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Background: Many attempts have been made to abbreviate mindfulness programmes in order to make them more accessible for general and clinical populations while maintaining their therapeutic components and efficacy. The aim of this study was to assess the efficacy of an 8-week mindfulness-based intervention (MBI) programme and a 4-week abbreviated version for the improvement of well-being in a non-clinical population., Method: A quasi-experimental, controlled, pilot study was conducted with pre-post and 6-month follow-up measurements and three study conditions (8- and 4-session MBI programmes and a matched no-treatment control group, with a sample of 48, 46, and 47 participants in each condition, respectively). Undergraduate students were recruited, and mindfulness, positive and negative affect, self-compassion, resilience, anxiety, and depression were assessed. Mixed-effects multi-level analyses for repeated measures were performed., Results: The intervention groups showed significant improvements compared to controls in mindfulness and positive affect at the 2- and 6-month follow-ups, with no differences between 8- vs. 4-session programmes. The only difference between the abbreviated MBI vs. the standard MBI was found in self-kindness at 6 months, favoring the standard MBI. There were marginal differences in anxiety between the controls vs. the abbreviated MBI, but there were differences between the controls vs. the standard MBI at 2- and 6-months, with higher levels in the controls. There were no differences in depression between the controls vs. the abbreviated MBI, but differences were found between the controls vs. the standard MBI at 2- and 6-months, favoring the standard MBI. There were no differences with regard to negative affect and resilience., Conclusion: To our knowledge, this is the first study to directly investigate the efficacy of a standard 8-week MBI and a 4-week abbreviated protocol in the same population. Based on our findings, both programmes performed better than controls, with similar effect size (ES). The efficacy of abbreviated mindfulness programmes may be similar to that of a standard MBI programme, making them potentially more accessible for a larger number of populations. Nevertheless, further studies with more powerful designs to compare the non-inferiority of the abbreviated protocol and addressing clinical populations are warranted., Clinical Trials.gov Registration ID: NCT02643927
BackgroundDepression is one of the most common disorders in Psychiatric and Primary Care settings and is associated with significant disability and economic costs. Low-intensity psychological interventions applied by Information and Communication Technologies (ICTs) could be an efficacious and cost-effective therapeutic option for the treatment of depression. The aim of this study is to assess 3 low-intensity psychological interventions applied by ICTs (healthy lifestyle, positive affect and mindfulness) in Primary Care; significant efficacy for depression treatment has previously showed in specialized clinical settings by those interventions, but ICTs were not used.
Method
Multicenter controlled randomized clinical trial in 4 parallel groups. Interventions have been designed and on-line device adaptation has been carried out. Subsequently, the randomized controlled clinical trial will be conducted. A sample of N = 240 mild and moderate depressed patients will be recruited and assessed in Primary Care settings. Patients will be randomly assigned to a) healthy lifestyle psychoeducational program + improved primary care usual treatment (ITAU), b) focused program on positive affect promotion + ITAU c) mindfulness + ITAU or d) ITAU. The intervention format will be one face to face session and four ICTs on-line modules. Patients will be diagnosed with MINI psychiatric interview. Main outcome will be PHQ-9 score. They will be also assessed by SF-12 Health Survey, Client Service Receipt Inventory, EuroQoL-5D questionnaire, Positive and Negative Affect Scale, Five Facet Mindfulness Questionnaire and the Pemberton Happiness Index. Patients will be assessed at baseline, post, 6 and 12 post-treatment months. An intention to treat and per protocol analysis will be performed.
Discussion
Low-intensity psychological interventions applied by Information and Communication Technologies have been not used before in Spain and could be an efficacious and cost-effective therapeutic option for depression treatment. The strength of the study is that it is the first multicenter controlled randomized clinical trial of three low intensity and self-guided interventions applied by ICTs (healthy lifestyle psychoeducational program; focused program on positive affect promotion and brief intervention based on mindfulness) in Primary Care settings.
Trial registration
Current Controlled Trials ISRCTN82388279. Registered 16 April 2014.
The first structured 8-week program on mindfulness, Mindfulness-based Stress Reduction (MBSR), was developed by Kabat-Zinn (1982) in a hospital linked to the University of Massachusetts. As is usual in private health systems, participants of these programs have to pay for them, making them less accessible to low-income individuals. Consequently, a large proportion of participants of mindfulness-based interventions have been high-income, white, Anglo-Saxon, and educated individuals actively seeking mindfulness training (Olano et al., 2015). Despite Kabat-Zinn's purported interest in offering mindfulness to low-income populations, few studies have investigated the efficacy and/or acceptability of these programs for individuals of low socioeconomic status (Roth and Creaser, 1997; Kabat-Zinn et al., 2016).Mindfulness programs are now taught in more than 50 countries worldwide (Kabat-Zinn et al., 2016), including Spanish- and Portuguese-speaking countries of Europe and the Americas (encompassed by the term “Latin” in this paper). Such Latin countries share obvious cultural influences and similarities—and during the implementation of mindfulness in these countries—Latin clinicians and researchers have observed that compared to non-Latin countries, there exist differences in how their patients learn and practice mindfulness (Demarzo et al., 2015). In this opinion paper, we briefly provide a preliminary conceptual framework for a culturally-syntonic approach to implementing mindfulness- and compassion-based (M and C) interventions in Latin societies. Furthermore, based on the authors' own clinical and teaching experiences, we offer recommendations for the effective teaching of M and C approaches in Latin countries.
The first structured 8-week program on mindfulness, Mindfulness-based Stress Reduction (MBSR), was developed by Kabat-Zinn (1982) in a hospital linked to the University of Massachusetts. As is usual in private health systems, participants of these programs have to pay for them, making them less accessible to low-income individuals. Consequently, a large proportion of participants of mindfulness-based interventions have been high-income, white, Anglo-Saxon, and educated individuals actively seeking mindfulness training (Olano et al., 2015). Despite Kabat-Zinn's purported interest in offering mindfulness to low-income populations, few studies have investigated the efficacy and/or acceptability of these programs for individuals of low socioeconomic status (Roth and Creaser, 1997; Kabat-Zinn et al., 2016).Mindfulness programs are now taught in more than 50 countries worldwide (Kabat-Zinn et al., 2016), including Spanish- and Portuguese-speaking countries of Europe and the Americas (encompassed by the term “Latin” in this paper). Such Latin countries share obvious cultural influences and similarities—and during the implementation of mindfulness in these countries—Latin clinicians and researchers have observed that compared to non-Latin countries, there exist differences in how their patients learn and practice mindfulness (Demarzo et al., 2015). In this opinion paper, we briefly provide a preliminary conceptual framework for a culturally-syntonic approach to implementing mindfulness- and compassion-based (M and C) interventions in Latin societies. Furthermore, based on the authors' own clinical and teaching experiences, we offer recommendations for the effective teaching of M and C approaches in Latin countries.
Self-compassion is natural, trainable and multi-faceted human capacity. To date there has been little research into the role of culture in influencing the conceptual structure of the underlying construct, the relative importance of different facets of self-compassion, nor its relationships to cultural values. This study employed a cross-cultural design, with 4,124 participants from 11 purposively sampled datasets drawn from different countries. We aimed to assess the relevance of positive and negative items when building the self-compassion construct, the convergence among the self-compassion components, and the possible influence of cultural values. Each dataset comprised undergraduate students who completed the "Self-Compassion Scale" (SCS). We used a confirmatory factor analysis (CFA) approach to the multitrait-multimethod (MTMM) model, separating the variability into self-compassion components (self-kindness, common humanity, mindfulness), method (positive and negative valence), and error (uniqueness). The normative scores of the Values Survey Module (VSM) in each country, according to the cultural dimensions of individualism, masculinity, power distance, long-term orientation, uncertainty avoidance, and indulgence, were considered. We used Spearman coefficients (rs) to assess the degree of association between the cultural values and the variance coming from the positive and negative items to explain self-compassion traits, as well as the variance shared among the self-compassion traits, after removing the method effects produced by the item valence. The CFA applied to the MTMM model provided acceptable fit in all the samples. Positive items made a greater contribution to capturing the traits comprising self-compassion when the long-term orientation cultural value was higher (rs = 0.62; p = 0.042). Negative items did not make significant contributions to building the construct when the individualism cultural value was higher, but moderate effects were found (rs = 0.40; p = 0.228). The level of common variance among the self-compassion trait factors was inversely related to the indulgence cultural value (rs = -0.65; p = 0.030). The extent to which the positive and negative items contribute to explain self-compassion, and that different self-compassion facets might be regarded as reflecting a broader construct, might differ across cultural backgrounds.