Exploring the Optimal Factor Structure of the Five Facet Mindfulness Questionnaire: Associations Between Mindfulness Facets and Dimensions of Psychopathology.

Recent studies of the Five Facet Mindfulness Questionnaire (FFMQ) and its condensed version (FFMQ-SF) fail to replicate the initially proposed five-factor structure in clinical samples. Failure to adequately understand the dimensionality of common mindfulness measures within clinical samples, therefore, represents an important gap in the current literature. The increasing popularity of mindfulness-based interventions warrants further investigation of differential associations between facets of mindfulness and different forms of psychopathology. We examined (a) the underlying structure of the FFMQ and FFMQ-SF, and (b) associations between FFMQ and FFMQ-SF facets and dimensions of psychopathology (i.e., internalizing and substance use disorders) in two large clinical samples (N = 2,779). Results from bass-ackwards analyses suggested similarly defensible five- and six-factor model solutions in terms of fit. The five-factor model was optimal when factoring in parsimony. Exploratory structural equation modeling revealed that all FFMQ facets with the exception of observe were negatively associated with the internalizing factor. Associations with substance use disorders were more complex. In both samples, five-factor FFMQ and FFMQ-SF models were determined to best represent these data. Whereas deficits in all FFMQ facets with the exception of observe correspond with lower internalizing psychopathology, a more nuanced association was observed with substance use disorders.

Emotion regulation accounts for associations between mindfulness and depression across and within diagnostic categories.

BACKGROUND: Previous research shows that mindfulness and emotion regulation (ER) are highly related to each other. Preliminary evidence in small clinical populations show that ER may partially account for the relationship between mindfulness and depressive symptoms. The present study aimed to investigate which diagnostic categories were associated with depressive symptoms after controlling for ER in a heterogeneous sample of treatment-seeking patients. METHODS: A large sample of psychiatric outpatients (N = 911) completed the Structured Clinical Interview for DSM-IV (SCID), Five Facet Mindfulness Questionnaire (FFMQ), Difficulties in Emotion Regulation Scale (DERS), and Clinically Useful Depression Outcome Scale (CUDOS). Partial correlations were conducted to evaluate to what degree the relationship between depression scores and facets of mindfulness were accounted for by ER scores. RESULTS: When controlling for baseline mindfulness, the relationship between emotion dysregulation and depression symptoms remained significant for all data points; however, when controlling for baseline emotion dysregulation, the association between mindfulness and depression was not significant in the majority of cases. Nonjudging was most resistant to this result. CONCLUSIONS: Although mindfulness is negatively associated with depressive symptoms, this association may be better accounted for by emotion dysregulation.

Re-examining borderline personality disorder and substance use disorder: The role of emotion dysregulation

BACKGROUND: Borderline personality disorder (BPD) and substance use disorder (SUD) frequently co-occur. Although some research has investigated the factors related to this comorbidity, few have isolated the effects of SUD on a BPD diagnosis. METHODS: Patients presenting for treatment were assessed with the Structured Clinical Interview for DSM-IV, the BPD module of the Structured Interview for DSM-IV Personality, the Difficulties in Emotion Regulation Scale (DERS), and the Five Facet Mindfulness Questionnaire (FFMQ). Analyses were conducted to determine how individuals diagnosed with BPD differ from individuals diagnosed with BPD and SUD. RESULTS: Among the BPD diagnostic criteria, patients with comorbid BPD and SUD endorsed impulsivity at higher rates, and patients with only BPD more frequently endorsed frantic efforts to avoid real or imagined abandonment. The 2 groups were not distinguished by scores on the DERS, although the comorbid group reported higher FFMQ scores, specifically on the acting with awareness subscale. CONCLUSIONS: Borderline personality disorder is fundamentally based on emotion dysregulation. Substance use and efforts to avoid abandonment are both forms of maladaptive coping that stem from this dysregulation, and individuals with BPD may tend to rely on one or the other. Future studies should continue to evaluate these clinical features across diverse groups.

Broader conceptualization of remission assessed by the remission from depression questionnaire and its association with symptomatic remission: a prospective, multicenter, observational study.

BACKGROUND: Goals of treating major depressive disorder (MDD) include achieving remission and avoiding relapse. It is possible that patients may have a broader view of remission than what is captured via clinician-rated scales. This patient perspective may, in turn, have an impact on treatment outcomes. METHODS: The association between a broader conceptualization of remission, based on the Remission from Depression Questionnaire (RDQ) score at baseline, and being in symptomatic remission after 6 months was evaluated in subjects (N = 613) with MDD in symptomatic remission at baseline (17-item Hamilton Rating Scale for Depression [HAMD-17] ≤7). Specific aspects of depression were assessed from physician and patient perspectives as secondary endpoints. A backwards selection strategy was used to statistically model remission status and determine association of factors with potential to influence remission. RESULTS: At month 6, after adjustment for baseline HAMD-17 score, there was no association between baseline RDQ score and symptomatic remission status (HAMD-17), relapse, composite remission status, healthcare resource utilization, or quality of life. There was no association between functional impairment scores at baseline (Sheehan Disability Scale and Social and Occupational Functioning Assessment Scale) and symptomatic remission status (HAMD-17) at month 6. CONCLUSIONS: This study indicates that RDQ-constructs are independent from symptomatic remission. Symptom severity at study entry appeared to be the only significant predictor of eventual relapse during the 6-month follow-up period. However, our results also suggest that the current definition of remission that is based on symptom reduction should be further elaborated and that alternative or additional definitions should be considered in determining remission.

Which facets of mindfulness are related to problematic eating among patients seeking bariatric surgery?

There has been growing research indicating the potential positive benefits of mindfulness-based interventions for obesity, but few studies have examined the relationship of mindfulness processes to obesity-related behaviors, particularly among clinical populations such as bariatric surgery candidates. The current study examined the relationship of specific mindfulness facets to a variety of problematic eating behaviors assessed through diagnostic interviews in a clinical sample of 820 patients seeking bariatric surgery. Results indicated that greater mindfulness on specific facets, particularly acting with awareness, was related to less binge and emotional eating. Greater mindfulness was also related, though less consistently, to less habitual overeating and grazing. The observing facet was generally unrelated to problematic eating, but in a few cases being more observant related to having greater eating problems. The results of the study and future directions are discussed in relation to research on problematic eating in obesity and mindfulness-based interventions.

Which facets of mindfulness predict the presence of substance use disorders in an outpatient psychiatric sample?

There have been inconsistent findings regarding the relationship of mindfulness to substance use disorders, which may be attributable in part to measurement issues and the use of nonclinical samples. The current study examined the relationship between specific facets of mindfulness and substance use disorders (SUD) in a clinical sample. The sample consisted of 867 patients seeking outpatient treatment and who completed diagnostic interviews and self-report assessments. Results indicated that deficits in acting with awareness, being nonjudgmental, and nonreactivity were related to the presence of a current SUD relative to those with no history of SUD, although only acting with awareness and being nonjudgmental were related when all of the facets were included in a logistic regression. Patients with a past history of SUD had greater deficits in acting with awareness relative to those with no history of SUD. Results were similar when examining alcohol use and drug use disorders separately. Current nicotine users had greater deficits in being nonjudgmental, but not on other mindfulness facets. The observing facet was not related to current or past history of SUD. The results of the study and future directions are discussed in relation to research on mindfulness-based treatments for addiction.

Diagnostic orphans for alcohol use disorders in a treatment-seeking psychiatric sample.

Individuals who endorse one or two of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criterion items for alcohol dependence but do not meet criteria for either alcohol abuse or dependence have been referred to in the literature as "diagnostic orphans." The goal of the present study is to compare diagnostic orphans for alcohol use disorders (AUD) to patients with lifetime DSM-IV alcohol abuse, alcohol dependence, and those with no-AUD symptoms on a series of demographic, diagnostic, and clinical measures. Participants were treatment-seeking psychiatric outpatients (n=1793; 61.5% women) who completed an in-depth, face-to-face diagnostic evaluation for DSM-IV axis I and axis II disorders. Results revealed that diagnostic orphans were younger, had a higher frequency of family history positive for alcoholism, and higher rates of cannabis dependence, as compared to the no-AUD symptoms group. Diagnostic orphans differed significantly from patients with alcohol abuse and dependence on a number of demographic, diagnostic, and clinical measures. Most notably, on a lifetime basis, diagnostic orphans were less likely to meet diagnostic criteria for various substance use disorders, as compared to individuals with alcohol abuse and dependence. Taken together, these results generally do not support combining diagnostic orphans to individuals with alcohol abuse.

An open randomized comparison of gatifloxacin versus cefixime for the treatment of uncomplicated enteric fever.

OBJECTIVE: To assess the efficacy of gatifloxacin versus cefixime in the treatment of uncomplicated culture positive enteric fever. DESIGN: A randomized, open-label, active control trial with two parallel arms. SETTING: Emergency Room and Outpatient Clinics in Patan Hospital, Lagankhel, Lalitpur, Nepal. PARTICIPANTS: Patients with clinically diagnosed uncomplicated enteric fever meeting the inclusion criteria. INTERVENTIONS: Patients were allocated to receive one of two drugs, Gatifloxacin or Cefixime. The dosages used were Gatifloxacin 10 mg/kg, given once daily for 7 days, or Cefixime 20 mg/kg/day given in two divided doses for 7 days. OUTCOME MEASURES: The primary outcome measure was fever clearance time. The secondary outcome measure was overall treatment failure (acute treatment failure and relapse). RESULTS: Randomization was carried out in 390 patients before enrollment was suspended on the advice of the independent data safety monitoring board due to significant differences in both primary and secondary outcome measures in the two arms and the attainment of a priori defined endpoints. Median (95% confidence interval) fever clearance times were 92 hours (84-114 hours) for gatifloxacin recipients and 138 hours (105-164 hours) for cefixime-treated patients (Hazard Ratio[95%CI] = 2.171 [1.545-3.051], p<0.0001). 19 out of 70 (27%) patients who completed the 7 day trial had acute clinical failure in the cefixime group as compared to 1 out of 88 patients (1%) in gatifloxacin group(Odds Ratio [95%CI] = 0.031 [0.004 - 0.237], p<0.001). Overall treatment failure patients (relapsed patients plus acute treatment failure patients plus death) numbered 29. They were determined to be (95% confidence interval) 37.6 % (27.14%-50.2%) in the cefixime group and 3.5% (2.2%-11.5%) in the gatifloxacin group (HR[95%CI] = 0.084 [0.025-0.280], p<0.0001). There was one death in the cefixime group. CONCLUSIONS: Based on this study, gatifloxacin is a better treatment for uncomplicated enteric fever as compared to cefixime. TRIAL REGISTRATION: Current Controlled Trials ISRCTN75784880.