Mindfulness-Based Interventions for Professionals Working in End-of-Life Care: A Systematic Review of the Literature.

Objectives: The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI's for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. Methods: A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. Results: A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and self-compassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants' identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study's methodology. Conclusions: Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals.

Creating a hierarchy of mental health stigma: testing the effect of psychiatric diagnosis on stigma.

BACKGROUND: Levels of mental health stigma experienced can vary as a function of the presenting mental health problem (e.g. diagnosis and symptoms). However, these studies are limited because they exclusively use pairwise comparisons. A more comprehensive examination of diagnosis-specific stigma is needed. AIMS: The aim of our study was to determine how levels of mental health stigma vary in relation to a number of psychiatric diagnoses, and identify what attributions predict levels of diagnosis-specific stigma. METHOD: We conducted an online survey with members of the public. Participants were assessed in terms of how much stigma they had, and their attributions toward, nine different case vignettes, each describing a different mental health diagnosis. RESULTS: We recruited 665 participants. After controlling for social desirability bias and key demographic variables, we found that mental health stigma varied in relation to psychiatric diagnosis. Schizophrenia and antisocial personality disorder were the most stigmatised diagnoses, and depression, generalised anxiety disorder and obsessive-compulsive disorder were the least stigmatised diagnoses. No single attribution predicted stigma across diagnoses, but fear was the most consistent predictor. CONCLUSIONS: Assessing mental health stigma as a single concept masks significant between-diagnosis variability. Anti-stigma campaigns are likely to be most successful if they target fearful attributions.

Tailoring Sexual Health Interventions for Middle-Aged and Older Adults, Including Vulnerable Populations: A Scoping Review.

Objective: This scoping review aims to synthesize existing literature on good practice in sexual health interventions for adults over 45 years and in vulnerable groups. Methods: Using PRISMA-ScR guidelines, search terms focused on sexual health, good practice, and vulnerable groups, in over-45s. Results: Of the nine studies that met the inclusion criteria, seven were focused on HIV and risk reduction. Use of alternative methods of communication, alongside inclusion of behavioral and cognitive measures such as condom use and perceived stigma, was key to tailoring interventions. Conclusions: This review highlights the imperative for further research on sexual health interventions with these overlooked populations.

Cognitive arousal mediates the relationship between perceived ostracism and sleep quality but it is not moderated by experiential avoidance.

Previous research suggests that longer-term perceived ostracism is related to poor sleep quality. In this study, we investigated the mediating effect of cognitive arousal on the perceived ostracism-sleep quality relationship. We also investigated whether experiential avoidance was a moderator of the cognitive arousal-sleep quality relationship. Participants (N = 251) were recruited through online research portals to take part in an online survey. A path analysis was used to test a moderated mediation effect between variables. It was found that cognitive arousal mediated the perceived ostracism-sleep quality relationship; however, experiential avoidance was not a significant moderator. These findings suggest that further research needs to be conducted to elucidate the mechanism of experiential avoidance to account for when it may impact sleep quality. Moreover, treatment interventions targeted at reducing cognitive arousal (e.g., cognitive behavioural therapy) prior to sleep are likely to bear some fruit.

Barriers to Mindfulness: a Path Analytic Model Exploring the Role of Rumination and Worry in Predicting Psychological and Physical Engagement in an Online Mindfulness-Based Intervention.

Little is known about the factors associated with engagement in mindfulness-based interventions (MBIs). Moreover, engagement in MBIs is usually defined in terms of class attendance ('physical engagement') only. However, in the psychotherapy literature, there is increasing emphasis on measuring participants' involvement with interventions ('psychological engagement'). This study tests a model that rumination and worry act as barriers to physical and psychological engagement in MBIs and that this in turn impedes learning mindfulness. One hundred and twenty-four participants were given access to a 2-week online mindfulness-based self-help (MBSH) intervention. Self-report measures of mindfulness, rumination, worry, positive beliefs about rumination, positive beliefs about worry and physical and psychological engagement were administered. A path analysis was used to test the linear relationships between the variables. Physical and psychological engagement were identified as two distinct constructs. Findings were that rumination and worry both predicted psychological disengagement in MBSH. Psychological engagement predicted change in the describe, act with awareness, non-judge and non-react facets of mindfulness while physical engagement only predicted changes in the non-react facet of mindfulness. Thus, rumination and worry may increase risk of psychological disengagement from MBSH which may in turn hinder cultivating mindfulness. Future suggestions for practice are discussed.

A Qualitative Study with Healthcare Staff Exploring the Facilitators and Barriers to Engaging in a Self-Help Mindfulness-Based Intervention.

In order to increase the cost-efficiency, availability and ease of accessing and delivering mindfulness-based interventions (MBIs), clinical and research interest in mindfulness-based self-help (MBSH) interventions has increased in recent years. Several studies have shown promising results of effectiveness of MBSH. However, like all self-help interventions, dropout rates and disengagement from MBSH are high. The current study explored the facilitators and barriers of engaging in a MBSH intervention. Semi-structured interviews with members of healthcare staff who took part in an MBSH intervention (n = 16) were conducted. A thematic analysis approach was used to derive central themes around engagement from the interviews. Analyses resulted in four overarching themes characterising facilitation and hindrance to engagement in MBSH. These are "attitude towards engagement", "intervention characteristics", "process of change" and "perceived consequences". Long practices, emerging negative thoughts and becoming self-critical were identified as the key hindrances, whilst need for stress reduction techniques, shorter practices and increased sense of agency over thoughts were identified as the key facilitators. Clinical and research implications are discussed.