The Relationship of Rumination, Worry and OCD Symptoms During Technology Supported Mindfulness Therapy for OCD.

BACKGROUND: In this study, we re-examined data from a previous randomized controlled trial investigating 'technology supported mindfulness' (TSM)-an 8-week treatment intervention for individuals experiencing OCD. The current analysis involves an examination of the longitudinal relationships between rumination, worry and OCD symptom changes during mindfulness treatment, in comparison to a waitlist control. METHODS: Participants experiencing OCD (n = 71) were randomly assigned to 8 weeks of (1) TSM or (2) waitlist control. We tested the extent to which rumination (using the Ruminative Response Scale) and worry (using the Penn State Worry Questionnaire) are associated with OCD symptom changes during the acute phase of treatment, concurrently (i.e., within the same longitudinal model). RESULTS: Generalized linear model (GLM) results indicated a significant time (week 1 vs. week 8) by condition interaction involving decreased rumination in the TSM condition: F(1, 61) = 13.37, p = 0.001, partial η2 = 0.18 and observed power = 0.94. A second GLM demonstrated decreased worry in the TSM condition: F(1, 69) = 37.34, p = 0.001, partial η2 = 0.35 and observed power = 0.83. Longitudinal 'latent difference' structural equation analyses demonstrated a cross-lagged association between worry (but not rumination) and OCD symptom changes. CONCLUSIONS: Individuals in the TSM condition experienced greater reductions in rumination and worry during 8 weeks of TSM treatment compared to the waitlist control, and reduced worry predicted subsequent OCD symptom reduction.

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia.

BACKGROUND: With an increasing proportion of older adults and the associated risk of Alzheimer's Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs. METHODS: This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives. DISCUSSION: This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk. TRIAL REGISTRATION: ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Effects of Yoga and Mindfulness Meditation on Stress-Related Variables: A Randomized Controlled Trial.

Stressful situations lead to change in or damage to the central nervous system, the hypothalamic-pituitary-adrenal axis, and autonomic function. Techniques for reducing stress such as yoga and mindfulness meditation have been reported to improve emotional regulation and mindfulness skill, as well as stress response. Mindfulness skill relies on intense focus to quiet the mind and bring concentration to the present moment. The present study was a randomized control trial to investigate the effects of an 8-week training program (three 45-minute sessions/week, one session with an instructor and two sessions as home practice) in mindfulness meditation or in yoga on stress and related variables in healthy people. Forty-four healthy participants were randomly allocated to one of three groups: a mindfulness group (n = 16), a yoga group (n = 13), and a control group (n = 15). The yoga training significantly modified heart rate variability, contributing to decreased relative power of the low-frequency band; the relative power of the high-frequency band increased after training. The mindfulness meditation training significantly improved mindfulness skill and concentration performance. In the present study, yoga was associated with increased heart rate variability and mindfulness meditation was associated with an increase in mindfulness skill and concentration performance.

Comparative Analysis of the Effects of Exercise and Kapalbhati Pranayama on Heart Rate Variability and Electroencephalogram Activity: Unveiling Physiological and Cognitive Insights.

Physical activity and mindfulness techniques, such as exercise and Kapalbhati Pranayama, are known to have positive effects on health and well-being. However, limited research has directly compared their impact on physiological and psychological parameters. This study aimed to investigate and compare the effects of exercise and Kapalbhati Pranayama on Heart Rate Variability (HRV) and Electroencephalogram (EEG) activity, shedding light on their contributions to overall health and mental well-being. The study was conducted at All India Institute of Medical Sciences (AIIMS) in Bhopal, India, from 2018 to 2022. A prospective interventional design was employed over two months, involving 20 participants with normal BMI and no respiratory or cardiac conditions. Exclusion criteria included lung or cardiac diseases, smoking history, dyspnoea during physical activity, pedal edema, and high blood pressure. The Kapalbhati Pranayama intervention was supervised and limited to 5 minutes. HRV was assessed using the HRV Brain Tap Neuralchek Machine before, during, and after Kapalbhati. For exercise, a mild-intensity cycling protocol was performed on healthy volunteers aged 20 to 50. HRV was recorded before, during, and after exercise. The EEG analysis revealed notable changes in brain wave patterns. At baseline, participants exhibited higher levels of delta, theta, and alpha waves, indicating a state of relaxation and calmness. During exercise, there was a significant increase in beta waves and a decrease in delta, theta, and alpha waves, reflecting heightened brain activity and alertness. After Kapalbhati, beta wave levels remained elevated, while delta and theta wave suppression was more pronounced, suggesting a stimulating effect on the brain similar to exercise. The changes in beta and gamma EEG waves could be attributed to factors such as exercise intensity, duration, frequency, and the release of endorphins during both exercise and Kapalbhati. The HRV analysis demonstrated distinct responses to exercise and Kapalbhati. Exercise led to a significant reduction in HRV parameters, characterized by increased heart rate and decreased time-domain HRV measures, aligning with the typical sympathetic nervous system dominance during physical activity. In contrast, Kapalbhati's impact on HRV parameters was milder, with minor changes in heart rate and subtle alterations in time-domain HRV measures. The high LF/HF ratio during Kapalbhati suggested a potential stimulation of the sympathetic nervous system. More comprehensive research is required to confirm these findings and understand the long-term effects of Kapalbhati on HRV and cardiovascular health. This study contributes to the understanding of how exercise and Kapalbhati Pranayama affect both cognitive and cardiovascular aspects of health. It highlights that both interventions increase brain activity and alertness, but Kapalbhati may have a more potent effect. Exercise significantly reduces HRV parameters, indicating sympathetic nervous system dominance, while Kapalbhati has milder HRV effects. Further research with larger and more diverse populations is essential to confirm and expand on these findings, providing insights into optimizing cognitive function and cardiovascular health through tailored approaches of exercise and Kapalbhati Pranayama.

Evaluation of Autonomic Nervous System Function During Sleep by Mindful Breathing Using a Tablet Device: Randomized Controlled Trial.

BACKGROUND: One issue to be considered in universities is the need for interventions to improve sleep quality and educational systems for university students. However, sleep problems remain unresolved. As a clinical practice technique, a mindfulness-based stress reduction method can help students develop mindfulness skills to cope with stress, self-healing skills, and sleep. OBJECTIVE: We aim to verify the effectiveness of mindful breathing exercises using a tablet device. METHODS: In total, 18 nursing students, aged 18-22 years, were randomly assigned and divided equally into mindfulness (Mi) and nonmindfulness (nMi) implementation groups using tablet devices. During the 9-day experimental period, cardiac potentials were measured on days 1, 5, and 9. In each sleep stage (sleep with sympathetic nerve dominance, shallow sleep with parasympathetic nerve dominance, and deep sleep with parasympathetic nerve dominance), low frequency (LF) value, high frequency (HF) value, and LF/HF ratios obtained from the cardiac potentials were evaluated. RESULTS: On day 5, a significant correlation was observed between sleep duration and each sleep stage in both groups. In comparison to each experimental day, the LF and LF/HF ratios of the Mi group were significantly higher on day 1 than on days 5 and 10. LF and HF values in the nMi group were significantly higher on day 1 than on day 5. CONCLUSIONS: The correlation between sleep duration and each sleep stage on day 5 suggested that sleep homeostasis in both groups was activated on day 5, resulting in similar changes in sleep stages. During the experimental period, the cardiac potentials in the nMi group showed a wide range of fluctuations, whereas the LF values and LF/HF ratio in the Mi group showed a decreasing trend over time. This finding suggests that implementing mindful breathing exercises using a tablet device may suppress sympathetic activity during sleep. TRIAL REGISTRATION: UMIN-CTR Clinical Trials Registry UMIN000054639; https://tinyurl.com/mu2vdrks.

Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial.

BACKGROUND: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. OBJECTIVE: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. METHODS: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. RESULTS: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=-0.96), depression (d=-1.06), pain severity (d=-1.12), and pain interference (d=-1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. CONCLUSIONS: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475.

Effectiveness of a positive psychology and mindfulness-based app on mental health for parents of children with a neurodevelopmental disorder: study protocol of a pragmatic international randomized controlled trial.

INTRODUCTION: Parents of children with a neurodevelopmental disorder (NDD) experience more stress than parents of typically developing children. In a cocreation process with experts and parents, a low-threshold application that uses exercises based on the principles of positive psychology and mindfulness was developed. This application, called "Adappt," aims at enhancing the ability to adapt of the parents and caregivers of children with NDDs and at supporting their mental health. This protocol describes the evaluation study of the effectiveness of Adappt, its core working mechanisms and user experiences. METHOD: A pragmatic international multicenter randomized controlled trial will compare the effectiveness of Adappt with a (delayed) waitlist control condition. At least 212 parents or primary caregivers of children younger than 18 years diagnosed with or suspected of a NDD will be randomly assigned to the intervention or waitlist control condition. Participants are excluded if they have severe anxiety or depression levels or are in treatment for mental health issues. Measures will be collected online at baseline, post-intervention (1 month after baseline), and 4 and 7 months after baseline. The primary outcome is the improvement in generic sense of ability to adapt as measured with the Generic Sense of Ability to Adapt Scale (GSAAS; (Front Psychol 14:985408, 2023)) at 4-month follow-up. Secondary outcomes are mental well-being, (parental) distress, and client satisfaction with "Adappt." DISCUSSION: Results of this study will contribute to knowledge on the effectiveness of a low-threshold application for parents of children with a NDD in multiple countries. If the application is found to be effective in improving mental health, recommendations will be made for implementation in health care. TRIAL REGISTRATION: This study is registered on clinicaltrials.gov (NCT06248762) on February 8, 2024, and the Open Science Framework ( https://osf.io/5znqv ).

Study protocol for the MIND-PD study: a randomized controlled trial to investigate clinical and biological effects of mindfulness-based cognitive therapy in people with Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PD) are very sensitive to the effects of stress. The prevalence of stress-related neuropsychiatric symptoms is high, and acute stress worsens motor symptoms. Animal studies suggest that chronic stress may accelerate disease progression, but evidence for this in humans is lacking. Mindfulness-based interventions (MBIs) train participants to focus on the present moment, on purpose and without judgement. Previous studies suggest that MBIs may alleviate stress and reduce depression and anxiety in PD. We aim to demonstrate the efficacy of Mindfulness-Based Cognitive Therapy (MBCT) as a non-pharmacologic treatment strategy for neuropsychiatric (and motor) symptoms in PD, and to identify the mechanisms underlying stress and stress reduction in PD. METHODS: In a prospective randomized controlled trial (RCT), we investigate whether 8 weeks of MBCT, as compared to care as usual, can reduce symptoms of anxiety and depression in people with PD. We aim to include 124 PD patients, who experience mild-moderate symptoms of anxiety and depression, are eligible for magnetic resonance imaging (MRI) and naïve to mindfulness, and who have a disease duration ≤ 10 years. Every participant is followed for 12 months. Clinical and biochemical assessments take place at baseline (T0), after 2 months (T1), and after 12 months (T2); MRI assessments take place at T0 and T2. Our primary outcome is the total score on the Hospital Anxiety and Depression Scale (HADS) at T1, while correcting for the HADS score at T0, age, and gender. Beyond testing the effects of MBCT on symptoms of anxiety and depression in PD, we explore whether MBCT: (1) has an effect on motor symptom severity, (2) influences cerebral and biochemical markers of stress, and (3) leads to a change in biomarkers of PD progression. DISCUSSION: MIND-PD is one of the first RCTs with a 1-year follow-up to investigate the effects of MBCT on symptoms of anxiety and depression in PD, and to explore possible mechanisms underlying stress and stress reduction in PD. Insight into these mechanisms can pave the way to new treatment methods in the future. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05779137. Registered on 12 January 2023.

Can mindfulness-based training impact explicit and implicit attitudes and sustainable nutrition behavior? A focus on vegetarianism.

OBJECTIVES: The aim of this study was to investigate the impact of a mindfulness intervention (IG) compared to an inactive control group (CG) on explicit and implicit attitudes toward vegetarian and meat-based foods, nutrition behavior measures, trait mindfulness and wellbeing. METHODS: In the IG (N = 66), we implemented a mindfulness-based intervention consisting of eight weekly group sessions online, along with an additional half-day session held on campus. The CG (N = 71) received no intervention or training. We employed a pre-/post-intervention design involving questionnaires (trait mindfulness, wellbeing, sustainable nutrition behavior scale), an online supermarket scenario, as well as an explicit rating task and an implicit association task using pictures of vegetarian and meat-based foods. Additionally, a voluntary follow-up testing was conducted two months after the final group session. RESULTS: No intervention effects were observed on explicit and implicit attitudes, wellbeing, or nutrition behavior measures. However, there was an increase in trait mindfulness within the IG. Exploratory cross-sectional findings indicated that trait mindfulness facets such as "Acting with Awareness" and "Outer Awareness", along with explicit attitudes, were significant predictors of self-reported sustainable consumption behavior. Additionally, sex and explicit attitudes were identified as significant predictors of vegetarian consumption behavior in the online supermarket task. CONCLUSION: Our findings could not substantiate previous claims regarding the potential causal effects of mindfulness practice on sustainable consumption behavior, specifically in the realm of sustainable and vegetarian nutrition, as well as subjective wellbeing. Future studies may benefit from implementing longer-term mindfulness-based interventions and considering other potential decisive factors, such as connectedness to nature and others. Integrating training elements focusing on these specific variables into the intervention could be valuable.

Is decreasing problematic mobile phone use a pathway for alleviating adolescent depression and sleep disorders? A randomized controlled trial testing the effectiveness of an eight-session mindfulness-based intervention.

Objective: The present study aimed to evaluate the efficacy of a mindfulness-based cognitive therapy (MBCT) intervention in reducing problematic mobile phone use, depression, and sleep disorders among adolescents. Additionally, it sought to investigate whether the decrease in problematic mobile phone use acted as a mediator in the relationship between the MBCT intervention and adolescent depression and sleep disorders. Methods: In a randomized controlled trial, a total of 104 adolescents were randomly assigned to the mindfulness group (n = 52) or the wait-list control group (n = 52). The mindfulness group students completed eight 45-min sessions of mindfulness training in four weeks. The outcomes were measured at baseline, postintervention, and at the 2-month follow-up. Results: Compared with the control group, the mindfulness group had significantly greater levels of mindfulness and lower levels of problematic mobile phone use, depression, and sleep disorders postintervention. The intervention effects were maintained at the 2-month follow-up. In addition, decreased problematic mobile phone use significantly mediated the association between the MBCT intervention and decreased depression and decreased sleep disorders. Conclusion: The findings suggest that MBCT could improve adolescent depression and sleep disorders and that decreasing problematic mobile phone use is an effective pathway accounting for the MBCT intervention effect on adolescent depression and sleep disorders.

Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial.

BACKGROUND: Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. OBJECTIVE: This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. METHODS: To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. RESULTS: This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. CONCLUSIONS: This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT's efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/53966.

The effect of educational intervention according to mindfulness on the psychological well-being of female heads of households.

OBJECTIVE: The low level of psychological well-being is one of the most common problems of the women who are the heads of households, and various educational programs have been conducted to improve the psychological well-being of such a group. The present study was conducted to outline the effectiveness of mindfulness-based educational intervention in the psychological well-being of women as the heads of households. METHODS: This research as a semi-experimental study was done by pretest-posttest design and control group. The study statistical population included all women as the heads of households in Shiraz, who had a file in the Shiraz based welfare office and at the same time their children were studying in schools covered by the 2nd district educational department of Shiraz in 2022-2023. Out of the female heads of the households in the statistical community, 30 women were selected as Purposive sampling and then randomly divided into two 15-individual groups, including experimental group (training on mindfulness-based therapy) and control group. The research tool included Ryff's psychological well-being scale (Ryff, 1989). The experimental group was subjected to training on mindfulness-based therapy (Baer et al., 2006) during eight 90-min sessions. However, the control group did not receive any intervention. RESULT: After running the intervention, a significant difference was seen between the components of autonomy, personal growth, purpose in life, self-acceptance, positive relationship with others, and psychological well-being after running the educational intervention between the experimental and control groups (P < 0.05), while no meaningful difference popped up between the experimental and control groups in terms of environmental mastery as one of the aspects measured in psychological well-being scale after the educational intervention (P = 0.602). CONCLUSION: According to the results, it seems that psychologists can benefit from the method of training on mindfulness-based therapy in order to increase the psychological well-being of women as the heads of households.

How we teach mindfulness matters: Adolescent development and the importance of informal mindfulness.

Given high levels of adolescent stress and educational institutions' key role in supporting students' mental health, mindfulness instruction is increasingly being implemented in schools. However, there is growing evidence adolescents find traditionally taught formal mindfulness (e.g., structured regular practice like meditation) challenging. Indeed, school-based studies report high levels of student non-compliance and lack of engagement with formal mindfulness strategies. Thus, informal mindfulness practices (e.g., unstructured brief moments integrated within daily routine) may be more accessible and developmentally appropriate for adolescents. Using a randomized experimental school-based design, this study sought to parse out the acceptability and effectiveness of formal and informal mindfulness for adolescents over time. Adolescents (n = 142; 73.9% female) were randomly assigned to a 4-week formal mindfulness, informal mindfulness, or comparison group and assessed on mental health, well-being, and educational outcomes. The informal mindfulness group (a) was more likely to report intending to frequently use the strategies (p = .025, Cramer's V = .262) and (b) reported increased dispositional mindfulness (i.e., general tendency to be mindful) from baseline to follow-up (p = .049, ηp2 = .034) which in turn mediated benefits on depression (indirect effect = -.15, 95% CI [-.31, -.03]), anxiety (indirect effect = -.21, 95% CI [-.36, -.06]), general stress (indirect effect = -.16, 95% CI [-.32, -.04]), school-related stress (indirect effect = -.15, 95% CI [-.28, -.05]), negative affect (indirect effect = -.17, 95% CI [-.35, -.04]), and attentional control (indirect effect = .07, 95% CI [.01, .13]). Thus, brief informal mindfulness strategies may be easier for students to use on a regular basis than formal mindfulness. Overall, these findings highlight the importance of going beyond a one-size-fits-all approach by offering accessible and engaging school-based mindfulness instruction to students. Recommendations for school psychologists seeking to teach mindfulness to adolescents are discussed, including the need to directly teach how to integrate informal mindfulness strategies in students' lives.

Dependable approaches to hypertension management: A review.

Hypertension, a prevalent chronic condition characterized by elevated blood pressure, is a significant global health burden, contributing to approximately 7.5 million premature deaths annually. While existing literature predominantly focuses on conventional treatment modalities, this paper offers unique insights into dependable approaches to hypertension management. Drawing upon epidemiological data, it highlights the increasing prevalence of hypertension across diverse populations, emphasizing demographic disparities and regional variations. This article underscores the need for tailored interventions considering individual risk profiles and socioeconomic determinants. Beyond conventional lifestyle modifications and pharmacological therapies, it explores emerging trends such as mindfulness-based interventions and integrative medicine in hypertension management. Additionally, it discusses the role of digital health technologies and telemedicine in enhancing patient engagement and remote monitoring, optimizing treatment outcomes. Furthermore, the paper addresses the evolving landscape of personalized medicine and genomic advancements in predicting individual responses to antihypertensive therapies, advocating for precision medicine approaches. This paper advocates for a holistic and patient-centered approach to hypertension management by offering a comprehensive overview of established and emerging strategies. It underscores the importance of interdisciplinary collaboration, continuous education, and innovative research endeavors to address the multifaceted challenges posed by hypertension and improve global cardiovascular health outcomes.

Mindfulness and self-regulation intervention for improved self-neglect and self-regulation in diabetic older adults.

The current study aimed to assess the impact of combined interventions including mindfulness and self-regulation on self-neglect and self-regulation among Iranian older adults with type 2 diabetes. This was a three-arm cluster randomized controlled trial study conducted among 135 older diabetic patients in Shiraz, Iran. Three urban healthcare centers (clusters) were randomly assigned to three study groups. The intervention groups received either a Self-Regulation-based Intervention Program (SRIP) or a Combined Mindfulness and Self-Regulation Intervention Program (CMSRIP), while the control group received routine care and COVID-19 prevention training. These training programs, which consisted of text and video-based content, were conducted over 24 weeks using WhatsApp as a mobile-based communication platform. Outcomes were measured using the Elder Self-Neglect Scale and Short-Form Self-Regulation Questionnaire at baseline, week 4, and week 16 post-intervention, with data analysis conducted using SPSS 20 software. The CMSRIP led to significantly greater improvement in the score of self-regulation (χ2 = 73.23, P-Value = < .001) and a reduction in the score of self-neglect (χ2 = 62.97, P-Value = < .001) at both 4 weeks and 16 weeks after education compared to SRIP. In the control group, there was also a slight improvement. Improvement of self-regulation and reduction of self-neglect in all three groups were less in week 16 than in week 4. Nevertheless, the changes in the intervention groups were significantly better than the control group. This study confirmed a combination of mindfulness-based intervention and self-regulation intervention can effectively improve self-neglect and self-regulation behavior in older patients with type 2 diabetes.Trial registration: This trial (ISRCTN77260130) was retrospectively registered on 28/09/2021.

Efficacy and Neural Mechanisms of Mindfulness Meditation Among Adults With Internet Gaming Disorder: A Randomized Clinical Trial.

Importance: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown. Objective: To explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying MM. Design, Setting, and Participants: This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou, China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023. Intervention: Participants underwent MM training (an 8-session meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks. Main Outcomes and Measures: This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and posttest assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI. Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM. Results: This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs posttest: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the PMR group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs posttest: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03). Conclusions and Relevance: In this study, MM was more effective in decreasing addiction severity and gaming cravings compared with PMR. These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.

Layperson-Delivered Telephone-Based Behavioral Activation Among Low-Income Older Adults During the COVID-19 Pandemic: The HEAL-HOA Randomized Clinical Trial.

Importance: Older adults are particularly vulnerable to loneliness and its physical and psychosocial sequelae, but scalable interventions are lacking, especially during disasters such as pandemics. Objective: To compare the effects of layperson-delivered, telephone-based behavioral activation and mindfulness interventions vs telephone-based befriending on loneliness among at-risk older adults. Design, Setting, and Participants: This assessor-blinded, 3-arm randomized clinical trial screened Chinese older adults through household visits and community referrals from April 1, 2021, to April 30, 2023, in Hong Kong. Eligible participants (≥65 years of age) who were lonely, digitally excluded, living alone, and living below the poverty line and provided consent to participate were randomized into behavioral activation, mindfulness, and befriending groups. Assessments were conducted at baseline, 1 month, and 3 months. Intervention: As part of the Helping Alleviate Loneliness in Hong Kong Older Adults (HEAL-HOA) dual randomized clinical trial, 148 older laypersons were trained to deliver a twice-weekly 30-minute intervention via telephone for 4 weeks. Main Outcomes and Measures: The primary outcome was loneliness measured by the UCLA Loneliness Scale (range, 20-80) and the De Jong Gierveld Loneliness Scale (range, 0-6), with higher scores on both scales indicating greater loneliness. Secondary outcomes were depression, perceived stress, life satisfaction, psychological well-being, sleep quality, perceived social support, and social network. Results: A total of 1151 participants (mean [SD] age, 76.6 [7.8] years; 843 [73.2%] female) were randomized to the behavioral activation (n = 335), mindfulness (n = 460) or befriending (n = 356) group. Most were widowed or divorced (932 [81.0%]), had primary education or below (782 [67.9%]), and had 3 or more chronic diseases (505 [43.9%]). Following intention-to-treat principles, linear mixed-effects regression model analyses showed that loneliness measured by the UCLA Loneliness Scale was significantly reduced in the behavioral activation group (mean difference [MD], -1.96 [95% CI, -3.16 to -0.77] points; P < .001]) and in the mindfulness group (MD, -1.49 [95% CI, -2.60 to -0.37] points; P = .004) at 3 months compared with befriending. Loneliness measured by the De Jong Gierveld Loneliness Scale was not significantly reduced at 3 months in the behavioral activation group (MD, -0.06 [95% CI, -0.26 to 0.13] points; P > .99]) but was in the mindfulness group (MD, 0.22 [95% CI, 0.03 to 0.40] points; P = .01) at 3 months compared with befriending. In the behavioral activation and mindfulness groups, sleep quality improved compared with befriending, but perceived stress increased. Psychological well-being and perceived social support improved in the behavioral activation group. No statistically significant between-group differences were observed in depression, life satisfaction, or social network. Conclusion and Relevance: In this randomized clinical trial, scalable psychosocial interventions delivered remotely by older laypersons appeared promising in reducing later life loneliness and addressing the pressing mental health challenges faced by aging populations and professional geriatric mental health workforce shortages. Further research should explore ways to maximize the clinical relevance and cost-effectiveness of these interventions. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2300072909.

A mindfulness-based intervention improves perceived stress and mindfulness in university nursing students: a quasi-experimental study.

University nursing students have been shown to experience psychological stress. A mindfulness-based intervention (MBI) may be a helpful tool for stress management. The aim of this study was to examine the effects of a MBI on improving mindfulness and reducing perceived stress in nursing students. A quasi-experimental study was conducted between July 2021 and February 2022. The intervention group participated in an 8-week mindfulness awareness course, which included 50 min of training and practice in mindfulness meditation techniques each week. Over the same 8 weeks, the control group watched a 50-min film each week. The mindful attention awareness scale (MAAS) and perceived stress scale (PSS) were administered before the intervention, intervention completion, and 2 and 6 months after the intervention. Data were analyzed using t test and generalized estimating equation. Overall, that the MBI showed a substantial effect on felt stress in comparison to the control group. When compared to the control group, the MBI showed a substantial impact on trait mindfulness. The MBI was beneficial for nursing students and could be considered a viable approach in nursing education to enhance mental wellbeing. It could be an effective method of relieving stress in a high-stress population.

Assessing the effects of an 8-week mindfulness training program on neural oscillations and self-reports during meditation practice.

Previous literature suggests that mindfulness meditation can have positive effects on mental health, however, its mechanisms of action are still unclear. In this pre-registered study, we investigate the effects of mindfulness training on lapses of attention (and their associated neural correlates) during meditation practice. For this purpose, we recorded Electroencephalogram (EEG) during meditation practice before and after 8 weeks of mindfulness training (or waitlist) in 41 participants (21 treatment and 20 controls). In order to detect lapses of attention and characterize their EEG correlates, we interrupted participants during meditation to report their level of focus and drowsiness. First, we show that self-reported lapses of attention during meditation practice were associated to an increased occurrence of theta oscillations (3-6 Hz), which were slower in frequency and more spatially widespread than theta oscillations occurring during focused attention states. Then, we show that mindfulness training did not reduce the occurrence of lapses of attention nor their associated EEG correlate (i.e. theta oscillations) during meditation. Instead, we find that mindfulness training was associated with a significant slowing of alpha oscillations in frontal electrodes during meditation. Crucially, frontal alpha slowing during meditation practice has been reported in experienced meditators and is thought to reflect relative decreases in arousal levels. Together, our findings provide insights into the EEG correlates of mindfulness meditation, which could have important implications for the identification of its mechanisms of action and/or the development of neuromodulation protocols aimed at facilitating meditation practice.

Effects of Mindfulness-Based Cancer Recovery training on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients undergoing chemotherapy.

RATIONALE: Mindfulness-Based Cancer Recovery (MBCR) program is a group course training for cancer patients that combines cancer knowledge and psychological knowledge, emphasizing focusing on the psychosomatic symptoms of cancer patients. Currently, the application value of Mindfulness-Based Cancer Recovery in improving psychosomatic health of cancer patients has been confirmed, however, its intervention effect on breast neoplasm patients has not yet been widely studied in China. PATIENT CONCERNS AND DIAGNOSES: This study introduced the Mindfulness-Based Cancer Recovery protocol into the rehabilitation process of breast cancer patients, aiming to elucidate the effects of Mindfulness-Based Cancer Recovery on anxiety, depression, post-traumatic stress disorder, and cancer-related fatigue in breast neoplasm patients, to provide a practical basis for improving the physical and mental health of breast cancer patients. INTERVENTION: In this study, 80 patients with chemotherapy-stage breast neoplasm attending the oncology department of a tertiary-level hospital from January 2022 to December 2022 were selected, 40 patients attending from January 2022 to June 2022 were included in the study group, and 40 patients attending from July 2022 to December 2022 were included in the control group. The control group was administered conventional care, and the study group was administered Mindfulness-Based Cancer Recovery based on conventional care in the control group for 8 weeks. After the intervention, hospital anxiety and depression scale, impact of event scale-revised, and cancer fatigue scale were used for evaluation. OUTCOMES: After the intervention, hospital anxiety and depression scale scores decreased in both groups compared with pre-intervention, with the study group scoring lower than the control group (P < .05). After the intervention, the impact of event scale-revised scores of the 2 groups decreased from the preintervention period, with the study group scoring lower than the control group (P < .05). After the intervention, cancer fatigue scale scores decreased in the 2 groups compared with the preintervention period, with the study group scoring lower than the control group (P < .05). LESSONS: Mindfulness-Based Cancer Recovery can effectively reduce the levels of anxiety, depression and post-traumatic stress disorder in breast neoplasm patients undergoing chemotherapy, reduce the levels of cancer-related fatigue, and promote the physical and mental health of patients.