The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial.

INTRODUCTION: There is a lack of studies evaluating mindfulness-based interventions for children with attention-deficit hyperactivity disorder (ADHD) compared with an evidence-based control. This randomized controlled trial (RCT) evaluated the effects of mindfulness for youth (MYmind) in improving children's attention, behavior, and parent-related outcomes versus cognitive behavioral therapy (CBT). METHODS: A total of 138 families of children with ADHD aged 8-12 years were recruited from the community with 69 randomized to MYmind and 69 to CBT. Participants were assessed at baseline, immediately after intervention, at 3 months and 6 months. The primary outcome was the attention score of the Sky Search subtest of the Test of Everyday Attention for Children (TEA-Ch). Secondary outcomes were child behavior and parent-related assessments. Linear mixed models were used to assess the efficacy of MYmind compared with CBT. RESULTS: Both MYmind and CBT significantly improved children's attention score at 6 months (MYmind: ß = 1.48, p = 0.013, Cohen's d = 0.32; CBT: ß = 1.46, p = 0.008, d = 0.27). There were significant within-group improvements in most secondary outcomes. No significant difference was shown for both primary or secondary outcomes between the two arms at any time point. CONCLUSIONS: Both MYmind and CBT appeared to improve children's attention and behavior outcomes, although no difference was found between these two interventions. This is the largest RCT so far comparing MYmind and CBT although there was loss of follow-up assessments during the pandemic. Further RCTs adopting a non-inferiority design are needed to validate the results.

The Effects of a Mindfulness-Based Family Psychoeducation Intervention for the Caregivers of Young Adults with First-Episode Psychosis: A Randomized Controlled Trial.

OBJECTIVE: In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program. METHOD: We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes. RESULTS: Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers' outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement. CONCLUSIONS: A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size.

Using Photovoice in a Mindfulness-Based Program to Understand the Experiences of Caregivers of Young Adults with Psychosis.

Studies have consistently shown that family caregivers experience caregiver burden and depression when they provide care for family members with psychosis. Photovoice is a participatory action research method of fostering dialogues about personal experiences by sharing and discussing photographs that may improve our understanding about how a mindfulness-based family psychoeducation program (MBFPE) can reduce the caregiver burden and improve their caregiving experience. We explored the experiences of the participants in their use of photovoice in a MBFPE. We investigated whether the MBFPE program generated positive changes for caregivers of young adults with psychosis. Using photovoice, we collected qualitative data to help develop a unique contextual understanding of MBFPE program outcomes and generate novel ideas, insights, suggestions, and questions on the basis of participant's perceptions. Participants in our pilot study and randomized controlled study of MBFPE were invited to participate in this photovoice activity. On the basis of a procedure developed for MBFPE, caregivers were invited to use photographs to express how mindfulness contributed to caregivers' management of their caregiving stress and burden. Caregiver's inquiry with the MBFPE instructors were transcribed for analysis together with the photographs. A grounded theory approach was adopted to analyze the photovoice images, participants' reflections, and inquiries of photographs. Six themes were developed in understanding the lived experience of caregivers in participation of MBFPE: (1) I pay attention to the present moment; (2) I care about my family; (3) I trust my children; (4) I appreciate the connection with and support from nature and the universe; (5) I observe my worries and guilt and learn not to be reactive; and (6) I find space in offering care and exercising self-care. The application of photovoice can offer an additional approach to enhance the awareness and insights of participants in a mindfulness-based program. Specific guidelines may be developed to enhance the learning of participants.

Prospective Memory Training for Healthy Older Adults: A Systematic Review.

OBJECTIVES: This review systematically synthesizes existing evidence of prospective memory training for healthy older adults (> 55 years). Existing prospective memory training include strategy-based, process-based and combined regimens. Strategy-based training focuses on different mnemonics to compensate for aging declines in prospective memory. Process-based training aims to restore related cognitive processes to support prospective memory. Combined training utilizes both strategy-based and process-based regimens to enhance prospective memory performance. METHODS: A total of 349 studies were identified from the Cochrane Library, EBSCO, PsycINFO and PubMed databases. RESULTS: Using predefined inclusion and exclusion criteria, 11 studies were included in the review. There were six studies of strategy-based training, two studies of process-based training and three studies of combined training. CONCLUSIONS: Overall, strategy-based training appears to facilitate prospective memory for healthy older adults. However, it is impossible to draw conclusions for process-based and combined training due to the preliminary nature of current evidence. CLINICAL IMPLICATIONS: Mental imagery or the use of external aids can be useful strategy-based approaches to facilitate prospective memory in older adults. Strategy-based training should target multiple prospective memory phases simultaneously to encourage transfers. Further studies will be required to draw conclusions on the effectiveness of process-based and combined training.

Effects of a Mindful Parenting Workshop for Parents of Adolescents and Young Adults Following Social Unrest in Hong Kong.

OBJECTIVES: The social unrest that began in Hong Kong in 2019 became a threat to public mental health, such as for depression and post-traumatic stress disorders. A supportive family environment is the most effective protective factor for mental health problems for young people who are exposed to conflict and violence. This study investigated the outcomes of a brief mindful parenting workshop on parent mental health and family functioning. METHODS: Using a randomized controlled trial design, 54 parents of adolescents and young adults were randomized into intervention group and waitlist control group. Depression, anxiety, post-traumatic stress symptoms, negative emotions, family functioning, and family conflicts were measured at baseline (pretest), following training, and at 3-month follow-up. RESULTS: We found a significant improvement in family functioning among parents in the intervention group when compared to those parents in the control group (F [1, 51] = 4.41, p = .04). When we further controlled the child-initiated physical conflict as covariate, a significant reduction of self-rated levels of depressive symptoms was found in the parents from the intervention group when compared to the parents in the control group (F [1, 49] = 5.14, p = .03). CONCLUSIONS: We found preliminary evidence that a brief mindful parenting workshop can strengthen parent and family mental health at times of social unrest. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04427683).

Effects of Mindfulness-Based Stress Reduction on Health and Social Care Education: a Cohort-Controlled Study.

Objectives: Mindfulness practice has been recommended as part of health and social care education and training because of its potential benefits in fostering clinical skills and attitudes, increasing self-care, and reducing the effect of stress in education and occupation. The objectives of this study were to evaluate the effects of a mindfulness-based stress reduction (MBSR) program on stress, physical distress, job burnout, work engagement, and empathy for health and social care education. Methods: Students (N = 124) from postgraduate programs in social work, counseling, and family therapy were recruited. Sixty-four students participated in an 8-week MBSR program as an elective course. Sixty students were recruited from other elective courses in the same cohort as control group participants. All participants completed self-report assessments. Results: The results suggested that MBSR was associated with significant improvements in perceived efficacy and vigor and significant reductions in physical distress, total job burnout, emotional exhaustion, and depersonalization of clients compared with the control group. Conclusions: This study contributes to the growing body of literature highlighting the potential use of mindfulness practice to improve students' personal well-being and professional growth in health and social care education. Mindfulness practice should be further promoted in health and social care education and training.

Brief Report: Mindfulness Training for Chinese Adolescents with Autism Spectrum Disorder and Their Parents in Hong Kong.

This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness program (MYmind) on Chinese adolescents with autism spectrum disorder and their parents in Hong Kong, China using a randomized controlled trial with a waitlist control group. Results showed the study had 80% compliance rate, 0% dropout rate, and 89% response rate. Between-group comparisons showed mindfulness had trend effects on parent's rumination (g = 1.16), mindful parenting (d = 0.6), parenting style (d = 0.59), and parenting stress (d = 0.5). The study demonstrated the feasibility of the MYmind program in the Chinese context. A larger trial with longer follow-up period is suggested to better examine the effect of mindfulness on adolescents with ASD and their parents.

A Brief Mindfulness-Based Family Psychoeducation Intervention for Chinese Young Adults With First Episode Psychosis: A Study Protocol.

Family psychoeducation (FPE) has been recommended as a major component in the treatment of psychosis. Many previous studies have implemented an intensive program design that often only emphasized improvements in patients' illness outcomes but the benefits for caregivers were limited. There have been calls for a time-limited but cost-effective FPE program to mitigate the looming reality of the suffering of people with psychosis and their families. A Brief Mindfulness-Based Family Psychoeducation for psychosis program is developed to reduce caregivers' burden and promote young adult's recovery. A randomized controlled trial will be conducted to compare this intervention with an ordinary FPE intervention. Both arms will involve six sessions, with a total contact time of 12 h. 300 caregivers of young adults who have experienced first episode psychosis within last 3 years will be recruited. Program effectiveness will be assessed by comparing outcomes measuring the caregivers' burden, mental health symptoms, positive well-being, and the young adult's mental health symptoms during the study and at 9-month post-randomization. The role of expressed emotions, interpersonal mindfulness, and non-attachment in mediating these outcomes will be explored. An additional qualitative approach Photovoice is selected to explore the complex family experiences and the benefits of mindfulness from the caregivers' personal perspectives. Trial Registration: The trial is registered with the United States Clinical Trials Registry (ClinicalTrials.gov): NCT03688009.

Effects of a mindfulness-based intervention (MYmind) for children with ADHD and their parents: protocol for a randomised controlled trial.

INTRODUCTION: Mindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design. METHODS AND ANALYSIS: This study will adopt a randomised controlled trial design including 140 children aged 8-12 years with ADHD together with one of their parents (n=140). These families will be randomised into intervention group (n=70) who will be offered the MYmind programme delivered by trained healthcare professionals, and an active control group (n=70) who will be offered the CBT programme. The intervention includes 8 weekly 90 min group sessions for children with ADHD (aged 8-12 years) and their respective parents. The primary and secondary outcomes will include children's attention, ADHD-related symptoms, behaviours, executive function and mindfulness levels measured by validated objective measures and parent's reported instruments. Parents' parental stress, parenting styles, ADHD related symptoms, well-being, rumination level and mindfulness levels will also be measured. Analysis is by intention to treat. The effects of intervention will be evaluated by comparing outcomes between the two arms, as well as comparing outcomes within subject through comparing measurements at baseline (T0), immediately after the 8 week intervention (T1) and at 3 (T2) and 6 (T3) months postintervention. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (The Joint CUHK-NTEC CREC). Participants will be required to sign informed consent form from both parents and children. Findings will be reported in conferences and peer-reviewed publications in accordance with recommendations of Consolidated Standards of Reporting Trials. TRIAL REGISTRATION NUMBER: ChiCTR1800014741; Pre-results.

Mindfulness-based cognitive therapy v. group psychoeducation for people with generalised anxiety disorder: randomised controlled trial.

BACKGROUND: Research suggests that an 8-week mindfulness-based cognitive therapy (MBCT) course may be effective for generalised anxiety disorder (GAD). AIMS: To compare changes in anxiety levels among participants with GAD randomly assigned to MBCT, cognitive-behavioural therapy-based psychoeducation and usual care. METHOD: In total, 182 participants with GAD were recruited (trial registration number: CUHK_CCT00267) and assigned to the three groups and followed for 5 months after baseline assessment with the two intervention groups followed for an additional 6 months. Primary outcomes were anxiety and worry levels. RESULTS: Linear mixed models demonstrated significant group × time interaction (F(4,148) = 5.10, P = 0.001) effects for decreased anxiety for both the intervention groups relative to usual care. Significant group × time interaction effects were observed for worry and depressive symptoms and mental health-related quality of life for the psychoeducation group only. CONCLUSIONS: These results suggest that both of the interventions appear to be superior to usual care for the reduction of anxiety symptoms.

Validation of a Chinese version of the Five Facet Mindfulness Questionnaire in Hong Kong and development of a short form.

Mindfulness-based interventions are increasingly being used in various populations to improve well-being and reduce psychological afflictions. However, there is lack of a validated mindfulness measurement in the Chinese language. This study validated the Chinese version of the Five Facet Mindfulness Questionnaire (FFMQ-C) in both a community sample of 230 adults and a clinical sample of 156 patients with significant psychological distress. Results showed a good test-retest reliability (.88) and a high internal consistency (.83 in the community sample and .80 in the clinical sample). Mindfulness as measured by FFMQ-C has moderate to large correlations with psychological distress and mental well-being. Two of the five subscales (describing and acting with awareness) showed incremental validity over the others in predicting psychological symptoms and mental health. Confirmatory factor analysis confirmed the five-factor structure of the FFMQ-C and demonstrated adequate model fit. A 20-item short form scale (FFMQ-SF) was developed using the proposed comprehensive criteria. These findings indicate that the FFMQ-C is reliable and valid to measure mindfulness in a Chinese population. Further study is needed to evaluate the psychometric properties of FFMQ-SF.

The effects of mindfulness-based stress reduction program on the mental health of family caregivers: a randomized controlled trial.

BACKGROUND: Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems. Few studies have examined the effectiveness of mindfulness-based stress reduction (MBSR) in improving their mental well-being. METHODS: Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were randomly assigned to the 8-week MBSR group (n = 70) or the self-help control group (n = 71). Validated instruments were used to assess the changes in depressive and anxiety symptoms, quality of life, self-efficacy, self-compassion and mindfulness. Assessments were conducted at baseline, post-intervention and at the 3-month follow-up. RESULTS: Compared to the participants in the control group, participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention (p < 0.01). The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention (p = 0.007), although this difference was not statistically significant at 3 months post-intervention (p = 0.084). There was also a statistically significant larger increase in self-efficacy (controlling negative thoughts; p = 0.041) and mindfulness (p = 0.001) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group. No statistically significant group effects (MBSR vs. control) were found in perceived stress, quality of life or self-compassion. CONCLUSIONS: MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden, although further studies that include an active control group are needed to make the findings more conclusive.