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1.  Conscious Presence and Self Control as a measure of situational awareness in soldiers – A validation study 
Background
The concept of `mindfulness´ was operationalized primarily for patients with chronic stressors, while it is rarely used in reference to soldiers. We intended to validate a modified instrument on the basis of the Freiburg Mindfulness Inventory (FMI) to measure soldiers’ situational awareness (“mindfulness”) in stressful situations/missions. The instrument we will explore in this paper is termed the Conscious Presence and Self Control (CPSC) scale.
Methods
The CPSC and further instruments, i.e., Perceived Stress Scale (PSS), stressful military experiences (PCL-M), life satisfaction (BMLSS), Positive Life Construction (ePLC), and self-perceived health affections (VAS), were administered to 281 German soldiers. The soldiers were mainly exposed to explosive ordnance, military police, medical service, and patients with posttraumatic stress disorders.
Results
The 10-item CPSC scale exhibited a one-factorial structure and showed a good internal consistence (Cronbach´s alpha = .86); there were neither ceiling nor bottom effects. The CPSC scores correlated moderately with Positive Life Construction and life satisfaction, and negatively with perceived stress and health affections. Regression analyses indicated that posttraumatic stress disorder symptoms (negative), and the development of effective strategies to deal with disturbing pictures and experiences (positive) were the best predictor of soldiers´ CPSC scores. Soldiers with health affections exhibiting impact upon their daily life had significantly lower CPSC scores than those without impairment (F=8.1; p < .0001).
Conclusions
As core conceptualizations of `mindfulness´ are not necessarily discussed in a military context, the FMI was adopted for military personnel populations, while its two factorial structure with the sub-constructs `acceptance´ and `presence´ was retained. The resulting 10-item CPSC scale had good internal consistence, sound associations with measures of health affections and life satisfaction, and thus can be used as a short and rapid measure in pre-post mission and interventional studies.
doi:10.1186/1752-4458-7-1
PMCID: PMC3558360  PMID: 23289791
Mindfulness; Conscious presence; Soldiers; Trauma; Validation; Questionnaire
2.  Validation of the Spanish versions of the long (26 items) and short (12 items) forms of the Self-Compassion Scale (SCS) 
Background
Self-compassion is a key psychological construct for assessing clinical outcomes in mindfulness-based interventions. The aim of this study was to validate the Spanish versions of the long (26 item) and short (12 item) forms of the Self-Compassion Scale (SCS).
Methods
The translated Spanish versions of both subscales were administered to two independent samples: Sample 1 was comprised of university students (n = 268) who were recruited to validate the long form, and Sample 2 was comprised of Aragon Health Service workers (n = 271) who were recruited to validate the short form. In addition to SCS, the Mindful Attention Awareness Scale (MAAS), the State-Trait Anxiety Inventory–Trait (STAI-T), the Beck Depression Inventory (BDI) and the Perceived Stress Questionnaire (PSQ) were administered. Construct validity, internal consistency, test-retest reliability and convergent validity were tested.
Results
The Confirmatory Factor Analysis (CFA) of the long and short forms of the SCS confirmed the original six-factor model in both scales, showing goodness of fit. Cronbach’s α for the 26 item SCS was 0.87 (95% CI = 0.85-0.90) and ranged between 0.72 and 0.79 for the 6 subscales. Cronbach’s α for the 12-item SCS was 0.85 (95% CI = 0.81-0.88) and ranged between 0.71 and 0.77 for the 6 subscales. The long (26-item) form of the SCS showed a test-retest coefficient of 0.92 (95% CI = 0.89–0.94). The Intraclass Correlation (ICC) for the 6 subscales ranged from 0.84 to 0.93. The short (12-item) form of the SCS showed a test-retest coefficient of 0.89 (95% CI: 0.87-0.93). The ICC for the 6 subscales ranged from 0.79 to 0.91. The long and short forms of the SCS exhibited a significant negative correlation with the BDI, the STAI and the PSQ, and a significant positive correlation with the MAAS. The correlation between the total score of the long and short SCS form was r = 0.92.
Conclusion
The Spanish versions of the long (26-item) and short (12-item) forms of the SCS are valid and reliable instruments for the evaluation of self-compassion among the general population. These results substantiate the use of this scale in research and clinical practice.
doi:10.1186/1477-7525-12-4
PMCID: PMC3896764  PMID: 24410742
Self-compassion; Validation; Spanish; Mindfulness
3.  Validation of a Spanish version of the psychological inflexibility in pain scale (PIPS) and an evaluation of its relation with acceptance of pain and mindfulness in sample of persons with fibromyalgia 
Background
Psychological flexibility has been suggested as a fundamental process in health. The Psychological Inflexibility in Pain Scale (PIPS) is one of the scales employed for assessing psychological inflexibility in pain patients. The aim of this study was to validate the Spanish version of the PIPS and secondly, to compare it to two other psychological constructs, the acceptance of pain and mindfulness scales.
Methods
The PIPS was translated into Spanish by two bilingual linguistic experts, and then, back-translated into English to assess for equivalence. The final Spanish version was administered along with the Pain Visual Analogue Scale, Fibromyalgia Impact Questionnaire, Hospital Anxiety Depression Scale, Pain Catastrophizing Scale, Chronic Pain Acceptance Questionnaire and the Mindful Attention Awareness Scale, to 250 Spanish patients with fibromyalgia. Face validity, construct validity, reliability (internal consistency and test-retest) and convergent validity were tested. Also a multiple regression analysis was carried out.The usual guidelines have been followed for cross-cultural adaptations.
Results
Data were very similar to the ones obtained in the original PIPS version. The construct validity confirmed the original two-components solution which explained 61.6% of the variance. The Spanish PIPS had good test-retest reliability (intraclass correlation coefficient 0.97) and internal consistency reliability (Cronbach’s alpha: 0.90). The Spanish PIPS’ score correlated significantly with worse global functioning (r = 0.55), anxiety (r = 0.54), depression (r = 0.66), pain catastrophizing (r = 0.62), pain acceptance (r = −0.72) and mindfulness (r = −0.47), as well as correlating modestly with pain intensity (r = 0.12). The multiple regression analyses showed that psychological inflexibility, acceptance and mindfulness are not overlapped.
Conclusions
The Spanish PIPS scale appears to be a valid and reliable instrument for the evaluation of psychological inflexibility among a sample of fibromyalgia patients. These results ensure the use of this scale in research as well as in clinical practice. Psychological inflexibility measures processes different from other related components such as acceptance and mindfulness.
doi:10.1186/1477-7525-11-62
PMCID: PMC3635918  PMID: 23594367
Psychological inflexibility; Pain; Fibromyalgia; Acceptance; Mindfulness
4.  The Mindful Attention Awareness Scale for Adolescents (MAAS-A): Psychometric Properties in a Dutch Sample 
Mindfulness  2011;2(3):201-211.
The factor structure and psychometric properties of the Dutch version of the Mindful Attention Awareness Scale for Adolescents (MAAS-A) was studied in a sample of adolescents (n = 717; age range, 11–17 years) of the general population. The MAAS-A and other questionnaires measuring other constructs were administered in high schools across the Netherlands. A one-factor structure was demonstrated using principal component analysis and was further confirmed using confirmatory factor analysis. The MAAS-A was shown to have high internal consistency. Expected negative correlations between mindfulness and self-reported stress and emotion regulation strategies such as rumination and catastrophizing were found. Further, mindfulness was positively correlated with happiness, healthy self-regulation, and with another recently developed measure of mindfulness in children and adolescents, the Child and Adolescent Mindfulness Measure. Mindfulness as measured by the MAAS-A correlated positively with quality of life, but an expected positive relationship with acceptance was not found. Interestingly, adolescents without meditation experience scored higher on the MAAS-A than adolescents without this experience. Further, adolescents with chronic disorders scored lower on the MAAS-A than adolescents without these disorders. Overall, this study has shown evidence of the first valid and reliable Dutch measure of mindfulness for adolescents. The factor structure, internal consistency, and convergent and divergent validity as well as their relationship to quality of life are comparable to the original MAAS-A.
doi:10.1007/s12671-011-0061-6
PMCID: PMC3146710  PMID: 21909342
MAAS-A; Mindfulness; Internal consistency; Construct validity; Psychometric properties
5.  Dispositional Mindfulness Co-Varies with Smaller Amygdala and Caudate Volumes in Community Adults 
PLoS ONE  2013;8(5):e64574.
Mindfulness, a psychological process reflecting attention and awareness to what is happening in the present moment, has been associated with increased well-being and decreased depression and anxiety in both healthy and patient populations. However, little research has explored underlying neural pathways. Recent work suggests that mindfulness (and mindfulness training interventions) may foster neuroplastic changes in cortico-limbic circuits responsible for stress and emotion regulation. Building on this work, we hypothesized that higher levels of dispositional mindfulness would be associated with decreased grey matter volume in the amgydala. In the present study, a self-report measure of dispositional mindfulness and structural MRI images were obtained from 155 healthy community adults. Volumetric analyses showed that higher dispositional mindfulness is associated with decreased grey matter volume in the right amygdala, and exploratory analyses revealed that higher dispositional mindfulness is also associated with decreased grey matter volume in the left caudate. Moreover, secondary analyses indicate that these amygdala and caudate volume associations persist after controlling for relevant demographic and individual difference factors (i.e., age, total grey matter volume, neuroticism, depression). Such volumetric differences may help explain why mindful individuals have reduced stress reactivity, and suggest new candidate structural neurobiological pathways linking mindfulness with mental and physical health outcomes.
doi:10.1371/journal.pone.0064574
PMCID: PMC3661490  PMID: 23717632
6.  Using the Daydreaming Frequency Scale to Investigate the Relationships between Mind-Wandering, Psychological Well-Being, and Present-Moment Awareness 
Recent findings have shown that mind-wandering – the occurrence of stimulus-independent and task-unrelated thoughts – is associated with negative affect and lower psychological well-being. However, it remains unclear whether this relationship is due to the occurrence of mind-wandering per se or to the fact that people who mind wander more tend to be generally less attentive to present-moment experience. In three studies, we first validate a French translation of a retrospective self-report questionnaire widely used to assess the general occurrence of mind-wandering in daily life – the Daydreaming Frequency Scale. Using this questionnaire, we then show that the relationship between mind-wandering frequency and psychological distress is fully accounted for by individual differences in dispositional mindful awareness and encoding style. These findings suggest that it may not be mind-wandering per se that is responsible for psychological distress, but rather the general tendency to be less aware and attentive to the present-moment. Thus, although mind-wandering and present-moment awareness are related constructs, they are not reducible to one another, and are distinguishable in terms of their relationship with psychological well-being.
doi:10.3389/fpsyg.2012.00363
PMCID: PMC3457083  PMID: 23055995
mind-wandering; daydreaming; mindful awareness; encoding style; psychological distress; well-being
7.  Mindfulness online: a preliminary evaluation of the feasibility of a web-based mindfulness course and the impact on stress 
BMJ Open  2012;2(3):e000803.
Objectives
Stress has been shown to have a number of negative effects on health over time. Mindfulness interventions have been shown to decrease perceived stress but access to interventions is limited. Therefore, the effectiveness of an online mindfulness course for perceived stress was investigated.
Design
A preliminary evaluation of an online mindfulness course.
Participants
This sample consisted of 100 self-referrals to the online course. The average age of participants was 48 years and 74% were women.
Interventions
The online programme consisted of modules taken from Mindfulness Based Stress Reduction and Mindfulness Based Cognitive Therapy and lasted for approximately 6 weeks.
Primary and secondary outcome measures
Participants completed the Perceived Stress Scale (PSS) before the course, after the course and at 1-month follow-up. Completion of formal (eg, body scan, mindful movement) and informal (eg, mindful meal, noticing) mindfulness activities was self-reported each week.
Results
Participation in the online mindfulness course significantly reduced perceived stress upon completion and remained stable at follow-up. The pre-post effect size was equivalent to levels found in other class-based mindfulness programmes. Furthermore, people who had higher PSS scores before the course reported engaging in significantly more mindfulness practice, which was in turn associated with greater decreases in PSS.
Conclusions
Because perceived stress significantly decreased with such limited exposure to mindfulness, there are implications for the accessibility of mindfulness therapies online. Future research needs to evaluate other health outcomes for which face-to-face mindfulness therapies have been shown to help, such as anxiety and depressive symptoms.
Article summary
Article focus
Stress maintained over time can cause a number of negative effects, both physically and psychologically.
Mindfulness interventions have been shown to have significant beneficial effects to health including significantly decreasing stress.
Research question: is an online mindfulness course a feasible way to provide an intervention and decrease perceived stress?
Key messages
An online mindfulness course can significantly decrease perceived stress.
The decrease in stress is maintained at 1 month follow-up and is comparable to other interventions.
The online mindfulness course is an accessible and acceptable way for people to receive an intervention that can offer a way to decrease levels of perceived stress.
Strengths and limitations of this study
The sample consisted of people who had signed up to and paid for the online course that limits the extent to which we can extrapolate to those who might use it because referred by others (such as a health professional).
The effect of practice on mindfulness was not examined, so it is unclear what mediates the change in perceived stress. Other factors contributing to a decrease in stress were not included in this preliminary evaluation.
doi:10.1136/bmjopen-2011-000803
PMCID: PMC3358627  PMID: 22614170
8.  Mindfulness training for stress management: a randomised controlled study of medical and psychology students 
BMC Medical Education  2013;13:107.
Background
Distress and burnout among medical and psychology professionals are commonly reported and have implications for the quality of patient care delivered. Already in the course of university studies, medicine and psychology students report mental distress and low life satisfaction. There is a need for interventions that promote better coping skills in students in order to prevent distress and future burnout. This study examines the effect of a seven-week Mindfulness-Based Stress Reduction (MBSR) programme on mental distress, study stress, burnout, subjective well-being, and mindfulness of medical and psychology students.
Methods
A total of 288 students (mean age = 23 years, 76% female) from the University of Oslo and the University of Tromsø were randomly allocated to an intervention or control group. The control group continued with their standard university courses and received no intervention. Participants were evaluated using self-reported measures both before and after the intervention. These were: the ‘General Health Questionnaire, Maslach Burnout Inventory Student version, Perceived Medical School Stress, Subjective Well-being, and Five Facet Mindfulness Questionnaire’ and additional indices of compliance.
Results
Following the intervention, a moderate effect on mental distress (Hedges’g 0.65, CI = .41, .88), and a small effect on both subjective well-being (Hedges’g 0.40, CI = .27, .63) and the mindfulness facet ‘non-reacting’ (Hedges’g 0.33, CI = .10, .56) were found in the intervention group compared with the control group. A higher level of programme attendance and reported mindfulness exercises predicted these changes. Significant effects were only found for female students who additionally reported reduced study stress and an increase in the mindfulness facet ‘non-judging’. Gender specific effects of participation in the MBSR programme have not previously been reported, and gender differences in the present study are discussed.
Conclusion
Female medical and psychology students experienced significant positive improvements in mental distress, study stress, subjective well-being and mindfulness after participating in the MBSR programme.
Trial registration
NCT00892138
doi:10.1186/1472-6920-13-107
PMCID: PMC3751423  PMID: 23941053
Stress management; Mental distress; Well-being; Five facet mindfulness questionnaire; Gender differences; Undergraduate medical and psychology education
9.  Young and restless: validation of the Mind-Wandering Questionnaire (MWQ) reveals disruptive impact of mind-wandering for youth 
Mind-wandering is the focus of extensive investigation, yet until recently there has been no validated scale to directly measure trait levels of task-unrelated thought. Scales commonly used to assess mind-wandering lack face validity, measuring related constructs such as daydreaming or behavioral errors. Here we report four studies validating a Mind-Wandering Questionnaire (MWQ) across college, high school, and middle school samples. The 5-item scale showed high internal consistency, as well as convergent validity with existing measures of mind-wandering and related constructs. Trait levels of mind-wandering, as measured by the MWQ, were correlated with task-unrelated thought measured by thought sampling during a test of reading comprehension. In both middle school and high school samples, mind-wandering during testing was associated with worse reading comprehension. By contrast, elevated trait levels of mind-wandering predicted worse mood, less life-satisfaction, greater stress, and lower self-esteem. By extending the use of thought sampling to measure mind-wandering among adolescents, our findings also validate the use of this methodology with younger populations. Both the MWQ and thought sampling indicate that mind-wandering is a pervasive—and problematic—influence on the performance and well-being of adolescents.
doi:10.3389/fpsyg.2013.00560
PMCID: PMC3753539  PMID: 23986739
mind-wandering; attention; reading comprehension; K-12 education; well-being
10.  Language-based Measures of Mindfulness: Initial Validity and Clinical Utility 
This study examined relationships among language use, mindfulness, and substance-use treatment outcomes in the context of an efficacy trial of mindfulness-based relapse prevention (MBRP) for adults with alcohol and other drug use (AOD) disorders (see Bowen, Chawla, Collins et al., in press). An expert panel generated two categories of mindfulness language (ML) describing the mindfulness state and the more encompassing “mindfulness journey,” which included words describing challenges of developing a mindfulness practice. MBRP participants (n=48) completed baseline sociodemographic and AOD measures, and participated in the 8-week MBRP program. AOD data were collected during the 4-month follow-up. A word count program assessed the frequency of ML and other linguistic markers in participants’ responses to open-ended questions about their postintervention impressions of mindfulness practice and MBRP. Findings supported concurrent validity of ML categories: ML words appeared more frequently in the MBRP manual compared to the 12-step Big Book. Further, ML categories correlated with other linguistic variables related to the mindfulness construct. Finally, predictive validity was supported: greater use of ML predicted fewer AOD use days during the 4-month follow-up. This study provided initial support for ML as a valid, clinically useful mindfulness measure. If future studies replicate these findings, ML could be used in conjunction with self-report to provide a more complete picture of the mindfulness experience.
doi:10.1037/a0017579
PMCID: PMC2799300  PMID: 20025383
Relapse Prevention; Mindfulness; Validity; Substance use; Linguistic marker; Language
11.  Improving the Quality of Adult Mortality Data Collected in Demographic Surveys: Validation Study of a New Siblings' Survival Questionnaire in Niakhar, Senegal 
PLoS Medicine  2014;11(5):e1001652.
Stéphane Helleringer and colleagues conducted a validation study in Niakhar, Senegal to investigate whether a new approach, sibling survival calendars, improves the quality of adult mortality data collected in demographic surveys.
Please see later in the article for the Editors' Summary
Background
In countries with limited vital registration, adult mortality is frequently estimated using siblings' survival histories (SSHs) collected during Demographic and Health Surveys (DHS). These data are affected by reporting errors. We developed a new SSH questionnaire, the siblings' survival calendar (SSC). It incorporates supplementary interviewing techniques to limit omissions of siblings and uses an event history calendar to improve reports of dates and ages. We hypothesized that the SSC would improve the quality of adult mortality data.
Methods and Findings
We conducted a retrospective validation study among the population of the Niakhar Health and Demographic Surveillance System in Senegal. We randomly assigned men and women aged 15–59 y to an interview with either the DHS questionnaire or the SSC. We compared SSHs collected in each group to prospective data on adult mortality collected in Niakhar. The SSC reduced respondents' tendency to round reports of dates and ages to the nearest multiple of five or ten (“heaping”). The SSC also had higher sensitivity in recording adult female deaths: among respondents whose sister(s) had died at an adult age in the past 15 y, 89.6% reported an adult female death during SSC interviews versus 75.6% in DHS interviews (p = 0.027). The specificity of the SSC was similar to that of the DHS questionnaire, i.e., it did not increase the number of false reports of deaths. However, the SSC did not improve the reporting of adult deaths among the brothers of respondents. Study limitations include sample selectivity, limited external validity, and multiple testing.
Conclusions
The SSC has the potential to collect more accurate SSHs than the questionnaire used in DHS. Further research is needed to assess the effects of the SSC on estimates of adult mortality rates. Additional validation studies should be conducted in different social and epidemiological settings.
Trial Registration
Controlled-Trials.com ISRCTN06849961
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Governments and international health agencies need accurate information on births and deaths in populations to help them plan health care policies and monitor the effectiveness of public health programs. The most common way of collecting information on vital statistics in an area or country is through civil registration, an administrative system used by governments to record vital events that occur in their populations. In low-to-middle-income countries that have limited resources to devote to such a system, unconventional techniques are often used to estimate mortality levels and trends. One such method is siblings' survival histories collected while conducting a health or other type of public survey. Those surveyed are asked to list all their maternal siblings by birth order and report survival status and current age (for living siblings) or age at death (for deceased siblings).
Use of siblings' survival histories leaves the accuracy of the mortality record vulnerable to reporting errors and selection bias. Selection bias is a statistical prejudice that is introduced by the choice of the individuals or groups taking part in the analysis. Reporting errors occur when an individual fails to report a sibling's death, misreports the age of a sibling, or does not recall the exact date when a sibling died.
Why Was This Study Done?
This study was conducted to estimate whether modifying a standard siblings' survival history questionnaire could improve the accuracy of data obtained. The researchers conducted a study in Niakhar, Senegal, using a modified siblings' survival history questionnaire to incorporate some innovative techniques for assisting memory recall, such as recall cues, to help prevent omissions. The researchers also introduced an event history calendar format to help with more accurate reporting of dates. This modified questionnaire is called the siblings' survival calendar.
What Did the Researchers Do and Find?
The researchers randomly assigned men and women registered by the Niakhar Health and Demographic Surveillance System, aged 15–59 years old, to an interview with the basic questionnaire or the modified siblings' survival calendar. The modifications included emphasizing the importance of accurate recall before the participant started and asking respondents to list their maternal siblings in the order that they came to the mind instead of birth order. Also, the researchers used supplementary interviewing techniques designed to stimulate the recall of potentially omitted siblings and also used an event history calendar approach for collecting data on ages at, and dates of, vital events that had affected the siblings of a respondent.
The researchers compared the results from the two survey instruments and precise data on adult mortality collected by continuous demographic surveillance in a small area of Senegal. They found that the calendar survey improved the sensitivity of survey data in recording adult female deaths. In addition, the modified questionnaire significantly reduced age and date heaping (the tendency of respondents to round off dates) observed with the basic questionnaire. The modified questionnaire took six minutes longer to complete on average than the basic questionnaire.
What Do These Findings Mean?
These findings suggest that a new approach (the siblings' survival calendar) that uses simple interview tools to improve estimates of mortality in resource-limited countries is feasible and may improve the quality of the data from siblings' survival histories, particularly in reporting female deaths. Although the study was limited by sample selectivity, limited external validity, and multiple testing, the findings suggest that this new approach has the potential to allow the collection of more accurate data from siblings' survival histories than that collected from the current questionnaire. The next step is to validate these findings in other settings.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001652.
The World Health Organization Regional Office for Africa has a page on vital statistics
Information on demographic data available in Senegal can be accessed on the website of the Agence Nationale de la Statistique et de la Démographie (in French)
The UN Statistics Division has a page on their vital registration and vital statistics coverage assessment
The World Mortality Report 2013 presents the latest mortality estimates developed by the Population Division of the United Nations, including the probability of dying between the ages of 15 and 60 years
The Institute for Health Metrics and Evaluation has developed a visualization tool that allows one to see how siblings' survival histories are adjusted to generate estimates of adult mortality
More information on Health and Demographic Surveys surveillance in Niakhar, Senegal, is available (in French) on the website of the Institut de Recherche pour le Développement
doi:10.1371/journal.pmed.1001652
PMCID: PMC4035258  PMID: 24866715
12.  Stress on health-related quality of life in older adults: the protective nature of mindfulness 
Aging & Mental Health  2014;19(3):201-206.
Objectives: The current study examined whether the link between stress and health-related quality of life was buffered by protective factors, namely mindfulness, in a sample of middle-aged and older adults.
Methods: In this cross-sectional study, 134 healthy, community-dwelling adults (ages 50–85 years) were recruited from Dallas, TX. The participants were screened for depressive symptoms and severity (using the Patient Health Questionnaire [PHQ-9]). All participants completed measures of self-reported health status (i.e. SF36v2: mental and physical health composites), life stress (using the Elders Life Stress Inventory [ELSI]), and trait mindfulness (i.e. Mindful Attention Awareness Scale).
Results: Hierarchical regressions (covarying for age, gender, and education) showed that life stress was inversely related to physical and mental health. Mindfulness was positively related to mental health. The negative effect of life stress on mental health was weakened for those individuals with higher levels of trait mindfulness.
Conclusions: The results suggest that mindfulness is a powerful, adaptive strategy that may protect middle-aged and older adults from the well-known harmful effects of stress on mental health.
doi:10.1080/13607863.2014.924090
PMCID: PMC4299552  PMID: 24940847
aging; mental health; mindfulness; stress
13.  Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features 
JMIR mHealth and uHealth  2013;1(2):e24.
Background
Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce.
Objective
Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting.
Methods
We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature.
Results
The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs.
Conclusions
While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored.
doi:10.2196/mhealth.2733
PMCID: PMC4114453  PMID: 25099314
mobile health; mHealth; mindfulness; social networks; personalized education; health informatics; evidence-based medicine
14.  A mind you can count on: validating breath counting as a behavioral measure of mindfulness 
Frontiers in Psychology  2014;5:1202.
Mindfulness practice of present moment awareness promises many benefits, but has eluded rigorous behavioral measurement. To date, research has relied on self-reported mindfulness or heterogeneous mindfulness trainings to infer skillful mindfulness practice and its effects. In four independent studies with over 400 total participants, we present the first construct validation of a behavioral measure of mindfulness, breath counting. We found it was reliable, correlated with self-reported mindfulness, differentiated long-term meditators from age-matched controls, and was distinct from sustained attention and working memory measures. In addition, we employed breath counting to test the nomological network of mindfulness. As theorized, we found skill in breath counting associated with more meta-awareness, less mind wandering, better mood, and greater non-attachment (i.e., less attentional capture by distractors formerly paired with reward). We also found in a randomized online training study that 4 weeks of breath counting training improved mindfulness and decreased mind wandering relative to working memory training and no training controls. Together, these findings provide the first evidence for breath counting as a behavioral measure of mindfulness.
doi:10.3389/fpsyg.2014.01202
PMCID: PMC4208398  PMID: 25386148
mindfulness; mind wandering; task-unrelated thought; attention; meta-awareness; meta-cognition; wanting; working memory training
15.  Children’s mental time travel during mind wandering 
The prospective bias is a salient feature of mind wandering in healthy adults, yet little is known about the temporal focus of children’s mind wandering. In the present study, (I) we developed the temporal focus of mind wandering questionnaire for school-age children (TFMWQ-C), a 12-item scale with good test–retest reliability and construct validity. (II) The criterion validity was tested by thought sampling in both choice reaction time task and working memory task. A positive correlation was found between the temporal focus measured by the questionnaire and the one adopted during task-unrelated thoughts (TUTs) by thought sampling probes, especially in the trait level of future-oriented mind wandering. At the same time, children who experienced more TUTs tended to show worse behavioral performance during tasks. (III) The children in both tasks experienced more future-oriented TUTs than past-oriented ones, which was congruent with the results observed in adults; however, in contrast with previous research on adults, the prospective bias was not influenced by task demands. Together these results indicate that the prospective bias of mind wandering has emerged since the school-age (9∼13 years old), and that the relationship between mental time travel (MTT) during mind wandering and the use of cognitive resources differs between children and adults. Our study provides new insights into how this interesting feature of mind wandering may adaptively contribute to the development of children’s MTT.
doi:10.3389/fpsyg.2014.00927
PMCID: PMC4140076  PMID: 25191301
mental time travel; mind wandering; task-unrelated thought; spontaneous thought; prospective cognition
16.  Assessing public speaking fear with the short form of the Personal Report of Confidence as a Speaker scale: confirmatory factor analyses among a French-speaking community sample 
Background:
The main aim of this study was to assess the reliability and structural validity of the French version of the 12-item version of the Personal Report of Confidence as Speaker (PRCS), one of the most promising measurements of public speaking fear.
Methods:
A total of 611 French-speaking volunteers were administered the French versions of the short PRCS, the Liebowitz Social Anxiety Scale, the Fear of Negative Evaluation scale, as well as the Trait version of the Spielberger State-Trait Anxiety Inventory and the Beck Depression Inventory-II, which assess the level of anxious and depressive symptoms, respectively.
Results:
Regarding its structural validity, confirmatory factor analyses indicated a single-factor solution, as implied by the original version. Good scale reliability (Cronbach’s alpha = 0.86) was observed. The item discrimination analysis suggested that all the items contribute to the overall scale score reliability. The French version of the short PRCS showed significant correlations with the Liebowitz Social Anxiety Scale (r = 0.522), the Fear of Negative Evaluation scale (r = 0.414), the Spielberger State-Trait Anxiety Inventory (r = 0.516), and the Beck Depression Inventory-II (r = 0.361).
Conclusion:
The French version of the short PRCS is a reliable and valid measure for the evaluation of the fear of public speaking among a French-speaking sample. These findings have critical consequences for the measurement of psychological and pharmacological treatment effectiveness in public speaking fear among a French-speaking sample.
doi:10.2147/NDT.S43097
PMCID: PMC3647380  PMID: 23662060
social phobia; public speaking; confirmatory factor analysis
17.  Evaluation of a Seven-Week Web-Based Happiness Training to Improve Psychological Well-Being, Reduce Stress, and Enhance Mindfulness and Flourishing: A Randomized Controlled Occupational Health Study 
Background. As distress in society increases, including work environments, individual capacities to compete with stress have to be strengthened. Objective. We examined the impact of a web-based happiness training on psychological and physiological parameters, by self-report and objective means, in an occupational health setting. Methods. Randomized controlled trial with 147 employees. Participants were divided into intervention (happiness training) and control groups (waiting list). The intervention consisted of a seven-week online training. Questionnaires were administered before, after, and four weeks after training. The following scales were included: VAS (happiness and satisfaction), WHO-5 Well-being Index, Stress Warning Signals, Freiburg Mindfulness Inventory, Recovery Experience Questionnaire, and Flourishing Scale. Subgroup samples for saliva cortisol and alpha-amylase determinations were taken, indicating stress, and Attention Network Testing for effects on attention regulation. Results. Happiness (P = 0.000; d = 0.93), satisfaction (P = 0.000; d = 1.17), and quality of life (P = 0.000; d = 1.06) improved; perceived stress was reduced (P = 0.003; d = 0.64); mindfulness (P = 0.006; d = 0.62), flourishing (P = 0.002; d = 0.63), and recovery experience (P = 0.030; d = 0.42) also increased significantly. No significant differences in the Attention Network Tests and saliva results occurred (intergroup), except for one saliva value. Conclusions. The web-based training can be a useful tool for stabilizing health/psychological well-being and work/life balance.
doi:10.1155/2013/676953
PMCID: PMC3893772  PMID: 24489588
18.  A randomized controlled pilot study of a brief web-based mindfulness training 
BMC Psychiatry  2011;11:175.
Background
Mindfulness has been shown to be effective in treating various medical and mental problems. Especially its incorporation in cognitive-behavioural interventions has improved long-term outcomes of those treatments. It has also been shown, that brief mindfulness-based trainings are effective in reducing distress. There have been few web-based interventions incorporating mindfulness techniques in their manual and it remains unclear whether a brief web-based mindfulness intervention is feasible.
Methods
Out of 50 adults (different distress levels; exclusion criteria: < 18 years, indication of psychotic or suicidal ideation in screening) who were recruited via e-mail and screened online, 49 were randomized into an immediate 2-weeks-treatment group (N = 28) or a waitlist-control group (N = 21), starting with a 2-week delay. Distress (BSI), perceived stress (PSQ), mindfulness (FMI), as well as mood and emotion regulation (PANAS/SEK-27) were measured at pre-, post- and 3-month follow-up (3MFU). Intention-to-treat analyses using MI for missing data and per-protocol analyses (≥ 50% attendance) were performed.
Results
26 participants of the treatment group completed post-measures. Most measures under ITT-analysis revealed no significant improvement for the treatment group, but trends with medium effect sizes for PSQ (d = 0.46) and PANASneg (d = 0.50) and a small, non-significant effect for FMI (d = 0.29). Per-protocol analyses for persons who participated over 50% of the time revealed significant treatment effects for PSQ (d = 0.72) and PANASneg (d = 0.77). Comparing higher distressed participants with lower distressed participants, highly distressed participants seemed to profit more of the training in terms of distress reduction (GSI, d = 0.85). Real change (RCI) occurred for PSQ in the treatment condition (OR = 9). Results also suggest that participants continued to benefit from the training at 3MFU.
Conclusion
This study of a brief web-based mindfulness training indicates that mindfulness can be taught online and may improve distress, perceived stress and negative affect for regular users. Although there were no significant improvements, but trends, for most measures under ITT, feasibility of such a program was demonstrated and also that persons continued to use techniques of the training in daily life.
Trial Registration
German Clinical Trials Register (DRKS): DRKS00003209
doi:10.1186/1471-244X-11-175
PMCID: PMC3250944  PMID: 22067058
19.  The effects of a mindfulness-based lifestyle programme for adults with Parkinson’s disease: protocol for a mixed methods, randomised two-group control study 
BMJ Open  2013;3(10):e003326.
Introduction
Parkinson's disease (PD) is the second most common neurodegenerative disorder in developed countries. There is an increasing interest in the use of mindfulness-related interventions in the management of patients with a chronic disease. In addition, interventions that promote personal control, stress-management and other lifestyle factors, such as diet and exercise, assist in reducing disability and improving quality of life in people with chronic illnesses. There has been little research in this area for people with PD.
Methods
A prospective mixed-method randomised clinical trial involving community living adults with PD aged <76 years and with moderate disease severity (Hoehn and Yahr stage 2) PD. Participants will be randomised into the ESSENCE 6-week programme or a matched wait list control group. ESSENCE is a multifaceted, healthy lifestyle and mindfulness programme designed to improve quality of life. We aim to determine whether participation in a mindfulness and lifestyle programme could improve PD-related function and explore self-management related experiences and changing attitudes towards self-management. The outcome measures will include 5 self-administered questionnaires: PD function and well-being questionnaire (PDQ39), Health Behaviours, Mental health, Multidimensional locus of control, and Freiburg mindfulness inventory. An embedded qualitative protocol will include in-depth interviews with 12 participants before and after participation in the 6-week programme and a researcher will observe the programme and take notes.
Analysis
Repeated measures of Analysis of Variance (ANOVA) will examine the outcome measures for any significant effects from the group allocation, age, sex, adherence score and attendance. Qualitative data will be analysed thematically. We will outline the benefits of, and barriers to, the uptake of the intervention.
Ethics
This protocol has received ethics approval from the Monash University Human Research Ethics Committee project number CF11/2662–2011001553.
Dissemination
This is the first research of its kind in Australia involving a comprehensive, lifestyle-based programme for people with PD and has the potential to involve a broader range of providers than standard care. The findings will be disseminated through peer reviewed journals, primary care conferences in Australia as well as abroad and through the Parkinson's community.
Registration details
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612000440820.
doi:10.1136/bmjopen-2013-003326
PMCID: PMC3796271  PMID: 24114370
PRIMARY CARE; COMPLEMENTARY MEDICINE
20.  Oculometric variations during mind wandering 
A significant body of literature supports the contention that pupil size varies depending on cognitive load, affective state, and level of drowsiness. Here we assessed whether oculometric measures such as gaze position, blink frequency and pupil size were correlated with the occurrence and time course of self-reported mind-wandering episodes. We recorded the pupil size of two subjects engaged in a monotonous breath counting task while keeping their eyes on a fixation cross. This task is conducive to producing mind-wandering episodes. Each subject performed ten 20-min sessions, for total duration of about 4 h. Subjects were instructed to report spontaneous mind-wandering episodes by pressing a button when they lost count of their breath. After each button press, subjects filled in a short questionnaire describing the characteristics of their mind-wandering episode. We observed larger pupil size during the breath-focusing period compared to the mind-wandering period (p < 0.01 for both subjects). Our findings contradict previous research showing a higher baseline pupil size during mind wandering episodes in visual tasks. We discuss possible explanations for this discrepancy. We also analyzed nine other oculometric measures including blink rate, blink duration and gaze position. We built a support vector machine (SVM) classifier and showed that mean pupil size was the most reliable predictor of mind wandering in both subjects. The classification accuracy of mind wandering data segments vs. breath-focusing data segments was 81% for the first subject and 77% for the second subject. Additionally, we analyzed oculometric measures in light of the phenomenological data collected in the questionnaires. We showed that how well subjects remembered their thoughts while mind wandering was positively correlated with pupil size (subject 1, p < 0.001; subject 2, p < 0.05). Feelings of well being were also positively correlated with pupil size (subject 1, p < 0.001; subject 2, p < 0.001). Our results suggest that oculometric data could be used as a neurocognitive marker of mind-wandering episodes.
doi:10.3389/fpsyg.2014.00031
PMCID: PMC3920102  PMID: 24575056
mind wandering; pupil size; blinks; gaze position; classification
21.  Changing Parent’s Mindfulness, Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial 
We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.
doi:10.1007/s10826-009-9304-8
PMCID: PMC3765025  PMID: 24013587
Mindfulness; Parenting; Intervention; Efficacy; Adolescence
22.  Mindfulness: A systematic review of instruments to measure an emergent patientreported outcome (PRO) 
Purpose
Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness.
Methods
Ovid Medline®, CINAHL®, and PsycINFO® were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. Discrepancies were discussed with a third reviewer, and scored by consensus. Finally, a level of evidence approach was used to synthesize results and study quality.
Results
Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n=5) or as a set of 2 to 5 subscales (n=5) were reviewed. The Mindful Attention Awareness Scale (MAAS) was evaluated by the most studies (n=27), and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire (FFMQ) received the highest possible rating (“consistent findings in multiple studies of good methodological quality”) for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test-retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking.
Conclusions
Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales.
doi:10.1007/s11136-013-0395-8
PMCID: PMC3745812  PMID: 23539467
Mindfulness; Instruments; Psychometrics; Measurement properties; COSMIN checklist; Systematic review
23.  Development of Specific Aspects of Spirituality during a 6-Month Intensive Yoga Practice 
The majority of research on yoga focuses on its psychophysiological and therapeutic benefits, while the spiritual aspects are rarely addressed. Changes of specific aspects of spirituality were thus investigated among 160 individuals (91% women, mean age 40.9 ± 8.3 years; 57% Christians) starting a 2-year yoga teacher training. We used standardized questionnaires to measure aspects of spirituality (ASP), mindfulness (FMI—Freiburg Mindfulness Inventory), life satisfaction (BMLSS—Brief Multidimensional Life Satisfaction Scale), and positive mood (lightheartedness/relief). At the start of the course, scores of the respective ASP subscales for search for insight/wisdom, transcendence conviction, and conscious interactions/compassion were high, while those for religious orientation were low. Within the 6 month observation period, both conscious interactions/compassion (effect size, Cohen's d = .33), Religious orientation (d = .21), Lightheartedness/Relief (d = .75) and mindfulness (d = .53) increased significantly. Particularly non-religious/non-spiritual individuals showed moderate effects for an increase of conscious interactions/compassion. The results from this study suggest that an intensive yoga practice (1) may significantly increase specific aspects of practitioners' spirituality, mindfulness, and mood, (2) that these changes are dependent in part on their original spiritual/religious self-perception, and (3) that there are strong correlations amongst these constructs (i.e., conscious interactions/compassion, and mindfulness).
doi:10.1155/2012/981523
PMCID: PMC3407840  PMID: 22852023
24.  Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial 
BMC Public Health  2011;11:131.
Background
Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavorable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored.
Methods/Design
The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analyzed with repeated measures analysis of covariance.
The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee.
Discussion
It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, self-care, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012.
Trial registration
Dutch Trial Register NTR2145.
doi:10.1186/1471-2458-11-131
PMCID: PMC3053244  PMID: 21349184
25.  An exploratory mixed methods study of the acceptability and effectiveness of mindfulness -based cognitive therapy for patients with active depression and anxiety in primary care 
BMC Psychiatry  2006;6:14.
Background
Mindfulness Based Cognitive Therapy (MBCT) is an 8-week course developed for patients with relapsing depression that integrates mindfulness meditation practices and cognitive theory. Previous studies have demonstrated that non-depressed participants with a history of relapsing depression are protected from relapse by participating in the course. This exploratory study examined the acceptability and effectiveness of MBCT for patients in primary care with active symptoms of depression and anxiety
Methods
13 patients with recurrent depression or recurrent depression and anxiety were recruited to take part in the study. Semi-structured qualitative interviews were conducted three months after completing the MBCT programme. A framework approach was used to analyse the data. Beck depression inventories (BDI-II) and Beck anxiety inventories (BAI) provided quantitative data and were administered before and three months after the intervention.
Results
The qualitative data indicated that mindfulness training was both acceptable and beneficial to the majority of patients. For many of the participants, being in a group was an important normalising and validating experience. However most of the group believed the course was too short and thought that some form of follow up was essential. More than half the patients continued to apply mindfulness techniques three months after the course had ended. A minority of patients continued to experience significant levels of psychological distress, particularly anxiety.
Statistically significant reductions in mean depression and anxiety scores were observed; the mean pre-course depression score was 35.7 and post-course score was 17.8 (p = 0.001). A similar reduction was noted for anxiety with a mean pre-course anxiety score of 32.0 and mean post course score of 20.5 (p = 0.039). Overall 8/11 (72%) patients showed improvements in BDI and 7/11 (63%) patients showed improvements in BAI. In general the results of the qualitative analysis agreed well with the quantitative changes in depression and anxiety reported.
Conclusion
The results of this exploratory mixed methods study suggest that mindfulness based cognitive therapy may have a role to play in treating active depression and anxiety in primary care.
doi:10.1186/1471-244X-6-14
PMCID: PMC1456957  PMID: 16603060

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