Mindfulness trait and the potential mediating role of emotional regulation strategies in bipolar disorder / Mindfulness rasgo y el potencial papel mediador de las estrategias de regulación emocional en el trastorno bipolar

En este estudio transversal se investiga la asociación entre los principales síntomas del Trastorno bipolar (TB) y las dificultades asociadas a las estrategias de regulación emocional (ERE) adaptativas y desadaptativas. Además, este estudio examina los efectos mediadores de las ERE con el mindfulness rasgo y el TB. Método. Veinticuatro adultos con TB completaron la Escala de Conciencia de Atención Plena (MAAS), el Inventario de Depresión de Beck (BDI-II), la Escala de Autoevaluación de Manía de Altman (ARSM), el Inventario de Ansiedad Rasgo (STAI-R), y el Cuestionario de Regulación Emocional Cognitiva (CERQ). Resultados. El análisis de regresión múltiple mostró cómo la depresión se relacionaba significativa y positivamente con la autoculpabilización, mientras que la ansiedad rasgo estaba positivamente asociada con la autoculpabilización y el catastrofismo. En segundo lugar, el análisis de mediación mostró un efecto de mediación significativo para la autoculpabilidad en la relación entre mindfulness y depresión (a*b = -.15; ICB 95% [-.36, -.03]) y entre mindfulness y ansiedad rasgo (a*b = -.09; ICB 95% [-.27, -.01]). Conclusiones. Nuestros resultados informan del papel de la auto-culpabilidad y el catastrofismo en el TB y de cómo éstas podrían mediar significativamente entre el mindfulness rasgo y el TB. Estos resultados sugieren que una práctica de meditación enfocada en el catastrofismo y la autoculpabilidad puede ser especialmente útil para reducir los síntomas en los pacientes bipolares.(AU)

This cross-sectional study investigates the association between the main symptoms of Bipolar disorder (BD) and emotional regulation dif-ficulties in adaptive and maladaptive emotional regulation strategies (ERS). In addition, this study examines the possible mediating effects of ERS with dispositional mindfulnessand bipolar symptoms. Method.Twenty-four adults diagnosed with BD completed the Mindful Attention Awareness Scale (MAAS), the Beck Depression Inventory (BDI-II), the Altman Mania Self-Assessment Scale (ARSM), the Trait Anxiety Inventory (STAI-R), and the Cognitive Emotional Regulation Questionnaire (CERQ). Results. First, mul-tiple regression analysis showed how depression was significantly positively related to self-blame, whereas trait anxietywas positively associated with self-blame and catastrophizing. Second, the results of the mediation analy-sis have shown a significant mediation effect for the self-blamein the rela-tionship between mindfulnessand depression (a*b = -.15; BCI 95% [-.36, -.03]) and between mindfulnessand trait anxiety (a*b = -.09; BCI 95% [-.27, -.01]). Conclusions. Our results report the role of self-blame and catastrophiz-ing in BD and how these might significantly mediate between dispositional mindfulness and symptoms of depression and anxiety. These results suggest that a meditation practice focused on reducing catastrophizing and self-blame may be especially helpful for symptoms of depression and anxiety in bipolar patients.(AU)

Comparison of two brief mindfulness interventions for anxiety, stress and burnout in mental health professionals: a randomised crossover trial.

Background: Anxiety, stress and burnout are a growing reality among mental health professionals, impacting negatively on them and their clients. Mindfulness-based interventions (MBIs) have demonstrated effectiveness in mitigating these sufferings. Nevertheless, there is a lack of knowledge on the impact of MBIs in Cuba. Objectives: To compare the effectiveness of two brief mindfulness-based interventions for reducing anxiety, work stress and burnout. Methods: A total of 104 mental health professionals from Havana (Cuba) participated in a randomised crossover trial. Group A received first an intervention involving body-centred practices (body scan and Hatha yoga) and a second intervention involving mind-centred practices (focused attention and open monitoring meditation). Group B received the same interventions but in reverse order. Four measures (anxiety, stress, burnout syndrome, and antecedents of burnout) were measured at baseline, posttest1, posttest2, and 6-months follow-up. Results: After the first intervention, there was a between-group difference for burnout syndrome, but the ES was similar for both groups. After the second intervention (implementing both practises), groups showed the largest effect sizes, and there was a between-group difference for antecedents of burnout. Results were partially maintained at 6-month follow-up. Conclusion: These results suggest that mind-centred practises can be as effective as body-centred practises for stress, anxiety and burnout reduction. The combination of both types of practises could be the most effective way of teaching mindfulness. About the sequence of implementation, teaching mind-centred practises first and then body-centred practises could be most effective for reducing antecedents of burnout.Clinical Trial Registration: www.clinicaltrials.gov NCT03296254.

Mindfulness-based and mindfulness-informed interventions in bipolar disorder: A meta-analysis based on Becker's method.

Bipolar disorder is a highly disruptive and debilitating problem. Mindfulness-based and mindfulness-informed interventions have exponentially emerged as third-generation therapies, applied to a wide spectrum of disorders, including bipolar disorder. However, the reviews and meta-analyses published to date are limited in their conclusions, as they are based on single-group pretest-posttest cohort designs and mostly focused on mindfulness-based interventions. The present review and meta-analysis try to address these limitations, including studies on informed mindfulness, controlled and single-group designs. It used a specific meta-analytical procedure that allows an imputation procedure in those designs lacking a comparison group, by means of separate omnibus tests for the experimental and control group. A total of 13 studies (N = 331) were selected. The results showed an absence of effects on depression (g = 0.21) and mania (g = -0.13), but significant moderate effect on anxiety (g = 0.53). In conclusion, both mindfulness interventions showed robust evidence on anxiety symptoms in pretest-posttest periods compared to control groups. Few studies and lack of evidence of follow-up periods were the main limitations found.

Interactions between Personality and Types of Mindfulness Practice in Reducing Burnout in Mental Health Professionals.

Research on mindfulness-based interventions reports mainly on improvements at the group level. Thus, there is a need to elaborate on the individual differences in their effectiveness. The aim of this study was twofold: (1) to examine which personality factors could influence burnout reduction associated with different types of mindfulness practice and (2) to evaluate the interaction between personality factors and the amount of home practice; both aims were controlled for sociodemographic characteristics. A total of 104 Cuban mental health professionals, who participated in a crossover trial, were included. The effect of personality (Cattell's 16 Personality Factors) was analyzed through regression analysis. First, the results revealed that Emotional Stability and Vigilance could negatively moderate the effectiveness of mindfulness-based interventions. Second, participants who scored low in Sensitivity or Vigilance could benefit more from the body-centered practices (i.e., body scan and Hatha yoga practices), but no significant results for the mind-centered practices (i.e., classical meditation) were found. Third, participants who scored high in Self-reliance could benefit more from informal practice. Other personality factors did not appear to moderate the effect of the interventions, though previous experience in related techniques must be considered. Recommendations and clinical implications are discussed. Trial registration number is NCT03296254 (clinicaltrials.gov).

Interfamily Therapy, a multifamily therapy model settled in infant-juvenile mental health services of Havana (Cuba): A qualitative study from participants' perspectives.

Interfamily therapy (IFT) is a specific model for multifamily therapy (MFT) of recent expansion in Latin American and European countries. In IFT a multifamily group becomes a community of learning where professionals and family members establish collaborative relationships and participate in dialogues. This study used a qualitative phenomenological approach to explore the participants' perspective of 14 members and ex-members of two IFT groups conducted in Infant-Juvenile Mental Health Centers in Havana (Cuba). In this study IFT was well accepted and effective, and it was perceived as beneficial due to its positive influence for participants, with benefits on a personal, family and social level. In addition, participants articulated a series of therapeutic elements of IFT that were essential to promote these benefits. In conclusion, IFT seems to be a useful therapeutic model in the treatment of children, adolescents and their families in a Cuban psychiatric setting.

Effectiveness of mindfulness-based interventions on anxiety for children and adolescents: A systematic review and meta-analysis.

AIM: This paper aims to investigate the extent to which mindfulness-based interventions serve to reduce anxiety in children and adolescents. A heterogeneous sample was used, including clinical and non-clinical population. METHODS: A literature search of controlled intervention studies published up to December 31, 2016, was carried out in PubMed, Lilacs, Cochrane, Embase, PsycInfo, Opengrey and Teseo databases. The effect size was calculated by Cohen's d. The Cochran Q statistic and the I2 index were used for the study of heterogeneity. An analysis was conducted using the random effects model. RESULTS: 829 articles were identified, of which 18 were finally selected. Of these, only three had statistically significant effect sizes. The overall combined result obtained was .013, but it did not result statistically significant (CI95% [-.102, .128].) The Q statistic was statistically significant (Q [18] = 28.497, P = . 39) and the I2 index was 40.34%, indicating a moderate heterogeneity. CONCLUSIONS: This meta-analysis did not obtain statistically significant results that could provide conclusions. In general, the studies analysed are small, of low power and have a marked heterogeneity, which implies that the findings are provisional and need to be supported by more robust studies. Although it cannot be ruled out that mindfulness-based interventions are not effective in the infant-juvenile population, it is also possible that this effect could not be detected due to the limited number of available studies. Larger investigations are needed, with sufficient statistical power and designs that control the variables potentially moderating, to establish clear conclusions.

Intervención enfermera sobre la calidad de vida en personas con cuidados paliativos domiciliarios: revisión sistemática / Nursing intervention on quality of life in people with home-based palliative care: a systematic review

OBJETIVO: Evaluar la efectividad de la intervención enfermera en la calidad de vida de las personas con cuidados paliativos domiciliarios. MÉTODO: Se realizó una revisión sistemática. Se consultaron las bases de datos PUBMED, CUIDEN, CUIDATGE, JBI, CINAHL, ENFISPO, PSYCINFO, EMBASE, LILACS, COCHRANE, TESEO y OPENGREY, analizándose 721 artículos científicos publicados entre 2003 y 2013. Se incluyeron estudios descriptivos, experimentales, cuasiexperimentales y revisiones sistemáticas. Dos autores de la revisión consideraron de forma individual la elegibilidad de los estudios incluidos, evaluaron la calidad de los mismos mediante fichas de lectura crítica (FLC 2.0) y extrajeron los datos. RESULTADOS: Ocho estudios cumplieron con los criterios de inclusión, e incluyen un total de 459 pacientes. Las edades estaban comprendidas entre los 24 y los 97 años, y un 49% de los participantes fueron mujeres. En todos los casos la intervención enfermera se realizó en el marco de un equipo multidisciplinar, estando habitualmente orientada hacia el control de síntomas de la enfermedad. CONCLUSIONES: El número de estudios encontrados en esta revisión, así como la calidad metodológica de los mismos, fueron limitados. Estos resultados apuntan a que los cuidados paliativos domiciliarios en los que se incluyen enfermeras producen mejoras en la calidad de vida del paciente y los cuidadores principales, además de mejor control de síntomas, disminución de la carga percibida debida a la enfermedad, mejora del estado de salud físico y mental, satisfacción con el cuidado recibido, reducción de las visitas a los servicios de urgencias y aumento del uso de documentos de voluntades anticipadas. Son necesarias mayores investigaciones con diseños de calidad que aporten evidencia sobre las intervenciones enfermeras en el cuidado de las personas que reciben cuidados paliativos a domicilio

OBJECTIVE: The aim of this study is to assess the effectiveness of nursing intervention on life quality of palliative patients in home-based care. METHOD A systematic review was conducted. The following databases were searched: PUBMED, CUIDEN, CUIDATGE, JBI, CINAHL, ENFISPO, PSYCINFO, EMBASE, LILACS, COCHRANE, TESEO and OPENGREY. An analysis was made of 721 scientific studies found and published between 2003 and 2013. Descriptive, experimental, quasi-experimental and systematic reviews were included. Two review authors individually considered the eligibility of the studies included, and, assessed the quality through critical reading (FLC 2.0) and extracted the data. RESULTS: The 8 studies selected that met the inclusion criteria, included a total of 459 PATIENTS: The ages ranged from 24 to 97 years, and 49% of participants were women. In all cases the nurse intervention was carried out within the framework of a multidisciplinary team, aimed at controlling disease symptoms. CONCLUSIONS: The number of studies found in this review, and the methodological quality of the data were limited. These results suggest that home-based palliative care in which nurses are included lead to improvements in the quality of life of patients and primary caregivers, in addition to better control of symptoms, decrease perceived burden from the disease, improving the state of physical and mental health, satisfaction with the care received, reduced visits to emergency departments, and increased use of living wills. Higher quality research designs are required that provide evidence for nursing interventions in the care of people receiving palliative care at home