Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial.

BACKGROUND: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. OBJECTIVE: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. METHODS: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants' ratings), participants' feedback regarding the text messaging intervention, and smoking cessation (assessed in person). RESULTS: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. CONCLUSIONS: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. TRIAL REGISTRATION: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819.

Collegiate Athletes' Expectations and Experiences with Mindful Sport Performance Enhancement.

Although mindfulness training for athletes is an area of increasing interest, few studies have focused on the qualitative experiences of athletes in such programs. Prior to beginning six sessions of mindful sport performance enhancement (MSPE) training, 45 mixed-sport collegiate athletes reported what they hoped and expected to get from the training, and responded afterward to open-ended questions about their experiences. Participants' responses were coded for themes with high inter-rater reliability. Athletes initially hoped to gain psychological benefits in both sport and everyday life, such as relaxation and less stress or anxiety, better emotion regulation, mental toughness, and self-awareness, as well as sport performance improvement. Overall, they found MSPE to be a positive experience and reported many of the same benefits that they expected. Participants also provided constructive feedback and recommendations for future MSPE training. Finally, there was evidence to suggest that athletes' expectations predicted similar improvements in outcome measures.

Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma.

Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies involving emotional disengagement are associated with greater PTSD symptom severity and related psychopathology. Methodological challenges are explored and suggestions for future research and PTSD prevention programs are discussed.

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive-behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive-behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive-behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations.

Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.