Resiliency Intervention for Siblings of Children With Autism Spectrum Disorder: A Randomized Pilot Trial.

BACKGROUND /OBJECTIVES: Neurotypical siblings (NT siblings) of children with autism spectrum disorder (ASD) are at elevated risk for emotional distress and adjustment problems. Resiliency is the ability to cope and adapt with ongoing stressors. We conducted a randomized waitlist-controlled pilot trial to examine the feasibility, acceptability, and preliminary efficacy of an adapted virtual mind-body resiliency group intervention for teen NT siblings of children with ASD. METHODS: We modified the Stress Management and Resiliency Training-Relaxation Response Resiliency Program for NT siblings of children with ASD (SibChat). We randomly assigned teens (aged 14-17) to immediate intervention (IG) versus waitlist control (WLC). The intervention included eight 60-minute weekly video conference group sessions. We assessed feasibility (enrollment, attendance, and retention) and acceptability (post treatment survey and weekly relaxation response practice). We explored group differences in pre-post change scores for 1) stress coping (Measure of Current Status-A) and 2) resiliency (Current Experiences Scale) using independent samples t tests and effect size calculations. RESULTS: We enrolled 83% of screened eligible teens. A total of 90% IG and 75% WLC participants attended at least 6/8 sessions. Among IG participants who completed the post treatment survey, 79% reported practicing relaxation response exercises at least "a few times a week". Comparing change in baseline to time 1, the IG showed better relative changes than the WLC group in stress coping (d = 0.60) and resiliency (d = 0.24). CONCLUSIONS: Our pilot trial showed promising feasibility, acceptability, and preliminary efficacy of SibChat on at least one of the 2 primary outcomes supporting further testing of the SibChat intervention. CLINICAL TRIAL REGISTRATION: US National Library of Medicine. REGISTRATION NUMBER: NCT04369417. https://clinicaltrials.gov/ct2/show/NCT04369417.

Maintenance of Effects and Correlates of Changes Following Mindfulness for Interdisciplinary Health Care Professional Students.

Objectives: To evaluate long-term outcomes after an 8-week mindfulness intervention, Mindfulness for Interdisciplinary Health Care Professionals (MIHP), and investigate relationships between outcomes overtime. Design/Methods: In this single-arm study, 35 participants received MIHP and completed measures of burnout, perceived stress, activity impairment, and dispositional mindfulness at baseline, post-MIHP, and a 3-month follow-up. Changes over time were evaluated using repeated-measures analysis of variance (ANOVA) and reliable change indices (RCIs). Then, correlations between dispositional mindfulness and distress/impairment outcomes were evaluated. Results: At follow-up, aspects of burnout and several mindfulness skills demonstrated maintained improvements. RCIs showed that a higher percentage of participants improved on all outcomes at each time period than declined-all outcomes showed little to no deterioration. However, most participants did not reliably change, and this was more pronounced at the follow-up. Changes in two mindfulness skills (acting with awareness and nonjudging of inner experience) were consistently negatively correlated with distress and impairment outcomes. Conclusions: Acquired mindfulness skills during MIHP were maintained at the follow-up. RCI analyses demonstrated that MIHP may protect against worsening stress and burnout during training. Two mindfulness skills, acting with awareness and nonjudging of inner experience, showed potential mechanistic effects on work-relevant outcomes. Booster sessions to encourage maintained mindfulness practices and skills should be investigated in future trials. This study was registered on clinicaltrials.gov (#NCT03403335) on January 11, 2018.

Effectiveness of a 4-Day Mindfulness-Based Intervention in a 2-Month Follow-Up for Chinese Incarcerated People.

Mindfulness-based interventions, an evidence-based stress reduction approach, may help incarcerated people cope with stress-related problems in the challenging environment of prison. However, due to their unique living environment, the duration and instructor guidance required by standard mindfulness-based interventions would be infeasible in most prisons. Therefore, the aims of the current study were to test the effects of two different 4-day interventions (i.e., instructor-guided and audio-based) with content similar to Mindfulness-Based Cognitive Therapy for newly incarcerated males, and to compare the effectiveness of the two interventions relative to a no-intervention control group. Using daily assessments, we explored changes in perceived stress, insomnia, and negative affect in the 56 days following the instructor-guided (N = 25), audio-based (N = 21), and control (N = 44) intervention; length of mindfulness practice during the follow-up was also compared between the two intervention groups. Hierarchical linear model results showed significantly greater linear decreases in perceived stress after both mindfulness interventions during the 56-day follow-up (γ11 = -0.011, p < .001, 95% CI [-0.017, -0.004] for instructor-guided intervention; γ12 = -0.013, p < .001, 95% CI [-0.018, -0.006] for audio-based intervention), as compared to the control group. Compared to the control group, the instructor-guided group reported a significantly greater decrease in insomnia (γ11 = -0.007, p < .001, 95% CI [-0.014, -0.002]), but the audio-based group did not (γ12 = -0.002, p = .160, 95% CI [-.007, .004]). Neither mindfulness-based intervention group reported a significantly greater decrease in negative affect compared to the control group (γ11 = -0.002, p = .170, 95% CI [-0.005, 0.001] for instructor-guided intervention; γ12 = -0.002, p = .150, 95% CI [-0.006, 0.002] for audio-based intervention). No significant difference between the two intervention groups was found in the change of outcomes (γ11 = 0.002, -0.005 and 0.000, p = .350, .130 and .390, 95% CI [-0.008, 0.011], 95% CI [-0.014, 0.004] and 95% CI [-0.004, 0.006] subsequently for perceived stress, insomnia and negative affect). Daily mindfulness practice was significantly longer for the audio-based group on the first day of follow-up (γ02 = -0.758, p < .05, 95% CI [-1.333, -0.129]), but it gradually decreased to the same amount as the instructor-guided group (t (32) = 0.051, p = .959). Short-term mindfulness interventions, either instructor-guided or audio-based, appear to be beneficial for Chinese prisoners in reducing stress. Live instruction may have potential benefit in reducing insomnia and sustaining daily practice.

Corrigendum to "Examining the effects of stress and psychological distress on smoking abstinence in cancer patients" [Prev. Med. Rep. 23 (2021) 101402].

[This corrects the article DOI: 10.1016/j.pmedr.2021.101402.].

Relationship between adverse childhood experiences and anxiety symptoms among Chinese adolescents: The role of self-compassion and social support.

Previous studies have revealed that adverse childhood experiences (ACEs) create a significant and lasting effect of increased anxiety. However, few studies have examined the mediating and moderating mechanisms underlying this relation. The present study aimed to explore the mediating role of self-compassion and moderating role of social support in ACEs-anxiety relationship among Chinese adolescents. In this cross-sectional study, 1,764 middle school students completed questionnaires measuring their levels of ACEs, anxiety, self-compassion (SC), and social support. Correlations of variables were computed using Pearson's r. Mediation and moderated mediation models were tested using PROCESS macro with the regression bootstrapping method. After covariates (age and gender) were controlled, results showed that: (1) ACEs were positively associated with anxiety symptoms; (2) self-compassion partially mediated the ACEs-anxiety association; (3) both ACEs-anxiety and SC-anxiety relationships were moderated by social support. Specifically, social support was associated with lower anxiety, particularly among students with fewer ACEs or lower level of self-compassion. Reducing possible adversities existing in environment may help to reduce risk of anxiety for adolescents. Cultivating self-compassion is crucial for adolescents' mental health, since it may play a role in ACEs-anxiety relationship. Social support would operate as a buffer to ACEs in the relation with anxiety, under the circumstances of mild adversities, and a promoter to self-compassion in the relation with anxiety, under the circumstances of low self-compassion.

Internalized stigma among cancer patients enrolled in a smoking cessation trial: The role of cancer type and associations with psychological distress.

PURPOSE: Cancer patients who smoke may experience significant stigma due both to their disease, and negative attitudes and beliefs regarding smoking. We investigated whether internalized stigma differed between currently smoking cancer patients diagnosed with lung or head and neck cancers, other smoking related cancers, and non smoking-related cancers, and whether internalized stigma was associated with psychological distress. METHODS: This cross-sectional analysis used baseline data on 293 participants enrolled in a multi-site randomized smoking cessation intervention trial of patients with recently diagnosed cancer. Internalized stigma was assessed using five Internalized Shame items from the Social Impact of Disease Scale. Smoking-related cancers included lung, head and neck, esophageal, bladder, kidney, liver, pancreatic, colorectal, anal, small intestinal, gastric, and cervical. We used multivariable linear regression to examine whether mean internalized stigma levels differed between individuals with lung and head and neck cancers, other smoking-related cancers, and non smoking-related cancers, adjusting for potential confounders. We further examined the association of internalized stigma with depression, anxiety, and perceived stress, overall and among cancer type groups. RESULTS: Thirty-nine percent of participants were diagnosed with lung or head and neck cancer, 21% with another smoking-related cancer, and 40% with a non smoking-related cancer. In multivariable-adjusted models, participants with lung or head and neck cancers (11.6, 95% confidence intervals (CI) = 10.8-12.2; p < 0.0001) or other smoking-related cancers (10.7, 95% CI = 9.8-11.7; p = 0.03) had higher mean internalized stigma scores compared to those non-smoking-related cancers (9.3, 95% CI = 8.6-10.0). We observed similar positive associations between internalized stigma and depressive symptoms, anxiety, and perceived stress among participants with smoking-related and non smoking-related cancers. CONCLUSIONS: Among smokers, those with smoking-related cancers experienced the highest levels of internalized stigma, and greater internalized stigma was associated with greater psychological distress across cancer types. Providers should assess patients for internalized and other forms of stigma, refer patients for appropriate psychosocial support services, and address stigma in smoking cessation programs.

Acceptability of a Virtual Mind-Body Intervention for Parents of Children With Autism or Learning Disabilities.

OBJECTIVE: Parents of children with learning/attentional disabilities (LAD) and autism spectrum disorder (ASD) are at elevated risk for chronic stress. Types of stress and treatment needs differ between these parent groups. We adapted our evidence-based mind-body intervention (SMART-3RP) for parents of children with LAD and ASD, delivered via videoconferencing. Preliminary results from our two wait-list randomized pilot trials suggest the programs were feasible and efficacious. To gain an in-depth understanding of acceptability, the purpose of this secondary analysis from the RCTs is to (1) explore feedback regarding the virtual SMART-3RP and (2) compare feedback across LAD and ASD parents. METHODS: Participants were randomized to immediate or delayed SMART-3RP (separate groups for LAD and ASD) and completed a feedback questionnaire post-intervention (N = 33 LAD, N = 37 ASD; 93% female, 93% white, Mage = 45.52, SD = 6.50). RESULTS: Participants reported the intervention had the right number of sessions (69%), session duration (83%), and amount of structure (83%). They felt comfortable during sessions (89%) and found mind-body skills helpful (89%). There were no significant differences between parent groups other than a trend for more ASD parents reporting sessions were too long (22% ASD vs. 6% LAD, X2 = 5.67, p =0.06). Qualitative themes were similar across parents and included that video delivery had some technical challenges but enabled participation; group support and mind-body skills were helpful; and further SMART-3RP sessions or therapy is needed. CONCLUSION: LAD and ASD parents found a synchronous video-based mind-body resiliency program acceptable. Technology limitations notwithstanding, online delivery was very satisfactory and overcame obstacles to participation.

A Comprehensive Resiliency Framework: Theoretical Model, Treatment, and Evaluation.

BACKGROUND: There is heterogeneity in conceptualizations of resiliency, and there is, to date, no established theoretically driven resiliency assessment measure that aligns with a targeted resiliency intervention. We operationalize resiliency as one's ability to maintain adaptive functioning in response to the ongoing, chronic stress of daily living, and we use a novel resiliency measure that assesses the target components of an evidence based resiliency intervention. We present our resiliency theory, treatment model, and corresponding assessment measure (Current Experience Scale; CES). METHODS: To establish the psychometric properties of the CES, we report the factor structure and internal consistency reliability (N = 273). Among participants in our resiliency intervention (N = 151), we explored construct validity in terms of associations with theoretical model constructs, a validated resiliency measure, and sensitivity to change from before to after the intervention. RESULTS: Results indicated that a 23-item, 6-factor solution was a good fit to the data (RMSEA = .08, CFI = .97; TLI =.96) and internal consistency was good (α = .81 to .95). The CES showed correlations in the expected direction with resiliency model constructs (all p's < .001) and significant post intervention improvements. CONCLUSION: Our resiliency theory, treatment model, and outcome appear aligned; the CES demonstrated promise as a psychometrically sound outcome measure for our resiliency intervention and may be used in future longitudinal studies and resiliency building interventions to assess individuals' resiliency to adapt to ongoing stress.

Moderators of a resiliency group intervention for frontline clinicians during the COVID-19 pandemic.

BACKGROUND: To mitigate the psychological burdens of COVID-19 for frontline clinicians (FCs), we adapted an existing evidence-based resiliency program, Stress Management and Resilience Training Relaxation Response Program (SMART-3RP), for FCs. This analysis explores moderators of stress coping to determine which subgroups of FCs benefited most from SMART-3RP. METHODS: 102 FCs from Mass General Brigham hospitals engaged in the adapted SMART-3RP. Assessments were completed at group entry (Week 0) and completion (Week 4). The primary outcome was stress coping, and we examined 15 possible baseline moderators. We fit linear mixed effects regression models and assessed potential baseline moderators using a likelihood ratio test. We report model-based estimates and confidence intervals for each moderator-by-time interaction (i.e., differential effect), where positive/negative values indicate more/less improvement in average perceived stress coping. RESULTS: Stress coping improved from Week 0 to Week 4 (mean improvement [95% CI] = 0.9 [0.6 to 1.2]). FCs with higher anxiety (differential effect [95% CI] = 0.3 [0.1 to 0.4]), depression (0.4 [0.2 to 0.6]), and loneliness (0.4 [0.1 to 0.6]), but lower levels of mindfulness (CAMS-Rfocus: 1.0 [0.4 to 1.6]; CAMS-Raccept: 1.3 [0.7 to 2.0]) and self-compassion (0.4, [0.1 to 0.8]) at baseline experienced greater benefits in perceived stress coping from the SMART-3RP. Baseline health uncertainty along with sociodemographic and work characteristics did not moderate stress coping. DISCUSSION: Results highlight particular sub-populations of FCs that may benefit more from a stress management intervention, especially during emergency responses (e.g., COVID-19 pandemic).

Development and Initial Validation of the Relaxation Sensitivity Index.

Relaxation sensitivity indexes the fear of relaxation-related events. The purpose of this study was to develop and provide initial validation of a self-report measure of relaxation sensitivity, the Relaxation Sensitivity Index (RSI). Three independent samples of undergraduate students (n=300 unselected, n=349 non-clinical, and n=197 clinical analogs with elevated anxiety/depression symptoms) completed self-report measures to examine the factor structure, reliability, and validity of the RSI. Results of exploratory and confirmatory factor analyses supported a three-factor structure (correlated Physical, Cognitive, and Social Concerns). The RSI demonstrated good internal consistency and construct validity as evidenced by expected correlations with measures of anxiety and depression symptoms. The RSI showed good predictive validity in terms of a history of fearful responding to relaxation. RSI scores were significantly higher in the symptomatic compared to non-clinical sample. Results suggest the RSI is a valid and reliable measure that may be useful in clinical and research settings.

Examining the effects of stress and psychological distress on smoking abstinence in cancer patients.

INTRODUCTION: Cancer patients who smoke report more stress and psychological distress than patients who do not smoke. It is unclear how these emotional symptoms may modify smoking behavior in cancer patients. We examined the influence of a smoking cessation intervention for cancer patients on stress and distress, and the effects of these symptoms on smoking abstinence. METHODS: Mixed-methods secondary analysis of data from the Smokefree Support Study, a two-site randomized controlled trial examining the efficacy of Intensive (IT; n = 153) vs. Standard Treatment (ST; n = 150) for smoking cessation in newly diagnosed cancer patients. Stress coping, perceived stress, distress, and anxiety were self-reported at baseline, 3, and 6 months. Abstinence was biochemically-confirmed at 6 months. A subset of patients (n = 72) completed qualitative exit-interviews. RESULTS: Patients were on average, 58 years old, 56% female, and smoked a median of 10 cigarettes/day. There were no significant treatment group × time interactions or main effects of treatment group on stress or distress measures (p's > 0.05), however there were significant main effects of time suggesting symptom improvements on each measure in both study groups (p's < 0.05). In adjusted logistic regression models, lower levels anxiety at 3 months predicted confirmed smoking abstinence at 6 months (p = .03). Qualitatively, at 6 months, patients reported their stress and smoking were connected and that the cessation counseling was helpful. CONCLUSIONS: Cancer patients enrolled in a smoking cessation trial report decreases in stress, distress and anxiety over time, and anxiety symptoms may impact smoking cessation success at follow-up resulting in an important intervention target.

Smokers with and without Epilepsy show Similar Smoking Rate, Dependence Level, Cessation Attempts, and Motives.

BACKGROUND: Individuals with epilepsy are up to twice as likely to be current cigarette smokers compared to those without. Moreover, one study showed current smoking is associated with an increased likelihood of seizures. However, outside of this one study, there is limited data on the presentation of specific smoking-related behaviors and cognitions in people with epilepsy, inhibiting our understanding of the severity of this behavior and our ability to formulate effective treatments for this population. PURPOSE: The current study examined smoking-related behaviors and cognitions among smokers with epilepsy compared to smokers without epilepsy. METHODS: Participants were 43 smokers with (Mage = 43.4, SD = 11.6) and 43 smokers without (Mage = 45.5, SD = 8.8) epilepsy recruited from an urban, academic setting within the U.S. Separate Analyses of Covariance (ANCOVAs) were conducted to evaluate differences between smokers with and without epilepsy in terms of smoking behavior (i.e., daily smoking rate, nicotine dependence, number of quit attempts, smoking duration, age of smoking onset) and smoking-related cognitive processes (i.e., smoking motives, perceived barriers to smoking cessation, cessation motives) after controlling for race and problematic alcohol use. RESULTS: Smokers with epilepsy did not differ from smokers without epilepsy in terms of smoking rate (p = .51, ηp2 = .01), nicotine dependence (p = .12, ηp2 = .03), age of smoking onset (p = .42, ηp2 = .01), number of quit attempts (p = .43, ηp2 = .01), barriers to cessation (p = .30 to .80, ηp2 = .00 to .01), or cessation motives (p = .28 to .60, ηp2 = .00 to .02). Smokers without epilepsy reported higher levels of smoking for sensorimotor manipulation reasons (p = .03, ηp2 = .06) and longer smoking duration (p = .03, ηp2 = .06) than smokers with epilepsy. CONCLUSIONS: Smokers with epilepsy do not appear to differ significantly from smokers without epilepsy in terms of smoking-related behaviors and cognitions, and may therefore benefit from current evidence-based treatments for smoking cessation that are not contraindicated for epilepsy (i.e., bupropion, varenicline).

Validation of the Chinese Version of Relaxation Sensitivity Index: A Tool for Predicting Treatment Effect in Mindfulness Interventions.

Background: The Relaxation Sensitivity Index (RSI) measures relaxation-related fears developed and validated in western samples. The RSI captures three facets of fear regarding relaxation: physical, cognitive, and social concerns. This study aimed to translate and identify the factor structure of the Chinese version of the RSI. Methods: In a preliminary study, 26 items were generated mainly by translation and modified from the original RSI. In Study 1, factor analysis and internal consistency reliability analysis were conducted on separated half samples of 597 Chinese college students. In Study 2, test-retest reliability, convergent, and predictive criterion validity were examined based on 465 Chinese college students. Results: Fourteen items were selected based on the factor loading and item prevalence in the preliminary study. Factor analysis based on Study 1 identified three factors: Social appealing, Social performance, and Physical concerns. In general, the RSI demonstrated good internal consistency (αs = 0.750-0.860), convergent validity and predictive criterion validity, while the test-retest reliability is relatively low (rs = 0.525-0.685). Notably, less related to the other two factors, Social performance concerns may be a unique factor solely predicting social anxiety (p <0.001), but not relaxation-induced anxiety (p = 0.442). Conclusion: The Chinese version of the RSI possesses a factor structure different from the western population. The robustness of factor structure and test-retest reliability was not as good as expected. Further research is warranted to explore the validity of the RSI in Chinese samples.

Responding to COVID-19 Stress: Disseminating Mind-Body Resiliency Approaches.

The COVID-19 pandemic has resulted in unprecedented stress and uncertainty, particularly among vulnerable populations such as healthcare workers who are facing a multitude of current and looming economic and psychosocial stressors. As clinician-scientists delivering mind-body interventions in our hospital, we suggest applying evidence-based mind-body techniques that promote resiliency and adaptive coping during these difficult times. Interventions that package a variety of mind-body skills into one cohesive program, such as the Stress Management and Resiliency Training - Relaxation Response Resiliency Program (SMART-3RP), offer promise for meeting the variety of stress management needs (e.g., health concerns, isolation) present during the COVID-19 pandemic. From our work with frontline healthcare clinicians and other caregiver populations, we offer recommendations for adapting the delivery, modality, and content of mind-body practices during the COVID-19 pandemic and suggest key skills for promoting resiliency and buffering against the future stressors that lie ahead for everyone.

Feasibility and Acceptability of a Community-Based Modified Mindfulness-Based Stress Reduction Program for the Under- and Unemployed.

BACKGROUND: Mindfulness-Based Stress Reduction (MBSR) often improves health outcomes, though literature primarily focuses on middle-class, employed individuals. With an estimated average of six million unemployed over the past year, and the recent uptick in unemployment due to the COVID-19 pandemic, it is important to identify methods to mitigate and reduce the negative health outcomes often associated with under- and unemployment. OBJECTIVES: We aimed to 1) outline the process of partnering with a community organization to implement a modified MBSR program for under- and unemployed individuals, and 2) present pilot data on preliminary results. METHODS: The modified MBSR program was implemented in two phases within a job training program for under- and unemployed individuals. In Phase I, group one received an eight-week program. Based on feedback, the MBSR program was reduced to six weeks and implemented for groups two and three (Phase II). Feasibility and acceptability were evaluated utilizing a mixed-methods approach. Changes in mindfulness, perceived stress, pain interference, anxiety, depression, and sleep disturbance were assessed pre-post the modified MBSR program. RESULTS: Thirty-three participants completed the program with twenty-nine post-survey responses. The modified MBSR program was feasible and acceptable as evidenced by the enrollment rate (96%), retention rate (72%), and qualitative feedback. Fifty-percent of participants self-reported weekly home practice compliance. Perceived stress and mindfulness demonstrated significant moderate improvements (d = .69, p = .005; d = .46, p = .001). Depression, anxiety, and pain interference results suggested small non-significant effect size improvements (d = .27, p = .19; d = .23, p = .31; d = .25, p = .07). Effects on fatigue and sleep disturbance were negligible. CONCLUSION: The modified MBSR program was feasible and acceptable to the organization and participants. Small to moderate improvements in mental health and pain interference outcomes were observed. Research using larger sample sizes and randomized designs is warranted.

Exploring correlates of improved depression symptoms and quality of life following tai chi exercise for patients with heart failure.

AIMS: Tai chi exercise has been shown in a prior randomized controlled trial to improve depression symptoms and quality of life (QoL) in patients with heart failure (HF), but correlates of these improvements are not well known. The purpose of this secondary analysis was to explore whether tai chi is associated with improvements in biopsychosocial and behavioural measures and whether such improvements are correlated with improved depression and QoL. METHODS AND RESULTS: Participants were n = 100 adults with chronic systolic HF (mean age = 67.4, SD = 12.0; 64% male; 96% White; New York Heart Association class = 1-3) randomized to a 12 week tai chi exercise intervention or health education control. Constructs of interest included social support, exercise self-efficacy, activity engagement, sense of coherence, and inflammatory biomarkers. Tai chi was associated with increased everyday activity engagement compared with the health education group (P < 0.05), but there were no group differences in social support or sense of coherence. Among tai chi participants, improved self-efficacy was correlated with QoL (r = 31, P = 0.05), and there was a trend toward improved depression symptoms and social support (r = -0.22, P = 0.13). Among all participants, controlling for intervention group, improved sense of coherence, and inflammation (C-reactive protein) were associated with improved depression symptoms, and improved self-efficacy, sense of coherence, and frequency of activity engagement were associated with improved QoL. CONCLUSIONS: Tai chi exercise promotes inter-related psychosocial improvements for patients with HF. A range of biopsychosocial and behavioural variables are relevant to mood management in patients with HF.

A systematic review and meta-analysis of mindfulness- and acceptance-based interventions for affect intolerance/sensitivity.

Affect intolerance/sensitivity, defined as one's sensitivity to, or inability to tolerate, affective states, is a transdiagnostic process implicated in the development and maintenance of numerous forms of psychopathology. Mindfulness and acceptance interventions are posited to improve affect intolerance/sensitivity; however, there has been no quantitative synthesis of this research to date. Seven electronic databases were searched up until November 2018. Hedges' g values, 95% confidence intervals, p-values, and Q-values were calculated for a series of random-effects models. Twenty-five studies (pooled N = 1778) met eligibility criteria and were included in the qualitative synthesis (n = 22 included in the meta-analysis). There was a small, significant effect of mindfulness and acceptance interventions on improving affect intolerance/sensitivity from pre-to post-intervention (Hedges' g = -0.37, 95% CI = -0.52 to -0.23, p < .001), with effects maintained up to 6-months (Hedges' g = -0.35, 95% CI = -0.61 to -0.09, p < .01). There was a significantly larger effect for studies with inactive compared to active controls. No significant effect size differences were found for intervention length (<8 vs. ≥ 8 sessions), intervention type (mindfulness vs. acceptance) or sample type (clinical vs. non-clinical). Mindfulness and acceptance interventions modestly improve affect intolerance/sensitivity.

"Cooling of the mind": Assessing the relevance of mindfulness training among people living with HIV using alcohol and other substances in South Africa.

RATIONALE: "Thinking too much" is a cultural idiom of distress identified across sub-Saharan Africa, including among people living with HIV (PLWH), which is associated with depression, substance use, and HIV medication nonadherence. Despite the relevance of mindfulness training to address thinking too much, improve HIV-related outcomes, and reduce substance use, efforts to adapt mindfulness training for this context and underserved populations more broadly have been limited. OBJECTIVE: We explored in this context: (a) the experience of thinking too much among PLWH struggling with adherence and substance use; (b) the appropriateness of mindfulness training to address thinking too much; and (c) potential barriers and facilitators to implementing mindfulness training. METHOD: We conducted semi-structured interviews with patients (n = 19) and providers (n = 11) at two clinics in a peri-urban area of Cape Town. Guided by the ADAPT-ITT model, we included an experiential mindfulness practice and participants shared their observations and descriptions of the intervention in the local language (isiXhosa). RESULTS: Participants found mindfulness relevant, culturally salient, and appropriate for refocusing the mind. Findings provide unique language offered by participants to tailor mindfulness training in the future (e.g., "hearing your veins," "cooling of the mind"). Participants identified potential implementation barriers, including lack of privacy, and facilitators to guide future adaptations. CONCLUSIONS: More research is needed to adapt and increase access to mindfulness training in resource-limited settings globally, while also maintaining treatment integrity and fidelity.