Psychometric Properties of the Spanish-language Version of the Interpersonal Mindfulness in Parenting (IM-P) Scale among Mothers of Preschool Children in Chile / Propiedades psicométricas de la versión en español de la Escala de Atención Plena (Mindfulness) Interpersonal en la Parentalidad en madres de preescolares en Chile

Abstract The Interpersonal Mindfulness in Parenting (IM-P) scale is one of the first measures that specifically assesses mindful parenting, a specific application of mindfulness, that has been defined as paying attention to your child and parenting in a particular way, intentionally, in the present moment, and non-judgmentally. Psychometric properties of a Spanish-language version of the IM-P scale were examined in a sample of 111 mothers of preschool-age children living in Santiago, Chile. The original IM-P model with five factors and 31 items showed indicators of goodness of fit within acceptable ranges, however two items presented extremely low factor loadings that suggest a lack of fit to the model. Also, there was a high correlation between two factors which were theoretical and conceptually very related: Compassion for the self and child and Non-judgmental Acceptance of the self and child. Therefore, it was considered appropriate to test a new four-factor model in which these two factors were merged into one, and items loading low in the previous model were eliminated. This new model showed a slightly better fit than the five-factor model. The resultant four-factor version and its subscales showed good internal consistencies. Construct validity of the IM-P scale was investigated by calculating correlations with general mindfulness (Five Facet Mindfulness Questionnaire, FFMQ). As expected, a significant positive correlation was found between the two measures (r=0.73, p<0.01), and among almost all subscales. In general, the results present sound psychometric properties of the Spanish translation of the IM-P in Chilean mothers of preschool children.

Resumen Las propiedades psicométricas de la versión en español de la escala de Atención Plena (Mindfulness) Interpersonal en la Parentalidad (IM-P) fueron examinadas en una muestra de 111 madres de niños y niñas de edad preescolar en Santiago de Chile. La estructura de cinco factores de la escala IM-P original no fue completamente respaldada mediante análisis factorial confirmatorio. Por lo tanto, se testeó una estructura de cuatro factores. Dos de los factores encontrados fueron coherentes con aquellos originalmente hipotetizados. Los otros consistieron en una re-agrupación de items de las subescalas Consciencia Emocional de si misma y del hijo(a), Aceptación sin juicio de si misma y del hijo(a) y Compasión hacia si misma y hacia su hijo(a), en dos factores: uno que da cuenta de compasión y no-juicio de la madre hacia si misma y, el otro que da cuenta de la compasión, no-juicio y consciencia emocional de la madre hacia su hijio. La versión resultante de cuatro factores y sus sub-escalas presentaron buena consistencia interna. Se analizó la validez de constructo mediante cálculo de correlaciones con mindfulness general (Cuestionario de cinco dimensiones de Mindfulness, FFMQ). Como se esperaba, se encontró una correlación positiva significativa entre las dos medidas (r=0.71, p<0.01), y entre la mayor parte de las subescalas. En general, los resultados dan cuenta de buenas propiedades psicométricas de la versión en español de la escala IM-P en madres de niños y niñas preescolares en Chile.

Mindful Parenting, Parenting Cognitions, and Parent-Youth Communication: Bidirectional Linkages and Mediational Processes.

OBJECTIVES: Mindful parenting and parenting cognitions likely have important linkages to each other and to parent-child communication, but these linkages have not been tested. In this article, we test the bidirectional linkages between mindful parenting and parenting cognitions (sense of competence, parent-centered attributions) and the underlying mediational processes that link them to parent-child communication (parental solicitation and youth disclosure). METHODS: Longitudinal, autoregressive cross-lagged models were run within a longitudinal sample of rural and suburban early adolescents and their mothers (n = 421; mean adolescent age = 12.14, 46% male, 73% white). RESULTS: Significant bidirectional linkages were found between mindful parenting and parenting cognitions across Time 1 and Time 2. Greater mindful parenting at Time 1 was associated with more positive parenting cognitions (e.g., greater perceptions of parental competence and fewer negative parent-centered attributions or self-blame) at Time 2. More positive parenting cognitions at Time 1 were also associated with greater levels of mindful parenting at Time 2. Mindful parenting at Time 2 mediated the association between parenting cognitions (both parent-centered attributions and sense of competence) at Time 1 and parental solicitation at Time 3. CONCLUSIONS: Mindful parenting and parenting cognitions influence each other over time. Parenting cognitions can affect parental solicitation via increases in mindful parenting. The discussion focuses on potential underlying processes.

Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience.

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework called Intersectional Neuroscience which adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task - which applies individualized machine learning algorithms to fMRI data - to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators' unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action.

Focus on the Breath: Brain Decoding Reveals Internal States of Attention During Meditation.

Meditation practices are often used to cultivate interoception or internally-oriented attention to bodily sensations, which may improve health via cognitive and emotional regulation of bodily signals. However, it remains unclear how meditation impacts internal attention (IA) states due to lack of measurement tools that can objectively assess mental states during meditation practice itself, and produce time estimates of internal focus at individual or group levels. To address these measurement gaps, we tested the feasibility of applying multi-voxel pattern analysis (MVPA) to single-subject fMRI data to: (1) learn and recognize internal attentional states relevant for meditation during a directed IA task; and (2) decode or estimate the presence of those IA states during an independent meditation session. Within a mixed sample of experienced meditators and novice controls (N = 16), we first used MVPA to develop single-subject brain classifiers for five modes of attention during an IA task in which subjects were specifically instructed to engage in one of five states [i.e., meditation-related states: breath attention, mind wandering (MW), and self-referential processing, and control states: attention to feet and sounds]. Using standard cross-validation procedures, MVPA classifiers were trained in five of six IA blocks for each subject, and predictive accuracy was tested on the independent sixth block (iterated until all volumes were tested, N = 2,160). Across participants, all five IA states were significantly recognized well above chance (>41% vs. 20% chance). At the individual level, IA states were recognized in most participants (87.5%), suggesting that recognition of IA neural patterns may be generalizable for most participants, particularly experienced meditators. Next, for those who showed accurate IA neural patterns, the originally trained classifiers were applied to a separate meditation run (10-min) to make an inference about the percentage time engaged in each IA state (breath attention, MW, or self-referential processing). Preliminary group-level analyses demonstrated that during meditation practice, participants spent more time attending to breath compared to MW or self-referential processing. This paradigm established the feasibility of using MVPA classifiers to objectively assess mental states during meditation at the participant level, which holds promise for improved measurement of internal attention states cultivated by meditation.

Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial.

BACKGROUND: The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS: The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS: Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS: The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION: The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Skin-to-skin contact and infant emotional and cognitive development in chronic perinatal distress.

OBJECTIVE: We examined whether the timing of maternal-neonate skin-to-skin contact (SSC) predicts infant emotional and cognitive development in the context of chronic maternal perinatal stress and depressive symptoms. STUDY DESIGN: This secondary analysis included data from a group-based prenatal care clinical trial for 37 pregnant women with low household income. Mothers completed the Perceived Stress Scale (PSS), and the Center for Epidemiologic Studies Depression Scale (CES-D) during the third trimester and postpartum. After birth, they reported timing of SSC, and completed the Infant Behavior Questionnaire-Revised Very Short Form (IBQ-R VSF) (M = 51.7 weeks, SD = 4.2). Increased PSS or CES-D score from the third trimester to post-birth indicates chronic maternal perinatal stress or depressive symptoms compared to a decrease or no change. Using hierarchical regression models, we examined if the timing of SSC makes a unique contribution in predicting infant outcomes in the context of chronic maternal perinatal stress and depressive symptoms. RESULTS: Stress-exposed infants had less negative emotionality if SSC is provided immediately after delivery, less than 10 min after birth. The effect of SSC on effortful control in relation to chronic perinatal stress was not statistically significant. The impact of timing of SSC on negative emotionality or effortful control in relation to chronic perinatal depressive symptoms was not statistically significant. CONCLUSION: This work implies that very early SSC may play a role in later infant emotion regulation process and could act as a protective factor in chronically stressed pregnant women.

Unfolding Relations among Mindful Parenting, Recurrent Conflict, and Adolescents' Externalizing and Internalizing Problems.

The current study examined unfolding relations among mothers' mindful parenting, parent-adolescent recurrent conflict, and adolescents' externalizing and internalizing problems. In a community sample of 117 families (31% black, Asian, American Indian, or Latino), parents and adolescents (52% female; average age = 12.13 years) were followed over 15 months. Parents answered questions about mindful parenting and recurrent conflict, and adolescents reported on their own externalizing and internalizing problems. Path analyses indicated that higher levels of mindful parenting were significantly related to lower levels of recurrent conflict 2-3 months later, controlling for previous levels of recurrent conflict. Moreover, lower levels of recurrent conflict were significantly related to lower levels of externalizing problems and internalizing problems 1 year later, controlling for previous levels of those problems. Subgroup analyses indicated that relations were comparable across subgroups defined by adolescent gender, race, parent marital status, and family financial strain. The effects of mindful parenting were robust even after accounting for other indicators of positive and supportive parenting, namely inductive reasoning and warmth in the parent-adolescent relationship. These findings highlight the potential of mindful parenting to improve family interactions and adolescent adjustment.

Corrigendum: Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience.

[This corrects the article DOI: 10.3389/fpsyg.2020.573134.].

A mindfulness and compassion-based program applied to pregnant women and their partners to decrease depression symptoms during pregnancy and postpartum: study protocol for a randomized controlled trial.

BACKGROUND: Pregnancy and the postpartum period are times of great change for women and their partners, often bringing substantial challenges and stress. Approximately 10%-20% of women suffer from mood disorders such as depression in the perinatal period. There are risks involved in using psychopharmacological interventions to treat perinatal depression. Mindfulness and compassion-based educational programs could be efficacious and cost-effective options for the prevention and treatment of perinatal mood disorders. The aim of this study is to assess the efficacy of an adapted Mindfulness-Based Childbirth and Parenting (MBCP) program that includes compassion training for pregnant women in primary care (PC) settings in the Spanish National Health System to decrease perinatal depression. METHODS: A multicenter randomized controlled trial (RCT) will be conducted. Participants will be pregnant women (n = 122) and their partners who wish to participate. They will be enrolled and assessed in PC settings and randomly assigned to either: (1) an adapted MBCP educational program tailored to the Spanish National Health System + treatment as usual (TAU); or (2) TAU only. The main outcome to be assessed will be depression, evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Secondary outcomes will include self-reported measures of perceived stress, affects, mindfulness, self-compassion, maternal self-efficacy, and use of health and social services. Patients will be assessed at four timepoints: baseline; post-treatment; and at three and six months after childbirth. Intention-to-treat and per-protocol analyses will be carried out using linear regression mixed models. Effect sizes will be estimated using Cohen's d. DISCUSSION: Perinatal depression is a significant health problem. An effective and low-cost childbirth education program that incorporates mindfulness and compassion practices may be a beneficial preventive complementary healthcare modality for expectant women and their partners. This study will be the first multicenter RCT in Spanish PC settings using adapted MBCP and compassion practices to reduce symptoms of depression during pregnancy and the postpartum period. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03247491. Registered on 31 July 2017.

The mindful moms training: development of a mindfulness-based intervention to reduce stress and overeating during pregnancy.

BACKGROUND: Pregnancy is a time of high risk for excessive weight gain, leading to health-related consequences for mothers and offspring. Theory-based obesity interventions that target proposed mechanisms of biobehavioral change are needed, in addition to simply providing nutritional and weight gain directives. Mindfulness training is hypothesized to reduce stress and non-homeostatic eating behaviors - or eating for reasons other than hunger or caloric need. We developed a mindfulness-based intervention for high-risk, low-income overweight pregnant women over a series of iterative waves using the Obesity-Related Behavioral Intervention Trials (ORBIT) model of intervention development, and tested its effects on stress and eating behaviors. METHODS: Overweight pregnant women (n = 110) in their second trimester were enrolled in an 8-week group intervention. Feasibility, acceptability, and facilitator fidelity were assessed, as well as stress, depression and eating behaviors before and after the intervention. We also examined whether pre-to-post intervention changes in outcomes of well-being and eating behaviors were associated with changes in proposed mechanisms of mindfulness, acceptance, and emotion regulation. RESULTS: Participants attended a mean of 5.7 sessions (median = 7) out of 8 sessions total, and facilitator fidelity was very good. Of the women who completed class evaluations, at least half reported that each of the three class components (mindful breathing, mindful eating, and mindful movement) were "very useful," and that they used them on most days at least once a day or more. Women improved in reported levels of mindfulness, acceptance, and emotion regulation, and these increases were correlated with reductions in stress, depression, and overeating. CONCLUSIONS: These findings suggest that in pregnant women at high risk for excessive weight gain, it is both feasible and effective to use mindfulness strategies taught in a group format. Further, increases in certain mindfulness skills may help with better management of stress and overeating during pregnancy. TRIAL REGISTRATION: ClinicalTrials.gov NCT01307683 , March 8, 2011.

A randomized, controlled trial of mindfulness-based stress reduction in HIV infection.

OBJECTIVE: Evidence links depression and stress to more rapid progression of HIV-1 disease. We conducted a randomized controlled trial to test whether an intervention aimed at improving stress management and emotion regulation, mindfulness-based stress reduction (MBSR), would improve immunological (i.e. CD4+ T-cell counts) and psychological outcomes in persons with HIV-1 infection. METHODS: We randomly assigned participants with HIV-1 infection and CD4 T-cell counts >350 cells/µl who were not on antiretroviral therapy in a 1:1 ratio to either an MBSR group (n = 89) or an HIV disease self-management skills group (n = 88). The study was conducted at the University of California at San Francisco. We assessed immunologic (CD4, c-reactive protein, IL-6, and d-dimer) and psychological measures (Beck Depression Inventory for depression, modified Differential Emotions Scale for positive and negative affect, Perceived stress-scale, and mindfulness) at 3, 6 and 12 months after initiation of the intervention; we used multiple imputation to address missing values. RESULTS: We observed statistically significant improvements from baseline to 3-months within the MBSR group in depression, positive and negative affect, perceived stress, and mindfulness; between group differences in change were significantly greater in the MBSR group only for positive affect (per item difference on DES-positive 0.25, 95% CI 0.049, 0.44, p = .015). By 12 months the between group difference in positive affect was not statistically significant, although both groups had trends toward improvements compared to baseline in several psychological outcomes that were maintained at 12-months; these improvements were only statistically significant for depression and negative affect in the MBSR group and perceived stress for the control group. The groups did not differ significantly on rates of antiretroviral therapy initiation (MBSR = 39%, control = 29%, p = .22). After 12 months, the mean decrease in CD4+ T-cell count was 49.6 cells/µl in participants in the MBSR arm, compared to 54.2 cells/µl in the control group, a difference of 4.6 cells favoring the MBSR group (95% CI, -44.6, 53.7, p = .85). The between group differences in other immunologic-related outcomes (c-reactive protein, IL-6, HIV-1 viral load, and d-dimer) were not statistically significant at any time point. CONCLUSIONS: MBSR improved positive affect more than an active control arm in the 3 months following the start of the intervention. However, this difference was not maintained over the 12-month follow-up and there were no significant differences in immunologic outcomes between intervention groups. These results emphasize the need for further carefully designed research if we are to translate evidence linking psychological states to immunological outcomes into evidence-based clinical practices.

Positive adaptations for trauma and healing (PATH), a pilot study of group therapy with Latino youth.

OBJECTIVE: This study examines the acceptability and preliminary efficacy of Positive Adaptations for Trauma and Healing (PATH), a manualized treatment for Latino youth and their caregivers. PATH is a culturally adapted program that incorporates a trauma model, positive psychology, and resilience. METHOD: Latino youth (N = 16) recruited from an urban community clinic participated in PATH with their caregiver. Pre- and postintervention measures on trauma symptoms, resilience, depression, caregiver's view of their youth's well-being, and positive and negative emotions were gathered. Following the intake meetings (1 to 3), the families participated in 10 90-minute weekly group sessions (total of 3 groups). Caregiver groups were conducted in Spanish, and youth in English. RESULTS: At pretest, 56% of the youth endorsed clinically significant symptoms on the UCLA PTSD Index (M = 34.2, SD = 11.2); the percentage dropped to 0% at posttest (M = 17.3, SD = 7.6). Youth reported pre- to posttest reductions on the Child Depression Inventory (mean difference [Mdiff] = 7.3; p = .004) and externalizing (Mdiff = 6.1; p < .001) and internalizing (Mdiff = 9.4; p < .001) behaviors on the caregiver-reported Child Behavior Checklist. Overall, there was high treatment engagement (93% attendance over 10 weeks). CONCLUSION: This novel treatment engaged a community-based Latino sample. The results suggest high acceptability and significant reduction in trauma symptoms and associated symptoms. This study included a small number of participants and results should be interpreted with caution. Future iterations will target larger number of participants to further assess feasibility. (PsycINFO Database Record

Changes in Mindful Parenting: Associations With Changes in Parenting, Parent-Youth Relationship Quality, and Youth Behavior.

OBJECTIVE: There is growing interest in mindful parenting and how this form of intentional, compassionate interactions with youth are associated with developmental outcomes. We investigated how mindful parenting changes over time, either naturally or in response to interventions, and how that change is associated with other proximal developmental changes. METHOD: We used data from a longitudinal, randomized-controlled study design (N = 432 families) to investigate the associations between changes in mindful parenting and 3 outcomes: positive parenting, parent-youth relationship quality, and youth aggression. Differences across 3 intervention conditions and between mothers and fathers were tested. RESULTS: Across conditions, changes in mindful parenting were strongly associated with changes in all 3 outcomes for both fathers and mothers. Changes in mindful parenting showed considerable variability within and across conditions. For fathers, differences in mindful parenting change were driven primarily by changes in the core mindful parenting dimension of emotional awareness. Mothers showed comparable changes in mindful parenting across conditions. CONCLUSIONS: Findings illustrate how changes in mindful parenting are associated with proximal changes that could lead to reduced youth behavior problems (e.g., aggression or substance use) and provide additional evidence for the contribution that mindfulness activities can make to standard parent training.

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison.

BACKGROUND: Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. METHODS: This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected. RESULTS: In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women's childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls. CONCLUSIONS: This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects. TRIAL REGISTRATION: The ClinicalTrials.gov identifier for the PEARLS  study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Randomized controlled trial of a positive affect intervention for people newly diagnosed with HIV.

OBJECTIVE: We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. METHOD: One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. RESULTS: For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. CONCLUSIONS: This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record

Does CenteringPregnancy Group Prenatal Care Affect the Birth Experience of Underserved Women? A Mixed Methods Analysis.

We examined the birth experience of immigrant and minority women and how CenteringPregnancy (Centering), a model of group prenatal care and childbirth education, influenced that experience. In-depth interviews and surveys were conducted with a sample of racially diverse Centering participants about their birth experiences. Interview transcripts were analyzed thematically. Study participants (n = 34) were primarily low-income, Spanish-speaking immigrants with an average age of 29.7. On a scale from 1 (not satisfied) to 10 (very satisfied), women reported high satisfaction with birth (9.0) and care (9.3). In interviews, they expressed appreciation for the choice to labor with minimal medical intervention. Difficulties with communication arose from fragmented labor and delivery care by multiple providers. Centering provided women with pain coping skills, a familiar birth attendant, and knowledge to advocate for themselves. High reported satisfaction may obscure challenges to providing high quality childbirth care for marginalized women. Further study should examine the potential of Centering to positively impact underserved women's birth experiences.

Mindful parenting predicts mothers' and infants' hypothalamic-pituitary-adrenal activity during a dyadic stressor.

Mindfulness in the parenting relationship has been proposed to help both parents and children better regulate stress, though this has not yet been shown at the physiological level. In this study, we tested relations between maternal mindfulness in parenting and both mothers' and their infants' hypothalamic-pituitary-adrenal (HPA) axis activity during a dyadic stressor 3 months later. Participants were 73 mother-infant dyads from a larger longitudinal study. At 3 months postpartum, mothers completed self-report measures of general dispositional mindfulness and parenting-specific mindfulness, as well as stressful life events. At 6 months postpartum, mother-infant dyads completed the Still Face task. Four saliva samples were collected from each dyad member for cortisol assay to index the HPA axis response. Hierarchical linear modeling of cortisol trajectories revealed a main effect of maternal parenting-specific mindfulness (mindful parenting), but not general dispositional mindfulness, on mothers' cortisol; mothers with higher mindful parenting showed steeper cortisol recovery slopes. In addition, maternal mindful parenting moderated the effect of life stress on later mother and infant cortisol. In the context of high life stress, maternal mindful parenting predicted lower infant cortisol levels, but more extended maternal cortisol elevations. Implications for a biobehavioral model of mindful parenting are discussed. (PsycINFO Database Record

'I've Changed My Mind', Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial.

BACKGROUND: Approximately 25 % of pregnant women suffer from a high level of Fear of Childbirth (FoC), as assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A, score ≥66). FoC negatively affects pregnant women's mental health and adaptation to the perinatal period. Mindfulness-Based Childbirth and Parenting (MBCP) seems to be potentially effective in decreasing pregnancy-related anxiety and stress. We propose a theoretical model of Avoidance and Participation in Pregnancy, Birth and the Postpartum Period in order to explore FoC and to evaluate the underlying mechanisms of change of MBCP. METHODS/DESIGN: The 'I've Changed My Mind' study is a quasi-experimental controlled trial among 128 pregnant women (week 16-26) with a high level of FoC, and their partners. Women will be allocated to MBCP (intervention group) or to Fear of Childbirth Consultation (FoCC; comparison group). Primary outcomes are FoC, labour pain, and willingness to accept obstetrical interventions. Secondary outcomes are anxiety, depression, general stress, parental stress, quality of life, sleep quality, fatigue, satisfaction with childbirth, birth outcome, breastfeeding self-efficacy and cost-effectiveness. The total study duration for women is six months with four assessment waves: pre- and post-intervention, following the birth and closing the maternity leave period. DISCUSSION: Given the high prevalence and severe negative impact of FoC this study can be of major importance if statistically and clinically meaningful benefits are found. Among the strengths of this study are the clinical-based experimental design, the extensive cognitive-emotional and behavioural measurements in pregnant women and their partners during the entire perinatal period, and the representativeness of study sample as well as generalizability of the study's results. The complex and innovative measurements of FoC in this study are an important strength in clinical research on FoC not only in pregnant women but also in their partners. TRIAL REGISTRATION: Dutch Trial Register (NTR): NTR4302 , registration date the 3rd of December 2013.

Feasibility and Preliminary Efficacy of a Novel RDoC-Based Treatment Program for Adolescent Depression: "Training for Awareness Resilience and Action" (TARA)-A Pilot Study.

BACKGROUND: The novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in adolescent depression and framed within the National Institute of Mental Health Research Domain Criteria. TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills, and value-based committed action. METHODS: We performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing depression and anxiety levels and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six adolescents (14-18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1), and 3 months after the end of TARA (T2). RESULTS: Significant improvement was seen in depression symptoms (Reynolds Adolescent Depression Scale Second Edition) between T0-T1 (t-value = -3.56, p = 0.002, CI = -6.64, -1.77) and T0-T2 (t-value = -4.17, p < 0.001, CI = -11.20, -3.75) and anxiety symptoms (Multidimensional Anxiety Scale for Children) between T0-T1 (t-value = -2.26, p = 0.033, CI = -4.61, -0.21) and T0-T2 (t-value = -3.06, p = 0.006, 95% confidence interval = -9.02, -1.73). Significant improvements in psychological flexibility, sleep, and mindfulness skills were also found between T0 and T2. LIMITATIONS: The sample size was small without a control condition. The pilot design did not allow for testing the hypothesized brain changes and effect of TARA on relevant systemic biomarkers. CONCLUSION: TARA is feasible in a sample of clinically depressed and/or anxious adolescents and preliminary efficacy was demonstrated by reduced depression and anxiety symptoms. The specific symptom and behavioral outcomes corresponded well with the hypothesized mechanisms of change.

Applying the RE-AIM Framework to Evaluate Integrative Medicine Group Visits Among Diverse Women with Chronic Pelvic Pain.

The purpose of this study was to evaluate group medical visits using an integrative health approach for underserved women with chronic pelvic pain (CPP). We implemented an integrative medicine program to improve quality of life among women with CPP using Centering, a group-based model that combines healthcare assessment, education, and social support. Patients were from university-affiliated and public hospital-affiliated clinics. We evaluated the program with qualitative and quantitative data to address components of the RE-AIM framework: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Participants of the Centering CPP Program participants (n = 26) were demographically similar to a sample of women with CPP who sought care at Bay Area hospitals (n = 701). Participants were on average 40 years of age, a majority of whom were racial/ethnic minorities with low household income (76%). Women who attended four or more sessions (n = 16) had improved health-related quality of life, including decreases in average number of unhealthy days in the past month (from 24 to 18, p < .05), depressive symptoms (from 11.7 to 9.0, p < .05), and symptom severity (from 4.2 to 3.1, p < .01). Sexual health outcomes also improved (30.5 to 50.3, p = .02). No improvements were observed for pain catastrophizing. Our pilot program provides preliminary data that an integrative health approach using a group-based model can be adapted and implemented to reach diverse women with CPP to improve physical and psychological well-being. Given these promising findings, rigorous evaluation of implementation and effectiveness of this approach compared with usual care is warranted.