Role of meditation to improve children's health: Time to look at other strategies.

In the United States, it is reported that up to 7 million of the population practice some form of meditation with the main purpose of improving emotional wellbeing and reducing stress. As the prevalence of mental health conditions continues to climb, other forms of health management strategies, including meditation practices, are increasingly used in adults. The evidence continues to emerge for the use of meditation as a way of managing health conditions in adults as demonstrated in systematic reviews and randomised controlled trials. There is also growing evidence evaluating the use of meditation practices and their potential benefits for child and adolescent health. Studies have identified improvements in mood and mental health conditions, school attendance and attention in the classroom in children and adolescents. This article aims to provide a perspective on commonly evaluated meditation types, such as Transcendental Meditation and mindfulness-based stress reduction. The article also aims to discuss the available evidence for the use of meditation to improve health and general wellbeing of children, including the use of meditation programs in schools, the current downfalls and limitations to the existing literature around meditation, and important points that healthcare practitioners need to consider when discussing the use of meditation as an additional strategy to manage and improve health and wellbeing in children and adolescents.

Mindfulness-based cognitive therapy experiences in youth with inflammatory bowel disease and depression: findings from a mixed methods qualitative study.

OBJECTIVES: Mindfulness-based cognitive therapy (MBCT) is effective in treating psychosocial comorbidities in inflammatory bowel disease (IBD); however, there have been no qualitative studies of MBCT experiences among youth with IBD. We aimed to examine the experiences of youth with IBD and depression who completed an adapted MBCT group programme, and the impact of common psychotherapy and group factors. DESIGN: This mixed method qualitative study, nested within a randomised controlled trial (RCT) of MBCT for youth with IBD, employed thematic analysis of qualitative data from three focus groups and open-ended survey questions. SETTING: The study was conducted in the outpatient department of a tertiary hospital for young adults in Brisbane, Australia. PARTICIPANTS: Out of sixty-four adolescents and young adults recruited to the RCT of MBCT for youth with IBD and depression, 29 completed the MBCT evaluation survey and 19 attended the focus groups. RESULTS: Four key themes emerged: 'connectedness and shared understanding', 'growing in wisdom', 'therapeutic alliance' and 'barriers to mindfulness practice'. Participants described MBCT experiences as healing and transformative with the themes of connectedness, growing in wisdom and therapeutic alliance laying the foundation for therapeutic change. Main barriers included fatigue, depression, time and travel constraints. CONCLUSIONS: The study identified key themes facilitating the process of therapeutic change within the MBCT programme for youth with IBD and elucidated common and group psychotherapy factors underlying the key themes. Participants perceived connecting with peers as essential for learning mindfulness skills which in turn strengthened the connection. Study findings will facilitate interpretation of the results of the RCT of MBCT in youth with IBD and inform the design of future studies of MBCT in this cohort. TRIAL REGISTRATION NUMBER: ACTRN12617000876392; Results.

Tending the Field of Mindfulness-Based Programs: The Development of International Integrity Guidelines for Teachers and Teacher Training.

Since Jon Kabat-Zinn first introduced a contemporary, secularized application of mindfulness for the relief of pain and stress in physical health-care settings, there has been a significant and rapid expansion of the range of mindfulness-based programs (MBPs) designed for various health care, education, workplace, and other settings. As is common with developing programs, these often run ahead of carefully considered and researched effectiveness evaluations. This raises questions of how to best train mindfulness teachers to skillfully facilitate such interventions while minimizing the potential for harm. In this article, we describe the work of an international group of senior teacher trainers who met to develop guidelines on the ethics and standards for teacher trainers and their training pathways. In this article, we will define MBPs; describe the process by which these international guidelines were developed; and share details of the collaborative team who made up the international network that worked on them. We offer these guidelines as "living documents" that specifically set out: (1) ethical standards for mindfulness teachers and trainers; (2) criteria and standards for teacher trainers; and (3) criteria and standards for training pathways. As "living documents," these will continue to be commented on and refined over time. Given that MBPs offered within secular settings in most countries currently have limited oversight or accreditation processes, we hope these guidelines will provide support and clarity to the teachers of all established and emerging MBPs, and their trainers and supervisors.

Mindfulness-Based Cognitive Therapy Experiences in Youth With Inflammatory Bowel Disease and Depression: Protocol for a Mixed Methods Qualitative Study.

BACKGROUND: Mindfulness-based programs are increasingly used as a part of integrated treatment for inflammatory bowel disease (IBD). However, the majority of research has been quantitative with limited qualitative exploration of patients' experiences of mindfulness programs and no studies among adolescents and young adults with IBD. Furthermore, there has been a paucity of research exploring the role of common psychotherapy and group factors within mindfulness programs. OBJECTIVE: This study aims to explore the experiences of adolescents and young adults with IBD and depression who completed a mindfulness-based cognitive therapy (MBCT) group program, as well as the role of therapeutic alliance, group affiliation, and other common psychotherapy and group factors. METHODS: This mixed methods qualitative study, nested within a randomized controlled trial (RCT) of MBCT for adolescents and young adults with IBD, will obtain qualitative data from focus groups and open-ended survey questions. The study aims to conduct three to four focus groups with 6-8 participants in each group. It will employ data and investigator triangulation as well as thematic analysis of the qualitative data. RESULTS: The study was approved by the Mater Hospital Human Research Ethics Committee and recruitment commenced in May 2019; study completion is anticipated by early 2020. CONCLUSIONS: The study will contribute to the assessment of acceptability and feasibility of the MBCT program for adolescents and young adults with IBD. It will also elucidate the role of previously unexplored common psychotherapy and group factors within mindfulness training and help inform the design of a future large-scale RCT of MBCT in this cohort. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12617000876392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373115. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/14432.

Protocol for a pilot randomised controlled trial of mindfulness-based cognitive therapy in youth with inflammatory bowel disease and depression.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic autoinflammatory disease of the gastrointestinal tract with peak age of onset during adolescence and young adulthood. Adolescents and young adults (AYAs) with IBD experience higher depression rates compared with peers who are well or have other chronic conditions. Mindfulness-based interventions are of particular interest because of their potential to improve both the course of IBD and depression. METHODS AND ANALYSIS: This study is a parallel design, single-blind, pilot randomised controlled trial (RCT) of mindfulness-based cognitive therapy (MBCT) in AYAs with IBD and depression. The trial aims to recruit 64 participants who will be randomly allocated to MBCT or treatment as usual. The primary outcome measure is the depression subscale score from the Depression, Anxiety and Stress Scale. Secondary outcomes include anxiety, stress, post-traumatic growth, IBD-related quality of life, illness knowledge, medication adherence, mindfulness, IBD activity, inflammatory markers, microbiome and brain neuroconnectivity changes. All outcomes other than neuroimaging will be collected at three time points: at baseline, at therapy completion and at 20 weeks. Neuroimaging will be conducted at baseline and at therapy completion. Mixed-effects linear and logistic regression modelling will be used to analyse continuous and dichotomous outcomes, respectively. Participants' experiences will be explored through focus groups, and thematic analysis will be used to generate relevant themes. ETHICS AND DISSEMINATION: The protocol has been approved by the Mater Hospital Human Research Ethics Committee (HREC) and University of Queensland HREC. Trial findings will be published in peer-reviewed journals and will be presented at scientific conferences. TRIAL REGISTRATION NUMBER: ACTRN12617000876392, U1111-1197-7370; Pre-results.

A systematic review and meta-analysis of mindfulness based interventions and yoga in inflammatory bowel disease.

BACKGROUND: Mindfulness interventions are increasingly used as a part of integrated treatment in inflammatory bowel disease (IBD) but there are limited data and a lack of consensus regarding effectiveness. OBJECTIVES: We explored the efficacy of mindfulness interventions compared to treatment as usual (TAU), or other psychotherapeutic interventions, in treating physical and psychosocial symptoms associated with IBD. METHODS: We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). We included a broad range of mindfulness interventions including mindfulness-based interventions and yoga, with no restrictions on date of publication, participants' age, language or publication type. We searched the following electronic databases: MEDLINE, EMBASE, PsycINFO, CINAHL and WHO ICTRP database. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines in conducting the review. RESULTS: We included eight studies in the meta-analysis. Mindfulness interventions showed a statistically significant effect on stress in both the short(SMD = -0.48; 95%CI:-0.97, 0.00; P = .05), and long term(SMD = -0.55; 95%CI:-0.78, -0.32; P < .00001), significant long term effects on depression (SMD = -0.36; 95%CI:-0.66, -0.07; P = .02) and quality of life (SMD = 0.38; 95%CI:0.08, 0.68; P = .01),and small but not statistically significant improvements in anxiety (SMD = -0.27; 95%CI:-0.65, 0.11; P = .16).Effects on physical outcomes were equivocal and not statistically significant. CONCLUSIONS: Mindfulness interventions are effective in reducing stress and depression and improving quality of life and anxiety, but do not lead to significant improvements in the physical symptoms of IBD. Further research involving IBD-tailored interventions and more rigorously designed trials is warranted.

Effects of mindfulness-based cognitive therapy on shame, self-compassion and psychological distress in anxious and depressed patients: A pilot study.

OBJECTIVES: The tendency to experience shame or guilt is associated differentially with anxiety and depression, with shame being associated with greater psychopathology. Correlational studies have shown self-compassion to be related to lower shame and rumination, and mindfulness-based interventions increase self-compassion. Therefore, mindfulness-based interventions may decrease shame. This pilot study aimed to assess the association of shame, rumination, self-compassion, and psychological distress and the effects of a mindfulness-based intervention on these measures in a clinical sample. DESIGN: Single-group design with pre-test and post-test measures. METHOD: Thirty-two service users who experienced clinically diagnosed depressive or anxiety disorders in a mindfulness-based cognitive therapy programme were assessed before and twenty-two after therapy with measures of shame-proneness, external shame, rumination, self-compassion, and psychological distress. RESULTS: Shame-proneness and external shame were positively correlated with self-coldness, and external shame was positively correlated with stress and depressive symptoms. Self-compassion increased and self-coldness decreased, while shame-proneness, rumination, anxiety, and stress symptoms decreased from pre- to post-treatment. There was no significant reduction in depressive symptoms, guilt-proneness, or external shame. CONCLUSION: Our preliminary findings suggest that mindfulness-based approaches may be helpful in increasing self-compassion and reducing shame-proneness in mixed groups of anxious and depressed patients. Controlled studies of the effects of mindfulness-based interventions on shame in clinical populations are warranted. PRACTITIONER POINTS: Shame-proneness and external shame showed different patterns of relationship with depressive and stress symptoms and with self-compassion. Shame-proneness decreased to a greater extent than external shame decreased following participation in an MBCT group. Mindfulness-based interventions may benefit shame-proneness to a greater extent than external shame.

A Framework for Supervision for Mindfulness-Based Teachers: a Space for Embodied Mutual Inquiry.

Over recent decades, there has been an exponential growth in mindfulness-based interventions (MBIs). To disseminate MBIs with fidelity, care needs to be taken with the training and supervision of MBI teachers. A wealth of literature exists describing the process and practice of supervision in a range of clinical approaches, but, as of yet, little consideration has been given to how this can best be applied to the supervision of MBI teachers. This paper articulates a framework for supervision of MBI teachers. It was informed by the following: the experience of eight experienced mindfulness-based supervisors, the literature and understandings from MBIs, and by the authors' experience of training and supervision. It sets out the nature and distinctive features of mindfulness-based supervision (MBS), representing this complex, multilayered process through a series of circles that denote its essence, form, content and process. This paper aims to be a basis for further dialogue on MBS, providing a foundation to increase the availability of competent supervision so that MBIs can expand without compromising integrity and efficacy.

The long-term effects of mindfulness-based cognitive therapy as a relapse prevention treatment for major depressive disorder.

BACKGROUND: Mindfulness-based Cognitive Therapy (MBCT) is a relapse prevention treatment for major depressive disorder. METHOD: An observational clinical audit of 39 participants explored the long-term effects of MBCT using standardized measures of depression (BDI-II), rumination (RSS), and mindfulness (MAAS). RESULTS: MBCT was associated with statistically significant reductions in depression from pre to post treatment. Gains were maintained over time (Group 1, 1-12 months, p = .002; Group 2, 13-24 months, p = .001; Group 3, 25-34 months, p = .04). Depression scores in Group 3 did begin to worsen, yet were still within the mild range of the BDI-II. Treatment variables such as attendance at "booster" sessions and ongoing mindfulness practice correlated with better depression outcomes (p = .003 and p = .03 respectively). There was a strong negative correlation between rumination and mindful attention (p < .001), consistent with a proposed mechanism of metacognition in the efficacy of MBCT. CONCLUSION: It is suggested that ongoing MBCT skills and practice may be important for relapse prevention over the longer term. Larger randomized studies of the mechanisms of MBCT with longer follow-up periods are recommended.