfulness-based stress reduction program for university students with academic evaluation anxiety.

The aim of this qualitative study was to investigate the subjective experiences of 29 university students who participated in an 8-week mindfulness-based stress reduction (MBSR) program for academic evaluation anxiety. Participants who self-referred to the Student Counseling Service underwent individual semi-structured interviews about how they experienced the personal relevance and practical usefulness of taking the MBSR program. Interviews were transcribed and analyzed through a team-based explorative-reflective thematic approach based on a hermeneutic-phenomenological epistemology. Five salient patterns of meaning (themes) were found: (1) finding an inner source of calm, (2) sharing a human struggle, (3) staying focused in learning situations, (4) moving from fear to curiosity in academic learning, and (5) feeling more self-acceptance when facing difficult situations. We contextualize these findings in relation to existing research, discuss our own process of reflexivity, highlight important limitations of this study, and suggest possible implications for future research.

The Five Factor Mindfulness Questionnaire in Norway.

The aim of this study was to adapt the Five Factor Mindfulness Questionnaire (FFMQ) for use in Norway. Three studies involving three different samples of university students (mean age 22 years, total N = 792) were conducted. Confirmatory factor analyses showed that a five factor structure provided an acceptable fit to the data. All five factors loaded significantly on the overall mindfulness factor. As expected, correlations between the FFMQ total scores and subscales were positive and significant, ranging from 0.45 to 0.65. Correlations between FFMQ total/subscales and Mindful Attention Awareness Scale (MAAS) were significant and negative (since low scores on the MAAS indicate high mindfulness), ranging from r = -0.17 to -0.69. The Norwegian FFMQ total score was inversely correlated with all indicators of psychological health: neuroticism (r = -0.61), ruminative tendencies (r = -0.41), self-related negative thinking (r = -0.40), emotion regulation difficulties (r = -0.66) and depression (r = -0.46 to r = -0.65). In contrast to the other FFMQ subscales, the FFMQ Observe subscale did not have a positive relation to psychological health in our mostly non-meditating sample. However, being able to non-judgmentally observe one's inner life and environment is a part of the mindfulness construct that might emerge more clearly with more mindfulness training. We conclude that the Norwegian FFMQ has acceptable psychometric properties and can be recommended for use in Norway, especially in studies seeking to differentiate between different aspects of mindfulness and how these may change over time.

The voices of fellow travellers: experienced therapists' strategies when facing difficult therapeutic impasses.

OBJECTIVE. We wanted to explore how psychotherapists from various theoretical affiliations handle difficult impasses in therapy, in a way that they experience helps the therapeutic process towards further constructive development. DESIGN. We purposefully sampled 12 highly skilled and experienced therapists from the leading theoretical affiliations in the field. We conducted semi-structured in-depth interviews to explore their recall of impasse experiences. Participants were interviewed individually about a specific impasse from their experience that later resolved successfully. METHODS. The transcribed interviews were analysed using a hermeneutically modified method of systematic text condensation. The results that come out of such analyses are 'meaning patterns' or 'themes'. Analyses were technically carried out with the assistance of Nvivo 8 software. RESULTS. Analysing the needs of the therapists when working through the impasses, we found two general themes across the sample: (1) the need for a move--from confusion and bodily tension to shared systems of meaning, and (2) the need for a witness--to find a home for the stalemate scenario in another relationship. We present how having these needs met evokes the experience of (3) the vital clearing--an experiential space between self and impasse. CONCLUSION. We discuss how our findings relate to contemporary psychotherapy theory concepts such as mentalization, mindfulness, and experiential capacity. We discuss our process of reflexivity in carrying out the study and suggest implications of our findings for further research.